Successful Treatment Outcome Research Articles

Clinicopathological Profile in Patients with Tubercular Cervical Lymphadenitis and Its Treatment Outcome.

Tuberculosis is a common occurrence in developing countries. Drug resistance, co-morbidities, and limited availability of new rapid tests such as the GeneXpert/MTB Rif assay make diagnosis and treatment of extrapulmonary tuberculosis burdensome. A cross-sectional study was carried out at Employees' State Insurance Corporation Medical College and Hospital, Faridabad, Haryana of patients treated for tubercular cervical lymphadenopathy from December 2021 to March 2023 in the department of ENT. This study included 58 patients. The clinicopathological profile of patients and the outcome of treatment with antitubercular therapy were noted. The majority of patients had level V (39.6%) involvement. Incidental diagnosis of diabetes mellitus was seen in 2 cases (3.4%). Fever was the commonest constitutional symptom observed in 27.5% of cases. FNAC was suggestive of tubercular abscess in 48.2% and the GeneXpert MTB/RIF assay detected Mycobacterial tuberculosis in all the cases with rifampicin resistance in only one case. 56 cases (96.5%) had complete resolution after completion of antitubercular therapy including patients with rifampicin resistance and patients with diabetes mellitus. In the remaining two cases, treatment was prolonged for a few months before the resolution of the disease was observed. Timely diagnosis, patient compliance to antitubercular therapy, and adequate management of comorbidities lead to successful treatment outcomes in tubercular cervical lymphadenitis. Delayed response to treatment in a few cases needs further research into factors like immune status, nutrition, living conditions, and quality of drugs available to the public.

Intelligent models for early Autism detection from MRI images

Autism Spectrum Disorders (ASDs) are neurodevelopmental conditions that usually manifest during childhood. It is a multi-symptom disorder, and its symptoms overlap with several other disorders. The early detection of these disorders is conducive to more successful treatment outcomes, as treatment is more effective before the disorder becomes severe. However, the conventional diagnostic procedures are quite time-consuming, with a typical confirmation period of several months with different specialists in speech and neurology. Recent advances in artificial intelligence (AI), specifically machine learning (ML) and deep learning (DL), have demonstrated considerable potential in addressing the diagnostic challenges associated with autism spectrum disorders (ASDs). In this paper, we propose a range of machine learning models, including a support vector machine (SVM), convolutional neural network (CNN), residual networks (ResNet), and vision transformers (ViT), to detect ASDs based on magnetic resonance images (MRI). The SVM model, in terms of accuracy, outperforms the other similar works, achieving a score of 94.03%.

MODIFIED VGG16 FOR ACCURATE BRAIN TUMOR DETECTION IN MRI IMAGERY

Brain tumors are one of the most severe medical conditions that require immediate attention and treatment. The early detection of brain tumors is of utmost importance, as it can significantly improve the chances of successful treatment outcomes and increase the patient's quality of life. This study proposes a novel methodology for the early detection of brain tumors in magnetic resonance imaging (MRI) images using a modified VGG16 neural network architecture. The dataset comprises both tumor and non-tumor MRI images collected from Kaggle and has preprocessing techniques applied to optimize the model's performance. The proposed approach delivers an impressive accuracy rate of 99.08%, demonstrating its efficacy in precise brain tumor detection. This new methodology is expected to aid doctors in accurate diagnosis and treatment planning, thereby helping to save more lives and improve the quality of life of patients suffering from brain tumors.

Identification of Novel Biomarkers for Post-Kasai Portoenterostomy in Biliary Atresia through Shotgun Proteomics Analysis

