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PubMed1997

Dietary factors associated with a low risk of colon cancer in coloured west coast fishermen.

OBJECTIVE: To examine the relative roles of dietary fibre, anti-oxidant vitamins and fish oils in the relatively low incidence of colon cancer in coloured West Coast fishermen. DESIGN: Dietary intake survey, based on food frequency questionnaire and household surveys. Blood sampling for vitamin and fatty acid concentrations. SETTING: Isolated West Coast fishing villages (sample population) and urban Cape Town inhabitants (controls). PARTICIPANTS: 101 male and female West Coast fishermen over the age of 40 years, and 99 age- and sex-matched urban whites. OUTCOME MEASURES: Dietary analysis by 'Foodfinder' technique, and nutrient blood levels. Statistical analysis using SASR program version 6. RESULTS: An analysis of the number of recorded cases of colorectal cancer over a period of 5 years leading up to the study confirmed a lower rate of colorectal cancer in the West Coast fishermen than in the Cape Town population: fishermen 6 cases/120000, urban whites 677/2 million. A significantly higher proportion of fishermen were smokers, had hypertension and gave a history of previous tuberculosis infections. Vitamin supplementation was noted in one-third of whites but in no fishermen. The results of the dietary analysis (mean (SD)) demonstrated that fishermen consumed less fibre (9.9 (4.7) g/d v. 17.4 (7.2) g/d; P < 0.01) and less fruit and vegetables (190 g/d v. 365 g/d; P < 0.001), with a lower intake of vitamin C, thiamin, riboflavin, vitamin B6 and folate. Sodium intake was higher in fishermen, whereas intakes of potassium, magnesium, calcium, iron, zinc and copper were lower. In addition, the daily intake of omega-3 fatty acids (fish oils), docosahexaenoic acid (C22:6) and eicosapentaenoic acid (C20:5) in the West Coast population was considerably higher (0.71 (0.51) g/d v. 0.14 (0.09) g/d; P < 0.0001 and 0.37 (0.3) g/d v. 0.05 (0.05) g/d; P < 0.0001, respectively) than in the urban population owing to their higher intake of fish (110 g v. 30 g/d; P < 0.001). Plasma fatty acids correlated positively with these dietary intake figures, showing fishermen to have higher levels of circulating omega-3 fatty acids, C20:5 (3.9 (1.8)% v. 0.66 (0.29)%; P < 0.001) and C22:6 (5.6 (1.8) v. 2.9 (0.08)%; P < 0.001) and lower levels of omega-6 fatty acids, C18:2 and C20:3 (29.7 (4.7)% v. 33.5 (5.6)%; P < 0.05 and 0.85 (0.48)% v. 1.5 (0.47)%; P < 0.001, respectively) compared with the urban group. CONCLUSION: The low incidence of colorectal carcinoma in West Coast fishermen might be explained by the protective effects of fish (omega-3) oils, but not by other "protective' dietary items such as fibre, anti-oxidant vitamins or calcium. The high incidence of hypertension may be related to a higher sodium intake, accompanying high consumption of salted fish, or to the higher prevalence of tobacco smoking.

Adult↗

PubMed2001

Neltenexine tablets in smoking and non-smoking patients with COPD. A double-blind, randomised, controlled study versus placebo.

