Challenges in the provision of tuberculosis preventive therapy to children in Gauteng Province, South Africa

Background. Tuberculosis preventive therapy (TPT) offered to children who come into contact with infectious adult pulmonary tuberculosis (TB) cases is an important childhood TB prevention strategy. Objectives. To document paediatric TPT coverage as per South African national TB guidelines, to measure basic knowledge of TPT in adult TB patients and healthcare workers (HCWs), and to determine challenges in TPT delivery in eligible children. Methods. We conducted a descriptive, cross-sectional study at primary healthcare clinics in South-West Tshwane, Gauteng Province, South Africa (SA). Structured interviews were conducted with adult TB patients to obtain socio-demographic data, TB and HIV history, data on child contacts and TPT knowledge. A separate questionnaire probed HCWs' knowledge of TPT. Patient folders and the clinical process flow of adult TB cases and children on TPT were also assessed. Results. We interviewed 100 adult TB patients and identified 28 child contacts who were eligible for TPT, including six children (21%, n=6/28) on TPT, all HIV-uninfected and <5 years of age. Instability in household configuration was the most common reason for eligible children not having been brought to health facilities for assessment (57%; n=4/7). Almost all adult TB patients were aware of their TB diagnosis (98%; n=98/100), but only half (48%; n=48/100) had knowledge of their TB type, and 55% (n=6/11) of the adult TB patients with drug-resistant TB were aware of the drug resistance. In addition, we interviewed 71 HCWs, and more than one-third of HCWs (37%; n=26/71) were fully knowledgeable about paediatric TPT eligibility criteria, with 63% (n=45/71) unaware that HIV-infected children of all ages qualified for TPT after exposure. Conclusions. TPT provision in eligible child TB contacts in an urban district in SA was found to be suboptimal, especially for HIVinfected children. Instability in household configuration was an important reason for suboptimal TPT provision. Training of HCWs on paediatric TPT guidelines is required, together with knowledge sharing on TPT with the TB patients

Novel PF74-like small molecules targeting the HIV-1 capsid protein: Balance of potency and metabolic stability

Of all known small molecules targeting human immunodeficiency virus (HIV) capsid protein (CA), PF74 represents by far the best characterized chemotype, due to its ability to confer antiviral phenotypes in both early and late phases of viral replication. However, the prohibitively low metabolic stability renders PF74 a poor antiviral lead. We report herein our medicinal chemistry efforts toward identifying novel and metabolically stable small molecules targeting the PF74 binding site. Specifically, we replaced the inter-domain-interacting, electron-rich indole ring of PF74 with less electron-rich isosteres, including imidazolidine-2,4-dione, pyrimidine-2,4-dione, and benzamide, and identified four potent antiviral compounds (

Intermediate-term outcome of Aurolab aqueous drainage implant

Purpose: To report the intermediate-term safety and efficacy of Aurolab aqueous drainage implant (AADI) in patients with glaucoma. Methods: Retrospective review of patients who underwent AADI between January 2013 and December 2016. Patients aged >16 years and with a minimum follow-up of 6 months were included. Success was defined as complete when the intraocular pressure was ?6 and ?21 mmHg without antiglaucoma medication and as qualified if those requiring additional antiglaucoma medications were included. Results: The study included 55 patients (55 eyes) with a mean age � standard deviation (SD) of 47.3 � 18.1 years with a mean follow-up of 16.7 � 11.4 months. Mean intraocular pressure reduced from 30.8 � 11.1 mmHg to 13.1 � 4.7, 14.1 � 4.8, 15.7 � 2.5 (P < 0.001) mmHg at 6 months, 1 year, and 2 years, respectively. The mean number of antiglaucoma medications reduced from 3.4 � 1 to 0.8 � 1.2, 0.7 � 1.1, 0.8 � 1 (P < 0.001) at 6 months, 1 year, and 2 years, respectively. The cumulative probability of complete and qualified success was 62% and 100% at 6 months, 54% and 92% at 1 year, and 43% and 88% at 2 years, respectively. Four patients failed during the follow-up period. Postoperative complication occurred in 28 eyes (51%), of which 17 eyes (31%) required intervention. Conclusion: AADI is a safe and effective treatment for the control of intraocular pressure in patients with glaucoma.

