Tuberculosis In A Nigerian Medium Security Prison

Introduction: Prisons worldwide have been cited as reservoirs for tuberculosis and also an ideal setting for interventions but little is known about the epidemiology and control of tuberculosis in Nigerian Prisons. Objective: To determine the prevalence of tuberculosis, role of prison in its control and the mortality from tuberculosis among prison inmate in Kuje prison, Abuja, Nigeria. Materials and Methods: This study was a retrospective study of cases of tuberculosis in Kuje prison between April, 2004 and December, 2008. Data was collected from their medical records. The inclusion criterion was: (1) Cases of tuberculosis in which the diagnosis was based on clinical history, smear positive test and chest x-ray radiograph. (2) Cases where the treatment of tuberculosis was according to treatment strategy recommended by World Health Organization. Results: A total of forty-eight inmates, aged 20 to 45years, were diagnosed with tuberculosis within the period of interest. The prevalence rate was 2.4%, based on a total prison population of 2002. Majority of cases 93.8% were first detected in Prison and the remaining 6.3% were detected prior to incarceration. Out of the 6.3% diagnosed prior to incarceration, 2.1% and 4.2% of cases have defaulted from DOTS for 2weeks and more than 4weeks respectively. Majority (66.7%) completed the treatment before discharging from prison, 29.2% were discharged from prison at various level of treatment and 4.2% of cases died while on reatment. Those who died were co-infected with HIV Conclusion: It was evident from this study that: The prevalence of tuberculosis in Kuje prison was high, prison has a role in diagnosis and treatment, adherence and treatment outcome were good and the main indicator for mortality was HIV infection. Primary prevention measures specifically targeting prisoners are needed to reduce prevalence of tuberculosis and also to achieve the objectives of National Health Policy on tuberculosis and leprosy. Keywords: Prison, tuberculosis, control, mortalit

Chimeric antigen receptor (CAR) T cells for the treatment of a kidney transplant patient with post-transplant lymphoproliferative disorder (PTLD)

Post-transplant lymphoproliferative disorder (PTLD) is a potentially fatal complication following kidney transplantation, and there is a critical and unmet need for PTLD treatments associated with more pronounced and durable responses. To date, reports on the use of CD19-targeted chimeric antigen receptor (CAR) T (CAR-T) cells in patients after solid organ transplant (SOT) have been anecdotal, clinical presentations and outcomes have been heterogenous, and a longitudinal analysis of CAR-T cell expansion and persistence in PTLD patients has not been reported. Our report describes a patient with a history of renal transplant who received CD19-directed CAR-T cell therapy for the treatment of refractory PTLD, diffuse large B cell lymphoma (DLBCL)-type. We show that even with the background of prolonged immunosuppression for SOT, it is possible to generate autologous CAR-T products capable of expansion and persistence in vivo, without evidence of excess T-cell exhaustion. Our data indicate that CAR-T cells generated from a SOT recipient with PTLD can yield deep remissions without increased toxicity or renal allograft dysfunction. Future clinical studies should build on these findings to investigate CAR-T therapy, including longitudinal monitoring of CAR-T phenotype and function, for PTLD in SOT recipients