Evaluation of Xpert MTB/RIF Versus AFB Smear and Culture to Identify Pulmonary Tuberculosis in Patients With Suspected Tuberculosis From Low and Higher Prevalence Settings.

BACKGROUND: The Xpert MTB/RIF (Xpert) assay is a rapid nucleic acid amplification test widely used in settings of high tuberculosis prevalence to detect tuberculosis as well asrpoBmutations associated with rifampin resistance. Data are needed on the diagnostic performance of Xpert in lower-prevalence settings to inform appropriate use for both tuberculosis detection and the need for respiratory isolation. METHODS: Xpert was compared to 2 sputum samples, each evaluated with acid-fast bacilli (AFB) smear and mycobacterial culture using liquid and solid culture media, from participants with suspected pulmonary tuberculosis from the United States, Brazil, and South Africa. RESULTS: Of 992 participants enrolled with evaluable results, 22% had culture-confirmed tuberculosis. In 638 (64%) US participants, 1 Xpert result demonstrated sensitivity of 85.2% (96.7% in participants with AFB smear-positive [AFB(+)] sputum, 59.3% with AFB smear-negative [AFB(-)] sputum), specificity of 99.2%, negative predictive value (NPV) of 97.6%, and positive predictive value of 94.9%. Results did not differ between higher- and low-prevalence settings. A second Xpert assay increased overall sensitivity to 91.1% (100% if AFB(+), 71.4% if AFB(-)), with specificity of 98.9%. In US participants, a single negative Xpert result predicted the absence of AFB(+)/culture-positive tuberculosis with an NPV of 99.7%; NPV of 2 Xpert assays was 100%, suggesting a role in removing patients from airborne infection isolation. Xpert detected tuberculosis DNA and mutations associated with rifampin resistance in 5 of 7 participants with rifampin-resistant, culture-positive tuberculosis. Specificity for rifampin resistance was 99.5% and NPV was 98.9%. CONCLUSIONS: In the United States, Xpert testing performed comparably to 2 higher-tuberculosis-prevalence settings. These data support the use of Xpert in the initial evaluation of tuberculosis suspects and in algorithms assessing need for respiratory isolation.

Does the distance between the patient's home and the laboratory influence laboratory monitoring of diabetes? / La distance entre domicile du patient et laboratoire influence-t-elle le suivi biologique du diabète ?

Objective: Laboratory tests play an important role in general practice. Access to a clinical laboratory is essential and can potentially influence whether or not these tests are performed. This study assessed the impact of the distance between the patient's home and the clinical pathology laboratory on laboratory monitoring of diabetes. Methods: This was a retrospective observational study conducted over a period of 3 years on a cohort of diabetic patients from 11 clinical pathology laboratories in the Saint-Etienne region. The primary endpoint was at least three HbA1c, one serum creatinine, one lipid profile and one microalbuminuria over a 12-month period. Statistical analysis was based on the following variables: distance between the patient's home and the clinical pathology laboratory, patient's age, their health insurance, type of urban area and the site of blood sampling. Results: Among the 12,773 subjects included, 1,889 (14.8%) complied with the monitoring procedure. The successful monitoring rate decreased by 38% when the distance from the laboratory was more than 5 km (OR 1.38 [1.18 to 1.61]). Monitoring compliance increased with age (OR 0.71 [0.61 to 0.83] for subjects 55-65 years old and 0.61 [0.53 to 0.71] for subjects over 65 years old). However, patients in rural areas and in urban areas with less than 10,000 inhabitants presented better compliance with monitoring than patients living in towns with more than 200,000 inhabitants. Conclusions: Compliance with laboratory monitoring decreased as the distance between the patient's home and the clinical pathology laboratory increased. These results raise the question of the possible role of home sampling and the availability of other relevant tests required for general practice.

26Postoperative diagnosis and outcome in patients with revision arthroplasty for aseptic loosening.

