To summarize, using a standardized and repro- ducible methodology, this study showed that mandibular ridge anatomy may influence treatmentoutcome with conventional complete dentures. The shape of the mandibular ridge may influence den- ture stability, while ridge resiliency may influence denture retention. Prognostic indicators are likely to take on increasing importance as a diagnostic tool for selection of patients for implant provision. Previous studies done in this area are equivocal and lack standardized methodologies for direct com- parison 2 . However, it must be emphasized that suc-
Our study showed that an 11.8% and 73.5% of the TB patients attending DOTS were cured and completed treatment, respectively. These account an overall treatment success rate of 85.2%, which was similar with the 2013 international treatment success rate of 86% among all new TB cases  and studies done elsewhere [20,21]. The treatment success rate obtained was slightly lower than those reported from Dabat (87.8%)  and Tigray (89.2%)  in north- ern Ethiopia. However, the treatment success rate was lower compared to the WHO treatment success report for Ethiopia (91%)  and the national TB success rate (91.4%) . On the other hand, the treatment success rate obtained in this study was higher than reports from sev- eral areas in Ethiopia, in which treatment success rates ranging from 26% to 80.7% were reported [9, 13–15, 17, 23, 24, 25]. The comparably more successful treatmentoutcome recorded in this study shows the promising performance of institutional DOTS in TB control program in the area. The increasing trend of TB treatment success from 2008 to 2013 obtained in this study was similar with a study in done in Addis Ababa . This might be due to improved adherence of TB patients to treatment that may signify the importance of the DOTS strategy.
The variables documented for retreatment patients were all routinely recorded on TB register, and included demographic details (age and sex), disease characteristics (disease classification, site of EPTB, HIV status Diabetes status) and treatment-related variables (Retreatment cases and treatmentoutcome). The data was entered into a structured proforma. The data collected was entered in Microsoft excel 2007 and analyzed using Epi Info 3.5.3. Descriptive statistics and Chi square test was used to test the association between variables of interest.
Tuberculosis is a global emergency with increasing incidence among urban poor. It is one of the major causes of adult deaths every year. Fundamental objectives of tuberculosis (TB) control are to detect disease as early as possible and to make sure that those diagnosed complete their treatment and be cured. In mid 1990s, Directly Observed Treatment Short course (DOTS) strategy was adopted as basis of TB control 1 . Treatment success under the DOTS strategy was determined by cure and treatment completion while unsuccessful treatment included patients who failed and defaulted 2 . One of the major barriers to successful treatmentoutcome is default from treatment. In 2006, WHO had reported 5% default rate for smear positive pulmonary tuberculosis (PTB) patients 1 . In developing countries, the major contributing factors to poor compliance to anti-TB drugs are feeling of being completely cured once signs and symptoms are resolved 3 , lack of patient motivation, side effects of drugs, duration of the treatment and the general poverty of the population affected, as well as socio-psychological factors 4 . Default or interruption from treatment may result in persistent infectiousness 5 , relapse, drug resistance 6 and increased morbidity and mortality 7 . Nigeria has the fourth largest burden of TB in the world. 8, 9 In order to promote drug adherence, WHO has emphasized on patient centered approach. 10 Directly observed treatment short course (DOTS) was introduced in 2004 in the University of Maiduguri Teaching Hospital (UMTH) Northeastern Nigeria and since then the success or otherwise of DOTS in UMTH has not been reported. Therefore, this study was to determine treatment success of directly observed treatment short course (DOTS) in the University of Maiduguri Teaching Hospital (UMTH) over a three-year period (January 2007 to December 2009).
tions were used for treatmentoutcome: (a) cured if patients have finished treatment with negative bacteriological result at the end of treatment, (b) treatment completed if patients have finished treatment, but without bacteriological result at the end of treatment, (c) treatment failure if a pulmonary TB patient was smear-positive at five month follow-up despite correct intake of medication, (d) defaulter if the patient inter- rupted treatment for two consecutive months or more than two months after registration, (e) died if the patient died from any cause during the course of treatment, (f) transferred out if treatment result is unknown due to transfer out to another health facility, and (g) successfully treated if patients were declared “cured” and “completed” treatment as per the pro- tocol.
