Results Of Drug Sensitivity Test Research Articles

Drug resistant form of tuberculosis in penitentiary system of Kazakhstan in 2008-2009

This paper presents the results of comparative analysis of data of epidemiological surveillance of drug resistant tuberculosis (TB) in civil and penitentiary system of public health in Kazakhstan during 2008-2009. The authors intended to clarify main priorities in detection and diagnostics of TB with multidrug resistance in penitentiary settings. As a result of the study, the practical recommendations are suggested such as developing bacteriological service, performing relevant investigation of patients before treatment using drug sensitivity testing (DST), organizing proper treatment of patients in settings of criminal executive system considering the DST results.

A study on the drug resistance to p-nitrobenzoic acid in Mycobacterium tuberculosis

To investigate the resistance of Mycobacterium tuberculosis (MTB) to p-nitrobenzoic acid (PNB), in order to provide the scientific basis for reliable identification of laboratory strains of mycobacterium. Strains of mycobacterium grown in PNB media were identified with additional traditional biochemical tests, according to the standard protocols of laboratory diagnostics for tuberculosis by the Chinese Antituberculosis Association. For mycobacteria grown in the PNB media but highly suspected as MTB by traditional biochemical tests, MPB64 monoclonal antibody was used for the differentiation between MTB and non-tuberculosis mycobacteria group (NTM). Minimal inhibitory concentrations (MIC) of PNB was further determined for culture-confirmed MTB, 10 strains of clinically isolated MTB (control), H(37)Rv standard strain, mycobacterium avium standard strain, and 5 strains of clinically isolated NTM. A total of 1114 strains of MTB were confirmed, among which 58 PNB manifested resistance. The rate of resistance was 5.21% (58/1114), with an MIC ranging for 1.0 - 1.5 g/L. The MICs of control MTB and H(37)Rv standard strain were 0.25 - 0.5 g/L and 0.25 g/L, respectively. Both mycobacterium avium standard strain and clinically isolated NTM showed an MIC of > 2.0 g/L. Differences between groups were statistically significant (t = 4.87, 5.09, 6.68, respectively, P < 0.01). In order to avoid laboratory misdiagnosis, for primary screening with NTB with PNB culture, the presence of MTB characteristics, including cream-colored broccoli-like colony morphologies, as well as clinical response to first-line anti-tuberculosis medications, despite PNB tolerance, warrants further investigations of traditional biochemical tests, differentiation with MPB64 monoclonal antibodies, or simply by the use of temperature manipulation or drug-sensitivity test results.

Analysis of the changes in bacterial types and drug sensitivity profiles of mycobacterial strains in Guangzhou over the last twelve years

To improve evidence-based care in the management of tuberculosis, we retrospectively analyzed the bacterial types and drug sensitivity test results of mycobacteria in Guangzhou over the past twelve years (from July 1998 to March 2010). Over these twelve years, a total of 14 095 mycobacterial strains isolated from different samples were subjected to type identification and drug sensitivity tests according to the Standard Protocols of Laboratory Diagnostics for Tuberculosis by the Chinese Antituberculosis Association. Chi-square test was performed for statistical analyses for comparisons between groups. Of 14 095 strains of mycobacteria isolated, 10 844 strains (76.84%) were MTB, and 3251 strains (23.16%) were non-tuberculosis mycobacteria (NTM). Compared with the result of the fourth national survey of tuberculosis epidemiology, which showed 11.1% of NTM, the one of our study was significantly different (χ(2) = 69.79, P < 0.001). Drug sensitivity tests of MTB showed tolerance rates of 28.99% (2729/9413), 21.75% (2047/9413), 17.45% (1643/9413) and 11.53% (1085/9413) against isoniazid, rifampin, streptomycin and ethambutol, respectively. An increasing trend was observed in MTB drug tolerance against streptomycin, rifampin and isoniazid, whereas more and more NTM strains were isolated in recent years. These findings are worthy of note for clinicians.

