Psychological well-being in Iraq and Afghanistan veterans: Risk and protective factors

OBJECTIVE

Much research on military veterans has focused on posttraumatic stress disorder (PTSD) and other negative outcomes, with few studies of positive outcomes. This study focused on psychological well-being (PWB) in relation to PTSD symptoms and the additional risk factors of sleep problems and depression, as well as a protective factor, self-regulation.

METHOD

Two hundred thirty-eight student veterans completed questionnaires online, with 115 completing follow-up questionnaires 2 months later.

RESULTS

Path analyses revealed significant associations of PWB with depression and self-regulation in expected directions within and across time points. Links of overall PWB with PTSD and sleep were mostly small and nonsignificant, but some differences were found for distinct domains of PWB. Finally, a significant interaction revealed that the negative association of baseline PTSD with 2-month PWB grew stronger as levels of self-regulation increased.

CONCLUSIONS

This finding may indicate that higher scores on our measure of self-regulation reflected emotional overcontrol and rigidity, but further research that attempts to replicate these findings is needed. Overall, findings support the need for examining a broader set of risk and protective factors predictive of outcomes in veterans who served during the recent era of wars in Iraq and Afghanistan. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Meaningfulness of service and marital satisfaction in Army couples

The vast numbers of military service members who have been deployed since 2001 highlights the need to better understand relationships of military couples. A unique consideration in military couples is the concept of meaningfulness of service, or the value service members and their partners place on military service in spite of the sacrifices it requires. In a sample of 606 Army couples, the authors used path analysis to examine how male service members' and female spouses' perceived meaningfulness of service added to the prediction of marital satisfaction in both members of the couple, when accounting for service members' PTSD symptoms. Spouses' perceived meaningfulness of service was linked with higher marital satisfaction in spouses, regardless of service member's perceived meaningfulness of service. Service members' perceived meaningfulness of service was also associated with increased marital satisfaction in service members, but only when their spouses also perceived higher meaningfulness. There were no significant interactions between service members' PTSD and either partner's perceived meaningfulness. Implications for enhanced attention to spousal perceptions of meaningfulness of service are discussed.

Clinical Evaluation of the Gen-Probe amplified mycobacterium tuberculosis direct test for rapid detection of Mycobacterium tuberculosis in select nonrespiratory specimens

The performance of the Amplified Mycobacterium Tuberculosis Direct Test (MTD; Gen-Probe, Inc., San Diego, Calif.) for rapid diagnosis of extrapulmonary tuberculosis was evaluated by testing 178 nonrespiratory specimens from 158 patients. Criteria for specimen inclusion were (i) a positive smear for acid-fast bacilli (n = 54) and (ii) the source if the smear was negative (tissue biopsies and aspirates and abscess material were tested; n = 124). Results were compared to those of mycobacterial culture; clinical history was reviewed when MTD and culture results disagreed. Forty-eight specimens (27.0%) were positive for mycobacteria, including 23 Mycobacterium tuberculosis complex specimens; of which 21 were smear positive. Twenty-five specimens were MTD positive; 20 of these grew M. tuberculosis complex. All of the five MTD-positive, M. tuberculosis complex culture-negative specimens were considered truly positive, based on review of the medical record. Of the three MTD-negative, M. tuberculosis complex culture-positive specimens, two contained inhibitory substances; one of the two was smear positive. Excluding the latter specimen from analysis, after chart review, the sensitivity, specificity, and positive and negative predictive values of the MTD were 92.6, 100, 100, and 98.7%, respectively, by specimen and 89.5, 100, 100, and 98.6% by patient. Given the few smear-negative samples from patients with extrapulmonary tuberculosis in our study, additional similar studies that include more smear-negative, M. tuberculosis complex culture-positive specimens to confirm our data are desirable.

Thrombin peptide, TP508, stimulates angiogenic responses in animal models of dermal wound healing, in chick chorioallantoic membranes, and in cultured human aortic and microvascular endothelial cells

The alpha-thrombin peptide, TP508, accelerates the healing of full-thickness wounds in both normal and ischemic skin. In wounds treated with TP508, a pattern of increased vascularization is consistently observed both grossly and microscopically when compared to wounds treated with saline. One possible mechanism by which the peptide accelerates wound healing is by promoting revascularization of granulation tissue at the injured site. To evaluate the angiogenic potential of TP508, the peptide was tested in the chick embryo chorioallantoic membrane (CAM), where it increased the density and size of CAM blood vessels relative to controls. Additionally, TP508 stimulated chemokinesis and chemotaxis in a dose-dependent fashion in cultured human aortic and human microvascular endothelial cells. Taken together, these in vivo and in vitro data support an angiogenic role for TP508 in wound healing. A working model is presented to explain how this 23-amino-acid peptide, which lacks proteolytic activity, is generated during wound healing and contributes to the nonproteolytic functions associated with alpha-thrombin during tissue repair.

Clinical evaluation of the BDProbeTec ET system for rapid detection of Mycobacterium tuberculosis

The performance of the BDProbeTec ET system (BD Biosciences, Sparks, Md.) for direct detection of Mycobacterium tuberculosis complex (MTBC) in respiratory specimens was evaluated by comparing results to those of conventional mycobacterial culture performed with the BACTEC 460 TB system and Middlebrook 7H11 biplates. Patients known to have been on antituberculous therapy were excluded from the analysis. Of 600 evaluable specimens (4 specimens were excluded from the analysis due to failure of the internal amplification control [IAC]) from 332 patients, 57 grew mycobacteria; 16 were MTBC (from 12 patients), and 41 were nontuberculous mycobacteria. Of the 16 MTBC culture-positive specimens, 12 were smear positive and 4 were smear negative. BDProbeTec ET detected 14 of the 16 MTBC culture-positive specimens, resulting in initial overall sensitivity, specificity, and positive and negative predictive values of 87.5, 99.0, 70.0, and 99.7%, respectively. After resolution of discrepancies by review of medical records and retesting of samples yielding discordant MTBC culture and BDProbeTec ET results, the revised overall sensitivity, specificity, and positive and negative predictive values of the BDProbeTec ET were respectively 93.8, 99.8, 93.8, and 99.8% by specimen and 91.7, 99.7, 91.7, and 99.7% by patient. The BDProbeTec ET System offers the distinct advantage of including an IAC in the specimen well. These data suggest that the test performance is very good, especially for smear-positive samples. However, the number of patients with tuberculosis in our study, especially those with smear-negative disease, was small; therefore, additional studies are needed.

