Use of the QuantiFERON-TB Gold test to confirm latent tuberculosis infection in a Canadian tuberculosis clinic

SETTING

Capital Health Tuberculosis (TB) Clinic, Edmonton, Alberta, Canada.

OBJECTIVE

To analyze the QuantiFERON-TB Gold In-Tube test (QFT) results after implementation as a routine test for tuberculin skin test (TST) positive patients.

DESIGN

From November 2004 until January 2007, patients who were TST-positive and were eligible for preventive treatment based on Canadian guidelines, were offered a QFT.

RESULTS

Of 1446 TST-positive patients, only 566 (39.6%) were QFT-positive. Categorized by reason for TST testing, 43.1% of 304 contacts, 32.8% of 348 employment screens and 24.2% of 298 post secondary school screens were QFT-positive. In contrast, 59.7% of 290 immigration screens were QFT-positive. A multivariate analysis found that QFT positivity was associated with older age, larger TST size, high-incidence TB region of birth, history of TB and chest X-ray findings suggestive of previous TB.

CONCLUSION

Implementation of the QFT as a secondary test for latent TB infection (LTBI) can significantly reduce the number of patients given LTBI treatment in a low-incidence country such as Canada.

Complications during the waiting period for carotid endarterectomy

We conducted a retrospective analysis to determine the number of cerebrovascular complications occurring in the period between initial presentation and operation in patients undergoing carotid endarterectomy. The notes of patients undergoing carotid endarterectomy during a 2-year period were used to quantify delays between initial presentation and surgery and complications occurring in this time period. A group of 49 patients was analyzed. The median time period between referral following initial cerebrovascular event and carotid endarterectomy was 62 days. During this time period 12 (24.5%) ischemic complications occurred including six transient ischemic attacks. Delays occurred at a variety of levels but included a median of 36 days before patients seen in the stroke clinic were referred to a surgeon and a median of 23 days before operation once patients had seen a surgeon. Significant delays still exist between initial presentation and carotid endarterectomy and can lead to further ischemic episodes prior to surgery.

Seroprevalence of tick-borne diseases among cattle in the Sudan

This study was carried out to determine the prevalence of Theileria annulata, Theileria mutans, Babesia bigemina, and Anaplasma marginale antibodies among cattle in the Sudan. A total of 600 serum samples were collected from indigenous (zebu) and crossbred cattle (zebu x Friesian) of both sex and different age groups. Indirect enzyme-linked immunosorbent assay was used to assess antibodies against tick-borne diseases in apparently healthy cattle. The overall prevalence rates of T. annulata, T. mutans, B. bigemina, and A. marginale antibodies were found to be 30.8%, 6.1%, 10.7%, and 38.9%, respectively. The highest seroprevalence of T. annulata was reported in Atbara and El Damer, Northern Sudan. There were no significant associations for the seroprevalence of all tick-borne diseases reported among different age groups. Although there were no significant differences between the two breeds of cattle examined for T. annulata, T. mutans, and B. bigemina antibodies, there was a significant difference for prevalence of antibodies against A. marginale, with highest percentages of antibodies in indigenous cattle. Six different combinations of mixed infection were detected. This is the first report in which antibodies against A. marginale among cattle in Northern Sudan is reported. The findings imply that antibodies to tick-borne infections are widely distributed in the region. The need for further investigations using more advanced techniques is recommended.

Ultrasound - first imaging modality in the detection of parathyroid adenomas

Abstract We present a series of 12 patients in whom the typical ultrasound features of parathyroid adenomas were accurately demonstrated. High resolution ultrasound [in experienced hands] is a highly sensitive accurate, safe and non invasive method of localizing parathyroid adenomas especially in patients with typically located glands and an absence of thyroid pathology. Our aim was to compare ultrasound with nuclear medicine as an imaging gold standard in patients with thyroid adenomas.

Youth exposure to smoking in the home and in cars: how often does it happen and what do youth think about it?

