History Of Previous Treatment Research Articles

Facilitators and Barriers to adherence to antiretroviral therapy among incarcerated people living with HIV in Iran: insights from a qualitative study

BackgroundEnsuring consistent adherence to antiretroviral therapy (ART) is crucial for effective HIV treatment and achieving viral suppression. Within prisons, the prevalence of HIV is notably high, and incarcerated individuals face an increased risk of transmitting the virus both during and after incarceration. However, facilitators and barriers to ART adherence among these individuals in low- and middle-income countries remain inadequately explored. This study applied the Social Ecological Model (SEM) to investigate how various individual, interpersonal, organizational, community and policy-level factors impact ART adherence among incarcerated populations in Iran during and post-incarceration.MethodsThis study employed a phenomenological qualitative approach using semi-structured interviews to gather insights. The research population consisted of people living with HIV (PLHIV) who had experienced incarceration and had been prescribed ART during their latest incarceration. Eleven PLHIV from two prisons located in Kerman and Tehran, Iran, formed the study group. Qualitative findings from the interviews were analyzed using a thematic approach. The findings were organized within the SEM framework to highlight key themes influencing ART adherence during and after incarceration.ResultsParticipants had an average age of 45.1 years (± 5.6). Various factors influence ART adherence during and post-incarceration. Participants highlighted the individual (e.g., HIV knowledge, previous treatment history, mental and physical health), interpersonal (e.g., family, friends, other incarcerated people, and prison health staff), organizational (e.g., ART treatment interventions, methadone maintenance therapy, and other health protocols), community (e.g., stigma, social isolation, discrimination and lack of access to community health services), and policy (e.g., financial interventions, and providing shelters) level factors influence ART adherence during and post-incarceration.ConclusionsThis study provides insights into the multi-level approach to ART adherence among PLHIV during and post-incarceration. It recommends implementing public health activities at the proposed multi-levels to maximize the synergies of intervention for the greatest impact.

Elastografia Acoustic radiation force Impulse (ARFI) para auxílio no diagnóstico de dois tumores malignos da bainha dos nervos periféricos caninos

ABSTRACT: This report described the use of acoustic radiation force impulse (ARFI) elastography in the diagnosis of two cases of canine malignant peripheral nerve sheath tumors. Both patients presented with lameness in the thoracic limb and no response to previous clinical treatment or trauma history. Physical examination revealed muscular atrophy in one of the thoracic limbs, in both dogs. B-mode axillary ultrasound showed the presence of a predominantly hypoechogenic, heterogeneous, irregular, nonencapsulated nodule with adjacent reactivity, measuring approximately 20.1 mm x 15.4 mm in the first case and 18.3 mm x 10.7 mm in the second. ARFI elastography was performed, showing areas of significant stiffness, with an average shear wave velocity of 4.12 m/s (case 1) and 4.35 m/s (case 2), suggesting malignancy. In both cases, the affected limb was amputated, and the tumors sent for histopathological analysis, which were; subsequently, diagnosed as malignant tumors of the peripheral nerve sheath. The ultrasonographic methods used were essential in the diagnosis and therapeutic conduct.

Prevalence of non-tuberculous mycobacteria among people with acid-fast positive presumptive tuberculosis in Mali.

Non-tuberculous mycobacteria (NTM) are environmental agents that can cause opportunistic pulmonary disease in humans and animals, often misdiagnosed as tuberculosis (TB). In this study, we describe the cases of NTM identified during the first national anti-TB drug resistance survey conducted in Mali and explore associated risk factors. Sputum was collected from people presenting for pulmonary TB diagnosis from April to December 2019, regardless of age. Microscopy-positive patients were enrolled and tested using the Xpert MTB/RIF assay. A patient who tested negative for the Mycobacterium tuberculosis complex (MTBC) was tested for the presence of mycobacteria by amplification of the IS6110 and 16SrRNA (16S) genes through double quantitative real-time PCR, followed by nested PCR and Sanger sequencing of the IS6110-negative samples for NTM species identification. 1,418 sputum smear-positive patients were enrolled, including 1,199 new cases, 211 previously treated cases, and 8 whose previous treatment history was unknown. Based on the results of Xpert MTB/RIF assay and in-house PCR methods, 1,331 (93.9%) patients were positive for MTBC, 48 (3.4%) for NTM, and no species identification was possible for 39 (2.7%). Advanced age of 65 and over with an OR 8.8 (95% CI 2.3-33.2 and p = 0.001) and previous TB treatment with an OR 3.4 (95% CI 1.2-9.6 and p = 0.016) were the risk factors statistically associated with NTM detection. M. avium complex (MAC) was the predominant NTM species, detected in 20 cases. Detection of NTM in people presumed to have TB is an ongoing challenge, confounding correct TB diagnosis. Concomitant use of microscopy and GeneXpert testing among at-risk individuals could improve patient management.

