Research shows, Inexpensive Urine Test For Tuberculosis Reduced Risk Of Death Among HIV-Positive Hospital Patients In Africa.
HIV-associated tuberculosis is difficult to diagnose and results in high mortality. Frequent extra-pulmonary presentation, inability to obtain sputum, and paucibacillary samples limits the usefulness of nucleic-acid amplification tests and smear microscopy.Therefore a urine-based, lateral flow, point-of-care, lipoarabinomannan assay (LAM) and the effect of a LAM-guided anti-tuberculosis treatment initiation strategy on mortality was assessed.
This inexpensive urine test for tuberculosis reduced the risk of death among HIV-positive hospital patients in Africa, where the combined effect of the two diseases is a leading cause of mortality.” Researchers found, “in a randomized controlled trial in four counties,” that “the test was associated with a 17% relative risk reduction in all-cause mortality after 8 weeks, possibly because TB treatment was started more quickly and in more patients.”
The findings were published online in The Lancet.This inexpensive urine test for tuberculosis reduced the risk of death among HIV-positive hospital patients in Africa, where the combined effect of the two diseases is a leading cause of mortality.” Researchers found, “in a randomized controlled trial in four counties,” that “the test was associated with a 17% relative risk reduction in all-cause mortality after 8 weeks, possibly because TB treatment was started more quickly and in more patients.”
Exposure to high levels of certain traffic air pollutants may increase risk of preterm birth for pregnant women with asthma.
By Dr Deepu
Exposure to high levels of certain traffic air pollutants may increase the risk of preterm birth in pregnant women with asthma.
Researchers analyzed data from over 223,000 single-child births and found this was especially true when women were exposed to pollutants just before conceiving, in early pregnancy and the last six weeks of pregnancy.
Exposure to high levels of certain traffic air pollutants may increase the risk of preterm birth in pregnant women with asthma.
Researchers analyzed data from over 223,000 single-child births and found this was especially true when women were exposed to pollutants just before conceiving, in early pregnancy and the last six weeks of pregnancy.
The analysis revealed that preterm births occurred in 11.7% of singleton
deliveries across the entire study population and 33.6% of these deliveries
were early preterm births. The significant
asthma interactions were sporadic
before 30 weeks gestation, but more common during weeks 34 to 36, with risk
highest among women with asthma exposed to NOx, CO and SO2.
The findings
were published online March 1 in the Journal of Allergy and ClinicalImmunology.
Combination therapy may be more effective than monotherapy for slowing disease progression in patients with PAH, suggests Meta-analysis
By Dr Deepu
Combination therapy was significantly more effective
than monotherapy for slowing disease progression in patients with
pulmonary arterial hypertension.
Investigators found that “compared with treatment with a single drug,
combination therapy was associated with a significantly lower risk for clinical
disease worsening and disease-related hospital admissions, and it was
associated with a trend toward reduced all-cause mortality and pulmonary arterial hypertension (PAH)-related mortality.” The findings were published in
Lancet Respiratory Medicine.
Source: read Full article on LANCET
Sleep Apnea May Impact Brain Function, mood and Skills
By Dr Deepu
HealthDay (2/29,
Dallas) reports that a study published in the Journal of Sleep Research
suggests that “sleep apnea may have an impact on brain function.” Investigators
“examined levels of two brain chemicals: glutamate and gamma-aminobutyric acid,
also known as GABA.” The research indicated that individuals “with sleep apnea
have lower levels of GABA and abnormally high levels of glutamate.”
New SCCM Consensus Definitions for Sepsis and Septic Shock
By Dr Deepu
A critical care task
force has proposed a new definition for sepsis and septic shock based on
advances in science and the testing of clinical criteria against patient
outcomes in EHR data. Find the link to download the full article from JAMA at the end.
The
new definition for sepsis includes evidence for infection, plus
life-threatening organ dysfunction, which is clinically characterized by an
acute change of two points or greater on the Sequential [Sepsis-related] Organ
Failure Assessment (SOFA) score.
