Analysis of tuberculosis surveillance in Hungary in 2000.

SETTING: Hungary, Central Europe, with a population of 10.3 million living in 20 administrative districts (19 counties and the capital). OBJECTIVE: To summarize the results of the first year of the revised National Tuberculosis Surveillance System. DESIGN: Retrospective survey of the National Tuberculosis Surveillance Center (NTSC) database. METHODS: Analysis of data on all tuberculosis cases reported to the NTSC in 2000. Drug susceptibility results were evaluated in line with WHO and IUATLD definitions. RESULTS: During 2000, a total of 3598 patients with tuberculosis were reported. Only 40% of these were bacteriologically confirmed. Although susceptibility testing has been required for previously untreated culture-positive cases, only 801 (67.8% of the bacteriologically confirmed cases) were tested in 2000. Drug resistance was detected in 10.7% of previously untreated and in 23.5% of previously treated patients. Multidrug-resistant (MDR) cases were not common: only 1.5% of the isolates from previously untreated patients and 4.9% of those from previously treated patients were MDR. CONCLUSIONS: The results suggest that the NTSC should work towards increasing the numbers of cases that are bacteriologically confirmed. In addition, some form of surveillance system should be instituted to ensure that mandatory susceptibility testing is performed on all isolates from previously untreated tuberculosis patients.

Drug-resistant tuberculosis in Budapest.

SETTING: Sixteen districts of Budapest, Hungary. OBJECTIVE: To determine the frequency of primary and secondary drug resistance, and to recommend treatment regimens. DESIGN: A retrospective survey. METHODS: Mycobacterium tuberculosis isolates were collected from 264 newly diagnosed and 147 previously treated patients. All strains were tested against isoniazid (INH), rifampicin (RIF), streptomycin (SM) and ethambutol (EMB) using the proportion method. Bacteriologic examinations were performed in the Diagnostic Laboratory of the Koranyi National Institute for Tuberculosis and Pulmonology in Budapest. RESULTS: Primary resistance to INH alone was 4%, to SM alone 2%, to RIF alone 0.4%, to INH and SM 1%, and to INH, RIF, SM and EMB 0.4%. Of the isolates of 78 relapse cases, six (8%) were resistant to INH alone, one (1%) to INH and RIF, two (3%) to INH, RIF, SM and EMB. Of the isolates of 69 patients notified with active tuberculosis for over a year, 51 (74%) were susceptible to the drugs tested. CONCLUSION: Based on the level of primary drug resistance as well as on the resistance pattern of relapse cases, it is recommended to start the treatment of newly detected and relapse cases with four drugs. The high rate of chronic cases with susceptible strains can be explained by poor compliance. To prevent development of resistant cases and to achieve good compliance, it is necessary to apply direct observation of treatment in all types of patients.

[Which patients are dying of tuberculosis in the 90-s?]. / Kik halnak meg tuberkulózisban a 90-es években?

Medical and social characteristics of 27 patients deceased in tuberculosis in the Korányi National Institute for Tuberculosis and Pulmonology, Budapest, were analysed and evaluated. M. tuberculosis strains sensitive to all antituberculotic drugs were isolated from all cases. Characteristics of patients: males over 40 years of age (17 cases), single (9 cases), alcoholics (16 cases) who were transferred from another hospital (13 cases). All patients had pulmonary tuberculosis, in 3 cases together with extrapulmonary lesions. Sputum direct smear examination revealed acid-fast bacteria in 9 cases. There were 8 relapses. It is proposed to consider possibility of tuberculosis in the presence of the above mentioned "risk factors".

The theophylline dilemma.

The effectivity of recently introduced beta adrenergic agents in the USA prompted physicians to reevaluate the usefulness of theophylline having been used solely as a bronchodilator in the treatment of obstructive respiratory tract diseases. As part of a complex therapy applied in different diseases (acute asthmatic attacks, chronic asthma, acute exacerbation, and long-term treatment of obstructive bronchitis) theophylline is still a drug of value. The risk of toxicity can be reduced to a minimum. In the prevention of certain symptoms (e.g. nocturnal dyspnoea of asthmatics) (slow release) theophylline preparations proved to be the most advantageous. In aged patients technical difficulties limit the use of inhalation therapy, the oral applicability of theophylline is a further advantage of this product.

