Elemental Composition of PM2.5 Aerosol in a Residential-Industrial Area of a Mediterranean Megacity.

Very little is known about the elemental composition and possible sources of fine aerosol particles from Mediterranean megacities. Fine aerosol particles were collected at a residential-industrial area in Greater Cairo, Egypt, during the period from October 2010 to May 2011. The elemental compositions of the collected samples were quantified by using a homemade energy dispersive x-ray fluorescence spectrometer, whereas black carbon was quantified by a black smoke detector. Fifteen elements have been quantified. Of these constituents, Ca, C, Cl, S, and Fe had the highest concentrations: greater than 1 µg m-3. The overall mean mass concentration of the collected samples equals 70 µg m-3; this value exceeds the European Union annual Air Quality Standard levels. The individual elemental concentrations of the fine particles were found to be dominated by elements linked to mineral dust. Most of the monthly variations of elemental concentrations can be attributed to seasonal meteorological conditions. Other possible sources were vehicle-exhaust and industrial activities. The results pinpoint the problem of identifying different sources when one source, in this case, the nearby deserts, is dominant. The results from this study contribute to the growing knowledge of concentrations, composition, and possible sources of ambient fine particulate matter.

Genetic diversity analysis of Aspergillus flavus isolates from plants and air by ISSR markers.

Aspergillus flavus is one of the most abundant and widely distributed fungi on earth. A. flavus produces aflatoxins (AFs), which are toxic secondary metabolites. AFs have harmful effects on public health (humans and animals) and agricultural crops. Inter-simple sequence repeat (ISSR) markers were used to analyze the genetic diversity of 30 A. flavus isolates from five agricultural crops and air. Genetic similarity coefficients (GSC) ranged from 0.51 to 0.10 based on three ISSR markers for the isolates tested. A. flavus isolates grouped into 6, 5, and 3 clusters using the unweighted pair-group method with arithmetic average of three ISSR markers. This study suggests that ISSR biotechnology is a highly useful tool for characterizing genetic diversity of A. flavus isolated from different sources.

Leveraging Global Fund's investments to expand innovative public-private provider engagement in TB.

BACKGROUND: TB remains a significant global health threat, claiming 1.3 million lives annually. The COVID-19 pandemic disrupted progress in the global TB response. Most patients with TB initially seek care from private providers, whereas only a small proportion are engaged by national programmes. The Global Fund is the major international source of funding for TB responses and supports the scale-up of innovative private-public mix (PPM) models in TB. METHODS: We collected programmatic and financial data on TB from 11 priority countries implementing PPM activities. Country examples and trends in the budget of Global Fund grants were analysed. RESULTS: These countries account for 60% of the global TB burden and Global Fund TB portfolio. PPM contributed 29% of national TB notifications in 2022 (range: 8% to 49%). During 2021-2023, US$1.4 billion was allocated for TB and US$155 million (11%) for PPM, while PPM contributed to 35% of national TB notification targets. PPM budgets increased over time from US$43 million (2002 to 2014) to US$129 million (2024 to 2026). CONCLUSION: The Global Fund's investments facilitated the expansion of innovative PPM models, improved access, and enhanced TB responses. Our indicative analysis underscores the need for evidence-based planning, collaboration, and increased domestic investment to accelerate the end of TB.