BACKGROUND: The most common cause of implant failure is aseptic loosening (AL), followed by prosthetic joint infection (PJI). This study evaluates the incidence of PJI among patients operated with suspected AL and whether the diagnosis of PJI was predictive of subsequent implant failure including re-infection, at 2 years of follow up. METHODS: Patients undergoing revision hip or knee arthroplasty due to presumed AL from February 2009 to September 2011 were prospectively evaluated. A sonication fluid of prosthesis and tissue samples for microbiology and histopathology at the time of the surgery were collected. Implant failure include recurrent or persistent infection, reoperation for any reason or need for chronic antibiotic suppression. RESULTS: Of 198 patients with pre-and intraoperative diagnosis of AL, 24 (12.1 %) had postoperative diagnosis of PJI. After a follow up of 31 months (IQR: 21 to 38 months), 9 (37.5 %) of 24 patients in the PJI group had implant failure compared to only 1 (1.1 %) in the 198 of AL group (p < 0.0001). Sensitivity of sonicate fluid culture (>20 CFU) and peri-prosthetic tissue culture were 87.5 % vs 66.7 %, respectively. Specificities were 100 % for both techniques (95 % CI, 97.9-100 %). A greater number of patients with PJI (79.1 %) had previous partial arthroplasty revisions than those patients in the AL group (56.9 %) (p = 0.04). In addition, 5 (55.5 %) patients with PJI and implant failure had more revision arthroplasties during the first year after the last implant placement than those patients with PJI without implant failure (1 patient; 6.7 %) (RR 3.8; 95 % CI 1.4-10.1; p = 0.015). On the other hand, 6 (25 %) patients finally diagnosed of PJI were initially diagnosed of AL in the first year after primary arthroplasty, whereas it was only 16 (9.2 %) patients in the group of true AL (RR 2.7; 95 % CI 1.2-6.1; p = 0.03). CONCLUSIONS: More than one tenth of patients with suspected AL are misdiagnosed PJI. Positive histology and positive peri-implant tissue and sonicate fluid cultures are highly predictive of implant failure in patients with PJI. Patients with greater number of partial hip revisions for a presumed AL had more risk of PJI. Early loosening is more often caused by hidden PJI than late loosening.

Non-hispanic whites have higher risk for pulmonary impairment from pulmonary tuberculosis.

BACKGROUND: Disparities in outcomes associated with race and ethnicity are well documented for many diseases and patient populations. Tuberculosis (TB) disproportionately affects economically disadvantaged, racial and ethnic minority populations. Pulmonary impairment after tuberculosis (PIAT) contributes heavily to the societal burden of TB. Individual impacts associated with PIAT may vary by race/ethnicity or socioeconomic status. METHODS: We analyzed the pulmonary function of 320 prospectively identified patients with pulmonary tuberculosis who had completed at least 20 weeks standard anti-TB regimes by directly observed therapy. We compared frequency and severity of spirometry-defined PIAT in groups stratified by demographics, pulmonary risk factors, and race/ethnicity, and examined clinical correlates to pulmonary function deficits. RESULTS: Pulmonary impairment after tuberculosis was identified in 71% of non-Hispanic Whites, 58% of non-Hispanic Blacks, 49% of Asians and 32% of Hispanics (p < 0.001). Predictors for PIAT varied between race/ethnicity. PIAT was evenly distributed across all levels of socioeconomic status suggesting that PIAT and socioeconomic status are not related. PIAT and its severity were significantly associated with abnormal chest x-ray, p < 0.0001. There was no association between race/ethnicity and time to beginning TB treatment, p = 0.978. CONCLUSIONS: Despite controlling for cigarette smoking, socioeconomic status and time to beginning TB treatment, non-Hispanic White race/ethnicity remained an independent predictor for disproportionately frequent and severe pulmonary impairment after tuberculosis relative to other race/ethnic groups. Since race/ethnicity was self reported and that race is not a biological construct: these findings must be interpreted with caution. However, because race/ethnicity is a proxy for several other unmeasured host, pathogen or environment factors that may contribute to disparate health outcomes, these results are meant to suggest hypotheses for further research.

Survival and Goat Milk Acidifying Activity of Lactobacillus rhamnosus GG Encapsulated with Agave Fructans in a Buttermilk Protein Matrix.

