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J Foot Ankle Surg. 2000 Sep-Oct;39(5):329-35.
Tuberculous osteomyelitis of the cuboid: a report of four cases.

Dhillon MS, Singh P, Sharma R, Gill SS, Nagi ON.

Post Graduate Institute of Medical Education and Research, Chandigarh, India. msdhillolide.net.in

Osteoarticular tuberculosis, although rare, has shown a resurgence in recent times, especially in immunocompromised patients. Involvement of the foot is infrequent, and the differential diagnosis is confusing, leading to diagnostic delays. We reviewed four cases of tuberculosis of the cuboid where the infection was limited to the bone without articular involvement. All four cases were adults and diagnostic delays were observed in all. Three of the cases had an osteolytic lesion on radiographs resembling a space-occupying lesion. Magnetic resonance imaging (MRI) or Computed tomography (CT) scans were helpful in three cases, and post-treatment MRI helped in evaluating outcome in one case. Antitubercular chemotherapy was sufficient to cause resolution of the lesion in three cases, while in one case surgical intervention was necessary. Since isolated osteomyelitis is usually seen only in the early stages of the disease process, early diagnosis and appropriate therapy are imperative to get good long-term results. Concomitant extraskeletal lesions are not always seen, nor is the organism cultured in a majority of the cases. Thus a high index of suspicion is mandatory in high-risk groups (immigrants, immunocompromised cases or those with history of contact); clinical and radiologic features, along with histopathologic evidence of granulomatous pathology should be sufficient to initiate therapy.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11055024&dopt=Abstract

Vestn Oftalmol. 2000 Jan-Feb;116(2):37-40.
[A clinico-pathogenetic classification of tuberculosis of the eye]

[Article in Russian]

Ustinova EI.

Clinical pathogenetic classification is based on the results of many-year observation of a large group of patients in whom the tuberculous etiology of ocular disease was confirmed by a universal approach based on reliable informative diagnostic criteria. Three pathogenetic and 4 clinical forms of ocular tuberculosis were distinguished. The classification for the first time includes ocular involvement in tuberculosis of the central nervous system and tuberculosis of defense system of the eye. Tuberculous diseases of the cornea, sclera, and retinal vessels are presented in combination with uveitis of this or that localization, because they are secondary towards uveitis. The classification includes 4 sections. The diagnosis based on this classification reflects the clinical features of disease and the time course of the process. The classification is diagnostically and therapeutically oriented. It suggests a rational choice of etiological diagnosis and therapy, which is determined by the pathogenetic and clinical forms of ocular tuberculosis.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11055225&dopt=Abstract

Pediatr Infect Dis J. 2000 Oct;19(10):968-72.
Evaluation of Mycobacterium tuberculosis transmission from a pediatrician and initial compliance to prophylaxis of contacts in an outpatient pediatric clinic.

Brassard P, Lamarre V.

Montreal Regional Health Board and Division of Clinical Epidemiology, Royal Victoria Hospital, Montreal, Quebec, Canada.

OBJECTIVE: The risk that latent infection will progress to active tuberculosis is greater in infants and children than for most other age groups. We set out to determine the rate of transmission of Mycobacterium tuberculosis to pediatric patients exposed to a pediatrician with smear-negative and culture-positive pulmonary tuberculosis. We also explored factors associated with compliance to prophylaxis. METHODS: Clinic and hospital billing records were used to identify patients age 5 or less who were seen during the pediatrician's potential contagious period. Patient were notified by registered mail of their putative exposure and were offered a tuberculin skin test screening with 5 tuberculin units of purified protein derivative (Tubersol, Connaught) and chest radiography of children with a tuberculin skin test > or =5 mm. RESULTS: A total of 456 patients were identified as exposed; 140 contacts never responded for evaluation and 93 letters were not delivered because of incorrect mailing addresses. Of the 223 who completed screening 1 (0,4%) had a initial skin test result of 8 mm. The remaining 222 contacts had repeated negative test results. The only positive child (15 months old) was born in Honduras and had received Calmette-Guerin bacillus at birth. No active tuberculosis cases were identified in the 456 contacts up to 2 years after exposure. Compliance with prophylaxis was associated with having two or less children in the household (odds ratio, 2.5; 95% confidence interval, 1.1 to 5.9). CONCLUSION: We found no evidence of transmission of M. tuberculosis in an outpatient pediatric setting. Only 43% of exposed children completed screening, and 38% of those offered prophylaxis completed their initial 3 months of therapy.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11055598&dopt=Abstract

Scand J Infect Dis. 2000;32(5):501-5.
Mycobacterium tuberculosis infections after renal transplantation.