DNA Methylation and Normal Chromosome Behavior in Neurospora Depend on Five Components of a Histone Methyltransferase Complex, DCDC

Methylation of DNA and of Lysine 9 on histone H3 (H3K9) is associated with gene silencing in many animals, plants, and fungi. In Neurospora crassa, methylation of H3K9 by DIM-5 directs cytosine methylation by recruiting a complex containing Heterochromatin Protein-1 (HP1) and the DIM-2 DNA methyltransferase. We report genetic, proteomic, and biochemical investigations into how DIM-5 is controlled. These studies revealed DCDC, a previously unknown protein complex including DIM-5, DIM-7, DIM-9, CUL4, and DDB1. Components of DCDC are required for H3K9me3, proper chromosome segregation, and DNA methylation. DCDC-defective strains, but not HP1-defective strains, are hypersensitive to MMS, revealing an HP1-independent function of H3K9 methylation. In addition to DDB1, DIM-7, and the WD40 domain protein DIM-9, other presumptive DCAFs (DDB1/CUL4 associated factors) co-purified with CUL4, suggesting that CUL4/DDB1 forms multiple complexes with distinct functions. This conclusion was supported by results of drug sensitivity tests. CUL4, DDB1, and DIM-9 are not required for localization of DIM-5 to incipient heterochromatin domains, indicating that recruitment of DIM-5 to chromatin is not sufficient to direct H3K9me3. DIM-7 is required for DIM-5 localization and mediates interaction of DIM-5 with DDB1/CUL4 through DIM-9. These data support a two-step mechanism for H3K9 methylation in Neurospora.

Surgical treatment of previously treated thoracic and thoracolumbar spinal tuberculosis

To explore the surgical measurements and principles in the treatment of thoracic and thoracolumbar spinal tuberculosis. A total of 232 cases of previously treated thoracic or thoracolumbar spinal tuberculosis in recent 7 years were retrospective analyzed. Preoperative assessments were as follows: Cobb angles of kyphosis: < 30° (n = 65), 30 - 60° (n = 147) and > 60° (n = 20); Frankel B (n = 13), C (n = 12), D (n = 41) and E (n = 166). Forty-eight cases were performed with one-stage transpedicular screw system and anterolateral debridement by single incision, 184 cases with one-stage anterior approach (debridement, fusion and plate-screw fixation) routinely. The tissues and liquor paris debrided from focus were sent for pathology, Bacillus tuberculosis detection and culture, and drug sensitivity test. The patients were given anti-tuberculosis therapy according to the results of drug sensitivity test for 1 - 1.5 years. The follow-up parameters included relapse rate, fusion of bone graft, the status of neurological restoring and kyphosis correction. All 232 cases recovered from perioperation and 230 cases achieved primary wound healing. Two cases undergoing single incision one-stage posterior instrumentation and anterolateral debridement were complicated with wound healing and sinus formation. There was delayed healed by changing dressings. The complications included intercostals neuralgia (n = 135) and pneumothorax or hydrothorax requiring no special measure (n = 13). The follow-up period ranged from 1.0 to 4.5 years old (mean: 2.6). There was no recurrence within the follow-up period and bone union was found in all cases. All 66 cases with neurological deficits recovered partially or totally. Kyphosis correction was achieved by 27.5° on average postoperatively and showed a mild loss of 4.2° on average during the follow-up period. All cases were confirmed pathologically as Bacillus tuberculosis infection. Bacillus tuberculosis was detected and cultured successfully in 107 cases (46.1%). Forty strains (37.4%) were drug resistant among which 8 strains (7.5%) was multi-drug resistant. For the patients with thoracic and thoracolumbar spinal tuberculosis, directional chemotherapy, one-stage anterior approach with thorough debridement, auto-rib or Ti-mesh fusion and plate-screw fixation may be the first-line therapy.

