Efficacy and safety of garenoxacin tablets on clinically diagnosed atypical pneumonia: Postmarketing surveillance in Japan

We performed a postmarketing surveillance study to determine the efficacy and safety of the oral quinolone antibacterial agent garenoxacin (Geninax^® Tablets 200 mg) against atypical pneumonia.Between October 2009 and July 2011, patients with community-acquired pneumonia visited 26 facilities in Japan; we collected survey forms from 105 of these patients who were suspected of having atypical pneumonia based on the Japanese Respiratory Society Guidelines for the Management of Community-Acquired Pneumonia in Adults. We examined the safety in 105 patients and the efficacy in 71 patients.1. The efficacy rates among patients suspected of having atypical pneumonia and those with a confirmed diagnosis of atypical pneumonia were 94.8% (55/58 patients) and 92.3% (12/13 patients), respectively. The efficacy rate was 4/4 for patients in whom Chlamydophila pneumoniae was detected (including 1 patient with a polymicrobial infection with another bacterial strain) and 90% (9/10 patients) for patients in whom Mycoplasma pneumoniae was detected (garenoxacin was ineffective in 1 of 2 patients with a polymicrobial infection with another bacterial strain).2. The incidence of adverse drug reactions (including abnormal laboratory tests) was 4.8% (5/105 patients). Among the adverse drug reactions, gastrointestinal disorders, infection and infestation, nervous system disorder, and skin and subcutaneous tissue disorder were observed in 2.9% of patients (3/105), 1.0% (1/105), 1.0% (1/105), and 1.0% (1/105), respectively.In conclusion, garenoxacin showed an efficacy rate of greater than 90% for suspected atypical pneumonia and confirmed atypical pneumonia. Garenoxacin is considered to be useful in daily practice.     

Acute hepatitis B in Japan: Incidence,clinical practices and health policy

Aim: The epidemiology of acute hepatitis B is unknown in many countries, and the clinical features of this disease remain unclear. In this study, we used the Diagnosis Procedure Combination (DPC) database to estimate the incidence of acute hepatitis B and investigate the clinical practices for acute hepatitis B in Japan. Methods: The DPC database is a nationwide discharge abstract and administrative claims database, covering 40% of all inpatient admissions to acute care hospitals between 1 July and 31 December each year in Japan. We identified cases with a diagnosis of acute hepatitis B between 2007 and 2008. Patient characteristics, length of stay, in‐hospital mortality and total charges were determined. Clinical practice patterns were examined, including drugs used and procedures performed during hospitalization. Results: We identified 890 cases with acute hepatitis B among 5.85 million inpatients in the database. The mean age was 40.0 years old and 76% were male. The incidence of acute hepatitis B was estimated to be approximately 2100–2400/year (17–19/1 million people per year). Of 890 cases, 53 (6.0%) developed fulminant hepatitis and 36 (4.0%) died. Nucleos(t)ide analogs were prescribed for 226 cases (25.4%). Only 194 cases (21.8%) were tested for HIV status. Conclusion: It is essential to monitor the trends of this communicable and preventable disease. The establishment and distribution of appropriate clinical evidence and guidelines are vital to improve the clinical practices for acute hepatitis B.     

Seroprevalence of brucellosis in goats and sheep in Thailand: Results from the Thai National Brucellosis Surveillance System from 2013 to 2015

In Thailand, brucellosis re‐emerged in humans in 2003 and is considered a public health risk to goat farmers as the disease is endemic in small ruminants. The Thai Department of Livestock Development (DLD ) established a nationwide surveillance system for brucellosis in goats and sheep in 1997. Using data from this surveillance system, we describe the seroprevalence of brucellosis from 2013 to 2015 in small ruminants and the spatial distribution of the disease throughout Thailand. Surveillance data collected included the number of animals and herds tested, the province of the animal and herd and the laboratory results. Seroprevalence was estimated at both the animal and herd levels. During the 3‐year period, 443,561 goats and sheep were tested for brucellosis by the DLD throughout Thailand using the Rose Bengal Plate Test (RBPT ) and the enzyme‐linked immunosorbent assay test for Brucella . Among the 3 years, 2013 had the highest proportion of herds that tested positive for brucellosis at 13.80% (95% CI, 12.52, 15.16). Overall, this study found that brucellosis seroprevalence in small ruminants is decreasing throughout Thailand. However, there is variability in the spread of the disease with provinces in the eastern and western regions of Thailand having higher proportions of animals and herds testing positive. Overall provinces in the south had the lowest proportion of animals and herds testing positive for brucellosis. Periodic review of surveillance data documents the impact of the current brucellosis control programme and supports a targeted response in higher prevalence regions when there are limited financial resources for control measures.     

von Hippel-Lindau disease: Deafness due to a non-MRI-visible endolymphatic sac tumor despite targeted screening

