Risk factors for atypical mycobacterial disease in patients with smear positive pulmonary TB

AbstractNon Tuberculous Mycobacteria (NTM) can cause severe infection in selected groups of patients and is very difficult to be differentiated from TB infection clinically or radiologically leading to miss diagnosis and wrong treatment in these cases, the Aim of the present study is to study risk factors associated with NTM disease in patients with Acid Fast Bacilli (AFB) smear positive, Subjects and methods: 1402 patients with AFB smear positive were included in the study, only 47 patients from the study group proved to have NTM disease (diagnosis was done according to ATS/IDSA criteria). Results: the mean age of the NTM patients was 61.8±23.2years, NTM was more common in older age groups and more common in white race patients, on using logistic regression analysis NTM disease was more commonly associated with old TB infection (42.6%) and with bed ridden patients on tracheostomy (31.9%). The most common organisms isolated were the MAC complex (55.3%) followed by M. Kansasii (34.04%). Conclusion: NTM disease should be put into consideration in patients with AFB smear positive and suffering from old TB infection or in bed ridden patients who are on tracheostomy, also if smear is positive for AFB and PCR is negative NTM should be suspected

Pattern of tuberculosis in patients of a university hospital during the period (2004–2011)

AbstractAim of the workTo identify the pattern of infection among diagnosed patients with tuberculosis presented to chest diseases clinic and/or admitted to the department of chest diseases in Bab El Shaaria (Al-Azhar) University hospital.Subjects and methodsBy retrospective analysis of available data, all patients who were diagnosed and registered in the period from January 2004 till December 2011 in the follow up records in TB clinic and in the chest diseases department in Bab El Shaaria University hospital were included. Data were collected from the patient files. These data included: full history, chest X-ray, sputum examination results, and all other data related to the patient’s condition.ResultsA total of 384 patients were registered in TB clinic in Bab El Shaaria University hospital with a diagnosis of tuberculosis (pulmonary or extra-pulmonary). Their age ranged from 3 to 80years, with mean age of 37.5+16.0years. As regards gender there were 178 male patients (46.4%), and 206 female patients (53.6%). As regards site affected there were 209 patients (54.4%) with pulmonary TB and 175 patients (45.6%) with extrapulmonary TB. The percentage of TB cases to the total number of chest clinic visitors per year was ranging between 0.08% and 0.8% with an average of 0.48%, while the percentage of pulmonary TB cases to the total number of TB cases per year was ranging between 27% and 65% of total TB cases per year with an average of 51.7%

Outflow mechanisms after deep sclerectomy with two different designs of collagen implant in an animal model

BACKGROUND: To study experimentally two different shapes of collagen implants (CI) used in deep sclerectomy (DS). The ability to promote drainage vessels, outflow mechanisms, success rates, and biodegradability, were studied prospectively in an animal model. MATERIALS AND METHODS: DS was performed in 20 eyes of ten rabbits. Each rabbit randomly received a cylindrical CI in one eye, while the other eye received a flat CI. Intraocular pressure (IOP) measurement, ultrasound biomicroscopy (UBM) examination of DS site and simultaneous fluorescein and indocyanin green anterior-segment angiography were performed preoperatively, at 1 and 2 weeks, 1, 2, 3, 6 and 9 months for each eye. At the end of the follow-up period, outflow facility (OF) was measured and histological examinations of the filtration site were performed. RESULTS: In the cylindrical implant group, IOP significantly dropped from a mean pre-operative value of 14.8+/-2.2 mmHg to a mean postoperative values of 10.9+/-3.3, 12.5+/-2.2, 11.8+/-2.6, 11.2+/-2.3, 10.7+/-1.9, 14.0+/- 3.2, 12.6+/-2.4 mmHg at 1, 2 weeks, and 1, 2, 3, 6, and 9 months, respectively. In the flat CI group, IOP significantly dropped from a mean preoperative value of 14.1+/-1.8 mmHg to a mean postoperative values of 10.4+/-2.7, 12.7+/-1.9, 12.5+/-3.2, 11.2+/-1.6, 11.6+/-1.8, 11.5+/-2.3, 11.0+/-2.2 mmHg at 1, 2 weeks, and at 1, 2, 3, 6, and 9 months, respectively. UBM images showed a gradual resorption of both type of CI during the first 3 months, and angiographies showed progressive growth of drainage vessels around the filtration site in both groups. The mean OF 9 months postoperatively for the cylindrical CI was 0.53 (SD +/- 0.23) ml/ min per mmHg and was 0.56 (SD+/-0.17) ml/min per mmHg for the flat CI (P=0.6). Histological examination revealed excellent biocompatibilty and a high density of drainage vessels in the sclera around the operative site in both groups. CONCLUSION: Using IOP and OF measurements, UBM, angiography, and histology, we were able to compare two types of CI used as space maintainer in DS. Both CIs showed efficient IOP lowering effect and outflow facility increase, possibly explained by stimulation of drainage vessels growth. Both implants showed excellent biocompatibility. The flat CI showed a slight tendency towards better overall performances

