Reply to Dr. Lai regarding Allopurinol Hypersensitivity Syndrome in patients of Asian ancestry

We thank Dr Lai for their interest in our study (1). While we did not show a statistically significant link between the use of allopurinol and mortality in people with gout, we agree that Allopurinol Hypersensitivity Syndrome (AHS) is the most serious side-effect of allopurinol, particularly in populations with South East Asian ancestry, leading to the recommendation to screen people of South East Asian descent for the HLA-B*5801 allele prior to starting treatment with allopurinol (2,3)

Illness perceptions of gout patients and the use of allopurinol in primary care: baseline findings from a prospective cohort study

BackgroundPatients’ perceptions of their illness are dynamic and can directly influence aspects of management. Our aim was to examine the illness perceptions of gout patients in UK primary care and associations with allopurinol use.MethodsA health questionnaire was sent to 1805 people with gout aged =18 years identified by a gout diagnosis or prescriptions for allopurinol or colchicine in their primary care medical records in the preceding 2 years. The questionnaire included selected items from the revised illness perception questionnaire (IPQ-R). Associations between illness perceptions and use of allopurinol were calculated using multinomial logistic regression adjusted for age, gender, deprivation status, body mass index, alcohol consumption, comorbidities and gout characteristics.ResultsOne thousand one hundred eighty-four participants responded to the baseline questionnaire (65.6 %). Approximately half of responders perceived that they were able to control (51.2 %) or affect their gout through their own actions (44.8 %). Three quarters perceived treatments to be effective (76.4 %) and agreed that gout is a serious condition (76.4 %). Patients who agreed that they could control their gout (Relative Risk Ratio, 95 % confidence interval 1.66 (1.12 to 2.45)) and that treatments were effective (2.24 (1.32 to 3.81)) were more likely to currently be using allopurinol than not using allopurinol. However, this significance was attenuated after adjustment for self-reported gout characteristics (1.39 (0.89 to 2.17) & 1.78 (0.96 to 3.29) respectively).ConclusionsPatients who perceive that they can control their gout and that treatments are effective are more likely to be using allopurinol, this suggests that better information is needed for the patient from GPs and rheumatologist to reassure and support their use of UL

Clinical Manifestations and Case Management of Ebola Haemorrhagic Fever caused by a newly identified virus strain, Bundibugyo, Uganda, 2007-2008

A confirmed Ebola haemorrhagic fever (EHF) outbreak in Bundibugyo, Uganda, November 2007-February 2008, was caused by a putative new species (Bundibugyo ebolavirus). It included 93 putative cases, 56 laboratory-confirmed cases, and 37 deaths (CFR = 25%). Study objectives are to describe clinical manifestations and case management for 26 hospitalised laboratory-confirmed EHF patients. Clinical findings are congruous with previously reported EHF infections. The most frequently experienced symptoms were non-bloody diarrhoea (81%), severe headache (81%), and asthenia (77%). Seven patients reported or were observed with haemorrhagic symptoms, six of whom died. Ebola care remains difficult due to the resource-poor setting of outbreaks and the infection-control procedures required. However, quality data collection is essential to evaluate case definitions and therapeutic interventions, and needs improvement in future epidemics. Organizations usually involved in EHF case management have a particular responsibility in this respect

Barriers and motivators to gaining access to smoking cessation services amongst deprived smokers – a qualitative study

BACKGROUND: Smoking is strongly associated with disadvantage and is an important contributor to inequalities in health. Smoking cessation services have been implemented in the UK targeting disadvantaged smokers, but there is little evidence available on how to design services to attract this priority group. METHODS: We conducted focus groups with 39 smokers aged 21–75 from the most socio-economically deprived areas of Nottingham UK who had made an unsuccessful attempt to quit within the last year without using smoking cessation services, to identify specific barriers or motivators to gaining access to these services. RESULTS: Barriers to use of existing services related to fear of being judged, fear of failure, a perceived lack of knowledge about existing services, a perception that available interventions – particularly Nicotine Replacement Therapy – are expensive and ineffective, and negative media publicity about bupropion. Participants expressed a preference for a personalised, non-judgemental approach combining counselling with affordable, accessible and effective pharmacological therapies; convenient and flexible timing of service delivery, and the possibility of subsidised complementary therapies. CONCLUSION: We conclude that smokers from these deprived areas generally had low awareness of the services available to help them, and misconceptions about their availability and effectiveness. A more personalised approach to promoting services that are non-judgemental, and with free pharmacotherapy and flexible support may encourage more deprived smokers to quit smoking

The Use of a Mobile Laboratory Unit in Support of Patient Management and Epidemiological Surveillance during the 2005 Marburg Outbreak in Angola

