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The tuberculin skin test in confirmed pulmonary tuberculosis in the state of Qatar: where we stand?
Objective: This is the first paper to evaluate the potency of the tuberculin skin test (TST) results in confirmed pulmonary tuberculosis in the developing country. Method: Data was collected retrospectively from the tuberculosis (TB) treatment unit during the period from 1998 to 2004. All charts diagnosed as active tuberculosis based on positive sputum smear or culture with documented TST were reviewed. The standard TST was done by injecting o.1 ml of 5 international units subcutaneous RT 23 purified protein derivative (PPD) on volar surface of the right arm. Results: There were 306 patients with confirmed active pulmonary tuberculosis of which 58% were smear positive and 42% were smear negative but culture positive. Expatriates accounted for 81% (247) and male for 74% (225) of the patients. The mean TST was 18.5 mm with standard deviation of 7.54 mm. TST was less than 5 mm in 8.2% (25) 5–10 mm in 1.6% (5) 10–15 mm in 11.1% (34) and more than 15 mm in 79.1% (242). False negative (reaction less than 10 mm) was significantly higher in Qatar nationals (17% vs 8% in expatriates) and those with associated diseases (16.3% vs 7% without associated diseases). Conclusion: Although 9.8% of confirmed pulmonary tuberculosis had false negative TST it remains a potent aide for epidemiological and diagnostic purposes and periodic assessment of this is highly recommended. In our community with BCG vaccination a reaction more than 10 mm should be considered positive.
Uniportal thoracoscopic surgery for difficult late stage empyema: Case series
Early aggressive and minimally invasive approach is an advanced surgical approach for chronic empyema management. The traditional video-assisted technique is considered superior over open thoracotomy for empyema management; however with further modification the uniportal video-assisted thoracoscopic surgery (UVATS) has greater advantage for surgeons providing better anatomical view of target tissues allowing bimanual instrumentation similar to open approach and nullifying the creation of dihedral angle by instruments that are not favorable in traditional VATS. The present case series describes different clinical scenarios including chronic empyema secondary to traumatic hemothorax recurrent tubercular empyema following postoperative open decortication and methicillin-resistant staphylococcus aureus chronic empyema in pediatric patient which are effectively managed with UVATS approach.