BACKGROUND: The aim of this double-blind, randomised, controlled study vs placebo was to evaluate the efficacy and tolerability of neltenexine (tablets) versus placebo (tablets), administered to smoking and non-smoking patients with chronic obstructive pulmonary disease (COPD). METHODS: Sixty patients with mild stable COPD were recruited. The exclusion criteria were lung cancer, pulmonary tuberculosis, asthma, cystic fibrosis, bronchiectasis, community-acquired pneumonia (CAP), intercurrent infections, concomitant treatment with corticosteroids, antitussives, beta2 agonists, anticholinergic and other mucolytic agents. The patients were allocated randomly to receive neltenexine (20 smokers and 20 non-smokers) or a matching placebo (20 smokers), 1 tablet twice daily for 20 days. The efficacy criteria were sputum characteristics and volume, difficulty in expectorating, cough, dyspnoea, pulmonary auscultation, forced expiratory volume in one second (FEV1), vital capacity and arterial partial oxygen pressure (PO2). Tolerability was monitored and adverse events were reported. RESULTS: At the study end, the improvement of patients treated with neltenexine (smokers and non-smokers) was greater and statistically significant as compared with the patients in the placebo group in terms of improvement of dyspnoea (p<0.02), cough (p<0.02), pulmonary auscultation (p<0.02), and difficulty in expectorating (p<0.02). Furthermore, a significant improvement of the sputum characteristics (p<0.02) and volume (p<0.01) was evidenced, as compared with patients treated with placebo, in non smoking patients treated with neltenexine and in smoking patients treated with neltenexine. CONCLUSIONS: The study confirmed earlier clinical experiences showing that neltenexine is effective in the treatment of COPD patients and highlighted the correlation between abstention from smoking and the efficacy of mucoactive treatment.

Adult↗

PubMed2004

The influence of reduced oxygen availability on pathogenicity and gene expression in Mycobacterium tuberculosis.

We investigated how Mycobacterium tuberculosis responded to a reduced oxygen tension in terms of its pathogenicity and gene expression by growing cells under either aerobic or low-oxygen conditions in chemostat culture. The chemostat enabled us to control and vary the oxygen tension independently of other environmental parameters, so that true cause-and-effect relationships of reduced oxygen availability could be established. Cells grown under low oxygen were more pathogenic for guinea pigs than those grown aerobically. The effect of reduced oxygen on global gene expression was determined using DNA microarray. Spearman rank correlation confirmed that microarray expression profiles were highly reproducible between repeat cultures. Using microarray analysis we have identified genes that respond to a low-oxygen environment without the influence of other parameters such as nutrient depletion. Some of these genes appear to be involved in the biosynthesis of cell wall precursors and their induction may have contributed to increased infectivity in the guinea pig. This study has shown that a combination of chemostat culture and microarray presents a biologically robust and statistically reliable experimental approach for studying the effect of relevant and specific environmental stimuli on mycobacterial virulence and gene expression.

Anaerobiosis↗

PubMed1995

Drug therapy of bacillus Calmette-Guérin sepsis.

Intravesical bacillus Calmette-Guérin (BCG) is widely used for the treatment of transitional cell carcinoma of the bladder. Although it is usually well tolerated, sepsis can occur, which has resulted in at least eight deaths [3]. The survival of Connaught BCG-infected mice treated with single and combination antibiotic and steroid therapy was evaluated. Triple-drug therapy with isoniazid, rifampin, and prednisolone resulted in 53% survival compared with 25% survival in the control group (P = 0.0209). A survival of only 10.5% was observed with treatment using prednisolone alone. This survival was worse than that of the control group (25%), and approached statistical significance (P = 0.0669). Our data suggest that BCG sepsis probably has components of both a hypersensitivity reaction and bacterial sepsis; they support the current use of combination antibiotic and steroid therapy for treatment of BCG sepsis in humans, but argue against treatment with steroids alone.

Animals↗

PubMedDate not supplied

[Causes of para-allergy to tuberculin].

Experiments on 56 rabbits infected with microorganisms of the genera Mycobacterium, Nocardia and Rhodococcus revealed that in response to the action of different antigens used T and B systems of immunity induced synthesis of antibodies reactive with nonspecific antigens (mycobacterial antigens, tuberculin). In some cases the statistically significant correlation between the dynamics of blast transformation and the specific lysis of lymphocytes in animals with Nocardia and Rhodococcus infections (in comparison with the controls) was determined when P.P.D. tuberculin was used as specific antigen. In the rabbits sera infected by Nocardia and Rhodococcus complement-fixation and hemagglutination antibodies to mycobacterial antigens were detected. These rabbits also exhibited skin reaction to P.P.D. tuberculin. The presence of common group-specific antigens in Nocardia and Rhodococcus, as well as in mycobacteria, determined the capacity of the former to sensitize experimental animals to tuberculin, with should be taken into consideration in making the allergic test to tuberculosis.

