#11: Post-malarial Hemolysis is Rare in Malawian Children with Cerebral Malaria

2021 ◽  
Vol 10 (Supplement_2) ◽  
pp. S18-S18
Author(s):  
Geoffrey Guenther ◽  
Rima Izem ◽  
Alexuse Saidi ◽  
Karl Seydel ◽  
Douglas Postels
Keyword(s):  
Cerebral Malaria ◽  
Malaria Infection ◽  
Parasite Clearance ◽  
Post Treatment ◽  
P Value ◽  
Antimalarial Treatment ◽  
African Children ◽  
The One ◽  
Queen Elizabeth Central Hospital

Abstract Background In severe malaria, artesunate decreases mortality compared to quinine. Artesunate’s introduction into clinical use in malaria-endemic areas revealed a unique adverse effect: severe hemolysis appearing several weeks after treatment completion. Though initial reports of post-artesunate hemolysis (PAH) were gathered from adult returning travelers, studies of African children revealed that PAH was less common in this semi-immune population. There are no published studies establishing the incidence and severity of PAH in several severe malarial syndromes in African children, including cerebral malaria (CM). We determined the incidence and severity of post-treatment hemolysis in Malawian children surviving CM by analyzing hospital and follow-up data from a long-standing study of CM pathogenesis. Methods Children aged 6 months to 14 years admitted to Queen Elizabeth Central Hospital (Blantyre, Malawi) with a clinical diagnosis of CM were enrolled in a retrospective cohort study. Children admitted before 2014 and treated with quinine (n=258) were compared to those admitted in 2014 and after and treated with artesunate (n=235). Hematocrit and parasite density were obtained at admission and every 6 hours until parasite clearance. The last hematocrit obtained during hospitalization was compared with the one-month post-hospitalization hematocrit value. Results The overall rate of a post-hospitalization decrease in hematocrit in children surviving CM was 5.3% (4.7% for quinine, 5.8% for artesunate, p value for difference= 0.582); no patients with a hematocrit decrease were symptomatic; none required transfusion. Of the 26 children with a decrease in hematocrit at one month after hospitalization, 23.1% had evidence of a new malaria infection. When children treated with quinine and artesunate were combined, a higher hematocrit on admission, lower quantitative histidine rich protein 2 level, and splenomegaly were independently associated with a post-treatment decrease in hematocrit. Conclusions In African survivors of CM, post-treatment hemolysis is rare, mild, and unassociated with the antimalarial treatment received.

scholarly journals Post-Malaria Anemia Is Rare in Malawian Children with Cerebral Malaria

2021 ◽  
Author(s):  
Geoffrey Guenther ◽  
Alexuse M. Saidi ◽  
Rima Izem ◽  
Karl Seydel ◽  
Douglas G. Postels
Keyword(s):  
Cerebral Malaria ◽  
Severe Malaria ◽  
Protein Level ◽  
Odds Ratio ◽  
Malaria Infection ◽  
Post Treatment ◽  
Hematocrit Level ◽  
Index Hospitalization

Artesunate therapy for severe malaria syndromes has been associated with post-treatment hemolysis and anemia. We defined post-malaria anemia as any decrease in hematocrit between the index hospitalization for severe malaria and 1 month after. We determined the incidence and severity of post-malaria anemia in Malawian children surviving cerebral malaria (CM) by analyzing hospital and follow-up data from a long-standing study of CM pathogenesis. Children enrolled before 2014 and treated with quinine (N = 258) were compared with those admitted in 2014 and after, and treated with artesunate (N = 235). The last hematocrit value obtained during hospitalization was compared with the 1-month post-hospitalization hematocrit value. The overall rate of a post-hospitalization decrease in hematocrit in children surviving CM was 5.3% (11 of 235 or 4.7% for quinine, 15 of 258 or 5.8% for artesunate; odds ratio, 3.23 [0.88, 18.38]); no patients with a decrease in hematocrit were symptomatic, and none required transfusion after hospitalization. Of the 26 children who had a decrease in hematocrit 1 month after hospitalization, 23.1% had evidence of a new malaria infection. When children treated with quinine and artesunate were combined, a higher hematocrit level on admission, lower quantitative histidine-rich protein level, and splenomegaly were associated independently with post-malaria anemia. In African survivors of CM, post-malaria anemia is rare, mild, and unassociated with the anti-malarial treatment received.

