Factors of Adherence to Concurrent Tuberculosis Treatment and Antiretroviral Therapy among HIV-TB Co-Infected Individuals in the East Region, Cameroon in the COVID-19 Era: A Retrospective Cohort Study

Context/Objectives: Tuberculosis (TB) and HIV co-infection is a serious health problem in Cameroon. The problems associated with poor adherence to treatment are on the increase worldwide. This problem can be observed in all situations where patients are required to administer their own medication, whatever the type of illness. The general objective of this study was to assess the factors affecting adherence to treatment among HIV-TB co-infected patients in health facilities in the East Region in the COVID context. Method: A retrospective cohort study before and during COVID-19 was conducted in HIV care units in 13 health districts in the East Region of Cameroon. Data were collected using a questionnaire recorded in the Kobo Collect android application, analyzed using SPSS version 25 software and plotted using Excel. Results: The pre-COVID-19 cohort compared to the during-COVID-19 cohort had a 1.90 risk of not adhering to treatment (OR: 1.90, CI {1.90 - 3.37}) and the difference was statistically significant at the 5% level (p-value = 0.029). Frequency of adherence was 65.4% (140/214). Adherence before COVID-19 was 56.9% whereas during COVID-19, it was 74.3%. Conclusion: The implementation of targeted interventions in the COVID-19 context, using evidence-based data and integrating the individual needs of HIV-TB co-infected patients, improved adherence to concurrent anti-tuberculosis treatment and antiretroviral therapy during the COVID-19 Era.

Inferring Mycobacterium Tuberculosis Drug Resistance and Transmission using Whole-genome Sequencing in a High TB-burden Setting in China

Objective China is among the 30 countries with a high burden of tuberculosis(TB)worldwide,and TB remains a public health concern.Kashgar Prefecture in the southern Xinjiang Autonomous Region is considered as one of the highest TB burden regions in China.However,molecular epidemiological studies of Kashgar are lacking.Methods A population-based retrospective study was conducted using whole-genome sequencing(WGS)to determine the characteristics of drug resistance and the transmission patterns.Results A total of 1,668 isolates collected in 2020 were classified into lineages 2(46.0%),3(27.5%),and 4(26.5%).The drug resistance rates revealed by WGS showed that the top three drugs in terms of the resistance rate were isoniazid(7.4%,124/1,668),streptomycin(6.0%,100/1,668),and rifampicin(3.3%,55/1,668).The rate of rifampicin resistance was 1.8%(23/1,290)in the new cases and 9.4%(32/340)in the previously treated cases.Known resistance mutations were detected more frequently in lineage 2 strains than in lineage 3 or 4 strains,respectively:18.6%vs.8.7 or 9%,P<0.001.The estimated proportion of recent transmissions was 25.9%(432/1,668).Multivariate logistic analyses indicated that sex,age,occupation,lineage,and drug resistance were the risk factors for recent transmission.Despite the low rate of drug resistance,drug-resistant strains had a higher risk of recent transmission than the susceptible strains(adjusted odds ratio,1.414;95%CI,1.023–1.954;P=0.036).Among all patients with drug-resistant tuberculosis(DR-TB),78.4%(171/218)were attributed to the transmission of DR-TB strains.Conclusion Our results suggest that drug-resistant strains are more transmissible than susceptible strains and that transmission is the major driving force of the current DR-TB epidemic in Kashgar.

Prevalence of Latent Tuberculosis Infection [LTBI] in Prison Officers: A Systematic Review and Meta-Analysis

This study aimed to perform a systematic review and meta-analysis to determine the LTBI prevalence in prison officers worldwide. A systematic search was performed in PubMed, WoS, Embase, and BVS, including all articles related to LTBI prevalence and risk factors. After critical evaluation and qualitative synthesis of the identified articles, a meta-analysis was used. Five studies carried out between 2012 and 2022 were included, with a total sample size of 1718 prison officers. The overall LTBI prevalence was 50% [95% confidence interval [CI]: 48% - 52%;n = 816], with high heterogeneity between studies. Smoking [OR = 1.76;CI 95% = 1.26 - 2.46] and males [OR = 2.08;CI 95% = 1.31 - 3.31] were positively related to a higher LTBI prevalence among prison officers. Thus, preventive measures and the rapid and accurate diagnosis of new cases should be emphasized to ensure tuberculosis control, especially among risk groups such as prison officers.