Role of the BACTEC radiometric method in the evaluation of patients with clinically probable tuberculous meningitis

Background:Confirmation of tuberculous meningitis (TBM) and initiation of treatment are often delayed due to limitations in isolating Mycobacterium tuberculosis from cerebrospinal fluid (CSF).Objectives:To evaluate the role of the BACTEC radiometric method in a clinical setting for the early diagnosis of TBM.Materials and Methods:Patients meeting criteria for clinically probable TBM over a 3 year period were included. Clinical features, results of CSF investigations (protein, glucose, cell count, Ziehl-Neelsen staining, culture in Löwenstein-Jensen (LJ) medium and BACTEC) and brain CT imaging were reviewed. Drug sensitivity was tested using BACTEC. Patients were started on standard treatment and functional outcome, and response at discharge and follow-up were assessed. Patients were divided according to whether or not M. tuberculosis was isolated by BACTEC and the clinical, radiological, and laboratory features compared.Results:Sixty patients were evaluated. The mean age was 30 years ± 11.7 years. Headache and fever were the most common symptoms and the mean duration was 26 days. CT findings were hydrocephalus (n=21), basal exudates (n=16), and tuberculoma (n=14). In 40 patients, M. tuberculosis was isolated by BACTEC and average 15 days was required for detection, whereas it was 30 days in LJ medium. Results of drug-sensitivity testing (n=32) were obtained average 7 days after isolation. Patients from whom M. tuberculosis had been isolated by BACTEC more often had tuberculomas in CT imaging (P=0.018).Conclusion:Use of the BACTEC method allows early confirmation in patients with clinically probable TBM. It can guide clinicians in the rational use of anti-tuberculosis treatment by confirming diagnosis and identifying drug- sensitivity.

Surgical retreatment of thoracic and thoracolumbar spinal tuberculosis

To explore the surgical measures and principles in the retreatment of thoracic and thoracolumbar spinal tuberculosis. Thirty retreatment cases of thoracic and thoracolumbar spinal tuberculosis in recent 3 years were retrospectively analyzed. The patients were hospitalized by inadequate decompression of spinal canal, tubercular toxic symptoms or sinuses. The disease course was an average of 6 months from the last operation. The patients were given anti-tuberculosis therapy according to the adjusted regimens for 2 - 8 weeks before reoperations. Ten cases were performed by anterior approach with debridement, 6 cases anterior approach (debridement, fusion & plate-screw fixation) and 4 cases dislodgment of transpedicular screw system and routine surgical treatment by anterior approach in one primary term. Debridement, Ti-mesh implantation and bone grafting, without taking out of the transpedicular screw systems was performed in 1 case of elder patient older than 70 years old with transpedicular screw system fixation. Nine cases underwent sinuses excision, debridement and dislodgment of transpedicular screw system in first attempt. After 2 - 3 weeks since incision healing, anterior approach was routinely performed. The tissues and liquor puris debrided from focus were sent for pathological examination, Bacillus tuberculosis detection and culture and drug sensitivity test. The patients were given anti-tuberculosis therapy according to the results of drug sensitivity test for 1 - 1.5 years. Follow-ups included relapse rate, fusion of bone graft and status of neurological recovery, etc. All 30 cases recovered from peroperation. The follow-up period ranged from 3 to 32 months (mean: 18 months). Fourteen of 21 cases with neurological deficits recovered partially or totally. All incisions had primary healing. No relapse occurred within follow-up period. All cases were confirmed with Bacillus tuberculosis infection by pathology. Bacillus tuberculosis was detected and cultured successfully in 16 cases (53.3%). Nine strains (56.3%) were drug resistant and in which 4 strains (25.0%) were multi-drug resistant. For the retreatment of thoracic and thoracolumbar spinal tuberculosis, targeted chemotherapy, thorough debridement and reasonable operative options are key to therapeutic success.

To effects of Puerarin Injection associated with Irbesartan on Cardiac Insufficiency at Decompensated Stage of chronic corpulmonale heart failure

