Retrospective Analysis of 170 Patients Followed up with Herpes Zoster and Postherpetic Neuralgia in Nothern Cyprus

Herpes zoster is viral infection that occurs with reactivation of the varicella-zoster virus (VZV). It is usually a painful but self-limited dermatomal rash with cutaneous distribution. Although it's usually a painful, self-limiting rash, it can be much more serious; In addition, acute cases often lead to postherpetic neuralgia (PHN) and seriously impair quality of life. It is important to recognize those at risk of developing postherpetic neuralgia, early treatment and prevent complications. Objectives :Our aim is to determine the clinical features of our herpes zoster diseases and to review the treatments in patients with postherpetic neuralgia. Methods: A search for HZ and PHN was conducted in a general practice research database, comprising 2 general practices( dermatologist and physatrist) and representing 5600 people. We analyzed a retrospective 170 case series of pediatirc and adults addmited to the dermatology and physical therapy and rehabilitation outpatient clinic between October 2018 and October 2020. Results: A total of 170 new cases had been diagnosed with HZ in the dermatology and physical therapy and rehabilitation clinics over 2 years . Female to male ratio was 2:1 and the age ranged from 5 years to 88 years. The thoracic dermatomes were the most commonly involved. The risk of developing PHN 1 month after the start of the zoster rash was 21 %. Independent risk indicators for the occurrence of PHN were age [55–74] years. Conclusion : The risk of developing PHN increases with age and with commorbitity. Preventive strategies such as vaccination should focus on patients with herpes zoster aged >55 years.

Use of the Bacterial Lysate OM-85 in the Paediatric Population in Italy: A Retrospective Cohort Study

Background: In Italy, the bacterial lysate OM-85 (Broncho-Vaxom®, Broncho-Munal®, Ommunal®, Paxoral®, Vaxoral®) is registered for the prophylaxis of recurrent respiratory tract infections (RTIs) in adults and children above one year of age, but there are limited data on its use in the paediatric population. We aim to estimate the impact of OM-85 treatment on RTIs and antibiotic prescriptions in children. Methods: This study included children aged 1 to 14 years enrolled in Pedianet, a paediatric general practice research database, from January 2007 to June 2017, having at least one prescription of OM-85. Children with less than 12 months of follow-up before (PRE period) and after (POST period) the OM-85 prescription were excluded. The frequency of antibiotic prescriptions and the frequency of RTI episodes in the PRE and POST periods were compared through the post-hoc test. Subgroup analysis was performed in children with recurrent RTIs. Results: 1091 children received 1382 OM-85 prescriptions for a total follow-up of 619,525.5 person-years. Overall, antibiotic prescriptions decreased from a mean of 2.8 (SD (standard deviation) 2.7) prescriptions in the PRE period to a mean of 2.2 (SD 2.6) prescriptions in the POST period (p < 0.0001). RTIs decreased from a mean of 3.4 (SD 2.9) episodes in the PRE period to a mean of 2.5 (SD 2.6) episodes in the POST period (p < 0.0001). No change in antibiotic class was noted, and co-amoxiclav remained the preferred therapy in 28% of cases, followed by amoxicillin. These results were confirmed among children with recurrent RTIs. Conclusions: OM-85 is effective in preventing both antibiotic prescriptions and RTIs in children.

Real-world effect of antidepressants for depressive disorder in primary care: protocol of a population-based cohort study

IntroductionClinical guidelines recommend antidepressants as the first line of treatment for adults with moderate-to-severe depression. Randomised trials provide the best evidence on the comparative effectiveness of antidepressants for depression, but are limited by a short follow-up and a highly selected population. We aim to conduct a cohort study on a large database to assess acceptability, efficacy, safety and tolerability of antidepressant monotherapy in people with depressive disorder in primary care.Methods and analysisThis is a protocol for a cohort study using data from the QResearch primary care research database, which is the largest general practice research database in the UK. We will include patients registered for at least 1 year from 1 January 1998, diagnosed with a new episode of depression and on antidepressant and a comparison group not on antidepressant. The exposure of interest will be treatment with antidepressant medications. Our outcomes will be acceptability (treatment discontinuation due to any cause), efficacy (clinical response and remission); safety (adverse events (AEs) and all-cause mortality); and tolerability (dropouts due to any AE) measured at 2 months, 6 months and 1 year. For each outcome, we will estimate the absolute risks for all antidepressants, and relative effects between antidepressants using Cox’s proportion hazards models. We will calculate HRs and 99.9% CIs for each outcome of interest.DiscussionThe main limitation is the observational nature of our study, while the major strengths include the large representative population contained in QResearch and the possibly high generalisability.

