Glutaraldehyde test for rapid diagnosis of pulmonary tuberculosis

OBJECTIVE

To determine the diagnostic value of blood glutaraldehyde gelification time in pulmonary tuberculosis (PTB).

DESIGN

We analysed the blood gelification time using 2.5% glutaraldehyde in 83 PTB patients, 46 patients with non-tuberculosis pulmonary disease and 43 healthy subjects.

RESULTS

The mean gelification time of PTB patients (556.9 +/- 122.4) is significantly less than non-tuberculosis pulmonary disease (708.0 +/- 100.5) and healthy subjects (821.2 +/- 138.3; P < 0.0001). The optimum cut-off point was 615 seconds by receiver operating characteristic curve analysis. The sensitivity, specificity, positive predictive value and negative predictive value were respectively 85.5%, 89.1%, 93.4% and 77.3% in distinguishing TB from non-PTB patients; and respectively 85.5%, 93.3%, 92.2% and 87.4% in distinguishing PTB patients from controls (non-PTB patients and healthy subjects).

CONCLUSION

Because many centres lack sputum culture capacity and sophisticated radiology facilities, the glutaraldehyde test in conjunction with other conventional methods of diagnosis (sputum smear for acid-fast bacilli and frontal chest X-ray) could be a rapid, easy, cost-effective and reliable test for the diagnosis of PTB.

Diabetes as the cause of end-stage renal disease affects the pattern of post kidney transplant rehospitalizations

INTRODUCTION

Although there are reports that link diabetes-induced end-stage renal disease (ESRD) with several post renal transplantation complications and conditions, few studies have directly focused on this issue. This study compared the pattern of rehospitalizations after renal transplantation among diabetic versus nondiabetic ESRD patients, measuring causes, length of stay, outcomes and costs.

METHODS

We retrospectively reviewed 366 randomly selected rehospitalization records of kidney transplant recipients between 1994 and 2006, including 69 who underwent renal transplantation due to diabetic nephropathy and 297, due to nondiabetic ESRD. We compared the two groups with respect to demographic and clinical variables: donor source, readmission pattern, rehospitalization cause, time interval between transplantation and hospitalization (T-H time), length of hospital stay (LOS), and intensive care unit (ICU) admission, hospital charges, and inpatient outcomes of graft loss and mortality.

RESULTS

The diabetes group, compared with nondiabetic group, had a greater mean age (53 +/- SD vs. 39 +/- SD years), proportion of admissions due to infections (44.9% vs. 32%) or renal dysfunction (14.5% vs. 29.6%), mean hospital charges ($5056 vs. $3046), and hospital mortality (18% vs. 4.3%; P<.05). Diabetic patients were readmitted sooner after transplantation than nondiabetic patients (11 vs. 18 months; P<.05). There was no difference between the groups with regard to gender, donor source, LOS, ICU admission, and graft loss.

CONCLUSION

The etiology of ESRD should be considered for scheduling post renal transplantation follow-up. Renal transplant recipients with diabetes-induced ESRD need further attention in follow-up programs.

Prolonged rehospitalizations following renal transplantation: causes, risk factors, and outcomes

BACKGROUND

Although some studies have described rehospitalization after transplantation, few have focused on risk factors and consequences of prolonged hospital stay. Our goal was to determine the causes, risk factors, and outcomes of prolonged rehospitalizations after renal transplantation.

PATIENTS AND METHODS

In this retrospective study, 574 randomly selected rehospitalization records of kidney transplant recipients were reviewed from 1994 to 2006. Admissions were divided into group 1, prolonged stay (length of stay >14 days, n=149), and group II, short stay (length of stay <or=14 days, n=425). Demographic data, cause of end-stage renal disease (ESRD), cause of readmission, ICU admission, time interval between transplantation and rehospitalization, costs, and in-patient mortality were compared between the two groups.

RESULTS

Mean (+/-SD) hospital stay was 10.6 +/- 9.8 days. Median hospital stay was 5 days for renal stones, 7 days for surgical complications, 8 days for malignancy, 9 days for infection, and 10 days for renal dysfunction. We found higher rates of ESRD due to diabetes in group I (28% vs. 15.4%; P=.006). Admissions due to infections (56.4% vs 42.4%; P=.003) or renal dysfunctions (55% vs 41.4%; P=.004) were the cause of higher proportions of total hospitalizations with prolonged stay. Prolonged stay also correlated with higher ICU admissions (8.8% vs 2.8%; P=.002) and mortality (6.7% vs 3.05%; P=.001). Mean total hospital cost for short versus prolonged hospitalizations were US$ 586 versus US$ 2750, respectively.