Introduction: Biliary Atresia (BA) causes neonatal cholestasis jaundice. The primary therapeutic treatment for BA is the Kasai portoenterostomy. Current diagnostic approaches for BA are imprecise and time-consuming, making early diagnosis crucial for successful treatment outcomes. Objective: This study aims to analyze proteins from Peripheral Blood Mononuclear Cells (PBMCs) obtained from children with BA compared with healthy children Methods and Study Design: We employed a large-scale, total shotgun quantitative serum proteomics approach to analyze the protein from PBMC samples from a discovery cohort. This approach allowed for the simultaneous identification and quantification of multiple proteins, enabling the detection of disease-specific protein expression patterns. The study is proteomic-based study. Results: We identified 24 proteins, by Liquid Chromatography-Mass Spectrometry (LC-MS) analysis that exhibited high discriminatory power for five subjects with BA post-Kasai operation compared to ten healthy controls. ATP2A3, LIN28B, SLC25A3, ITGB3, COX5A, and HLA-B identified proteins of upregulation were predicted to associate with BA post-Kasai operation. Discussion: Our findings highlight the utility of proteomic techniques in BA research. The identified proteomic markers offer promise for improving BA diagnostic accuracy and timeliness, leading to enhanced treatment outcomes for affected children. Conclusion: Proteomic analysis revealed a set of potential biomarkers for early and accurate diagnosis of biliary atresia. These biomarkers hold significant clinical value and have the potential to transform the management of biliary atresia by facilitating timely intervention and improving patient outcomes.

Tuberculosis patients’ satisfaction with directly observed treatment short course strategy and associated factors in Southern Ethiopia: a mixed method study

AabstractBackgroundTuberculosis (TB) is a second major global public health problem and the leading infectious cause of death in Ethiopia. Patients under directly observed treatment short-courses (DOTs) have a higher treatment success rate and reduced drug resistance. A successful treatment outcome and adherence to the treatment are related to patient satisfaction with the DOT strategy. Client satisfaction is one of the indicators of the quality of care. In this perspective, there were limited studies in Ethiopia related to patient satisfaction with the DOTs strategy in the prevention and control of TB to achieve the ‘’END TB Strategy.’’ Therefore, this study was aimed at identifying the TB patients’ satisfaction with the DOTs strategy and associated factors in Gamo Zone, Southern Ethiopia.MethodsAn institutional-based cross-sectional study design for quantitative data and a phenomenological approach were employed for qualitative data. The calculated sample size was 374. A systematic random sampling method was used to select study participants. A pre-tested structured interviewer-administered questionnaire for quantitative data and focus group discussions (FGDs) for qualitative data were used for data collection. Bivariable and multivariable analyses were used. The determinants with a p-value < 0.05 were declared to have a significant association with the outcome variable, and an adjusted odd ratio with a 95% confidence interval (CI) was used.ResultsA total of 358 patients participated in the study, with a response rate of 95.72%. The majority of study participants’ ages ranged between 25 and 34 years. The tuberculosis DOT satisfaction rate was 61.17% [56.10-66.25%, 95%CI]. The TB patients who took treatment for 20 weeks or more were 3.97 times [AOR = 3.97; 95% CI (1.55–10.16)] more likely to be satisfied with the DOTs service provided. However, the participants who perceived transport costs as high were 79% [AOR = 0.21; 95% CI (0.06–0.71)] less likely to be satisfied with DOTs. Qualitatively, the participants reported that there was a major problem with laboratory services, which resulted in delays and long appointments to get the results in addition to lack of clean toilets and safe water to swallow medications.ConclusionThe satisfaction rate for tuberculosis DOTs observed in this study appears to be relatively lower in comparison to other studies. Availing DOTs service nearby patients to enhance the accessibility of the service is crucial to improving patients’ satisfaction with DOTs service. Reducing laboratory result delays by improving laboratory service is essential to enhancing patients’ satisfaction with DOTs. Moreover, improving toilet services, and availing safe water to swallow medications is recommended to enhancing patients’ satisfaction with DOTs service.

Predictive Factors for the Successful Outcome of Urethral Sphincter Injections of Botulinum Toxin A for Non-Neurogenic Dysfunctional Voiding in Women.

