History Of Previous Treatment Research Articles

RETRACTED ARTICLE: The powerful effects of social media platforms on orthodontic patient knowledge’s improving, attitude management and it is influence on financial income of the orthodontic clinic

The aim of this study was increasingly influencing the health care landscape, so orthodontic patients can easily obtain information about orthodontic. The aim of this study was to investigate the benefits of using social media sites as a source of information to orthodontic patients for improving their knowledge about orthodontic care and treatment and the extend of its on reduce the duration of orthodontic treatment (DOT) and investigate the potential benefits of using social media platforms in marketing in orthodontic practices to increase the financial income of orthodontic clinics. 150 orthodontic patients were recruited as participants from the orthodontic clinic at the Near East University (in North Cyprus). The patients were 13 years and over from both sexes. Patients were excluded if they were not users of social media sites, had a history of previous orthodontic treatment, craniofacial syndrome, or low mental abilities. About 74% of the participants (mostly females) confirmed that social networking sites were the major driver for them to take the decision to come to the orthodontist and start orthodontic treatment. 73% of the respondents reported using social media sites as a source of information related to orthodontic treatment, where the Instagram was the most used program.

Predictors of Quality of Life in Adults and Adolescents with Acne: A Cross-Sectional Study.

Acne is becoming more prevalent in adults, particularly women across the globe. Although previous studies have compared clinical and epidemiologic characteristics of adolescent and adult acne, an adequate understanding of the quality of life (QoL) of adult acne patients and associated comorbidities are still lacking. We sought to compare the differences between adolescent and adult patient groups, regarding gender, socio-clinico-demographic factors, and comorbid associations, as well as their relatedness with life quality. This is a cross-sectional study with 1013 acne patients. Data on the severity, onset and location of acne, sex, family history of acne, smoking and alcohol habits, medication history, presence of seborrhea, and other comorbidities were collected. We employed the classification used by the American Academy of Dermatology for assessing acne severity. To assess the QoL in the patients, the Dermatology Life Quality Index (DLQI) score was used. Of the 1013 patients included in this study; 380 (female: 333, male: 47) were adult, and 633 (female: 535 and male: 98) were adolescent cases. The median total DLQI scores of adult and adolescent groups were not significantly different. Our results showed that factors such as age, gender, duration, body mass index, family history, and psychiatric disorders exhibited no impact on QoL in both adolescents and adults. Age of onset was correlated with DLQI scores in the adult group. The main influencers of DLQI in the adult group were allergic disorders, hormonal imbalances, and previous treatment history. Besides, major influencers in adolescent patients were acne severity, acne location, hirsutism, hyperseborrhea, premenstrual exacerbation, menstrual irregularities, previous treatment history, and smoking. The findings of our current study have shown that DLQI has been influenced by different factors in adolescents and adults that should be kept in mind.

Medical and legal aspects of the activities of the Committee on the management of drug-resistant tuberculosis

Purpose. To highlight the medical and legal aspects of the activities of the Committee on Management (CM) of drug-resistant tuberculosis (DR-TB). Materials and methods. Analysis of reports on the work of the CM and regulations governing its activities. Results. TB DR remains a problem in many national health services (NHAs). In recent years, in the Republic of Moldova, its share has been about ¼ among all new cases and ½ among all cases of retreatment. In this regard, CM is an important element in the quality assurance system for TB DR management. In 2020, by decision of the CM, 536 patients were included in the TB DR treatment program. In their structure, new patients accounted for 43.5%, patients with relapse - 25.2%, patients after ineffective treatment - 16.4%, and patients from among those previously lost to follow-up - 14.9%. Decisions on the place and mode of chemotherapy, treatment adjustment and assessment of its effectiveness (ET) were made by the CM based on clinical judgment, taking into account the data of DR testing, the history of previous treatment, the severity and localization of TB etc. The above ensured the management of patients according to the recommendations of the National Clinical Protocol and the WHO Consolidated Guidelines for the Treatment of TB DR. The experience of the NHA accumulated in recent years in the use of information and communication technologies (teleconsultations „doctordoctor” etc.) allowed the NCM in the context of the COVID-19 pandemic to hold meetings online. Conclusion. CM is an important element in the system of quality assurance of TB DR management, which uses modern medical standards and information technologies in its activities, respects the rights and legitimate interests of patients.

