Performance of the Abbott RealTime CT/NG for detection of Chlamydia trachomatis and Neisseria gonorrhoeae.

A multicenter clinical study was conducted to evaluate the performance characteristics of the Abbott RealTime CT/NG assay, a multiplex real-time PCR assay, for simultaneous detection of Chlamydia trachomatis and Neisseria gonorrhoeae. The specimens were collected from a total of 3,832 male and female subjects at 16 geographically diverse sites. Specimens included male and female urine samples, male urethral swabs, female endocervical swabs, and self-collected and clinician-collected vaginal swabs. Specimens were tested with the automated Abbott RealTime CT/NG assay, Aptima Combo 2 assay (Gen-Probe), ProbeTec ET CT/GC assay (Becton Dickinson), and culture for N. gonorrhoeae. The Aptima Combo 2 assay, the ProbeTec assay, and the N. gonorrhoeae culture were used as the reference assays. For each subject, a patient infected status (PIS) was determined based on the combined results from the reference assays. The overall prevalence in female subjects was 8.9% for C. trachomatis and 3.8% for N. gonorrhoeae. The overall male prevalence was 18.2% for C. trachomatis and 16.7% for N. gonorrhoeae. The overall sensitivity and specificity of the Abbott RealTime CT/NG assay were 92.4% and 99.2% for C. trachomatis and 96.9% and 99.7% for N. gonorrhoeae, respectively. In comparison, the sensitivity and specificity, respectively, for the Aptima Combo 2 assay were 94.5% and 99.0% for C. trachomatis and 96.1% and 99.5% for N. gonorrhoeae, and those for the ProbeTec ET assay were 90.3% and 99.5% for C. trachomatis and 92.0% and 97.3% for N. gonorrhoeae in this study. The Abbott RealTime CT/NG assay offers C. trachomatis and N. gonorrhoeae dual detection with high sensitivity and specificity. The automated assay provides a useful alternative nucleic acid amplification assay for clinical laboratories and clinicians.

Factors predicting 6-month retention among people with opioid use disorders accessing outpatient methadone maintenance therapy in Tshwane, South Africa.

BACKGROUND: In South Africa (SA), increasing illicit opioid use and associated health challenges can be managed with opioid substitution therapy (OST), such as methadone, if the recommended dose and duration of use are prescribed. The Community Oriented Substance Use Programme (COSUP) provides free methadone to patients with opioid use disorder in Tshwane, SA, on need-based criteria. OBJECTIVES: To determine selected sociodemographic and substance use treatment factors associated with retention for at least 6 months among participants receiving methadone as part of OST in COSUP. METHODS: This was a retrospective cohort study using secondary data of patients treated with methadone at 8 COSUP sites. The factors associated with at least 6 months' retention for 575 participants from December 2016 to September 2018 were analysed. RESULTS: There were 91.3% males, 86.4% South Africans and 85.9% black Africans, with a median age of 30 years. At baseline, the majority were injecting heroin (55.5%) and were provided with free methadone (59.3%). The median dose of methadone at 6 months or on leaving the programme was 20 mg; 38.4% of participants were retained for at least 6 months. Of those not retained, the median duration on methadone was 56 days, whereas for those retained for at least 6 months, the median number of days on methadone were 254. After adjusting for sex and age, participants receiving methadone doses <50 mg had lower odds of being retained (0 - 20 mg: adjusted odds ratio (aOR) 0.25; p=0.002; 95% confidence interval (CI) 0.10 - 0.61; >20 - 40 mg: aOR 0.20; p<0.001; 95% CI 0.08 - 0.49) than those administered ≥50 mg. Participants who received free methadone had 3.75 the odds of being retained than those buying it themselves (p<0.001; 95% CI 2.47 - 5.70). Participants treated in the inner city had 5.19 the odds of being retained than those in a suburban setting (p<0.001; 95% CI 2.99 - 9.03). Compared with black African participants, white participants had 3.39 the odds of being retained (p=0.001; 95% CI 1.64 - 7.00). Injecting heroin users had 0.63 the odds of being retained (p=0.032; 95% CI 0.41 - 0.96). CONCLUSIONS: To maximise retention on OST, methadone should be free, with maintenance doses >50 mg. Reasons for lower retention among participants from periurban settings, those who inject and those from previously disadvantaged racial groups need to be explored, and findings used to inform programming.

Practice choices of clinical associates: Policy realisation or practical reality?