Posttraumatic symptomatology of a rural Filipino population in Merida, Leyte in the wake of Super Typhoon Yolanda (Haiyan)

Objectives@#The goal of the research was to provide local data on the varieties of posttraumatic symptomatology among survivors of Super typhoon Haiyan in a rural community in Merida, Leyte.@*Methodology@#This is a single point non-invasive study of Filipino survivors of typhoon Yolanda who came from Merida, Leyte, involving administration of a symptom checklist i.e. Post Traumatic Stress Disorder Checklist- Civilian version (PCL-C) to assess the occurrence of posttraumatic symptoms in the selected group of volunteers with no history of psychiatric illness. The PCL-C was given as part of a community screening for symptoms of PTSD conducted three months after the typhoon. There were two ways of scoring the PTSD Checklist- Civilian version (PCL-C) - either by computing for the total severity score or by scoring each response category just like one would in the Diagnostic and Statistical Manual (DSM IV TR) criteria. The sum of all PCL-C item scores indicated the severity of Post Traumatic Stress Disorder (PTSD). A score of 30 and above represented the occurrence of PTSD. T-test was used to determine differences in the severity scores of those who met the criteria for PTSD using the total "severity scoring method" and those who did not.@*Results@#A total of 29 respondents took part in the study where the majority were female (28/29 or 96.55%). The results showed that Filipinos suffered more re-experiencing symptoms but less avoidance symptoms compared to the DSM IV-TR criteria. Nine of 29 (31.03%) respondents were assessed as having Post Traumatic Stress Disorder (PTSD) based on the total "severity score method': However, none fulfilled the PTSD DSM IV TR criteria when the response "category scoring method" was used. Those who met the severity criteria had significantly higher scores in items 1 (Repeated, disturbing memories, thoughts, or images of a stressful experience from the past?), 3 (Suddenly acting or feeling as if a stressful experience were happening again?), 5 (Having physical reactions when something reminded you of a stressful experience from the past?), 6 (Avoid thinking about or talking about a stressful experience from the past or avoid having feelings related to it?) and 13 (Trouble falling or staying asleep?).@*Conclusion@#There seems to be a difference in how the Filipinos experience trauma compared to Western models such as described in the Diagnostic Symptom Manual (DSM IV TR) criteria though caution is warranted in interpreting the results due to the small sample size and the predominance of female respondents.

Systematic Review of Management of Otitis Media with Effusion in Children.

Aim: Otitis media with effusion in children can result in impairment of speech and language development secondary to the effects of conductive hearing loss from the disease. The review was conducted as part of a clinical practice guideline to assist healthcare providers in the management of this condition. Study Design: Systematic review. Place and Duration of Study: Development Group on Otitis Media with Effusion in Children Clinical Practice Guidelines, Medical Development Division, Ministry of Health Malaysia, between 17 August 2010 and 21 February 2012 Methodology: Literature search was carried out on multiple electronic databases. In addition, the reference lists of all retrieved articles were searched to identify relevant studies. Experts in the field were also contacted to identify further studies. All searches were officially conducted between 17 August 2010 and 21 February 2012. All literature retrieved was appraised using Critical Appraisal Skills Programme (Oxford) by at least two members and presented in the form of evidence tables and discussed during development group meetings. The articles used in this review were graded using the US/Canadian Preventive Services Task Force Level of Evidence [7]. Results: A total of 356 relevant titles were identified and 147 abstracts were screened Thirty one articles were used in the results. There was good evidence for non surgical intervention as the initial mode of management. It consists of active observation and medical therapy. Short term (less than six weeks) intranasal steroid can be used for otitis media with effusion (OME) with concurrent allergic rhinitis and adenoid hypertrophy (p<0.001). There was good evidence that oral steroids, prolonged intranasal steroids, antibiotics, antihistamines or decongestants, auto inflation, homeopathy and mucolytics are not beneficial. Surgical intervention should be considered after three months of persistent otitis media with effusion with in children with hearing loss >25 dB (at three frequency average). Myringotomy with ventilation tube (VT) insertion is the procedure of choice. Combined adenoidectomy should be considered in children with persistent OME and hypertrophied adenoids (p<0.001). Conclusion: The initial management of OME in children consists of active observation. Short term (up to 6 weeks) use of intranasal steroids can be used in children with concurrent adenoid hypertrophy or allergic rhinitis. Surgical management is considered after three months of persistent OME. Myringotomy with VT insertion is the procedure of choice.

