The effect of single dose of brimonidine-purite 0.15％ on choroidal thickness in healthy volunteers / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To evaluate the potential posterior segment effects of topical application of brimonidine-purite 0.15％ through measurement of choroidal thickness (CT) in healthy eyes using enhanced depth imaging spectraldomain optical coherence tomography (EDI-SD-OCT).METHODS:Thirty-two eyes of 32 healthy subjects were included in this prospective,placebo controlled interventional clinical trial.They received one drop of topical preservative-free artificial tears as placebo for the first day and one drop of brimonidine-purite 0.15％ for the second day.Intraocular pressure,ocular perfusion pressure (OPP),and EDI-SD-OCT were performed at baseline,at 1,3 and 5h after the treatments.RESULTS:Compared to the measurements obtained at baseline,the CT measurements obtained after the topical application of brimonidine-purite 0.15％ significantly increased at the sub-fovea (P=0.001),at temporal 1500 μm to the fovea (P=0.003) and at nasal 1500 μm to the fovea (P=0.003).Choroidal thickness was unchanged in placebo group during the study (P ＞0.05).There was no significant reduction in the OPP in both groups (P ＞0.05).There were no adverse events during the study.CONCLUSIONS:Contrary to expectations,topical administration of brimonidine-purite 0.15％ resulted with thickening of sub-foveal,temporal and nasal CT.This might be related to altered auto-regulation mechanisms in choroidal vessels.

Investigation of relationship of iris color with retinal nerve fiber layer, macula and choroid thickness in healthy individuals / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To determine whether there was a significant relationship between eye iris color with axial length, intraocular pressure, retinal nerve fiber layer (RNFL) thickness, macular thickness and choroidal thickness.METHODS:A prospective cross-sectional study involving 92 eyes of 92 healthy volunteers.These were divided into dark colored-eye (DCE) and light-colored eye (LCE) groups according to iris color.The RNFL and macular thicknesses were analysed with standard optical coherence tomography (OCT) protocol while choroidal thickness was analysed with electronic data interchange (EDI) protocol in all subjects.Choroidal thickness was measured at the fovea, 1500 μm nasal and 1500 μm temporal to the fovea in a horizontal section.RESULTS:Of the 92 eyes included, 62 (67.4%) were dark-colored while 30 (32.6%) were light-colored.The mean age was 29.22±5.86y in the subjects with DCE and 28.86±6.50y in those with LCE.No significant difference was detected in mean age, axial length, macular thickness, choroidal thickness and intraocular pressure (IOP) between the groups (P>0.05).However, RNFL thicknesses varied depending on the quadrant measured, and were lower in both global and the nasal and temporal quadrants for individuals with LCE (P≤0.022).CONCLUSION:No significant differences were found in IOP, macular thickness and choroid thickness between individuals with DCE and LCE.Meanwhile, the RNFL thickness is lower.

Optimisation of the MAGAT gel dosimeter compositions

Background: an effective polymer gel dosimeter can be fabricated by varying the composition of its chemical components

Materials and Methods: the MAGAT gel dosimeter formulations that used different compositions of Methacrylic acid [MAA] and gelatin were extensively investigated in the present study according to the R2-dose response and R2-dose sensitivity. The irradiation of MAGAT gel was performed by 6-MV photon beam at a dose range 1 to 10 Gy and was imaged by 1.5T Magnetic Resonance Imaging [MRI]. The dose response of MAGAT gel dosimeter was obtained from spin-spin relaxation rate [R2] of MRI signal

Results: the MAGAT gel dosimeter composed of 5% gelatin and 6% MAA gave the highest sensitivity [1.1180 s[-1]Gy[-1]]

Conclusion: understanding the effects of the compositional changes will help to clarify the mechanisms involved in the dose response of the MAGAT gel dosimeter

Immune responses against Mycobacterium tuberculosis-specific proteins PE35 and CFP10 in mice immunized with recombinant Mycobacterium vaccae