P1018Evolution of atrioventricular conduction disorders after TAVI

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D Irles ◽  
F Salerno ◽  
R Cassagneau ◽  
R Eschallier ◽  
C Maupain ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Primary Endpoint ◽  
Univariate Analysis ◽  
P Value ◽  
Conduction Disorders ◽  
Av Conduction ◽  
One Year ◽  
The One ◽  
Valve Implantation

Abstract Background The evolution of atrioventricular block (AVB) after Trans Aortic Valve Implantation (TAVI) is poorly understood, and indications of pacemaker (PM) implantation after TAVI not well defined. Modern PM algorithms can help studying the evolution of these AV conduction disorders after TAVI. SafeR® mode (Sorin® PM) allows to monitor precisely the AV conduction and to store AVB episodes in the PM memory as intracardiac electrograms, which can be re-read and validated afterwards. Methods From November 2015 and January 2017, all patients implanted in one of the 19 French enrolling centers with a Sorin® PM set in SafeR® mode after TAVI could be prospectively included in the study. All the PM interrogation files were centrally collected. The primary endpoint (PE) was the presence of at least one episode of high grade AVB (HG-AVB) beyond day 7 (D7) to one year after the TAVI. It could be validated either by the presence of a HG-AVB on EKG or telemetry, or by the confirmation of a HG-AVB in the PM memory files. Results 273 patients were included in the study, the PE was assessable in 197 patients. PE was validated in 74.6% patients. In univariate analysis, the use of an oversized prothesis or balloon, and all early episodes of HG-AVB (all those occurring up to D7) influence the validation of the PE. Other AV conduction disorders have no influence on the PE (Table). In multivariate analysis, only HG-AVB occurring between D2 and D7 has a significant influence on the PE. Factors influencing HG-AVB after TAVI Studied factor HG-AVB episode(s) during the one year follow up No HG-AVB episode during the one year follow up p value RBBB before TAVI (%) 41 34 0,346 Low implantation (>6mm) (%) 59 37 0,156 Use of Autoexpansive Valve (%) 62 62 0,990 Oversizing (%) 19 6 0,022 HG-AVB per TAVI (%) 56 30 0,001 HG-AVB D0-D1 (%) 53 24 0,001 HG-AVB D2-D7 (%) 68 34 0,001 New or wiser LBBB and improvement of PR interval after TAVI (%) 30 39 0,253 Influence of predefined factors on the Primary Endpoint. Conclusion The analysis of the SafeR® algorithm files in patients implanted with a PM after TAVI show a high incidence of HG-AVB during the one year follow up. In multivariate analysis, only HG-AVB occurring between D2 and D7 significantly influence the PE, confirming that AV conduction disorders occurring during the first 24 hours may spontaneously normalize. Acknowledgement/Funding Microport CRM

Group Versus Individual Cognitive Treatment for Obsessive-Compulsive Disorder: Changes in Severity at Post-Treatment and One-Year Follow-up

2009 ◽  
Vol 38 (2) ◽  
pp. 227-232 ◽  
Author(s):  
Elena Cabedo ◽  
Amparo Belloch ◽  
Carmen Carrió ◽  
Christina Larsson ◽  
Héctor Fernández-Alvarez ◽  
...  
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Post Treatment ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Cognitive Behaviour ◽  
One Year ◽  
The One ◽  
The Individual ◽  
Group Cbt

Background: Very few studies have compared the efficacy of individual and group cognitive behaviour therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD) by taking into consideration the change in OCD severity in both the short and long term. Aims: To conduct an open trial of individual versus group CBT for OCD, comparing the clinical and statistically significant changes in severity both at post-treatment and one year later. Method: Forty-two OCD subjects were assigned to individual (n = 18) or group CBT (n = 24, in four groups). Sixteen and 22 subjects completed the treatment in the individual and group conditions, respectively. The Yale-Brown Obsessive Compulsive Scale was recorded at pre-treatment, post-treatment and at the one-year follow-up. Results: At the end of treatment, the clinically significant change was comparable for the two treatment conditions and remained stable at the one-year follow-up. Of the 16 participants who completed the individual CBT treatment, 68.75% were classified as recovered at post-treatment, compared to 40.9% of those receiving group CBT. At follow-up the rate of recovery decreased to 62.5% in individual CBT and to 31.8% in group CBT. Conclusions: Group CBT is effective in decreasing OCD severity. The post-treatment changes were maintained one year later. Nevertheless, these changes were higher in the individual delivery of CBT.

