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Sydney, Australia

Scott G.M.,SEALS
Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology

Cytomegalovirus (CMV) remains the leading viral cause of disease following orthotopic liver transplantation (OLT) despite the availability of antiviral agents for prophylaxis and therapy. Examine the viral factors that influence the outcome of CMV infection following valganciclovir prophylaxis or laboratory-guided preemptive therapy in OLT recipients. The value of valganciclovir prophylaxis and laboratory-guided preemptive therapy for the prevention of CMV infection and disease was observed in 64 OLT recipients. Prophylaxis was given to all CMV seronegative recipients receiving a liver from a seropositive donor (D+R-; n=15), and all other recipients were randomised to receive either prophylaxis (n=24) or laboratory-guided preemptive therapy (n=25). Recipients were monitored for CMV DNAemia, viral load, emergence of antiviral resistant strains and co-infections. CMV end-organ disease and antiviral resistant strains only occurred in D+R- recipients despite the use of prophylaxis in these patients. The D+R- recipients commencing prophylaxis immediately following transplantation had better outcomes compared to those for whom prophylaxis was delayed due to renal impairment. Prophylaxis reduced the incidence of CMV DNAemia, persistent infection, and high viral loads for CMV seropositive (D-R+and D+R+) recipients, but laboratory-guided preemptive therapy effectively controlled CMV infection and prevented disease in these OLT recipients. Delaying the commencement of valganciclovir prophylaxis may be associated with worse outcomes for high-risk OLT recipients. Laboratory-guided pre-emptive therapy remains an alternative approach for seropositive recipients at lower risk of CMV disease. Copyright © 2011 Elsevier B.V. All rights reserved. Source

Lahra M.M.,SEALS
Communicable diseases intelligence quarterly report

The Australian Gonococcal Surveillance Programme monitors antibiotic susceptibility testing of Neisseria gonorrhoeae isolates in all states and territories. In 2011, the in vitro susceptibility of 4,133 isolates of gonococci from public and private sector sources was determined by standardised methods. Varying antibiotic susceptibility patterns were again reported across jurisdictions and regions. Resistance to the penicillins nationally was 25%, and with the exception of the Northern Territory and Tasmania, ranged from 17% in South Australia and Western Australia, to 44% in Victoria. Quinolone resistance, most at high minimal inhibitory concentration (MIC) levels, was 27% nationally (except in the Northern Territory and Tasmania), ranging from 12% in the Australian Capital Territory to 40% in Victoria. Decreased susceptibility to ceftriaxone (MIC 0.06 mg/L or more), was found nationally in 3.2% of isolates, a decrease from 4.8% in 2010. There has not been an isolate of N. gonorrhoeae with a ceftriaxone MIC value greater than 0.125 mg/L reported in Australia. Nationally, all isolates remained sensitive to spectinomycin. Azithromycin surveillance was performed in the Australian Capital Territory; New South Wales; Queensland; Western Australia; the Northern Territory and South Australia. Resistance was found in low numbers of gonococci, with MIC values up to 16 mg/L. The source and site of the isolates referred to the program varied by geographic location. In larger urban centres the ratio of male to female cases was high, and rectal and pharyngeal isolates were common in men. In other centres, and in rural Australia, the male to female ratio was lower, and most isolates were from the genital tract. This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced by any process without prior written permission from the Commonwealth. Requests and inquiries concerning reproduction and rights should be addressed to the Commonwealth Copyright Administration, Attorney General's Department, Robert Garran Offices, National Circuit, Barton ACT 2600 or posted at http://www.ag.gov.au/cca. Source

Pillai D.,SEALS | Callen S.,RCPA Chemical Pathology Quality Assurance Programs
Annals of Clinical Biochemistry

Background: Up to 2007 there was no formal external quality assurance programme for plasma free metanephrines. A pilot programme was conceived by the AACB (Australian Association of Clinical Biochemists) Working Party on biogenic amines. With support from the AACB and Royal College of Pathologists of Australasia Quality Assurance programmes, a pilot study was developed. Data from this study are presented for the first time. Methods: Twelve lyophilized plasma samples were distributed to 15 centres. Samples were spiked with metanephrine (metadrenaline), normetanephrine (normetadrenaline) and 3-methoxytyramine, all derived from human urine. Concentrations were arranged in a linear relationship. The analytes were present at six levels and samples were duplicated. Results: High-pressure liquid chromatography and tandem mass spectrometry methods showed acceptable precision but in general enzyme immunoassay displayed a higher degree of imprecision as well as a negative bias. Conclusions: Differences in calibration and matrix effects are likely to have been responsible for the discrepancy between chromatographic and immunoassay methods. These differences need to be further examined although efforts at standardization between different methods have been hampered by the lack of a universal calibrator for plasma metanephrines. Meanwhile, a laboratory's performance characteristics can be monitored and enhanced by participation in suitable external quality assurance programmes. Source

Dolan K.,University of New South Wales | Teutsch S.,University of New South Wales | Scheuer N.,University of New South Wales | Levy M.,University of Sydney | And 4 more authors.
European Journal of Epidemiology

To determine hepatitis C incidence and the demographic and behavioural predictors in seronegative drug injecting prisoners. Prisoners in New South Wales, Australia who: were aged 18 years and over; reported IDU; had been continuously imprisoned; had a documented negative HCV antibody test result in prison in the last 12 months; provided written informed consent. Subjects were interviewed about their demographic characteristics and detailed risk factors for transmission prior to, and since, imprisonment. A blood sample was collected to screen for HCV antibodies by ELISA and RNA by PCR. Of 253 inmates recruited, 120 were continuously imprisoned and included in this analysis. Sixteen acquired HCV infection indicating an incidence of 34.2 per 100 person years (CI: 19.6-55.6). Risk factors for transmission included prior imprisonment, methadone treatment and greater than 10 years of education. Although the frequency of injecting was reduced in prison, 33.6% continued to inject drugs, most commonly methamphetamine, and 90% of these reported sharing injecting equipment. Prison inmates were at high risk of HCV infection, despite some reduction in high-risk behaviours and access to prevention services. To prevent HCV transmission in prisons, better prevention strategies are required. © 2010 Springer Science+Business Media B.V. Source

Ward S.,SEALS | Sugo E.,Sydney Childrens Hospital | Verge C.F.,Sydney Childrens Hospital | Wargon O.,Sydney Childrens Hospital
Australasian Journal of Dermatology

We report three cases of primary osteoma cutis in children, two of whom (siblings) were associated with Albright's hereditary osteodystrophy (AHO), manifesting as short stature with autosomal dominant inheritance from the father, but no dysmorphic features and no parathyroid hormone (PTH) resistance. Osteoma cutis can manifest as an isolated skin disease, a secondary condition to other skin diseases (such as acne), or in association with several syndromes, including AHO, which in turn may be associated with PTH resistance. The management and prognosis of patients diagnosed with osteoma cutis is determined by whether the skin manifestation has occurred in isolation, in association with a syndrome, or as a secondary skin disease. These three paediatric cases highlight the importance of understanding the aetiology and associations of osteoma cutis in order to appropriately investigate and manage patients who present with this rare skin disease. © 2011 The Authors Australasian Journal of Dermatology © 2011 The Australasian College of Dermatologists. Source

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