CONCLUSION

In this study, we found that prolonged hospital stays accounted for >62% of all hospital costs; however, they comprised only 26% of the patients. High-risk kidney transplant recipients for prolonged hospitalizations should be closely observed for infections and graft rejection.

Hospitalization Databases: A Tool for Transplantation Monitoring

INTRODUCTION

We sought to account for changes in posttransplant hospitalization patterns in terms of the changes in demographic and transplantation-related variables.

METHODS AND MATERIALS

We retrospectively analyzed 1860 cases of kidney transplantation performed between 1992 and 2004 in terms of demographic and transplantation-related variables. Of the 1860 cases, rehospitalization records in the first year posttransplantation were available for 1152 cases, which were assessed for causes of admission, mortality, graft loss, length of stay, and hospital charges.

RESULTS

The pattern of rehospitalizations showed the following trends: (1) Increased rate of infection; (2) Decreased rate of graft rejection; and (3) Peak costs of rehospitalization between 1999 and 2000.

CONCLUSION

We believed that the increased infection rate and decreased rejection rate may have been related at least partly to the shift in the treatment protocol from azathioprine-based to mycophenolate mofetil regimens in 2000. Furthermore, the peak in the relative frequency of diabetes mellitus and hypertension as the etiology of end-stage renal disease among those having undergone transplantation between 1999 and 2000 may have been responsible for the peak in rehospitalization costs and length of hospital stay. We are strongly of the opinion that hospital statistics are a valuable tool for health care policymakers to monitor transplantation outcomes.

Mixed-level orthogonal array design for the optimization of solid-phase extraction of some pesticides from surface water

An orthogonal array design (OAD), OA32(4(1) x 2(28)), was employed as a chemometric method for the optimization of the solid-phase extraction (SPE) of atrazine, diazinon, ametryn and fenthion in surface water. Seven parameters: the type of eluting solvent, type of sorbent, flow-rate of eluting solvent, sample pH, sample volume, elution volume, addition of modifier and flow-rate of water sample were studied and optimized by a mixed-level OAD. The effects of these factors and some two-variable interactions on the recovery of the pesticides were quantitatively evaluated by the analysis of variance and percentage contribution techniques. The final optimized condition was employed for the SPE of selected micro-organic pollutants from Karoun river water, south of Iran. Atrazine and ametryn were tentatively identified and determined at the 0.7 and 0.9 microg l(-1) level, respectively.

Phenotypic characterization of a tobacco mutant impaired in auxin polar transport

A mutation in tobacco (Nicotiana tabacum L. cv `Xanthi') called lat (low auxin transport) that changes many morphogenic features throughout the life of the plant has been isolated. Abnormalities were observed in seed development, embryogenesis, cotyledon formation, leaf initiation and development, leaf veination pattern, and flower development. Selfed R₂ lat mutant plants set between 60% and 90% fewer seeds than wild-type tobacco, and about 10% of these seeds did not germinate. Non-germinating seeds contained either abnormal embryos or abnormal endosperm tissues. There was no uniformity in the stage at which embryonic development ceased in the aberrant seeds. Seedlings often revealed abnormal and highly varied phenotypes after germination. In some of these cases, cotyledons were heart-shaped, fused, cup-shaped, or cylindrical. Leaf morphology ranged from normal to cup-shaped, and some leaves occasionally produced shoots from the leaf midvein. Flowers ranged from normal to compound with occasional fused floral parts or split petals. Stamens were sometimes petal-like. This unusual assortment of phenotypic changes suggested that the mutation might affect a basic component of plant metabolism. We found that polar transport of indole-3-acetic acid (IAA) was reduced to about 9-19% of the wild-type level in the inflorescence axis of selfed R₂ lat mutants. In addition, supplementation of 1-naphthaleneacetic acid (NAA) to sterile media suppressed some of the abnormalities of the lat mutation so long as the plants grew there. Similarities in the phenotype of embryos, cotyledon and leaf shapes, translocation of labeled IAA, and response to applied NAA indicate that the lat locus of tobacco may be analogous to the pin locus of Arabidopsis, or produce a protein that functions in the same auxin-transport pathway.