Background: Fractures of humeral shaft in adults are common injuries. Humeral shafts non-union either from late presentation after initial treatment by traditional bone setters or failed non-operative orthodox care is...Background: Fractures of humeral shaft in adults are common injuries. Humeral shafts non-union either from late presentation after initial treatment by traditional bone setters or failed non-operative orthodox care is a major problem in this part of the world. This non-union is a major treatment challenge with increased cost of care and morbidity in this part of the world. Humeral shaft non-union can be treated with locked intra-medullary nailing (LIMN) or dynamic compression plating (DCP). Study on comparison of these methods of fixation in this part of the world is scarce in literature search, hence the reason for this study. Objective: The objectives of this study are: (1) to compare early clinical outcome following fixation of humeral shaft fracture nonunion with DCP versus LIMN;(2) to compare the time of radiologic fracture union of DCP with LIMN;(3) to compare complications following fixation of humeral shaft fracture nonunion with DCP versus LIMN. Patients and Methods: This was a randomized control study done for 2 years in which fifty adult patients with humeral shaft non-union were recruited. The patients were grouped into 2 (P = DCP & N = LIMN). Forty five of the patients completed the follow up periods of the study and then analyzed. The P group had ORIF with DCP while the N group had ORIF with LIMN. Both groups had grafting with cancellous bones. Each patient was followed up for a period of 6 months at the time which radiographic union is expected. Any patient without clinical and/or radiographic evidence of union after six months of surgery was diagnosed as having recurrent non-union. The data generated was analyzed using SPSS Version 23. The results were presented in charts and tables. The paired t-test was used while considering p value Result: Forty five patients completed follow up. There was a male preponderance (4:1), right humerus predominated (3:2). Motor vehicular accidents were the commonest cause of the fractures (62%). Most non-union fractures occurred at the level of the middle 3<sup>rd</sup> of the humeral shaft (60%). Failed TBS treatment was the commonest indication for the osteosynthesis (71%). More patients had plating (53%) compared to 47% who had LIMN. Most patients (93.4%) had union between 3 to 6 months irrespective of fixation type with no significant statistical difference between the union rate of DCP and LIMN (p value 0.06) with similar functional outcome and complication rates irrespective of the type of fixation. Conclusion: This study showed that the success rates in term of fracture union, outcome functional grades and complication rates were not directly dependent on the types of the fixation: plating or locked intra-medullary nailing.展开更多
Objective:To assess the effectiveness and adverse drug reactions of all-oral regimens for patients with multidrug-resistant tuberculosis.Methods:This retrospective study was conducted at 10 Programmatic Management of ...Objective:To assess the effectiveness and adverse drug reactions of all-oral regimens for patients with multidrug-resistant tuberculosis.Methods:This retrospective study was conducted at 10 Programmatic Management of Drug Resistant Tuberculosis sites in Punjab province of Pakistan.Patients receiving treatment for drug resistant tuberculosis from July 2019 to December 2020 with at least interim result i.e.6th month culture conversion or final outcomes(cured,complete,lost to follow-up,failure,death)available,were included in the study.Data was extracted from electronic data management system.For the reporting and management of adverse drug events,active tuberculosis drug safety monitoring and management was implemented across all sites.All the data was analyzed using SPSS version 22.Results:Out of 947 drug resistant tuberculosis patients included in this study,579(68%)of the patients had final outcomes available.Of these,384(67.9%)successfully completed their treatment.Out of 368(32%)patients who had their interim results available,all had their 6th month culture negative.Combining new medications was thought to result in serious adverse outcomes such as QT prolongation.However,this study did not record any severe adverse events among patients.Conclusions:All-oral regimens formulation guided by overall treatment effectiveness resulted in treatment outcomes comparable to those obtained with traditional injectable treatment.展开更多
Objective Clinical characteristics and outcome in COVID-19 with brucellosis patients has not been well demonstrated,we tried to analyze clinical outcome in local and literature COVID-19 cases with brucellosis before a...Objective Clinical characteristics and outcome in COVID-19 with brucellosis patients has not been well demonstrated,we tried to analyze clinical outcome in local and literature COVID-19 cases with brucellosis before and after recovery.Methods We retrospectively collected hospitalization data of comorbid patients and prospectively followed up after discharge in Heilongjiang Infectious Disease Hospital from January 15,2020 to April29,2022.Demographics,epidemiological,clinical symptoms,radiological and laboratory data,treatment medicines and outcomes,and follow up were analyzed,and findings of a systematic review were demonstrated.Results A total of four COVID-19 with brucellosis patients were included.One patient had active brucellosis before covid and 3 patients had nonactive brucellosis before brucellosis.The median age was54.5 years,and all were males(100.0%).Two cases(50.0%)were moderate,and one was mild and asymptomatic,respectively.Three cases(75.0%)had at least one comorbidity(brucellosis excluded).All4 patients were found in COVID-19 nucleic acid screening.Case C and D had only headache and fever on admission,respectively.Four cases were treated with Traditional Chinese medicine,western medicines for three cases,no adverse reaction occurred during hospitalization.All patients were cured and discharged.Moreover,one case(25.0%)had still active brucellosis without re-positive COVID-19,and other three cases(75.0%)have no symptoms of discomfort except one case fell fatigue and anxious during the follow-up period after recovery.Conducting the literature review,two similar cases have been reported in two case reports,and were both recovered,whereas,no data of follow up after recovery.Conclusion These cases indicate that COVID-19 patients with brucellosis had favorable outcome before and after recovery.More clinical studies should be conducted to confirm our findings.展开更多
Objective:To systematically review the influencing factors of the treatment outcome of multidrug-resistant pulmonary tuberculosis and provide reference for the prevention and treatment of multidrug-resistant pulmonary...Objective:To systematically review the influencing factors of the treatment outcome of multidrug-resistant pulmonary tuberculosis and provide reference for the prevention and treatment of multidrug-resistant pulmonary tuberculosis.Method:Case control studies on the factors influencing the treatment outcome of multidrug-resistant pulmonary tuberculosis in Chinese databases(CNKI,VIP,Wanfang,Sinomed)and English databases(Pubmed,Web of science,Medline,Embase,Scopus)were searched and collected by computer.The search period was from the establishment of the database to January 2023.After screening and quality evaluation,RevMan5.4 was used for meta-analysis.Result:Totally 18 articles were ultimately included,with a sample size of 7328 people.The results showed that retreatment,complications,adverse reactions,and gender were related to the treatment outcome of multidrug-resistant pulmonary tuberculosis.The OR values and 95%CI of each factor were 0.22(0.17-0.29),0.38(0.32-0.46),0.27(0.17-0.44),and 0.43(0.33-0.56),respectively.Conclusion:Complications,retreatment,adverse reactions,and male gender are effective risk factors for the treatment outcome of multidrug-resistant pulmonary tuberculosis.In clinical practice,more targeted measures are needed for different types of patients.Due to the limitations of the number of studies,the above conclusions require more research to support them.展开更多
Background: The aim was to evaluate the nonsurgical Root Canal Treatment (nRCT) outcome, the restorative condition and the relationship between the coronal restoration quality and the outcome of teeth endodontic treat...Background: The aim was to evaluate the nonsurgical Root Canal Treatment (nRCT) outcome, the restorative condition and the relationship between the coronal restoration quality and the outcome of teeth endodontic treated by undergraduates at the University of Caxias do Sul School of Dentistry (UCS-SD), Brazil, between 2019 and 2021. Materials and Methods: Data from the endodontically treated cases were retrieved, and the patients were recalled for a follow-up appointment at the university. The endodontic diagnosis, radiographs, and the presence of definitive restorations were analyzed in the clinical records. During the follow-up appointment, endodontically treated teeth were classified as present or absent. The nRCT was classified as successful (complete or incomplete healing) or failure (uncertain or unsatisfactory healing). Coronal restoration was classified as absent or present. When it was present, it was classified as permanent or temporary, and its quality as adequate or inadequate restoration. The results were presented as percentages. Results: A total of 257 teeth were endodontically treated. The most prevalent diagnosis was Chronic Apical Periodontitis (33.33%) and the most commonly treated teeth were premolars (46.15%). A total of 52 (21%) treated teeth were clinically and radiographically reexamined. The success rate for the nRCT was 98.08%. About 61.54% of this sample had a definitive composite resin restoration. Conclusion: The nRCT success rate was high. Special attention should be given to the presence and quality of the definitive restoration. Clinical Implications: There was no statistically significant impact between the coronal restoration and the nRCT success (P > 0.05).展开更多
