Treatment Centers Research Articles

Variability in addictive and carcinogenic potential of smokeless tobacco products marketed in Mumbai, India: a surveillance study

India has the highest incidence worldwide of smokeless tobacco (SLT)-associated oral cancer, accounting for nearly 70% of all SLT users globally. Nicotine and tobacco-specific N-nitrosamines (TSNA) play critical roles in the addictive and carcinogenic potential, respectively, of SLT products. Our group has previously reported substantial variability in nicotine and TSNA levels across a small SLT product sample in India, calling for systematic surveillance. However, there is no information available on the current levels of these constituents in Indian SLT. We analysed 321 samples representing 57 brands of eight popular types of manufactured SLT products purchased from five local markets in Mumbai, India between August, and September 2019. The sampling locations were Mumbai Central, Kurla, Thane, Vashi, and Airoli. Product pH, moisture content, total and unprotonated (biologically available) nicotine, and TSNA levels were measured at the Advanced Centre for Treatment, Research, and Education in Cancer (ACTREC) in Mumbai. Total nicotine content ranged from 0.45 to 35.1mg/g across products. The unprotonated nicotine fraction contributed 0.1-100% of the total nicotine content. The carcinogenic TSNA levels ranged 0.06-76 ug/g for N'-nitrosonornicotine (NNN), 0.02-19.2 ug/g for 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), and 0.01-6.51 ug/g for 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL). Consistent with our previous study, we observed substantial variations across different brands of the same product type. This is the most extensive and the first within-country study to report brand-specific nicotine and TSNA levels in SLT products marketed in Mumbai, India. Our results show that levels of these constituents remain extremely variable across Indian SLT and are strikingly high in many products. Enhanced public education and continued efforts to reduce SLT use prevalence in India are critical for reducing the global burden of SLT-associated morbidity and mortality. Regulation of nicotine and TSNA levels in SLT products should be considered. This work was supported by the National Institutes of Health (USA) grant R01-TW010651 and, in part, by grants R01-CA180880 and R50-CA211256. The LC-MS/MS analysis was supported in part by XII Plan project funding from the Department of Atomic Energy, Government of India.

Arteriovenous Malformations in Osler-Weber-Rendu Syndrome: Pathophysiology, Clinical Manifestations, and Advances in Management

Osler-Weber-Rendu Syndrome, or Hereditary Hemorrhagic Telangiectasia (HHT), is a rare genetic disorder marked by the development of arteriovenous malformations (AVMs) throughout the body. These abnormal vascular connections bypass the capillary network, leading to significant clinical challenges. This article reviews the pathophysiology, clinical manifestations, and advances in the management of AVMs in HHT. The genetic basis of HHT involves mutations in the ENG, ACVRL1, and SMAD4 genes, which play critical roles in the TGF-β signaling pathway. These mutations result in endothelial dysfunction, contributing to the formation of AVMs. The clinical impact of AVMs is significant, particularly when they occur in the brain, lungs, liver, or gastrointestinal tract, where they can lead to life-threatening complications. This review also explores current diagnostic and management strategies, emphasizing the importance of a multidisciplinary approach. Interventional techniques such as embolization, stereotactic radiosurgery, and microsurgical resection are discussed, alongside emerging therapies like anti-angiogenic drugs and gene therapy. These advancements have led to more personalized and effective treatment plans for patients. As a result, the management of AVMs in HHT has seen significant progress, with a growing emphasis on individualized care. Continued research and the development of specialized treatment centers are crucial for further improving patient outcomes in this complex condition.

Patient and quality characteristics in the treatment with disulfiram (Antabus) in the German "Network for Alcohol Aversive Pharmacotherapy"