Percutaneous Transhepatic Treatment of Benign Bile Duct Strictures Using Retrievable Covered Stents: Long-Term Outcomes in 148 Patients.

ObjectiveTo investigate the long-term outcomes of percutaneous treatment of benign biliary strictures using temporary placement of a retrievable expanded polytetrafluoroethylene (PTFE) covered stent.Materials and MethodsWe retrospectively analyzed the outcomes of 148 patients (84 male and 64 female; age range, 11–92 years) who underwent percutaneous transhepatic placement and removal of a retrievable PTFE-covered stent for the treatment of benign biliary strictures between March 2007 and August 2019 through long-term follow-up. Ninety-two patients had treatment-naïve strictures and 56 had recurrent/refractory strictures.ResultsStent placement was technically successful in all 148 patients. The mean indwelling period of the stent was 2.4 months (median period, 2.3 months; range, 0.2–7.7 months). Stent migration, either early or late, occurred in 28 (18.9%) patients. Clinical success, defined as resolution of stricture after completing stent placement and removal, was achieved in 94.2% (131 of 139 patients). The overall complication rate was 15.5% (23 of 148 patients). During the mean follow-up of 60.2 months (median period, 52.7 months; range, 1.6–146.1 months), 37 patients had a recurrence of clinically significant strictures at 0.5–124.5 months after removal of biliary stent and catheter (median, 16.1 months). The primary patency rates at 1, 3, 5, 7, and 10 years after removal of biliary stent and catheter were 88.2%, 70.0%, 66.2%, 60.5%, and 54.5%, respectively. In the multivariable Cox proportional hazard regression analysis, sex, age, underlying disease, relation to surgery, stricture type, biliary stones, history of previous treatment, and stricture site were not significantly associated with the primary patency.ConclusionLong-term outcomes suggest that percutaneous treatment of benign biliary strictures using temporary placement of retrievable PTFE-covered stents may be a clinically effective method.

Microbial profile of infectious corneal ulcer in a remote Himalayan teaching hospital in Himachal Pradesh (India)

Purpose: To study the microbiological profile of clinically diagnosed infectious keratitis cases in tertiary care hospitals in Solan, HP (India). Design: The study design involves prospective cross-sectional study. Materials and Methods: It was a prospective cross-sectional study that included clinically diagnosed corneal ulcer patients from September 1, 2018 to September 1, 2019. The demographic data, predisposing risk factors, clinical details, previous treatment history, investigations, treatment, and visual outcomes were analyzed. Results: A total of 36 patients were included in the study, and no significant difference between the number of males and females was noted (P = 0.74). The most common etiology of ulcer was corneal trauma in 25 (69%) patients. Injury with vegetative material was the most common mode of injury (18 of 25, 72%), followed by injury during construction work (3 of 25, 12%). Twelve of 36 (33%) cases were fungal, 6 (16%) were found to be bacterial and 2 (5%) cases had mixed organisms. The most common organism isolated was Fusarium spp. in 8 (40%) cases. The most common bacterial isolate was Staphylococcus aureus in 4 (20%) cases, followed by one each of Streptococcus pneumonia (5%) and Pseudomonas spp. (5%). Thirteen patients (36%) reached outpatient department between 7 and 14 days and 15 (42%) patients 2 weeks after the start of symptoms with no significant difference in the two genders (P = 0.97). Conclusion: Majority of infectious corneal ulcers in our region are fungal due to injuries during predominantly agriculture-based lifestyles and need urgent management.

Biomarkers for Locally Advanced Hepatocellular Carcinoma Patients Treated with Liver-Directed Combined Radiotherapy