BACKGROUND: The Bachelor of Clinical Medical Practice (BCMP) programme was introduced in South Africa as a strategy to fill human resource gaps in both the public sector and rural communities. A previous study explored the practice intentions of BCMP students from one university prior to graduation. OBJECTIVES: To determine whether the actual practice choices of these BCMP graduates reflect their practice intentions. METHODS: A cross-sectional analytical study invited all graduates from the four cohorts of BCMP graduates (N=250) who graduated during the period 2011 - 2014 to complete an online survey. Data were exported and analysed using Stata 13. Chi-square tests of independence were done to explore associations in the data. RESULTS: More than 80% of participants were currently employed in the public sector, with over 50% in rural settings. Factors such as where clinical associates spent most of their lives (i.e. where they were born and raised) and bursary obligations influenced their current practice choices. There was no association between gender and rural practice choice. Intention to emigrate was not associated with origin, gender or race. Almost 90% of participants indicated an interest in furthering their studies; 46% of these intended a change in career, with 65% interested in studying medicine. CONCLUSIONS: The practice choices of the first four cohorts of this degree were similar to their intended practice choices. Although the policy intentions of public sector employment and rural practice have been met, it is not clear what will happen once bursary obligations are fulfilled. The reasons for increased intentions to change career need further research, as a change of career would countermand gains achieved in implementing the policy.

Amrinone-associated thrombocytopenia: pharmacokinetic analysis.

Amrinone-associated thrombocytopenia is thought to result from nonimmune-mediated peripheral platelet destruction. Platelet destruction may be a concentration-dependent toxic effect of amrinone or its principal metabolite N-acetylamrinone. Eighteen children receiving amrinone after heart surgery were prospectively evaluated to correlate the pharmacokinetics of amrinone and N-acetylamrinone with thrombocytopenia. Amrinone and N-acetylamrinone plasma concentrations were determined by HPLC during loading, infusion, and terminal elimination, with concurrent monitoring of platelet counts. Thrombocytopenia developed in eight patients (platelet count, 66 +/- 17 x 10(9) platelets/L [mean +/- SD]). Peak and steady-state amrinone plasma concentration, amrinone total dose, duration of amrinone exposure, and amrinone area under curve (AUC) were similar between patients with and without thrombocytopenia. N-Acetylamrinone peak concentration, steady-state concentration, N-acetylamrinone AUC, and ratio of N-acetylamrinone to amrinone were greater in patients with thrombocytopenia. This association suggests that N-acetylamrinone, and not amrinone, may be the mediator of thrombocytopenia in children receiving amrinone.

Efficacy of oral acyclovir treatment of acute herpes zoster.

Oral acyclovir, 800 mg five times per day for seven days, was compared with placebo in a randomized, double-blind trial conducted at three centers in the United Kingdom. The study group consisted of 364 elderly immunocompetent patients with herpes zoster who were entered within 72 hours of the onset of rash. Acyclovir significantly reduced the times to last new lesion formation (p less than 0.01), loss of vesicles (p less than 0.01), and full crusting (p = 0.03). No significant hastening of rash healing was seen in those who started therapy later than 48 hours after the onset of rash. There was also a significant reduction pain during treatment with acyclovir (p = 0.02). Acyclovir produced no effects on the frequency or severity of post-herpetic neuralgia. No clinically important adverse effects of acyclovir were reported.

Mixed infiltrative and obstructive disease on high-resolution CT: differential diagnosis and functional correlates in a consecutive series.

Fourteen of 400 consecutive patients having high-resolution computed tomography (HRCT) with expiratory images showed findings of infiltrative lung disease on inspiratory HRCT and air trapping on expiratory CT. Diagnoses included hypersensitivity pneumonitis, sarcoidosis, atypical infection, and pulmonary edema. The extent of infiltrative abnormalities and air trapping were correlated with pulmonary function tests (PFT) in 11 patients. PFT indicated a mixed pattern in five, an obstructive pattern in three, and a restrictive pattern in three. Forced expiratory volume (FEV) in 1 second/forced vital capacity (FVC) correlated significantly with the extent of air-trapping (r = 0.60; p = 0.05). The extent of infiltrative abnormalities correlated significantly and negatively with forced vital capacity (r = -0.82, p = 0.002), FEV1 (r = -0.59, p = 0.05), total lung capacity (TLC) (r = -0.67, p = 0.05), and DLCO (r = -0.75, p = 0.02). Findings of lung infiltration on inspiratory HRCT scans and air trapping on expiratory CT correlated respectively with PFT measures of restrictive and obstructive lung disease.

Progress towards polio eradication: an African perspective.

