Detection of Mycobacterium tuberculosis DNA from peripheral blood in patients with HIV-seronegative and new cases of smear-positive pulmonary tuberculosis by polymerase chain reaction.

Tuberculosis is still one of the most important cause of mortality and morbidity in many countries and there is a need for new methods for accurate and rapid diagnosis of tuberculosis. To determine the sensitivity and specificity of polymerase chain reaction (PCR) method, we have evaluated Mycobacterium tuberculosis DNA in peripheral blood samples with PCR technique in adult patients with human immunodeficiency virus (HIV)-negative and new cases of smear-positive pulmonary tuberculosis. We investigated the relationship between characteristic of the patients, radiological extension of the disease, sputum smear grade, presence of cavity, body-mass index (BMI) serum albumin level, total delay time and PCR positivity. Forty patients (33 male and 7 female; mean age 37.8 +/- 14.1) and 20 healthy control subjects (13 male and 7 female; mean age 35.6 +/- 7.3) were enrolled in this study. PCR was positive in 16 of 40 (40%) patients with pulmonary tuberculosis and negative in 24 of 40 (60%). None of the healthy controls had positive PCR results. The overall sensitivity specificity and accuracy of the PCR assay was 40, 100 and 60%, respectively. We found the positive correlation between PCR positivity and sputum smear grade (r=0.46, P=0.003) radiological extension of the disease (r=0.69, P=0.001), presence of cavity (r=0.90, P=0.001). We conclude that the detection of M. tuberculosis DNA from peripheral blood by PCR technique is useful for the rapid diagnosis of tuberculosis patients with HIV-negative. Hematogenous dissemination was important in tuberculosis patients and peripheral blood samples were suitable and easy materials. However, standardization of the PCR method must be ensured for the diagnosis of tuberculosis.

Comparison of second controller medications in addition to inhaled corticosteroid in patients with moderate asthma.

The objective of this study was to compare the efficacy and safety of the second controller medications (long-acting beta2-agonist, leukotriene receptor antagonist and sustained-release theophylline) used in addition to inhaler corticosteroid treatment in moderate persistent asthma. A total of 64 patients with asthma, in the moderate persistent asthma category, were divided into three groups. Patients, all of whom were concurrently using inhaled corticosteroid (Budesonide 400 microg twice daily), were treated for 3 months with either inhaled formoterol 9 microg twice daily (first group), oral zafirlukast 20 mg twice daily (second group), or sustained-release theophylline 400 mg once daily (third group). All of the patients were subjected to assessments on the subject of peak expiratory flow (PEF) variability, forced expiratory volume in 1 sec (FEV1), asthma symptom scores (daytime and night-time), supplemental terbutalin use, asthma exacerbations and adverse events. Over the 3-month treatment period. In all of the three groups, significant improvements were recorded in the lung function, asthma symptom scores and supplemental terbutalin use criteria, as a result oftreatments applied. Formoterol treatment resulted in significantly greater and earlier improvements compared with the other two groups in several criteria: PEF variability (17.9 +/- 2.5; 21.9 +/- 3.2; 23.7 +/- 3.3; P < 0.001); asthma symptom score (daytime) (1.6 +/- 0.5; 1 +/- 0.5; 2.0 +/- 0,5; P < 0.05); asthma symptom score (night-time) (1.2 +/- 0.4; 2.2 +/- 0.5; 16 +/- 0.6; P < 0001); and supplement alter butalin use (1.2 +/- 0.3; 1.8 +/- 0.5; 1.7 +/- 0.5; P < 0.05). However, at the end of the treatment, in all of the three groups studied, improvements were attained in overall asthma control and there was no statistical difference among the groups. Although there were no side effects which required the discontinuation of the treatment, it was observed that the maximum side effect was in the second group (20%, 31.6% and 20%, respectively). In conclusion, in patients who still have symptoms on treatment with inhaled corticosteroids, the addition of a long-acting beta2-agonist, leukotriene antagonists or sustained-release theophylline to the treatment is a logical approach, and, in addition to inhaled corticosteroids, any one of these second controller medications may be chosen in patients with moderate asthma.