Lactobacillus rhamnosus GG (L. rhamnosus GG) cells were encapsulated in buttermilk proteins by spray drying, alone (E), or with Agave tequilana fructans (CEF). Buttermilk proteins acted as a thermo-protector for the probiotic cells undergoing the spray-dried process. The addition of Agave fructans in CEF microcapsules significantly enhanced storage stability and survival to in vitro simulated gastrointestinal conditions, compared to E capsules. After 14 days storage at - 20 °C, the number of living cells in CEF microcapsules was in the order of 7.7 log CFU • mL-1 and the survivability in simulated gastrointestinal environment was 73.23%. Spray-dried microparticles were cultured in goat milk to study biomass production. Agave fructans offered a favorable microenvironment and better growth substrate. The population of CEF viable cells reached 1.08 ± 0.02 × 1010 CFU • mL-1 after 18 h of fermentation. In contrast, the population of E viable cells were 3.0 ± 0.01 × 109 CFU • mL-1. The generation time of CEF, L. rhamnosus GG was 15% faster than E, L. rhamnosus GG. Encapsulation with buttermilk proteins in the presence of Agave fructans by spray drying could be suitable for preservation of probiotic powders and may be for a more effective application of probiotics in goat dairy products.

Impact of Larger Sputum Volume on Xpert® MTB/RIF Assay Detection of Mycobacterium tuberculosis in Smear-Negative Individuals with Suspected Tuberculosis.

As a strategy to improve the sensitivity of nucleic acid-based testing in acid-fast bacilli (AFB) negative samples, larger volumes of sputum (5-10 mL) were tested with Xpert® MTB/RIF from 176 individuals with smear-negative sputum undergoing tuberculosis evaluation. Despite larger volumes, this strategy had a suboptimal sensitivity of 50% (4/8).

Gorilla diet in the Lopé Reserve, Gabon: : A nutritional analysis.

The results of an analysis of gorilla diet in the Lopé Reserve, Gabon are presented. Samples were assayed for nutrients and plant secondary compounds (total phenols, condensed tannins and alkaloids) in an attempt to explain gorilla food choice. The diet is the most diverse so far analysed for gorillas; it seems to be a balance between sugary fruit, proteinaceous leaves, and relatively fibrous stems. Most fruits and herbaceous stems are succulent, but some drier, fibrous fruit and bark is also consumed. Seeds are another component of the diet, including unripe ones. Fruit, seeds, leaves and bark may all contain very high levels of total phenols and condensed tannins; but all herbaceous stems assayed contain low levels of these compounds. Alkaloids are not apparently a significant component of gorilla foods, and may be avoided. Gorillas at Lopé tend to avoid fatty fruit, and select leaves which are high in protein and low in fibre compared to the general vegetation. When fruit and preferred young leaves are scarce, proteinaceous barks and mature leaves, and sugary pith, are important sources of nutrients. We conclude that gorillas exploit the broad frugivore niche in West African lowland forests, and are part of the frugivore community there. What distinguishes them is their ability to eat large fibrous fruit, mature leaves and stems, and to overcome high levels of phenolics (we use "phenolics" as an umbrella term for both total phenols and condensed tannins). Gorilla diet at Lopé overlaps greatly with that of sympatric, frugivorous, primates, and resembles more closely that of chimpanzees than it does gorilla diet studied elsewhere in Africa.

Composition of the diet of chimpanzees and comparisons with that of sympatric lowland gorillas in the lopé reserve, gabon.

Over an eight-year period, a total of 174 food items were recorded for chimpanzees (Pan t. troglodytes) in the Lopé Reserve in central Gabon. Plant foods, principally fruit, dominated the diet but insects were eaten regularly, and predation on at least three species of mammal occurred infrequently. The diversity of the vegetative component of the diet (leaves, stems, and bark) was probably underestimated by fecal analysis. Comparison of chimpanzee diet at Lopé with that of sympatric lowland gorillas showed the majority of foods were eaten by both species (73% of chimpanzee food items and 57% of gorilla food items). The overlap of fruit species was greater (82% and 79%, respectively) than that of other food classes. Both chimpanzees and gorillas harvested the majority of their plant foods arboreally (76% and 69%, respectively). The high degree of dietary overlap suggested that ecological competition between these two closely related species might exist. Few overt signs of competition for food either between or within species were observed but when fruit was scarce, the diets of the two species showed greatest divergence. The major differences between chimpanzee and gorilla diet at Lopé were the larger quantities of vegetative foods regularly eaten by gorillas and their ability to resort to a diet dominated by vegetative foods when fruit was scarce. In these respects, chimpanzees at Lopé resembled populations of Pan troglodytes studied elsewhere while Lopé gorillas resembled mountain gorillas (Gorilla g. beringei) and bonobos (Pan paniscus) in their greater dependence on vegetative foods. © 1993 Wiley-Liss, Inc.