Successful dental treatment using case for carpule as a distraction technique during local anesthesia: a case report

Dental anxiety is described as a feeling of apprehension followed by some fear that something might happen during dental treatment, and most of the time it is also accompanied by fear. During pediatric dental care, dental anxiety is common and can be controlled through behavioral management of the child, using traditional techniques such as “tell-show-do”, cards, videos, music, imitation, voice control and distraction. Objective: To report a clinical case of a child with Down’s Syndrome and a negative history of previous dental treatment, in which behavioral management was successfuly carried out with the distraction technique, using a case in the carpule syringe. Case report: The guardian of a child 7-year[1]old male patient with Down’s Syndrome and a negative history of previous dental treatment sought for dental treatmant. During the interview, the guardian reported the child’s negative experience due to the drastic use of restraint measures. The clinical examination revealed the presence of biofilm, active caries and an indication for extractions. As the child was resistant to treatment, behavioral management sessions were carried out. Due to the various needs for more invasive procedures, preparation for anesthesia was carried out. For this stage, an alligator-type visual distraction device was used, which acts as a cover for the carpule syringe. After correct management, the child was more receptive to treatment, which was carried out without the need for drastic physical restraint measures. Conclusion: The use of the case to camouflage the carpule proved to be effective as a behavioral management technique in improving the child’s behavior, reducing fear and decreasing anxiety.

Predictors of poor treatment outcomes among drug-resistant tuberculosis patients in Hunan province, China

BackgroundDrug-resistant tuberculosis (DR-TB) is a significant public health concern, often resulting in poor treatment outcomes. This study aims to identify predictors of poor treatment outcomes among patients with DR-TB in Hunan Province, China. MethodsA retrospective cohort study was conducted in Hunan Province using data collected between 2013 and 2018 among patients with DR-TB treatment. Univariable and multivariable parametric survival analyses were performed using a shared frailty survival model with a Weibull distribution and Gamma frailty to identify determinants of poor treatment outcomes. Adjusted hazard ratios (AHR) with a 95 % confidence interval (CI) were calculated for the best-fitted model. The goodness of fit for the model was assessed using the Cox-Snell residual test. ResultsA total of 1384 bacteriologically confirmed DR-TB patients were included in the analysis. Of these, 9.97 % (95 % CI: 8.05–11.67 %) experienced poor treatment outcomes. The hazard of poor treatment outcomes was significantly higher among patients with a history of previous TB treatment compared to those with new TB (AHR = 1.82, 95 % CI: 1.27–2.61). Additionally, each one-day delay in diagnosis was associated with a slightly increased hazard of poor treatment outcomes (AHR = 1.00034, 95 % CI:1.000041–1.00064). Patients who received medication supervision and consistent treatment follow-up (i.e., systematic management) had a significantly lower hazard of poor treatment outcomes than those without systematic management (AHR = 0.08, 95 % CI: 0.05–0.14). ConclusionA substantial proportion of DR-TB patients in Hunan Province experience poor treatment outcomes, with prior TB treatment and delays in diagnosis being key predictors. Early diagnosis and systematic management, including medication supervision and consistent follow-up, significantly reduce the risk of poor treatment outcomes. Focused interventions for previously treated TB cases are crucial to improving treatment outcomes and mitigating the risk of long-term physical sequelae among DR-TB survivors.

