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1.
Int J Tuberc Lung Dis ; 26(5): 426-432, 2022 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-35505490

RESUMO

BACKGROUND: The GenoType MTBDRsl v2 is a molecular test designed for the rapid detection of resistance to second-line anti-TB drugs in Mycobacterium tuberculosis complex (MTBC).OBJECTIVE: To assess the use of MTBDRsl in a programmatic setting and to describe the resistance patterns in a high HIV-TB-endemic area in South Africa.METHODS: We performed a retrospective data analysis of all MTBDRsl results in patients with newly diagnosed rifampicin-resistant TB (RR-TB). We compared its performance on direct testing of smear-positive and smear-negative specimens. Results were examined to observe the detected resistance-conferring mutations.RESULTS: Of 1873 RR-TB/multidrug-resistant TB (MDR-TB), 37.4% were smear-negative and 62.5% were smear-positive. Among smear-negative specimens, the MTBDRsl showed an inconclusive rate of 61.2%, while the inconclusive rate from smear-positive specimens was 6.6%. The most common mutation observed in case of fluoroquinolone resistance occurred at the gyrA gene, codon 90 (A90V) (61/158, 38.6%), and the most common mutation in injectable aminoglycoside resistance occurred in the rrs region, A1401G (71/108, 65.7%).CONCLUSION: In HIV-TB-prevalent settings, routine use of the MTBDRsl is more effective when performed directly on smear-positive specimens. In view of currently used injectable-free regimens, this test requires revision.


Assuntos
Infecções por HIV , Mycobacterium tuberculosis , Tuberculose Resistente a Múltiplos Medicamentos , Humanos , Antituberculosos/uso terapêutico , Genótipo , Infecções por HIV/epidemiologia , Mycobacterium tuberculosis/genética , Estudos Retrospectivos , Rifampina/uso terapêutico , África do Sul/epidemiologia , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico
2.
Ann R Coll Surg Engl ; 104(2): 47-49, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-35100853

RESUMO

The presence of an adenocarcinoma and non-Hodgkin's lymphoma in an individual is an uncommon finding. In this case report, we discuss the case of an elderly man presenting with a synchronous moderately differentiated colonic adenocarcinoma alongside a distal ileal extranodal marginal zone lymphoma, on a background of ulcerative colitis. He underwent an elective open panproctocolectomy with an end ileostomy for the management of his malignancy.


Assuntos
Adenocarcinoma/patologia , Colite Ulcerativa , Neoplasias do Colo/patologia , Neoplasias do Íleo/patologia , Linfoma não Hodgkin/patologia , Neoplasias Primárias Múltiplas/patologia , Idoso , Humanos , Masculino
3.
Ann R Coll Surg Engl ; 104(2): e47-e49, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34482743

RESUMO

The presence of an adenocarcinoma and non-Hodgkin's lymphoma in an individual is an uncommon finding. In this case report, we discuss the case of an elderly man presenting with a synchronous moderately differentiated colonic adenocarcinoma alongside a distal ileal extranodal marginal zone lymphoma, on a background of ulcerative colitis. He underwent an elective open panproctocolectomy with an end ileostomy for the management of his malignancy.


Assuntos
Adenocarcinoma , Colite Ulcerativa , Neoplasias do Colo , Linfoma não Hodgkin , Neoplasias Primárias Múltiplas , Adenocarcinoma/diagnóstico , Adenocarcinoma/etiologia , Adenocarcinoma/cirurgia , Idoso , Colite Ulcerativa/complicações , Neoplasias do Colo/diagnóstico , Neoplasias do Colo/etiologia , Neoplasias do Colo/cirurgia , Humanos , Linfoma não Hodgkin/complicações , Linfoma não Hodgkin/diagnóstico , Linfoma não Hodgkin/patologia , Masculino , Neoplasias Primárias Múltiplas/diagnóstico , Neoplasias Primárias Múltiplas/patologia , Neoplasias Primárias Múltiplas/cirurgia
4.
Br Dent J ; 230(10): 624-625, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-34050273
5.
Int J Tuberc Lung Dis ; 23(6): 720-727, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31315705

