Pulmonary Tuberculosis

BACKGROUND Tuberculosis is a global pandemic which affects millions of people every year. The treatment of tuberculosis consists of simultaneous use of a number of drugs for a prolonged period of time, therefore anti-tuberculosis treatment induced toxicity is a real problem. Many risk factors which make a tuberculosis patient prone to the development of hepatotoxicity associated with the anti-tuberculosis treatment have been identified. The aim of this study was to determine common risk factors responsible for precipitation of hepatotoxicity following treatment with anti-tuberculosis drugs. METHODS This cross-sectional study was conducted in the Department of Pulmonary Medicine, Ayub Teaching Hospital, Abbottabad from 20th April 2013 to 19th March 2014. Patients -' , who were newly diagnosed cases of tuberculosis in whom treatment of tuberculosis with first line anti-tuberculosis drugs was initiated and were 20 years or older, were included. The precipitation of drug induced hep...

Methods. We conducted a case-control study of tuberculosis cases identified during 1990 -2001 using the General Practice Research Database in the United Kingdom. Cases were patients with a first time diagnosis of tuberculosis accompanied by at least 6 months of treatment with at least 3 different tuberculosis medications. Up to 4 controls were matched to each case on age, sex, the practice attended by the case, index date, and amount of prior computerized records. Results. The study encompassed 497 new cases of tuberculosis and 1,966 controls derived from 16,629,041 person-years at risk (n ‫؍‬ 2,757,084 persons). The adjusted odds ratio (OR) of tuberculosis for current use of a glucocorticoid compared with no use was 4.9 (95% confidence interval [95% CI] 2.9 -8.3). The adjusted ORs for use of <15 mg and >15 mg of prednisone or its equivalent daily dose were 2.8 (95% CI 1.0 -7.9) and 7.7 (95% CI 2.8 -21.4), respectively. Adjusted ORs of tuberculosis were 2.8 for patients with a body mass index (BMI) <20 compared with normal BMI; 1.6 for current smokers compared with nonsmokers; and 3.8, 3.2, 2.0, and 1.4 for those with history of diabetes, emphysema, bronchitis, and asthma, respectively, compared with those without such history (all P values <0.05).

Tuberculosis continues to be a major global health problem. Lack of accurate, rapid and costeffective diagnostic tests poses a huge obstacle to global TB control. While several new diagnostic tools are being developed and evaluated for TB, it is important that new tools are introduced for widespread use only after careful validation of accuracy, impact as well as costeffectiveness in real-world settings. While there are large numbers of studies on the accuracy of TB diagnostic tests, there are few studies that are focused on cost and cost-effectiveness. There are currently no widely accepted standards on how to evaluate costs of a TB test. In this review, we describe the basic approach for computing the costs of TB diagnostic tests, and provide templates for various data elements and parameters that go into the costing ana lysis. We hope this will pave the way for a standardized methodology for costing of TB diagnostic tests. Such a tool would enable improved and more generalizable costing analyses that can provide a strong foundation for more sophisticated economic analyses that evaluate the full economic and epidemiological impact resulting from the implementation and routine use of performance-verified new and innovative diagnostic tools. This, in turn, will facilitate evidence-based adoption and use of new diagnostics, especially in resource-limited settings.

To study the impact of fused (18)F-fluoro-deoxy-D-glucose (FDG)-hybrid positron emission tomography (PET) and computed tomography (CT) images on conformal radiation therapy (CRT) planning for patients with esophageal carcinoma. Thirty-four patients with esophageal carcinoma were referred for concomitant radiotherapy and chemotherapy with radical intent. Each patient underwent CT and FDG-hybrid PET for simulation treatment in the same radiation treatment position. PET-images were coregistered using five fiducial markers. Target delineation was initially performed on CT images and the corresponding PET data were subsequently used as an overlay to CT data to define the target volume. FDG-PET identified previously undetected distant metastatic disease in 2 patients, making them ineligible for curative CRT. The Gross Tumor Volume (GTV) was decreased by CT and FDG image fusion in 12 patients (35%) and was increased in 7 patients (20.5%). The GTV reduction was &gt;or=25% in 4 patients due ...