Multisite reproducibility of Etest for susceptibility testing of Mycobacterium abscessus, Mycobacterium chelonae, and Mycobacterium fortuitum

A multicenter study was conducted to assess the inter- and intralaboratory reproducibility of the Etest for susceptibility testing of the rapidly growing mycobacteria. The accuracy also was evaluated by comparing Etest results to those obtained by broth microdilution. Ten isolates (four of the Mycobacterium fortuitum group, three of Mycobacterium abscessus, and three of Mycobacterium chelonae) were tested against amikacin, cefoxitin, ciprofloxacin, clarithromycin, doxycycline, imipenem, and trimethoprim-sulfamethoxazole in each of four laboratories. At each site, isolates were tested three times on each of three separate days (nine testing events per isolate) using common lots of media and Etest strips. Interlaboratory agreement among MICs (i.e., mode +/- 1 twofold dilution) varied for the different drug-isolate combinations and overall was best for trimethoprim-sulfamethoxazole (75% for one isolate and 100% for all others), followed by doxycycline and ciprofloxacin. Interlaboratory agreement based on interpretive category also varied and overall was best for doxycycline (100% for all isolates), followed by trimethoprim-sulfamethoxazole and ciprofloxacin. Interlaboratory reproducibility among MICs was most variable for imipenem, and agreement by interpretive category was lowest for imipenem and amikacin. Modal Etest MICs agreed with those by broth microdilution only for doxycycline and the sulfonamides. For all other drugs, the modal MICs by the two methods differed by more than +/- 1 twofold dilution for one or more isolates. In all cases, the Etest MIC was higher and would have caused reports of false resistance. In summary, the Etest in this evaluation did not perform as well as broth microdilution for susceptibility testing of the rapidly growing mycobacteria. It was problematic for most species and drugs, primarily because of a trailing endpoint and/or high MICs compared to broth. Its use will necessitate further investigation, including determination of the optimal medium and incubation conditions and clarification of endpoint interpretation.

Evaluation of the BBL MGIT (Mycobacterial growth indicator tube) AST SIRE system for antimycobacterial susceptibility testing of Mycobacterium tuberculosis to 4 primary antituberculous drugs

OBJECTIVE

To evaluate the performance of the BBL MGIT (Mycobacterial Growth Indicator Tube) AST SIRE system for the antimycobacterial susceptibility testing of Mycobacterium tuberculosis to isoniazid (at a concentration equivalent to the lower concentration used for testing by the method of proportion), rifampin, ethambutol, and streptomycin.

DESIGN

Thirty-one clinical isolates and 30 challenge strains provided by the Centers for Disease Control and Prevention (CDC) were tested by MGIT AST SIRE using 2 methods of inoculum preparation, and results were compared with those of the method of proportion, which was considered the reference method. Clinical isolates for which the results of the 2 methods were discordant also were tested at 2 reference laboratories.

RESULTS

Based on data from our site and the reference laboratories, agreement rates between initial MGIT AST SIRE results and the method of proportion for the clinical isolates with the inoculum prepared from a McFarland equivalent and from a positive MGIT tube, respectively, were 100% and 96.8% for isoniazid, 100% and 100% for rifampin, 96.8% and 100% for ethambutol, and 100% and 100% for streptomycin, excluding the isolate for which the discordant streptomycin result could not be resolved. For the 30 challenge isolates, agreement rates between MGIT AST SIRE and expected results and between method of proportion and expected results, respectively, were 96.7% and 93.3% for isoniazid, 93.3% and 100% for rifampin, 83. 3% and 100% for ethambutol, and 93.3% and 100% for streptomycin. For the clinical isolates, the mean time to an MGIT AST SIRE result of susceptible was 6.15 +/- 0.13 days (range, 5-8 days). For a result of resistant, the mean time overall was 5.00 +/- 0.24 days (range, 3-8 days).

CONCLUSION

These data suggest that the MGIT AST SIRE system, using either method of inoculum preparation, is an acceptable alternative to the BACTEC 460 TB method of susceptibility testing of clinical isolates of M tuberculosis to isoniazid, rifampin, ethambutol, and streptomycin. Reasons for the lower agreement with the CDC challenge isolates should be investigated. Further evaluation of the MGIT AST SIRE system using a concentration of isoniazid equivalent to the higher concentration tested by the method of proportion would be useful, because the decision concerning use of this agent generally is based on the susceptibility test result at the higher concentration.

Evaluation of the enhanced amplified Mycobacterium tuberculosis direct test for direct detection of Mycobacterium tuberculosis complex in respiratory specimens

OBJECTIVE

To evaluate the performance of the enhanced Mycobacterium Tuberculosis Direct Test (E-MTD), for the direct detection of M tuberculosis complex (MTBC) in respiratory specimens.

DESIGN

Two hundred seventy-four respiratory specimens from 151 patients in respiratory isolation were tested with the E-MTD, and the results were compared with the results of mycobacterial smear, culture, and the earlier form of the test, MTD-1.

RESULTS

Forty-one specimens were culture positive for mycobacteria (20 MTBC and 21 nontuberculous mycobacteria), 23 of which were smear positive (16 MTBC, 7 nontuberculous mycobacteria). Twenty-four specimens were positive by E-MTD, and 21 were positive by MTD-1. Of the 20 MTBC culture-positive specimens, 19 were positive by the E-MTD and 19 were positive by the MTD-1. The remaining specimens were MTBC negative by all methods. After resolution of discrepancies, the sensitivity, specificity, and positive and negative predictive values were 95.2%, 100%, 100%, 99.6% for the MTD-1 and 95.2%, 98.8%, 87.0%, and 99.6%, for the E-MTD. For the E-MTD smear-positive and smear-negative specimens, these same values were 93.8%, 100%, 100%, and 87.5% and 100%, 98.8%, 62.5%, and 100%, respectively.

