Skin problems in children under five years old at a rural hospital in Southern Ethiopia

Objective: To examine the prevalence of cutaneous disorders in children under 5 years old who attended a rural hospital in Southern Ethiopia.Methods: A prospective cross-sectional study was conducted from January 26 to February 20, 2015 in children under 5 years old who attended Gambo Rural Hospital in West Arsi of the Oromia Region, Ethiopia.Results: A total of 324 children were included(59.6% male) whose median age was 16.4months. In total, 147 children [45.4%; 95% confidence interval(CI): 40.0%–50.8%]under 5 years had a skin problem, of which 101(68.7%) consulted for that reason. The other 46(31.3%) consulted for a general health problem and the dermatological condition was a secondary finding during the physical exploration. In 93 children(28.7%; 95% CI:20%–33.8%), it was the main disease, and in 54 children(16.5%; 95% CI: 13.0%–21.1%)it was concomitant with other diseases. The most common dermatological disease was scabies(n = 44, 13.6%; 95% CI: 10.3%–17.7%). Impetigo was diagnosed in 32 children(9.9%; 95% CI: 7.1%–13.3%), of which 23(71.9%) had complicated impetigo. Nineteen children(5.9%; 95% CI: 3.8%–9.0%) had eczema, 10(3.1%) had eczema associated to other conditions. The following most frequent skin problems were tinea(n = 9; 2.8%),infected wound and ulcer(n = 7; 2.2%), and burns(n = 6; 1.9%).Conclusions: Skin problems, mainly scabies, impetigo, and eczema were common in young children attended at a rural hospital in Southern Ethiopia. Children under 5 years should be examined thoroughly to rule out skin diseases, especially scabies.

Evaluation of the Ex-PRESS~ P-50 implant under scleral flap in combined cataract and glaucoma surgery

AIM： To evaluate the efficacy and safety of glaucoma drainage device Ex-PRESS~ P-50 for combined cataract surgery and glaucoma.·METHODS： Patients having cataract and open angle glaucoma or patients with open advanced glaucoma which needed two or more antiglaucoma medications were included. Combined cataract surgery and glaucoma with Ex-PRESS~ P-50 model placed under scleral flap was performed.·RESULTS： Out of 40 eyes of 40 patients（55% male and45% female） completed the study during one-year follow-up. The mean of age was 76.6 ±11.02 y. The intraocular pressure（IOP） decreased significantly during the 12-month follow-up from 23.5 mm Hg to 16.8 mm Hg（Wilcoxon signed ranks test, P 〈0.001）. A 59.5% of patients did not need any topical treatment, 10.8% of them needed one active principle, 27% needed two active principles, and 2.7% of them needed three active principles for successful IOP control（〈21 mm Hg）.·CONCLUSION：Combinedsurgeryofphacoemulsification with Ex PRESS~ P-50 lowers IOP from the preoperative baseline and reduces significantly the number of antiglaucoma active principles for IOP control after the operation.

GOECP/SEOR radiotheraphy guidelines for non-small-cell lung cancer

Non-small cell lung cancer(NSCLC) is a heterogeneous disease accounting for approximately 85% of all lung cancers. Only 17% of patients are diagnosed at an early stage. Treatment is multidisciplinary and radiotherapy plays a key role in all stages of the disease. More than 50% of patients with NSCLC are treated with radiotherapy(curative-intent or palliative). Technological advancesincluding highly conformal radiotherapy techniques, new immobilization and respiratory control systems, and precision image verification systems-allow clinicians to individualize treatment to maximize tumor control while minimizing treatment-related toxicity. Novel therapeutic regimens such as moderate hypofractionation and advanced techniques such as stereotactic body radiotherapy(SBRT) have reduced the number of radiotherapy sessions. The integration of SBRT into routine clinical practice has radically altered treatment of early-stage disease. SBRT also plays an increasingly important role in oligometastatic disease. The aim of the present guidelines is to review the role of radiotherapy in the treatment of localized, locally-advanced, and metastatic NSCLC. We review the main radiotherapy techniques and clarify the role of radiotherapy in routine clinical practice. These guidelines are based on the best available evidence. The level and grade of evidence supporting each recommendation is provided.

Austrian syndrome:Resurgence of an old and deadly triad

Introduction The Gram-positive bacterium,Streptococcus pneumoniae(S.pneumoniae),often colonizes the nasopharynx;however,it is one of the major microorganisms that cause pneumonia and meningitis.[[1],[2],[3]]It presents several virulence factors,such as surface proteins and enzymes,pneumolysin toxin,and a polysaccharide capsule,which is mainly responsible for the immune response;the capsule also facilitates classification of the bacterium into several serotypes.[1,2]In vulnerable individuals,the bacterium may lead to the development of invasive pneumococcal disease(IPD),which is defined as an infection of normally sterile locations.

