Archive for November 26, 2013

A prospective series case study of pyogenic liver abscess: recent trands in etiology and management.

Indian J Surg. 2012 Oct;74(5):385-90.

Mangukiya DO, Darshan JR, Kanani VK, Gupta ST.


Department of Surgery, Surat Municipal Institute of Medical Education & Research, Surat, Gujarat India ; SMIMER Hospital, N/R Sahara Darwaja, Opp. Bombay Market, Umarwada, Surat, 395010 Gujarat India.


Our study aims to review the literature on the management of pyogenic liver abscess, focusing on the choice of drainage. A case series of our experience with clinicopathological correlation is presented to highlight the indication and outcome of each modality of drainage. Intravenous antibiotic is the first line, and mainstay, of treatment. Drainage is necessary for large abscesses, equal to or larger than 5 cm in size, to facilitate resolution. While percutaneous drainage is appropriate as first-line surgical treatment in most cases, open surgical drainage is prudent in cases of rupture, multiloculation, associated biliary, or intra-abdominal pathology. Percutaneous drainage may help to optimize clinical condition prior to surgery. Nevertheless, in current good clinical practices, the choice of therapy needs to be individualized according to patient’s clinical status and abscess factors. They are complementary in the management of liver abscesses.


November 26, 2013 at 2:53 pm

Bacterial diarrhea in persons with HIV infection, United States, 1992-2002.

Clin Infect Dis 2005 Dec 1; 41(11) :1621-7.

Sanchez TH, Brooks JT, Sullivan PS, et al.

Division of HIV/AIDS Prevention–Surveillance and Epidemiology, National Center for HIV, STD, and TB Prevention, National Center for Infectious Disease, Centers for Disease Control and Prevention, Atlanta, GA, USA.


To describe trends in bacterial diarrhea among human immunodeficiency virus (HIV)-infected persons during 1992-2002, we examined data from a longitudinal record review study of persons with HIV infection who were receiving medical care in >100 medical facilities in 9 major United States cities.


An analysis was performed using data from 44,778 persons who were followed up for a mean of 2.6 years. We calculated incidence rates and rate ratios for bacterial diarrhea, by stage of HIV disease, and determined odds ratios (ORs) to compare bacterial diarrhea diagnosis in 2002 versus 1992.


The mean annual incidence of bacterial diarrhea was 7.2 cases per 1000 person-years. The incidence of Clostridium difficile-associated diarrhea, the most common bacterial cause of diarrhea, was 4.1 cases per 1000 person-years. Compared with persons without AIDS, persons with AIDS were more likely to have bacterial diarrhea (incidence rate ratio, 1.3-9.9, varying by clinical versus immunologic AIDS and type of bacterial diarrhea). Between 1992 and 2002, the overall rate of bacterial diarrhea in persons with clinical AIDS decreased (OR, 0.4; 95% confidence interval, 0.2-0.6). During the same period, bacterial diarrhea rates among other persons in the analysis did not significantly change.


C. difficile is the most common recognized cause of bacterial diarrhea among persons infected with HIV. The risk for bacterial diarrhea increases with increased severity of HIV disease. Health care professionals should be aware that patients with AIDS are at increased risk for bacterial diarrhea, and they should reinforce recommendations for decreasing the chances of acquiring bacterial diarrhea.



November 26, 2013 at 2:51 pm

Practice guidelines for the management of infectious diarrhea.

Clin Infect Dis 2001 Feb 1; 32(3) :331-51.

Guerrant RL, Van Gilder T, Steiner TS, et al.

Division of Geographic and International Medicine, University of Virginia Health Sciences Center, Charlottesville, VA, USA.


November 26, 2013 at 2:50 pm

Adverse drug reactions to antiretroviral therapy: Results from spontaneous reporting system in Nigeria.

Perspect Clin Res. 2013 Apr;4(2):117-24.

Agu KA, Oparah AC.


Department of Clinical Pharmacy and Pharmacy Practice, University of Benin, Nigeria.



This study evaluated the suspected adverse drug reactions (ADR) reported from a spontaneous reporting program in Human Immunodeficiency Virus (HIV) positive patients receiving antiretroviral therapy (ART) in Nigeria.


This descriptive study analyzed individual case safety reports (ICSRs) in HIV-positive patients receiving ART between January 2011 and December 2011 in 38 secondary hospitals. All ICSRs during this period were included. Chi-square was used to test the association between variables at 95% confidence interval.


