Performance of tuberculin skin test and quantiferon-TB-gold in tube assay in diagnosing active and latent tuberculosis in high burden settings

Background: many clinicians wish to employ Mycobacterium tuberculosis [MTB]-specific interferon gamma [IFN-gamma] release assays [IGRAs] as a diagnostic test, for active tuberculosis [TB]. They are alternative or adjunct to the tuberculin skin test [TST] in screening for latent tuberculosis infection [LTBI], but there are scarce data directly comparing the tests performance in high burden settings for the diagnosis of active and/or latent TB in low- and middle- income countries [LMICs]

Objective: to compare the performance of Quanti-FERON-TB-Gold in tube assay [QFG-IT] with the TST for identifying active and LTBI in relatively high TB burden settings

Design: in a cross-sectional study, we compared the TST and QFG-IT assay in a cohort of 210 participants classified into three groups; Group I investigated for LTBI and included 74 health care workers [HCWs] with known close contact to active TB cases, Group II; 83 patients investigated for active TB disease, Group III; 53 apparently healthy, control subjects

Results: Of 210 participants in the 3 groups, 117 [55.7%] had a TST result of >/=10 mm; 42 [20%] of them had indurations >/=15 mm. QFG-IT was positive in 69 [32.9%] of the cohort, in 23 [31.1%] of 74 HCWs investigated for LTBI and in 40 [48.2 %] in patients clinically suspected to be tuberculous; 63 [75.9%] of them proved to have active TB. Among healthy control, 6 [11.3%] were positive, meanwhile 21 [10.0%] from the enrolled cohort had indeterminate QFG-IT results. In patients investigated for active TB, QFG-IT was positive in 16/19 cases [84.2%] of PTB, and in 22/39 cases [56.4%] of EPTB. Sensitivity, specificity, positive and negative predictive values of QFG-IT assay were 65.62%, 80%, 95%, and 28.6%, meanwhile they were 90.57%, 50%, 90.57% and 33.33% for TST, respectively. Positive QFG-IT tests were associated with older age, female gender, BCG vaccination and longer duration of work in health care setting. Overall agreement between the 2 tests was moderate [75.66%, kappa 0.526] and in healthy control was fair 78.13% [kappa 0.201]. Also, there were moderate agreements between the two tests among HCWs investigated for LTBI and patients investigated for active TB [76.17%, kappa 0.570], and [77.49%, kappa 0.511], respectively

Conclusion: we showed moderate agreement between TST and QFG-IT test in diagnosing LTBI and active TB infection in high burden setting. Despite higher specificity of QFG-IT test. TST remains a cost effective test in LMICs with limited budget for use of IGRA tests as screening tool in national control programs. However, QFG-IT in conjunction with TST improves the diagnostic yield, can help identifying at-risk groups and reduce the indication of preventive chemotherapy in high burden settings

Home-based pulmonary rehabilitation program: effect on exercise tolerance and quality of life in chronic obstructive pulmonary disease patients

A key component in the management of chronic obstructive pulmonary disease [COPD] patients is pulmonary rehabilitation [PR], the corner stone of which is exercise training. This study aims to evaluate the effect of a two-months, home-based PR program with outpatient supervision every two weeks, on exercise tolerance and health-related quality of life [HRQL] using Arabic-translated standardized generic and specific questionnaires in COPD patients recently recovered from acute exacerbation. Randomized clinical trial. A total of 39 COPD patients who recovered from acute exacerbation were randomly allocated either a two-month home-based PR program in addition to standard medical therapy or standard medical therapy alone in the period between July 2008 and March 2009. Pulmonary function tests [PFTs], six-minute walk distance [6-MWD] test, Arabic-translated chronic respiratory disease questionnaire-self administered standardized format [CRQ-SAS] and quality of life scale Short Form [SF-36] were compared between 25 patients with moderate to severe COPD who underwent a two-month PR program [group 1] and 14 COPD patients who did not [group 2]. Group 1 showed significant improvement in the 6-MWD, and HRQL scores at two months compared with the usual care patients in group 2 [P less than 0.05]. Improvement in both CRQ-SAS and SF036 scores were statistically significant and comparable in group 1. The supervisited, post discharge, two-month home-based PR program is an effective non pharmacological intervention in the management of stable patients with COPD. The 6-MWD is a simple, inexpensive and safe test to assess physical and functional capabilities among COPD patients. HRQL can be measured in patients with COPD either by disease-specific tools that have been specifically designed for use in patients with respiratory system disorders or by generic HRQL tools that can be used across populations with a variety of medical conditions. The Arabic-translated CRQ-SAS is a new tool for assessment of Arabic-speaking patients with chronic respiratory diseases

