Characterization of Mycobacterium tuberculosis isolated from cancer patients with suspected tuberculosis infection in Egypt: identification, prevalence, risk factors and resistance pattern.

Data are sparse on Mycobacterium tuberculosis infection among patients with cancer in Egypt. We sought to detect the presence of tuberculosis (TB) disease among patients with malignant conditions and suspected TB and to study the main risk factors. Also, we compared different diagnostic procedures and detected the antimicrobial susceptibility of M. tuberculosis isolates against rifampin and isoniazid. One hundred patients were included in this study, all of them had malignant conditions and were suspected by the clinicians of having TB. Identification of M. tuberculosis in different specimens was performed by smear microscopy, followed by Lowenstein-Jensen medium and Mycobacterium growth indicator tube (MGIT) cultures and artus(®) real-time PCR. In addition, an indirect MGIT anti-TB susceptibility test was carried out against rifampin and isoniazid. A total of 76% of studied cases were found to be TB positive. The frequencies of TB-positive cases in the bronchogenic, haematological and solid tumour malignancy groups were 21%, 25% and 30%, respectively. Significant differences between pulmonary and extrapulmonary TB in different malignancy groups were recorded. Real-time PCR showed the highest overall diagnostic efficiency. Multidrug-resistance of M. tuberculosis to both rifampin and isoniazid was detected in 28.6% of examined isolates. Infection in cancer patients with TB was significantly more often recorded among elderly patients and those suffering from poverty. Pulmonary TB is more common than extrapulmonary TB in patients with malignancy. Real-time PCR is the most accurate and rapid method for TB diagnosis. MGIT-rifampin resistance may be used as a reliable marker for detection of multidrug-resistant TB. Diagnosis and instituting treatment course for active or latent TB infection are crucial before starting anticancer therapy.

Clinical practice and the use of laboratory tests at the May 15 Hospital in Egypt.

The purpose of this study was to assess physicians' practices in the use of laboratory tests at a public hospital in Egypt. Methods included medical record reviews, interviews with selected physicians, literature review, and cost analysis. Three variables were examined in the medical record: appropriateness of laboratory tests, laboratory tests performed but not used as a basis for clinical treatment, and laboratory tests requested but not performed. Direct and indirect costs for each test were calculated. Results of the study indicated that 31.4% of the tests were inappropriate, 20.1% of test results were not used in treatment decisions, and 16.3% were not performed. Inappropriate and unused tests accounted for 22.6% of the annual total budget deficit for the hospital laboratory. To improve the quality of patient care and to decrease the wasteful use of resources, the hospital formed process improvement terms to develop clinical guidelines for problem-prone tests and to improve processes for requesting and providing laboratory results in a timely manner.

The impact of civil disturbances on the migration of physicians: the case of Lebanon.

This report examines the impact of war on the migratory patterns of physicians in Lebanon, a country with ever-raging civil disturbances for the past 15 years. The data base included two cohorts of medical graduates of the American University of Beirut: the 1960 through 1969 cohort, whose education and training were completed before the onset of the civil war, and the 1970 through 1979 cohort, who was exposed to the turmoil in Lebanon during either their study or their residency training. Between- and within-cohort comparison of their locations 5 years after graduation was made. Findings suggest that there is an association between civil instability and migration. This relationship could not be explained by possible confounders like nationality, training abroad, and board certification. On the contrary, factors that potentiated migration in the earlier cohort before the onset of the war were less frequent in the latter cohort with the increased tendency to migrate.

The impact of civil disturbances on the migration of physicians: the case of Lebanon.

During the 1970s, the migratory flow of physicians was an issue of major concern to the world medical community. Numerous publications have focused on the issue of the foreign medical graduates in the United States the impact of the "brain drain" on developing countries, and the various related issues of licensure, quality of medical care, "reverse" foreign aid, and ways and means to stem the tide of migration. Of the numerous studies on this subject, however, few have focused on the impact of civil disturbances and political instability on the decision of physicians to emigrate, even though this type of migration has been known to occur during or subsequent to political crises. Examples include the large-scale emigration of Hungarian, Cuban, and Czechoslovakian physicians to the United States in the late 1950s and 1960s. Mejia refers to this type of migration and characterizes it as "... likely to be sudden, to reach a high peak within a short period of time and to decline almost as rapidly...." This description fits closely the definition of a "point epidemic"--a condition wherein the political events that led to the outflow of these physicians constituted a one-time event, limited in time and duration. Lebanon presents a different picture: ever-raging civil disturbances have plagued that country continuously for the past 11 years. The epidemiologic analogy is more akin to an "endemic" situation, with point exacerbations and remissions between ferocious fighting and relative peace leading to situations of acute, subacute, and chronic civil instability.(ABSTRACT TRUNCATED AT 250 WORDS)