Pain and analgaesics in patients with hard-to-heal ulcers: using telemedicine or standard consultations

2020 ◽  
Vol 29 (Sup8) ◽  
pp. S18-S27
Author(s):  
Hanna Wickström ◽  
Rut F Öien ◽  
Patrik Midlöv ◽  
Peter Anderberg ◽  
Cecilia Fagerström
Keyword(s):  
High Intensity ◽  
Pain Treatment ◽  
Statistical Significance ◽  
Healing Time ◽  
Categorical Variables ◽  
Rank Test ◽  
P Value ◽  
Significant Difference ◽  
Video Consultation ◽  
Normally Distributed

Objective: To compare consultations carried out via video with those performed in person for patients with painful, hard-to-heal ulcers, with a focus on ulcer pain and pain treatment. A further aim was to investigate predictors for pain and pain treatment. Method: This was a register-based, quasi-experimental study based on data from the Swedish Registry of Ulcer Treatment (RUT). A total of 100 patients with hard-to-heal ulcers diagnosed via video consultation were compared with 1888 patients diagnosed in person with regard to pain assessment, intensity and treatment. Ulcer pain intensity was assessed by the visual analogue scale (VAS). Normally distributed variables (age, VAS) were compared between consultation groups using Student's t-test. Non-normally distributed variables (ulcer size, ulcer duration) were compared using the Mann–Whitney U-test, except for healing time, which was analysed with a log-rank test. Categorical variables (gender, ulcer aetiology and prescribed analgesics) were compared using Pearson's chi-square test (χ2). A p value of less than 0.05 was considered to indicate statistical significance. Predictors for pain and pain treatment were analysed in multiple regression analyses. Results: The results showed a high presence of pain; 71% of patients with pain reported severe ulcer pain. There was no significant difference in ability to assess pain by VAS in the group diagnosed via video consultation (90%) compared with the group diagnosed in person (86%) (χ2, p=0.233). A significantly higher amount of prescribed analgesics was found for patients diagnosed via video (84%) compared with patients diagnosed by in-person assessment (68%) (χ2, p=0.044). Predictors for high-intensity pain were female gender or ulcers due to inflammatory vessel disease, while the predictors for receiving analgesics were older age, longer healing time and being diagnosed via video consultation. Conclusion: To identify, assess and treat ulcer pain is equally possible via video as by in-person consultation. The results of this study confirm that patients with hard-to-heal ulcers suffer from high-intensity ulcer pain, with a discrepancy between pain and pain relief. Further well-designed randomised controlled studies are necessary to understand how best to deploy telemedicine in ulcer pain treatment.

Pain and analgesics in patients with hard-to-heal ulcers: using telemedicine or standard consultations

2021 ◽  
Vol 30 (Sup6) ◽  
pp. S23-S32
Author(s):  
Hanna Wickström ◽  
Rut F Öien ◽  
Patrik Midlöv ◽  
Peter Anderberg ◽  
Cecilia Fagerström
Keyword(s):  
High Intensity ◽  
Pain Treatment ◽  
Statistical Significance ◽  
Healing Time ◽  
Categorical Variables ◽  
Rank Test ◽  
P Value ◽  
Significant Difference ◽  
Video Consultation ◽  
Normally Distributed

Objective: To compare consultations carried out via video with those performed in person for patients with painful, hard-to-heal ulcers, with a focus on ulcer pain and pain treatment. A further aim was to investigate predictors for pain and pain treatment. Method: This was a register-based, quasi-experimental study based on data from the Swedish Registry of Ulcer Treatment (RUT). A total of 100 patients with hard-to-heal ulcers diagnosed via video consultation were compared with 1888 patients diagnosed in person with regard to pain assessment, intensity and treatment. Ulcer pain intensity was assessed by the visual analogue scale (VAS). Normally distributed variables (age, VAS) were compared between consultation groups using Student's t-test. Non-normally distributed variables (ulcer size, ulcer duration) were compared using the Mann–Whitney U-test, except for healing time, which was analysed with a log-rank test. Categorical variables (gender, ulcer aetiology and prescribed analgesics) were compared using Pearson's chi-square test (χ2). A p value of less than 0.05 was considered to indicate statistical significance. Predictors for pain and pain treatment were analysed in multiple regression analyses. Results: The results showed a high presence of pain; 71% of patients with pain reported severe ulcer pain. There was no significant difference in ability to assess pain by VAS in the group diagnosed via video consultation (90%) compared with the group diagnosed in person (86%) (χ2, p=0.233). A significantly higher amount of prescribed analgesics was found for patients diagnosed via video (84%) compared with patients diagnosed by in-person assessment (68%) (χ2, p=0.044). Predictors for high-intensity pain were female gender or ulcers due to inflammatory vessel disease, while the predictors for receiving analgesics were older age, longer healing time and being diagnosed via video consultation. Conclusion: To identify, assess and treat ulcer pain is equally possible via video as by in-person consultation. The results of this study confirm that patients with hard-to-heal ulcers suffer from high-intensity ulcer pain, with a discrepancy between pain and pain relief. Further well-designed randomised controlled studies are necessary to understand how best to deploy telemedicine in ulcer pain treatment.