Septic
shock is now defined to include sepsis with fluid-unresponsive hypotension,
serum lactate level greater than 2 mmol/L, and the need for vasopressors to
maintain mean arterial pressure of 65 mm Hg or greater.
The
new definitions do away with the current use of two or more systemic
inflammatory response syndrome (SIRS) criteria for sepsis diagnosis. Components
of SIRS include tachycardia, tachypnea, hyperthermia or hypothermia, and
elevated white blood count.
Led
by Mervyn Singer, MD, of University College London, and Clifford Deutschman,
MD, MS, of Hofstra-Northwell School of Medicine in New Hyde Park, N.Y., the
international task force that developed the new definitions unanimously
considered the requirement for two or more SIRS criteria to be unhelpful in the
diagnosis of sepsis.
They
conducted a study to examine the validity of the revised sepsis definitions in
a cohort of 148,907 suspected sepsis infections.
Their
analysis identified a rapid method for identifying suspected sepsis outside the
critical care hospital setting which includes two or more of the following
clinical criteria: respiratory rate of 22/min or greater, altered mentation or
systolic blood pressure of 100 mm Hg or less.
The
bedside clinical scoring system is known as "quick SOFA" or qSOFA.
It
is endorsed by SCCM, the American Thoracic Society, the European Respiratory
Society, and the European Society of Intensive Care Medicine and related
organizations in Africa, Asia, South America, and the Middle East.
The Task Force now
recommends that sepsis and septic shock be defined as follows:
- Definitions:
Sepsis: Life-threatening organ dysfunction caused by a
dysregulated host response to infection
Septic shock: Sepsis
with circulatory and cellular/metabolic abnormalities profound enough to
substantially increase mortality
- Clinical Criteria:
Sepsis: Suspected or documented infection and an acute increase
of ≥ 2 SOFA points (a proxy for organ dysfunction)
Septic Shock: Sepsis
and vasopressor therapy needed to elevate MAP ≥ 65 mmg Hg and lactate > 2
mmol/L (18 mg/dL) after adequate fluid resuscitation
Download the Full article from JAMA
Download the Full article from JAMA
ATS Guidelines on evaluation of suspected PTE in pregnancy
By Dr Deepu
Background:
Pulmonary embolism (PE) is a leading cause of maternal mortality in the
developed world. Along with appropriate prophylaxis and therapy, prevention of
death from PE in pregnancy requires a high index of clinical suspicion followed
by a timely and accurate diagnostic approach.
Methods: To provide guidance on this important
health issue, a multidisciplinary panel of major medical stakeholders was
convened to develop evidence-based guidelines for evaluation of suspected
pulmonary embolism in pregnancy using the Grades of Recommendation, Assessment,
Development, and Evaluation (GRADE) system. In formulation of the recommended
diagnostic algorithm, the important outcomes were defined to be diagnostic
accuracy and diagnostic yield; the panel placed a high value
onminimizingcumulative radiationdose when determining the recommended sequence
of tests.
Results: Overall,
the quality of the underlying evidence for all recommendations was rated as
very low or low, with some of the evidence considered for recommendations
extrapolated from studies of the general population. Despite the low-quality
evidence, strong recommendations were made for three specific scenarios: performance
of chest radiography (CXR) as the first radiation-associated procedure; use of
lung scintigraphy as the preferred test in the setting of a normal CXR; and
performance of computed-tomographic pulmonary angiography (CTPA) rather than
digital subtraction angiography (DSA) in a pregnant woman with a nondiagnostic
ventilation– perfusion (V/Q) result.
Discussion: The
recommendations presented in this guideline are based upon the currently
available evidence; availability of new clinical research data and development
and dissemination of new technologies will necessitate a revision and update.