infiltrate and focal vacuolization were found at the dermoe- pidermal junction. Edema, vessel ectasia, a mild perivascu- lar lymphocytic infiltrate, and mucin deposits were found in the reticular dermis and a lymphocytic infiltrate surrounded hair follicles. At that time anti‐SSA antibodies were present, but there were no other abnormalities in the full blood count, renal function, or urinary sediment. There was improvement with topical hydrocortisone, tacrolimus, and photoprotection. One month later, the patient developed fever and lost 1.5 kg in weight, and 3 months later, the rash on the cheeks returned (Figure 1B). Repeat biopsies in the malar region were per- formed in July 2012 but a tissue orientation error prevented in- terpretation. At that time, a lupus band test from unaffected skin revealed the presence of IgM and IgG granular deposits in the basement membrane. Hydroxychloroquine (HCQ) 400 mg/d was started and the rash improved (Figure 1C). Despite HCQ, in December 2012, symmetrical painful violaceous lesions ap- peared on the tip of the fingers and toes. These resolved with deflazacort 30 mg/d for 1 week, progressively discontinued in the following 3 months. In June 2013, still on HCQ, worsening of the malar rash was documented. In April 2014, the patient reported the onset of pruritic well‐defined hyperkeratotic pap- ules initially in the lower limbs, rapidly spreading to the but- tocks, upper torso, arms, palms of hands and scalp, resulting in severe alopecia (Figure 1D). The complete full blood count, hepatic and renal function tests were within normal ranges. A more extensive profile revealed ANA positivity (1/1280), with an elevated anti‐dsDNA, a low C4 and C3. The patient was then treated with daily deflazacort 30 mg, azathioprine (AZA) 50 mg and anti‐histaminics, with no improvement. At that time, scabies was suspected and topical treatment with ben- zyl benzoate was prescribed on two occasions. Several scalp punch biopsies in September 2014 (Figure 2B) were reported as compatible with lupus, folliculitis being reported in one of
A1F1. Exclusion criteria were classic contraindications to interferon or ribavirin therapy, including autoimmune disorders, pregnancy, limiting psychiatric, ophthalmological or cardiological disorders, platelet count less than 75,000/mm 3 , neutrophil counts less than 1500 cells/mm 3 , and haemoglobin levels less than 10 g/ dl. Child-Pugh C cirrhosis, and positive hepatitis B antigen were also excluded. Antiviral therapy included pegylated interferon alpha-2b (PEG intron, Schering Plough) and ribavirin (Rebetol, Schering Plough), initially given as a function of the patient’s weight. The initial dosage was always higher than 1 mg/kg/week subcutaneously for pegylated interferon alpha-2b and 10.6 mg/ kg/day orally for ribavirin. The duration of treatment was defined according to consensus recommendations according to genotype, HCV viral load, presence of cirrhosis and failure of previous treatment. All patients were followed for at least 6 months after treatment discontinuation in order to assess their SVR. HCV RNA was measured in the serum using the reverse PCR (COBAS TM Amplicator TM , Roche). Genotyping was performed using the Inno-Lipa assay (Innogenetics, Ghent, Belgium). Hepatic necroinflammation and fibrosis were assessed by the METAVIR scoring system . Fibrosis was staged on a scale of F0–F4: F0 = no fibrosis, F1 = portal tract expansion by fibrosis, F2 = less than 50% bridging fibrosis, F3 = more than 50% bridging fibrosis without cirrhosis, and F4 = established cirrhosis. Steatosis was staged as follows: 0: no steatosis, 1: 1–29% of hepatocytes, 2: 30– 49% of hepatocytes and 3: $50% of hepatocytes.
MDR-TB case definition was based on the WHO definitions and reporting framework for tuberculosis that was revised in 2013 and updated in December 2014 . Briefly, new patients are those who have no history of prior TB treatment, or they have received less than one month of anti-TB drugs. Previously treated TB patients include those patients treated as new cases for more than one month who are smear or culture positive. The treatment outcomes of MDR-TB patients were reported according to the following six outcome categories: (i) “Cured”: treatment completed as recommended by the national policy without evidence of failure and three or more consecutive cultures taken at least 30 days apart are negative after the intensive treatment phase; (ii) “Treatment completed”: treatment completed as recommended by the national policy without evidence of failure but no record that three or more consecutive cultures taken at least 30 days apart are negative after the intensive phase; (iii) “Treatment failed”: Treatment termi- nated or need for permanent regimen change of at least two anti-TB drugs; (iv) “Died”: a patient who died for any reason during the course of treatment; (v) “Lost to follow-up”: a patient whose treatment was interrupted for 2 consecutive months or more; (vi) “Not evaluated”: A patient for whom no treatmentoutcome is assigned (it could be a transfer out case).
