Diagnostic accuracy of intracellular mycobacterium tuberculosis detection for tuberculous meningitis.

RATIONALE: Early diagnosis and treatment of tuberculous meningitis saves lives, but current laboratory diagnostic tests lack sensitivity. OBJECTIVES: We investigated whether the detection of intracellular bacteria by a modified Ziehl-Neelsen stain and early secretory antigen target (ESAT)-6 in cerebrospinal fluid leukocytes improves tuberculous meningitis diagnosis. METHODS: Cerebrospinal fluid specimens from patients with suspected tuberculous meningitis were stained by conventional Ziehl-Neelsen stain, a modified Ziehl-Neelsen stain involving cytospin slides with Triton processing, and an ESAT-6 immunocytochemical stain. Acid-fast bacteria and ESAT-6-expressing leukocytes were detected by microscopy. All tests were performed prospectively in a central laboratory by experienced technicians masked to the patients' final diagnosis. MEASUREMENTS AND MAIN RESULTS: Two hundred and eighty patients with suspected tuberculous meningitis were enrolled. Thirty-seven had Mycobacterium tuberculosis cultured from cerebrospinal fluid; 40 had a microbiologically confirmed alternative diagnosis; the rest had probable or possible tuberculous meningitis according to published criteria. Against a clinical diagnostic gold standard the sensitivity of conventional Ziehl-Neelsen stain was 3.3% (95% confidence interval, 1.6-6.7%), compared with 82.9% (95% confidence interval, 77.4-87.3%) for modified Ziehl-Neelsen stain and 75.1% (95% confidence interval, 68.8-80.6%) for ESAT-6 immunostain. Intracellular bacteria were seen in 87.8% of the slides positive by the modified Ziehl-Neelsen stain. The specificity of modified Ziehl-Neelsen and ESAT-6 stain was 85.0% (95% confidence interval, 69.4-93.8%) and 90.0% (95% confidence interval, 75.4-96.7%), respectively. CONCLUSIONS: Enhanced bacterial detection by simple modification of the Ziehl-Neelsen stain and an ESAT-6 intracellular stain improve the laboratory diagnosis of tuberculous meningitis.

Incidence and associated factors for single and recurrent falls among the elderly in an urban community of Beijing.

OBJECTIVE: To investigate the incidence of falls and recurrent falls, and explore associated factors for single and recurrent falls among urban community-dwelling elderly in Beijing. METHODS: A cross-sectional study was conducted in 472 elderly in the Longtan community of Dongcheng district, Beijing in 2009. Data regarding the incidence of fall and recurrent falls in the previous year, as well as associated factors were collected from the elderly through face-to-face interviews. RESULTS: The incidence of falls and recurrent falls was 17.8% and 6.1%, respectively, and it increased with age (χ2for trend=21.06, 19.20, P=0.001, 0.002). Binary logistic stepwise regression analysis showed that age (OR=2.20), living alone (OR=4.67) and gait disturbance (OR=1.27) were risk factors, while housing with elevators (OR=0.35), appropriate width/height of stair steps (OR=0.78), sufficient lighting for stairway (OR=0.45) and regular exercise (OR=0.12) could lower the risk for single fall; factors such as low monthly family income (OR=1.39), poor vision (OR=1.83), low physical ability (OR=4.47), abnormal static balance (OR=2.48), and fear of falls(OR=2.23) were risk factors, while appropriate width/height of stair steps (OR=0.49) and easiness of access to daily supplies (OR=0.41) were protective factors for recurrent falls. CONCLUSION: The incidence of falls in community-dwelling elderly people in Beijing is common, and falls and their related injuries have been associated with both intrinsic and extrinsic factors.

Efficacy and safety of acarbose in the treatment of elderly patients with postprandial hypotension.

