PTSD malingering detection in damage claim cases: Diagnostic accuracy in cases of personal injury as a result of motor vehicle accidents.

This study aimed to assess the accuracy of post-traumatic stress disorder (PTSD) diagnoses made by mental health experts in people reporting post-traumatic stress symptoms related to traffic accidents. Data were collected from sixty participants: 30 with possible traumatic experiences and 30 who had never experienced this or other types of traumatic events. Six professional diagnosticians examined the participants with Structured Clinical Interview for the Study of Axis I Disorders (SCID-I for DSM-IV-TR) in conditions similar to those typical of judicial cases related to traffic accident damage claims. There was no significant difference in the number of PTSD diagnoses between malingerers and non-malingerers. Some PTSD symptoms were more frequently recognized in malingerers. This study demonstrates that even professional diagnosticians with clinical and jurisprudence experience have significant difficulty identifying PTSD malingering. This difficulty can be linked to the limitations of diagnoses based on introspective reports.

Mortality in people with mental disorders in Poland: A nationwide, register-based cohort study.

BACKGROUND: Mortality among people with mental disorders is higher in comparison with the general population. There is a scarcity of studies on mortality in the abovementioned group of people in Central and Eastern European countries. METHODS: The study aimed to assess all-cause mortality in people with mental disorders in Poland. We conducted a nationwide, register-based cohort study utilizing data from two nationwide registries in Poland: the registry of healthcare services reported to the National Health Fund (2009-2018) and the all-cause death registry from Statistics Poland (2019). We identified individuals who were consulted or hospitalized in public mental healthcare facilities and received at least one diagnosis of mental disorders (International Statistical Classification of Diseases and Health Problems [ICD-10]) from 2009 to 2018. Standardized mortality ratios (SMRs) were compared between people with a history of mental disorder and the general population. RESULTS: The study comprised 4,038,517 people. The SMR for individuals with any mental disorder compared with the general population was 1.54. SMRs varied across diagnostic groups, with the highest values for substance use disorders (3.04; 95% CI 3.00-3.09), schizophrenia, schizotypal and delusional disorders (2.12; 95% CI 2.06-2.18), and pervasive and specific developmental disorders (1.68; 95% CI 1.08-2.29). When only inpatients were considered, all-cause mortality risk was almost threefold higher than in the general population (SMR 2.90; 95% CI 2.86-2.94). CONCLUSIONS: In Poland, mortality in people with mental disorders is significantly higher than in the general population. The results provide a reference point for future longitudinal studies on mortality in Poland.

Forensic Engineering of Advanced Polymeric Materials-Part VII: Degradation of Biopolymer Welded Joints.

Welding technology may be considered as a promising processing method for the formation of packaging products from biopolymers. However, the welding processes used can change the properties of the polymer materials, especially in the region of the weld. In this contribution, the impact of the welding process on the structure and properties of biopolymer welds and their ability to undergo hydrolytic degradation will be discussed. Samples for the study were made from polylactide (PLA) and poly(3-hydroxyalkanoate) (PHA) biopolymers which were welded using two methods: ultrasonic and heated tool welding. Differential scanning calorimetry (DSC) analysis showed slight changes in the thermal properties of the samples resulting from the processing and welding method used. The results of hydrolytic degradation indicated that welds of selected biopolymers started to degrade faster than unwelded parts of the samples. The structure of degradation products at the molecular level was confirmed using mass spectrometry. It was found that hydrolysis of the PLA and PHA welds occurs via the random ester bond cleavage and leads to the formation of PLA and PHA oligomers terminated by hydroxyl and carboxyl end groups, similarly to as previously observed for unwelded PLA and PHA-based materials.

Prediction studies of environment-friendly biodegradable polymeric packaging based on PLA. Influence of specimens' thickness on the hydrolytic degradation profile.