Lassa fever is a viral haemorrhagic fever found mostly in West Africa where it is endemic but generates periodic outbreaks in the dry seasons. The virus is spread by the rat species named mastomys natalensis. While th...Lassa fever is a viral haemorrhagic fever found mostly in West Africa where it is endemic but generates periodic outbreaks in the dry seasons. The virus is spread by the rat species named mastomys natalensis. While the illness is minor in most cases, the mortality is significant in hospitalized patients. Few completely equipped treatment centers existed in Nigeria previous to current increase in frequency requiring demand for new treatment centers without the full complement of essential capabilities. Aim: To analyze the profile and treatment outcome in patients hospitalized in one of such new resource-constrained centers at the Benue State University Teaching Hospital Makurdi, Nigeria. Methodology: This was a retrospective, descriptive hospital-based research encompassing January 2020 to March 2023. Medical records of those admitted to the isolation center were reviewed. The relevant data was coded and analyzed using IBM SPSS version 23. Results: One hundred and ten (110) individuals were hospitalized for probable or suspected Lassa fever throughout the research period. A total of 35 confirmed patients satisfied the inclusion criteria and were included as the study subjects. There were 23 (65.7%) men and 12 (34.3%) females. Their mean age was 35.36 ± 12.21 years (range 15-61 years). The treatment outcome showed that 24 (75%) survived and were discharged, 5 (15.6%) were referred out of the facility for dialysis and 3 died, providing a mortality of 8.6%. The causes of mortality in study patients were acute kidney injury and encephalopathy. Conclusion: Lassa fever is endemic in Benue state with all types of individuals afflicted. The outcome of treatment was good despite resource difficulties. Lassa fever can be successfully managed even in resource-challenged situations typically encountered in developing countries.展开更多
Objective Several COVID-19 patients have overlapping comorbidities. The independent role of each component contributing to the risk of COVID-19 is unknown, and how some non-cardiometabolic comorbidities affect the ris...Objective Several COVID-19 patients have overlapping comorbidities. The independent role of each component contributing to the risk of COVID-19 is unknown, and how some non-cardiometabolic comorbidities affect the risk of COVID-19 remains unclear.Methods A retrospective follow-up design was adopted. A total of 1,160 laboratory-confirmed patients were enrolled from nine provinces in China. Data on comorbidities were obtained from the patients’ medical records. Multivariable logistic regression models were used to estimate the odds ratio(OR) and 95% confidence interval(95% CI) of the associations between comorbidities(cardiometabolic or non-cardiometabolic diseases), clinical severity, and treatment outcomes of COVID-19.Results Overall, 158(13.6%) patients were diagnosed with severe illness and 32(2.7%) had unfavorable outcomes. Hypertension(2.87, 1.30–6.32), type 2 diabetes(T2 DM)(3.57, 2.32–5.49),cardiovascular disease(CVD)(3.78, 1.81–7.89), fatty liver disease(7.53, 1.96–28.96), hyperlipidemia(2.15, 1.26–3.67), other lung diseases(6.00, 3.01–11.96), and electrolyte imbalance(10.40, 3.00–26.10)were independently linked to increased odds of being severely ill. T2 DM(6.07, 2.89–12.75), CVD(8.47,6.03–11.89), and electrolyte imbalance(19.44, 11.47–32.96) were also strong predictors of unfavorable outcomes. Women with comorbidities were more likely to have severe disease on admission(5.46,3.25–9.19), while men with comorbidities were more likely to have unfavorable treatment outcomes(6.58, 1.46–29.64) within two weeks.Conclusion Besides hypertension, diabetes, and CVD, fatty liver disease, hyperlipidemia, other lung diseases, and electrolyte imbalance were independent risk factors for COVID-19 severity and poor treatment outcome. Women with comorbidities were more likely to have severe disease, while men with comorbidities were more likely to have unfavorable treatment outcomes.展开更多
BACKGROUND The rising number of people using methamphetamine leads to an increasing need for treatment options for this patient group.Evidence-based research on the efficacy of treatment programs for methamphetamine u...BACKGROUND The rising number of people using methamphetamine leads to an increasing need for treatment options for this patient group.Evidence-based research on the efficacy of treatment programs for methamphetamine users is limited.Due to specific characteristics of methamphetamine users,the question arises whether established treatment methods for individuals using other substances can be effective for the treatment of methamphetamine dependence as well.We hypothesize that there are significant differences between the two groups that may affect the effectiveness of treatment and worsen the prognosis of treatment outcomes for methamphetamine users compared to consumers of other substances.AIM To investigate potential differences in cognitive functioning and psychopathology between methamphetamine users and other substance users and possible correlations with treatment outcomes.METHODS A total of 110 subjects were recruited for an observational,longitudinal study from a German inpatient addiction treatment center:55 patients with methamphetamine dependence and 55 patients with dependence of other substances(“OS group”).Both groups were examined at beginning(baseline)and end of treatment(after 6 mo)with regard to treatment retention,craving,cognitive functioning,psychosocial resources,personality traits,depression,and other psychiatric symptoms.Instruments used were Raven’s IQ test,Mannheimer craving scale,cognitrone cognitive test battery,NEO personality factors inventory,Hamilton depression scale,Becks depression inventory,and a symptom checklist.The statistical methods used were χ^(2)-test,t-test and multiple mixed ANOVAs.RESULTS A total drop-out rate of 40%(methamphetamine-group:36.4%;OS-group:43.6%)was observed without significant differences between groups.At baseline,methamphetamine-group subjects significantly differed from OS-group individuals in terms of a lower intelligence quotient,fewer years of education,slower working speed,and decreased working accuracy,as well as less cannabinoid and cocaine use.Methamphetamine-group subjects further showed a significantly lower score of conscientiousness,depressive,and psychiatric symptoms than subjects from the OSgroup.In both groups,a reduction of craving and depressive symptoms and an improvement of working speed and working accuracy was noted after treatment.CONCLUSION There are differences between methamphetamine users and users of other drugs,but not with regard to the effectiveness of treatment in this inpatient setting.There are differences in cognitive function and psychopathology between methamphetamine and other drugs users.The existing treatment options seem to be an effective approach in treating methamphetamine dependence.展开更多
<b>Background: </b>Nigeria<i>,</i> one of the high burden Tuberculosis countries<i>,</i> has developed various intervention strategies to ensuring universal access to quality-assure...<b>Background: </b>Nigeria<i>,</i> one of the high burden Tuberculosis countries<i>,</i> has developed various intervention strategies to ensuring universal access to quality-assured tuberculosis diagnosis and treatment. However<i>,</i> low case detection and unsuccessful treatment outcome still remains a serious challenge in most states. Community Tuberculosis care was born against this background in 2010 as a complementing front to combat the challenges<i>,</i> bringing directly observed treatment short-course strategy beyond the clinic settings to the door steps of patients. This study evaluates the contributions of the intervention to Tuberculosis case detection and treatment outcomes in two states in Nigeria. <b>Materials and Method:</b> A retrospective study with multistage sampling technique was employed to review 23<i>,</i>241 presumptive Tuberculosis cases enrolled for management between 2014-2017. Chi-square (<i>χ</i><sup>2</sup>) test was used for test of association between the independent variables and the main outcomes of the study<i>,</i> with statistical significance set at p-value of 5%. <b>Results</b>: The annual percentage increase for both states was 24.7%<i>,</i> 189.8% and 114.5% in the study group as against 5.2%<i>,</i> 44.6% and 65.6% in control group. Overall<i>,</i> 23.8% were bacteriologically positive (either AFB or Gene-Xpert MTB/Rif) and 1.4% were clinically evaluated to be positive<i>,</i> while 74.8% were bacteriologically negative. Of the total 5861 cases treated<i>,</i> successful treatment rate of the patients in the study group was 88.6% as compared to 76.1% in the control group. The relationship between the referral system from communities where the intervention program was implemented and the case detection/treatment outcome was statistically significant (OR 95% CI = 3.15<i>,</i> 2.95 - 3.35). <b>Conclusion</b>: The community level Tuberculosis intervention led to significantly better case detection and treatment outcome when compared to the conventional approach (p ≤ 0.05). Therefore<i>,</i> full community engagement should be advocated as a major strategy for End Tuberculosis planed by WHO since the patients are found in the community and not in the health facilities.展开更多