Dysfunctional voiding (DV) is not uncommon in women with non-neurogenic voiding dysfunction. Because of its unknown pathophysiology, effective and durable treatment is lacking. This study aimed to analyze the results of treatment and predictive factors for a successful outcome of botulinum toxin A (BoNT-A) treatment in female patients with DV. In total, 66 women with DV confirmed by a videourodynamic study (VUDS) were treated with a BoNT-A injection into the urethral sphincter once (n = 33) or several times (n = 33). VUDS was performed before (baseline) and after the BoNT-A treatment. Patients with a global response assessment of the voiding condition of 2 or 3 and a voiding efficiency (VE) of >20% than baseline were considered to have a successful outcome. The baseline demographics, VUDS parameters, and VUDS DV subtypes were compared between the successful and failed groups. Predictive factors for a successful outcome were investigated by logistic regression analyses. Successful and failed outcomes were achieved in 27 (40.9%) and 39 (59.1%) women, respectively. After BoNT-A injections, the maximum flow rate (Qmax), voided volume, and VE all significantly increased, and the postvoid residual (PVR) was slightly improved. No significant difference in the number of injections and medical comorbidity was found between the groups. However, the successful group had a higher incidence of previous pelvic surgery. No significant difference in the treatment outcome was found among patients with different urethral obstruction sites. Significant improvements in Qmax, voided volume, PVR, VE, and the bladder outlet obstruction (BOO) index were noted in the successful group. A lower VE at baseline and a history of surgery were identified as predictive factors for a successful outcome of BoNT-A injections for treating DV. BoNT-A injections into the urethral sphincter can effectively improve VE in 40.9% of women with DV. Women with higher BOO grades and previous pelvic surgery are predicted to have a successful treatment outcome.

Quantum imaging-based nanobiosensors: Pioneering point-of-care approach for early diagnosis of environmental-linked breast cancer

Early detection is paramount for successful treatment outcomes in cancer diagnosis. Among women across the globe, breast cancer (BC) ranks as one of the deadliest forms of cancer. Prolonged exposure to numerous environmental pollutants has been linked to epigenetic reprogramming, which entails changes in the expression patterns of non-coding RNAs. These alterations have been strongly linked to an increased risk of developing BC. Women are confronted with hazardous smoke from polluting stoves and fuels for longer as they often perform home duties such as cooking. Inefficient combustion emits black carbon (sooty particles), which enters the bloodstream and is strongly connected to an elevated risk of BC. The use of several analytical methods, such as real-time polymerase chain reaction, microarray, and sequencing, has numerous disadvantages, such as high expenses, limitations in sensitivity, and lack of accuracy. However, the emergence of quantum dots (QDs), nanoscale semiconductor particles with unique optical properties, and the development of quantum imaging-based sensors offer a glimpse into the future of medical technology. These sensors have the potential to completely change the medical field by offering highly precise, non-invasive, and reliable techniques for early diagnosis. Our article delves into the intricacies of QDs imaging-based sensors, their applications in BC detection, and their transformative impact on improving patient care. In recent years, the confluence of quantum science and diagnostic imaging has opened new avenues for BC diagnosis. The present state of quantum imaging-based BC diagnosis sensors is examined in this article, along with potential future developments with the help of artificial intelligence.

Tackling Impediments: Bespoke Solutions for Optimized Implant Outcomes

The field of implantology has transformed dental restoration, yet significant challenges persist that can impede successful treatment outcomes. This review examines the technical and biological roadblocks encountered in dental implant procedures, highlighting the vital role of tailored innovations in overcoming these obstacles. Advances in materials science, digital technology, and surgical techniques are crucial for enhancing osseointegration and ensuring overall implant success. Common complications include surgical issues such as infections and nerve damage, prosthetic challenges like misalignment and aesthetic concerns, and biological threats such as peri-implantitis and bone loss. To combat these, proactive management strategies—encompassing meticulous preoperative planning, regular monitoring, and personalized solutions—are essential for improving patient care. This review underscores the importance of interdisciplinary collaboration of prosthodontists, oral surgeons, periodontists and oral radiologists in mitigating risks and presents effective management strategies to optimize outcomes. By elevating awareness of potential complications and implementing precise diagnosis and treatment planning, practitioners can significantly enhance the longevity and effectiveness of dental implants, ultimately securing a better quality of life for patients.