Evaluation of Treatment Outcome Among MDR-TB Patients in Respect to Their Diabetic Status

Diabetes mellitus is an established risk factor of tuberculosis. Failure of the tubercular treatment outcome is higher among patients who are simultaneously suffering from diabetes. This study aims to observe the treatment outcome of the multi drug resistant tuberculosis patients in respect to their diabetic status. This cross sectional study has been conducted in a tertiary level hospital specialized for the diseases of the chest, during the period of January to December of the year 2019. Ethical approval for the research work has been acquired and informed written consent from the patients has been taken prior conducting the study and data collection. Face to face interview and review of medical records has been undertaken to collect data. Collected data has been analyzed with IBM SPSS software. Among 200 respondents, 53.0% patients showed to have early treatment response whereas, 47.0% had delayed treatment response. Among them, 80 patients were diabetic, where, 82.5.0% showed to have delayed response to the treatment and only 17.5% had early response to the treatment. Out of 120 non-diabetic respondents 77.5% had early response to the treatment and 22.5% had delayed response to the treatment. The treatment outcome of an MDR-TB patient found to be dependent on patient’s gender, age, marital status, monthly family income, history of previous TB treatment and also diabetic status (p<0.05). According to this study, diabetic MDR-TB patients are on increased risk of responding late to the treatments than the non-diabetic MDR-TB patients.

Treatment outcomes and associated factors among patients with multidrug-resistant tuberculosis in Southwestern Oromia, Ethiopia: ten-year retrospective analysis

BackgroundTreatment of rifampicin-resistant or multidrug-resistant tuberculosis (RR/MDR-TB) requires the use of second-line anti-TB drugs, which are less effective and more toxic. This study assessed treatment outcomes and factors associated with unfavorable treatment outcomes among RR/MDR-TB patients in Southwestern Oromia, Ethiopia.MethodsA multicenter retrospective study was conducted on 226 RR/MDR-TB patients (six extrapulmonary and 220 pulmonary) treated under a national TB program between 2013 and 2022 at five treatment facilities in Southwestern Oromia, Ethiopia. RR/MDR-TB patient data, such as sociodemographic, clinical, and laboratory results and treatment outcomes, were collected from the RR/MDR-TB registry using a standard data extraction form between April and June 2023. Logistic regression analysis was used to explore the associations between risk factors and unfavorable treatment outcomes.ResultsAmong 220 pulmonary RR/MDR-TB patients, 181 (82.3%) achieved favorable treatment outcomes (161 cured and 20 treatment completed). However, 39 (17.7%) patients had unfavorable treatment outcomes (12 were lost to follow-up, seven experienced treatment failure, and 20 died). Of the six extrapulmonary RR/MDR-TB patients, five (83.3%) had favorable treatment outcomes, and one (16.7%) was lost to follow-up. Pulmonary RR/MDR-TB patients with HIV infection (AOR = 4.85, 95% CI: 1.90 to 12.39), history of previous TB treatment (AOR = 3.09, 95% CI: 1.21 to 7.86), and low baseline BMI (AOR = 2.86, 95% CI: 1.06 to 7.72) had increased risk of unfavorable treatment outcomes.ConclusionAlthough the majority of RR/MDR-TB patients have favorable treatment outcomes, a significant proportion of patients still experienced unfavorable outcomes. Patients with HIV infection, history of previous TB treatment, and low baseline BMI require special attention to improve pulmonary RR/MDR-TB treatment outcomes. Future studies with larger sample sizes are required to evaluate treatment outcomes and associated factors among patients with extrapulmonary RR/MDR-TB.

Nonsurgical Endodontic Retreatment of a Cystic Apical Lesion Associated with Root Resorption: A Promising Approach

This case report highlights the successful management of a cystic apical lesion associated with root resorption through nonsurgical endodontic retreatment, utilizing calcium-enriched mixture (CEM) cement as an obturating biomaterial. A 35-year-old woman presented with mild discomfort in the mandibular right first molar (#46), with radiographic evidence of a well-defined radiolucent lesion at the apex of the mesial root. The tooth had a history of previous failed endodontic treatment with poor root canal obturation, indicating internal root resorption. Nonsurgical endodontic retreatment was performed, and the canals were filled/sealed with CEM cement. Follow-up radiographs showed a gradual reduction in the size of the cystic lesion. At 54 months, complete bone healing of the cystic apical lesion was evident. This case report provides clinical evidence supporting the potential efficacy of nonsurgical endodontic retreatment using CEM cement in managing certain cystic apical lesions, offering a promising alternative to traditional surgical enucleation, even in cases with inflammatory root resorption. Further research is needed to validate the long-term efficacy of this approach in larger patient populations.