617 Who Benefits the Most from Burn Camps?

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S162-S163
Author(s):  
Jennifer B Radics-Johnson ◽  
Daniel W Chacon ◽  
Li Zhang
Keyword(s):  
Retrospective Review ◽  
Burn Injury ◽  
Statistical Significance ◽  
Categorical Variables ◽  
P Value ◽  
Continuous Variables ◽  
Self Evaluation ◽  
Significant Difference ◽  
Return Home ◽  
The Impact

Abstract Introduction Burn camps provide a unique environment and activities for children that have experienced a burn-injury. Positive outcomes from attending burn camp include increased self-esteem, decreased feelings of isolation and a greater sense of self-confidence. In a 3-year retrospective review of camper evaluations from one of the largest and longest running week-long burn camps in the nation for ages 5–17, we aimed to assess if a child’s gender, age, TBSA or ethnicity affected the impact that burn camp had on a child. Methods A 3-year retrospective review of a Burn Camp’s camper evaluation forms was conducted for campers that attended burn camp between 2017–2019. Camp rosters were reviewed to determine the camper gender, age, TBSA and ethnicity. Camper self-evaluation forms completed at the end of each camp session were reviewed to record camper responses to questions regarding their opinions on the impact camp had on them as well as how camp will impact their lives once they return home. Categorical variables were summarized as frequency and percentage, and continuous variables were described as median and range. To check the relationship between two categorical variables, Chi-square test was used. To compare the continuous variable among groups, Kruskal-Wallis ANOVA was used. Statistical significance was declared based on a p value< 0.5. Results Within 2017–2019, there were 413 camper records. Participants’ demographic characteristics are summarized in Table 1. There were 208 males (50.3%) and 205 females (49.6%). The median age of campers were 11.86, 12.44 and 12.45 for 2017–2019, with the range from 5.16 years to 17.96 years. The median TBSA were 20, 20 and 18 for 2017–2019, with the range from 0.08 to 90. Collectively there were 47.7% Hispanic (n= 197); 24.2% Whites (n=100); 13.1% Black (n= 54); 4.6% Asian (n=19) and 7.7% Other (n=32). There were 395 camper self-evaluation forms submitted. Results of three questions there we were interested in are summarized collectively in Table 2. 57% of campers responded, “Yes, Definitely” to the question “After going to this event, will you feel more comfortable being around your classmates or friends?” 54% responded, “ Yes, Definitely” to the question “Do you feel more confidents in sharing your burn story with others when returning home?” and 51% responded “Yes, Definitely” to “Did you learn anything that will help you when you return home?” Conclusions In analyzing the camper responses, there was no statistically significant difference in responses comparing gender, age, TBSA or ethnicity.

The IC50 Assay Is Predictive of Molecular Response, and Indicative of Optimal Dose in De-Novo CML Patients.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 1109-1109
Author(s):  
Deborah L White ◽  
Verity A Saunders ◽  
Thea Kalebic ◽  
Timothy P Hughes
Keyword(s):  
De Novo ◽  
Statistical Significance ◽  
Continuous Variable ◽  
Rank Test ◽  
P Value ◽  
Molecular Response ◽  
Optimization Strategy ◽  
Log Reduction ◽  
Significant Difference ◽  
The Impact

