A strong association of allopurinol-induced SJS/TEN with the HLA-B*5801 allele was observed in a Thai population. The results suggest that HLA-B*5801 is a valid genetic marker for screening Thai individuals who may be at risk for allopurinol-induced life-threatening SJS and TEN.
This study aimed to screen for anal cancer and to determine its cytomorphology using liquid-based cytology (LBC) with specimens preserved in 95% ethyl alcohol. Anal swabs were collected for cytological examination from 177 adult, HIV-infected patients. After collection, sample slides were reviewed and classified according to their cytomorphology using the modified Bethesda 2001 system. An abnormal anal Pap smear was found in 26.0% of the patients. The diagnoses were: 66.7% negative for intraepithelial lesions (NIL), 14.1% with atypical squamous cells of undetermined significance (ASC-US), 10.7% (19) with low-grade squamous intraepithelial lesions (LSIL), and 1.13% with high-grade squamous intraepithelial lesions (HSIL). The cytological evaluation was an unsatisfactory result only with 6.67%. The present modified LBC using 95% ethyl alcohol as the preservative could thus be used for anal cancer screening. The number of SILs in Thai HIV-infected patients is lower than that in Western countries. We found anal cytology a satisfactory tool for early screening and detection of anal dysplasia commonly found in high-risk, HIV-infected patients.
Background
Treatment of melioidosis comprises intravenous drugs for at least 10 days, followed by oral trimethoprim-sulfamethoxazole (TMP-SMX) for 12 to 20 weeks. Twelve weeks of oral TMP-SMX is recommended in Australia, and 20 weeks in Thailand.
Methods
For this open-label, pragmatic, multicenter, non-inferiority, randomized controlled trial, we enrolled patients with culture-confirmed melioidosis who had received oral eradication treatment for 12 weeks and had no clinical evidence of active melioidosis. We randomly assigned patients to stop (12-week regimen) or continue treatment for another eight weeks (20-week regimen). The primary endpoint was culture-confirmed recurrent melioidosis within one year after enrollment. The non-inferiority margin was a hazard ratio (HR) of 2.0. The secondary composite endpoint combining overall recurrent melioidosis and mortality was assessed post-hoc.
Results
658 patients were enrolled: 322 to the 12-week regimen and 336 to the 20-week regimen. Five patients (2%) in the 12-week regimen and 2 patients (1%) in the 20-week regimen developed culture-confirmed recurrent melioidosis (HR 2.66; 95% confidence interval [CI] 0.52-13.69). The criterion for non-inferiority of primary event was not met (one-sided P=.37). However, all-cause mortality was significantly lower in the 12-week regimen group than in the 20-week regimen group (1 [0.3%] vs. 11 [3%]; HR 0.10; 95% CI 0.01-0.74). The criterion for non-inferiority of the secondary composite endpoint combining overall recurrent melioidosis and mortality was met (one-sided P=.022).
Conclusions
Based on the lower total mortality and non-inferiority of the secondary composite endpoint observed, we recommend the 12-week regimen of TMP-SMX for oral eradication treatment of melioidosis.
Objective:
We investigated human papillomavirus (HPV) infection and detected anal squamous intraepithelial lesions by modified liquid-based cytology (LBC) and p16/Ki67 dual-staining.
Methods:
Anal swabs (n=393) were collected from patients with HIV infection. Anal cells were kept in 95% ethyl alcohol for modified LBC. DNA was extracted from cells for HPV detection and genotyping using real-time PCR and reverse line blot hybridization. Results: Nine samples (2.3%) were unsatisfactory specimens, 74.8% (294/393) were negative for intraepithelial malignancies (NILM) and 22.9% (90/393) exhibited squamous intraepithelial lesions (SIL). In the latter category, 13.7% of samples (54/393) contained atypical squamous cells of undetermined significance (ASCUS), 6.9% (27/393) were classified as low-grade SIL (LSIL) and 2.3% (9/393) as high-grade SIL (HSIL). A total of 331 from 393 swab samples were suitable for detection of HPV infection. Among these, 34.1% (113/331) were positive. HPV 58 (15.9%) was the most common genotype, followed by HPV 18 (14.2%) and HPV 16 (11.5%). The severity of abnormal cells was significantly associated with HPV infection. Dual staining with p16/Ki-67 was performed on 130 samples: in 30.8% (40/130) of samples positive staining was significantly associated with severity of abnormal cells. Agreement between cytology, p16/Ki67 dual-staining and high-risk HPV detection was 100% in HSIL samples. Interestingly, eight apparently NIML cases might have contained abnormal cells, since they were positive by both p16/Ki67 dual-staining and high-risk HPV detection.
Conclusion:
Anal specimens screened using modified LBC with 95% ethyl alcohol solution as the fixative are suitable for screening anal precancerous lesions by cytology, HPV testing and p16/Ki-67 dual staining.
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