Prevention Modalities Research Articles

Management of Psychiatric Disorders in Patients with Chronic Kidney Diseases.

Management of Psychiatric Disorders in Patients with Chronic Kidney Diseases.

Comparison of Offloading Dressing with Conventional Dressing in Healing of Plantar Diabetic Foot Ulcers: A Randomised Clinical Trial

Introduction: The first ever description of Diabetic Foot Ulcers (DFUs), made in the literature was in the mid-19th century. The management principles for it were laid by late 19th century and are still being followed. For a chronic DFU to heal, offloading of pressure, surgical debridement, correction of hyperglycaemia, the use of antibiotics are the corner stone of management. Offloading is an essential modality of prevention and treatment of recurrent plantar DFU. Aim: To compare offloading dressing to conventional dressing in promoting healing of diabetic plantar ulcers. Materials and Methods: This randomised clinical trial was conducted at Mahatma Gandhi Medical College and Research Institute, Pondicherry between January 2019 to June 2020 among the patients with DFU coming to the Department of General Surgery. A total of 44 patients were included in the study, 22 of these patients underwent offloading dressing and 22 underwent conventional dressing and these patients were followed-up for a duration of 6 weeks and compared on 2nd, 4th and 6th weeks. The patients were compared according to age, gender, duration of diabetes, glycaemic control, risk factors, previous surgery such as wound debridement or previous toe amputation, vascular assessment and site of ulcer, reduction in size of ulcer. The ulcers in both the groups were classified according to the Wagener’s grading of ulcer classification. All data collected was entered into Microsoft Excel 2016 and analysed using Statistical Package for the Social Sciences (SPSS) version 16.0 (IBM SPSS, US) software. A p-value less than 0.05 was considered as statistically significant. Results: Among 44 patients, there was equal number of males and females in both the groups, with the total mean age 53.97±10.10 years. The majority of the study population belonged to the 5th decade (51-60 years), where the youngest patient was of 29 years and oldest was of 72 years. There were 22 patients in offloading group and 24 patients in conventional dressing group as one patient had bilateral plantar ulcers and one patient had two separate ulcers on the plantar aspect of the foot. Total of 45.45% in conventional group and 31.82% of the study population in offloading group had diabetes for 5-10 years of duration. Bad glycaemic control was seen in 40.90% of offloading population and 50% in conventional population. The size reduction percentage of ulcers on comparing both the groups was found to be significant for 2nd week review (p-value=0.03) and was nearly significant for the 6th week review (p-value=0.05). Conclusion: Summarising the above conducted study, offloading dressing was found to be a more efficacious alternative to the conventional dressing as there was greater difference observed in the reduction of the size of ulcer and the patients in the conventional group needed more number of dressings and the duration of healing in the two groups.

Status of breast cancer screening strategies and indicators in Iran: A scoping review.

Background:This scoping review aimed to investigate the status of breast cancer (BC) preventive behaviors and screening indicators among Iranian women in the past 15 years. BC, as the most common cancer in women, represents nearly a quarter (23%) of all cancers. Presenting the comprehensive view of preventive modalities of BC in the past 15 years in Iran may provide a useful perspective for future research to establish efficient services for timely diagnosis and control of the disease.Materials and Methods:The English and Persian articles about BC screening modalities and their indicators in Iran were included from 2005 to 2020. English electronic databases of Web of Science, PubMed, and Scopus, and Persian databases of Scientific Information Database (SID) and IranMedex were used. The critical information of articles was extracted and classified into different categories according to the studied outcomes.Results:A total of 246 articles were assessed which 136 of them were excluded, and 110 studies were processed for further evaluation. Performing breast self-examination, clinical breast examination, and mammography in Iranian women reported 0%–79.4%, 4.1%–41.1%, and 1.3%-45%, respectively. All of the educational interventions had increased participants’ knowledge, attitude, and practice in performing the screening behaviors. The most essential screening indicators included participation rate (3.8% to 16.8%), detection rate (0.23–8.5/1000), abnormal call rate (28.77% to 33%), and recall rate (24.7%).Conclusion:This study demonstrated heterogeneity in population and design of research about BC early detection in Iran. The necessity of a cost-effective screening program, presenting a proper educational method for increasing women's awareness and estimating screening indices can be the priorities of future researches. Establishing extensive studies at the national level in a standard framework are advised

Cancer awareness & its association with demographic variables & mobile phone usage among the rural population of a district in north India.