More than adecade ago disulfiram lost its approval for use in Germany. Nonetheless, aconsiderable number of psychiatric hospital outpatient departments as well as practicing physicians continue to prescribe it. These professionals have formed the "Network for Alcohol Aversive Pharmacotherapy" (NAP) to maintain a high quality of this treatment approach. To describe the current use of disulfiram with respect to patient numbers and characteristics, side effects, and use of concomitant multimodal treatment forms. Since 2019 the NAP has conducted an annual retrospective survey among its members regarding the aforementioned parameters. From 2019 to 2023 atotal of 1579 treatment cases were described by 33centers, 152 patients reported atotal of 241 drinking events, 26of them resulting in hospitalization but none causing complications or permanent harm. The most frequent side effects, in descending order, were unpleasant body odor (2.5%), fatigue, male sexual dysfunction, mildly elevated liver enzymes, allergic skin reactions and polyneuropathy (0.8%). More than one quarter of the patients suffered from comorbid depression, and approximately 5% from ADHD, borderline or other personality disorders, trauma-related disorders and anxiety disorders, respectively. Of the patients 33% were treated with antidepressants and 12% with sedating antipsychotics. Various forms of concomitant group therapy were offered to 66% of the patients. Treatment with disulfiram is legally possible, generally well-tolerated and safe. It is offered in most treatment centers as part of acomprehensive treatment plan that includes multimodal treatment of comorbid psychiatric disorders.

Delayed global standardization and prefectural disparities in systematic lupus erythematosus treatment in Japan: a nationwide study using the National Database of Health Insurance Claims and Specific Health Checkups of Japan.

To evaluate the status of the global standardization of, and prefectural differences in, systematic lupus erythematosus (SLE) treatments in Japan. The Japanese National Database of Health Insurance Claims and Specific Health Checkups (NDB Japan) was used. A patient with SLE was defined as having a disease with ICD10 code M321 or M329 between April 2019 and March 2020, for which oral corticosteroids (OCS), immunosuppressive agents or biologic agents were prescribed at least once during a given month. SLE treatments were evaluated by treatment center type and prefecture. In total, 74,277 patients met the definition of SLE. The SLE prevalence was 60 per 100,000 (range: 47 - 102 per 100,000 by prefecture). Nationwide, 79.4% of the patients (range: 52.1% - 93.3% by prefecture) visited a specialized treatment center (STC); 37.4% (range: 26.4% - 51.3% by prefecture) received only OCS, with fewer of these patients visiting a STC than a non-STC (34.8% and 49.7%, p<0.001); and 21.4% (range: 10.7% - 35.0%) received HCQ, with more of these patients visiting a STC than a non-STC (23.0% and 13.5%; p<0.001). NDB Japan demonstrated delayed global standardization of, and prefectural disparity in, SLE treatments in Japan.

Optimizing oocyte yield utilizing a machine learning model for dose and trigger decisions, a multi-center, prospective study

The objective of this study was to evaluate clinical outcomes for patients undergoing IVF treatment where an artificial intelligence (AI) platform was utilized by clinicians to help determine the optimal starting dose of FSH and timing of trigger injection. This was a prospective clinical trial with historical control arm. Four physicians from two assisted reproductive technology treatment centers in the United States participated in the study. The treatment arm included patients undergoing autologous IVF cycles between December 2022–April 2023 where the physician use AI to help select starting dose of follicle stimulating hormone (FSH) and trigger injection timing (N = 291). The control arm included historical patients treated where the same doctor did not use AI between September 2021 and September 2022. The main outcome measures were total FSH used and average number of mature metaphase II (MII) oocytes. There was a non-significant trend towards improved patient outcomes and a reduction in FSH with physician use of AI. Overall, the average number of MIIs in the treatment vs. control arm was 12.20 vs 11.24 (improvement = 0.96, p = 0.16). The average number of oocytes retrieved in the treatment vs. control arm was 16.01 vs 14.54 (improvement = 1.47, p = 0.08). The average total FSH in the treatment arm was 3671.95 IUs and the average in the control arm was 3846.29 IUs (difference = −174.35 IUs, p = 0.13). These results suggests that AI can safely assist in refining the starting dose of FSH while narrowing down the timing of the trigger injection during ovarian stimulation, benefiting the patient in optimizing the count of MII oocytes retrieved.

The Effects of Psychopathy Facets on Treatment Involvement.

The current study explored the relations between patient characteristics and psychopathic traits in predicting treatment involvement. We rated treatment involvement using detailed archival clinical files of 218 individuals committed to the Massachusetts Treatment Center (MTC). Psychopathy Checklist-Revised (PCL-R) scores had been rated from a previous study on the same sample. Overall, PCL-R Facets 2 and 4 significantly predicted decreases in treatment involvement, suggesting the characteristics associated with these facets have the most disruptive effects on treatment involvement. Exploratory analyses were also conducted assessing the relations between the PCL-R facets and the individual treatment involvement components. Whereas Facet 2 significantly predicted lower levels in all three individual treatment involvement components, Facet 4 only significantly predicted lower levels in two, highlighting the differentiating effects of these facets. Identifying the components that have either positive or negative effects on treatment involvement can allow clinicians to tailor treatments to optimize treatment involvement and outcome.

