Résumé
Despite the availability of effective preventive measures and chemotherapy, the prevalence of tuberculosis [TB] is increasing in the developing world and in much of the industrialized world as well. Children are among the most vulnerable and the most difficult to diagnose with tuberculosis. Early and precise diagnosis of childhood tuberculosis is necessary in order to prevent mortality and morbidity and unjustified chemotherapy. One of the main objectives of the research in the field of mycobacteriology is the development of new methods that will improve and expedite the diagnosis and treatment of tuberculosis and other mycobacterial infections. HealthTech, in collaboration with DynaGen, Inc., in the United States, developed the MycoDotTM serological assay. Several techniques have been developed to improve the diagnosis of tuberculosis including newer radiometric methods; DNA probes mycolic acid chromatography polymerase chain reaction. We aimed in our work to diagnose active tuberculosis either pulmonary or extra pulmonary by different new diagnostic methods. In this study included 58 children ranged from 5 to 7 years old and suspected to have tuberculosis, based on the findings of history taking, clinical examination, PPD skin test, chest X-ray, and sputum examination by Zeil-Nielsen staining for acid fast bacilli. These patients were classified into four classes class 0: no known recent exposure, no infection [PPDnegative], no disease; class I: latent infection as defined by a positive PPD [>/= 10 mm in duration] and no clinical or radiographic evidence of active TB; class II: active TB confirmed by positive clinical pictures and radiographic evidence of active TB with positive sputum staining; Class III: PPD-positive [>/= 5 mm in duration] with evidence of past disease by history or compatible chest radiograph [e.g., upper lobe fibronodular disease] but negative sputum smear [treated patients]. All patients sera were subjected to TB identification by rapid test and MycoDot tests and PBMC separated from blood for PCR reaction. The positive results of the three tests for diagnosis of TB in the four groups of classes were detected as followings: By PCR the four classes were diagnosed as: Class 0 [5.3%], Class I [50%], Class II [70%] and Class III [14.3%]. By MycoDot diagnosis of the four groups was as: Class 0 [0%], Class I [4.5%], Class II [50%] and Class III [0%]. Diagnosis of the four groups by +ve rapid test was as: Class 0 [0%], Class I [0%], Class II [30%] and Class III [0%]. As a conclusion, PCR is a sensitive and rapid method for detection of latent and active TB within few hours, while in anti-LAM IgG was quite specific detection of active disease. The assay can be performed without sophisticated instrumentation with minimal training, which make the assay for random detection of active TB
Résumé
1: 23 patients of hepato-splenic bilharziasis with history of ruptured oesophago-gastric varices belonging to child's classification A. were subjected to portal decompression by shunt operations comprising 5 patients for interposition mesocaval shunt and 18 for distal Lieno-renal. 2. Pre-operative biochemical, hematologic, electrolytes, radiology, endoscopic E.C.G. and pathology studies as well as percutaneous trans-splenic portal manometry were carried out for them. 3. Post-operative biochemical and E.C.G. assessement were done for all patients. Follow up portal manometry for patients subjected to mesocaval operation and endoscopic assessement of the varices for patients subjected to Warren's operation were done to evaluate portal decompression. 4. An important comparative follow up E.C.G. finding was progressive significant shortening of Q-1c interval 3 and 6 months after Warren's, but not mesocaval operations, the causes of which were discussed. 5. Such finding can offer valuable achievement as regard assessment of emodynamic efficacy of the type of shunt concerning portal decompression portal perfusion, a non-invasive E.C.G. follow up tool to evaluate persistance of shunt patency and finally a possible indicator for shunt occlusion