ABSTRACT
Diagnosis of tuberculous meningitis (TBM) is always a challenge. We must give importance for duration of clinical manifestations. Cerebrospinal fluid (CSF) has own characteristic and it have to be control several times during the treatment. Adenosin deaminase with cut off more than 15 UI/mL and M. tuberculosis polymerase chain reaction in CSF are the most relevant diagnostic tests. Radiologic test gives diagnostic clues but do not confirm the diagnosis. In the future we can structure a score with all these elements to support the clinician in the diagnostic process. The treatment of TBM because of its high morbidity and high mortality has to be necessarily more intensive and prolonged and we must select drugs with a good penetration into the central nervous system (SNC). A therapeutic scheme with duration of 12 months with two phases is proposed, the diary phase during the first three months of treatment includes isoniacid, rifampicin, pirazinamid and ethambutol or moxifloxacin. Streptomycin must not be included due to own erratic SNC penetration and its known toxicity. The second twice a week phase has to be changed by a three times per week phase during 9 months and it must include isoniacid, rifampicin and pirazinamide. Dexamethasone is added during the first 6 weeks of treatment. Patients with HIV infection than required treatment with antiretroviral drugs have to start ART treatment when diary phase has finished and must not include protease or integrase inhibitors.
El diagnóstico de la meningitis tuberculosa (MTBC) es siempre un desafío. Debemos dar importancia a las manifestaciones clínicas y su duración. El análisis citoquímico del LCR tiene características propias y debe ser controlado varias veces durante el tratamiento. La adenosin deami-nasa con punto de corte > 15 UI/mL y la RPC para M. tuberculosis en LCR son las pruebas más relevantes. Las imágenes aportan elementos valiosos pero no establecen el diagnóstico por si solas. A futuro se puede estructurar un puntaje con todos estos elementos para apoyar al clínico en el proceso diagnóstico. El tratamiento de la MTBC, dada su alta morbilidad y mortalidad, necesariamente debe ser más intensivo y prolongado, y debemos seleccionar fármacos con buena penetración en el SNC. Se propone un esquema de 12 meses. La fase diaria debería durar tres meses e incluir isoniacida, rifampicina, pirazinamida y etambutol o moxifloxacina. Estreptomicina no debería ser incluida dada su mala penetración en el SNC y reconocida toxicidad. La fase de mantención debería ser trisemanal e incluir isoniacida, rifampicina y pirazinamida. Dexa-metasona debe administrarse durante las primeras seis semanas de tratamiento. En el caso de pacientes con infección por VIH que requieran iniciar TARV ésta debe ser aplazada para después de la fase diaria y no debería incluir inhibidores de proteasa e integrasa.
Subject(s)
Humans , Antitubercular Agents/administration & dosage , Tuberculosis, Meningeal/diagnosis , Tuberculosis, Meningeal/drug therapy , Clinical ProtocolsABSTRACT
Objective To study the effect of morphine on gene expression of enzymes involved in salvage and catabolism pathways of purine nucleotides metabolism in nerve cells.Methods PC12 cells were cultivated and divided into morphine treated groups which were treated with morphine(10 mg?L~(-1) culture) for 12,24,48, 72 h,and control groups which were treated with normal saline for 12,24,48 and 72 h.Total RNA of PC12 cells was isolated.HGPRT,AK,ADK mRNA levels were determined by using the reverse transcription polymerase chain reaction(RT-PCR); the ?-actin mRNA expression was used as an internal control.Results As compared with corresponding control groups,HGPRT mRNA levels in PC12 cells were increased significantly after 12 and 24 h treatment with morphine(P
ABSTRACT
La tuberculosis pleural es una condición prevalente en hasta un 30 por ciento de los pacientes con tuberculosis, y de hecho constituye una de las manifestaciones más frecuentes de la presentación inicial. El diagnóstico de la tuberculosis pleural usualmente presenta la dificultad característica de demostrar la infección por Mycobacterium tuberculosis mediante confirmación directa en tinciones y cultivos, lo que ha impulsado el establecimiento de nuevos criterios y el desarrollo de intervenciones dirigidas a mejorar la sensibilidad de los métodos diagnósticos. Se reporta el caso de un paciente con derrame pleural unilateral cuya presentación clínica satisface los criterios diagnósticos de tal condición.
Pleural tuberculosis is a condition present in more than 30% of patients with tuberculosis, in fact it is a rather common initial presentation. Pleural tuberculosis diagnostic is often difficult by direct confirmation of Mycobacterium tuberculosis in cultures and stains, it has lead the development of new criteria and interventions focused in the improvement of the sensibility diagnostic methods. We describe a patient with unilateral pleural effusion who met the criteria of this clinical condition.
Subject(s)
Humans , Male , Adult , Tuberculosis, PleuralABSTRACT
OBJECTIVE: To investigate whether synovial fluid adenosine deaminase activity is useful in the differential diagnosis of joint swelling and in estimating the disease activity. METHOD: Adenosine deaminase activity was determined in the synovial fluid taken from patients with rheumatoid arthritis (n=21), osteoarthritis (n=ll), ankylosing spondylitis (n=3), and gouty arthritis (n=2). This enzyme activity was compared with the laboratory indices (ESR, CRP) in the blood and the other parameters in the synovial fluid. RESULT: More increased adenosine deaminase activity was found in the synovial fluid taken from patients with rheumatoid arthritis, ankylosing spondylitis, and gouty arthritis, as compared with that of osteoarthritis patients. Synovial fluid ADA activity was significantly corelated with the WBC count in the synovial fluid, but there was no statistical corelation between other synovial parameters and adenosine deaminase activity. CONCLUSION: Adenosine deaminase activity is useful in the differential diagnosis of joint swelling between inflammatory joint disease and osteoarthritis, but not useful in estimating the disease activity.