Demographic characteristics and clinical features of patients presenting with different forms of cutaneous leishmaniasis, in Lay Gayint, Northern Ethiopia.

Cutaneous leishmaniasis (CL) is a neglected tropical disease caused by Leishmania parasites, that can cause long-term chronic disabilities. The clinical presentation of CL varies in both type and severity. CL presents as three main clinical forms: localised lesions (localised cutaneous leishmaniasis, LCL); mucocutaneous leishmaniasis (MCL) that affects the mucosa of the nose or the mouth; or as disseminated not ulcerating nodules (diffuse cutaneous leishmaniasis, DCL). Here we recruited a cohort of CL patients in a newly established leishmaniasis treatment centre (LTC) in Lay Gayint, Northwest Ethiopia, and collected detailed demographic and clinical data. The results of our study show that more males than females present to the LTC to seek diagnosis and treatment. 70.2% of CL patients presented with LCL and 20.8% with MCL. A small number of patients presented with DCL, recidivans CL (a rare form of CL where new lesions appear on the edges of CL scars) or with a combination of different clinical presentations. The duration of illness varied from 1 month to 180 months. Over a third of CL patients had additional suspected CL cases in their household. Despite the majority of CL patients having heard about CL, only a minority knew about its transmission or that it could be treated. Most CL patients lived in areas where environmental factors known to be associated with the transmission of CL were present. This work highlights that CL is an important public health problem in Lay Gayint and emphasises the urgent need for more CL awareness campaigns, better health education and better disease management practices.

Anaplastic thyroid cancer: A review of recent evidence and summary of an Australian institutional protocol.

Anaplastic thyroid cancer (ATC), a rare and highly aggressive malignancy, is characterized by an exceptionally poor prognosis, where the majority of patients present with extensive local invasion and/or distant metastases. 20-30% of ATCs harbor the BRAF-V600E mutation. Neoadjuvant BRAF-targeted therapy may have the potential to downstage and facilitate surgical resection for patients with locally advanced and unresectable primary tumors with BRAF mutation and may convey a survival advantage in those with metastatic disease. There is emerging evidence to support the use of other targeted agents, including multikinase inhibitors, as well as the incorporation of immunotherapy into the treatment regimen. Rapid molecular and pathological diagnosis and expert multidisciplinary discussion at specialized treatment centers are critical to expedite investigations and initiate treatment for this complex and rapidly progressive disease.

Integrative therapeutics for ocular surface disorders.

Integrative medicine techniques are increasingly accepted into the treatment paradigm for many chronic disorders including eye disease. Over 71% of patients, including 67% of those with eye disorders, use some form of Integrative therapy. Physicians should be well versed in evidence-based therapies to know how to refer patients for the best complimentary care. We highlight the most effective integrative therapeutics from different complementary treatment paradigms to offer a framework for approaching therapy in patients with ocular surface disorders (OSDs). Lifestyle and behavioral modifications help a proportion of people with OSDs like dry eye disease and allergic conjunctivitis, which are interrelated disorders. Nutrition and supplementation can also play a role in addressing underlying inflammation and improving OSD symptoms. Acupuncture and traditional herbal medicine may also benefit some patients. New technologies offer innovative treatment pathways in the treatment of OSD but require referral to Ocular Surface Treatment Centers. Integrative treatment approach for OSD incorporates allopathic medicine, traditional remedies and lifestyle behavioral interventions, Ayurveda and herbal medicine, Nutritional Supplements, Homeopathy, Acupuncture and Chinese Medicine. New cutting-edge technologies offer breakthroughs in difficult to treat ocular surface cases. Collaboration between allergy or otolaryngology offices, complementary practitioners, as well as optometrists and ophthalmologists in Ocular Surface Treatment Centers can offer patients new avenues of treatment.

HIV viral suppression in the era of dolutegravir use: Findings from a national survey in Tanzania.

