Improve Treatment Success Research Articles

Literature Review: Relationship of Family Support with the Medication Adherence in Tuberculosis Patients (TB)

Background: Tuberculosis is an infectious disease caused by the bacterium Mycobacterium tuberculosis. Tuberculosis treatment programs are long and cause some side effects that make patients not adherent to treatment so that family support is needed. Purpose: This study aims to discuss family support with medication adherence in patients with pulmonary tuberculosis. Methods: The type of research that studies the literature using the PRISMA ( Preferred Reporting Items for Systematic Reviews and Meta-analyses ) method. This literature study took 17 electronic journals from 112 international and national electronic journals namely pubmed, google scholar, and one search published between 2014 and 2019 with research inclusion criteria, namely articles containing family support and medication adherence in patients with pulmonary tuberculosis. Results: Most of the literature states that family support is in the good category and has high medication adherence. The most extended family support given to pulmonary tuberculosis patients is informational support and emotional support, while the least support provided is instrumental support. The most dominant adherence factors are the patient's desire to recover or good patient motivation, the role of the family or good family support, and the role of the health worker as a PMO. The relationship of family support with medication adherence in patients with pulmonary tuberculosis showed a significant relationship. Conclusion: The literature states that the better the family support given to patients with pulmonary tuberculosis, the higher the compliance to take medication for these patients. Family support can improve treatment success in patients with pulmonary TB.

Cost comparison of nine-month treatment regimens with 20-month standardized care for the treatment of rifampicin-resistant/multi-drug resistant tuberculosis in Nigeria.

BackgroundGlobally, drug resistant tuberculosis (DR-TB) continues to be a public health threat. Nigeria, which accounts for a significant proportion of the global burden of rifampicin/multi-drug resistant-TB (RR/MDR-TB) had a funding gap of $168 million dollars for TB treatment in 2018. Since 2010, Nigeria has utilized five different models of care for RR/MDR-TB (Models A-E); Models A, B and C based on a standardized WHO-approved treatment regimen of 20–24 months, were phased out between 2015 and 2019 and replaced by Models D and E. Model D is a fully ambulatory model of 9–12 months during which a shorter treatment regimen including a second-line injectable agent is utilized. Model E is identical to Model D but has patients hospitalized for the first four months of care while Model F which is to be introduced in 2020, is a fully ambulatory, oral bedaquiline-containing shorter treatment regimen of 9–12 months. Treatment models for RR/MDR-TB of 20–24 months duration have had treatment success rates of 52–66% while shorter treatment regimens have reported success rates of 85% and above. In addition, replacing the second-line injectable agent in a shorter treatment regimen with bedaquiline has been found to further improve treatment success in patients with fluoroquinolone-susceptible RR/MDR-TB.Reliable cost data for RR/MDR-TB care are limited, specifically costs of models that utilize shorter treatment regimens and which are vital to guide Nigeria through the provision of RR/MDR-TB care at scale. We therefore conducted a cost analysis of shorter treatment regimens in use and to be used in Nigeria (Models D, E and F) and compared them to three models of longer duration utilized previously in Nigeria (Models A, B and C) to identify any changes in cost from transitioning from Models A-C to Models D-F and opportunities for cost savings.MethodsWe obtained costs for TB diagnostic and monitoring tests, in-patient and out-patient care from a previous study, inflated these costs to 2019 NGN and then converted to 2020 USD. We obtained other costs from the average of six health facilities and drug costs from the global drug facility. We modeled treatment on strict adherence to two Nigerian National guidelines for programmatic and clinical management of drug-resistant tuberculosis.ResultsWe estimated that the total costs of care from the health sector perspective for Models D, E and F were $4,334, $7,705 and $3,420 respectively. This is significantly lower than the costs of Models A, B and C which were $14,781, $12, 113, $7,572 respectively.ConclusionReplacing Models A–C with Models D and E reduced the costs of RR/MDR-TB care in Nigeria by approximately $5,470 (48%) per patient treated and transitioning from Models D and E to Model F would result in further cost savings of $914 to $4,285 (21 to 56%) for every patient placed on Model F. If the improved outcomes of patients managed using bedaquiline-containing shorter treatment regimens in other countries can be attained in Nigeria, Model F would be the recommended model for the scale up of RR/MDR-TB care in Nigeria.

