Incidence and predictors of anemia among adults on HIV care at South Gondar Zone Public General Hospital Northwest Ethiopia, 2020; retrospective cohort study

Background Anemia is a major public health problem worldwide which accounts 24.8% of the population. Subsequently, anemia is a leading killer of people living with human immunodeficiency virus and many of these deaths occur in developing countries including Ethiopia. Cross sectional studies have done on anemia and human immunodeficiency virus. However, there is limited study on incidence of anemia and its predictors among adults on HIV care, especially no survival study has been conducted in the study area. Objective To assess incidence and predictors of anemia among adults on Human immunodeficiency virus care. Methods An institution-based retrospective cohort study was conducted among 434 adults on HIV care from January 1st 2015 to December 30th 2019 at Debre Tabor Referral Hospital. A computer-generated simple random sampling technique was employed to select the study participants. Ethical clearance was obtained from the Institutional Review Board of Bahir Dar University, and also, we got implied consent to review charts from the concerned bodies in the hospital. Data were entered using Epi-data version 3.1 and analyzed by using STATA version 14.0. A Kaplan Meier survival curve was utilized to estimate anemia free survival time. Bivariable and Multivariable Cox proportional hazards model were fitted to identify predictors of anemia. Results The overall incidence density rate of anemia was 6.27 (95% CI: 0.051, 0.077) per 100 person years. Clinical stage III/IV (AHR = 1.04; 95% CI = 1.02, 1.06), Body Mass Index less than 18.5 kg/m2 (AHR = 3.11; 95% CI = 1.56, 6.22), serum creatinine greater than 1.1 IU/L(AHR = 2.07; 95% CI = 1.12, 3.81) and fair/poor level of adherence(AHR = 1.05; 95% CI = 1.03, 1.07) were statistically significant predictors of anemia while increased anti-retroviral treatment duration (AHR = 0.98; 95% CI = 0.97, 0.99) decrease the risk of anemia at 95% confidence level. Conclusion The overall incidence density rate of anemia was high. Patients with clinical stage III/IV, body mass index < 18.5 kg/m2, serum creatinine greater than 1.1 IU/L and fair/poor level of adherence were significant predictors of anemia while increased antiretroviral treatment duration had decreased the risk of anemia. Recommendation Even if the overall incidence rate of anemia was lower as compared to previous studies in Ethiopia, still the incidence of anemia was high. So, prevention measures should be taken beside with HIV care especially within 6-months ART initiation.

Ruxolitinib Re-Treatment in Patients with Myelofibrosis: Real-World Evidence on Patient Characteristics and Outcomes

Ruxolitinib is an FDA-approved treatment of intermediate- and high-risk myelofibrosis. In the phase 3 COMFORT studies, ruxolitinib reduced spleen volume in patients with myelofibrosis, with a median time to response of 3 months. However, nearly 20% of patients discontinued by month 4 with few treatment options available following discontinuation of ruxolitinib treatment. In this study, 2 independent patient care data sources were queried (Cardinal Health Oncology Provider Extended Network [OPEN] and HealthCore Integrated Research Environment [HIRE®]), and a retrospective review of medical charts was conducted. Patients aged ≥18 years with a diagnosis of myelofibrosis (primary or secondary), use of ruxolitinib for myelofibrosis, and documented physician-directed ruxolitinib interruption were included. Among 26 included patients, pre-interruption median (interquartile range [IQR]) ruxolitinib treatment duration was 123 (57–391, OPEN) and 110 (37–148, HIRE) days. Half the patients interrupted treatment within 3 months, commonly for adverse events (42% and 71%, respectively). After restarting ruxolitinib, median (IQR) re-treatment duration was 196 (54–553) and 166 (108–262) days, respectively. Consistent with previous reports, symptoms and spleen size improved in (OPEN/HIRE) 45%/43% and 40%/33% of evaluable patients, respectively. Further studies investigating the management of dose modifications and interruptions are needed to optimize benefit from ruxolitinib therapy.

