My research month

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My research month
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• Tuberculosis
• - 2005 WHO estimation global incidence of 8.8
  million active TB (was 6.4 million in 1990) and
  1.6 million deaths per year
• - Incidence declining in developed countries but
  increasing sharply in resource poor countries
  (especially those with HIV epidemics)
• - One third of world population infected with MTB
  

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• TB situation in Korea
• - 50,000 new active case per year (increasing)
• - Increasing MDR/XDR TB cases (currently 2.8 of
  new TB cases are MDR, 15 of the MDR TB cases are
  XDR)
• - North Korea no reliable epidemiological info
  available but recent anecdotal reports suggest a
  very grave TB situation

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• Anaerobic adaptation of MTB
• - Non-replicating persistent state induced by
  oxygen deprived environment in vitro
• - MTB genome study showed that it is well
  equipped with the genes for anaerobic metabolic
  processes
• - Animal studies showed that MTB is found in
  oxygen deprived environments of the TB infected
  lungs
• - At this anaerobic state, MTB is resistant to
  isoniazid and partially resistant to rifampin but
  sensitive to metronidazole
• - One previous clinical trial reported
  significantly better clinical outcome when
  metronidazole was added to the standard drug
  regimen for advanced TB

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• Goals of this study
• -To evaluate the efficacy of metronidazole in
  killing an anaerobic sub-population of MTB in MDR
  TB pts
• -To see if PET and HRCT scans can be effectively
  used for monitoring TB chemotherapy

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• Brief description of the study
• - 60 subjects (who are admitted to the Masan TB
  Hospital in Korea for initiation of treatment for
  newly dxed MDR TB)
• - Randomized and double blinded to the treatment
  arm (standard regimen metronidazole) or placebo
  arm (standard reg. placebo)
• - Total 8 weeks of treatment with metronidazole
  or placebo
• - PET/CT and HRCT will be done at the entry to
  the study and after the 8 weeks

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• The task assigned to me during this month was to
  find ways to do QUANTITATIVE analysis on these
  imaging studies (PET-CT and HRCT)
• - In previous TB studies, images have been
  evaluated qualitatively only
• - This meant that I had to get familiar with a
  few different image processing softwares (AMIDE,
  MIPAV, OSIRIX)

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E201
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• I chose the volume in the thoracic cavity
  corresponding to Hounsfield Units of -1000 to
  -100 on the CT scan

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E101
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Quantitative Analysis of individual lesions