Download the Guideline Here: Pregnancy PE
ATS Guidelines on childhood ILDs
By Dr Deepu
ATS guidelines on childhood ILDs. Interstitial lung
disease (ILD) in infants is caused by entities that are distinct from those
that cause ILD in older children and adults. Growing recognition and
understanding of the various entities that cause ILD in children has led to the
need for improved classification and evaluation. A committee was convened by
the American Thoracic Society (ATS) to develop guidelines to inform clinicians,
patients, and organizations regarding the classi- fication, evaluation, and
management of childhood ILD (chILD).
There is growing
recognition and understanding of the entities that cause interstitial lung
disease (ILD) in infants. These entities are distinct from those that cause ILD
in older children and adults.
A multidisciplinary panel was convened to
develop evidence based guidelines on the classification, diagnosis, and
management of ILD in children, focusing on neonates and infants under 2 years
of age. Recommendations were formulated using a systematic approach. Outcomes
considered important included the accuracy of the diagnostic evaluation,
complications of delayed or incorrect diagnosis, psychosocial complications
affecting the patient’s or family’s quality of life, and death.
After common causes of DLD are
excluded, neonates and infants with childhood ILD syndrome should be evaluated
by a knowledgeable subspecialist. The evaluation may include echocardiography,
controlled ventilation high-resolution computed tomography, infant pulmonary
function testing, bronchoscopy with bronchoalveolar lavage, genetic testing,
and/or lung biopsy. Preventive care, family education, and support are
essential.
Download the full
article here – ILD GUIDELINES
X Ray - Tuberculosis
By Dr Deepu
Images can be used freely but dont forget to give credits for us during usage.
Images can be used freely but dont forget to give credits for us during usage.
Who Issues Global Emergency Against Zika Virus. Facts about Zika Virus
By Dr Deepu
Introduction
Zika virus is an emerging mosquito-borne virus that was first identified in Uganda in 1947 in rhesus monkeys through a monitoring network of sylvatic yellow fever. It was subsequently identified in humans in 1952 in Uganda and the United Republic of Tanzania. Outbreaks of Zika virus disease have been recorded in Africa, the Americas, Asia and the Pacific.
Genre: Flavivirus
Vector: Aedes mosquitoes (which usually bite during the morning and late afternoon/evening hours)
Reservoir: Unknown
Signs and Symptoms
The incubation period (the time from exposure to symptoms) of Zika virus disease is not clear, but is likely to be a few days. The symptoms are similar to other arbovirus infections such as dengue, and include fever, skin rashes, conjunctivitis, muscle and joint pain, malaise, and headache. These symptoms are usually mild and last for 2-7 days.
During large outbreaks in French Polynesia and Brazil in 2013 and 2015 respectively, national health authorities reported potential neurological and auto-immune complications of Zika virus disease. Recently in Brazil, local health authorities have observed an increase in Zika virus infections in the general public as well as an increase in babies born with microcephaly in northeast Brazil. Agencies investigating the Zika outbreaks are finding an increasing body of evidence about the link between Zika virus and microcephaly. However, more investigation is needed before we understand the relationship between microcephaly in babies and the Zika virus. Other potential causes are also being investigated.
Transmission
Zika virus is transmitted to people through the bite of an infected mosquito from the Aedes genus, mainly Aedes aegypti in tropical regions. This is the same mosquito that transmits dengue, chikungunya and yellow fever.
Zika virus disease outbreaks were reported for the first time from the Pacific in 2007 and 2013 (Yap and French Polynesia, respectively), and in 2015 from the Americas (Brazil and Colombia) and Africa (Cape Verde). In addition, more than 13 countries in the Americas have reported sporadic Zika virus infections indicating rapid geographic expansion of Zika virus.
Diagnosis
Zika virus is diagnosed through PCR (polymerase chain reaction) and virus isolation from blood samples. Diagnosis by serology can be difficult as the virus can cross-react with other flaviviruses such as dengue, West Nile and yellow fever.
Prevention
Mosquitoes and their breeding sites pose a significant risk factor for Zika virus infection. Prevention and control relies on reducing mosquitoes through source reduction (removal and modification of breeding sites) and reducing contact between mosquitoes and people.