Abstract PO-265: Perceived barriers and facilitators for breast cancer screening influences among African American women ages 40-75

Abstract Introduction: Breast cancer is the most commonly diagnosed cancer in women in the United States. Breast cancer screening mammography helps detect cancer earlier, improving treatment success. Similar to other screening exams, making the decision to get screened for breast cancer involves evaluating the risks and benefits of the procedure which can vary by age. While the assessment for breast cancer screening is often personal, few screening decision aids have been created with ethically and racially diverse women for use in a variety of settings, including low-resource settings. We aim to characterize the primary influences among African American women when making a decision about breast cancer screening mammography and how these influences may differ based on age in order to better engage this demographic to inform decision aid development. Methods: Focus groups were performed to elicit the views and opinions of African American women ages 40 to 75 on the topic of breast cancer screenings. Using the Andersen Behavioral Model of Health Services Use, a qualitative analysis of the focus groups transcripts was performed using a deductive coding approach. The Andersen Model included predisposing factors (e.g. age, knowledge, beliefs, fears and fatalism), enabling factors (e.g. health insurance and health utilization), and need factors (e.g. physician recommendation and family/personal history). Sociodemographic information was collected, and quantitative data were summarized using descriptive statistics. Results: This study included 51 African American women ages 40 -75 (ages 40-49 n=23, ages 50-75 n=28). In the 40-49 age cohort, 82.3% (n=19) has had at least one mammography and 69.6% (n=16) had high health literacy. In the 50-75 age cohort, 100% of women had at least one mammography and 71.4% (n=20) had high health literacy. For all of the women in the study, the major influences for breast cancer screening include physician recommendation, family/personal medical history as well as health utilization (e.g. wanting to be proactive about their health). Participants indicated that topic of autonomy was also important as they prioritized caring for themselves and making a personal decision. However, for women ages 50- 75, customer service was also a major influence for breast cancer screening (e.g. how they were treated while accessing medical services for breast cancer screening). Conclusions: The primary influences for breast cancer screening among African American women age 40-75 can vary with age. A better understanding of these influences can help inform decision aids to meet the needs of ethnically and racially diverse women across various ages eligible for breast cancer screening mammography. Citation Format: Kamilah S. Abdur-Rashid, Ashley J. Housten, Graham A. Colditz. Perceived barriers and facilitators for breast cancer screening influences among African American women ages 40-75 [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-265.

Analysis of treatment success with new inclusion criteria for antibiotic therapy for uncomplicated appendicitis: A multicentre cohort study.

Conservative antibiotic treatment for uncomplicated appendicitis is debated because of the unproven criteria for use and relatively high failure rate. We developed inclusion criteria to optimize antibiotic therapy use and compared the success rate to that seen in previous literature. Our antibiotic therapy inclusion criteria were developed based on clinical findings (symptom onset ≤48hours and body temperature ≤38.3℃), laboratory parameters (white blood cell count ≤12000/mL) and radiologic findings (appendiceal diameter ≤12mm and no appendicolith). Patients who met inclusion criteria were enrolled from three hospitals between 2016 and 2017. Treatment success was defined as a response to antibiotic therapy and no recurrent symptoms within 1year. We compared our success rate with previous clinical trial success rates. There were 240 patients enrolled (116 men and 124 women) with a mean age of 38.7years. After initial antibiotic treatment, 233 patients (97.1%) responded to therapy and were discharged. There were no post-treatment complications with Clavien-Dindo grade ≥III. During the 1-year follow-up period, the treatment success rate was 88.8% (213/240) and the recurrence rate was 8.6% (20/233; 15 underwent surgery and 5 received antibiotics again). In contrast, the combined treatment success rate for six previous clinical trials was 76.5% (573/749) and the recurrence rate was 21.6% (157/727). The group enrolled with the new inclusion criteria showed an improved treatment success rate compared to previous studies. These criteria will aid in determining optimal conservative treatment use in patients with uncomplicated appendicitis.

