Implementing 3HP vs. IPT as TB preventive treatment in Pakistan.

BACKGROUND: We assessed treatment uptake and completion for 6 months of isoniazid (6H) and 3 months of isoniazid plus rifapentine weekly (3HP) in a programmatic setting in Pakistan.METHODS: All household contacts were clinically evaluated to rule out TB disease. 6H was used for TB preventive treatment (TPT) from October 2016 to April 2017; from May to September 2017, 3HP was used for contacts aged ≥2 years. We compared clinical evaluation, TPT uptake and completion rates between contacts aged ≥2 years in the 6H period and in the 3HP period.RESULTS: We identified 3,442 contacts for the 6H regimen. After clinical evaluation, 744/1,036 (72%) started treatment, while 46% completed treatment. In contrast, 3,722 contacts were identified for 3HP. After clinical evaluation, 990/1,366 (72%) started treatment, while 67% completed treatment. Uptake of TPT did not differ significantly between the 6H and 3HP groups (OR 1.03, 95%CI 0.86-1.24). However, people who initiated 3HP had 2.3 times greater odds (95% CI 1.9-2.8) of completing treatment than those who initiated 6H after adjusting for age and sex.CONCLUSION: In programmatic settings in a high-burden country, household contacts of all ages were more likely to complete TPT with shorter weekly regimens, although treatment uptake rate for the two regimens was similar.

The United Kingdom Primary Immune Deficiency (UKPID) registry 2012 to 2017.

This is the second report of the United Kingdom Primary Immunodeficiency (UKPID) registry. The registry will be a decade old in 2018 and, as of August 2017, had recruited 4758 patients encompassing 97% of immunology centres within the United Kingdom. This represents a doubling of recruitment into the registry since we reported on 2229 patients included in our first report of 2013. Minimum PID prevalence in the United Kingdom is currently 5·90/100 000 and an average incidence of PID between 1980 and 2000 of 7·6 cases per 100 000 UK live births. Data are presented on the frequency of diseases recorded, disease prevalence, diagnostic delay and treatment modality, including haematopoietic stem cell transplantation (HSCT) and gene therapy. The registry provides valuable information to clinicians, researchers, service commissioners and industry alike on PID within the United Kingdom, which may not otherwise be available without the existence of a well-established registry.

The United Kingdom Primary Immune Deficiency (UKPID) Registry: report of the first 4 years' activity 2008-2012.

This report summarizes the establishment of the first national online registry of primary immune deficency in the United Kingdom, the United Kingdom Primary Immunodeficiency (UKPID Registry). This UKPID Registry is based on the European Society for Immune Deficiency (ESID) registry platform, hosted on servers at the Royal Free site of University College, London. It is accessible to users through the website of the United Kingdom Primary Immunodeficiency Network (www.ukpin.org.uk). Twenty-seven centres in the United Kingdom are actively contributing data, with an additional nine centres completing their ethical and governance approvals to participate. This indicates that 36 of 38 (95%) of recognized centres in the United Kingdom have engaged with this project. To date, 2229 patients have been enrolled, with a notable increasing rate of recruitment in the past 12 months. Data are presented on the range of diagnoses recorded, estimated minimum disease prevalence, geographical distribution of patients across the United Kingdom, age at presentation, diagnostic delay, treatment modalities used and evidence of their monitoring and effectiveness.

Practice of venom immunotherapy in the United Kingdom: a national audit and review of literature.

BACKGROUND: Venom immunotherapy (VIT) is the only effective treatment for prevention of serious allergic reactions to bee and wasp stings in sensitized individuals. However, controversies exist relating to diagnosis, indications for treatment and treatment schedules. We audited current practice of VIT in the United Kingdom to evaluate adherence to international guidelines. METHODS: An online questionnaire was sent to all clinicians practising immunotherapy identified on the British Society of Allergy and Clinical Immunology website. Eighty-six questionnaires were sent and 53 responses (61.6%) were received. Of these, 48 (85%) carried out VIT at their centre. RESULTS: Skin prick tests (SPT) and serum venom-specific IgE (SSIgE) were equally preferred as first-line investigation. Fifty percent of the respondents perform intradermal tests if both SPT and SSIgE are negative. While 8% of respondents commence VIT in patients with negative SSIgE and a history of severe reaction, 57% prefer to repeat the tests in 6-12 months if serum tryptase is elevated. If the insect responsible is uncertain and SSIgE is detected against bee and wasp venoms, 22% of the respondents will desensitize to both while 32% initiate treatment against the venom with the higher SSIgE. A protocol of weekly up-dosing for 12 weeks is preferred for induction and only 25% of respondents have ever used rush or ultra-rush protocols. Three years is thought to be optimum duration of VIT by most (56%). Eleven percent perform sting challenges at the end of treatment. Although 47% measure SSIgE at the end of treatment, only 3% use these results as a basis for discontinuing VIT. CONCLUSION: Currently there is considerable variation in the diagnosis and management of hymenoptera venom allergy in the United Kingdom. This audit has demonstrated that the current international guidelines for the diagnosis and management of hymenoptera venom allergy are not being followed by UK allergy practitioners.