优化T-SPOT.TB在区分脊柱结核与其他脊柱感染中的诊断效能

目的 探讨结核感染T细胞斑点试验(T-SPOT.TB)在脊柱结核(STB)鉴别诊断中的效能,并通过受试者工作特征(ROC)曲线最佳截断值优化诊断效能。方法 收集2010年1月—2019年5月某院脊柱感染患者的临床资料,包括术前T-SPOT.TB检测结果、白细胞计数、C-反应蛋白、血沉、降钙素原和结核抗体等相关数据,根据诊断标准进行临床诊断,分析T-SPOT.TB在术前诊断STB与其他脊柱感染中的灵敏度和特异度,评价优化后的T-SPOT.TB指标的诊断效能。结果 共纳入132例患者,其中78例(59.09%)为STB,54例(40.91%)为非结核脊柱感染。T-SPOT.TB在鉴别诊断STB方面的灵敏度为67.68%,特异度为66.67%。单因素logistic回归分析显示,与非结核脊柱感染比较,T-SPOT.TB检测诊断STB的OR值为4.188(95%CI:1.847~9.974,P<0.001)。优化T-SPOT.TB评价指标,通过绘制ROC曲线,确定ESAT-6、CFP-10、CFP-10+ESAT-6在STB和非结核脊柱感染鉴别诊断中的最佳截断值,分别为12.5、19.5、36,曲线下面积(AUC)分别是0.765 6、0.741 5、0.778 6,均具有较好的诊断性能,其中以CFP-10+ESAT-6的AUC最高。CFP-10+ESAT-6特异性斑点数在脊柱结核诊断中性能更佳,其诊断准确度为75.56%,较优化前T-SPOT.TB的67.42%高。结论 T-SPOT.TB检测在区分STB与非结核脊柱感染方面显示出较高的诊断效能,T-SPOT.TB检测呈阳性,尤其是当CFP-10+ESAT-6的斑点数超过36时,提示脊柱结核的可能性较大。

结核特异性QFT⁃TB在结核患者不同类型标本中的检测价值

目的比较结核诊断实验室特异性细胞免疫IGRAs体外检测QuantiFERON-TB Gold(QFTTB)方法对肺结核、肺外结核和特殊人群样本的诊断效能,为临床诊疗提供依据。方法收集2023年1-7月实验室检查细菌学检测结核患者546例[痰涂片阳性(AFB+)146例,痰涂片阳性(AFB-)247例],分子生物学阳性结核患者117例(Xpert 69例,TB-DNA 48例),病理组织学阳性患者36例。肺外结核患者72例,特殊样本胸水276例,腹水25例。采用QFT-TB方法进行检测,利用χ^(2)检验进行组间比较,对比其阳性率和符合率的方法学评估。结果肺结核、肺外结核和结核密切接触者QFT-TB检测阳性率为83.69%、69.44%和32.41%。在AFB+、GeneXpert、TB-DNA和病理证实确诊为结核病患者QFT-TB方法的符合率为91.09%、88.40%、81.25%和72.22%。结核性胸膜炎患者胸水检测阳性率为60.50%、腹水阳性率为44.00%。结论QFT-TB检测在辅助诊断肺结核有较好价值,对于基于胸、腹水的检测用于肺外结核的诊断有一定的参考意义。

高强TB9钛合金次生α相析出行为及力学性能

研究单/双重时效热处理对TB9合金次生α相形貌及力学性能的影响规律。借助XRD分析合金相组成,采用光学显微镜和扫描电子显微镜观察显微组织,着重分析微观组织形貌随时效温度变化的演变特征,测试室温拉伸性能和断裂韧度。研究结果表明:单重时效时,晶粒内次生α相呈锯齿状和片层状析出,随着时效温度升高,α相尺寸增大,片层状α相含量增加;430℃时效时,合金强度较低,塑性较好,在470℃时效时合金强度最高;随时效温度的提高,强度先增大后维持在同一强度水平。双重时效时,晶粒内次生α相主要呈锯齿状析出,随时效温度升高,α相尺寸增大,抗拉强度先升高后降低,最高可达1542 MPa,且塑性变化较小。双重时效下合金的抗拉强度较单重时效大幅提高,这主要是由于晶界附近第二相析出强化和晶内锯齿结构α相的共同作用。