Introduction: In the era of biomarker-driven cancer therapy, robust biomarkers for hepatocellular carcinoma (HCC) have not been well-defined. In this hypothesis-generating study, we investigated biomarkers that can be incorporated to predict treatment outcomes in patients with locally advanced HCC who are administered liver-directed combined radiotherapy (LDCRT). Methods: Ninety-nine patients with HCC who were treated with conventional fractionation LDCRT between July 2016 and October 2018 were enrolled in this prospective single-arm study. Clinical outcomes and possible serum biomarkers, including soluble programmed cell death ligand-1 (sPD-L1), interleukin (IL)-10, IL-6, cell-free DNA (cfDNA), inter-alpha inhibitor H4, and interferon-gamma, were analyzed. The primary endpoint was disease progression, and additional endpoints were local failure-free rate, intrahepatic failure-free rate, and lung metastasis-free rate. Results: The median follow-up period was 18.7 months. The 1-year progression-free rate was 38.2%. Increasing baseline sPD-L1 per pg/mL, previous treatment history, protein induced by vitamin K absence-II >1,629 mAU/mL, and multiple tumors were the adverse factors for progression based on multivariate analysis. Survival tree analysis revealed three prognostic groups for progression, in which patients with multiple lesions and baseline sPD-L1 ≥41.07 pg/mL showed the worst outcomes. For dynamic changes in biomarker levels, sPD-L1 fold change and cfDNA fold-change values were unfavorable factors for progression. Conclusion: Baseline sPD-L1, sPD-L1 fold change, and cfDNA fold-change values showed the highest potential as biomarkers for predicting post-treatment progression after LDCRT in HCC patients. By incorporating clinical factors, these biomarkers may be useful for devising a biomarker-driven treatment paradigm in locally advanced HCC.

Biocomposite’s Multiple Uses for a New Approach in the Diagnosis of Parkinson’s Disease Using a Machine Learning Algorithm

Neurodegenerative diseases drastically affect human beings without distinction; it does not matter if they are male or female. Sometimes, it is not clear why a person in their life developed a well-known disease in the world such as Parkinson’s disease (PD). Nowadays, various novel machine learning-based algorithms for evaluating Parkinson’s disease have been designed. The most recent strategy, which was developed using deep learning and can forecast the severity of Parkinson’s disease, is the one described here. To identify this disease, a thorough medical history, previous treatment history, physical examinations, and some blood tests and brain films must be completed. Diagnoses are more critical since they are less expensive and less time-consuming. Voice data from 253 people used in the current study corroborates the doctor’s diagnosis of Parkinson’s disease. To acquire the best results from the data, preprocessing is done. To perform the balancing procedure, a systematic sampling strategy was used to select the data that would be analyzed. Several data groups were constructed using a feature selection technique based on the label’s effect strength. Classification algorithms and performance evaluation criteria employ DT, SVM, and kNN. The classification algorithm and data group with the highest performance value were chosen, and the model was created due to this selection. The SVM approach was employed when constructing the model, and 45% of the original data set data were used. The data was sorted from most relevant to least important. 86% performance accuracy was achieved, in addition to excellent results in all other areas of the project. As a result, it has been established that medical decision support will be provided to the doctor with the assistance of the data set obtained from the speech recordings of the individual who may have Parkinson’s disease and the model that has been developed.

Status of drug resistant tuberculosis among patients attending a tuberculosis unit of West Bengal: A record based cross-sectional study.

Context:Tuberculosis (TB) is one of the main causes of death due to infectious diseases worldwide. Multidrug resistance/rifampicin resistance (MDR/RR) TB remains a public health crisis. India has the highest burden of tuberculosis and multidrug resistant TB (MDR TB) in the world. There is wide geographical variation in the epidemic and its trends that can be updated by regular reporting and sound surveillance systems. The current study tries to fill this gap by analyzing the data of TB patients from a Tuberculosis Unit, studying socio-demographic and clinical profile from December 2017 to November 2019 in Nadia district of West Bengal.Aims:The aims of this work were to study socio-demographic and clinical profile of TB patients attending Tuberculosis Unit of West Bengal, and to find out factors associated with drug-resistant TB.Settings and Design:Record-based study from Tuberculosis Unit.Methods:Records of all patients who undergo CBNAAT in TU are stored as monthly unit. We randomly selected 10 months from a period of December 2017 to November 2019 by using lot method. Data of all patients undergoing CBNAAT at Kalyani – Gayeshpur Tuberculosis Unit during randomly selected 10 months were accessed.Statistical Analysis Used:Monthly data was entered in Microsoft Excel and descriptive tests of significance, proportions and Chi-square were applied.Results:There was male preponderance for testing of tuberculosis. Seven percent of the TB suspects were HIV positive. The positivity rate of MTB by CBNAAT was 23%. Four percent of the samples were Rifampicin resistance. Tobacco consumption, contact with TB case and Diabetes were common risk factors of TB. Most of the information was missing in the records.Conclusions:Most of Rifampicin Resistant cases showed very low Ct value in CBNAAT. Previous history of TB treatment and positive HIV status was significantly associated with RR TB. There is a need to capture complete information on the records of presumptive TB cases.