Lack of awareness is one of the major reasons for the high morbidity and mortality associated with cancers. The present study was aimed to evaluate the awareness of prevalent cancers among the rural population in a district of north India and its association specifically with mobile phone usage. Using a stratified random sampling technique, households in three villages of Gautam Buddh Nagar district of India were selected. A house-to-house survey on cancer awareness was conducted among adults in selected households and data were analyzed to check for the association of such an awareness with sociodemographic factors and internet usage. The study included 59 males and 145 females, with majority (115) being in the age group of 18-30 yr. Although most (96.5%) of the participants were aware of cancer, the common risk factors and warning signs of cancer were known to only a few. Specific risk factors for cervical and breast cancers were, however, not known to a majority (79.9% and 72.2%). A significant association between the awareness of general risk factors and warning signs as well as specific aspects including risk factors for breast, cervical and oral cancer, HPV vaccine and the education level of the participants (P<0.05 for all). Knowledge of risk factors, warning signs and cancer prevention modalities was higher among mobile phone users who accessed internet for health information. There was no significant association between age group and cancer risk factor awareness, though females were more aware of the risk factors for breast cancer (P=0.002). The findings of this study highlight the existing low level of awareness of cervical and breast cancers among the rural population. The association of cancer awareness with education level and mobile phone-based internet usage suggests the potential utility of internet-based platforms such as m-health programmes for cancer prevention activities.

Evaluation of Gender Differences in Response to Photobiomodulation Therapy, Including Laser Acupuncture: A Narrative Review and Implication to Precision Medicine.

Background: The influence of gender is significant in the manifestation and response to many diseases and in the treatment strategy. Photobiomodulation (PBM) therapy, including laser acupuncture, is an evidence-based treatment and disease prevention modality that has shown promising efficacy for a myriad of chronic and acute diseases. Anecdotal experience and limited clinical trials suggest gender differences exist in treatment outcomes to PBM therapy. There is preliminary evidence that gender may be as important as skin color in the individual response to PBM therapy. Purpose: To conduct a literature search of publications addressing the effects of gender differences in PBM therapy, including laser acupuncture, to provide a narrative review of the findings, and to explore potential mechanisms for the influence of gender. Methods: A narrative review of the literature on gender differences in PBM applications was conducted using key words relating to PBM therapy and gender. Results: A total of 13 articles were identified. Of these articles, 11 have direct experimental investigations into the response difference in gender for PBM, including laser acupuncture. A variety of cadaver, human, and experimental studies demonstrated results that gender effects were significant in PBM outcome responses, including differences in tendon structural and mechanical outcomes, and mitochondrial gene expression. One cadaver experiment showed that gender was more important than skin tone. The physiologic mechanisms directing gender differences are explored and postulated. Conclusions: The review suggests that to address the requirements of a proficient precision medicine-based strategy, it is important for PBM therapy to consider gender in its treatment plan and dosing prescription. Further research is warranted to determine the correct dose for optimal gender treatment, including gender-specific treatment plans to improve outcomes, taking into account wavelength, energy exposure, intensity, and parameters related to the deliverance of treatment to each anatomical location.

Effect of Radiotherapy on Microhardness and Surface Morphology of Pretreated Primary Teeth with Silver Diamine Fluoride: An In vitro Study

Background: Radiation therapy has proven to be an effective modality in treating children suffering from cancer. High prevalence of dental caries is seen in children undergoing radiation therapy. This is primarily due to the direct effects of these harmful radiation on the enamel and not as a consequence to the reduced salivary flow. Mechanical properties of the enamel have been seen to be affected by radiation according to various studies conducted.&#x0D; Objectives: The objective of this study is to evaluate whether radiotherapy causes changes in the microhardness and surface morphology of enamel in primary teeth pretreated with silver diamine fluoride.&#x0D; Methodology: 22 primary teeth samples will be divided into two groups, 11 samples each-study group which will be pretreated with silver diamine fluoride (SDF) and control group. Both groups will be subjected to radiotherapy of 10 Gy radiation for a duration of 6 days. The samples will be tested for Vickers microhardness test and SEM analysis for surface morphological changes post radiotherapy. Statistical analysis will be done using “chi square test, paired and unpaired student t -test”. Surface microhardness and morphological changes of the study and control group compared.&#x0D; Expected Results: It is expected that SDF application will be effective modality in prevention of caries due to frequent radiation exposure in children suffering from cancer and undergoing radiotherapy.&#x0D; Conclusion: The study will conclude that SDF will cause a reduction in the microhardness of the surface and lesser morphological changes in the enamel of the primary teeth post radiation therapy in children suffering from cancer.

