No abstract

Patients with end-stage renal disease (ESRD) receiving hemodialysis (HD) treatment have a markedly shortened life expectancy in large part owing to cardiovascular disease (CVD), not explained by established risk factors. We tested the hypothesis that therapy with valsartan, an angiotensin receptor blocker and amlodipine, an antioxidant calcium channel blocker will reduce oxidative stress and the plasma levels of asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthase. We confirmed that compared with age- and gender-matched healthy controls, ESRD patients have excessive oxidative stress and arginine methylation as indexed by elevated plasma levels of oxidation products of lipids (13-hydroxyoctadecadienoic acid (13-HODE)), thiols (oxidized:reduced glutathione, oxidized glutathione (GSSG):GSH), proteins, and nucleic acids, and the methylation products ADMA and symmetric dimethylarginine (SDMA). We undertook a double blind, crossover study of equi-antihypertensive treatment with amlodipine and valsartan for 6 weeks each to test our hypothesis. Both treatments significantly reduced GSSG:GSH, 8-hydroxy 2-deoxyguanosine, ADMA, and SDMA levels and amlodipine reduced 13-HODE. We conclude that hypertensive patients with ESRD receiving HD have evidence of extensive oxidation of lipids, thiols, proteins, and nucleic acids and methylation of arginine that could contribute to CVD. Many of these changes can be reduced by short-term treatment with amlodipine and valsartan.

SummaryOur aim was to identify the factors that influence the care-seeking behaviour of chest symptomatics in urban and rural areas in South India. We conducted in-depth interviews with 649 participants: 80% of 310 urban residents and 63% of 339 rural people had sought care (P < 0.01), 93% within 1 month of onset of symptoms. Private health care facilities were the first and preferred point of contact for 57% of urban and 48% of rural participants; the major reasons were proximity to residence and their perception that good-quality care would be available there. Symptomatics who did not seek care attributed their inaction to insufficient severity of symptoms (51%), unaffordability (46%) and lack of time due to work pressures (25%). Socio-economic factors such as literacy and family income significantly influenced care-seeking behaviour. Our results indicate that most chest symptomatics seek care promptly; their initial response is to go to the nearest private health care facility, shifting to another if they are dissatisfied. Fifty per cent of the participants who did not seek care felt that their symptoms were not severe.

We compared the sensitivity and specificity of the phenol ammonium sulfate (PhAS) sediment smear microscopy method for detection of acid-fast bacilli with those of direct smear microscopy, using culture results for Mycobacterium tuberculosis as the "gold standard." The sensitivities of the PhAS and direct smear methods were 85% (465 of 547) and 83% (454 of 547), respectively, and the specificity of each method was 97%. The PhAS method was better accepted by the laboratory technicians and safer but necessitates an overnight sedimentation, which delays reporting of results until 1 day after sputum collection.Each year, there are an estimated 2 million tuberculosis deaths and 8 million new cases of tuberculosis worldwide (3, 13). In developing countries, diagnosis of pulmonary tuberculosis depends primarily on the identification of acid-fast bacilli (AFB) using Ziehl-Neelsen sputum smear microscopy, a technique more than 100 years old. The sensitivity of this method varies (7) and depends upon collection of sufficient sputum, proper preparation of smears, good staining technique, careful examination of smears, and availability of a good microscope. Several methods have been tried to improve smear microscopy for AFB (1, 4-6, 9, 11, 12), but these have limitations under field conditions. Developing new smear microscopy methods which would be feasible under field conditions remains a priority for improving the diagnosis of pulmonary tuberculosis. In developing countries, laboratory technicians sometimes tend to sidestep the sputum examination owing to apprehensions about the infectiousness of sputum samples and due to the cumbersome method of preparing direct smears from the mucus portion of the sample. We evaluated the sensitivity, specificity, and acceptability of a new smear microscopy method using phenol ammonium sulfate (PhAS) for sedimentation of sputum.The study was conducted at a large tertiary-care hospital in Chennai, Tamil Nadu, South India. Each patient attending the outpatient department of the hospital was screened for chest symptoms. One spot sputum specimen was collected in a McCartney bottle from each patient who reported having a cough for 3 weeks or longer. Patients who were on antituberculosis treatment at the time were excluded from the study. All samples were collected during the months of August and September 2001.Processing of sputum samples. Sputum specimens were transported and processed within 4 h of collection. Each sample was divided into two portions of 3 to 5 ml each by pouring the sample from one McCartney bottle to another, such that both portions were approximately equal in volume and appeared similar in quality. The two portions were randomly allocated; one to the modified Petroff method for culture of Mycobacterium tuberculosis (10) and the other to the PhAS sediment smear method. For the Petroff method, sputum was homogenized for 15 min in a shaker by using an equal volume of 4% sodium hydroxide. After centrifugation at 3,000 rpm for 15 min in a Megafuge 1.0 (Heraeus), the deposit ...

Following DOTS implementation, prevalence of culture-positive tuberculosis decreased rapidly following a gradual decline for the previous 30 years. In the absence of a large HIV epidemic and with relatively low levels of rifampicin resistance, DOTS was associated with rapid reduction of tuberculosis prevalence.