Application of new biodegradable polymer packaging based on polylactide (PLA), susceptible to organic recycling, can help in the waste reduction in landfills. In this paper, the results of the study on abiotic degradation of PLA and its blend containing 15 mol% of poly[(R,S)-3-hydroxybutyrate], as a model for the first step of organic recycling were presented. The samples used for this study have different shapes and thicknesses: rigid films and cuboid-bars. Particular emphasis was placed on determining the pattern of degradation products released into the medium. Originally, the results of present study revealed that the application of electrospray ionization mass spectrometry supported by high performance liquid chromatography allowed envisaging the differences in the degradation products pattern released from the studied PLA-based samples differing in thickness. The significant differences in degradation products pattern were predominately observed in the first steps of incubation process and are caused by an autocatalytic effect, which occurs mainly during degradation of the large size PLA samples. Although, the thickness of PLA-based packaging changes the degradation product patterns, however this does not increase the total amounts of acids released to the medium. Thus, it may be concluded that thickness should not affect significantly organic recycling of the packaging.

Enhanced exhalation of matrix metalloproteinase-9 and tissue inhibitor of metalloproteinase-1 in patients with COPD exacerbation: a prospective study.

BACKGROUND: Matrix metalloproteinase-9 (MMP-9) and its inhibitor tissue inhibitor of metalloproteinase-1 (TIMP-1) are involved in the pathogenesis of airway inflammation in patients with chronic obstructive pulmonary disease (COPD). However, no study so far has addressed their value as noninvasive biomarkers of airways inflammation. OBJECTIVE: To evaluate MMP-9 and TIMP-1 concentrations in the exhaled breath condensate (EBC) of patients with stable COPD and also during the exacerbation episode. METHODS: EBC and serum samples were collected in 17 stable-phase COPD patients who were current smokers as well as during their first exacerbation episode, and in 22 asymptomatic smokers. EBC and serum levels of MMP-9 and TIMP-1 were measured with ELISA kit. RESULTS: Mean EBC MMP-9 and TIMP-1 levels were higher in patients with stable COPD than in asymptomatic smokers. Exacerbation of COPD increased 2-fold the exhalation of MMP-9 (18.5 ± 10.1 ng/ml vs. 8.9 ± 6.2 ng/ml, p = 0.01) and TIMP-1 (to 41.1 ± 20.4 ng/ml vs. 16.4 ± 6.8 ng/ml, p < 0.001). Both, MMP-9 and TIMP-1 in EBC correlated negatively with FEV(1) (% predicted) at baseline (r = -0.78, p < 0.001 and r = -0.73, p < 0.001) and during the exacerbation episode (r = -0.57, p = 0.02 and r = -0.65, p = 0.005). Similar negative correlations were noted with FVC (% predicted), except for MMP-9 in EBC at exacerbation. Exhaled MMP-9 and TIMP-1 did not correlate with serum concentrations in COPD patients, either at baseline or during exacerbation. CONCLUSION: Exhaled MMP-9 and TIMP-1 increased during COPD exacerbation and was negatively correlated with spirometric variables, which suggests the usefulness of their measurement in EBC for the monitoring of airways inflammation. However, to better assess their diagnostic or prognostic value larger studies are necessary.

Effect of diets with different contents of soybean alpha-galactosides and crude fibre on modification of duodenal microstructure and selected parameters of nutrient utilization in young turkeys.

The aim of the present study was to assess the physiological response of growing turkeys' duodenal surface to dietary replacement of a common dietary component--soybean meal (SBM) with a soy protein isolate (SPI), as this treatment was associated with almost complete removal of alpha-galactosides from the diet (from 2.44 to 0.15%). Additionally, the utilization of selected dietary ingredients upon dietary treatments was recorded. Effects of raffinose-family oligosaccharides were assessed as well in low- and high-fibre dietary environment (3.5 and 5.3% of crude fibre, respectively). This study revealed that the duodenal morphological parameters were differently affected by dietary treatments at different production stages, i.e. at 4 and 8 weeks of life. Although villus height/crypt depth ratio (VCR) was insignificantly decreased by high-alpha-galactoside treatment in younger 4-week birds, the presence of these oligosaccharides in the diet positively influenced the VCR index in 8-week turkeys. A similar tendency was observed when calcium retention was considered. Different contents of dietary crude fibre affected the physiological action of alpha-galactosides, including duodenal crypts depth and phosphorus retention in the 4-week birds, as well as duodenal goblet cells number and nitrogen utilization in the older turkeys. A high content of alpha-galactosides in the diet resulted in increased hydration of intestinal contents, but without a significant decline in the dry matter digestibility and utilization of nitrogen, calcium and phosphorus. Having in mind the development and physiology of the GIT, it may preliminary be concluded that in later production stages, total withdrawal of soybean alpha-galactosides from turkeys' diets does not seem to be nutritionally advisable.