Radiological signs are not characteristic and MRI is a highly sensitive technique to visualize synovitis and effu- sions, but not the specific one 18. It can help in distinguish- ing TB arthritis from other proliferating synovial arthropa- thies 19. Apart from presenting MRI images, we provided a bacteriological proof – Löwenstein-Jensen culture positive finding for M. tuberculosis in synovial fluid, the latter not always achieved in routine clinical practice but still the most valuable diagnostic criteria in TB. Histological finding itself, when it presents specific granuloma, would not be a better diagnostic criterion, having in mind many diseases which are characterized with a granulomatous process. However, diag- nosis of TB synovitis may be based on clinical and radio- graphic signs only, and then, a successful treatmentoutcome serves as the best proof of TB etiology. In routine clinical practice, special methods for M. tuberculosis detection are available, including rapid bacteriological methods like polimerase chain reaction. All the particular methods of TB diagnosis include clinician's suspicion on TB firstly. Chen et al. 12 described the usefulness of arthroscopic operation for the management of synovial TB of the knee joint both in its diagnosis and treatment.
transverse dimensional changes in surgical skeletal Class III patients with and without presurgical orthodontics. J Oral Maxillofac Surg. 2010 Aug;68(8):1807-12. 34. Liao YF, Chiu YT, Huang CS, Ko EW, Chen YR. Presurgical orthodontics versus no presurgical orthodontics: treatmentoutcome of surgical orthodontic correction for skeletal class III open bite. Plast Reconstr Surg. 2010 Dec;126(6):2074-83. 35. Kim CS, Lee SC, Kyung HM, Park HS, Kwon TG. Stability of mandibular setback
Patients were classiﬁed into ﬁve (5) groups by treatmentoutcome: cure (completed treatment with at least two sub- sequent negative smear examinations), default (those that did not attend regular appointments for more than 30 days), death by TB, other cause of death (died during TB treatment of another cause), and MDR-TB (multidrug-resistant tuber- culosis). Patients who initially were thought to have TB but were subsequently found to have a different diagnosis were excluded from the analysis.
Objectives: Anxiety disorders are common psychiatric conditions that cause significant disability, poor quality of life and enormous social cost. Although treatments with demonstrable efficacy are available a great number of patients fail to respond or remains with clinically significant residual symptoms after treatment. The objective of this study is to review aspects related to treatment resistance and pharmacological strategies to deal with anxiety disorders resistant to treatment. Method: Narrative review. Results: We discuss conceptual aspects related to treatment resistance or refractoriness, predictors of poor treatmentoutcome, and finally, some strategies to deal with anxiety disorders (including social anxiety disorder, generalized anxiety disorder and panic disorder) that do not respond to standard therapeutic interventions. Conclusion: Treatment resistance in anxiety disorders remains a challenge to clinical practice going from non standardized concepts of response and resistance to a paucity of controlled studies concerning therapeutic strategies.
ABSTRACT: BACKGROUND: Organophophorous poisoning constitutes one of the most frequent poisoning in clinical practice all over the country and especially in this area where agriculture is the chief economic occupation. Acute organophophorous poisoning ranks foremost in the list of agents which causes acute pesticide poisoning in the developing countries. Acute poisoning, accidental or due to deliberate ingestion or inhalation of these organophosphate chemicals is an important and one of the most common medical emergencies. Hence the present study is undertaken to assess severity of poisoning, management and outcome of organophosphorous poisoning cases admitted in Government General Hospital, Kakinada, A. P. AIMS/OBJECTIVES: 1. Assessment of severity of Organophosphorous poisoning according to Driesbach’s criteria 2. To study the morbidity and mortality in these patients. MATERIALS AND METHODS: In this descriptive study fifty patients with organophosphorous insecticide poisoning were evaluated by clinical examination. They were investigated, treated and their treatmentoutcome were analyzed. RESULTS: 1. Chlorpyriphos and monocrotophos(together 66%) were the most commonly used pesticides. 2. 82% cases reached the hospital within 6 hours for commencement of treatment and were mostly of moderate to severe degree of OP poisoning while mild cases of accidental poisoning reached after 12 hours. Hence the mortality is high in the former group only. 3. When the severity of poisoning was graded by applying Dreisbach's criteria at the time of admission 34% had severe degree of poisoning, 26% had moderate poisoning while 40% of cases presented with mild degree of poisoning. (Most of the cases were accidental inhalation and skin contact exposure.) 4. Among the patients belonging to moderate to severe degree of poisoning 30% of patients were put on assisted mechanical ventilation, indications being uncontrolled pulmonary secretions, continuing hypoxia, not relieved with routine Oxygen therapy and respiratory paralysis. 5. The mortality rate in the present study is 14% (7 cases out of 50). All of them expired despite good ventilatory support and intensive medical care. 6. In this study among 17 cases of severe degree poisoning, 5 patients expired and the remaining 12 cases recovered with Intensive medical care and mechanical ventilatory support.