CONTEXTE: La TB reste une menace importante pour la santé mondiale, faisant 1,3 million de morts chaque année. La pandémie de COVID-19 a perturbé les progrès de la riposte mondiale à la TB. La plupart des patients atteints de TB recherchent d'abord des soins auprès de prestataires privés, tandis que seule une petite proportion est engagée par des programmes nationaux. Le Fonds mondial est la principale source internationale de financement de la lutte contre la TB et soutient l'extension de modèles innovants de partenariats public-privé (PPM, pour l'anglais « public-private mix ¼) dans le domaine de la TB. MÉTHODES: Nous avons recueilli des données programmatiques et financières sur la TB dans 11 pays prioritaires mettant en œuvre des activités de PPM. Des exemples de pays et les tendances du budget des subventions du Fonds mondial ont été analysés. RÉSULTATS: Ces pays représentent 60% de la charge mondiale de morbidité de la TB et du portefeuille du Fonds mondial de lutte contre la TB. La PPM a contribué à 29% des notifications nationales de TB en 2022 (fourchette : 8­49%). Au cours de la période 2021­2023, 1,4 milliard de dollars US ont été alloués à la TB et 155 millions de dollars US (11%) à la PPM, tandis que la PPM a contribué à 35% des cibles nationales de notification de la TB. Les budgets PPM ont augmenté au fil du temps, passant de 43 millions de dollars US (2002 à 2014) à 129 millions de dollars américains (2024 à 2026). CONCLUSION: Les investissements du Fonds mondial ont facilité l'expansion de modèles PPM innovants, l'amélioration de l'accès et le renforcement des ripostes à la TB. Notre analyse indicative souligne la nécessité d'une planification fondée sur des données probantes, d'une collaboration et d'une augmentation des investissements nationaux pour accélérer l'éradication de la TB.

Modified micromarsupialization technique as an alternative primary treatment for ranulas: A case series in a resource-challenged economy.

OBJECTIVES: Ranula is one of the commonest salivary gland cysts that mostly occur due to mucus extravasation from the sublingual salivary gland. Treatment of this lesion is still somewhat shrouded in controversy and varies from conservative treatment to surgical excision of the causative gland. MATERIALS AND METHODS: This was a case series in quasi-experimental design that evaluated the outcome and complications of the modified micromarsupialization technique as a newly introduced treatment at our center for simple sublingual ranula over a 2-year period. RESULTS: Twenty patients were treated by the modified micromarsupialization technique and followed up for 1 year. There was complete resolution following this technique in 17 patients (85%) with no evidence of recurrence or complications, whereas 2 patients (10%) showed partial resolution and the remaining 1 patient (5%) showed a failure and recurrence. The age of the patient, the size of the ranula, and the retention of sutures throughout the study period did not significantly affect the treatment outcome. CONCLUSIONS: The modified micromarsupialization technique was a simple and effective treatment that should be used as a primary treatment option for simple ranulas and we recommend it to be the first-choice treatment before surgical excision of the sublingual gland, especially in a resource-challenged economy like ours.

Resistance to first-line tuberculosis drugs in three cities of Nigeria.

OBJECTIVES: To determine the levels of resistance to first-line tuberculosis drugs in three cities in three geopolitical zones in Nigeria. METHODS: A total of 527 smear-positive sputum samples from Abuja, Ibadan and Nnewi were cultured on BACTEC- MGIT 960. Drug susceptibility tests (DST) for streptomycin, isoniazid, rifampicin and ethambutol were performed on 428 culture-positive samples on BACTEC-MGIT960. RESULTS: Eight per cent of the specimens cultured were multi-drug-resistant Mycobacterium tuberculosis (MDR-TB) with varying levels of resistance to individual and multiple first-line drugs. MDR was strongly associated with previous treatment: 5% of new and 19% of previously treated patients had MDR-TB (OR 4.1 (95% CI 1.9-8.8), P = 0.001) and with young adult age: 63% of patients with and 38% without MDR-TB were 25-34 years old (P = 0.01). HIV status was documented in 71%. There was no association between MDR-TB and HIV coinfection (P = 0.9) and gender (P > 0.2 for both). CONCLUSIONS: MDR-TB is an emerging problem in Nigeria. Developing good quality drug susceptibility test facilities, routine monitoring of drug susceptibility and improved health systems for the delivery of and adherence to first- and second-line treatment are imperative to solve this problem.

Clinico-pathological profile of acute promyelocytic leukaemia at Al-Amal Oncology-Haematology Centre, Qatar.

