Cigarette smoking and culture conversion in patients with susceptible and M/XDR-TB.

BACKGROUND: Tuberculosis (TB) is a leading cause of morbidity and mortality worldwide. Active cigarette smoking may have a significant impact on treatment responses to anti-tuberculosis treatment. OBJECTIVE: To ascertain the effect of smoking on Mycobacterium tuberculosis sputum culture conversion rates following treatment initiation in patients with susceptible, multidrug-resistant and extensively drug-resistant TB (M/XDR-TB). METHOD: Sputum cultures of smoking and non-smoking patients with pulmonary TB (PTB) treated at a referral centre in Germany were evaluated. RESULTS: Between January 2012 and March 2017, 247 patients with PTB treated at the Medical Clinic of Research Center Borstel, Borstel, Germany, were included in the study. Of 247 patients, 65 (26.3%) were infected with multidrug-resistant strains of M. tuberculosis (MDR-TB). Sputum culture examinations were performed on a weekly basis. Active smoking (n = 111; time to culture conversion [TCC] 50.7 days, interquartile range [IQR] 26.5-73.0) and former smoking (n = 72; TCC 43.1 days, IQR 19.8-56.0) significantly delayed culture conversion rates (P < 0.001) when compared with never smoking (n = 64; TCC 33.2 days, IQR 8.0-50.3). Delay in TCC among smoking, non-MDR-TB patients (n = 138; TCC 47.3 days, IQR 19.0-89.0) was comparable with non-smoking, MDR-TB patients (n = 20; TCC 53.0 days, IQR 18.0-71.0). The shortest TCC was observed in non-smoking, non-MDR-TB patients (n = 44; TCC 33.0 days, IQR 10.0-48.5), whereas the longest was seen in smoking, MDR-TB patients (n = 45; TCC 60.7 days, IQR 33.3-89.0); P < 0.001). CONCLUSION: Active cigarette smoking and, to a lesser extent, former cigarette smoking, substantially delayed culture conversion in PTB.

Perspectives for personalized therapy for patients with multidrug-resistant tuberculosis.

According to the World Health Organization (WHO), tuberculosis is the leading cause of death attributed to a single microbial pathogen worldwide. In addition to the large number of patients affected by tuberculosis, the emergence of Mycobacterium tuberculosis drug-resistance is complicating tuberculosis control in many high-burden countries. During the past 5 years, the global number of patients identified with multidrug-resistant tuberculosis (MDR-TB), defined as bacillary resistance at least against rifampicin and isoniazid, the two most active drugs in a treatment regimen, has increased by more than 20% annually. Today we experience a historical peak in the number of patients affected by MDR-TB. The management of MDR-TB is characterized by delayed diagnosis, uncertainty of the extent of bacillary drug-resistance, imprecise standardized drug regimens and dosages, very long duration of therapy and high frequency of adverse events which all translate into a poor prognosis for many of the affected patients. Major scientific and technological advances in recent years provide new perspectives through treatment regimens tailor-made to individual needs. Where available, such personalized treatment has major implications on the treatment outcomes of patients with MDR-TB. The challenge now is to bring these adances to those patients that need them most.

Mental state attribution in schizophrenia: what distinguishes patients with "poor" from patients with "fair" mentalising skills?

PURPOSE: Although many patients with schizophrenia are impaired in mental states attribution abilities, a significant number perform within normal or near-normal ranges in mental state attribution tasks. No studies have analysed cognitive or behavioural differences between patients with - to some extent - preserved mental state attribution skills and those with poor mentalising abilities. MATERIAL AND METHODS: To examine characteristics of "poor" and "fair" mentalisers, 58 patients with schizophrenia performed a mental state attribution task, a test of general intelligence, and two executive functioning tests. "Poor" and "fair" mentalising skills were defined according to a median-split procedure; the median score in the patient group was also within two standard deviations of the control group. In addition, patients' social behavioural skills and psychopathological profiles were rated. RESULTS: Patients performing within normal or near normal ranges on the mental state attribution task had fewer social behavioural abnormalities than patients with poor mentalising abilities (even when controlled for intelligence), but did not differ in executive functioning. Fair mental state performers showed less disorganisation and excitement symptoms than poor performers. The degree of disorganisation mediated the influence of mental state attribution on social behavioural skills. CONCLUSIONS: Schizophrenia patients with (partially) preserved mentalising skills have fewer behavioural problems in the social domain than patients with poor mentalising abilities. Conceptual disorganisation mediates the prediction of social behavioural skills through mentalising skills, suggesting that disorganised patients may require special attention regarding social-cognitive skills training.