The effectiveness of a collaborative infertility counseling (CIC) on pregnancy outcome in women undergoing in vitro fertilization: a randomized trial

BackgroundThe optimal objective of infertility treatments is to increase pregnancy rate. The aim of this study was to assess the effectiveness of a collaborative counseling program on pregnancy rate in women undergoing in vitro treatment.MethodsThis was a parallel group randomized trial on a sample of 60 women attending to an infertility research center affiliated to Mashhad University of Medical Sciences for fertility treatment. Women were randomly assigned to an intervention or a control group. Then, a five-session program offered to the intervention group while the control group received nothing expect the usual care. The primary outcome for the study was positive pregnancy test at the end of study. Statistical analyses including independent samples t-test were performed to explore the data.ResultsThe outcome analysis showed that there were no significant differences in pregnancy rate between the intervention and the control groups (P = 0.298). Also, there were no significant differences in follicle and embryo numbers between two groups. However, a significant difference was observed between two groups in terms of oocyte numbers where the intervention group had more oocyte (P = 0.014).ConclusionOverall the findings indicated that the collaborative infertility counseling did not improve treatment success in infertile women undergoing in vitro fertilization.Trial registrationIRCT201110267915N1. Registered 2014.07.25-Retrospectively registered (http://en.irct.ir/trial/8359).

Classifying ADHD subtypes/presentations considering the joint effect of three levels of investigation

Aim Discriminant validity of the Attention Deficits/Hyperactive Disorders (ADHD) subtypes/presentations is not yet clear. The purpose of this study was to investigate joint contribution of the strongest factors of the three dimensions, namely psychopathology, neuropsychology and electrophysiology for subtyping of presentations. Method A sample of 104 boys aged 7–12 years was subdivided into three groups with ADHD combined (n = 22), inattentive (n = 25) and hyperactive/impulsive subtype (n = 14), and 43 typically developing controls (TDC). Children were investigated regarding the Child Behavior Checklist (CBCL), the Integrated Visual and Auditory Test (IVA), and EEG spectral power during eyes closed resting state. Subsequently, statistical analysis included discriminant functional analysis and principle component analysis. Results Neuropsychological parameters had the highest contribution in classifying of the groups. EEG parameters had no effect on differentiation of the groups, and among the psychopathological parameters, only the oppositional behavioral disorder score contributed to correctly classify 74.3% of the groups. Furthermore, we found four factors with eigenvalues higher than 1 in the ADHD and typical groups, with one factor characterized by four CBCL scales, another one by auditory and visual vigilance, speed and beta band power, the third by auditory and visual prudence, and forth by theta band power. Conclusions Our results demonstrated that ADHD subtypes/presentations can be differentiated from each other at different levels of investigation despite some clinical symptoms overlap. The results suggested that not only psychopathology but also the impairment of sensory processing should be assessed in children with ADHD in order to use this additional information for a jointly multilevel clinical intervention, which may improve treatment success.

Impacts of social support on the treatment outcomes of drug-resistant tuberculosis: a systematic review and meta-analysis

ObjectiveTo assess the effectiveness of social support on treatment success promotion or lost to follow-up (LTFU) reduction for patients with drug-resistant tuberculosis (DR-TB).DesignWe searched Pubmed, Web of Science, Embase, Scopus...