Abstract We have previously demonstrated significant interpatient variability in the IC50imatinib, a measure of the intrinsic sensitivity of a patient to imatinib induced kinase inhibition. Furthermore, this measure is predictive of the achievement of major molecular response (MMR > 3 log reduction in BCR-ABL) in de-novo CML patients treated with imatinib (n=60)1. In an expanded patient pool (n=116) we now perform an evaluation of the IC50 as a predictor of response, and address the IC50imatinib as a guide to dose selection. Samples were obtained with informed consent from de novo CML patients enrolled to either the TIDEL (600mg imatinib) or TOPS (randomised 400mg vs 800mg imatinib) trials. Blood was collected pre therapy, and the IC50 was performed as previously1. Outcome data was assessed using Kaplan Meier Analysis and the log rank test was used to assess statistical significance. In our previous analysis the IC50imatinib was divided about the median value for the cohort (0.6μM) into low and high IC50, with a significantly greater proportion of patients with low IC50imatinib achieving MMR by 12 months. In this expanded patient pool, we confirm this finding (<median of 0.7μM for this patient group) (low IC50 65% of patients achieve MMR by 12 mo vs high IC50 39% of patients p=0.014) Dividing the IC50’s into quartiles we now demonstrate that the IC50imatinib is a continuous variable with a greater proportion of patients in the lower quartile achieving MMR than those in the higher (Table 1 Total). Addressing the issue of dose we demonstrate that no patients with IC50>0.95uM achieve MMR on 400mg, and that this is statistically significantly when compared to all other groups. At 600mg while there is no overall significant difference there is a statistically relevant difference between groups 1, 2 and 4 as indicated. In contrast, at 800 mg the effect of IC50imatinib is overcome. MMR by 12 months Total 400mg 600mg 800mg p value Group1 <0.5μM 67% (27) 83% (12)* 50% (8)* 86% (7) 0.470 Group 2 >0.5<0.7μM 63% (30) 67% (6)* 53% (17)* 71% (7) 0.337 Group 3 >0.7<0.95μM 45% (31) 40%(5)* 30% (10) 56% (16) 0.139 Group 4>0.95μM 32% (28) 0% (7)* 22% (9)* 58% (12) 0.016 P value 0.042 0.018 0.108 0.778 Table 1: Dividing the patients into quartile based on the IC50 imatinib and assessing the Impact of dose on the achievement of MMR by 12 month. *p value <0.05 between groups (n). The failure to achieve a Complete Cytogenetic Response by 12 months is considered a suboptimal response. Assessing the molecular equivalent (≥2 log reduction in BCR-ABL) we demonstrate that a significantly greater proportion of patients with IC50imatinib>0.7μM fail to achieve a 2 log reduction when treated with 400mg (IC50 <0.7μM 11%: >0.7μM 33% p=0.034), and 600mg (IC50 <0.7μM 12%: >0.7μM 22% p=0.036). However, there is no significant difference in the 800mg patient cohort (IC50 <0.7μM 7%: >0.7μM 14% p=0.79). This analysis confirms that the IC50imatinib, is predictive of imatinib response. Patients with an IC50imatinib <0.7μM are likely to respond well to doses of 400mg imatinib, as suggested by evaluation of statistically relevant outcome benefit. In contrast patients with higher IC50imatinib (>0.7μM) may benefit from higher dosing regimens (p=0.012). Thus, the accurate assessment of IC50imatinib could support dose optimization strategy for patients with a suboptimal response.

scholarly journals Application of high-intensity laser in pain treatment of patients with knee osteoarthritis

2021 ◽  
Vol 13 (2) ◽  
Author(s):  
Valentina Koevska ◽  
Erieta Nikolic-Dimitrova ◽  
Biljana Mitrevska ◽  
Cvetanka Gjerakaroska-Savevska ◽  
Marija Gocevska ◽  
...  
Keyword(s):  
High Intensity ◽  
Pain Treatment ◽  
Statistical Significance ◽  
Joint Space ◽  
Pharmacological Therapy ◽  
Vas Score ◽  
Days Of Therapy ◽  
Significant Difference ◽  
High Intensity Laser ◽  
Intensity Laser