To clone and express Mycobacterium tuberculosis [M. tuberculosis] proteins PE35 and culture filtrate protein [CFP]10 in Mycobacterium vaccae [M. vaccae], and subsequently, evaluate the humoral and cellular immunity responses against these recombinant constructs in mice. The DNA of PE35 and CFP 10 genes were cloned into the shuttle plasmid pDE22, and the recombinant plasmids were electroporated into M. vaccae. The recombinant constructs were then tested for expression of PE35 and CFP10 by Western immunoblotting using rabbit anti-sera. Furthermore, splenocytes and sera from groups of 5 mice immunized with recombinant M. vaccae [rVaccae] were tested for cellular and humoral responses in proliferation, and antibody assays. Experiments were carried out in the laboratory of the Faculty of Medicine, Kuwait University, Safat, Kuwait between 2009 and 2011. The results of Western immunoblot suggested the expression of only PE35. However, splenocyte assays showed positive proliferation in response to peptide pools, and 4 and 5 of the 6 overlapping synthetic peptides covering the sequence of PE35 and CFP10. In addition, positive antibody reactivity was detected with PE35 peptide pool and a single peptide, namely, P2. The expression of PE35 and CFP10 proteins in rVaccae constructs led to the induction of cellular immune responses to multiple epitopes

Priorities for primary health care research in Qassim, central Saudi Arabia

To determine the major research priorities in the field of Primary Health Care [PHC] in Qassim, Saudi Arabia. The study was a cross-sectional survey including academicians, researchers, and PHC program managers in Qassim. A self-administered questionnaire was used as the survey instrument. A scale of 1-5 was given for prioritizing the health issues [5=highest priority; 1=lowest priority]. A list of PHC research topics including prevalent health issues addressed by PHC programs was provided to the respondents. Responses were collected from April 2012 to June 2012, and the data was analyzed. A total of 101 eligible participants were invited to participate in the survey; out of these 85 [84.2%] responded. Diabetes mellitus [4.82 +/- 0.44] was the top priority, followed by hypertension [4.67 +/- 0.54], and bronchial asthma [4.35 +/- 0.79]. Other priority areas included child health, maternal health, and quality of care. Leishmaniasis and foodborne illness were the lowest priorities. This study identified the priority areas that need to be focused on for PHC research in Qassim. The survey lays a foundation upon which we can build future research

Morphometric study of sacral hiatus in adult human Egyptian sacra: their significance in caudal epidural anesthesia

The reliability and success of caudal epidural anesthesia depends on anatomic variations of sacral hiatus [SH] as observed by various authors. SH is an important landmark during caudal epidural block [CEB]. The purpose of the present study was to clarify the morphometric characteristics of the SH in human Egyptian dry sacra and pelvic radiographs and identification of nearest ony landmarks to permit correct and uncomplicated caudal epidural accesses. The present study was done on 46 human adult Egyptian dry sacra. The maximum height, midventral curved length, and maximum breadth of each sacrum were measured and sacral and curvature indices were calculated. According to sacral indices, sacra were divided into 2 groups [22 male and 24 female sacra]. SH was evaluated in each sacrum according to its shape, level of its apex, and base according to sacral and coccygeal vertebrae, length, anteroposterior [AP] diameter at its apex, and transverse width at its base. Linear distances were measured between the apex of SH and second sacral foramina, right and left superolateral sacral crests. The distance between the 2 superolateral sacral crests also was measured. The most common types of SH were the inverted U and inverted V [in male] and inverted V and dumbbell shaped [in female]. Absent SH was observed in male group only. The most common location of SH apex was at the level of S4 in all groups of dry sacra and S3 in all groups of lumbosacral spine radiographs, whereas S5 was the common level of its base. The mean SH length, transverse width of its base, and AP diameter of its apex were 2.1 +/- 0.80, 1.7 +/- 0.26, and 0.48 +/- 0.19 cm. Female sacra showed narrower SH apex than male. The distance between the S2 foramen and the apex of the SH was 4.1 +/- 1.14, 3.67 +/- 1.21, and 4.48 +/- 1.01 cm in total, female and male sacra, respectively. Sacrum and SH showed morphometric variations in adult Egyptians. The equilateral triangle is an important guide to detect SH easily and increases the success rate of CEB. Insertion of a needle into the SH for caudal block is suggested to be done at its base to avoid the anatomic variations of its apex

Insecticide susceptibility status of the malaria vector Anopheles arabiensis in Khartoum city, Sudan: differences between urban and periurban areas

Vector resistance to insecticides is becoming a major obstacle to malaria prevention measures. A baseline survey was carried out in Khartoum city, Sudan, during September-November 2007, to map the insecticide susceptibility status of Anopheles arabiensis and to examine the correlation with insecticide usage in urban agriculture. Susceptibility tests were conducted in 6 sentinel sites representing urban and periurban strata of the city. Mortality rates and knockdown times were calculated for 8 insecticides on a total of 9820 specimens. An. arabiensis was susceptible to bendiocarb [98.1%], propoxur [100%], fenitrothion [100%], deltamethrin [99.8%] and lambda-cyhalothrin [99.2%]. Susceptibility rates were significantly different between urban and periurban sites for malathion [80.8% vs 56.0%], DDT [99.0% vs 95.0%] and permethrin [98.5% vs 96.3%]. The 50% knockdown times were significantly higher in periurban than urban populations of An. arabiensis for deltamethrin, lambda-cyhalothrin and malathion

