Clinical characteristics, drug resistance, and treatment outcomes among tuberculosis patients with diabetes in Peru.

OBJECTIVES: Diabetes is a risk factor for active tuberculosis (TB). Data are limited regarding the association between diabetes and TB drug resistance and treatment outcomes. We examined characteristics of TB patients with and without diabetes in a Peruvian cohort at high risk for drug-resistant TB. Among TB patients with diabetes (TB-DM), we studied the association between diabetes clinical/management characteristics and TB drug resistance and treatment outcomes. METHODS: During 2005-2008, adults with suspected TB with respiratory symptoms in Lima, Peru, who received rapid drug susceptibility testing (DST), were prospectively enrolled and followed during treatment. Bivariate and Kaplan-Meier analyses were used to examine the relationships of diabetes characteristics with drug-resistant TB and TB outcomes. RESULTS: Of 1671 adult TB patients enrolled, 186 (11.1%) had diabetes. TB-DM patients were significantly more likely than TB patients without diabetes to be older, have had no previous TB treatment, and to have a body mass index (BMI) >18.5 kg/m(2) (p<0.05). In patients without and with previous TB treatment, the prevalence of multidrug-resistant TB was 23% and 26%, respectively, among patients without diabetes, and 12% and 28%, respectively, among TB-DM patients. Among 149 TB-DM patients with DST results, 104 (69.8%) had drug-susceptible TB and 45 (30.2%) had drug-resistant TB, of whom 29 had multidrug-resistant TB. There was no association between diabetes characteristics and drug-resistant TB. Of 136 TB-DM patients with outcome information, 107 (78.7%) had a favorable TB outcome; active diabetes management was associated with a favorable outcome. CONCLUSIONS: Diabetes was common in a cohort of TB patients at high risk for drug-resistant TB. Despite prevalent multidrug-resistant TB among TB-DM patients, the majority had a favorable TB treatment outcome.

Anti-inflammatory effect of jeongshintang through suppression of p38 activation in human astrocytoma, U373MG cells.

Jeongshintang (JST) is a Korean herbal prescription, which has been successfully used for cerebral diseases. However, the anti-inflammatory effect of JST on Alzheimer's disease (AD) is still not fully understood. In this study, we investigated the effects of JST in attenuating the inflammatory response induced by interleukin (IL)-1beta plus beta-amyloid [1-42] fragment (A beta) in the human astrocyte cell line, U373MG. The production of IL-6, IL-8, and prostaglandin (PG)E2 was significantly increased by IL-1beta plus A beta (1-42) in a time-dependent manner (P < 0.05). JST significantly inhibited the IL-1beta plus A beta (1-42)-induced IL-6, IL-8, and PGE2 production at 24 h (P < 0.05). Maximal inhibition rate of IL-6, IL-8, and PGE2 production by JST was about 54.40%, 56.01%, and 44.06% respectively. JST (0.01-1 mg/ml) also attenuated the expression of cyclooxygenase (COX)-2 and activation of p38 MAPK induced by IL-1beta and A beta (1-42). These results demonstrated that JST has an anti-inflammatory effect, which might explain its beneficial effect in the treatment of various neurodegenerative diseases such as AD.

Acquisition of drug resistance in multidrug-resistant Mycobacterium tuberculosis during directly observed empiric retreatment with standardized regimens.

The risk of acquiring additional drug resistance in strains of multidrug-resistant tuberculosis (MDR-TB) during failure of empiric standardized retreatment regimens is poorly defined. We sought to estimate this risk by comparing drug susceptibility profiles and RFLP patterns of paired MDR-TB isolates collected from 27 patients before and after retreatment failure. Among 23 patients with paired isolates with concordant RFLP patterns, 19 (83%) had become resistant to at least one additional drug after failed retreatment. In this limited group of MDR-TB patients, acquisition of resistance was common during failure of empiric drug regimens. Further study is needed to confirm these findings.