scholarly journals The Feasibility of a Novel Dose Painting Procedure to Treat Prostate Cancer Based on mpMR Images and Hierarchical Clustering

2021 ◽  
Author(s):  
Seyed Masoud Rezaeijo ◽  
Bijan Hashemi ◽  
Bahram Mofid ◽  
Mohsen Bakhshandeh ◽  
Arash Mahdavi ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Hierarchical Clustering ◽  
Post Treatment ◽  
P Value ◽  
Agglomerative Clustering ◽  
Dose Painting ◽  
Significant Difference ◽  
Target Volumes ◽  
Adc Values

Abstract BackgroundWe aimed to assess the feasibility of a novel dose painting (DP) procedure for treating prostate cancer with dominant intraprostatic lesions (DILs) based on mpMR images and hierarchical clustering with a machine learning technique. MethodsThe mpMR images of 120 patients were used to create hierarchical clustering and draw a dendrogram. Three clusters were selected for performing agglomerative clustering. Then, the DIL acquired from the mpMR images of 20 patients were categorized into three groups to have them treated with a novel DP procedure being composed of three planning target volumes (PTVs) determined as PTV1, PTV2, and PTV3 in treatment plans. The DP procedure was carried out on the patients wherein a total dose of 80, 85, and 91 Gy were delivered to the PTV1, PTV2, and PTV3, respectively. Dosimetric and radiobiologic parameters (TCP & NTCP) of the DP procedure were compared with those of the conventional IMRT and 3DCRT procedures carried out on another group of 20 patients. A post-treatment follow-up was also made four months after the radiotherapy procedures.ResultsAll the dosimetric variables and the NTCPs of the organs at risks revealed no significant difference between the DP and IMRT procedures. Regarding the TCP of three investigated PTVs, significant differences were observed between the DP vs. IMRT and also DP vs. 3DCRT procedures. At post-treatment follow-up, the DIL volumes and ADC values in the DP group differed significantly (p-value<0.001) from those of the IMRT. However, the whole prostate ADC and PSA indicated no significant difference (p-value>0.05) between the DP vs. IMRT. ConclusionsThe results of this comprehensive clinical trial illustrated the feasibility of our novel DP procedure for treating prostate cancer based on mpMR images validated with acquired patients’ dosimetric and radiobiologic assessment and their follow-ups. This study confirms significant potential of the proposed DP procedure as a promising treatment planning to achieve effective dose escalation and treatment for prostate cancer.Trial registrationIRCT20181006041257N1; Iranian Registry of Clinical Trials, Registered: 23 Oct. 2019, https://en.irct.ir/trial/34305

Evaluating the Effect of Probiotic Containing Milk on Salivary mutans streptococci Levels

2012 ◽  
Vol 37 (1) ◽  
pp. 9-14 ◽  
Author(s):  
A Juneja ◽  
A Kakade
Keyword(s):  
Lactobacillus Rhamnosus ◽  
Post Treatment ◽  
Mutans Streptococci ◽  
Control Group ◽  
P Value ◽  
Group I ◽  
Probiotic Lactobacillus ◽  
Group Ii ◽  
The Difference