Background: Despite the availability of highly effective treatment for decades, Tuberculosis (TB) remains a major health problem in Nigeria due to the increasing association between HIV and TB observed over the past t...Background: Despite the availability of highly effective treatment for decades, Tuberculosis (TB) remains a major health problem in Nigeria due to the increasing association between HIV and TB observed over the past three decades when HIV was discovered. However, the proportion of TB and or TB/HIV co-infected patients who have successful TB treatment outcome is not well known. This study determined the treatment outcome of TB/HIV co-infected patients with HIV negative patients in two states in Nigeria. Materials and Methods: A retrospective study of secondary data from eight Directly Observed Treatment Short (DOTS) course and Anti- Retroviral Therapy (ART) service providers in Benue and Federal Capital Territory (FCT), Nigeria, was carried out. The period under review covers January, 2010 to December, 2013. Results: Out of the total 5266 TB cases reviewed, the HIV prevalence rate was 52%. They were predominantly (53.3%) male with mean age of 34.4 years (SD = 15.1 years). More than two-third (72.5%) of HIV-negative patients had successful treatment compared to 1718 (62.7%) HIV-positive patients. Of the 2334 HIV co-infected patients, 19.5% defaulted, 11.5% had died, 5.6% were transferred out and 0.7% failed treatment compared to HIV-negative patients amongst whom 18.3% defaulted, 3.6% died, 3.9% were transferred out and 1.6% failed treatment (p Conclusion: The favourable treatment outcome of HIV-negative patients is more than that of HIV-positive patients and the most probable predictable factor responsible is the CD4 count of patient;indicating that TB/HIV co-infection has remained a major public health problem in Benue state and FCT. Hence there is the need for sustained strengthening and expansion of the national TB/HIV programmes.展开更多
Introduction: Tuberculosis (TB) is a major public health concern in Ethiopia. Analysis of TB case notification and treatment outcomes is crucial to understand the TB control program performance. The current study was ...Introduction: Tuberculosis (TB) is a major public health concern in Ethiopia. Analysis of TB case notification and treatment outcomes is crucial to understand the TB control program performance. The current study was carried out to assess trends of TB case notifications, treatment success rate and factors associated with unsuccessful treatment outcome among TB patients in West Gojjam Zone of Amhara Region, Ethiopia. Method: A retrospective cohort study was conducted in West Gojjam Zone. Demographic and clinical data were reviewed for all TB patients registered between July 2007 and June 2012 at 30 randomly selected public health facilities of the study zone. In addition, annual case notification reports of the study zone were used to analyze trends in TB case notifications. Logistic regression analysis was used to assess the association between potential predictor variables and unsuccessful treatment outcomes. Results: Tuberculosis case notification for all forms of TB decreased from 203/100,000 population in 2007 to 155/100,000 population in 2012. Among patients whose treatment outcomes were evaluated, 94.4% were successfully treated, 0.3% had treatment failure, 1.5% defaulted and 3.7% died. In multivariate analysis, the odds of unsuccessful treatment outcome was higher among retreatment cases than new cases (adjusted OR, 3.44;95% CI: 1.92, 6.19). HIV co-infected cases were more likely to have unsuccessful treatment outcome compared to HIV negatives (adjusted OR, 2.68;95% CI: 1.92, 3.72). Conclusion: Tuberculosis case notification rates showed a decreasing trend between 2007 and 2012. The treatment success rate exceeded the 90% treatment success rate target as set by the WHO. Special attention is required for patients with high risk of unsuccessful treatment outcome. Therefore, retreatment cases, and HIV positive cases need strict follow up throughout their treatment period.展开更多
Background: Few data is available in low-burden TB-HIV countries on TB treatment outcomes. We evaluated TB patients (pts) characteristics by HIV status and compared treatment outcomes in relation to HIV status, CD4 co...Background: Few data is available in low-burden TB-HIV countries on TB treatment outcomes. We evaluated TB patients (pts) characteristics by HIV status and compared treatment outcomes in relation to HIV status, CD4 count and antiretroviral therapy (ART). Methods: We performed a retrospective analysis of 447 adult TB pts who registered and initiated treatment in our center from 2014 to 2015. Results: Pts were categorized as HIV-negative (n = 399, 89.3%), HIV-positive on ART (n = 42, 9.4%) and HIV-positive not on ART (n = 6, 1.3%). The proportion of pts with extended TB therapy was higher among HIV-positive pts (p = 0.03). Increased age was associated with higher death rates regarding treatment success (OR 1.08;95% CI 1.01 - 1.17, p = 0.03). Statistically significant higher mortality was found among HIV-positive pts on ART (OR 9.93;95% CI 1.36 - 72.37, p = 0.03) and HIV-positive pts not on ART (OR 397.00;95% CI 44.27 to 3559.91, p ≤ 0.0001) compared to HIV-negative pts. When multivariate analyses were restricted to HIV-positive pts, being not on ART was associated with higher mortality (OR 40.0;95% CI 4.37 - 365.78, p = 0.001). Conclusions: There was significant difference in death rates between HIV-positive and HIV-negative TB pts. HIV-positive pts not on ART had a significantly higher mortality.展开更多
Background:Anti-tuberculosis drug resistance is a major public health problem that threatens the progress made in tuberculosis care and control worldwide.Treatment success rates of multidrug-resistant tuberculosis(MDR...Background:Anti-tuberculosis drug resistance is a major public health problem that threatens the progress made in tuberculosis care and control worldwide.Treatment success rates of multidrug-resistant tuberculosis(MDR-TB)is a key issue that cannot be ignored.There is a paucity of evidence that assessed studies on the treatment of MDR-TB,which focus on the effectiveness of the directly observed treatment,short-course(DOTS)-Plus program.Therefore,it is crucial to assess and summarize the overall treatment outcomes for MDR-TB patients enrolled in the DOTS-Plus program in recent years.The purpose of this study was to thus assess and summarize the available evidence for MDR-TB treatment outcomes under DOTS-Plus.Methods:A systematic review and meta-analysis of published literature was conducted.Original studies were identified using the databases MEDLINE®/PubMed®,Hinari,and Google Scholar.Heterogeneity across studies was assessed using the Cochran’s Q test and I2 statistic.Pooled estimates of treatment outcomes were computed using the random effect model.Results:Based on the 14 observational studies included in the meta-analysis,it was determined that 5047 patients reported treatment outcomes.Of these,the pooled prevalence,63.5%(95%CI:58.4-68.5%)successfully completed full treatment(cured or treatment completed)with a pooled cure rate of 55.6%,whereas 12.6%(95%CI:9.0-16.2%)of the patients died,14.2%(95%CI:11.6-16.8%)defaulted from therapy,and 7.6%(95%CI:5.6-9.7%)failed therapy.Overall 35.4%(95%CI:30-40.8%)of patients had unsuccessful treatment outcomes.An unsatisfactorily high percentage 43%(95%CI:32-54%)of unsuccessful treatment outcomes was observed among patients who were enrolled in standardized treatment regimens.Conclusion:This study revealed that patients with MDR-TB exhibited a very low treatment success rate compared to the World Health Organization 2015 target of at least 75 to 90%.The high default rate observed by conducting this literature review could possibly explain the spread of the MDR-TB strain in various populations.A better treatment success rate was observed among patients in individualized treatment regimens than in standardized ones.Conducting further individual-based meta-analysis is recommended to identify potential factors for defaulting treatment using large-scale and multi-center studies.展开更多
Background:The impact of the human immunodeficiency virus(HIV)on tuberculosis(TB),and the implications for TB and HIV control,is a public health challenge in Ghana-almost a quarter(23%)of all TB cases were HIV positiv...Background:The impact of the human immunodeficiency virus(HIV)on tuberculosis(TB),and the implications for TB and HIV control,is a public health challenge in Ghana-almost a quarter(23%)of all TB cases were HIV positive in 2010.The integration of TB/HIV services has therefore emerged as an essential component of the national response to TB and HIV.The aim is to reduce fragmentation,improve access,enhance efficiency and improve quality of care.Ghana’s TB/HIV policy comprises three linked sets of activities:effective implementation of the Stop TB Strategy for TB control,improved HIV prevention and care,and the implementation of additional TB/HIV activities.Different models of service delivery with increasing integration of TB/HIV activities are expected to provide greater access to more comprehensive care.The objective of this paper is to assess the impact of TB/HIV integration on TB treatment outcomes and to explore the usefulness of TB treatment outcomes as TB/HIV indicators.Methods:A before-and-after study to observe the introduction of TB/HIV activities into TB programmes in three hospitals with different levels of integration was conducted.Anonymised patient data was collated from TB registers from each facility,and analysed to determine if TB treatment outcomes changed significantly after integration.Results:TB treatment success was 50%(95%CI 49-52)prior to,and 69%(95%CI 65-73)after,integration(Χ243.96,p<0.00).Treatment success increased from 43%to 53%at the one-stop shop(OSS),from 69%to 78%at the partially integrated site(PIS)and substantially from 46%to 78%at the referral site(RS)(Χ264.54;p<0.01).Defaults and cases transferred out reduced from 14.3%and 15.3%prior to integration,to 1.4%and 9.0%after integration,respectively,accounting for a significant increase in treatment success.Death rates remained high at 18%in all cases studied and 25%in HIV-associated cases after integration.Conclusion:TB/HIV integration may improve TB treatment success,but its exact impact is difficult to ascertain due to non-specificity and design limitations.TB mortality may be more useful as an indicator for monitoring TB/HIV activities in Ghana.展开更多
