First detection of Omicron variant BA.4.1 lineage in dogs, Chile.

SARS-CoV-2's rapid global spread caused the declaration of COVID-19 as a pandemic in March 2020. Alongside humans, domestic dogs and cats are also susceptible to infection. However, limited reports on pet infections in Chile prompted a comprehensive study to address this knowledge gap. Between March 2021 and March 2023, the study assessed 65 pets (26 dogs and 39 cats) from 33 COVID-19+ households alongside 700 nasal swabs from animals in households with unknown COVID-19 status. Using RT-PCR, nasal, fecal, and environmental samples were analyzed for the virus. In COVID-19+ households, 6.06% tested positive for SARS-CoV-2, belonging to 3 dogs, indicating human-to-pet transmission. Pets from households with unknown COVID-19 status tested negative for the virus. We obtained 2 SARS-CoV-2 genomes from animals, that belonged to Omicron BA.4.1 variant, marking the first report of pets infected with this lineage globally. Phylogenetic analysis showed these sequences clustered with human sequences collected in Chile during the same period when the BA.4.1 variant was prevalent in the country. The prevalence of SARS-CoV-2 in Chilean pets was relatively low, likely due to the country's high human vaccination rate. Our study highlights the importance of upholding and strengthening human vaccination strategies to mitigate the risk of interspecies transmission. It underscores the critical role of the One Health approach in addressing emerging zoonotic diseases, calling for further research on infection dynamics and risk factors for a comprehensive understanding.

Waning and boosting of antibody Fc-effector functions upon SARS-CoV-2 vaccination.

Since the emergence of SARS-CoV-2, vaccines targeting COVID-19 have been developed with unprecedented speed and efficiency. CoronaVac, utilising an inactivated form of the COVID-19 virus and the mRNA26 based Pfizer/BNT162b2 vaccines are widely distributed. Beyond the ability of vaccines to induce production of neutralizing antibodies, they might lead to the generation of antibodies attenuating the disease by recruiting cytotoxic and opsonophagocytic functions. However, the Fc-effector functions of vaccine induced antibodies are much less studied than virus neutralization. Here, using systems serology, we follow the longitudinal Fc-effector profiles induced by CoronaVac and BNT162b2 up until five months following the two-dose vaccine regimen. Compared to BNT162b2, CoronaVac responses wane more slowly, albeit the levels remain lower than that of BNT162b2 recipients throughout the entire observation period. However, mRNA vaccine boosting of CoronaVac responses, including response to the Omicron variant, induce significantly higher peak of antibody functional responses with increased humoral breadth. In summary, we show that vaccine platform-induced humoral responses are not limited to virus neutralization but rather utilise antibody dependent effector functions. We demonstrate that this functionality wanes with different kinetics and can be rescued and expanded via boosting with subsequent homologous and heterologous vaccination.

Waning and boosting of functional humoral immunity to SARS-CoV-2.

Since the emergence of the SARS-CoV-2 virus, we have witnessed a revolution in vaccine development with the rapid emergence and deployment of both traditional and novel vaccine platforms. The inactivated CoronaVac vaccine and the mRNA-based Pfizer/BNT162b2 vaccine are among the most widely distributed vaccines, both demonstrating high, albeit variable, vaccine effectiveness against severe COVID-19 over time. Beyond the ability of the vaccines to generate neutralizing antibodies, antibodies can attenuate disease via their ability to recruit the cytotoxic and opsinophagocytic functions of the immune response. However, whether Fc-effector functions are induced differentially, wane with different kinetics, and are boostable, remains unknown. Here, using systems serology, we profiled the Fc-effector profiles induced by the CoronaVac and BNT162b2 vaccines, over time. Despite the significantly higher antibody functional responses induced by the BNT162b2 vaccine, CoronaVac responses waned more slowly, albeit still found at levels below those present in the systemic circulation of BNT162b2 immunized individuals. However, mRNA boosting of the CoronaVac vaccine responses resulted in the induction of significantly higher peak antibody functional responses with increased humoral breadth, including to Omicron. Collectively, the data presented here point to striking differences in vaccine platform-induced functional humoral immune responses, that wane with different kinetics, and can be functionally rescued and expanded with boosting.

