Predictors Of Poor Treatment Outcome Research Articles

Factors associated with unsuccessful tuberculosis treatment among homeless persons in Brazil: A retrospective cohort study from 2015 to 2020.

Tuberculosis (TB) is a preventable and a curable disease. In Brazil, TB treatment outcomes are particularly worse among homeless populations who are either of black race, malnourished or living with HIV/AIDS and other comorbidities. This study therefore evaluated factors associated with unsuccessful TB treatment among homeless population (HP) compared to those with shelter. The study population was composed of 284,874 people diagnosed with TB in Brazil between 2015 and 2020 and reported in the Information System for Notifiable Diseases (SINAN), among which 7,749 (2.72%) were homeless and 277,125 (97.28%) were sheltered. Cox regression analysis was performed with both populations to identify factors associated with unsuccessful TB treatment, and significant predictors of TB treatment outcomes. Results show that HP are more susceptible to unfavorable outcomes when compared to sheltered people (Hazard Ratio (HR): 2.04, 95% CI 1.82-2.28). Among the HP, illicit drug use (HR: 1.38, 95% CI 1.09-1.74), mental disorders (HR: 2.12, 95% CI 1.08-4.15) and not receiving directed observed treatment (DOT) (HR: 18.37, 95% CI 12.23-27.58) are significant predictors of poor treatment outcomes. The use of illicit drugs (HR: 1.53, 95% CI 1.21-1.93) and lack of DOT (HR: 17.97, 95% CI 11.71-27.59) are associated with loss to follow-up, while lack of DOT (HR: 15.66, 95% CI 4.79-51.15) was associated with mortality among TB patients. Homeless population living in Brazil are twice at risk of having an unsuccessful treatment, compared to those who are sheltered, with illicit drugs use, mental disorders and lack of DOT as risk factors for unsuccessful TB outcomes. Our findings reinforce the arguments for an intersectoral and integral approach to address these determinants of health among the vulnerable homeless populations.

Successful outcomes for patients with drug-resistant tuberculosis despite civil unrest and COVID-19 in Haiti.

Globally, treatment outcomes for people with multi-drug/rifampin-resistant tuberculosis (MDR/RR-TB) are sub-optimal, with MDR/RR-TB programs further weakened due to the COVID-19 pandemic, and in Haiti, by severe civil unrest. We assessed the impact of these disruptions on treatment outcomes at GHESKIO, in Port-au-Prince, Haiti. We conducted a retrospective analysis including all adults (age ≥18 years) who initiated MDR/RR-TB treatment at GHESKIO from 2010 to 2020. We assessed predictors of poor treatment outcome using multivariable logistic regression, adjusting for baseline characteristics and year of treatment. 453 patients initiated treatment for MDR/RR-TB at GHESKIO. Median age was 31 (IQR: 25, 40), 233 (51.4%) were male, and 100 (22.1%) were living with HIV. Three hundred sixty-nine patients (81.5%) achieved cure, 42 (9.3%) died, 40 (8.8%) were lost to follow-up and 2 (<1%) failed treatment. HIV status was associated with poor treatment outcome (aRR: 1.65 (95% CI: 1.09, 2.48)) but there was no difference by year of treatment initiation. Outcomes for patients with MDR/RR-TB remained outstanding, even during the COVID-19 pandemic and severe civil unrest in Haiti. We attribute this resilience in care to the adaptability of program staff and provision of economic and psychosocial support.

Effect of a digital biopsychometric risk profile of patients with cancer on the delivery of risk-stratified personalised prehabilitation.

