Early Treatment Outcome of Humeral Shaft Fracture Non-Union in Adults: Comparative Study of Plating versus Interlocking Nailing

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 3rd 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.

Clinical Presentation and Treatment Outcomes of Pregnancy-Related Acute Kidney Injury among Pregnant Women Admitted at the Benjamin Mkapa Hospital in Tanzania

Background: Globally, PRAKI is among the leading causes of death in pregnant women. The prevalence, causes and outcome of this condition vary among countries due to differences in environmental, socioeconomic, and health delivery systems. The common causes that have been reported in several studies are PIH, Haemorrhages and Sepsis while the outcomes may be either complete renal recovery, progression to CKD and hence dialysis dependency or death. This study aimed at determining clinical presentation and treatment outcomes of Pregnancy-Related Acute Kidney Injury in Pregnant women admitted at the Benjamin Mkapa Hospital, Dodoma, Tanzania. Results: Out of 4007 pregnant women who were admitted to the maternity ward 51 pregnant women were found to have PRAKI. Of those with PRAKI, 74.5% were between 21 to 25 years. The leading causes of PRAKI were PPH 12 (23.53%), Eclampsia 12 (23.53%), and pre-eclampsia 12 (23.5%). Hemodialysis therapy was provided to 22 (43.1%) patients, 15 (29.4%) individuals recovered spontaneously with medical management and 14 (27.5%) missed haemodialysis therapy due to various reasons. The mortality due to PRAKI was 17 (33.3%). Conclusion and Recommendation: Pre-eclampsia/eclampsia and post-partum haemorrhage were found to be the main causes of PRAKI. The mortality related to PRAKI is high and Hemodialysis therapy is vital help to prevent deaths for pregnant women with PRAKI. Pregnant women who develop acute kidney injury should be followed closely and a nephrologist should be consulted early. Early referral should be done by the lower level facilities for all at-risk pregnant women to a specialized multidisciplinary health facility.

Hidden army within:Harnessing the microbiome to improve cancer treatment outcomes

The gut microbiome has emerged as a critical player in cancer pathogenesis and treatment response.Dysbiosis,an imbalance in the gut microbial community,impacts tumor initiation,progression,and therapy outcomes.Specific bacterial species have been associated with either promoting or inhibiting tumor growth,offering potential targets for therapeutic intervention.The gut microbiome in-fluences the efficacy and toxicity of conventional treatments and cutting-edge immunotherapies,highlighting its potential as a therapeutic target in cancer care.However,translating microbiome research into clinical practice requires addres-sing challenges such as standardizing methodologies,validating microbial bio-markers,and ensuring ethical considerations.Here,we provide a comprehensive overview of the gut microbiome's role in cancer highlighting the need for on-going research,collaboration,and innovation to harness its full potential for im-proving patient outcomes in oncology.The current editorial aims to explore these insights and emphasizes the need for standardized methodologies,validation of microbial biomarkers,and interdisciplinary collaboration to translate microbiome research into clinical applications.Furthermore,it underscores ethical consider-ations and regulatory challenges surrounding the use of microbiome-based the-rapies.Together,this article advocates for ongoing research,collaboration,and innovation to realize the full potential of microbiome-guided oncology in impro-ving patient care and outcomes.

Treatment outcomes and adverse drug reactions among patients with drug-resistant tuberculosis receiving all-oral,long-term regimens:First record viewing report from Pakistan

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.

Treatment Outcomes in COVID-19 Patients with Brucellosis:Case Series in Heilongjiang and Systematic Review of Literature

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.

Meta‑analysis of influencing factors associating with treatment outcome of multidrug resistant tuberculosis

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.

Root Canal Treatment Outcome and Restorative Condition of Teeth Treated by Undergraduates—A Clinical and Radiographic Evaluation

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).

Lassa Fever: Patients Profile and Treatment Outcomes at Benue State University Teaching Hospital Makurdi, North-Central Nigeria

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.

Association of Overlapped and Un-overlapped Comorbidities with COVID-19 Severity and Treatment Outcomes: A Retrospective Cohort Study from Nine Provinces in China

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.

