Extra Cases Research Articles

Public preferences for One Health approaches to emerging infectious diseases: A discrete choice experiment

There is increasing scientific consensus that a One Health approach (acknowledging links between human, animal and environmental health) is the most effective way of responding to emerging infectious disease (EID) threats. However, reviews of past EID events show that successful implementation of control strategies hinge on alignment with public values. Given the limited evidence about public values in this area, we sought to understand public preferences for attributes associated with One Health strategies for EID prevention and control, using a discrete choice experiment (DCE).The DCE was conducted in 2016 using an online panel of Australian respondents aged over 18. Participants were presented with 18 pairs of scenarios describing One Health strategies and outcomes, and asked to select their preferred one. Scenarios were described by nine attributes with varying levels: personal autonomy, economic development, environmental health, community cohesion, free trade and travel, zoonotic risk, mortality, animal welfare and food security.Respondents were broadly representative of the Australian population (n = 1999, mean age 45.3 years (range 18–89); 50.7% male). The public preferred scenarios in which individual freedoms are not restricted for the greater good; unemployment is low; the environment is healthy; there is good community cohesion; travel, imports and exports are tightly controlled; there is lower mortality and incidence of disease; and where animal welfare and food security are protected. Although lower morbidity and mortality were preferable, respondents were willing to accept extra cases of severe disease and deaths to avoid reductions in some attributes. However, a mixed logit model indicated significant heterogeneity. A latent class analysis suggested wide variability across respondent classes in the valuation of attributes, and the trade-offs respondents were willing to accept. Therefore, a single approach to managing EID using One Health is unlikely to be acceptable to all community members.

Microscopic examination of Gram-stained smears for anogenital gonorrhoea in men who have sex with men is cost-effective: evidence from a modelling study

ObjectiveTo assess the cost-effectiveness of three testing strategies with or without light microscopic Gram-stained smear (GSS) evaluation for the detection of anogenital gonorrhoea among men who have sex with men...

Is the public-private mix approach increasing tuberculosis case notification in Azad Jammu and Kashmir, Pakistan? A cross-sectional study

Background: Pakistan ranks among high tuberculosis (TB) burden countries, with about 200,000 missing TB cases. Despite significant increase in case detection and treatment outcomes through public-private mix (PPM) globally, the contribution of the private sector may vary in different parts of Pakistan Methods: This was a cross sectional study conducted in state of Azad Jammu and Kashmir (AJK), Pakistan. The study was a retrospective record review of routine TB notification and treatment outcomes for 2015 to 2016 in districts with and without a PPM approach. The study was conducted in all districts of AJK, including all public and private health facilities. Intra-district comparison in PPM supported districts was also carried out. Results: Total notified TB cases during 2015-16 were 11479. Districts with PPM support has notified 5882 (51.24%) of TB cases while districts without PPM support contributed 5597 (48.87%). Pulmonary clinical diagnosis was higher in PPM supported districts (45.43%) as compared to districts without PPM support (31.11%). Notification of extra pulmonary TB cases was lower in PPM supported districts (1256; 21.35%) as compared to districts without PPM support (1877; 33.54%). Unfavourable treatment outcomes (treatment failure, died, lost to follow-up) was higher in PPM facilities (5.84%). Conclusion: The study shows minimal increase in TB case finding through the PPM approach. While this is an important aspect in END TB strategy, this needs more careful evaluation.

Ocular Manifestations among Systemic Tuberculosis Cases: A Hospital Based Study from Nepal

Aim: To study the frequency of various ocular manifestations in diagnosed cases of active pulmonary and extra pulmonary tuberculosis in two different major hospitals in Nepal. Method: A hospital based, cross sectional descriptive study was conducted in the National Tuberculosis Centre, Bhaktapur and BP Koirala Lions Center for Ophthalmic Studies (BPKLCOS), Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal during a period of 18 months from February 2010 to August 2011. Diagnosed cases of systemic tuberculosis were evaluated by ophthalmologists for any ophthalmic manifestations. Results: There were 585 cases in the study. 399 (68%) were cases of pulmonary tuberculosis and 186 (32%) were that of extra pulmonary tuberculosis. Ocular manifestations were seen in 2.6% (15 patients) of the study population; 1.25% (6 patients) in cases of pulmonary tuberculosis and 5.37% (9 patients) in extra pulmonary tuberculosis cases. Uveitis (40%) followed by papilloedema (33%) were the two most common ocular manifestations. Of the 25 affected eyes of 15 patients, 2 eyes of patients with choroiditis involving the macular area were legally blind. Majority of the affected cases (67%) had bilateral involvement. Conclusion: Ocular manifestations in tuberculosis vary greatly ranging from mild episcleritis to potentially blinding posterior uveitis, clinical acumen being of great importance in timely diagnosis and treatment so that vision threatening complications can be prevented. Ocular manifestations are more common in extra pulmonary tuberculosis cases.