Abstract

Objective: Endolymphatic sac tumours (ELSTs) of the inner ear occur in 16% of patients with the hereditary tumor syndrome von Hippel-Lindau disease (vHL). ELSTs of all sizes can cause irreversible hearing loss which can, however, be prevented through early diagnosis and treatment. We aim to emphasize the challenges of prophylactic ELST screening and to explore the role of audiometry in pre-symptomatic ELST screening. Design: For a period of 17 years our patient was screened for ELSTs with inner-ear MRI (magnetic resonance imaging), audiometry, and clinical interviews. Study sample: A male vHL patient who became deaf in one ear due to a radiologically undetectable ELST. Results: Despite annual MRIs, the ELST was not visible until four months after onset of deafness when it appeared as a 1.4 × 1.4 mm tumor mass. Although his hearing was objectively within normal limits for the first 14 years, a distinct pattern of low-frequency hearing loss could retrospectively be seen at all audiometries. Conclusions: Audiometry is a candidate screening tool for detection of non-symptomatic pre-MRI-visible ELSTs, and we have initiated an international collaborative study to further determine its application. At present, we suggest an ELST screening protocol of yearly audiological assessment and inner ear MRI.     

Surveillance and uncertainty: community pharmacy responses to over the counter medicine abuse

The sale of over‐the‐counter (OTC) medicines from community pharmacies offers important opportunities for members of the public to access medicines and self‐treat conditions. They are increasingly recognised, however, as having the potential for abuse and harm despite their perceived relative safety. This study reports on a qualitative study that explored the experiences and views of community pharmacy staff in relation to current practices and concerns, management and support relating to OTC medicine abuse. Semi‐structured interviews were undertaken with a purposive sample of ten pharmacists and seven medicines counter assistants in the United Kingdom. Analysis of interviews indicated that a range of medicines was implicated, including opiates, sedative antihistamines, laxatives and decongestants. A surveillance role was apparent for assistants, who placed emphasis on regulations, procedure and monitoring frequency of purchases to manage abuse, with referral on to pharmacists. Frequency of purchase was central to assistants’ definition of those suspected of OTC medicine abuse, which pharmacists also utilised as well as a distinction between intentional abuse and unintentional medicine misuse. A lack of information about customers, easy access to, and poor communication between community pharmacies were emergent barriers to pharmacists providing more support. Many appeared uncertain of referral options or how pharmacists could effectively stop the problem of abuse. The commercial environment was a particular concern, in relation to customer expectations, medicine advertising and easy access to different community pharmacies. A key tension emerged between providing medicine supplies that permitted consumer freedom, with the needs of healthcare professionals to understand more about those consumers qua patients. Policy implications include the need for improved knowledge for community pharmacy staff about signposting to relevant services, increased awareness of who might be affected, and a review of how pharmacists can have more information about patients to inform OTC medicine sales.     

Molecular epidemiology of influenza B virus and implications in immunization strategy,Southern Brazil

Epidemiological indicators have shown the substantial impact of influenza B (Flu B) on the development of severe acute respiratory infection (SARI) and on mortality rates. In Brazil, the trivalent vaccine, composed of only one Flu B lineage is available. We investigated Flu B infections in clinical samples collected by the epidemiological surveillance service of Paraná State, Brazil, from 2013 to 2016. The Flu B lineages Yamagata- (B/Yam) and Victoria-like (B/Vic) were identified using the qRT-PCR assay, and notification forms were reviewed. Among 379 Flu B positive samples evaluated, 370 (98%) were characterized as B/Yam or B/Vic lineages. Both co-circulated with a frequency of 47% and 53%, respectively. B/Yam infected equally both genders, while B/Vic was more frequent in females (71%). The median age of patients infected by B/Vic (23y; 11–35) was lower than that of patients infected by B/Yam (32y; 12–50). Mismatch between the vaccine and the circulating strain was observed in the 2013 season, with a high number of SARI cases. B/Vic lineage was associated with a larger number of SARI cases (62%), while B/Yam with influenza-like illness (ILI) (61%). Differences were observed in the strains circulating in separate regions of Paraná State. B/Vic was prevalent in the northwestern (67%) and B/Yam in the southeastern region (60%). The unpredictability of Flu B lineage circulation causes a substantial increase in severe disease during epidemics in a vaccine mismatch season. In addition, the differences in the epidemiological profile of the target population of Flu B infections in relation to other respiratory viruses, as well as among the B/Vic and B/Yam lineages may also be associated to an increase in disease burden. These findings have direct consequences on vaccination strategies. Therefore, further molecular epidemiology studies of Flu B in Brazil are required to corroborate these primary results.     

Science to Practice: IT Solutions to Drive Standardized Report Recommendations for Abdominal Aortic Aneurysm Surveillance

Inadequate imaging surveillance has been identified as the most significant contributor to abdominal aortic aneurysm (AAA) rupture. Radiologists can contribute value to patient care and reduce morbidity and mortality related to AAA by incorporating evidence-based management recommendations from the ACR and Society of Vascular Surgery into their report impression. The challenges lie in achieving 100% radiologist compliance to incorporate the recommendations and ensuring that the patient is notified by their provider, the follow-up examination is scheduled, and the patient returns for an imaging test that may be scheduled 3 to 5 years in the future. To address these barriers, radiology quality and informatics leads have harnessed IT solutions to facilitate integration of content, communication of results, and patient follow-up.