Tanzania has made significant progress in improving access to HIV care and treatment. However, virologic suppression among people living with HIV (PLHIV) has not been fully realized. In March 2019, Tanzania introduced a World Health Organization (WHO)-recommended dolutegravir-based regimen as the default first-line regimen. Eighteen months later we investigated the HIV viral suppression rates and the factors associated with lack of viral suppression among PLHIV (children and adults) in Tanzania. A cross-sectional survey was conducted from September to December 2020 among PLHIV on antiretroviral therapy (ART) in Tanzania. Whole blood samples, demographic data and clinical information were obtained from eligible adults (≥15 years) and children (< 15 years) attending thirty-six HIV care and treatment centres located in 22 regions of Tanzania mainland. A whole blood sample from each participant was processed into plasma and HIV viral load was estimated using real-time PCR. HIV viral suppression was defined at a cut-off of < 50 copies/mL as recommended by WHO. Analyses were conducted using descriptive statistics to establish the national representative prevalence of viral suppression, and logistic regression analyses to determine independent factors associated with non-suppression. A total of 2,039 PLHIV on ART were recruited; of these, adults and children were 57.5% (n = 1173) and 42.5% (n = 866), respectively. Among the adult population, the mean age and standard deviation (SD) was 42.1 ± 12.4 years, with 64.7% being female. Among children, the mean age and SD were 9.6 ± 3 years, and 53.2% were female. Overall viral suppression at < 50 copies/mL (undetectable) was achieved in 87.8% of adults and 74.4% of children. Adults and children on dolutegravir-based regimen recorded viral suppression rates of 89.7% and 85.1% respectively. Factors independently associated with lack of viral suppression status in the adult population were age and ART adherence while in the children population, the factors were sex, ART adherence, and current ART regimen (p<0.05). Dolutegravir-based regimens are promising to help attain epidemic control in Tanzania. More efforts especially on ART adherence are needed to attain optimal treatment outcomes for children and adults PLHIV in Tanzania.

Surface guided ring gantry radiotherapy in deep inspiration breath hold for breast cancer patients.

This study investigated the use of surface guided radiotherapy (SGRT) in combination with a tomotherapy treatment mode using discrete delivery angles for deep inspiration breath hold (DIBH) treatments of breast cancer (bc). We aimed to assess the feasibility and dosimetric advantages of this approach. We evaluated camera occlusion in the Radixact treatment system bore and the stability of DIBH signals during couch movement. The SGRT system's ability to maintain signal and surface image accuracy was analyzed at different depths within the bore. Dosimetric parameters were compared and measured for 20 left-sided bc patients receiving TomoDirect (TD) tangential radiotherapy in both DIBH and free breathing (FB). The SGRT system maintained surface coverage and precise DIBH-signal at depths up to 40cm beyond the treatment center. Camera occlusion occurred in the clavicular and neck regions due to the patient's morphology and gantry geometry. Nonetheless, the system accurately detected respiratory motion for all measurements. The DIBH plans significantly (p<0.001) reduced mean heart and left anterior descending artery (LAD) radiation doses by up to 40%, with a 50% reduction in near-maximum heart and LAD doses, respectively. No significant dosimetric differences between DIBH and FB were observed in other investigated parameters and volumes. Camera occlusion and couch movement minimally impacted the real-time surface image accuracy needed for DIBH treatments of bc. DIBH reduced heart and LAD radiation doses significantly compared to FB, indicating the feasibility and dosimetric benefits of combining these modalities.

Evolution of Movement Disorders in Patients With CLN2-Batten Disease Treated With Enzyme Replacement Therapy.

Neuronal ceroid lipofuscinosis type 2 (CLN2-disease) is an inherited childhood-onset neurodegenerative condition, with classical early features of speech delay, epilepsy, myoclonus, ataxia, and motor regression. This study aimed to better characterize the spectrum of movement disorders in CLN2-disease in a cohort of children receiving enzyme replacement therapy (ERT). A cohort of 18 children attending a single center for treatment with cerliponase alfa ERT was systematically assessed using a standardized structured history and a double-scored, video-recorded examination using the Unified Batten Disease Rating Scale (UBDRS) and Abnormal Involuntary Movement Scale. Noncanonical movement disorders are common: while ataxia (89%) and myoclonus (83%) were near-universal, spasticity and dystonia were experienced by over half (61% each), with children having a median of 4 distinct movement disorder phenotypes. This progression was stereotyped with initial ataxia/myoclonus, then hyperkinesia/spasticity, and later hypokinesia. ERT slows progression of movement disorders, as measured by the UBDRS physical subscale, with 1.45 points-per-month progression before diagnosis and 0.44 points-per-month while on treatment (p = 0.019). Movement disorders are a core feature of CLN2-disease and follow a typical pattern of progression which is slowed by ERT. Identifying and treating movement disorders should become standard, especially given increased patient survival.