Reliability assessment and correlation analysis of evaluating orthodontic treatment outcome in Chinese patients

This study aimed to assess the reliability of experienced Chinese orthodontists in evaluating treatment outcome and to determine the correlations between three diagnostic information sources. Sixty-nine experienced Chinese orthodontic specialists each evaluated the outcome of orthodontic treatment of 108 Chinese patients. Three different information sources： study casts （SC）, lateral cephalometric X-ray images （LX） and facial photographs （PH） were generated at the end of treatment for 108 patients selected randomly from six orthodontic treatment centers throughout China. Six different assessments of treatment outcome were made by each orthodontist using data from the three information sources separately and in combination. Each assessment included both ranking and grading for each patient. The rankings of each of the 69 judges for the 108 patients were correlated with the rankings of each of the other judges yielding 13 873 Spearman rs values, ranging from -0.08 to ＋0.85. Of these, 90% were greater than 0.4, showing moderate-to-high consistency among the 69 orthodontists. In the combined evaluations, study casts were the most significant predictive component （R2=0.86, P〈0.000 1）, while the inclusion of lateral cephalometric films and facial photographs also contributed to a more comprehensive assessment （R2=0.96, P〈0.000 1）. Grading scores for SC＋LX and SC＋PH were highly significantly correlated with those for SC＋LX＋PH （r（SC＋LX）vs.（SC＋LX＋PH）=0.96, r（SC＋PH）vs.（SC＋LX＋PH）=0.97）, showing that either SC＋LX or SC＋PH is an excellent substitute for all three combined assessment,

Long-term treatment outcomes of clevudine in antiviral-naive patients with chronic hepatitis B

AIM:To evaluate the treatment outcomes of clevudine compared with entecavir in antiviral-naive patients with chronic hepatitis B(CHB).METHODS:We retrospectively analyzed the clinical data of CHB patients treated with clevudine 30 mg/d and compared their clinical outcomes with patients treated with entecavir 0.5 mg/d.The biochemical response,as assessed by serum alanine aminotransferase(ALT) activity,virologic response,as assessed by serum hepatitis B virus DNA(HBV DNA) titer,serologic response,as assessed by hepatitis B e antigen(HBeAg) status,and virologic breakthrough with genotypic mutations were assessed.RESULTS:Two-hundred and fifty-four patients [clevudine(n = 118) vs entecavir(n = 136)] were enrolled.In clevudine-treated patients,the cumulative rates of serum ALT normalization were 83.9% at week 48 and 91.5% at week 96(80.9% and 91.2% in the entecavir group,respectively),the mean titer changes in serum HBV DNA were-6.03 and-6.55 log 10 copies/mL(-6.35 and-6.86 log 10 copies/mL,respectively,in the entecavir group),and the cumulative non-detection rates of serum HBV DNA were 72.6% and 83.1%(74.4% and 83.8%,respectively,in the entecavir group).These results were similar to those of entecavir-treated patients.The cumulative rates of HBeAg seroconversion were 21.8% at week 48 and 25.0% at week 96 in patients treated with clevudine,which was similar to patients treated with entecavir(22.8% and 27.7%,respectively).The virologic breakthrough in the clevudine group occurred in 9(7.6%) patients at weeks 48 and 15(12.7%) patients at week 96,which primarily corresponded to genotypic mutations of rtM204I and/or rtL180M.There was no virologic breakthrough in the entecavir group.CONCLUSION:In antiviral-naive CHB patients,longterm treatment outcomes of clevudine were not inferior to those of entecavir,except for virologic breakthrough.

Treatment outcome,cognitive function,and psychopathology in methamphetamine users compared to other substance users

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.