The addition of silver nitrate cautery to antiseptic nasal cream for patients with epistaxis: A systematic review and meta-analysis

ObjectiveTo compare the outcomes of the addition of silver nitrate cautery versus antiseptic cream alone in paediatric patients with recurrent epistaxis. MethodsA systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines and a search of electronic information was conducted to identify all Randomised Controlled Trials (RCTs) and non-randomised studies comparing the outcomes of the addition of silver nitrate cautery versus antiseptic cream alone in paediatric patients with recurrent epistaxis. Treatment success and persistence of bleeding were primary outcome measures. Secondary outcome measures included treatment side effects. Fixed effects modelling was used for the analysis. ResultsFour studies enrolling 240 patients were identified. There was no significant difference between silver nitrate cautery group and antiseptic cream alone group in terms of complete resolution (Odds Ratio [OR] = 1.07, P = 0.81), the partial resolution (OR = 1.02, P = 0.96) and persistence of bleeding (OR = 0.91, P = 0.71). For secondary outcomes, antiseptic nasal cream was associated with few side effects such as rash in one case and several complaints of bad smell or taste. ConclusionsThe addition of silver nitrate cautery is not superior to the use of antiseptic cream alone in paediatric patients with recurrent epistaxis as it does not improve treatment success or persistence of bleeding.

Euphrasia Eye Drops in Preterm Neonates With Ocular Discharge: A Randomized Double-Blind Placebo-Controlled Trial.

Aim: To investigate whether the early administration of Euphrasia eye drops® in preterm neonates presenting with ocular discharge fosters the resolution of the ocular discharge and reduces the need for topical antibiotic therapy, as compared to placebo.Methods: We conducted a randomized double-blind placebo-controlled trial at the University Children's Hospital Bern, Switzerland. Preterm neonates with white, yellow, or green ocular discharge were included. Infants were randomly assigned (1:1) to the Euphrasia arm (Euphrasia eye drops®, Weleda AG, Arlesheim) or the placebo arm (NaCl 0.9%). Euphrasia or placebo was administrated at a dose of one drop in each eye four times a day over a period of 96 h. The primary outcome was the treatment success, defined as no ocular discharge at 96 h and no use of topical antibiotic therapy during the 96-h intervention.Results: A total of 114 neonates were screened and 84 were randomized. Among neonates in the Euphrasia arm, 22 (55.0%) achieved our primary outcome compared to 21 (51.2%) in the placebo arm (p = 0.85). In the Euphrasia arm, time to resolution of reddening tended to fall within the shorter bracket of 24 to 48 h (24 (92.3%) vs. 12 (80.0%) in the placebo arm, p = 0.34) and relapse or first signs of reddening during the 96-h intervention tended to be lower [3 (7.9%) eyes vs. 8 (18.2%) eyes in the placebo arm, p = 0.17]. Tearing at 96 h tended to be lower in the Euphrasia arm [5 (12.8%) eyes in the Euphrasia arm vs. 12 (27.3%) eyes in the placebo arm, p = 0.10].Discussion: Euphrasia did not significantly improve treatment success, defined as no ocular discharge at 96 h and no use of topical antibiotic therapy during the 96-h intervention. However, results suggest that Euphrasia may be of benefit for symptoms such as reddening and tearing, and thus improve the comfort of patients.Trial Registration: The trial is registered at the US National Institutes of Health (ClinicalTrials.gov) NCT04122300 and at the portal for human research in Switzerland SNCTP000003490.

Bacterial urinary tract infection and subclinical bacteriuria in the dog: a current review

Bacterial urinary tract infection (UTI) is a common clinical presentation in dogs and a frequent reason for the prescription of antimicrobial drugs. UTI refers to adherence, multiplication and persistence of an infectious agent within the urogenital system. This causes an associated inflammatory response as well as the pertaining clinical signs. Depending on the site of infection, UTI's may be classified as bacterial cystitis, prostatitis or pyelonephritis. In contrast, subclinical bacteriuria (SB) is defined as the presence of a significant number of bacteria in the urine of an individual not showing clinical signs referrable to UTI. UTI's typically occur as a consequence of ascending pathogen migration from the host's own fecal or distal urogenital microbial flora. The most commonly isolated pathogen in cases of UTI and SB is Escherichia coli. The diagnosis is based on clinical signs and the results of urine examination and culture. The recently revised guidelines of the International Society for Companion Animal Infectious Diseases provide detailed recommendations for diagnosis and management of different forms of bacterial UTI's in dogs. Adherence to treatment guidelines will improve treatment success and is imperative in avoiding further deterioration of the antimicrobial resistance situation.