In vivo biocompatibility assessment of (PTFE–PVDF–PP) terpolymer-based membrane with potential application for glaucoma treatment

The aim of the work was to evaluate the in vivo biological behaviour of polymeric membrane materials for glaucoma implants. The base material was biostable synthetic terpolymer (PTFE–PVDF–PP) with proved biocompability (PN-EN ISO 10993). The samples manufactured in the form a membrane were subjected to chemical and physical treatment to create an open pore system within the polymer matrix. As a porogenic phase biodegradable natrium alginate in a fibrous form was employed. The non-perforating deep sclerectomy technique was performed in a rabbit model. The clinical observations were made after 14 and 30 days. During the study clinical symptoms of a moderate degree were observed, and histopathological changes were typical for foreign body implantation. At the end stage of the study no significant difference in histopathological assessment was found between control and experimental group. Similarities observed in both groups and relatively mild histopathological changes in the tissue surrounding the implant indicate that the observed symptoms come from a deep scleral trauma caused by surgery, and not by the presence of the implant itself

PET/CT Imaging of c-Myc Transgenic Mice Identifies the Genotoxic N-Nitroso-Diethylamine as Carcinogen in a Short-Term Cancer Bioassay

Background: More than 100,000 chemicals are in use but have not been tested for their safety. To overcome limitations in the cancer bioassay several alternative testing strategies are explored. The inability to monitor non-invasively onset and progression of disease limits, however, the value of current testing strategies. Here, we report the application of in vivo imaging to a c-Myc transgenic mouse model of liver cancer for the development of a short-term cancer bioassay. Methodology/Principal Findings: mCT and 18 F-FDG mPET were used to detect and quantify tumor lesions after treatment with the genotoxic carcinogen NDEA, the tumor promoting agent BHT or the hepatotoxin paracetamol. Tumor growth was investigated between the ages of 4 to 8.5 months and contrast-enhanced mCT imaging detected liver lesions as well as metastatic spread with high sensitivity and accuracy as confirmed by histopathology. Significant differences in the onset of tumor growth, tumor load and glucose metabolism were observed when the NDEA treatment group was compared with any of the other treatment groups. NDEA treatment of c-Myc transgenic mice significantly accelerated tumor growth and caused metastatic spread of HCC in to lung but this treatment also induced primary lung cancer growth. In contrast, BHT and paracetamol did not promote hepatocarcinogenesis. Conclusions/Significance: The present study evidences the accuracy of in vivo imaging in defining tumor growth, tumor load, lesion number and metastatic spread. Consequently, the application of in vivo imaging techniques to transgeni

Pro-inflammatory profile of preeclamptic placental mesenchymal stromal cells: new insights into the etiopathogenesis of preeclampsia.