Mediastinal parathyroid adenoma: diagnostic and management challenges

Primary hyperparathyroidism due to ectopic parathyroid adenomas can pose diagnostic and management challenges, especially when imaging studies have localised the lesions to different sites. We report a case of symptomatic hypercalcaemia due to a mediastinal parathyroid adenoma. Ultrasonography identified a nodule posterior to the right thyroid gland. However, computed tomography and technetium-99m sestamibi scintigraphy revealed an ectopic parathyroid adenoma located in the anterior mediastinum. The adenoma was successfully removed through a median sternotomy. However, postoperatively, the patient developed prolonged symptomatic hypocalcaemia, possibly due to suppression of the normal parathyroid gland function, although the presence of concomitant hungry bone syndrome was possible. The histopathology of the mediastinal mass was consistent with a parathyroid adenoma.

Legionella in clinical specimens and hospital water supply facilities: molecular detection and genotyping of the isolates

To evaluate genus- and species-specific polymerase chain reactions [PCRs] for the detection of the genus Legionella and the species Legionella pneumophila in clinical specimens and hospital water supplies, and to establish a simple and reproducible random amplification of polymorphic DNA [RAPD]-PCR technique for genotyping of Legionella. A total of 70 respiratory tract specimens [bronchoalveolar lavage: n = 46; endotracheal secretions: n = 9; sputum: n = 15] from patients with atypical pneumonia, and 283 environmental samples [water: 20; swabs: 263] collected from water storage and supply facilities of the Mubarak Al-Kabeer Hospital, Kuwait, were tested by culture and genus-specific PCR for the detection of Legionella. The L pneumophila isolates were subsequently typed by serology and RAPD-PCR using serotype-specific sera and arbitrary primers, respectively. Of the 70 clinical samples, culture yielded 2 [2.9%] whereas genus-specific PCR detected Legionella in 20 [28.6%] samples. The 2 culture-positive specimens were also positive for L.-pneumophila-specific PCR. Testing of swab and water samples by culture and genus-specific PCR yielded 61 [21.6%] and 67 [23.7%] positive samples, respectively. All of the 61 culture-positive samples were also positive by genus-specific PCR and 45 of them were positive for L.-pneumophila-specific PCR. Serological typing of 43 L pneumophila isolates showed that 8 of these belonged to serotype 1 and 35 to serotype 3; however, RAPD-PCR analyses demonstrated polymorphisms among the isolates of both serotypes. A higher association between PCR and culture was observed for the environmental samples than for the clinical samples. The application of genus- and species-specific PCRs and RAPD is useful in the detection and typing of Legionella in clinical and environmental samples

Cell-mediated immune responses to complex and single mycobacterial antigens in tuberculosis patients with diabetes

To evaluate cell-mediated immune [CMI] response in diabetic and non-diabetic tuberculosis [TB] patients and healthy subjects in response to complex, fractionated and single antigens of Mycobacterium tuberculosis. Peripheral blood mononuclear cells [PBMC] were obtained from patients suffering from pulmonary TB and type II diabetes [n = 7], pulmonary TB without diabetes [n = 10] and healthy subjects without TB and diabetes [n = 10]. PBMC were assessed for CMI responses in antigen-induced proliferation assays in response to complex mycobacterial antigens [whole cells, cell walls and culture filtrate of M. tuberculosis], a battery of naturally purified or recombinant produced secreted [ESAT6, MPT59, MPT64 and MTB38] and cytosolic [MTB10, MTB70, ML10, ML28, ML36, ML65 and MB65] mycobacterial antigens and fractionated culture filtrate proteins [fractions F1-F10] of M. tuberculosis. The majority [>70%] of diabetic and non-diabetic TB patients and healthy subjects responded to the complex antigens of M. tuberculosis. However, among the single antigens, ESAT6 was most frequently recognized by TB patients with and without diabetes, but least recognized by healthy subjects. The secreted antigens MPT59 and MPT64 were recognized by all the groups, whereas the cytosolic antigens were recognized best by healthy subjects. When tested with fractionated secreted proteins present in the culture filtrate of M. tuberculosis, the best responses in both diabetic and non-diabetic TB patients were obtained with fractions containing low-molecular-weight proteins. Diabetic and non-diabetic TB patients respond frequently to secreted low-molecular-weight ESAT6 antigen of M. tuberculosis, indicating that this antigen may be useful in the diagnosis of TB in both the groups

