Journal club articles, by date with most recent first
Policy changes needed for diagnosis of smear-negative TB in HIV or in developing world
published 29-07-2007
Views : 398
Times marked as favorite : 52
"Summary
"The HIV epidemic has led to large increases in the frequency of smear-negative pulmonary tuberculosis, which has poor treatment outcomes and excessive early mortality compared with smear-positive disease. We used a combination of systematic review, document analysis, and global expert opinion to review the extent of this problem. We also looked at policies of national tuberculosis control programmes for the diagnosis of smear-negative pulmonary tuberculosis to assess their coverage, identify the diagnostic difficulties, and find ways to improve the diagnosis of this type of tuberculosis, with a focus on resource-constrained settings with high HIV infection rates. We propose that the internationally recommended algorithm for the diagnosis of smear-negative pulmonary tuberculosis should be revised to include HIV status, severity of AIDS and tuberculosis, and early use of chest radiography in the decision tree. Increased use of promising methods of diagnosis such as sputum liquefaction and concentration and increased availability of fluorescence microscopy should be explored and encouraged. Culturing of sputum in resource-constrained settings with high HIV infection rates should also be encouraged, existing facilities should be made full use of and upgraded, and effective quality-assurance systems should be used. Innovative ways to address human resources issues involved in addressing the diagnostic difficulties are also needed. The development of rapid, simple, and accurate tuberculosis diagnostic tools with applicability at point of care and remote location is essential. To achieve these goals, greater political commitment, scientific interest, and investment are needed."
"There are consistent differences in cardiovascular state between acute illness in malaria and recovery that prolong the electrocardiographic QT interval and have been misinterpreted as resulting from antimalarial cardiotoxicity. Of the different classes of antimalarial drugs, only the quinolines, and structurally related antimalarial drugs, have clinically significant cardiovascular effects. Drugs in this class can exacerbate malaria-associated orthostatic hypotension and several have been shown to delay ventricular depolarisation slightly (class 1c effect), resulting in widening of the QRS complex, but only quinidine and halofantrine have clinically significant effects on ventricular repolarisation (class 3 effect). Both drugs cause potentially dangerous QT prolongation, and halofantrine has been associated with sudden death. The parenteral quinoline formulations (chloroquine, quinine, and quinidine) are predictably hypotensive when injected rapidly, and cardiovascular collapse can occur with self-poisoning. Transiently hypotensive plasma concentrations of chloroquine can occur when doses of 5 mg base/kg or more are given by intramuscular or subcutaneous injection. At currently recommended doses, other antimalarial drugs do not have clinically significant cardiac effects. More information on amodiaquine, primaquine, and the newer structurally related compounds is needed."
A recent meta-analysis of delayed cord clamping at delivery, reported in JAMA, found evidence of improved hematological status (higher hematocrit, ferritin, less frequent anemia) in infants following delayed cord clamping than with normal (non-delayed) clamping.
As the accompanying editorial points out, the level of certainty of this information (being from a meta-analysis) is such that doctors may want to consider the practice, but more research including large randomized-controlled trials are needed before making it a recommendation.
Isoniazid prophylaxis reduces mortality in HIV-infected South African children
published 16-05-2007
Views : 1022
Times marked as favorite : 57
This was a double blind placebo controlled trial involving 263 South African children infected with HIV. The median age was 24.7 months. The treatment group received isoniazid prophylaxis daily or three times weekly. The study was ended early because the safety monitoring board found that the mortality was significantly greater (more than twice as high) in the placebo group.
Another study shows delayed cord clamping leads to higher hemoglobin levels during first months
published 29-03-2007
Views : 683
Times marked as favorite : 42
A randomized, controlled trial in Zambia showed that delayed cord clamping at birth led to higher hemoglobin levels for the first 4 months of life. The sample size was only about 45 per group but results were significant.
Male circumcision confirmed as effective in reducing HIV transmission
published 27-03-2007
Views : 1076
Times marked as favorite : 38
Two newly reported randomized, controlled trials of male circumcision in Africa, involving nearly 10,000 men, confirm that male circumcision significantly reduces the risk of HIV acquisition. Circumcised men were only half as likely to become as infected as the control group over a two-year period. This is a highly significant and important result: a vaccine that was 50% effective would be considered a huge success. See the studies (click read more) and accompanying review and commentary for the overall implications and where we should go from here.
Two newly reported randomized, controlled trials of male circumcision in Africa, involving nearly 10,000 men, confirm that male circumcision significantly reduces the risk of HIV acquisition. Circumcised men were only half as likely to become as infected as the control group over a two-year period. This is a highly significant and important result: a vaccine that was 50% effective would be considered a huge success. See the studies (click