The objective of the present study was to evaluate whether placental mesenchymal stromal cells (PDMSCs) derived from normal and preeclamptic (PE) chorionic villous tissue presented differences in their cytokines expression profiles. Moreover, we investigated the effects of conditioned media from normal and PE-PDMSCs on the expression of pro-inflammatory Macrophage migration Inhibitory Factor (MIF), Vascular Endothelial Growth Factor (VEGF), soluble FMS-like tyrosine kinase-1 (sFlt-1) and free β-human Chorionic Gonadotropin (βhCG) by normal term villous explants. This information will help to understand whether anomalies in PE-PDMSCs could cause or contribute to the anomalies typical of preeclampsia. METHODS: Chorionic villous PDMSCs were isolated from severe preeclamptic (n = 12) and physiological control term (n = 12) placentae. Control and PE-PDMSCs’s cytokines expression profiles were determined by Cytokine Array. Control and PE-PDMSCs were plated for 72 h and conditioned media (CM) was collected. Physiological villous explants (n = 48) were treated with control or PE-PDMSCs CM for 72 h and processed for mRNA and protein isolation. MIF, VEGF and sFlt-1 mRNA and protein expression were analyzed by Real Time PCR and Western Blot respectively. Free βhCG was assessed by immunofluorescent. RESULTS: Cytokine array showed increased release of pro-inflammatory cytokines by PE relative to control PDMSCs. Physiological explants treated with PE-PDMSCs CM showed significantly increased MIF and sFlt-1 expression relative to untreated and control PDMSCs CM explants. Interestingly, both control and PE-PDMSCs media induced VEGF mRNA increase while only normal PDMSCs media promoted VEGF protein accumulation. PE-PDMSCs CM explants released significantly increased amounts of free βhCG relative to normal PDMSCs CM ones. CONCLUSIONS: Herein, we reported elevated production of pro-inflammatory cytokines by PE-PDMSCs. Importantly, PE PDMSCs induced a PE-like phenotype in physiological villous explants. Our data clearly depict chorionic mesenchymal stromal cells as central players in placental physiopathology, thus opening to new intriguing perspectives for the treatment of human placental-related disorders as preeclampsia

Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications

BACKGROUND Limited information exists about the epidemiology and outcome of surgical patients at increased risk of postoperative pulmonary complications (PPCs), and how intraoperative ventilation was managed in these patients. OBJECTIVES To determine the incidence of surgical patients at increased risk of PPCs, and to compare the intraoperative ventilation management and postoperative outcomes with patients at low risk of PPCs. DESIGN This was a prospective international 1-week observational study using the ‘Assess Respiratory Risk in Surgical Patients in Catalonia risk score’ (ARISCAT score) for PPC for risk stratification. PATIENTS AND SETTING Adult patients requiring intraoperative ventilation during general anaesthesia for surgery in 146 hospitals across 29 countries. MAIN OUTCOME MEASURES The primary outcome was the incidence of patients at increased risk of PPCs based on the ARISCAT score. Secondary outcomes included intraoperative ventilatory management and clinical outcomes. RESULTS A total of 9864 patients fulfilled the inclusion criteria. The incidence of patients at increased risk was 28.4%. The most frequently chosen tidal volume (VT) size was 500 ml, or 7 to 9 ml kg1 predicted body weight, slightly lower in patients at increased risk of PPCs. Levels of positive end-expiratory pressure (PEEP) were slightly higher in patients at increased risk of PPCs, with 14.3% receiving more than 5 cmH2O PEEP compared with 7.6% in patients at low risk of PPCs (P < 0.001). Patients with a predicted preoperative increased risk of PPCs developed PPCs more frequently: 19 versus 7%, relative risk (RR) 3.16 (95% confidence interval 2.76 to 3.61), P < 0.001) and had longer hospital stays. The only ventilatory factor associated with the occurrence of PPCs was the peak pressure. CONCLUSION The incidence of patients with a predicted increased risk of PPCs is high. A large proportion of patients receive high VT and low PEEP levels. PPCs occur frequently in patients at increased risk, with worse clinical outcome