Clinical standards for drug-susceptible pulmonary TB.

BACKGROUND: The aim of these clinical standards is to provide guidance on 'best practice´ for diagnosis, treatment and management of drug-susceptible pulmonary TB (PTB).METHODS: A panel of 54 global experts in the field of TB care, public health, microbiology, and pharmacology were identified; 46 participated in a Delphi process. A 5-point Likert scale was used to score draft standards. The final document represents the broad consensus and was approved by all 46 participants.RESULTS: Seven clinical standards were defined: Standard 1, all patients (adult or child) who have symptoms and signs compatible with PTB should undergo investigations to reach a diagnosis; Standard 2, adequate bacteriological tests should be conducted to exclude drug-resistant TB; Standard 3, an appropriate regimen recommended by WHO and national guidelines for the treatment of PTB should be identified; Standard 4, health education and counselling should be provided for each patient starting treatment; Standard 5, treatment monitoring should be conducted to assess adherence, follow patient progress, identify and manage adverse events, and detect development of resistance; Standard 6, a recommended series of patient examinations should be performed at the end of treatment; Standard 7, necessary public health actions should be conducted for each patient. We also identified priorities for future research into PTB.CONCLUSION: These consensus-based clinical standards will help to improve patient care by guiding clinicians and programme managers in planning and implementation of locally appropriate measures for optimal person-centred treatment for PTB.

Complete Genome Sequence of Novel Polerovirus-Associated RNA Infecting Pepper (Capsicum spp.) in South Africa.

The complete genome sequence of a novel polerovirus-associated RNA infecting pepper in South Africa was determined. The nucleotide sequence identity of 78.3% with closely related species suggested that this associated RNA was novel, and the name pepper vein yellows virus-associated RNA is proposed for this RNA fragment.

A prospective study of significant non-fatal injuries in small children in Cape Town : lessons for prevention

Paediatric trauma is the leading cause of death in the 5-14 year-old age group in South Africa and elsewhere in the world; with attendant considerable morbidity. This prospective study analyzed 100 consecutive children (under the age of 12 years old) presenting with injuries requiring admission to a trauma center inCapeTown. The most common cause of injuries were motor vehicle accidents (33) followed by falls (31); sports (8);poisoning (3); and bicycle accidents (2). Fourteen (14) children were injured non-accidentally. The majority of injured children were from poor socio-economic circumstances with a mean family income of 894R (130 USD) per month. Alcohol played a role in the etiology of at least 21of the injuries.Children are vulnerable to injuries in our society and there is presently too little direction on preventative aspects of these injuries

Cholecystogastric fistula presenting with haematemesis: diagnosed by endoscopic retrograde cholangiography.

The case is reported of a 72-year-old woman suffering from morbid obesity, who presented with haematemesis while on anti-coagulant therapy. The source of the bleeding proved to be the gastric exit of a cholecystogastric fistula. Subsequent cholangitis was successfully treated by endoscopic retrograde cholangiography (ERC) and endoscopic sphincterotomy (ES) while simultaneously the extent of the fistula was established. Cholecystectomy and closure of the fistula was contraindicated because of her morbid obesity. She remained well for 6 months but then presented with a gallstone ileus while another stone was found to be escaping from the gastric fistula. Her morbid obesity resulted in surgical procrastination, which eventually proved fatal. This patient experienced both of the most common types of complication in cholecysto-enteral fistulation, cholangitis and gallstone ileus. Although cholecysto-enteral fistulas (CEF) are probably less common than several decades ago, they are now most likely to be diagnosed during ERC. Gastroenterologists therefore need to be aware of their potential to contribute to the diagnosis and treatment of this surgical condition.

Neurologic symptoms due to possible chromium deficiency in long-term parenteral nutrition that closely mimic metronidazole-induced syndromes.

BACKGROUND: We previously described a patient on home parenteral nutrition (HPN) who developed glucose intolerance and neuropathy that only responded to an infusion of chromium. A patient on HPN who had neuropathy and glucose intolerance was studied. He was also on metronidazole, which could have caused the neuropathy, but the symptoms and signs persisted. METHODS: Baseline clinical examination, nerve conduction studies, serum vitamin and trace element levels, and glucose tolerance were measured. Then, 250 micrograms of trivalent chromium as the chloride salt was infused daily for 2 weeks. The above studies were repeated. RESULTS: The patient at baseline had peripheral neuropathy of the axonal type and was glucose intolerant. Serum chromium was raised in this patient above the reference range. Despite raised serum levels, the infusion of chromium resulted in clinical remission that was marked 4 days after starting the infusion. Normalization of nerve conduction also occurred within 3 weeks of the initial study. CONCLUSIONS: Neuropathy and glucose intolerance may occur despite increased serum chromium levels and respond to chromium infusion. The previous use of drugs such as metronidazole should not exclude chromium as a potential treatment for neuropathy in HPN patients.

