Effect Of Appropriate Treatment Research Articles

Epispadias, a correctable cause of structural infertility in a middle-aged man: a case report

BackgroundEpispadias is a rare form of genito-urinary congenital anomaly and presentation in the middle-ages is even rarer. The reproductive outcome of treatment which was almost immediate, highlights the life changing effect of appropriate treatment for this condition in a middle-aged patient. We hereby report this rare case of a middle-aged man presenting with complete male epispadias with background infertility and the outcome of effective treatment. (Reviewer #1. Comment 1).Case presentationOur patient is a 54-year-old security guard who presented to our facility in February 2022 (Reviewer #1. Comment 3) with passage of urine from an abnormal opening since birth. Examination revealed a middle-aged man having ammoniacal smell. He had a spade like glans penis, ventral hooding, urethral meatus at the root of the penis dorsally with no chordee. He was diagnosed to have complete male epispadias (CME) for which he eventually had a modified Cantwell–Ransley procedure under general anaesthesia. About 3 months after the procedure, patient was able to impregnate his wife, a feat he will be achieving for the first time in his life.ConclusionsThe right treatment irrespective of age at presentation could significantly improve the quality of life of patients as evidenced by our patient whom after surgery was able to impregnate his wife for the first time at 54 years of age.

Should the Treatment of Patients with Repeated Embryo Implantation Failure Be Adapted as a Function of the Endometrial Cytokine Profile? A Single-Center Experience.

Repeated embryo implantation failures (RIF) is a source of distress and frustration for patients and clinicians alike. Today's approaches for treating RIF are largely empirical and have limited effectiveness. The main causes of RIF are poor endometrial receptivity and poor-quality embryos. Recent studies have suggested the involvement of immune dysregulation due to an imbalance between T-helper (Th) 1 and Th2 cytokines; this opens up perspectives for treating women with RIF and increasing the implantation rate. We conducted an interventional, longitudinal, prospective cohort study of the impact of correcting the cytokine imbalance on the clinical pregnancy rate in women with RIF. Seventy-seven women with RIF underwent an endometrial biopsy during the implantation window. The cytokine profile was evaluated by studying the activation and maturation of uterine natural killer (uNK) cells, the IL-15/Fn-14 mRNA ratio (a biomarker of uNK activation/maturation), and the IL-18/TWEAK mRNA ratio (a marker of angiogenesis and the Th1/Th2 balance). Personalized treatment was initiated for women with an abnormal endometrial cytokine profile (hyper-activation or hypo-activation). We documented the clinical pregnancy rate after subsequent embryo transfers. In total, 72.7% (56/77) of patients had an abnormal endometrial cytokine profile (hyper-activation in 68.8% (n = 53) and hypo-activation in 3.9% (n = 3). After treatment (or not) as a function of the endometrial profile, the overall clinical pregnancy rate was 30.2%. Our results indicated a potential positive effect of appropriate treatment on the ongoing pregnancy rate in women with RIF, despite the small number of cases analyzed. The results must now be validated in randomized studies with larger numbers of well-characterized patients. By applying a previously published decision tree, this treatment approach could be implemented in clinics worldwide.

Role of Cytokines in EGPA and the Possibility of Treatment with an Anti-IL-5 Antibody

Eosinophilic granulomatosis with polyangiitis (EGPA) is a type of systemic vasculitis with eosinophilia in the peripheral blood, which is preceded by bronchial asthma or allergic disease. EGPA is pathologically characterized by microangiopathy granulomatosis vasculitis. Vasculitis can be exacerbated and cause central nervous system and cardiovascular disorders and gastrointestinal perforation. Histological examination reveals eosinophil infiltration and granulomas in lesions in areas such as the lung, nervous system, and skin. Laboratory tests show inflammatory findings such as C-reactive protein (CRP) elevation, increased eosinophils, elevated serum IgE, and elevated myeloperoxidase-anti-neutrophil cytoplasmic antibodies (MPO-ANCA). MPO-ANCA is positive in approximately 40–70% of cases of this disease. EGPA is a necrotizing vasculitis that affects small- and medium-sized blood vessels; however, it differs from other types of ANCA-related vasculitis (such as microscopic polyangiitis and granulomatosis) because it is preceded by bronchial asthma and eosinophilia in the blood and tissues. Treatment with immunosuppressive agents such as steroids or cyclophosphamide depends on the Five Factor Score, which predicts the prognosis and severity of the condition. If the effect of appropriate treatment with steroids is insufficient, the anti-interleukin-5 antibody mepolizumab can be administered. The combination of mepolizumab with standard treatment leads to a significantly longer duration of remission, a higher proportion of patients who achieve sustained remission, and less steroid use than with a placebo.

