Treatment Of Chronic Cases Research Articles

Alleviating the burden of depression: a simulation study on the impact of mental health services.

Depressive disorders are ranked as the single leading cause of disability worldwide. Despite immense efforts, there is no evidence of a global reduction in the disease burden in recent decades. The aim of the study was to determine the public health impact of the current service system (status quo), to quantify its effects on the depression-related disease burden and to identify the most promising strategies for improving healthcare for depression on the population level. A Markov model was developed to quantify the impact of current services for depression (including prevention, treatment and aftercare interventions) on the total disease burden and to investigate the potential of alternative scenarios (e.g., improved reach or improved treatment effectiveness). Parameter settings were derived from epidemiological information and treatment data from the literature. Based on the model parameters, 10,000,000 individual lives were simulated for each of the models, based on monthly transition rates between dichotomous health states (healthy vs. diseased). Outcome (depression-related disease burden) was operationalized as the proportion of months spent in depression. The current healthcare system alleviates about 9.5% (95% confidence interval [CI]: 9.2%-9.7%) of the total disease burden related to depression. Chronic cases cause the majority (83.2%) of depression-related burden. From a public health perspective, improving the reach of services holds the largest potential: Maximum dissemination of prevention (26.9%; CI: 26.7%-27.1%) and treatment (26.5%; CI: 26.3%-26.7%) would result in significant improvements on the population level. The results confirm an urgent need for action in healthcare for depression. Extending the reach of services is not only more promising but also probably more achievable than increasing their effectiveness. Currently, the system fails to address the prevention and treatment of chronic cases. The large proportion of the disease burden associated with chronic courses highlights the need for improved treatment policies and clinical strategies for this group (e.g., disease management and adaptive or personalized interventions). The model complements the existing literature by providing a new perspective on the depression-related disease burden and the complex interactions between healthcare services and the lifetime course.

Long-term follow-up in a single-bundle arthroscopic acromioclavicular joint reconstruction after Rockwood III to VI dislocation.

This retrospective study presents the clinical and radiographic results of a single-bundle arthroscopic acromioclavicular joint reconstruction in 45 patients with a mean follow-up of 4.8 years. Patients with a Rockwood grade III or higher were included. Clinical results were based on satisfaction, pain and functional scores. These outcome scores were compared to coracoclavicular distance measurement on X-ray. Secondly, clinical outcome scores were compared between patients who had surgery in the first 6 weeks after trauma and patients treated after 6 weeks. Overall, X-ray showed a good reduction in 71.1% of the patients (less than 50% loss of reduction). These patients showed better clinical results than patients with radiographical failure in terms of satisfaction (p = .001), Constant (p = .001), DASH (p = .031) and SPADI (p = .005) scores. In total, 78% of the patient had surgery in the first 6 weeks after trauma. When treated later (mean time to surgery of 8.8 months), patients showed worse results for satisfaction (p = .003) and DASH score (p = .006), suggesting that treatment of chronic cases might warrant additional fixation techniques. As a conclusion, these results showed that, in the acute approach, single-bundle arthroscopic coracoclavicular fixation is a good treatment in acromioclavicular joint dislocation Rockwood grade III or higher.

Multimodality surgical treatment approach to acne keloidalis nuchae based on lesion morphology

Acne keloidalis nuchae (AKN) correctly termed “folliculitis keloidalis”, is an unusual form of chronic folliculitis and cicatricial alopecia that affects nape of neck. AKN can lead to significant scarring with tumor like masses and alopecia. Treatment in chronic cases is challenging with recurrence being common. Several modalities are being tried with variable success. We aim to report our experience with multimodality surgical approach. Five patients of chronic AKN refractory to intralesional steroids were treated between 2015 - 2018 with (1) excision and primary closure or (2) punch excision followed by healing with secondary intention or (3) intralesional cryotherapy, based on lesion morphology, site and extent . All patients also underwent long-pulsed (LP) neodymium-doped yttrium aluminum garnet (Nd:YAG)laser hair removal for the affected part with an aim to prevent new lesions from developing in the surrounding area. Patients were followed at regular intervals till 6 months. 100% patients were satisfied with the treatment outcome. They showed 80%–90% overall reduction in lesions with satisfactory cosmetic outcome. Complete removal of follicles leads to least chance of local recurrence. Surgical excision remains the most effective modality of management. In case of lesions <5 mm, punch excision can be gratifying. Cryotherapy is useful where excision and primary closure is not feasible. Hair removal lasers can prevent new lesions in the sorrounding area. Combined multimodality approach tailored to the type of lesions gives maximal result with a better cosmetic outcome.