Clinical profile and outcomes in very elderly patients with atrial fibrillation anticoagulated with rivaroxaban: data from the EMIR study

Objectives To analyze the clinical profile,adequacy of treatment with rivaroxaban and outcomes in octogenarians with atrial fibrillation(AF),taking rivaroxaban in clinical practice.Methods Observational and non-interventional study that included AF adults recruited from 79 Spanish centers,anticoagulated with rivaroxaban ≥ 6 months before being included.Data were analyzed according to age(≥ 80 vs.< 80 years) at baseline.Results Out of 1433 patients,453(31.6%) were octogenarians at baseline.Compared to younger patients,octogenarians had more comorbidities,higher CHA2DS2-VASc(4.5 ± 1.3 vs.3.0 ± 1.4;P < 0.001) and HAS-BLED scores(2.0 ± 1.0 vs.1.4 ± 1.0;P < 0.001).Overall,the dose of rivaroxaban was adequately prescribed in 83.4% of patients,but more frequently in the younger population(71.1% vs.89.1%;P = 0.039).After a mean follow-up of 2.2 ± 0.6 years,annual rates of stroke + systemic embolism + transient ischemic attack,MACE,cardiovascular death and major bleeding were 1.03%,1.24%,1.03% and 1.75%,respectively,in octogenarian patients.Except for progressive heart failure death and major bleeding,rates of outcomes in octogenarians were similar compared to younger patients.In octogenarians,the concomitant use of antiplatelet agents and non-severe dementia were independently associated with the development of ischemic stroke,whereas previous coronary revascularization and heart failure with MACE,and higher HAS-BLED score with major bleeding.Conclusions In clinical practice,around one third of patients taking rivaroxaban are octogenarians.These patients have many comorbidities and a high thromboembolic risk.Despite that,rates of adverse events remain low.Rivaroxaban is adequately prescribed in the majority of octogenarians.

Failed medial patellofemoral ligament reconstruction:Causes and surgical strategies

Patel ar instability is a common clinical problem encountered by orthopedic surgeons specializing in the knee. For patients with chronic lateral patellar instability, the standard surgical approach is to stabilize the patella through a medial patellofemoral ligament(MPFL) reconstruction. Foreseeably, an increasing number of revision surgeries of the reconstructed MPFL will be seen in upcoming years. In this paper, the causes of failed MPFL reconstruction are analyzed:(1) incorrect surgical indication or inappropriate surgical technique/patient selection;(2) a technical error; and(3) an incorrect assessment of the concomitant risk factors for instability. An understanding of the anatomy and biomechanics of the MPFL and cautiousness with the imaging techniques while favoring clinical over radiological findings and the use of common sense to determine the adequate surgical technique for each particular case, are critical to minimizing MPFL surgery failure. Additionally, our approach to dealing with failure after primary MPFL reconstruction is also presented.

通过手术导致的重量损失由胃绕过在疾病的肥胖的病人改进非含酒精的脂肪肝疾病

AIM:To evaluate the effects of surgical weight loss(Roux-en-Y gastric bypass with a modified Fobi-Capella technique) on non alcoholic fatty liver disease in obese patients.METHODS:A group of 26 morbidly obese patients aged 45 ± 2 years and with a body mass index 】 40 kg/m 2 who underwent open surgical weight loss operations had paired liver biopsies,the first at surgery and the second after 16 ± 3 mo of weight loss.Biopsies were evaluated and compared in a blinded fashion.The presence of metabolic syndrome,anthropometric and biochemical variables were also assessed at baseline and at the time of the second biopsy.RESULTS:Percentage of excess weight loss was 72.1% ± 6.6%.There was a reduction in prevalence of metabolic syndrome from 57.7%(15 patients) to 7.7%(2 patients)(P 【 0.001).Any significance difference was observed in aspartate aminotransferase or alanine aminotransferase between pre and postsurgery.There were improvements in steatosis(P 【 0.001),lobular(P 【 0.001) and portal(P 【 0.05) inflammation and fibrosis(P 【 0.001) at the second biopsy.There were 25(96.1%) patients with non alcoholic steatohepatitis(NASH) in their index biopsy and only four(15.3%) of the repeat biopsies fulfilled the criteria for NASH.The persistence of fibrosis(F 】 1) was present in five patients at second biopsy.Steatosis and fibrosis at surgery were predictors of significant fibrosis postsurgery.CONCLUSION:Restrictive mildly malabsorptive surgery provides significant weight loss,resolution of metabolic syndrome and associated abnormal liver histological features in most obese patients.

