Management of Adult Patients With Drug Reaction With Eosinophilia and Systemic Symptoms: A Delphi-Based International Consensus.

Importance: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare but potentially fatal drug hypersensitivity reaction. To our knowledge, there is no international consensus on its severity assessment and treatment. Objective: To reach an international, Delphi-based multinational expert consensus on the diagnostic workup, severity assessment, and treatment of patients with DRESS. Design, Setting, and Participants: The Delphi method was used to assess 100 statements related to baseline workup, evaluation of severity, acute phase, and postacute management of DRESS. Fifty-seven international experts in DRESS were invited, and 54 participated in the survey, which took place from July to September 2022. Main Outcomes/Measures: The degree of agreement was calculated with the RAND-UCLA Appropriateness Method. Consensus was defined as a statement with a median appropriateness value of 7 or higher (appropriate) and a disagreement index of lower than 1. Results: In the first Delphi round, consensus was reached on 82 statements. Thirteen statements were revised and assessed in a second round. A consensus was reached for 93 statements overall. The experts agreed on a set of basic diagnostic workup procedures as well as severity- and organ-specific further investigations. They reached a consensus on severity assessment (mild, moderate, and severe) based on the extent of liver, kidney, and blood involvement and the damage of other organs. The panel agreed on the main lines of DRESS management according to these severity grades. General recommendations were generated on the postacute phase follow-up of patients with DRESS and the allergological workup. Conclusions and Relevance: This Delphi exercise represents, to our knowledge, the first international expert consensus on diagnostic workup, severity assessment, and management of DRESS. This should support clinicians in the diagnosis and management of DRESS and constitute the basis for development of future guidelines.

Post-acute phase and sequelae management of epidermal necrolysis: an international, multidisciplinary DELPHI-based consensus.

BACKGROUND: Long-term sequelae are frequent and often disabling after epidermal necrolysis (Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN)). However, consensus on the modalities of management of these sequelae is lacking. OBJECTIVES: We conducted an international multicentric DELPHI exercise to establish a multidisciplinary expert consensus to standardize recommendations regarding management of SJS/TEN sequelae. METHODS: Participants were sent a survey via the online tool "Survey Monkey" consisting of 54 statements organized into 8 topics: general recommendations, professionals involved, skin, oral mucosa and teeth, eyes, genital area, mental health, and allergy workup. Participants evaluated the level of appropriateness of each statement on a scale of 1 (extremely inappropriate) to 9 (extremely appropriate). Results were analyzed according to the RAND/UCLA Appropriateness Method. RESULTS: Fifty-two healthcare professionals participated. After the first round, a consensus was obtained for 100% of 54 initially proposed statements (disagreement index < 1). Among them, 50 statements were agreed upon as 'appropriate'; four statements were considered 'uncertain', and ultimately finally discarded. CONCLUSIONS: Our DELPHI-based expert consensus should help guide physicians in conducting a prolonged multidisciplinary follow-up of sequelae in SJS-TEN.

Evaluation of Testicular Biometry and Spermatozoa Recovered after Slaughter from Cauda Epididymal of Awassi Ram.

Rams play an important role in reproductive efficiency because each ram or semen contains half of the genetic material of its descendants. In Iraq, the Awassi sheep are the most common indigenous breed, highly adaptable to tough environmental conditions. The present study was carried out to evaluate testicular biometry and spermatozoa recovered after the slaughter at different ages in Awassi rams. A total of thirty-three pairs (n=66 testes) of Awassi rams testicles were collected after the slaughter at the abattoir in Baghdad and divided into three groups according to age. Rams less than a year old were grouped as G1, rams aged one to two years were grouped as group G2, and rams older than two years as group G3. There were significant differences (P<0.05) in testicular weight, length, width, and diameter in both right and left increased steadily in group G1 to reach a maximum in group G3. The epididymal weight and length (right and left) were significant (P<0.05) in group G3. The spermatozoa concentration obtained from the left testicle increased significantly (P<0.05) in groups G2 and G3 compared to group G1, while the right spermatozoa concentration increased significantly (P<0.05) in group G3 when compared to group G1. In conclusion, it can be concluded that the biometry of testicular and epididymal (right and left) in this study was influenced by progressing age, and the spermatozoa concentration obtained from the left testicle was higher active than the right one in adult Awassi rams.

Quality of life in an Italian cohort of people living with HIV in the era of combined antiretroviral therapy (Evidence from I.A.N.U.A. study-investigation on antiretroviral therapy).