Elevated exhalation of hydrogen peroxide and circulating IL-18 in patients with pulmonary tuberculosis.

Mycobacteria are the strong stimulators of respiratory burst, resulting in production of reactive oxygen species and nitrogen intermediates. The aim of our study was to assess the concentration of hydrogen peroxide (H(2)O(2)) in expired breath condensate (EBC) and the serum level of interleukin-18 (IL-18) in patients with active pulmonary tuberculosis (TB) before introduction of chemotherapy and after 2 months of treatment. Sixteen patients, current cigarette smokers, with advanced pulmonary TB were enrolled into the study. As a control served two groups: I group--16 asymptomatic cigarette smokers, II group--17 healthy never smoked subjects. The level of H(2)O(2) in EBC was significantly higher in patients with TB (1.3+/-0.7 microM) as compared to cigarette are healthy nonsmoker subjects (0.4+/-0.1 and 0.2+/-0.1 microM, respectively, P<0.05). Two months of treatment significantly decreased the level of H(2)O(2) exhalation in TB patients (0.5+/-0.3 microM) to the value that was not different from that in asymptomatic smokers but was still higher than in never smoked subjects. Serum concentration of IL-18 in TB patients was higher than that found in both control groups either before and after antituberculous treatment (P<0.05). Exhaled H(2)O(2) did not correlate with circulating IL-18 in TB patients before or after treatment. These results demonstrated the occurrence of oxidative stress in the airways of TB patients completely attenuating after 2 months of successful antituberculous treatment.

The mentally ill: the way they perceive their own illness and their expectations from the society.

People diagnosed as mentally ill face the suffering of their own disease as well as the social stigmatization, which, in turn, can aggravate their psychopathological symptoms and exacerbate their social isolation. Mental diseases and their symptoms cause an ill person to seem recondite for the people around. She or he feels different from everybody else, thus requires special care, sensitivity, and respect from the others. A supportive and full of acceptation environment is indispensable to optimize socio-professional therapy and rehabilitation of the ill. The society should possess some knowledge of mental diseases and respect the dignity and human rights of the ill. The aim of our work was to show how the mentally ill perceive their illness as well as specify the patients' expectations concerning their relations with the healthy people from their environment. This work consists of a theoretical part, a research which contains the results of a questionnaire, and conclusions. There were 52 patients who took part in the research. They were all aware of their illness, although the research was held during the lighter phase of the disease or its remission. The analysis of the collected data indicates that the ill perceived their disease as a burden and obstacle to fulfilling their principal aims. The disease also engendered negative emotional reactions in them and significantly impaired the quality of their life.

Circulation level of matrix metalloproteinase-9 is correlated with disease severity in tuberculosis patients.

SETTING: Parenchymal lung destruction accompanied by active tuberculosis is, at least in part, caused by host as well as bacillus metalloproteinases. Mycobacterium tuberculosis has been shown to stimulate MMP-9 expression in the lung of infected organisms. DESIGN: We have used quantitative zymography and computer-assisted image analysis to measure the levels of type IV collagenases in 20 serum samples of patients with active tuberculosis and in 23 serum samples of healthy volunteers. RESULTS: Mean levels of the serum MMP-9 were over three-fold higher in tuberculous samples compared with normal serum (P < 0.0001), whereas the MMP-2 levels did not differ in these two groups. The levels of MMP-9 were significantly higher in subjects with advanced disease than in those with only limited disease changes (P < 0.05). CONCLUSIONS: We suppose that the elevation of serum MMP-9 levels in patients with tuberculosis is affected by the augmentation of synthesis and/or secretion of this enzyme by inflammatory cells in response to M. tuberculosis infection. The observed association between the serum MMP-9 level and the extent of radiological change suggests that the quantification of the serum level of this enzyme may constitute a supplementary test in pulmonary tuberculosis diagnostics.