RESUMO

BACKGROUND In KwaZulu-Natal, South Africa, the incidence of extensively drug-resistant tuberculosis (XDR-TB) is driven by the transmission of resistant strains. As data suggest that cases may be spatially clustered, we sought to identify 'hotspots' and describe these communities. METHODS We enrolled XDR-TB patients diagnosed from 2011 to 2014 in eThekwini. Global positioning system (GPS) coordinates for participant homes were collected and hotspots were identified based on population-adjusted XDR-TB incidence. The sociodemographic features of hotspots were characterised using census data. For a subset of participants, we mapped non-home XDR-TB congregate locations and compared these with results including only homes. RESULTS Among 132 participants, 75 (57%) were female and 87 (66%) lived in urban or suburban locations. Fifteen of 197 census tracts were identified as XDR-TB hotspots with ≥95% confidence. Four spatial mapping methods identified one large hotspot in northeastern eThekwini. Hotspot communities had higher proportions of low educational attainment (12% vs. 9%) and unemployment (29.3% vs. 20.4%), and lower proportion of homes with flush toilets (36.4% vs. 68.9%). The case density shifted towards downtown Durban when congregate locations (e.g., workplaces) for 43 (33%) participants were mapped. CONCLUSIONS In eThekwini, XDR-TB case homes were clustered into hotspots with more poverty indicators than non-hotspots. Prevention efforts targeting hotspot communities and congregate settings may be effective in reducing community transmission. .


Assuntos
Tuberculose Extensivamente Resistente a Medicamentos/epidemiologia , Tuberculose Pulmonar/epidemiologia , Adulto , Cidades , Estudos Transversais , Demografia , Tuberculose Extensivamente Resistente a Medicamentos/etiologia , Feminino , Sistemas de Informação Geográfica , Humanos , Incidência , Masculino , Fatores Socioeconômicos , África do Sul/epidemiologia , Tuberculose Pulmonar/etiologia
6.
World J Urol ; 37(1): 165-172, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29882105

RESUMO

BACKGROUND: Cisplatin-based neoadjuvant chemotherapy (NAC) for muscle invasive bladder cancer improves all-cause and cancer specific survival. We aimed to evaluate whether the detection of carcinoma in situ (CIS) at the time of initial transurethral resection of bladder tumor (TURBT) has an oncological impact on the response to NAC prior to radical cystectomy. PATIENTS AND METHODS: Patients were identified retrospectively from 19 centers who received at least three cycles of NAC or induction chemotherapy for cT2-T4aN0-3M0 urothelial carcinoma of the bladder followed by radical cystectomy between 2000 and 2013. The primary and secondary outcomes were pathological response and overall survival, respectively. Multivariable analysis was performed to determine the independent predictive value of CIS on these outcomes. RESULTS: Of 1213 patients included in the analysis, 21.8% had concomitant CIS. Baseline clinical and pathologic characteristics of the 'CIS' versus 'no-CIS' groups were similar. The pathological response did not differ between the two arms when response was defined as pT0N0 (17.9% with CIS vs 21.9% without CIS; p = 0.16) which may indicate that patients with CIS may be less sensitive to NAC or ≤ pT1N0 (42.8% with CIS vs 37.8% without CIS; p = 0.15). On Cox regression model for overall survival for the cN0 cohort, the presence of CIS was not associated with survival (HR 0.86 (95% CI 0.63-1.18; p = 0.35). The presence of LVI (HR 1.41, 95% CI 1.01-1.96; p = 0.04), hydronephrosis (HR 1.63, 95% CI 1.23-2.16; p = 0.001) and use of chemotherapy other than ddMVAC (HR 0.57, 95% CI 0.34-0.94; p = 0.03) were associated with shorter overall survival. For the whole cohort, the presence of CIS was also not associated with survival (HR 1.05 (95% CI 0.82-1.35; p = 0.70). CONCLUSION: In this multicenter, real-world cohort, CIS status at TURBT did not affect pathologic response to neoadjuvant or induction chemotherapy. This study is limited by its retrospective nature as well as variability in chemotherapy regimens and surveillance regimens.


Assuntos
Antineoplásicos/uso terapêutico , Carcinoma in Situ/terapia , Cistectomia , Quimioterapia de Indução , Terapia Neoadjuvante , Neoplasias da Bexiga Urinária/terapia , Idoso , Carcinoma in Situ/mortalidade , Carcinoma in Situ/patologia , Cisplatino/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento , Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/patologia
7.
J Dairy Sci ; 102(1): 100-112, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30415846