EL LECTOR DE CRÓNICA ROJA ENTRE GUSTOS E IMÁGENES. CASO DIARIO EXTRA.

The red chronicle is a genre that is used to name the reports, which, for the most part, present attacks on the life of a human being. The printed media, popularly called “Amarillistas” or “Sensationalists”, have encouraged the growth of this section by the form, background, images and headlines that tell a story. From there, that a group of consumers of this genre has been born and grows - mainly in written media -, specifically the case of the Ecuadorian newspaper Extra- that has a profile according to their sexes, ideologies, ages, tastes, levels of study, occupations and civil status. That target remains faithful and almost loyal to the news that arrives in the newspapers, which are distributed even from dawn so that consumers have that product in their hands and read it. After that, there is a process of internalization and comments on the events between family members or groups. But not only the public or the consumer searches for Extra newspaper, so do the advertisers to show their advertising. This has been modified because the public also evolves. This article is raised and developed in the literature review of other research and is developed under the deductive method, because the object of the general is investigated to the particular, then the synthetic method is applied to qualitatively explain the subject raised.

Course and Contributors to Back Pain in Middle-aged Women Over 9 Years: Data From the Australian Longitudinal Study on Women's Health.

Community-based, cohort study. Our aim was to determine the course of back pain in middle-aged women over a 9-year period, and assess whether obesity and physical inactivity are associated with more frequent back pain. Back pain is the leading cause of disability worldwide. With minimal effective therapies and rising financial burden, identifying modifiable risk factors remains a key priority. The Australian Longitudinal Study on Women's Health is a cohort study of community-based, middle-aged women who completed questionnaires every 3 years between 2004 and 2013. Approximately, 10,530 women completed the survey in 2004 (mean age 55.5 yrs), and 9020 completed follow-up 9 years later. Self-reported data on back pain in the last 12 months and other sociodemographic factors were collected at all four surveys. 'Frequent back pain' was defined as back pain reported at ≥ three surveys. Back pain was common and persistent, with 48% having back pain in ≥ three out of four surveys. Baseline obesity (relative risk [RR] 1.18, 95% confidence interval [CI] 1.12-1.25), lack of vigorous physical activity (RR 1.17, 95% CI 1.10-1.25), depressive symptoms (RR 1.40, 95% CI 1.33-1.47), and low-education status (RR 1.17, 95% CI 1.12-1.24), were independently associated with an increased risk of frequent back pain (all P < 0.001). Overall, 28% of the risk of frequent back pain could be attributed to these factors, equating to one extra case of frequent back pain for every five women with depressive symptoms, for every 11 obese women, for every 12 women with low-education status, and for every 13 women who do not do vigorous physical activity, at baseline. Obesity, depressive symptoms, low-education status, and lack of vigorous physical activity are associated with higher risk of frequent back pain over the following 9 years among women in their mid-50 s. Targeting these risk factors may lessen the burden of back pain. 2.

Cases of Extra- Medullary Myeloma Presenting As Liver Infiltrates: A Single Community Hospital Experience