CONCLUSION

The results suggest that the E-MTD is a reliable method for the direct detection of MTBC in smear-positive respiratory specimens.

Enhanced mycobacterium tuberculosis direct test for detection of M. tuberculosis complex in positive ESP II broth cultures of nonrespiratory specimens

The reliability of the Gen-Probe enhanced Mycobacterium Tuberculosis Direct Test (E-MTD) for identification of M. tuberculosis complex (MTBC) in ESP II broth cultures of nonrespiratory specimens was evaluated by testing aliquots from 262 signal-positive bottles. Cultures of blood were excluded from analysis because of the high rate (13/18 [72.2%]) of equivocal results for aliquots from cultures that were negative for MTBC. E-MTD results were compared to those obtained by usual laboratory protocol, whereby MTBC was identified by DNA probe (Gen-Probe, Inc.), testing colonies on a solid medium. For the first 112 cultures, from which 34 mycobacteria (including 8 MTBC) were recovered, both fresh and frozen aliquots were tested. E-MTD results on both fresh and frozen aliquots agreed with identification by usual protocol in all cases; so for the remaining 150 cultures, only frozen aliquots were tested. Of the total 262 ESP II cultures (158 patients) evaluated, 60 (22.9%) grew mycobacteria, including 17 MTBC. Of these 17 aliquots, 16 were E-MTD positive, as was one culture that was negative for mycobacteria. The latter culture was from a patient who had a specimen collected the following day from which MTBC was isolated; therefore, the E-MTD result was considered a true positive. Sensitivity, specificity, and positive and negative predictive values of E-MTD were 94.1, 100, 100, and 99.6%, respectively. The mean times (+/- SEM) from specimen receipt to identification of MTBC were 17 (+/- 2) days (range, 5-30 days) for ESP II plus E-MTD and 19 (+/- 1) days (range, 6-28 days) for the usual protocol (Student's t test, P, not significant). These data indicate that the performance of E-MTD for identification of MTBC in fresh or frozen aliquots of broth from positive ESP II cultures of nonrespiratory specimens, excluding blood, is excellent. However, because the E-MTD did not significantly reduce time to identification of MTBC in these cultures, limiting testing to those types of specimens most likely to yield MTBC is reasonable.

Enhanced Amplified Mycobacterium Tuberculosis Direct Test for detection of Mycobacterium tuberculosis complex in positive BACTEC 12B broth cultures of respiratory specimens

The reliability of the Gen-Probe enhanced Amplified Mycobacterium Tuberculosis Direct Test (MTD) for identification of Mycobacterium tuberculosis complex (MTBC) in BACTEC 12B broth cultures of respiratory specimens was evaluated by testing aliquots from 268 bottles with a growth index of >/=50. MTD results were compared to those obtained by usual laboratory protocol, whereby MTBC was identified by DNA probe (Gen-Probe, Inc.) testing sediment from broth samples or colonies on a solid medium. For the first 134 cultures, from which 68 mycobacterial isolates (including 27 MTBC isolates) were recovered, both fresh and frozen aliquots were tested. MTD results for the frozen aliquots agreed with the identification by usual protocol in all cases, whereas there was one false-negative MTD result with fresh aliquots. For the remaining 134 cultures, only frozen aliquots were tested. Of the total 268 broth cultures (from 210 patients) evaluated, 137 (51.1%) grew mycobacteria, including 60 MTBC isolates. All 60 isolates were MTD positive, as was one additional culture that grew Mycobacterium gordonae. The latter culture was from a patient who was diagnosed with tuberculosis a few months earlier and was on therapy; therefore, the MTD result was considered a true positive. Sensitivity, specificity, and positive and negative predictive values of MTD were 100%. The mean times from specimen receipt to identification of MTBC were 15 (+/-1) days (range, 4 to 27 days) for BACTEC plus MTD and 19 (+/-1) days (range, 6 to 36 days) for the usual protocol (P < 0.001). These data indicate that the MTD is a rapid, reliable method for identification of MTBC in fresh or frozen aliquots of broth from positive BACTEC 12B cultures of respiratory specimens.

Multisite reproducibility of results obtained by the broth microdilution method for susceptibility testing of Mycobacterium abscessus, Mycobacterium chelonae, and Mycobacterium fortuitum

A multicenter study was conducted to assess the interlaboratory reproducibility of broth microdilution testing of the more common rapidly growing pathogenic mycobacteria. Ten isolates (four Mycobacterium fortuitum group, three Mycobacterium abscessus, and three Mycobacterium chelonae isolates) were tested against amikacin, cefoxitin, ciprofloxacin, clarithromycin, doxycycline, imipenem, sulfamethoxazole, and tobramycin (M. chelonae only) in four laboratories. At each site, isolates were tested three times on each of three separate days (nine testing events per isolate) with a common lot of microdilution trays. Agreement among MICs (i.e., mode +/- 1 twofold dilution) varied considerably for the different drug-isolate combinations and overall was best for cefoxitin (91.7 and 97.2% for one isolate each and 100% for all others), followed by doxycycline, amikacin, and ciprofloxacin. Agreement based on the interpretive category, using currently suggested breakpoints, also varied and overall was best for doxycycline (97.2% for one isolate and 100% for the rest), followed by ciprofloxacin and clarithromycin. Reproducibility among MICs and agreement by interpretive category was most variable for imipenem. Based on results reported from the individual sites, it appears that inexperience contributed significantly to the wide range of MICs of several drugs, especially clarithromycin, ciprofloxacin, and sulfamethoxazole. New interpretive guidelines are presented for the testing of M. fortuitum against clarithromycin; M. abscessus and M. chelonae against the aminoglycosides; and all three species against cefoxitin, doxycycline, and imipenem.