847. A Qualitative Exploration of New and Existing HIV PrEP Modalities Among Men Who Have Sex with Men in Philadelphia

BackgroundDaily oral pre-exposure prophylaxis (PrEP) is highly effective at preventing HIV when used as directed among men who have sex with men (MSM). However, challenges with uptake and adherence to daily oral PrEP have prompted the development of new modes of administration, including a long-acting, intramuscular injectable. We sought to explore the treatment characteristics that may influence the willingness and uptake of long-acting injectable PrEP as opposed to the daily pills among a racially diverse sample of MSM.MethodsBetween January and May 2021, we actively recruited 28 HIV-negative MSM (8 Black, 10 Latinx, 10 White) who lived in Philadelphia, PA during the past 12 months using social networking sites (e.g., Facebook and Instagram) and a community listserv. Qualitative data collection used a hybrid approach in which 4 focus groups and 10 semi-structured interviews were conducted virtually. Focus groups were kept racially and ethnically homogenous to identify differences in emerging themes related to PrEP willingness and preferences for specific prevention modalities.ResultsParticipants discussed differing levels of interest and willingness to use long-acting injectable PrEP as opposed to the daily pills. The main perceived facilitator for injectable PrEP included convenience of use such as having fewer concerns with adhering to daily pills. Perceived barriers to injectable PrEP included (1) a dislike of needles as well as (2) concerns of potential side effects and (3) lower treatment efficacy (i.e., whether it will be as effective as the daily pills). While Black and Latinx MSM reported experiences of racism and discrimination within the healthcare system, they also reported greater willingness to consider intramuscular injectables if their healthcare providers would provide in-depth information about the risks and benefits of this new modality. ConclusionOur findings provide important guidance for the development and promotion of future strategies to enhance the uptake of long-acting injectable PrEP to address the HIV epidemic among MSM. Primary care providers should play a key role in ameliorating concerns related to hesitancy towards injectable PrEP, including emphasizing ease of dosing, effectiveness, and safety of long-acting PrEP to prevent infection.Disclosures All Authors: No reported disclosures

Falls and potential therapeutic interventions among elderly and older adult patients with cancer: a systematic review.

The aim of this study was to perform a systematic review for previous publications that have assessed the incidence, risk factors, and favorable procedures to prevent and manage falls among cancer survivors of elderly and older adults. This systematic review was undertook using PubMed, SCOPUS, Web of Science, Medline, and Cochrane Database of clinical studies and systematic reviews to determine the incidence, risk factors, favorable inpatient and outpatient management, and non-pharmacological interventions for falls among elderly and older adult patients with cancer from 2010 to October, 2020. After the comprehensive screening, clinical studies, meta-analysis, systematic reviews, and established guidelines were included in this review. Only 5 clinical studies (3 randomized and 2 single-arm studies), 5 systematic reviews, and 6 established guidelines were considered eligible. The five systematic reviews provide risk factors of falls and the 6 guidelines provide assessment & prevention modalities of falls, however, the 6 clinical studies provide the non-pharmacological intervention for falling among cancer survivors. Many factors associated are demonstrated among wide range of elderly individuals. Earlier falls were reliably listed as an important risk factor of falls in the two inpatient and outpatient environments including both general older people and geriatric cancer populations. This review concludes that the assessment of falls among older individuals with cancer is the most important way for determining who could need additional observation and treatment program. Health professions involving physical therapy and occupational therapy have an important function for promoting health well-being in elderly and older adults with cancer.

Use of a Wearable Posture-Correcting Device to Train Residents in Plastic Surgery: A Novel Approach to Surgical Ergonomics and Prevention of Associated Musculoskeletal Disorders.