e13636 Background: Cancer symptoms and treatment consequences such as fatigue, nausea, distress and breathlessness contribute to inactivity, malnutrition, sarcopenia and ultimately poor clinical outcomes. Multimodal prehabilitation, with a focus on physical activity, nutrition and emotional well-being, is associated with improved treatment outcomes. However, prehabilitation needs to be personalised to maximise adherence and impact. Digital solutions offer an opportunity to collect and consolidate health data to facilitate the personalisation of prehabilitation programmes. Methods: Patients were referred from the NHS to an independent digital prehabilitation provider, Onkohealth Ltd. Baseline health metrics were collected via validated survey tools and wearable technology to develop a biopsychometric profile including the following modifiable factors. Multi-morbidity risk (MMR) was represented as a score from 0-14. Frailty estimation was based on walking speed. Diet quality was based on the World Cancer Research Fund diet score with higher score for better quality food items (range 0-3). Psychological wellbeing was measured via an emotional distress scale (range 0-10) and self-efficacy (range 0-40). Exercise metrics included 1 minute heart rate recovery (1m HRR) and 30 second Sit to Stand test (30sSTS). Risk-stratification was undertaken using the validated thresholds for each of these 9 modifiable risk metrics, including BMI. EuroQoL EQ5D5L was used to report quality of life as health utility (EQ-HU). Results: 303 patients with a range of cancer diagnosis [gastrointestinal (41%), biliopancreatic (10%) gynaecological (16%) and breast (20%) were included. 72% of patients had at least one high-risk metric and 30% had &gt;3 high risk metrics. 42% of patients were obese, 34% had a high MMR and 25% had a slow walking speed. There were strong correlations between age and MMR (rho=0.53; p&lt;0.001) and walking speed (rho=0.33; p=0.004). 16% had a low HRR and 17% had a low STS. STS had significant correlation with walking speed [rho=0.47; p&lt;0.001) and BMI (rho=0.34; p&lt;0.001). 42% of patients reported a low quality diet. High levels of anxiety were recorded in 21% of patients and high levels of depression in 26% of patients. Higher levels of anxiety (rho-0.24; p=0.002) and distress (rho=0.29; p&lt;0.001) and lower levels of self-efficacy (rho= 0.25, p&lt;0.001) were associated with lower EQ HU. Conclusions: This study demonstrated that 7 in 10 cancer patients have at least one risk factor and 1 in 4 patients have more than 3 predictors of poor treatment outcomes. Bio-psychometric profiling highlights modifiable risk factors and provides a focus for prehabilitation to be personalised. The findings also highlighted the importance of psychological wellbeing as high levels of emotional distress were associated with lower reported quality of life.

Development, reach, acceptability and associated clinical changes of a group intervention to improve caregiver-adolescent relationships in the context of adolescent depression.

Adolescents with depression often experience relationship problems with their caregivers, which predict poorer treatment outcomes. Personalising interventions by targeting factors associated with poor treatment outcomes may enhance the effectiveness of interventions. We report the development and initial evaluation of an intervention designed to target caregiver-adolescent relationship problems in the context of adolescent depression. Following a literature search to identify established caregiver interventions, we developed a new group intervention for caregivers through an iterative process including six rounds of the group with n=53 caregivers of adolescents age 13-18 in the context of an integrated care pathway for adolescent depression. Caregivers rated their family functioning at the beginning and end of the program and provided anonymous satisfaction ratings. Enrolment and attendance data were examined. Youth with lived experience of depression and their caregivers provided input that was incorporated in the final version of the intervention. The final intervention consists of 8 weekly, 1.5h group sessions, delivered face-to-face, addressing: psychoeducation, the cognitive-behavioural model and caregiving, positive caregiving, listening and validation, expressing emotions effectively, and problem solving. Reach (56%), attendance (M=63%, SD=31%), and satisfaction (M=92%; SD=7%) supported the feasibility of the program. Caregivers reported significant improvements in family functioning, t(21)=2.68, p=.014, d z=0.56 [95% CI 0.11-1.0]. A group intervention is acceptable to caregivers of adolescents with depression and may be associated with improved family functioning. Further research is needed, including a randomised controlled trial to test effects of the intervention on various dimensions of the caregiver-youth relationship and on youth depression outcomes.

Prognostic significance of thyroid-stimulating hormone receptor antibodies in moderate-to-severe graves' orbitopathy.

Retrospective study. The purpose of this retrospective study was to assess the changes in thyroid-stimulating hormone receptor (TSH-R) antibody levels following treatment in patients with moderate-to-severe and active Graves' orbitopathy (GO) and to investigate the correlation between these antibodies and treatment response. The subjects of this study comprised of patients newly diagnosed with moderate-to-severe and active GO within the age range of 19 to 79 years. All participants underwent intravenous methylprednisolone (IVMP) therapy for a duration of 12 weeks. Patients with a clinical activity score (CAS) decrease to or less than 3 and no symptom recurrence for at least 3months after the last dose of IVMP were classified as "Group 1". Those with a CAS equal to or greater than 4 were classified as "Group 2". TSH-R antibody levels were measured prior to and following IVMP treatment and treatment response was evaluated after the completion of IVMP therapy. All patients were monitored for a minimum of 6 months post-treatment, with ocular examinations and laboratory tests at the initial visit being included in the analysis. The medical records of the 96 patients with GO were retrospectively reviewed. Seventy-five patients (78.1%) were response and 21 (21.9%) were non-responsive to IVMP treatment. A higher TSH-R antibody (TRAb) and thyroid-stimulating antibody (TSAb) following treatment were associated with a high risk of no treatment response (P = 0.017; P = 0.047, respectively). TRAb and TSAb levels before treatment were significantly related to TRAb and TSAb levels after treatment (P < 0.001, respectively). The cut-off values for the prediction of poor treatment response of the TRAb and TSAb before and after treatment were 8.305 IU/L, 5.035 IU/L and 449.5%, 361%, respectively (P = 0.027, P =0.001 and P = 0.136, P = 0.004, respectively). It was observed that elevated levels of TRAb and TSAb prior to IVMP treatment were positively correlated with post-treatment levels of these antibodies. Furthermore, in cases of non-response to IVMP therapy, a diminished decline in both antibodies was observed, and elevated levels of TRAb and TSAb post-treatment were found to be a significant predictor of poor treatment outcome. Measurement of TRAb and TSAb throughout the course of treatment in moderate-to-severe and active cases of GO may offer valuable insights into treatment prognosis and aid in the decision-making process regarding the potential need for increased IVMP dosage or alternative therapeutic strategies.