Background:Data regarding tuberculosis(TB)treatment outcomes,proportion of TB/HIV co-infection and associated factors have been released at different TB treatment facilities in Ethiopia and elsewhere in the world as p...Background:Data regarding tuberculosis(TB)treatment outcomes,proportion of TB/HIV co-infection and associated factors have been released at different TB treatment facilities in Ethiopia and elsewhere in the world as part of the auditing and surveillance service.However,these data are missing for the TB clinic offering directly observed treatment short-course(DOTs)at Debre Tabor General Hospital(DTGH).Methods:The authors analysed the records of 985 TB patients registered at the DTGH from September 2008 to December 2016.Data on patients’sex,age,type of TB,and treatment outcomes were extracted from the TB treatment registration logbook.The treatment outcome of patients was categorized according to the National TB and Leprosy Control Program guidelines:cured,treatment completed,treatment failed,died,and not evaluated(transferred out and unknown cases).Results:Around half of the registered patients were males(516,52.4%).In terms of TB types,381(38.7%),241(24.5%),and 363(36.9%)patients had smear-negative pulmonary TB,smear-positive pulmonary TB,and extra pulmonary TB,respectively.Six hundred and seventy-two patients(90.1%)had successful treatment outcomes(cured and treatment completed),while 74 patients(9.9%)had unsuccessful treatment outcomes(death and treatment failure).TB treatment outcome was not associated with age,sex,type and history of TB,or co-infection with HIV(P>0.05).The proportion of TB/HIV co-infection was at 24.2%,and these were found to be significantly associated with the age groups of 25-34,35-44 and≥65 years:(aOR:0.44;95%CI:0.25-0.8),(aOR:0.39;95%CI:0.20-0.70),(aOR:4.2;95%CI:1.30-12.9),respectively.Conclusions:The proportion of patients with successful treatment outcomes was above the World Health Organization target set for Millennium Development Goal of 85%and in line with that of the global milestone target set at>90%for 2025.Relatively higher proportions of transfer-out cases were recorded in the present study.Similarly,the proportion of TB/HIV co-infection cases was much higher than the national average of 8%.Thus,the health facility under study should develop strategies to record the final treatment outcome of transfer-out cases.In addition,strategies to reduce the burden of TB/HIV co-infection should be strengthened.展开更多
Background:With current chemotherapy treatment,>90%of survival has been obtained for Burkitt lymphoma(BL).In this study,the demographic characteristics and treatment outcomes are presented for 78 children in China ...Background:With current chemotherapy treatment,>90%of survival has been obtained for Burkitt lymphoma(BL).In this study,the demographic characteristics and treatment outcomes are presented for 78 children in China with central nervous system-positive(CNS+)BL.Methods:This retrospective study consecutively enrolled 78 CNS+BL patients in Beijing Children’s Hospital(BCH)from 2007 to 2019 who received the BCH B-cell non-Hodgkin’s lymphoma regimen(modified by French-American-British mature lymphoma B-cell 96[FAB/LMB96]C1 arm±rituximab).Clinical characteristics,methods of disease detection in the CNS,and outcomes were evaluated.Univariate and multivariate analyses were used to assess prognostic factors.Results:The median age of 65 boys and 13 girls at the time of diagnosis was 5.7 years(ranging from 1 to 14 years).Patients were followed up for a median time of 34 months(ranging from 1 to 72 months).Bone marrow invasion was found in 38(48.7%)patients.There were 48(61.5%),44(56.4%),and 25(32%)patients with cranial nerve palsy,intracerebral mass(ICM),and parameningeal extension,respectively.Abnormal cerebrospinal fluid(CSF)morphology and CSF immunophenotype appeared in 15(19.2%)and 15(19.2%)patients,respectively.There were 69(88.5%)patients treated with chemotherapy combined with rituximab,and nine patients were treated solely with chemotherapy.Finally,five patients died of treatment-related infection,recurrence occurred for 13,and one developed a second tumor.The 3-year overall survival and event-free survival rates were 78.9%±4.7%and 71.4%±6.0%,respectively.Treatment with chemotherapy only,ICM positivity,and>4 organs involved at diagnosis were independent risk factors.Conclusions:Rituximab combined with a modified LMB96 regimen has greatly increased the efficacy of treatment for Chinese children with CNS+BL,and with the continuous collection of outcome data,treatment-related complications are decreasing.For further verification,a large sample multicentre randomized controlled study should be performed to explore a treatment scheme for Chinese children with even greater efficacy.展开更多
Background:In China,an indigenously developed electronic medication monitor(EMM)was designed and used in 138 counties from three provinces.Previous studies showed positive results on accuracy,effectiveness,acceptabili...Background:In China,an indigenously developed electronic medication monitor(EMM)was designed and used in 138 counties from three provinces.Previous studies showed positive results on accuracy,effectiveness,acceptability,and feasibility,but also found some ineffective implementations.In this paper,we assessed the effect of implementation of EMMs on treatment outcomes.Methods:The longitudinal ecological method was used at the county level with aggregate secondary programmatic data.All the notified TB cases in 138 counties were involved in this study from April 2017 to June 2019,and rifampicinresistant cases were excluded.We fitted a multilevel model to assess the relative change in the quarterly treatment success rate with increasing quarterly EMM coverage rate,in which a mixed effects maximum likelihood regression using random intercept model was applied,by adjusting for seasonal trends,population size,sociodemographic and clinical characteristics,and clustering within counties.展开更多
BACKGROUND For the management of lateral lymph node(LLN)metastasis in patients with rectal cancer,selective LLN dissection(LLND)is gradually being accepted by Chinese scholars.Theoretically,fascia-oriented LLND allows...BACKGROUND For the management of lateral lymph node(LLN)metastasis in patients with rectal cancer,selective LLN dissection(LLND)is gradually being accepted by Chinese scholars.Theoretically,fascia-oriented LLND allows radical tumor resection and protects of organ function.However,there is a lack of studies comparing the efficacy of fascia-oriented and traditional vessel-oriented LLND.Through a preliminary study with a small sample size,we found that fasciaoriented LLND was associated with a lower incidence of postoperative urinary and male sexual dysfunction and a higher number of examined LLNs.In this study,we increased the sample size and refined the postoperative functional outcomes.AIM To compare the effects of fascia-and vessel-oriented LLND regarding short-term outcomes and prognosis.METHODS We conducted a retrospective cohort study on data from 196 patients with rectal cancer who underwent total mesorectal excision and LLND from July 2014 to August 2021.The short-term outcomes included perioperative outcomes and postoperative functional outcomes.The prognosis was measured based on overall survival(OS)and progression-free survival(PFS).RESULTS A total of 105 patients were included in the final analysis and were divided into fascia-and vesseloriented groups that included 41 and 64 patients,respectively.Regarding the short-term outcomes,the median number of examined LLNs was significantly higher in the fascia-oriented group than in the vessel-oriented group.There were no significant differences in the other short-term outcomes.The incidence of postoperative urinary and male sexual dysfunction was significantly lower in the fascia-oriented group than in the vessel-oriented group.In addition,there was no significant difference in the incidence of postoperative lower limb dysfunction between the two groups.In terms of prognosis,there was no significant difference in PFS or OS between the two groups.CONCLUSION It is safe and feasible to perform fascia-oriented LLND.Compared with vessel-oriented LLND,fascia-oriented LLND allows the examination of more LLNs and may better protect postoperative urinary function and male sexual function.展开更多
Background:Since 2005,the Myanmar National Tuberculosis Programme(NTP)has been implementing active case finding(ACF)activities involving mobile teams in hard-to-reach areas.This study revealed the contribution of mobi...Background:Since 2005,the Myanmar National Tuberculosis Programme(NTP)has been implementing active case finding(ACF)activities involving mobile teams in hard-to-reach areas.This study revealed the contribution of mobile team activities to total tuberculosis(TB)case detection,characteristics of TB patients detected by mobile teams and their treatment outcomes.Methods:This was a descriptive study using routine programme data between October 2014 and December 2014.Mobile team activities were a one-stop service and included portable digital chest radiography(CXR)and microscopy of two sputum samples.The algorithm of the case detection included screening patients by symptoms,then by CXR followed by sputum microscopy for confirmation.Diagnosed patients were started on treatment and followed until a final outcome was ascertained.Results:A total of 9349 people with symptoms suggestive of TB were screened by CXR,with an uptake of 96.6%.Of those who were meant to undergo sputum smear microscopy,51.4%had sputum examinations.Finally,504 TB patients were identified by the mobile teams and the overall contribution to total TB case detection in the respective townships was 25.3%.Among total cases examined by microscopy,6.4%were sputum smear positive TB.Treatment success rate was high as 91.8%in study townships compared to national rate 85%(2014 cohort).Conclusions:This study confirmed the feasibility and acceptability of ACF by mobile teams in hard-to-reach contexts,especially when equipped with portable,digital CXR machines that provided immediate results.However,the follow-up process of sputum examination created a significant barrier to confirmation of the diagnosis.In order to optimize the ACF through mobile team activity,future ACF activities were needed to be strengthened one stop service including molecular diagnostics or provision of sputum cups to all presumptive TB cases prior to CXR and testing if CXR suggestive of TB.展开更多
