Effectiveness and cost effectiveness of screening immigrants schemes for tuberculosis (TB) on arrival from high TB endemic countries to low TB prevalent countries.

BACKGROUND: Immigrants to developed countries are a major source of TB. Therefore amongst strategies adopted for TB control in developed countries include; 1) Screening immigrants at ports of entry referred to as "Port of Arrival Screening" (PoA) and 2) Passive screening (PS) for TB which means screening immigrants through general practices, hospitals, chest-clinics and emergency departments. Evidence of the effectiveness and cost effectiveness of these strategies is not consistent. OBJECTIVE: Evaluate efficiency of active PoA TB screening for immigrants from TB endemic-regions compared with Passive Screening of immigrant-populations from TB endemic-regions. METHODS: Major electronic-databases and reference lists of relevant studies were searched. Experts of immigrants' TB screening were contacted for additional studies published or unpublished. Systematic search of major databases identified only retrospective cohort-studies. Their qualities were assessed using Scottish Intercollegiate Guidelines Network (SIGN) methodological checklist for comparative cohort-studies. RESULTS: Systematic electronic searches identified 1443 citations. Of these 74 studies were retrieved for evaluation against the review's inclusion/exclusion criteria (see study inclusion/exclusion criteria). Four studies met the inclusion criteria (figure 2) which were low in the evidence hierarchy of primary effectiveness studies and had heterogeneities between them. Thus descriptive data-synthesis was performed. Proportionately PoA screening had the lowest percentage of receipt of tuberculin skin test (TST) and the highest percentage of non-attendance for TST reading (table 2). Active PoA screening reduced infectiousness by 34% compared to 30% by passive screening and new entrants screened at PoA were 80% less likely to be hospitalised Odds ratio (OR) = 0.2 (95% confidence interval (CI) 0.1 - 0.2). [Table: see text]. ECONOMIC ANALYSIS: One cost effectiveness analysis was found that compared the costs of; active PoA screening, general practice screening and homeless screening groups. The cost of detecting a case of TB were; £1.26, £13.17 and £96.36 for PS, homeless screening and active PoA screening respectively. The cost of preventing a case of TB were; £6.32, £23.00 and £10.00 for PS, homeless screening and PoA screening respectively, showing there is little difference between the different strategies. CONCLUSION: Active PoA screening is worth doing with significant benefits including early identification of risk groups with possible timely treatment/chemoprophylaxis intervention, prevention of transmission by significantly reducing infectiousness with subsequent avoidance of hospitalisation in active PoA screening group.

Recombinant activated factor VII as treatment for intractable haemorrhage.

The objective of this study was to determine the outcome of patients treated with recombinant activated factor VII (rFVIIa) to promote haemostasis in intractable bleeding associated with trauma injury or other causes. The medical records of 44 consecutive patients treated with rFVIIa were retrospectively reviewed for blood product use before and after treatment. A statistically significant decrease in blood product transfusion was evident in 23 trauma patients and 21 patients with other causes of bleeding who survived more than 4 hours after rFVIIa infusion. Although 10/23 trauma patients and 12/21 other causes patients died, between 2 and 50 days after rFVIIa infusion, these deaths were due to causes other than haemorrhage. The early use of rFVIIa was associated with decreased 50-day mortality in patients with severe trauma requiring massive transfusion, but was not associated with increased risk of severe thrombotic events.

Toxicity studies in mice of common spices, Cinnamomum zeylanicum bark and Piper longum fruits.

Acute (24 hours) and chronic (90 days) oral toxicity studies on the ethanolic extracts of common spices Cinnamomum zeylanicum Nees bark and Piper longum L. fruits were carried out in mice. Acute dosages were 0.5, 1.0 and 3 g/kg while the chronic dosage was 100 mg/kg/day. All external morphological, hematological and spermatogenic changes, in addition to body weight and vital organ weights, were recorded. The extracts of both the plants caused no significant acute or chronic mortality compared to the control during this study. During chronic treatment there was no significant change in the pre- and post treatment body weight of the test animals while the weight gain in the control group was significant. C. zeylanicum treatment caused reduction in liver weight while P. longum caused a significant increase in the weight of the lungs and spleen of the treated animals compared to the control. Hematological studies revealed a significant fall in hemoglobin level of C. zeylanicum treated animals. Both of the extracts induced a significant increase in reproductive organ weights, sperm motility, sperm count and failed to illicit any spermatotoxic effect.

The effect of repeated-dose activated charcoal on the pharmacokinetics of sodium valproate in healthy volunteers.

AIMS: We investigated the effects of repeated-dose charcoal administered several hours after sodium valproate on the pharmacokinetics of a single dose of the drug in healthy volunteers. METHODS: The pharmacokinetics of sodium valproate were studied in seven healthy volunteers after administration of a syrup (300 mg) on two occasions, one of which was followed by administration of repeated doses of oral charcoal starting 4 h after the drug up to 32 h (total dose 80 g). RESULTS: Valproate was rapidly absorbed with maximum concentrations 1 h after administration. The area under the plasma concentration-time curve to 48 h (AUC (0.48 h)) was 408 +/- 114.5 (s.d.) mg l-1 h in the control phase and 398 +/- 108.6 mg l-1 h after charcoal and the t1/2 elimination was 20 +/- 6.8 h in the control phase, and 22 +/- 9.2 h after charcoal (NS). CONCLUSIONS: Repeated-dose activated charcoal does not appear to enhance the rate of elimination of sodium valproate after therapeutic doses of the drug and any beneficial effect of charcoal in overdose may be to prevent absorption of valproate still present in the gut.