Hering's Law Assessment Tool revisited: introducing a modified novel version--Patients' Response Assessment Tool after Homeopathic Treatment (PRATHoT) in chronic cases.

Hering's Law Assessment Tool emerged as a systematic outcome assessment tool following homeopathic intervention. The authors intend to modify it and develop a new tool-Patient Response Assessment Tool after Homeopathic Treatment (PRATHoT)-in chronic cases through Delphi technique for systematic categorization of probable outcomes following individualized homeopathic treatment in chronic cases. The PRATHoT was drafted after literature review and iterative Delphi rounds with multidisciplinary expert panel, setting Fleiss κ of 0.41 to 1.00 a priori as the desired level of multirater agreement. Following pilot testing, the tool was implemented on 37 patients suffering from knee osteoarthritis over 6 months. Logistic regression analysis confirmed that higher PRATHoT score was significantly associated with achieving pain visual analogue scale responses from the second follow-up visit onwards (B = 0.037-0.066; SE = 0.021-0.036; P = .003-.048). The tool appeared to have acceptable psychometric properties; hence, it may be considered as a promising tool, amendable for further development.

Internal Fixation of Symphyseal Disruption Resulting From Childbirth

To investigate the clinical and radiographic results after operative treatment of complete symphyseal disruption resulting from childbirth and to evaluate residual pain and implant failure in relation to the timing of surgery. Retrospective study. Tertiary pelvis and acetabulum care unit at a general hospital. Ten consecutive women with complete symphysis disruption associated with childbirth were included from a database of 603 patients with pelvic fracture. No patients with this diagnosis were excluded. All patients were followed until clinical healing of the symphysis or union of the fusion. Open reduction and internal fixation in acute (less than 2 weeks from childbirth, four patients) and after failed nonoperative treatment in subacute cases (2 weeks to 6 months after childbirth, three patients). Fusion of the symphysis with iliac crest bone graft and plate fixation after failed nonoperative treatment in chronic cases (greater than 6 months, three patients). Analyzed variables included the Lindahl score, maintenance of postoperative reduction, implant failure, malunion, and necessity of reoperation. Mean age of the patients was 32 years (range, 24-37 years). Mean follow up was 29 months (range, 5-139 months). The mean postoperative Lindahl score was 68 ± 14.6 points (range, 38-80 points). There were three excellent, four good, two fair, and one poor result. Fair or poor results occurred in one subacute and two chronic cases. There were two revision surgeries. One patient underwent implant removal resulting from dyspareunia 3.1 years postoperatively. One subacute patient had conversion to symphyseal fusion after implant failure as a result of a fall 11 years after index surgery. Major complications occurred in two and minor complications in three patients. Radiographic loosening of implants was observed in all subacute cases. All fusions healed and symptoms improved at last follow up. Operative management significantly improved the functional outcomes of all three subgroups and can be an acceptable treatment option for labor-induced complete symphysis pubis disruption.

Eficácia dos exercícios de controle motor na dor lombopélvica: uma revisão sistemática

O objetivo da revisão foi avaliar a eficácia dos exercícios de controle motor nas dores lombares (DL) e pélvicas. O estudo foi uma revisão sistemática de ensaios clínicos aleatorizados que investigaram a eficácia dos exercícios de controle motor no tratamento da DL e pélvica de várias populações. A eficácia desses exercícios foi sumarizada de acordo com os níveis de evidência empregados pela organização Cochrane. Oito ensaios cumpriram os critérios de inclusão. Há evidência limitada de que, a curto prazo, nos casos de DL aguda, exercícios de controle motor não sejam mais eficazes do que tratamento médico em diminuir dor e incapacidade. Entretanto, a longo prazo, há evidência limitada de que são capazes de reduzir o índice de recorrência nesses pacientes. Na DL crônica, existe forte evidência da eficácia dos exercícios de controle motor na diminuição da dor e incapacidade, quando comparados à fisioterapia convencional ou a nenhum tratamento. Há evidência limitada de que exercícios de controle motor sejam tão eficazes quanto a cirurgia de fusão lombar. Há evidência limitada de que, a curto e longo prazo, exercícios de controle motor sejam eficazes no tratamento das dores pélvicas pós-parto. Assim, exercícios de controle motor não melhoram a dor e incapacidades nos casos agudos. No entanto, podem ser indicados como prevenção de recorrência e para indivíduos com quadros crônicos a fim de aliviar a dor, reduzir a incapacidade e melhorar a qualidade de vida.