Amplification of six putative RDI genes of Mycobacterium tuberculosis for cloning and expression in Escherichia coli and purifications of expressed proteins

To amplify, clone and express in Escherichia coli six open reading frames [ORFs] predicted in the RD1 DNA segment of Mycobacterium tuberculosis and purify the expressed proteins to homogeneity. DNA corresponding to the coding regions of six RD1 ORFs, i.e. ORF10 to ORF15, was amplified from genomic DNA of M. tuberculosis, cloned in the plasmid vector pPCR-Script and subcloned in expression plasmid vectors pET29a and/or pGEX-4T for expression in E. coli as fusion proteins. The recombinant fusion proteins were identified by sodium dodecyl polyacrylamide gel electrophoresis and Western immunoblotting. Attempts were made to obtain purified proteins, free of the fusion partner, using affinity and fast protein liquid chromatography. DNA corresponding to all six targeted RD1 ORFs was amplified from the genomic DNA of M. tuberculosis and five of the six ORFs, with the exception of ORF13, were cloned in the plasmid vectors and expressed in E. coli. Because of extensive degradation of ORF10 and ORF12 fusion proteins or nonbinding to the affinity columns of ORF15 fusion proteins, only ORF11 and ORF14 proteins were purified, free of the fusion partner, to homogeneity. All of the six targeted RD1 genes were amplified and five expressed using E. coli hosts, but only two of the expressed proteins were purified to homogeneity. Alternative expression systems are required to obtain all RD1 proteins for functional characterization

Whole blood assays to identify Th1 cell antigens and peptides encoded by mycobacterium tuberculosis-specific RD1 genes

To identify Th1 cell-stimulating antigens/peptides encoded by the genes predicted in the Mycobacterium tuberculosis-specific genomic region of difference [RD]1, deleted in Mycobacterium bovis Bacille Calmette-Guerin[BCG], by using synthetic peptides and whole blood from tuberculosis [TB] patients. Heparinized peripheral blood was obtained from culture-proven pulmonary TB patients [n = 16] attending the Chest Disease Hospital, Kuwait. Whole blood was diluted with tissue culture medium RPMI-1640 and tested for Th1 cell stimulation using antigen-induced proliferation and interferon- [IFN-] secretion assays. The antigens included a peptide pool of 220 peptides covering the sequence of 12 open reading frames [ORFs] of RD1 [RD1mix], peptide pools of RD1 ORF5 [ORF5mix], ORF6 [ORF6mix] and ORF7 [ORF7mix], and individual peptides of ORF6 [P6.1-P6.6] and ORF7 [P7.1-P7.6]. M. tuberculosis culture filtrate, cell walls and whole-cell M. bovis BCG were used as complex mycobacterial antigens. The results obtained with different antigens and peptides were statistically analyzed for significant differences using Z test. The complex mycobacterial antigens [culture filtrate, cell walls and M.bovis BCG] and RD1mix induced comparable [p > 0.05] positive antigen-induced proliferation and IFN- responses with whole blood from TB patients. However, the positive IFN- responses induced by ORF6mix and ORF7mix were higher than ORF5mix. Among the individual peptides, P6.4 and P7.1 of ORF6 and ORF7, respectively, induced the highest IFN- responses, suggesting that these peptides represented the immunodominant Th1 cell epitopes of RD1 ORF6 and ORF7 in the patients tested. The whole blood assays with synthetic peptides are useful to identify Th1 cell antigens/peptides encoded by genes located in M. tuberculosis-specific genomic regions

Polymerase-chain-reaction-based detection of fetal rhesus d and Y-chromosome-specific DNA in the whole blood of pregnant women during different trimesters of pregnancy