热变形参数对TB15钛合金动态再结晶行为的影响

采用热模拟压缩试验机对TB15钛合金进行变形温度为810~930℃、应变速率为0.001~10 s^(-1)、压下量为60%的等温热压缩试验,研究了热变形参数对TB15钛合金动态再结晶行为的影响。结果表明:TB15钛合金不同应变速率下的应力-应变曲线呈现出不同特征。随应变速率增大,流动软化曲线呈现“V”型特征。当应变速率在0.001~0.1 s^(-1)范围时,随变形温度升高和应变速率减小,动态再结晶(DRX)体积分数和DRX晶粒尺寸增大,且DRX晶粒尺寸增幅较DRX体积分数更加显著。在低应变速率变形时,原始β晶粒被小角度晶界分成形状规整的多边形亚晶粒,小角度晶界通过连续吸收位错和渐进晶格旋转的方式向大角度晶界转变从而实现连续动态再结晶。随着应变速率增大,再结晶晶粒形核位置从原始β晶粒内部逐渐向晶界附近转移,在原始β晶界形成均匀细小的“项链状”再结晶晶粒,此时易于由晶界弓弯机制引发不连续动态再结晶。

TB-DNA、IGRAs、TB-Ab在肺结核中的诊断价值

目的探究结核分枝杆菌核酸(TB-DNA)、γ-干扰素释放试验(IGRAs)和结核分歧杆菌抗体(TB-Ab)检测在肺结核中的诊断价值。方法收集2022年6月至2023年1月莆田学院附属医院收治的154例疑似肺结核患者,所有患者均接受TB-DNA、IGRAs和TB-Ab检测,评价不同检测方法的检测阳性率、诊断肺结核的灵敏度、特异度、阳性预测值、阴性预测值及诊断准确率;采用受试者工作特征曲线(ROC)评估不同检测方法对肺结核的诊断效能。结果154例疑似肺结核患者中,107例确诊为肺结核(肺结核组),47例确诊为非肺结核的其他肺部疾病(对照组)。肺结核组TB-DNA、IGRAs和TB-Ab阳性率均高于对照组,差异有统计学意义(P<0.05)。TB-DNA、IGRAs检测诊断肺结核的灵敏度和诊断准确率均高于TB-Ab检测,差异有统计学意义(P<0.05),TB-DNA检测诊断肺结核的阴性预测值高于TB-Ab检测,差异有统计学意义(P<0.05)。ROC曲线分析结果显示,TB-DNA诊断肺结核的AUC为0.851(明显大于IGRAs诊断的0.770)、TB-Ab诊断的0.770,IGRAs诊断的AUC明显大于TB-Ab,差异均有统计学意义(P<0.05)。IGRAs+TB-DNA联合诊断的灵敏度、诊断准确率明显高于IGRAs单独检测(P<0.05);IGRAs+TB-Ab联合诊断的灵敏度明显高于IGRAs、TB-Ab单独检测,诊断准确率明显高于TB-Ab单独检测(P<0.05);TB-DNA+TB-Ab联合诊断的灵敏度、阴性预测值、诊断准确率明显高于TB-Ab单独检测(P<0.05)。TB-DNA、IGRAs、TB-Ab两两联合检测和三者联合检测诊断肺结核的灵敏度、特异度、阳性预测值、阴性预测值及诊断准确率比较,差异均无统计学意义(P>0.05)。结论相比TB-Ab和IGRAs检测,TB-DNA检测对肺结核的诊断价值更高;TB-DNA、IGRAs、TB-Ab两两联合检测对肺结核的诊断效能高于单一指标检测。