This can be done by using insect repellent; wearing clothes (preferably light-coloured) that cover as much of the body as possible; using physical barriers such as screens, closed doors and windows; and sleeping under mosquito nets. It is also important to empty, clean or cover containers that can hold water such as buckets, flower pots or tyres, so that places where mosquitoes can breed are removed.
Special attention and help should be given to those who may not be able to protect themselves adequately, such as young children, the sick or elderly.
During outbreaks, health authorities may advise that spraying of insecticides be carried out. Insecticides recommended by the WHO Pesticide Evaluation Scheme may also be used as larvicides to treat relatively large water containers.
Travellers should take the basic precautions described above to protect themselves from mosquito bites.
Treatment
Zika virus disease is usually relatively mild and requires no specific treatment. People sick with Zika virus should get plenty of rest, drink enough fluids, and treat pain and fever with common medicines. If symptoms worsen, they should seek medical care and advice. There is currently no vaccine available.
Key facts
Zika virus disease is caused by a virus transmitted by Aedes mosquitoes.
People with Zika virus disease usually have a mild fever, skin rash (exanthema) and conjunctivitis. These symptoms normally last for 2-7 days.
There is no specific treatment or vaccine currently available.
The best form of prevention is protection against mosquito bites.
The virus is known to circulate in Africa, the Americas, Asia and the Pacific.
Zika virus disease is caused by a virus transmitted by Aedes mosquitoes.
People with Zika virus disease usually have a mild fever, skin rash (exanthema) and conjunctivitis. These symptoms normally last for 2-7 days.
There is no specific treatment or vaccine currently available.
The best form of prevention is protection against mosquito bites.
The virus is known to circulate in Africa, the Americas, Asia and the Pacific.
Introduction
Zika virus is an emerging mosquito-borne virus that was first identified in Uganda in 1947 in rhesus monkeys through a monitoring network of sylvatic yellow fever. It was subsequently identified in humans in 1952 in Uganda and the United Republic of Tanzania. Outbreaks of Zika virus disease have been recorded in Africa, the Americas, Asia and the Pacific.
Genre: Flavivirus
Vector: Aedes mosquitoes (which usually bite during the morning and late afternoon/evening hours)
Reservoir: Unknown
Signs and Symptoms
The incubation period (the time from exposure to symptoms) of Zika virus disease is not clear, but is likely to be a few days. The symptoms are similar to other arbovirus infections such as dengue, and include fever, skin rashes, conjunctivitis, muscle and joint pain, malaise, and headache. These symptoms are usually mild and last for 2-7 days.
During large outbreaks in French Polynesia and Brazil in 2013 and 2015 respectively, national health authorities reported potential neurological and auto-immune complications of Zika virus disease. Recently in Brazil, local health authorities have observed an increase in Zika virus infections in the general public as well as an increase in babies born with microcephaly in northeast Brazil. Agencies investigating the Zika outbreaks are finding an increasing body of evidence about the link between Zika virus and microcephaly. However, more investigation is needed before we understand the relationship between microcephaly in babies and the Zika virus. Other potential causes are also being investigated.
Transmission
Zika virus is transmitted to people through the bite of an infected mosquito from the Aedes genus, mainly Aedes aegypti in tropical regions. This is the same mosquito that transmits dengue, chikungunya and yellow fever.
Zika virus disease outbreaks were reported for the first time from the Pacific in 2007 and 2013 (Yap and French Polynesia, respectively), and in 2015 from the Americas (Brazil and Colombia) and Africa (Cape Verde). In addition, more than 13 countries in the Americas have reported sporadic Zika virus infections indicating rapid geographic expansion of Zika virus.
Diagnosis
Zika virus is diagnosed through PCR (polymerase chain reaction) and virus isolation from blood samples. Diagnosis by serology can be difficult as the virus can cross-react with other flaviviruses such as dengue, West Nile and yellow fever.