Suppressive effects of PG201, an ethanol extract from herbs, on collagen-induced arthritis in mice.

OBJECTIVE: PG201 has been formulated using 12 herbs known to have anti-inflammatory and protective effects on damaged tissue and bone among other functions. The present study was done in order to assess the therapeutic effects of PG201 in collagen-induced arthritis (CIA) in mice. METHODS: DBA/1 mice were immunized with bovine type II collagen. After a second collagen immunization, mice were treated with PG201 orally at 10 mg/kg once a day for 18 days. Paws were evaluated macroscopically for redness, swelling and deformities. The levels of TNF-alpha and IL-1beta in the ankle were examined. The severity of arthritis within the knee joints was evaluated by histological assessment of cartilage destruction and pannus formation. Molecular indicators related to CIA pathology were analysed by measuring the serum levels of matrix metalloproteinase 2 (MMP-2), tissue inhibitor of matrix metalloproteinase 2 (TIMP-2) and the anti-inflammatory cytokines interleukin (IL)-4 and IL-10. RESULTS: Administration of PG201 significantly suppressed the progression of CIA and inhibited the production of TNF-alpha and IL-1beta in the paws. The erosion of cartilage was dramatically reduced in mouse knees after treatment with PG201. In the serum of PG201-treated mice, the level of TIMP-2 and the ratio of TIMP-2 to MMP-2 were significantly elevated, and the level of IL-4, but not of IL-10, was increased. CONCLUSION: Administration of PG201 has therapeutic effects on CIA. Protection of cartilage was particularly prominent. PG201 is a potential therapy for rheumatoid arthritis.

2,2-Dimethyl-4,5-diaryl-3(2H)furanone derivatives as selective cyclo-oxygenase-2 inhibitors.

A series of 2,2-dimethyl-5-[4-(methylsulfonyl)phenyl]-4-phenyl-3(2H)furanones was prepared and evaluated for their ability to inhibit cyclo-oxygenase-2 (COX-2).

Using treatment failure under effective directly observed short-course chemotherapy programs to identify patients with multidrug-resistant tuberculosis.

SETTING: Public ambulatory care centers in three districts of northern metropolitan Lima, Peru. OBJECTIVE: To document drug resistance patterns of isolates of Mycobacterium tuberculosis from patients identified as treatment failures under a model tuberculosis (TB) control program based on directly observed, short-course chemotherapy (DOT-SCC). DESIGN: Case series. RESULTS: In a referred, consecutive sample of 173 patients identified as treatment failures on DOT-SCC, 160 (92.5%) had culture-positive TB. Of those 160, 150 (93.8%) had active, pulmonary multidrug-resistant TB (MDR-TB, resistance to at least isoniazid [INH] and rifampicin [RIF]). Sixty of the 150 (40.0%) had isolates resistant to at least INH, RIF, ethambutol (EMB) and pyrazinamide (PZA), the initial first-line empiric treatment regimen used locally. Forty-four (29.3%) had isolates resistant to at least INH, RIF, EMB, PZA and streptomycin (SM), the first retreatment regimen. This series of patients had isolates resistant to a mean of 4.5 of the ten drugs tested. The local profile of multidrug resistance is very different from that obtained from national data from Peru. CONCLUSION: In this setting, treatment failure on DOT-SCC is strongly predictive of active MDR-TB. Because of existing local drug resistance patterns in northern Lima, 89.3% of MDR-TB patients identified as treatment failures will receive ineffective therapy with two or fewer secondary TB drugs if they are given the five-drug empiric retreatment regimen endorsed by the World Health Organization. Further short-course chemotherapy for these patients would only serve to amplify ominous existing drug resistance patterns.

[Development of integrated traditional Chinese and western medicine and change of medical policy in China].