Do glucocorticoids contribute to brain aging?

The hippocampus, an area with abundant glucocorticoid receptors, continues to be the focus of research on effects of glucocorticoids on the aging brain. Based on recent studies, the primary structural change found during aging is synaptic loss, rather than neuronal loss. High levels of glucocorticoids are associated with synaptic loss in the hippocampus, hippocampal atrophy, and cognitive decline during aging in some individuals. However, increasing levels of glucocorticoid are not always found since early experiences can alter sensitivity to negative feedback and the level of activation of the hypothalamic-pituitary-adrenal axis in aged individuals. New ways in which glucocorticoids may contribute to brain aging are discussed, including decreased responses to glucocorticoids possibly as a result of decreased glucocorticoid receptors and also altered regulation of neuronal turnover in the dentate gyrus. Decreased responsiveness of glial fibrillary acidic protein to glucocorticoids during aging could facilitate reactive gliosis and loss of synapses by altering neuron-astrocyte interactions. Neuronal turnover is regulated by glucocorticoids in the dentate gyrus where ongoing neurogenesis may be important for hippocampal-based memory formation in adulthood. Although the age-related decline in neurogenesis can be reversed by removal of adrenal steroids, the death of dentate granule neurons is also greatly increased by this treatment. Recent studies show age-related resistance to induced apoptosis and neurogenesis in the dentate gyrus following adrenalectomy, which is associated with increased expression of transforming growth factor-beta1. Therefore, the contribution of glucocorticoids to brain aging depends on the physiological and cellular context and some of these effects are reversible.

Resistance of the dentate gyrus to induced apoptosis during ageing is associated with increases in transforming growth factor-beta1 messenger RNA.

Up-regulation of endogenous neurotrophic factors may protect against apoptosis during ageing. Recent studies showed that the expression of several neurotrophic factors increased with age in specific regions of the rat brain. Previously, we showed that removal of trophic adrenal steroids by adrenalectomy induced apoptosis in the dentate gyrus of adult rats, which was accompanied by increased expression of transforming growth factor-beta1 (TGF-beta1) messenger RNA. In this study, we compared the relative densities of apoptotic cells in the dentate gyrus with TGF-beta1 messenger RNA expression in virgin male Fischer 344 rats ranging from 2 to 26 months of age across three treatment groups: adrenalectomy, adrenalectomy with corticosterone replacement, or sham operation. Seven days after adrenalectomy an increase in the density of apoptotic cells was observed in rats of all age groups compared with sham-operated and corticosterone-treated groups. By in situ hybridisation, the glial messenger RNAs, TGF-beta1 and glial fibrillary acidic protein as a marker of ageing, increased following adrenalectomy in the dentate gyrus in rats of all ages compared with control groups. Interestingly, within adrenalectomy groups, both the number and density of apoptotic cells decreased significantly by 6-8 months with a further decrease at 24-26 months of age. Furthermore, the amount of apoptosis corresponded to changes in TGF-beta1 expression, notably in: (i) adrenalectomised rats showing a significant inverse correlation and (ii) 24-26-month-old rats with the lowest induced apoptosis showing increased expression at the time of adrenalectomy. These studies show that resistance to adrenalectomy-induced apoptosis in the dentate gyrus is associated with increases in TGF-beta1 messenger RNA expression. Furthermore, the endogenous up-regulation of neurotrophic factors, such as the increase in TGF-beta1 expression in the oldest rats, suggests that the aged brain may have compensatory mechanisms, which protect against apoptosis.

