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Pharmacologic and non-pharmacologic interventions to prevent hypersensitivity reactions of non-ionic iodinated contrast media: a systematic review protocol

Por: Umakoshi · H. · Nihashi · T. · Shimamoto · H. · Yamada · T. · Ishiguchi · H. · Takada · A. · Hirasawa · N. · Ishihara · S. · Takehara · Y. · Naganawa · S. · Davenport · M. · Terasawa · T.
Introduction

Iodinated contrast media are commonly used in medical imaging and can cause hypersensitivity reactions, including rare but severe life-threatening reactions. Although several prophylactic approaches have been proposed for severe reactions, their effects remain unclear. Therefore, we aim to review systematically the preventive effects of pharmacologic and non-pharmacologic interventions and predictors of acute, hypersensitivity reactions.

Methods and analysis

We will search the PubMed, EMBASE and Cochrane Central Register of Controlled Trials databases from 1 January 1990 through 31 December 2019 and will examine the bibliographies of eligible studies, pertinent review articles and clinical practice guidelines. We will include prospective and retrospective studies of any design that evaluated the effects of pharmacological and non-pharmacological preventive interventions for adverse reactions of non-ionic iodinated contrast media. Two assessors will independently extract the characteristics of the study and intervention and the quantitative results. Two independent reviewers will assess the risk of bias using standard design-specific validity assessment tools. The primary outcome will be reduction in acute contrast media-induced hypersensitivity reactions. The secondary outcomes will include characteristics associated with the development of contrast media-induced acute hypersensitivity reactions, and adverse events associated with specific preventive interventions. Unique premedication regimens (eg, dose, drug and duration) and non-pharmacological strategies will be analysed separately. Average-risk and high-risk patients will be considered separately. A meta-analysis will be performed if appropriate.

Ethics and dissemination

Ethics approval is not applicable, as this will be a secondary analysis of publicly available data. The results of the analysis will be submitted for publication in a peer reviewed journal.

PROSPERO registration number

CRD42019134003

Transmission of tuberculosis and predictors of large clusters within three years in an urban setting in Tokyo, Japan: a population-based molecular epidemiological study

Por: Izumi · K. · Murase · Y. · Uchimura · K. · Kaebeta · A. · Ishihara · K. · Kaguraoka · S. · Takii · T. · Ohkado · A.
Objective

Molecular epidemiology is a promising tool for understanding tuberculosis transmission dynamics but has not been sufficiently utilised in Asian countries including Japan. The aim of this study was to estimate the proportion of TB cases attributable to recent transmission and to identify risk factors of genotype clustering and the development of large clusters within 3 years in an urban setting in Japan.

Design and setting

Long-term cross-sectional observational study combining the characteristics of patients with culture-positive TB notified in Shinjuku City, Tokyo (2002–2013), with genotype data of Mycobacterium tuberculosis.

Primary outcome measure

Genotype clustering rate and association between genotype clustering status and explanatory variables.

Results

Among 1025 cases, 515 were localised within 113 genotype clusters. The overall clustering rate was 39.2%. Significantly higher rates were found in patients aged

Conclusion

Our results indicated that a large proportion of patients with culture-positive TB were involved in the recent TB transmission chain. Foreign-born persons still have a limited impact on transmission in the Japanese urban setting. Intensified public health interventions, including the active case finding, need to focus on individuals with socioeconomic risk factors that are significantly associated with tuberculosis transmission and clusters with shorter registration intervals between the first two cases.

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