Commencement Of Treatment Research Articles

‘Dry’ Pericarditis with Rapid Progression to Tamponade as a Feature of COVID-19

Pericardial inflammation is a recognised feature of coronavirus disease (COVID-19). The authors herein present the case of a female with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection who developed a large and life-threatening pericardial effusion over a few days following the onset of pericarditis, despite prompt commencement of treatment. This was successfully drained, and she was discharged in stable condition on oral nonsteroidal anti-inflammatory drugs and colchicine.At 6-week follow-up she had made a full recovery, and repeat echocardiography demonstrated no recurrence of effusion or evidence of constrictive physiology.

A Discussion on Blood Vessel Thromboembolism

Blood vessel thromboembolism is a perceived inconvenience of fundamental heparin treatment. Normal for the element is blood vessel impediment by platelet-fibrin thrombi with distal ischemia happening four to twenty days after the commencement of heparin treatment, gone before by significant thrombocytopenia with platelet includes in the scope of 30,000 to 40,000 for every cubic millimetre. The clinically evident impediment might be gone before by gastrointestinal and musculoskeletal side effects that give off an impression of being ischemic in root, and may serve to caution the clinician of these entanglements. Past reports of these marvels just as late investigations of the impact of heparin are explored. The normal factor relating thromboembolism and thrombocytopenia is heparin-prompted platelet accumulation. Proper treatment comprises of suspension of heparin, and anticoagulation with sodium warfarin if essential. Vascular strategies are preceded as demonstrated.

Prevalence and predictors of ocular complications among children undergoing nephrotic syndrome treatment in a resource-limited setting

BackgroundNephrotic syndrome is the most common glomerulopathy among children aged 2–18 years and high dose corticosteroids are the backbone of its management. Potentially blinding ocular complications often result from nephrotic syndrome and/or its treatment. We conducted a study to determine the prevalence and predictors of ocular complications among children undergoing nephrotic syndrome treatment at Mulago National Referral Hospital.MethodsThis was a cross-sectional study conducted for three [3] months at the pediatric renal unit of Mulago National Referral Hospital (MNRH). Data from a consecutive sample of 100 children was collected using a semi-structured questionnaire, entered into Epi-data 4.4.2 and exported to STATA 14 for analysis at univariate, bivariate and multivariate levels. A robust Poisson regression model was used to identify predictors of ocular complications.ResultsOut of 100 patients examined, 80(80%) had ocular complications. The median age was 10 (IQR: 7–12) and 52 (52%) were girls. The most frequent complications were hypertrichosis and refractive errors in 71% (95%CI 61.1–79.6) and 56% (95%CI 45.7–65.9) of the patients respectively. Age above 10 years was the predictor for ocular complications with a RR = 1.37 (95%CI:1.14–1.64) p = 0.001.ConclusionsWe found a high prevalence of ocular complications among children with nephrotic syndrome in this tertiary hospital. The predictor of ocular complications was age greater than 10 years. We recommend that all children with nephrotic syndrome undergo a baseline ocular examination prior to commencement of treatment and be reviewed periodically by an ophthalmologist.

Multivariate prediction of mixed, multilevel, sequential outcomes arising from in vitro fertilisation

In vitro fertilisation (IVF) comprises a sequence of interventions concerned with the creation and culture of embryos which are then transferred to the patient’s uterus. While the clinically important endpoint is birth, the responses to each stage of treatment contain additional information about the reasons for success or failure. As such, the ability to predict not only the overall outcome of the cycle, but also the stage-specific responses, can be useful. This could be done by developing separate models for each response variable, but recent work has suggested that it may be advantageous to use a multivariate approach to model all outcomes simultaneously. Here, joint analysis of the sequential responses is complicated by mixed outcome types defined at two levels (patient and embryo). A further consideration is whether and how to incorporate information about the response at each stage in models for subsequent stages. We develop a case study using routinely collected data from a large reproductive medicine unit in order to investigate the feasibility and potential utility of multivariate prediction in IVF. We consider two possible scenarios. In the first, stage-specific responses are to be predicted prior to treatment commencement. In the second, responses are predicted dynamically, using the outcomes of previous stages as predictors. In both scenarios, we fail to observe benefits of joint modelling approaches compared to fitting separate regression models for each response variable.