Enhanced lipid peroxidation in cancer tissue homogenates in non-small cell lung cancer.

The oxidative modification of nucleic acids by reactive oxygen species may lead to malignant conversion, but its exact role in lung cancer biology is still not clear. Lipid peroxidation, a well-known index of free radicals activity, is a process of oxidative polyunsaturated acids destruction. Our study was aimed to investigate the level of lipid peroxidation ex vivo in tumor tissue and lung parenchyma obtained from patients with non-small cell lung cancer. Thirty-two patients with lung cancer (including 19 with squamous cell lung cancer) were enrolled in the study. During a surgical resection, tumor tissue and lung parenchyma were obtained and the concentration of lipid peroxidation products, i.e. conjugated dienes and lipid hydroperoxides, measured. In the whole group of patients the concentrations of conjugated dienes and lipid hydroperoxides in the tumor tissue were higher than those in lung parenchyma (1.008 +/- 0.503 A233 nm vs. 0.717 +/- 0.283 A233 nm; p < 0.05 and 0.109 +/- 0.062 A532 nm vs. 0.102 +/- 0.087 A532 nm; p < 0.05, respectively). Similar results were obtained in squamous cell carcinoma patients (0.975 +/- 0.348 A233 nm vs. 0.708 +/- 0.300 A233 nm; p > 0.02 and 0.094 +/- 0.029 A532 nm vs. 0.080 +/- 0.071 A532 nm; p < 0.05, respectively). In both groups of patients, a positive correlation between concentration of conjugated dienes in tumor tissue and clinical stage (R = 0.45; R = 0.52; p < 0.05, respectively) was found. Our results confirm the enhanced lipid peroxidation in cancer tissue as compared with matched lung parenchyma. Additionally, a higher level of oxidative stress, expressed as the concentration of conjugated dienes in tumor tissue, was associated with clinical progression of the tumor.

[Virtual bronchoscopy: a new tool of non-invasive imaging of airway inner surface based on standard spiral computed tomography of the chest]. / Wirtualna bronchoskopia--nowe narzedzie nieinwazyjnego obrazowania wnetrza dróg oddechowych, uzyskane ze standardowego badania klatki piersiowej spiralna tomografia komputerowa.

The aim of the study is to assess the new method of radiological imaging of the inner surface of a tracheobronchial tree in order to determine to what extend it can replace the standard bronchoscopy. The spiral CT examinations of 43 patients with hilar lung tumor in virtual mode had been reconstructed retrospectively and compared to the results of fiberoptic bronchoscopy. There was a significant correlation between both methods to reveal stenoses or occlusions of airway lumen. Virtual endoscopy turned out to be an unsatisfactory method in the visualisation of mucosal changes.

[The evaluation of efficacy and tolerability of salbutamol administered by nebulization in patients with stable severe bronchial asthma]. / Ocena skutecznosci i tolerancji Salbutamolu w nebulizacji u chorych na stabilna ciezka astme oskrzelowa.

The aim of the study was the assessment of the effect of salbutamol in nebulization on ventilatory parameters and heart action in patients with stable severe well controlled bronchial asthma. The study was performed in 30 asthmatics (19 females and 11 men) with incomplete reversibility of airflow obstruction after salbutamol inhalation administered via MDI device. The mean age was 47 years, the duration of asthma--18 years. Mean FVC value was 2.46 L (66.6%), FEV1--1.76 L (56.8%), and MEF50--1.74 L/s (40.4% predicted). The study was performed according to the double-blind crossover method with placebo used. On the first day the reversibility test with 400 mg salbutamol was performed. On the two consecutive days salbutamol (Steri-Neb Salamol 2.5 mg) and placebo in nebulization were randomly administered. Ventilatory parameters were measured before and in 20, 40, 60, 120, 180 and 240 minutes after the nebulization. At the same time points the heart action was assessed by physical examination. The changes in FVC, FEV1 and MEF50 were expressed in absolute values and as a relative increase in relation to predictive value. The significant improvement of measured ventilatory parameters was observed as early as 20 minute after the nebulization. This increase in MEF50 lasted 2 hours, in FEV1--3 hours and in FVC 4 hours. The relative increase in MEF50 was significant higher than the remaining parameters. The significant increase in heart rate was noted after salbutamol nebulization.