This cases series describes the profile of adult patients with acute promyelocytic leukaemia (APt) at a referral hospital in Qatar. Of 34 acute myeloid leukaemia (AML) cases diagnosed, 11(32%) were classified as APt. Disseminated intravascular coagulation was common at presentation (91%). Severe thrombocytopenia was seen in 73%, leukocytosis in 55% and severe anaemia in 45%. Only 2 patients were of the classic hypergranular type. In the remaining 9 patients, 3 morphological subtypes were recognized: microgranular variant (6 patients), hyperbasophilic (2 patients) and regular nuclear outline M3r (1 patient). Translocation t(15;17) was detected in 63% of cases. APL constitutes a high proportion of AML cases in Qatar, with considerable morphological heterogeneity and a oredominance of APL variants with unfavourable oresenting features.

Performance-based technical support for drug-resistant TB responses: lessons from the Green Light Committee.

Drug-resistant tuberculosis (DR-TB) constitutes a global threat and a major contributor to deaths related to antimicrobial resistance. Despite progress in DR-TB detection and treatment over the last decade, huge gaps remain in treatment coverage, access to quality care and treatment outcome. Global Fund investments have been critical to scaling up the existing and new diagnostic tools, treatment coverage and people-centred service delivery. The United Nations General Assembly (UNGA) high-level meeting represents unprecedented opportunities to accelerate towards addressing DR-TB. Established in 2000 and funded by the Global Fund since 2009, the Green Light Committee (GLC) mechanism has evolved from project approval to providing demand-based technical assistance to countries to scale up response to DR-TB based on their need and priorities. Lessons learnt from the GLC mechanism over 10 years demonstrate that a result-based, systematic and accountable technical assistance model to support scale-up of DR-TB response is critically important. Meeting the UNGA declaration targets requires major scale-up of current efforts and new tools, and hence the need for predictable, consistent and sustained technical support to countries, including through the regional GLC mechanism. The application of the principles and processes of this model could be adapted and replicated to design a similar performance-based and quality-assured technical support mechanism.

Enhancing tuberculosis case finding in Tanzania: implementation of a quality improvement initiative.

Tuberculosis (TB) is one of the major causes of morbidity and mortality in Tanzania. A quality improvement (QI) initiative was implemented by the National Tuberculosis Programme with support from The Global Fund to enhance TB case finding. The initiative involved identifying gaps in the quality of services, introducing tools, building capacity of health workers, and strengthening laboratory and referral services. The initiative was piloted at sub-national level and subsequently scaled-up nationally. Overall, 1280 health workers were trained, leading to an 81% cumulative increase in notified TB cases in the pilot region and 4000 additional TB cases notified nationally. The QI initiative could serve as a model for the improvement of TB case notification in other settings.

La tuberculose (TB) est une des causes majeures de morbidité et de mortalité en Tanzanie. Une initiative d'amélioration de la qualité (QI) en trois points a été mise en œuvre par le Programme National Tuberculose avec un soutien du Fonds Mondial pour améliorer la détection des cas de TB. L'initiative a impliqué l'identification des failles de qualité des services de TB, l'introduction d'outils, le renforcement des capacités du personnel de santé, le renforcement du laboratoire TB et des services de référence. L'initiative a été pilotée au niveau sous national et ensuite étendue au niveau national : 1280 personnels de santé ont été formés, la coordination de la QI a été renforcée et ceci a contribué à 81% de l'augmentation cumulée des cas de TB notifiés dans la région pilote et à la notification de 4000 cas de TB supplémentaires au niveau national. L'initiative QI pourrait servir de modèle pour améliorer la notification des cas de TB dans d'autres contextes.