OESTRUS SYNCHRONIZATION, ARTIFICIAL INSEMINATION AND EARLY REBREEDING IN YANKASA SHEEP

COMPONENTS of an intensive sheep production system including oestrus synchronization, artificial insemination and early rebreeding were investigated in two trials with Yankasa sheep. Treatment of ewes with progrestagen pessaries for 12 days resulted in good synchronization of first and second post-treatment oestrus. In Trial I, (January–February, 1982) 33 ewes were treated, of which 81.8% showed oestrus within 4 days after the end of progrestagen treatment while 72.7% showed a second oestrus within 21 days. In Trial II, (August – September, 1982), 48 eyes were treated, of which 87.5 and 77.1% showed first and second oestrus respectively over the same periods as in Trial I. Mean interval (± s.e.m) between first and second induced oestrus in both trials was 16.4 ±0.1 days (n = 61). About 90% of ewes exhibiting oestrus were detected 2 to 4 and 17 to 20 days after progrestagen treatment for first and second oestrus respectively. Lambing reates of ewes to artificial insemination or natural mating at the second induced oestrus in Trial I were 50.0 and 91.7% respectively, Corresponding lambing rates in Trial II were 65.0 and 86.70%. Rebreeding interval in ewes which lambed in Trial I was 59.1 ±0.8 days following commencement of progestagen treatment approximately one month after lambing. Lambing rate in this group was 78.6%.

Acquired platelet dysfunction in newly diagnosed myeloma.

This is a case of an unexpected and dramatic bleeding complication in a patient post‐bone marrow biopsy performed for investigation of an IgA paraprotein with the results confirming multiple myeloma. Subsequent investigations were suggestive of an acquired platelet disorder indicated by abnormal platelet light aggregometry readings. It was observed that the impaired platelet aggregation corrected on reduction of the paraprotein load following commencement of antimyeloma treatment and plasma exchange. This case is of significant clinical relevance as it highlights a risk factor for serious complication in patients undergoing procedures in those with untreated plasma cell dyscrasias.

Clinical course and prognosis of patients with lung cancer who develop anticancer therapy-related pneumonitis.

Pneumonitis can be triggered by anti-cancer therapies: cytotoxic chemotherapy, tyrosine kinase inhibitors, and immune checkpoint inhibitors. There are few treatment options for patients who develop such pneumonitis and their treatment including chemotherapy is generally difficult thus would limit patient's prognosis. In this study, we investigated the clinical course of patients with lung cancer who developed anti-cancer therapy-related pneumonitis. We retrospectively examined data of patients who had developed pneumonitis triggered by anti-cancer agents and required hospitalization from January 2014 to March 2019 and analyzed their subsequent clinical course and prognosis. The median age of the 58 study patients was 68years and 82.8% were men. The median interval between first receiving the responsible agent and drug-induced pneumonitis was 7.4weeks. Approximately 38% of patients were subsequently able to receive some anti-cancer therapy. The median post-pneumonitis overall survival (OS) from commencement of anti-cancer treatment was 13.2months. No significant differences were found in survival time between treatment agents. However, patients who received some anticancer therapy after pneumonitis had significantly longer survival times than those did not (HR = 4.11, p = 0.0003) and patients who took longer to develop pneumonitis had a longer survival (HR = 2.28, p = 0.0148). Multivariate analysis revealed that short interval to onset and no post-pneumonitis anticancer therapy were independent predictors of short survival. Although patients who developed pneumonitis had relatively short survival times, the interval between initial therapy and pneumonitis had survival impact. Survival can be prolonged by administering further cancer treatment after resolution of pneumonitis.