Use of a Wearable Posture-Correcting Device to Train Residents in Plastic Surgery: A Novel Approach to Surgical Ergonomics and Prevention of Associated Musculoskeletal Disorders.

The Effects of High-Intensity Interval Training (HIIT) on Fall Risk Factors in Healthy Older Adults: A Systematic Review.

High-intensity interval training (HIIT) improves functional capacity, muscle power and physical performance in older adults with and without comorbidities. The aim of this study was to explore the effectiveness of HIIT as a method for reducing major fall risk factors (balance, muscle strength and physical activity) in older adults. A systematic literature search was conducted following the PRISMA guidelines. A computerized search was conducted using electronic databases (PubMed, CINAHL, Cochrane Library, APA PsycInfo, Web of Science, Scopus, PEDro, and AgeLine) published up to July 2021. Eleven papers (9 studies) of moderate quality (mean of 5.5 in Pedro scale) involving 328 healthy older adults met the inclusion criteria. Studies were characterized by high heterogeneity in terms of methodology, HIIT modality and protocol, subject characteristics, and outcome measures. Results indicate that HIIT cannot be recommended as a single modality for fall prevention in older adults due to insufficient data and no consensus among the studies. HIIT appears to be a safe and well-tolerated supplement to proven fall prevention programs, due to its effects on lower limb strength reflected in functional performance tests, and on dynamic balance and subjective balance perception. However, caution is warranted following HIIT, especially after the first session, due to possible temporary instability.

Fecal Microbiota Transplantation As a Therapeutic Option for Graft-Versus-Host-Disease: A Systematic Review and Future Directions

Introduction:In recent years, there has been an expanding focus on interplay between intestinal microbiotal diversity and outcome of acute graft versus host disease(GVHD) in hematopoietic stem cell transplantation (HCT) recipients. One of the compelling intervention to maintain healthy gut microbiota for better outcome of GVHD in HCT recipients is Fecal microbial transplantation(FMT). Several non randomized small clinical studies and case reports on the efficacy and safety of FMT were reported so far. However, the ultimate role of FMT as a therapeutic option to treat GVHD is yet to be determined due to lack of randomised, large scale, statistically significant studies. Here in, we report a systemic review of literature available so far in an effort to establish a definite role of FMT.Methodology: A systemic literature search was conducted using various electronic databases. The case reports, case series and clinical studies related to FMT were used as a therapeutic or preventative modality specifically for GVHD are included.Results: Upon pooling of data, 87 patients from 6 studies and 5 case reports were included in the study in which complete remission(CR) occured in 43.7% and partial remission(PR) occured in 20.7% patients which is equivalent to 64.4% overall response rate in treating GVHD. Furthermore, out of all the species in fecal matter, clostridium was found to be the most valuable species in decreasing the rates of GVHD re-occurrence. Only a limited number of patients had treatment-related mortality(TRM) from GVHD while few showed mild GI-related (abdominal pain/distention, nausea, regurgitation) and non-GI adverse reactions including infections, anemia, thrombocytopenia, paroxysmal, and atrial fibrillation. We emphasize that the most of the patients did not have any major complications after FMT.Conclusion:We conclude that the FMT is a safe and effective strategy for the management of GVHD based on our study. The establishment of gut diversity along with the patient's intrinsic factors like fucosyltransferase 2 (FUT2) secretor status and baseline gut microbial diversity play a major role in the success of FMT. Given the restricted size and absence of randomized data, one cannot portray FMT as a standard of care yet, however, the low or absent toxicity along with improvement in survival justifies this modality to be tested in a randomized fashion. We strongly encourage the transplant community to enroll patients in innovative trials utilizing FMT, as this may be a one of the safest strategies for both prevention and treatment of GVHD DisclosuresNo relevant conflicts of interest to declare.

An Evaluation of Current Preventative Measures Used in Equine Practice to Maintain Distal Forelimb Functionality: A Mini Review.