Introduction:Multiple Myeloma (MM) accounts for 13% of all hematologic malignancies. Plasma cells (PC) proliferation is mainly restricted to the bone marrow (BM) in most of the patients. Extramedullary myeloma (EMM) is defined by the PCs outside the bone marrow. The prevalence of EMM in myeloma patients has been reported at 7 to 15 percent in newly diagnosed patients and from 6 to 20 percent in relapsed setting. Patients with EMM have poor prognosis with a median overall survival of < 6 months. This abstract presents two cases of MM with initial presentation as a liver infiltrate.Cases:Case one: 74-year-old female presented with epigastric pain. Physical exam was unremarkable. Labs showed Hemoglobin (Hb) 8.3 g/dL, Creatinine (Cr) 2.0 mg/Dl and normal liver function test. Ultrasound showed multiple hypoechoic liver nodules. Biopsy of the liver nodule confirmed plasma cells. Her kappa/lambda ratio 3338, Lactate dehydrogenase (LDH) 423 IU/L, beta2 microglobulin was 9 mg/L. Serum and urine immunofixation(IFE) both confirmed a monoclonal kappa light chain clone. Skeletal survey was negative. BM biopsy showed 30 % kappa clonal plasma cells. Fluorescence in situ hybridization was positive for hyperdiploidy of chromosomes 7, 9, 11, 14, and 17 with partial deletion of IgH gene. Treatment with CyBorD (weekly dexamethasone 20 mg, bortezomib 1.3 mg/m2, and cyclophosphamide 300mg/m2) was started. After 6 months therapy, patient achieved partial response. Then her regimen was switched from CyBorD to VRD (Revlimid 10 mg, bortezomib 1.3 mg/m2 and dexamethasone 40 mg) because of severe side effect. She achieved a good partial response.Case two: 57-year-old male presented with right upper quadrant abdominal pain. Physical exam showed diffuse tenderness but no rigidity or guarding. Initial labs showed Hb 8.4g/dL, Cr 1. 7 mg/dL, total bilirubin of 3 mg/ dl, alanine aminotransferase 81 U/ l and aspartate aminotransferase 98 U/ l. CT abdomen pelvis showed metastatic disease to omental implants, splenomegaly and an enlarged liver. Patient underwent surgery in which it was noticed that omentum was adhered to stomach wall whose wedge resection showed plasma cells infiltrate. Liver biopsy also showed diffuse myeloma infiltration. His kappa /lambda ratio 0.0029, LDH 2187 IU/ L, beta 2 microglobulin was 8 mg/L. Serum electrophoresis showed M spike 3. 8 g with IFE confirmed IgG lambda band. Skeletal survey showed several osteolytic lesions in iliac bone. BM biopsy showed hypercellularity with 90 % plasma cells. Patient was started on CyBorD regimen. Repeat labs after first cycle was significant for rising free lambda light chain making us refer the patient to a University Hospital for further treatments. He was recently started on VDT- PACE ( bortezomib, dexamethasone, thalidomide, cisplatin, doxorubicin, cyclophosphamide, and etoposide).Conclusion:EMM with liver metastasis as initial presentation is rare. Since the low incidence of EMM there are no specific treatment guidelines. There are no clear prognostication factors for EMM. Patients are treated in same way as MM. The current initial treatment relies on whether the patient is a transplant candidate or not.Our first patient showed a good response to treatment. However the second patient had primary refractory disease. Given his young age more intensive chemotherapy like VDT-PACE is a good choice If necessary, should be followed by a autologous transplantation or even allogenic transplantation and/ or involving CAR T- cell therapy.A better understanding of how myeloma cells grow and thrive, as well as the biology of extramedullary tumors, is needed in order to develop better strategies for the treatment of EMM in future. DisclosuresNo relevant conflicts of interest to declare.

Probabilistic approach for assessing cancer risk due to benzo[a]pyrene in barbecued meat: Informing advice for population groups.

BackgroundConsumption of meat prepared by barbecuing is associated with risk of cancer due to formation of carcinogenic compounds including benzo[a]pyrene (BaP). Assessment of a population’s risk of disease and people’s individual probability of disease given specific consumer attributes may direct food safety strategies to where impact on public health is largest. The aim of this study was to propose a model that estimates the risk of cancer caused by exposure to BaP from barbecued meat in Denmark, and to estimate the probability of developing cancer in subgroups of the population given different barbecuing frequencies.MethodsWe developed probabilistic models applying two dimensional Monte Carlo simulation to take into account the variation in exposure given age and sex and in the individuals’ sensitivity to develop cancer after exposure to BaP, and the uncertainty in the dose response model. We used the Danish dietary consumption survey, monitoring data of chemical concentrations, data on consumer behavior of frequency of barbecuing, and animal dose response data.FindingsWe estimated an average extra lifetime risk of cancer due to BaP from barbecued meat of 6.8 × 10−5 (95% uncertainty interval 2.6 × 10−7 − 7.0 × 10−4) in the Danish population. This corresponds to approximately one to 4,074 extra cancer cases over a lifetime, reflecting wide uncertainty. The impact per barbecuing event on the risk of cancer for men and women of low body weight was higher compared to higher bodyweight. However, the difference due to sex and bodyweight between subgroups are dwarfed by the uncertainty.InterpretationThis study proposes a model that can be applied to other substances and routes of exposure, and allows for deriving the change in risk following a specific change in behaviour. The presented methodology can serve as a valuable tool for risk management, allowing for the formulation of behaviour advice targeted to specific sub-groups in the population.