RESUMO

Undesired browning of Parmesan cheese can occur during the latter period of ripening and cold storage despite the relative absence of reducing sugars and high temperatures typically associated with Maillard browning. Highly reactive α-dicarbonyls such as methylglyoxal (MG) are products and accelerants of Maillard browning chemistry and can result from the microbial metabolism of sugars and AA by lactic acid bacteria. We demonstrate the effects of microbially produced MG in a model Parmesan cheese extract using a strain of Lactobacillus casei 12A engineered for inducible overexpression of MG synthase (mgsA) from Thermoanaerobacterium thermosaccharolyticum HG-8. Maximum induction of plasmid-born mgsA led to 1.6 mM MG formation in Parmesan cheese extract and its distinct discoloration. The accumulation of heterocyclic amines including ß-carboline derivatives arising from mgsA expression were determined by mass spectrometry. Potential MG-contributing reaction mechanisms for the formation of heterocyclic amines are proposed. These findings implicate nonstarter lactic acid bacteria may cause browning and influence nutritional aspects of Parmesan by enzymatic conversion of triosephosphates to MG. Moreover, these findings indicate that the microbial production of MG can lead to the formation of late-stage Maillard reaction products such as melanoidin and ß-carbolines, effectively circumventing the thermal requirement of the early- and intermediate- stage Maillard reaction. Therefore, the identification and control of offending microbiota may prevent late-stage browning of Parmesan. The gene mgsA may serve as a genetic biomarker for cheeses with a propensity to undergo MG-mediated browning.


Assuntos
Aminas/metabolismo , Carbono-Oxigênio Liases/metabolismo , Queijo/microbiologia , Compostos Heterocíclicos/metabolismo , Lacticaseibacillus casei/enzimologia , Reação de Maillard , Aminas/química , Animais , Carbono-Oxigênio Liases/genética , Queijo/análise , Queijo/normas , Cromatografia Gasosa-Espectrometria de Massas , Compostos Heterocíclicos/química , Temperatura Alta , Lacticaseibacillus casei/genética , Lacticaseibacillus casei/metabolismo , Plasmídeos , Aldeído Pirúvico/metabolismo
8.
Lupus ; 28(2): 163-173, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30580659

RESUMO

OBJECTIVES: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that leads to a variety of negative health outcomes resulting from inflammation in various organ systems. Although treatment continues to advance, fatigue remains one of the most salient, poorly understood and addressed patient complaints. Understanding the mechanisms of fatigue can help guide the development of interventions to improve health outcomes. The aim of this research was to evaluate the contribution of six variables (disease activity, insomnia, depression, stress, pain and physical health) to fatigue in SLE without concomitant fibromyalgia (FM). METHODS: A total of 116 ethnically diverse, primarily female participants (91%) with SLE, receiving care at university medical centers, completed assessments of disease activity and quality of life outcomes (FACIT-FT, Insomnia Severity Index, Perceived Stress Scale (PSS-4), Pain Inventory, Depression-PHQ-9, and LupusPRO-physical function). All patients met the American College of Rheumatology classification criteria for SLE and did not have a known diagnosis of FM. Multivariate linear and stepwise regression analyses were conducted with fatigue (FACIT-FT) as the dependent variable, and the above six variables as independent variables. RESULTS: Mean (SD) age was 39.80 (13.87) years; 50% were African American, 21% Caucasian, 13% Hispanic, 9% Asian and 8% other. Mean (SD) FACIT-FT was 20.09 (12.76). Collectively, these six variables explained 57% of the variance in fatigue. In the multivariate model, depression, stress and pain were significantly and independently associated with fatigue, but not disease activity, sleep or physical health. Stress had the largest effect on fatigue (ß 0.77, 95% CI 0.17-1.38, p = 0.01), followed by depression (ß 0.66, 95% CI 0.21-1.10, p = 0.005). On stepwise regression analysis, only stress, depression and pain were retained in the model, and collectively explained 56% of the variance in fatigue. All three remained independent correlates of fatigue, with the largest contribution being stress (ß 0.84, 95% CI 0.27-1.42, p = 0.005), followed by depression (ß 0.79, 95% CI 0.44-1.14, p < 0.001) with fatigue. CONCLUSION: Stress, depression and pain are the largest independent contributors to fatigue among patients with SLE, without concurrent FM. Disease activity, sleep and physical health were not associated with fatigue. The evaluation of stress, depression and pain needs to be incorporated during assessments and clinical trials of individuals with SLE, especially within fatigue. This stress-depression-fatigue model requires further validation in longitudinal studies and clinical trials. Significance and innovation: • Disease activity, sleep, pain, stress, depression, and physical health have been reported individually to be associated with fatigue in lupus. This analysis evaluated the role of each and all of these six variables collectively in fatigue among patients with SLE without a known diagnosis of FM. • Disease activity, sleep and physical health were not significantly related to fatigue, but depression, stress and pain were. • The results emphasize the need to evaluate and treat fatigue in individuals with SLE utilizing a biopsychosocial approach, particularly in the realm of clinical trials. Behavioral medicine interventions are shown to be most effective for the treatment of depression, stress and pain.


