Analysis of care-seeking pathways of tuberculosis patients in Guangxi, China, with and without decentralised tuberculosis services.

SETTING: Tuberculosis (TB) care has been decentralised to township hospitals in a rural, poor area of Guangxi, China, since 1 April 2005. Routine county-based TB care was provided in a comparable control area. OBJECTIVE: To compare patients' care-seeking behaviours between the intervention and control groups. METHODS: In February 2007, all 230 new pulmonary TB smear-positive patients registered in the intervention and control groups between 1 April 2005 and 31 July 2006 were approached; of these, 171 were surveyed using a structured questionnaire. Their patient records were reviewed to minimise recall bias. RESULTS: Patients in the intervention group spent less for treating TB symptoms prior to TB diagnosis compared with the control group (P < 0.01). Travel costs were lower in the intervention than control group, but the difference was not statistically significant (P > 0.05). Diagnostic delays for patients in the intervention and control groups were respectively 26 and 38 days (t = -0.835, P> 0.05). Logistic regression suggested that visiting county general hospitals tended to prolong patient diagnostic delay and cost more before TB diagnosis. CONCLUSION: Decentralising TB services to township hospitals brought TB care closer to rural patients, shortened TB patient care-seeking pathways and reduced costs before TB diagnosis.

Assessment of urinary endothelin-1 and nitric oxide levels and their relationship with clinical and pathologic types in primary glomerulonephritis.

To determine the relationship between the urinary endothelin (ET-1), nitric oxide (NO) levels and the clinical, pathologic types of primary glomerulonephritis (GN) patients, urinary levels of ET-1 and NO were detected in 27 patients with biopsy-proven primary GN and 12 normal controls by radioimmunoassay and by copper-plated and cadmium column reduction assay, respectively. The results showed that urinary ET-1 levels in the patients with primary GN were significantly higher than in normal controls (p < 0.01), while the urinary ET-1 levels in patients with moderate mesangial proliferation GN were significantly higher than those in patients with mild mesangial proliferation GN (p < 0.05). Urinary ET-1 levels in patients whose clinical feature was nephrotic syndrome were found to be higher than in patients whose clinical feature was nephritic syndrome. However, urinary NO levels were to the contrary (p < 0.05). The ratio of ET-1/NO in primary GN patients was significantly higher than that in normal controls, and it positively correlated with the 24-hour urinary excretion of protein. These results suggest that urinary ET-1 levels are related to the proliferation of mesangial cells. The imbalance between ET-1 and NO may be related to the pathogenesis of primary GN and the occurrence of proteinuria.

Assessment of renal function in the early stages of nephrotoxicity induced by iodinated contrast media.

To determine whether there are early renal function parameters (RFP) which can be monitored to rapidly detect nephrotoxicity induced by contrast media (CM), we observed RFP in 16 patients with normal renal function before and after administration of CM. Forty-eight hours after diatrizoate meglumine administration, blood urea nitrogen (BUN) and serum creatinine (SCr) increased (p < 0.05). In all patients, acute tubular damage was revealed by early urinary RFP. Increases in levels of serum angiotensin-I-converting enzyme (ACE), beta(2)-microglobulin (beta(2)M) and urinary albumin (Alb) were associated with alterations in glomerular function. The changes in early RFP occurred earlier than those of BUN and SCr. The present study demonstrates that serum ACE, beta(2)M, urinary Alb, gamma-glutamyl-transpeptidase and N-acetyl-beta-D-glucosidase are sensitive parameters for the early assessment of subclinical nephrotoxicity induced by CM.

[The termination of early pregnancy by inducing menstrual flow with crystalline trichosanthinin complex in 86 cases].

PIP: It is reported in this article that, by taking crystalline Trichosanthinin complex, menstrual flow can be induced and pregnancy stopped during a period of 42 days' cessation of menstrual flow. 86 cases were investigated from January to October, 1982, of which 68 had been diagnosed by hCG-RIA as pregnancies, 18 as nonpregnancies. With the taking of medicine, the menstrual flow for the 18 cases of nonpregnancy was induced successfully. Pregnancy termination, too, turned out to be satisfactory in 58 out of the 68 cases. The total success rate amounted to 88.37%. Vaginal bleeding appeared on the 3rd day for the nonpregnancies and on the 3rd to 5th day for the pregnancies. The bleeding generally was confined to 3-7 days. Bleeding volume for 88.16% of all cases was no more than that for normal menstruation. It was discovered that for 63 of the 67 cases the menstruation returned to normal, while for the remaining 4 cases, menstruation was postponed and then returned to normal in the 2nd cycle.^ieng