La tuberculosis (TB) es una de las principales causas de morbilidad y mortalidad en Tanzanía. El Programa Nacional contra la Tuberculosis introdujo, con el apoyo del Fondo Mundial, una iniciativa triple de mejoramiento de la calidad (QI) encaminada a reforzar la búsqueda de casos de TB. La iniciativa comportaba el reconocimiento de las deficiencias en la calidad de los servicios de TB, la introducción de instrumentos, el fortalecimiento de la capacidad de los trabajadores de salud y el refuerzo de los laboratorios de TB y los servicios de remisiones. Después de un ensayo piloto a escala subnacional, se amplió la iniciativa a todo el país. Se capacitaron 1280 trabajadores de salud y se reforzó la coordinación de la QI, con lo cual se propició un aumento acumulado de 81% de los casos de TB notificados en la región piloto y la notificación de 4000 casos de TB adicionales a escala nacional. La iniciativa de QI podría servir como modelo para mejorar la notificación de casos de TB en otros entornos.

Validation of bleach-treated smears for the diagnosis of pulmonary tuberculosis.

SETTING: Health centres in Awassa, southern Ethiopia. DESIGN: Consecutive patients visiting health centre laboratories for the evaluation of suspected pulmonary tuberculosis (TB) between June and September 2006 were investigated. On-the-spot, morning and second on-the-spot sputum samples were pooled for each patient. Direct smears were stained with hot Ziehl-Neelsen (ZN) technique and aliquots cultured for mycobacteria on Löwenstein-Jensen media. The remaining sputum was treated with household bleach, aliquoted and processed with short-term digestion, centrifugation and sedimentation techniques, and stained with ZN. RESULTS: Acid-fast bacilli were detected in respectively 126 (25%), 141 (28%), 169 (34%) and 198 (40%) of the 497 pooled sputum samples processed by the direct, short-term, sedimentation and centrifugation techniques (P < 0.001). The sensitivity of the direct, short-term, sedimentation and centrifugation techniques was respectively 51.1%, 53.2%, 57.6% and 63.6%. The difference between the direct smear and centrifugation (P < 0.001) or sedimentation (P < 0.005) methods was significant. The specificity of the direct, short-term digestion, sedimentation and centrifugation techniques was respectively 97%, 93%, 86.5% and 80.8%. CONCLUSIONS: Bleach treatment of sputum and centrifugation significantly improves the sensitivity of smear microscopy for the diagnosis of TB in a health centre in a high TB burden area. It is more sensitive, but possibly less specific, than other bleach methods.

Short-term bleach digestion of sputum in the diagnosis of pulmonary tuberculosis in patients co-infected with HIV.

The bleach digestion of sputum may improve the yield of smear microscopy but has not been validated in patients with HIV. Therefore we assessed the performance of bleach-digested smear microscopy among patients with HIV. One thousand three hundred and twenty one patients with chronic cough submitted three sputum samples for direct smear microscopy and were offered HIV tests. One sample was selected for a bleach-digested smear and another one was cultured. Patients were classified as having 'definite' (>or=2 positive smears), 'very likely' (smear-negative, culture- positive), 'less likely' (one smear-positive, culture-negative) and 'unlikely' (smear and culture negative) tuberculosis (TB). In all, 566/1045 (54%) patients were HIV positive and 731/1186 (62%) were culture positive. The digested smears were positive in 123/125 (98%) 'definite', 4/118 (3%) 'very likely' and 1/174 'unlikely' TB patients with HIV and in 125/127 (98%) 'definite', 2/74 (3%) 'very likely', 4/4 'less likely' and 2/127 'unlikely' TB without HIV. Three direct smears identified 252 (57%) and one digested smear 254 (57%) of the 444 patients with 'definite' or 'very likely' TB. One bleach-digested smear performed similarly to three direct smears. Both methods were less sensitive in HIV-positive patients. Further studies are needed to compare the performance of the two methods under operational conditions.

Same-day smears in the diagnosis of tuberculosis.