MiRNA-seq identification and clinical validation of CD138+ and circulating miR-25 in treatment response of multiple myeloma

BackgroundDespite significant advancements in multiple myeloma (MM) therapy, the highly heterogenous treatment response hinders reliable prognosis and tailored therapeutics. Herein, we have studied the clinical utility of miRNAs in ameliorating patients’ management.MethodsmiRNA-seq was performed in bone marrow CD138+ plasma cells (PCs) of 24 MM and smoldering MM (sMM) patients to analyze miRNAs profile. CD138+ and circulating miR-25 levels were quantified using in house RT-qPCR assays in our screening MM/sMM cohort (CD138+ plasma cells n = 167; subcohort of MM peripheral plasma samples n = 69). Two external datasets (Kryukov et al. cohort n = 149; MMRF CoMMpass study n = 760) served as institutional-independent validation cohorts. Patients’ mortality and disease progression were assessed as clinical endpoints. Internal validation was performed by bootstrap analysis. Clinical benefit was estimated by decision curve analysis.ResultsmiRNA-seq highlighted miR-25 of CD138+ plasma cells to be upregulated in MM vs. sMM, R-ISS II/III vs. R-ISS I, and in progressed compared to progression-free patients. The analysis of our screening cohort highlighted that CD138+ miR-25 levels were correlated with short-term progression (HR = 2.729; p = 0.009) and poor survival (HR = 4.581; p = 0.004) of the patients; which was confirmed by Kryukov et al. cohort (HR = 1.878; p = 0.005) and MMRF CoMMpass study (HR = 1.414; p = 0.039) validation cohorts. Moreover, multivariate miR-25-fitted models contributed to superior risk-stratification and clinical benefit in MM prognostication. Finally, elevated miR-25 circulating levels were correlated with poor survival of MM patients (HR = 5.435; p = 0.021), serving as a potent non-invasive molecular prognostic tool.ConclusionsOur study identified miR-25 overexpression as a powerful independent predictor of poor treatment outcome and post-treatment progression, aiding towards modern non-invasive disease prognosis and personalized treatment decisions.

High Intra-Tumor Transforming Growth Factor Beta 2 Level as a Predictor of Poor Treatment Outcomes in Pediatric Diffuse Intrinsic Pontine Glioma

Here, we report that tumor samples from newly diagnosed pediatric diffuse intrinsic pontine glioma (DIPG) patients express significantly higher levels of transforming growth factor beta 2 (TGFB2) messenger ribonucleic acid (mRNA) than control pons samples, which correlated with augmented expression of transcription factors that upregulate TGFB2 gene expression. Our study also demonstrated that RNA sequencing (RNAseq)-based high TGFB2 mRNA level is an indicator of poor prognosis for DIPG patients, but not for pediatric glioblastoma (GBM) patients or pediatric diffuse midline glioma (DMG) patients with tumor locations outside of the pons/brainstem. Notably, DIPG patients with high levels of TGFB2 mRNA expression in their tumor samples had significantly worse overall survival (OS) and progression-free survival (PFS). By comparison, high levels of transforming growth factor beta 3 (TGFB3) mRNA expression in tumor samples was associated with significantly better survival outcomes of DIPG patients, whereas high levels of transforming growth factor beta 1 (TGFB1) expression was not prognostic. Our study fills a significant gap in our understanding of the clinical significance of high TGFB2 expression in pediatric high-grade gliomas.

CD22 Exon 12 Deletion as an Independent Predictor of Poor Treatment Outcomes in B-ALL.