Clinical evaluation of the enhanced Gen-Probe Amplified Mycobacterium Tuberculosis Direct Test for rapid diagnosis of tuberculosis in prison inmates

The reliability of the enhanced Amplified Mycobacterium Tuberculosis Direct Test (E-MTD; Gen-Probe, Inc., San Diego, Calif.) for rapid diagnosis of pulmonary tuberculosis (TB) was evaluated by testing 1, 004 respiratory specimens from 489 Texas prison inmates. Results were compared to those of mycobacterial culture (BACTEC TB 460 and Middlebrook 7H11 biplates), smear for acid-fast bacilli (AFB; auramine O), and clinical course. After chart review, three patients (nine specimens) who were on antituberculosis therapy before the study began were excluded from final analysis. Of the remaining 995 specimens, 21 were AFB smear positive: 13 grew Mycobacterium tuberculosis complex (MTBC), 6 grew nontuberculous mycobacteria, and 2 (from two patients diagnosed with TB and started on therapy after the study began) were culture negative. Twenty-eight specimens (20 patients) were positive for MTBC by culture and E-MTD. Seven specimens (seven patients) were positive by culture alone; three were from patients who had other E-MTD-positive specimens, two were false-positive cultures, and two were false-negative E-MTD results. Eight specimens were positive by E-MTD only; four specimens (four patients) were false-positive E-MTD results, and four specimens were from two patients with earlier E-MTD-positive specimens that grew MTBC. Thus, there were 22 patients with TB (10 smear positive and 12 smear negative). The sensitivity and specificity of the AFB smear for diagnosis of TB, by patient, were 45.5 and 98.9%, respectively. After resolving discrepancies, these same values for E-MTD were 90.9 and 99.1% overall, 100 and 100% for the smear-positive patients, and 83.3 and 99.1% for the smear-negative patients. Excluding the one smear-negative patient whose E-MTD-negative, MTBC culture-positive specimen contained inhibitory substances, the sensitivity of E-MTD was 95.2% overall and 90.9% in smear-negative patients. The specificity and positive predictive value of E-MTD can be improved, without altering other performance characteristics, by modifying the equivocal zone recommended by the manufacturer. These data suggest that E-MTD is a reliable method for rapid diagnosis of pulmonary TB, irrespective of the AFB smear result. Guidelines for the most appropriate use of E-MTD with smear-negative patients are needed.

Evaluation of the ESP culture system II for testing susceptibilities of Mycobacterium tuberculosis isolates to four primary antituberculous drugs

The reliability of the ESP Culture System II (herein referred to as ESP II) for testing susceptibilities of Mycobacterium tuberculosis isolates to isoniazid, rifampin, ethambutol, and streptomycin was evaluated by comparing results to those of the method of proportion (MOP), which was considered the reference method, for 20 clinical isolates and 30 challenge strains provided by the Centers for Disease Control and Prevention (CDC). Clinical isolates also were tested with the BACTEC TB 460 system; these results agreed with those obtained by the MOP for all isolates and all drugs, except the high concentration of isoniazid, for which agreement was 95%. After resolution of discrepancies, levels of agreement between ESP II and MOP for the clinical isolates were 95 and 100%, respectively, for the low and high concentrations of isoniazid, 100% for rifampin and ethambutol, and 95% for streptomycin. For the 30 challenge isolates, ESP II results for both concentrations of isoniazid agreed with the expected results in all cases, whereas agreement was 93% for both rifampin and streptomycin and 90% for ethambutol. All discrepancies with the CDC isolates were due to failure of ESP II to correctly classify resistant strains. By testing isolates yielding discrepant ethambutol and streptomycin results with a lower concentration of both drugs in the ESP II system, agreement increased to 93% for ethambutol and 100% for streptomycin. For the clinical isolates, the times to an ESP II result of susceptible (means +/- standard errors of the means) were 8.47 +/- 0.12 days (range, 7 to 10 days) and 8.73 +/- 0.29 days (range, 5 to 11 days) when the inoculum was prepared from a McFarland equivalent and from a seed bottle, respectively. The time to an ESP II result of resistant varied by drug and method of inoculum preparation, ranging from 5.50 +/- 0.22 days for ethambutol with the inoculum prepared from a McFarland standard to 8. 0 days for ethambutol with the inoculum prepared from a seed bottle. These data suggest that the ESP II system is a rapid and reliable method for testing susceptibilities of M. tuberculosis isolates to isoniazid and rifampin. Performance, however, may be suboptimal for ethambutol and streptomycin. Testing additional ethambutol-resistant and streptomycin-resistant strains with two concentrations of both drugs is necessary.

Clinical evaluation of the BDProbeTec strand displacement amplification assay for rapid diagnosis of tuberculosis

The reliability of the BDProbeTec MTB Test (Becton Dickinson, Sparks, Md.) for direct detection of Mycobacterium tuberculosis in respiratory specimens was evaluated by comparing results to those of conventional mycobacterial culture, with the BACTEC TB 460 and Middlebrook 7H11 biplates. Patients known to have tuberculosis were excluded from analysis. Of 523 specimens from 277 patients, 53 grew a mycobacterium: 24 specimens of M. tuberculosis and 29 specimens of nontuberculous mycobacteria. After initial testing, 42 specimens were positive by the BDProbeTec, for overall sensitivity, specificity, and positive and negative predictive values of 95.8, 96. 2, 54.8, and 99.8%, respectively. After resolution of discrepancies, 28 specimens were positive by the BDProbeTec, for overall sensitivity, specificity, and positive and negative predictive values of 100, 99.2, 85.7, and 100%, respectively. These same values were 100, 80.8, 93.4, and 100%, respectively, for smear-positive samples and 100, 99.4, 75.0, and 100%, respectively, for smear-negative specimens.

In vitro activity of antimicrobial combinations against clinical isolates of susceptible and resistant Mycobacterium tuberculosis

SETTING

University of Texas Medical Branch, Clinical Microbiology Laboratory.

