Anti-tuberculosis drug resistance in Portugal.

SETTING: A survey based upon a representative sample of smear-positive pulmonary tuberculosis patients was undertaken in Portugal, as part of the World Health Organization's Global Project on Anti-Tuberculosis Drug Resistance Surveillance. OBJECTIVE: To determine the level of primary antituberculosis drug resistance at both national and regional levels, and to assess its relative weight within the performance of the National Tuberculosis Programme (NTP). DESIGN: Mycobacterium tuberculosis isolates from 1,105 patients with smear-positive pulmonary tuberculosis admitted to 46 randomly stratified treatment centres all over mainland Portugal were submitted to susceptibility testing with four drugs. Human immunodeficiency virus (HIV) testing was included in the patients' evaluation scheme. RESULTS: Of the strains isolated, 197 (17.8%) were resistant to at least one drug. Primary resistance to isoniazid was 7.7% and to rifampicin 1.9%. Acquired drug resistance was 39.2% in total, any acquired resistance to isoniazid 31.1% and to rifampicin 20.9%. Primary multidrug resistance (MDR) was 1.8% and acquired MDR was 20.9%. HIV testing was positive in 29.2% of MDR-TB cases. CONCLUSIONS: Drug resistance in Portugal is high. Primary MDR and particularly acquired MDR occur in a high proportion of cases, indicating a need for improvement in NTP performance.

Left ventricular function after late thrombolysis with alteplase in myocardial infarction.

OBJECTIVE: Late thrombolytic treatment (after 6 hours from pain onset) for acute myocardial infarction has been shown to improve survival in a cohort of patients. The mechanisms underlying such benefit have been debated and a controversy exists about the influence of late thrombolysis over left ventricular function as one potential mechanism. The present study intended to clarify the effects of late thrombolysis with alteplase on left ventricular function parameters. DESIGN: Prospective, multicenter, randomised, double-blind study. Ancillary study to LATE trial. PATIENTS: We studied 103 patients, 81.6% men, randomly allocated to alteplase (100 mg over 3 hours) or placebo 6 to 24 hours after onset of myocardial infarction. METHODS: Left ventricular function parameters by radionuclide ventriculography were evaluated at 1 and 6 months after myocardial infarction. RESULTS: At 1 month, left ventricular ejection fraction was 48.86% on alteplase and 43.19% in placebo group (p = 0.028), with greater benefits for septal and apical regions. At 6 months no significant differences were found. CONCLUSIONS: Those data suggest that late thrombolysis with alteplase improves left ventricular function 1 month after myocardial infarction although the difference did not persist at 6 months. Improvement of left ventricular function shall, therefore, be considered as one of the possible mechanisms underlying the benefit of late thrombolysis.

[Isonitrile (sestamibi) as a valid alternative to thallium 201 for myocardial perfusion studies]. / O isonitrilo (SestaMibi) como alternativa válida ao Tálio 201 para os estudos de perfusão miocárdica.

OBJECTIVE: SestaMIBI is a new technetium labeled radiopharmaceutical agent approved for myocardial perfusion studies. In the present work the authors analyzed the accuracy of this agent on the study of ischemic heart disease. CONCEPTION: The present paper was made considering the results of four previous studies around defined goals performed by the same research group. SETTING: Cardiology and Nuclear Medicine departments in a general hospital. RESULTS: Planar studies: global sensitivity for the diagnosis of ischemic heart disease was 100% and specificity of 67%. Tomocintigraphic studies and segmentary analysis of IHD: the accuracy for stenosis involving the left anterior descending artery was of 80%, 91% for the right coronary artery and 67.2% for left circumflex artery. Planar studies versus tomocintigraphy--SPECT (comparative study in the same population): global sensitivity of 86% for planar method and 97% for "SPECT". In patients with single vessel disease the results are also better with "SPECT" (75% vs 94%). In this series the presence of rest perfusion defects is frequent. In 75% was possible to correlate them with a significant lesion over the related coronary artery. The positive predictive value of this finding is of 92% for the lesions on the left coronary artery, 100% for left cincumflex and 59% for the right coronary artery. CONCLUSIONS: 1. The SestaMIBI is an excellent radiopharmaceutical agent for myocardial perfusion studies. 2. The accuracy of this agent for diagnosis of ischemic heart disease is quite good with a high sensitivity and specificity values. This conclusion is also valid for those patients with single vessel disease. 3. Scintigraphic studies performed with planar acquisition provide good quality images. Nevertheless tomoscintigraphy (SPECT) is more accurate namely in patients with single vessel disease. 4. In the present state of the art and regarding our results we can conclude that is too early for considering SestaMIBI like and agent for viability studies.

Multidrug and extensively drug-resistant tuberculosis in Lisbon and Vale do Tejo, Portugal, from 2008 to 2010.

Tuberculosis (TB) was explicitly recognized as a major global public health problem in the early 1990s and, if it is to be eliminated, it is essential that every country organize control activities in line with its own epidemiological situation. Portugal still remains among the countries with intermediate incidence, with 2756 cases of TB diagnosed in 2009. The incidence of multidrug-resistant (MDR) TB has been decreasing, representing an average of 1.7% of the total number of TB cases, with about 25% of extensively drug-resistant (XDR) TB, and with more than two thirds residing in the region of Lisbon and Vale do Tejo (LVT). The aim of this study is to evaluate risk factors and treatment outcomes associated with MDR and XDR-TB in LVT during the time period of 2008-2010. In 50 (2.4%) out of 2093 culture-positive TB cases from patients diagnosed in the LVT region, Mycobacterium tuberculosis (MTB) isolates were identified as MDR-TB; 12 (24%) met the criteria for XDR-TB. It was noted that HIV-positive status and retreatment cases are still closely associated with drug-resistant TB. Although the WHO target of about 75% treatment success rates for MDR-TB was not yet achieved, extensive drug susceptibility testing and the availability of second- and third-line drugs under strictly supervised treatment conditions permitted relatively good treatment success rates in MDR and XDR-TB cases in Lisbon.