Development and pilot implementation of a novel protocol to assess capacity and readiness of health systems to adopt HPV detection-based cervical cancer screening in Europe

BackgroundCervical cancer remains a significant public health concern in Europe. Effective introduction and scaling up of human papillomavirus (HPV) detection-based cervical cancer screening (CCS) requires a systematic assessment of health systems capacity. However, there is no validated capacity assessment methodology for CCS programmes, especially in European contexts. Addressing this gap, our study introduces an innovative and adaptable protocol for evaluating the capacity of CCS programmes across varying European health system settings.MethodsOur research team developed a three-step capacity assessment framework, incorporating a health policy review checklist, a facility visit survey, and key informants’ interview guide followed by a strengths, weaknesses, opportunities and threats (SWOT) analysis. Piloting this comprehensive approach, we explored the CCS capacity in three countries: Estonia, Portugal and Romania. These countries were selected due to their contrasting healthcare structures and resources, providing a diverse overview of the European context.ResultsConducted over a period of 9 months, the capacity assessment covered multiple resources, 27 screening centres, 16 colposcopy and treatment centres and 15 key informant interviews. Our analysis highlighted both shared and country-specific challenges. A key common issue was ensuring high compliance to follow-up and management of screen-positive women. We identified considerable heterogeneity in resources and organization across the three countries, underscoring the need for tailored, rather than one-size-fits-all, solutions.ConclusionsOur study’s novelty lies in the successful development of this capacity assessment methodology implementable within a relatively short time frame, proving its feasibility for use in various contexts and countries. The resulting set of materials, adaptable to different cancer types, is a ready-to-use toolkit to improve cancer screening processes and outcomes. This research marks a significant stride towards comprehensive capacity assessment for CCS programmes in Europe. Future directions include deploying these tools in other countries and cancer types, thereby contributing to the global fight against cancer.

Predictors of Poor Adherence to Antiretroviral Treatment among HIV Positive Patients at Tamale West Hospital, Ghana

Background: Adherence to Antiretroviral therapy is necessary to reduce the viral load of people diagnosed with HIV and help boost the persons’ immunity against opportunistic infections due to the virus. Therefore, this study aimed to assess the level of adherence to ART and its associated factors among HIV clients at the Tamale west hospital. Methods: The current study employed a descriptive study design, and sampled a total of 104 clients receiving ART in the Tamale West Hospital in the Northern Region of Ghana. Results: The results showed that weekly adherence was 94.2%, monthly adherence (76%), quarterly adherence (71%), half yearly adherence (51.9%) and only 33.7% have religiously adhered to ART medication from the initiation of their treatment. The treatment profile of the clients revealed that the majority of them (44.7%) had been receiving antiretroviral therapy (ART) for a duration of 5 years. Additionally, 25.2% had been on ART for 1 year, while 22.3% had been on the treatment for a period ranging from 6 to 10 years. Educational level [(CI: -0.101, 0.001), p&lt;0.052], forgetfulness [(CI: 0.186, 0.581), p&lt;0.001], side effects [(CI: 0.072, 0.400), p&lt;0.005], education on medication [(CI: 0.015, 0.540), p&lt;0.038], confidentiality of services [(CI: 0.012, 0.543), p&lt;0.041], and cost of transportation to treatment centre [(CI: 0.006, 0.167), p&lt;0.035] were significantly associated with treatment adherence to ART among the clients. Conclusions: The adherence rate as determined in the current study did not meet the expected target set by the Ghana National AIDS control programme. A continuous friendly ART services and an intervention to cater for the transport cost of clients would have helped improve adherence among the study clients.

Which Position for Novice Surgeons? Effect of Supine and Prone Positions on Percutaneous Nephrolithotomy Learning Curve.