Background: The aim of this study was to evaluate the indications and results of video-assisted thoracic surgery (VATS) for the management of tuberculosis in 10 patients with unusual clinical and radiologic presentation for the disease. Methods: From March 2000 to March 2002, 96 diagnostic VATS operations for unclear thoracic lesions were performed at the authorsÕ institution. Their final diagnosis for 10 (10.4%) of these patients was tuberculosis. The suspected preoperative diagnoses were pancoast tumour (n = 1), pericardial effusion (n = 1), pleural mesothelioma (n = 1), pleural empyema (n = 2), mediastinal lymphoma (n = l), and lung cancer (n = 4). Results: For all the patients, the diagnosis of tuberculosis was achieved by VATS. The duration of drainage was 2.5 days. There have been neither morbidity nor mortality since surgery. The hospital stay was 3 to 5 days. Conclusion: Thoracoscopy is a safe and effective procedure for the management of tuberculosis. Tuberculosis should be kept in mind during the differential diagnosis of unknown thoracic lesions, and also for patients who live in economically well developed countries and are not immune compromised.

Background Vitamin D was used to treat tuberculosis in the pre-antibiotic era, and its metabolites induce antimycobacterial immunity in vitro. Clinical trials investigating the effect of adjunctive vitamin D on sputum culture conversion are absent.

Treatment of multidrug-resistant tuberculosis has become one of the major problems in public health. Understanding the molecular mechanisms of drug resistance has been central to tuberculosis research in recent times. DNA microarray technology provides the platform to study the genomic variations related to these mechanisms on a comprehensive level. To investigate the role of efflux pumps in drug resistance, we have constructed a custom DNA microarray containing 25 drug efflux pump genes of Mycobacterium tuberculosis (Indian Patent file no. 2071=DEL=2007) and monitored changes in the expression of these genes on exposure of common antituberculous drugs. Expression profiling of efflux pump genes in multidrug-resistant M. tuberculosis isolates showed overexpression of 10 genes following exposure to various anti-tuberculous drugs. Although two of these genes (Rv3065 and Rv2938) have already been reported to be active drug efflux pumps in M. tuberculosis in earlier studies, the increased activities of other eight efflux pump genes (Rv1819, Rv2209, Rv2459, Rv2477c, Rv2688, Rv2846, Rv2994, and Rv3728) have been demonstrated in multidrug-resistant isolates by us for the first time. After confirmation of differential expressions of these genes by real-time reverse transcription polymerase chain reaction, it was observed that a simultaneous overexpression of efflux pump genes Rv2459, Rv3728, and Rv3065 was associated with resistance to the combination of isoniazid and ethambutol, and these drugs, along with streptomycin, were identified to group together, where efflux-mediated drug resistance appears to be important in M. tuberculosis and follows a constant pattern of induction in multidrug-resistant isolates. Isoniazid and ethambutol combination was also found to be affected in 10% (6=60) of the clinical isolates in the presence of carbonyl cyanide m-chloro phenylhydrazone in resazurin microtitre plate assay, supporting the role of efflux pumps in the resistance to these drugs. Overexpression of two of the genes (Rv2477 and Rv2209) has also been observed with ofloxacin stress in M. tuberculosis.

The mycobacterial antigens and the factors related to protection for the development of active tuberculosis are not known. In a natural model of tuberculosis, we studied 10 patients with active pulmonary tuberculosis (non-protective immune response) and 38 healthy household contacts (protective immune response). We tested the lymphocyte proliferative response by T cell Western blotting to eight different antigen fractions and lo two purified mycobacterial antigens of 30 and 64 kD. Patients with active tuberculosis recognized fractions with molecular weights of 80–114, 60–80, 28–41 and 14–19kD. Household contacts recognized the same fractions except the 14–19 kD. The response lo the 64-kD antigen was not significantly different between groups. In contrast, 10% of the patients with active tuberculosis and 73% of the household contacts responded to the 30-kD antigen. The humoral response against the 30-kD antigen by ELISA showed a significantly higher production of antibodies in tuberculosis patients compared with household contacts. We conclude that patients with active pulmonary tuberculosis develop an immune response characterized by poor proliferative response to the 30-kD antigen with a strong humoral response, whereas the opposite occurs in healthy subjects infected by Mycobacterium tuberculoses.