Assuntos
Etnicidade/estatística & dados numéricos , Fadiga/epidemiologia , Lúpus Eritematoso Sistêmico/fisiopatologia , Lúpus Eritematoso Sistêmico/psicologia , Adulto , Chicago/epidemiologia , Transtorno Depressivo/epidemiologia , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Dor/epidemiologia , Escalas de Graduação Psiquiátrica , Qualidade de Vida , Índice de Gravidade de Doença , Estresse Psicológico/epidemiologia
10.
J Photochem Photobiol B ; 183: 251-257, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29734113

RESUMO

In modern era, the great interest and demand among chemists and researchers for metal nanoparticles is increasing in the application of biomedical fields, textiles, cosmetics and various sectors. Consequently, the present study reports an eco-friendly, cost-effective, rapid and easy method to produce environment-friendly metal nanoparticles to prevent exhaustion of metal resources. In this context, gold and silver metal nanoparticles were green synthesized using the Root Extract of Coleous forskohlii (RECo) as capping and reducing agent. The synthesized gold (GNPs) and silver nanoparticles (SNPs) were characterized using UV-Visible spectrophotometer, High-resolution transmission electron microscopy (HR-TEM), Particle size analysis (PSA), Fourier-transform infrared spectroscopy (FT-IR) and X-Ray Diffractometer (XRD). Their clinical importance was analysed using anti-oxidant assay (DPPH - 2,2-diphenyl-1-picrylhydrazyl and Phosphomolybdenum PMA) and cytotoxicity (MTT assay) against HEPG2 (liver cancer cell lines). Further, the antimicrobial activity against two microorganisms were tested using disc diffusion method against Proteus vulgaris pathogen and Micrococcus luteus pathogen. RECo-GNPs and SNPs were found to be stable in aqueous medium for a longer time and exhibited favorable anti-oxidant, anti-bacterial and anti-cancer activity. The phytoconstituents present in the root extract of Coleous forskohlii was elucidated using GC-MS analysis.


Assuntos
Anti-Infecciosos/química , Antioxidantes/química , Ouro/química , Nanopartículas Metálicas/química , Plectranthus/química , Prata/química , Anti-Infecciosos/farmacologia , Sobrevivência Celular/efeitos dos fármacos , Testes de Sensibilidade a Antimicrobianos por Disco-Difusão , Química Verde , Células Hep G2 , Humanos , Nanopartículas Metálicas/toxicidade , Micrococcus luteus/efeitos dos fármacos , Microscopia Eletrônica de Transmissão , Extratos Vegetais/química , Raízes de Plantas/química , Raízes de Plantas/metabolismo , Plectranthus/metabolismo , Proteus vulgaris/efeitos dos fármacos , Espectrofotometria Ultravioleta , Espectroscopia de Infravermelho com Transformada de Fourier , Difração de Raios X
11.
Nat Commun ; 9(1): 1421, 2018 04 12.
Artigo em Inglês | MEDLINE | ID: mdl-29650949

RESUMO

Acute allergic symptoms are caused by allergen-induced crosslinking of allergen-specific immunoglobulin E (IgE) bound to Fc-epsilon receptors on effector cells. Desensitization with allergen-specific immunotherapy (SIT) has been used for over a century, but the dominant protective mechanism remains unclear. One consistent observation is increased allergen-specific IgG, thought to competitively block allergen binding to IgE. Here we show that the blocking potency of the IgG response to Cat-SIT is heterogeneous. Next, using two potent, pre-selected allergen-blocking monoclonal IgG antibodies against the immunodominant cat allergen Fel d 1, we demonstrate that increasing the IgG/IgE ratio reduces the allergic response in mice and in cat-allergic patients: a single dose of blocking IgG reduces clinical symptoms in response to nasal provocation (ANCOVA, p = 0.0003), with a magnitude observed at day 8 similar to that reported with years of conventional SIT. This study suggests that simply augmenting the blocking IgG/IgE ratio may reverse allergy.