Objective To explore the curative effects of Puerarin Injection associated with Irbesartan on decompensated chronic cor pulmonale heart failure. Methods A total of 168 cases conforming to the diagnostic standards were randomized into control group (92 cases) and therapy group (76 cases). In the control group: Based on the results of sputum and X-ray, broad-spectrum antibiotics were firstly selected and used for 3 days after admission. Then sensitive antibiotics were selected according to the results of sputum culture and drug sensitivity test. Medicine for relieving cough and asthma, and apophlegmatisant were used routinely. Patients with heart failure were treated with Digoxin or diuresis. In addition to the above treatments, the therapeutic group were treated with Puerarin Injection 600mg and Irbesartan 75mg once a day. The two groups were both treated for 20 days. Results ①The incipient slope, 0.8 slope, 0.5 slope and the minimal surplus were all significantly changed (P＜0.01) in therapeutic group after the treatment. There were significant difference in the incipient slope, 0.8 slope, 0.5 slope and the minimal surplus before and after treatment both in the control group and therapeutic group. ②The plasma viscosity and blood viscosity decreased observably (P＜0.01) after the treatment in the therapeutic group, and more obviously than that in the control group (P＜0.01). ③The arterial oxygen pressure (PaO2) and arterial oxygen saturation (SaO2) in the therapeutic group were enhanced more prominently than that of the control group (P＜0.01). ④The mean pulmonary arterial pressure (mPAP) and pulmonary vascular resistance (PVR) decreased obviously in the therapeutic group after the treatment, and more observably than those in the control group (P＜0.01). ⑤The cardiac output and cardiac index were improved prominently in the therapeutic group after the treatment, and more obviously than that of the control group (P＜0.01). ⑥The heart functional capacity (NYHA) improved significantly after the treatment both in the control group and the therapeutic group (P＜0.05). Conclusions Puerarin Injection and Irbesartan could remarkablely change the erytlu'ocyte deformabifity, improve the hemorheology, lower pulmonary hypertension, and improve the cardiac function and the clinical efficacy in decompensation stage. Key words: Puerarin Injection; Irbesartan; Corpulmonale; Heart functional capacity (NYHA)

Trend of Multidrug and Extensively Drug Resistant Tuberculosis in a Tuberculosis Referral Hospital, 2001~2005

Background: Multidrug-resistant tuberculosis (MDR-TB) and extensively drug resistant tuberculosis (XDR-TB) are serious threats to worldwide tuberculosis control, but the national burden and the trends of infectious spread are largely unknown. Methods: We retrospectively reviewed the results of drug sensitivity tests and medical records of patients that were diagnosed with culture-confirmed pulmonary tuberculosis and were admitted to the National Masan Tuberculosis Hospital between 2001 and 2005. Results: From 2001 to 2005, the proportion of MDR-TB among new cases was 9.2%, 13.8%, 16.9%, 23% and 27.0% in 2001, 2002, 2003, 2004 and 2005, respectively, and the proportion of MDR-TB among previously treated cases was 58.5%, 60.2%, 62.7%, 61.7% and 71.3% in 2001, 2002, 2003, 2004 and 2005, respectively. A significant increasing trend could be discerned for MDR-TB among both new and previously treated cases (p

Comparison of Clinical Characteristics between Pulmonary Tuberculosis Patients with Extensively Drug-resistance and Multi-drug Resistance at National Medical Center in Korea

Background: Recently, in addition to multi-drug resistant tuberculosis (MDR-TB), extensively drug-resistant tuberculosis (XDR-TB) has become rapidly growing public health threat. This study examined the clinical differences between pulmonary TB patients with extensively drug resistance (XDR) and multi-drug resistance (MDR) at the National Medical Center in Korea in order to determine the clinical characteristics associated more with XDR-TB than MDR-TB. Methods: Patients who received a diagnosis of culture-confirmed pulmonary TB and a drug sensitivity test (DST) for anti-TB drugs at the National Medical Center between January 2000 and August 2007 were enrolled in this study. The patients were identified into the XDR-TB or MDR-TB group according to the DST results. The clinical characteristics were reviewed retrospectively from the medical records. Statistical analysis for the comparisons was performed using a -test, independent samples t-test or binary logistic regression where appropriate. Results: A total 314 patients with culture-confirmed pulmonary TB were included. Among them, 18 patients (5.7%) had XDR-TB and 69 patients (22%) had MDR-TB excluding XDR-TB. A comparison of the clinical characteristics, revealed the XDR-TB group to have a higher frequency of a prior pulmonary resection for the treatment of TB (odds ratio [OR], 3.974; 95% confidence interval [CI], 1.052~15.011; P value 0.032) and longer average previous treatment duration with anti-TB drugs, including a treatment interruption period prior to the diagnosis of XDR, than the MDR-TB group (XDR-TB group, 72.67 months; MDR-TB group, 13.09 months; average treatment duration difference between two groups, 59.582 months; 95% CI, 31.743~87.420; P value, 0.000). In addition, a longer previous treatment duration with anti-TB drugs was significantly associated with XDR-TB (OR, 1.076; 95% CI, 1.038~1.117; P value, 0.000). A comparison of the other clinical characteristics revealed the XDR-TB group to have a higher frequency of male gender, diabetes mellitus (DM), age under 45, treatment interruption history, cavitations on simple chest radiograph and positive result of sputum AFB staining at the time of diagnosis of XDR. However, the association was not statistically significant. Conclusion: Pulmonary TB patients with XDR have a higher frequency of a prior pulmonary resection and longer previous treatment duration with anti-TB drugs than those with MDR. In addition, a longer previous treatment duration with anti-TB drugs is significantly associated with XDR-TB.

