Resistance patterns of multidrug-resistant tuberculosis in Western Province, Papua New Guinea.

Few data are available on tuberculosis (TB) drug resistance patterns in Papua New Guinea (PNG) due to the lack of facilities for mycobacterial culture. Many patients from the Western Province seek care in Queensland health clinics in the Torres Strait. Since 2000, we have treated 161 TB cases from PNG, of whom 40 proved to have multidrug-resistant TB (MDR-TB; two human immunodeficiency virus positive). Drug susceptibility testing (DST) shows high levels of resistance to other drugs in the MDR-TB cases (streptomycin 93%, ethionamide 87%, ethambutol 18%, pyrazinamide 10%). No extensively drug-resistant TB (XDR-TB) has been identified. MDR-TB seems to be highly prevalent in the Western Province of PNG, and unless treatment is guided by DST, the risk of XDR-TB emerging is high.

Metalloproteinase inhibition reduces constrictive arterial remodeling after balloon angioplasty: a study in the atherosclerotic Yucatan micropig.

BACKGROUND: Arterial remodeling after balloon angioplasty has been recognized as a major determinant of restenosis. Perturbation of collagen metabolism might be important. After balloon injury, matrix metalloproteinase (MMP) expression is upregulated. We investigated the effect of Batimastat, a nonspecific MMP inhibitor, on late lumen loss, arterial remodeling, and neointima formation after balloon dilation. METHODS AND RESULTS: In atherosclerotic iliac arteries of 12 Yucatan micropigs, balloon dilation was performed, with intravascular ultrasound and quantitative angiography used before and after balloon dilation and at 42-day follow-up. The animals were randomly divided into 2 groups, the Batimastat group (n=6) and the vehicle group (n=6). All animals were intraperitoneally injected with either Batimastat or a vehicle immediately after balloon dilation and at 2 weeks and 4 weeks after balloon dilation. Angiographic and echographic late lumen loss in the Batimastat group versus the vehicle group was 0.3+/-0.1 versus 0.8+/-0.1 mm (P=0.01) and 2.2+/-0.5 versus 4.9+/-0.7 mm(2) (P=0.004), respectively. Late media-bounded area loss was used as a measure of remodeling after balloon dilation and was 0.9+/-0.6 mm(2) in the Batimastat group compared with 3.8+/-0.8 mm(2) in the vehicle group (P=0.003, mixed model analysis P=0.01). Neointima formation was 1.3+/-0.3 mm(2) in the Batimastat group and 1.0+/-0.2 mm(2) in the vehicle group (P=0. 542). CONCLUSIONS: Metalloproteinase inhibition by Batimastat significantly reduced late lumen loss after balloon angioplasty by inhibition of constrictive arterial remodeling, whereas neointima formation was not inhibited by MMP inhibition.