QuantiFERON-TB Gold Plus与QuantiFERON-TB Gold In-Tube在骨关节结核辅助诊断中的比较研究

目的:评价QuantiFERON-TB Gold Plus(简称“QFT-Plus”)和QuantiFERON-TB Gold In-Tube(简称“QFT-GIT”)检测辅助诊断骨关节结核的应用价值及其检测结果的一致性。方法:选取2023年4—9月于首都医科大学附属北京胸科医院就诊的骨关节结核患者88例作为观察组,非结核性骨关节疾病患者123例作为对照组。所有研究对象同时行外周血QFT-Plus和QFT-GIT检测。分析QFT-Plus和QFT-GIT辅助诊断骨关节结核的价值,评价两种方法检测结果的一致性。结果:211例研究对象中,剔除4例检测为不确定结果者,最终将207例研究对象检测结果纳入诊断性能评估(观察组86例,对照组121例)。QFT-Plus检测的敏感度为95.3%(95%CI:87.9%~98.5%),特异度为70.2%(95%CI:61.2%~78.0%),阳性预测值为65.5%(95%CI:60.2%~77.5%),阴性预测值为95.5%(95%CI:88.3%~98.6%);QFT-GIT检测的敏感度为91.9%(95%CI:83.4%~96.4%),特异度为66.9%(95%CI:57.7%~75.1%),阳性预测值为66.4%(95%CI:57.1%~74.6%),阴性预测值为92.0%(95%CI:83.8%~96.5%)。QFT-Plus和QFT-GIT检测结果的总一致率为91.8%(95%CI:88.1%~95.5%),阳性一致率为92.4%(95%CI:87.7%~97.2%),阴性一致率为90.9%(95%CI:84.9%~96.9%),一致性检验Kappa值为0.832(95%CI:0.756~0.908,P<0.001)。结论:QFT-Plus与QFT-GIT检测结果具有良好的一致性,在骨关节结核诊断中具有相似的辅助诊断效能。

GeneXpert MTB/RIF检测技术在新疆结核病防治规划中的应用效果

目的:探索在施行结核病防治“新疆模式”中,全面应用GeneXpert MTB/RIF(简称“GeneXpert”)检测发现肺结核及利福平耐药肺结核的效果。方法:从“中国疾病预防控制信息系统”的子系统“结核病管理信息系统”中,收集2017—2020年新疆维吾尔自治区(简称“新疆”)肺结核登记数据,对全面应用GeneXpert检测的效果进行分析,评价2017-2020年肺结核病原学阳性率、利福平耐药检测率、利福平耐药患者发现水平的变化。结果:GeneXpert设备覆盖率、GeneXpert检测率、病原学阳性率分别从2017年的20.00%(22/110)、0.32%(126/39 261)和20.17%(7919/39 261)提高到2020年的100.00%(110/110)、75.16%(19 610/26 090)和57.94%(15 116/26 090),差异均有统计学意义(χ^(2)=40.705,P<0.001;χ^(2)=174.087,P<0.001;χ^(2)=47.569,P<0.001)。病原学阳性患者数从2017年的7919例提高到2020年的15 116例,仅GeneXpert检测阳性患者数从2017年的6例提高到2020年的7194例,所占比例从0.08%(6/7919)提高到47.59%(7194/15 116),差异有统计学意义(χ^(2)=83.824,P<0.001)。病原学阳性肺结核患者利福平耐药筛查率和GeneXpert耐药检测率分别从2017年的44.49%(3523/7919)和1.85%(65/3523)提高到2020年的99.79%(15 084/15 116)和96.13%(14 501/15 084),差异均有统计学意义(χ^(2)=133.333,P<0.001;χ^(2)=250.893,P<0.001)。结论:GeneXpert检测技术的应用,可以明显提升病原学阳性和利福平耐药肺结核的发现水平,有利于新疆结核病疫情的快速下降。

The Retrospective Diagnostic Potential of Gene Xpert MTB/RIF for the Analysis of Formalin-Fixed Paraffin-Embedded Tissue from Extrapulmonary Tuberculosis Patients

Tuberculosis(TB)is a chronic disease caused by infection with Mycobacterium tuberculosis.Laboratory confirmation of this infection is challenging due to the paucibacillary nature of extrapulmonary tuberculosis(EPTB).