Extraction of fetal electrocardiogram (ECG) by extended state Kalman filtering and adaptive neuro-fuzzy inference system (ANFIS) based on single channel abdominal recording

Fetal electrocardiogram (ECG) gives information about the health status of fetus and so, an early diagnosis of any cardiac defect before delivery increases the effectiveness of appropriate treatment. In this paper, authors investigate the use of adaptive neuro-fuzzy inference system (ANFIS) with extended Kalman filter for fetal ECG extraction from one ECG signal recorded at the abdominal areas of the mother’s skin. The abdominal ECG is considered to be composite as it contains both mother’s and fetus’ ECG signals. We use extended Kalman filter framework to estimate the maternal component from abdominal ECG. The maternal component in the abdominal ECG signal is a nonlinear transformed version of maternal ECG. ANFIS network has been used to identify this nonlinear relationship, and to align the estimated maternal ECG signal with the maternal component in the abdominal ECG signal. Thus, we extract the fetal ECG component by subtracting the aligned version of the estimated maternal ECG from the abdominal signal. Our results demonstrate the effectiveness of the proposed technique in extracting the fetal ECG component from abdominal signal at different noise levels. The proposed technique is also validated on the extraction of fetal ECG from both actual abdominal recordings and synthetic abdominal recording.

Treatment of Youth Depression in Primary Care Under Usual Practice Conditions: Observational Findings from Youth Partners in Care

The effectiveness of treatments for youth depression in primary care, under usual practice conditions, is largely unstudied. This study aims at estimating the effect of "appropriate treatment," defined as treatment that approximates guideline standards, on clinical outcomes for depressed primary care youth patients by using observational analyses from a randomized trial. Participants were 344 youths aged 13-21 enrolled in the Youth Partners in Care trial. Youths screening positive for depression from six primary care practices in five different health care organizations were randomly assigned to either (1) usual care enhanced by provider education on depression evaluation and management, or (2) a quality improvement (QI) intervention designed to improve access to antidepressant medications and/or cognitive behavior therapy for depression; usual practice conditions otherwise applied. Observational analysis was conducted on the effects of appropriate treatment (antidepressant medication use by algorithms or 6 or more psychotherapy visits) on severe depression (Center for Epidemiologic Studies-Depression score ≥ 24) at 6 months. Selection into treatment is accounted for by using instrumental variables analysis, with randomized QI intervention status as the instrument. At 6 months, youths receiving "appropriate treatment," compared with others, were significantly less likely to have severe depression (10.9% vs. 45.2%, p<0.0001). Similar findings were observed among youths with depressive disorders and sub-syndromal depressive symptoms, and among Latino and other youths. Among depressed primary care youths, care that approximates guideline standards but retains leniency substantially reduces the likelihood of severe depression at 6 months. Such findings apply to youths with or without depressive disorder, and among Latino youth.

