MPT64 patch test for the diagnosis of active pulmonary tuberculosis: a randomised controlled trial in Peru.

SETTING: There remains a lack of effective and inexpensive diagnostic tools for active tuberculosis (TB) disease. Testing immune responses to proteins secreted by Mycobacterium tuberculosis, such as MPT64, may be a diagnostic option. OBJECTIVE: To evaluate the sensitivity and specificity of a patch test using MPT64 for the diagnosis of active TB disease. DESIGN: This randomised, double-blind, placebo-controlled, prospective study in Lima, Peru, involved 55 healthy controls and 457 symptomatic individuals referred for routine TB testing by the National TB Control Programme. All subjects underwent a comprehensive diagnostic workup, and received an active patch on one arm and a placebo patch on the opposite arm, which were read after 4 days. RESULTS: Eighty-one (18%) of the symptomatic participants were classified as having definite TB, while an additional 98 (21%) had probable TB. The patch tests performed the same in both groups, with a sensitivity of 27% and specificity of 74%. The area under the receiver operating characteristic curve was 0.495 (95%CI 0.425-0.565). CONCLUSIONS: Contrary to existing literature, the MPT64 patch was not sensitive and specific to detect active TB. Given the potential of the test, understanding possible differences in the protein source or underlying genetic factors should be explored further.

Soporte respiratorio de alto flujo con cánula nasal / No disponible

La oxigenoterapia es la primera medida a tomar ante un paciente con insuficiencia respiratoria. Los sistemas utilizados pueden ser de bajo o de alto flujo, según suplan o no la necesidad de flujo del paciente. Desde hace algún tiempo, se ha añadido a este arsenal terapéutico el alto flujo con cánula nasal (AFCN), dispositivo que utiliza una mezcla de aire y oxígeno, calentado y humidificado. Entre las ventajas que tiene podemos citar la mayor fiabilidad de la fracción inspirada de oxígeno (FiO2), mejor tolerancia y confort, lavado de espacio muerto orofaríngeo y disminución del esfuerzo inspiratorio. Estas propiedades sitúan al AFCN por encima de la simple oxigenoterapia, haciéndola muy útil en el tratamiento del paciente con insuficiencia respiratoria aguda y crónica

Oxygen therapy is the first step to take in a patient with respiratory failure. The systems can be low or high flow, as fit or not fit the patient´s flow demand. For some time, we have a news device that has been added to the therapeutic arsenal, high flow nasal cannula (HFNC). These devices use a mixture of air and oxygen, heated and humidified. Among the advantages we can cite the increased reliability of the inspiratory oxygen fraction (FiO2), better tolerance and comfort, washing oropharyngeal dead space and decreased inspiratory effort. These properties place the HFNC above simple oxygen therapy, making it very useful in the treatment of patients with chronic and acute respiratory failure

Ambliopía secundaria a quiste de iris / Amblyopia secondary to iris cyst

CASO CLÍNICO: Varón de 5 años de edad con ambliopía anisometrópica meridional secundaria a quiste de epitelio pigmentario de iris. Es evaluado mediante biomicroscopia ultrasónica (BMU) y tomografía de coherencia óptica de polo anterior (OCT Visante). DISCUSIÓN: La OCT de polo anterior, aunque con limitaciones, es una herramienta útil en la evaluación de lesiones de polo anterior. Puede ser preferible, en la infancia, a la BMU

CLINICAL CASE: A 5 year-old child diagnosed with moderate anisometropic amblyopia secondary to primary cyst of iris pigment epithelium. He was evaluated with ultrasound biomicroscopy (BMU) and optical coherence tomography (OCT) of anterior segment. DISCUSSION: The OCT, although with some limitations, is a useful tool to study the anterior segment. It is probably more recommendable than BMU in the childhood (AU)

Amblyopia secondary to iris cyst.

CLINICAL CASE: A 5 year-old child diagnosed with moderate anisometropic amblyopia secondary to primary cyst of iris pigment epithelium. He was evaluated with ultrasound biomicroscopy (BMU) and optical coherence tomography (OCT) of anterior segment. DISCUSSION: The OCT, although with some limitations, is a useful tool to study the anterior segment. It is probably more recommendable than BMU in the childhood.

