Contact investigation based on serial interferon-gamma release assays (IGRA) in children from the hematology-oncology ward after exposure to a patient with pulmonary tuberculosis.

BACKGROUND: Interferon-gamma release assays (IGRAs) have high specificity and sensitivity for the diagnosis of tuberculosis (TB) infection. However, their role as a screening tool in children with immunodeficiency disorders is still unclear. In the present study, we performed a contact investigation using serial IGRAs on children with immunodeficiency conditions exposed to a contagious TB patient. METHODS: Children who were exposed to a contagious TB case underwent serial QuantiFERON(®) TB Gold In-Tube (QFT-GIT) and T-SPOT(®).TB (T-SPOT) testing. RESULTS: Eighteen children were tested. At the first testing, only two children (11 %) were positive to T-SPOT. Indeterminate results were more frequent with QFT-GIT (35 %) than with T-SPOT (12 %). In the multivariable analysis, a statistically significant association of lymphocyte count <500 cells/mm(3) (p < 0.00005) and low age (p = 0.03) with indeterminate results for the QFT-GIT test but not for T-SPOT (p = 0.10 and p = 0.88, respectively) was found. At the end of October 2012, 15 of the 18 children were alive and none developed active TB disease. CONCLUSION: T-SPOT provided more determinate results and was less influenced by low age and lymphocytopenia than QFT-GIT in this population of immunodeficient children. These findings suggest that T-SPOT is a more accurate test for the identification of TB infection in young children with lymphocytopenia and should be preferred to QFT-GIT under such specific conditions.

Evaluation of use of antibiotics without prescription among young adults in Albania case study: Tirana and Fier District.

BACKGROUND: Self-medication is defined as the utilization of drugs to treat self-diagnosed disorders or symptoms, or the irregular or continuous use of a prescribed drug for chronic or repeated diseases or symptoms. The main problem with self-medication with antimicrobials is the emergence of pathogenic resistance. Antimicrobial resistance is an existing problem world-wide, mainly in developing countries. The aims and objectives of the study presented in this article are to evaluate the prevalence of purchase of antibiotics without prescription and appropriateness of use among adults and to determine the impact of the education level on the sensibility level over the use of antibiotics. METHODS: This was a questionnaire based study of 3 month duration. The study includes data from 350 young adults (182 men/172 women, mean age ± SD: 34.72 ± 13.7 years), who visited ten different pharmacies located in the city of Tirana and the "Olympus" Private Medical Clinic in Fier between December 2012 and March 2013. Also a part of questionnaires was distributed by e-mail. RESULTS: The results of this study showed that out of 350 young adults, 273 (78.14%) of them used antibiotics as self medication. The most common reasons for self administration of antibiotics were fever 171 (29.23%), sore throat 170 (29.06%) and cough 83 (14.19%). In this study we observed that the most common source of information regarding self-medication is the pharmacy (community pharmacists) 166 (36.40%) and most common antibiotic used as self-medication is amoxicillin 70 (19.39%). Authors also determined the impact of education level over the use of antibiotics. The results showed that adults with low and medium education level (7.986% and 43.056% respectively) were most likely to use antibiotics as self-medication. CONCLUSIONS: The findings from this study highlight the striking prevalence of self-medication among young adults in Albania and the lack of awareness about the risks associating their use. We recommend that a holistic approach must be taken to prevent this problem from escalating which would involve awareness and education regarding the implications of self medication, strategies to prevent the supply of medicines without prescription by pharmacies and strict rules regarding pharmaceutical advertising.Hippokratia 2014; 18 (3): 217-220.