Unveiling the clinical profiles of heart failure across diverse stages and phenotypes: insights from the national echocardiographic society registry

Abstract Background The modern comprehension of heart failure (HF), based on a staging paradigm, demands systematic screening to promptly identify individuals at risk, those in the pre-HF stage, and symptomatic HF patients across various phenotypes (HFpEF, HFmrEF, and HFrEF). The discernment of clinical profiles within these categories holds significant potential for improving screening and ensuring timely therapeutic interventions. Material and Methods Our national echocardiographic society executed a multicenter HF screening program. General practitioners in 13 primary care centers utilized the original mobile app to determine referrals for transthoracic echocardiography and N-terminal pro-B-type natriuretic peptide (NT-proBNP) testing in patients without a prior HF diagnosis. The 2021 ESC guidelines' algorithms were employed for HF diagnosis (HFpEF, HFmrEF, HFrEF). This study identifies two pre-heart failure (pre-HF) stages: "heart stress" (elevated NT-proBNP in asymptomatic individuals with risk factors, regardless of structural heart disease or cardiac dysfunction) and individuals "at risk for HF" (normal NTproBNP and at least one HF risk factor). Ultimately, all patients were categorized into six groups: (I) no HF, no risk; (II) at risk for HF; (III) heart stress; (IV) HFpEF; (V) HFmrEF; and (VI) HFrEF. Subsequently, the eleven clinical variables were compared among groups (II) to (VI) using chi-square test. Results Among 930 screened outpatients (mean age 66±11 years, 61% female), diagnosis of HF was established in 34.2% (Figure, pie). Heart stress was found in 22.3% patients, and 38.1% were at risk for HF, while 5.5 % had neither HF nor risk factors. Group comparison revealed that older individuals were more frequent in the HFpEF group, females predominated in the heart-stress and HFpEF groups, and males in the HFrEF group (Figure, table). Obesity was the most frequent among those at risk and HFmrEF. Atrial fibrillation and pathological ECG increased gradually from those at risk to HFrEF. Previous MI was the most common in heart stress and HFmrEF groups, while arterial hypertension >10 years prevailed in HFpEF and HFmrEF patients. Diabetes mellitus > 5 years was present in 24-28% across groups. CKD or eGFR≤60 ml/min/1.73m² increased gradually towards HFmrEF. The family history of CMP or SCD was positive in 17-24%, with no significant differences observed across groups. Additionally, a small number of patients had a history of previous cardiotoxic cancer treatment, and no significant differences were found between groups. Conclusions The mobile phone application used in primary care successfully identified a significant number of pre-heart failure patients requiring further evaluation. Different HF stages and phenotypes exhibit distinct clinical profiles, aiding in the screening process and contributing to a deeper understanding of the heart's pathophysiological adaptation to diverse risk factors during HF development.

Risk factors associated with post-tuberculosis sequelae: a systematic review and meta-analysis

Post-tuberculosis (TB) sequelae present a significant challenge in the management of TB survivors, often leading to persistent health issues even after successful treatment. Identifying risk factors associated with post-TB sequelae is important for improving outcomes and quality of life of TB survivors. This systematic review and meta-analysis aims to identify risk factors associated with long-term physical sequelae among TB survivors. We systematically searched Medline, Embase, PROQUEST, and Scopus for studies on long-term physical sequelae among TB survivors up to December 12, 2023. The primary outcome of interest was to quantify risk factors of long-term physical sequelae (i.e., respiratory, hepatic, hearing, neurological, visual, renal, and musculoskeletal sequelae). We included all forms of TB patients who experienced long-term physical sequelae. We used narrative synthesis for risk factors reported once and random-effect meta-analysis for primary outcomes with two or more studies. Findings were presented with odds ratios (OR) and 95% confidence intervals (CI). Publication bias was assessed using funnel plots and Egger regression, and heterogeneity was examined with a Galbraith radial plot. The protocol was registered on Prospero (CRD42021250909). A total of 73 articles from 28 countries representing 31,553TB-treated patients were included in the narrative synthesis, with 64 of these studies included in the meta-analysis. Risk factors associated with post-TB lung sequelae include older age (OR=1.62, 95% CI: 1.07-2.47), previous TB treatment history (OR=3.43, 95% CI: 2.37-4.97), smoking (OR=1.41, 95% CI: 1.09-1.83), alcohol consumption (OR=1.84, 95% CI: 1.04-3.25), smear-positive pulmonary TB diagnosis (OR=3.11, 95% CI: 1.77-6.44), and the presence of radiographic evidence of pulmonary lesions at the commencement of treatment (OR=2.04, 95% CI: 1.07-3.87). Risk factors associated with post-TB liver injury included pre-existing hepatitis (OR=2.41, 95% CI: 1.16-6.08), previous TB treatment (OR=2.64, 95% CI: 1.22-6.67), hypo-albuminemia (OR=2.10, 95% CI: 1.53-2.88), HIV co-infection (OR=2.72, 95% CI: 1.66-4.46), and CD4 count <200mm3 in HIV-infected individuals (OR=2.03, 95%CI: 1.26-3.27). Risk factors associated with post-TB hearing loss include baseline hearing problems (OR=1.72, 95% CI: 1.30-2.26), and HIV co-infection (OR=3.02, 95% CI: 1.96-4.64). This systematic review and meta-analysis found that long-term physical post-TB sequelae including respiratory, hepatic, and hearing impairment were associated with a range of socio-demographic, behavioral, and clinical factors. Identification of these risk factors will help to identify patients who will benefit from interventions to reduce the burden of suffering from post-TB treatment. Healy Medical Research Raine Foundation, the Australian National Health and Medical Research Council, and Curtin University Higher Degree Research Scholarship fund the study.