Horses are used in a variety of equestrian disciplines predisposing them to musculoskeletal injury or disease including osteoarthritis and tendinopathy. As a result, a number of preventative measures are used within equine medicine and husbandry, ranging from therapeutic shoeing to the use of nutraceuticals. Despite their popularity and routine use evidence base and clinical outcomes are variable, bringing into question the efficacy of these prophylactic measures. In recent years a small number of studies have been performed examining the effect of specific strategies in order to quantify the preventative and protective claims such modalities have on joint and forelimb health. Few have robustly demonstrated a capacity to protect the limb by reducing inflammation, or promoting regenerative pathways. This review focusses on performance horses specifically, and the resounding theme that emerges in current research is the need for longitudinal studies to inform scientific conclusions surrounding single and multi-modal use. Furthermore, there is a requirement to prioritise evidence-based medicine to inform optimal clinical practice.

Inadvertent life-threatening total spinal anesthesia following caudal block in a preschool child underwent urologic surgery: A rare case report.

Introduction and importanceCaudal block is considered to be safe and provide optimal analgesia for pediatric patients undergoing sub-umbilical operations. It overcomes opioid-related side effects, particularly the dangers associated with respiratory depression in small children.Case presentationA 5-year-old male underwent uneventful hypospadias surgery under general endotracheal anesthesia. Caudal block planned to be administered postoperatively for postoperative analgesia then performed after palpation of sacral cornu with 8 ml of 0.25% bupivacaine. A few minutes later, the patient became apneic, heart rate, blood pressure, and oxygen saturation dropped abruptly—immediate resuscitation with ventilatory support, fluid bolus, and atropine administration. After a minute patients' vital signs returned to the normal range then 2 h later patient started to breathe spontaneously and consciousness is regained. After close follow-up for 24 h in the post-anesthesia care unit patient was discharged to the pediatric ward then discharged to home without any neurologic sequelae after 3 days.Clinical discussionTotal spinal anesthesia in a very infrequent incident during central neuraxial blocks, especially in the pediatrics population where a caudal block is usually performed. Manifestation of this event can be detected by loss of consciousness, cessation of respiratory effort, hemodynamic instability, and dilated pupils. Delayed treatment can result in cardiopulmonary arrest.ConclusionUnanticipated total spinal anesthesia following central neuraxial blocks can potentially cause severe adverse consequences. Preventive modalities must be employed to avoid this incident. Early recognition and instant management should be instituted to avoid dangerous complications following the total spinal blockade.

Fitting a vaccine into the HIV prevention landscape.

Fitting a vaccine into the HIV prevention landscape.

Vitamin D Supplementation: A Potential Prevention Method against Contagious Viral Respiratory Illnesses

This narrative review explores the protective value of Vitamin D (VD) and its metabolites, such as Vitamin D2 (VD2) and Vitamin D3 (VD3), and their preventive health potentials backed by evidence-based medicine against viral respiratory illnesses (VRI). With the recent events of late 2019, a severe acute respiratory illness began to sweep the globe. This SARS illness was of coronavirus-2 variant known as SARS-CoV-2 (COVID-19). With COVID-19 in mind, the purpose of this paper was to explore a preventative health model utilizing evidence-based medical research to safeguard against similar viral catastrophes. The knowledge gained is essential for the future education of the general population and necessary for a more preemptive and protective approach to VRIs. Google Scholar, PubMed, and DuckDuckgo were the most often utilized internet search engines and databases to collect sources. Twelve evidence-based medical articles were selected based on specific inclusionary and exclusionary criteria. More specifically, eleven systematic-review and meta-analyses (SRMA) and one Randomized Controlled Trial (RCT) were selected. The data extracted from the eleven articles were analyzed to understand the relationship between VD, VD3, and Viral Respiratory illnesses (VRIs). VD is known to have various protective actions on the immune system (IS). First, VD activates gene transcription upon innate immune cells to increase viral defensive proteins such as Defensins and Cathelicidins (Laaski, 2011; Liu, 2006; NIH, 2020). More importantly, VD down-regulates certain specific adaptive immune cells named T helper 2 (Th2). The Th2 cellular pathway indirectly downregulates T helper 1 (Th1), cell pro-inflammatory cytokine storms, thus assisting with viral clearance (Huang, Wang, Li et al., 2020). More EBM research displays an inverse relationship between VD status and VRI, like incidences, severity, and duration of VRIs (Abioye, Bromage &amp; Fawz 2021). Recommendations for future research were presented to understand VD better and its possible use as a potential therapeutic or preventive medicine modality for the public. Proposals on health policy changes within health agencies like the United States Preventative Task Force (USPTF) were also provided. Changes included mandatory health VD screens tables and their metabolites for patients of different ages and breeds to achieve proper VRI protection to prevent future pandemics.