High-frequency oscillations(HFOs)in the electroencephalography(EEG)have been extensively investigated as a potential biomarker of epileptogenic zones.The understanding of the role of HFOs in epilepsy has been advanced...High-frequency oscillations(HFOs)in the electroencephalography(EEG)have been extensively investigated as a potential biomarker of epileptogenic zones.The understanding of the role of HFOs in epilepsy has been advanced considerably over the past decade,and the use of scalp EEG facilitates recordings of HFOs.HFOs were initially applied in large scale in epilepsy surgery and are now being utilized in other applications.In this review,we summarize applications of HFOs in 3 subtopics:(1)HFOs as biomarkers to evaluate epilepsy treatment outcome;(2)HFOs as biomarkers to measure seizure propensity;(3)HFOs as biomarkers to reflect the pathological severity of epilepsy.Nevertheless,knowledge regarding the above clinical applications of HFOs remains limited at present.Further validation through prospective studies is required for its reliable application in the clinical management of individual epileptic patients.展开更多
文摘Background: Fractures of humeral shaft in adults are common injuries. Humeral shafts non-union either from late presentation after initial treatment by traditional bone setters or failed non-operative orthodox care is a major problem in this part of the world. This non-union is a major treatment challenge with increased cost of care and morbidity in this part of the world. Humeral shaft non-union can be treated with locked intra-medullary nailing (LIMN) or dynamic compression plating (DCP). Study on comparison of these methods of fixation in this part of the world is scarce in literature search, hence the reason for this study. Objective: The objectives of this study are: (1) to compare early clinical outcome following fixation of humeral shaft fracture nonunion with DCP versus LIMN;(2) to compare the time of radiologic fracture union of DCP with LIMN;(3) to compare complications following fixation of humeral shaft fracture nonunion with DCP versus LIMN. Patients and Methods: This was a randomized control study done for 2 years in which fifty adult patients with humeral shaft non-union were recruited. The patients were grouped into 2 (P = DCP & N = LIMN). Forty five of the patients completed the follow up periods of the study and then analyzed. The P group had ORIF with DCP while the N group had ORIF with LIMN. Both groups had grafting with cancellous bones. Each patient was followed up for a period of 6 months at the time which radiographic union is expected. Any patient without clinical and/or radiographic evidence of union after six months of surgery was diagnosed as having recurrent non-union. The data generated was analyzed using SPSS Version 23. The results were presented in charts and tables. The paired t-test was used while considering p value Result: Forty five patients completed follow up. There was a male preponderance (4:1), right humerus predominated (3:2). Motor vehicular accidents were the commonest cause of the fractures (62%). Most non-union fractures occurred at the level of the middle 3<sup>rd</sup> of the humeral shaft (60%). Failed TBS treatment was the commonest indication for the osteosynthesis (71%). More patients had plating (53%) compared to 47% who had LIMN. Most patients (93.4%) had union between 3 to 6 months irrespective of fixation type with no significant statistical difference between the union rate of DCP and LIMN (p value 0.06) with similar functional outcome and complication rates irrespective of the type of fixation. Conclusion: This study showed that the success rates in term of fracture union, outcome functional grades and complication rates were not directly dependent on the types of the fixation: plating or locked intra-medullary nailing.
文摘Objective:To assess the effectiveness and adverse drug reactions of all-oral regimens for patients with multidrug-resistant tuberculosis.Methods:This retrospective study was conducted at 10 Programmatic Management of Drug Resistant Tuberculosis sites in Punjab province of Pakistan.Patients receiving treatment for drug resistant tuberculosis from July 2019 to December 2020 with at least interim result i.e.6th month culture conversion or final outcomes(cured,complete,lost to follow-up,failure,death)available,were included in the study.Data was extracted from electronic data management system.For the reporting and management of adverse drug events,active tuberculosis drug safety monitoring and management was implemented across all sites.All the data was analyzed using SPSS version 22.Results:Out of 947 drug resistant tuberculosis patients included in this study,579(68%)of the patients had final outcomes available.Of these,384(67.9%)successfully completed their treatment.Out of 368(32%)patients who had their interim results available,all had their 6th month culture negative.Combining new medications was thought to result in serious adverse outcomes such as QT prolongation.However,this study did not record any severe adverse events among patients.Conclusions:All-oral regimens formulation guided by overall treatment effectiveness resulted in treatment outcomes comparable to those obtained with traditional injectable treatment.
基金supported by the Fundamental Research Funds for“National Natural Science Foundation of China”[82274350]the Central public welfare research institutes[Z0734]+2 种基金Scientific and technological innovation project of CACMS[CI2021B003,CI2021A01314,CI2021A00704]National Natural Science Foundation of China[82274350]COVID-19project of the National Administration of Traditional Chinese Medicine[GZY-KJS2021-007,2020ZYLCYJ05-13,2020ZYLCYJ07-5]
文摘Objective Clinical characteristics and outcome in COVID-19 with brucellosis patients has not been well demonstrated,we tried to analyze clinical outcome in local and literature COVID-19 cases with brucellosis before and after recovery.Methods We retrospectively collected hospitalization data of comorbid patients and prospectively followed up after discharge in Heilongjiang Infectious Disease Hospital from January 15,2020 to April29,2022.Demographics,epidemiological,clinical symptoms,radiological and laboratory data,treatment medicines and outcomes,and follow up were analyzed,and findings of a systematic review were demonstrated.Results A total of four COVID-19 with brucellosis patients were included.One patient had active brucellosis before covid and 3 patients had nonactive brucellosis before brucellosis.The median age was54.5 years,and all were males(100.0%).Two cases(50.0%)were moderate,and one was mild and asymptomatic,respectively.Three cases(75.0%)had at least one comorbidity(brucellosis excluded).All4 patients were found in COVID-19 nucleic acid screening.Case C and D had only headache and fever on admission,respectively.Four cases were treated with Traditional Chinese medicine,western medicines for three cases,no adverse reaction occurred during hospitalization.All patients were cured and discharged.Moreover,one case(25.0%)had still active brucellosis without re-positive COVID-19,and other three cases(75.0%)have no symptoms of discomfort except one case fell fatigue and anxious during the follow-up period after recovery.Conducting the literature review,two similar cases have been reported in two case reports,and were both recovered,whereas,no data of follow up after recovery.Conclusion These cases indicate that COVID-19 patients with brucellosis had favorable outcome before and after recovery.More clinical studies should be conducted to confirm our findings.
基金Major Science and Technology Projects in Hainan Province(ZDKJ2016008‑02)。
文摘Objective:To systematically review the influencing factors of the treatment outcome of multidrug-resistant pulmonary tuberculosis and provide reference for the prevention and treatment of multidrug-resistant pulmonary tuberculosis.Method:Case control studies on the factors influencing the treatment outcome of multidrug-resistant pulmonary tuberculosis in Chinese databases(CNKI,VIP,Wanfang,Sinomed)and English databases(Pubmed,Web of science,Medline,Embase,Scopus)were searched and collected by computer.The search period was from the establishment of the database to January 2023.After screening and quality evaluation,RevMan5.4 was used for meta-analysis.Result:Totally 18 articles were ultimately included,with a sample size of 7328 people.The results showed that retreatment,complications,adverse reactions,and gender were related to the treatment outcome of multidrug-resistant pulmonary tuberculosis.The OR values and 95%CI of each factor were 0.22(0.17-0.29),0.38(0.32-0.46),0.27(0.17-0.44),and 0.43(0.33-0.56),respectively.Conclusion:Complications,retreatment,adverse reactions,and male gender are effective risk factors for the treatment outcome of multidrug-resistant pulmonary tuberculosis.In clinical practice,more targeted measures are needed for different types of patients.Due to the limitations of the number of studies,the above conclusions require more research to support them.
文摘Background: The aim was to evaluate the nonsurgical Root Canal Treatment (nRCT) outcome, the restorative condition and the relationship between the coronal restoration quality and the outcome of teeth endodontic treated by undergraduates at the University of Caxias do Sul School of Dentistry (UCS-SD), Brazil, between 2019 and 2021. Materials and Methods: Data from the endodontically treated cases were retrieved, and the patients were recalled for a follow-up appointment at the university. The endodontic diagnosis, radiographs, and the presence of definitive restorations were analyzed in the clinical records. During the follow-up appointment, endodontically treated teeth were classified as present or absent. The nRCT was classified as successful (complete or incomplete healing) or failure (uncertain or unsatisfactory healing). Coronal restoration was classified as absent or present. When it was present, it was classified as permanent or temporary, and its quality as adequate or inadequate restoration. The results were presented as percentages. Results: A total of 257 teeth were endodontically treated. The most prevalent diagnosis was Chronic Apical Periodontitis (33.33%) and the most commonly treated teeth were premolars (46.15%). A total of 52 (21%) treated teeth were clinically and radiographically reexamined. The success rate for the nRCT was 98.08%. About 61.54% of this sample had a definitive composite resin restoration. Conclusion: The nRCT success rate was high. Special attention should be given to the presence and quality of the definitive restoration. Clinical Implications: There was no statistically significant impact between the coronal restoration and the nRCT success (P > 0.05).