OBJECTIVE: To assess the feasibility of completing the diagnosis of tuberculosis (TB) in 1 day by collecting only on-the-spot specimens. METHODS: Individuals with suspected TB attending district hospitals in Abuja submitted three sputum samples for routine diagnosis (the standard approach). One additional sample was collected 1 h after the first sputum (the same-day approach). One sputum sample was cultured. Blood samples were tested for HIV. RESULTS: Two hundred and twenty-four patients with chronic cough had 135/672 (20%) positive on-the-spot smears and 47/224 (21%) positive morning smears. The same-day and internationally recommended approaches identified 44 and 45 of the 78 patients with positive cultures, respectively. 106/194 (55%) patients were HIV positive. Only 9-11% of their smears were positive compared with 30-32% for HIV negatives (P < 0.01). CONCLUSION: It could be possible to diagnose TB in a single day by examining two spot specimens, but the feasibility needs to be confirmed on a larger scale.

Bleach-digested sputum smears for the diagnosis of TB in HIV-infected individuals.

We describe the performance of bleach-digested Zeihl-Neelsen (ZN) smears in TB suspects with/without HIV. In total, 51 (26%) and 62 (31%) out of the first 198 spot and digested smears were positive. Seven of the 30 HIV-positive patients had TB and their ZN smears were negative, scanty or 1 +. Six of seven digested smears were scanty. Forty-two of 115 HIV-negative patients had TB. Eleven (26%) of their digested smears were negative, 12 (29%) scanty and 19 (45%) positive. Despite the lower bacilli numbers of HIV-positive patients, the technique had sensitivity and specificity similar to that in HIV-negative patients.

A community-based isoniazid preventive therapy for the prevention of childhood tuberculosis in Ethiopia.

BACKGROUND: Although children in contact with adults with tuberculosis (TB) should receive isoniazid (INH) preventive therapy (IPT), this is rarely implemented. OBJECTIVE: To assess whether a community-based approach to provide IPT at the household level improves uptake and adherence in Ethiopia. METHODS: Contacts of adults with smear-positive pulmonary TB (PTB+) were visited at home and examined by health extension workers (HEWs). Asymptomatic children aged <5 years were offered IPT and followed monthly. RESULTS: Of 6161 PTB+ cases identified by HEWs in the community, 5345 (87%) were visited, identifying 24 267 contacts, 7226 (29.8%) of whom were children aged <15 years and 3102 (12.7%) were aged <5 years; 2949 contacts had symptoms of TB and 1336 submitted sputum for examination. Ninety-two (6.9%) were PTB+ and 169 had TB all forms. Of 3027 asymptomatic children, only 1761 were offered (and accepted) IPT due to INH shortage. Of these, 1615 (91.7%) completed the 6-month course. The most frequent reason for discontinuing IPT was INH shortage. CONCLUSION: Contact tracing contributed to the detection of additional TB cases and provision of IPT in young children. IPT delivery in the community alongside community-based TB interventions resulted in better acceptance and improved treatment outcome.

Role of Hyperplasia of Gingival Lymphatics in Periodontal Inflammation.

Lymphatic vessels are important for maintenance of tissue fluid homeostasis and afferent antigen transport. In chronic inflammation, lymphangiogenesis takes place and is characterized by lymphatic endothelial cell proliferation and lymphatic hyperplasia. Vascular endothelial growth factor C (VEGFC) is the main known lymphangiogenic growth factor, and its expression is increased in periodontitis, a common chronic infectious disease that results in tissue destruction and alveolar bone loss. The role of lymphangiogenesis during development of periodontitis is unknown. Here, we test if transgenic overexpression of epithelial VEGFC in a murine model is followed by hyperplasia of lymphatic vessels in oral mucosa and if the lymphatic drainage capacity is altered. We also test if lymphatic hyperplasia protects against periodontal disease development. Transgenic keratin 14 (K14)-VEGFC mice had significant hyperplasia of lymphatics in oral mucosa, including gingiva, without changes in blood vessel vasculature. The basal lymph flow was normal but slightly lower than in wild-type mice when oral mucosa was challenged with lipopolysaccharide from Porphyromonas gingivalis. Under normal conditions, K14-VEGFC mice exhibited an increased number of neutrophils in gingiva, demonstrated enhanced phagocyte recruitment in the cervical lymph nodes, and had more alveolar bone when compared with their wild-type littermates. After induction of periodontitis, no strain differences were observed in the periodontal tissues with respect to granulocyte recruitment, bone resorption, angiogenesis, cytokines, and bone-related protein expressions or in draining lymph node immune cell proportions and vascularization. We conclude that overexpression of VEGFC results in hyperplastic lymphatics, which do not enhance lymphatic drainage capacity but facilitate phagocyte transport to draining lymph nodes. Hyperplasia of lymphatics does not protect against development of ligature-induced periodontitis.