Anemia in patients with high-risk acute coronary syndromes admitted to Intensive Cardiac Care Units

Background Little information exists about the role of anemia in patients with acute coronary syndromes(ACS)admitted to Intensive Cardiac Care Units(ICCU).The aim of this study was to assess the prevalence of anemia and its impact on management and outcomes in this clinical setting.Methods All consecutive patients admitted to eight different ICCUs with diagnosis of non-ST segment elevation ACS(NSTEACS)were prospectively included.Anemia was defined as hemoglobin<130 g/L in men and<120 g/L in women.The association between anemia and mortality or readmission at six months was assessed by the Cox regression method.Results A total of 629 patients were included.Mean age was 66.6 years.A total of 197 patients(31.3%)had anemia.Coronary angiography was performed in most patients(96.2%).Patients with anemia were significantly older,with a higher prevalence of comorbidities,poorer left ventricle ejection fraction and higher GRACE score values.Patients with anemia underwent less often coronary angiography,but underwent more often intraaortic counterpulsation,non-invasive mechanical ventilation and renal replacement therapies.Both ICCU and hospital stay were significantly longer in patients with anemia.Both the incidence of mortality(HR=3.36,95%CI:1.43–7.85,P=0.001)and the incidence of mortality/readmission were significantly higher in patients with anemia(HR=2.80,95%CI:2.03–3.86,P=0.001).After adjusting for confounders,the association between anemia and mortality/readmission remained significant(P=0.031).Conclusions Almost one of three NSTEACS patients admitted to ICCU had anemia.Most patients underwent coronary angiography.Anemia was independently associated to poorer outcomes at 6 months.

Stereotactic body radiation therapy:A good dance partner of oligometastatic non-small cell lung cancer to the sound of SINDAS study

The European Organization for Research on Treatment of Cancer Research published a consensus statement to establish the key criteria to define oligometastatic disease(OMD).According to those criteria,all lesions(both primary and metastatic)should be amenable to radical intent treatment with acceptable toxicity.Several retrospective studies have shown that adding local ablative therapy to the treatment of OMD improves outcomes;however,due to the diverse selection criteria and treatment strategies used in those studies,it is difficult to compare directly results to draw definitive conclusions.In recent years,prospective phase II trials,such as the SABR-COMET and"Oligomez"trials,have shown that stereotactic body radiation therapy(SBRT)improves outcomes in patients with OMD.More recently,interim results of the randomised phase 3 SINDAS trial were reported at the annual meeting of the American Society of Clinical Oncology 2020 demonstrating that upfront SBRT added to systemic treatment with tyrosine kinase inhibitors yielded a significant benefit in both progression-free survival and overall survival in patients with epidermal growth factor receptor-mutant oligometastatic non-small cell lung cancer.In the present editorial,we review the definition and historical context of advanced non-small cell lung cancer with OMD.In addition,we review the scientific evidence for local ablative therapy and SBRT and discuss the results of recently published prospective studies.We also discuss in depth the results of the SINDAS study,including the strengths and weaknesses of the study and the barriers to extrapolating these results to routine clinical practice.

Current treatment landscape for oligometastatic non-small cell lung cancer

The management of patients with advanced non-small cell lung carcinoma(NSCLC)has undergone major changes in recent years.On the one hand,improved sensitivity of diagnostic tests,both radiological and endoscopic,has altered the way patients are staged.On the other hand,the arrival of new drugs with antitumoral activity,such as targeted therapies or immunotherapy,has changed the prognosis of patients,improving disease control and prolonging survival.Finally,the development of radiotherapy and surgical and interventional radiology techniques means that radical ablative treatments can be performed on metastases in any location in the body.All of these advances have impacted the treatment of patients with advanced lung cancer,especially in a subgroup of these patients in which all of these treatment modalities converge.This poses a challenge for physicians who must decide upon the best treatment strategy for each patient,without solid evidence for one optimal mode of treatment in this patient population.The aim of this article is to review,from a practical and multidisciplinary perspective,published evidence on the management of oligometastatic NSCLC patients.We evaluate the different alternatives for radical ablative treatments,the role of primary tumor resection or radiation,the impact of systemic treatments,and the therapeutic sequence.In short,the present document aims to provide clinicians with a practical guide for the treatment of oligometastatic patients in routine clinical practice.

Ocular surface squamous neoplasia resistant to topical interferon alpha 2b in a patient with follicular lymphoma

Dear Editor,Treatment for ocular surface squamous neoplasia(OSSN)includes topical mitomycin C(MMC),5-fluorouracil(5-FU)and interferon(IFN)-alpha 2b eyedrops[1-2].Compared to other treatments,such as mitomycin C(MMC),IFN-alpha 2b is well tolerated and causes fewer side effects[1-2].

