Clinical relevance of nontuberculous mycobacteria (NTM) isolated from 180 chronically ill patients and 385 healthy controls in Zambia was evaluated to examine the contribution of these isolates to tuberculosis (TB)-like disease. The proportion of NTM-positive sputum samples was signifi cantly higher in the patient group than in controls; 11% and 6%, respectively (p<0.05). NTM-associated lung disease was diagnosed for 1 patient, and a probable diagnosis was made for 3 patients. NTM-positive patients and controls were more likely to report vomiting and diarrhea and were more frequently underweight than the NTM-negative patients and controls. Chest radiographs of NTM-positive patients showed deviations consistent with TB more frequently than those of controls. The most frequently isolated NTM was Mycobacterium avium complex. Multiple, not previously identifi ed mycobacteria (55 of 171 NTM) were isolated from both groups. NTM probably play an important role in the etiology of TB-like diseases in Zambia.

Background: Chronic obstructive lung disease (COPD) is a frequent co-morbidity in patients hospitalised with community-acquired pneumonia (CAP). In recent retrospective studies, higher mortality in patients with CAP and COPD was found. Objectives: The aim of the study was to determine the 30-day mortality and to evaluate the differences in CAP severity scoring in hospitalised patients with COPD. Methods: A subanalysis of a randomized clinical trial was performed. Results: A total of 262 patients with CAP were included. Ninety-five (36.3%) patients had COPD. A total of 28 (10.7%) patients died within 30 days. No differences between patients with and without COPD in 30-day mortality were observed [8 (8.4%) vs. 20 (12.0%), p = 0.37]. In the Pneumonia Severity Index (PSI), significant differences in age, gender and heart rate between patients with and without COPD were observed. Patients with COPD were stratified in higher PSI classes. In the CURB-65 score, age ≥65 years was significantly higher in patients with COPD [72 (75.8%) vs. 88 (52.7%), p = <0.01]. In a multivariate analysis, only the need for intensive care unit admission and high serum glucose were predictors of mortality [OR 32.50 (95% CI 6.87–153.75), p < 0.01; OR 7.34 (95% CI 1.19–45.4), p = 0.03]. Conclusions: Mortality was not increased in patients with COPD hospitalised with CAP. Severity scores are influenced by age and gender. Further studies evaluating CAP in patients with COPD are needed to explain these findings.

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The physician's need for standardization of ultrasonic instrumentation might appear to be too obvious a requirement to be worthy of further comment.Nevertheless, many engineers do not appreciate the extent to which the diagnostic process in ultrasound as currently practiced is dependent upon the subjective impressions of the interpreter and the variations that occur in similar models of the same machine or the drift in any single machine with time.Diagnostic ultrasound is capable of producing highly diagnostic data without discomfort to the patient, injection of contrast media, ionizing radiation or undue expense. At this institution, ultrasound examinations now exceed 10,000 per annum; and this use of ultrasound has decreased the need for highly invasive procedures such as angiography or expensive ones such as whole body x -ray computerized tomography (CT). Despite these advantages, at some other hospitals, ultrasound is not available, even for obstetrics, and there are a number,of obvious restrictions to the rapid acceptance of this useful technique: 1)There is a lack of adequately trained technicians to produce diagnostic scans. 2)There is a dearth of physicians trained in the interpretation of ultrasound. This is a markedly different problem from the acceptance of a new x -ray technique such as CT.In x -ray CT scanning the basic physics of ionizing radiation is familiar to radiologists, and the systems investigated are those for which the anatomy and pathology is already well known. In contrast, the physics of ultrasound is new to radiologists, while the anatomy and pathology of the organs studied, including the heart, liver, obstetrics and gynecology, lay outside the realm of general radiological procedures. 3)Ultrasound equipment is poorly standardized, subject to drift and, most important, there appears to be a total lack of any adequate tissue phantom on which the equipment performance can be optimized before clinical use.The answer to the first problem lies in increased training programs for technicians and stricter certification requirements, together with the development of automated scanners. The lack of physician training will slowly be overcome as ultrasound training becomes a requisite for Board certification in radiology. There remains the problems inherent in unstable and suboptimal equipment which must be appreciated by industry before any solutions can be provided.A physician wishing to institute an ultrasound service may purchase a machine which is deemed to be capable of generating grey -scale images of diagnostic quality.The chance of having such a machine delivered from the factory in our experience is small. The rigorous tests to which the machine is subjected before delivery may not include the production of clinical images. This deficiency indicates the great need for an adequate tissue phantom so that specifications of the machines which are relevant to the production of clinically useful scans can be more adequately tested. One standard test currently employed involves the AIUM test ob...