Insect-eating by sympatric Lowland gorillas (Gorilla g. gorilla) and chimpanzees (Pan t. troglodytes) in the Lopé Reserve, Gabon.

Sympatric populations of lowland gorillas (Gorilla gorilla gorilla) and chimpanzees (Pan troglodytes troglodytes) in the Lopé Reserve in central Gabon consumed insects at similar average frequencies over a 7-year period (30% versus 31% feces contained insect remains). Data came mostly from fecal analysis supplemented by observation and trail evidence. The weaver ant (Oecophylla longinoda) was the species eaten most frequently by both gorillas and chimpanzees. Other species of insects wore eaten but there was virtually no overlap: Chimpanzees used tools to eat Apis bees (and their honey) and two large species of ants; gorillas ate three species of small ants. Thus, despite their shared habitat, the esources utilized were not identical as gorillas do not show the tool-use "technology" of chimpanzees. The frequency of insect-eating by both species of ape varied seasonally and between years but in different ways. This variation did not seem to be related to the ratio of fruit to foliage in their diets. Gorillas of all age-classes ate insects at similar rates. Comparisons with insectivory by other populations of gorillas indicate differences exist. Mountain gorillas (Gorilla g. beringei) in the Virunga Volcanoes, Rwanda, consume thousands of invertebrates daily, eating them inadvertently with handfuls of herbaceous foods but they deliberately ingest insect-foods only rarely. Lowland gorillas at Lopé habitually ate social insects, and their selective processing of herbaceous foods probably minimizes inadvertent consumption of other invertebrates. Gorillas at Belinga in northeastern Gabon, 250 km from Lop6, ate social insects at similar rates but ignored weaver ants in favor of Cubitermes sulcifrons, a small species of termite that occurs at Lopé but was not eaten by gorillas. This indicates that local traditions similar to those reported for chimpanzees also exist amongst populations of gorillas. © 1992 Wiley-Liss, Inc.

Composition of the diet of lowland gorillas at Lopé in Gabon.

This report describes the composition of the diet of lowland gorillas, Gorilla gorilla gorilla, at Lopé in central Gabon. This population inhabits mature evergreen tropical forest and is not habituated to human observers. Data were collected during 6 years of an ongoing long-term study, from feeding-trails and by direct observation, but mostly by fecal analysis. Gorillas ate 182 plant foods from 134 species and 36 families. The fruit diet was diverse: 95 species were consumed, most with succulent pulp, and some immature seeds were eaten. Fruit remains were recorded in 98% of dung. Vegetative parts of Aframomum and Marantaceae formed staple foods, as they were abundant, accessible, and available year-round. Soil and social insects were also ingested; remains of weaver ants were recorded in one third of feces. More foods have been recorded for gorillas at Lopé than elsewhere and this is the most frugivorous population studied so far.

Allopatric tuberculosis host-pathogen relationships are associated with greater pulmonary impairment.