Background and Objectives: Percutaneous nephrolithotomy (PCNL) is a current treatment method with high success rates and low complication rates in treating large kidney stones. It can be conducted in different positions, especially supine and prone positions. PCNL in the supine position is becoming increasingly common due to its advantages, such as simultaneous retrograde intervention and better anesthesia management. This study aimed to assess how the choice of position impacts the PCNL learning curve. Materials and Methods: The results of the first 50 consecutive PCNL cases performed by two separate chief residents as primary surgeons in supine and prone positions in a reference center for stone treatment between August 2021 and January 2023 were evaluated. The two groups' demographic and clinical data, stone-free rates, operation times, and fluoroscopy times were compared. Results: While the mean operation time was 94.6 ± 9.8 min in the supine PCNL group, it was 129.9 ± 20.3 min in the prone PCNL group (p < 0.001). Median fluoroscopy times in the supine PCNL and prone PCNL groups were 31 (10-89) seconds and 48 (23-156) seconds, respectively (p = 0.001). During the operation, the plateau was reached after the 10th case in the supine PCNL group, while it was reached after the 40th case in the prone PCNL group. Conclusions: For surgeons who are novices in performing PCNL, supine PCNL may offer both better results and a faster learning curve. Prospective and randomized studies can provide more robust conclusions on this subject.

An Overview of the Management of Drug-Resistant Tuberculosis in Six French-Speaking African Countries from 2018 to 2022.

Drug-resistant tuberculosis (DR-TB) poses a significant public health challenge, particularly in resource-limited settings. The prevalence and management of DR-TB in African countries require comprehensive strategies to improve patient outcomes and control the spread of the disease. Aggregated routine data (from 2018 to 2022) on multidrug-resistant TB (MDR-TB) were collected from the National TB Programs (NTPs) from all six countries. The diagnostic capacity for MDR-TB was globally insufficient. The system for collecting and transporting samples was sometimes inoperative. A total of 2353 cases of MDR-TB were reported, with 86.4% receiving treatment. The gap between the expected number of MDR-TB cases and the number reported per country varied from 51.5% to 88.0%, depending on the year. Fifty-two extensively drug-resistant (XDR) TB cases received treatment regimens over five years, with variations across countries. All patients received free follow-up examinations, nutritional and financial support for travel expenses to the outpatient care and treatment centers. The MDR-TB treatment success rates for all regimens between 2018 and 2021 ranged from 44.4 to 90.9%, varying by country and year. The information system relied on primary tools, reporting tools, and digital solutions. Progress has been made in MDR-TB management; however, challenges persist, necessitating resources to enhance access to rapid molecular screening tests.

Wilson's disease in Sardinian population: The experience of a pediatric referral center.

Wilson's disease (WD) in children and adolescents is predominantly asymptomatic or oligo-symptomatic. The symptoms are nonspecific and difficult to distinguish from other hepatic or neuropsychiatric disorders. In this study, we present the experience of a pediatric referral center for WD diagnosis and treatment. We retrospectively analyzed clinical and laboratory data from 99 patients with WD of Sardinian origin, including physical examination, laboratory biochemical testing, liver biopsy, and genetic analysis. Patients were prevalently oligo-symptomatic or asymptomatic. The median age of diagnosis was 8.78 years. Ceruloplasmin values were lower than normal values in all analyzed patients. Twenty-four-hour urinary copper levels were higher than 40 μg/24-h in 92/96 patients. In all analyzed patients with the exception of one, liver copper was higher than 250 μg/g of dry weight but all had >75 μg/g of dry weight. Statistical analysis showed correlation between the age at diagnosis, serum copper, and 24-h urinary copper. Correlation was also found between serum copper and 24-h urinary copper. Molecular analysis of ATP7B gene allowed complete characterization in all the analyzed patients. A high index of clinical suspicion and biochemical tests including liver tests, serum ceruloplasmin, and basal 24-h urinary copper excretion and genotype determination are key to WD diagnosis. The long experience that a referral center for WD possesses is an important factor in making WD diagnosis a more accurate process. Studies in animal models on WD could be used as a guide to further investigate the molecular mechanisms that regulate copper metabolism and influence the natural history of WD.

TeleCleft: Development and Evaluation of a Mobile Application for Monitoring Cleft Patients.

Development and evaluation of a mobile application for remote monitoring and guidance of pediatric patients diagnosed with cleft lip and/or palate (CL ± P) and their caregivers. This is a pilot cross-sectional, applied, and quantitative study. The study was conducted in two tertiary care treatment centers in Brazil. The participants included 20 caregivers and infants undergoing treatment with nasoalveolar molding (NAM) for CL ± P. The intervention involved using the TeleCleft mobile application for remote monitoring and guidance of caregivers and infants during NAM treatment. The main outcome measures included usability and satisfaction of users with the TeleCleft application. The results showed high usability and satisfaction ratings among users of the TeleCleft application. Most participants found remote monitoring to be effective and expressed positive opinions about its convenience and usefulness. TeleCleft could be a viable tool for remote monitoring and guidance, reducing the need for patients and caregivers to travel to treatment centers, which could potentially alleviate the burden of care faced by families during the journey of CL ± P treatment.