Determinants of Kidney Function and Accuracy of Kidney Microcysts Detection in Patients Treated With Lithium Salts for Bipolar Disorder

Objectives: Early kidney damage during lithium treatment in bipolar disorder is still hypothetical. We aimed at identifying the determinants of a decreased measured glomerular filtration rate (mGFR) and the accuracy of kidney MRI imaging in its detection.Methods: In this cross-sectional cohort study, 217 consecutive lithium-treated patients underwent mGFR and kidney MRI with half-Fourier turbo spin-echo and Single-shot with long echo time sequences.Results: Median age was 51 [27–62] years, and median lithium treatment duration was 5 [2–14] years. 52% of patients had a stage 2 CKD. In multivariable analysis, the determinants of a lower mGFR were a longer lithium treatment duration (β −0.8 [−1; −0.6] ml/min/1.73 m2 GFR decrease for each year of treatment), a higher age (β −0.4 [−0.6; −0.3] ml/min/1.73 m2 for each year of age, p &lt; 0.001), albuminuria (β −3.97 [−6.6; −1.3], p = 0.003), hypertension (β −6.85 [−12.6; −1.1], p = 0.02) and hypothyroidism (β −7.1 [−11.7; −2.5], p = 0.003). Serum lithium concentration was not associated with mGFR. Renal MRI displayed renal microcyst(s) in 51% of patients, detected as early as 1 year after lithium treatment initiation. mGFR and lithium treatment duration were strongly correlated in patients with microcyst(s) (r = −0.64, p &lt; 0.001), but not in patients with no microcysts (r = −0.24, p = 0.09). The presence of microcysts was associated with the detection of an mGFR &lt;45 ml/min/1.73 m2 (AUC 0.893, p &lt; 0.001, sensitivity 80%, specificity 81% for a cut-off value of five microcysts).Conclusion: Lithium treatment duration and hypothyroidism strongly impacted mGFR independently of age, especially in patients with microcysts. MRI might help detect early lithium-induced kidney damage and inform preventive strategies.

Acupoint stimulation-related therapies for the management of insomnia disorder: A systematic review and meta-analysis protocol

Review question / Objective: This meta-analysis will not only summarize all the ASRTs reported in clinical trials but also evaluate their effect on objective and subjective indices related to insomnia disorder. We will also perform subgroup analyses to identify possible confounders of the effects of ASRTs including treatment characteristics (e.g., acupoint selection, stimulation method, treatment duration) and patient characteristics (e.g., age, comorbidities, severity, and course of insomnia disorder). In doing so, we will endeavor to answer questions about whether efficacy varies according to the aspect of sleep targeted and whether the effects differ according to different modes of acupoint stimulation, acupoints applied, or specific types of insomnia, thereby providing the evidence to develop specific recommendations on prescribing ASRTs for insomnia disorder.

Effect of Soy Isoflavones Supplementation on Adiponectin Levels in Postmenopausal Women

Decreased adiponectin levels has been demonstrated in postmenopausal (PMP) women. Soy isoflavones, as an herbal product have been shown to increase adiponectin level but the results are inconclusive and inconsistent. The present study reassessed the data on the impact of soy isoflavones supplementation on adiponectin levels in PMP women through a meta-analysis. A systematic search was performed in the databases of PubMed, Web of science, Scopus and the Cochrane library. The literature search identified 830 studies with duplicates. Out of those, 80 were screened for title and abstract and 12 articles were ultimately selected for the analysis. Meta-regression and subgroup analyses, based on the moderator variables such as treatment duration, dose of soy isoflavones and BMI were performed. The quality of the studies was evaluated using the Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach. The results revealed that soy isoflavones supplementation significantly increased the circulating level of adiponectin in PMP women (SMD: 0.36 µg/mL; 95% CI (0.05 to 0.66); P= 0.02). No publication bias was observed using Begg's (P = 0.38) and Egger's (P = 0.07) tests. Sensitivity analysis indicated the results were completely powerful and stable. Moreover, Meta-regression and subgroup analyses indicated a significant increase of adiponectin levels in subgroups of dose > 50 mg and treatment duration less or equal 3 months. Our findings showed significantly increase in adiponectin levels after isoflavones-supplemented soy consumption in postmenopausal women, who received dose > 50 mg of soy isoflavones in treatment duration ≤ 3 months.