Combinatory Treatment with Oseltamivir and Itraconazole Targeting Both Virus and Host Factors in Influenza A Virus Infection.

Influenza virus infections and their associated morbidity and mortality are a major threat to global health. Vaccination is an effective influenza prevention measure; however, the effectiveness is challenged by the rapid changes in the influenza virus genome leading to viral adaptation. Emerging viral resistance to the neuraminidase inhibitor oseltamivir limits the treatment of acute influenza infections. Targeting influenza virus-host interactions is a new and emerging field, and therapies based on the combination of virus- and host-directed drugs might significantly improve treatment success. We therefore assessed the combined treatment with oseltamivir and the repurposed antifungal drug itraconazole on infection of polarized broncho-epithelial Calu-3 cells with pdm09 or Panama influenza A virus strains. We detected significantly stronger antiviral activities in the combined treatment compared to monotherapy with oseltamivir, permitting lower concentrations of the drug than required for the single treatments. Bliss independence drug interaction analysis indicated that both drugs acted independently of each other. The additional antiviral effect of itraconazole might safeguard patients infected with influenza virus strains with heightened oseltamivir resistance.

Enhancement of Tuberculosis Detection Using Ensemble Classifier with Quadtree Method: A Preliminary Study

Tuberculosis is an infectious disease caused by a bacillus called Mycobacterium tuberculosis. It can lead to death in untreated and inappropriately treated patients. An early diagnosis of the disease not only improves treatment success but also reduces death rates. Lung region is the most affected part of Tuberculosis and the process of medical image classification is still carried out manually using the knowledge of the physician or radiologist, which leads to inaccurate and slow process of TB identification. Therefore, this study proposed to enhance tuberculosis detection using a different combination of machine learning and image processing methods on the image dataset.

The Intergenerational Impact of a Slow Pandemic: HIV and Children.

Human immunodeficiency virus (HIV) has, over the last four decades, infected millions of young women and their children. Interventions developed in parallel with the spread of the virus have been able to reduce rates of vertical transmission from mother to child. The impact of HIV in children can be direct in children living with HIV (CLHIV) and exposed to HIV and uninfected, or indirect through impacts on their parents, caregivers, and family. In 2018, the United Nations joint programme on AIDS (UNAIDS) estimated that 1.7 million children were living with HIV, 160,000 were newly infected with HIV, and 100,000 died from HIV. Improvement in treatment regimens can improve the life chances of children, but adherence to treatment is a problem, especially for adolescents. Injectable long acting treatments, or interventions to improve service delivery and support for adolescents living with HIV may improve treatment success. In addition to failures of HIV prevention and treatment in CLHIV, there are concerns over exposure to the virus and antivirals leading to delayed child development. To improve the wellbeing of children affected by HIV, social support is necessary, but we need to find ways of enhancing the impact of interventions, perhaps through combining them.

Management of early pregnancy loss with mifepristone and misoprostol: clinical predictors of treatment success from a randomized trial