The aims of this study were to assess the Health Related Quality of Life (HRQoL) of People Living with HIV/AIDS (PLWHA) who attend outpatient services in Genoa, Italy, and to evaluate the relationship between HRQoL and clinical factors, primarily: CD4+ cell count, viral load and HIV-Hepatitis C Virus (HCV) coinfection. A cross-sectional study was performed involving a sample of 943 consecutive patients. Firstly the EuroQol-Five Dimensions-Three Level (EQ-5D-3L) self-reported questionnaire was used to evaluate HRQoL, while socio-demographic information was collected using a separate self-administered questionnaire. Descriptive statistical analysis was then used to show the socio-demographic and clinical characteristics of the sample. Having characterized the sample, Pearson's correlation technique was used to assess the relationship between HRQoL and socio-demographic and clinical characteristics. Finally, multivariable linear regression was used to determine factors associated with HRQOL. The median EQ-Visual analogue scale (EQ-VAS) score was 75.4 (SD 18.4). We found statistically significant associations between the EQ-VAS score and age, coinfection with HCV+, education, other drugs taken over cART, hospitalization due to HIV and a CD4+ cell count <200 mm3 compared with CD4+ cell count >500 mm3. Factors independently associated with lower HRQoL were: older age, coinfection with HCV+, other drugs used in addition to cART, hospitalization due to HIV and CD4+ cell count <200 mm3 compared with CD4+ cell count >500 mm3.

Interferon-γ assay, a high-sensitivity, specific and appropriate method for detection of bovine tuberculosis in cattle.

Bovine tuberculosis (TB) is an important zoonotic disease that is caused by Mycobacterium bovis. Eradication efforts in developed countries have reduced the prevalence of this disease significantly. TB can be difficult to diagnose based only on the clinical signs; therefore, it is usually diagnosed in the field with the tuberculin skin test and diagnostic blood tests, including the lymphocyte proliferation assay, the interferon (IFN)-γ assay, and enzyme-linked immunosorbent assay. The aim of this study was to compare the tuberculin and IFN-γ tests. A total of 110 animals were evaluated by tuberculin skin test (TST) and IFN-γ assay; the culture was selected as a gold standard. The animals were selected randomly from 700 cattle on dairy farms, aged 3-5years and suspected of having TB. Ten cattle were positive using the TST and nine were positive by IFN-γ assay. All nine positive samples in the IFN-γ assay were positive in culture too. The observed errors in IFN-γ assay were less due to laboratorial tools. It is suggested that all positive samples in TST are also positive by IFN-γ too.

Renal patients' views on generic prescribing and substitution: example from the United Arab Emirates.

This survey examined current patient awareness and understanding of generic substitution. We surveyed 188 renal patients using 36 multiple-choice questions in 2 hospitals in the United Arab Emirates. We found that 70% of patients were aware of the availability of generic medicines, 60% understood the terms "generic" and "branded" in relation to medicines and 64% were conscious of generic substitution practice. However, 32% did not know if they were taking generics and 31% felt that generics were not equivalent or only sometimes equivalent to branded medicines. Nearly half (47%) the patients stated they would refuse generic substitution of ciclosporin when it became available if this was just to save the health authority money. In our opinion, random generic substitution should not be implemented because there is still uncertainty and lack of knowledge among patients.

Renal patients' views on generic prescribing and substitution: example from the United Arab Emirates

This survey examined current patient awareness and understanding of generic substitution. We surveyed 188 renal patients using 36 multiple-choice questions in 2 hospitals in the United Arab Emirates. We found that 70% of patients were aware of the availability of generic medicines, 60% understood the terms [generic] and [branded] in relation to medicines and 64% were conscious of generic substitution practice. However, 32% did not know if they were taking generics and 31% felt that generics were not equivalent or only sometimes equivalent to branded medicines. Nearly half [47%] the patients stated they would refuse generic substitution of ciclosporin when it became available if this was just to save the health authority money. In our opinion, random generic substitution should not be implemented because there is still uncertainty and lack of knowledge among patients

Prevalence and antimicrobial resistance of Campylobacter species isolated from chicken carcasses during processing in Iran.

