Comparison of blue laser imaging and narrow band imaging for the differentiation of diminutive colorectal polyps: A randomized controlled trial.

BACKGROUND: To compare the diagnostic efficacy of blue laser imaging (BLI)- bright and narrow band imaging (NBI) modes of image enhanced endoscopy (IEE) in differentiating neoplastic and non-neoplastic lesions of diminutive colorectal polyps. METHODS: We conducted a prospective randomized controlled trial from September 2015 to July 2016. The participants were randomly assigned (1:1) for colonoscopy with polyp classification under NBI or BLI-bright mode without magnification. Histopathologic diagnosis was used as the gold standard. RESULTS: Three hundred and twenty-four diminutive polyps in 164 patients were included for analysis (BLI: 162 polyps in 73 patients, NBI: 162 polyps in 91 patients). These polyps were located at colon proximal to sigmoid (61.1 and 58.0%) and rectosigmoid colon (38.9 and 42.0%) in the BLI and NBI groups, respectively. Most polyps (71.9%) were adenomatous with one malignant polyp (0.3%). BLI achieved 86.4% accuracy, 98.3% sensitivity, 55.6% specificity, 85.2% positive predictive value (PPV), and 92.6% negative predictive value (NPV), similar to NBI which exhibited 90.1% accuracy, 99.1% sensitivity, 67.4% specificity, 88.5% PPV, and 96.9% NPV in the diagnosis of adenomatous polyps. Based on the location of the polyp, both modes of IEE provided ≥ 95% NPV for diagnosis of adenomatous polyps at the rectosigmoid colon. CONCLUSIONS: BLI-bright and NBI modes of IEE have similar accuracy in differentiation between neoplastic and non-neoplastic lesions of diminutive polyps. Both modes provided ≥ 90% NPV which allows for the adaptation of the American Society of Gastrointestinal Endoscopy "diagnose-and-leave" recommended strategy for diminutive polyps at the rectosigmoid colon.

PREVALENCE AND FACTORS ASSOCIATED WITH MULTIDRUG-RESISTANT TUBERCULOSIS AT SIRIRAJ HOSPITAL, BANGKOK, THAILAND.

The objective of this study was to determine the prevalence and factors associated with multidrug-resistant tuberculosis (MDR-TB) at Siriraj Hospital, Bangkok, Thailand. We conducted a retrospective unmatched case-control study of patients clinically diagnosed and microbiologically confirmed to have tuber- culosis (TB) at Siriraj Hospital from 2010 to 2012. Patient characteristics, clinical data, microbiological findings, outcomes and drug susceptibilities were recorded. A total of 188 subjects were included in the study; 52.1% (98) were males; the mean age was 48.9 years. Subjects were categorized into one of two groups, as follows: non-MDR-TB (141 patients) and MDR-TB (47 patients). The prevalence of MDR- TB was 2.6%. Co-morbidities of study subjects included diabetes mellitus (16.5%), HIV infection (16%) and cancer (5.9%). One hundred thirty-one patients (69.7%) had pulmonary TB. Factors significantly associated with MDR-TB were age < 65 years (OR = 6.94; 95% CI: 1.02-45.49; p = 0.048), history of TB (OR = 51.86; 95% CI: 12.35-217.79; p < 0.001), HIV co-infection (OR = 3.83; 95% CI: 1.02-14.38; p = 0.047) and alcohol consumption (OR = 3.90; 95% CI: 1.03-14.72; p = 0.045). Of the 146 patients for whom a clinical outcome was available, 51 (34.9%) had an unfavorable outcome. Poor compliance (OR = 13.51; 95% CI: 3.97-45.45; p < 0.001) and previous history of TB (OR = 8.16; 95% CI: 1.76-37.73; p = 0.007) were associated with an unfavorable outcome. MDR-TB was significantly associated with: patients aged < 65 years, those with a previous history of TB, those with HIV co-infection and those who drank alcohol. These factors should be kept in mind when treating TB patients at Siriraj Hospital, Thailand.