Cost of hemophilia A in Brazil: a microcosting study

BackgroundPatients with Hemophilia are continually monitored at treatment centers to avoid and control bleeding episodes. This study estimated the direct and indirect costs per patient with hemophilia A in Brazil and evaluated the cost variability across different age groups.MethodsA prospective observational research was conducted with retrospective data collection of patients assisted at three referral blood centers in Brazil. Time-driven Activity-based Costing method was used to analyze direct costs, while indirect costs were estimated based on interviews with family and caregivers. Cost per patient was analyzed according to age categories, stratified into 3 groups (0–11;12–18 or older than 19 years old). The non-parametric Mann-Whitney test was used to confirm the differences in costs across groups.ResultsData from 140 hemophilia A patients were analyzed; 53 were 0–11 years, 29 were 12–18 years, and the remaining were older than 19 years. The median cost per patient per year was R$450,831 (IQR R$219,842; R$785,149; $174,566), being possible to confirm age as a cost driver: older patients had higher costs than younger’s (p = 0.001; median cost: 0–11 yrs R$299,320; 12–18 yrs R$521,936; ≥19 yrs R$718,969).ConclusionThis study is innovative in providing cost information for hemophilia A using a microcosting technique. The variation in costs across patient age groups can sustain more accurate health policies driven to increase access to cutting-edge technologies and reduce the burden of the disease.

The Incidence and Influencing Factors of Sleep Disorders in Cyber Knife Patients during Treatment.

This study first analyzes the incidence and influencing factors of sleep disorders in Cyber Knife patients during treatment, in order to provide more accurate strategies for clinical prevention, early diagnosis, and treatment. A total of 101 patients who underwent Cyber Knife treatment at Tumor Diagnosis and Treatment Center, Huashan Hospital Affiliated to Fudan University from April 2022 to April 2023 were selected as the research objects. The Pittsburgh Sleep Quality Index (PSQI) was used for evaluation. Patients with PSQI ≥8 points were included in the occurrence group, and patients with PSQI <8 points were included in the non-occurrence group. The general sociological and disease-related characteristics of the patients, such as education, chemotherapy or targeted therapy, somatic symptoms and other features were collected. χ2 test was performed first to determine the difference between two groups, and Logistic regression analysis was used to identify the predictors of sleep disorders in Cyber Knife patients. A total of 101 Cyber Knife patients were included in this study, of which 43 patients (42.58%) without sleep disorders were included in the non-occurrence group. There were 22 cases (21.78%) of mild disorder, 22 cases (21.78%) of moderate disorder, and 14 cases (13.86%) of severe disorder, all of which were included in the occurrence group. There were significant differences in education level (primary and junior high schools: 32 (55.17%) vs. 15 (34.88%) patients, p = 0.043), family monthly income (≤5000 CNY (1 USD = 6.48 CNY): 36 (62.07%) vs. 15 (34.88%) patients, p = 0.007), somatic symptoms (35 (60.34%) vs. 17 (39.53%) patients, p = 0.038), self-rating anxiety scale (SAS) (>50: 32 (55.17%) vs. 15 (34.88%) patients, p = 0.043), self-rating depression scale (SDS) (>53: 35 (60.34%) vs. 18 (41.86%) patients, p = 0.038), numerical rating scale (NRS) (>3: 30 (51.72%) vs. 13 (30.23%) patients, p = 0.031) between the group of occurrence and no occurrence group. Education level (odds ratio (OR) = 2.845, p = 0.038), somatic symptoms (OR = 2.666, p = 0.048), SAS (OR = 2.889, p = 0.042), SDS (OR = 2.928, p = 0.027) and NRS (OR = 2.981, p = 0.025) had a statistically significant effect on sleep disorders in Cyber Knife patients. Cyber Knife patients are prone to sleep disorders during treatment. It is necessary to pay more attention to and take measures to reduce the occurrence of sleep disorders in clinical practice.