[PSP Scale: German version of the Personal and Social Performance Scale: valid instrument for the assessment of psychosocial functioning in the treatment of schizophrenia]. / PSP-Skala - Deutsche Version der Personal and Social Performance Scale : Validiertes Messinstrument zur Erfassung des psychosozialen Funktionsniveaus in der Schizophrenietherapie.

In the treatment of schizophrenia, the domain of psychosocial functioning is an important aspect of therapeutic success that should be considered in addition to the reduction of psychopathology. Valid and standardised measures are necessary for diagnostics and the assessment of patients" personal, social and professional functioning. The German version of the Personal and Social Performance (PSP) Scale (with its four subdimensions: "socially useful activities, work and study included", "personal and social relationships", "self-care" and "disturbing and aggressive behaviour") was administered to patients with schizophrenia in previous studies. These data demonstrated this scale to be a reliable, valid and efficient tool for measuring psychosocial functioning in schizophrenia. Thus, it is argued that, for everyday clinical practice, the PSP Scale is useful for the assessment of psychosocial functioning in schizophrenia during short, medium and long-term treatment courses.

Energy and fibre intake in a group of captive giraffe (Giraffa camelopardalis) offered increasing amounts of browse.

We investigated the effect of diet on intake of energy and fibre in a group of three captive adult giraffe by weighing offered diet items and leftovers for 7 days after an adaptation period of 7 days. Digestion coefficients were calculated using, as internal marker, the acid detergent lignin content of a faecal sample pooled from subsamples taken during the last 5 days of intake measurement. Two lucerne hay-only diets of differing quality (L1, L2) were fed, as well as the regular diet of lucerne hay and concentrates (L2C), and the regular diet supplemented with 3 or 6 kg of edible, fresh browse material (L2CB3, L2CB6). The proportion of roughage in the ingested diets L2CB6 (45 +/- 5% dry matter), L2CB3 (35 +/- 3%) and L2C (37 +/- 10%) did not differ significantly. Digestible energy intake was low on the hay-only diets [L1: 0.28 +/- 0.06 MJ/kg body weight (BW)0.75; L2: 0.33 +/- 0.10 MJ/kg BW0.75] and increased from L2C (0.60 +/- 0.13 MJ/kg BW0.75) to a significant increase with L2CB3 (0.72 +/- 0.17 MJ/kg BW0.75); no further increase was obvious for L2CB6 (0.63 +/- 0.15MJ/kg BW0.75). The results confirm that giraffes are unlikely to meet energy requirements on lucerne hay-only diets. In a feeding scenario where both lucerne hay and the concentrate component of the diet are fed ad libitum, the animals tended to exchange hay for browse when browse was added. Only the higher level of browse supplementation led to a potentially beneficial increase in fibre intake. Whether additional browse supplementation will lead to increased intakes in a feeding scenario with restricted concentrate provision can be suspected but remains to be demonstrated.

[The prevalence of acute necrotizing ulcerative gingivitis in Swiss military collectives]. / Die Prävalenz der akuten nekrotisierenden ulzerativen Gingivitis in Schweizer Militärkollektiven.

A group of 1595 military trainees (age range 18 to 30) were screened for the appearance of acute necrotizing ulcerative gingivitis. In a second phase four military dentists examined over 2800 newly entered trainees. Criteria for the diagnosis of ANUG were (1) Ulceration and necrosis of the interdental papilla, (2) bleeding and (3) pain. Among the 1595 recruits no ANUG could be detected, and no case of ANUG was reported by the four military-dentists. Thus, the prevalence of acute necrotizing ulcerative gingivitis was calculated to be below 0.03%.