Survivin drives tumor-associated macrophage reprogramming: a novel mechanism with potential impact for obesity.

PURPOSE: Recent studies point to adipose-derived stem cells (ASCs) as a link between obesity and cancer. We aimed to determine whether survivin, which is highly secreted by ASCs from subjects with obesity, might drive a pro-tumoral phenotype in macrophages. METHODS: The effect of ASC conditioned medium on the macrophage phenotype was assessed by expression studies. Survivin intracellular localization and internalization were examined by subcellular fractionation and immunofluorescence, respectively. Loss- and gain-of-function studies were performed using adenoviral vectors, and gene expression patterns, migration and invasion capacities of cancer cells were examined. Heterotypic cultures of ASCs, macrophages and cancer cells were established to mimic the tumor microenvironment. Survivin-blocking experiments were used to determine the impact of survivin on both macrophages and cancer cells. Immunohistochemical analysis of survivin was performed in macrophages from ascitic fluids of cancer patients and healthy controls. RESULTS: We found that obese-derived ASCs induced a phenotypic switch in macrophages characterized by the expression of both pro- and anti-inflammatory markers. Macrophages were found to internalize extracellular survivin, generating hybrid macrophages with a tumor-associated phenotype that included secretion of survivin. Exogenous expression of survivin in macrophages generated a similar phenotype and enhanced the malignant characteristics of cancer cells by a mechanism dependent on survivin phosphorylation at threonine 34. Survivin secreted by both ASCs from subjects with obesity and tumor-associated macrophages synergistically boosted the malignancy of cancer cells. Importantly, survivin was mainly detected in ascites-associated macrophages from patients with a malignant diagnosis. CONCLUSION: Our data indicate that survivin may serve as a molecular link between obesity and cancer and as a novel marker for tumor-associated macrophages.

Heat-evolved microalgal symbionts increase coral bleaching tolerance.

Coral reefs worldwide are suffering mass mortalities from marine heat waves. With the aim of enhancing coral bleaching tolerance, we evolved 10 clonal strains of a common coral microalgal endosymbiont at elevated temperatures (31°C) for 4 years in the laboratory. All 10 heat-evolved strains had expanded their thermal tolerance in vitro following laboratory evolution. After reintroduction into coral host larvae, 3 of the 10 heat-evolved endosymbionts also increased the holobionts' bleaching tolerance. Although lower levels of secreted reactive oxygen species (ROS) accompanied thermal tolerance of the heat-evolved algae, reduced ROS secretion alone did not predict thermal tolerance in symbiosis. The more tolerant symbiosis exhibited additional higher constitutive expression of algal carbon fixation genes and coral heat tolerance genes. These findings demonstrate that coral stock with enhanced climate resilience can be developed through ex hospite laboratory evolution of their microalgal endosymbionts.

Identification of chronic obstructive pulmonary disease subgroups in 13 Asian cities.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a heterogeneous condition that can differ in its clinical manifestation, structural changes and response to treatment. OBJECTIVE: To identify subgroups of COPD with distinct phenotypes, evaluate the distribution of phenotypes in four related regions and calculate the 1-year change in lung function and quality of life according to subgroup. METHODS: Using clinical characteristics, we performed factor analysis and hierarchical cluster analysis in a cohort of 1676 COPD patients from 13 Asian cities. We compared the 1-year change in forced expiratory volume in one second (FEV1), modified Medical Research Council dyspnoea scale score, St George's Respiratory Questionnaire (SGRQ) score and exacerbations according to subgroup derived from cluster analysis. RESULTS: Factor analysis revealed that body mass index, Charlson comorbidity index, SGRQ total score and FEV1 were principal factors. Using these four factors, cluster analysis identified three distinct subgroups with differing disease severity and symptoms. Among the three subgroups, patients in subgroup 2 (severe disease and more symptoms) had the most frequent exacerbations, most rapid FEV1 decline and greatest decline in SGRQ total score. CONCLUSION: Three subgroups with differing severities and symptoms were identified in Asian COPD subjects.