Associations between pneumonia and residential distance to livestock farms over a five-year period in a large population-based study.

In a recent study of electronic health records (EHR) of general practitioners in a livestock-dense area in The Netherlands in 2009, associations were found between residential distance to poultry farms and the occurrence of community-acquired pneumonia (CAP). In addition, in a recent cross-sectional study in 2494 adults in 2014/2015 an association between CAP and proximity to goat farms was observed. Here, we extended the 2009 EHR analyses across a wider period of time (2009–2013), a wider set of health effects, and a wider set of farm types as potential risk sources. A spatial (transmission) kernel model was used to investigate associations between proximity to farms and CAP diagnosis for the period from 2009 to 2013, obtained from EHR of in total 140,059 GP patients. Also, associations between proximity to farms and upper respiratory infections, inflammatory bowel disease, and (as a control disease) lower back pain were analysed. Farm types included as potential risk sources in these analyses were cattle, (dairy) goats, mink, poultry, sheep, and swine. The previously found association between CAP occurrence and proximity to poultry farms was confirmed across the full 5-year study period. In addition, we found an association between increased risk for pneumonia and proximity to (dairy) goat farms, again consistently across all years from 2009 to 2013. No consistent associations were found for any of the other farm types (cattle, mink, sheep and swine), nor for the other health effects considered. On average, the proximity to poultry farms corresponds to approximately 119 extra patients with CAP each year per 100,000 people in the research area, which accounts for approximately 7.2% extra cases. The population attributable risk percentage of CAP cases in the research area attributable to proximity to goat farms is approximately 5.4% over the years 2009–2013. The most probable explanation for the association of CAP with proximity to poultry farms is thought to be that particulate matter and its components are making people more susceptible to respiratory infections. The causes of the association with proximity to goat farms is still unclear. Although the 2007–2010 Q-fever epidemic in the area probably contributed Q-fever related pneumonia cases to the observed additional cases in 2009 and 2010, it cannot explain the association found in later years 2011–2013.

Tuberculosis infection among cocaine crack users in Brazil

BackgroundWHO recommends treatment for latent tuberculosis infection (LTBI) in the homeless and people who use drugs (PWUD). The optimal test for LTBI screening is uncertain. MethodsA cross-sectional study was conducted among the homeless and drug-rehabilitation clinic clients chronically using crack in Western Brazil. Participants were interviewed and offered HIV testing plus tuberculin skin testing (TST) and QuantiFeron®-Gold-in-Tube (QFT). We considered LTBI when either TST or QFT were positive. Factors associated with LTBI were adjusted in a multivariate model. ResultsAmong 372 subjects with at least one valid test, 216 (58%) had LTBI. TST was not read in 18.4%; QFT was indeterminate in 2.5%. TST detected 27 (26%) extra LTBI cases among 75 QFT-negative individuals. PWUD had over three-fold odds for LTBI. TST was 4.5 times more likely to be positive in BCG-vaccinated individuals. ConclusionGiven the high risk of progression to disease in this population, the high rates of loss to TST reading and the possibility of false-positive TST results from BCG vaccination, we endorse current CDC recommendations to use QFT for LTBI screening among the homeless and PWUD. However, because adding TST to a negative QFT increased LTBI detection considerably, TST should be considered in QFT-negative individuals.

Nonlinear analysis for extreme large bending deflection of a rectangular plate on non-uniform elastic foundations

An analysis is presented for different bearing loadings of a plate resting on various linear and nonlinear foundations subjected to different boundary conditions such as the circled clamped, simply supported, and mixed boundary conditions. The highly accurate solutions of the plate deflection and the stress under different work conditions are obtained by the novel wavelet-homotopy technique, which are in full agreement with previous ones in literature. Different from previous studies, our solutions are also valid for the extra large plate bending cases, which are rarely considered before. Particularly, we consider the important case that the connection coefficients of various foundations are variational, which seems to be overlooked in previous studies owing to their extreme difficulties in mathematical treatments and programming. Besides, to overcome the limitation of existing wavelet technique of poor capability on handling complex boundary conditions, we reconstruct the boundary wavelet by the Coiflets so that it can be used to handle the governing partial differential equations subjected to nonhomogeneous boundary conditions. Moreover, we introduce the homotopy iteration technique so that the computational efficiency improves to a large extent as compared with the traditional Homotopy Analysis Method (HAM) technique. It is expected the proposed wavelet-homotopy method can be as a new generation of analytical tool for solving strong nonlinear problems subjected to complicated boundary conditions, especially for those with variable coefficients.