We previously reported a splicing defect (CD22ΔE12) associated with the deletion of exon 12 of the inhibitory co-receptor CD22 (Siglec-2) in leukemia cells from patients with CD19+ B-precursor acute lymphoblastic leukemia (B-ALL). CD22ΔE12 causes a truncating frameshift mutation and yields a dysfunctional CD22 protein that lacks most of the cytoplasmic domain required for its inhibitory function, and it is associated with aggressive in vivo growth of human B-ALL cells in mouse xenograft models. Although CD22ΔE12 with selective reduction of CD22 exon 12 (CD22E12) levels was detected in a high percentage of newly diagnosed as well as relapsed B-ALL patients, its clinical significance remains unknown. We hypothesized that B-ALL patients with very low levels of wildtype CD22 would exhibit a more aggressive disease with a worse prognosis because the missing inhibitory function of the truncated CD22 molecules could not be adequately compensated by competing wildtype CD22. Here, we demonstrate that newly diagnosed B-ALL patients with very low levels of residual wildtype CD22 ("CD22E12low"), as measured by RNAseq-based CD22E12 mRNA levels, have significantly worse leukemia-free survival (LFS) as well as overall survival (OS) than other B-ALL patients. CD22E12low status was identified as a poor prognostic indicator in both univariate and multivariate Cox proportional hazards models. CD22E12low status at presentation shows clinical potential as a poor prognostic biomarker that may guide the early allocation of risk-adjusted, patient-tailored treatment regimens and refine risk classification in high-risk B-ALL.

Management, clinical outcomes, and its predictors among heart failure patients admitted to tertiary care hospitals in Ethiopia: prospective observational study

BackgroundHeart failure is a global pandemic, as it affects approximately 64.34 million people worldwide with a $346.17 billion global economic burden. The prevalence of heart failure has increased from 43.4 to 46.5% in the last 10 years in lower and middle-income countries. Most of the studies conducted in Ethiopia were retrospective cross-sectional, with limited study participants, and conducted in a single setting that commonly addresses the prevalence and pattern of heart failure rather than clinical outcome, associated factors, and specific management in different areas. Hence, this study aimed to assess management, clinical outcomes and their predictors among heart failure patients admitted to tertiary care hospitals in Ethiopia.MethodsA prospective observational study design was conducted on heart failure patients admitted at two tertiary care hospitals in Ethiopia from September 2020 to May 2021. Using semi-structured questionnaires relevant data were collected from patients’ medical records and face-to-face interviewing. Data were analyzed using SPSS version 23.0. A multivariate Cox regression model was performed to identify independent predictors of 90-day all-cause mortality. Variables with P values < 0.05 were considered statistically significant.ResultsOut of 283 patients enrolled in this study, 52.3% were male and the mean (± SD) age was 52.4 ± 17.9 years. The most common medications prescribed during hospitalization and discharge were diuretics (98.9% vs 95.6%), angiotensin I converting enzyme inhibitors/angiotensin II receptor blockers (48.8% vs 67.3%), and beta-blockers (46.6% vs 64.7%), respectively. In the present study, the 90-day all-cause mortality was 10.2%. Hypertension (HR = 3.7, 95% CI 1.2–11.6), cardiogenic shock (HR = 8.7, 95% CI 3.2–20.8), alcohol drinking (HR = 2.8, 95% CI 1.1–7.8), absence of angiotensin I converting enzyme inhibitors/angiotensin II receptor blockers (HR = 0.02, 95% CI 0.0–0.2), and reduced ejection fraction (HR = 1.5, 95% CI 1.1–3.8) were predictors of 90-day all-cause mortality.ConclusionHigh 90-day all-cause mortality was observed among heart failure patients in the present study. In the current study, the majority of heart failure patients were treated with diuretics. Alcohol drinking, hypertension, cardiogenic shock, reduced ejection fraction, and absence of angiotensin I converting enzyme inhibitors/angiotensin II receptor blockers drugs were predictors of poor treatment outcomes for whom restriction of alcohol consumption, early management of hypertension, reduced ejection fraction, cardiogenic shock, and providing angiotensin I converting enzyme inhibitors/angiotensin II receptor blockers drugs for all heart failure patients would be recommended to improve these poor treatment outcomes.