Topical calcipotriol therapy in nail psoriasis :A study of 24 cases

There are few reports regarding the treatment of nail psoriasis with topical calcipotriol. We undertook a case series study to evaluate the efficacy and safety of calcipotriol ointment (50 microg/g) in the treatment of nail psoriasis in 24 patients. This study involved 19 women and 5 men with nail psoriasis referred to Dermatology clinics of Razi hospital. The duration of trial was from October 2002 to September 2004. Informed consent was obtained from all patients before entering into the study. The patients applied calcipotriol ointment to the affected nails twice daily without occlusion for 3 months. Patients were seen by two academic dermatologists initially, after 2 weeks, and then at monthly intervals. The efficacy and safety were clinically assessed and any side effect was recorded. Patients who showed 50 percent or greater reduction in the baseline subungual thickness in at least one nail were considered to be responders and were offered continuation of therapy for an additional 2 months. After discontinuation of therapy, followup visits were performed at 1 and 2 months. After 3 months of therapy, fourteen patients showed significant clinical improvement, two of them were completely free from nail lesions after 5 months. Calcipotriol was particularly effective in subungual hyperkeratosis, onycholysis, and discoloration. In four patients fingertip tenderness and in one case the pain of involved distal phalanx were significantly reduced. No clinical response was observed in four patients. Only two cases showed adverse reactions. Topical Calcipotriol is an effective treatment for nail psoriasis and can be considered to be a safe topical treatment in chronic cases; its high tolerability allows prolonged usage without severe side effects.

Tuberculosis epidemiology and control in Veracruz, Mexico.

Tuberculosis (TB) rates remain high in regions of Southern Mexico despite the existence of a National Tuberculosis Program. Understanding TB epidemiology in such settings would assist in the design of improved TB control and highlight the challenges confronting TB control in developing countries. We conducted a retrospective review of treatment control cards from 1991 to 1994 in five municipalities in a semiurban region of Southern Mexico. The relatively high rate of TB observed, 42.6 per 100,000 inhabitants, did not change significantly during the study period. Cure rates among new cases were 79% and significantly lower among retreatment cases (62%). Directly observed therapy (DOT) was administered to 84% of patients. Approximately one-half of the retreatment cases who were not cured were compliant with therapy, suggesting that drug resistance contributed to these poor results. Of particular concern was a core group of 16 patients who had received at least three treatments. This region of Mexico has persistently high TB rates despite a DOT-based TB control programme which achieves an overall cure rate of 77%. There exist many retreatment cases for whom cure rates are significantly lower. These cases may serve as a core group for the dissemination of drug resistant TB. The control programme is being reinforced by a nominal register of patients, decreasing administrative barriers for drug supply to individual patients and the availability of mycobacteria cultures. In addition to these measures, in regions which are approaching the levels of efficacy recommended by the WHO it may be appropriate to consider focusing efforts on the identification and treatment of chronic cases.

Clinical experiences with cytotoxic immunosuppressive treatment of idiopathic thrombocytopenic purpura.

After a review of the literature, a series of 21 patients with ITP treated with non-steroidal immunodepressive agents is presented. The agents were azathioprine (AZP), methotrexate (MTX), cyclophosphamide (CPH), vinblastine (VLB) and L-asparaginase (L-ase). No permanent, unmaintained remission in chronic, self-perpetuating cases of ITP could be obtained, even after splenectomy. However, AZP was useful in the treatment of chronic cases, either alone or in combination with steroids, where it displayed a useful steroid sparing effect. CPH and MTX were generally ineffective. VLB induced striking temporary thrombocytoses, and L-ase was followed by an early thrombocytosis, but proved too toxic to be employed consistently. Single case reports and remission percentages are reported.

The Treatment of Chronic Cases of Gas Poisoning by Continuous Oxygen Administration in Chambers

The Treatment of Chronic Cases of Gas Poisoning by Continuous Oxygen Administration in Chambers