Intensive Phase Non-Compliance to Anti Tubercular Treatment in Patients with HIV-TB Coinfection: A Hospital-based Cross-Sectional Study

We aimed to study the prevalence and determinants of non compliance to intensive phase anti tubercular treatment (ATT) in 111 HIV-TB coinfection patients, attending the APEX Referral Center for HIV/AIDS at Medical College, Kolkata with a specially-designed, semi-structured, pre-tested questionnaire. Compliance was defined as taking ≥95% of the total scheduled doses of anti-TB medicines during the intensive phase. Data was collected on socio-demographic parameters, disease information, patient’s knowledge and barriers to treatment. The prevalence of non-compliance to ATT in HIV-TB coinfection patients was found to be 40.5% (95% C.I. = 30.5, 50.5). Multivariate logistic regression analysis showed that absence of proper counseling, lack of knowledge about correct route of TB transmission, visiting quacks during ATT and the urge to leave treatment once patient started feeling better were the significant determinants of non-compliance. “No Counseling” increased chances of non- compliance (adjusted O.R.) 47.12 times (95% C.I. = 7.99, 195.27); thereby being the single most influential variable towards the outcome. The present study finds an alarmingly high prevalence of non-compliance to ATT among HIV-TB coinfection patients. The results clearly indicate that adequate counseling about this coinfection and the importance of compliance, along with better patient-friendly orientation of DOTS programme is urgently needed. Collaborative TB-HIV activities are essential to ensure better ATT compliance in coinfection patients.     

Histopathology of retinoblastoma: Does standardization make a difference in reporting?

The International Retinoblastoma Staging Working Group (IRSWG) provided guidelines for tissue handling of eyes enucleated for retinoblastoma. We adopted these guidelines from January 2009. Reviewing histopathology slides between January 2006 and December 2010 we found significantly more number of eyes with massive choroidal, optic nerve, and anterior segment invasion by tumor cells in the post‐IRSWG era. The guidelines provided by the IRSWG; in addition to being standardized; recognize more eyes with histopathologic risk factors compared to techniques applied in the past. This may translate to more children receiving adjuvant chemotherapy and contribute to reduced mortality rates in the future. Pediatr Blood Cancer 2013;60:336–337. © 2012 Wiley Periodicals, Inc.     

Electrocardiographic and echocardiographic changes in perinatal asphyxia

Objective  To study the usefulness of cardiac enzymes in evaluating myocardial damage in perinatal asphyxia. Methods  Thirty term babies with perinatal asphyxia and without any congenital malformations were selected as cases. They were compared with thirty healthy term babies without asphyxia. Myocardial dysfunction was evaluated using clinical, electrocardiography, echocardiography and cardiac enzymes i.e, troponin-T and CK-MB levels. Results  Among the 30 cases 23 had evidence of myocardial involvement while one baby in the control group had ECG evidence compatible with cardiac involvement. Cardiac enzymes were significantly increased in babies with perinatal asphyxia. The mean level of C-troponin-T among cases and controls were 0.22±0.28 and 0.003±0.018 while CK-MB levels were 121±77.4 IU/L and 28.8 ± 20.2 IU/L respectively. C-troponin-T had higher sensitivity and specificity compared to CK-MB levels. Moreover, C troponin-T levels correlated well with severity and outcome in babies with perinatal asphyxia. Conclusion  C-Tropopnin assay is useful in evaluating the severity of myocardial damage and outcome in perinatal asphyxia.     

Genomic organization and evolution of immunoglobulin kappa gene enhancers and kappa deleting element in mammals

We have studied the genomic structure and evolutionary pattern of immunoglobulin kappa deleting element (KDE) and three kappa enhancers (KE5′, KE3′P, and KE3′D) in eleven mammalian genomic sequences. Our results show that the relative positions and the genomic organization of the KDE and the kappa enhancers are conserved in all mammals studied and have not been affected by the local rearrangements in the immunoglobulin kappa (IGK) light chain locus over a long evolutionary time (120 million years of mammalian evolution). Our observations suggest that the sequence motifs in these regulatory elements have been conserved by purifying selection to achieve proper regulation of the expression of the IGK light chain genes. The conservation of the three enhancers in all mammals indicates that these species may use similar mechanisms to regulate IGK gene expression. However, some activities of the IGK enhancers might have evolved in the eutherian lineage. The presence of the three IGK enhancers, KDE, and other recombining elements (REs) in all mammals (including platypus) suggest that these genomic elements were in place before the mammalian radiation.     

Automated TUNEL assay on tissue sections via robotics

The manual TUNEL (terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling) method for detecting deoxyribonucleic acid (DNA) fragmentation during apoptosis is widely used to determine cell death in tissue sections. However, manually staining large numbers of slides is cumbersome and may result in inconsistent signal intensities. We have developed a simple automated TUNEL assay using a robotic platform and a popular apoptosis detection kit. Comparing manual and automatic staining methods of serially sectioned murine tissue blocks showed no differences in quality or quantity of signal. The automated TUNEL assay allows larger throughput and provides consistent results across many tissue types.     

Good Research Practices for Measuring Drug Costs in Cost Effectiveness Analyses: An Industry Perspective: The ISPOR Drug Cost Task Force Report—Part V

Objectives:  The industry perspective on drug costs should be framed by the need for decision-makers to use actual and relevant costs, and to inform real-world decisions regarding medication selection and use. The objective of this report is to provide guidance and recommendations on how manufacturers should approach the use of drug costs.
Methods:  The Task Force was appointed with the advice and consent of the ISPOR Board of Directors. Members were experienced developers or users of drug cost information working in academia and industry, and came from several countries. Following the core assumptions developed and outlined by the Task Force, a draft report was prepared. Comments were solicited on the outline and several draft reports both from a core group of external reviewers and more broadly from the ISPOR membership of ISPOR via the ISPOR Web site.
Results:  The industry should always strive for: 1) a focus on drug value and not just cost; 2) credibility—that is correct and consistent costs; 3) transparency—by disclosing the prices and costs, and ensuring that they reflect the actual cost of the drug whenever possible; and 4) providing actionable results that help customers comprehend the value offered by a drug therapy and to use products more efficiently and effectively.
Conclusions:  Understanding and accounting for all costs and consequences of the use of a medical treatment is in the best interests of all parties involved in the prescribing, consuming, reimbursement, selling, and manufacturing of bio/pharmaceuticals. Transparency, consistency, and clear communication of costs and value are essential for appropriate decision-making and should be important goals for all parties.