Animals↗

PubMed2006

Human T-cell responses to 25 novel antigens encoded by genes of the dormancy regulon of Mycobacterium tuberculosis.

The dormancy (DosR) regulon of Mycobacterium tuberculosis is expressed in vitro during hypoxia and low-dose nitric oxide stimulation. Tubercle bacilli are thought to encounter these conditions in humans during latent infection. In this study, immune responses were evaluated to 25 most strongly induced DosR-regulon-encoded proteins, referred to as latency antigens. Proliferation assays were performed using M. tuberculosis-specific T-cell lines and peripheral blood mononuclear cells (PBMC) from tuberculosis (TB) patients, tuberculin skin test positive (TST+) individuals and uninfected controls. All 25 latency antigens were able to induce production of interferon-gamma (IFN-gamma) by T-cell lines. Eighteen latency antigens were also recognized by PBMC of M. tuberculosis-infected individuals, which indicates expression of the DosR-regulon during natural infection. Differential analysis showed that TST+ individuals recognized more latency antigens and with a stronger cumulative IFN-gamma response than TB patients, while the opposite profile was found for culture filtrate protein-10. In particular Rv1733c, Rv2029c, Rv2627c and Rv2628 induced strong IFN-gamma responses in TST+ individuals, with 61%, 61%, 52% and 35% responders, respectively. In conclusion, several new M. tuberculosis antigens were identified within the DosR-regulon. Particularly strong IFN-gamma responses to latency antigens were observed in latently infected individuals, suggesting that immune responses against these antigens may contribute to controlling latent M. tuberculosis infection.

Adolescent↗

PubMed1995

Evaluation of infection control measures in preventing the nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis in a New York City hospital.

OBJECTIVE: To evaluate the efficacy of Centers for Disease Control and Prevention (CDC)-recommended infection control measures implemented in response to an outbreak of multidrug-resistant (MDR) tuberculosis (TB). DESIGN: Retrospective cohort studies of acquired immunodeficiency syndrome (AIDS) patients and healthcare workers. The study period (January 1989 through September 1992) was divided into period I, before changes in infection control; period II, after aggressive use of administrative controls (eg, rapid placement of TB patients or suspected TB patients in single-patient rooms); and period III, while engineering changes were made (eg, improving ventilation in TB isolation rooms). SETTING: A New York City hospital that was the site of one of the first reported outbreaks of MDR-TB among AIDS patients in the United States. PARTICIPANTS: All AIDS patients admitted during periods I and II. Healthcare workers on nine inpatient units with TB patients and six without TB patients. RESULTS: The epidemic (38 patients) waned during period II and only one MDR-TB patient presented during period III. The MDR-TB attack rate among AIDS patients hospitalized on the same ward on the same days as an infectious MDR-TB patient was 8.8% (19 of 216) during period I, decreasing to 2.6% (5 of 193; P = 0.01) during period II. In a small group of healthcare workers with tuberculin skin test data, conversions during periods II through III were higher on wards with than without TB patients (5 of 29 versus 0 of 15; P = 0.15), although the difference was not statistically significant. CONCLUSIONS: Transmission of MDR-TB among AIDS patients decreased markedly after enforcement of readily implementable administrative measures, ending the outbreak. However, tuberculin skin-test conversions among healthcare workers may not have been prevented by these measures. CDC guidelines for prevention of nosocomial transmission of TB should be implemented fully at all US hospitals.

AIDS-Related Opportunistic Infections↗

PubMed1991

Mortality from lung cancer among Sardinian patients with silicosis.