The objective of this study was to determine the prevalence and antimicrobial resistance of Campylobacter spp. isolated from chicken carcasses during different stages of broiler processing in a major commercial poultry processing plant in southwestern Iran. Overall, 84 chicken carcasses were sampled from 4 sites along the processing line during a total of 7 visits. In addition, 14 water samples from the chiller tank were taken. Using the cultural method, 186 of 336 (55.4%) carcasses were positive for Campylobacter. Campylobacter jejuni was more frequently isolated (89.4%) than Campylobacter coli (10.6%). The frequency of Campylobacter spp. on carcasses was 54.8% after defeathering, 51.2% after evisceration, 69.0% 20 min after the chilling period started, and 46.4% 24 h after the chilling period completed. Campylobacter was positive in 85.7% of the samples taken from the chilling water. The frequency of Campylobacter spp.-positive carcasses was reduced in complete chilled chickens but not during the slaughtering process. Susceptibilities of Campylobacter isolates were determined for 10 antimicrobial drugs using the disk diffusion method. Of the 198 Campylobacter isolates tested, 92.9% were resistant to one or more antimicrobial agents. Resistance to tetracycline was the most common finding (78.3%), followed by resistance to ciprofloxacin (62.1%), nalidixic acid (58.6%), and enrofloxacin (44.4%).

Detection of Coxiella burnetii by nested PCR in bulk milk samples from dairy bovine, ovine, and caprine herds in Iran.

The epidemiology of Q-fever in Iran is essentially unknown. This study was conducted to determine the prevalence rate of Coxiella burnetii in bulk milk samples from dairy bovine, ovine, and caprine herds in Chaharmahal va Bakhtiari province, Iran. In this study, 376 bulk milk samples from 79 dairy bovine, ovine, and caprine herds were tested for C. burnetii using a nested PCR assay. The animals whose milk samples collected for this study were clinically healthy. In total, 13 of 210 (6.2%) bovine milk samples were positive; the positive samples originated from 5 of 28 (17.9%) commercial dairy herds. All 110 ovine bulk milk samples from 31 sheep breeding farms were negative and only 1 of 56 (1.8%) caprine bulk milk samples from 20 goat breeding farms was positive for C. burnetii. Although no extensive prevalence study was undertaken, the results of this study indicate that clinically healthy cattle are important sources of C. burnetii infection in Iran. To our knowledge, this study is the first report of direct identification of C. burnetii by PCR in bulk milk samples from dairy bovine and caprine herds in Iran. Further intensive prevalence studies on Coxiella infection among farmers, milk-processing workers, veterinarians, and slaughterhouse workers and on possible dangers of dairy products will be needed to elucidate the epidemiology of Q fever in Iran.

An immunoglobulin binding protein (antigen 5) of the stable fly (Diptera: Muscidae) salivary gland stimulates bovine immune responses.

The stable fly, Stomoxys calcitrans (L.) (Diptera: Muscidae), is an economically important pest of livestock. Previous studies demonstrated lymphocyte suppression by crude salivary gland extract (SGE) of the stable fly. A dominant 27-kDa protein identified in the SGE was reported to stimulate immunodominant antibody responses in exposed cattle. The purpose of this study was to determine whether this protein, now identified as ahomolog of insect proteins named antigen 5 (Ag5), was responsible for the lymphocyte suppression and whether naive calves can mount an immune response to it. Calves raised in the winter were immunized with recombinant Ag5 (rAg5) expressed in Drosophila S2 cells or with "natural" Ag5 protein isolated by preparative gel electrophoresis of SGE. Control calves were immunized with adjuvant alone. Rising antibody concentrations to rAg5 were detected in two of three calves immunized with rAg5 and one of three calves immunized with natural Ag5. Recall lymphocyte responses to rAg5 were detected at 21 and 28 d postimmunization in calves immunized with rAg5 but not in calves immunized with the natural Ag5 or those exposed to adjuvant alone. Mitogen-stimulated bovine lymphocyte responses were not suppressed by rAg5. Further investigation using immunoblotting revealed that rAg5 binds to the Fc and F (ab')2 portions of bovine IgG, but not to an Fab fragment. These findings suggest that Ag5 of the stable fly salivary gland is not immunosuppressive but that it has immunoglobulin binding properties and can invoke specific antibody and memory lymphocyte responses in immunized calves.

Bovine subclinical ketosis in dairy herds in Iran.

