Anti-tuberculosis drug inducd hepatitis - a Sri Lankan experience.

OBJECTIVE: To assess the incidence of anti-tuberculosis (TB) drug induced hepatitis (AIH) in Sri Lankan patients, determine risk factors of AIH, and to address management options in AIH. DESIGN: A prospective study. SETTING: Chest Hospital, Welisara, Sri Lanka, from April 2001 to April 2002. PATIENTS: Seven hundred and eighty three patients with a confirmed diagnosis of TB and resident in the Colombo and Gampaha districts who presented to Chest Hospital, Welisara, Sri Lanka. METHODS: WHO recommended treatment was commenced in all cases. AIH was diagnosed when patients complained of decreased appetite with nausea or vomiting and elevated serum bilirubin (SB; >1.1 mg/dL) or elevated serum alanine transferase (ALT; > 3 times upper limit of normal). RESULTS: Of 783 enrolled patients, 74 (9.5%) developed AIH, the majority (58%) developing AIH within the first 2 weeks of the intensive phase of treatment. AIH was more common among patients over 60 years (p = 0.018), who developed pulmonary TB (p = 0.028), and in patients weighing 33-55 kg (p = 0.004). Age, weight and rifampicin overdosage were significant predictors of AIH. Of the 74 AIH patients, standard treatment was restarted in 60, treatment modified in six, two defaulted and six died. CONCLUSIONS: The incidence of AIH in Sri Lanka is 9.5% in treated patients. AIH was associated with age, low body weight and rifampicin overdosage.

Physics and chemistry of antimicrobial behavior of ion-exchanged silver in glass.

The results of a comprehensive study involving the antimicrobial activity in a silver ion-exchanged glass are presented. The study includes the glass composition, the method of incorporating silver into the glass, the effective concentration of the silver available at the glass surface, and the effect of the ambient environment. A quantitative kinetic model that includes the above factors in predicting the antimicrobial activity is proposed. Finally, experimental data demonstrating antibacterial activity against Staphylococcus aureus with correlation to the predicted model is shown.

Outcome of treatment of multidrug resistant tuberculosis.

Multidrug resistant tuberculosis (MDRTB) is a growing problem worldwide. It is an emerging problem in Sri Lanka too although the exact data are not known. This report describes treatment and outcome of 14 MDRTB patients. All have had previous anti-tuberculosis treatment. Out of 32 previous treatment episodes, treatment has been either irregular or defaulted in 26(81%), which has largely contributed to the emergence of drug resistance. Treatment commenced with a combination of second line anti-tuberculosis drugs, namely, amikacin, ciprofloxacin, ethionamide, clofazimine and pyrazinamide. Four patients were considered cured, another four failed treatment, five defaulted treatment and one died. Previous sensitivity to second line drugs and proper isolation facilities were not available. Preparedness to face the threat of MDRTB is essential. Measures should be taken to reduce the rate of defaulters of anti-tuberculosis treatment, and facilities to treat MDRTB should be expanded.

Force spectroscopy of hepatocytic extracellular matrix components.

We present atomic force microscopy and force spectroscopy data of live hepatocytes (HEPG2/C3A liver cell line) grown in Eagle's Minimum Essential Medium, a complex solution of salts and amino acids commonly used for cell culture. Contact-mode imaging and force spectroscopy of this system allowed correlation of cell morphology and extracellular matrix (ECM) properties with substrate properties. Force spectroscopy analysis of cellular "footprints" indicated that the cells secrete large polymers (e.g., 3.5mum contour length and estimated MW 1000kDa) onto their substrate surface. Although definitive identification of the polymers has not yet been achieved, fluorescent-labeled antibody staining has specified the presence of ECM proteins such as collagen and laminin in the cellular footprints. The stretched polymers appear to be much larger than single molecules of known ECM components, such as collagen and heparan sulfate proteoglycan, thus suggesting that the cells create larger entangled, macromolecular structures from smaller components. There is strong evidence which suggests that the composition of the ECM is greatly influenced by the hydrophobicity of the substrate surface, with preferential production and/or adsorption of larger macromolecules on hydrophobic surfaces.