Pituitary tumor in a woman with a 47,XXX karyotype--case report.

BACKGROUND: The 47,XXX karyotype is a rare sex chromosome anomaly. This karyotype is usually not associated with a characteristic physical phenotype. CASE REPORT: In presented case a 47 triple X women with pituitary tumor and premature ovarian failure is identified. Diagnosis of a 47,XXX individual remains difficult because specific clinical criteria used to identify this condition are not available. CONCLUSIONS: The case described should attract attention to how difficult it is to diagnose properly a genetic disease in young women with correct phenotype.

[Testosterone and SHBG levels in blood serum in women with anorexia nervosa]. / Stezenia testosteronu i SHBG w surowicy krwi u kobiet z jadlowstretem psychicznym.

The reports concerning serum levels of sex hormone binding globulin (SHBG) and testosterone in women with anorexia nervosa are controversial and few in number. The aim of the study was to assess the levels of FSH, LH, PRL, unbound and bound testosterone, SHBG, estradiol, free T4, TSH in women with anorexia nervosa. The TFI (testosterone free index) used to assess SHBG ability to bind testosterone was also calculated. The studied group consisted of 29 women with anorexia nervosa: 15 women untreated hormonally and 14 women treated with estrogens and progestagens. The control group consisted of 13 women with regular menstrual cycle being in the first phase of menstrual cycle, with proper body weight and mean age comparable to the patients with anorexia nervosa. No statistically significant differences between studied groups concerning the serum concentration of FSH, LH, PRL, free testosterone, LH/FSH ratio, TSH and free T4 were found. The total testosterone concentration was statistically significantly lower in the group without hormonal therapy, contrary to SHBG concentration, which was higher in the group treated hormonally. Although there are reports about elevated SHBG and free testosterone levels in patients with anorexia nervosa, our study has shown no significant differences between women with untreated hormonally anorexia nervosa and healthy control group.

Comparison of hydrogen peroxide generation and the content of lipid peroxidation products in lung cancer tissue and pulmonary parenchyma.

Lipid peroxidation, as a well-known index of reactive oxygen species activity, not only in lung biochemistry, is an oxidative process associated with membrane lipid destruction. Also, the oxidative modification of nucleic acids by reactive oxygen species is of remarkable biological importance as it may contribute to malignant conversion, but its exact role in lung cancer biology is still not clear. Our study aimed to investigate the level of lipid peroxidation ex vivo in tumour tissue and lung parenchyma obtained from patients with lung cancer. Forty-two patients with lung cancer were enrolled into the study. During a surgical resection, tumour tissue and lung parenchyma were obtained and concentration of lipid peroxidation products, thiobarbituric acid-reactive substances and Schiff bases, and spontaneous generation of hydrogen peroxide, were measured. The concentration of thiobarbituric acid-reactive substances (P<0.001) in the tumour tissue was higher than that in lung parenchyma. In small cell lung cancer as well as in squamous cell carcinoma patients, a positive correlation between spontaneous generation of hydrogen peroxide in tumour tissue and clinical stage (r = 0.43; r = 0.46; respectively) was found. Our results prove enhanced lipid peroxidation in cancer tissue as compared with matched-lung parenchyma. In small cell lung cancer and squamous cell carcinoma patients, the high level of oxidative stress, expressed as a spontaneous generation of hydrogen peroxide in tumour tissue, was associated with clinical progression of tumour's stage.

[Evaluation of the relationship between the clinical course of severe asthma and ventilatory parameters]. / Ocena zwiazków miedzy klinicznym przebiegiem ciezkiej astmy oskrzelowej a wskaznikiem wentylacji.

