Transcriptome and metabolome analyses of the immune response to light stress in the hybrid grouper (Epinephelus lanceolatus ♂ × Epinephelus fuscoguttatus ♀).

Light intensity is an important environmental factor that affects fish growth and health through multiple physiological activities and metabolism and eventually impacts aquaculture harvest. There is a need to evaluate the fish stress response to light intensities, which will benefit aquaculture. Here, hybrid grouper (Epinephelus lanceolatus ♂ × Epinephelus fuscoguttatus ♀) was treated with three light intensities for evaluation of the light stress response, including high light intensity (1 250 lx), low light intensity (10 lx) and moderate light intensity (250 lx). Transcriptome analysis showed that a total of 71 318 unigene sequences were obtained with an N50 of 2 589 bp. Compared to the control group (250 lx), 1 697 differentially expressed genes (DEGs), a considerable quantity, were detected in the 1 250 lx group. Among those genes, 548 were upregulated, and the remaining 149 genes showed decreased expression. Comparatively small numbers of DEGs were detected in the 10 lx group; 54 out of 103 genes exhibited upregulated expression, and 49 genes showed downregulation. For further KEGG analysis, 82 DEGs were enriched in nine common signalling pathways in immunity, of which 73 DEGs were significantly inhibited in the 1 250 lx group. In contrast, only 11 DEGs were enriched in three immunity pathways, with nine DEGs showing a significant increase in the 10 lx group. The metabolome analysis revealed 59 and 44 differential metabolites (DMs) from the 1 250 lx and 10 lx groups, respectively. Of note, those DMs from the 1 250 lx-treated group were tendentiously involved in amino acid metabolism and lipid metabolism pathways, while the purine metabolism, amino acid metabolism and lipid metabolism pathways were mostly found in the 10 lx treatment group. In summary, our data indicated that high light intensity significantly inhibited the immune response in hybrid grouper, while low light intensity presented low stimulation of immune activity. In addition, both high and low light intensity could inhibit protein synthesis and amino acid metabolism. Taken together, hybrid grouper exhibited a much milder stress response to low light intensity than to high light intensity.

Attitudes and knowledge of newly diagnosed tuberculosis patients regarding the disease, and factors affecting treatment compliance.

SETTING: An urban university teaching hospital. OBJECTIVES: To determine patients' attitudes to tuberculosis and their knowledge of the disease, and factors associated with treatment compliance. DESIGN: All adult patients commenced on treatment for tuberculosis from September 1994 to February 1996 were interviewed on initiation of treatment. To assess patient compliance with treatment, hospital clinical records were reviewed retrospectively. RESULTS: A total of 135 patients with a mean age (+/-SD) of 41.9 (+/-17.4) years (range 15-84 years) were interviewed. The patients had limited understanding and knowledge about tuberculosis. There was a negative correlation between patient age and tuberculosis knowledge score (r = -0.18, P = 0.038). Patients with tertiary education had better knowledge than the others. Of 118 patients who were followed-up in our chest clinic, 80 (67.8%) completed the prescribed treatment. Compliance with treatment and follow-up was not affected by age, sex, ethnic group, educational level, occupation, extent of knowledge, tuberculosis symptoms, hospitalisation for tuberculosis or duration of the prescribed treatment regimen. There was a trend toward poorer compliance among patients who equated disappearance of tuberculosis symptoms with cure of the disease. CONCLUSIONS: Malaysian patients with newly diagnosed tuberculosis attending a university teaching hospital had misconceptions and limited knowledge about the disease and its treatment. Educational background was an important determinant of a patient's level of knowledge about tuberculosis. Compliance was not affected by patient characteristics. Adequate counselling and education of patients and close relatives on tuberculosis and the necessity for prolonged treatment may help to improve treatment compliance.

Delay in the diagnosis and treatment of pulmonary tuberculosis in patients attending a university teaching hospital.

SETTING: University Hospital, Kuala Lumpur, Malaysia. OBJECTIVE: To investigate patient and doctor delays in the diagnosis and treatment of pulmonary tuberculosis in patients attending a tertiary teaching hospital. DESIGN: A total of 97 patients with newly diagnosed pulmonary tuberculosis at our hospital were interviewed to study the process of case-finding since the onset of symptoms. Time intervals between onset, first medical consultation and the final diagnosis and commencement of antituberculosis treatment were determined. Demographic and clinical features were evaluated for their effect on these intervals. RESULTS: 36 cases were sputum smear-positive and 61 were smear-negative. Tuberculosis was eventually confirmed in 32 of the smear-negative cases. The medians of patient delay, doctor delay and total delay were 2 weeks, 7 weeks and 12.5 weeks, respectively. The majority of the patients consulted private general practitioners but the diagnosis of tuberculosis was rarely suspected; chest X-ray and sputum examinations were under-utilized. CONCLUSION: To shorten patient delay the public should be educated about the symptoms of tuberculosis and the importance of early medical consultation. Private general practitioners should be more alert to the diagnostic possibility of tuberculosis and refer the patients promptly to the government hospitals for appropriate investigation.