Assuntos
Anticorpos Monoclonais/farmacologia , Dessensibilização Imunológica/métodos , Glicoproteínas/imunologia , Hipersensibilidade/terapia , Imunoglobulina G/farmacologia , Receptores de IgE/imunologia , Adolescente , Adulto , Alérgenos/administração & dosagem , Alérgenos/imunologia , Alérgenos/isolamento & purificação , Pelo Animal/química , Pelo Animal/imunologia , Animais , Anticorpos Monoclonais/biossíntese , Ligação Competitiva , Gatos , Misturas Complexas/química , Misturas Complexas/imunologia , Modelos Animais de Doenças , Feminino , Glicoproteínas/administração & dosagem , Glicoproteínas/isolamento & purificação , Humanos , Hipersensibilidade/imunologia , Hipersensibilidade/fisiopatologia , Imunoglobulina E/química , Imunoglobulina E/imunologia , Imunoglobulina E/metabolismo , Imunoglobulina G/biossíntese , Masculino , Camundongos , Pessoa de Meia-Idade , Ligação Proteica/efeitos dos fármacos , Receptores de IgE/química , Receptores de IgE/metabolismo
12.
J Dairy Sci ; 101(2): 968-978, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29274980

RESUMO

Endogenous production of α-dicarbonyls by lactic acid bacteria can influence the quality and consistency of fermented foods and beverages. Methylglyoxal (MG) in Parmesan cheese can contribute toward undesired browning during low temperature ripening and storage conditions, leading to the economic depreciation of affected cheeses. We demonstrate the effects of exogenously added MG on browning and volatile formation using a Parmesan cheese extract (PCE). To determine the influence of Lactobacillus on α-dicarbonyls, strains were screened for their ability to modulate concentrations of MG, glyoxal, and diacetyl in PCE. It was found that a major metabolic pathway of MG in Lactobacillus is a thiol-independent reduction, whereby MG is partially or fully reduced to acetol and 1,2-propanediol, respectively. The majority of lactobacilli grown in PCE accumulated the intermediate acetol, whereas Lactobacillus brevis 367 formed exclusively 1,2-propanediol and Lactobacillus fermentum 14931 formed both metabolites. In addition, we determined the inherent tolerance to bacteriostatic concentrations of MG among lactobacilli grown in rich media. It was found that L. brevis 367 reduces MG exclusively to 1,2-propanediol, which correlates to both its ability to significantly decrease MG concentrations in PCE, as well as its significantly higher tolerance to MG, in comparison to other lactobacilli screened. These findings have broader implications toward lactobacilli as a viable solution for reducing MG-mediated browning of Parmesan cheese.


Assuntos
Queijo/análise , Lactobacillus/metabolismo , Aldeído Pirúvico/metabolismo , Compostos Orgânicos Voláteis/análise , Cor , Diacetil/análise , Fermentação , Glioxal/análise , Lactobacillus/genética , Aldeído Pirúvico/administração & dosagem , Aldeído Pirúvico/análise , Compostos de Sulfidrila/metabolismo
13.
Lupus ; 27(5): 728-737, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29087259

RESUMO

Objectives LupusPRO has shown good measurement properties as a disease-specific patient-reported outcome tool in systemic lupus erythematosus (SLE). For the purpose of clinical trials, the version 1.7 (v1.7) domain of Pain-Vitality was separated into distinct Pain, Vitality and Sleep domains in v1.8, and the psychometric properties examined. Methods A total of 131 consecutive SLE patients were self-administered surveys assessing fatigue (FACIT, SF-36), pain (Pain Inventory, SF-36), insomnia (Insomnia Severity Index), emotional health (PHQ-9, SF-36) and quality of life (SF-36, LupusPRO) at routine care visits. Internal consistency reliability (ICR) for each domain was obtained using Cronbach's alpha. The convergent construct validity of LupusPRO domains with corresponding SF-36 domains or tools were tested using Spearman correlation. Varimax rotations were conducted to assess factor structures of the LupusPRO v1.8. Results Mean (SD) age was 40.04 (14.10) years. Scores from the LupusPRO-Sleep domain strongly correlated with insomnia scores, while LupusPRO-Vitality correlated strongly with fatigue (FACIT) and SF-36 vitality. The LupusPRO-Pain domain correlated strongly with pain (SF36 Bodily-Pain, Pain Inventory) scores. Similarly, the LupusPRO domains of Physical and Emotional Health had significant correlations with corresponding SF-36 domains. The ICR for HRQoL and non-HRQoL were 0.96 and 0.81. LupusPRO (domains HRQoL and QoL) scores correlated with disease activity. Principal component analysis included seven factor loadings presenting for the HRQOL subscales (combined Sleep, Vitality, and Pain), and three factors for the NHRQoL (Combined Coping and Social Support). Conclusions LupusPRO v1.8 (including its Sleep, Vitality, and Pain domains) has acceptable reliability and validity. Use of LupusPRO as an outcome measure in clinical trials would facilitate responsiveness assessment.