Efficacy of Biofeedback Therapy for Giggle Incontinence in Children: How Many Sessions Are Required?

Giggle incontinence (GI) is characterized by the sudden and involuntary expulsion of urine coinciding with episodes of laughter. The underlying pathophysiology of this condition remains unclear, and various treatment approaches are employed. The objective of this study is to assess the effectiveness of biofeedback (BF) therapy in treating GI and ascertain the requisite number of therapy sessions needed for efficacy. Medical records of children treated with BF therapy for GI between November 2022 and November 2023 were retrospectively analyzed. The success of treatment was assessed after four and eight sessions, as well as following three maintenance sessions. Treatment outcomes were evaluated using the scoring system recommended by the International Children's Continence Society (ICCS), which categorizes responses into three levels: no response (Score 0), partial response (Score 1), and complete response (Score 2). Thirteen patients were initially diagnosed with GI. Of these, 10 patients were included in the study as three discontinued treatments. The cohort comprised an equal gender distribution with five females (50.0%) and five males (50.0%). The mean age of patients was 8.9 ± 3.3 (range 5-16) years. Two out of ten patients had a history of previous treatment for overactive bladder, while three had received treatment for primary monosymptomatic nocturnal enuresis. Following the completion of all BF sessions, the rate of complete response was observed at 80.0% (n = 8), while the partial response rate accounted for 10.0% (n = 1). Statistical analysis revealed significant differences in response scores after four and eight sessions (p < 0.01) as well as between the results after eight sessions and the completion of maintenance sessions (p < 0.01). BF therapy demonstrates a high success rate in managing GI. Completion of at least eight BF therapy sessions enhances the probability of a successful outcome in the treatment of GI. Additionally, it has been observed that maintenance sessions contribute to the increased efficacy of the treatment.

Health care seeking behaviour of patients reporting to a dental health Institution- A cross sectional study

This study aimed to assess the factors influencing healthcare-seeking behaviour among patients presenting to a dental institution. Oral diseases, such as dental caries and periodontal diseases are prevalent global health concerns, particularly in developed countries, whereas oral cancers are more common in developing countries. In India, there is observed lower utilization of dental care services and higher rates of dental problems. This descriptive study involved 220 patients who visited a dental college and hospital in India. Patients were interviewed to gather information on their chief complaint, history of previous treatment for the complaint, and reasons for delaying dental treatment. The study identified several key factors contributing to delays in seeking dental treatment. Negligence was cited by 27.1% of patients, absence of symptoms by 14.5%, and financial constraints by 9%. Gender, occupation, and education level of patients also showed varying impacts on healthcare-seeking behaviour. Negligence, lack of symptom awareness, and financial constraints, particularly in rural and suburban areas were the significant barriers to timely dental treatment among patients in a dental institution in India.