Despite daunting competing health priorities, Africa has made significant progress in polio control. Northern and Southern Africa appear to be polio-free and may shortly be certified as such; however, polio still remains endemic in West and Central Africa and the Horn of Africa. Countries "in difficult circumstancess", wracked by major civil wars, have particularly low routine vaccine coverage, although NIDS have been carried out during negotiated days of tranquillity. AFP surveillance has also improved, although the quality of stool specimens is still far from ideal. There is, nevertheless, an extraordinary political commitment to the eradication campaign. Lessons from the history of polio in the continent need to be heeded in designing end-game strategies. Obstacles on the path to successful eradication are undoubtedly more formidable on the African continent--perhaps the most serious of all are the continuing wars. International political commitment and focussed and empowering developmental aid are urgently needed.

Modes of death in the pediatric intensive care unit: withdrawal and limitation of supportive care.

OBJECTIVE: To determine the frequency of withdrawal or limitation of supportive care for children dying in a pediatric intensive care unit (ICU). DESIGN: Retrospective review of medical records. SETTING: Pediatric ICU in a tertiary care children's hospital. PATIENTS: All children dying in the pediatric ICU over a 54-month period (n = 300). INTERVENTIONS: Medical record review. MEASUREMENTS AND MAIN RESULTS: Data recorded for each patient included diagnosis, mode of death, and whether the child was brain dead. Each patient was assigned to one of the following mode of death categories: brain dead; active withdrawal of supportive care (meaning removal of the endotracheal tube); failed cardiopulmonary resuscitation; allowed to die without cardiopulmonary resuscitation (do-not-resuscitate status). A total of 300 patients were identified. Diagnoses included postoperative congenital heart disease (n = 56), head trauma (n = 38), near-miss sudden infant death syndrome (n = 28), pneumonia (n = 22), sepsis (n = 21), near-drowning (n = 21), various anoxic insults (n = 20), multiple trauma (n = 17), and patients with other diagnoses (n = 77). Mode of death was active discontinuation of support in 95 (32%) patients, do-not-resuscitate status in 78 (26%), brain death in 70 (23%), and failed cardiopulmonary resuscitation in 57 (19%). CONCLUSIONS: In a large, multidisciplinary pediatric ICU, the most common mode of death was active withdrawal of support. In addition, more than half (173/300, 58%) of children dying in the pediatric ICU underwent either active withdrawal or limitation (do-not-resuscitate status) of supportive care.

Age-related amrinone pharmacokinetics in a pediatric population.

OBJECTIVES: To measure the plasma concentrations of amrinone and N-acetyl-amrinone achieved using current pediatric dosing recommendations. To examine the pharmacokinetics of amrinone in an extended age range of pediatric patients. To examine any age-related differences in the relative contribution of hepatic metabolism vs. renal elimination of amrinone. DESIGN: Prospective study. SETTING: A pediatric intensive care unit in a tertiary care teaching hospital. PATIENTS: Thirty-one patients aged 4 days to 15 yrs who required a constant infusion of amrinone. INTERVENTIONS: Blood samples were obtained 15 mins after each 0.75 mg/kg loading dose, and every 6 hrs during a constant infusion of amrinone to measure plasma amrinone, N-acetyl-amrinone and N-glycolyl-amrinone concentrations by high-performance liquid chromatography. Blood samples to measure amrinone, N-acetyl-amrinone, and N-glycolyl-amrinone concentrations during elimination were also obtained at regular intervals after discontinuation of the infusion. Six-hour urine collections were obtained to measure amrinone renal clearance. MEASUREMENTS AND MAIN RESULTS: Plasma amrinone concentrations > or = 2 micrograms/mL were obtained in 13 of 14 patients after a 3-mg/kg loading dose. There was a six-fold variability in steady-state plasma amrinone concentrations in patients receiving the same ordered infusion rate. There was a significant (p = .001) difference between the ordered and measured amrinone infusion rates. Six (19.4%) of 31 patients had steady-state plasma amrinone concentrations of < or = 2 micrograms/mL. There was a large variability in the volume of distribution, clearance, and elimination half-life which did not appear to be age-related. Renal clearance of amrinone ranged between 0.4 and 2.18 mL/kg/min, and did not increase with age. There was no increase in the proportion of children with a high plasma steady-state N-acetyl-amrinone/amrinone ratio over time from 1 to 24 months of life. CONCLUSIONS: Administering a 3-mg/kg amrinone loading dose in four divided doses over 1 hr resulted in relatively rapid therapeutic plasma concentrations without excessively high concentrations and good clinical tolerance. The wide interindividual variation in clearance and volume of distribution resulted in a variable dose-concentration relationship; children receiving lower amrinone infusion rates may-have subtherapeutic plasma steady-state concentrations. There did not appear to be any age-related change in renal clearance or hepatic metabolism of amrinone in children aged 1 to 24 months.