Knowledge of Tuberculosis, Services of TB Control Programme and Associated Socio-Demographic Inequity among Rural Participants of Jaipur, Rajasthan, India: A Cross Sectional Study

Background: Tuberculosis (TB) is one of the top 10 causes of death worldwide. India is still the highest TB burden country. There is a scarcity of data on TB knowledge from Rajasthan state of India. Objective: The objective of this study was to estimate the prevalence of knowledge about TB and services of TB control programme and to determine its correlates among rural population of Jaipur, Rajasthan. Methods: Cross-sectional community based study was carried out at Model Rural Health Research Unit, Jaipur, a unit of Department of Health Research, Ministry of Health & Family Welfare, Government of India. Results: Study reports the result from 1993 adult participants from 10 villages of 2 sub-districts of district Jaipur. About 88.9% of studied participants knew that TB is an infectious disease and it spreads from TB patient to healthy person in close contact. Only 22.3% of participants knew “DOTS is the treatment for TB”. While, only 58.9% knew “sputum is used for diagnosis of TB” at health centers. Scheduled castes, scheduled tribes and backward classes social groups knew less than the mainstream “General” social group. The observed difference was statistically significant (p 0.05). Logistic regression analysis estimated the relative contribution to knowledge status. Conclusion: The knowledge of study participants on transmission of tuberculosis was similar to knowledge of population in country wide study. They poorly knew sputum is used for diagnosing tuberculosis disease;socio-demographic inequity exists in this knowledge too. People from older age groups, underprivileged social groups and minority need extra educational activities.

2型糖尿病合并肺结核患者空腹血糖水平与痰涂片、T-SPOT.TB结果的关系及结核分枝杆菌rpoB基因检测临床意义

目的探究2型糖尿病(type 2 diabetes nephropathys,T2DM)合并肺结核患者空腹血糖(fasting plasma glucose,FPG)水平与痰涂片、结核分枝杆菌T细胞斑点实验(T-cell spot test for tuberculosis infection,T-SPOT.TB)结果的关系及结核分枝杆菌rpoB基因检测的临床意义。方法选取2022年1月—2023年1月昆明市第三人民医院收治102例T2DM合并肺结核患者作为研究组,另选同期在我院治疗的102例单纯肺结核患者作为对照组。比较2组临床资料、痰涂片和T-SPOT.TB检查结果,并对研究组不同FPG水平患者痰涂片阳性率、T-SPOT.TB阳性率进行比较,分析痰涂片阳性率、T-SPOT.TB阳性率与患者FPG水平的相关性。对2组进行结核分枝杆菌培养,分离利福平(rifampicin,RFP)耐药菌株和敏感菌株,比较2组2种菌株rpoB基因检测结果。结果研究组咳嗽、呼吸困难、厌食、盗汗、胸痛、咯血、发热发生率、痰涂片阳性率、T-SPOT.TB阳性率均高于对照组(P均<0.05)。不同FPG水平患者痰涂片阳性率比较,差异具有统计学意义(P=0.003);T-SPOT.TB阳性率比较,差异无统计学意义(P=0.262);痰涂片阳性率与T2DM合并肺结核患者FPG水平呈正相关(rs=0.386,P=0.015),T-SPOT.TB阳性率与FPG水平无明显相关性(rs=0.127,P=0.326)。研究组RFP耐药菌株多于对照组,研究组RFP耐药菌株rpoB基因突变率高于RFP敏感菌株(P均<0.05)。结论T2DM合并肺结核患者FPG水平与痰涂片结果呈正相关,但与T-SPOT.TB结果无相关性。与单纯肺结核患者相比,T2DM合并肺结核患者更易感染耐药株。通过检测耐药基因rpoB,可快速识别检测结核分枝杆菌对RFP耐药性,为临床治疗提供科学指导。