AIM

Little is known about what youth think about restricting smoking in their homes or in cars. The present study characterises the frequency of youth being exposed to smoking in their homes and cars, and the beliefs that youth have about restricting people from smoking around youth in those locations.

METHODS

Data from the 2004 Youth Smoking Survey (YSS) were used to examine youth exposure to smoking and beliefs about smoking in the home and car among 29,243 Canadian youth in grades 5-9. Logistic regression models were conducted to examine if being exposed to smoking at home or in the car were associated with the beliefs youth have about either smoking around children at home or smoking around children in cars.

RESULTS

In 2004, 23.1% of youth in grades 5-9 were exposed to smoking in their home on a daily or almost daily basis, 26.3% were exposed to smoking while travelling in a car at least once in the previous week. The majority of youth reported that they do not think smoking should be allowed around children at home (90.6%) or in cars (90.2%). Males were more likely than females to report that smoking should not be allowed around children at home (OR 1.38) or in cars (OR 1.39). Youth living in a house where someone smokes inside daily were more likely to report that smoking should not be allowed around children at home (OR 1.20) or in cars (OR 1.21). Youth living in a house where the rules do not prevent people from smoking inside were also more likely to report that smoking should not be allowed around children at home (OR 2.07) or in cars (OR 1.76). Youth who have ridden in a car with someone who was smoking cigarettes in the past 7 days were more likely to report that smoking should not be allowed around children in cars (OR 1.73).

CONCLUSIONS

It is common for Canadian youth to be exposed to SHS in their homes or while in cars on a frequent basis even though the vast majority of youth do not think smoking should be allowed around children in those locations. This new evidence suggests that programs and policies designed to prevent individuals from smoking around youth in these locations should be a public health priority.

Predictors of in-hospital mortality for intracerebral hemorrhage: a hospital-based study in Pakistani adults

INTRODUCTION

Intracerebral hemorrhages (ICHs) comprise 5% to 30% of all strokes with a case fatality rate of 30% to 50%. With an increasing elderly population, nontraumatic ICH is likely to present as a recurring medical emergency in Pakistan. There is scarce documentation in Pakistan regarding the predictors for mortality in patients with ICH that can guide physicians in their management. We conducted a hospital-based study to determine the predictors of in-hospital mortality from ICH in patients admitted to a tertiary care facility.

MATERIALS AND METHODS

We reviewed case records of patients above 17 years admitted to The Aga Khan University Hospital, Karachi, Pakistan, between July 1995 and December 1997, with the primary diagnosis of ICH confirmed on computed tomography scanning. Clinical and risk factors were also evaluated.

RESULTS

The data of 221 patients was analyzed. Seventy-one (32%) patients died during hospital stay, half of whom died during the first 2 days of hospitalization. Patients who died during hospital stay were more likely on admission to have intraventricular extension of the primary hemorrhage (odds ratio = 10.6, P < .01), a Glasgow Coma Score less than 12 on admission (odds ratio = 4.8, P < .01), and a systolic blood pressure greater than or equal to 180 mm Hg (odds ratio = 2.7, P = .03).

CONCLUSIONS

Our study suggests that Glasgow Coma Score and intraventricular extension are predictors of acute mortality, consistent with published results. Elevated systolic blood pressure at admission, also found to be a predictor of acute mortality from ICH, may be explained alternatively by internal and external stroke-induced stress factors. The actual mechanisms for high admission systolic blood pressure remain unclear.

P-glycoprotein expression is associated with sestamibi washout in primary hyperparathyroidism

Background

The detection of parathyroid adenomas by 99mTc-labelled hexakis 2-methoxyisobutyl isonitrile (sestamibi) scintigraphy is influenced by several factors, including tumour size and serum level of parathyroid hormone (PTH). This study examined the relationship between sestamibi accumulation and multidrug resistance (MDR)-related P-glycoprotein (P-gp) expression in a large series of surgically excised parathyroid tumours.

Methods

Seventy-eight patients underwent dual-phase sestamibi imaging before parathyroidectomy. Expression of P-gp within tumour cells was assessed by immunohistochemistry. Tumour size was measured and the ellipsoid volume calculated. Scan results were analysed in relation to preoperative serum levels of calcium and PTH, P-gp expression and tumour volume.