Are patients with pulmonary tuberculosis who are identified through active case finding in the community different than those identified in healthcare facilities?

The lack of healthcare access contributes to large numbers of tuberculosis (TB) cases being missed and has led to renewed interest in outreach approaches to increase detection. It is however unclear whether outreach activities increase case detection or merely identify patients before they attend health facilities. We compared adults with cough of >2 weeks' duration recruited in health facilities (1202 participants) or in urban slums (2828 participants) in Nigeria. Participants provided demographic and clinical information and were screened using smear microscopy. The characteristics of smear-positive and smear-negative individuals were compared stratified by place of enrolment. Two hundred nine health facility participants (17.4%) and 485 community-based participants (16.9%) were smear positive for pulmonary TB. Community-based smear-positive cases were older (mean age, 36.3 vs. 31.8 years), had longer cough duration (10.3 vs. 6.8 weeks) and longer duration of weight loss (4.6 vs. 3.6 weeks) than facility-based cases; and they complained more of fever (87.4% vs. 74.6%), chest pain (89.0% vs. 67.0%) and anorexia (79.5% vs. 55.5%). Community smear-negative participants were older (mean, 39.4 vs. 34.0 years), were more likely to have symptoms and were more likely to have symptoms of longer duration than smear-negative facility-based participants. Patients with pulmonary TB identified in the community had more symptoms and longer duration of illness than facility-based patients, which appeared to be due to factors differentially affecting access to healthcare. Community-based activities targeted at urban slum populations may identify a different TB case population than that accessing stationary services.

Microbiological validation of smear microscopy after sputum digestion with bleach; a step closer to a one-stop diagnosis of pulmonary tuberculosis.

BACKGROUND: Smear microscopy is relatively insensitive for the diagnosis of TB. The digestion of sputum with household bleach prior to smear preparation has been reported to improve its sensitivity. This method has not been validated. METHODS: Seven hundred and fifty six patients with symptoms suggestive of pulmonary TB (PTB) were asked to submit 3 sputum specimens for direct microscopy. One specimen was selected at random for culture and another specimen was digested to prepare a further smear. The WHO case definition (>or=2 positive smears or one positive smear and positive culture) was used to compare the sensitivity and specificity of the smears. FINDINGS: Four hundred and fifty five (60%) patients were culture-positive. Of these, 235 (31%) had "definite" PTB and 223 (29%) "very likely" PTB (smear-negative, culture-positive). The WHO case definition identified 51% (235/458) of the patients with "definite" or "very likely" PTB. One digested smear detected 219 (93%) of the 235 patients with "definite" PTB and 10 patients with "very likely" PTB (sensitivity (95%CI) 50% (45-55%); specificity 99% (97-100%)). The positive and negative predictive values for one digested smear were 98% (95-99%) and 56% (52-60%) respectively, which were not different (p>0.5) to the WHO case definition (100% and 57%, respectively). INTERPRETATION: One bleach-digested smear is as sensitive and specific as the WHO case definition for the diagnosis of PTB.

Ten-year experiences of the tuberculosis control programme in the southern region of Ethiopia.