Malaria Diagnosis and Treatment: Perception of Community Pharmacists in Abuja Metropolis, Nigeria

Malaria is a life threatening infectious disease that constitutes a major global public health and economic concern. Consequently, the WHO has recommended a T3 initiative (Test, Treat & Track) to help curb the scourge globally. This study aimed to ascertain the efficacy of malaria diagnosis in malaria case management and perception of community pharmacists on the WHO recommended standard of parasitological diagnosis before commencement of treatment within Abuja metropolis. A descriptive cross sectional study was performed amongst 207 community pharmacists within Abuja Metropolis. Data was obtained through structured, self-administered questionnaire. The association of respondent characteristics with the awareness, practice, and perception of malaria testing, and treatment was evaluated by Chi-square analysis for proportion. Where the number of categories was less than five, Fisher exact test was used. Seventy-two percent (72.9%) were aware of the WHO recommended T3 initiative on malaria case management. However, less than 10% of respondents had training in all the three components. On practice, 28.5% of community pharmacists carry out malaria diagnosis with a confirmatory test before instituting treatment. Ninety-two percent (92.3%) treat malaria based on clinical signs and symptoms only. Despite the high rate of clinical diagnosis, a majority (84.1%) agreed that the confirmatory test is more effective and efficient in malaria case management than clinical diagnosis. Most respondents (60.4%) reported that the confirmatory test most readily available was mRDT. Eighty-seven percent (87%) have good perception on parasitological confirmatory testing for malaria diagnosis and most respondents have confidence in results from the malaria confirmatory test while 68.6% trust their malaria confirmatory test skill. A little above half (52.7%) of the respondents treat for malaria regardless of negative confirmatory test results when the patient insists on treatment. A higher proportion (39%) of male community Pharmacists compared to females carry out malaria diagnosis with a confirmatory test before treatment. There was significant association of perception on the efficacy of a parasitological confirmatory test for malaria with age and work experience and there was significant association of work experience with the practice of confirmatory testing before treatment (P<0.05). Inferentially, this is call to action for government, professional bodies in the health sector and all committed to fight the scourge of malaria for more awareness to the general public on importance of the WHO T3 and capacity strengthening for the frontline health workers – community pharmacy attending to community needs on malaria case management.

Tetanus: the clinical features of 11 cases

Tetanus is an infectious disease induced by wound invasion of Clostridium tetani, which is ubiquitous among soil. Many more cases are reported in Japan than in other developed countries. In this study, we report 11 cases of tetanus experienced at our hospital and discuss the preceding trauma and treatment course. The mean age at onset was 68 years old (35-86 years) and 7 cases required intensive care. Some preceded injuries were clearly contaminated, and others were small and minor. Even minor injuries developed serious tetanus. Trauma was not identified in 2 cases yet both used their family garden every day and had a high risk of exposure to C tetani, suggesting that micro-wounds may have been a gateway to entry. The average length of stay in the intensive care unit was 28 days (4-73 days) and average total hospitalization was 55 days (13-114 days). Only 4 out of 11 cases were diagnosed correctly by the initial physician and others, especially when the trauma was minor or absent, were misdiagnosed even when presenting with characteristic symptoms like lockjaw and posterior neck stiffness. Tetanus should be diagnosed based on medical history and physical examination due to lack of high specific testing. Therefore, a detailed history taking is required, including hobbies in addition to the appropriate neurological examination, thereby facilitating a quick diagnosis and commencement of treatment as soon as possible.

Pathogenetic approaches in the prevention of surgical infections and treatment of gunshot wounds

We performed experimental studies on 50 rabbits, where morphologically using the electron microscopy, we studied the changes in the tissues and lymphatic bed with a gunshot injury. The experimental results showed that the lymphatic system undergoes a significant restructuring after a gunshot wound, and the regional lymph stimulation contributes to a significant acceleration of the wound healing process by the 3rd day after the commencement of treatment.

Accuracy of predicted versus achieved aligner treatment outcome of a complex case using digital heatmaps

Abstract A female patient, aged 15 years and 4 months at the commencement of treatment, presented with a mild Class III malocclusion, an anterior open bite and crowded, lingually collapsed arches. Non-surgical treatment was undertaken utilising the extraction of a lower incisor and clear aligners to control the vertical dimension, extrude the incisors and resolve the crowding. The case was completed in 21 months. Favourable occlusal and facial/aesthetic outcomes were obtained. A unique feature of this case report was that digital files of the prescribed and achieved outcomes were available for superimposition, and so it was possible to demonstrate the level to which the clinical outcome matched the virtual prescribed plan designated in the ClinCheck® software.