The aim of this study was to determine whether or not a noninvasive procedure utilizing maternal peripheral blood as the source of DNA and polymerase chain reaction [PCR] could be used to detect fetal rhesus D [RhD] status as well as fetal gender during different gestational stages of pregnancy. Maternal blood samples were obtained from 54 RhD-negative pregnant women during the first trimester [6-13 weeks, n = 14], second trimester [14-26 weeks, n = 26] and third trimester [27-40 weeks, n = 14]. Genomic DNA was extracted from the whole blood and analyzed by seminested and nested PCR for detection of DNA sequences corresponding to RhD [n = 54] and Y chromosome [n = 48] using RhD and Y-chromosome-specific oligonucleotide primers, respectively. The seminested/nested PCR results were compared with the RhD status and gender of the babies after delivery. The sensitivity and specificity of seminested PCR for detection of fetal RhD positivity in whole blood of pregnant women were 81 and 100%, respectively, while the sensitivity and specificity of nested PCR for detection of male fetuses, using Y-chromosome-specific DNA as a marker, were 96 and 91%, respectively. There were no significant differences in the PCR results with samples obtained from women at different gestational stages of pregnancy. Seminested and nested PCRs for detection of fetal RhD and gender status, respectively, by using the blood of pregnant women during different gestational stages of pregnancy, are reliable noninvasive procedures with high sensitivity and specificity

Identification of transcriptionally active open reading frames within the RD1 genomic segment of Mycobacterium tuberculosis

To identify transcriptionally active open reading frames [ORFs], predicted by bioinformatics, within RD1 genomic segment of Mycobacterium tuberculosis using reverse transcription-polymerase chain reaction [RT-PCR]. M. tuberculosis H37Rv was grown in Middlebrook 7H9 medium for 8 weeks and total RNA was isolated using standard procedures. The cDNA was synthesized using first-strand cDNA synthesis kit and general primers provided in the kit [pd [N][6], and/or Not I-d[T][18]] as well as forward primers specific for each predicted RD1 ORF. Specific forward and reverse primers in PCR were used to amplify ORF-specific cDNA. The amplified products were identified on the basis of size using agarose gel electrophoresis, and their identity was confirmed by DNA sequencing. RT-PCR demonstrated expression of 13 of the 14 bioinformatics-predicted ORFs within RD1 genomic segment of M. tuberculosis. However, cDNA synthesis and PCR amplifications of specific products varied with respect to primer requirement and reaction conditions, respectively. All ORFs of <1.5 kb were amplified in standard RT-PCR, whereas several large-size ORFs [>1.5 kb] required internal primers for amplification in semi-nested RT-PCR. The sequencing of RT-PCR-amplified products of ORFs confirmed their identity. Bioinformatics analysis of DNA can accurately predict ORFs within M. tuberculosis-specific genomic regions, and RT-PCR is a suitable technique to confirm their expression in bacteria

Mycobacterial gene cloning and expression, comparative genomics, bioinformatics and proteomics in relation to the development of new vaccines and diagnostic reagents

Recent advances in molecular and genomic techniques have facilitated research on several aspects of mycobacteriology, such as diagnosis and the identification of new vaccines and therapeutic targets for various diseases, including tuberculosis. The aim of this review was to analyze the implications of advances in molecular and genomic techniques on the development of new vaccines for tuberculosis as well as immunological reagents to diagnose the disease. Gene cloning and expression, DNA and protein sequencing, polymerase chain reaction, comparative genomics, bioinformatics, proteomics and DNA and peptide synthesis coupled with the application of cellular immunology techniques have led to the identification of several antigens of Mycobacterium tuberculosis, which have potential for diagnosis and vaccine applications. For example, cross-reactive mycobacterial antigens like heat shock proteins, MTB32 and MTB39, have been identified as new vaccine candidates, and antigens encoded by M. tuberculosis-specific genomic regions as new reagents for diagnosis

HLA-DR binding prediction and experimental evaluation of T-cell epitopes of mycolyl transferase 85B [Ag85B], a major secreted antigen of mycobacterium tuberculosis

To identify T-cell epitopes of Ag85B by analysis of its sequence for prediction to bind HLA-DR alleles and evaluate the predicted peptides for recognition by T cells in antigen-induced proliferation assays. Materials/Subjects and The complete sequence of Ag85B was analyzed for HLA-DR binding prediction to 51 HLA-DR alleles by using a virtual matrix-based prediction program [ProPred]. Synthetic peptides covering the sequence of mature Ag85B were also analyzed for binding to HLA-DR alleles, and evaluated for recognition in antigen-induced proliferation assays with Ag85B-specific T-cell lines established from the peripheral blood mononuclear cells of 10 HLA-DR-heterogeneous tuberculosis patients. The ProPred analysis of the full-length Ag85B [325 aa], signal peptide [40 aa] and the mature protein [285 aa] predicted their binding to 100, 76 and 98% of the 51 HLA-DR alleles, respectively. The analysis of 31 synthetic peptides for binding to HLA-DR alleles showed that 4 of them could bind >50% HLA-DR alleles, and were considered promiscuous. Testing of Ag85B-specific T-cell lines with synthetic peptides showed that all of the T-cell lines responded to one or more peptides of Ag85B, and 9 of the 10 cell lines responded to one or more of the four peptides considered promiscuous for binding to HLA-DR alleles. The ProPred program was useful in predicting the HLA-DR alleles binding regions of Ag85B and identifying the promiscuous peptides recognized by T cells

