Detection of Mycobacterium tuberculosis in bronchoalveolar lavage from patients with sputum smear-negative pulmonary tuberculosis using a polymerase chain reaction assay

Abstract The objective of this study was to evaluate the utility of a polymerase chain reaction (PCR) assay in detecting Mycobacterium tuberculosis in bronchoalveolar lavage (BAL) specimens of patients suspected of having active pulmonary tuberculosis (TB) but who were sputum smear-negative. Patients undergoing investigation for suspected pulmonary TB at the University Hospital, Kuala Lumpur, and who were sputum smear-negative underwent fibreoptic bronchoscopy and BAL. One portion of each lavage specimen was submitted for smear examination for acid-fast bacilli and mycobacterial culture and the other portion assayed by PCR for the presence of a 562-base pair DNA segment belonging to the insertion sequence IS986, unique to the M. tuberculosis complex. As controls, lavage specimens from patients with other lung lesions were also similarly tested. The PCR assay gave a positivity rate of 80.9% (55 of 68) compared with 8.8% of smear examination and 7.4% of culture for detecting M. tuberculosis in BAL specimens. The assay was positive in two of 45 BAL specimens from 35 control subjects. The PCR assay was more sensitive than smear and culture in detecting M. tuberculosis in BAL specimens of patients with sputum smear-negative pulmonary TB.     

COMPARING THE EFFICACY OF CISAPRIDE AND RANITIDINE IN OESOPHAGITIS: A DOUBLE-BLIND,PARALLEL GROUP STUDY IN GENERAL PRACTICE

SUMMARY Patients with endoscopically confirmed oesophagitis (n=49) were treated for 8 weeks with either cisapride (10 mg four times a day) or ranitidine (150 mg twice a day) in a double-blind study in general practice. Mean overall symptom scores fell from 10.8 to 4.5 in the cisapride group and from 9.9 to 4.4 in the ranitidine group over the course of the study. The proportion of patients reporting improvements in individual symptoms in the two treatment groups (cisapride and ranitidine respectively) were: heartburn, 66% and 55%; acid regurgitation, 53% and 47%; epigastric pain, 60% and 52%; satiety, 57% and 47%; bloating, 69% and 71%; belching, 65% and 72%; nausea, 62% and 85%; vomiting, 77% and 66%; poor appetite, 50% and 75%. Improvement in the endoscopic grade of oesophagitis was observed in 66% of patients receiving cisapride and 63% of those receiving ranitidine. It was concluded that cisapride is as effective as ranitidine in relieving the symptoms of oesophagitis and in healing oesophageal erosions.     

Immunosuppression should be stopped in patients with renal allograft failure

Patients returning to haemodialysis or peritoneal dialysis after a failed kidney transplantation sometimes have a renal allograft left in situ for some urine production. Low-dose immunosuppressive medication is often continued in such patients. To evaluate the morbidity and mortality between patients in time periods with (group A) or without (group B) low-dose maintenance immunosuppression, the present study was initiated. In a multi-centre cohort study we analysed data from patient files, which showed failure after at least 3 months graft function between 10 August 1972 and 4 April 1996, including 197 kidney transplantations. A total of 1.7 versus 0.51 infections per patient year was found in groups A and B, respectively (odds ratio [OR]: 3.4, 95% confidence interval [CI]: 2.5-4.5). There was an increased mortality in group A compared to group B (OR 3.4, 95% CI: 1.8-6.3), both from infectious disease (OR 2.8, 95% CI: 1.1-7.0), and cardiovascular disease (OR 4.9, 95% CI: 1.8-13.5). Continuation of immunosuppressive medication did not lead to fewer rejections (defined as a painful, tender graft and/or haematuria and/or low-grade non-infectious fever). Transplantectomy-related morbidity and mortality were acceptable. The increase in morbidity and mortality associated with low-dose maintenance immunosuppression argues in favour of stopping these medicaments when failed renal allograft patients return to dialysis.