Osteoarthritis is a rheumatic disease characterized by degeneration and decay of cartilage in the joints. As the disease worsens, the joint space narrows causing numbness and pain, which often impairs movement. In addition to pharmacological therapy, low-intensity laser (LILT), high-intensity laser (HILT) and exercise are used to treat osteoarthritis (OA) of the knee. HILT is a new modality in our country and the experience from its application is small, especially in the treatment of OA of the knee. Aim of the paper was to compare the effect of HILT with LILT in the treatment of OA of the knee. Material and methods: This was a randomized comparative unilateral blind study involving 72 patients divided into two groups. The first group was treated with HILT, the second group treated with LILT. Outcome measure was the visual analogue scale (VAS) for pain, which was made on the first and tenth day of treatment. Statistical significance was defined as p <0.05. Results: We found a significant difference between the two groups in terms of VAS score after 10 therapies  in favor to a significantly lower score, that is, less pain in the HILT group (p = 0.0035). The comparison of the VAS score between the two times in the two groups separately showed that in both, the HILT and the LILT groups, the VAS score after 10 days of therapy was significantly lower compared to thatat 0 time, for consequently p = 0.00001vsp = 0.00001. Conclusion: Treatment with HILT and LILT significantly reduces pain and stiffness in patients with OA. Patients treated with HILT had better results, i.e., had a significant reduction in pain than patients treated with LILT. HILT was more effective than LILT.

scholarly journals COMPARISON BETWEEN TWO TYPES OF ABDUCTION ORTHOTICS IN TREATING CONGENITAL CLUBFOOT

2017 ◽  
Vol 25 (4) ◽  
pp. 125-128
Author(s):  
Luiz Carlos Ribeiro Lara ◽  
Bruno Leite Gil ◽  
Lucio Carlos de Azevedo Torres Filho ◽  
Tarsila Pagnan Silva dos Santos
Keyword(s):  
Statistical Significance ◽  
Deformity Correction ◽  
Categorical Variables ◽  
P Value ◽  
Congenital Clubfoot ◽  
Level Of Evidence ◽  
Orthotic Device ◽  
Significant Difference ◽  
Group 2 ◽  
Group 1

ABSTRACT Objective: The objective of this study was to analyze and compare the effectiveness of two types of abduction orthotics used for the feet, the Denis-Browne type (traditional) and the Dobbs type (dynamic), with regard to maintenance of deformity correction and prevention of recurrence . Method: In this comparative retrospective case study, information was collected from the medical records of children with idiopathic congenital clubfoot (CCF). We evaluated a total of 43 feet in 28 patients, which were divided into two groups. Group 1 was comprised of 16 patients with a total of 24 CCFs treated with the traditional orthotic device. Group 2 consisted of 12 patients with a total of 19 CCFs treated with the dynamic orthotic device. The statistical analysis used the ANOVA test to compare the categorical variables between the groups. A significance level of 5% was adopted (p-value≤0.05) . Results: In Group 1, recurrence was observed in 2 feet (8.33%), and in 1 foot in Group 2 (5.26%). No significant difference in effectiveness was seen between the two types of orthotic devices . Conclusion: Both abduction devices were seen to be effective in maintaining correction of congenital clubfoot deformities. There was no statistical significance between type of orthotic device and recurrence. Level of Evidence III, Retrospective Comparative Study.

scholarly journals Burnout and Empathy: A Cross-Sectional Study among Resident Physicians in Public Sector Hospitals of a Developing Country

2021 ◽  
Vol 3 (4) ◽  
pp. 121-124
Author(s):  
Muhammad Hamza Khalid ◽  
Rafia Ishtiaq ◽  
Laiba Fatima ◽  
Hassaan Ahmed ◽  
Aqsa Masood ◽  
...  
Keyword(s):  
Statistical Significance ◽  
Working Hours ◽  
Maslach Burnout Inventory ◽  
Cross Sectional Study ◽  
Categorical Variables ◽  
P Value ◽  
Sectional Study ◽  
Cross Sectional ◽  
Significant Difference ◽  
Resident Burnout

