Use of GeneXpert and the role of an expert panel in improving clinical diagnosis of smear-negative tuberculosis cases.

SETTING: A high proportion of notified tuberculosis cases in the Philippines are clinically diagnosed (63%) as opposed to bacteriologically confirmed. Better understanding of this phenomenon is required to improve tuberculosis control. OBJECTIVES: To determine the percentage of smear negative presumptive tuberculosis patients that would be diagnosed by GeneXpert; compare clinical characteristics of patients diagnosed as tuberculosis cases; and review the impact that the current single government physician and a reconstituted Tuberculosis Diagnostic committee (expert panel) may have on tuberculosis over-diagnosis. DESIGN: This a cross-sectional study of 152 patients 15-85 years old with two negative Direct Sputum Smear Microscopy results, with abnormal chest X-ray who underwent GeneXpert testing and review by an expert panel. RESULTS: Thirty-two percent (48/152) of the sample were Xpert positive and 93% (97/104) of GeneXpert negatives were clinically diagnosed by a single physician. Typical symptoms and X-ray findings were higher in bacteriologically confirmed tuberculosis. When compared to the GeneXpert results the Expert panel's sensitivity for active tuberculosis was high (97.5%, 39/40), specificity was low (40.2%, 35/87). CONCLUSION: Using the GeneXpert would increase the level of bacteriologically confirmed tuberculosis substantially among presumptive tuberculosis. An expert panel will greatly reduce over-diagnosis usually seen when a decision is made by a single physician.

Role of bilastine in the management of allergic rhinitis and urticaria: an Asia-Pacific consensus statement.

The prevalence of allergic diseases is increasing globally, most particularly in middle- to low-income countries. This article examines the burden of allergic rhinitis and chronic urticaria in the Asia-Pacific region, unmet clinical needs, and the potential role of bilastine in the management of these conditions. An International Advisory Group meeting was convened in association with the Asian Pacific Society of Respirology Annual Congress in November 2014, followed by a literature review, and consensus-based outcomes from the meeting and literature review are described. Regional estimates of the prevalence of allergic rhinitis range from 10% to 50%, while little is known regarding the burden of urticaria in the Asia-Pacific region. A survey of allergy patients in the region identified fast, complete, and long-lasting symptom relief as the medication attributes most important to patients. International treatment guidelines for allergic rhinitis and urticaria advocate the first-line use of second-generation, no-sedating H1-antihistamines, such as bilastine, over their first-generation counterparts and a range of these agents are available to Asia-Pacific patients. The newer agents possess many of the properties of an "ideal" antihistamine (once daily administration, rapid and complete symptom relief, limited potential for drug-drug interactions, minimal side effects). The burgeoning prevalence of allergic diseases in the Asia-Pacific region and the uncontrolled symptoms that these patients experience demand a new antihistamine that offers the highest number of positive features according to the international guidelines.

Prevalence of asthma among Filipino adults based on the National Nutrition and Health Survey (NNHeS)

BACKGROUND: Prevalence surveys are important to aid in assessing the current burden of diseases, which will impact on the public health agenda as well as preventive interventions and health policies. Three previous local surveys on asthma prevalence of Filipino adults have been carried out. This is the fourth local survey and is also a part of the second NNHeS study, which is carried out every five years. The purpose of the survey is to determine the trend in asthma prevalence and to aid in formulating and evaluating local initiatives.OBJECTIVE: To determine the prevalence of asthma among Filipino adultsMETHODOLOGY: Using a multi-staged cluster sampling methodology, this study evaluated 7,202 adults at least 20 years old, from 3,744 households, 79 provinces and 17 regions. A pre-validated written questionnaire for wheezing among children based on the International Study of Asthma and Allergies of Childhood (ISAAC) was used as the survey instrument. This instrument was adopted since it has been widely used as a case definition for asthma, which allows for comparison of prevalence outcomes across time and population.RESULTS: The overall prevalence of asthma based on wheezing for the past 12 months was 8.7% (SE 0.4%). Males had a higher prevalence of wheezing for the past 12 months at 9.4% (SE 0.5%) compared to females at 8.2% (SE 0.5%). The overall prevalence of asthma based on wheezing at any time was 14.3% (SE 0.5%). Males had a higher prevalence of wheezing at any time of 14.8% (SE 0.7%) compared to females at 13.8% (SE 0.6%). The prevalence of adult asthma in the rural area was slightly higher than in the urban area (15.3% vs 13.3%), but the difference was not statistically significant.CONCLUSION: The overall prevalence of adult asthma in the Philippine based on the second NHHeS is 8.7%. This figure is lower than previous reported local prevalence data. The prevalence of adult asthma in the rural and urban setting is almost similar.

Prevalence of allergic rhinitis in Filipino adults based on the National Nutrition and Health Survey 2008.

BACKGROUND: There has been no documented data on the prevalence of allergic rhinitis among Filipino adults. OBJECTIVE: The objective of this study is to determine the prevalence of allergic rhinitis among adults in the Philippines. METHODS: Using a multi-staged cluster sampling methodology, this study evaluated 7,202 adults from 3,744 households, 79 provinces and 17 regions. A pre-validated written questionnaire for allergic rhinitis based on the International Study of Asthma and Allergies of Childhood was used as the survey instrument. RESULTS: The response rate obtained from the interview was 94.1%. The overall prevalence of nose symptoms in the past 12 months was 20% while prevalence of nose symptoms at any time in the past was 23.8%. The proportion among both sexes was similar. The prevalence was highest among the respondents 40-49 years old. The overall prevalence of nose and eye symptoms for the past twelve months was 14.0%. The prevalence of respondents who reported presence of nose problems for the past twelve months was similar across the 12 months of the year with highest rates noted in the months of June and May. Respondents from the rural area (22.1%) reported a higher prevalence of nose symptoms for the past twelve months compared to respondents from urban area (18%). There was no significant difference in prevalence of nose symptoms among residents living in coastal and/or inland areas. CONCLUSION: The overall prevalence of allergic rhinitis in the Philippines based on the 2008 National Nutrition and Health Survey is 20.0%.