A clinical approach in the management of endodontic-periodontal lesions of endodontic origin: Two case reports with 2-year follow-up

Abstract The term “endodontic-periodontal” (endo-perio) lesions describe lesions with the involvement of pulpal tissues and the periodontium of a tooth. These cases regarding the diagnosis, management, and prognosis of teeth are challenging for the clinician. The aim of this article was to discuss two cases of endo-perio lesions in molars with large periapical radiolucencies. Two healthy male individuals came with a chief complaint of pain during chewing. During clinical examination, a deep periodontal pocket of 10 mm and 7 mm, respectively, was noticed in both cases, and large periapical radiolucencies extended to the apical region were confirmed by the intraoral periapical radiographs. Evaluation of the symptoms together with the clinical findings determined the diagnosis endo-perio lesion of endodontic origin and accordingly the decision for the management. The successful treatment outcome with the periodontal healing in both cases was observed soon 40 days after orthograde root canal treatment. Conservative endodontic therapy was the key to the healing of the periapical tissues in endo-perio lesions of endodontic origin. The clinical approach as well as the 2-year follow-up of those compromised endo-perio lesions showed that endodontic therapy resulted in the healing, whereas no periodontal therapy was performed and the initial decision-making was confirmed.

Embryo multinucleation: detection, possible origins, and implications for treatment.

Cell cycle regulation is crucial to assure expansion of a cell population, while preserving genome integrity. This notion is especially relevant to fertilization and early embryo development, a time when the cell cycle transforms from meiotic into mitotic cycles. Zygote-to-embryo transition is acutely error-prone, causing major developmental perturbations, including cleavage delays, tri- and multi-chotomous cleavages, and cell fragmentation. Another such alteration is bi- and multinucleation, consisting of the simultaneous formation of two or more nuclei at interphase. Indeed, multinucleation affects a large proportion of early human embryos, typically at the two-cell stage. Mechanistically, several factors, including spindle dysfunction, failed cleavage, and cell fusion, may generate this cell anomaly. In assisted reproduction treatment, multinucleation is associated with reduced developmental rates and lower implantation rates in Days 2-3 embryo transfers. However, many multinucleated embryos can develop to the blastocyst stage. In blastocyst transfers, the current evidence does not suggest a major impact of a previous history of multinucleation on the odds of euploidy or successful treatment outcomes. Human embryo multinucleation remains a not-fully-understood but developmentally relevant and intriguing phenomenon which requires further research of its generative mechanisms and clinical implications.

Silencing Nrf2 in cisplatin resistant non-small cell lung cancer cells augments sensitivity towards EGFR inhibitor

Recently, non-small cell lung cancer (NSCLC) has been the prime concern of cancer clinicians due to its high mortality rate worldwide. Cisplatin, a platinum derivative, has been used as a therapeutic option for treating metastatic NSCLC for several years. However, acquired, or intrinsic drug resistance to Cisplatin is the major obstacle to the successful treatment outcome of patients. Dysregulation of Nrf2 (nuclear factor erythroid 2-related factor 2) and EGFR (epidermal growth factor receptor) signaling have been associated with cellular proliferation, cancer initiation, progression and confer drug resistance to several therapeutic agents including Cisplatin in various cancers. To dissect the molecular mechanism of EGFR activation in resistant cells, we developed Cisplatin-resistant (CisR) human NSCLC cell lines (A549 and NCIH460) with increasing doses of Cisplatin treatment over a 3-month period. CisR cells demonstrated increased proliferative capacity, clonogenic survivability and drug efflux activity compared to the untreated parental (PT) cells. These resistant cells also showed higher levels of Nrf2 and EGFR expression. Here, we found that Nrf2 upregulates both basal and inducible expression of EGFR in these CisR cells at the transcriptional level. Moreover, genetic inhibition of Nrf2 with siRNA in CisR cells showed increased sensitivity towards the EGFR tyrosine kinase inhibitor (TKIs), AG1478. Our study, therefore suggests the use of Nrf2 inhibitors in combinatorial therapy with EGFR TKIs for the treatment of resistant NSCLC.