strategies for the prevention of VAT, and other observational studies. he authors found that administration of systemic antimicrobials (with or without aerosolized antimicrobials) in patients with VAT was not associated with decreased mortality when compared to placebo or no treatment (odds ratio - OR 0.56, 95% conidence interval - CI95% 0.27-1.14). However, most of the studies that provided relevant data noted that administration of antimicrobial agents, as opposed to placebo or no treatment, in patients with VAT was associated with a lower frequency of subsequent pneumonia and more ventilator-free days; however, the length of ICU stay and duration of mechanical ventilation were not shortened. In addition, selective digestive decontamination (SDD) was not shown to be an efective preventive strategy against VAT (OR 0.62, 95%CI 0.27-1.14).
Background: Endovascular treatment (ET) of iliac occlusive disease (IOD) is well established in literature. Use of stents in IOD has achieved long-term limb salvage and patency rates similar to those of open surgery, with lower morbidity and mortality rates. Objectives: To report the long-term outcomes, particularly limb salvage and patency rates, of ET for IOD and the factors associated with these outcomes. Methods: This retrospective cohort study included patients with IOD who underwent iliac angioplasty (IA), between January 2009 and January 2015. Patients with critical limb ischemia or incapacitating claudication were included. Results: In total, 48 IA procedures were performed in 46 patients, with an initial technical success rate of 95.83%. Failure occurred in two patients, who were excluded, leaving 44 patients and 46 IA. The primary patency, secondary patency, limb salvage, and survival rates at 1200 days were 88%, 95.3%, 86.3%, and 69.9%, respectively. Univariate and multivariate Cox regression revealed that the primary patency rate was significantly worse in patients with TASC type C/D than in patients with TASC type A/B (p = 0.044). Analysis of factors associated with major amputation using Cox regression showed that the rate of limb loss was greater in patients with TASC type C/D (p = 0.043). Male gender was associated with reduced survival (p = 0.011). Conclusions: TASC type C/D was associated with a higher number of reinterventions and with worse limb loss and primary patency rates. Male gender was associated with a worse survival rate after ET of IOD.
The search for variables influencing target lesion revascularization is important for the adequate management of patients undergoing percutaneous angioplasty with drug- eluting stent implantation. Since these polymer and drug- associated endoprostheses were developed, innumerous scientific studies have been conducted to demonstrate their effectiveness and safety. In the present study, we were able to demonstrate good effectiveness and safety of drug-eluting stents in the treatment of coronary artery diseases, with revascularization event-free survival of approximately 90%, and lower rates of target lesion revascularization of approximately 9%, a result that is consistent with that of the literature. The rates of mortality, late thrombosis and reinfarction were of approximately 2%, 0.5% and 0.5%, respectively.
The poor results of total arthroplasty for treatment of rotator cuff arthropathy related to loss of the glenoid component led to hemiarthroplasty being the procedure of choice for treatment of this condition during some time. Recently, reverse shoulder prosthesis has gained great popularity due to a clinical impression of better results, despite the fact that there are still few comparative results. (10)
Currently, there is a trend toward evaluating subjective outcomes and quality of life reported by patients (6, 19-21). Questionnaires are self reported measures developed to demonstrate the outcomes and effects of treatment on the quality of life and satisfaction (19, 22). The scoliosis Research Society instrument (SRS 24) was a simple practical tool developed to measure the effects of surgical treatment in AIS (23). SRS-22, a modification of this tool, was presented afterwards (24). Recently, SRS-30 was introduced as a new skillful combination of SRS-24 and SRS-22 (25). In the current study, we aimed to assess the outcome of surgical treatment of AIS and to assess its correlation with patient satisfaction.
Objective: Neuroendoscopic surgery in children has particular features and is associated with different success rates (SR). The aim of this study was to identify putative factors that could inluence the outcome in pediatric patients. Methods: Clinical data of 177 patients under 18 years of age submitted to 200 consecutive neuroendoscopic procedures from January 2000 to January 2010 were reviewed. Results: The overall success rate was 77%. Out of the patients with successful outcomes, 46% were under six months, 68% were between six months and one year of age, and 85% older than one year. Neuroendoscopic techniques provide very good results for a wide number of indications in children. Tumor-related cerebrospinal luid (CSF) circulation problems and aqueductal stenosis seem to be particularly well suited to neuroendoscopic treatment regardless of the patient’s age. Conclusion: Patients’ age and etiology of hydrocephalus were associated with a different outcome. In all cases, surgical experience is extremely important to reduce complications.