BACKGROUND: Host pathogen relationships can be classified as allopatric, when the pathogens originated from separate, non-overlapping geographic areas from the host; or sympatric, when host and pathogen shared a common ancestral geographic location. It remains unclear if host-pathogen relationships, as defined by phylogenetic lineage, influence clinical outcome. We sought to examine the association between allopatric and sympatric phylogenetic Mycobacterium tuberculosis lineages and pulmonary impairment after tuberculosis (PIAT). METHODS: Pulmonary function tests were performed on patients 16 years of age and older who had received ≥20 weeks of treatment for culture-confirmed M. tuberculosis complex. Forced Expiratory Volume in 1 min (FEV1) ≥80%, Forced Vital Capacity (FVC) ≥80% and FEV1/FVC >70% of predicted were considered normal. Other results defined pulmonary impairment. Spoligotype and 12-locus mycobacterial interspersed repetitive units-variable number of tandem repeats (MIRU-VNTR) were used to assign phylogenetic lineage. PIAT severity was compared between host-pathogen relationships which were defined by geography and ethnic population. We used multivariate logistic regression modeling to calculate adjusted odds ratios (aOR) between phylogenetic lineage and PIAT. RESULTS: Self-reported continental ancestry was correlated with Mycobacterium. tuberculosis lineage (p<0.001). In multivariate analyses adjusting for phylogenetic lineage, age and smoking, the overall aOR for subjects with allopatric host-pathogen relationships and PIAT was 1.8 (95% confidence interval [CI]: 1.1, 2.9) compared to sympatric relationships. Smoking >30 pack-years was also associated with PIAT (aOR: 3.2; 95% CI: 1.5, 7.2) relative to smoking <1 pack-years. CONCLUSIONS: PIAT frequency and severity varies by host-pathogen relationship and heavy cigarette consumption, but not phylogenetic lineage alone. Patients who had disease resulting from allopatric-host-pathogen relationship were more likely to have PIAT than patients with disease from sympatric-host-pathogen relationship infection. Further study of this association may identify ways that treatment and preventive efforts can be tailored to specific lineages and racial/ethnic populations.

Evidence for chronic lung impairment in patients treated for pulmonary tuberculosis.

BACKGROUND: Patients with pulmonary tuberculosis are likely to develop pulmonary impairment after tuberculosis (PIAT). The stability of PIAT and the relationship of PIAT to the duration of delay in tuberculosis diagnosis and treatment have not been fully characterized. METHODS: We performed serial pulmonary function tests (PFTs) in a cohort treated for pulmonary tuberculosis after 20 weeks of tuberculosis therapy and again on or after treatment completion to determine the stability of PIAT. PFTs were compared with the duration of delay in tuberculosis diagnosis and treatment, as well as other demographic variables. RESULTS: The median duration between the first and second tests was 15 (interquartile range 9-34) weeks. The mean change in FVC was -0.02l (95% confidence interval [CI] -0.09, 0.06), and the % predicted was -0.02 (95% CI -2.17, 2.12). FEV1 changes were 0l (95% CI -0.05, 0.06), and the % predicted was -0.11 (95% CI -1.82, 1.60). PIAT was not related to the duration of delay in tuberculosis diagnosis or treatment, age or smoking. CONCLUSIONS: PIAT was not associated with the duration of delay in tuberculosis diagnosis and treatment and did not significantly change during follow-up. These data demonstrate that, for many individuals, the completion of tuberculosis treatment is the beginning, not the end, of their tuberculosis illness.

Evaluación de albúmina porcina como sustituto parcial de clara de huevo en panqués de chocolate / Evaluation of Porcine Albumin as a Partial Replacement for Egg White in Chocolate Cakes

Se analizó el efecto de la sustitución de clara de huevo por albúmina sérica porcina (ASP) en panqués de chocolate. La ASP se obtuvo mediante un método escalado de aislamiento por cromatografía de interacción hidrofóbica. En la formulación del panqué se reemplazó el 50 y 100% de la clara de huevo con ASP. Todos los panqués presentaron valores similares (P >0.05) de los parámetros de color en la miga: L (25,7-26,2), a* (9,8-10,1) y b* (14,5-15,0) y en la costra: L (25,7-26,2), a* (9,8-10,1) y b* (14,5-15,0). La textura (2,9 N) y el volumen (148,9 ± 1,8 cm ³) de los panqués con 50% de ASP fueron similares (P> 0,05) a los de los controles. El análisis sensorial indicó que los panqués en los que se reemplazó 50% de la clara por ASP, gustaron tanto como los controles. Los panqués con un reemplazo del 100%, gustaron menos. La excelente calidad microbiológica de los panqués muestra las óptimas condiciones sanitarias durante la obtención de la ASP y su elaboración.