Recurrent Pulmonary Tuberculosis in China, 2005 to 2021

Despite posing a significant challenge to global tuberculosis (TB) elimination efforts, recurrent TB remains understudied due to the challenges of long-term observation. To investigate the burden of recurrent TB using data from patients with pulmonary TB (PTB) in China. This retrospective cohort study included all bacteriologically confirmed or clinically diagnosed PTB cases reported to the Tuberculosis Information Management System with completed or successful treatment outcomes from January 1, 2005, to December 31, 2021. Data were analyzed from July 15, 2022, to October 28, 2023. Newly diagnosed PTB was classified into primary, hematogenous disseminated, or secondary PTB. The primary outcome was the annual recurrence rate, stratified by disease classification, over the 17-year observation period. The recurrence rate for year n was calculated by dividing the number of patients with recurrent TB in year n by observed person-years in year n. The secondary outcome was the annual proportion of recurrent TB among reported cases and associated risk factors. Of 13 833 249 patients with TB reported to the Tuberculosis Information Management System, 10 482 271 with PTB met the inclusion criteria. Of these, 68.9% were male, 22.3% were 65 years or older, 89.6% were of Han ethnicity, and 68.4% were agricultural workers. A total of 413 936 patients experienced a recurrent TB episode after successful treatment, resulting in an overall recurrence rate of 0.47 (95% CI, 0.47-0.48) per 100 person-years. The recurrence rate for patients with primary PTB was 0.24 (95% CI, 0.22-0.26) per 100 person-years; for hematogenous disseminated PTB, 0.37 (95% CI, 0.36-0.38) per 100 person-years; and for secondary PTB, 0.48 (95% CI, 0.47-0.48) per 100 person-years. The cumulative proportion of recurrences within the first 2 years accounted for 48.9% of all recurrent cases. The proportion of recurrent cases among notified incident cases increased 1.9-fold from 4.7% in 2015 to 8.8% in 2021. Among other factors, ages 45 to 64 years (adjusted hazard ratio, 1.77 [95% CI, 1.65-1.89]) and having completed treatment (adjusted hazard ratio, 1.16 [95% CI, 1.14-1.18]) were identified as associated with recurrence. In this retrospective cohort study, the PTB recurrence rate was substantially higher than the incidence, and the proportion of recurrent cases increased. Almost half of the recurrence occurred within the first 2 years, suggesting that routine posttreatment follow-up may represent an important strategy for accelerating TB elimination.

Enhanced skin cancer diagnosis using optimized CNN architecture and checkpoints for automated dermatological lesion classification

Skin cancer stands as one of the foremost challenges in oncology, with its early detection being crucial for successful treatment outcomes. Traditional diagnostic methods depend on dermatologist expertise, creating a need for more reliable, automated tools. This study explores deep learning, particularly Convolutional Neural Networks (CNNs), to enhance the accuracy and efficiency of skin cancer diagnosis. Leveraging the HAM10000 dataset, a comprehensive collection of dermatoscopic images encompassing a diverse range of skin lesions, this study introduces a sophisticated CNN model tailored for the nuanced task of skin lesion classification. The model’s architecture is intricately designed with multiple convolutional, pooling, and dense layers, aimed at capturing the complex visual features of skin lesions. To address the challenge of class imbalance within the dataset, an innovative data augmentation strategy is employed, ensuring a balanced representation of each lesion category during training. Furthermore, this study introduces a CNN model with optimized layer configuration and data augmentation, significantly boosting diagnostic precision in skin cancer detection. The model’s learning process is optimized using the Adam optimizer, with parameters fine-tuned over 50 epochs and a batch size of 128 to enhance the model’s ability to discern subtle patterns in the image data. A Model Checkpoint callback ensures the preservation of the best model iteration for future use. The proposed model demonstrates an accuracy of 97.78% with a notable precision of 97.9%, recall of 97.9%, and an F2 score of 97.8%, underscoring its potential as a robust tool in the early detection and classification of skin cancer, thereby supporting clinical decision-making and contributing to improved patient outcomes in dermatology.

Enhancing Tuberculosis Care in Madhya Pradesh Through Public-Private Partnerships: An Evaluation of the Patient Provider Support Agency (PPSA) Model