The mortality of 724 subjects with silicosis, first diagnosed in 1964-70 in the Sardinia region of Italy, was followed up through to 31 December 1987. Smoking, occupational history, chest x ray films, and data on lung function were available from clinical records for each member of the cohort. The overall cohort accounted for 10,956.5 person-years. The standardised mortality ratios (SMRs) for selected causes of death (International Classification of Diseases (ICD) eighth revision) were based on the age specific regional death rates for each calendar year. An excess of deaths for all causes (SMR = 1.40) was found, mainly due to chronic obstructive lung disease, silicosis, and tuberculosis with an upward trend of the SMR with increasing severity of the International Labour Office (ILO) radiological categories. Twenty two subjects died from lung cancer (SMR = 1.29, 95% confidence interval (95% CI) = 0.8-2.0). The risk increased after a 10 and 15 year latency but the SMR never reached statistical significance. No correlation was found between lung cancer and severity of the radiological category, the type of silica (coal or metalliferous mines, quarries etc), or the degree of exposure to silica dust. A significant excess of deaths from lung cancer was found among heavy smokers (SMR = 4.11) and subjects with airflow obstruction (SMR = 2.83). A nested case-control study was planned to investigate whether the association between lung cancer and airway obstruction was due to confounding by smoking. No association was found with the ILO categories of silicosis or the estimated cumulative exposure to silica. The risk estimate for lung cancer by airflow obstruction after adjusting by cigarette consumption was 2.86 for a mild impairment and 7.23 for a severe obstruction. The results do not show any clear association between exposure to silica, severity of silicosis, and mortality from lung cancer. Other environmental or individual factors may act as confounders in the association between silicosis and lung cancer. Among them, attention should be given to chronic airways obstruction as an independent risk factor for lung cancer in patients with silicosis.

Aged↗

PubMed1997

Isoniazid preventive therapy for tuberculosis in HIV-1-infected adults: results of a randomized controlled trial.

OBJECTIVES: To determine the efficacy of isoniazid 300 mg daily for 6 months in the prevention of tuberculosis in HIV-1-infected adults and to determine whether tuberculosis preventive therapy prolongs survival in HIV-1-infected adults. DESIGN AND SETTING: Randomized, double-blind, placebo-controlled trial in Nairobi, Kenya. SUBJECTS: Six hundred and eighty-four HIV-1-infected adults. MAIN OUTCOME MEASURES: Development of tuberculosis and death. RESULTS: Three hundred and forty-two subjects received isoniazid and 342 received placebo. The median CD4 lymphocyte counts at enrolment were 322 and 346 x 10(6)/l in the isoniazid and placebo groups, respectively. The overall median follow-up from enrolment was 1.83 years (range, 0-3.4 years). The incidence of tuberculosis in the isoniazid group was 4.29 per 100 person-years (PY) of observation [95% confidence interval (CI) 2.78-6.33] and 3.86 per 100 PY of observation (95% CI, 2.45-5.79) in the placebo group, giving an adjusted rate ratio for isoniazid versus placebo of 0.92 (95% CI, 0.49-1.71). The adjusted rate ratio for tuberculosis for isoniazid versus placebo for tuberculin skin test (TST)-positive subjects was 0.60 (95% CI, 0.23-1.60) and for the TST-negative subjects, 1.23 (95% CI, 0.55-2.76). The overall adjusted mortality rate ratio for isoniazid versus placebo was 1.18 (95% CI, 0.79-1.75). Stratifying by TST reactivity gave an adjusted mortality rate ratio in those who were TST-positive of 0.33 (95% CI, 0.09-1.23) and for TST-negative subjects, 1.39 (95% CI, 0.90-2.12). CONCLUSIONS: Overall there was no statistically significant protective effect of daily isoniazid for 6 months in the prevention of tuberculosis. In the TST-positive subjects, where reactivation is likely to be the more important pathogenetic mechanism, there was some protection and some reduction in mortality, although this was not statistically significant. The small number of individuals in this subgroup made the power to detect a statistically significant difference in this subgroup low. Other influences that may have diluted the efficacy of isoniazid include a high rate of transmission of new infection and rapid progression to disease or insufficient duration of isoniazid in subjects with relatively advanced immunosuppression. The rate of drug resistance observed in subjects who received isoniazid and subsequently developed tuberculosis was low.