Purpose: To evaluate the changes in mutans streptococci counts in saliva after short term probiotic intervention and its delayed effects on salivary mutans streptococci count. Methods: 40 children in the age group of 12-15 years with medium to high caries activity were randomly divided into Group I Control (plain milk group) and Group II Experimental (probiotic supplemented milk group). Duration of the study was 9 weeks; which was evenly divided into three phases: baseline, intervention and post-treatment period; each phase consisting of three weeks. After baseline period of 3 weeks, children in group I were given plain milk and in group II milk containing probiotic Lactobacillus rhamnosus hct 70 for 3 weeks; followed by a 3 weeks follow up period. After every phase saliva samples were collected to estimate salivary mutans streptococci counts. Results: The difference in the post follow up mutans streptococci count of group I and group II, was highly significant with p value &lt; 0.001. In the control group, the difference in the mean salivary baseline, post treatment and post follow up mutans streptococci counts was not statistically significant (p = 0.001). In the experimental probiotic group, the difference in mean salivary baseline, post treatment and post follow up mutans streptococci counts was statistically highly significant ( p = 0.000, p ≤ 0.001). Conclusions: Statistically significant reduction in salivary mutans streptococci counts immediately after consumption of probiotic Lactobacillus rhamnosus hct 70 containing milk suggest a beneficial effect of probiotic Lactobacillus rhamnosus hct 70 in the prevention of dental caries.

scholarly journals The effect of oral miltefosine in treatment of antimoniate resistant anthroponotic cutaneous leishmaniasis: An uncontrolled clinical trial

2021 ◽  
Vol 15 (3) ◽  
pp. e0009241
Author(s):  
Masoumeh Tayyebi ◽  
Emadodin Darchini-Maragheh ◽  
Pouran Layegh ◽  
Bita Kiafar ◽  
Vahid Mashayekhi Goyonlo
Keyword(s):  
Cutaneous Leishmaniasis ◽  
Laboratory Data ◽  
Post Treatment ◽  
P Value ◽  
Base Line ◽  
Cure Rate ◽  
Intention To Treat ◽  
Days Of Therapy ◽  
Treat Analysis

Background Recent circumstantial evidence suggests increasing number of Iranian patients with cutaneous leishmaniasis (CL) who are unresponsive to meglumine antimoniate (MA), the first line of treatment in Iran. Oral meltifosine was previously reported to be effective in visceral leishmaniasis as well CL. The current study is designed to determine efficacy and safety of oral miltefosine for the treatment of anthroponotic cutaneous leishmaniasis (ACL) cases who were refractory to MA in Iran. Methodology/Principal findings Miltefosine was orally administered for 27 patients with MA resistant ACL with approved L.tropica infection, at a dosage of ∼2.5 mg/kg daily for 28 days. Patients were evaluated on day 14 and 28, as well as 3, 6 and 12 month post treatment follow up sessions. Laboratory data were performed and repeated at each visit. Data were analyzed using SPSS version 17. Twenty-seven patients including 16 men (59.25%) and 11 women (40.74%) with mean age of 28.56 ± 4.8 (range 3–54 years old) were enrolled. Total number of lesions were 42 (1–4 in each patient). Most of lesions were on face (76.19%). Mean lesions’ induration size was 2.38 ± 0.73 cm at the base-line which significantly decreased to1.31 ± 0.58 cm and 0.61 ±0.49 cm after 14 and 28 days of therapy, respectively (p value <0.05). At 12-months follow-up post treatment, 22 patients had definite/partial cure (81.48%) including 17 definitely cured patients, corresponding to a cure rate of 68% on per protocol analysis, and 62.96% according to intention to treat analysis. Recurrence of lesion was only occurred in one patient (3.70%). Nausea was the most subjective complication during the therapy (33.33%). Conclusion Oral miltefosine could be an effective alternative for the treatment of MA-resistant ACL.

Hydroxyurea to Increase Hemoglobin Level in Thalassemia Intermedia.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 3769-3769
Author(s):  
Donatella Baronciani ◽  
Stefania Vaquer ◽  
Paola Carta ◽  
Eliana Lai
Keyword(s):  
Fetal Hemoglobin ◽  
Hemoglobin Concentration ◽  
Hemoglobin Level ◽  
Post Treatment ◽  
Wilcoxon Test ◽  
P Value ◽  
Thalassemia Intermedia ◽  
Hemoglobin F ◽  
Pre Treatment