BackgroundThe quality of care that patients receive in the private sector has been reported to be poor. Madhya Pradesh began adopting the PPSA model in September 2020, initially covering 44 districts. By April 2022, the state achieved 100% coverage, becoming the first state in the country to implement PPSA across all 52 districts. Although PPSA is now operational in every district, health indicators in the private sector have shown little improvement, and notifications from the private sector remain significantly below the annual targets The patient provider support agency (PPSA) pilot program has demonstrated newer strategies for private sector engagement to be able to deliver significant outcomes. the study explores the strengths and limitations of the private sector engagement model from the healthcare providers’ perspective MethodsThis was a mixed–methods study in which both quantitative and qualitative data were simultaneously collected. Quantitative data collection (using routinely collected programmatic data) is supported by qualitative data collection (in-depth interviews).This study was conducted to study the impact of the PPSA service implementation model on notification status, patient care activities and outcomes through record review among all 52 districts of Madhya Pradesh between October 2020- December 2022 as well as to explore the strengths and limitations of the PPSA model from the healthcare providers’ perspectives using a mixed-methods approach. ResultThere was a increase in the number of TB patients notified in the private sector (62%), number of patients receiving benefits of the Nikshay Poshan Yojna through Direct Bank Transfer (91%), number of patients tested for Human Immunodeficiency Virus (100%), Diabetes, and universal drug susceptibility testing (25%), as well as successful treatment outcomes in the post-PPSA period as compared to the pre-PPSA period. Seventeen in-depth interviews of health care providers from the public (n=8) and private sector (n=9) highlighted the operational challenges and solutions to implementation of the PPSA. Inadequate Human resource, poor coordination with NTEP Staff, poor mapping of PP’s, mobile based counselling & limited home visit to TB patients were the perceived challenges and regular support to the private health facilities and MIS data, trainings and hand-holding, supportive supervision from the State, and strict need based tendering policies were few of the suggestions to improve the PPSA model were some of the solutions. ConclusionThe implementation of the Patient Provider Support Agency (PPSA) model in Madhya Pradesh has not only improved notification rates and successful treatment outcomes but also strengthened the overall engagement of private healthcare providers in TB management. Enhanced collaboration, regular facility mapping, and sustained educational efforts have led to a more robust approach to TB care that extends across both public and private sectors. While challenges such as funding inconsistencies and service delivery fluctuations highlight areas for further improvement, the overall success of the PPSA model in Madhya Pradesh provides a promising framework for other regions aiming to enhance TB care through public-private partnerships. Future efforts should focus on addressing the identified gaps and scaling up these successful practices to ensure high-quality care for all TB patients, irrespective of where they seek treatment.

Long-term complications and management of dental trauma in the adult patient - Part 2: discoloured, displaced and missing teeth.

The second paper in this two-part review series aims to outline the long-term complications of dental trauma in the adult patient in relation to discoloured, displaced or missing teeth. A brief overview of the cause of discolouration is outlined, followed by assessment and management options. These can include bleaching, veneers, or crown restorations to mask the discolouration. Displacement of teeth from the socket can occur due to luxation injuries. Management can include simple digital manipulation, surgical repositioning, or orthodontic extrusion based on the severity of extrusion and the time from injury. Teeth can be lost early or in the long-term following dental trauma and associated hard and soft tissues deficiencies may also ensue. Replacement options can include a removable partial prosthesis, resin-retained bridge or dental implants. Often, hard and soft tissue augmentation procedures may be required to address any defects and rebuild lost anatomical contours. A thorough assessment followed by the development of a sound management plan which takes patients' general and local factors into account can ensure a predictable and successful treatment outcome. This would end in an aesthetically pleasing and a functionally stable result for the patient.

Drug utilization evaluation of ceftazidime-avibactam in a tertiary care hospital

Background: The World Health Organization considers antimicrobial resistance a major global threat, and ceftazidime-avibactam (CAZ-AVI) is a treatment for multidrug-resistant Gram-negative infections. The FDA approved its use in 2015 for infections with limited treatment options. Methods: A retrospective study was conducted in a hospital in India to analyse the use of CAZ-AVI formulation in patients. Data was collected from electronic records and included information on patient demographics, clinical and microbiological profiles, antibiotic treatment, and patient outcomes for those in the ICU. Results: A total of 110 patients were included in the study. On assessing the results of this study, it was found that, the median age of population who received CAZ-AVI was 63 years and hypertension, diabetes mellitus were the common comorbidities present in the patients. Out of 110 subjects, 66 (60%) patients were started with a high-end antibiotic as an empirical therapy. While analysing the resistance pattern, it was found that 22 (20%) were resistant and 84 (76%) of the study subjects were sensitive to ceftazidime-avibactam. There was higher clinical success for BSI, CUTI, VAP amongst the indications of CAZ-AVI and combination of CAZ-AVI with aztreonam has given the most successful treatment outcome. The combination of CAZ-AVI with one or two high end antibiotics was observed as a common clinical practice. Conclusions: The analysis of results showed encouraging clinical cure rates. Our study results suggest that ceftazidime-avibactam could be an effective standard therapy for managing MDR Gram -negative organisms.