AIDS-Related Opportunistic Infections↗

PubMed2003

Conventional and molecular epidemiology of tuberculosis in Manitoba.

BACKGROUND: To describe the demographic and geographic distribution of tuberculosis (TB) in Manitoba, thus determining risk factors associated with clustering and higher incidence rates in distinct subpopulations. METHODS: Data from the Manitoba TB Registry was compiled to generate a database on 855 patients with tuberculosis and their contacts from 1992-1999. Recovered isolates of M. tuberculosis were typed by IS6110 restriction fragment length polymorphisms. Bivariate and multivariate logistic regression models were used to identify risk factors involved in clustering. RESULTS: A trend to clustering was observed among the Canadian-born treaty Aboriginal subgroup in contrast to the foreign-born. The dominant type, designated fingerprint type 1, accounts for 25.8% of total cases and 75.3% of treaty Aboriginal cases. Among type 1 patients residing in urban areas, 98.9% lived in Winnipeg. In rural areas, 92.8% lived on Aboriginal reserves. Statistical models revealed that significant risk factors for acquiring clustered tuberculosis are gender, age, ethnic origin and residence. Those at increased risk are: males (p < 0.05); those under age 65 (p < 0.01 for each age subgroup); treaty Aboriginals (p < 0.001), and those living on reserve land (p < 0.001). CONCLUSION: Molecular typing of isolates in conjunction with contact tracing data supports the notion of the largest ongoing transmission of a single strain of TB within the treaty-status population of Canada recorded to date. This data demonstrates the necessity of continued surveillance of countries with low prevalence of the disease in order to determine and target high-risk populations for concentrated prevention and control measures.

Adolescent↗

PubMed1984

Average? Ideal? Desirable? A brief overview of height-weight tables in the United States.

Insurance companies have dominated the development of height-weight tables. Initially, tables indicated average weights for insurees, revealing weight gains with increasing age. While pneumonia and tuberculosis were leading causes of death, underweight was considered undesirable because it was associated with those conditions. Extra weight was then thought to represent a reserve that could be drawn upon in time of illness. As those diseases were brought under control, the risk factors in overweight received increased attention. Since the 1940s, tables have been developed by the Metropolitan Life Insurance Company for "ideal" and "desirable" weights, defined as weights associated with the lowest mortality rate. Body frame size, although poorly defined, was factored into the tables. The data base and philosophy of the tables have been questioned by some researchers. Recently, Metropolitan issued 1983 height and weight tables based on life insurance statistics. Weights for height are slightly higher than in the previous (1959) tables. Although stated weights are those associated with the lowest mortality, they are not labeled "ideal" or "desirable". A method for determining body frame size through measurements of elbow breadth is presented. Health care providers should be aware of the latest revisions of these widely used tables, their philosophy, and data source to ensure most suitable use.

Actuarial Analysis↗

PubMed1995

[Tuberculosis in children in Madagascar. 122 cases observed at the Soavinandriana-Antananarivo Hospital Center].

A group of 122 observations of pediatric tuberculosis has been studied. Nurslings represented 34% of the group, children under 8 years old 75% and only 10% were above 12. The sex ratio was 1,1. In a statistically significant way, tuberculous children were less often immunized by BCG than reference children not infected by tuberculosis. Contact has been traced back to close family in 42% of cases. Weight loss was significant at diagnosis time and after treatment the difference with the reference group disappeared. Extrapulmonary localizations were less frequent with children under 2, pulmonary and extrapulmonary localizations associations could be observed with 14% of children under 2 and with 31% of the whole children developing a proved tuberculosis. The importance of bronchial fibroscopy has been pointed out, for it allowed to detect 30% of abnormalities and to prove the diagnosis of tuberculous in 25% of cases. It is regrettable that the National Tuberculosis Control Programme did not prescribe chemoprophylaxis of contact children in its routine instructions, yet it is well known that child tuberculosis is rarely contagious and is not considered a priority by a programme. Finally, the authors reported that the number of pediatric tuberculosis managed in the country showed an obvious underestimation of the problem and they hope this work would lead to think more frequently of that diagnosis in the future.