Evaluation of C-reactiveprotein as early indicator of blook culture positivity in veonates

To determine the Sensitivity, Specificity and Predict values of C - reactive protein as an early indicator of Neonatal Sepsis. Design: It was an observational study of newborns suspected sepsis. Place and Duration of study: The study was carried out in the Department of Paediatrics, Karachi Medical Et Dental College and Abbasi Shaheed Hospital, Karachi over a period of eight months [March 1, 2001 to October 31, 2001]. Patient and Neonates admitted to intensive care nursery of the Abbasi Shaheed Hospital Karachi were evaluated for Neonatal Sepsis. C-reactive protein as screening test was performed along with blood culture from peripheral venepuncture. The gold standard for the Diagnosis of Sepsis was positive blood culture. Result: The positive C- reactive protein found in 14 of 21 episodes associated with the positive blood culture, but in 15 of 29 negative cases it was also found positive. The sensitivity and specificity are equal to negative predict value and positive predict value respectively i.e. 66.66% and 48.27%. CRP estimation have some value in early diagnosis of Neonatal sepsis but the frequent occurrence of raised CRP in sera of uninfected neonates eliminates it as a useful indicator of infection but may suggest an active tissue damaging process. We do not advocate to rely on the result of single test, even with the combination of test, we still stress the importance of correlating the clinical and laboratory data. We recommend that a scoring system should be designed for our setup, using those test that are easy to perform, economical, reliable, should have high predictive value and should ideally identify all infected infants [high sensitivity]

Seroprevalence of three emerging arboviral infections in Kuwaiti nationals

Diseases caused by dengue, s and fly fever and hanta viruses pose a major health risk in many countries. We determined the threat of these arboviral infections through a serologic using enzyme linked immunosorbent assay [ELISA] based tests. Hantavirus-specific antibodies were also detected using immunofluorescence. Of 499 samples tested for dengue virus IgG antibodies l4% were as positive for dengue positive by all the ELISA tests. Among the 42 showing strong IgG reactivity, only 1 was positive for dengue virus IgM antibodies. All samples tested for IgG antibodies to s and fly fever virus were negative. Hantavirus antibodies were detected in 11% of the 46 samples from high-risk individuals. The low prevalences suggest that at present these infections are not a serious problem in Kuwait

Obstetric performance of a patient with multiple uterine and cervical fibroids and expectant management of retained placenta

The aim of this case report is to describe the obstetric performance of a patient with multiple uterine and supravaginal cervical fibroids. A 36-year-old, gravida 3 para 0+2 with multiple uterine and cervical fibroids presented with inevitable abortion at 17 weeks gestation. She had a spontaneous rupture of membranes followed by expulsion of fetus as breech with entrapment of aftercoming head by a cervical fibroid. Oxytocin infusion and digital traction were able to deliver the fetus. The placenta, however, was trapped in the fundal area and could not be delivered under general anesthesia because of mechanical obstruction by the fibroid. Expectant management was successful in expulsion of the placenta within 7 days without complication

Detection of Mycobacterium tuberculosis complex and non-tuberculous mycobacteria by multiplex polymerase chain reactions

The ability of two-band and three-band multiplex polymerase chain reactions to detect and differentiate Mycobacterium tuberculosis complex from non-tuberculous mycobacteria was evaluated. The polymerase chain reactions differentiated between M. tuberculosis and non-tuberculous mycobacteria when standard strains and clinical isolates of mycobacteria were tested. The sensitivity of the two-band and three-band techniques to detect M. tuberculosis in clinical specimens, compared with smear and/or culture, was 88% and 75% respectively. Although both techniques showed 100% specificity, the superior sensitivity of the two-band technique suggests that it could be more useful in the diagnosis of tuberculosis and in differentiating M. tuberculosis complex from non-tuberculous mycobacteria