Early pregnancy loss is a common event in the first trimester, occurring in 15%-20% of confirmed pregnancies. A common evidence-based medical regimen for early pregnancy loss uses misoprostol, a prostaglandin E1 analog, with a dosage of 800 μg, self-administered vaginally. The clinical utility of this regimen is limited by suboptimal effectiveness in patients with a closed cervical os, with 29% of patients experiencing early pregnancy loss requiring a second dose after 3 days and 16% of patients eventually requiring a uterine aspiration procedure. This study aimed to evaluate clinical predictors associated with treatment success in patients receiving medical management with mifepristone-misoprostol or misoprostol alone for early pregnancy loss. We performed a planned secondary analysis of a randomized trial comparing mifepristone-misoprostol with misoprostol alone for management of early pregnancy loss. The published prediction model for treatment success of single-dose misoprostol administered vaginally included the following variables: active bleeding, type of early pregnancy loss (anembryonic pregnancy or embryonic and/or fetal demise), parity, gestational age, and treatment site; previous significant predictors were vaginal bleeding within the past 24 hours and parity of 0 or 1 vs >1. To determine if these characteristics predicted differential proportions of patients with treatment success or failure, we performed bivariate analyses; given the small proportion of treatment failures in the combined treatment arm, both arms were combined for analysis. Thereafter, we performed a logistic regression analysis to assess the effect of these predictors collectively in each of the 2 treatment groups separately as well as in the full cohort as a proxy for the combined treatment arm. Finally, by using receiver operating characteristic curves, we tested the ability of these predictors in association with misoprostol treatment success to discriminate between treatment success and treatment failure. To quantify the ability of the score to discriminate between treatment success and treatment failure in each treatment arm as well as in the entire cohort, we calculated the area under the curve. Using multivariable logistic regression, we then assessed our study population for other predictors of treatment success in both treatment groups, with and without mifepristone pretreatment. Overall, 297 evaluable participants were included in the primary study, with 148 in the mifepristone-misoprostol combined treatment group and 149 in the misoprostol-alone treatment group. Among patients who had vaginal bleeding at the time of treatment, 15 of 17 (88%) in the mifepristone-misoprostol combined treatment group and 12 of 17 (71%) in the misoprostol-alone treatment group experienced expulsion of pregnancy tissue. Among patients with a parity of 0 or 1, 94 of 108 (87%) in the mifepristone-misoprostol treatment group and 66 of 95 (69%) in the misoprostol-alone treatment group experienced expulsion of pregnancy tissue. These clinical characteristics did not predict treatment success in the combined cohort alone (area under the curve=0.56; 95% confidence interval, 0.48-0.64). No other baseline clinical factors predicted treatment success in the misoprostol-alone treatment arm or mifepristone pretreatment arm. In the full cohort, the significant predictors of treatment success were pretreatment with mifepristone (adjusted odds ratio=2.51; 95% confidence interval, 1.43-4.43) and smoking (adjusted odds ratio=2.15; 95% confidence interval, 1.03-4.49). No baseline clinical factors predicted treatment success in women receiving medical management with misoprostol for early pregnancy loss. Adding mifepristone to the medical management regimen of early pregnancy loss improved treatment success; thus, mifepristone treatment should be considered for management of early pregnancy loss regardless of baseline clinical factors.

Standards der ernährungsmedizinischen Versorgung in der ambulanten und stationären Pädiatrie durch spezialisierte Einrichtungen der Kinder- und Jugendmedizin

Healthy growth and development are based on an adequate supply of energy and nutrients and are a prerequisite for the maintenance of health and performance ability. In cases of illness, malnutrition impedes the recovery process and promotes the development of complications. The high prevalence of malnutrition is conspicuous, particularly in children below 2 years of age and those with chronic illnesses, e.g. Crohn’s disease, celiac disease, diabetes mellitus, asthma, allergies and epilepsy. A qualified dietary therapy can improve treatment success and therefore reduce disease-related complications.A preventive and therapeutic nutritional counseling requires significantly more time and personnel for children compared to adults. In childhood the treatment has to be individualized in the context and course of the underlying disease, including treatment of parents, family and other care providers over various age and developmental stages. The treatment of malnutrition in childhood and adolescence not only requires counseling as part of a multiprofessional holistic treatment with sustained follow-up, but also the elaboration and implementation of professional training concepts.In this statement standards for pediatric nutritional treatment and therapy are described for the outpatient and inpatient areas, which seem to be urgently necessary to achieve the individual treatment goals including the necessary resources. This also involves the interdisciplinary collaboration in a team consisting of a pediatrician, nutritional expert, pediatric nursing staff as well as psychologists and social workers where applicable; however, in order to achieve an appropriate time-consuming and personnel-intensive management of children and adolescents with malnutrition, remuneration by health insurers needs to be provided. Thus, it is necessary that the medical directive (Heilmittel-Richtlinie, HMR) as well as the diagnosis-related groups (DRG) are extended to all pediatric patients with nutrition-related diseases to enable cost-covering reimbursement of pediatric nutritional counseling and training not only in outpatient but also inpatient pediatric management.