Assuntos
Lúpus Eritematoso Sistêmico/diagnóstico , Medidas de Resultados Relatados pelo Paciente , Adulto , Emoções , Feminino , Nível de Saúde , Humanos , Lúpus Eritematoso Sistêmico/fisiopatologia , Lúpus Eritematoso Sistêmico/psicologia , Lúpus Eritematoso Sistêmico/terapia , Masculino , Saúde Mental , Pessoa de Meia-Idade , Dor/diagnóstico , Dor/fisiopatologia , Dor/psicologia , Medição da Dor , Valor Preditivo dos Testes , Psicometria , Qualidade de Vida , Reprodutibilidade dos Testes , Sono , Distúrbios do Início e da Manutenção do Sono/diagnóstico , Distúrbios do Início e da Manutenção do Sono/fisiopatologia , Distúrbios do Início e da Manutenção do Sono/psicologia
14.
Artigo em Inglês | MEDLINE | ID: mdl-28630205

RESUMO

The country of Georgia has a high burden of multi- and extensively drug-resistant tuberculosis (XDR-TB). To evaluate whether mutations in gyrB and eis genes increased the sensitivity of detection of phenotypic resistance to ofloxacin and kanamycin or capreomycin compared to use of the first-generation MTBDRsl assay alone, which tests for mutations in gyrA and rrs genes, a retrospective study of stored Mycobacterium tuberculosis isolates was performed. All isolates underwent DNA sequencing of resistance-determining regions. Among 112 M. tuberculosis isolates with DNA extraction data, targeted sequencing was successfully performed for each gene as follows: for gyrA, 98% sensitivity; for gyrB, 96%; for rrs, 93%; for the eis gene and its promoter, 93%. The specificity and hence the positive predictive value of gyrA and gyrB mutations for detecting ofloxacin resistance were 100%. The addition of gyrB mutations increased the sensitivity of phenotypic ofloxacin resistance detection by 13% (75% to 88%). All rrs resistance-conferring mutations were A1401G, and this mutation had low sensitivity (40% and 18%) and high specificity (95% and 100%) in predicting phenotypic capreomycin and kanamycin resistance, respectively. The eis C-14T mutation increased the sensitivity of phenotypic kanamycin resistance detection by 9% (18% to 27%) and was found solely in kanamycin phenotypic resistance isolates. Our data showed that the inclusion of eis C-14T and gyrB mutations in addition to rrs and gyrA mutations improves the sensitivity of detection of phenotypic ofloxacin and kanamycin resistance, respectively.


Assuntos
Acetiltransferases/genética , Proteínas de Bactérias/genética , DNA Girase/genética , Farmacorresistência Bacteriana Múltipla/genética , Mycobacterium tuberculosis/efeitos dos fármacos , Mycobacterium tuberculosis/genética , Tuberculose Resistente a Múltiplos Medicamentos/genética , Antituberculosos/uso terapêutico , Sequência de Bases , Capreomicina/uso terapêutico , República da Geórgia , Humanos , Canamicina/uso terapêutico , Mycobacterium tuberculosis/isolamento & purificação , Ofloxacino/uso terapêutico , Estudos Retrospectivos , Análise de Sequência de DNA , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/microbiologia
15.
J Arthroplasty ; 32(3): 777-782, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-27667534

RESUMO

BACKGROUND: Accelerometer-based, portable navigation devices have been introduced as a less invasive and simpler technique to perform navigated surgical implantation of knee prostheses. They have been postulated to have better accuracy than conventional instruments in restoration of alignment in total knee arthroplasty. METHODS: A total of 190 patients were enrolled in this prospective, randomized controlled trial and underwent total knee arthroplasty using either the KneeAlign or conventional guides. Multiplanar alignment was evaluated with a CT imaging protocol. RESULTS: A total of 86.5% of portable navigation device and 82.2% of conventional group had a postoperative hip-knee angle within 3° of neutral alignment (P = .54). There was no significant difference between the 2 groups for component coronal and sagittal plane alignment. Portable navigation device did not significantly increase the time to perform the surgery. CONCLUSION: Portable navigation device demonstrates accurate restoration of alignment; however, there was no statistically significant difference when compared with conventional guides.