A five year retrospective study of paediatric tuberculosis patients registered in Nanded Municipal Corporation

Background: Tuberculosis (TB) is one of the most serious infections in the world contributing one third of the world’s population. Near about 11% of the childhood mortality and morbidity caused by tuberculosis worldwide, especially in developing countries. The aims and objectives of this study were to study retrospectively the clinical profile and treatment outcome of paediatric TB cases treated under RNTCP.Methods: An observational record based study was conducted among paediatric patients registered under Revised National Tuberculosis Control Programme (RNTCP) in NANDED city to know their disease profile from 2011- 2015.Results: In this study, the mean age of the study subjects was 10.58 years, most of them were in the 11-14 year age group (62.9%) followed by 6-10 years (25%) and 0-5 years (12.1%) respectively. with a female to male ratio of 6.1: 3.8. There were more cases of tuberculosis among female children with significantly more girls (61.4%) than boys (38.6%) {χ2=8.924, p&lt; 0.01154 (S)} and 46.2% of them had extra pulmonary TB. Out of total (132), pulmonary TB cases were (53.8%) and among the extra pulmonary TB cases, tuberculous lymphadenitis (26.5%) was the commonest form for all ages followed by Abdominal Koch’s in 9.1%. Category I and II was started on 91.7% and 8.3% patients respectively. Overall, treatment completion rate was 82.5% and the default rate was 2.3% with a cure rate of 15.2%. More than one fourth of the study subjects gave a history of contact with tuberculosis patient.Conclusions: The probable reason for more prevalence of TB among females may be due to, neglected female child’s nutrition and health status in society. Paediatric tuberculosis still continues to be a major problem in 1-5 years of age who are undernourished and belonging to lower socioeconomic status.

Risk factors, clinico-epidemiological profile of tuberculosis among children attending a tertiary care hospital: a two year study

Background: TB remains as the one among the top 10 causes of death worldwide. In 2016, 10.4 million people fell ill with TB, and 1.7 million died from the disease with 0.4 million with HIV. At least 1 million children become ill with TB each year. Children represent about 10-11% of all TB cases. Having knowledge of the risk factors for tuberculosis infection in children is important to evaluate the level of ongoing transmission of infection and to help adapt activities within national TB control programs. The main objective is to study the risk factors and their association and variable clinical features in cases of pulmonary and extra pulmonary tuberculosis.Methods: The main objective is to study the risk factors and their association and variable clinical features in cases of pulmonary and extra pulmonary tuberculosis.Results: 98 cases of TB were confirmed out of total 628 with a prevalence of 17.07% in the study with 78 PTB cases and 20 EPTB. Females were more with male to female ratio of 0.7:1.5-9 years was the most common age group in the study. Statistically significant association was found between old history of ATT, HIV positivity, contact with an open case of TB and malnutrition (p value&lt;0.05). TB meningitis was the most common EPTB (10/20 cases) followed by tuberculous lymphadenitis (5/20). 69.39% (68/98 cases) were smear positive, radiologically 59.18% of cases were positive and Tuberculin skin test was positive in 46.94%.Conclusions: Childhood tuberculosis is a neglected entity in developing countries due to underreporting and difficulties in diagnosis due to variable clinical picture in children. Hence epidemiological surveillance studies in children are required to determine the actual prevalence of pulmonary and extra pulmonary cases of tuberculosis. Increased efforts are required to isolate TB bacilli from body fluids to identify early the childhood cases and manage them to prevent disease burden in the community.