The main objective of our study was to determine the prevalence of burnout and to identify various socio-demographic factors which are associated with resident burnout. As a secondary objective, we aimed to assess levels of empathy among the residents. A descriptive cross-sectional study was performed among residents working in Holy Family Hospital, Benazir Bhutto Hospital, and District Headquarter Hospital, all of which are situated in district Rawalpindi of Punjab, Pakistan. Data were collected from January 2019 to April 2019 using a convenient sampling technique. The participants were requested to complete Maslach Burnout Inventory to measure burnout and Jefferson Scale of Physician Empathy to measure empathy from January 2019 to April 2019. For data analysis IBM SPSS © version 25.0 was used. Descriptive statistics were used to summarize the quantitative variables. Chi-square test was used to determine the association between burnout and categorical variables. Then, those independent variables with p-value < 0.05 were subjected to binary logistic regression to identify predictors of burnout. A P-value of < 0.05 was used as the criterion for statistical significance and OR with 95% confidence interval was used to indicate the strength of association. Independent sample t-test was used to assess empathy among the groups. The prevalence of burnout in our sample was 78%. The average burnout score of the sample was 81±13.45. Weekly working hours (p-value < 0.05) and the type of specialty (p-value < 0.05) were significantly associated with resident burnout. Residents working more than 80 hours were more prone to develop burnout [AOR 2.700(1.42-5.120)]. Medical residents were found to be at a higher risk of developing burnout as compared to surgical residents [(AOR 2.097(1.16-3.78)]. Residents working less than 80 hours per week had more empathy scores as compared to residents working more than 80 hours and this result was statistically significant (p-value < 0.05). However, no significant difference in empathy was found for age, gender, marital status, and posts. Therefore, weekly working hours should be reduced to diminish burnout and increase empathy, thereby, promoting the quality of care being delivered to the patient. Moreover, efforts should be made to reduce burnout in medicine residents so that we may promote the doctor-patient relationship.

Effects of cardioprotective medications on breast cancer survival: A retrospective study from an academic center from Southern Illinois.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e12540-e12540
Author(s):  
Manjari Rani Regmi ◽  
Priyanka Parajuli ◽  
Asad Cheema ◽  
Odalys Estefania Lara Garcia ◽  
Nitin Tandan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Beta Blocker ◽  
Hazard Ratio ◽  
Categorical Variables ◽  
Rank Test ◽  
P Value ◽  
Breast Cancer Patients ◽  
Cardiovascular Risks ◽  
Significant Difference

e12540 Background: Cardiovascular disease is one of the leading causes of deaths in breast cancer patients. Pre-existing cardiac conditions and cardiovascular risks associated with chemotherapy affect the overall mortality of these patients. Cardio protective medications like beta-blocker, ACEIs, ARBs, statin, and potassium-sparing diuretics have shown to increase the survival odds. In our study, we investigated the survival of breast cancer patients who were on cardio protective medications. Methods: Our retrospective cohort study included breast cancer patients from Simmons Cancer Institute, Springfield, Illinois from January 1st, 2014 to December 31st, 2017. The first step comprised of screening patients using ICD code of breast cancer. Next, a retrospective chart review led to selecting eligible patients with biopsy proven breast cancer diagnosis within the aforementioned dates. We excluded patients who were diagnosed outside the give time frame. Data on age, gender, medical comorbidities, medications, and survival status were also collected. Comparisons between categorical variables were compared with the Chi-Squared test. Survival curves were estimated using Kaplan-Meier methodology and analyzed with a log rank test. Predictors of survival are assessed with Cox proportional hazards regression analyses. Results: Screening using ICD codes resulted in 1618 patients. Of those, 478 had biopsy proven diagnosis within the dates mentioned. 301 out of 478 patients were on some kind of cardio protective medication (88 on beta-blockers, 73 on ACEIs, 41 on ARBs, 87 on statins, and 12 on potassium sparing diuretics). We looked into survival analysis in patients on different cardioprotective medications. ARBs and potassium sparing diuretics showed increased likelihood of survival as the hazard ratio (HR) was found to be 0.512 (95% Cl: 0.068-3.832, p-value:0.0919) and HR 0.390 (95% CI: 0.130-1.66, p-value:0.514) respectively. In contrast, other cardio protective medications showed decreased trends for survival. The HR of beta blocker was 1.734 (95% CI: 0.508-5.919, p-value: 0.379) and of ACEIs was 1.350 (95% CI: 0.395-4.613, p-value: 0.632). Similarly, statins had a hazard ratio of 1.534 (95% CI: 0.512- 4.594, p-value:0. 444). Conclusions: We found that the cardio protective medications showed no statistically significant difference in survival in breast cancer patients. Given the smaller sample size and single center study, further multi-center clinical trial is warranted to establish a stronger association.

scholarly journals Comparative study between bone patellar tendon bone and quadrupled hamstring autografts in arthroscopic anterior cruciate ligament reconstruction with aperture fixation

