Diagnosis of latent tuberculosis infection among immunodeficient individuals: Review of concordance between interferon-γ release assays and the tuberculin skin test
Abstract: Mycobacterium tuberculosis remains as a major threat to global health. Nearly a third of the world's population is estimated to have latent M. tuberculosis infection, and this is considered to be a major reservoir of potential active disease. Immunocompromised individuals, such as those with chronic renal failure requiring haemodialysis, solid organ transplant recipients, and individuals infected with the human immunodeficiency virus (HIV) have an increased likelihood of progression from latent infection to active disease, due to impaired cell-mediated immunity. Owing to the absence of a systematic review evaluating concordance between interferon-gamma release assays (IGRAs) and the tuberculin skin test (TST) in the diagnosis of latent tuberculosis infection (LTBI) among immunodeficient individuals, this literature review aims to evaluate the reported agreement between IGRAs and TST in the diagnosis of LTBI. It will also assess the utility of IGRAs among individuals with weak immune systems as well as determine the degree of concordance among three diagnostic tests (TST, QuantiFERON, and TSPOT-TB) for LTBI.
A review of teicoplanin used in the prevention and treatment of serious infections caused by gram-positive bacteria and compared its effects with some other antibiotics
Abstract:Teicoplanin is an antibiotic used in the prevention and treatment of serious infections caused by Gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA) and Enterococcus faecalis. It is a semi-synthetic glycopeptide antibiotic with a spectrum of activities similar to vancomycin. Its mechanism of action is inhibition of bacterial cell wall synthesis teicoplanin is marketed by Sanofi Aventis Coperation under the brand name of Targocid. It has been shown that oral administration of teicoplanin is effective in the treatment of Pseudomembranous colitis and Clostridium difficile-associated diarrhoea, with comparable efficacy to vancomycin. The effectiveness of this antibiotic is associated with its carbon chain length. It's tried in this review article to introduce teicoplanin synthases, structure and its structure effect on treatment and also introduce the advantages of teicoplanin in bacterial infection treatment and compared its effects with some other antibiotics like vancomycin and linezolid. Based on the above data, it can be concluded that teicoplanin usage, specially intervenes injection of it, is a successful antibiotic treatment against bacterial infections caused by Gram-positive bacteria, particularly methicillin-resistant Staphylococcus aurous (MRSA). The teicoplanin effect is directly related to the length of its carbon chain. It was shown that treatment with combination of teicoplanin and vancomycin or teicoplanin and linezolid have more influence over the treatment process. The most important advantage of teicoplanin usage in treatments is its lower side effects on patients than other antibiotics.
Discriminating between latent and active tuberculosis: The role of interleukin-2 as biomarker
We read with interest the paper by Mihret et al. who evaluated a number of cytokines or chemokines for the discrimination between active disease and non-active tuberculosis infection.1 In the last years, the potential role of distinct T-cell subsets as biomarkers of active tuberculosis (TB) and/or latent tuberculosis infection (LTBI) has been studied.2 Since the diagnosis of LTBI remains challenging without a gold standard reference,3 a rapid and specific diagnosis tool is essential for discrimination of active TB from LTBI. Cytokines play a critical role during primary and latent infection. Interleukin-2 (IL-2) is a well-known pro-inflammatory cytokine that promotes proliferation and differentiation of antigen-specific memory T-cells.4
We evaluated the potential role of IL-2 in whole blood stimulated with Mycobacterium tuberculosis-specific antigens in the QuantiFERON-TB Gold In Tube (QFT-G-IT) for the discrimination of active and latent tuberculosis. In this study, patients were recruited from the infectious diseases ward at the Masih Daneshvari Hospital, National Research Institute of Tuberculosis and Lung Diseases (NRITD), affiliated to Shahid Beheshti University of Medical Sciences, Tehran, Iran. Individuals were classified as having active TB when the diagnosis was confirmed by positive M. tuberculosis culture from sputum specimens and positive response to QFT-G-IT test. LTBI was defined as a positive response to QFT-G-IT in the absence of symptomatic, microbiological, or radiological evidence of active tuberculosis. Healthy controls were BCG vaccinated individuals with no known exposure to M. tuberculosis and a negative response to the QFT-G-IT. We do not include in the study individuals who had positive human immunodeficiency virus screening result. The study received approval from the Ethical Committee of Tehran University of medical sciences.
