Original Papers

Background: Chronic obstructive pulmonary disease (COPD) is a progressive and debilitating disease and is going to be the 3rd most common cause of death worldwide. Pulmonary hypertension (PH) has severely bad influence on prognosis in COPD patients. Hence, early diagnosis of it is important for appropriate therapy. Echocardiography is used for this purpose, which requires cardiologist and expensive equipment which may not be available anywhere. CA-125, a biomarker of ovarian cancer, has shown to be associated with left ventricular failure. We aimed to show the relationship between CA-125 levels and PH in patients with COPD. 

Methods: Ninety patients with stable COPD were enrolled into the study. Levels of CA-125 were measured from venous blood, and in the same

day systolic pulmonary artery pressure (sPAP) was measured by transthoracic echocardiography. Results: Of 90 Patients 51 had PH and 39 had

not. Patients with PH had significantly higher CA-125 levels compared with controls (mean 39.15 U/mL vs. 24.22 U/mL, P < 0.04). Levels of CA-125

were correlated with sPAP (r=017, P =0.01). 

Conclusions: The CA-125 biomarker can be used to identify COPD patients with pulmonary hypertension. Since it is cheap and easily available it can help in centers with less access to echocardiography. 

Keywords: CA-125, chronic obstructive pulmonary disease, pulmonary hypertension

Worldwide, although the incidence of the sensitive/ susceptible tuberculosis diminished, the number of drug resistant tuberculosis is growing. The bacteriological diagnosis, genetic and phenotypic, becomes essential for the epidemic control. The resistance appears as a phenotypic expression of mutations from M. tuberculosis genome. The mutations that appear for Rifampicin are in region rpoB, for Isoniazid in region katG and inhA, for Ethambutol - embB, Quinolone - gyrA, Aminoglicozid and Cyclical Peptides - rrs.

To follow the concordance of results of drug sensitivity test (DST) throughphenotypicandgeneticmethod, weanalyzed a group of 40 patients with TB-DR. We performed drug susceptibility testing on Lowenstein-Jensen medium according to the instructions of the manufacturer. The strains were tested indirect genetic too, Genotype MTBDR plus for INH and RIF and Genotype MTBDRsl for the second line drugs.

 

The concordance between genetic method and the phenotypic method is 95%, 5% from the patients have different sensitivity to INH and RIF, but phenotypical they are resistant, meaning that they have other mutations undetected by the strip.

 

The most common mutation in region rpoB is MUT3 (52%) associating the absence of band W8. Mutations in the region rpoB MUT1 and MUT2A are 12.5%, and 15% respectively.

For high resistance to INH, the most common is MUT1 for katG 95% and for low resistance to INH MUT1 from region inhA - 30%. For the second line drugs, the most frequent concordance between genetic method and phenotypic method is for EMB, of 30%, genetically speaking the strains display no mutation in region embB, but are resistant in phenotypic method.

For FQ, KAN, AMK and CAP the concordance between the two methods is of 100% to all tested strains.

In conclusion, genetic methods have high sensitivity, they are fast and shorten significantly the diagnosis time. 

Keywords: Mycobacterium tuberculosis, drug resistant tuberculosis, drug susceptibility testing, line probe assay