BACKGROUND: Postprandial hypotension (PPH) occurs frequently in elderly people and may lead to syncope, falls, dizziness, weakness, angina pectoris, and stroke. Some studies suggest that the magnitude of the postprandial fall in blood pressure (BP) is influenced by the rate at which glucose enters the small intestine. We hypothesized that acarbose (alpha-glucosidase inhibitor), a hypoglycemic agent that decreases the rate of glucose absorption in the small intestine, would attenuate PPH in the elderly, and would be safe in the treatment. METHODS: Forty-three elderly in-patients with PPH were recruited. All of them were in relatively stable conditions. They had semi-liquid standard meals without and with acarbose for the two following days: screening day and intervention day. Blood pressure and heart rate (HR) were recorded at baseline and every 15 minutes for 120 minutes using a non-invasive ambulatory blood pressure monitoring system during the study, and ejection fraction (EF) and fractional shortening (FS) were measured by two dimensional echocardiography. RESULTS: Compared with the screening day, the falls in systolic, diastolic and mean arterial blood pressure (SBP, DBP, MAP) (all P < 0.05) were significantly attenuated after taking acarbose during breakfast, so were MAP (P < 0.05) during lunch, DBP (P < 0.05) and MAP (P < 0.05) during supper. The change of HR was not statistically significant after taking acarbose in three meals. EF and FS were positively correlated with the relief rate. The effective power was 63%, and the incidence of adverse drug reaction (ADR) was 9%. CONCLUSION: Acarbose is effective and safe in the treatment of elderly patients with PPH.

[Consequence and risk factors of falls-related injuries in community-dwelling elderly in Beijing].

OBJECTIVE: To investigate the incidence of falls during the past year,as well as the consequence of falls so as to explore the risk factors for fall-related injuries in the community-dwelling elderly in Beijing. METHODS: A cross-sectional study was conducted in a community in Beijing. A total of 1512 persons aged 60 years and over were selected using stratified cluster sampling method. Information related to all kinds of falls was collected with a standardized structured questionnaire through face-to-face interview. Binary logistic regression was used to explore the related factors for consequence of any falls, especially falls-related injuries in the elderly. RESULTS: 272 older adults had one falling episode at the baseline study, with the incidence rate of fall and the frequency of falls as 18.0% (272/1512) and 379 times respectively. Among the 1512 interviewees, 8.7% (131) suffered from injuries as a result of falls. Out of the total 379 times of falls, 143 resulted in injuries. Most common injuries appeared to be soft tissue related (84 times, 58.7%) and epidermal abrasion (57 times, 39.9%), followed by fracture (20 times, 14.0%) and open wound (9 times, 6.3%). The most common injured areas were lower limbs (67 times, 46.9%), followed by upper limbs (39 times, 27.3%), head (27 times, 18.9%), face (19 times, 13.3%), hip (11 times,2.9%), waist/abdomen (10 times, 2.6%), chest (6 times, 1.6%) ,vertebral column (5 times, 1.3%) and neck (3 times, 0.8%). Data from logistic regression analysis showed that being female (OR = 2.09), with proper bench height (OR = 1.94), being alcoholic (OR = 3.10), being able to walk more than 400 meters (OR = 2.11), fear of falls (OR = 3.30) etc. were risk factors, while enough handrails provided in surrounding areas (OR = 0.41) showed as the protective factor for falls-related injuries in the elderly. CONCLUSION: The incidence rates of falls and falls-related injuries among elderly community-dwellers in urban areas of Beijing were considered to be high. Falls and its related injuries were caused by varied factors, suggesting the intervention strategies should be targeted to the related factors as well as focusing on primary prevention.

[A prospective study on recurrent falls and related factors in elderly from the urban communities in Beijing].

OBJECTIVE: To investigate the incidence and risk factors for recurrent falls in community-dwelling elderly in Beijing. METHODS: A cross-sectional study was conducted in 472 elderly in the Longtan community of Dongcheng district,Beijing in 2009. Data on recurrent falls within the past 12 months were collected through face-to-face interview, with both single factor analysis and logistic regression analysis used to explore the related factors on recurrent falls in the elderly. RESULTS: The incidence of recurrent falls among 472 older adults was 6.1% (29) within the past 12 months. Results from logistic regression analysis showed that factors as higher family monthly income(OR = 1.39, 95% CI:0.67-2.16), afraid of being fallen(OR = 2.23, 95% CI:1.47-3.85)and abnormal static balance(OR = 2.48, 95% CI:1.84-4.05)were risk factors, while bench height in the surrounding environment(OR = 0.49, 95% CI:0.21-1.12)and easiness of access to daily supplies (OR = 0.41, 95%CI:0.14-1.16)were protective factors for recurrent falls. CONCLUSION: The incidence of recurrent falls among the elderly from the communities in Beijing was high. Since falls could be caused by various factors, intervention should be targeting on risk factors in a multi-dimensional way.