Adolescent↗

PubMed1989

[Tuberculous meningitis and acquired immunodeficiency syndrome].

A series composed by 13 patients suffering Tuberculous Meningitis (TM) and Acquired Immunodeficiency Syndrome (AIDS) is reported. The characteristics of the disease are compared with those obtained from a control group. TM reached a frequency of 18% in the first 66 patients with AIDS and neurologic disorders attended by the authors. The male/female ratio was 12:1. There was lesser frequency of headache in the group with TM and AIDS, but there was a greater frequency of lymph nodes, anemia, leukopenia, hypergammaglobulinemia and elevated ESR that in the control group. These differences were statistically significative. Parabolic and hyperbolic correlations were found between the number of cells and the albumin or glucose concentration in the CSF (and also between the later two parameters) of the patients with TM and AIDS. The treatment was very efficacious, but the proper duration and the long-term results of the therapy are unknown due to the difficult follow-up.

Acquired Immunodeficiency Syndrome↗

PubMed2002

Completeness of notifiable infectious disease reporting in the United States: an analytical literature review.

Despite state and local laws requiring medical providers to report notifiable infectious diseases to public health authorities, reporting is believed to be incomplete. Through means of an analytical literature review, the authors synthesize current knowledge on the completeness of disease reporting and identify factors associated with reporting completeness. The review was limited to published studies, conducted in the United States between 1970 and 1999, that quantitatively assessed infectious disease reporting completeness. Thirty-three studies met the inclusion criteria. Reporting completeness, expressed between 0% and 100%, was treated as the dependent outcome variable in statistical analysis; disease, study location, time period, study design, and study size were treated as independent variables. Fifty-six distinct measures of reporting completeness were identified for 21 diseases. Reporting completeness varied from 9% to 99% and was most strongly associated with the disease being reported. The mean reporting completeness for acquired immunodeficiency syndrome, sexually transmitted diseases, and tuberculosis as a group was significantly higher (79%) than for all other diseases combined (49%) (p < 0.01).

Communicable Disease Control↗

PubMed1996

[Serum levels of solubule tumor necrosis factor (TNF) receptors in patients with pulmonary tuberculosis].

Tumor necrosis factor alpha (TNF-alpha) is released from cells of monocyte/macrophage lincage and mediates the development of a variety of clinical and pathomorphological features in various infectious diseases, autoimmune diseases and cancer. In the case of tuberculosis, it is suggested that the release of TNF-alpha in the affected regions and into the circulation could account for the pathological and clinical features such as the development of necrotic lesions and fever and weight loss in TB patients. In the present study, the levels of soluble TNF receptor type I (sTNFR type I) and type II (sTNFR type II) and TNF-alpha in the sera of patients with pulmonary TB were assayed, and we tried to know whether these levels have clinical significance in determining the disease activity in TB patients. The serum levels of both sTNFR types I and II were significantly higher in TB patients (n = 22) who were previously untreated than in the healthy control (n = 14): for sTNFR type I, 2.82 +/- 1.37 ng/ml vs. 1.40 +/- 0.33 ng/ml (p < 0.0001), and for sTNFR type II, 3.83 +/- 1.76 ng/ml vs. 1.62 +/- ng/ml (p < 0.0001). The serum levels of sTNFR types I and II in TB patients showed significant correlations with their serum levels of CRP. The serum levels of TNF-alpha in these TB patients was 2.21 +/- 1.72 pg/ml, whereas TNF-alpha was not detectable in the sera of 9 healthy control. The serum levels of sTNFR type I and II were significantly higher in cavitary TB (n = 17) than in non-cavitary TB (n = 5). When TB patients were treated with antituberculosis drugs and clinical improvements were achieved, the elevated levels of sTNFR type I and TNF-alpha in the sera of same 5 patients measured before starting treatment showed significant decline and the serum levels of sTNFR type II showed also declined, however, the decline was statistically not significant. From all the results obtained in this study, we conclude that the assay of the serum levels of sTNFR in TB patients is useful in the evaluation of the disease activity of TB.