Repeated hepatic intra-arterial chemotherapy based on results of anticancer drug sensitivity test in patients with synchronous hepatic metastases from colorectal cancer

We determined whether hepatic intra-arterial infusion of 5-fluorouracil (5-FU) in patients with synchronous hepatic metastases from colorectal cancer, in whom the primary lesion was resectable but hepatic metastatic lesions were non-resectable helped improve survival time when administered on the basis of the results of the anticancer drug sensitivity test. The study population consisted of 29 patients with synchronous hepatic metastases from colorectal cancer who underwent surgical resection of the primary lesion alone. Of these 29 patients, 21 received hepatic intra-arterial infusion of 5-FU postoperatively after the 5-FU sensitivity test. The remaining 8 patients underwent surgical resection of the primary lesion but neither sensitivity testing nor hepatic intra-arterial chemotherapy. Tissue fragments were cultured, with each concentration of 5-FU in the thermoreversible gelation polymer forming a three-dimensional structure at 37 degrees C. The viability of tumor cells was evaluated according to WST methods; inhibitory concentration of 50% (IC50) values were calculated. We considered cancer tissue to be sensitive to IC50 values that were below twice the peak plasma concentration (120 microg/ml). Of the 21 patients, 10 had sensitivity to 5-FU and 11 had no sensitivity. The response rates were 90.0% and 9.1%, respectively. The median survival times were 38 months and 10 months in these groups, respectively, and 7 months in patients who received no chemotherapy. This finding indicates a significantly longer survival time in the sensitive group, compared with either the insensitive group or the no chemotherapy group (P = .0014 P = .0023). The cumulative survival rate was significantly higher in the sensitive group compared with the insensitive group (P = .0001) Ultimately, the group with sensitivity to 5-FU showed a significantly longer median survival time than the insensitive group.

Pathogen spectrum and correlative factors of nosocomial infection in patients with lung cancer

Lung cancer is one of the most common malignant tumors in China. Surgical resection is still the first choice of treatment for most lung cancer patients. The prognosis of lung cancer after surgical treatment is correlated to many factors. One of them is nosocomial infection. This study is to investigate the distribution of the pathogens causing nosocomial infection and its correlative factors in patients with lung cancer. One hundred and thirteen cases that had hospital-acquired infection out of 1227 surgically treated patients with lung cancer were analyzed statistically. Of all the pathogenic species, the most prevalent species were Gram-negative bacteria with average positive detection of 64.03% (299/467). The second were Gram-positive bacteria (145/467, 31.05%) and the third were fungi (23/467, 4.92%). The results of drug sensitivity tests showed that all of strains had higher resistance rate. The rate of extended spectrum β-lactamases (ESBLs) and meticillin-resistant Staphylococcus (MRS) was very high. The incidence of nosocomial infection was seriously correlated with age, fatness, long smoking history, complicated diseases such as diabetes, damaged renal function and using time of mechanical ventilation over 24 hours. The nosocomial infection of lung cancer patients after surgical treatment is seriously correlated with patient's age, fatness, long smoking history, complicated diseases such as diabetes, damaged renal function and using time of mechanical ventilation over 24 hours. More attentions should be paid to the pathogenic species and its correlative factors of nosocomial infection in lung cancer patients. The resistance of bacteria to the commonly used antibiotics is produced in various degrees. During clinical therapy with antibiotics, antibiotics should be selected according to the results of drug sensitivity tests. In order to reduce the production of drug-resistance, the appropriate use of antibiotics must be strengthened.