OBJECTIVE

To evaluate in vitro the activity of rifabutin plus each of four other antimicrobial agents: isoniazid, amoxicillin/clavulanate, sparfloxacin and clarithromycin, against five susceptible (S-MTB) and five multidrug-resistant (MDR-TB) clinical isolates of Mycobacterium tuberculosis.

DESIGN

The antimicrobial activity of each two-drug combination was assessed by macrodilution checkerboard technique using Bactec 460 and classified as synergistic, additive, or antagonistic, using the fractional inhibitory concentration index.

RESULTS

For S-MTB, rifabutin + amoxicillin/clavulanate, rifabutin + isoniazid, rifabutin + sparfloxacin and rifabutin + clarithromycin acted synergistically against four, three, one and one isolate, respectively; clarithromycin + rifabutin was additive for one isolate. None of the combinations were antagonistic against S-MTB. For MDR-TB, rifabutin + amoxicillin/clavulanate, rifabutin + isoniazid, rifabutin + sparfloxacin and rifabutin + clarithromycin acted synergistically against one, one, one and two isolates, respectively, and additively against two, one, one and two isolates, respectively. Rifabutin + amoxicillin/clavulanate, rifabutin + isoniazid, and rifabutin + clarithromycin were antagonistic against one, two and two MDR-TB isolates, respectively.

CONCLUSION

Certain drug combinations acted synergistically against MDR-TB; however, the clinical predictive value of these in vitro experiments is unknown.

Reliability of mycobacteria growth indicator tube for testing susceptibility of Mycobacterium tuberculosis to ethambutol and streptomycin

The reliability of mycobacterial growth indicator tubes (MGIT) for testing susceptibility of Mycobacterium tuberculosis to ethambutol and streptomycin was evaluated by comparing MGIT results to those obtained by the radiometric BACTEC TB system and the method of proportion. The method of proportion was considered the reference method. To resolve discrepancies, all three testing methods were repeated. For the 74 isolates evaluated, initial ethambutol results agreed by all three methods for 64 (86.5%) of them; 58 were susceptible and 6 were resistant. MGIT and method-of-proportion results agreed for 67 isolates, and BACTEC results agreed with method-of-proportion results for 71 (P = 0.096). Initial streptomycin results obtained by all three methods agreed for 69 (93.2%) isolates: 55 were susceptible and 14 were resistant. MGIT and method-of-proportion results were concordant for 69 isolates, and BACTEC and method-of-proportion results agreed for 73 (P = 0.049). The mean times to MGIT results were 5.58 +/- 0.10 days (range, 3 to 9 days) for ethambutol and 5.47 +/- 0.11 days (range, 3 to 9 days) for streptomycin, compared to a mean of 7.41 +/- 0.20 days (range, 4 to 12 days) for both drugs with the BACTEC system (P < 0.001).

Mycobacterial growth indicator tube for susceptibility testing of Mycobacterium tuberculosis to isoniazid and rifampin

The reliability of mycobacteria growth indicator tubes (MGIT) for susceptibility testing of Mycobacterium tuberculosis to isoniazid and rifampin was evaluated by comparing MGIT results to those obtained by the radiometric BACTEC TB system. To resolve discrepancies, MGIT and BACTEC TB tests were repeated, and the method of proportion was performed. For the 89 isolates evaluated, there was complete agreement between MGIT and BACTEC results for rifampin: 70 isolates were susceptible, and 19 were resistant. After initial testing of isoniazid, both methods agreed for 85 isolates (95.5%): 72 were susceptible, and 13 were resistant by both methods; 2 were resistant by BACTEC but susceptible by MGIT, and 2 were resistant by MGIT but susceptible by BACTEC. Based on results of discrepant analysis for the latter four isolates, all four were resistant to isoniazid. Thus, MGIT correctly detected susceptibility and resistance to isoniazid for 97.3% and 100% of the isolates, respectively. The mean time to MGIT results was 6.38 +/ 0.11 days (range, 6 to 14 days), compared to a mean of 9.09 +/- 1.90 days (range, 4 to 12 days) for BACTEC (p < .001). MGIT provides a rapid and reliable, nonradiometric alternative to BACTEC for susceptibility testing of M. tuberculosis to isoniazid and rifampin.

Evaluation of the Roche AMPLICOR MTB assay for the detection of Mycobacterium tuberculosis in sputum specimens from prison inmates

The reliability of the Roche Mycobacterium tuberculosis polymerase chain reaction (PCR) assay (AMPLICOR MTB) for the diagnosis of pulmonary tuberculosis was evaluated by testing expectorated sputum specimens from 187 inmates in Texas state prisons and comparing the results to culture and medical history. Of the 80 specimens that were culture positive for mycobacteria, 36 specimens from 16 patients grew M. tuberculosis. Forty-six specimens were smear positive for acid-fast bacilli (AFB), and of these, M. tuberculosis was isolated from 24. On initial testing, 52 specimens were PCR positive. Thirty-one of these 52 were culture positive for M. tuberculosis, and 21 were culture negative, resulting in a PCR sensitivity and specificity of 86.1 and 96.1%, respectively. After resolving discrepancies by review of the medical history and repeat testing, PCR sensitivity, specificity, and positive and negative predictive values, respectively, were 92.8, 99.8, 98.1, and 99.2%. For AFB smear-positive specimens, the sensitivity, specificity, and positive and negative predictive values, were 95.8, 100, 100, and 93.3, respectively; whereas, for AFB smear-negative specimens, these values were 87.5, 99.7, 95.5, and 99.4%, respectively. These results confirm the reliability of the AMPLICOR MTB assay for direct detection of M. tuberculosis in AFB smear-positive sputum specimens and suggest a potential role in evaluating AFB smear-negative sputum specimens.