文摘Lassa fever is a viral haemorrhagic fever found mostly in West Africa where it is endemic but generates periodic outbreaks in the dry seasons. The virus is spread by the rat species named mastomys natalensis. While the illness is minor in most cases, the mortality is significant in hospitalized patients. Few completely equipped treatment centers existed in Nigeria previous to current increase in frequency requiring demand for new treatment centers without the full complement of essential capabilities. Aim: To analyze the profile and treatment outcome in patients hospitalized in one of such new resource-constrained centers at the Benue State University Teaching Hospital Makurdi, Nigeria. Methodology: This was a retrospective, descriptive hospital-based research encompassing January 2020 to March 2023. Medical records of those admitted to the isolation center were reviewed. The relevant data was coded and analyzed using IBM SPSS version 23. Results: One hundred and ten (110) individuals were hospitalized for probable or suspected Lassa fever throughout the research period. A total of 35 confirmed patients satisfied the inclusion criteria and were included as the study subjects. There were 23 (65.7%) men and 12 (34.3%) females. Their mean age was 35.36 ± 12.21 years (range 15-61 years). The treatment outcome showed that 24 (75%) survived and were discharged, 5 (15.6%) were referred out of the facility for dialysis and 3 died, providing a mortality of 8.6%. The causes of mortality in study patients were acute kidney injury and encephalopathy. Conclusion: Lassa fever is endemic in Benue state with all types of individuals afflicted. The outcome of treatment was good despite resource difficulties. Lassa fever can be successfully managed even in resource-challenged situations typically encountered in developing countries.
基金This study was supported by the‘National Major Science and Technology Projects of China'[2018ZX10101001-005-003,2018ZX10101001-005-004]
文摘Objective Several COVID-19 patients have overlapping comorbidities. The independent role of each component contributing to the risk of COVID-19 is unknown, and how some non-cardiometabolic comorbidities affect the risk of COVID-19 remains unclear.Methods A retrospective follow-up design was adopted. A total of 1,160 laboratory-confirmed patients were enrolled from nine provinces in China. Data on comorbidities were obtained from the patients’ medical records. Multivariable logistic regression models were used to estimate the odds ratio(OR) and 95% confidence interval(95% CI) of the associations between comorbidities(cardiometabolic or non-cardiometabolic diseases), clinical severity, and treatment outcomes of COVID-19.Results Overall, 158(13.6%) patients were diagnosed with severe illness and 32(2.7%) had unfavorable outcomes. Hypertension(2.87, 1.30–6.32), type 2 diabetes(T2 DM)(3.57, 2.32–5.49),cardiovascular disease(CVD)(3.78, 1.81–7.89), fatty liver disease(7.53, 1.96–28.96), hyperlipidemia(2.15, 1.26–3.67), other lung diseases(6.00, 3.01–11.96), and electrolyte imbalance(10.40, 3.00–26.10)were independently linked to increased odds of being severely ill. T2 DM(6.07, 2.89–12.75), CVD(8.47,6.03–11.89), and electrolyte imbalance(19.44, 11.47–32.96) were also strong predictors of unfavorable outcomes. Women with comorbidities were more likely to have severe disease on admission(5.46,3.25–9.19), while men with comorbidities were more likely to have unfavorable treatment outcomes(6.58, 1.46–29.64) within two weeks.Conclusion Besides hypertension, diabetes, and CVD, fatty liver disease, hyperlipidemia, other lung diseases, and electrolyte imbalance were independent risk factors for COVID-19 severity and poor treatment outcome. Women with comorbidities were more likely to have severe disease, while men with comorbidities were more likely to have unfavorable treatment outcomes.
基金the German Federal Ministry of Health(partially).
文摘BACKGROUND The rising number of people using methamphetamine leads to an increasing need for treatment options for this patient group.Evidence-based research on the efficacy of treatment programs for methamphetamine users is limited.Due to specific characteristics of methamphetamine users,the question arises whether established treatment methods for individuals using other substances can be effective for the treatment of methamphetamine dependence as well.We hypothesize that there are significant differences between the two groups that may affect the effectiveness of treatment and worsen the prognosis of treatment outcomes for methamphetamine users compared to consumers of other substances.AIM To investigate potential differences in cognitive functioning and psychopathology between methamphetamine users and other substance users and possible correlations with treatment outcomes.METHODS A total of 110 subjects were recruited for an observational,longitudinal study from a German inpatient addiction treatment center:55 patients with methamphetamine dependence and 55 patients with dependence of other substances(“OS group”).Both groups were examined at beginning(baseline)and end of treatment(after 6 mo)with regard to treatment retention,craving,cognitive functioning,psychosocial resources,personality traits,depression,and other psychiatric symptoms.Instruments used were Raven’s IQ test,Mannheimer craving scale,cognitrone cognitive test battery,NEO personality factors inventory,Hamilton depression scale,Becks depression inventory,and a symptom checklist.The statistical methods used were χ^(2)-test,t-test and multiple mixed ANOVAs.RESULTS A total drop-out rate of 40%(methamphetamine-group:36.4%;OS-group:43.6%)was observed without significant differences between groups.At baseline,methamphetamine-group subjects significantly differed from OS-group individuals in terms of a lower intelligence quotient,fewer years of education,slower working speed,and decreased working accuracy,as well as less cannabinoid and cocaine use.Methamphetamine-group subjects further showed a significantly lower score of conscientiousness,depressive,and psychiatric symptoms than subjects from the OSgroup.In both groups,a reduction of craving and depressive symptoms and an improvement of working speed and working accuracy was noted after treatment.CONCLUSION There are differences between methamphetamine users and users of other drugs,but not with regard to the effectiveness of treatment in this inpatient setting.There are differences in cognitive function and psychopathology between methamphetamine and other drugs users.The existing treatment options seem to be an effective approach in treating methamphetamine dependence.
文摘<b>Background: </b>Nigeria<i>,</i> one of the high burden Tuberculosis countries<i>,</i> has developed various intervention strategies to ensuring universal access to quality-assured tuberculosis diagnosis and treatment. However<i>,</i> low case detection and unsuccessful treatment outcome still remains a serious challenge in most states. Community Tuberculosis care was born against this background in 2010 as a complementing front to combat the challenges<i>,</i> bringing directly observed treatment short-course strategy beyond the clinic settings to the door steps of patients. This study evaluates the contributions of the intervention to Tuberculosis case detection and treatment outcomes in two states in Nigeria. <b>Materials and Method:</b> A retrospective study with multistage sampling technique was employed to review 23<i>,</i>241 presumptive Tuberculosis cases enrolled for management between 2014-2017. Chi-square (<i>χ</i><sup>2</sup>) test was used for test of association between the independent variables and the main outcomes of the study<i>,</i> with statistical significance set at p-value of 5%. <b>Results</b>: The annual percentage increase for both states was 24.7%<i>,</i> 189.8% and 114.5% in the study group as against 5.2%<i>,</i> 44.6% and 65.6% in control group. Overall<i>,</i> 23.8% were bacteriologically positive (either AFB or Gene-Xpert MTB/Rif) and 1.4% were clinically evaluated to be positive<i>,</i> while 74.8% were bacteriologically negative. Of the total 5861 cases treated<i>,</i> successful treatment rate of the patients in the study group was 88.6% as compared to 76.1% in the control group. The relationship between the referral system from communities where the intervention program was implemented and the case detection/treatment outcome was statistically significant (OR 95% CI = 3.15<i>,</i> 2.95 - 3.35). <b>Conclusion</b>: The community level Tuberculosis intervention led to significantly better case detection and treatment outcome when compared to the conventional approach (p ≤ 0.05). Therefore<i>,</i> full community engagement should be advocated as a major strategy for End Tuberculosis planed by WHO since the patients are found in the community and not in the health facilities.