Radiographic absorptimetry of trabecular bone pattern: a forensic marker for identification

Forensic pathologists and anthropologists use radiographic comparison for identification purpose for its uniqueness and stability overtime. The reliability of identification process is increased with the increasing number of methods used, so the need for methological variation is a must. The aim of the present study was to verify the reliability of trabecular bone pattern as a marker for identification and to investigate the influence of degenerative bone changes [osteoporosis] on trabecular archietecture overtime period. The sample studied in this research entailed forty-eight post menopausal wonen, Dual energy X-ray absorptiometry [DEXA] and Plan X-ray to wrist, lumber spine femoral regions were done at the beginning of research and after one year. Bone mineral density [BMD], Z score, T score and degree of osteoporosis were determined, twicely. The uniqueness and stability of trabecular pattern over one year period was examined using densitographs of wrist region [radius]. A computerized technique [contour program] was used to compare densitographs of same individuals [one year apart] and of different individuals, correlation coefficients were calculated for all possible combinations of pairs of densitographs. The results showed that the degree of osteoporosis was increased with age. A significant relation between the degree of osteoporosis and T score as well as Z score was encountered in our sample. A cut-off level r= 0.70 [of correlation coefficients] was estimated for positive identification of trabecular pattern densitographs of the same individual. In conclusion; densitographs of trabecular bone can be used as a quantifiable method for identification of humans in all age groups. Also, it is not influenced by bone degenerative diseases

Polymerase chain reaction-based DNA analysis for gender identification of antemortem and postmortem human skin

Gender identification is an important investigative tool as it can be used to assess rapid information in forensic cases involving missing persons, intersex problems, mass disaster and in crime scenes. The aim of the present work was to assess the reliability of the skin as a tissue sample whether fresh or putrified for gender determination and to validate an application of gene print sex determination system. Forty skin samples were used [15 obtained from cadavers, and 25 from discarded surgically resected skin]. DNA extraction was done using two methods [crude and column] with two different kits, [Puregene cell, tissue kit and GFX purification kit]. Amplification of the single copy X-Y homologous amelogenin gene using PCR technology was followed. The results showed that DNA extracted by the column method was of high quality with no gross contaminants as compared to the crude method. The success rate of the amelogenin amplification was 100% in all skin samples [antemortem and postmortem]. It enabled gender identification from as low as 100 mg skin sample with low cost and less complicated technique. In conclusion the amelogenin gene sex determination system is a highly discriminating and reliable method and skin can be used as a good source for DNA extraction used for identification purposes

Radiographic absorptiometry of trabecular bone pattern: a forensic marker for identification

Forensic pathologists and anthropologists use radiographic comparison for identification purpose for its uniqueness and stability overtime. The reliability of identification process is increased with the increasing number of methods used, so the need for methodological variation is a must. The aim of the present study was to verify the reliability of trabecular bone pattern as a marker for identification and to investigate the influence of degenerative bone changes [osteoporosis] on trabecular architecture overtime period. The sample studied in this research entailed forty-eight post menopausal women, Dual energy X-ray absorptiometry [DEXA] and Plain X-ray to wrist, lumber spine and femoral regions were done at the beginning of research and after one year. Bone mineral density [BMD], Z score, T score and degree of osteoporosis were determined, twicely. The uniqueness and stability of trabecular pattern over one year period was examined using densitographs of wrist region [radius]. A computerized technique [contour program] was used to compare densitographs of same individuals [one year apart] and of different individuals, correlation coefficients were calculated for all possible combinations of pairs of densitographs. The results sowed that the degree of osteoporosis was increased with age. A significant relation between the degree of osteoporosis and T score as well as Z score was encountered in our sample. A cut-off level r=0.70 [of correlation coefficients] was estimated for positive identification of trabecular pattern densitographs of the same individual. In conclusion; densitographs of trabecular bone can be used as a quantifiable method for identification of humans in all age groups. Also, it is not influenced by bone degenerative diseases