Mortality of sick children after outpatient treatment at first-level health facilities in rural western Kenya

(1) To determine whether mortality rates were raised in sick children in the 30 days after visiting first-level health facilities in an area under demographic surveillance in western Kenya, (2) to identify the types of illnesses associated with increased mortality and (3) to estimate the effectiveness of appropriate treatment. All sick children (2-59 months of age) who attended one of the seven participating first-level health facilities from May to August 2003 were identified. A standardized mortality ratio was computed to compare their mortality rate in the 30 days after a sick visit with that of the community under active demographic and health surveillance. A multivariate Cox Proportional Hazards model was used to identify illnesses associated with death and to estimate the protective effectiveness of appropriate treatment for potentially life-threatening diseases. A total of 1383 eligible children made 1697 sick visits; 33 (2.4%) died within 30 days. Compared with children 2-59 months in the general population, sick children had a 5.3 times greater mortality rate [95% confidence interval (CI) 3.8-7.5]. In a multivariate survival analysis, significant risk factors for mortality included age <24 months [Hazard Ratio (HR) 4.4, 95% CI 1.5-12.6], malnutrition (HR 15.5, 95% CI 6.1-39.8), severe pneumonia (HR 12.9, 95% CI 3.0-56.4) and anaemia (HR 3.3, 95% CI 1.5-7.2). Appropriate treatment for a child's most severe illness reduced mortality by 78% (95% CI 57-89%). We estimate that improvements in diagnosis and appropriate treatment at first-level health facilities for children 2-59 months could reduce overall under-5 mortality in the area by 12-14%.

Comparing Psychiatric Service Use among Low-Income Women and Women in a General Household Population

This article examines the use of outpatient mental health services in a sample of low-income women (Mothers' Well-Being Study [MWS]) and compares the findings with a sample of similar-aged women in the general population (National Comorbidity Survey [NCS]). Overall, the prevalence of any 12-month mental health was significantly greater for MWS respondents compared with NCS respondents. Only a quarter of each sample with any had received treatment at an outpatient mental health service in the past year. The authors identify implications for social workers who to improve access and quality of care for women in need of specialty mental health and substance use services. KEY WORDS: low-income women; mental health services; substance abuse; welfare ********** The landmark release of Mental Health: A Report of the Surgeon General called for Americans to seek help if you have a mental health problem or think you have symptoms of a mental disorder (U.S. Department of Health and Human Services, 1999, p. 453). The surgeon general's report facilitated widespread attention to the detrimental effects of mental health problems, identified barriers that many people face in seeking treatment, and compiled evidence supporting the positive effects of appropriate treatment. It indicated that recent population studies, such as the Epidemiologic Catchment Area survey (Regier et al., 1993) and the National Comorbidity Survey (NCS) (Kessler et al., 1994), provided benchmark data on the prevalence of service use among people with psychiatric disorders and substance use problems; such population-based prevalence data offer valuable indicators for comparative purposes. The NCS, funded by the National Institute of Mental Health (NIMH), was the first survey to administer face-to-face structured psychiatric interviews to a nationally representative U.S. sample. The NCS has served as a benchmark for the prevalence of mental health and substance abuse disorders in the United States and has also provided data on the level and type of service use for these disorders. It has allowed researchers examining underrepresented groups to compare their findings regarding psychiatric disorders and service use rates with national norms. For instance, in previous studies of homeless women (Bassuk, Buckner, Perloff, & Bassuk, 1998) and Native Americans (Beals et al., 2005), researchers have compared their findings with the NCS as a way of identifying unique needs and possible inequities in vulnerable populations. The Mothers' Well-Being Study (MWS), also funded by NIMH, replicated the NCS, but with a sample of women who were receiving welfare in 1998. This population was underrepresented in the NCS, and the MWS was an opportunity for researchers, service providers, and policymakers to attain a better understanding of welfare mothers' service needs. The NCS and MWS used similar diagnostic instruments to assess a range of 12-month psychiatric disorders and used the same questions about service use in four service sectors (that is, general medical, specialty mental health and substance abuse services, human services, and self-help). The present study contributes to social workers' understanding of welfare clients' service needs and the extent to which their need for psychiatric and substance abuse services is met. We evaluated outpatient mental health services use in a random sample of low-income women (the MWS) and compared the findings with results of analyses conducted on a sample of similar-aged women in the general population (the NCS). Given prior research and the relatively resource-poor environment of the area from which the MWS women were sampled, we expected that MWS women would have lower rates than NCS women of general medical and specialty service use. Because of their contacts with the welfare system, we expected that MWS respondents would have higher rates than NCS respondents of treatment seeking in the human services and self-help sectors. …