Prevention
Mosquitoes and their breeding sites pose a significant risk factor for Zika virus infection. Prevention and control relies on reducing mosquitoes through source reduction (removal and modification of breeding sites) and reducing contact between mosquitoes and people.
This can be done by using insect repellent; wearing clothes (preferably light-coloured) that cover as much of the body as possible; using physical barriers such as screens, closed doors and windows; and sleeping under mosquito nets. It is also important to empty, clean or cover containers that can hold water such as buckets, flower pots or tyres, so that places where mosquitoes can breed are removed.
Special attention and help should be given to those who may not be able to protect themselves adequately, such as young children, the sick or elderly.
During outbreaks, health authorities may advise that spraying of insecticides be carried out. Insecticides recommended by the WHO Pesticide Evaluation Scheme may also be used as larvicides to treat relatively large water containers.
Travellers should take the basic precautions described above to protect themselves from mosquito bites.
Treatment
Zika virus disease is usually relatively mild and requires no specific treatment. People sick with Zika virus should get plenty of rest, drink enough fluids, and treat pain and fever with common medicines. If symptoms worsen, they should seek medical care and advice. There is currently no vaccine available.
Radiology Signs -Juxta Phrenic Peak Sign
By Deepu
The juxtaphrenic peak sign refers to the peaked or tented appearance of a hemidiaphragm which can occur in the setting of lobar collapse.
It is caused by retraction of the lower end of diaphragm at an inferior accessory fissure, major fissure or inferior pulmonary ligament. It is commonly seen in upper lobe collapse but may also be seen in middle lobe collapse.
The juxtaphrenic peak sign refers to the peaked or tented appearance of a hemidiaphragm which can occur in the setting of lobar collapse.
It is caused by retraction of the lower end of diaphragm at an inferior accessory fissure, major fissure or inferior pulmonary ligament. It is commonly seen in upper lobe collapse but may also be seen in middle lobe collapse.
The negative pressure of upper lobe atelectasis causes upward retraction of the visceral pleura, and protrusion of extrapleural fat into the recess of the fissure is responsible
Occurs in upper lobe atelectasis, describes the triangular opacity projecting superiorly at the medial half of the diaphragm
Ambrisentan and Tadalafil combination highly effective in scleroderma associated PAH
By Dr Deepu
Scleroderma associated PAH is a rare entity and has a very dismal response to currently available Pulmonary arterial hypertension therapy. Hasson et al recently published a study in AJRCCM November issue (vol 192 no.9). They assessed the effect of up-front combination PAH therapy in ssc-PAH.
Patients, newly diagnosed with SSc- PAH were given ambrisentan 10mg and Tadalafil daily for 36 weeks.
Primary endpoints - Right ventricular mass and Pulmonary Vascular resistance (Functional, hemodynamic and Imaging )
Secondary end points- stroke volume, 6MWD, pro-bnp .
Results showed a reduction in median RV mass and mean pulmonary vascular resistance and a improved median Stoke volume, 6MWD, pro-bnp.
So the study demonstrated, up-front combination therapy with ambrisentan and Tadalafil could be very effective in treatment naive SSc- PAH.
Read the research paper
Scleroderma associated PAH is a rare entity and has a very dismal response to currently available Pulmonary arterial hypertension therapy. Hasson et al recently published a study in AJRCCM November issue (vol 192 no.9). They assessed the effect of up-front combination PAH therapy in ssc-PAH.
Patients, newly diagnosed with SSc- PAH were given ambrisentan 10mg and Tadalafil daily for 36 weeks.
Primary endpoints - Right ventricular mass and Pulmonary Vascular resistance (Functional, hemodynamic and Imaging )
Secondary end points- stroke volume, 6MWD, pro-bnp .
Results showed a reduction in median RV mass and mean pulmonary vascular resistance and a improved median Stoke volume, 6MWD, pro-bnp.
So the study demonstrated, up-front combination therapy with ambrisentan and Tadalafil could be very effective in treatment naive SSc- PAH.
Read the research paper
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