Harry M. Vars Research Award. Increase in lumbar spine bone mineral content in patients on long-term parenteral nutrition without vitamin D supplementation.

BACKGROUND: We had previously shown that short-term withdrawal of vitamin D in patients with metabolic bone disease complicating home parenteral nutrition (HPN) corrected osteomalacia. We therefore conducted a prospective study of the effect of long term withdrawal of vitamin D in patients on home parenteral nutrition. METHODS: Baseline measurements of bone mineral content, serum levels of calcium, phosphorus, parathormone, 25-OH and 1,25 (OH)2D; urinary calcium; and bone mineral density were measured. Then all parenteral vitamin D was withdrawn and the above parameters were followed for a mean of 4.5 years. RESULTS: Lumbar spine bone mineral content (LSBMC) was 0.79 +/- 0.06 g/cm2 at the start of the study, well below the reference value, 1.16 +/- 0.13 g/cm2. Parathyroid hormone (PTH) (0.48 +/- 0.24 pmol/L) and 1,25-(OH)2D levels (22.8 +/- 7.9 pmol/L) were low and 25-hydroxyvitaniin D levels were normal (33.3 +/- 5.5 nmol/L) before removing vitandn D from the HPN solutions. After withdrawal of vitamin D for 4.5 +/- 0.2 years LSBMC increased from 0.79 +/- 0.06 to 0.93 0.07 g/cm2 (p < 0.005). Calcium phosphorus, magnesium and 25-hydroxyvitamin D did not change significantly, 1,25(OH)2D, and PTH levels became normal after withdrawal of vitamin D. CONCLUSIONS: In selected patients with depressed PTH levels, long-term withdrawal of vitamin D during HPN increases LSBMC and levels of PTH and 1,25(OH)2D. There is no reduction of the mean level of 25-hydroxyvitamin D.

[The treatment of myocardial infarction during the hospital stage and shortly thereafter: now and 10 years ago]. / De behandeling van het myocardinfarct gedurende de ziekenhuisfase en kort daarna: nu en 10 jaar geleden.

OBJECTIVE: Comparison between the early and the late eighties of the application of thrombolysis and revascularisation in the acute phase of a myocardial infarction. LOCATION: University Hospital, Rotterdam. DESIGN: Prospective with historical comparison. METHODS: All patients admitted between May 1987 and May 1990 with a myocardial infarction and aged up to 71 years were included (n = 430). Numbers of procedures and survival during the following year were compared with data of patients admitted from 1981 to the end of 1983 (n = 706). RESULTS: In 1981-1983 thrombolytics were administered to 9% of the patients, in 1987-1990 to 40%. Revascularisation procedures during the next year were performed in 17% and 50% of the patients respectively. Hospital mortality decreased from 14% to 10% (p < 0.05), one-year survival increased from 75% to 83% (p < 0.05). For patients from 1987-1990 one-year survival was higher after thrombolysis treatment: 90% versus 78% without (p < 0.01), and after revascularisation: 94% versus 87% without (p < 0.01). CONCLUSION: Compared with 1981-1983 the treatment is at present more directed towards reperfusion and revascularisation of the ischaemic myocardium, resulting in invasive treatment in 50% of the patients now as opposed to 25% in the early eighties. The survival rate during the first year has improved.

Laser Stark spectrometer for the measurement of ammonia in flue gas.

The physical background of a laser Stark spectrometer dedicated to the measurement of ammonia slip through DeNo(x) reactors in power stations is treated. The dependence of the ammonia measurement on temperature and pressure variations is derived and verified experimentally. Selection of spectral lines with both a good absorption coefficient and a high sensitivity to the Stark effect, within the range of the CO(2) laser, has been carried out. If a (12)CO(2) laser is used at a temperature of 573 K and at atmospheric pressure, the 10R8 laser line is recommended for best results. The 10R18 line of the (13)CO(2) laser yields a still higher sensitivity (detection limit 0.4 ppm) for a moderate electric field. Theoretical predictions for the sensitivity of ammonia detection are compared with experimental data. Results of measurements in an industrial environment are presented.

Photoacoustic measurement of ammonia in the atmosphere: influence of water vapor and carbon dioxide.

The photoacoustic determination of the ammonia concentration in atmospheric air by absorption of CO(2) laser radiation at 9.22 microm is influenced by the presence of H(2)O and CO(2). Kinetic cooling due to the coupling of excited CO(2) and N(2) levels causes important changes in phase and amplitude of the photoacoustic signal. Theoretical background is presented to deduce the correct NH(3) concentration from the signal. The experimental setup used to perform field measurements is described. Adhesion of NH(3) to the walls of the resonant photoacoustic cell was investigated. Temperature effects are treated. Field data of NH(3) and H(2)O concentrations are presented.