Assuntos
Artroplastia do Joelho/instrumentação , Cirurgia Assistida por Computador/instrumentação , Acelerometria , Idoso , Artroplastia do Joelho/métodos , Feminino , Humanos , Joelho/cirurgia , Articulação do Joelho/cirurgia , Prótese do Joelho , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Cirurgia Assistida por Computador/métodos
16.
Epidemiol Infect ; 144(10): 2209-16, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-26926092

RESUMO

Scarce data exist on the relationship between diabetes and extrapulmonary tuberculosis (EPTB). We evaluated whether diabetes impacts site of TB and risk of death in patients with EPTB. We evaluated a cohort of TB cases from the state of Georgia between 2009 and 2012. Patients aged ⩾16 years were classified by diabetes status according to medical records. Site of EPTB was determined by culture and/or state TB classification. Death was defined by all-cause mortality. Of 1325 eligible reported TB cases, 369 (27·8%) had any EPTB including 258 (19·5%) with only EPTB and 111 (8·4%) with pulmonary TB and EPTB. Of all TB cases, 158 had diabetes (11·9%). In multivariable analysis, the odds of any EPTB was similar in patients with and without diabetes [adjusted odds ratio 1·04, 95% confidence interval (CI) 0·70-1·56]. The risk of death was 23·8% in patients with EPTB and diabetes vs. 9·8% in those with no diabetes (P < 0·01); after adjusting for covariates the difference was not significant (aRR 1·19, 95% CI 0·54-2·63). Diabetes was common in patients with EPTB and risk of death was high. Improved understanding of the relationship between diabetes and EPTB is critical to determine the extent that diabetes affects TB diagnosis and clinical management.


Assuntos
Diabetes Mellitus/mortalidade , Tuberculose/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Diabetes Mellitus/etiologia , Feminino , Georgia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Tuberculose/microbiologia , Adulto Jovem
17.
Clin Infect Dis ; 62(7): 887-895, 2016 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-26757804

RESUMO

BACKGROUND: Medical treatment for multidrug-resistant (MDR)-tuberculosis is complex, toxic, and associated with poor outcomes. Surgical lung resection may be used as an adjunct to medical therapy, with the intent of reducing bacterial burden and improving cure rates. We conducted an individual patient data metaanalysis to evaluate the effectiveness of surgery as adjunctive therapy for MDR-tuberculosis. METHODS: Individual patient data, was obtained from the authors of 26 cohort studies, identified from 3 systematic reviews of MDR-tuberculosis treatment. Data included the clinical characteristics and medical and surgical therapy of each patient. Primary analyses compared treatment success (cure and completion) to a combined outcome of failure, relapse, or death. The effects of all forms of resection surgery, pneumonectomy, and partial lung resection were evaluated. RESULTS: A total of 4238 patients from 18 surgical studies and 2193 patients from 8 nonsurgical studies were included. Pulmonary resection surgery was performed on 478 patients. Partial lung resection surgery was associated with improved treatment success (adjusted odds ratio [aOR], 3.0; 95% confidence interval [CI], 1.5-5.9; I(2)R, 11.8%), but pneumonectomy was not (aOR, 1.1; 95% CI, .6-2.3; I(2)R, 13.2%). Treatment success was more likely when surgery was performed after culture conversion than before conversion (aOR, 2.6; 95% CI, 0.9-7.1; I(2)R, 0.2%). CONCLUSIONS: Partial lung resection, but not pneumonectomy, was associated with improved treatment success among patients with MDR-tuberculosis. Although improved outcomes may reflect patient selection, partial lung resection surgery after culture conversion may improve treatment outcomes in patients who receive optimal medical therapy.


Assuntos
Pneumonectomia/estatística & dados numéricos , Tuberculose Resistente a Múltiplos Medicamentos/cirurgia , Tuberculose Pulmonar/cirurgia , Adulto , Antituberculosos/uso terapêutico , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/epidemiologia
18.
Acta Crystallogr E Crystallogr Commun ; 71(Pt 10): o712-3, 2015 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-26594437

RESUMO

In the title compound, C21H29N3O, the dihedral angle between the planes of the aromatic rings is 8.1 (2)°. The ethyl groups at one terminal site of the compound are disordered over two sets of sites with occupancies of 0.775 (9) and 0.225 (9). The mol-ecule has an E conformation about the N=C bond. The mol-ecular structure features an intra-molecular O-H⋯N hydrogen bond, which closes an S(6) loop. In the crystal, weak C-H⋯π inter-actions leads to the formation of a three-dimensional network.