用于痕量监测Zr^(4+)、Cr_(2)O_(7)^(2-)、Fe^(3+)、HPO_(4)^(2-)和指纹识别的功能化Eu^(3+)/Tb^(3+)配位聚合物荧光探针的构筑

采用芳香族π共轭及含氮原子有机连接剂,合成同构铽、铕发光配位聚合物(CPs){[Eu(PLIA)_(1.5)(H_(2)O)_(2)]·H_(2)O}_(n)(1)和{[Tb(PLIA)_(1.5)(H_(2)O)_(2)]·H_(2)O}_(n)(2),其中H_(2)PLIA=5-((吡啶-4-基甲基)氧基)苯-1,3-二甲酸。对合成的配合物进行了结构测定、表征和荧光痕量识别实验研究。2个同构配合物具有理想的三维框架结构,π…π堆积及氢键等弱相互作用增强了其化学稳定性;表征显示配位聚合物1和2具有良好的荧光性质、结晶性、热力学稳定性及结构完整性,可作为荧光传感的材料。1和2对水溶液中的Zr^(4+)、Cr_(2)O_(7)^(2-)和Fe^(3+)、HPO_(4)^(2-)具有选择性好、灵敏度高的荧光识别能力,其检出限分别为0.139μmol·L^(-1)(1,Zr^(4+))、0.626μmol·L^(-1)(1,Cr_(2)O_(7)^(2-))、0.430μmol·L^(-1)(2,Fe^(3+))、1.36μmol·L^(-1)(2,HPO_(4)^(2-))。探究了1和2作为探针的荧光猝灭机理。更有趣的是,1和2具有指纹识别性能,其荧光指纹纹路清晰连贯,细节明显,可被清晰观察。

Ce^(3+)-Tb^(3+)共掺杂黄磷炉渣微晶玻璃的发光与能量传递

以黄磷炉渣为原料,采用高温熔融法制备Ce^(3+)-Tb^(3+)共掺杂黄磷炉渣发光微晶玻璃,通过差热分析(DTA)、X射线衍射(XRD)、稳态/瞬态荧光(FLS)、CIE色度等探究不同的Tb^(3+)掺杂量对微晶玻璃析出晶相、发光性能和样品色度的影响。结果表明,Ce^(3+)和Tb^(3+)的引入,微晶玻璃主晶相为硅灰石,在310 nm波长激发下,随着Tb^(3+)掺杂量增加,位于380 nm处Ce^(3+)的特征发射峰减小,543 nm处Tb^(3+)的特征发射峰增强,证实Ce^(3+)和Tb^(3+)之间存在能量传递,能量传递效率达到24.55%。此外,通过调整Tb^(3+)掺杂量,微晶玻璃发光颜色可由蓝光调至绿光,从而实现发光颜色的可控化。

时效温度对TB15钛合金微观组织和力学性能影响

采用扫描电镜、电子背散射衍射仪、X射线衍射仪和万能材料试验机等研究了不同时效温度对固溶态的TB15钛合金组织和力学性能的影响。结果表明:合金在单相区固溶后,组织主要由等轴β晶粒组成,在较低温度时效后,基体析出了针状α相和等温ω相,在β晶界附近出现无析出区(PFZ),随着时效温度的升高,PFZ和ω相消失,α相由针状向片状形貌转变,在晶界附近出现了晶界魏氏体α相(α_(WGB))。随时效温度的增加,合金硬度降低,抗拉强度先升高后下降,伸长率则相反。在500℃时效后合金抗拉强度达到峰值1431.73 MPa,但伸长率仅为3.82%;在530℃时效时合金获得较好的综合力学性能,此时的抗拉强度为1155 MPa,伸长率为7.21%。

GeneXpert MTB/RIF粪便检测在儿童结核病中的研究进展

儿童活动性结核病存在标本获取困难和病原学诊断阳性率低等问题,而利福平耐药实时荧光定量核酸扩增检测技术(Mycobacterium tuberculosis and rifampin-resistant,简称“Xpert”)作为一种快速检测结核分枝杆菌(MTB)和利福平耐药性的方法,以较高的敏感度和特异度为结核病的诊断提供了可靠的依据。目前,该方法已广泛应用于痰液或胃液检测,关于粪便样本对诊断肺结核的应用价值基本得到肯定,但肺外结核应用仍需要大量研究验证。笔者就该方法用于检测儿童结核病粪便样本中的MTB进行综述,为Xpert用于儿童粪便检测在临床中的应用提供参考。