Risk factors for mortality among multi-drug resistant tuberculosis patients in treatment follow-up centers, eastern Ethiopia: a retrospective follow-up study.

multi-drug resistance tuberculosis (MDR-TB) is associated with an increased risk of mortality among patients on treatment. Ethiopia is the countries with the high MDR-TB burden. This study aimed to determine the extent of mortality and associated factors among MDR-TB patients on treatment in eastern Ethiopia. all completely documented data from June 2014 to January 2017 on MDR-TB patients were extracted from patients´ records, between December 2016 and January 2017, in Dader and Dire Dawa MDR treatment follow-up centers. Sociodemographic characteristics, clinical characteristics of MDR-TB patients, and treatment outcomes were extracted from the patients' records. Descriptive statistical methods were used to characterize the sociodemographic variables and the extent of mortality. Binary and multivariable logistic regression analyses were performed to assess factors associated with mortality using an adjusted odds ratio (AOR) at 95% confidence interval (CI). Statistical significance was considered at a P-value of less than 0.05. among 150 MDR-TB patients, 60.7% of them were males and their mean age was 30.34 + 1.06 years. In this study, the overall mortality rate was 11.3% (95% CI= 6.74-17.52). Previous history of ant-TB treatment (AOR=6.7, 95% CI: 1.59 - 17.15, P= 0.019), hospitalization (AOR=19.55, 95% CI: 6.23-43.37, P=0.001), and human immunodeficiency virus (HIV) coinfection (AOR=6.3, 95% CI: 2.98- 14.0, P= 0.008) were significantly associated with this mortality. considerably high rate of mortality among MDR-TB patients on treatment highlights the need for more efforts in TB treatment and monitoring the program to limit mortality among MDR-TB patients in the study settings.

Presumed Unilateral Quiescent Multifocal Tuberculous Choroiditis

A 43-year-old housewife presented to the retina clinic with a 5-year history of poor vision in the left eye. There was no antecedent history of trauma. At presentation, the best-corrected visual acuity was 6/5 and counting fingers in the right and left eye, respectively. Examination of the anterior segment was essentially normal in both eyes. Fundus examination with binocular indirect ophthalmoscopy of the right eye revealed a normal fundus, whereas the left eye had a pale optic disc, widespread hyperpigmented scars some located subvascular, subretinal fibrosis, occluded vessels, and macular atrophic changes. The systemic examination was essentially normal. There was a positive history of previous treatment for pulmonary tuberculosis (TB) about 5 years before presentation at the retina clinic. Due to the ocular findings in the left eye and a history of pulmonary TB, a diagnosis of left-healed presumed tuberculous choroiditis was made.

Risk factors for perioperative complications in laparoscopic surgeries of retrorectal cystic lesions.

BACKGROUNDThe incidence of retrorectal lesions is low, and no consensus has been reached regarding the most optimal surgical approach. Laparoscopic approach has the advantage of minimally invasive. The risk factors influencing perioperative complications of laparoscopic surgery are rarely discussed.AIMTo investigate the risk factors for perioperative complications in laparoscopic surgeries of retrorectal cystic lesions.METHODSWe retrospectively reviewed the medical records of patients who underwent laparoscopic excision of retrorectal cystic lesions between August 2012 and May 2020 at our hospital. All surgeries were performed in the general surgery department. Patients were divided into groups based on the lesion location and diameter. We analysed the risk factors like type 2 diabetes mellitus, hypertension, the history of abdominal surgery, previous treatment, clinical manifestation, operation duration, blood loss, perioperative complications, and readmission rate within 90 d retrospectively.RESULTSSevere perioperative complications occurred in seven patients. Prophylactic transverse colostomy was performed in four patients with suspected rectal injury. Two patients underwent puncture drainage due to postoperative pelvic infection. One patient underwent debridement in the operating room due to incision infection. The massive-lesion group had a significantly longer surgery duration, higher blood loss, higher incidence of perioperative complications, and higher readmission rate within 90 d (P < 0.05). Univariate analysis, multivariate analysis, and logistic regression showed that lesion diameter was an independent risk factor for the development of perioperative complications in patients who underwent laparoscopic excision of retrorectal cystic lesions.CONCLUSIONThe diameter of the lesion is an independent risk factor for perioperative complications in patients who undergo laparoscopic excision of retrorectal cystic lesions. The location of the lesion was not a determining factor of the surgical approach. Laparoscopic surgery is minimally invasive, high-resolution, and flexible, and its use in retrorectal cystic lesions is safe and feasible, also for lesions below the S3 level.

