Stepwise implementation of a new diagnostic algorithm for multidrug-resistant tuberculosis in Haiti.

SETTING: The uptake of tests endorsed by the World Health Organization to detect and appropriately confirm multidrug-resistant tuberculosis (MDR-TB) in low-income countries remains insufficient. OBJECTIVE: To validate the implementation of line-probe assays (LPA) and liquid culture to develop an algorithm to detect MDR-TB in the challenging setting of Haiti. METHODS: Through an EXPAND-TB (Expanding Access to New Diagnostics for TB) partnership, proficiency testing and validation of 221 acid-fast bacilli positive specimens were performed. Sensitivity, cost and processing time were analysed. RESULTS: Using liquid vs. solid culture shortened the turnaround time from 54 to 19 days, with a sensitivity of 100% vs. 98.6% and a total cost reduction of 13%. LPA detected all TB and MDR-TB cases at a lower cost than culture, in a mean time of 7.5 days. CONCLUSION: The combined use of molecular and liquid culture techniques accelerates the accurate diagnosis of TB and susceptibility testing against first-line drugs in a significantly shorter time, and is less expensive. The implementation of this new algorithm could significantly and accurately improve the screening and treatment follow-up of patients affected with TB and MDR-TB.

Complex coronary bifurcation lesions treated with the novelpolymer-free dedicated bifurcation paclitaxel-eluting stent (Nilepax): clinical and angiographic clinical results of theprospective, multicentre bipax clinical trial

Aims: We report the angiographic and clinical outcomes of patients with de novocoronary bifurcation lesions treated with the Nile PAX dedicated device.Methods and results: From Dec/08 to Mar/09, a total of 102 pts with singlebifurcation lesion were prospectively enrolled in this non-randomised, multicenter(10 sites in Europe/South America) study. Lesion criteria were vessel size 2.5-3.5mm in the parent vessel (PV) and 2.0-3.0 mm in the SB, and lesion length <14 mmin the PV. Clinical follow-up (FU) was scheduled at 1, 3, 6, 9 and 12 months, andyearly up to 5 years. Angiographic FU was scheduled at 9 months (primaryendpoint). Angiographic analysis was performed by an independent angiographiccore laboratory. Data analysis and management was performed by an independentdata coordinating center; also, all clinical events were independently adjudicatedby a clinical events committee. Mean age was 63 years, 29% had diabetes, 16previous MI, and 40% previous intervention. The LAD/Dg was the most prevalentlocation (75%), and 60% had significant involvement of both branches. In theprocedure, PV was predilated in 97%; the study stent was successfully attemptedand implanted in 99%. Overall, 25% of SB received an additional stent; and 94%of lesions had final kissing-balloon inflation. By quantitative coronary angiography,baseline mean lesion length, vessel diameter and% diameter stenosis were: 10.9mm, 2.99 mm and 72% in the PV, and 4.1 mm, 2.28 mm, and 38% in the SB, respectively. Angiographic success (residual stenosis <50%, final TIMI 3 flow, andabsence of dissection) was achieved in 98%. There was only 1 major adversecardiac event (MACE) during hospitalisation, which was adjudicated as a non-Qmyocardial infarction during hospitalisation, and no additional adverse events werereported up to 30 days...

[Mitral and tricuspid valvuloplasty with balloon catheterization in the same procedure. A case report]. / Valvoplastia mitral e tricúspide com cateter balão no mesmo procedimento. Relato de caso.

Percutaneous mitral and tricuspid balloon valvuloplasty was realized in the same procedure using a double lumen exchange catheter that could accommodate two guide wires and two balloons (19 mm and Trefoil 3 c 10 mm--Schneider) with simultaneous insufflation. Hemodynamically successful was accomplished as evidenced by a decrease in mean mitral gradient from 34 mmHg to 1 mmHg and a decrease in mean tricuspid gradient from 5 mmHg to 3 mmHg. These results were confirmed by serial Doppler echocardiographic studies and by correspondent reduction in symptoms.

[Percutaneous mitral valvuloplasty using balloon catheterization. Immediate results in 80 cases]. / Valvuloplastia percutânea mitral por balão. Resultados imediatos de 80 casos.

In our first 80 attempts of percutaneous double balloon mitral valvuloplasty (BMV) 77 procedures have been successful. The mean patients age was 44 +/- 17 years, there were 16 men; 12 patients had previously been operated, 29 patients had important valvular deterioration (calcifications, thickening or unpliability) or of subvalvar system. For technical failure BMV was performed with only one balloon in 8 patients. BMV resulted in significant improvement in haemodynamic values: the mean capillary pressure fell from 22 +/- 6 to 12 +/- 5 mmHg (p less than 0.001), the mean mitral gradient from 15 +/- 6 to 5 +/- 3 mmHg (p less than 0.001). Cardiac index remained unchanged. The hemodynamic valve area, by Gorlin formula, increased from 1.09 +/- 0.29 to 2.19 +/- 0.72 cm2 (p less than 0.001). Doppler and echocardiography data were similar to haemodynamic data. Mitral valve area obtained with BMV was equivalent to the area usually obtained in closed mitral commissurotomy. There were 3 tamponades. The first, in a patient to whom BMV was not successful. For the 2 others, surgically evacuated, intracavitary pressures were measured after surgical pericardial drain. BMV was of little efficacy in one patient who died 3 days thoracotomy. The three tamponades were caused by straight tip balloon left ventricle perforation. There was no tamponade with pigtail tip catheter balloon. Mitral valve regurgitation was never increased more than 1 + Interatrial septal defect with QP/QS greater than or equal to 1.5 and less than 2 was present in 5 patients. BMV may be a useful alternative to surgery with low incidence of complication. Mitral valve area increase is similar with both treatment.