Morphological and anatomical studies on larval trematode of genus Brachylaima (Brachylaimidae) from the land snail, Monacha obstructa.

The metacercariae of genus Brachylaima were collected from the kidney of the land snail Monacha obstructa. About thirteen to fifteen metacercariae were collected from each snail. The metacercariae observed were elongated rather than oval. The gonads were no so developed inspite of the great similarity between this larval stage and the adults. No larval stages rather than the metacercariae were observed. The specimens were examined in fresh status and then stained with carmine and fast green as counter stain. The excretory system was developed to very great extent. This seems to be the first record of this larval stage in Egypt since 1899 when Looss collected the adult of B. aequans from Gerbillus aegyptiacus. The heavy infection of snails reflects the higher incidence of this parasite among land snails as intermediate host. Since, the life cycle of this parasite is not yet confirmed experimentally in Egypt, the species has not been identified.

The histopathological effect of metacercariae of the genus Brachylaima on the land snail, Monacha obstructa.

The histopathological changes in the kidney of the land snail Monacha obstructa and the histochemistry of the body wall of the parasite were studied. The histological pictures of the infected kidney showed extensive degree of degeneration in the renal tissue with multiple necrotic foci. Due to the mechanical and feeding effects of the parasite, the renal lamellae were disintegrated. Also, suckers increased the renal damage. In some levels of the kidney, the renal tissue was completely disappeared except the connective tissue of kidney capsule. Also, it was observed that there was a clear space between the parasites and renal tissue probably as a trial of evasion from the Host's reaction. The histochemical study on the metacercarial body wall revealed that it is consisting of three layers arranged as outer, middle and inner layers. Staining with Periodic Acid Schiff proved that the body wall is rich in mucopolysaccharide content. The idea that this parasite can be used as a biocontrol agent is also discussed.

Larval stages of digenetic trematodes of Pirenella conica from Deversoir Ismailia, Egypt.

Two cercariae are described from the prosobranch snail Pirenella conica collected from Deversoir marine-water, Ismailia, Egypt. One of the ercariae is prepleuro-lophoercous group, belonging to genus Stictodora, while the second is a Ephemera monostome cercaria. The latter is a new record for Pirenella conica snail in marine water from Ismailia. Details are present on the morphology and behavior of the cercariae and rediae, as well as of their development within the snail, with discussion and comparison of previously described cercariae. The incidence of single (pure) and simultaneous mixed (double) infection of snail with two larval trematodes were also determined.

High rate of rifampicin resistance of Mycobacterium tuberculosis in the Taif region of Saudi Arabia.

This retrospective study was undertaken to determine the prevalence and pattern of resistance to antituberculosis drugs among patients with sputum-proven pulmonary tuberculosis who were seen in Taif Chest Hospital over 24 months (between June 1986 and May 1988). The overall prevalence was 22.6% and the majority (53%) were resistant to two drugs. Resistance to streptomycin was most frequent (16%) followed by rifampicin (15%). Resistance to isoniazid was surprisingly low (6.5%). 23.3% of the resistant group had previously received antituberculosis drugs as against 15.4% in the sensitive group. There was a significant association between previous therapy and resistance to antituberculosis drugs. Recommendations to reduce the problem of resistance and to improve compliance are discussed.

The effects of charcoal and sorbitol (alone and in combination) on plasma theophylline concentrations after a sustained-release formulation.

1. The effects of charcoal and sorbitol, alone and in combination, were investigated in eight healthy female volunteers who received 600 mg slow-release theophylline (two 300 mg capsules). 2. The area under the plasma concentration time curve to 24 h (AUC0-24) after theophylline alone was significantly greater than after both the charcoal and charcoal plus sorbitol phase. 3. Charcoal and charcoal with sorbitol also significantly reduced the maximum plasma theophylline concentration (Tmax) and time to maximum concentration (Cmax). 4. Sorbitol significantly increased Cmax and shortened Tmax. 5. Although sorbitol did not reduce the adsorptive efficacy of charcoal, its use alone may be deleterious in poisoning with sustained-release theophylline products.

Drug adsorption to charcoals and anionic binding resins.

1. The in-vitro binding of four drugs with differing physiochemical properties to two commercial charcoal preparations and two anionic binding resins was studied at 37 degrees C and pH 7.4. 2. The two charcoal preparations (Carbomix and Medicoal) behaved similarly and adsorbed metoclopramide and antipyrine to a greater degree than warfarin or paracetamol. 3. Cholestyramine had a significantly greater maximum adsorption capacity (K2) for warfarin and significantly lower adsorption capacity for paracetamol and metoclopramide than did the charcoals. 4. Colestipol behaved similarly but also bound metoclopramide to a significantly greater extent than did either cholestyramine or charcoal and antipyrine to a significantly lesser extent than did Carbomix. 5. There appeared to be no consistent relationship between the maximum adsorption capacity of the adsorbents for the drugs tested and the physicochemical properties of those drugs (e.g. basic or acidic structure, pKa or molecular weight).