A case report of granulomatosis with polyangiitis (GPA) – A rare presentation of strawberry gingiva to dentists and oral and maxillofacial surgeons

We present a case of isolated strawberry gingivitis without systemic involvement in an otherwise healthy young male.Early recognition and biopsy allowed for successful management of the lesion and initiation of systemic therapy for the Granulomatosis with polyangiitis (GPA), with no recognised end-organ damage.The key learning points include having a low threshold for biopsy and early referral to an oral and maxillofacial surgeon with a view to prompt assessment and commencement of treatment with planned long term follow up.

Comparison of efficacy of extracorporeal magnetic innervation and Kegel exercises for stress urinary incontinence in adult women: study protocol for a randomized controlled trial.

Stress urinary incontinence (SUI) is defined as a complaint of inadvertent loss of urine occurring as a result of an increase in intraabdominal pressure. Strong evidence supports the use of pelvic floor muscle training (PFMT) as the first-line conservative treatment for SUI. Extracorporeal magnetic stimulation (EMS) is a non-invasive, effective, acceptable, and safe therapeutic modality for SUI. Although PFMT and EMS share most of their influences on the pathophysiology of SUI, it is unclear whether one of these routinely used treatment modalities is superior to another in terms of improvement of clinical outcomes or cost-effectiveness. To the best of our knowledge, no randomized controlled trials have so far directly compared PFMT with EMS. Our aim here is to describe a protocol for such a study.This will be a parallel-group, single-blind, randomised controlled trial compliant with the SPIRIT, CONSORT, and TIDieR reporting guidelines. Participants will be women aged 18 to 65 years who have previously given at least one vaginal delivery (at least 12 months before joining the study) who present with symptoms of SUI lasting at least 6 months yet have not previously received treatment for it. In the first study arm, patients will receive an eight-week, high-intensity, home-based Kegel exercises regimen. In the second study arm, the treatment scheme will consist of 2 sessions of EMS per week for a total of eight weeks. The primary outcome will be effectiveness of treatment as measured by the International Consultation on Incontinence Questionnaire Urinary Incontinence-Short Form overall score, eight weeks, three months, and six months after commencement of treatment.

Tumor volumes as a predictor of response to the anti-EGFR antibody drug conjugate depatuxizumab mafadotin.

BackgroundThe adverse impact of increasing brain tumor size on the efficacy of antibody-drug conjugates (ADCs) was investigated preclinically then validated with clinical data.Methods—Preclinical studyThe impact of tumor size on ADC tumor delivery and treatment response was evaluated in an EGFR-amplified patient-derived glioblastoma (GBM) model following treatment with Depatuxizumab mafadotin (Depatux-M). Biodistribution and imaging studies correlated drug distribution with starting treatment volume and anti-tumor activity.Methods—Clinical studyM12-356 was a Phase I study of Depatux-M in patients with GBM. Blinded volumetric analysis of baseline tumor volumes of M12-356 patients was undertaken by two reviewers and results correlated with response and survival.ResultsPreclinically, imaging and biodistribution studies showed specific and significantly higher tumor uptake of zirconium-89 labeled Depatux-M (89Zr-Depatux-M) in mice with smaller tumor volume (~98 mm3) versus those with larger volumes (~365 mm3); concordantly, mice with tumor volumes ≤100 mm3 at treatment commencement had significantly better growth inhibition by Depatux-M (93% vs 27%, P < .001) and significantly longer overall survival (P < .0001) compared to tumors ≥400 mm3. Clinically, patients with tumor volumes <25 cm3 had significantly higher response rates (17% vs. 0%, P = .009) and longer overall survival (0.5 vs 0.89 years, P = .001) than tumors above 25 cm3.ConclusionBoth preclinical and clinical data showed intra-tumoral concentration and efficacy of Depatux-m inversely correlated with tumor size. This finding merit further investigation with pretreatment tumor volume as a predictor for response to ADCs, in both gliomas and other solid tumors.