Uncommon Sites for Body Stuffing: A Literature Review.

Introduction: ‘‘Body stuffing’ refers to concealment of illegal drugs within the human body to avoid arrest. Emergency physicians and law enforcement authorities should be aware of uncommon sites of concealment used to avoid detection. Methods: A literature search of Medline (Pubmed), Science Direct and the Cochrane databases was done, for articles relating to body packing or body stuffing of illegal drugs and sites of concealment. Results: A total of 55 full text articles and one abstract were reviewed after removing duplicates and non relevant titles. Seventeen articles were included in the results. Cocaine was the most common drug. Body stuffing is more common among males in the 3rd to 4th decade of life. The majority of cases, 99% (1144 cases), involved concealment in the oral cavity or ingestion. Unusual sites for body stuffing reported were the external auditory canal (5 cases), the rectum (3 cases), the superior oropharynx and glans penis (one case each). Complications reported are fatal toxicity, aspiration and oesophageal obstruction. Conclusion: Although uncommon, ear, nose and throat orifices have been used in body stuffing. Authorities and attending physicians should be aware that these orifices can be used to conceal drugs and proceed to a full otorhinolaryngologic examination if warranted.

Post-exposure prophylaxis against rabies at two newly designated intradermal rabies vaccination clinics in Kerala, India.

Background. The two-site intradermal rabies vaccination (IDRV) regimen was recently introduced in Kerala. We aimed to determine factors associated with exposure of category III severity among patients seeking prophylaxis against rabies at IDRV clinics. Methods. This hospital-based, cross-sectional study was done at two clinics in Thiruvananthapuram district, Kerala. Data were collected using a semi-structured questionnaire by direct interview and 320 patients were included. Bivariate analysis of quantitative variables was done using t-test and that of qualitative variables using chi-square test. Results. The mean (standard deviation) age of patients was 32.4 (19.6) years. Among the 320 cases, 202 (63.1%) had category III exposure. Lower extremities were the most frequent site of exposure (146, 45.6%). The most frequent mode of exposure was being bitten by an animal (214, 66.9%), often a dog. Residence in rural areas, exposure to dogs and wounds on the extremities had a significant association with severity of exposure. Conclusion. Animal exposures were more among people from rural areas. About two-thirds of exposures which necessitated post-exposure prophylaxis were category III.

Rickets: an overview and future directions, with special reference to Bangladesh. A summary of the Rickets Convergence Group meeting, Dhaka, 26-27 January 2006.

Rickets has emerged as a public-health problem in Bangladesh during the past two decades, with up to 8% of children clinically affected in some areas. Insufficiency of dietary calcium is thought to be the underlying cause, and treatment with calcium (350-1,000 mg elemental calcium daily) is curative. Despite this apparently simple treatment, little is known about the most appropriate management of bone deformities of affected children, and further studies are needed to determine the details of dosing and duration of calcium therapy, the role of bracing, and specific indications for surgical intervention. Effective preventive measures that can feasibly reach entire communities are needed, and these may differ between various affected regions.

Oral histoplasmosis presenting as oral ulcer in a non-HIV patient.

A 40-year-old man presented with chronic mouth ulcer for the last six months. Histopathological examination of the biopsy from the lesion confirmed a diagnosis of histoplasmosis. Although histoplasmosis commonly manifests in immunocompromized patients, like HIV, the present case was negative for HIV. Histoplasmosis is endemic in certain parts of the world and it is comparatively rare in the South Asian region, particularly Malaysia. Thirty-seven cases of histoplasmosis were reported from Malaysia (Ng and Siar, 1996), between July 1967 and October 1997. Despite the apparent rarity of the disease, clinicians and pathologists should be aware of the possibility of histoplasmosis when cases of oral ulcer are encountered.