19.
Int J Tuberc Lung Dis ; 19(6): 685-92, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25946360

RESUMO

SETTING: National tuberculosis (TB) treatment facility in the country of Georgia. OBJECTIVE: To determine the prevalence of diabetes mellitus (DM) and pre-DM among patients with TB using glycosylated-hemoglobin (HbA1c), and to estimate the association between DM and clinical characteristics and response to anti-tuberculosis treatment. DESIGN: A cohort study was conducted from 2011 to 2014 at the National Centre for TB and Lung Disease in Tbilisi. Patients aged ⩾ 35 years with pulmonary TB were included. HbA1c was used to define DM (⩾ 6.5%), pre-DM (⩾ 5.7-6.4%), and no DM (<5.7%). Interviews and medical chart abstraction were performed. Regression analyses estimated associations between DM and 1) baseline TB characteristics and 2) anti-tuberculosis treatment outcomes. RESULTS: A total of 318 newly diagnosed patients with TB were enrolled. The prevalence of DM and pre-DM was 11.6% and 16.4%, respectively. In multivariable analyses, patients with TB-DM had more cavitation (adjusted OR [aOR] 2.26), higher smear grade (aOR 2.37), and more multidrug-resistant TB (MDR-TB) (aOR 2.27) than patients without DM. The risk of poor anti-tuberculosis treatment outcomes was similar among patients with and those without DM (28.1% vs. 23.6%). CONCLUSION: DM and pre-DM were common among adults with newly diagnosed pulmonary TB in Tbilisi, Georgia, and DM was associated with more clinical symptoms, and MDR-TB, at presentation.


Assuntos
Antituberculosos/uso terapêutico , Diabetes Mellitus/epidemiologia , Mycobacterium tuberculosis/efeitos dos fármacos , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/epidemiologia , Adulto , Biomarcadores/sangue , Distribuição de Qui-Quadrado , Diabetes Mellitus/sangue , Diabetes Mellitus/diagnóstico , Feminino , República da Geórgia/epidemiologia , Hemoglobinas Glicadas/análise , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Mycobacterium tuberculosis/isolamento & purificação , Razão de Chances , Estado Pré-Diabético/sangue , Estado Pré-Diabético/diagnóstico , Estado Pré-Diabético/epidemiologia , Valor Preditivo dos Testes , Prevalência , Estudos Prospectivos , Fatores de Risco , Escarro/microbiologia , Resultado do Tratamento , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Tuberculose Resistente a Múltiplos Medicamentos/microbiologia , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/microbiologia
20.
Spectrochim Acta A Mol Biomol Spectrosc ; 142: 292-302, 2015 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-25706599

RESUMO

Synthesis of new complexes of Ni(II) (1) and Zn(II) (2) with [1-(2-hydroxy-3,5-diiodobenzylidene)-4-phenylthiosemicarbazide] have been reported. The composition of these two complexes 1 and 2 is discussed on the basis of IR, (1)H NMR and UV spectral data along with their X-ray crystallographic data. The crystal structure of these two complexes has revealed that the free ligand (L) is deprotonated twice at the oxygen and sulfur atoms and they are coordinated with the complexes through phenoxide-O, azomethine-N and thiolate-S atoms. The single-crystal X-ray structures of complex (1) exhibits a square planar structure, while complex (2) reveals trigonal bipyramidal distorted square based pyramidal structure. Anticancer activity of ligand and the complexes 1-2 are evaluated in human adenocarcinoma (MCF-7) cells. The preliminary bioassay indicates that the free ligand and the complexes 1-2 exhibit inhibitory activity against the human adenocarcinoma cancer cell lines.


Assuntos
Antineoplásicos/química , Antineoplásicos/farmacologia , Complexos de Coordenação/química , Complexos de Coordenação/farmacologia , Semicarbazidas/química , Semicarbazidas/farmacologia , Adenocarcinoma/tratamento farmacológico , Sobrevivência Celular/efeitos dos fármacos , Cristalografia por Raios X , Humanos , Ligantes , Células MCF-7 , Espectroscopia de Ressonância Magnética , Modelos Moleculares , Níquel/química , Níquel/farmacologia , Espectrofotometria Infravermelho , Zinco/química , Zinco/farmacologia
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