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Am J Respir Crit Care Med. 2000 Oct;162(4 Pt 1):1323-9.
Accuracy and utility of commercially available amplification and serologic tests for the diagnosis of minimal pulmonary tuberculosis.

Al Zahrani K, Al Jahdali H, Poirier L, Rene P, Gennaro ML, Menzies D.

Montreal Chest Institute, Respiratory Epidemiology Unit, Department of Microbiology of the Royal Victoria Hospital, McGill University; Hopital Maisonneuve Rosemont, University of Montreal, Montreal, Quebec, Canada.

Diagnosis of patients with minimal active tuberculosis (TB) is difficult, as there is no single test with high sensitivity and specificity. The yield and clinical utility of a combination of diagnostic tests were prospectively studied among 500 consecutive patients referred for sputum induction for diagnosis of possible active TB. Patients underwent sputum induction, chest X-ray, tuberculin testing, and had blood drawn for serologic testing (Detect-TB test; Biochem ImmunoSystems). Sputum was examined with fluorescent microscopy and PCR (Amplicor MTB-Roche) and cultured for mycobacteria using liquid (BACTEC) and solid media. For the diagnosis of the 60 cases of active TB, sensitivity and specificity, respectively, of the following diagnostic tests were mycobacterial culture, 73% and 100%; PCR, 42% and 100%; chest X-ray, 67-77% and 66-76%; tuberculin testing, 94% and 20%; and serology, 33% and 87%. After consideration of PCR and radiographic and clinical characteristics, a positive serologic test was independantly associated with diagnosis of active disease (adjusted odds of disease if positive, 2.6; 95% confidence limits, 1.1,6.1). No currently available test has sensitivity and specificity high enough for the accurate diagnosis of minimal pulmonary TB. Utilization of a combination of tests, together with consideration of key clinical characteristics, could improve diagnostic accuracy.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11029339&dopt=Abstract

Am J Respir Crit Care Med. 2000 Oct;162(4 Pt 1):1419-22.
Does size matter? Utility of size of tuberculin reactions for the diagnosis of mycobacterial disease.

Al Zahrani K, Al Jahdali H, Menzies D.

Montreal Chest Institute, and the Respiratory Epidemiology Unit of McGill University, Montreal, Quebec, Canada.

It is a common belief that larger tuberculin reactions are more serious, and more likely to indicate patients with active tuberculosis (TB) or at high risk of disease in the future. Among 182 close contacts, and 502 patients suspected of possible active TB, 529 underwent tuberculin skin testing (TST) and 605 had a chest radiograph. Final diagnoses, based on all available clinical, microbiological, histological, and radiographic information, were active TB, 68; inactive TB, 274; nontuberculous mycobacterial disease, 14; conditions associated with anergy, 36; no detectable abnormality (except a positive TST) or condition unrelated to TB, 213; and negative TST, no further evaluation, 79. Among these patients, TST of 5 mm or larger was significantly more likely to indicate active or inactive TB (p < 0.001). However, among patients with TST of 5 mm or greater, the size and frequency distribution of tuberculin reactions were not different between subjects with different diagnoses, nor between subjects with different types or extent of radiographic findings. As well, TST reactions were no different in 121 subjects with or 176 subjects without a history of BCG vaccination. In close contacts or patients suspected of active TB, reactions less than 5 mm indicated lower likelihood of active or inactive disease, but above that threshold, size of tuberculin reaction did not matter.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11029355&dopt=Abstract

Int J Mol Med. 2000 Nov;6(5):575-80.
Two BCG vaccine formulations prepared from the same strain with different J774 macrophage activation capacities and patterns of NF-kappaB induction.

Darieva ZA, Lasunskaia EB, Kipnis TL, Dias Da Silva W.

Laboratorio de Biologia do Reconhecer, Centro de Biociencias e Biotecnologia, Universidade Estadual do Norte Fluminense, Campos/RJ, Rio de Janeiro, Brazil.