2017 ◽  
Vol 3 (2) ◽  
pp. 185 ◽  
Author(s):  
Dilip S. Shaktawat ◽  
Anil Kumar Mishra ◽  
Manoj R. Kashid ◽  
Amit Chaudhry ◽  
Rajshekhar . ◽  
...  
Keyword(s):  
Patellar Tendon ◽  
Cruciate Ligament ◽  
Statistical Significance ◽  
Symptomatic Improvement ◽  
Fixation Method ◽  
P Value ◽  
Significant Difference ◽  
Aperture Fixation ◽  
Anterior Cruciate ◽  
Bone Patellar Tendon

<p class="abstract"><strong>Background:</strong> Bone patellar tendon bone <strong>(</strong>BPTB) and hamstring (HT) auto grafts have been used routinely in reconstruction of ACL over past two decades. Controversy still remains as to which graft is superior over other. Many studies have compared these graft options using different implants and different methods of fixation. Continuation of efforts in the same direction; purpose of the study is to compare these two graft options utilizing identical implants and similar method of fixation.</p><p class="abstract"><strong>Methods:</strong> 40 patients of clinically and radiologically diagnosed ACL tear fulfilling the inclusion and exclusion criteria were randomized into two groups to undergo arthroscopic ACL reconstruction using quadrupled hamstring graft (n=20) and bone patellar tendon bone auto graft (n=20) utilizing bioscrew by aperture fixation method in both the groups. They were compared post operatively for symptomatic improvement, clinical and rolimeter laxity tests and Lysholm functional knee scoring at 02 year.<strong></strong></p><p class="abstract"><strong>Results:</strong> At the end of 02 years laxity measurement by rolimeter showed slightly better results in BPTB group; however it was not statistically significant (p value= 0.362). Knee pain at the end of 02 year was slightly more in HT groups (45%) as compared to BPTB group (35%) but not significant (p value =0.748). Instability symptoms are comparable in both the groups (sense of giving away on exertion). Manual laxity testing by Lachman and Pivot shift tests were comparable in both the groups with p value of 0.695 and 0.999 respectively. Lysholm functional knee score also showed no statistical significance (p value =0.957).</p><p><strong>Conclusions:</strong> There is no significant difference between HT and BPTB auto grafts in terms of clinical and functional outcome at the end of 02 years. </p>

scholarly journals Performance of the BD FACSPresto near to patient Analyzer in comparison with representative conventional CD4 instruments in Cameroon.

2020 ◽  
Author(s):  
Bertrand Sagnia ◽  
Fabrice MBAKOP Ghomsi ◽  
Ana Gutierrez ◽  
Samuel SOSSO ◽  
Rachel KAMGAING ◽  
...  
Keyword(s):  
T Lymphocytes ◽  
T Lymphocyte ◽  
Statistical Significance ◽  
P Value ◽  
Resource Constrained ◽  
Inform Consent ◽  
Remote Areas ◽  
Significant Difference ◽  
Sensitivity Specificity ◽  
Cd4 Testing