Real-world data on the infliximab biosimilar CT-P13 (Remsima®) in inflammatory bowel disease

BACKGROUND In recent years,biological therapies have revolutionized the management of inflammatory bowel disease(IBD);however,they are expensive.The development of biosimilar products has allowed us to reduce healthcare costs and improve patients’access to these treatments.Although various studies support the similarity between infliximab and its biosimilar CT-P13 in terms of efficacy and safety,there are unmet needs regarding research on these agents in the context of IBD.AIM To analyze clinical response rates to CT-P13 and adverse events in IBD patients treated in real-life practice.METHODS An observational,prospective,multicenter study of IBD patients treated with CTP13 in clinical practice who were naïve to biological treatments or failed to respond to other anti-tumor necrosis factor drugs or had switched from infliximab originator was carried out.No diagnostic or follow-up interventions were conducted on patients outside usual clinical practice.The primary endpoints were clinical response rates and number of adverse events.The primary efficacy variable was the proportion of patients who were in clinical remission and/or had a clinical response at 3,6,9,and 12 mo.RESULTS A total of 220 IBD patients treated with CT-P13(Remsima®)were included in the study:87(40%)with ulcerative colitis and 133(60%)with Crohn’s disease.Mean age of the patients was 41.47(SD 15.74)years,and 58%were female.Nineteen(9%)patients started treatment with CT-P13 after switching from infliximab.Of the remaining 201 patients,142(65%)were naïve to biologic agents.At baseline,68.6%(n=138/201)of patients presented with active disease.After 12 mo of treatment,14.8%(n=12/81)presented with active disease,and 64.2%(n=52/81)were in clinical remission without corticosteroids.After 3 mo,75.5%(n=115/152)had a clinical response or achieved clinical remission,which was sustained for 12 mo(85.2%;n=69/81).There was a decrease in specific IBD indices at 3,6,9,and 12 mo(P<0.001).A total of 34 adverse events were reported by 27(12.3%)patients,9(26.5%)of which were serious.CONCLUSION CT-P13 is an effective and safe infliximab biosimilar for the treatment of IBD in real-life practice and may be a valid and attractive alternative for the treatment of IBD.

Laparoscopic-assisted instillation of epinephrine and levobupivacaine enables cornual excision and anatomical reconstruction in unruptured cornual pregnancy

The objective of this report is to describe the possible use of intramiometrial vasoconstrictive agents for laparoscopic management of interstitial pregnancy and the consequences in anatomical results and reproductive outcomes. Cornual resection can be performed by laparoscopy, but the high vascularization of this area may result in profuse bleeding and laparoscopic suturing under these conditions might be impossible for the majority of the surgeons. We present a case that describes the possible use of intramiometrial instillation of a solution of diluted epinephrine and levobupivacaine under laparoscopic guidance that permitted a bloodless cornual excision with complete reconstruction. Vasoactive agents might have potentially serious cardiovascular side effects and the correct election of the active principle and the dosage is essential to reduce the risk of the surgery and obtain good anatomical results and reproductive outcomes. In conclusion, unruptured interstitial pregnancies can be managed successfully with intramyometrial instillation of epinephrine and bupivacaine. This simple technique is particularly attractive as it facilitates anatomical reconstruction of the cornual area, gives enough time to perform a complete suture of the defect and reduces the risk of laparotomic conversion.

A Case Report of Lymphocytic Hypophysitis Related to Pregnancy

A 39-year-old woman consulted in the postpartum period because of agalactia, polyuria, polydipsia, and headache and decreased visual acuity. The initial analysis was compatible with a panhypopituitarism. The magnetic resonance (MRI) showed an expansive sellar and suprasellar lesion of high density in the basal study and enhancement after contrast administration, in contact with the optic chiasm, so urgent surgery was indicated. While waiting for the surgery, intravenous corticosteroids were initiated and the symptoms rapidly resolved. Most of the pituitary axes were recovered, except the diabetes insipidus. The control MRI showed complete resolution of the sellar mass. The surgery was canceled and the diagnosis of lymphocyte hypohpyisitis was made. Lymphocyte hypophysitis is an uncommon disease in which inflammation of the pituitary gland occurs. This results in a permanent or transient hormonal insufficiency. Lymphocyte hypophysitis is a very rare condition that occurs preferentially in women in the peripartum period. Early initiation of high doses of systemic corticosteroids may avoid unnecessary surgery in some cases.