Wagner Cone Midterm Survivorship and Outcomes

BackgroundTotal hip arthroplasty (THA) in patients with abnormal proximal femoral anatomy requires an individualized treatment approach to prevent complications. Metaphyseal engaging stems in this population risk fracture, size/offset mismatch, and aseptic loosening. The Wagner conical femoral implant is a short diaphyseal engaging femoral stem that could improve treatment success in this difficult patient population. MethodsWe identified 302 consecutive patients undergoing THA using the Wagner cone femoral prosthesis between January 2010 and January 2017. Clinical, radiographic, and patient-reported outcomes were obtained through chart review and radiographic measurements of postoperative X-rays. We used multivariate analysis to determine predictors of poor outcomes. Kaplan-Meier curves were created to demonstrate implant survivorship with reoperation and revision as endpoints. The average follow-up was 3.2 years, with a minimum of 2 years. ResultsThe implant retention survival rate during the 3.2-year study period was 98.7%. The overall reoperation rate was 4.2%, with infection followed by fracture being the most common reasons for reoperation. No patients were revised for aseptic loosening, and no patients were revised for subsidence. The average subsidence was 1.1 mm. The Harris Hip Score improved from 48.6 ± 7.3 (range, 28-64) preoperatively to 86.1 ± 8.5 (range, 66-100) at latest follow-up. The patient-reported satisfaction rate was 98.3%. ConclusionThe Wagner cone femoral prosthesis demonstrated excellent clinical, radiographic, and patient-reported functional outcomes at midterm follow-up. We recommend use of the Wagner cone in THA patients with challenging proximal femoral anatomy, small femoral diameter, or poor metaphyseal bone quality.

New perspectives on difficult-to-treat tuberculosis based on old therapeutic approaches

Tuberculosis (TB) is an important clinical and public health issue worldwide. Despite improved treatment success rates following the introduction of antibiotics in daily clinical practice, the expected decline in incidence has been hampered by HIV epidemics and multi- and extensively drug-resistant TB. During the pre-antibiotic era, TB therapies were mainly based on improving hygiene conditions, strengthening the immune system, and targeting the rest of the affected lungs with invasive techniques. Detailed knowledge of old non-pharmacological therapies might support physicians and researchers in the identification of new solutions for difficult-to-treat patients. We performed a narrative literature review on the main old therapeutic options prescribed for patients with TB. The main recommendations and contraindications of sanatorium therapies (i.e., bed rest, fresh air, sunlight) and pulmonary collapse techniques are reviewed, evaluating their physiological basis and their impact on patient outcomes. We report studies describing new interventional pulmonary and surgical techniques and assess new perspectives based on old medical and surgical treatments, whose potential implementation could help complicated patients.

Mould Infections of Traumatic Wounds: A Brief Narrative Review.

Mould infections may follow traumatic injuries, with direct fungal inoculum in the site of injury and subsequent angioinvasion, possibly resulting in tissue necrosis and systemic dissemination. The pathogenesis of mould infections following trauma injuries presents unique features compared with classical mould infections occurring in neutropenic or diabetic patients, because a large fraction of post-traumatic mould infections is observed in previously healthy individuals. Most of the published clinical experience and research on mould infections following traumatic injuries regards soldiers and infections after natural disasters. However, following trauma and soil contamination (e.g., agricultural or automotive injuries) other immunocompetent individuals may develop mould infections. In these cases, delays in correct diagnosis and treatment may occur if pertinent signs such as necrosis and absent or reduced response to antibacterial therapy are not promptly recognized. Awareness of mould infections in at-risk populations is needed to rapidly start adequate laboratory workflow and early antifungal therapy in rapidly evolving cases to improve treatment success and reduce mortality.