[Arteriographic correlation in 30 patients with renal vascular disease diagnosed with multislice CT]. / Correlación arteriográfica en 30 pacientes con patología vascular renal diagnosticada mediante TC multicorte.

OBJECTIVE: To determine the usefulness of multislice computed tomography (MSCT) in the evaluation of renal vascular disease against a gold standard of digital subtraction angiography (DSA). MATERIAL AND METHODS: We evaluated 30 patients with arterial hypertension and/or kidney failure that underwent MSCT to rule out a vascular cause and DSA to confirm a vascular cause suspected at MSCT. MSCT examinations were performed on a 10-detector scanner with intravenous administration of 80 ml of iodinated contrast (300 mg iodine/ml) at a flow rate of 5 ml/s. A total of 71 renal arteries, 56 main and 15 accessory, were evaluated. Arterial stenoses were classified as: grade 0 (normal artery), grade I (stenosis < 50%), grade II (> or = 50% and < 70%), grade III (> or = 70%), grade IV (occlusion). Stenosis > or = grade II was considered hemodynamically significant. RESULTS: The findings at MSCT and DSA were identical in 56 (78.8%) renal arteries; MSCT overestimated the degree of stenosis in 13 (18.3%) cases. All grade III stenoses were detected at MSCT. In the diagnosis of hemodynamically significant stenosis, MSCT had a sensitivity of 96.5%, specificity 78.5%, accuracy 85.9%, positive predictive value 75.6%, and negative predictive value 97%. CONCLUSIONS: MSCT is a good noninvasive imaging technique for the evaluation of renal vessels; it is useful for screening patients with kidney disease to rule out potentially treatable vascular causes.

Correlación arteriográfica en 30 pacientes con patología vascular renal diagnosticada mediante TC multicorte / Arteriographic correlation in 30 patients with renal vascular disease diagnosed with multislice CT

Objetivo. Determinar la utilidad de la tomografía computarizada multicorte (TCMC) en la valoración de la patología arterial renal, tomando como patrón oro la angiografía con sustracción digital (ASD). Material y métodos. Se evalúan 30 pacientes con hipertensión arterial o insuficiencia renal, a los que se había realizado una TCMC para descartar etiología vascular de su padecimiento, y en los que ante sospecha de la misma, se practicó una ASD de confirmación diagnóstica. Las TCMC se realizaron en un equipo de 10 detectores, con administración intravenosa de 80 ml de contraste yodado (300 mg de yodo/ml) a flujo de 5 ml/s. Se valoraron 71 arterias renales, 56 principales y 15 accesorias. Las estenosis arteriales se clasificaron para su evaluación en: grado 0 (arteria normal), grado I (estenosis < 50%), grado II (>= 50%, pero < 70%), grado III (>= 70%), grado IV (oclusión). Las estenosis de grado II o superior se consideraron hemodinámicamente significativas. Resultados. En 56 arterias renales (78,8%) se realizó una valoración idéntica en TCMC y ASD. En 13 casos (18,3%) la TCMC sobrevaloró el grado de estenosis. Todas las estenosis de grado III fueron detectadas con TCMC. En el diagnóstico de las estenosis hemodinámicamente significativas la TCMC demostró sensibilidad del 96,5%, especificidad del 78,5%, exactitud del 85,9%, valor predictivo positivo del 75,6% y negativo del 97%. Conclusiones. La TCMC es un buen método de imagen no invasivo en la evaluación de los vasos renales, y resulta útil en el cribado de los pacientes con patología nefrológica en los que se busca descartar una etiología vascular potencialmente tratable (AU)