Apaydin S, Altiparmak MR, Serdengecti K, Ataman R, Ozturk R, Erek E.

Department of Nephrology, Cerrahpasa Medical Faculty, Istanbul, Turkey.

The incidence of tuberculosis was found to be 5.8% (16/274) in 274 kidney graft recipients in our centre between 1986 and 1998. The kidney recipients were evaluated retrospectively. A total of 51 recipients received isoniazid prophylaxis for 6 months. The prevalence of tuberculosis was found similar (6% vs. 8.8%, p = 0.15) between recipients with prophylaxis and no prophylaxis. Eight patients were recipients of cadaveric donor kidneys and 8 were recipients of living donor kidneys. Lungs were the most frequently affected site, as in the normal population. M. tuberculosis grew in 7 patients. In 5 patients, M. tuberculosis was also detected on direct microscopy and polymerase chain reaction. In 4 patients, diagnosis was made on clinical grounds and later confirmed by positive response to therapy. In 8 patients, invasive procedures were performed for diagnosis. Five patients had miliary tuberculosis at the time of diagnosis. In 3 patients dissemination occurred during follow-up. Nine patients responded to anti-tuberculous therapy while still preserving their graft function, 1 patient rejected the graft while under treatment and returned to haemodialysis. Five patients (31%) died. Since the risk of dissemination of tuberculosis is high in these patients, anti-tuberculous therapy should be started whenever clinical findings suggestive of tuberculosis are present, even in the absence of any microbiological and/or histological evidence.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11055654&dopt=Abstract

Scand J Infect Dis. 2000;32(5):507-10.
Mycobacterium tuberculosis drug resistance in Turkey, 1976-97.

Bengisun JS, Karnak D, Palabiyikoglu I, Saygun N.

Laboratory of Clinical Bacteriology, Ankara University, Medical Faculty, Ibn-i Sina Hospital, Turkey.

Drug-resistant tuberculosis is increasing day by day and is a significant threat to tuberculosis control because there are few drugs effective against Mycobacterium tuberculosis. This study evaluates the resistance of the microorganism to primary anti-tuberculosis drugs over the 21-y period 1976-97. Records from the bacteriology laboratory of the Department of Chest Diseases and Tuberculosis, Ankara University Medical Faculty were evaluated retrospectively. Among 3,418 mycobacteria strains, 3,319 (97.1%,) M. tuberculosis were isolated and their susceptibility was examined by the proportion method in Loewenstein-Jensen medium. It was found that 60.8% of isolated strains were susceptible, whereas 39.2%, were resistant to at least one drug. Multi-drug resistant tuberculosis (MDR-TB) was found in 194 (5.8%) materials. Over the 21-y period studied, total resistance to isoniazid (INH), rifampicin (RF) and streptomycin (SM) were determined as 10.5, 6.9 and 7.0%, respectively. It was also observed that the resistance rates to INH or SM increased, whereas resistance to RF was not changed within this period. While resistance to the 2-drug combination RF+SM increased, resistance to INH+SM decreased significantly. There was no change in resistance to the 2-drug INH + RF or 3-drug INH + RF + SM combinations in the same period. In conclusion, combined therapy is still useful and available for the treatment of resistant tuberculosis, and INH should be included in the chemotherapeutic regimen even if high resistance rates are shown to exist.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11055655&dopt=Abstract

Loss of hair changes the appearance of a person, and the identity of the person in social context to a certain extent. Hair growth is a complex biological process, which has not yet been completely understood. A multitude of therapeutic measures, including drugs, surgery, and suppelements have been made available, and used. However, due to the diversity of the problems underlying hair loss, there is no single solution for all hair loss cases. Most of chemical drugs and hair transplantation surgeries are not free from varying degrees of undesirable side effects on health.

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