Results

Sixty-four of the 78 sestamibi scans were positive and 14 negative. Smaller adenomas (less than 0·5 cm3) were more likely to be sestamibi negative than larger lesions (P = 0·006). Ten of 14 adenomas with negative imaging showed strong P-gp membrane positivity and 45 of 64 lesions with a positive scan did not show P-gp membrane expression, indicating a significant association between high P-gp membrane immunoreactivity and negative sestamibi result (P = 0·006).

Conclusion

These data suggest an association between P-gp membrane expression and false-negative sestamibi scan result. Inhibition of the P-gp transmembrane pump using MDR modulators may therefore improve the sensitivity of sestamibi scintigraphy.

Occurrence and characterization of Salmonella from chicken nuggets, strips, and pelleted broiler feed

Raw, frozen chicken nuggets and strips have been identified as a significant risk factor in contracting foodborne salmonellosis. Cases of salmonellosis as a result of consuming partly cooked chicken nuggets may be due in part to Salmonella strains originating in broiler feed. This study was undertaken to determine the occurrence and characterize the strains of Salmonella contaminating chicken nuggets, strips, and pelleted feeds, in an attempt to demonstrate whether the same Salmonella strains present in broiler feed could be isolated from raw, frozen chicken nuggets and strips available for human consumption. Salmonellae were recovered using the Health Canada MFHPB-20 method for the isolation and identification of Salmonella from foods. Strains were characterized by serotyping, phage typing, antimicrobial resistance typing (R-typing), and by pulsed-field gel electrophoresis (PFGE). Salmonellae were isolated from 25-g samples in 27% (n=92) of nugget and strip samples, 95% (n=20) of chicken nugget meat samples, and from 9% (n=111) of pelleted feed samples. Salmonella Heidelberg, Salmonella Enteritidis, and Salmonella Orion were the most commonly isolated serovars from chicken nuggets and strips, nugget and strip meat, and pelleted broiler feeds, respectively. Salmonella Enteritidis phage type (PT) 13a with PFGE pattern SENXAI.0006 and R-type sensitive as well as Salmonella Enteritidis PT13a with PFGE pattern SENXAI.0068 and R-type sensitive were isolated from pelleted feed, and chicken nugget and strip meat in two separate instances. Data showed that Salmonella strains isolated from broiler feed were indistinguishable from strains isolated from packaged raw, frozen chicken nuggets and strips. However, results did not rule out the possibility that breeding stock or contamination during processing may have contributed to chicken meat contamination by Salmonella.

First subject evaluated with simulated BION treatment in genioglossus to prevent obstructive sleep apnea

We are using percutaneous electrical stimulation to simulate BION activation of posterior genioglossus during sleep to prevent occurrences of obstructive sleep apnea (OSA). Patients with OSA due to tongue prolapse are recruited in this ongoing clinical study for an overnight session in a sleep laboratory. Bipolar hooked wires are inserted percutaneously into the tongue muscle, from under the chin at midline, and used for neuromuscular stimulation. Data are collected with polysomnography and analyzed to compare the efficacy of proposed treatment to conventional CPAP or the untreated state. Encouraging preliminary results from the first study participant are described.

Staphylococcus aureus bacteremia in patients receiving pegylated interferon-alpha and ribavirin for chronic hepatitis C virus infection