Gestational Diabetes Mellitus: Clinical Characteristics and Perinatal Outcomes in a Multiethnic Population of North Italy.

Aim To evaluate clinical characteristics and perinatal outcomes in a heterogeneous population of Caucasians born in Italy and High Migration Pressure Countries (HMPC) women with GDM living in Piedmont, North Italy. Methods We retrospectively analyzed data from 586 women referring to our unit (2015–2020). Epidemiological (age and country of origin) and clinical-metabolic features (height, weight, family history of DM, parity, previous history of GDM, OGTT results, and GDM treatment) were collected. The database of certificates of care at delivery was consulted in relation to neonatal/maternal complications (rates of caesarean sections, APGAR score, fetal malformations, and neonatal anthropometry). Results 43.2% of women came from HMPC; they were younger (p < 0.0001) and required insulin treatment more frequently than Caucasian women born in Italy (χ2 = 17.8, p=0.007). Higher fasting and 120-minute OGTT levels and gestational BMI increased the risk of insulin treatment (OGTT T0: OR = 1.04, CI 95% 1.016–1.060, p=0.005; OGTT T120: OR = 1.01, CI 95% 1.002–1.020, p=0.02; BMI: OR = 1.089, CI 95% 1.051–1.129, p < 0.0001). Moreover, two or more diagnostic OGTT glucose levels doubled the risk of insulin therapy (OR = 2.03, IC 95% 1.145–3.612, p=0.016). We did not find any association between ethnicities and neonatal/maternal complications. Conclusions In our multiethnic GDM population, the need for intensive care and insulin treatment is high in HPMC women although the frequency of adverse peripartum and newborn outcomes does not vary among ethnic groups. The need for insulin therapy should be related to different genetic backgrounds, dietary habits, and Nutrition Transition phenomena. Thus, nutritional intervention and insulin treatment need to be tailored.

The European Prevalence of Resistance Associated Substitutions among Direct Acting Antiviral Failures.

Background: Approximately 71 million people are still in need of direct-acting antiviral agents (DAAs). To achieve the World Health Organization Hepatitis C elimination goals, insight into the prevalence and influence of resistance associated substitutions (RAS) is of importance. Collaboration is key since DAA failure is rare and real-life data are scattered. We have established a European collaboration, HepCare, to perform in-depth analysis regarding RAS prevalence, patterns, and multiclass occurrence. Methods: Data were extracted from the HepCare cohort of patients who previously failed DAA therapy. Geno—and subtypes were provided by submitters and mostly based on in-house assays. They were reassessed using the Comet HCV subtyping tool. We considered RAS to be relevant if they were associated with DAA failure in vivo previously reported in literature. Results: We analyzed 938 patients who failed DAA therapy from ten different European countries. There were 239 genotypes (GT) 1a, 380 GT1b, 19 GT2c, 205 GT3a, 14 GT4a, and 68 GT4d infections. Several unusual subtypes (n = 15) (GT1b/g/l, GT3b, GT4k/n/r/t) were present. RAS appeared in over 80% of failures and over a quarter had three or more RAS. Multiclass RAS varied over target region and genotype between 0–48%. RAS patterns such as the Q30R + L31M and Q30R + Y93H in GT1a, the L31V + Y93H and L31V + Y93H for GT1b, and A30K + L31M and A30K/V + Y93H for GT3a all occurred with a prevalence below 5%. Conclusion: RAS occur frequently after DAA failures and follow a specific genotype and drug related pattern. Interpretation of the influence of RAS on retreatment is challenging due to various patterns, patients’ characteristics, and previous treatment history. Moving towards HCV elimination, an ongoing resistance surveillance is essential to track the presence of RAS, RAS patterns and gather data for a re-treatment algorithm.