Are serum hsCRP and IL-6 prognostic markers in somatic symptom disorder and related disorders? An exploratory analysis in a prospective cohort study

ObjectiveTo investigate the roles of hsCRP and IL-6 as prognostic markers for treatment outcome in SSRD. MethodsIn this prospective cohort study, 237 consecutive outpatients diagnosed with SSRD at the Clinical Centre of Excellence for Body Mind and Health, the Netherlands were assessed. At intake, venepuncture was performed for serum hsCRP and IL-6. Baseline scores for PHQ-9, GAD7, physical symptom score (PSQ-51) and BPI questionnaires were obtained. Patients were followed up at the end of their usual treatment programme, which lasted approximately 12 months. ResultsHigher baseline hsCRP was associated with high physical symptom scores (PSQ-51), but not BPI, GAD-7 and PHQ-9 questionnaire scores at end of treatment. No association was identified between baseline IL-6 and follow-up symptom questionnaire scores after treatment. Adjustment for age, gender and somatic comorbidity showed no significant change in the association. ConclusionThis exploratory analysis provides some evidence that in patients with SSRD, high baseline serum hsCRP may predict poorer treatment outcomes in physical symptoms but not depression, anxiety or pain symptoms. Baseline serum hsCRP may therefore be a useful factor in identifying SSRD patients who are at risk of a persistent high physical symptom burden.

A scoping review of psychosocial interventions to reduce internalised shame

Objective: Internalised shame has been linked to psychopathology and consistently identified as a predictor of poor treatment outcomes and premature therapy termination. We conducted a scoping review of therapist-delivered psychosocial interventions to reduce internalised shame to learn how to improve outcomes for individuals experiencing shame. Method: Six bibliographical databases were searched for studies measuring internalised shame pre- and post-treatment. We screened 6846 abstracts; 42 full-text manuscripts were retrieved, with 16 studies meeting the inclusion criteria. Of these, 10 studies examined between- and within-subject effects, and 6 studies exclusively examined within-subject effects. Results: Twelve of the sixteen included studies reported small to moderate within-group reductions in internalised shame. Between group analyses showed that shame interventions may be more effective than no treatment or treatment as usual, but not more effective than an active comparator. Conclusion: Successful treatments often involved psychoeducation, experiential exercises, and techniques to increase social support and emotional expression; however, study quality was weak to moderate and the importance of each of these techniques for reducing internalised shame was not determined.

Treatment outcome and associated factors of bacterial meningitis at pediatric wards of southwestern Ethiopian hospital: a prospective observational study

BackgroundMeningitis is a common infectious cause of morbidity and mortality in pediatric age-groups. Acute bacterial meningitis is considered a medical emergency, because it is a life-threatening infection that requires immediate treatment. Therefore the study was aimed to assess the magnitude and predictors of poor treatment outcome among pediatric patients admitted to Bedele General Hospital.MethodsA prospective observational study was conducted at pediatric wards of Bedele General Hospital from February 12, 2020 to August 11, 2020. Lumbar puncture, in the absence of contraindications, was performed under aseptic conditions for all patients with suspected bacterial meningitis to collect cerebrospinal fluid specimen. Multivariable logistic regression was used to determine the predictors of poor treatment outcome.ResultOf the 196 pediatric patients involved, 112(57.1%) were male and the mean and standard deviation of their age was 6.09 ± 4.46. Regarding to their clinical profile, a total of 101(51.5%) were completely immunized and 115(58.7%) were given corticosteroid during their treatment. In our study the most frequently occurred clinical manifestation of meningitis was fever 164(83.67%), neck rigidity149 (76.02%), and irritability 122(62.24%). Regarding to their pharmacotherapy, the most commonly prescribed antibiotics were Ampicillin 104(24.82%), and Gentamycin 102(24.34%). The magnitude of good treatment outcome was 132(67.35%) whereas 64(32.65%) were poorly controlled. The presence of comorbidity (AOR = 3.64, 95CI%:1.83–7.23,P = < 0.001),corticosteroid use (AOR = 2.37, 95CI%:1.17–4.81,P = 0.017) and oxygen administration (AOR = 3.12, 95CI%: 1.34–7.25, P = 0.008) was a predictor of meningitis treatment outcome.ConclusionThe treatment outcome of meningitis was good in of two-third of the patients. It was found that the presence of comorbidity, the administration of oxygen and use of corticosteroid was predictors of the treatment outcomes of bacterial meningitis in children. Therefore, in patients with these factors, appropriate meningitis treatment should be encouraged and locally applicable treatment guidelines should be prepared to improve patient outcome. Finally, the meningitis patients should be given corticosteroid and oxygen as treatment and special attention should be given for patients having co-morbidities.

Association between Time to Local Tumor Control and Treatment Outcomes Following Repeated Loco-Regional Treatment Session in Patients with Hepatocellular Carcinoma: A Retrospective, Single-Center Study.