Cumulative incidence of venous thromboembolism during pregnancy and puerperium: a hospital-based study.

Pregnancy is associated with an increased risk of venous thromboembolism. The rate of occurrence of this complication has not been reported from this area previously. The aim of this study was to establish the incidence of venous thromboembolism in pregnancy and puerperium by using objective diagnostic methods. From January 1986 to December 1998, 39,757 deliveries were registered at King Fahad Hospital, Al Baha, and 59 of these were referred to hematology services with a clinical suspicion of venous thromboembolism. The majority (86%) of these underwent objective diagnostic methods such as ascending venogram (AV) and color Doppler imaging (CDI) of the venous system for the diagnosis of deep venous thrombosis (DVT). Pulmonary scintigraphy was performed when available and echocardiography was included towards the end of the study. Fifty-nine patients with suspicion of pregnancy-associated venous thromboembolism (PAVTE) were studied. The diagnosis was confirmed in 50 patients, who received anticoagulation therapy. DVT was diagnosed in 35 (70%) cases and pulmonary embolism in 27 (54%) cases. The cumulative incidence of PAVTE was 1.25 cases per 1,000 deliveries (95% confidence interval = 0.89-1.16). One patient died during the study period (0.025 case per 1,000 deliveries). There was a predominance of venous thromboembolism during the postpartum period (66%), and DVT occurred more frequently in the left leg (77%). The risk of pregnancy-associated venous thromboembolism is low and a resulting death rare. Proximal or whole-limb DVT occurs more frequently and there is a predilection for the left leg. The majority of events occur in the postpartum period. A hypercoagulable state probably exists and needs further evaluation.

Molecular analysis of Peptostreptococcus micros isolates from patients with periodontitis.

BACKGROUND: Recent studies provide strong evidence implicating Peptostreptococcus micros in the pathogenesis of various oral infections, including oropharyngeal abscesses and periodontal disease. To date, very little is known regarding the role of P. micros in periodontal disease. Therefore, a genetic analysis was initiated to differentiate among strains of P. micros infecting periodontal patients. METHODS: Sixty DNA samples of P. micros isolated from 15 patients with periodontal disease were evaluated. Arbitrarily primed polymerase chain reactions (AP-PCR) were performed using primer 3 (AGTCAGCCAC) and primer 13 (CAGCACCCAC). The PCR products were analyzed by gel electrophoresis. RESULTS: The primers produced several unique patterns among the strains tested. Primer 3 resulted in 30 different patterns, whereas primer 13 resulted in 31 different patterns, which were distinct from those seen with primer 3. In 8 of 15 patients, the PCR profile was identical for all isolates cultured from that patient, indicating a clonal infection. In 4 of 15 patients, 2 different genotypes were identified. In the remaining 3 patients, all isolates cultured from these patients exhibited a unique genotype. CONCLUSIONS: While P. micros appears to be heterogeneous throughout a population of periodontal patients, each patient is, for the most part, infected with a limited number of genotypes. These results demonstrate the genetic diversity of P. micros and the usefulness of AP-PCR for future epidemiological studies in understanding the role P. micros plays in periodontal disease pathogenesis.

Furazolidone toxicosis in female Japanese quail (Coturnix coturnix japonica): pathomorphological changes in reproductive tract and reversibility of the induced changes.

Female Japanese quail (Coturnix coturnix Japonica) placed in 3 equal groups were given 600, 400 or 0 mg furazolidone (Fz)/kg feed for 4 w and then withdrawn for another 4 w. Another (pair-fed) group of same size was given basal feed as much as was consumed by the quail fed 600 mg Fz/kg feed. Fz feeding decreased body weight, feed intake and egg production. Ovaries of the Fz-fed quail decreased in weight and size and were studded with small follicles. Magnum, isthmus and uterus in Fz-fed groups had decreased area, height and number of mucosal folds compared with the control group. Microscopically, in Fz-fed groups, the mucosal glands in magnum and isthmus had decreased cell height with centrally located nuclei and foamy cytoplasm. In the 600 mg Fz-fed group, some birds had atrophy of the glandular tissue in the mucosa and infiltration of mononuclear cells and fibroblasts. Upon cessation of the Fz feeding, all parameters reversed gradually and became non-significantly different from control quail. These observations suggested that Fz-induced changes in mature female quail were reversible.