A Multicentre Randomised Controlled Study Evaluating the Effect of a Standardised Education Programme on Quality of Life, Disease Severity, and Disease Knowledge in Patients with Moderate-To-Severe Psoriasis: The EDUPSO Study

Background: Psoriasis is a chronic inflammatory skin disease that has a profound effect on health-related quality of life (HRQoL). Patient education programmes may help patients to gain life-long control over their chronic disease. Objective: This multicentre randomised controlled study evaluated whether a standardised multidisciplinary education programme was beneficial to psoriasis patients. Methods: Adults with moderate-to-severe psoriasis were randomly assigned (1:1) to an intervention group to receive an educational programme or to a control group to receive usual care. Randomization was stratified by previous treatment history. The primary outcome was HRQoL, assessed by scoring the Skindex-29 domains emotion, symptom, and functioning. Psoriasis severity was assessed using the psoriasis area severity index (PASI). Levels of perceived stress, patient knowledge about psoriasis, and patient satisfaction were also assessed. Follow-up evaluations were performed at 3, 6, and 12 months. Results: A total 142 patients formed the intention-to-treat population: 70 in the control group and 72 in the intervention group. Skindex component scores and the PASI were significantly lower at 3, 6, and 12 months as compared to baseline in both groups, but no significant differences were found between the groups. Knowledge about psoriasis improved significantly during follow-up amongst patients from the intervention group compared to controls (68% of correct answers vs. 56%; p < 0.01). Patient satisfaction with psoriasis management and treatment was also better in the intervention group. Conclusions: The standardised education programme did not improve HRQoL and disease severity in psoriasis, but led to a significant improvement in patient knowledge about the disease and increased patient satisfaction.

Treatment Outcomes Among Notified Pulmonary Tuberculosis Cases in 67 Refugee Health Facilities in the Eastern Africa-IGAD Region: Historical Cohort, 2014-2017

Background: Refugees are at increased risk for Tuberculosis (TB). In 2020, more than 3.9 million refugees were hosted in refugee camps/settlements in member countries of Intergovernmental Authority on Development (IGAD), East Africa. Regional evidence, therefore, on treatment outcome is important to improve the quality of TB care and strengthen the monitoring and evaluation system in the refugee settings. Objective: To assess trends of pooled TB treatment outcomes at the regional level and identify factors associated with unsuccessful treatment outcome among patients with pulmonary TB (PTB), bacteriologically confirmed pulmonary TB (BCPTB) and clinically diagnosed pulmonary TB (CDPTB) in refugee camps in IGAD region from 2014 to 2017. Methods: A retrospective cohort study was conducted in 67 refugee health facilities located in four countries (Ethiopia=25, Uganda=33, Kenya=5 and Sudan=4). Demographic and clinical data of all PTB patients registered between January 1, 2014 and December 31, 2017 were used. Descriptive analysis was done on the data and multivariate logistic regression analysis was used to identify baseline covariates associated with unsuccessful treatment. Results: A total of 4,072 TB cases (42%, 28%, 12% and 19% were from Kenya, Ethiopia, Sudan, and Uganda respectively) were included with more than half (62.4%) being BCPTB. 59.2% were males and 13.5% were HIV co-infected. The pooled treatment success rate (TSR) in the period under review was 80.7%. TSR was higher among the CDPTB compared to BCPTB cases in 2014 (86.5% vs. 81.3%), 2015 (87.5% vs. 84.8%) and 2016 (81.0 vs. 80.6%); but reversed in favour of BCPTB in 2017 (77.1% vs. 74.3%). Overall, 13.6% of the cases had unsuccessful treatment (treatment failed, died, or lost to follow-up). The factors significantly associated with unsuccessful treatment were positive HIV status (aOR 2.6[CI: 1.7 - 4.2]), male gender (aOR 1.7[CI: 1.4 - 3.8]), previous TB history (aOR 1.5[CI: 1.0 - 2.2]) and older age (aOR 1.7[CI: 1.1 - 2.8]). Conclusion: TB Treatment success rate in the refugee camps remained below the global target (≥ 90). TB-HIV co-infection, Male gender, previous history of treatment and age (15-34 &amp;old age) increased the risk for unsuccessful treatment outcomes among PTB patients in the refugee camps.