In this study, thirty patients with active TB and 30 cases with LTBI had positive QFT-G-IT test and all of the controls (N = 30) had negative QFT-G-IT result. After 72-h of stimulation by antigens from the QFT-G-IT assay, IL-2 secretion was quantitated in supernatants by using ELISA (Mabtech AB, Sweden). All the plasma specimens were tested in duplicate and expressed in pg/ml. The differences in levels of IL-2 among groups were analyzed using non-parametric analysis of variance with the Kruskall–Wallis test. As shown in Fig. 1, LTBI group induced significantly greater production of IL-2 than patients with active TB infection (P value = 0.019, Kruskal–Wallis test). The discrimination performance (assessed by the area under ROC curve) between LTBI and patients with active TB was 0.816 (95%CI: 0.72–0.97) (Fig. 2). Cut-offs were estimated at various sensitivities and specificities and at the maximum Youden's index (YI), i.e. sensitivity specificity–1. Maximum discrimination was reached at a cut-off of 13.9 pg/mL for IL-2 following stimulation with 82% sensitivity, 86% specificity, 85% PPV and 83% NPV.
Severity of anxiety disorders in patients with chronic obstructive pulmonary disease
Abstract:Objective: Patients with chronic physical diseases sometimes show increased loss of function; such patients need more care. Anxiety is a well-known symptom that is prevalent among chronic obstructive pulmonary disease patients that can prolong and increase the risk of hospitalization. The purpose of this study was to evaluate the severity of anxiety in the mentioned patients and to examine the presence of symptoms and appropriate treatment strategies to understand the role of psychological functions in physical patients. Methods: This was a cross sectional study conducted in Masih Daneshvari Hospital. One hundred forty- three patients entered into the project by accessible method and signed the informed consent; they filled demographic information and Hamilton anxiety and depression questionnaires. Data were analyzed by SPSS-16. Results: Of the participants, 68% were above 60 years of age; 78% were male; 89% were married; and 38% were self-employed. Also, among the participants, 51% were illiterate; 72% had history of smoking; 46% had history of substance abuse; and 49% had moderate to severe anxiety disorder. Moreover, of the patients with severe anxiety, 41.3% had severe muscle spasms; and severe sleeplessness was found in 38.5% of those with severe anxiety disorder. Severe anxiety related symptoms were found in 20.3% of the patients with severe anxiety disorder. Depressed mood was found in 27.3% of the patients with severe anxiety disorder. Severe physical and muscular signs were found in 35.7% of those with severe anxiety disorder. Conclusion: According to our findings, many chronic diseases such as chronic obstructive pulmonary disease may contain anxiety and depression which result in vulnerability. Therefore, evaluation of anxiety in such patients is of importance for alleviating the disease.
The comparison of extemporaneous preparations of omeprazole, pantoprazole oral suspension and intravenous pantoprazole on the gastric pH of critically ill-patients
Abstract:Background: Stress-related mucosal disease occurs in many critically ill-patients within 24 h of admission. Proton pump inhibitor therapy has been documented to produce more potent inhibition of gastric acid secretion than histamine 2 receptor antagonists. This study aimed to compare extemporaneous preparations of omeprazole, pantoprazole oral suspension and intravenous (IV) pantoprazole on the gastric pH in intensive care unit patients. Materials and Methods: This was a randomized single-blind-study. Patients of ≥ 16 years of age with a nasogastric tube, who required mechanical ventilation for ≥ 48 h, were eligible for inclusion. The excluded patients were those with active gastrointestinal bleeding, known allergy to omeprazole and pantoprazole and those intolerant to the nasogastric tube. Fifty-six patients were randomized to treatment with omeprazole suspension 2 mg/ml (40 mg every day), pantoprazole suspension 2 mg/ml (40 mg every day) and IV pantoprazole (40 mg every day) for up to 14 days. Gastric aspirates were sampled before and 1-2.5 h after the drug administration for the pH measurement using an external pH meter. Data were analyzed using SPSS (version 21.0). Results: In this study, 56 critically ill-patients (39 male, 17 female, mean age: 61.5 ± 15.65 years) were followed for the control of the gastric pH. On each of the 14 trial days the mean of the gastric pH alteration was significantly higher in omeprazole and pantoprazole suspension-treated patients than in IV pantoprazole-treated patients (P < 0.001). Conclusion: Omeprazole and pantoprazole oral suspension are more effective than IV pantoprazole in increasing the gastric pH.
sychological symptoms before and after a 14-day initial inpatient treatment in tuberculosis patients compared with their primary caregivers and healthy controls