Two BCG vaccine formulations of the Moreau strain, commercially manufactured for anti-tuberculosis vaccination, ID-BCG, or anti-cancer adjuvant therapy, Onco-BCG, were compared for immunogenic activity in vitro. The growth rates of both vaccines in murine macrophages were the same, however, Onco-BCG induced stronger and longer-lasting secretion of TNF-alpha, IL-6 and nitric oxide. Onco-vaccine was also more potent in inducing NF-kappaB p65/p50 DNA-binding activity whilst in ID-BCG-infected cells the activity was transient and then gradually replaced by the transcriptionally inactive homodimer p50/p50. Comparative analysis of mycobacterial antigens of the two vaccines demonstrated a difference in expression of the 19 kDa and 38 kDa lipoproteins detected only in Onco-BCG extracts. These results suggest that these molecules may be responsible for the vigorous activation of macrophages induced by the Onco-vaccine. The data obtained show that vaccines from the same BCG strain, when manufactured differently, can vary significantly in their antigen expression and, consequently, in their capacity for macrophage activation which could contribute to the difference in their immunopotentiating effects.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11029527&dopt=Abstract

Mol Microbiol. 2000 Oct;38(1):85-102.
A study of the YopD-lcrH interaction from Yersinia pseudotuberculosis reveals a role for hydrophobic residues within the amphipathic domain of YopD.

Francis MS, Aili M, Wiklund ML, Wolf-Watz H.

Department of Cell and Molecular Biology, Umea University, S-901 87 Umea, Sweden.

The enteropathogen Yersinia pseudotuberculosis is a model system used to study the molecular mechanisms by which Gram-negative pathogens translocate effector proteins into target eukaryotic cells by a common type III secretion machine. Of the numerous proteins produced by Y. pseudotuberculosis that act in concert to establish an infection, YopD (Yersinia outer protein D) is a crucial component essential for yop regulation and Yop effector translocation. In this study, we describe the mechanisms by which YopD functions to control these processes. With the aid of the yeast two-hybrid system, we investigated the interaction between YopD and the cognate chaperone LcrH. We confirmed that non-secreted LcrH is necessary for YopD stabilization before secretion, presumably by forming a complex with YopD in the bacterial cytoplasm. At least in yeast, this complex depends upon the N-terminal domain and a C-terminal amphipathic alpha-helical domain of YopD. Introduction of amino acid substitutions within the hydrophobic side of the amphipathic alpha-helix abolished the YopD-LcrH interaction, indicating that hydrophobic, as opposed to electrostatic, forces of attraction are important for this process. Suppressor mutations isolated within LcrH could compensate for defects in the amphipathic domain of YopD to restore binding. Isolation of LcrH mutants unable to interact with wild-type YopD revealed no single domain responsible for YopD binding. The YopD and LcrH mutants generated in this study will be relevant tools for understanding YopD function during a Yersinia infection.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11029692&dopt=Abstract

Nippon Ronen Igakkai Zasshi. 2000 Jul;37(7):561-4.
[A very elderly autopsy case of cecal cancer with pulmonary lymphangitis carcinomatosa]

[Article in Japanese]

Matsubara M, Kohara K, Uemura K, Taguchi K, Igase M, Yamagata H, Nakura J, Miki T.

Department of Geriatric Medicine, Ehime University School of Medicine.

A 91-year-old man was admitted with colliquative diarrhea, anorexia and weight loss. He had a history of healed tuberculosis, hypertension and atherosclerotic abdominal aortic aneurysms. On admission, shortness of breath without cough, exertional dyspnea, and ascites were also noticed. His chest X-ray and CT showed almost normal findings in the lung fields except for calcified old pleurisy. Since laboratory tests revealed thrombocytopenia, low fibrinogen, and increased CA19-9. DIC induced by an unknown cancer was diagnosed. He died on the eighth day due to progressive respiratory failure which did not respond to oxygen therapy. Autopsy revealed that he had a poorly differentiated adenocarcinoma in the cecum complicated with pulmonary lymphangitis carcinomatosa. Lymphangitis should be considered in the case of unexplained progressive respiratory failure developing in patient with cancer, even in the absence of X-ray findings.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11031830&dopt=Abstract

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