Abstract Hydroxyurea (HU) has been shown to increase fetal hemoglobin (HbF) levels in patients with Sickle Cell Disease and Thalassemia Intermedia. Because there are no defined protocols for the use of this drug, we studied the effect of HU in a group of thalassemia intermedia (genetically defined) patients with at least one of the following features: Low hemoglobin level ( hemoglobin < 7 gr/dl) Bulky extramedullary erythroid masses We started the enrollment in February 2003 and 8 patients with a minimum follow up of 8 months have been evaluated ( range 8–16 months ) ( mean 13,6 months; median 14 months ). Mean age of the patients was 39.8 years ( range 28–49 years); all were not transfused at the moment of the study entry. HU was administered orally at a mean daily dose of 8.8 mg/kg (range 4–12 mg/kg). The drug was well tolerated; only one patient discontinued the treament for 2 months for pleural effusion. Table summarizes the pre and post treatment characteristics of this group of patients. Data reported are median (range), the differences between pre and post treatment values were analyzed with the the Wilcoxon test for non parametric observations. In this group of patients a mean increase of hemoglobin level of 1.2 g/dl was registered. Extramedullary erythroid expansion, studied by computed tomography scan did not show any change in this follow-up period. These results confirm that HU may improve Hb level in thalassemia intermedia patients even if other aspects must be studied and longer follow-up is necessary. Treatment results Pre treatment Post treatment Two tailed P value Values are expressed as median (range). P value = Wilcoxon test Hemoglobin level (g/dl) 6.6 (4.9–7.9) 7.8 (7.1–9.8) 0.05 Erythropoietin value (mU/ml) 679 (98–2855) 191 (71–1690) 0.2 Erythroblasts % leucocytes 191 (80–567) 153 (2–426) 0.2 Mean Corpuscolar volume (micron3) 77 (66–87) 82 (69–91) 0.08 Mean Hemoglobin Concentration (pg/rbc) 22 (21–25) 25 (22–27) 0.02 Hemoglobin F (%) 94.7 (52.9–97.7) 96.8 (58.7–98.4) 0.06

scholarly journals COMPARATIVE EVALUATION OF EFFICACY OF TOPICAL SALICYLIC ACID OINTMENT AND 5-FLUOROURACIL CREAM IN WARTS PATIENTS

2021 ◽  
Vol 9 (01) ◽  
pp. 164-170
Author(s):  
Pankaj Kumar Gond ◽  
◽  
Dev Prakash Shivhare ◽  
Neetu Purwar ◽  
Ajay Kumar Singh ◽  
...  
Keyword(s):  
Salicylic Acid ◽  
Treatment Modalities ◽  
P Value ◽  
Complete Regression ◽  
Randomized Design ◽  
Test Of Significance ◽  
The Common ◽  
The One ◽  
One Way Anova

Context: Warts are one of the common diseases in India. There are various modalities used for the treatment of warts. Very few studies have been done which compare the efficacy of topical salicylic acid and 5-Fluorouracil cream in warts patients. Aim: To compare the efficacy of topical salicylic acid ointment and 5% 5-fluorouracil cream in warts patients. Settings and Design: Completely randomized design. Methods and Material: Total 300 clinically diagnosed patients of warts which were divided into three groups (each contains 100 patients) depending on the treatment modalities which includes modality I treated with 16% salicylic acid, modality II treated with 5% 5-fluorouracil and modality III treated with the combination of 16% salicylic acid and 5% 5-fluorouracil. The evaluation of therapy was done by estimating the reduction in wart volume, complete regression of lesion, absence of recurrence of treated lesion after 3 months follow up. Statistical analysis used: Significant conclusion was drawn after applying the one way Anova test of significance. Results and conclusion: In Modality III, 99.95 % clearance was seen in warts volume at 12 weeks of treatment followed by Modality I (99.67% clearance in warts volume) and Modality II (99.31% clearance in warts volume) which were statistically significant at p value <0.01 level. Combination of 5-Fluorouracil and 16% salicylic acid is best for the treatment of warts with maximum recovery from warts with minimum adverse effect.