Background: Whether the number of loco-regional treatment sessions and the time required to obtain local tumor control (LTC) affects the prognosis of patients with hepatocellular carcinoma (HCC) remains controversial. This study aimed to determine whether a longer time to LTC is a significant and independent predictor of poor treatment outcomes. Methods: In this retrospective study, we analyzed data of 139 treatment-naive patients with HCC who were not eligible for a treatment other than transarterial chemoembolization (TACE) at baseline. The outcome analyses were performed using the Cox proportional hazard model and Kaplan–Meier method, while the overall survival (OS) and progression free survival (PFS) were the primary study endpoints. Results: Overall, LTC was achieved in 82 (59%) of patients, including 67 (81%) patients who achieved LTC following TACE sessions alone and 15 (19%) subjects required additional ablation session. The median OS did not differ significantly between groups that needed 2, 3, or >3 locoregional treatment sessions to achieve LTC (p = 0.37). Longer time to LTC (in weeks) was significantly associated with shorter OS in univariate analysis (p = 0.04), but not in an adjusted model (p = 0.14). Both univariate and adjusted analyses showed that longer time to reach LTC was significantly associated with shorter PFS (adjusted HR = 1.04, 95% CI 1.001–1.09, p = 0.048). Conclusions: These findings show that the longer time to LTC is not an independent predictor of OS, but suggest that PFS may be significantly shorter in patients with longer time to LTC.

Pharmacotherapy Pattern and Treatment Outcomes of Stroke Patients Admitted to Jimma University Medical Center, Ethiopia.

BackgroundDespite the fact that stroke has been reported as one of the top three leading causes of death and morbidity in Ethiopia, there are limited data regarding the management of stroke and clinical outcomes. Hence, the present study aimed to evaluate the pharmacotherapy of stroke and factors associated with poor treatment outcomes.MethodsA retrospective cross-sectional study was conducted at Jimma University Medical Center (JUMC) among adult stroke patients managed from 2014 to 2017. Clinical characteristics, treatment, and outcomes data were analyzed by using SPSS version 21. Multivariable logistic regression was performed to identify the predictors of poor treatment outcomes. Two-sided P < 0.05 was accepted as statistically significant.ResultsA total of 153 illegible patient cases were included in this study. The majority, 111 (72.5%), were male and the mean age of the patients was 57±13.7 years. Among 153 stroke patients, 112 (73.2%) patients presented with ischemic stroke. Aspirin and statins (78.6%) were the most commonly used treatment among ischemic stroke patients, whereas enalapril was used in about (43%) of stroke patients to treat high blood pressure. About 61 (40%) stroke patients had poor treatment outcomes; of this, 36 (23.5%) died in hospital. Older age (AOR = 1.034; 95% CI: 1.003–1.069), history of heart failure (AOR = 4.26; 95% CI: 1.58–11.48), loss of consciousness diabetes (AOR = 3.05 95% CI: 1.25–7.44), and aspiration pneumonia (AOR = 5.94; 95% CI: 2.46–14.32) were significantly associated with poor treatment outcomes.ConclusionOverall, treatment of stroke patients was sub-optimal and almost half of the patients had poor treatment outcomes. Availing of thrombolytic therapy, devising appropriate preventive measures of risk factors (hypertension), and decreasing preventable complication such as aspiration pneumonia could improve patient outcomes.

Antiretroviral Therapy for HIV-Associated Cutaneous Kaposi's Sarcoma: Clinical, HIV-Related, and Sociodemographic Predictors of Outcome.

Kaposi's sarcoma (KS) is an AIDS-defining malignancy that can improve or worsen with antiretroviral therapy (ART). We aimed at identifying clinical, HIV-related, and sociodemographic factors associated with either progression or nonprogression (regression or stable disease) of ART-treated HIV-associated KS in patients with limited cutaneous disease. We conducted a prospective cohort study of ART-treated HIV-associated KS cases. Clinical, HIV-related, and sociodemographic variables were collected at baseline, and patients were followed up to determine treatment outcomes. Cox regression, linear mixed effects model, and Spearman's rank correlation were used for analysis. Half (50%) of the study participants had KS regression or stable disease, whereas the other half (50%) had disease progression during the treatment and follow-up period. Among the data analyzed, presence of KS nodules at baseline (hazard ratio = 5.47; 95% confidence interval = 1.32–22.65; p = .02) was an independent predictor of poor treatment outcome. Progressors and nonprogressors were indistinguishable in the changes they experienced in the HIV plasma viral load and CD4 counts as a result of ART. Even when cutaneous presentation is limited, the presence of nodular morphotype KS lesions should be considered an indicator for combined ART plus chemotherapy. Temporal trends in CD4 counts and HIV viral loads did not correlate with treatment outcome in ART-treated HIV-associated KS.