Utilidad de las técnicas de espirometría y oximetría en la predicción de alteración pulmonar en trabajadores de la minería del carbón en Paipa-Boyacá / Utility of spirometry and oximetry in the prediction of pulmonary alteration among coal miners from Paipa, Colombia

Antecedentes. En 2003 se reportó incidencia de 762 casos de neumoconiosis y 3686 casos de enfermedad respiratoria crónica en Colombia.Objetivo. Evaluar la utilidad de las técnicas de espirometría y oximetría para determinar la prevalencia de disfuncionalidad respiratoria en trabajadores de minas de carbón de Paipa–Boyacá y establecer posibles factores asociados, como edad y tiempo de exposición, para proponer medidas preventivas de salud ocupacional.Material y métodos. Estudio de corte transversal, observacional, analítico. Mediante instrumento previamente diseñado se encuestó a 410, trabajadores de las minas de carbón. Se evaluaron aspectos generales del trabajo, antecedentes de salud y parámetros de función respiratoria por espirometría y oximetría.Resultados. Grupo de sujetos jóvenes: promedio de edad 35,07 años (SD=11,75). Promedio de exposición 12,8 años (SD=11,8). Alta prevalencia de síntomas respiratorios: tos (42,7 por ciento); expectoración (31,46 por ciento); disnea (48,8 por ciento); dolor torácico (19,75 por ciento). En 26,1 por ciento alteración funcional respiratoria y en 3,99 por ciento, hipoxemia. Tiempo de exposición superior a cinco años se asoció con alteración respiratoria (RP=1,75) y con hipoxemia (RP= 9,30). Igualmente edad superior a 40 años se asoció con alteración espirométrica (RP=1,91) e hipoxemia (RP=3,07). Conclusiones. Actividad de alto riesgo. Altas prevalencias de sintomatología sugestiva de neumoconiosis y enfermedad pulmonar crónica en progreso. Se encuentran elevadas prevalencia de anormalidad del patrón respiratorio y de hipoxemia, lo cual sugiere que estas estimaciones podrían ser predictores del desarrollo de enfermedad pulmonar crónica de origen laboral.

[Effect of intragastric balloon as an alternative method for weight loosing in obese patients]. / Efecto del balón intragástrico como método alternativo en la pérdida de peso en pacientes obesos.

UNLABELLED: Obesity has increased worldwide affecting people of all ages and accounting for a severe public health problem. There exist several treatment options for obesity: dietary, pharmacological, physical exercising, psychotherapy, and surgical. Placement of the so-called intragastric ballonn, a silicone device similar to a 600-mL sphere, has been proposed, indicated for patients with a body mass index higher than 30 kg/m(2). OBJECTIVE: To assess the effect of the intragastric balloon as an alternative method for weight loosing in obese patients. METHODOLOGY: Longitudinal, experimental, descriptive, and exploring study. The sample includes 40 obese patients. Anthropometrical measurements including weight, height, abdominal circumference, tricipital and subscapular folds were done; the body mass index (BMI), muscle surface area and fat a surface area were calculated at baseline, first, third and sixth months after balloon placement. RESULTS: The sample comprised 31 women (77.5%) y 9 men (22.5%). The mean age for women was 35.87 years, and for men 44.67 years. At the end of the study, there was a total mean weight reduction of 18.25 kg, BMI 5.95 kg/m(2), abdominal circumference 13.53 cm, and arm circumference 4.14 cm, in both genders; the decrease in anthropometrical measurements was higher in men than women. CONCLUSIONS: The intragastric balloon showed to be an effective method for weight loosing in obese patients, with better outcomes in men than women.