The aim of present study was to investigate whether there was any delay in the diagnosis and treatment of inpatients with smear-positive pulmonary tuberculosis followed-up in our centre.We reviewed clinical records in February 1999 and identi¢ed 134 hospitalized patients with smear-positive pulmonary tuberculosis. Clinical ¢les of the patients were analysed and a questionnaire was completed. Severalintervals and delays were calculated.Median application interval was 17?5 days [95% con¢dence interval (CI) 21?3^32?4 days], median referral interval was 3?5 days (95% CI 6?8^11?4 days), median diagnosis interval was 3 days (95% CI 3?3^4?5 days) and median initiation of treatment interval was 1 day (95% CI 1?1^1?6 days). Patient's delay was present in 28?4% of cases. The referral interval was longer than 2 days in 82 patients (institutional delay).Ninety-three patients (69?4%) had delaysin the diagnosis and 34 patients (25?4%) haddelays in the treatment.There was a doctor's delay in 119 of 134 patients (88?8%) and clinic's delay in 98 patients (73?2%).Our results have suggested that hospitalized patients with smear-positive pulmonary tuberculosis experience several delays. These delays mayresultinincreased risk for transmission of infection.Decrease inthe riskof infection for community and medical personal may only be obtained by preventing these delays.

Objective: To assess treatment outcomes and determinants of outcome among tuberculosis patients. Design: A longitudinal study design involving a cohort of sputum smear-positive pulmonary tuberculosis patients at initiation of therapy, who were followed up to the end of treatment at eighth month. Setting: Tuberculosis treatment centers in Ibadan, Nigeria Results: A total of 1,254 patients were followed up with a mean age of 35.0±3.3 years. The percentages of patients with treatment outcomes assessed in the study were as follows: cure (76.6%), failure (8.1%), default (6.6%), transferred out (4.8%), and death (1.9%). The cure rate varied signifi cantly between treatment centers from 40 to 94.4% (P<0.05). The treatment centers located within the specialist health centers at Jericho and the University College Hospital had 50 and 75% cure rates, respectively. The mean age of cured patients was 31.2±3.1 years, which was signifi cantly lower than the mean age of those with poor treatment outcomes (36.7±3.5 years; P<0.05). Males had a higher risk of a poor treatment outcome (RR=1.8; 95% CI: 1.02-1.94) than females. Also, patients with a poor knowledge of tuberculosis had a higher risk of having a poor treatment outcome (RR=1.35; 95% CI: 1.25-1.62) compared to those with a good knowledge. Conclusion: Variations in health center treatment outcomes and poor knowledge of tuberculosis among patients suggest that poor program implementation quality may be a major modifi able determinant of treatment outcomes in our environment.

Objectives: To analyse the traditional and molecular epidemiology of drug-resistant tuberculosis (DRTB) in Houston and Harris County, Texas in the setting of decreasing disease incidence. Methods: Case-control study of 193 patients with DRTB and 1977 patients with drugsusceptible TB (DSTB) identified from a population-based surveillance, 1995-2001.

PE and PPE proteins appear to be important for virulence and immunopathogenicity in mycobacteria, yet the functions of the PE/PPE domains remain an enigma. To decipher the role of these domains, we have characterized the triacylglycerol (TAG) hydrolase LipY from Mycobacterium tuberculosis, which is the only known PE protein expressing an enzymatic activity. The overproduction of LipY in mycobacteria resulted in a significant reduction in the pool of TAGs, consistent with the lipase activity of this enzyme.

La tuberculose pulmonaire est un problème majeur de santé publique. Dans sa forme commune, le diagnostic est habituellement aisé, mais elle peut se présenter sous une forme trompeuse et entrainer un retard diagnostic et thérapeutique. Nous rapportons le cas d'un patient âgé de 25ans, étudiant, sans antécédents pathologiques particuliers, hospitalisé dans notre formation pour un syndrome bronchique trainant avec altération de l'état général. L'examen clinique pleuropulmonaire est normal, l'examen des aires ganglionnaires trouve une adénopathie sus claviculaire droite, la radiographie thoracique de face objective une opacité hilaire droite hétérogène à contours irréguliers, la TDM thoracique retrouve un processus lésionnel tissulaire du lobe supérieur droit qui s'étend vers le médiastin et englobe partiellement la veine cave supérieure avec une adénopathie latérotracheale droite nécrosée. La fibroscopie bronchique objective un élargissement des éperons intersegmentaires du lobe supérieur droit, les biopsies réalisées avec étude histologique sont non concluantes. Les recherches de BK dans les expectorations et dans le liquide d'aspiration bronchique sont negatives. L'IDR à la tuberculine est à 15mm. C'est la ponction transparietale scannoguidée avec étude anatomopathologique qui confirme le diagnostic de tuberculose caseofolliculaire. La sérologie VIH est négative. Le diagnostic de tuberculose pulmonaire pseudotumorale chez un immunocompétent a été retenu et le patient a été mis sous traitement antibacillaire (régime standard national Marocain) par rifampicine, isoniazide, pyrazinamide et éthambutol pendant 6 mois avec évolution clinique et radiologique favorable. La tuberculose pulmonaire ne cesse de tromper le clinicien par son polymorphisme clinique et radiologique, elle doit être évoquée devant toute atteinte pulmonaire d'allure tumorale pour permettre une prise en charge précoce de la maladie.