Predictors of Treatment Outcomes among Pediatric Patients Hospitalized with Pneumonia in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.

Background Pneumonia remains the leading cause of hospitalization and mortality in young children in low- and middle-income countries. This study is aimed to assess predictors of treatment outcomes among pediatric patients hospitalized with pneumonia in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Methods A facility-based retrospective cross-sectional study was conducted among pediatric patients admitted with pneumonia, considering patient medical charts recorded for a 1-year period from February 2017 to February 2018. The sample size was computed based on a single population proportion formula and giving a total sample size of 207. The systematic random sampling method was employed to select patient cards from the sampling frame. The data extraction format was used to extract any relevant information from patient chart. The processed data were analyzed by using Statistical Package for Social Sciences (SPSS, version 21). Descriptive statistics were used to summarize the patients' baseline characteristics and related information. The logistic regression model was fitted to determine factors associated with treatment outcomes. To identify predictors of poor treatment outcome, the level of significance was set at P < 0.05. Results From a total of 207 patient charts reviewed, more than half (55.6%) of the study participants were males. Majority of patients, 130 (62.8%), were in the age range of 1 month–11 months. Furthermore, 191 (92.3%) patients had good treatment outcome. Patients who treated with ceftriaxone + azithromycin were less likely to have poor treatment outcome compared with patients who were placed on crystalline penicillin (AOR = 0.86, 95% CI 0.01–0.83). On the contrary, patients who stayed ≥ 8 days were about 14.3 times more likely to have poor treatment outcome compared with patients who stayed ≤ 3 days (AOR = 14.3, 95% CI 1.35–151.1). Conclusion Even though the study revealed good treatment outcome among the pediatric patients, particular consideration should be given to children in need of other interventions.

Medical History, Clinical Features, Treatment Outcome and Its Predictors Among Infectious Keratitis Patients in Jimma University Medical Center, Southwest Ethiopia: Prospective Observational Study.

BackgroundInfectious keratitis is a major global cause of visual impairment and irreversible blindness among the corneal diseases. Its diagnosis and management remain getting challenge. The clinical and visual outcome remains poor in developing countries. The aim of this study was to determine treatment outcome and its predictors among patients with infectious keratitis.MethodsProspective observational study was conducted among adult patients diagnosed with infectious keratitis at the Ophthalmology Department in Jimma University Medical Center from April 1 to September 30, 2019. The primary outcome indicator was response of the ulcer to empirical treatment. Ulcers that did not heal and required surgery had a poor outcome. Variables with a p-value of <0.25 were entered into a multivariate logistic regression model to determine the independent predictors of poor treatment outcome and variables with a p-value of <0.05 were considered statistically significant.ResultsThe research involved 131 adult patients. Eighty-seven (66.4%) were males. The mean age was 39.38 (±18.9) years. Eighty-three (63.4%) patients had poor treatment outcome. Mean length of hospital stay was 17.38 (±12.563) days. Poor visual outcome was observed among 71 (54.2%) participants. Evisceration was done for seven (5.3%) patients. Independent predictors of poor treatment outcome include perforation at admission (AOR=6.1, 95%CI: 1.5–25.1), presence of comorbidity (AOR=7.7, 95%CI: 2.16–27.3), poor adherence (AOR=5.3, 95%CI: 1.8–25.9), traditional medicine use (AOR=6.7, 95%CI: 1.8–25.4), ulcer depth >1/3 (AOR=7.6, 95%CI: 2.48–48.23) and farm workers (AOR=3.59, 95%CI: 1.09–11.77). Major complications occurred after admissions were perforation (14.5%), followed by endophthalmitis (7.63%) and corneal opacity (6.87%).Conclusion and RecommendationOur study found high poor treatment outcomes and high poor visual outcomes. Presence of comorbidity, perforation at admission, traditional medicine use, working on a farm, poor adherence, and ulcer depth were the predictors of poor treatment outcome. This high poor outcome requires a nationwide interventional study and urgent intervention that may reach rural communities.