Efecto del balón intragástrico como método alternativo en la pérdida de peso en pacientes obesos / Effect of intragastric balloon as an alternative method for weight loosing in obese patients

La obesidad se ha incrementado a nivel mundial, afectando a personas de todas las edades, constituyendo un grave problema de salud pública. Existen diversos tipos de tratamiento para la obesidad: dietético, farmacológico, entrenamiento físico, psicoterapia y quirúrgico. Se ha propuesto la colocación de un dispositivo de silicona similar a una esfera con una cantidad de 600ml denominado balón intragástrico indicado en pacientes con un índice de masa corporal superior a 30 kg/m2. Objetivo: Evaluar el efecto del Balón Intragástrico como método alternativo en la pérdida de peso en pacientes obesos. Metodología: Estudio de tipo exploratorio, descriptivo, longitudinal y experimental. La muestra está constituida por 40 personas obesas. Se realizaron mediciones antropométricas de peso, talla, circunferencia abdominal y braquial, pliegues tricipital y subescapular; se calculó índice de masa corporal (IMC), área muscular y área grasa; al inicio, primero, tercer y sexto mes de la colocación del balón. Resultados: Muestra conformada por 31 mujeres (77,5%) y 9 hombres (22,5%). El promedio de edad del sexo femenino fue 35,87 años, y del masculino 44,67 años. Al momento de finalizar el estudio se registró una pérdida total de peso promedio de 18,25 kg, IMC 5,95 kg/m2, circunferencia de cintura 13,53 cm y circunferencia braquial 4,14 cm en ambos sexos; la disminución de las medidas antropométricas fue mayor en los hombres que en las mujeres. Conclusiones: El balón intragástrico resultó ser un método efectivo en la pérdida de peso en pacientes obesos; con mejor resultado en los hombres que en las mujeres (AU)

Obesity has increased worldwide affecting people of all ages and accounting for a severe public health problem. There exist several treatment options for obesity: dietary, pharmacological, physical exercising, psychotherapy, and surgical. Placement of the so-called intragastric ballonn, a silicone device similar to a 600-mL sphere, has been proposed, indicated for patients with a body mass index higher than 30 kg/m2. Objective: To assess the effect of the intragastric balloon as an alternative method for weight loosing in obese patients. Methodology: Longitudinal, experimental, descriptive, and exploring study. The sample includes 40 obese patients. Anthropometrical measurements including weight, height, abdominal circumference, tricipital and subscapular folds were done; the body mass index (BMI), muscle surface area and fat a surface area were calculated at baseline, first, third and sixth months after balloon placement. Results: The sample comprised 31 women (77.5%) y 9 men (22.5%). The mean age for women was 35.87 years, and for men 44.67 years. At the end of the study, there was a total mean weight reduction of 18.25 kg, BMI 5.95 kg/m2, abdominal circumference 13.53 cm, and arm circumference 4.14 cm, in both genders; the decrease in anthropometrical measurements was higher in men than women. Conclusions: The intragastric balloon showed to be an effective method for weight loosing in obese patients, with better outcomes in men than women (AU)

Clinically inapparent adrenal mass in a patient with familial adenomatous polyposis.

Familial adenomatous polyposis (FAP) is an autosomal dominant condition characterized by multiple colorectal adenomas that can progress to carcinoma. FAP can be associated with diverse extracolonic manifestation, including desmoid tumors and adrenal masses. We report our experience with a patient diagnosed of FAP, who developed a desmoid tumor and an adrenal mass in the follow-up. To our knowledge, this is the first case in the literature in which a hypersecretion of aldosterone and cortisol in the adrenal mass of a patient diagnosed of FAP has been demonstrated.

Tiroiditis aguda causada por Escherichia coli / Acute thyroiditis caused by Escherichia coli

La tiroiditis aguda es una entidad poco frecuente debido a la relativa resistencia del tiroides a las infecciones. Se debe, principalmente, a infecciones bacterianas, y los gérmenes más frecuentes son los aerobios grampositivos como Staphylococcus aureus, Streptococcus pyogenes, Streptococcus epidermidis y Streptococcus pneumoniae. Uno de los mecanismos por los que se puede producir la infección de la glándula tiroidea es la diseminación hematógena, que es una causa poco habitual en pacientes inmunocompetentes. Presentamos el caso de una paciente con una tiroiditis aguda causada por Escherichia coli, sin enfermedad tiroidea anterior ni compromiso del sistema inmune, con el antecedente de una infección del tracto urinario complicada previa