The effect of porcine serum albumin (PSA) as a substitute for egg white (EW) in chocolate cakes was examined. PSA was obtained by a lab-scaled method of Hydrophobic Interaction Chromatography. 50 and 100% of the normal level of EW was replaced with PSA in cake formulation. All cakes had similar (P > 0.05) crumb L (25.7-26.2), a* (9.8-10.1) y b* (14.5-15.0) and crust: L (25.7-26.2), a* (9.8-10.1) y b* (14.5-15.0) color values. Texture (2.9 N) and volume (148.9 1.8 cm ³) of cakes with 50% PSA replacing EW were similar (P > 0.05) to those of the controls. Sensory analysis indicated that cakes replaced with 50% EW for ASP were as well liked as control cakes. The excellent microbiological quality of formulated cakes points out the optimal sanitary conditions in the PSA isolation and in the cake elaboration process.

Características fisioquímicas, microbiológicas y sensoriales de panqués de chocolate adicionados con proteínas de suero porcino / Physicochemical and microbiological characteristic and sensory analysis of chocolate cakes added with porcine serum proteins

Se evaluó la adición de suero porcino liofilizado sobre la calidad y aceptación de un panqué de chocolate. El suero se separó de sangre obtenida de un Matadero Tipo Inspección Federal (TIF) de Hermosillo, México, el cual cuenta con el Sistema HACCP (Análisis de Riesgos, de Identificación y Control de Puntos Críticos) para asegurar la calidad de la producción. Los panqués se elaboraron reemplazando 0; 2; 4; 6 y 8% de harina de trigo por suero liofilizado, determinándose: humedad, contenido proteico y aminoácidos esenciales, color, textura, volumen, calidad microbiológica, aceptación y preferencia. Las concentraciones de proteína de los panqués fueron de 6,0; 7,5; 8,5; 10,2; y 12% al utilizar niveles de crecientes de suero. El contenido de proteína en los panqués con 8% de suero se duplicó y el de lisina aumentó un 40% con respecto a los controles. No hubo diferencias (P>0,05) en los parámetros de color de los panqués. Todos los tratamientos tuvieron una textura en el rango de los suaves, con valores de fuerza de compresión de 1,77 a 2,0 Newtons. El volumen aumentó en proporción directa a la concentración de proteína porcina. En las pruebas de agrado, 51% de los jueces evaluaron al panqué sustituido con 8% de suero con las más alta calificación, mientras que el 74% prefirió este producto al compararlo con un panqué comercial. Todos los panqués mostraron excelente calidad microbiológica. Debido a lo anterior se concluye que, la incorporación de proteína animal al panqué de chocolate mejoró el contenido proteico y el volumen del panqué sin afectar sus características físicas y microbiológicas ni la aceptación del consumidor.

Caracterización del suero porcino producido bajo condiciones controladas en un rastro de la ciudad de Hermosillo México / Characterization of porcine serum obtained under controlled conditions in a slaughterhouse of Hermosillo México

Se analizó suero obtenido de 14 muestreos de sangre de cerdo (10 L) cada uno, obtenido en la línea de sacrificio de una sala de matanza Tipo Inspección Federal (TIF) de Hermosillo, México, con sistema HACCP (Análisis de Riesgos, Identificación y Control de puntos Críticos) implementado. El análisis proximal del suero liofilizado fue: humedad 2,3 g por ciento, proteína 84,3 g por ciento, grasa 4,0 g por ciento y cenizas 4,6 g por ciento. El contenido graso fue mayor (P<0,05) en las muestras de invierno que en las de los meses cálidos, mientras que el contenido proteico no varió. Las concentraciones de IgA, IgG e IgM en suero fresco y liofilizado corresponden a los extremos más altos de los niveles reportados, sin presentarse diferencia (P<0,05) entre los dos tratamientos. La cuenta de mesofílicos aerobios fue < 10UFC/g, los organismos coliformes < 3 NMP/g y no se observó la presencia de Salmonella spp ni de Staphylococcus aureus en ninguna de las muestras. La calidad del suero indica el éxito del Sistema HACCP implementado en la planta y la potencialidad alimentaria del suero porcino