Background: We planned to raise public awareness and decentralize directly observed tuberculosis treatment at village level using volunteer community members in order to reduce prolonged delays in seeking care and improve compliance to tuberculosis treatment. We do not know the magnitude of tuberculosis knowledge gap and preferred modality of tuberculosis treatment supervision among the public in Tigray. Objectives: To assess knowledge of pulmonary tuberculosis and to determine level of acceptance regarding village-based tuberculosis treatment using volunteers among the general public. Method: A cross sectional survey was conducted among 838 adults (≥15 years) in 8 districts of Tigray region. Respondents selected from 70 villages using a multistage cluster sampling technique were interviewed using a pre-tested questionnaire in July 2002. Result: The mean and median knowledge score of respondents about pulmonary tuberculosis (PTB) was 5.24 and 6.67 (maximum score of 10) respectively. Female respondents (Adjusted Odds Ratio (AOR)=1.86; 95% Confidence interval (CI)=1.39-2.47), illiterates (AOR=1.64; 95% CI=1.1-2.47) and rural residents (AOR=1.95; 95% CI=1.37-2.76) were more likely to have a low level of knowledge score. Among respondents who had prior knowledge of PTB (n=717), 599 (83.5%) accepted the idea of tuberculosis (TB) treatment by volunteer community members. Illiterates, rural residents, married and respondents with large family size were more likely to support supervised TB-treatment using volunteers. Respondents' preferred treatment supervisors were: volunteer community health workers (60%), public health staff (16.5%) and family members (12.7%). Conclusion: There is a wide knowledge gap among the public regarding PTB. The idea of organizing directly observed TB treatment using volunteers appears to be accepted.

Isoniazid (INH) is an effective first-line antituberculosis drug. KatG, a catalase-peroxidase, converts INH to an active form in Mycobacterium tuberculosis, and katG mutations are major causes of INH resistance. In the present study, we sequenced katG of 108 INH-resistant M. tuberculosis clinical isolates. Consequently, 9 novel KatG mutants with a single-amino-acid substitution were found. All of these mutants had significantly lower INH oxidase activities than the wild type, and each mutant showed various levels of activity. Isolates having mutations with relatively low activities showed high-level INH resistance. On the basis of our results and known mutations associated with INH resistance, we developed a new hybridization-based line probe assay for rapid detection of INH-resistant M. tuberculosis isolates.

The HN878 strain of Mycobacterium tuberculosis is regarded as "hypervirulent" due to its rapid growth and reduced survival of infected mice when compared with other clinical isolates. This property has been ascribed due to an early increase in type I IFNs and a failure to generate TH1-mediated immunity, induced by a response to an unusual cell wall phenolic glycolipid expressed by the HN878 isolate. We show, however, that although type I IFN does play an inhibitory role, this response was most apparent during the chronic disease stage and was common to all M. tuberculosis strains tested. In addition, we further demonstrate that the HN878 infection was associated with a potent TH1 response, characterized by the emergence of both CD4 and CD8 T cell subsets secreting IFN-␥. However, where HN878 differed to the other strains tested was a subsequent reduction in TH1 immunity, which was temporally associated with the rapid emergence of a CD4 ؉ CD25 ؉ FoxP3 ؉ CD223 ؉ IL-10 ؉ regulatory T cell population. This association may explain the paradoxical initial emergence of a TH1 response in these mice but their relatively short time of survival.