Subclinical ketosis (SCK) is defined as elevated concentrations of ketone bodies in the absence of clinical signs of ketosis. It is an important metabolic disease in dairy cattle during early lactation and is associated with losses in milk production and several other periparturient diseases. Limited information is available regarding the prevalence of SCK in dairy herds in Iran. The objectives of this study were (i) to determine the incidence of SCK in the dairy herds in Kerman province of Iran using serum beta-hydroxybutyrate (BHB) concentrations, and (ii) to investigate the relationship between serum concentrations of BHB and glucose of cows with SCK. In the present study, 90 multiparous Holstein cows (4-6 years old) from 11 commercial dairy herds were evaluated 3-4 weeks after calving. The distribution of blood BHB concentrations seemed to suggest a cut-off point of 1200 micromol/L between cows with and without SCK. At this cut-off point, 14.4% of tested cows (13/90) were classified as subclinically ketotic, with the prevalence rate within herd ranging from 10% to 20%. Cows with SCK were detected in all the investigated dairies except one. Blood glucose concentrations in cows with SCK were significantly lower (p < or = 0.05) than in cows without SCK, and serum BHB and glucose concentration were inversely correlated (r = -0.43, p < or = 0.05). The results suggest that, using a cut-off of 1200 micromol/L, BHB concentrations can be used during early lactation for diagnosis and to make management decisions for prevention and treatment.

Frequency of peptic ulcer disease during and after Ramadan in a United Arab Emirates hospital.

We aimed to study the effect of Ramadan fasting on the occurrence of peptic ulcer disease and its complications in patients presenting to the Accident and Emergency Department at Al-Ain hospital, United Arab Emirates (UAE). We retrospectively reviewed patient records over the 10-year period, 1992 to 2002. Of 470 patients treated for peptic ulcer disease, 215 were seen during Ramadan and 255 in the month after Ramadan. The frequency of peptic ulcer disease was higher after Ramadan than during Ramadan but this was not statistically significant. Peptic ulcer disease occurred more frequently in the age group 30-49 years. Peptic ulcer perforation occurred more frequently after Ramadan but the difference was not significant. Regression analysis identified the following variables as predictors of peptic ulcer disease: anorexia, pain, hypertension, smoking, epigastric pain, diabetes and family history.

Frequency of peptic ulcer disease during and after Ramadan in a United Arab Emirates hospital

We aimed to study the effect of Ramadan fasting on the occurrence of peptic ulcer disease and its complications in patients presenting to the Accident and Emergency Department at Al-Ain hospital, United Arab Emirates [UAE]. We retrospectively reviewed patient records over the 10-year period, 1992 to 2002. Of 470 patients treated for peptic ulcer disease, 215 were seen during Ramadan and 255 in the month after Ramadan. The frequency of peptic ulcer disease was higher after Ramadan than during Ramadan but this was not statistically significant. Peptic ulcer disease occurred more frequently in the age group 30-49 years. Peptic ulcer perforation occurred more frequently after Ramadan but the difference was not significant. Regression analysis identified the following variables as predictors of peptic ulcer disease: anorexia, pain, hypertension, smoking, epigastric pain, diabetes and family history

In vitro release of cytarabine from swellable matrices of CnEmCn triblock copolymers.

Matrices loaded with cytarabine were prepared by compression of the tailor made triblock copolymers C17E227C17 and C17E454C17 (where C=methylene and E=oxyethylene). Observations of the swelling characteristics of copolymer matrices on immersion in distilled water indicated an increase in the thickness of the gel layer around the matrices following ingress of water into the matrices. The in vitro release of cytarabine was characterised from matrices of different molar mass and with different known drug loadings. The release of cytarabine from the copolymer matrices was predominantly by a Fickian diffusion mechanism; the release rate was dependent on drug loading and independent of copolymer molar mass.

[Comparative study of the prevalence of Epstein-Barr virus infections in Iran and Germany]. / Vergleichende Untersuchung der Durchseuchung mit Epstein-Barr-Virusinfektionen im Iran und in Deutschland.

352 persons from Iran and 469 persons from West-Germany were tested for EBV-antibodies using an immunofluorescence assay. In Iran the virus infection starts early in infancy and attains higher antibody values as compared with age related German population. In the age group of 1-5 years 70% of the Iranians are antibody positive in contrast to only 56% of the Germans in the same age group. The high prevalence of EBV-antibodies is due to unfavourable hygienic facilities as well as to regional overpopulation.

Dorsal herniation of the gut with posterior opening of the terminal colon: a rare manifestation of the split notochord syndrome.

A newborn infant with a rare variety of combine anterior and posterior rachischisis in the lumbosacral spine is reported. The associated anomalies in this infant were meningomyelocele, communication of the colon with the spinal cleft, and anal atresia.