文摘Background: Despite the availability of highly effective treatment for decades, Tuberculosis (TB) remains a major health problem in Nigeria due to the increasing association between HIV and TB observed over the past three decades when HIV was discovered. However, the proportion of TB and or TB/HIV co-infected patients who have successful TB treatment outcome is not well known. This study determined the treatment outcome of TB/HIV co-infected patients with HIV negative patients in two states in Nigeria. Materials and Methods: A retrospective study of secondary data from eight Directly Observed Treatment Short (DOTS) course and Anti- Retroviral Therapy (ART) service providers in Benue and Federal Capital Territory (FCT), Nigeria, was carried out. The period under review covers January, 2010 to December, 2013. Results: Out of the total 5266 TB cases reviewed, the HIV prevalence rate was 52%. They were predominantly (53.3%) male with mean age of 34.4 years (SD = 15.1 years). More than two-third (72.5%) of HIV-negative patients had successful treatment compared to 1718 (62.7%) HIV-positive patients. Of the 2334 HIV co-infected patients, 19.5% defaulted, 11.5% had died, 5.6% were transferred out and 0.7% failed treatment compared to HIV-negative patients amongst whom 18.3% defaulted, 3.6% died, 3.9% were transferred out and 1.6% failed treatment (p Conclusion: The favourable treatment outcome of HIV-negative patients is more than that of HIV-positive patients and the most probable predictable factor responsible is the CD4 count of patient;indicating that TB/HIV co-infection has remained a major public health problem in Benue state and FCT. Hence there is the need for sustained strengthening and expansion of the national TB/HIV programmes.
文摘Introduction: Tuberculosis (TB) is a major public health concern in Ethiopia. Analysis of TB case notification and treatment outcomes is crucial to understand the TB control program performance. The current study was carried out to assess trends of TB case notifications, treatment success rate and factors associated with unsuccessful treatment outcome among TB patients in West Gojjam Zone of Amhara Region, Ethiopia. Method: A retrospective cohort study was conducted in West Gojjam Zone. Demographic and clinical data were reviewed for all TB patients registered between July 2007 and June 2012 at 30 randomly selected public health facilities of the study zone. In addition, annual case notification reports of the study zone were used to analyze trends in TB case notifications. Logistic regression analysis was used to assess the association between potential predictor variables and unsuccessful treatment outcomes. Results: Tuberculosis case notification for all forms of TB decreased from 203/100,000 population in 2007 to 155/100,000 population in 2012. Among patients whose treatment outcomes were evaluated, 94.4% were successfully treated, 0.3% had treatment failure, 1.5% defaulted and 3.7% died. In multivariate analysis, the odds of unsuccessful treatment outcome was higher among retreatment cases than new cases (adjusted OR, 3.44;95% CI: 1.92, 6.19). HIV co-infected cases were more likely to have unsuccessful treatment outcome compared to HIV negatives (adjusted OR, 2.68;95% CI: 1.92, 3.72). Conclusion: Tuberculosis case notification rates showed a decreasing trend between 2007 and 2012. The treatment success rate exceeded the 90% treatment success rate target as set by the WHO. Special attention is required for patients with high risk of unsuccessful treatment outcome. Therefore, retreatment cases, and HIV positive cases need strict follow up throughout their treatment period.
文摘Background: Few data is available in low-burden TB-HIV countries on TB treatment outcomes. We evaluated TB patients (pts) characteristics by HIV status and compared treatment outcomes in relation to HIV status, CD4 count and antiretroviral therapy (ART). Methods: We performed a retrospective analysis of 447 adult TB pts who registered and initiated treatment in our center from 2014 to 2015. Results: Pts were categorized as HIV-negative (n = 399, 89.3%), HIV-positive on ART (n = 42, 9.4%) and HIV-positive not on ART (n = 6, 1.3%). The proportion of pts with extended TB therapy was higher among HIV-positive pts (p = 0.03). Increased age was associated with higher death rates regarding treatment success (OR 1.08;95% CI 1.01 - 1.17, p = 0.03). Statistically significant higher mortality was found among HIV-positive pts on ART (OR 9.93;95% CI 1.36 - 72.37, p = 0.03) and HIV-positive pts not on ART (OR 397.00;95% CI 44.27 to 3559.91, p ≤ 0.0001) compared to HIV-negative pts. When multivariate analyses were restricted to HIV-positive pts, being not on ART was associated with higher mortality (OR 40.0;95% CI 4.37 - 365.78, p = 0.001). Conclusions: There was significant difference in death rates between HIV-positive and HIV-negative TB pts. HIV-positive pts not on ART had a significantly higher mortality.
基金The authors declare that they did not receive funding for this research from any source.
文摘Background:Anti-tuberculosis drug resistance is a major public health problem that threatens the progress made in tuberculosis care and control worldwide.Treatment success rates of multidrug-resistant tuberculosis(MDR-TB)is a key issue that cannot be ignored.There is a paucity of evidence that assessed studies on the treatment of MDR-TB,which focus on the effectiveness of the directly observed treatment,short-course(DOTS)-Plus program.Therefore,it is crucial to assess and summarize the overall treatment outcomes for MDR-TB patients enrolled in the DOTS-Plus program in recent years.The purpose of this study was to thus assess and summarize the available evidence for MDR-TB treatment outcomes under DOTS-Plus.Methods:A systematic review and meta-analysis of published literature was conducted.Original studies were identified using the databases MEDLINE®/PubMed®,Hinari,and Google Scholar.Heterogeneity across studies was assessed using the Cochran’s Q test and I2 statistic.Pooled estimates of treatment outcomes were computed using the random effect model.Results:Based on the 14 observational studies included in the meta-analysis,it was determined that 5047 patients reported treatment outcomes.Of these,the pooled prevalence,63.5%(95%CI:58.4-68.5%)successfully completed full treatment(cured or treatment completed)with a pooled cure rate of 55.6%,whereas 12.6%(95%CI:9.0-16.2%)of the patients died,14.2%(95%CI:11.6-16.8%)defaulted from therapy,and 7.6%(95%CI:5.6-9.7%)failed therapy.Overall 35.4%(95%CI:30-40.8%)of patients had unsuccessful treatment outcomes.An unsatisfactorily high percentage 43%(95%CI:32-54%)of unsuccessful treatment outcomes was observed among patients who were enrolled in standardized treatment regimens.Conclusion:This study revealed that patients with MDR-TB exhibited a very low treatment success rate compared to the World Health Organization 2015 target of at least 75 to 90%.The high default rate observed by conducting this literature review could possibly explain the spread of the MDR-TB strain in various populations.A better treatment success rate was observed among patients in individualized treatment regimens than in standardized ones.Conducting further individual-based meta-analysis is recommended to identify potential factors for defaulting treatment using large-scale and multi-center studies.
文摘Background:The impact of the human immunodeficiency virus(HIV)on tuberculosis(TB),and the implications for TB and HIV control,is a public health challenge in Ghana-almost a quarter(23%)of all TB cases were HIV positive in 2010.The integration of TB/HIV services has therefore emerged as an essential component of the national response to TB and HIV.The aim is to reduce fragmentation,improve access,enhance efficiency and improve quality of care.Ghana’s TB/HIV policy comprises three linked sets of activities:effective implementation of the Stop TB Strategy for TB control,improved HIV prevention and care,and the implementation of additional TB/HIV activities.Different models of service delivery with increasing integration of TB/HIV activities are expected to provide greater access to more comprehensive care.The objective of this paper is to assess the impact of TB/HIV integration on TB treatment outcomes and to explore the usefulness of TB treatment outcomes as TB/HIV indicators.Methods:A before-and-after study to observe the introduction of TB/HIV activities into TB programmes in three hospitals with different levels of integration was conducted.Anonymised patient data was collated from TB registers from each facility,and analysed to determine if TB treatment outcomes changed significantly after integration.Results:TB treatment success was 50%(95%CI 49-52)prior to,and 69%(95%CI 65-73)after,integration(Χ243.96,p<0.00).Treatment success increased from 43%to 53%at the one-stop shop(OSS),from 69%to 78%at the partially integrated site(PIS)and substantially from 46%to 78%at the referral site(RS)(Χ264.54;p<0.01).Defaults and cases transferred out reduced from 14.3%and 15.3%prior to integration,to 1.4%and 9.0%after integration,respectively,accounting for a significant increase in treatment success.Death rates remained high at 18%in all cases studied and 25%in HIV-associated cases after integration.Conclusion:TB/HIV integration may improve TB treatment success,but its exact impact is difficult to ascertain due to non-specificity and design limitations.TB mortality may be more useful as an indicator for monitoring TB/HIV activities in Ghana.
基金This research did not receive any funding from any organization.
