Compliance in pulmonary tuberculosis patients using directly observed treatment short course

Five hundred newly diagnosed cases of pulmonary tuberculosis patients were studied at Iwo Local Government tuberculosis (TB) control clinic Alaye, Iwo, Osun state of Nigeria. The study was to determine (a) the rate of compliance to antituberculous drugs in newly diagnosed pulmonary tuberculosis (PTB) patients over a 2-year period in Iwo, Nigeria treated with directly observed treatment short-course (DOTS). DOTS is a short course treatment lasting 6-8 months and (b) the effect of DOTS and the use of home visitors on compliance with a view to formulating a model that can be used all over Nigeria to stem the resurgence of PTB. All newly diagnosed cases of PTB at Iwo, Osun state of Nigeria were treated with DOTS over a two-year period. TB home visitor provided with a motorcycle was used throughout the treatment period with free drug provision by Damien Foundations of Belgium based in Ibadan, Nigeria. The rate of compliance was noted in all cases. Total (100 percent) compliance and cure rate were recorded with the use of DOTS and TB home visitor in this study. The home visitor carried out 50 visitations during the study period. The use of DOTS with free drug provision and the use of home visitor as used in this study confirmed its effectiveness in enhancing compliance and hence cure of PTB. The study is a model that can be adopted for the whole of Nigeria and other countries globally if tuberculosis must be controlled.     

Percutaneous large-core biopsy of papillary breast lesions

Neisseria meningitidis, Haemophilus influenzae, and Streptococcus pneumoniae possess the ability to cleave human IgA1 antibodies, and all successfully colonize and occasionally invade the human upper respiratory tract. N. meningitidis invades the bloodstream after a period of nasopharyngeal colonization. We directly compared levels of IgA1 protease activity in strains (n=52) derived from the cerebrospinal fluid or blood of patients with meningococcal disease with strains of N. meningitidis obtained from asymptomatic carriers (n=25). IgA1 protease activity was determined by a sensitive semiquantitative ELISA assay. Levels of IgA1 protease activity were significantly higher (P<0.0001) in strains associated with invasive meningococcal disease (98% with detectable activity, mean = 580 mU) than with those obtained from asymptomatic carriers (76% with detectable activity, mean = 280 mU). Despite marked variation in enzyme activity, almost all strains (96%) possessed the gene for IgA1 protease. Given the panmictic population structure of the bacterial isolates investigated, these data, obtained from two groups infected with N. meningitidis, but with markedly different clinical outcomes, provide the first quantitative evidence that IgA1 protease activity is a virulence determinant that contributes to the pathogenic phenotype, and suggest IgA1 protease as a potential target for prophylaxis.     

Kalirin inhibition of inducible nitric-oxide synthase

Nitric oxide (NO) acts as a neurotransmitter. However, excess NO produced from neuronal NO synthase (nNOS) or inducible NOS (iNOS) during inflammation of the central nervous system can be neurotoxic, disrupting neurotransmitter and hormone production and killing neurons. A screen of a hippocampal cDNA library showed that a unique region of the iNOS protein interacts with Kalirin, previously identified as an interactor with a secretory granule peptide biosynthetic enzyme. Kalirin associates with iNOS in vitro and in vivo and inhibits iNOS activity by preventing the formation of iNOS homodimers. Expression of exogenous Kalirin in pituitary cells dramatically reduces iNOS inhibition of ACTH secretion. Thus Kalirin may play a neuroprotective role during inflammation of the central nervous system by inhibiting iNOS activity.     

Segmental antigen challenge increases fibronectin in bronchoalveolar lavage fluid

Fibronectin may contribute to asthma pathogenesis by recruitment and activation of inflammatory cells, and by promotion of subepithelial fibrosis. Fibronectin is produced by several types of airway cells, including epithelial cells, fibroblasts, and alveolar macrophages. To test the hypothesis that antigen-induced airway inflammation is associated with increased local generation of fibronectin, segmental bronchoprovocation (SBP) with antigen and saline was performed in 17 atopic patients. Bronchoalveolar lavage (BAL) was performed at 5 min and 48 h after segmental challenge with saline or antigen. Fibronectin concentrations in BAL fluid, measured by enzyme-linked immunosorbent assay (ELISA), increased more than 5-fold 48 h after antigen challenge (65 [47 to 110] versus 407 [240 to 697] ng/ml, median and 25 to 75% interquartiles, p < 0.05). Fibronectin concentrations 48 h after antigen challenge correlated with histamine concentrations 5 min after antigen challenge and numbers of eosinophils, neutrophils, macrophages, and total cells in BAL fluid 48 h after antigen challenge. BAL was more enriched in fibronectin 48 h after challenge than would be predicted solely from increased permeability of plasma proteins. Western blot analysis showed that fibronectin in BAL fluid was largely intact and contained the extra domain-A (ED-A) splice variant of cellular fibronectin, indicative of local production. We conclude that antigen challenge in atopic subjects causes increased production of fibronectin by airway cells and speculate that this response may contribute to airway remodeling in allergic inflammation.     

UVB irradiation alters cellular responses to cytokines: role in extracellular matrix gene expression

Chronic myeloid leukemia course was evaluated versus sex in 271 patients. Chronic stage involved more pronounced leukocytosis, thrombocytosis and splenomegaly in females, the latter showing higher susceptibility to anemia. As a result, treatment has to deal with a greater mass of tumor. A relatively longer survival time in males (44 and 42 months, respectively) suggest a higher effectiveness of therapy in such patients. When diagnosed, leukocytosis, thrombocytosis, enhanced splenomegaly and anemia should be regarded as factors of unfavorable prognosis.     

A meta-analysis of non-Hodgkin's lymphoma among farmers in the central United States

A meta-analysis of studies examining the association between non-Hodgkin's lymphoma (NHL) and employment as a farmer in the central United States was performed to verify the observation by Blair et al. [1993] that this group is at excess risk of NHL. Six studies were selected for the meta-analysis, and the estimator of relative risk calculated was 1.34 (95% confidence interval (CI) = 1.17, 1.55). Exposures associated with NHL and associated with agricultural commodities frequently produced in the central United States are infectious microorganisms and pesticides. Examination of the production patterns of the farms in this region did not reveal a single specific risk factor consistently found on all farms; however, past production patterns suggest that exposure to either infectious microorganisms or pesticides might be a risk factor for NHL in this group of farmers.     

Depression in elders with dementia: implications for home healthcare practice

In addition to severe cognitive decline, depressive symptoms occur in almost 50% of patients with dementia. Depressive symptoms can be treated successfully, thereby reducing clinical manifestations of coexisting dementia and improving quality of life for these patients and their families. Practical assessment, interventions, and referral guidelines are presented for home healthcare nurse generalists whose caseloads include elders with both cognitive decline and depressive symptoms.