Newer fluoroquinolones for treating respiratory infection: do they mask tuberculosis?

Possible masking of tuberculosis (TB) in treatment of community-acquired respiratory infection by newer fluoroquinolones has not been examined in randomised controlled trials. We undertook a randomised, open-label controlled trial involving adults with community-acquired pneumonia or infective exacerbation of bronchiectasis encountered in government chest clinics in Hong Kong. 427 participants were assigned by random permutated blocks of 20 to receive either amoxicillin clavulanate (n = 212) or moxifloxacin (n = 215). Participants were followed for 1 yr for active pulmonary TB. Excluding three participants with positive baseline culture, 13 developed active pulmonary TB: 10 (4.8%) out of 210 were given amoxicillin clavulanate, and three (1.4%) out of 214 were given moxifloxacin. The difference was significant by both proportion and time-to-event analysis. Post hoc analysis showed a significant decrease in the proportion with active pulmonary TB from 4.8% to 2.4% and 0% among participants given amoxicillin clavulanate (n = 210), moxifloxacin for predominantly 5 days (n = 127) and 10 days (n = 87), respectively. The log rank test for trend also showed a significant difference between the three subgroups. Regression models reaffirmed the linear effect; the adjusted odds ratio (95% confidence interval) of active pulmonary TB after moxifloxacin exposure up to predominantly 10 days was 0.3 (0.1-0.9). Newer fluoroquinolones appear to mask active pulmonary TB.

Immunomodulatory effects of yun zhi and danshen capsules in health subjects--a randomized, double-blind, placebo-controlled, crossover study.

Immunostimulating polysaccharides extracted from the Chinese medicinal plant Yun Zhi (Coriolus versicolor) have been found to enhance various immunological functions, and Danshen (Salvia miltiorrhiza) to show beneficial effects on the circulatory system. In the present clinical study, we investigated if regular consumption of Yun Zhi and Danshen capsules could improve cellular immunity in healthy subjects. One hundred healthy subjects were recruited to take Yun Zhi (50 mg/kg body weight) plus Danshen (20 mg/kg body weight) or placebo capsules daily for four successive months and, after a 2-month wash-out period, crossover to take placebo or Yun Zhi plus Danshen capsules for four successive months. Flow cytometry was used to assess the lymphocyte subtypes and concentration of T helper (Th) cell cytokines in culture supernatant. Gene expression of cytokines and cytokine receptors of peripheral blood mononuclear cells (PBMC) was analyzed by cDNA expression array. Results showed that regular oral consumption of Yun Zhi-Danshen capsules could significantly elevate PBMC gene expression of interleukin (IL)-2 receptor, increase the percentage and absolute counts of T helper cell and ratio of CD4(+) (T helper)/CD8(+) (T suppressor and cytotoxic T) cell, and significantly enhance the ex vivo production of typical Th1 cytokine interferon-gamma from PBMC activated by phytohemagglutinin and lipopolysaccharide (all p<0.005). Such consumption had no adverse effects on liver and renal functions, and the biochemical bone profile. Therefore, regular consumption of Yun Zhi and Danshen could be beneficial for immunological functions by potential enhancement of cell-mediated immunity in healthy subjects without any adverse effects.

Neurologic complications of cardiovascular diseases.

Neurocardiology considers the interrelationships between the circulatory and nervous systems. An appreciation of the anatomic relationship preceded the concept of the clinical relationship of the two systems. Epidemiologic studies link risk factors of the cardiovascular and nervous systems. Neurologic signs and symptoms are often the presenting indication of cardiovascular disease. Neurologic complications occur during the natural history of cardiovascular disease, during diagnostic evaluation, and in the treatment process. A knowledge of potential complications as well as their frequency will help the physician make ethical and valid recommendations to patients concerning their management. This article highlights some of the potential complications that may be encountered in the management of patients with cardiovascular diseases.