文摘Background:Data regarding tuberculosis(TB)treatment outcomes,proportion of TB/HIV co-infection and associated factors have been released at different TB treatment facilities in Ethiopia and elsewhere in the world as part of the auditing and surveillance service.However,these data are missing for the TB clinic offering directly observed treatment short-course(DOTs)at Debre Tabor General Hospital(DTGH).Methods:The authors analysed the records of 985 TB patients registered at the DTGH from September 2008 to December 2016.Data on patients’sex,age,type of TB,and treatment outcomes were extracted from the TB treatment registration logbook.The treatment outcome of patients was categorized according to the National TB and Leprosy Control Program guidelines:cured,treatment completed,treatment failed,died,and not evaluated(transferred out and unknown cases).Results:Around half of the registered patients were males(516,52.4%).In terms of TB types,381(38.7%),241(24.5%),and 363(36.9%)patients had smear-negative pulmonary TB,smear-positive pulmonary TB,and extra pulmonary TB,respectively.Six hundred and seventy-two patients(90.1%)had successful treatment outcomes(cured and treatment completed),while 74 patients(9.9%)had unsuccessful treatment outcomes(death and treatment failure).TB treatment outcome was not associated with age,sex,type and history of TB,or co-infection with HIV(P>0.05).The proportion of TB/HIV co-infection was at 24.2%,and these were found to be significantly associated with the age groups of 25-34,35-44 and≥65 years:(aOR:0.44;95%CI:0.25-0.8),(aOR:0.39;95%CI:0.20-0.70),(aOR:4.2;95%CI:1.30-12.9),respectively.Conclusions:The proportion of patients with successful treatment outcomes was above the World Health Organization target set for Millennium Development Goal of 85%and in line with that of the global milestone target set at>90%for 2025.Relatively higher proportions of transfer-out cases were recorded in the present study.Similarly,the proportion of TB/HIV co-infection cases was much higher than the national average of 8%.Thus,the health facility under study should develop strategies to record the final treatment outcome of transfer-out cases.In addition,strategies to reduce the burden of TB/HIV co-infection should be strengthened.
基金by a grant from the special fund of the pediatric medical coordinated development center of the Beijing Children’s Hospital(No.XTZD20180204).
文摘Background:With current chemotherapy treatment,>90%of survival has been obtained for Burkitt lymphoma(BL).In this study,the demographic characteristics and treatment outcomes are presented for 78 children in China with central nervous system-positive(CNS+)BL.Methods:This retrospective study consecutively enrolled 78 CNS+BL patients in Beijing Children’s Hospital(BCH)from 2007 to 2019 who received the BCH B-cell non-Hodgkin’s lymphoma regimen(modified by French-American-British mature lymphoma B-cell 96[FAB/LMB96]C1 arm±rituximab).Clinical characteristics,methods of disease detection in the CNS,and outcomes were evaluated.Univariate and multivariate analyses were used to assess prognostic factors.Results:The median age of 65 boys and 13 girls at the time of diagnosis was 5.7 years(ranging from 1 to 14 years).Patients were followed up for a median time of 34 months(ranging from 1 to 72 months).Bone marrow invasion was found in 38(48.7%)patients.There were 48(61.5%),44(56.4%),and 25(32%)patients with cranial nerve palsy,intracerebral mass(ICM),and parameningeal extension,respectively.Abnormal cerebrospinal fluid(CSF)morphology and CSF immunophenotype appeared in 15(19.2%)and 15(19.2%)patients,respectively.There were 69(88.5%)patients treated with chemotherapy combined with rituximab,and nine patients were treated solely with chemotherapy.Finally,five patients died of treatment-related infection,recurrence occurred for 13,and one developed a second tumor.The 3-year overall survival and event-free survival rates were 78.9%±4.7%and 71.4%±6.0%,respectively.Treatment with chemotherapy only,ICM positivity,and>4 organs involved at diagnosis were independent risk factors.Conclusions:Rituximab combined with a modified LMB96 regimen has greatly increased the efficacy of treatment for Chinese children with CNS+BL,and with the continuous collection of outcome data,treatment-related complications are decreasing.For further verification,a large sample multicentre randomized controlled study should be performed to explore a treatment scheme for Chinese children with even greater efficacy.
文摘Background:In China,an indigenously developed electronic medication monitor(EMM)was designed and used in 138 counties from three provinces.Previous studies showed positive results on accuracy,effectiveness,acceptability,and feasibility,but also found some ineffective implementations.In this paper,we assessed the effect of implementation of EMMs on treatment outcomes.Methods:The longitudinal ecological method was used at the county level with aggregate secondary programmatic data.All the notified TB cases in 138 counties were involved in this study from April 2017 to June 2019,and rifampicinresistant cases were excluded.We fitted a multilevel model to assess the relative change in the quarterly treatment success rate with increasing quarterly EMM coverage rate,in which a mixed effects maximum likelihood regression using random intercept model was applied,by adjusting for seasonal trends,population size,sociodemographic and clinical characteristics,and clustering within counties.
文摘BACKGROUND For the management of lateral lymph node(LLN)metastasis in patients with rectal cancer,selective LLN dissection(LLND)is gradually being accepted by Chinese scholars.Theoretically,fascia-oriented LLND allows radical tumor resection and protects of organ function.However,there is a lack of studies comparing the efficacy of fascia-oriented and traditional vessel-oriented LLND.Through a preliminary study with a small sample size,we found that fasciaoriented LLND was associated with a lower incidence of postoperative urinary and male sexual dysfunction and a higher number of examined LLNs.In this study,we increased the sample size and refined the postoperative functional outcomes.AIM To compare the effects of fascia-and vessel-oriented LLND regarding short-term outcomes and prognosis.METHODS We conducted a retrospective cohort study on data from 196 patients with rectal cancer who underwent total mesorectal excision and LLND from July 2014 to August 2021.The short-term outcomes included perioperative outcomes and postoperative functional outcomes.The prognosis was measured based on overall survival(OS)and progression-free survival(PFS).RESULTS A total of 105 patients were included in the final analysis and were divided into fascia-and vesseloriented groups that included 41 and 64 patients,respectively.Regarding the short-term outcomes,the median number of examined LLNs was significantly higher in the fascia-oriented group than in the vessel-oriented group.There were no significant differences in the other short-term outcomes.The incidence of postoperative urinary and male sexual dysfunction was significantly lower in the fascia-oriented group than in the vessel-oriented group.In addition,there was no significant difference in the incidence of postoperative lower limb dysfunction between the two groups.In terms of prognosis,there was no significant difference in PFS or OS between the two groups.CONCLUSION It is safe and feasible to perform fascia-oriented LLND.Compared with vessel-oriented LLND,fascia-oriented LLND allows the examination of more LLNs and may better protect postoperative urinary function and male sexual function.
基金The program was funded by WHO/TDR Impact grant to two TDR alumni from DMRThe funders had no role in study design,data collection and analysis,decision to publish,or preparation of the manuscript。
文摘Background:Since 2005,the Myanmar National Tuberculosis Programme(NTP)has been implementing active case finding(ACF)activities involving mobile teams in hard-to-reach areas.This study revealed the contribution of mobile team activities to total tuberculosis(TB)case detection,characteristics of TB patients detected by mobile teams and their treatment outcomes.Methods:This was a descriptive study using routine programme data between October 2014 and December 2014.Mobile team activities were a one-stop service and included portable digital chest radiography(CXR)and microscopy of two sputum samples.The algorithm of the case detection included screening patients by symptoms,then by CXR followed by sputum microscopy for confirmation.Diagnosed patients were started on treatment and followed until a final outcome was ascertained.Results:A total of 9349 people with symptoms suggestive of TB were screened by CXR,with an uptake of 96.6%.Of those who were meant to undergo sputum smear microscopy,51.4%had sputum examinations.Finally,504 TB patients were identified by the mobile teams and the overall contribution to total TB case detection in the respective townships was 25.3%.Among total cases examined by microscopy,6.4%were sputum smear positive TB.Treatment success rate was high as 91.8%in study townships compared to national rate 85%(2014 cohort).Conclusions:This study confirmed the feasibility and acceptability of ACF by mobile teams in hard-to-reach contexts,especially when equipped with portable,digital CXR machines that provided immediate results.However,the follow-up process of sputum examination created a significant barrier to confirmation of the diagnosis.In order to optimize the ACF through mobile team activity,future ACF activities were needed to be strengthened one stop service including molecular diagnostics or provision of sputum cups to all presumptive TB cases prior to CXR and testing if CXR suggestive of TB.
基金supported by grants from the National Key R&D Program of China(2017YFC1307500 to QW)the Capital Health Research and Development of Special Program(2016-1-2011 and 2020-1-2013 to QW)+2 种基金the Beijing-Tianjin-Hebei Cooperative Basic Research Program(H2018206435 to QW)the Beijing Natural Science Foundation(Z200024 to YGW and QW)the National Natural Science Foundation of China(81801280 to GR,81601126 to JR).
文摘High-frequency oscillations(HFOs)in the electroencephalography(EEG)have been extensively investigated as a potential biomarker of epileptogenic zones.The understanding of the role of HFOs in epilepsy has been advanced considerably over the past decade,and the use of scalp EEG facilitates recordings of HFOs.HFOs were initially applied in large scale in epilepsy surgery and are now being utilized in other applications.In this review,we summarize applications of HFOs in 3 subtopics:(1)HFOs as biomarkers to evaluate epilepsy treatment outcome;(2)HFOs as biomarkers to measure seizure propensity;(3)HFOs as biomarkers to reflect the pathological severity of epilepsy.Nevertheless,knowledge regarding the above clinical applications of HFOs remains limited at present.Further validation through prospective studies is required for its reliable application in the clinical management of individual epileptic patients.
