Pooled Sputum for Xpert MTB/RIF Testing: A Cost-Saving Strategy in Mwanza, Tanzania

Background: Tuberculosis (TB) diagnostics, such as Xpert MTB/RIF, is still limited by cost. Testing of pooled samples from presumptive TB patients has been thought as a cost-saving strategy to diagnose TB. We assessed the utility and cost-saving of pooled Xpert MTB/RIF testing strategy for the diagnosis of TB in Mwanza, Tanzania. Methods: Sputum samples from Presumptive TB patients were submitted to TB laboratory for routine diagnosis of TB using Xpert MTB/RIF. The TB results from the individual sputum samples were used as the reference standard and were concealed to the investigating laboratory technicians. The remainder of samples were collected serially and were pooled (5 samples per pool) for testing. The agreement of the results between individual sample testing against pooled sample testing and cost-savings was assessed. Results: A total of 250 sputum samples from presumptive TB patients were analyzed and 50 pools were made with each pool containing 5 samples. Of the 50 sputum pools made, Mycobacterium tuberculosis (MTB) was detected in 17 (34.0%) pools. Results from the individual sputum samples MTB/RIF testing were retrieved for all 250 samples and there were 28 (11.2%) samples in which MTB was detected whereas 222 (88.8%) samples had no MTB detected. Following re-analysis of positive pools, all 28 (100%) individual positive MTB samples were detected within the 17 positive pools, with 1 to 3 individual MTB positive samples per pool. The individual sputum samples were correctly identified by pooled sputum on Xpert MTB/RIF testing, with the sensitivity of 100% and specificity of 100%. Using pooling of sputum samples strategy, we saved 46.0% (115/250) of the cartridges. Conclusion: The pooled sputum testing strategy reduced cartridge costs by 46.0% and has the potential to increase the affordability of Xpert MTB/RIF testing in countries with limited resources, such as Tanzania.

Diagnosis Experience of Patients with Cervical, Thoracic and Lumbar Multi-Segment Spinal Stenosis: A Case Report and Literature Review

Background: The incidence of cervical, thoracic and lumbar spinal canal stenosis is low. It is difficult to identify the main focus and responsible segment, and it is also difficult to select the sequence of staging surgery. We report a patient with triple stenosis. Case Presentation: In this paper, we introduced a 61-year-old female patient with cervical, thoracic and lumbar spinal canal stenosis who had previously undergone “lumbar discectomy” in the outer hospital. The postoperative effect was not good and the symptoms were poor. The diagnosis was “cervical spinal stenosis and lumbar postoperative surgery”. The staged spinal canal decompression operation and Duhuo Jisheng Decoction (DHJSD) treatment were conducted in our hospital. After three months of follow-up, the functional and imaging results were satisfactory. Conclusions: The main focus and responsible spinal segment should be determined by the comprehensive analysis of medical history, signs, and images. Surgery combined with Chinese herbal medicine DHJSD therapy may be an effective treatment for this kind of disease.

Diagnostic ion filtering strategy for chemical characterization of Guge Fengtong Tablet with high-performance liquid chromatography coupled with electrospray ionization quadrupole time-of-flight tandem mass spectrometry

The present study was designed to characterize the chemical constituents of Guge Fengtong Tablet(GGFTT).Based on the chromatographic retention behavior,fragmentation pathways of chemical components and the published literatures,a diagnostic ion filtering strategy with electrospray ionization quadrupole time-of-flight tandem mass spectrometry(HPLC-ESI-Q-TOF/MS) was established to identify the multiple bioactive constituents of GGFTT.The rapid identification of forty-seven components,including 18 phenolic acids,8 saponins,14 gingerol-related compounds,and 7 diarylhepatonoids,was accomplished using this newly developed method.The coupling of HPLC-ESI-Q-TOF/MS with the diagnostic ion filtering strategy was useful and efficient for the in-depth structural elucidation of chemical compounds of GGFTT.

Hepatic paragonimiasis:a single-center retrospective analysis of 32 cases in China's Mainland

Background:In paragonimiasis,the lungs and pleural cavity are the major target organs,and the central nervous system can also be affected.The liver is an organ in which ectopic paragonimiasis rarely occurs.Because the symptoms and examinations in hepatic paragonimiasis(HP)are not typical,the disease is often misdiagnosed in the clinic.Methods:From February 2008 to March 2015,our department accepted 32 patients who presented with a liver mass upon ultrasound and computed tomography imaging and in whom the source of the mass could not be identified upon numerous further diagnostic tests.We ultimately obtained surgical biopsies of their lesions for pathological examination.We analysed the clinical data of these cases,along with their disease characteristics,the diagnostic strategies employed and their treatment experiences.Additionally,we performed patient follow-up for a period of 6–12 months.Results:All patients underwent half/partial hepatectomy and were diagnosed with HP upon pathological examination.They recovered well after surgery and their original symptoms were markedly improved without recurrence.The liver functions of the patients reached normal levels before discharge and no additional liver lesions were found upon diagnostic imaging.Conclusion:The diagnosis of HP based on clinical manifestations,laboratory tests or image examination is difficult and only pathologic analysis of biopsies could confirm HP.Surgical treatment not only removes lesions,but also allows for pathologic biopsy.This study encompasses the largest number of HP patients to date,but the surgical outcomes require further research and long-term follow-up.