Traumatic Dental Injuries in Pediatric Patients: A Retrospective Analysis.

AimThis retrospective study aimed to analyze dental traumatic injuries and their management in children up to 16 years of age.Materials and methodsRecords of the patients who sustained dental trauma from 2013 to 2018 were evaluated for age, gender, etiology, type of injuries, and their management. Children were divided into three groups—primary (0–5 years), mixed (6–11 years), and permanent dentition group (12–16 years). Dental trauma was assessed by Ellis and Davey's classification of tooth fracture along with other associated injuries.ResultsTotal records of 466 children with 750 injured teeth (665 permanent and 85 primary) were evaluated. Males were reported twice as females. Fall was noted as the major etiological factor (93.1%). The highest frequency of dental trauma was observed in the permanent dentition group (54.7%). Ellis class IV fracture was the most common dental injury and maxillary central incisor was the most frequently injured tooth. Soft tissue injury was noted as the most commonly associated injury. Most of the dental traumatic injuries in permanent teeth were treated by root canal treatment while the majority of primary dentitions were managed by observation and wound care.ConclusionEllis class IV fracture was noted as the most frequent type of dental injury and fall was a major etiological factor. The permanent dentition group of children was more affected and a male predominance was observed.Clinical significanceThe information gained from the present study would help in providing various preventive modalities to parents, caregivers, and teachers regarding these injuries in the future and also facilitate several new researches in this field.How to cite this articlePatidar D, Sogi S, Patidar DC, et al. Traumatic Dental Injuries in Pediatric Patients: A Retrospective Analysis. Int J Clin Pediatr Dent 2021;14(4):506–511.

EP.FRI.815 Hartmann’s at 100: Relevant or Redundant?

Abstract Introduction Henri Albert Hartmann first described resection of the rectosigmoid colon and exteriorization of the bowel with a colostomy in 1921. As we approach the centenary anniversary of Hartmann’s procedure we feel it is the appropriate time to discuss this significant surgical advancement and its relevance in modern day surgery. Methods We provide a contemporary overview of the literature, highlighting various aspects of the Hartmann’s procedure applicable to both today’s clinical practice and that of tomorrow. Results Hartmann’s procedure was initially performed for colorectal carcinoma in 1921. One hundred years on, the Hartmann’s procedure remains a safe and effective option in select patients with colorectal cancer and at high risk of anastomotic failure. In recent years, the majority of Hartmann’s procedures have been performed for benign disease and the majority of these cases are in the emergency setting. As hospital admissions with acute diverticulitis continue to rise steeply, the importance of the Hartmann’s procedure in the field of surgery continues. Hartmann’s procedure has adapted as surgery has advanced. Hartmann’s is now performed both laparoscopically and robotically with good postoperative outcomes. Conclusions In 1921, few would have predicted how modern day medicine and surgery is today. Hartmann’s procedure has survived the surgical test of time, and its key principles remain the same. As we look to the future, it is unlikely that it’s role will be lost to surgical advances, but to alternative management modalities in disease prevention.

Women\u2019s sexual scripting in the context of universal access to antiretroviral treatment\u2014findings from the HPTN 071 (PopART) trial in South Africa