Burns and COVID-19

Background: A burn injury necessitates immediate emergency treatment that should be furnished securely to the victims. Appropriate precautions need to be undertaken to cut down the risk of exposure. A proper assessment and treatment commencement ought to be carried out before the viral infection has even been excluded as it is a race against time. The prognosis is determined by the established factors with viral infection acting as an ancillary addition. Burns are associated with many systemic disorders such as coagulopathy, sepsis, and respiratory distress which need to be differentiated from similar manifestations of the disease. Materials and Methods: A retrospective study was conducted in our burn unit (analysing data from Burn Registry of the Department), comparing various parameters during the pandemic year with those of the previous year. The aim was to observe whether COVID-19 has any sinister impact on burn management and outcome or not. Results: There was a 30.5% decrease in burn admissions with reduction in male burns (9%; M: F ratio decreased from 3:2 to 1:1) and delayed presentations (4%). The epidemiological parameters largely remained unaltered. The intensive care unit (ICU) admission rate and mortality remained the same. Our COVID positivity rate among burns was 5.3%. Conclusion: We conclude that incidence of burn admissions decreased during the pandemic with increase in delayed presentations. The ICU admission rate and mortality increased by 9% rate (outcome) remained unchanged. Hence, COVID-19 did not at the end of the “first wave” put any sinister impact on burn increased, management as well as the outcome.

A Case of Mandibular Prognathism with Generalized Aggressive Periodontitis and Crowding

Aggressive periodontitis during adolescence has a poor prognosis due to rapid alveolar bone resorption. Few studies have investigated long-term follow-up after surgical orthodontic treatment performed in conjunction with that for invasive periodontitis. Here, we report a case of mandibular prognathism accompanied by generalized aggressive periodontitis and crowding. A 31-year-old woman was referred to our department for treatment of masticatory dysfunction due to reverse overjet. The patient exhibited a class III molar relationship, protrusion of the ANB of －6.0°, and severe maxillary crowding. Initial periodontal examination revealed deep periodontal pockets and extensive inflammation. Mandibular prognathism accompanied by generalized aggressive periodontitis and crowding was diagnosed. Therefore, it was necessary to adopt an interdisciplinary approach involving surgical, orthodontic, and periodontal treatment. Prior to commencement of orthodontic treatment, plaque control, scaling, and root planing of all teeth were performed by a periodontist to suppress inflammation and reduce probing depth. During pre-surgical orthodontic treatment, the maxillary first premolars were extracted to reduce crowding of the maxillary incisors. To correct the mandibular prognathism, the mandible was repositioned by sagittal split ramus osteotomy. Proper occlusion of the incisors and maximum intercuspation were achieved by post-surgical orthodontic treatment. After completion of active orthodontic treatment, acceleration of inflammation was observed together with aggravated resorption of the alveolar bone surrounding the molars. However, reduction of probing depth and inflammation were observed after scaling and root planing. The surgical-orthodontic treatment time was 1 year and 11 months, which was followed by a 2-year retention period. There was no tooth loss due to periodontitis, and an overall satisfactory outcome was achieved.

Factors Impacting on the Early Versus Late Major Adverse Cardiovascular Events Amongst Oncology Patients Receiving Non-Anthracycline Chemotherapy

Cardiovascular (CV) events following commencement of cancer treatment are becoming increasingly recognised. The extent to which baseline CV factors influence the onset of major adverse cardiovascular events (MACE) in patients treated with non-anthracycline chemotherapy is not well characterised. The aim of our study was to examine the association between baseline cardiovascular risk factors and early and late complications of non-anthracycline chemotherapy.

Progastrin-Releasing Peptide Precursor and Neuron-Specific Enolase Predict the Efficacy of First-Line Treatment with Epidermal Growth Factor Receptor (EGFR) Tyrosine Kinase Inhibitors Among Non-Small-Cell Lung Cancer Patients Harboring EGFR Mutations.