Acute suppurative thyroidits is a rare entity because of the relative resistance of the thyroid gland to infections. It is mostly caused by bacteria, being the most frequent pathogens Gram positive germs, like Staphylococcus aureus, Streptococcus pyogenes, Streptococcus epidermidis and Streptococcus pneumoniae. One of the mechanisms that can produce a thyroid gland infection is the hematogenous dissemination, an uncommon way in immunocompetent patients. We present a patient with an acute thyroiditis caused by Escherichia coli, without previous thyroid disease or compromise in her immune system and with the antecedent of a complicated urinary tract infection

Outcome of bilateral hip hemiarthroplasty for displaced fracture of the hip.

Our aim was to evaluate the outcome in patients with bilateral non-simultaneous hip fracture treated with hemiarthroplasty at our institution between 1997 and 2003. We looked for any important modification factor that could change the devastating functional and social results. Twenty-two patients with a mean age of 79 at the initial fracture and 82 at the subsequent fracture were evaluated; all were Garden grade III-IV. The second fracture happened a mean of 28 months after the first one. The outcome measurement was the incidence of hip pain, recovery of pre-injury level of ambulation and activities of daily living at a minimum follow-up of one year. Following the first hemiarthroplasty patients deteriorated in their walking capacity and other activities of daily life, and this happened to an even greater extent after the second operation. With respect to walking ability (measured in metres) we concluded that it improved if a modular hemiarthroplasty was used after both fractures (p<0.05) and that worse functional outcomes were observed when different kinds of hemiarthroplasties were used in the same patient.;

Neumomediastino espontáneo como complicación de la cetoacidosis diabética / Spontaneous pneumomediastinum as a complication of diabetic ketoacidosis

El neumomediastino espontáneo es una rara condición definida por la presencia de gas en el interior del mediastino, sin la presencia de un traumatismo torácico o intervencionismo médico previo. Se presenta en este artículo un caso de neumomediastino espontáneo en una paciente de 21 años con diagnóstico previo de diabetes mellitus tipo 1 desde los 13 años, que ingresa por cetoacidosis diabética. La paciente había suspendido su tratamiento con insulina en las últimas 48 h. En el momento del ingreso se detecta un neumomediastino espontáneo que se resuelve de manera paralela a la resolución del trastorno metabólico. Se describe el caso clínico, los mecanismos fisiopatológicos y el pronóstico de esta complicación infrecuente de la cetoacidosis diabética (AU)

Spontaneous pneumomediastinum is a rare condition defined as the presence of gas in the mediastinum not occurring after chest trauma or medical procedures. We present a case of spontaneous pneumomediastinum in a 21-year-old woman who had had type 1 diabetes mellitus since the age of 13 years and who was admitted to hospital with diabetic ketoacidosis. She had interrupted her dosage of insulin in the previous 48 hours. On admission, she was found to have a spontaneous pneumomediastinum, which resolved following correction of the metabolic disturbance. We describe the case and review the pathophysiological mechanisms and prognosis of this infrequent complication of diabetic ketoacidosis (AU)

Enteral feeding in stable chronic obstructive pulmonary disease patients.

OBJECTIVE: The study aimed to compare the effectiveness of a defined formula diet with a blenderized diet on nutritional and respiratory function parameters and to determine the bacteriological load of the two formulations. METHODOLOGY: Seventeen patients, aged 50-75 years, admitted to the University of the Philippines-Philippine General Hospital for chronic bronchitis and/or emphysema, were studied. They were divided into two groups according to dietary regimens. Each group of patients received either the standardized commercial formula or the blenderized formula for 2 weeks. Evaluation of dietary intake, anthropometric measurements, laboratory examinations and lung function were assessed. Subjective evaluation (patient's and physician's assessment) was also sought. Microbiological examinations were performed on the prepared enteral formulas. RESULTS: There was a slight increase in weight and in pulmonary function in both groups but these results did not differ significantly. Possible formula contamination was confirmed. Furthermore, in the overall assessment, the physician and patients rated both formulas as comparable.