Bacteremia has rarely been reported in patients receiving treatment for hepatitis C virus (HCV) infection. We describe the features and investigation of four cases of Staphylococcus aureus bacteremia occurring between 3 November 2004 and 10 January 2005 in patients on therapy for chronic HCV infection. The unusual occurrence of S. aureus bacteremia in a series of patients led to an epidemiologic investigation and molecular typing methods were employed to assess the relatedness of cases. The mean time of bacteremia onset was week 10 of HCV treatment. No patient had neutropenia previously. The average duration of bacteremia was 2.6 days and complications included acute renal failure (2/4), disseminated intravascular coagulopathy (DIC) with sepsis syndrome (1/4), septic arthritis (1/4), spinal epidural abscess (1/4) and endocarditis (1/4). Two patients were in the same weight class for dosing, but no other epidemiologic links were found. One patient admitted to intravenous drug use (IVDU) and a second was suspected of IVDU. The two other patients were cirrhotic, but had no further identifiable risk factors. All bacterial isolates were methicillin-susceptible. By pulsed-field gel electrophoresis, two cases were found to have identical bacterial strains. However, fluorescent-based amplified fragment-length polymorphism analysis demonstrated distinct band patterns in all four cases. The epidemiologic data and molecular analysis of this cluster of S. aureus bacteremia cases among patients receiving combination therapy for treatment of chronic HCV infection suggest that these cases were not related. Additionally, IVDU and cirrhosis, but not neutropenia, are identified as potential risk factors for this uncommon complication of HCV therapy.

Neuroprotection of the nigrostriatal dopaminergic neurons by melatonin in hemiparkinsonium rat

BACKGROUND & OBJECTIVES

Several lines of evidence point to a significant role of antioxidants in Parkinson's disease (PD). Few studies report that melatonin, a neurohormone, is one of the best physiological antioxidants. Review of literature indicates that none of the drugs so far studied for preventing the PD was found to be promising for use. Therefore in the present study the effect of neuroprotectory melatonin was tested against 6-hydroxydopamine (6-OHDA) neurotoxicity for striatal dopaminergic neurons in the rat.

METHODS

Thirty animals were randomly divided into two groups. Animals of group 1 received saline (melatonin vehicle) daily 1 ml ip for seven days. Melatonin (500 mug/kg body weight dissolved in 1 ml saline ip) was administered in rats of group 2 for seven days. Then all animals of groups 1 and 2 were lesioned unilaterally with 8 mug 6-OHDA into the lateral striatum on 8(th) day. Various behaviour and histological tests were used to evaluate the neuroprotective effect of melatonin.

RESULTS

Statistically significant difference in various behaviour tests was found between post lesion values of group 1 and group 2 (P<0.001 in apomorphine-induced rotational behaviour, staircase test (success rate), disengage time and P<0.05 in stepping test, initiation time, postural balance test).

INTERPRETATION & CONCLUSION

Our results demonstrated that melatonin acted as an effective neuroprotective agent for striatal dopaminergic neurons in 6-OHDA lesioned rat model of Parkinson's disease.

Arsenic trioxide for treatment of myelodysplastic syndrome: An experience from India

13156

Background: Myelodysplastic Syndrome (MDS) is a heterogeneous group of clonal diseases of the haematopoietic stem cells. The hallmark of the disease is ineffective haematopoiesis characterized by dysplasia with incomplete maturation and progressive increase in the percentage of myeloblast. No standard treatment is currently available for MDS. The early clinical experience has confirmed the activity of arsenic trioxide in MDS. The drug is able to induce differentiation and apoptosis and to inhibit cell proliferation or angiogenesis. It has the potential to be active in tumour models in MDS. The preliminary result of ongoing studies conducted in patients with MDS suggests that arsenic trioxide produces haematological improvement including durable transfusion independence in 30% of patients. The aim of our study was to see the response of MDS with arsenic trioxide and to see the toxicity profile of arsenic trioxide in Asian Indian population. Methods: During period from July 2005 to December 2005 we selected consecutive 10 patients of MDS in Refractory Anaemia, Refractory anaemia with ringed sideroblasts, Refractory anaemia with blast excess, Refractory anaemia with blast excess in transformations and chronic myelo monocytic leukemia phases. All patients had performance status more than 60%, some karyotypic abnormalities & in cytopenic phase. Median age of the patients 65 years (range 42 to 70 years). All patients were treated with arsenic trioxide 10mg (Alkem/India) daily for 2 hours infusion 28 days. In 15 days interval 3 courses were repeated. Response assessments were done by haematological, cytogenetic & quality of life assessment. All patients were evaluated after 3 courses of arsenic trioxide. Result: Sixty percent (6 patients) patients had shown major haematological response, forty percent minor & twenty percent has major cytogenetic response. Twenty percent of the patients has disease progression where as 20% has stable disease. The only mild adverse effects were seen in forms of nausea, vomiting, diarrhea, abdominal pain & dermatitis in 30% of patients. Only one patient (10%) had QT prolongation in ECG. Conclusion: We concluded that arsenic trioxide is very useful drug in myelodysplastic syndrome. It is also well tolerated in Asian Indian Population.

