Several therapeutic procedures have been proposed as bridging treatments for patients with hepatocellular carcinoma(HCC)awaiting liver transplantation(LT).The most used treatments include transarterial chemoembolizati...Several therapeutic procedures have been proposed as bridging treatments for patients with hepatocellular carcinoma(HCC)awaiting liver transplantation(LT).The most used treatments include transarterial chemoembolization and radiofrequency ablation.Surgical resection has also been successfully used as a bridging procedure,and LT should be considered a rescue treatment in patients with previous HCC resection who experience tumor recurrence or post-treatment severe decompensation of liver function.The aims of bridging treatments include decreasing the waiting list dropout rate before transplantation,reducing HCC recurrence after transplantation,and improving post-transplant overall survival.To date,no data from prospective randomized studies are available;however,for HCC patients listed for LT within the Milan criteria,prolonging the waiting time over 6-12 mo is a risk factor for tumor spread.Bridging treatments are useful in containing tumor progression and decreasing dropout.Furthermore,the response to pre-LT treatments may represent a surrogate marker of tumor biological aggressiveness and could therefore be evaluated to prioritize HCC candidates for LT.Lastly,although a definitive conclusion can not be reached,the experiences reported to date suggest a positive impact of these treatments on both tumor recurrence and post-transplant patient survival.Advanced HCC may be downstaged to achieve and maintain the current conventional criteria for inclusion in the waiting list for LT.Recent studies have demonstrated that successfully downstaged patients can achieve a 5-year survival rate comparable to that of patients meeting the conventional criteria without requiring downstaging.展开更多
Background: Ensuring prompt diagnosis and timely malaria treatment will prevent most cases of uncomplicated malaria from progressing to severe and fatal illness. To avoid this progression, treatment must begin as soon...Background: Ensuring prompt diagnosis and timely malaria treatment will prevent most cases of uncomplicated malaria from progressing to severe and fatal illness. To avoid this progression, treatment must begin as soon as possible, generally within 24 hours after symptoms onset. The reason why mothers/caretakers delay in malaria prompt diagnosis and timely treatment for under-five is not well studied in the study area as well as in Ethiopia. Objective: To assess determinants of delay in malaria prompt diagnosis and timely treatment among under-five children in Shashogo Woreda, Hadiya Zone, Southern Ethiopia, 2013. Methods: An unmatched case control study was conducted from March 25-April 25, 2013. A total sample size of 302 with 151 cases and 151 controls were selected by systematic random sampling techniques. Cases were under-five children who had clinical malaria and sought treatment after 24 hours of symptoms onset, and controls were under-five children who had clinical malaria and sought treatment within 24 hours of symptoms onset. Both bivariate and multivariate logistic regressions were done to identify determinant of delay in malaria prompt diagnosis and timely treatment. Results: A total of 151 mothers/caretakers of cases and 151 mothers/caretakers of controls were interviewed. Illiterate mothers (AOR = 7.14;95%CI: 1.10, 46.39), monthly income ≤500 ETB (AOR = 5.49;95%CI: 2.09, 14.45), females sex (AOR = 3.45;95%CI: 1.62, 7.34), distance from health facility >5 km (AOR = 4.31;95%CI: 1.22, 15.23), absence of history of child death (AOR = 4.21;95%CI: 1.514, 11.68), side effects of antimalarial drugs (AOR = 2.91;95%CI: 1.15, 7.33) and khat chewing (AOR = 2.38;95%CI: 1.28, 5.79) were determinants of delay in malaria prompt diagnosis and timely treatment of under-five children. Conclusion: Mother’s education, monthly income, distance from health facility, absence of history of child death, complained about side effects of drugs and khat chewing were predictors of delay of prompt diagnosis and timely malaria treatment. Effective malaria control programs revision would be required to avoid delay of prompt diagnosis and timely treatment for under-five children.展开更多
Cystic echinococcosis(CE) is a complex, chronic and neglected disease with a worldwide distribution. The liver is the most frequent location of parasitic cysts. In humans, its clinical spectrum ranges from asymptom-at...Cystic echinococcosis(CE) is a complex, chronic and neglected disease with a worldwide distribution. The liver is the most frequent location of parasitic cysts. In humans, its clinical spectrum ranges from asymptom-atic infection to severe, potentially fatal disease. Four approaches exist in the clinical management of CE: surgery, percutaneous techniques and drug treatment for active cysts, and the "watch and wait" approach for inactive cysts. Allocation of patients to these treat-ments should be based on cyst stage, size and location, available clinical expertise, and comorbidities. However, clinical decision algorithms, efficacy, relapse rates, and costs have never been properly evaluated. This paper reviews recent advances in classification and diagnosisand the currently available evidence for clinical deci-sion-making in cystic echinococcosis of the liver.展开更多