Radiation induced breast cancer is a highly complex phenomenon, which most likely involves the accumulation of several genetic and epigenetic events. Studies of atomic bomb survivors, patients who underwent multiple fluoroscopic examinations during treatment for pulmonary tuberculosis, those who received therapeutic radiation for benign breast disease, such as acute post-partum mastitis, or those with an enlarged thymus or skin haemangioma and patients with Hodgkin's disease treated by mantle radiotherapy established that the risk of breast cancer increases with exposure to ionising radiation. The carcinogenic effect of therapeutic or accidental radiation is highest when exposure occurs during childhood and exposure after age 40 imparts low or minimal risk. The risk of bilateral breast cancer is not significantly increased in the survivors of atomic bomb and therapeutic radiations. Fractionated exposures for therapeutic radiation are similar to a single exposure of the same total dose in their ability to induce breast cancer; this risk remains high for many years after exposure. Younger age at first full term pregnancy confers a protective effect against the risk of breast cancer in the survivors of atomic bomb but long-term data on this beneficial effect after therapeutic radiation is not available.

Retreatment of tuberculosis is the leading risk factor for drug resistance if the management is not adequate and complete. The objective of this study was to evaluate the management of cases of retreatment in Cotonou. This was a retrospective, descriptive cross type which covered a period of 5years. Outcomes of retreatment cases were compared against those for new cases that were registered during the same period. We analyzed the cases of 389 retreatment patients and 4542 new cases. The success rates of treatment were generally satisfactory (80% vs. 86%, P=0.0001). Of adverse outcomes, the rate of loss of sight of was 12% versus 7%, P=0.26, the rate was 23% for cases of occasions. The failure rate was low and similar in both populations (2%). The retreatment regimen for patients with TB in Cotonou appears to give generally satisfactory results. The high loss to follow-up in case of retreatment means that a personalized therapeutic approach for such patients is needed in general and ...

Molecular tests show low sensitivity for smear-negative pulmonary tuberculosis (SNPT). We propose a screening and risk assessment system for SNPT using Artificial Neural Networks (ANNs) based on patient́s signals and symptoms. Prognostic and risk assessment models exploit a multilayer perceptron (MLP) and an inspired adaptive resonance theory (iART) network. Model&#39;s development considered data from 136 SNPT suspects from a general hospital. MLP showed higher sensitivity (100%, CI 78-100), as compared to other techniques, such as SVM linear (86%; CI 60-96), MLR (79%; CI 95% 53-93) and CART (71%; CI 95% 45-88). MLR also showed slight higher specificities (85%; CI 95% 59-96), as compared to MLP (80%; CI 95% 54-93), SVM linear (75%,CI 95% 49-90) and CART (65%; CI 95% 39-84). In terms of area under receiver operation curve (AUC), the MLP model exhibited a higher value (0.918, CI 95% 0.824-1.000) than SVM linear (0.796, CI 95% 0.651-0.970) and MLR (0.782, CI 95% 0.663-0.960). Remarkab...

To explore the feelings and experiences of TB patients, and to highlight how TB stigma may affect case finding and compliance with treatment. Qualitative research approach using focus groups and individual interviews. Sekondi-Takoradi Metropolitan district, Ghana. Purposeful selection of TB patients receiving TB at four government hospitals in the district. None. Because of TB stigma, majority of the patients failed to recognise their symptoms as due to TB, and attributed it to malaria and ordinary cough. They reported to the hospital only after prolonged period of self-medication in the community, with some indicating multiple visits before a diagnosis was made. When diagnosed, some were worried and cried, questioned how they got the disease, contemplated committing suicide, and others doubted it was TB. Most of them hid the diagnosis from others, and were isolated within the family and community. Most TB patients failed to recognize their symptoms as due to TB, because of the stig...

OBJETIVO: Avaliar o impacto do treinamento da equipe do Programa Saúde da Família (PSF) e da busca ativa domiciliar na detecção de casos de TB em uma comunidade de baixa renda de Fortaleza. MÉTODOS: Intervenção realizada na área de abrangência de um centro de saúde de Fortaleza, Ceará, com cinco equipes do PSF, responsáveis por cerca de 25.000 pessoas. Treinaram-se todas as equipes de saúde do centro de saúde e implantou-se a busca ativa domiciliar apenas na área de abrangência da Equipe 5. Comparou-se o número de casos detectados em cada uma das cinco áreas antes e depois da intervenção, bem como os casos na área 5 com os das outras áreas e com os casos notificados no município de Fortaleza durante o mesmo período. RESULTADOS: Observou-se um aumento no número de casos de TB detectados na área do estudo: de 1 caso em 2002 para 22 em 2004 (p < 0,005), sem diferença entre a área em que foi feita a busca domiciliar e as outras quatro (p > 0,05). Houve um aumento significativo no número de casos detectados na área do estudo em comparação com aquele no município como um todo (p < 0,05). CONCLUSÕES: O treinamento e a sensibilização da equipe de saúde da família foram capazes de promover um aumento na detecção de casos de TB em uma comunidade de baixa renda.