No significant financial relationships to disclose.

Assessment of nutrition in cancer patients and its effect on treatment outcome—A study from a developing country

6125

Background: In developing countries one-third of the people suffer from mal-nutrition. It has been shown that a good nutritional status can reduce complications of treatment, strengthen the immune system and contribute to the patient’s general well being throughout treatment. A good nutritional status is therefore essential for optimal treatment of a cancer patient. The aim of our study was to see the nutritional status of cancer patients on diagnosis and effect of nutrition on outcome of therapy. Methods: In this study we prospectively analyzed the nutritional status of 500 cancer patients in Netaji Subhash Chandra Bose Cancer Research Institute, a tertiary cancer center of eastern India during period from January 2004 to December 2005. The age range of the patients was 19 years to 74 years (median age 46 years). The parameter analyzed were weight for age, total protein, serum albumin and mid arm circumference. The weight for age and mid arm circumference were taken as normal if they were between 3rd and 97th percentile curve of the growth chart recommended by the Indian Council of Medical Research. The albumin level and the total protein were considered normal if the value is equal to or more than 3gm% and 5.8gm%. Result: It was seen that total 120 patients (24%) were low weight for age and 100 patients (20%) had low mid arm circumference. Total 90 patients (18%) had low serum albumin while 130 patients (26%) were low serum protein. Low weight for age, low serum albumin and low mid arm circumference were significant factors in disease free survival and toxicity of chemotherapy (p value < .001) Conclusion: We conclude that mal-nutrition is a major finding in cancer patients in developing country like ours. The patient with mal-nutrition had less disease free survival and more toxicities during therapy as compared to well-nourished patients.

No significant financial relationships to disclose.

Effect of wheat grass juice in supportive care of terminally ill cancer patients— A tertiary cancer centre experience from India

8634

Background: The solid content of juice made from wheat grass is 70% chlorophyll. Chlorophyll is often referred to as “The blood of plant life” and has almost the same chemical structure as haemoglobin. Chlorophyll cleanses the blood by improving the supply of oxygen to the circulatory system. Wheat grass is also a complete protein with about 30 enzymes, vitamins & minerals. Wheat grass juice has been proven over many years to benefit people in numerous ways, building the blood, restoring balance in the body, removing toxic metals from the cells, nourishing the liver & kidneys and restoring vitality. The aim of our study was to see the effect of wheat grass juice in terminally ill cancer patients to improve the quality of life. Methods: During period from January 2003 to December 2005 we selected 400 solid organ cancer patients in our palliative care unit of Netaji Subhash Chandra Bose Cancer Research Institute to see the effect of wheat grass on improvement of haemoglobin level, serum protein & performance status on terminally ill cancer patients. The age range of the patients was 22 year to 87 year (median age 42 years). The different types of cancers were Lung (25%), Breast (20%), Oesophagaus (11%), Colon (9%), Ovary (8%), Hepatocellular carcinoma (6%), Stomach (6%) and others (15%) respectively. We cultivated wheat grass in our campus. When the grasses were 5 days old we took the fresh leaves including roots and made fresh juice out of that and had given 30ml of juice to all our 400 cancer patients for continuous 6 months. Result: The mean levels of haemoglobin, Serum total protein, albumin and performance status were 8gm%, 5.4gm%, 2.2gm% and 50%. Fifty patients required transfusion support & those patients were excluded from the study. Other 348 patients are evaluated 6 months after giving wheat grass juice. The mean values for haemoglobin, total protein & albumin were improved significantly (pvalue < .005) and were observed mean of 9.6gm%, 7.4gm% and 3.1gm%. White blood cell & platelet count were same in both the cases. The performance status was improved from 50% to 70% (Karnofsky) after wheat grass treatment. Conclusion: We concluded that wheat grass juice is an effective alternative of blood transfusion. Its use in terminally ill cancer patients should be encouraged.