Heterogeneity of Indonesian primary school students’ mathematical critical thinking skills through problem-based learning: A meta-analysis

The synthesis of some empirical researches revealed that the implementation of problem-based learning (PBL) has a heterogeneous effect size on the mathematical critical thinking skills (MCTS) of primary school students in Indonesia. However, it seems that no researches were investigating the causative factors of the heterogeneity of primary students’ MCTS through PBL. Therefore, this meta-analysis research was employed to examine three potential factors that were PBL class capacity, PBL treatment duration, and mathematics topic predicted as the causative factors of the heterogeneity of primary students’ MCTS. The Q Cochrane test by using the Comprehensive Meta-Analysis (CMA) application was used to examine these potential factors. The synthesis of ten primary studies published in 2015 – 2020 and indexed by Scopus, Google Scholar, Sinta, and Web of Science, showed that PBL treatment duration and mathematics topic were the significant factors causing the heterogeneity of primary students’ MCTS. However, PBL class capacity was not a significant factor causing the heterogeneity of primary students’ MCTS. Thus, primary school mathematics teachers should consider PBL treatment duration established and mathematics topics selected in cultivating primary students’ MCTS by implementing PBL.

Using Ear Molding to Treat Congenital Auricular Deformities

Objective: To explore the utility of ear molding in the treatment of congenital auricular deformations.Study Design: A retrospective chart/photograph review of a consecutive series of infants treated with the EarWell System from 2017 to 2020 was performed. Data on type of auricular deformity, treatment side, and auricular length and width were collected weekly for all study participants.Result: A total of 173 patients (274 ears) with congenital auricular anomalies were included. The treatment duration for lop ears and Stahl's ears was shorter than for other deformations. The mean treatment EarWell duration of participants who started ear molding within 14 days of birth was shorter than that of those who started treatment more than 14 days after birth with the same ear deformation. For participants with unilateral ear deformities, the length and width of both the affected and healthy ears increased over the course of treatment, equalizing after 3 weeks. For participants with bilateral ear deformities, the length and width of both ears increased rapidly over the first 3 weeks of treatment, and the length and width of both ears gradually equalized after treatment.Conclusion: Ear molding is an important intervention for treating congenital auricular deformations, and can increase auricular length and width. Early identification and initiation of treatment is crucial in the management of congenital auricular deformation.

Patients Satisfaction with the Methods of Treatment used for Gallstones: A Cross-sectional Study

Background: If gallstones are not causing discomfort, there is usually no need to treat them. Many people with gallstones do not experience any symptoms for a long time. In addition, any treatment can have side effects, and operations are always associated with a certain level of risk. Gallbladder stones are treated differently than stones in the bile duct. If symptoms such as cramp-like pain (colic) occur, they can be relieved with medication. Such pain can only be prevented permanently by removing the gallbladder. An operation is also an option for people without symptoms but with very large gallstones - or with a porcelain gallbladder. The wall of the gallbladder is calcified and there is an increased risk of gallbladder cancer. Methods: This was an analytical cross-sectional study to spotlight the satisfaction levels of the Saudi Population towards the different treatment options for gallstones. The study was carried out at universities, hospitals, and malls in KSA. Data were collected from patients and the general population during a period from June to October 2021. Results: Most of the patients were highly satisfied with the treatment clarification done by the treating doctor (n= 42, 8.8%), the treatment choice for gallstones, the complications that occurred during their treatment period (n= 34, 7.1%), their condition after the end of the treatment period (n= 41, 8.6%), and the treatment method for condition (n=35, 7.3%). On the other hand, there was a proportion of participants who were not satisfied with the treatment duration (n= 39, 8.1%) and the follow-up after the end of the treatment period (n= 46, 9.6%). Conclusion: Participants are highly satisfied with treatment choice and treatment effectiveness. However, they were not satisfied with treatment duration and treatment complications.