Identifying risk factors for recurrent multidrug resistant tuberculosis based on patient’s record data from 2016 to 2021: retrospective study

Globally, the prevalence of multidrug-resistant tuberculosis (MDR-TB) has been increasing recently. This is a major public health concern, as MDR-TB is more difficult to treat and has poorer outcomes compared to drug-sensitive tuberculosis. The main objective of the study was to identify risk factors for recurrent multidrug-resistant tuberculosis, at Alert Specialized Hospital, Addis Ababa, by using different parametric shared frailty models. From January 2016 to December 2021, a retrospective study was conducted on MDR-TB patients at Alert Specialized Hospital in Addis Ababa. The data for the study were collected from the medical records of MDR-TB patients at the hospital during this time period. Gamma and inverse-Gaussian shared frailty models were used to analyze the dataset, with the exponential, Weibull, and lognormal distributions included as baseline hazard functions. The data were analyzed using R statistical software. The median recurrence time of the patients was 12 months, and 149 (34.3%) had recurrences. The clustering effect was statistically significant for multiple drug-resistant tuberculosis patients’ recurrence. According to the Weibull-Inverse-Gaussian model, factors that reduced time to MDR-TB recurrence included lower weight (ɸ = 0.944), smoking (ɸ = 0.045), alcohol use (ɸ = 0.631), hemoptysis (ɸ = 0.041), pneumonia (ɸ = 0.564), previous anti-TB treatment (ɸ = 0.106), rural residence (ɸ = 0.163), and chronic diseases like diabetes (ɸ = 0.442) were associated with faster recurrence. While, higher education (ɸ = 3.525) and age (ɸ = 1.021) extended time to recurrence. For weight increment, smokers and alcohol users, clinical complications of hemoptysis and pneumonia, patients with pulmonary disease who had a history of previous anti-TB treatment, and being rural residents are prognostic factors. There was a significant clustering effect at the Alert Specialized Hospital in Addis Ababa, Ethiopia. The Weibull-Inverse Gaussian Shared Frailty Model was chosen as the best model for predicting the time to recurrence of MDR-TB.

Notes from the Field: Mpox Cluster Caused by Tecovirimat-Resistant Monkeypox Virus - Five States, October 2023-February 2024.

The antiviral drug tecovirimat* has been used extensively to treat U.S. mpox cases since the start of a global outbreak in 2022. Mutations in the mpox viral protein target (F13 or VP37) that occur during treatment can result in resistance to tecovirimat† (1,2). CDC and public health partners have conducted genetic surveillance of monkeypox virus (MPXV) for F13 mutations through sequencing and monitoring of public databases. MPXV F13 mutations associated with resistance have been reported since 2022, typically among severely immunocompromised mpox patients who required prolonged courses of tecovirimat (3-5). A majority of patients with infections caused by MPXV with resistant mutations had a history of tecovirimat treatment; however, spread of tecovirimat-resistant MPXV was reported in California during late 2022 to early 2023 among persons with no previous tecovirimat treatment (3). This report describes a second, unrelated cluster of tecovirimat-resistant MPXV among 18 persons with no previous history of tecovirimat treatment in multiple states.

Long-term results of artificial urinary sphincter in women: A retrospective monocentric study

BackgroundStress urinary incontinence (SUI) is a public health issue, with major impact on quality of life. An efficient treatment for intrinsic sphincter deficiency (ISD) is the artificial urinary sphincter (AUS). ObjectivesAnalyzing patient survival in terms of revision-free survival, removal-free survival and global survival without reintervention long-term results concerning continence status and complications. DesignWomen with severe ISD and negative Bonney test who were treated with AUS first implantation between 1987 and 2022 were included. ResultsIn our study, 478 patients were treated by AUS first implantation with a mean age of 59.7. The median follow-up time was 13.2years. The median revision-free survival was 19.5years with survival rates at 10, 20 and 30years were 86%, 47% and 32% respectively. Removal-free survival rates at 10, 20 and 30years were 84%, 80% and 60% respectively. Median reintervention-free survival was 17.5years. Survival was negatively affected by neurological etiology of the ISD, history of previous incontinence treatment and intraoperative complications with more early removals in the latter group. The absence of previous incontinence surgery was a protecting factor. Continence status was assessed at 10, 20 and 30years follow-up with a fully continence rate of respectively 83%, 68% and 61%. Intraoperative complication rate was 17.7%, explantation rate was 14% and the revision rate was 23%. ConclusionWomen treated with AUS have an excellent revision-free, removal-free and global survival rate. AUS is a very efficient treatment for women with ISD in terms of continence results with an acceptable intraoperative and long-term complication rate of which patients should be well informed before choosing this treatment for their SUI. Level of evidence4.