Assessment of Contributions of Community Tuberculosis Intervention to Tuberculosis Case Detection and Treatment Outcome in Two States in Nigeria

Background: Nigeria, one of the high burden Tuberculosis countries, has developed various intervention strategies to ensuring universal access to quality-assured tuberculosis diagnosis and treatment. However, 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, 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. Materials and Method: A retrospective study with multistage sampling technique was employed to review 23,241 presumptive Tuberculosis cases enrolled for management between 2014-2017. Chi-square (χ2) test was used for test of association between the independent variables and the main outcomes of the study, with statistical significance set at p-value of 5%. Results: The annual percentage increase for both states was 24.7%, 189.8% and 114.5% in the study group as against 5.2%, 44.6% and 65.6% in control group. Overall, 23.8% were bacteriologically positive (either AFB or Gene-Xpert MTB/Rif) and 1.4% were clinically evaluated to be positive, while 74.8% were bacteriologically negative. Of the total 5861 cases treated, 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, 2.95 - 3.35). Conclusion: The community level Tuberculosis intervention led to significantly better case detection and treatment outcome when compared to the conventional approach (p ≤ 0.05). Therefore, 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.

Evaluation of Tuberculosis Treatment Outcome of TB/HIV Co-Infection: A Four-Year Retrospective Cohort Study in HIV-Prevalent Setting of North Central Nigeria

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.

Tuberculosis Case Notification and Treatment Outcomes in West Gojjam Zone, Northwest Ethiopia: A Five-Year Retrospective Study

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.

Impact of HIV Status,CD4 Count and Antiretroviral Treatment on Tuberculosis Treatment Outcomes in a Low-Burden Country

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.

Impact of a clinical pathway on treatment outcome in patients with acute pancreatitis

AIM:To determine the impact of a clinical pathway(CP) on acute pancreatitis(AP) treatment outcome.METHODS:A retrospective analysis of medical records was performed. We compared the results of AP treatment outcome over two time periods in our centre,before(2006-2007) and after(2010-2012) the implementation of a CP. The CP comprised the following indicators of quality:performance of all laboratory tests on admission(including lipids and carbohydrate deficient transferrin),determination of AP aetiology,abdomen ultrasound(US) within the first 24 h after admission,contrast-enhanced computed tomography of the abdomen in all cases of suspected pancreatic necrosis,appropriately selected and sufficiently used antibiotic therapy(if necessary),pain control,adequate hydration,control of haemodynamic parameters and transfer to the Intensive Care Unit(ICU)(if necessary),endoscopic retrograde cholangiopancreatography(ERCP) in biliary AP,surgical treatment(if necessary),and advice on outpatient follow-up after discharge. A comparison of the length of stay with that in other Slovenian hospitals was also performed.RESULTS:There were 139 patients treated in the three-year period after the introduction of a CP,of which 81(58.3%) were male and 58(41.7%) female. The patients' mean age was 59.6 ± 17.3 years. The most common aetiologies were alcoholism and gallstones(38.8% each),followed by unexplained(11.5%),drug-induced,hypertriglyceridemia,post ERCP(2.9% each) and tumours(2.2%). Antibiotic therapy was prescribed in 72(51.8%) patients. Abdominal US was performed in all patients within the first 24 h after admission. Thirty-two(23.0%) patients were treated in the ICU. Four patients died(2.9%). In comparison to 2006-2007,we found an increased number of alcoholic and biliary AP and an associateddecrease in the number of unexplained aetiology cases. The use of antibiotics also significantly decreased after the implementation of a CP(from 70.3% to 51.8%; P = 0.003). There was no statistically significant difference in mortality(1.8% vs 2.9%). The length of stay was significantly shorter when compared to the Slovenian average(P = 0.018).CONCLUSION:The introduction of a CP has improved the treatment of patients with AP,as assessed by all of the observed parameters.

Primary gastric mucosa associated lymphoid tissue lymphoma: Clinical data predicted treatment outcome

AIM: To determine clinical characteristics and treatment outcome of gastric lymphoma after chemotherapy and immuno-chemotherapy. METHODS: Thirty four patients with primary gastric mucosa associated lymphoid tissue (MALT) lymphoma (Ann Arbor stages Ⅰ to Ⅳ) were enrolled. All had upper gastric endoscopy, abdominal ultrasonography, CT and H pylori status assessment (histology and serology). After anti-H pylori treatment and initial chemotherapy, patients were re-examined every 4 mo. RESULTS: Histological regression of the lymphoma was complete in 22/34 (64.7%) and partial in 9 (26.5%) patients. Median follow up time for these 31 responders was 60 mo (range 48-120). No regression was noted in 3 patients. Among the 25 (73.5%) H pylori positive patients, the eradication rate was 100%.CONCLUSION: Using univariate analysis, predictive factors for overall survival were international prognostic index (IPI) score, hemoglobin level, erythrocyte sedimentation rate (ESR), and platelet numbers (P < 0.005). In addition to this, Cox proportion hazard model differentiate IPI score, ESR, and platelets as predictors of survival.