Abstract Background In the context of scaling the viral load in resource limited settings, following HIV infected patient’s adults and children with CD4+ T-lymphocyte count still very important in settings where the decentralization of treatment still has some challenges. Effective HIV monitoring in these resource-constrained settings needs affordable and reliable CD4+ T lymphocytes enumeration methods. We investigated the validity of a BD FACSPresto POC which is a dedicated system for enumeration that uses immunofluorescent technologies. In this study, we have assessed the sensitivity, specificity and correlation between most representative flow cytometry instruments present in Cameroon with more than 5000 CD4 T cells tests per year including FACSCalibur, FACSCount, and PIMA POC from Becton dinkinson and ALERE respectively. Methods 268 patients aged from 1 to 72 years old were enrolled and included in the study after inform consent. The BD FACSPresto POC CD4+ T cell technology was placed at CIRCB and operated by technician staff. HIV infected patients were from Chantal BIYA international reference Center (CIRCB), Centre de Sante Catholique de NKOLODOM, Centre de Sante Catholique de BIKOP and CASS de Nkolndongo – Yaounde We compared the accuracy of the BD FACSPresto and three existing reference technologies with more than 5000 tests per year like FACSCalibur, FACSCount and PIMA according to the number of CD4 test done per year and their repartition in the country. Bland – Altman method and correlation analysis were used to estimate mean bias and 95% limits of agreement and to compare the methods, including analysis by subgroup of participant gestational age. In addition sensitivity and specificity were determined. Statistical significance was set at p-value < 0.05 Results The BD FACSPresto POC system has excellent precision, accuracy and linearity for CD4+ T lymphocytes enumeration. Good correlations were obtained between the BD FACSPresto poc system and other single platform methods. Bland–Altman plots showed interchangeability between two machines mean bias BD-FACSPresto vs PIMA= -126,522(-161,221 to -91,822) BD-FACSPresto vs FACSCount= -38,708 (-58,935 to -18,482) and FACSPresto vs FACSCALIBUR= 0,791(-11,908 to 13,491). Mean difference with Absolute CD4+ T-lymphocyte values obtained from the BD FACSPresto system correlated well with PIMA, FACSCount, and FACSCalibur method with R 2 equal to 0.88, 0.92 and 0.968 respectively with P < 0.001 for all. The mean comparison between values obtained from BD FACSPresto with PIMA, FACSCount, and FACSCalibur using paired T test give P=0.17, P=0.5 and P=0.6 respectively meaning that there is no significant differences between values obtained with BD FACSPresto and PIMA, FACSCount or FACSCalibur CD4 enumeration machines. Further analysis revealed close agreement between all the three instruments with no significant difference between the forth methods (P=0.91) Conclusion This BD-FACSPresto POC system is a simple, robust and reliable system for enumeration of absolute and percentage of CD4+ T-lymphocytes especially suitable for remote areas with limited resources. Having one BD-FACSPresto POC system easy to use, should reduce the cost and thus increase and improved access to CD4 testing for HIV infected patients in resource-constrained countries. BD-FACSPresto POC CD4 will enable reduction in patient time and improve the overall quality of ART service count and may improve test access in remote areas. This technology can allow for greater decentralization and wider access to CD4 testing and ART

scholarly journals Time to viral load suppression and its associated factors in cohort of patients taking antiretroviral treatment in East Shewa Zone, Oromiya, Ethiopia, 2018

2019 ◽  
Author(s):  
Jemal H Ali
Keyword(s):  
Viral Load ◽  
Marital Status ◽  
Associated Factors ◽  
Plasma Viral Load ◽  
Baseline Viral Load ◽  
Rank Test ◽  
P Value ◽  
People Living With Hiv ◽  
Age Group ◽  
Significant Difference

Abstract Background: Human immuno-deficiency virus is a virus that causes Acquired Immuno- Deficiency Syndrome. The key goal of ART is to achieve and maintain durable viral suppression. Thus, the most important use of the viral load is to monitor the effectiveness of therapy after initiation of ART. The main objective of the study was to determine the time for virological suppression and its associated factors among people living with HIV taking antiretroviral treatments in East shewa zone, Oromiya, Ethiopia. Methods: The study was conducted in East Shewa zone, Oromiya, Ethiopia from August 2017 to January 2018. Patients diagnosed with human immunodeficiency virus presenting to the study health centers between October 3, 2011 and March 1, 2013 were included in the study given the following criteria: age 18 years or greater, eligible to start ART. All patients with baseline viral load measurement were included in the study. Interaction between explanatory variables with the response variable was analyzed by using cross tab features of SPSS, IBM Inc. Significance group comparison was done by Kaplan Meier log rank test. Cox proportional hazard model was used to select significant factors to the variability between groups. Data was collected by using structured questionnaires and interview. A total of ETB 81,120.00 was utilized to carry out the study. Result: plasma viral load was suppressed below detection level in 72% of individuals taking different regimen of ART. The median HIV-1 plasma viral load in the cohort was log 5.3111 copies/ml. Survival curve difference were observed in category of marital status (p-value 0.023) and baseline CD4 values (p-value 0.023) whereas no significant difference were observed in Educational status (p-value 0.404), MUAC (p- value 0.407) BMI(p-value 0.335) and BTB(p-value 0.257). Estimated median time to PVL suppression was 181days (CI: 140.5-221.4) with the age group of 30-39years having minimum time to achieve suppression with 92 days (CI: 60.1-123.8) and the maximum time required to reach the level was age group between 50-59 years. Conclusion: Estimated time to achieve PVL after taking ART was found to be 181 days. Factors affecting time to suppression level was marital status and baseline CD4.

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