Miss-management in treatment failure of pulmonary tuberculosis

To investigate the risk factor of treatment failure of pulmonary tuberculosis excluding multi-drug resistant cases from the standpoint of both clinical management and tuberculosis control. Retrospective chart review of patients who admitted to Fukujuji Hospital for treatment failure of pulmonary tuberculosis excluding multi-drug resistant cases from Jan. 1993 to Dec. 2003. Out of 24 treatment failure cases available for analysis, 4 cases were associated with chronic tuberculous empyema with broncho-pleural fistula, and among them, chronic empyema was considered to be the main cause of treatment failure in one case. In 6 cases, poor adherence to medication was confirmed or suspected, and 2 of these 6 cases was also associated with miss-management. In 9 cases miss-management was found without poor adherence or chronic empyema, and in 8 out of these 9 cases, miss-management was considered to be the main cause of treatment failure. In 5 cases no apparent risk factor was found, but in 2 out of these 5 cases the ignorance of the results of drug sensitivity tests (and, therefore, miss-management) was strongly suspected. Summing up, in 10 out of 24 cases (41.7%), the miss-management was considered to be the main cause of treatment failure, and it was more frequently seen than poor adherence to medication. Clinicians should be aware of these risk factors of treatment failure such as chronic empyema, weak regimen in bacteriological negative cases, rifampicin+ethambutol regimen, and miss-management of drug adverse effect. From the standpoint of tuberculosis control in Japan we considered that, in addition to DOT, strategy to secure the quality of tuberculosis treatment is by all means needed.

Clinical Study of Pulmonary Tuberculosis for Admitted Patients at National Masan Tuberculosis Hospital

OBJECTIVE: Although the prevalence of pulmonary tuberculosis has decreased progressively after the national control program for tuberculosis began, nowadays the number of MDRTB is increasing seriously. MDRTB tends to be poor responsive to current antituberculosis regimens. It is mainly due to poor compliance, high rate of side reaction of secondary drugs, and limitation in number of available drugs. The purpose of present study is to evaluate the clinical features of pulmonary tuberculosis patients admitted in one national tuberculosis hospital and to expose the problems pertaining to current remedies, to increase the treatment efficacy for pulmonary tuberculosis including MDRTB in the end. METHOD: Retrospective analysis of 336 pulmonary tuberculosis patients admitted in National Masan Tuberculosis Hospital was done. Contents of analysis were patients profile, the first diagnosed time and medical institutes, family history, residence, previous treatment history, chief complaints at the time of admission, lesion site on chest X-ray film, combined deseases, side reaction to antibuberculosis drugs, used drugs before admission and the results of drug sensitivity test. RESULTS: The ratio between male and female was 4:1. Age showed relatively even distribution from 3rd to 6 th decades. 64.6% of the patients was diagnosed at public health center. Weight loss was the most common complaint at admission. Bilateral lesions on chest X-ray films were 59.8%. 1 30patients had combined desease, of which DM was the most common(37.7%). 95patients had family history, of which parents were the most common(41.7%). According to the time of first diagnosis, 31 patients were diagnosed before 1980, and after then the number of patients was increased by degrees Residence overwhelmed in pusan and gyung-nam province. 258 patients got previous treatment history, of which 112 patients(43.4%) had more than 3 times and only 133 patients(51.6%) got regular medication. 97 patients used more than other 3 drugs in addition to INH, EMB, RFP and PZA before admission. 154 patients were informed with the results of drug sensitivity test. of which 77 patients had resistance to more than 5 drugs. Gastrointestinal problem was the most common in side reaction to drugs. CONCLUSION: In the case of weigt loss of unknown cause, tuberculosis should be suspected. In first treatment, sufficient and satisfactory explanation for tuberculosis is necessary and treatment period should not be stict to 6 month-short term therapy. In retreatment, new drugs should not be added to used drugs enen though drug sensitivity restlts show sensitivity to some of them. Proper time for surgical intervention should not be delayed.