Relationship between different surgical methods,hemorrhage position,hemorrhage volume,surgical timing,and treatment outcome of hypertensive intracerebral hemorrhage

BACKGROUND:The present study aimed to explore the relationship between surgical methods,hemorrhage position,hemorrhage volume,surgical timing and treatment outcome of hypertensive intracerebral hemorrhage(HICH).METHODS:A total of 1 310 patients,who had been admitted to six hospitals from January 2004 to January 2008,were divided into six groups according to different surgical methods:craniotomy through bone fl ap(group A),craniotomy through a small bone window(group B),stereotactic drilling drainage(group C1 and group C2),neuron-endoscopy operation(group D) and external ventricular drainage(group E) in consideration of hemorrhage position,hemorrhage volume and clinical practice. A retrospective analysis was made of surgical timing and curative effect of the surgical methods.RESULTS:The effectiveness rate of the methods was 74.12% for 1 310 patients after onemonth follow-up. In this series,the disability rate was 44.82% 3–6 months after the operation. Among the 1 310 patients,241(18.40%) patients died after the operation. If hematoma volume was >80 mL and the operation was performed within 3 hours,the mortality rate of group A was signifi cantly lower than that of groups B,C,D,and E(P<0.05). If hematoma volume was 50–80 mL and the operation was performed within 6–12 hours,the mortality rate of groups B and D was lower than that of groups A,C and E(P<0.05). If hematoma volume was 20–50 mL and the operation was performed within 6–24 hours,the mortality rate of group C was lower than that of groups A,B and D(P<0.05).CONCLUSIONS:Craniotomy through a bone f lap is suitable for patients with a large hematoma and hernia of the brain. Stereotactic drilling drainage is suggested for patients with hematoma volume less than 80 mL. The curative effect of HICH individualized treatment would be improved via the suitable selection of operation time and surgical method according to the position and volume of hemorrhage.

Fecal markers of inflammation used as surrogate markers for treatment outcome in relapsing inflammatory bowel disease

AIM： To evaluate fecal calprotectin （FC） as a surrogate marker of treatment outcome of relapse of inflammatory bowel disease （IBD） and, to compare FC with fecal myeloperoxidase （MPO） and fecal eosinophil protein X （EPX）. METHODS： Thirty eight patients with IBD, comprising of 27 with ulcerative colitis （UC） and 11 with Crohn＇s disease （CD） were investigated before treatment （inclusion）, and after 4 and 8 wk of treatment. Treatment outcomes were evaluated by clinical features of disease activity and endoscopy in UC patients, and disease activity in CD patients. In addition, fecal samples were analyzed for FC by enzyme-linked immunosorbent assay （ELISA）, and for MPO and EPX with radioimmunoassay （RIA）. RESULTS： At inclusion 37 of 38 （97%） patients had elevated FC levels （〉 94.7 μg/g）. At the end of the study, 31 of 38 （82%） patients fulfilled predefined criteria of a complete response IUC 21/27 （78%）; CD 10/11 （91%）]. Overall, a normalised FC level at the end of the study predicted a complete response in 100% patients, whereas elevated FC level predicted incomplete response in 30%. Normalised MPO or EPX levels predicted a complete response in 100% and 90% of the patients, respectively. However, elevated MPO or EPX levels predicted incomplete response in 23% and 22%, respectively. CONCLUSION： A normalised FC level has the potential to be used as a surrogate marker for successful treatment outcome in IBD patients. However, patients with persistent elevation of FC levels need further evaluation. FC and MPO provide superior discrimination than EPX in IBD treatment outcome.