Prevalence and factors associated with successful treatment of hypertension in sub-Saharan Africa: a meta-analysis

Hypertension is a growing public health challenge in sub-Saharan Africa (SSA). However, the evidence on the prevalence and factors associated with successful treatment outcome of hypertension among adults in SSA is scarce and inconsistent. We conducted a systematic review and meta-analysis of observational studies that reported on the prevalence and/or factors associated with successful treatment outcome of hypertension among adults in sub-Saharan Africa. The aim of this study was to provide a comprehensive and updated summary of the evidence on this topic and to identify potential sources of heterogeneity among the studies. We searched databases such as PubMed, Embase, National Institute of Health, CINAHL, and Scopus for studies conducted on the prevalence and factors associated with successful treatment of hypertension in sub-Saharan Africa. We searched for articles published in English from 2014 to 2024. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines was followed. Analysis was done using Meta XL version 5.3. Twenty-four studies were included in the analysis; eighteen were conducted in Ethiopia. The pooled prevalence of uncontrolled hypertension was 54% (95% CI: 0.48-0.60) with a high heterogeneity observed among the studies (I2=97%). Factors associated with treatment outcomes included gender, adherence to medication, obesity, and physical activity. This study revealed that there was a significant association between sex, adherence to medication, physical activity and obesity and hypertension treatment outcome.

Key themes in periodontal treatment: Lessons learned from 40-year experiences.

Periodontitis is one of the most prevalent oral diseases with significant implications for systemic health. This study aims to explore themes influencing successful long-term outcomes in periodontal treatment through a historical lens, focusing on various factors influencing the longevity of periodontal health and dentition stability. Utilizing an inductive qualitative thematic analysis approach, this study utilized a retrospective chart review of 19 patient records spanning, on average, 40 years. Four major themes contributing to periodontal stability were identified: (1) adequate patient plaque control; (2) regular periodontal maintenance; (3) collaboration between hygienists and periodontists; and (4) the application of various periodontist/dentist-performed procedures. Current findings underscore the importance of these factors in preserving patients' periodontal health by emphasizing conservative treatment approaches in the maintenance and retention of the natural dentition. Adequate patient plaque control is essential for maintaining a patient's periodontal health and dentition long-term. A regular periodontal maintenance schedule should be assigned and modified as necessary for each individual patient's care. Collaborative care with hygienist colleagues and ensuring there are flexible treatment options for patients can lead to successful treatment outcomes when hygiene alone is not sufficient. Periodontitis is a widespread oral disease with significant systemic health implications. This study examined patient records to identify factors contributing to long-term periodontal stability and maintenance of teeth. By analyzing 19 patient charts over an average of 40 years using a qualitative approach, four key themes were identified in successful patient treatments: effective patient plaque control, regular periodontal maintenance, collaboration between dental hygienists and periodontists, and the addition of other approaches by periodontists and dentists when necessary. The study underscores the importance of these factors in preserving periodontal health and retaining natural teeth with conservative treatment approaches. This research highlights the critical role of sustained, multifaceted dental care and professional collaboration in achieving successful long-term oral and systemic health outcomes.

O-079 Reflecting on the fertility journey: Insights from couples who discontinued fertility treatment without giving birth