BackgroundHIV treatment-based prevention modalities present new opportunities for women to make decisions around sex, intimacy, and prevention. The Universal test and treat (UTT) strategy, where widespread HIV testing is implemented and all people with HIV can access treatment, has the potential to change how sex is understood and HIV prevention incorporated into sexual relationships. We use the frame of sexual scripting to explore how women attribute meaning to sex relative to UTT in an HIV prevention trial setting. Exploring women’s sexual narratives, we explored how HIV prevention feature in the sexual scripts for women who had access to UTT in South Africa (prior to treatment guideline changes) and increased HIV prevention messaging, compared to places without widespread access to HIV testing and immediate access to treatment.MethodsWe employed a two-phased thematic analysis to explore longitudinal qualitative data collected from 71 women (18–35 years old) between 2016 and 2018 as part of an HIV prevention trial in the Western Cape Province, South Africa. Of the participants, 58/71 (82%) were from intervention communities while 13/71 (18%) lived in control communities without access to UTT. Twenty participants self-disclosed that they were living with HIV.ResultsWe found no narrative differences between women who had access to UTT and those who did not. HIV and HIV prevention, including treatment-based prevention modalities, were largely absent from women’s thinking about sex. In their scripts, women idealised romantic sex, positioned sex as ‘about relationships’, and described risky sex as ‘other’. When women were confronted by HIV risk (for example, when a partner disclosed his HIV-positive status) this created a point of disjuncture between this new perception of risk and their accepted relationship scripts.ConclusionThese findings suggest that HIV-negative women did not include their partners’ use of antiretroviral therapy in their sexual partnership choices. For these women, the preventive benefits of UTT are experienced passively—through community-wide viral suppression—rather than through their own behaviour change explicitly related to the availability of treatment as prevention. We propose that prevention-based modalities should be made available and supported and framed as an intervention to promote relationship well-being.

Cost-effectiveness of Erenumab versus Surgical Trigger Site Deactivation for the Treatment of Migraine Headaches: A Systematic Review

PURPOSE: Migraine headache is a common, debilitating condition responsible for astronomical societal burden. The chronicity of migraine headaches necessitates the use of many healthcare services. Preventative treatment remains the desirable option for this patient population. Pharmacologic advances have led to the development of erenumab, a monoclonal antibody calcitonin gene-related peptide receptor antagonist that directly interferes with the known biochemical pathway of migraine initiation. Alternatively, surgical decompression of migraine trigger sites is a historically effective preventative option for certain patients experiencing migraine headaches. As new treatments emerge, the large economic burden of migraine headaches require cost evaluation against already available preventative modalities. METHODS: Studies evaluating the cost-effectiveness of both erenumab and surgical trigger site deactivation were found using EMBASE and MedLine. Prospective, retrospective, and modeling paradigm studies were all included. Relevant economic data was extracted from this literature and the cost of treatment with erenumab was compared with surgical decompression. RESULTS: Direct healthcare utilization costs included acute migraine treatment along with estimated cost of medical services. Speculative models predicted a direct annual healthcare cost ranging from $11,404 to $12,988 for patients experiencing episodic migraine. For chronic migraine patients, this range extended to $25,604. Annual indirect costs, accounting for loss in work productivity, ranged from $7601 to $19,377. The market price of erenumab is $6900 per year. Prospective and model-based studies evaluating surgical trigger site deactivation reported an average one time surgical cost between $6956 and $10,303. In episodic migraine, subsequent annual healthcare costs were approximately $900 after both treatments. CONCLUSIONS: This review suggests that the upfront cost of surgical treatment in migraine headaches will be surpassed by the cost of treatment with erenumab after 1 year. These two treatment options have divergent characteristics: erenumab is a recurring treatment for which we are extrapolating effectiveness beyond the first years, whereas operative treatment is a more invasive intervention with longer term efficacy data. While surgical resection may be the cost-conscious, proven option, erenumab represents a potentially revolutionary noninvasive treatment option for patients suffering from migraine refractory to other treatments. Not all patients are candidates for deactivation surgery. Moving forward, neurologists and plastic surgeons should collaborate to develop a migraine treatment algorithm that considers both cost and treatment efficacy for their patients.

Interplay Between Skin Microbiota Dysbiosis and the Host Immune System in Psoriasis: Potential Pathogenesis.

Psoriasis is a multifactorial immune-mediated disease. The highly effective and eligible treatment for psoriasis is limited, for its specific pathogenesis is incompletely elucidated. Skin microbiota is a research hotspot in the pathogenesis of immune-mediated inflammatory skin diseases nowadays, and it may have significant involvement in the provocation or exacerbation of psoriasis with broadly applicable prospects. It is postulated that skin microbiota alternation may interplay with innate immunity such as antimicrobial peptides and Toll-like receptors to stimulate T-cell populations, resulting in immune cascade responses and ultimately psoriasis. Achieving a thorough understanding of its underlying pathogenesis is crucial. Herein, we discuss the potential immunopathogenesis of psoriasis from the aspect of skin microbiota in an attempt to yield insights for novel therapeutic and preventive modalities for psoriasis.