Nitric oxide and salt sensitivity.

Studies in laboratory animals suggest that altered nitric oxide (NO) production may be associated with salt sensitivity. In this investigation we determined whether the endogenous NO production was altered in salt-sensitive human subjects when salt intake was changed. Salt sensitivity was assessed from the magnitude of the blood pressure (BP) lowering obtained when the salt intake was reduced from high to a low intake. The combined urinary excretion of nitrites and nitrates, the major metabolites of NO, was employed as an index of endogenous NO production. Salt-sensitive subjects (n = 23) were older, heavier, and had greater waist-to-hip ratios and higher baseline BP than salt-resistant individuals (n = 25). In salt-sensitive subjects, mean blood pressure (MBP) decreased 11.8+/-0.7 mm Hg, and NO metabolite excretion increased from 823+/-102 to 1530+/-148 mmol/24 h, when salt intake was reduced from 316 to 28 micromol/day. NO metabolite excretion was 45% lower during high salt (0.66+/-0.1 micromol/mg creatinine) than during low salt intake (1.12+/-0.1 micromol/mg creatinine) (P < .001). In contrast, when salt intake was reduced, salt-resistant subjects exhibited no significant mean changes in BP or NO metabolite excretion. During low salt intake, NO metabolite excretion (micromol/ day) was significantly higher in salt-sensitive individuals. The magnitude of decrease of systolic blood pressure, diastolic blood pressure, or MBP induced by reducing salt intake was not related to the increase in urinary excretion of NO metabolite levels (r2 = 0.009; P = .66). In summary, to the extent that urinary NO metabolite levels reflect the activity of the endogenous NO system, our results support the view that salt sensitivity may in part be determined by an inability to increase or to sustain NO production in response to high salt. Insufficient NO production during high salt may in turn lead to altered pressure-natriuresis relationships and to an increase in BP. The possibility that the increase in BP induced by high salt intake in salt-sensitive individuals could be the key factor in reducing NO metabolite levels can not be ruled out.

Insulin and blood pressure responses to changes in salt intake.

In this study we evaluated the role of insulin in hypertension and on salt sensitivity. The study was conducted in 47 consecutive patients attending the Center for the Detection and Treatment of Cardiovascular and Metabolic Risk factors. The relationships between fasting and post-glucose load insulin levels and the blood pressure (BP) responses to changes in salt intake, were investigated. No correlation was observed between fasting or 2-h post-load insulin levels and mean BP (MBP), systolic BP (SBP) or diastolic BP (DBP). The plasma concentrations of insulin were not significantly related to body mass index (BMI) (r2 = 0.05; P = 0.135). Neither fasting nor 2-h post-load insulin predicted the BP response to changes in salt intake. A reduction in salt intake from 316 +/- 13 to 26 PM 3 mmoles/day, produced similar BP lowering in subjects with fasting insulin >15 microU/ml and in subjects with normal fasting insulin levels (<15 microU/ml). In addition, no relationship was observed between the magnitude of the BP responses to salt and the levels of insulin, either fasting (r2 = 0.007; P = 0.86) or 2-h after a glucose load (r2 = 0.01; P = 0.213). A very strong association was found between body weight or BMI and MBP (r2 = 0.443; P< 0.0001). In conclusion, our results are against the view of a cause-effect relationship between insulin and BP levels. In addition, the insulin status of a patient does not predict (nor determines) his (her) vascular reactivity to changes in salt intake. Finally, our findings further support the existence of a strong and direct association between body weight and hypertension, and speak against a major role of insulin in the pathogenesis of hypertension associated with obesity.

[Double tachyarrhythmia: left anterior fascicular ventricular tachycardia associated with atrial flutter and fibrillation. Report of a case]. / Doble taquiarritmia: taquicardia ventricular fascicular anterior izquierda asociada a fibrilación y flutter auriculares. Reporte de un caso.