Effectiveness of DOTS regime in terms of cure, failure, default and relapse in the treatment of TB patients

Background: DOTS has given very good results in terms of cure and satisfaction among tuberculosis patients. But still some failure and relapse cases occur. Hence studies on effectiveness of DOTS are required. The objectives of research were to study the effectiveness of DOTS regime in terms of cure, failure, default and relapse in the treatment of TB patientsMethods: A hospital based prospective follow up observational study was undertaken in the department of general medicine at a tertiary care medical college and hospital. The present study was conducted among the 60 eligible subjects as per the inclusion and exclusion criteria laid down for the present study.Results: 41 were pulmonary cases and 19 were extra pulmonary patients. At the end of intensive phase only 7 cases were sputum positive out of 37 which reduced to three at the end of extended intensive phase of treatment which further reduced to two at the end of two months of continuation phase. But by the end of completion of continuation phase, one case again became sputum positive i.e. failure case making a final tally to three. It was seen that there was significant weight gain over the period of time in both pulmonary and extra pulmonary cases. The cure rate was 78%. One patient died. Two defaulted and three were failure cases.Conclusions: The DOTS was found to be 78% effective in terms of cure rate. Still there is a huge gap of 22% found in the present scenario which needs to be addressed seriously and by all to prevent multi drug resistant tuberculosis.

One extra cancer case per 5,000 patients taking varsartan, says EMA

One extra cancer case per 5,000 patients taking varsartan, says EMA

Tuberculosis in otolaryngological practice

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Tuberculosis has become a common occurrence in Otorhinolaryngology with increasing number of extra pulmonary cases. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;This is a study of 27 patients who visited ENT OPD of Dr. D. Y. Patil Medical College, Pune, with variety of manifestations of tuberculosis in the ENT region. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Majority of those suffered from tuberculous cervical lymphadenopathy, other manifestations included laryngeal tuberculosis, tuberculous otitis media, lupus vulgaris and tuberculous infection of a pre auricular sinus. FNAC and histopathologic examination proved to be reliable tools of diagnosis. Five of these patients suffered from concurrent pulmonary tuberculosis. All these responded well to category 1 anti-tubercular therapy well. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Tuberculosis in Otorhinolaryngology shows a variety of manifestations so it should be kept in mind whenever dealing with unusual presentations.&lt;/span&gt;&lt;/p&gt;

A study of treatment outcomes of pulmonary tuberculosis and extrapulmonary tuberculosis patients in a tertiary care centre

Background: Directly observed treatment remains one of the most widely-accepted global health interventions for tuberculosis. Tuberculosis treatment outcome is one of the performance indicators of the programme set by World Health Organization.Methods: This study was conducted in a tertiary care centre Chennai. A retrospective analysis of the profile and treatment outcome of all tuberculosis patients registered from January 2015 to December 2015 at DOTS centre under RNTCP was conducted. Data on treatment outcomes was analysed using appropriate statistical methods and percentages were calculated.Results: Out of 118 TB cases, 59.3% had pulmonary while 40.7% had extra-pulmonary TB. Sputum positive PTB is more common than sputum negative which is 74.2% and 25.8% respectively. Frequency of TB lymphadenitis is being the common presentation among extra pulmonary TB cases, followed by TB pleurisy. Success rate (cure rate plus treatment completion rate) for new cases was 63.1% and for retreatment cases was 36.9% while the overall success rate was 81%.Conclusions: Effective measures have to be taken in the programme to move forward to help in the eradication of TB. Tuberculosis mostly affects males of the economically productive age group and causes economic losses. The success rate of new cases was higher compared to retreatment cases though the overall success rate was lower compared to the RNTCP norms. Proper education on DOTS can help in improving the success rate and cure rate.

Cost-effectiveness analysis comparing companion diagnostic tests for EGFR, ALK and ROS-1 versus next-generation sequence (NGS) in advanced adenocarcinoma lung cancer patients.

9068 Background: Success of a target therapy is directly correlated with the accuracy of its companion diagnostic test. Without a corresponding biomarker, target therapy may yield shorter survival, waste time, increase burdens and costs. As important as conducting cost-effectiveness studies for therapies, it is also valuable to compare different molecular tests. In lung cancer, the mutational status of EGFR and translocation of ALK and ROS-1 are commonly tested to offer the best intervention. Our objective is to evaluate the cost-effectiveness of a unique exam using NGS versus other routinely used tests such as the ones which involve RT-PCR and FISH. Methods: Target population is NSCLC, adenocarcinoma, and candidates to first-line therapy. Strategy 1: test EGFR mutation if EGFR test is negative, individual follow to FISH for ALK; if FISH is negative, follow to FISH for ROS-1. Strategy 2: differs from 1 since FISH for ALK and ROS are requested together. Strategy 3: all individuals are submitted to NGS (multicomplex platform which include EGFR, ALK, ROS-1 and other genes). Tests could also be classified as unknown due to the quality of tumor sample. Prevalence of biomarker, test accuracy and proportion of unknown results were used to calculate each decision tree branch. Sensitivity and specificity was obtained from literature review using Sanger as reference standard for RT-PCR tests and NGS. The study was analyzed from a healthcare-payer perspective based on Brazilian private sector. Costs were based on data from diagnostic companies, ANS and AMB-CBHPM 2016. Results: The use of NGS added 24% extra cases correct identified as well as extra costs (US$ 800.76; PPP 2015) attributed to the molecular testing. The ICER comparing NGS with sequential tests was US$ 3,381.82/correct case detected. Comparing strategy 2:1, the ICER was US$937.86/correct case detected. Conclusions: this study is part of an effort to integrate companion diagnostics discussions on precision medicine and covered drugs in the Brazilian health system. These findings can also subsidy cost-effectiveness studies that incorporates subsequent treatments and survival.