Adult↗

PubMed1980

The role of delayed hypersensitivity in the enhancement of host resistance to infection.

Swiss-Webster mice were vaccinated by the intraperitoneal route (i.p.) with Mycobacterium tuberculosis BCG and challenged i.p. 4-10 weeks later with 10(4) virulent Salmonella typhimurium in the presence or absence of purified derivative (PPD) of tuberculin. Normal control mice were similarly challenged. Such an infection was fatal to the normal mice within 12 days. BCG vaccination prolonged the survival time and protected about 36% of the salmonella-infected mice from death. In contrast, tuberculin sensitivity, elicited in the BCG-vaccinated mice, significantly increased the survival time and protected about 70% of the mice against an otherwise fatal challenge. When these experiments were repeated using an infective dose of 10(6) organisms, the protective effect of the tuberculin reaction became substantially reduced, but there remained a statistically significant improvement in the survival distribution of the challenged mice as compared with that among the BCG-vaccinated mice. The examination of peritoneal washings obtained from BCG-vaccinated mice stimulated with PPD showed that the enhanced resistance to salmonella infection was directly associated with a quantitatively increased influx of phagocytic leukocytes accumulating at the site of infection as a result of the elicitation of tuberculin sensitivity.

Animals↗

PubMed1990

[Influence of health education on compliance with antituberculous chemoprophylaxis in children: a community trial].

Antituberculous chemoprophylaxis with isoniazide during a period of one year is very useful although it is not readily accepted. A community trial is designed in order to test if three health education interventions increase patients compliance with such treatment in case of tuberculin positive children who are not ill. The two interventions performed by nurses, one by phone, and the second one by a home visit, resulted in statistically significant difference when compared to the control group. This did not occur, however, with the intervention performed by the doctor in his office. A cost-effectiveness study demonstrates that the most efficient intervention has been the phone call.

Child↗

PubMed2000

[Drug resistance in Mycobacterium tuberculosis. A multicenter study of the Barcelona area. Grupo de Trabajo sobre Resistencias en Tuberculosis].

BACKGROUND: The aims of this multicenter study was to establish the level of primary and acquired drug resistance of M. Tuberculosis strains isolated in Barcelona and to identify possible risk groups using clinical data. PATIENTS AND METHODS: All tuberculosis patients with isolation and identification of M. tuberculosis strains from October 1995 to September 1997 were included. Susceptibility tests isoniazid, rifampin, ethambutol, streptomycin and pyrazinamide were performed using the Bactec 460 system and the proportions method on solid medium. Logistic progression was used for statistical analysis. RESULTS: The total number of patients included was 1,749 (1,535 non-treated and 214 previously treated). Primary drug resistance was 5.7% (isoniazid 3.8%; rifampin 1.0%, streptomycin 2.1%, ethambutol 0.3% and pyrazinamide 1.0%). Acquired drug resistance was 20.5% (isoniazid 17.3%, rifampin 9.8%, ethambutol 1.9%, streptomycin 4.7% and pyrazinamide 6.5%). Primary drug resistance was associated with people over 60 years old and women. CONCLUSIONS: The low level of drug resistance enables antituberculosis treatment of non-treated patients to start with the standardised three-drug regimes except in the case of foreign people from countries with a high level of drug resistance. Susceptibility tests are recommended on all M. tuberculosis strains isolated, together with controlled studies of drug resistance surveillance.

Adolescent↗