From 1237 ICSRs collated, only 1119 (90.5%) were valid for analysis. Mean age of patients was 35.3 (95%CI, 35.1-35.5) years; and 67.1% were females. A total of 1679 ADR cases were reported, a mean (± Standard Deviation, SD) of 1.5 (± 0.8) ADR cases per patient. Of reported ADRs, 63.2%, 8.2% and 19.3% occurred in patients on Zidovudine-based, Stavudine-based and Tenofovir-based regimens, respectively. The commonest ADRs included (12.0%) peripheral neuropathy, (11.4%) skin rash, (10.1%) pruritus and (6.5%) dizziness. ADR occurrence was associated with ART regimens, concomitant medicines and age (P < 0.05) unlike gender. Anaemia was associated with Zidovudine (AZT)/ Lamivudine (3TC) /Nevirapine (NEV) regimen [Odds ratio, OR = 6.4 (3.0-13.8); P < 0.0001], and peripheral neuropathy with Stavudine (d4T)/3TC/NEV regimen [OR = 8.7 (5.8-30.0), P < 0.0001] and Tenofovir (TDF)/Emtricitabine (FTC)/Efavirenz (EFV) regimen [OR = 2.1 (1.0-4.1), P = 0.0446]. Skin rash and peripheral neuropathy were associated with patients aged < 15years [OR = 3.0 (1.3-6.6), P = 0.0056] and 45-59years [OR = 1.9 (1.3-2.7), P = 0.0006] respectively. Palpitation and polyuria were associated with Salbutamol [OR = 55.7 (4.9-349.6), P = 0.0000] and Nonsteroidal anti-inflammatory drugs (NSAIDS) [OR = 50.2 (0.9-562.1), P = 0.0040] respectively.


ADRs were less likely to occur in patients on stavudine-based and tenofovir-based regimens compared to zidovudine-based regimens. Peripheral neuropathy was also found to be associated with tenofovir-based regimen. This may require further studies and evaluation.


November 26, 2013 at 2:49 pm

Cost-effectiveness of the once-daily efavirenz/emtricitabine/tenofovir tablet compared with the once-daily elvitegravir/cobicistat/emtricitabine/tenofovir tablet as first-line antiretroviral therapy in HIV-infected adults in the US.

Clinicoecon Outcomes Res. 2013 Sep 2;5:437-45.

Juday T, Correll T, Anene A, Broder MS, Ortendahl J, Bentley T.


Bristol-Myers Squibb, Plainsboro, NJ, USA.



February 2013 US treatment guidelines recommend the once-daily tablet of efavirenz/emtricitabine/tenofovir (Atripla®) as a preferred regimen and the once-daily tablet of elvitegravir/cobicistat/emtricitabine/tenofovir (Stribild™) as an alternative regimen for first-line treatment of human immunodeficiency virus (HIV). This study assessed the clinical and economic trade-offs involved in using Atripla compared with Stribild as first-line antiretroviral therapy in HIV-infected US adults.


A Markov cohort model was developed to project lifetime health-related outcomes, costs, quality-adjusted life years (QALYs), and cost-effectiveness of Stribild compared with Atripla as first-line antiretroviral therapy in HIV-1-infected US patients. Patients progressed in 12-week cycles through second-line, third-line, and nonsuppressive therapies, acquired immune deficiency syndrome, and death. Baseline characteristics and first-line virologic suppression, change in CD4 count, and adverse effects (lipid, central nervous system, rash, renal) were based on 48-week clinical trial results. These results demonstrated equivalent virologic suppression between the two regimens. Point estimates for virologic suppression (favoring Stribild) were used in the base case, and equivalency was used in the scenario analysis. Published sources and expert opinion were used to estimate costs, utilities, risk of acquired immune deficiency syndrome, mortality, subsequent-line CD4 count, clinical efficacy, and adverse events. Costs were reported in 2012 US dollars. Sensitivity analyses were conducted to assess robustness of results.


Compared with patients initiating Atripla, patients initiating Stribild were estimated to have higher lifetime costs. Stribild added 0.041 QALYs over a lifetime at an additional cost of $6,886, producing an incremental cost-effectiveness ratio of $166,287/QALY gained. Results were most sensitive to first-line response rates, product costs, and likelihood of renal adverse events. When equivalent efficacy was assumed, Atripla dominated Stribild with lower costs and greater QALYs.


At a societal willingness to pay of $100,000/QALY, Stribild was not cost-effective in the base case compared with Atripla for first-line HIV treatment.


November 26, 2013 at 2:47 pm


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