Abstract Study question How can we enhance the experience of individuals pursuing fertility treatment, from the standpoint of those who have faced unsuccessful outcomes in their treatments? Summary answer The current study identified ways to improve couples’ experience by addressing their unmet needs within the context of fertility care. What is known already Couples seeking fertility treatment face many challenges. Previous studies reported that 20% to 30% of couples decide to discontinue treatment before achieving pregnancy. Exploring ways to improve the experience of individuals seeking fertility treatment is therefore important to reduce treatment dropout. Previous studies have addressed the needs of individuals seeking fertility care, particularly in terms of information and psychosocial support. These studies were predominantely quantitative, limiting the exploration of couples’ subjective perspective. The present study addressed this limitation by using a qualitative research design, allowing for the emergence of other unmet needs and a more nuanced description of couples’ experiences. Study design, size, duration Eleven Canadian couples (n = 22 participants) who stopped fertility treatment without giving birth took part in a qualitative study in Quebec, which was approved by the researchers’ institutional review board. Data were collected between December 2022 and August 2023 as part of a larger qualitative study examining the individual and relational experiences of couples who stopped fertility treatment as well as the clinical context that may have contributed to their decision of discontinuing treatment. Participants/materials, setting, methods Couples who experienced at least one unsuccessful fertility treatment cycle and decided to stop without giving birth were eligible to participate. Ten mixed-gender/sex and one same-gender/sex couples participated in a dyadic online semi-structured interview. Participants were aged between 28 and 47 years old. Four couples were childless. Each interview lasted between 40 and 65 minutes. Interviews were transcribed and verbatims were analyzed by two independent coders using the NVivo software through thematic analysis. Main results and the role of chance During the interviews, partners discussed unmet needs and suggested ways in which these needs could be addressed. Eight themes regarding ways to improve the experience of individuals seeking fertility treatment emerged as as result of the thematic analysis. Namely, (1) providing more information to set realistic expectations (e.g., discussing the demands of fertility treatment and the possibility of treatment not working), (2) improving the physical environment within fertility clinics (e.g., providing a room for couples to gather their thoughts after a difficult announcement), (3) enhancing the sensitivity and availability of healthcare professionals (e.g., showing empathy towards the challenges that couples may face), (4) supplying reliable and accessible information that are expressed in simple non-medical terms (e.g., taking the time to explain medical terms and procedures), (5) promoting patient autonomy regarding fertility care (e.g., suggesting treatment options that take their context into account), (6) providing psychological support (e.g., increasing access to mental health professionals), (7) making patient-centered fertility care more accessible (e.g., offering low-cost psychosocial support), and (8) normalizing the experience of infertility and fertility treatment (e.g., encouraging couples to talk about their experience, offering support groups). Limitations, reasons for caution Participants discontinued fertility treatment without giving birth, making them more likely to have had negative experiences in fertility clinics. Individuals undergoing treatment or who have had successful treatment outcomes might have different perspectives. Additionally, couples came from only four fertility clinics in Quebec, Canada, limiting the heterogeneity of the sample. Wider implications of the findings The present study highlighted areas where services for couples undergoing fertility treatment could be enhanced. Findings may help healthcare providers gain a deeper understanding of the needs of their patients, and inform the development of sensible and reliable resources, which might ultimately help reduce treatment discontinuation. Trial registration number not applicable

To assess the effectiveness of Mirabegron in reducing urodynamic detrusor overstimulation in patients with Overactive Bladder Syndrome (OAB).

Objective: To investigate the efficacy of mirabegron in treating overactive bladder by assessing its impact on urodynamic detrusor overactivity (DO). Study Design: Cross-sectional study. Setting: Center for Urology and Transplantation in Sindh. Period: April 6, 2022, to October 4, 2022. Methods: Sixty-four individuals presenting OAB symptoms and without prior OAB medication use were included after obtaining informed consent and conducting relevant medical evaluations. Patients demonstrating signs of detrusor overactivity were evaluated through urodynamic assessments. Collected data, including patient history and study outcomes, were recorded using a standardized Proforma (Annexure I). Patient demographics, age, and gender distribution were documented. Patients with urodynamic detrusor overactivity were administered 50.0 mg mirabegron tablets once daily for a period of 13 weeks. A noteworthy percentage of patients reported substantial success after three months of treatment. Results: The average age of study participants was 50 years. The mean duration of OAB symptoms was 20.22 ± 15.38 months. Of the total 64 patients, 41 were female (64.06%) and 23 were male (34.94%). Notably, successful treatment outcomes were observed in 49 cases (76.56%). Conclusion: Mirabegron emerges as a valuable therapeutic option for individuals dealing with overactive bladder. This study underscores its efficacy in managing OAB sympt0oms, with a notable success rate of 76.6%. These findings contribute to the growing body of evidence supporting mirabegron as an effective treatment for overactive bladder syndrome.