PurposeLung cancer is the leading cause of cancer-related mortality and non-small-cell lung cancer (NSCLC) accounts for 80–90% of all lung cancers. However, biomarkers to predict the prognosis of NSCLC patients upon treatment with tyrosine kinase inhibitors remain unreliable. Different types of EGFR mutations can help predict the efficacy of tyrosine kinase inhibitor (TKI) treatment among advanced NSCLC patients harboring them. However, survival varies among individuals harboring the same mutation after targeted therapy. This study aimed to investigate the value of serum tumor markers (STMs) and EGFR mutations in the prognostic assessment of progression-free survival (PFS) in advanced-stage EGFR-mutated NSCLC.Patients and MethodsA retrospective clinical review was performed on 81 NSCLC patients harboring EGFR mutations and for whom STM data, measured before commencement of first‐line treatment with tyrosine kinase inhibitors, were available. Associations among EGFR mutations, STMs, baseline clinical features, and PFS were analyzed. Kaplan−Meier method was used to plot survival curves, and Cox logistic regression models were used to identify independent prognostic factors.ResultsExon 19 deletion (19-del) in EGFR, negative neuron-specific enolase (NSE), negative pro-gastrin-releasing peptide precursor (ProGRP) value, and “never smoking” status were significantly associated with improved PFS (P=0.007, P=0.001, P<0.001, and P<0.001, respectively). Multivariate Cox analysis revealed that 19-del in EGFR, never smoking, negative ProGRP value, and negative NSE were independent predictors of PFS.ConclusionThis study demonstrated that 19-del in EGFR may predict longer PFS in advanced-stage EGFR-mutated NSCLC treated with TKIs. Additionally, longer PFS can be predicted by serum tumor markers with negative ProGRP value, negative NSE value before initial treatment, and “never smoking.” Therefore, in addition to the EGFR mutation type and smoking status, physicians can also prognosticate the PFS of tyrosine kinase inhibitors treatment according to the values of ProGRP and NSE before treatment.

Knowledge on mother-to-child transmission of HIV, and sexuality and fertility desires among people living with HIV in North-Central, Nigeria.

Introductionmother-to-child transmission (MTCT) is the transmission of HIV from a mother to the child during pregnancy, labour and breastfeeding. People living with HIV (PLHIV) are sexually active and also HIV can be transmitted while trying to achieve pregnancy involving unprotected hetero-sexual intercourse. Fertility desire among PLHIV is increasing due to improved quality of life and survival following commencement of anti-retroviral treatment and available reproductive health services. The objective of the study was to determine the association between knowledge on MTCT of HIV and sexuality and fertility desire.Methodsthis study was descriptive cross-sectional applying systematic sampling technique among PLHIV using semi-structured interviewer administered questionnaires. Data was analysed using SPSS version 23.0. Chi square test was used for statistical analysis. At 95% confidence interval a P-value of <0.05 was considered to be statistically significant.Resultsa total of 168 PLHIV were studied, 63.3% females and 36.7% males. Majority (81.5%) of the respondents were sexually active and 64.1% had fertility desire. On awareness of MTCT 62.5% had heard of MTCT but only 28.2% had good knowledge. No association was found between knowledge of MTCT and sexuality and fertility desire respectively.ConclusionPLHIV had high awareness but poor knowledge on MTCT of HIV, hence the need for healthcare workers to provide sexual and reproductive health counselling including information on MTCT to both male and female PLHIV during routine clinic visits.

Tropical fever in remote tropics: tuberculosis or melioidosis, it depends on the lab

Diagnostics tests used to identify the cause of infection using proteomics and genomics have revolutionised microbiology laboratories in recent times. However, approaches to build the capacity of clinical microbiology services in the rural tropics by simply transplanting these approaches have proven difficult to sustain. Tropical fever in the remote tropics is, by definition, a clinical diagnosis where the aetiology of fever is not known, treatment is empirical, guided by clinical suspicion with treatment failure often attributed to incorrect diagnosis or antimicrobial resistance. Tuberculosis (TB) in rural Papua New Guinea (PNG) is mostly diagnosed clinically, perhaps supported by microscopy. In fact, a ‘tuberculosis patient’ in rural PNG is included in the TB register upon commencement of TB treatment with or without any laboratory-based evidence of infection. The roll-out of GeneXpert is continuing to transform TB diagnostic certainty in TB endemic communities. Melioidosis is endemic in tropical regions and is increasingly reported to mimic TB. Isolation and identification of the causative agent Burkholderia pseudomallei remains the gold standard. Here, we discuss the increasing divide between rural and urban approaches to laboratory-based infection diagnosis using these two enigmatic tropical infectious diseases, in rural PNG, as examples.