The regulatory role of vitamin D receptor (VDR) gene variants of BsmI, ApaI, TaqI, and FokI polymorphisms on vitamin D3-modulated macrophage phagocytosis with live Mycobacterium tuberculosis and lymphoproliferative response to M. tuberculosis culture filtrate antigen (CFA) was studied in patients with pulmonary tuberculosis (n = 46) and in normal healthy subjects (NHS) (n = 64). Vitamin D3 at a concentration of 1 × 10−7 M enhanced the phagocytic potential of normal subjects who had a phagocytic index of less than 20%. This increase was seen in subjects with the genotypes BB (p = 0.017), AA (p = 0.016), tt (p = 0.034), and FF (p = 0.013) and the extended genotype BBAAtt (p = 0.034). Normal subjects with BBAAtt performed better phagocytosis than individuals with bbaaTT genotype (p = 0.034). Vitamin D3 at 10−9, 10−8, and 10−7 M concentrations suppressed the lymphoproliferative response to CFA antigen in normal subjects. This decreased lymphocyte response was observed in normal individuals with the genotypes BB (p = 0.0009), tt (p = 0.016), and FF (p = 0.008) and the extended genotype BBAAtt (p = 0.02). Addition of vitamin D3 had no significant effect on macrophage phagocytosis and lymphoproliferative response to CFA in pulmonary TB patients. This may be due to the unresponsive nature of the cells to the action of vitamin D3 or the downregulated VDR expression by virtue of the disease, which renders them inactive. The genotypes BB, tt, and the extended genotype BBAAtt may be associated with increased expression of VDR which in turn regulate the action of vitamin D3 and modulate the immune functions to M. tuberculosis in NHS.

Métodos. Se diseñó un estudio de casos y testigos pareados por edad y por municipio de tratamiento. Se seleccionaron como casos 251 pacientes mayores de 15 años que abandonaron el tratamiento antituberculoso y como testigos pacientes que concluyeron la farmacoterapia (razón 1:1) durante el periodo de enero de 1998 a diciembre de 2001. Se obtuvieron datos de aspectos demográficos y socioeconómicos, hábitos de vida y características de la atención. Las variables se seleccionaron y agruparon utilizando un modelo teórico jerarquizado. Por medio de un análisis de regresión logística condicional, se estimó la razón de posibilidades (odds ratio, OR), con un intervalo de confianza de 95% (IC95%).

Limited data exists to inform contact tracing guidelines in children and HIV-affected populations. We evaluated the yield and additionality of household contact and source case investigations in Swaziland, a TB/HIV high-burden setting, while prioritizing identification of childhood TB. In partnership with 7 local TB clinics, we implemented standardized contact tracing of index cases (IC) receiving TB treatment. Prioritizing child contacts and HIV-affected households, screening officers screened contacts for TB symptoms and to identify risk factors associated with TB. We ascertained factors moderating the yield of contact tracing and measured the impact of our program by additional notifications. From March 2013 to November 2015, 3,258 ICs (54% bacteriologically confirmed; 70% HIV-infected; 85% adults) were enrolled leading to evaluation of 12,175 contacts (median age 18 years, IQR 24-42; 45% children; 9% HIV-infected). Among contacts, 196 TB cases (56% bacteriologically confirmed) w...

Aspergillus infections are among the most feared opportunistic infections in humans because they are capable of causing several distinct pulmonary diseases. The aim of this study was to determine the prevalence of Aspergillus species in patients with pulmonary pneumonia and susceptibility testing to the most commonly used antifungal agents.
A total of 311 specimens were collected from patients presented with the pulmonary complaint. Out of which, 139 (44.6%) yielded Aspergillus growth. Aspergillus isolates were obtained from Bronchoalveolar lavage and sputum. Ten species of Aspergillus were identified, A. flavus, A. niger, and A. terreus were the most frequently isolated species. Antifungal susceptibility of 10 different Aspergillus spp. isolates were performed using E-test. Voriconazole and caspofungin were having full inhibitory activity (100%) against tested Aspergillus spp., while some resistance was observed against itraconazole and posaconazole (50% and 75% respectively). Aspergillus was found to be the predominant fungal pathogen isolated from patients with pulmonary diseases, notably from patients with COPD and pulmonary TB.