High rate of successful treatment outcomes among childhood rifampicin/multidrug-resistant tuberculosis in Pakistan: a multicentre retrospective observational analysis

BackgroundThere was a complete lack of information about the treatment outcomes of rifampicin/multidrug resistant (RR/MDR) childhood TB patients (age ≤ 14 years) from Pakistan, an MDR-TB 5th high burden country. Therefore, this study evaluated the socio-demographic characteristics, drug resistance pattern, treatment outcomes and factors associated with unsuccessful outcomes among childhood RR/MDR-TB patients in Pakistan.MethodsThis was a multicentre retrospective record review of all microbiologically confirmed childhood RR/MDR-TB patients (age ≤ 14 years) enrolled for treatment at seven units of programmatic management of drug-resistant TB (PMDT) in Pakistan. The baseline and follow-up information of enrolled participants from treatment initiation until the end of treatment were retrieved from electronic nominal recording and reporting system. World Health Organization (WHO) defined criterion was used for deciding treatment outcomes. The outcomes of “cured” and “treatment completed” were collectively grouped as successful, whereas “death”, “treatment failure” and “lost to follow-up” were grouped together as unsuccessful outcomes. Multivariable binary logistic regression analysis was used to find factors associated with unsuccessful outcomes. A p-value < 0.05 reflected statistically significant findings.ResultsA total of 213 children RR/MDR-TB (84 RR and 129 MDR-TB) were included in the study. Majority of them were females (74%), belonged to the age group 10–14 years (82.2%) and suffered from pulmonary TB (85.9%). A notable proportion (37.1%) of patients had no history of previous TB treatment. Patients were resistant to a median of two drugs (interquartile range: 1–4) and 23% were resistant to any second line anti-TB drug. A total of 174 (81.7%) patients achieved successful treatment outcomes with 144 (67.6%) patients being cured and 30 (14.1%) declared treatment completed. Among the 39 (18.3%) patients with unsuccessful outcomes, 35 (16.4%) died and 4 (1.9%) experienced treatment failure. In multivariable analysis, the use of ethambutol had statistically significant negative association with unsuccessful outcomes (odds ratio = 0.36, p-value = 0.02).ConclusionsIn this study, the WHO target of successful treatment outcomes (≥ 75%) among childhood RR/MDR-TB patients was achieved. The notable proportion of patients with no history of previous TB treatment (37.1%) and the disproportionately high number of female patients (74%) respectively stress for infection control measures and provision of early and high quality care for female drug susceptible TB patients.

Epidemiologic features and burden of atopic dermatitis in adolescent and adult patients: A cross-sectional multicenter study

BackgroundAtopic dermatitis (AD) is considered as one of the most frequent chronic skin conditions. Previous AD epidemiologic studies have been mainly retrospective and/or have been performed through surveys instead of in-person visits. Epidemiological studies concerning AD in Latin American countries are scarce. ObjectiveTo describe sociodemographic and clinical features and the economic burden of AD on children and adult patients in Colombia through in-person visits. MethodsThis was a cross-sectional study of 212 patients that included sociodemographic and clinimetric data. The diagnostic criteria of Hanifin and Rajka was used and data relating to disease distribution, disease severity (through the BSA: Body surface area; EASI: Eczema Area and Severity Index; SCORAD: Scoring Atopic Dermatitis), Fitzpatrick's skin phototypes, personal and familiar history of allergic diseases, previous treatments, and personal history of comorbidities, was collected. ResultsPatient age range was 12–76, and 52.8% were female. Disease distribution was mainly flexural (19.6%). Early age start, Denni-Morgan fold, and infections tendency were more frequent in adolescents compared to adults. Mean age of diagnosis was 12 years old, AD diagnosis was made mostly by a dermatologist, 48.1% (102 patients) reported alcohol consumption, and 59% of consumers were heavy drinkers. Comorbidities found were: chronic rhinitis (68.9%) food allergy (32.5%), allergic conjunctivitis (29.7%), and asthma (28.8%). Around 81% earned less than $896 US dollars and 59% invested 6–30% of their monthly budget yearly, and 40% had work or school absenteeism. Mean scores of BSA, EASI, and SCORAD involvement were 32.6, 13.7, and 42.4, respectively. ConclusionsThis study adds well-supported data through an in-depth clinical and economical characterization of Colombian adolescents and adult patients with atopic dermatitis and shows its high impact and burden on patients and their families. It also contributes to understand the burden of AD in Latin America.