Objective. To determine the usefulness of multislice computed tomography (MSCT) in the evaluation of renal vascular disease against a gold standard of digital subtraction angio -graphy (DSA). Material and methods. We evaluated 30 patients with arterial hypertension and/or kidney failure that underwent MSCT to rule out a vascular cause and DSA to confirm a vascular cause suspected at MSCT. MSCT examinations were performed on a 10-detector scanner with intravenous administration of 80 ml of iodinated contrast (300 mg iodine/ml) at a flow rate of 5 ml/s. A total of 71 renal arteries, 56 main and 15 accessory, were evaluated. Arterial stenoses were classified as: grade 0 (normal artery), grade I (stenosis < 50%), grade II (>= 50% and < 70%), grade III (>= 70%), grade IV (occlusion). Stenosis >= grade II was considered hemodynamically significant. Results. The findings at MSCT and DSA were identical in 56 (78.8%) renal arteries; MSCT overestimated the degree of stenosis in 13 (18.3%) cases. All grade III stenoses were detected at MSCT. In the diagnosis of hemodynamically significant stenosis, MSCT had a sensitivity of 96.5%, specificity 78.5%, accuracy 85.9%, positive predictive value 75.6%, and negative predictive value 97%. Conclusions. MSCT is a good noninvasive imaging technique for the evaluation of renal vessels; it is useful for screening patients with kidney disease to rule out potentially treatable vascular causes (AU)

[Exploration of the anterior segment by optical coherence tomography-3]. / Exploración del segmento anterior mediante tomografía óptica de coherencia 3.

PURPOSE: To show the utility of optical coherence tomography (OCT) for studying the anterior segment and to explain its potential advantages as compared to ultrasonic biomicroscopy (UBM). MATERIALS AND METHODS: We have described the findings in 5 patients with different pathologies of the anterior segment, all of whom were studied with UBM and OCT-3 adjusted for the anterior segment. There were 2 cases of an acute attack of closed angle glaucoma, 1 case of rubeosis iridis, 1 case of penetrating ocular trauma and 1 case of a primary stromal iris cyst. RESULTS: OCT was found to be as useful as UBM in detecting angle closure in patients affected by an acute attack of glaucoma. In addition, OCT was more comfortable for the patient and faster than UBM in obtaining images, with the exploration mean time using OCT being less than five minutes while that with UBM was over ten minutes. OCT has also been demonstrated to be a safe and valuable non-contact examination in other iris pathologies such as rubeosis iridis, for checking the permeability of iridotomies and even for studying iris masses such as primary stromal iris cysts. In these entities OCT may reach a higher resolution than ultrasonic biomicroscopy. CONCLUSION: OCT-3, with an adjustable focus, can obtain images from the scleral angle, as well as from other ocular structures like the iris, thus assisting in the diagnosis of numerous pathologies.

Selective use of drains in thyroid surgery.

OBJECTIVE: To identify whether there are differences in the use of drains and, if used, which would be the best for thyroid surgery. DESIGN: Prospective, longitudinal, comparative, randomized study. SETTING: General Hospital Mexico City, Mexico. PATIENTS AND METHODS: One hundred fifty patients were studied, divided into three groups: group A, without drain; group B, with a Penrose drain; and group C, with a semirigid suction drain. On the basis of the preoperative diagnosis, subtotal or total thyroidectomy or hemithyroidectomy was performed. Analyzed variables were thyroid volume (TV), transoperative bleeding (TOB), flow of postoperative drain (PD), length of hospital stay (HS), and complications, such as seromas, hematomas, and hemorrhages. Statistical Analysis. Multiple variant analysis, using Scheffe's procedure and chi2. RESULTS: Group A had an average TOB of 107 mL, HS of 2 days, and TV of 153.24 mL with two complications (seromas). Group B had an average TOB of 149.8 mL, HS of 2.6 days, TV of 175.4 mL, PD of 29.6 mL, and three complications (2 seromas and 1 hematoma). Group C had an average TOB of 161.5 mL, HS of 3.11 days, TV of 173.5 mL, PD of 25.84 mL, and two seromas. No differences existed regardless of the type of drain used between groups B and C. CONCLUSION: Statistical analysis showed that the size of the gland, diagnosis, type of surgery, transoperative bleeding, and complications are not valid arguments to leave an external drain in thyroid surgery. No advantages were found between the Penrose or the semirigid suction drains. Hospital stay was longer in patients with the suction drain. These results support the notion that the use of wound drainage cannot substitute for meticulous dissection and transoperative hemostasis.