Is uncertain vulvovaginal candidiasis a marker of vulvodynia? A study in a Dutch general practice research database

BackgroundA recent Dutch study in general practice showed a clear relationship between the diagnosis of vulvovaginal candidiasis (VVC) and symptoms suggestive of provoked vulvodynia (PVD). PVD accounts for the largest group of vulvar pains, but is often not recognised by GPs.AimTo investigate whether diagnostic uncertainty about VVC in general practice could also point to the diagnosis of PVD, and whether and how this diagnostic uncertainty affects management.Design & settingAn observational study in 2014 in Dutch general practices of the NIVEL Primary Care Database.MethodWomen with an uncertain diagnosis of VVC were distinguished from those with certain VVC based on the occurrence of recurrent episodes and persisting complaints, despite treatment. Factors known to be associated with PVD were hypothesised to be more prevalent in women with uncertain VVC. Data on symptom management by GPs were collected.ResultsIn total 7066 women with VVC or uncertain VVC were included. Uncertain VVC was found to account for 28% of these patients. Compared to VVC, the group uncertain VVC included significantly more women with female genital symptoms, tiredness, irritable bowel syndrome (all P<0.001), feeling anxious, reduced sexual desire, depressive disorder, relationship problems, and micturition symptoms (all P<0.05). Compared to VVC, the group uncertain VVC included significantly higher mean numbers of telephone consultations (P<0.001), more referrals to gynaecology (P = 0.009), and higher mean numbers of prescriptions per patient (P<0.001).ConclusionThis study's findings indicate that uncertain VVC could be a marker of PVD. GPs might reconsider their diagnostics and management when women present recurrent and persistent vulvovaginal complaints, especially if accompanied by dyspareunia, functional syndromes, micturition symptoms, and psychological conditions.

Subclinical hypothyroidism: Should we treat?

Subclinical hypothyroidism (also known as compensated hypothyroidism or mild hypothyroidism) is a condition associated with a raised serum concentration of thyroid stimulating hormone (TSH) but a normal serum free thyroxine (FT4). It is common, affecting about 10% of women above the age of 55 years. Autoimmunity is the commonest cause of subclinical hypothyroidism. About 2.5% of patients with subclinical hypothyroidism progress to clinically overt hypothyroidism each year; the rate of progression is higher in patients with thyroid autoantibodies and higher thyroid stimulating hormone levels. However, thyroid function normalises spontaneously in up to 40% cases. Only a small minority of patients with subclinical hypothyroidism have symptoms, and the evidence to support that levothyroxine ameliorate the symptoms in these patients is weak. Subclinical hypothyroidism in younger patients (<65 years) is associated with an increased risk of coronary heart disease, heart failure and cerebrovascular disease. The risk increases with increasing levels of thyroid stimulating hormone, and is particularly high in patients with TSH levels ≥10.0 mu/L. There is lack of evidence from randomised controlled trials as to whether levothyroxine treatment can prevent these risks, although a large observational study of the UK general practice research database has shown that levothyroxine may reduce the risk of coronary heart disease in younger patients (<70 years). Therefore, the decision whether to treat or not to treat subclinical hypothyroidism should be made after careful consideration of the patient’s age, the presence of symptoms, the presence of thyroid antibodies and other risk factors such as cardiovascular disease.

Data Integration Framework

This paper presents a proposal for a data integration framework. The purpose of the framework is to locate automatically records of participants from the ALSPAC database (Avon Longitudinal Study of Parents and Children) within its counterpart GPRD database (General Practice Research Database). The ALSPAC database is a collection of data from children and parents from before birth to late puberty. This collection contains several variables of interest for clinical researchers but we concentrate in asthma as a golden standard for evaluation of asthma has been made by a clinical researcher. The main component of the framework is a module called Mapper which locates similar records and performs record linkage. The mapper contains a library of similarity measures such Jaccard, Jaro-Winkler, Monge-Elkan, MatchScore, Levenstein and TFIDF similarity. Finally, the author evaluates the approach on quality of the mappings.