Assessing the Efficacy of Novel Antiviral Therapies in Treating Hepatitis C.

Hepatitis C virus (HCV) infection is a major global health burden, with an estimated 58 million people chronically infected worldwide, according to the World Health Organization (WHO).While many people remain asymptomatic during the early stages of infection, chronic hepatitis C can cause long-term liver damage, significantly increasing the morbidity and mortality associated with the disease. The primary objective of this technical report is to find the efficacy of novel antiviral therapies in treating hepatitis C in a tertiary care hospital in Lahore. This technical report was done in Shalamar Hospital, Lahore, from June 2023 to June 2024. Data for the report were collected retrospectively from 500 patients through a review of patient medical records from the hospital. Medical and electronic health records provided the patient demographics (age, gender, ethnicity), hepatitis C genotype, liver disease stage (fibrosis or cirrhosis staging), previous treatment history, and type of antiviral therapy administered (direct-acting antivirals (DAA)).Out of 500, there were 280 (56%) male and 220 (44%) female patients. The mean age of the patients was 41.23±5.67 years. Patients were divided among mild, advanced, and post-liver transplant as 320 (64%), 150 (30%), and 30 (6%), respectively.Among the DAA regimens, sofosbuvir-based therapies had the highest sustained virologic response (SVR) rate of 95%, followed by glecaprevir/pibrentasvir at 93%. Ledipasvir/sofosbuvir and other DAAs showed slightly lower SVR rates, at 89% and 87%, respectively, indicating high overall efficacy across different therapies. This report concluded that DAAsare highly effective in treating hepatitis C, with an overall SVR rate of 92% and good tolerability across most patient groups. However, patients with genotype III, advanced liver disease, or post-liver transplant status may require personalized treatment approaches due to slightly lower efficacy.

Malocclusion traits as risk indicators for depression in young adults: A population-based cross-sectional study

BackgroundAlthough malocclusion has historically drawn attention for its effects on craniofacial development, oral function, and aesthetics, recent studies have started to investigate the possible association between malocclusion and other aspects of overall health, such as mental health. ObjectivesThis study aimed to analyze various dental malocclusion characteristics and their potential association with depressive symptoms among young adults. The National Health and Nutrition Examination Survey was used for data procurement. MethodsThis cross-sectional study was conducted using a nationally representative population sample, including data from 3,806 participants surveyed between 1988 and 1994 under the National Health and Nutrition Examination Survey III. The inclusion criteria were completion of the clinical assessment for malocclusion traits, being dentate, reporting no history of previous or current orthodontic treatment, reporting no dental pain, and responding to a questionnaire about psychiatric status. Statistical evaluations involved logistic regression modeling and chi-squared tests, considering the complex sampling design nature of the survey. ResultsCrude and adjusted logistic regression models indicated no significant association between malocclusion traits and major depressive episodes (MDEs). Conversely, the same models revealed a positive association between malocclusion traits (specifically, upper crowding and two or more cumulative malocclusion traits) and dysthymia in both crude and adjusted analyses. ConclusionSpecific malocclusion traits were associated with dysthymia, whereas no such associations existed with MDEs. These findings suggest that the association between malocclusion and depression is complex and multifaceted.

Comparative Study on Symptomatic Response and Toxicity of Concurrent Chemo-Radiotherapy and Radiotherapy Alone in the Treatment of Cervical Cancer

This prospective observational study was carried out to compare the symptomatic response and acceptable toxicity in concurrent chemo-radiotherapy and radiotherapy alone in the treatment of cervical cancer. A total of 60 patients (30 patients in arm A &amp; 30 patients in arm B) who have biopsy proven cervical carcinoma with no history of previous treatment were selected from the Department of radiotherapy Rajshahi Medical College Hospital, Rajshahi &amp; in the department of Radiation &amp; Oncology, National Institute of Cancer Research &amp; Hospital. All patients in both arms received external beam radiation with 50Gy in 25 daily fractions over five weeks. Followed by three insertions (one insertion per week) of Intracavitary brachytherapy each 700 cGy. Patients in arm-A received Inj. Cisplatin 40mg/m2 in IV infusion on the first day of each treatment per week in addition to radiotherapy. In this study it was observed that a significant symptomatic improvement was found in arm-A after treatment than arm-B and no severe unwanted reaction was noted in most of the patients. Systematic toxicity developed in both groups and comparatively more in arm-A (chemo radiation) but that was not statistically significant and well managed with conservative treatment. Regarding performance status patients treated with concurrent chemo radiation showed better performance status than the patient treated with radiotherapy alone. In this study it was observed that patients of carcinoma cervix treated with concurrent chemo radiotherapy was effective for symptomatic improvement and feasible with acceptable toxicity for advanced cancer of the uterine cervix than those with radiation alone.