Detection of Mycobacterium tuberculosis in BACTEC 12B broth cultures by the Roche Amplicor PCR assay

To evaluate the ability of the Amplicor MTB Assay to detect Mycobacterium tuberculosis complex (MTBC) organisms in BACTEC 12B broth cultures, 249 cultures with a growth index (GI) of > or = 20 from 160 patients were tested retrospectively. Specimens were processed by standard methods, and then BACTEC 12B vials and Middlebrook 7H11/7H115 plates were inoculated, incubated, and interpreted in accordance with the manufacturer's instructions and laboratory protocol. From 12B vials with a GI of > or = 20, and aliquot of broth was removed and frozen at -20 degrees C until assayed by PCR. PCR results were compared to those obtained by the usual laboratory protocol, whereby MTBC organisms were identified by a DNA probe assay performed on broth from 12B vials with a GI or > or = 300 or on colonies from solid medium. Of the 249 broth cultures evaluated, 142 contained mycobacteria, including 44 that contained MTBC organisms. Of these 44 cultures, 41 were PCR positive; the 3 that were PCR negative were blood specimens collected in an Isolator tube. All 98 cultures with nontuberculous mycobacteria and the 107 that did not contain mycobacteria were PCR negative. Thus, the sensitivity and specificity of PCR were 93 and 100%, respectively. For those culture sin which MTBC organisms were identified by both the DNA probe and PCR assays, the mean time from specimen inoculation to detection and identification of MTBC organisms was 16 (range, 4 to 26) days for the PCR and 28 (range, 13 to 43) days for the DNA probe assay (P < 0.0001). In summary, PCR is a rapid, reliable method for detection of MTBC organisms in BACTEC 12B broth cultures with a GI of > or = 20.

AMPLICOR MTB polymerase chain reaction test for identification of Mycobacterium tuberculosis in positive Difco ESP II broth cultures

The reliability of the Roche AMPLICOR polymerase chain reaction (PCR) Mycobacterium tuberculosis (MTB) test for identification of M. tuberculosis complex (MTBC) in Difco ESP II broth cultures was evaluated by testing aliquots from all cultures, regardless of specimen type, that were signaled positive by the ESP instrument. Polymerase chain reaction results were compared to those obtained by usual laboratory protocol, whereby MTBC was identified by DNA probe (Gen Probe, Inc., San Diego, California, USA), testing sediment from broth samples or colonies on a solid medium. Of the 242 signal-positive ESP II cultures (from 182 patients) evaluated, 98 (40.5%) contained mycobacteria, including 26 MTBC. On initial testing, 27 samples were positive by PCR; 22 of these were MTBC culture positive, and 5 were culture negative for mycobacteria. The sensitivity, specificity, and positive and negative predictive values of PCR were 84.6, 97.7, 81.5, and 98.1%, respectively. Based on review of the medical records of the patients for whom PCR and culture results were discrepant, one PCR-positive culture negative was a true PCR positive; thus the actual sensitivity, specificity, and positive and negative predictive values of PCR were 85.2, 98.1, 85.2, and 98.1%. Two of the PCR-negative, MTBC culture-positive samples were blood specimens collected in an Isolator tube; and these tubes contain sodium polyanetholsulfonate, which seems to inhibit PCR. If blood specimens are excluded from analysis, the sensitivity, specificity, and positive and negative predictive values for PCR are 92.0, 97.6, 85.2, and 98.8%, respectively. The mean times from specimen receipt to identification of MTBC were 19 (+/- 2) days (range, 6 to 39 days) for ESP II plus AMPLICOR MTB PCR and 25 (+/- 2) days (range, 8 to 42 days) for DNA probe testing of sediment from broth or colonies on solid media (p < .05). These data indicate that the AMPLICOR MTB PCR test is a rapid, reliable method for identification of MTBC in positive ESP II cultures, excluding blood specimens collected in Isolator tubes.

Clinical evaluation of the Roche AMPLICOR PCR Mycobacterium tuberculosis test for detection of M. tuberculosis in respiratory specimens

The reliability of the Roche AMPLICOR Mycobacterium tuberculosis test (AMPLICOR MTB) for the diagnosis of pulmonary tuberculosis was evaluated by testing 956 respiratory specimens from 502 patients and comparing results with results by culture and medical history. Of those 135 specimens that were culture positive for mycobacteria, 61 specimens from 31 patients grew M. tuberculosis. Fifty-two specimens were smear positive for acid-fast bacteria (AFB); M. tuberculosis was isolated from 41 of these specimens. On initial testing, the sensitivity and specificity of the AMPLICOR MTB assay, compared with culture, were 78.7 and 99.3%, respectively. After resolution of discrepancies (by review of medical history), the sensitivity, specificity, and positive and negative predictive values of the AMPLICOR MTB assay were 79.4, 99.6, 92.6, and 98.6%, respectively. Two specimens from two patients with no clinical evidence of tuberculosis were AMPLICOR MTB positive and culture positive for Mycobacterium avium complex. For AFB smear-positive specimens, the sensitivity, specificity, and positive and negative predictive values of AMPLICOR MTB were 97.6, 100, 100, and 90.9%, respectively. For AFB smear-negative specimens, the sensitivity, specificity, and positive and negative predictive values of AMPLICOR MTB were 40.0, 99.5, 69.2, and 98.7%, respectively. Our results support the use of AMPLICOR MTB for rapid diagnosis of tuberculosis in patients whose respiratory specimens are AFB smear positive. Further studies are needed to determine the most clinically relevant and cost-effective use of this assay with AFB smear-negative specimens.

Chemistry and biology of the 2 beta-alkyl-3 beta-phenyl analogues of cocaine: subnanomolar affinity ligands that suggest a new pharmacophore model at the C-2 position

A series of 2 beta-alkyl-3 beta-phenyltropanes (i.e., the 2 beta-alkyl analogues of the WIN series) were prepared as analogues of cocaine and tested for their ability to displace [3H]mazindol binding and to inhibit high-affinity dopamine uptake into striatal nerve endings (synaptosomes). These 2 beta-alkyl analogues were readily prepared in optically pure form starting from cocaine by proceeding through the 2 beta-phenyl-bearing aldehyde 6 as a key intermediate. Wittig reaction of 6 with the appropriate phosphorane and hydrogenation delivered the final products. All new compounds with the exception of 8e were found to exhibit nanomolar or subnanomolar affinity for the cocaine binding site in the rat striatum. These results are in apparent opposition to the binding model previously proposed which suggests a hydrogen bond donor-acceptor interaction to be present in the vicinity of the C-2 substituent. Taken together with our previous reports and recent findings from other laboratories, we suggest a new pharmacophore model in which 2 beta-substituents lacking H-bond acceptors enhance affinity to the binding site through hydrophobic interactions. The new SAR data contained herein may be relevant to the design of possible cocaine antagonists.