A STUDY ON FACTORS ASSOCIATED WITH HOSPITALISATION AMONG TUBERCULOSIS PATIENTS AND THEIR OUTCOME:A CROSS SECTIONAL STUDY IN DEPARTMENT OF PULMONARY MEDICINE IN A TERTIARY CARE CENTRE

Objectives: To investigate factors associated with hospitalization among TB patients, factors that lead to longer hospitalization time, outcome of hospitalized TB patients,the predictors of poor treatment outcomes and mortality in a cohort of hospitalized TB patients in the Department of Pulmonary Medicine, IPGME&amp;R, Kolkata. Methods:A cross-sectional study was conducted among205 adult patients diagnosed with tuberculosis as per selection criteria were included in this study. Out of these participants,106 patients are cases who are indoor TB patients in the Department of Pulmonary Medicine, IPGME&amp;R and 99 patients are controls who are TB patients attending the outdoor of Department of pulmonary Medicine,IPGME&amp;R. Results:As per the case and control analysis, factors which are statistically signicant in hospitalisation of TB patients are respiratory failure, hypotension, persistent fever, Hypoalbuminemia, hydropneumothorax, pneumothorax, Pyopneumothorax, Empyema, Anemia, low BMI &lt;18 and pulmonary TB given in the table below in the order of signicance as per p value,Odds ratio and 95% condence interval. Conclusion:Early case detection and effective treatment of tuberculosis and ensuring regularity of treatment adherence would probably lead to reduction of hospitalization and TB related mortality.

Treatment Outcome and Its Determinants among Patients Admitted to Stroke Unit of Jimma University Medical Center, Southwest Ethiopia.

Background Stroke is a public health problem in Ethiopia. Despite the high prevalence of stroke in Ethiopia, there is a paucity of data with regard to drug treatment, treatment outcome, and risk factors of poor treatment outcome of stroke. Hence, this study is aimed at assessing treatment outcome and its determinants among patients admitted to stroke unit of Jimma University Medical Center (JUMC). Methods A two-year hospital-based retrospective cross-sectional study was employed to analyze the medical records of patients admitted with stroke to stroke unit of Jimma University Medical Centre from February 1st, 2016 to March 30th, 2018. Data was entered by Epidata manager version 4.0.2 and analyzed by SPSS version 24. Multivariable logistic regression analysis with the backward stepwise approach was done to identify independent predictors of poor treatment outcome of stroke. Variables with P value less than 0.05 were considered as statically significant determinants of poor treatment outcome. Results Of 220 patients with stroke admitted to the Jimma University, 67.30% were male. Nearly two thirds (63.18%) of them had poor treatment outcomes. Dyslipidimics were administered to 60% of the patients, and the most popular antiplatelet used was aspirin, which was prescribed to 67.3% the patients. Age ≥ 65 adjusted odd ratio ((AOR): 2.56; 95% CI: 1.95-9.86, P = 0.001), presence of comorbidity (AOR: 5.25; 95% CI: 1.08-17.69, P < 0.001), admission with hemorrhagic stroke (AOR: 18.99; 95% CI: 7.05-42.07, P < 0.001), and admission to the hospital after 24 hour of stroke onset (AOR: 4.98; 95% CI: 1.09-21.91, P = 0.03) were independent predictors of poor treatment outcomes. Conclusion Substantial numbers of stroke patients had poor treatment outcomes. Elderly patients, patients diagnosed with hemorrhagic stroke, patients with comorbidity, and those with delayed hospital admission were more likely to have poor treatment outcome. Hence, frequent monitoring and care should be given for the aforementioned patients. Awareness creation on the importance of early admission should be delivered particularly for patients who have risk factors of stroke (cardiovascular diseases).

Patterns of Neck Node Metastasis in Carcinoma of Oral Cavity

Objectives: To find out the patterns of cervical lymph node metastasis in oral cavity carcinoma.&#x0D; Methods: This is across sectional study which was carried out in the department of Otolaryngology &amp; Head Neck Surgery Dhaka Medical College Hospital (DMCH), Sir Salimullah Medical College Hospital (SSMC), Bangabandhu Sheikh Mujib Medical University (BSMMU) and National Institute of Cancer Research &amp; Hospital (NICRH) from July 2013 to December 2014.Total 96 cases were included in this study. Data were collected by detail history, clinical examination, relevant investigation and result were processed manually and analyzed with the help of SPSS.&#x0D; Results: In this study 72 (75%) patients presented with clinically palpable neck nodes and 24 (25%) presented without neck node. Among 24 cases 7 cases was radiologically positive neck node. Out of 96 cases stage III was the highest (50.96%) followed by stage IV (27.01%), stage II (13.52%) and stage I (8.32%). That is 23 (23.92%) patients present with early stage and 73 (76.18%) patients present in late or advanced stage. Level l was the highest 49 (61.71%), followed by level all 35(44.1%), level lll 10 (12.6%).&#x0D; Conclusion: As cervical lymph node metastasis is a critical event for patients with squamous cell carcinoma of oral cavity, as this is the most reliable predictor of poor treatment outcomes. Thus for appropriate treatment it is very important to know this pattern of metastases.&#x0D; Bangladesh J Otorhinolaryngol; October 2020; 26(2): 102-108