SETTINGS: The tuberculosis control programme, southern region of Ethiopia. OBJECTIVE: To assess the impact of the expansion of the DOTS strategy on tuberculosis (TB) case finding and treatment outcome. DESIGN: Reports of TB patients treated since the introduction of DOTS in the region were reviewed. Patients were diagnosed and treated according to World Health Organization (WHO) recommendations. Case notification and treatment outcome reports were compiled quarterly at district level and submitted to the regional programme. RESULTS: Of 136,572 cases registered between 1995 and 2004, 47% were smear-positive, 25% were smear-negative and 28% had extra-pulmonary tuberculosis (EPTB). In 2004, 94% of the health institutions were covered by DOTS. Between 1995 and 2004, the smear-positive case notification rate increased from 45 to 143 per 100,000 population, the case detection rate from 22% to 45%, and the treatment success rate from 53% to 85%. The default and failure rates decreased from 26% to 6% and from 7% to 1%, respectively. DISCUSSION: There was a steady increase in the treatment success rate with the decentralisation of DOTS. Although 94% coverage was achieved after 10 years, the stepwise scale-up was important in securing resources and dealing with challenges. The programme achieved 85% treatment success; however, with the current low case detection rate (45%), the 70% WHO target seems unachievable in the absence of alternative case-finding mechanisms.

Prevalence of smear-positive pulmonary tuberculosis in a rural district of Ethiopia.

SETTING: A rural district in Southern Ethiopia. OBJECTIVE: To estimate the prevalence of smear-positive pulmonary tuberculosis (TB). DESIGN: In this cross-sectional study, adults aged >14 years were surveyed by home-to-home visit, and asked about cough of > or = 2 weeks with or without sputum, chest pain or difficulty in breathing. Symptomatic suspects submitted three sputum samples for standard smear microscopy. RESULTS: Of 16697 adults surveyed, 436 (2.6%) were symptomatic and submitted sputum samples. Thirteen (3%) were positive for acid-fast bacilli, and the prevalence of smear-positive TB was 78 per 100 000 population (95%CI 36-120). Twenty-four smear-positive cases identified through the existing health care delivery were on anti-tuberculosis medication at the time of the survey. The ratio of smear-positive cases on treatment to those newly detected by the survey was 2:1. CONCLUSION: The prevalence of TB in this rural setting was unexpectedly low. For every two cases of smear-positive TB on treatment, there was one undetected infectious case in the community. However, as our screening technique did not allow detection of cases who did not report symptoms, the true prevalence may have been underestimated.

A one-day method for the diagnosis of pulmonary tuberculosis in rural Ethiopia.

Smear diagnosis of pulmonary tuberculosis (PTB) requires three sputum examinations over 2 days. We evaluated the performance of two sputum specimens obtained on a single day (the second specimen submitted 1 h after the first) against the standard 2-day method in rural Ethiopia. A total of 243 suspects were enrolled; 52 had confirmed PTB: 49 (94%) were detected by the same-day method and 51 (98%) by the standard method (P > 0.5). The same-day approach would reduce the number of visits required for diagnosis, save resources for the health system and the patient, and ultimately improve case detection in poorer countries.

Comparison of scanty AFB smears against culture in an area with high HIV prevalence.

To verify among tuberculosis (TB) suspects attending hospitals in Abuja, Nigeria, if sputum smears graded as scanty are false-positive, sputum smears from 1068 patients were graded with the International Union Against Tuberculosis and Lung Disease classification. One specimen was cultured. Eight hundred and twenty-four (26%) smears were positive, 137 (4%) scanty and 2243 negative. Of 1068 cultures, 680 (64%) were positive. One hundred and thirty (95%) scanty and 809 (98%) positive smears were culture-positive. Twelve of 18 patients with a single scanty smear and 51 of 52 with > or = 2 scanty smears were culture-positive. Fewer than < 5% scanty results, < 1% of the patients treated for TB, are false-positive.