This useful article, with plenty of photos, balances the lack of good treatment options with the need to "do something" about these common skin problems.
This study showed that, in healthy volunteers, sublingual furosemide (frusemide) was well absorbed. "In healthy volunteers, sublingual administration is associated with a higher Cmax, a higher bioavailability and a more accentuated initial natriuretic response than oral furosemide. Sublingual administration may offer advantages over oral administration of furosemide in certain clinical situations."
Usefulness in our resource-limited settings might include any time when injectable furosemide is not available.
This study found that topical zinc cream, applied at the time of skin testing, increased the size of reactions to tuberculin and candida skin tests. The effect was observed only in zinc-deficient patients (as determined by blood levels). The importance is that topical zinc cream could be used to improve the sensitivity of the TB skin test in areas of marginal nutrition where zinc deficiency is prevalent.
This is a great little study that would be relatively easy to duplicate in an African setting. If the blood zinc levels are to be determined, there would probably be substantial cost, but if not, the cost would be relatively low.
Abstract
In 50 healthy Peruvian shantytown residents, zinc cream applied to tuberculosis skin-test sites caused a 32% increase in induration compared with placebo cream. Persons with lower plasma zinc had smaller skin-test reactions and greater augmentation with zinc cream. Zinc deficiency caused false-negative skin-test results, and topical zinc supplementation augmented antimycobacterial immune responses enough to improve diagnosis.
Rao VB, Pelly TF, Gilman RH, Cabrera L, Delgado J, Soto G, et al. Zinc cream and reliability of tuberculosis skin testing. Emerg Infect Dis]. 2007 Jul. Available from http://www.cdc.gov/EID/content/13/7/1101.htm. Free full content
When should antiretroviral treatment be started in patients with both tuberculosis and HIV infections? There are many considerations including the pill burden, possible drug reactions, drug interactions, immune reconstitution syndrome, and so on. This prospective study looked at a cohort of 329 coinfected patients and examined their survival according to when ARTs were begun. After adjusting for other variables, there was a strong improved probability of survival in the patients who began ART early.
Abstract
Antiretroviral therapy (ART) is lifesaving in patients with advanced HIV infection, but the magnitude of benefit in HIV-infected patients receiving tuberculosis (TB) treatment remains uncertain, and population-based data from developing countries are limited. We prospectively collected data about HIV-infected TB patients from February 2003 through January 2004 in Ubon-ratchathani, Thailand. During 12 months, HIV was diagnosed in 329 (14%) of 2,342 patients registered for TB treatment. Of patients with known outcomes, death during TB treatment occurred in 5 (7%) of 71 who received ART and 94 (43%) of 219 who did not. Using multivariate analysis, we found a large reduction in the odds of death for patients receiving ART before or during TB treatment (odds ratio, 0.2; 95% confidence interval, 0.1–0.5), adjusting for CD4 count, smear status, co-trimoxazole use, and treatment facility. ART is associated with a substantial reduction in deaths during TB treatment for HIV-infected TB patients in Thailand.
"Results Primary outcome data were available for 311 (98.4%) people, 77% of whom were thought to have a psychotic illness. Patients allocated haloperidol plus promethazine were more likely to be tranquil or asleep by 20 minutes than those who received intramuscular haloperidol alone (relative risk 1.30, 95% confidence interval 1.10 to 1.55; number needed to treat 6, 95% confidence interval 4 to 16; P=0.002). No differences were found after 20 minutes. However, 10 cases of acute dystonia occurred, all in the haloperidol alone group. "
This article reports on results of ART in 212 Cambodian children with median age of 6 years old. Most were on stavudine, lamivudine, and nevirapine. Median CD4 at baseline was 6 (!).
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