Case Notification of Cutaneous Leishmaniasis at Different Elevations in the North-Central Ethiopia from 2018 To 2022.

We aimed to analyze a four-year trend of Cutaneous leishmaniasis (CL) to determine risk levels and hotspots in North-central Ethiopia. This retrospective study was conducted at Boru Meda Hospital (BMH) from March to April 2023, focusing on CL patients treated at the leishmaniasis treatment center (LTC). Data collected included age, gender, CL type, and other clinical factors. Each patient's origin was traced and geographically mapped by elevation to assess CL risk levels. There were a total of 573 CL patients reported from 46 districts, with a higher number of male patients (n=356) compared to female patients (n=217) (P <0.001). The median age of the patients was 21 years [15-30], with the highest number of CL cases observed among individuals aged 16 to 30 years. The majority of cases (69%) presented with localized CL (LCL). About 39% of patients had a previous treatment history for CL. A significant clustering of CL cases was observed at elevation of 2301-3300 meters above sea level (χ2:17.5; P <0.001), with the highest incidence (case notification) of 14.2/100,000 population. Foci of CL, were burdened at higher elevations and no clinical variation were observed between elevation differences. The majority of cases were concentrated in an area covering approximately 21.4% of the total land mass. CL continues to be a significant issue in North-central Ethiopia and has the potential to spread to new areas.

Association Between Frailty and Pelvic Organ Prolapse in Elderly Women: A Retrospective Study

Introduction and HypothesisThis study evaluated the association between pelvic organ prolapse (POP), frailty, and sarcopenia to explore how POP treatment can extend healthy life expectancy in elderly women.MethodsWe conducted a retrospective study of prospectively collected data, comparing women with mild POP (stages 0–II) with those with advanced POP (stages III and IV). The inclusion criteria for this study were women who visited the clinic with at least one symptom of pelvic floor dysfunction and underwent imaging studies between April 2020 and November 2022. Initially, 119 patients met these inclusion criteria. Patients were excluded if they had a history of previous POP treatment, did not respond to the study survey, or were lost to follow-up. After applying these exclusion criteria, 82 patients were included in the final analysis, of whom 65 underwent surgery (laparoscopic sacrocolpopexy, colpocleisis, tension-free vaginal tape, and native tissue repair). Assessments included POP Quantification, Kihon Checklist, Pelvic Organ Prolapse Quality of Life (P-QOL) questionnaire, International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), and Incontinence Symptom Questionnaire (ICIQ-SF). Pelvic muscles were measured using MRI or CT. Immunohistochemical analysis of estrogen receptor alpha (ERα), estrogen receptor beta , and androgen receptor was performed on surgical specimens from 43 patients.ResultsThe median age of participants was 75 years. Of the 82 patients, 48 (58.5%) were classified as frail or pre-frail, and 22 (26.8%) exhibited motor impairment. Advanced POP (stages 3 and 4) was seen in 41 patients. These patients had more motor function impairments (advanced, 16; mild, 6; p = 0.01). Patients with advanced POP had poorer P-QOL, ICIQ-SF (median: 9.5 vs 4, p = 0.006) and OABSS (7 vs 4, p = 0.008) scores, and smaller pubococcygeus muscle diameter (2.5 vs 3 cm, p = 0.017). Postoperatively, significant improvements were seen in P-QOL (all domains except personal relationships: p < 0.001), total IPSS (11 vs 4, p < 0.001), OABSS (6 vs 5, p = 0.033), and ICIQ-SF scores (6 vs 2, p < 0.001). ERα expression was associated with preoperative frailty (r = −0.37, p = 0.014).ConclusionsAdvanced POP correlates with poorer QOL, worse urinary symptoms, and reduced pubococcygeus muscle diameter, consistent with sarcopenia, compared with mild POP.