No significant financial relationships to disclose.

Frozen chicken nuggets and strips and eggs are leading risk factors for Salmonella Heidelberg infections in Canada

A case-control study was conducted from 1 January to 31 May 2003 to identify risk factors for S . Heidelberg infection in Canada. Controls were pair-matched by age group and telephone exchange to 95 cases. Exposures in the 7 days before illness/interview were assessed using multivariate conditional logistic regression. Consumption of home-prepared chicken nuggets and/or strips [matched odds ratio (mOR) 4.0, 95% confidence interval (CI) 1.4-13.8], and undercooked eggs (mOR 7.5, 95% CI 1.5-75.5) increased the risk of illness. Exposure to a farm setting lowered the risk (mOR 0.22, 95% CI 0.03-1.00). The population-attributable fraction associated with chicken nuggets/strips was 34% and with undercooked eggs was 16%. One-third of study participants did not perceive, handle or prepare chicken nuggets and strips as high-risk products, although the majority of the products on the Canadian market are raw. These findings have prompted changes in product-labelling policy and consumer education.

Effect of fluoxetine and cocaine on the expression of clock genes in the mouse hippocampus and striatum

Long-term drug-induced alterations in CNS gene expression may be responsible for some therapeutic effects, such as antidepressant action, as well as for psychopathological conditions, such as drug addiction and abuse. Transcription factors called "clock" genes can be affected by psychotropic drugs and may modify the expression pattern of other genes. In this study in mice, we investigated the delayed effects of single and repeated (i.e. 14 days) administration of the antidepressant fluoxetine and the psychostimulant cocaine on the brain expression of clock genes Period1, Period2, Period3, Clock, Bmal1, Cryptochrome1, Cryptochrome2, and NPAS2 (neuronal PAS domain protein 2), and their putative target gene, serotonin N-acetyltransferase. Mice were treated at ZT05 (lights on at 5:00 am; ZT00). Brain samples (i.e. hippocampus, striatum, and prefrontal cortex) were processed for a semi-quantitative mRNA assay. Repeated but not single treatment with either drug increased serotonin N-acetyltransferase expression in all areas tested. On the other hand, the expression of clock genes was differentially affected depending on the drug (i.e. fluoxetine and cocaine), treatment schedule (i.e. single and repeated), and brain area (i.e. hippocampus and striatum) tested. More pronounced changes were induced by repeated rather than single administrations of fluoxetine or cocaine. We propose that the effects of psychoactive drugs on clock transcription factors may mediate long-term drug-induced changes, possibly by regulating the expression of a second set of genes (i.e. clock-controlled genes).

Conservation of the N-terminus of some phage tail proteins

To study the interaction between lipopolysaccharide and protein, a comparative approach was employed using seven Salmonella enterica serovar Typhimurium typing phages as the protein model systems. This interaction has been studied in detail in the Salmonella enterica serovar Typhimurium phage P22 system and involves only the viral tailspike protein. Similarity between these phages and phage P22 was monitored in this Report by assaying restriction endonuclease digestions, capsid size, reactivity to the P22 tailspike protein monoclonal antibody, mAb92, which reacts with the N-terminus of the P22 tail protein and the ability to produce a PCR fragment using primers made to the ends of the P22 tailspike gene. The data indicate that tailspike similarity exists between most of these phages and a scheme reclassifying them is presented and that the N-terminus of the P22 tailspike protein may be a motif for many phage systems and may serve as a aid in the taxonomy of phages. The data suggest a classification scheme in which the N-terminus of some tailspike proteins (head-binding region in some tail proteins) may play a critical element role in the classification of Salmonella viruses.