Traumatic brain injury reduces hippocampal high-affinity [3H]choline uptake but not extracellular choline levels in rats

Hippocampal cholinergic hypofunction may contribute to memory deficits following experimental traumatic brain injury. These studies examined two important factors in acetylcholine synthesis: choline availability and neuronal uptake. No reductions in basal extracellular choline levels, using microdialysis, were observed 2 weeks after cortical impact injury. However, studies of high affinity [3H]choline uptake in the hippocampus, measured in a synaptosomal preparation, found a reduction in the maximum velocity of choline uptake (Vmax), while no differences in affinity constants (Km) were found. The results suggest that post-traumatic cholinergic deficits are not attributable to decreased availability of choline, but may be associated with either a decreased ability of cholinergic neurons to take up choline and/or a loss of cholinergic neurons.

Structure-activity relationship studies of N-sulfonyl analogs of cocaine: role of ionic interaction in cocaine binding

Six new N-sulfonylated analogs of cocaine have been prepared, and these compounds have been evaluated for their ability to inhibit [3H]mazindol binding and [3H]dopamine uptake into striatal synaptosomes. The N-sulfonyl compounds still inhibited binding and uptake at low micromolar concentrations despite the neutral character of the tropane nitrogen, thus suggesting that the binding of cocaine to the dopamine transporter may not require protonation of its nitrogen and ionic interaction with its recognition site.

Muscarinic stimulation of gallbladder epithelium. I. Electrophysiology and signaling mechanisms

To understand the effects of acetylcholine (ACh) on fluid-absorbing epithelia, we carried out experiments on Necturus gallbladder epithelium. Binding studies with 1-quinuclidinyl[phenyl-4(N)-3H]benzilate (QNB) demonstrated that Necturus gallbladder epithelial cells express high-affinity muscarinic receptors. The effects of ACh and carbachol were exerted from the basolateral surface and consisted of a transient hyperpolarization of both cell membranes and a concomitant decrease in the apparent fractional resistance of the apical membrane. Atropine blocked both effects. ACh also elicited transient elevations of inositol 1,4,5-trisphosphate and intracellular free calcium ([Ca2+]i) levels, the latter by both release from intracellular stores and basolateral influx. The phospholipase C antagonist U-73122 inhibited the effects of ACh, whereas inhibition of prostaglandin and guanosine 3',5'-cyclic monophosphate synthesis with indomethacin or methylene blue, respectively, had no effect. In conclusion, Necturus gallbladder epithelium expresses muscarinic receptors in the basolateral membrane. Receptor activation stimulates phospholipase C and elevates cellular levels of inositol 1,4,5-trisphosphate and [Ca2+]i. The elevation in [Ca2+]i activates K+ channels but apparently not Cl- channels.

GBR 12909 fails to antagonize cocaine-induced elevation of dopamine in striatal slices

The effects of cocaine and 1-(2-bis (4-fluorophenyl)methoxy)-ethyl)-4-(3-phenyl-propyl) piperazine (GBR 12909), alone and together, on [3H] dopamine efflux from superfused rat striatal slices was studied. Both drugs elicited a concentration-dependent increase in spontaneous [3H]dopamine efflux. GBR 12909 when added together with cocaine, had no effect on cocaine-induced [3H] dopamine efflux. It was also determined that GBR 12909 was fully efficacious as an inhibitor of synaptosomal [3H] dopamine uptake and, whether administered in vitro or in vivo, acted in a manner consistent with competitive inhibition. These data are discussed in reference to the recent report that i.p. administration of GBR 12909 antagonized the effect of cocaine on extracellular striatal dopamine levels when infused directly through the dialysis probe, perhaps by acting as a 'partial agonist' at the inhibitory site on the dopamine transporter (Rothman et al., 1991 Pharmacol. Biochem. Behav. 40, 387-397).

Cocaine and dopamine differentially protect [3H]mazindol binding sites from alkylation by N-ethylmaleimide

The binding of cocaine, d-amphetamine and dopamine to the site on the dopamine transporter labeled by [3H]mazindol was investigated in rat striatal membranes. N-Ethylmaleimide inhibited about 95% of the specific binding of 5 nM [3H]mazindol in a concentration-dependent manner. The effect of 10 mM N-ethylmaleimide was completely prevented by cocaine (EC50 of 3 microM), but neither 300 microM dopamine nor d-amphetamine afforded any significant protection. On the other hand, high concentrations of cocaine, d-amphetamine and dopamine provided similar protection against inhibition by 0.1 mM N-ethylmaleimide. Taken together these data support the hypothesis that a significant portion of the cocaine binding domain on the transporter is distinct from that of either dopamine or amphetamine. This distinction may be sufficient to allow properly designed drugs to prevent cocaine binding without inhibiting DA transport.

Glycosylation of high-affinity thrombin receptors appears necessary for thrombin binding

Monosaccharide binding competition, lectin affinity chromatography, and glycosylation inhibitors have been used to determine if glycosylation plays a role in thrombin-receptor interactions. Mannose appeared to specifically inhibit thrombin binding to mouse embryo (ME) and hamster fibroblasts. Concanavalin A bound to antibody-purified receptor fractions, and was used as an affinity ligand to purify receptor fractions that retained thrombin binding activity. Cells treated with tunicamycin (6.25 ng/ml) for 24 h lost approximately 35% of their high-affinity thrombin binding sites, yet binding of receptor monoclonal antibody TR-9 was not affected, indicating that the receptor was present in the membrane, but unable to bind thrombin. Thus thrombin receptor glycosylation may be directly involved in thrombin binding.