Analysis of Causes for Primary Treatment Failure of Pulmonary Tuberculosis

Background : Nowadays drug resistant tuberculosis is making problems in the treatment of pulmonary tuberculosis and its number is increasing. Several reasons for this are considered including irregular medication, poor drug compliance and wrong regimens. But there are treatment failure cases in spite of regular medication with short-term standard regimens. We reviewed clinical data of 50 patients to find out possible causes of this. Method : Subject of this study was 50 patients who failed in the primary treatment of pulmonary tuberculosis in spite of regular medication with short-term standard regimens. All of them were under treatment with secondary regimens in National Masan Tuberculosis Hospital on Oct 1996. The patient's records were analyzed retrospectively and direct interviews with patients were done. Results : There were relatively more patients in the age of 20th. Male overwhelmed in number. There were smoking in 22 patients and drinking in 24 patients during medication. 17(34%) patients had family history of tuberculosis. Public health center was the most common site for the initial diagnosis among medical institutes. 42 patients had subjective symptoms for pulmonary tuberculosis. 38 patients got sufficient explanation from medical institute about tuberculosis and medication courses. 24 patients had bilateral lesions on chest X-ray film and 43 patients had cavitary lesions. 29 patients had past history for pulmonary tuberculosis with regular medication. The results of drug sensitivity test showed resistance in 41 patients of whom we could get the results. Conclusion : Main cause of treatment failure of pulmonary tuberculosis in spite of regular medication with short-term standard regimens was drug resistance. Several factors were considered to be related to high prevalence of drug resistance, including age of 20th, male, family history for tuberculosis, bilateral lesions or remaining cavitary lesion on chest X-ray film.

Major enteropathogenic bacteria isolated from diarrheal patients in Bolivia: A hospital-based study.

A total of 1,234 fecal samples from diarrhea cases were examined for etiological bacterial agents at medical facilities in La Paz and Sucre, Bolivia. Eighty strains of Shigella spp., 39 strains of Salmonella spp., 29 strains of Vibrio cholerae, and 222 strains of enteropathogenic Escherichia coli (139 EPEC, 55 ETEC, 29 EIEC, and 1 EHEC) were isolated. With regard to the serovars of Shigella, S. flexneri 2a, 3a, and 1b were predominant. In the case of Salmonella, S. enteritidis was the most common, followed by S. typhi, S. poona, and S. paratyphi B. Out of 29 cholera strains, 25 belonged to biovar El Tor, serovar Ogawa while the remaining 4 were serovar Inaba. Among 55 strains of ETEC serotypes, 5 showed ST producers but none showed LT producers. Likewise, among 55 strains of enterohemorrhagic serotypes, only one strain (O157:H7) produced verocytotoxin (VT 2). The results of drug sensitivity tests revealed the predominance of Shigella, EPEC, and ETEC strains resistant to aminobenzil-penicillin (ABPC) and trimethoprim. Since diarrheal patients in Bolivia are treated mainly with ABPC or sulfamethoxazole/trimethoprim (SXT) and rarely with gentamicin, kanamycin, or other drugs, it is possible that ABPC- and SXT-resistant strains will increase and persist in the near future.

