Unusual sites of tuberculosis in patients with rheumatologic conditions

INTRODUCTION: Tuberculosis (TB) is a chronic infectious disease, with a growing incidence seen worldwide. Among the tuberculous infections, pulmonary TB remains to be the most common, with extrapulmonary TB seen in only less than 2.0% of this population. Although the latter remains to be rare, it is commonly found in the lymph nodes, gastrointestinal (GI) and genitourinary (GU) tracts, weight- bearing joints, and the meninges. But, however rare extra- pulmonary tuberculosis may be, some patients have reported the occurrence of such in less common sites.In patients with autoimmune diseases, the diagnosis and management of microbial infections remain complicated because of their immunocompromised nature, and because of the medications they receive. As tuberculosis is a curable disease, early identification and proper treatment should be applied to avoid further patient compromise.OBJECTIVE: The objective of this paper is to present three cases of patients diagnosed with extrapulmonary tuberculosis at atypical sites namely tuberculous cellulitis, endometrial tuberculosis, and tuberculous dactylitis, accompanying a primary rheumatologic disease.CASES: Case 1 is a patient with Dermatomyositis who presented with pain and non- traumatic ecchymosis on his right gluteus, later diagnosed as TB cellulitis through a positive AFB smear of the aspirate. Case 2 is a patient with SLE whose amenorrhea was initially attributed to Cyclophosphamide. However, further work up revealed tuberculous bacteria through AFB smear of the curetting, hence was diagnosed with Endometrial TB. Case 3 reports another patient with SLE, who was diagnosed with recurrent TB dactylitis through a positive AFB smear of the biopsy.CONCLUSION: Despite the high endemicity of the Philippines for tuberculosis, extra- pulmonary TB continues to be underrecognized. Patients with autoimmune conditions are most likely to suffer from such infections due to their immunocompromised state. High suspicion and management remain to be the cornerstone to avoid diagnostic delays, and improve outcome.

The traceability chain of 131I measurements for nuclear medicine in Cuba.

The national traceability chain for (131)I activity measurements performed in nuclear medicine in Cuba is described. At the highest (primary) level, liquid scintillation counting employing the CIEMAT/NIST method is used; at the secondary level, a secondary standard radionuclide calibrator is utilized that allows for a quick and simple transference of the measurement unit to the tertiary level of end-users' instruments. The equivalence of Cuban standards and the assessment of measurement uncertainties at the end-user level are determined through the results of measurement comparisons.

Some results of a simulated test for administration of activity in nuclear medicine.

This paper describes the results obtained using a simulated test for administration of activity in nuclear medicine between 2002 and 2004. Measurements in the radionuclide calibrator are made during the different stages of the procedure. The test attempts to obtain supplementary information on the quality of the measurement, with the aim of evaluating in a more complete way the accuracy of the administered activity value compared with the prescribed one. The participants' performance has been assessed by means of a statistical analysis of the reported data. Dependences between several attributes of the simulated administration tests results are discussed. Specifically, the proportion of satisfactory results in the 2003-2004 period was found to be higher than in 2002. It reveals an improvement of the activity administration in the Cuban nuclear medicine departments since 2003.

Non-stimulated Ca2+ leak pathway in cerebellar granule neurones.

The aim of this study was to investigate the pathways of calcium influx routes in non-stimulated cerebellar granule neurones by use of standard microspectrofluorimetric techniques. Repetitive application of Ca2+-free solutions for various time intervals induced decreases of resting cytosolic free Ca2+ concentration ([Ca2+]i) which were followed, on Ca2+ readmission, by a full recovery, always to the initial resting [Ca2+]i levels. Use of drugs to deplete calcium stores (thapsigargin, alone or combined with low levels of ionomycin) did not cause release of Ca2+ from the intracellular stores nor enhanced the activity of the Ca2+ entry pathway. This influx was mainly independent of voltage operated calcium channels, since both L-type channel blockers (nitrendipine) and the hyperpolarizing agent pinacidil (a K+-channel opener) were without effect. Contribution from glutamate receptors to this influx was eliminated since a combination of blockers of NMDA and AMPA glutamate receptors (NBQX and D-AP5) did not affect the properties of the Ca2+ response. The Ca2+ leak pathway was sensitive to micromolar levels of lanthanum and gadolinium, and to the compound 2-APB, features shared by several channels of the TRP superfamily. In summary, our results show the presence of a Ca2+ permeable pathway, active and patent in resting conditions in cerebellar granule neurones, and which is different from the voltage-operated calcium channels and not operated by depletion of the stores.

Comparisons of activity measurements with radionuclide calibrators-A tool for quality assessment and improvement in nuclear medicine.

A national program of ongoing comparisons for assaying gamma-emitting radiopharmaceuticals for amount of radioactivity using radionuclide calibrators was begun in 2000. Nuclides of the most wide-spread use in Cuban nuclear medicine, 131I, 201Tl and (99m)Tc, as well as two measurement geometries, glass vials and plastic syringes, were employed. In this paper, the participants' performance is assessed by mean of a statistical analysis of the reported data. Performance tables have been obtained and a chi2 statistic is calculated from observed and expected frequencies, with the aim of testing the hypothesis about the independence of some characteristics of the comparison results, at a significance level alpha=0.05. The proportion of satisfactory results in the years 2002-2004 were found to be at the same level, but higher than in 2000. It reveals an improvement of the measurement quality since 2002. The causes of improvement were investigated using the statistical treatment of several data available as supplementary information.

Comparisons of activity measurements with radionuclide calibrators.

The correct administration to a patient of the prescribed activity of a radiopharmaceutical is an important factor to ensure the confidence in the diagnosis or the therapeutic efficiency, while at the same time keeping the unnecessary human exposure as low as possible. Comparisons of activity measurements for 131I, 201Tl and 99mTc with radionuclide calibrators were organized the first time in Cuba during 2002 with the aim of obtaining information about the quality of administration of radiopharmaceuticals. Ten Cuban nuclear medicine departments and the laboratories involved in the production of these kinds of compounds participated in the comparison runs. The results presented in this paper facilitated the identification of several problems and initiated corrective actions. In addition, they indicate the necessity of establishing Quality Systems in nuclear medicine in Cuba.

A procedure for the standardization of gamma reference sources for quality assurance in activity measurements of radiopharmaceuticals.

A simplified procedure for the standardization of gamma reference sources, for use in quality assurance of activity measurements during production and application of radiopharmaceuticals in Cuban nuclear medicine laboratories, is described. The method is based on the reliable achievement of consistent measurements by both gamma-spectrometry and ionization chamber techniques, and allows to obtain reference sources with uncertainties lower than 2%. Experimental setup, validation procedure and typical results obtained for 99mTc, 131I, 201Tl and 153Sm are described and discussed. The method will serve also as a secondary reference system for radioactivity measurements in the country.