Missed Opportunities for Diagnosing Bacilliferous Pulmonary Tuberculosis by Optical Microscopy versus GeneXpert MTB/RIF in Endemic Areas

Objective: To assess the missed opportunities from the diagnosis of bacilliferous pulmonary tuberculosis by optical microscopy compared to GeneXpert MTB/RIF between 2015 and 2019. Methods: This is a retrospective analysis of the diagnostic results of bacilliferous pulmonary tuberculosis in patients suspected of pulmonary tuberculosis at their first episode during the period. GeneXpert MTB/RIF (GeneXpert) and optical microscopy (OM) after Ziehl-Neelsen stained smear were performed on each patient’s sputum or gastric tubing fluid sample. Results: Among 341 patients suspected of pulmonary tuberculosis, 229 patients were declared bacilliferous tuberculosis by the two tests (67%), 220 patients by GeneXpert and 95 patients by OM, i.e. 64.5% versus 28% (p i.e. 58.5% of the positive cases detected by the two tests (134/229 patients) and 39.3% of the patients suspected of tuberculosis (134/341 patients). On the other hand, among 95 patients declared positive by OM, the GeneXpert ignored 9 (9.5%), i.e. 4% of all the positive cases detected by the two diagnostic tests (9/229 patients) and 3% of the patients suspected of tuberculosis (9/341 patients). The differences observed between the results of the two tests were statistically significant at the 5% threshold (p Conclusion: This study reveals missed diagnostic opportunities for bacilliferous pulmonary mycobacteriosis, statistically significant with optical microscopy than GeneXpert. The GeneXpert/optical microscopy couple could be a good contribution to the strategies for the elimination of pulmonary tuberculosis in sub-Saharan Africa.

Surgical Management of Mitral Valve Infective Endocarditis with Accidental Finding of Open Pulmonary Tuberculosis

Objective: This case report aimed to highlight intersections of TB and Cardiovasular diseases which carry high morbidity and mortality rates. Methods: We are reporting the surgical management of forty seven years female who had back ground history of IDDM (Insulin dependent diabetic Mellitus), ESRD (End stage renal disease) on HD (haemodialysis) also she had left subclavian artery stenosis, and paroxysmal atrial fibrillation. She was diagnosed with mitral valve infective endocarditis and found accidently to have an open pulmonary tuberculosis (TB) on the day before surgery. Results: She was started on first line anti-TB treatment. She was isolated in her private room and airborne precautions measures applied. The patient underwent a tissue Mitral Valve replacement and tricuspid valve repair annuloplasty. Special precautions were applied in Theatre and on cardiopulmonary bypass Machine guided by KAMC-J disinfection protocol. The patient made good recovery postoperatively. She was discharged well on day 7 post operatively. Conclusion: Intersections of TB and cardiovasular diseases carry high morbidity and mortality rates. Early diagnosis and early anti tuberculosis treatment can surely improve the patient prognosis. Our decontamination and disinfective procedures are recommended. Cases like this should be monitored long term for the development of further cardiovascular complication.

应变速率对TB6钛合金绝热剪切敏感性的影响

在室温下采用分离式霍普金森压杆对TB6钛合金帽型试样进行动态加载,研究了应变速率对TB6钛合金绝热剪切敏感性的影响。结果表明,应变速率1950~2510 s^(-1)时,4组试样均表现出明显的应变硬化效应;在绝热温升作用下,4组试样均发生热塑失稳形成绝热剪切带;受冲击载荷和材料晶粒尺寸影响,基体和绝热剪切带之间的过渡区域变形梯度不明显;热剪切带内100 nm等轴晶的形成是旋转动态再结晶机制作用的结果。通过观察金相、表征绝热剪切敏感性及计算扩展能发现,TB6钛合金绝热剪切敏感性随应变速率增加而增加。