Perinatal anti-androgen treatment and genotype affect the mesotelencephalic dopamine system and behavior in mice.

Sex and strain differences in tyrosine hydroxylase activity (TH) of brain dopamine systems have been reported for mice. To investigate if there might be a causal relationship between perinatal androgen secretion and regional mesotelencephalic TH activity, BALB/cJ and C57BL/6ByJ male mice were treated perinatally with cyproterone, a steroidal anti-androgen (or vehicle), and orchiectomized at 1 month of age. Two-way analysis of variance indicated significant treatment and strain effects in the mesencephalon and tuber olfactorium: perinatal cyproterone treatment lowered TH activity, and BALB/cJ had higher regional TH activities than those of C57BL/6ByJ. The most prominent behavioral effects of cyproterone treatment were found in the expression of scratching, which was considerably increased in both strains. Possible implications of these results are discussed.

Genetic determination of mesencephalic tyrosine hydroxylase activity in the mouse.

The hereditary factors that affect mesencephalic tyrosine hydroxylase (TH) activity were investigated in highly inbred mouse strains (CXBI/ByJ, C57BL/6ByJ, and BALB/cJ). The progenitor strains and their F1 hybrids, were compared for mesencephalic TH activity with each other and with replicated F2 generations. Quantitative and non-parametric genetic analysis of the data raise the possibility that there is a major gene with robust additive effect that is primarily responsible for the difference between the progenitor strains with intermediate and high mesencephalic TH activity. Strain differences in mesencephalic TH activity have been linked to differences in number of dopamine (DA) neurons in that area. If genetic variation of mesencephalic TH activity is entirely attributable to variation in number of mesencephalic dopamine (DA) neurons, identification of the genetic sources of variation of mesencephalic TH activity may take us a step closer to animal models and preparations that are needed in the study of the physiological and constitutional mechanisms of human disorders in which DA neurotransmission is involved.

[The present and future of the campaign against tuberculosis in Hungary]. / Gegenwart und Zukunft des Kampfes gegen die Tuberkulose in Ungarn.

The situation of the fight against tuberculosis in Hungary is analysed. It is found that the steady decrease of incidence was temporary. The consequent application of the different measures of the fight against tuberculosis will lead to a further decline of the incidence.

Tuberculosis epidemiological situation in the world and in Hungary (1882-1982).

The centenary of the discovery of the tuberc bacillus (Koch-centenary) threw light on the unsolved problems of the epidemiology of tuberculosis in the world. Despite of the definitively significant progress made since the turn of the century the world-wide elimination and eradication of tuberculosis is not yet accomplished. Deficiencies in the fight against tuberculosis in the developing countries which represent two-third of the world play firstly a role in it. The number of new tuberculosis cases keeps being about 5.000 yearly in Hungary thus the present programme requires modification. An increased fight against tuberculosis on a global scale may be successful only with international collaboration and with higher rate of financial support provided by the highly developed industrial countries.

Methionine enkephalin inhibits the bursting activity of the Br-type neuron in Helix pomatia L.

The present study demonstrates that methionine enkephalin can inhibit the normal bursting activity pattern of the RPal or Br-type neuron and this inhibition can be blocked by prior treatment with naloxone, the selective opiate antagonist. The study demonstrates indirectly the presence of opiate-like receptors in Helix pomatia.

Naloxone selectively blocks dopamine response of Br-type neuron in Helix pomatia L.

The present study demonstrates that the potent opiate antagonist, naloxone can selectively block the DA induced inhibition of the bursting activity pattern of the RPal or Br-type neuron. The dopamine inhibitory affect can also be blocked by haloperidol, a established dopamine receptor blocker.

Ultrastructure of the bimodal pacemaker neuron in the central nervous system of Helix pomatia L.

Fine structure of the identified (RPal) giant neuron of Helix pomatia has been investigated after isolation. The following findings have been established: 1. The cytoplasm of the RPal neuron is electron-microscopically characterized by a strongly invaginated nuclear envelope, a highly-developed rER system, a large number of free ribosomes and by 110-250 nm-sized neurosecretory-like granules with finely-granulated inner content. 2. The fine-structural arrangement of the cytoplasm exhibited a seasonal variation, viz. in winter it was found to be layered, while in spring it showed a homogeneous structure. 3. On the cell surface free axon profiles containing vesicles were sometimes found, which might be afferent connections to the cell body.