A patient with episodes of palpitation in whom the electrocardiogram showed a right bundle branch (RBBB) configuration and right axis deviation underwent electrophysiologic study and radiofrequency ablation. Left ventricular endocardial mapping during ventricular tachycardia (VT) identified the earliest ventricular activation in the anterolateral wall of the left ventricle. The fused Purkinje potential was recorded at that site, and preceded the QRS complex by 47 mseg, with pace mapping showing an optimal match between the paced rhythm and the clinical VT. The stimulus to QRS time was equal to the Purkinje potential-QRS time. Several radiofrequency lesions were applied in this region, one of them resulted with termination of the tachycardia. Following delivery of this lesion the ventricular tachycardia couldn't be induced either at baseline or during isoproterenol infusion. During VT, atrial fibrillation and atrial flutter were observed, cardioversion was performed reverting to sinus rhythm.

Nature of drug resistance and predictors of multidrug-resistant tuberculosis among patients seen at the Philippine General Hospital, Manila, Philippines.

SETTING: This study was conducted at the University of the Philippines--Philippine General Hospital (UP-PGH), Manila, Philippines. OBJECTIVES: To determine the nature of drug resistance among patients with pulmonary tuberculosis (PTB), and to establish clinical predictors of drug-resistant tuberculosis. DESIGN: Descriptive, prospective study. METHODS: Patients with positive culture for Mycobacterium tuberculosis were interviewed regarding past history of anti-tuberculosis treatment, BCG vaccination, chest X-ray and family contact. M. tuberculosis isolates from 299 patients were tested for susceptibility to rifampicin, isoniazid (INH), ethambutol and streptomycin using the submerged disc proportion method. Pyrazinamide (PZA) susceptibility test was done with standard laboratory powder in 7H10 media. RESULTS: Of the 299 M. tuberculosis isolates, 17% were fully susceptible to the 5 primary drugs and 54% were resistant to 2 or more drugs (multidrug resistant TB [MDR-TB]). Initial drug resistance rate was high with ethambutol (39%) and INH (17%). Previous history of anti-tuberculosis treatment was significantly associated with MDR-TB (Odds Ratio [OR] 2.44, 95% confidence interval). Incomplete anti-TB treatment taken for longer than 3 months increased the likelihood of MDR-TB (OR 4.6, P < 0.0001). CONCLUSION: The high rate of MDR-TB was associated with previous anti-tuberculosis treatment. The chance of developing MDR-TB was significantly increased when inadequate prior treatment was given for more than 3 months.

Clinical effectiveness of a combination of bromhexine and amoxicillin in lower respiratory tract infection. A randomized controlled trial.

A multicenter double-blind randomized trial was performed in 22 teaching hospitals to compare the clinical effectiveness of the combination of amoxicillin (CAS 26787-78-0) plus bromhexine (CAS 3572-43-8) versus amoxicillin alone given 4 times a day for 5 to 7 days in the treatment of clinically diagnosed community-acquired bacterial lower respiratory tract infections. 392 adult patients diagnosed clinically to have acute bronchitis or pneumonia of bacterial etiology were recruited for the study with 192 subjects given amoxicillin (250 mg) plus bromhexine (8 mg) (Drug AB) and 200 receiving amoxicillin (250 mg) (Drug AA) alone 4 times a day for 5 to 7 days. Clinical response, improvement in symptom scores using a visual analogue scale, and bacteriologic response were monitored at Days 3, 5 and 7 of treatment. Results showed that although 180/192 (94%) given Drug AB and 185/200 (93%) given Drug AA had favorable clinical response at the end of treatment, the infection was completely resolved for 89/192 (46%) among the Drug AB group and in 67/200 (34%) of patients on Drug AA (p = 0.022). Also, patients given Drug AB had significantly greater reduction of their symptom scores at Day 3 for symptoms of cough discomfort, cough frequency, ease of expectoration and sputum volume. Among the subset of patients with pneumonia, the cure rates for Drug AB and Drug AA were 24/50 (47%) and 11/50 (22%), respectively (p = 0.008). A respiratory pathogen was cultured in only 72/392 (18%) of subjects.(ABSTRACT TRUNCATED AT 250 WORDS)