文摘Several therapeutic procedures have been proposed as bridging treatments for patients with hepatocellular carcinoma(HCC)awaiting liver transplantation(LT).The most used treatments include transarterial chemoembolization and radiofrequency ablation.Surgical resection has also been successfully used as a bridging procedure,and LT should be considered a rescue treatment in patients with previous HCC resection who experience tumor recurrence or post-treatment severe decompensation of liver function.The aims of bridging treatments include decreasing the waiting list dropout rate before transplantation,reducing HCC recurrence after transplantation,and improving post-transplant overall survival.To date,no data from prospective randomized studies are available;however,for HCC patients listed for LT within the Milan criteria,prolonging the waiting time over 6-12 mo is a risk factor for tumor spread.Bridging treatments are useful in containing tumor progression and decreasing dropout.Furthermore,the response to pre-LT treatments may represent a surrogate marker of tumor biological aggressiveness and could therefore be evaluated to prioritize HCC candidates for LT.Lastly,although a definitive conclusion can not be reached,the experiences reported to date suggest a positive impact of these treatments on both tumor recurrence and post-transplant patient survival.Advanced HCC may be downstaged to achieve and maintain the current conventional criteria for inclusion in the waiting list for LT.Recent studies have demonstrated that successfully downstaged patients can achieve a 5-year survival rate comparable to that of patients meeting the conventional criteria without requiring downstaging.
文摘Background: Ensuring prompt diagnosis and timely malaria treatment will prevent most cases of uncomplicated malaria from progressing to severe and fatal illness. To avoid this progression, treatment must begin as soon as possible, generally within 24 hours after symptoms onset. The reason why mothers/caretakers delay in malaria prompt diagnosis and timely treatment for under-five is not well studied in the study area as well as in Ethiopia. Objective: To assess determinants of delay in malaria prompt diagnosis and timely treatment among under-five children in Shashogo Woreda, Hadiya Zone, Southern Ethiopia, 2013. Methods: An unmatched case control study was conducted from March 25-April 25, 2013. A total sample size of 302 with 151 cases and 151 controls were selected by systematic random sampling techniques. Cases were under-five children who had clinical malaria and sought treatment after 24 hours of symptoms onset, and controls were under-five children who had clinical malaria and sought treatment within 24 hours of symptoms onset. Both bivariate and multivariate logistic regressions were done to identify determinant of delay in malaria prompt diagnosis and timely treatment. Results: A total of 151 mothers/caretakers of cases and 151 mothers/caretakers of controls were interviewed. Illiterate mothers (AOR = 7.14;95%CI: 1.10, 46.39), monthly income ≤500 ETB (AOR = 5.49;95%CI: 2.09, 14.45), females sex (AOR = 3.45;95%CI: 1.62, 7.34), distance from health facility >5 km (AOR = 4.31;95%CI: 1.22, 15.23), absence of history of child death (AOR = 4.21;95%CI: 1.514, 11.68), side effects of antimalarial drugs (AOR = 2.91;95%CI: 1.15, 7.33) and khat chewing (AOR = 2.38;95%CI: 1.28, 5.79) were determinants of delay in malaria prompt diagnosis and timely treatment of under-five children. Conclusion: Mother’s education, monthly income, distance from health facility, absence of history of child death, complained about side effects of drugs and khat chewing were predictors of delay of prompt diagnosis and timely malaria treatment. Effective malaria control programs revision would be required to avoid delay of prompt diagnosis and timely treatment for under-five children.
基金Supported by The EU grant FP7/2007-2013,No.602051-HERACLES(to Brunetti E)
文摘Cystic echinococcosis(CE) is a complex, chronic and neglected disease with a worldwide distribution. The liver is the most frequent location of parasitic cysts. In humans, its clinical spectrum ranges from asymptom-atic infection to severe, potentially fatal disease. Four approaches exist in the clinical management of CE: surgery, percutaneous techniques and drug treatment for active cysts, and the "watch and wait" approach for inactive cysts. Allocation of patients to these treat-ments should be based on cyst stage, size and location, available clinical expertise, and comorbidities. However, clinical decision algorithms, efficacy, relapse rates, and costs have never been properly evaluated. This paper reviews recent advances in classification and diagnosisand the currently available evidence for clinical deci-sion-making in cystic echinococcosis of the liver.