Delayed Parasite Clearance Rates and Low Clinical and Parasitological Responses Following Treatment of Uncomplicated Falciparum Malaria With Artemether-lumefantrine in Ethiopian- Sudan Border, Western Ethiopia

2021 ◽  
Author(s):  
geletta Tadele Leta ◽  
Fatou Kene Jaiteh ◽  
Mary oboh mary ◽  
Sisay dhugassa Lemma ◽  
Alfred Amambua Ngwa ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Falciparum Malaria ◽  
Parasite Clearance ◽  
Dried Blood Spots ◽  
Uncomplicated Falciparum Malaria ◽  
P Value ◽  
The Status ◽  
Lost To Follow Up ◽  
Al Treatment

Abstract BackgroundThe appearance of artemisinin-resistant parasites in Africa is catastrophic as many cases and deaths from malaria are usually reported in the continent. This study was the first to evaluate the status of artemether-lumefantrine (AL) efficacy, seventeen years after the introduction of this drug in the study area. This study aimed to assess PCR- corrected clinical and parasitological responses at 28 days following AL treatment.MethodsSixty uncomplicated falciparum malaria patients were enrolled, treated with standard doses of AL, and monitored for 28 days with clinical and parasitological assessments from September 15 to December 15, 2020. Molecular analysis was done on dried blood spots collected from each patient from day 0 and on follow-up days 1, 2, 3, 7, 14, 21, and 28. Descriptive statistics and binary logistic regressions were done using SPSS 20.0 statistical software. A p-value of less or equal to 0.05 was considered significant.ResultsSixty patients enrolled in the study, ten were lost to follow-up; and the results were analyzed for 50 patients. All of the patients were fever-free on day 3. But, two patients febrile on day 1 became febrile on day 7 of the follow-up period. Day 3 parasites positivity rate was zero and 60 % using microscopy and PCR, respectively. Parasite clearance on day 3 was more among patients ≥ 15 years as compared with < 15 years (AOR= 6.71, P=0.021). 14 of 50 patients tested were parasite positive on day 7 by PCR. In addition, 7 patients had persisted parasitemia by PCR from day 0 to day 28 of the follow-up. The PCR-corrected adequate clinical and parasitological response (ACPR) rate was 59.2 %. PCR adjusted AL treatment failures was 40.8% and it was noted as 0 early treatment failure, 10.2% late clinical failures, and 30.6% late parasitological failures. Recrudescence and new infection rate within 28 days was7/50(14%) and1/50 (2%) respectively.Conclusionartemisinin resistance is suspected in the study area as parasite positivity rate on day 3 was greater than 10%. A slow parasitological clearance was followed by low-density parasitemia persistence and recrudescences. AL treatment failure was greater than the 10% threshold for treatments in use as per WHO. These findings suggest probably a decreased sensitivity of the parasite for the artemisinin component and the partner drug and highlight the need for prompt reassessment of the efficacy of AL and other factors that may contribute to low parasite susceptibility to the drug.

Catheter-directed foam sclerotherapy treatment of saphenous vein incompetence

VASA ◽  
2012 ◽  
Vol 41 (2) ◽  
pp. 120-124 ◽  
Author(s):  
Asciutto ◽  
Lindblad
Keyword(s):  
Saphenous Vein ◽  
Short Term ◽  
Foam Sclerotherapy ◽  
Results Of Treatment ◽  
Ulcer Healing Rate ◽  
Complete Obliteration ◽  
Ceap Classification ◽  
One Year ◽  
The One

Background: The aim of this study is to report the short-term results of catheter-directed foam sclerotherapy (CDFS) in the treatment of axial saphenous vein incompetence. Patients and methods: Data of all patients undergoing CDFS for symptomatic primary incompetence of the great or small saphenous vein were prospectively collected. Treatment results in terms of occlusion rate and patients’ grade of satisfaction were analysed. All successfully treated patients underwent clinical and duplex follow-up examinations one year postoperatively. Results: Between September 2006 and September 2010, 357 limbs (337 patients) were treated with CDFS at our institution. Based on the CEAP classification, 64 were allocated to clinical class C3 , 128 to class C4, 102 to class C5 and 63 to class C6. Of the 188 patients who completed the one year follow up examination, 67 % had a complete and 14 % a near complete obliteration of the treated vessel. An ulcer-healing rate of 54 % was detected. 92 % of the patients were satisfied with the results of treatment. We registered six cases of thrombophlebitis and two cases of venous thromboembolism, all requiring treatment. Conclusions: The short-term results of CDFS in patients with axial vein incompetence are acceptable in terms of occlusion and complications rates.

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