"Sect of Integration of Chinese and Western Medicine" came into the world four hundred years ago when Traditional Chinese Medicine (TCM) contacted Western Medicine (WM) at the beginning of the 17th century. It collected historical experiences showing that the cooperation of TCM and WM is more efficient for the cure and prevention of disease than each of them separately. Now the recognition that the cooperation of eastern and western medicine is more efficient to cure disease is spreading widely. This study will help Korean eastern and western medicine to find their directions. First, the concept of "sect of Integration of Chinese and Western Medicine" which was established between the beginning of the 17th century and the middle of the 20th century, and Integration of Traditional Chinese and Western Medicine (ITCWM) which was formed after the middle of the 20th century will be discussed. The relationship of "sect of Integration of Chinese and Western Medicine" and ITCWM and political consideration for the establishment of ITCWM will also be discussed. Finally, the current status of ITCWM in China will be discussed. New trends of thought appeared in Chinese medicine, owing to the cultural background of modern China, the development of WM, and the academic background of the intellectual class. "Sect of Integration of Chinese and Western Medicine" and ITCWM are different in historical and social background. However, purpose, foundation of thoughts and logical idea are fundamentally the same. It can be said that "sect of Integration of Chinese and Western Medicine" provided academic mood to open the way for ITCWM and ITCWM is a succession of "sect of Integration of Chinese and Western Medicine". The concept of ITCWM has many ways of explanation. However, it can be said to build up the foundation of new medical area including Chinese special way of medical treatment and new methods of modern medicine, succeeding a legacy of TCM. ITCWM began before the establishment of People's Republic of China. Mao Ze-dong (1893-1976), a powerful politician, and Li Ding-ming (1881-1947) who had many experiences and insight for TCM and WM played important roles at this stage. The period from the New China to the Great Proletarian Cultural Revolution (1966-1975) is the term for the establishment of the shape of ITCWM. "The effort of research and development on TCM-WM integration" was adapted as one of hygienic policies for curing of epidemic disease and succession and development of the heritage of TCM to establish new medical area. TCM class for western medical doctors was opened and mass media was used to spread out ITCWM throughout China. During the period of the Great Proletarian Cultural Revolution, ITCWM had to be stepped back and stagnant. Only the TCM class of western medical doctors and some clinical applications were barely kept moving on and alive. From the period of the Great Proletarian Cultural Revolution to the end of the 1980s, there are the movement of re-preparation of ITCWM, education of successors, and the establishment of the Institute of ITCWM. Hospitals began to establish department of ITCWM. Furthermore, it was clearly indicated in the constitutional law that "We not only have to develop modern medicine but also traditional medicine". The equality of TCM and WM was legally established in this time. From the 1990s, "equality of TCM and WM" was adapted as one of the hygienic policies, and department of ITCWM was opened in traditional Chinese medical school and western medical school. ITCWM has been settled down as a new academic field through education, training, research, academic activity, and publishing text books. In conclusion, the motive of the development of ITCWM was the policy such as "the effort of research and development on TCM-WM integration" abd "equality of TCM and WM" aimed at the development of Chinese medical area. It is no doubt helpful to organize systems and policy-making for the cooperation of eastern and western medicine in Korea.

[A study on the Korean traditional medical literatures before Koryo dynasty].

So far, the research has not been actively carried out on the oriental medical books of traditional Korean origin, published before Koryo Dynasty. It was attempted in this study for better understanding of current and pre-Koryo Dynasty oriental medicine by introducing and translating those medical books originated from pre-Koryo Dynasty. However the medical formularies of pre-Koryo Dynasty were written and handed down up to the present rather by Chinese and Japanese medical books. And this study was performed based on these books. It was assumed that Koryonosabang was written by an old master of oriental medicine. Backjaesinjibbang was written by a person who lived in the same period and Shillabubsabang, Shillabubsayugwanbimilyosulbang, Shillabubsabimilbang by a monk doctor during Kokuryo, Backjae and the Unified Silla Dynasty, respectively. ...