This paper explores the architecture of the Mount Sinai Sanatorium in Sainte-Agathe-des-Monts (Qc) to disentangle the role of religion in the treatment of tuberculosis. In particular, we analyze the design of Mount Sinai, the jewel in the crown of Jewish philanthropy in Montreal, in relation to that of the nearby Laurentian Sanatorium. While Mount Sinai offered free treatment to the poor in a stunning, Art Deco building of 1930, the Protestant hospital had by then served paying patients for more than two decades in a purposefully home-like, Tudor-revival setting. Using architectural historian Bernard Herman's concept of embedded landscapes, we show how the two hospitals differed in terms of their relationship to site, access, and, most importantly, to city, knowledge, and community. Architects Scopes & Feustmann, who designed the Laurentian hospital, operated an office at Saranac Lake, New York, America's premier destination for consumptives. The qualifications of Mount Sinai architects Spence & Goodman, however, derived from their experience with Jewish institutions in Montreal. Following Herman's approach to architecture through movement and context, how did notions of medical therapy and Judaism intersect in the plans of Mount Sinai?

mended for the prevention of active disease. However, the adverse effects and acceptability of this preventive therapy are largely uncharacterized. We prospectively followed 157 high-school students exposed to, and probably infected with, M. tuberculosis strains resistant to INH. All 157 students were prescribed preventive therapy with rifampin (10 mg/kg up to 600 mg daily) for 24 wk. While receiving therapy, 41 (26%) reported one or more adverse effects; of these, 18 had therapy interrupted temporarily, two permanently. Four (2.5%) had alanine aminotransferase elevations greater than two timer the upper limit of normal (range, 91 to 161 U /L); of these, one had therapy permanently stopped. Six (3.8%) self-discontinued therapy. No student was found to have active disease during the 2 yr of the study (exact 95% upper confidence limit, 2.2). We assumed that without preventive therapy, seven cases of tuberculosis would have occurred during these 2 yr. Therefore, we estimated that rifampin had a minimum protective effect of 56%. In conciusion, preventive therapy with rifampin was well tolerated and well accepted, and it appears effective in preventing active tuberculosis. Villarino ME, Ridzon R, Weismuller PC, Elcock M, Maxwell RM, Meador J, Smith P), Carson ML, Gelter LJ. Rifampin preventive therapy for tuberculosis infection: experience with 157 adolescents. AM J RESPIR CRIT CARE MED 1997;155:1735-1738.

Thoracopulmonary actinomycosis can mimic various lung pathologies such as bronchogenic carcinoma, tuberculosis and fungal pneumonia, to name but a few. The common causative agent is Actinomyces israelii. The disease is successfully diagnosed only if there is a high index of suspicion and a thorough evaluation with multidisciplinary involvement. We present a case of thoracopulmonary actinomycosis in a young immunocompetent man who did not have any predisposing illness, and who was treated initially for pulmonary tuberculosis. He showed good response to injection crystalline penicillin, which was later changed to oral amoxicillin.

Detection of latent Mycobacterium tuberculosis is a challenge in the diagnosis of asymptomatic, subclinical tuberculosis. We report the development of an immunofluorescence technique to visualize and enumerate M. tuberculosis in latently infected rabbit lungs where no acid-faststained organisms were seen and no cultivable bacilli were obtained by the agar-plating method.

Efecto de la fluticasona inhalada sobre la inflamación pulmonar administrada durante y después de la sensibilización de cobayas Utilidad de la PAAF guiada por TC en el diagnóstico de lesiones mediastínicas Fracciones inspiratorias elevadas de O2 con el uso del dispositivo convencional de nebulización de fármacos

The present investigation was carried out to determine the possible bioactive components of tuber of Ruellia tuberosa L. (Acanthaceae) using GC-MS analysis. Twenty five compounds were identified. The prevailing compounds in the ethanol extract of tuber of R. tuberosa were Lupeol (68.14%), Stigmasterol (8.89%), á-Sitosterol (3.99%), Sucrose (2.24%), Cholest-5-ene, 3-bromo-, (3á- (2.24%), Octadecane, 2-methyl- (2.10%), Nonadecane, 2-methyl- (1.93%), Eicosane, 2-methyl- (1.79%) Heptacosane (1.43%) and Heptacosane (1.29%).