From sperm to offspring: Assessing the heritable genetic consequences of paternal smoking and potential public health impacts.

Individuals who smoke generally do so with the knowledge of potential consequences to their own health. What is rarely considered are the effects of smoking on their future children. The objective of this work was to review the scientific literature on the effects of paternal smoking on sperm and assess the consequences to offspring. A literature search identified over 200 studies with relevant data in humans and animal models. The available data were reviewed to assess the weight of evidence that tobacco smoke is a human germ cell mutagen and estimate effect sizes. These results were used to model the potential increase in genetic disease burden in offspring caused by paternal smoking, with specific focus on aneuploid syndromes and intellectual disability, and the socioeconomic impacts of such an effect. The review revealed strong evidence that tobacco smoking is associated with impaired male fertility, and increases in DNA damage, aneuploidies, and mutations in sperm. Studies support that these effects are heritable and adversely impact the offspring. Our model estimates that, with even a modest 25% increase in sperm mutation frequency caused by smoke-exposure, for each generation across the global population there will be millions of smoking-induced de novo mutations transmitted from fathers to offspring. Furthermore, paternal smoking is estimated to contribute to 1.3 million extra cases of aneuploid pregnancies per generation. Thus, the available evidence makes a compelling case that tobacco smoke is a human germ cell mutagen with serious public health and socio-economic implications. Increased public education should be encouraged to promote abstinence from smoking, well in advance of reproduction, to minimize the transmission of harmful mutations to the next-generation.

Portal Hypertension: 2 years Experience in Department of Pediatric Gastroenterology and Nutrition, at a Tertiary Care Hospital, Bangladesh

Background: Portal hypertension is a clinical syndrome defined by a pathologic increase of portal venous pressure. The objectives of this study were to evaluate etiological and clinical presentation of portal hypertension admitted in a tertiary care centre of Bangladesh.Materials and Methods: This cross sectional study was done at the Department of Paediatric Gastroenterology &amp; Nutrition, BSMMU on 100 consecutive cases admitted during the period from July 2013 through June 2015. Confirmation of the presence of portal hypertension was done by demonstration of oesophageal varices during upper GI endoscopic examination. The diagnosis of chronic liver disease was based on a combination of clinical, biochemical (abnormal liver function tests) and ultrasonographic (coarse echotexture of liver) features. Extrahepatic portal hypertension was diagnosed on the basis of clinical, normal liver function test and ultrasonographic evidence of portal or splenic vein thrombosis, with or without cavernous transformation. Doppler ultrasound showed increase portal venous pressure.Results: Patient's age group was 2 to 15 years. 69 cases were extra hepatic portal hypertension. Haematemesis and/or melaena were found in 42(60.9%) and splenomegaly was found in 68(98.6%) cases. Of extra hepatic 69 cases 10% had history of umbilical sepsis. Of the 31cases of CLD with portal hypertension, haematemesis and/or melaena was found in 20(64.5%) cases, splenomegaly in 30(96.8%), ascites 8(25.8%).Most (50%) of CLD cases were cryptogenic followed by Wilson’s disease 29%. Of the 100 cases, endoscopy revealed grade 3 esophageal varices in 45% cases. All the patients were treated with propranolol. EVL was done in 70% cases.Conclusion: In this study, most of the cases were extra hepatic portal hypertension. Gastrointestinal bleeding &amp; splenomegaly were found in most of the cases. No risk factor was found in most of extra hepatic cases. Portal vein thrombosis &amp; cryptogenic were the most common cause in extra-hepatic and intra-hepatic cases respectively.J Shaheed Suhrawardy Med Coll, June 2016, Vol.8(1); 26-29