Immunocytochemical localization of laminin in hamster tracheal epithelial cell cultures

EM examination of 28 day cultures of enzymatically dissociated hamster tracheal epithelial (HTE) cells grown on collagen coated millipore filters reveals that fragments of basal lamina may be present at the basal plasmalemma. Since the basal lamina consists of several major components including type IV collagen, heparan sulfate proteoglycans, entactin/nidogen, and laminin, questions naturally arise concerning the presence of such a structure in this cell culture system. When immunocytochemical procedures utilizing anti-laminin antibody and PAP techniques are carried out with paraffin sections of HTE culture at 1,2,3, and 4 weeks in vitro, LM analysis reveals that a thin, dense line of reaction product is present between the basal surface of the HTE cells and the underlying collagen substrate. Immunoblotting evaluation carried out with supernatants of 7d HTE cell homogenates and HTE cell conditioned media also indicate that laminin is being produced by the tracheal cells. Thus, the presence of basal lamina-like fragments, the immunocytochemical localization of laminin, and immunoblot identification of laminin in hamster tracheal epithelial cell cultures, suggest that, although basal lamina components may be produced by HTE cells, at the time points tested, they are not yet being organized into a complete basal lamina.

Synthetic peptides bind to high-affinity thrombin receptors and modulate thrombin mitogenesis

Initiation of cell proliferation by thrombin requires signals generated by thrombin interaction with specific high-affinity receptors and thrombin enzymic activity. Using synthetic peptides representing various domains of thrombin, we have identified a region adjacent to the proteolytic pocket of thrombin which confers high-affinity binding and generation of mitogenic signals. One peptide, representing residues 508 to 530 of human prothrombin (p508-530), inhibits up to 70% of the specific binding of 125I-alpha-thrombin at concentrations of less than 100 nM, enhances the ability of thrombin to stimulate DNA synthesis and stimulates DNA synthesis in cells treated with 25 ng/ml phorbol myristate acetate (PMA). Thus, this peptide or a portion of this peptide appears to represent the high-affinity receptor binding domain of thrombin. In contrast to the 23 amino acid peptide (p508-530), the tetrapeptide RGDA (p517-520) contained in this region competes for 125I-thrombin binding at concentrations from 100 to 2000 nM, but inhibits rather than stimulates the mitogenic effects of alpha-thrombin. Non-homologous peptides, or fibronectin-specific peptides (such as RGDS or GRGDSP) do not compete for 125I-alpha-thrombin binding and have no effect on thrombin mitogenesis. These studies demonstrate that peptides representing portions of the binding domain of thrombin: i) can generate receptor-occupancy related signals that enhance thrombin mitogenesis and are themselves mitogenic in cells treated with PMA; or ii) in the case of RGDA (which may be too small to generate signals), can act as antagonists, inhibiting the mitogenic effects of thrombin by preventing thrombin-receptor interaction.

125I-thrombin binds to clustered receptors on noncoated regions of mouse embryo cell surfaces

We used electron microscope autoradiography (EMAR) to visualize the interaction of 125I-thrombin with its surface receptors on mouse embryo (ME) cells. Autoradiographic grains were spaced over the surface of cells in a periodic nonrandom pattern, indicating 125I-thrombin association with clusters of thrombin receptors. The grain spacing varied slightly from cell to cell, indicating subpopulations of cells with different numbers of thrombin receptors. The average distance between grains on ME cells after binding 125I-thrombin (125 ng/ml) at 37 degrees C was 1.65 +/- 0.49 microns. The average distance between grains on prefixed cells and cells incubated with 125I-thrombin at 4 degrees C was not significantly different from that observed at 37 degrees C. This indicates that thrombin receptors are clustered before thrombin binding and that the thrombin receptor aggregates do not redistribute into large aggregates on the surface of cells subsequent to thrombin binding. The number of grains per cluster also does not change under these three binding conditions. Thus, the number of occupied receptors in each cluster appears to be constant. On the basis of the average grain number and spacing, we estimate that each cluster is approximately 400 nm in diameter containing approximately 550 thrombin-binding sites. These receptor-clusters are not associated with specialized structures or coated regions of the membrane. Additionally, grains observed within cells were not found associated with coated vesicles. Therefore, neither the clustering patterns nor internalization of 125I-thrombin are characteristic of molecules which bind to receptors and are internalized by receptor-mediated endocytosis.

Receptor-bound thrombin is not internalized through coated pits in mouse embryo cells

The localization of thrombin receptors on mouse embryo (ME) cells was examined using electron microscope (EM) immunocytological techniques. ME cells were fixed with formaldehyde, prior to thrombin binding, and thrombin visualized on cell surfaces using affinity-purified antithrombin rabbit antibody and colloidal gold labeled anti-rabbit IgG. Colloidal gold particles were found in clusters on the surface of cells incubated with thrombin. There were approximately seven particles per cluster observed in thin sections with cluster diameters ranging from 70 to 200 nm. These clusters were not observed on cells incubated without thrombin. The total number of particles present on cells incubated with and without thrombin indicate that the colloidal gold labeling is approximately 98% specific for thrombin. Only four colloidal gold particles out of approximately 1,200 were associated with coated pits. Thus the thrombin receptor clusters do not appear to associate with coated membrane regions. To determine whether receptor-bound thrombin was internalized by receptor-mediated endocytosis, ME cells were incubated with 125I-thrombin and examined using EM autoradiography and the trypsin sensitivity of 125I-thrombin which was associated with the cells. In two types of experiments, where thrombin was incubated with cells at 4 degrees C and the temperature increased to 37 degrees C and where initial incubation was at 37 degrees C, the receptor-directed specific internalization proceeded at approximately the same rate as nonspecific internalization. These studies indicate that thrombin that binds to its receptors on ME cells is not rapidly internalized by receptor-mediated endocytosis.