geoffrey modest medical blogs

  A recent Spanish study found that vitamin D given to hospitalized patients was associated with significantly decreased ICU admissions and mortality, in a preprint pre-peer reviewed article (see  covid vit d decreases ICU and mortality lancet2021  in dropbox, or   https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3771318#   )    Details:  -- 930 patients who were admitted with Covid-19 in Barcelona, 551 randomized to vitamin D3 in the form of  calcifediol  vs 379 controls       -- patients were given 532 µg (21,280 IU) of vitamin D on day 1 of hospital admission and 266 µg (10,640 IU) on days 3, 7, 15, and 30  -- 56% male, mean age 63, 86% white/8% Asian  -- baseline 25(OH)D was 15 ng/mL in the treated group vs 12   ng/mL  in the nontreated group (p<0.001); of these, 66% had levels <20   ng/mL : 55% in the treated group and 50% in the untreated [these numbers do not exactly match...

John Bernardo MD sent me the following, in response to my blog this week on CDC guidelines for LTBI treatment. John is a local expert on TB as a well-regarded national one (has been on some CDC study groups regarding LTBI detection/treatment), and is a great clinician (and person). His reference to 3HP is to the weekly inh/rifapentine therapy for 3 months (see http://gmodestmedblogs.blogspot.com/2018/07/updated-ltbi-treatment-with-weekly-meds.html for my first blog on 3HP, as well as the mmwr on it, which has the references john alludes to).  And, he did give me permission to share this, along with its source…  geoff I would be a bit careful with the 3HP regimen. -          It really has been studied only in recently infected people – most over 16 y/o – early in the infection process.  So extrapolating effectiveness, especially by “noninferiority” to 9 mos INH, to all populations with LTBI may be a stretch. - ...

a study in England found that commercially available IGRAs (interferon- g  release assays, specific for M. tuberculosis) do not have sufficient accuracy for the diagnostic evaluation of suspected tuberculosis (see  tb igra not accurate lancetinfdz2019 in dropbox, or doi.org/10.1016/S1473-3099(18)30613-3). Details: -- 845 adults with suspected tuberculosis were prospectively followed for 6 to 12 months for the subsequent diagnosis of tuberculosis, comparing the accuracy of commercially available IGRAs -- patients greater than 16 years old were enrolled from 10 National Health Service hospitals in five English cities -- patients are classified as culture-confirmed tuberculosis, highly probable tuberculosis (clinical and radiologic features highly suggestive of TB and unlikely caused by other diseases), clinically indeterminate diagnoses, and those where active tuberculosis was excluded (mostly with a history of exposure to ...

A recent article found that one month of  rifapentine  plus  isoniazid  (INH) daily was  noninferior  to a nine-month INH course in patients with HIV and either latent tuberculosis infection (LTBI) or living in an ar ea with high TB prevalence  (see   tb   ltbi   hiv   inh   rifapentine  1 month nejm2019  in  dropbox , or DOI: 10.1056/NEJMoa1806808)       Details:   -- 3000 HIV-infected people living in areas of high TB prevalence (at least 60 cases per 100,000  population ) or having evidence of LTBI.  From 45 sites in 10 countries.   -- Randomized to open label  regimen of daily  rifapentine  (300mg a day for weight <35kg, 450mg per day for weight   35-45 kg, and 600mg a day for weight >45kg) plus INH 300mg plus pyridoxine for one month ;  vs  INH plus pyridoxine for 9 months   -- 54% women, median age 35, 52% from Africa/8%...