The aim of the study was the assessement of relations between the clinical symptoms of asthma, ventilatory parameters and nonspecific bronchial hyperresponsiveness. 22 patients with severe asthma, 12 females and 10 men, aged 43-68 years (mean 56) were observed for two years. The duration of asthma ranged from 6 to 38 years (mean 18). All the patients were treated with inhalatory steroids in dose 800-1200 mg. Three months before entering the study the patients had no exacerbation or respiratory tract infection. Throughout the study diary cards were filled and the symptoms were recorded on 0-4 scale. PEF was measured two times a day, the highest value noted. Spirometry and reversibility tests were performed. On the last day patients underwent histamine challenge test. Data from four weeks were analyzed statistically. The significant correlation was established between PEF variability and clinical symptoms scores, both mean and measured in the last day of the study. The relationship between mean PEF variability and bronchial hyperresponsiveness was also observed.

Increased serum concentrations of conjugated diens and malondialdehyde in patients with pulmonary tuberculosis.

During pulmonary inflammation increased amounts of reactive oxygen species (ROS) and reactive nitrogen intermediates (RNI) are produced as a consequence of phagocyte respiratory burst. One of the manifestation of these free radical-mediated processes is lipid peroxidation (LP). The aim of our study was to assess the concentration of lipid peroxidation products (LPPs), conjugated diens (CD) and malondialdehyde (MDA), in patients with active TB. Forty-two patients were enrolled into the study. Half (group I) had advanced TB and were sputum smear-positive. The remainder (group II) had only small radiographical changes and were sputum smear-negative. Serum concentrations of CD and MDA were measured at days 0, 7, 14 and 28 in group I and day 0 in group II. We found that in all patients with active TB CCD (1.0 +/- 0.05A233) and CMDA (2.01 +/- 0.16 nmol dl-1) were significantly elevated compared to healthy controls (0.67 +/- 0.03A233 and 1.36 +/- 0.08 nmol dl-1, respectively) (P < 0.001). The highest levels of LPPs were in patients with advanced TB. These concentrations were stable during the first month of anti-tuberculous therapy. Our data indicated that, as in bacterial pneumonia, LPPs were enhanced in active TB. The levels of LPPs depended on the form of the disease as they were higher in subjects with advanced disease than in those with only small radiographical changes. Further studies are needed to assess the role of antioxidants as adjuvant therapy in patients with pulmonary TB.

Clinical utility of a commercial ligase chain reaction kit for the diagnosis of smear-negative pulmonary tuberculosis.

SETTING: In paucibacillary forms of smear-negative tuberculosis it is very difficult to establish a correct and rapid diagnosis, as several weeks are usually required to obtain positive results from culture. In the last few years new rapid techniques based on molecular biology for the detection of Mycobacterium tuberculosis have been introduced. OBJECTIVE: The aim of this study was to evaluate the utility of the ligase chain reaction method (LCx, Abbott) for the diagnosis of smear-negative pulmonary tuberculosis. DESIGN: Thirty smear-negative patients with radiographic changes and clinical signs consistent with TB participated in the study. Sputum and bronchial aspirate were assessed according to traditional methods on Löwenstein-Jensen medium, and bronchoalveolar lavage (BAL) was assessed by the LCx test and the Bactec 460 system. Another 30 patients with non-tuberculous infections were included in the study as controls. RESULTS: Of the 30 patients suspected of tuberculosis, 19 had active disease on clinical, bacteriological and radiographic grounds, nine inactive tuberculosis and two had lung cancer. Bacteriological confirmation was obtained in 12 of the 19 (63.2%) patients with active tuberculosis. The sensitivity of sputum culture was 42.1% and bronchial aspirate culture 47.4%. BAL fluid revealed positive results in 57.9% using both LCx and Bactec. The results of the LCx assay can be obtained in 5 hours as opposed to several weeks using other methods. CONCLUSION: The LCx test may be useful in the diagnosis of smear-negative pulmonary tuberculosis and may be recommended in these clinical situations.