Clinical and Bacteriologic Characteristics of Retreated Tuberculosis Patients

Background: Although pulmonary tuberculosis is effectively controlled with 6 months or 9 months short course standard regimens, comparable numbers of treatment failures ensued because of inadequate treatment mainly due to patient's poor compliance. Indequate treatment with standard regimens during initial treatment may cause emergence of drug resistance and prolong the duration of chemotherapy. Also it may make the patient lesser compliant and finally increase the morbidity and the mortality. Methods: A clinical study was done to evaluate clinical and bacteriological characteristics of 94 patients who were retreated for pulmonary tuberculosis. Results: 1) 62 of the 94 patients were male and 32 patients were female. Mean age is 51 years old in male and 45 years old in female. 2) The extent of the disease on the chest radiograph was minimal in 10(11.1%) patients, moderate in 31(33.3%) patients, and far advanced in 52(55.6%) patients. 3) On sputum bacteriologic examination, 73(77.7%) patients were positive in sputum AFB smear and/or culture for Mycobacterium tuberculosis. 4) Results of drug sensitivity test performed in 42 patients showed that the resistance to one drug is in 9(20.5%) patients, two drugs in 18(40.8%) patients, and more than three drugs in 14(31.8%) patients. 5) Poor patient's compliance was the leading cause of the retreatment of pulmonary tuberculosis(43.6%) 6) Only 24(25.5%) patients of the 94 retreatment patients were successfully treated and 39(41.6%) patients were dropped out during follow-up. Conclusion: We concluded that poor patient's compliance was the most important cause of treatment failure not only in primary treatment patients but also in retreatment patients. Primary treatment of pulmonary tuberculosis should be completed under strict monitoring of the patient because significant number of retreatment patients had multiple drug resistance and poor outcome.

Drug sensitivity and expression of beta-lactamase in enterococci isolated at Okayama University Hospital

The following results were obtained from a study of Enterococci isolated at the Okayama University Hospital from 1990 to 1994. 1) The isolation frequency of Enterococci was about 6% for each year. 2) The percentage of Enterococcus faecalis (E. faecalis) among Enterococci decreased each year, but the percentage of Enterococcus faecium (E. faecium), and Enterococcus avium (E. avium) increased each year. 3) Results of drug sensitivity tests revealed that the incidence of ofloxacin (OFLX) resistant E. faecalis and E. avium increased each year. Also, the resistance of E. faecalis to ampicillin (ABPC), the primary medication choice for treating E. faecalis, increased each year. 4) A few vancomycin (VCM) non-sensitive Enterococci were isolated. These bacteria showed low-sensitivity toward ABPC, imipenem (IPM), gentamicin (GM), and OFLX, and the extent of multiple drug resistance increased each year. 5) One hundred strains of Enterococci were selected to examine the expression of beta-lactamase using the broth method and the iodine-starch method. However, beta-lactamase producing strains were not detected.

Prediction of Doxorubicin Resistance In Vitro in Myeloma, Lymphoma, and Breast Cancer by P-Glycoprotein Staining

Prior studies have shown that the P-glycoprotein is a cell membrane efflux pump that is quantitatively increased in expression in multidrug-resistant tumor cell lines. In this study, fresh tumor tissues from patients with multiple myeloma, malignant lymphoma, or metastatic breast cancer were studied immunohistochemically for P-glycoprotein expression and for in vitro sensitivity to doxorubicin. Twenty-six patients who were either previously untreated or in relapse after chemotherapy had tumor specimens submitted that could be evaluated in both assays. The testing was done independently and blindly in separate laboratories instead of our being provided relevant clinical data on the patients. Tumor cells from 12 of the 26 patients (46%) stained positively for P-glycoprotein. Fifteen of the 26 specimens (58%) exhibited drug resistance in vitro. Although only three (21%) of the 14 P-glycoprotein-negative tumors exhibited in vitro resistance to doxorubicin, all 12 fresh tumors that stained positively for P-glycoprotein were resistant to doxorubicin. The difference in frequency of intrinsic doxorubicin resistance between P-glycoprotein-negative and -positive tumors was highly significant (P less than .001). Similar trends were observed in each of the individual tumor categories and were statistically significant in myeloma and breast cancer. Four of the biopsy specimens that stained positively for P-glycoprotein and exhibited doxorubicin resistance were from patients who had not received prior cytotoxic chemotherapy. Similar conclusions were reached when results of drug sensitivity tests were ranked in relation to the median infective dose rather than by criteria based on correlations with clinical drug resistance. Our findings indicate that positive staining for P-glycoprotein associated with multidrug resistance predicts intrinsic cellular resistance of human cancers to doxorubicin. We anticipate that immunohistochemical staining for P-glycoprotein will prove useful in clinical oncology.

Long-term chemotherapy in the treatment of chronic pulmonary tuberculosis with cavitation

Long-term chemotherapy in the treatment of chronic pulmonary tuberculosis with cavitation