Cryptorchid investigation of an adult cob pony with unknown history

AbstractA 400 kg, male, adult cob pony presented with a history of stallion‐like behaviour without testicles palpable. The blood oestrone sulphate level was 4.90 ng/ml, consistent with cryptorchidism (0.1–10.0 ng/ml; IDEXX). Age was estimated at 8 years by dentition. Previous veterinary treatment history was unavailable. Examination under general anaesthesia found no evidence of prior surgical castration. Investigation of the inguinal region was unremarkable with no evidence of an inguinal extension of the gubernaculum testis or vaginal process on either side. Exploratory laparotomy of the right abdomen revealed a cystic, 5 × 8 cm mass with homogenous tapering stalk. This was removed by emasculation. Histological examination identified the mass as a benign testicular teratoma. Blood anti‐Mullerian hormone 5 days after the surgery measured 0.9 ng/ml. The pony made a full recovery and the owner reported the behavioural issues have resolved.

Risk factors associated with drug-resistant tuberculosis in Ethiopia: A systematic review and meta-analysis.

The emergence of drug-resistant tuberculosis (DR-TB) is becoming a challenge to the national TB control programmes including Ethiopia. Different risk factors are associated with DR-TB. Identifying these risk factors in a local setting is important to strengthen the effort to prevent and control DR-TB. Thus, this study aimed to assess the risk factors associated with DR-TB in Ethiopia. The Preferred Reporting Items for Systematic Reviews and Meta-analyses checklist was followed to conduct this study. We systematically searched the articles from electronic databases and grey literature sources. We used the JBI tools to assess the quality of studies. Data were analysed using STATA version 15. We estimated the pooled odds ratio (OR) along with 95% Confidence Interval (CI). The forest plot and I2 heterogeneity test were used to assess heterogeneity among studies. We explored the presence of publication bias through visual inspection of the funnel plot and Egger's regression test. After screening 2238 articles, 27 studies were included in the final analysis. Based on the pooled analysis of the OR, unemployment (OR; 2.71, 95% CI; 1.64, 3.78), previous TB history (OR; 4.83, 95% CI; 3.02, 6.64), contact with known TB patient (OR; 1.72, 95% CI; 1.05, 2.40), contact with the known multi-drug resistant (MDR) TB patient (OR; 2.54, 95% CI; 1.46, 3.63) and having pulmonary TB (PTB; OR; 1.80, 95% CI; 1.14, 2.45) were found to be the risk factors of DR-TB, while elders (OR; 0.77, 95%CI; 0.60, 0.95) including above 45 years (OR; 0.76, 95%CI; 0.55, 0.97) and males (OR; 0.86, 95%CI; 0.76, 0.97) had lower DR-TB risk, compared to their counterparts. A previous history of TB treatment is a major risk factor for acquiring DR-TB in Ethiopia that might be due to poor adherence during the first-line anti-TB treatment. Besides, having contact with a TB patient, contact with an MDR-TB patient, having PTB and being unemployed were the risk factors of DR-TB in Ethiopia. Thus, active screening of TB contacts for DR-TB might help to detect DR-TB cases as early as possible and could help to mitigate its further transmission across the community.

Sofosbuvir-velpatasvir in Mexican patients with hepatitis C: A retrospective review

IntroductionThe sofosbuvir-velpatasvir (SOF/VEL) combination is a direct-acting antiviral therapy that is authorized and available in Mexico, making the performance of a real-world multicenter study that evaluates the sustained virologic response at 12 weeks post-treatment a relevant undertaking. MethodsA retrospective review of the case records of 241 patients seen at 20 hospitals in Mexico was conducted to assess hepatitis C treatment with the SOF/VEL combination (n = 231) and the sofosbuvir/velpatasvir/ribavirin (SOF/VEL/RBV) combination (n = 10). The primary efficacy endpoint was the percentage of patients that achieved SVR at 12 weeks after the end of treatment. ResultsOverall SVR was 98.8% (95% CI 97.35–100%). Only three patients did not achieve SVR, two of whom had cirrhosis and a history of previous treatment with peg-IFN. Of the subgroups analyzed, all the patients with HIV coinfection, three patients with genotype 3, and the patients treated with the SOF/VEL/RBV combination achieved SVR. The subgroups with the lower success rates were patients that were treatment-experienced (96.8%) and patients with F1 fibrosis (95.5%). The most frequent adverse events were fatigue, headache, and insomnia. No serious adverse events were reported. ConclusionTreatments with SOF/VEL and SOF/VEL/RBV were highly safe and effective, results coinciding with those of other international real-world studies.