Memantine hydrochloride versus pralidoxime in the treatment of chlorpyrifos - induced pulmonary toxicity in albino rats

Chlorpyrifos [CP] is a broad-spectrum organophosphorus insecticide that is widely employed for control of many agricultural and household pests. It is extremely toxic to humans and animals. The antidotal therapy of acute organophosphorus poisoning hasn't been satisfactorily solved till now in spite of the knowledge of the basic mechanism of action of these toxic substances. The aim of this work was to investigate the effect of acute CP intoxication on the alveolar structure of albino rats and to compare the therapeutic efficacy of memantine hydrochloride [MEM]k, and amantadine derivative, and the currently used oxime [pralidoxime chloride [2-PAM] Six groups of rats were used in this study, each of ten animals. The control groups [group I, II, III], The intoxicated group [group IV that received CP in a dose of 40 mg/kg body weight orally for two consecutive days and the treated groups which, included group V [rats treated with PAM and atropine sulfate [ATS] for 2 days]. Blood samples were collected from all animals one hour after drug administration for estimation of plasma acetylcholinesterase [AchE] enzyme level. The animals were sacrificed 24 hours after the last injection and the lungs of each animal were examined histologically by the light and the transmission electron microscopes. The present study demonstrated significant reduction in the level of plasma AchE in CP group. On he other hand, the enzyme levels increased in both groups of CP and MEM and CP and 2-PAM [but still less than normal control levels]. The enzyme reactivation was much more evident with MEM treatment. Histologically, CP treatment resulted in severe pulmonary congestion with extravasation of blood cells, thickening of pulmonary interstitial and evident ultratructural aerations of the alveolar structures. Treatment with MEM after CP resulted in greater alternations of CP-induced alveolar lesions than 2-PAM treatment. In conclusion, he results of this study suggested that CP is a potent pulmonary toxicant, and MEM is more effective reactivator of CP-inhibited AchE than 2-PAM. It also offered greater alveolar protection than 2 PAM

Age identification in Egyptian children by mandibular dimensions. A comparative radiological study with bones of the hand and wrist

One of the major problems in forensic science is personal identification of living persons, dead corpses or skeletal remains. A number of techniques exist for age estimation, depending upon the material available for analysis and the maturation stage that the individual had reached at the time of his / her demise. The current methods of children and young adults aging, are based on dental eruption, long bones length and bones of the wrist have their limitations. The mandible may provide an accessible and accurate tool for estimation of age, due to its dense nature and unique shape. The objectives: The objectives of this study are; to assess the reliability of the mandible as a tool for age estimation, to develop an equation specific for Egyptian children obtained from their mandibular dimensions, and to compare the age estimated from their mandibles with age estimated from their bones of the hand and wrist region. Subject and methods: This study was carried out on standardized X-ray of the mandible and bones of the hand and wrist for 50 Egyptian children [consent has been taken from their guardians]. Seven measurements were applied to each mandible [Length of the Mandibular Body [LB], Full Length of Half the Mandible [LHM], Height of the Mandibular Body [HM], Minimum Ramus Breadth [MiRB], Maximum Ramus Breadth [MxRB], Maximum Ramus Height [MxRH], Gonial Angle [GA]]. The estimated age from mandibles was compared with that estimated from primary ossification centers of the bones of the hand and wrist. All mandibular measurements showed significant statistical values except for the gonial angle [GA]. Regression analysis on the measurements was done and two equations for age determination were obtained: The first depends on the mandibular body variants mainly [in case of partial erosion of ramus] as follows: Y = -12.72 + [2.19 x LB] + [0.23 x LHM] + [0.85 x HM] Y = age in years, LB [length of the body of the mandible], LHM [full length of half the mandible] and HM [height of the mandibular body]. The mean error was 0.065 year. The second equation was applied if the mandible as a whole was intact: Y = -12.73 + [2.21 x LB] + [0.86 x HM] + [1.097 x MiRB] Y = age in years, LB [length of the body of the mandible], HM [height of the mandibular body], Mi RB [Minimum ramus breadth]. The mean error was 0.02 year. Age was estimated from X-ray of the wrist and hand then, compared to age estimated from mandibular equations, where the last method was more accurate. The mandibular equations can be used for accurate age estimation in Egyptian children