A mobile laboratory unit (MLU) was deployed to Uige, Angola as part of the World Health Organization response to an outbreak of viral hemorrhagic fever caused by Marburg virus (MARV). Utilizing mainly quantitative real-time PCR assays, this laboratory provided specific MARV diagnostics in the field. The MLU operated for 88 consecutive days allowing MARV-specific diagnostic response in <4 hours from sample receiving. Most cases were found among females in the child-bearing age and in children less than five years of age including a high number of paediatric cases implicating breastfeeding as potential transmission route. Oral swabs were identified as a useful alternative specimen source to the standard whole blood/serum specimens for patients refusing blood draw. There was a high concordance in test results between the MLU and the reference laboratory in Luanda operated by the US Centers for Disease Control and Prevention. The MLU was an important outbreak response asset providing valuable support in patient management and epidemiological surveillance. Field laboratory capacity should be expanded and made an essential part of any future outbreak investigation

All-sky search for gravitational-wave bursts in the second joint LIGO-Virgo run

We present results from a search for gravitational-wave bursts in the data collected by the LIGO and Virgo detectors between July 7, 2009 and October 20, 2010: data are analyzed when at least two of the three LIGO-Virgo detectors are in coincident operation, with a total observation time of 207 days. The analysis searches for transients of duration < 1 s over the frequency band 64-5000 Hz, without other assumptions on the signal waveform, polarization, direction or occurrence time. All identified events are consistent with the expected accidental background. We set frequentist upper limits on the rate of gravitational-wave bursts by combining this search with the previous LIGO-Virgo search on the data collected between November 2005 and October 2007. The upper limit on the rate of strong gravitational-wave bursts at the Earth is 1.3 events per year at 90% confidence. We also present upper limits on source rate density per year and Mpc^3 for sample populations of standard-candle sources. As in the previous joint run, typical sensitivities of the search in terms of the root-sum-squared strain amplitude for these waveforms lie in the range 5 10^-22 Hz^-1/2 to 1 10^-20 Hz^-1/2. The combination of the two joint runs entails the most sensitive all-sky search for generic gravitational-wave bursts and synthesizes the results achieved by the initial generation of interferometric detectors.Comment: 15 pages, 7 figures: data for plots and archived public version at https://dcc.ligo.org/cgi-bin/DocDB/ShowDocument?docid=70814&version=19, see also the public announcement at http://www.ligo.org/science/Publication-S6BurstAllSky

183. GOUT AS A CONSEQUENCE OF SLEEP APNOEA: A MATCHED COHORT STUDY

Background: Gout and obstructive sleep apnoea are both common problems in primary care and associated with considerable co-morbidity. Serum uric acid levels are frequently elevated in sleep apnoea patients and one previous cohort study found that people with sleep apnoea are at increased risk of gout during the first year after diagnosis. This study aimed to examine the association between sleep apnoea and subsequent development of gout over a longer follow-up period.Methods: This was a matched retrospective cohort study undertaken in the UK Clinical Practice Research Datalink (CPRD). Individuals aged 18 years and over with an incident diagnosis of sleep apnoea between 1990 and 2010 were identified and followed-up until 2015. Each sleep apnoea case was matched to four age-, gender- and GP-practice matched controls. Incidence rates of gout were calculated per 1000 person-years and hazard ratios (HR) estimated using Cox regression adjusted for body mass index (BMI), diabetes mellitus, ischaemic heart disease, hypertension, hyperlipidaemia, diuretic use, alcohol use and smoking. Risk of incident gout was assessed at different time-points: 1, 5 and 10 years. Furthermore, analyses were stratified by BMI categories (normal BMI<25kg/m2, overweight BMI 25-30kg/m2, obese BMI ≥30kg/m2).Results: The study sample consisted of 15,878 individuals with sleep apnoea and 63,283 controls: median follow-up was 8.03 years. 782 (5.2%) of cases and 1,640 (2.3%) of controls developed gout. Incidence rate of gout per 1000 person-years was 7.83 (95% CI 7.29, 8.40) among those with sleep apnoea and 4.00 (3.80, 4.19) among those without [adjusted HR 1.32 (1.20, 1.45)]. At 1, 2 and 5 years of follow-up, adjusted HRs for incident gout were 1.37 (1.07, 1.75), 1.41 (1.19, 1.69) and 1.36 (1.17, 1.57) respectively. Gout incidence rates per 1000 person-years were higher among those with sleep apnoea across BMI categories and increased with higher BMI in both exposure groups, however proportionately more so in the controls, resulting in both crude and adjusted HRs to decrease with increasing BMI: 1.74 (1.22, 2.48), 1.25 (1.05, 1.49), 1.23 (1.09, 1.41) for normal, overweight and obese categories.Conclusion: The novelty of this study lies in assessing both short and long term association of sleep apnoea with incident gout in a large primary care setting population. People with sleep apnoea continued to be at higher risk of developing gout beyond the first year after sleep apnoea diagnosis. Furthermore, the independent risk of gout conferred by sleep apnoea appears to be larger in those with normal BMI