Mutations in codon 315 of the katG gene associated with high-level resistance to isoniazid

The aim of this study was to investigate the significance of mutation in codon 315 of katG gene and its correlation with high-level of resistance to isoniazid, nuclotide and amino acid changes in mycobacterium tuberculosis [MTB] isolates randomly collected from sputums of 42 patients with active pulmonary tuberculosis in different regions of Belarus. Drug susceptibility testing was determined using the CDC standard conventional proportional method. DNA Extraction, katG gene amplification, and DNA sequencing analysis were performed. Six isolates [14%] bearing multi-mutations in three codons [309,315 and 316], 26 Isolates [61.9%] demonstrated multi-mutations in all or two of the above codons, and 8 [19%] were found to have a single mutation in 315. Four types of mutations were identified in codons 315: AGC-ACC [n=36]85%, AGC-AGG [n=1] 2.3%, AGC-AAC [n=2] 4.7%, AGC-GGC [n=1] 2.3%, one type of mutation in 316: GGC-AGC [n=18]41.4%, and four types of mutations in 309: GGT-GGT [n=7]16.1%, GGT-GCT [n=4]9.2%, GGT-GTC [n=3]6.9%, GGT-GGG [n=1]2.7%. In 2 [4.7%] isolates mutations were identified in codons 463, 357, and in codons 454, 357 respectively. MTB in patients from Belarus were found to have high-level resistance to isoniazid in the isolates with mutations in codon 315 [> 10 micro g/mL]

Pyogenic psoas abscess: discussion of its epidemiology, etiology, bacteriology, diagnosis, treatment and prognosis - case report

Psoas muscle abscess is a rare condition with vague clinical presentation, which presents a diagnostic challenge requiring a high index of suspicion. We report a case of primary pyogenic psoas abscess caused by Staphylococcus aureus. In this article, the epidemiology, etiology, bacteriological diagnosis and treatment options of this condition are discussed

Acute suppurative necrotizing pancholangitis. A case report

To present a case of ascending cholangitis with resulting necrosis of the biliary system with perforation. Clinical Presentation and Intervention: A 40-year-old male patient presented with upper abdominal pain, fever and jaundice assessed clinically and investigated by laboratory and radiological tests. Endoscopic retrograde cholangiogram and surgery were performed. However, because of extensive suppurative pancholangitis involving most of the intrahepatic radicles, sound surgical drainage could not be accomplished. Unfortunately, the patient died 2 days after surgery. In this case of severe cholangitis, endoscopic and surgical interventions were not successful and might have contributed to the worsening of the condition

Bile duct injuries in laparoscopic cholecystectomy.

Bile duct injuries were analysed in a prospective study of 1,250 cases of laparoscopic cholecystectomy. The aim of the study was to identify the incidence and causes of bile duct injuries in the course of laparoscopic cholecystectomy, and to recommend the possible ways to avoid this serious complication. Materials and Special computer forms were created to record detailed patient pre-operative, operative, and postoperative follow-up data for later study. Operative cholangiography was done only on a selective basis. Bile duct injuries were classified according to the Bismuth classification. Four cases [0.3%] of bile duct injuries were encountered in the study: 2 of them were classified as major [Bismuth classification grade II] and the other 2 as minor [diathermy puncture]. All injuries were attributed to distortion of Calot's triangle and failure to clearly identify the anatomy. A recent history of acute cholecystitis, a history of jaundice, pancreatitis and repeated or technically difficult endoscopic retrograde cholangiopancreatography [ERCP] were associated with local inflammatory changes that had possibly contributed to the distorted anatomy at Calot's triangle and consequently to the injury. All injuries were detected during surgery and immediately repaired. Major bile duct injuries were repaired by choledocho-enterotomy, while minor injuries were treated by simple sutures around the T tube in the common bile duct. All patients were asymptomatic with normal liver function tests on follow-up for a period up to 3 years after surgery. Conclusions: The incidence of bile duct injuries in laparoscopic cholecystectomy is comparable to open surgery. Patients with a clinical history of acute cholecystitis, or a recent history of jaundice and repeated ERCP should be considered for operative cholangiography in order to help reduce the chances of bile duct injuries