BackgroundDespite some studies suggesting a possible association between human leukocyte antigen, HLA-B*5801 and allopurinol induced Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN), the evidence of association and its magnitude remain inconclusive. This study aims to systematically review and meta-analyze the association between HLA-B*5801 allele and allopurinol-induced SJS/TEN.MethodsA comprehensive search was performed in databases including MEDLINE, Pre-MEDLINE, Cochrane Library, EMBASE, International Pharmaceutical Abstracts (IPA), CINAHL, PsychInfo, the WHO International, Clinical Trial Registry, and ClinicalTrial.gov from their inceptions to June 2011. Only studies investigating association between HLA-B*5801 with allopurinol-induced SJS/TEN were included. All studies were extracted by two independent authors. The primary analysis was the carrier frequency of HLA-B*5801 comparison between allopurinol-induced SJS/TEN cases and each comparative group. The pooled odds ratios were calculated using a random effect model.ResultsA total of 4 studies with 55 SJS/TEN cases and 678 matched-controls (allopurinol-tolerant control) was identified, while 5 studies with 69 SJS/TEN cases and 3378 population-controls (general population) were found. SJS/TEN cases were found to be significantly associated with HLA-B*5801 allele in both groups of studies with matched-control (OR 96.60, 95%CI 24.49-381.00, p < 0.001) and population-control (OR 79.28, 95%CI 41.51-151.35, p < 0.001). Subgroup analysis for Asian and Non-Asian population yielded similar findings.ConclusionWe found a strong and significant association between HLA-B*5801 and allopurinol-induced SJS/TEN. Therefore, HLA-B*5801 allele screening may be considered in patients who will be treated with allopurinol.

We found a strong relationship between the HLA-B*1502 allele and carbamazepine-induced SJS and TEN in Han-Chinese, Thai, and Malaysian populations. HLA-B*1502 screening in patients requiring carbamazepine therapy is warranted.

OBJECTIVES:To evaluate Health Related Quality of Life (HRQoL) among general population of Quetta city, Pakistan. METHODS: The study was designed as a questionnaire-based cross sectional analysis. European Quality of Life scale (EQ-5D) was used for assessment of HRQoL. A total of 1500 healthy participants from March 2011 to July 2011, aging 18 years and above were approached. Descriptive statistics were used to describe demographic characteristics of the general population. Percentages and frequencies were used to categorize the categorical variables, while means and standard deviations were calculated for the continuous variables. Inferential statistics (Mann-Whitney and Kruskal Wallis tests) were used where appropriate. HRQoL was scored using values adapted from the UK general population survey. All analyses were performed using SPSS 16.0. RESULTS: One thousand five hundred questionnaires were distributed and 1255 were returned (with response rate of 83.67%). Six hundred and forty three (51.2%) were males. Majority (nϭ427, 34.0%) were categorized in age group of 28-37 years. Three hundred and thirty three (26.5%) had intermediate level of education. Two hundred and ninety one (23.2%) had monthly income of in between 10001-15000 Pakistan rupees with 828 (66.0%) having urban residency. HRQoL was measured as 0.64Ϯ0.21 and VAS score was 68.71Ϯ11.71. Only age and marital status, among all demographic characteristics had significant relation with HRQoL score (pϽ0.05). CONCLUSIONS: Results of the present study provide the general health status of healthy population of Quetta city, Pakistan, which could sever as baseline data for further investigations.

BackgroundSeveral decision support tools have been developed to aid policymaking regarding the adoption of pneumococcal conjugate vaccine (PCV) into national pediatric immunization programs. The lack of critical appraisal of these tools makes it difficult for decision makers to understand and choose between them. With the aim to guide policymakers on their optimal use, we compared publicly available decision-making tools in relation to their methods, influential parameters and results.MethodsThe World Health Organization (WHO) requested access to several publicly available cost-effectiveness (CE) tools for PCV from both public and private provenance. All tools were critically assessed according to the WHO's guide for economic evaluations of immunization programs. Key attributes and characteristics were compared and a series of sensitivity analyses was performed to determine the main drivers of the results. The results were compared based on a standardized set of input parameters and assumptions.ResultsThree cost-effectiveness modeling tools were provided, including two cohort-based (Pan-American Health Organization (PAHO) ProVac Initiative TriVac, and PneumoADIP) and one population-based model (GlaxoSmithKline's SUPREMES). They all compared the introduction of PCV into national pediatric immunization program with no PCV use. The models were different in terms of model attributes, structure, and data requirement, but captured a similar range of diseases. Herd effects were estimated using different approaches in each model. The main driving parameters were vaccine efficacy against pneumococcal pneumonia, vaccine price, vaccine coverage, serotype coverage and disease burden. With a standardized set of input parameters developed for cohort modeling, TriVac and PneumoADIP produced similar incremental costs and health outcomes, and incremental cost-effectiveness ratios.ConclusionsVaccine cost (dose price and number of doses), vaccine efficacy and epidemiology of critical endpoint (for example, incidence of pneumonia, distribution of serotypes causing pneumonia) were influential parameters in the models we compared. Understanding the differences and similarities of such CE tools through regular comparisons could render decision-making processes in different countries more efficient, as well as providing guiding information for further clinical and epidemiological research. A tool comparison exercise using standardized data sets can help model developers to be more transparent about their model structure and assumptions and provide analysts and decision makers with a more in-depth view behind the disease dynamics. Adherence to the WHO guide of economic evaluations of immunization programs may also facilitate this process.Please see related article: http://www.biomedcentral.com/1741-7007/9/55

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