The long-term effects of a family based economic empowerment intervention (Suubi+Adherence) on suppression of HIV viral loads among adolescents living with HIV in southern Uganda: Findings from 5-year cluster randomized trial.

BackgroundThe rapid scale-up of HIV therapy across Africa has failed to adequately engage adolescents living with HIV (ALWHIV). Retention and viral suppression for this group (ALWHIV) is 50% lower than for adults. Indeed, on the African continent, HIV remains the single leading cause of mortality among adolescents. Strategies tailored to the unqiue developmental and social vulnerabilities of this group are urgently needed to enhance successful treatment.MethodsWe carried out a five-year longitudinal cluster randomized trial (ClinicalTrials.gov ID: NCT01790373) with adolescents living with HIV (ALWHIV) ages 10 to 16 years clustered at health care clinics to test the effect of a family economic empowerment (EE) intervention on viral suppression in five districuts in Uganda. In total, 39 accredited health care clinics from study districts with existing procedures tailored to adolescent adherence were eligible to participate in the trial. We used data from 288 youth with detectable HIV viral loads (VL) at baseline (158 –intervention group from 20 clinics, 130 –non-intervention group from 19 clinics). The primary end point was undetectable plasma HIV RNA levels, defined as < 40 copies/ml. We used Kaplan-Meier (KM) analysis and Cox proportional hazard models to estimate intervention effects.FindingsThe Kaplan-Meier (KM) analysis indicated that an incidence of undetectable VL (0.254) was significantly higher in the intervention condition compared to 0.173 (in non-intervention arm) translated into incidence rate ratio of 1.468 (CI: 1.064–2.038), p = 0.008. Cox regression results showed that along with the family-based EE intervention (adj. HR = 1.446, CI: 1.073–1.949, p = 0.015), higher number of medications per day had significant positive effects on the viral suppression (adj.HR = 1.852, CI: 1.275–2.690, p = 0.001).InterpretationA family economic empowerment intervention improved treatment success for ALWHIV in Uganda. Analyses of cost effectiveness and scalability are needed to advance incorporation of this intervention into routine practice in low and middle-income countries.

Clinical effectiveness of enrofloxacin 100 mg/mL injectable solution for the treatment of acute anaplasmosis in cattle caused by Anaplasma marginale

Anaplasma marginale is a gram-negative rickettsial pathogen that can cause clinical anemia and death in cattle. The objective of this study was to evaluate the effectiveness of enrofloxacin (ENR) 100 mg/mL at a single subcutaneous dose of 5.7 mg/lb (12.5 mg/kg) for treatment of acute anaplasmosis (ANA) in mature beef cows (n=67). Following intravenous inoculation with A. marginale-infected blood, cattle were monitored for clinical signs of ANA. Upon meeting case criteria, cattle were randomly assigned to receive ENR or saline (SAL). Treatment success, defined as 28 d post-treatment survival and resolution of abnormal clinical scores, was 81.8% (27/33) and 44.1% (15/34) (P=0.0032) for ENR and SAL treated cows, respectively. Mortality was 47% (16/34) and 3% (1/33) in SAL and ENR, respectively (P=0.0027). Packed cell volume at 7, 14, 21, and 28 d post-treatment was significantly greater in ENR compared to SAL (P&lt;0.05). In this study, ENR improved treatment success compared to SAL, reduced ANA mortality, and maintained greater packed cell volumes post-clinical signs compared to SAL. Extra-label use of fluoroquinolones in food animals is prohibited in the United States, but ENR (Baytril® 100-CA1) was recently conditionally approved for treatment of ANA.