Active Pharmacovigilance for Primaquine Radical Cure of Plasmodium vivax Malaria in Odisha, India

Plasmodium vivax malaria elimination requires radical cure with chloroquine/primaquine. However, primaquine causes hemolysis in glucose-6-phosphate dehydrogenase-deficient (G6PDd) individuals. Between February 2016 and July 2017 in Odisha State, India, a prospective, observational, active pharmacovigilance study assessed the hematologic safety of directly observed 25 mg/kg chloroquine over 3 days plus primaquine 0.25 mg/kg/day for 14 days in 100 P. vivax patients (≥ 1 year old) with hemoglobin (Hb) ≥ 7 g/dL. Pretreatment G6PDd screening was not done, but patients were advised on hemolysis signs and symptoms using a visual aid. For evaluable patients, the mean absolute change in Hb between day 0 and day 7 was −0.62 g/dL (95% confidence interval [CI]: −0.93, −0.31) for males (N = 53) versus −0.24 g/dL (95%CI: −0.59, 0.10) for females (N = 45; P = 0.034). Hemoglobin declines ≥ 3 g/dL occurred in 5/99 (5.1%) patients (three males, two females); none had concurrent clinical symptoms of hemolysis. Based on G6PD qualitative testing after study completion, three had a G6PD-normal phenotype, one female was confirmed by genotyping as G6PDd heterozygous, and one male had an unknown phenotype. A G6PDd prevalence survey was conducted between August 2017 and March 2018 in the same region using qualitative G6PD testing, confirmed by genotyping. G6PDd prevalence was 12.0% (14/117) in tribal versus 3.1% (16/509) in nontribal populations, with G6PD Orissa identified in 29/30 (96.7%) of G6PDd samples. Following chloroquine/primaquine, notable Hb declines were observed in this population that were not recognized by patients based on clinical signs and symptoms.

Birdshot retinochoroiditis in Brazil: a multicenter review of 40 patients

Background Birdshot retinochoroiditis (BRC) is a rare and chronic bilateral uveitis mostly found in Caucasians. As few data are available about the clinical course of BRC in Hispanic patients, we aimed to report the clinical findings and the evolution of BRC in Brazilian patients. Methods This retrospective cohort multicenter nationwide study was performed by analyzing the records of patients with BRC diagnoses from Brazilian ophthalmological centers from April 1995 to May 2020. Results Forty patients (80 eyes) with a diagnosis of BRC were evaluated. The mean age was 53 years, and there was no sex predominance. All tested patients (34/40) were positive for HLA-A29. The diagnosis of BRC was made following the Levinson et al. criteria, and all ancillary tests were performed to exclude differential diagnoses. Clinical signs and symptoms, such as complications and treatment, were described. Conclusions BRC evolution in Brazilian patients seems to have some peculiarities that diverge from the published literature available about Caucasians, as AS inflammation is higher in this population.

Conjunctivitis

Conjunctivitis represents an inflammation of conjunctiva with cellular infiltration, exudation, and vascular dilation. According to the course of the disease, conjunctivitis can be acute, hyperacute, and chronic. Morphologically, conjunctivitis can appear with papillary reaction, follicular reaction, cicatrizing, granulomatous and membranous changes. This chapter discusses all types of conjunctivitis, their clinical signs and symptoms, and basic approaches of treatment. This chapter includes before and after treatment photos of atypical inferiorly localized shield ulcer, Tularemia-associated Parinaud oculoglandular syndrome, and Stevens-Johnson disease. Pictures are included In the ligneous conjunctivitis patient's case taken at diagnosis as well as 10 years later, demonstrating stable condition with appropriate treatment throughout the period.

The Evolution of Peripheral Nerve Treatment for Trigeminal Neuralgia - Peripheral Injections

Trigeminal neuralgia presents as a characteristic severe painful condition that usually afflicts the area(s) innervated by the branches of the facial sensory nerves, especially the elderly females. The diagnosis can usually be made based solely on the presenting clinical signs and symptoms. Early literatures had revealed that there have always been two major means of treatment for trigeminal neuralgia; medical and surgical. Medical treatments involved systemic intake of various drugs or the topical applications of many different materials, not forgetting that bleeding and purging has been tried in the past. The introduction of anti-convulsants during the second World War had changed completely the way this painful condition was treated as this therapy later become the mainstay treatment for trigeminal neuralgia. Their beneficial effects, however may not be long lasting. This review summarises the evolution of peripheral nerve injection as a treatment for trigeminal neuralgia over the last 150 years.

Diagnosis of tuberculosis among COVID-19 suspected cases in Ghana

Background Tuberculosis (TB) and COVID-19 pandemics are both diseases of public health threat globally. Both diseases are caused by pathogens that infect mainly the respiratory system, and are involved in airborne transmission; they also share some clinical signs and symptoms. We, therefore, took advantage of collected sputum samples at the early stage of COVID-19 outbreak in Ghana to conduct differential diagnoses of long-standing endemic respiratory illness, particularly tuberculosis. Methodology Sputum samples collected through the enhanced national surveys from suspected COVID-19 patients and contact tracing cases were analyzed for TB. The sputum samples were processed using Cepheid’s GeneXpert MTB/RIF assay in pools of 4 samples to determine the presence of Mycobacterium tuberculosis complex. Positive pools were then decoupled and analyzed individually. Details of positive TB samples were forwarded to the NTP for appropriate case management. Results Seven-hundred and seventy-four sputum samples were analyzed for Mycobacterium tuberculosis in both suspected COVID-19 cases (679/774, 87.7%) and their contacts (95/774, 12.3%). A total of 111 (14.3%) were diagnosed with SARS CoV-2 infection and six (0.8%) out of the 774 individuals tested positive for pulmonary tuberculosis: five (83.3%) males and one female (16.7%). Drug susceptibility analysis identified 1 (16.7%) rifampicin-resistant tuberculosis case. Out of the six TB positive cases, 2 (33.3%) tested positive for COVID-19 indicating a coinfection. Stratifying by demography, three out of the six (50%) were from the Ayawaso West District. All positive cases received appropriate treatment at the respective sub-district according to the national guidelines. Conclusion Our findings highlight the need for differential diagnosis among COVID-19 suspected cases and regular active TB surveillance in TB endemic settings.

Musculoskeletal Manifestations in Sjogren’s Syndrome

Sjögren’s syndrome (SS) is a chronic, autoimmune, inflammatory disease characterized by lymphocytic infiltration, destruction and dysfunction of the exocrine glands. Sjögren’s syndrome can be described as primary or secondary, depending on whether it occurs alone or in association with other systemic autoimmune diseases. Systemic manifestations of SS involve the musculoskeletal system. SS can be seen in association with both joint and muscle manifestations, including arthralgia and arthritis, as well as myopathy, which is usually asymptomatic. Besides, it may include bone metabolic disorders, fatigue and fibromyalgia. The diagnosis of Sjögren’s syndrome is based on characteristic clinical signs and symptoms. The etiology and pathogenesis of SS is elusive and has not yet been clarified. There is no curative treatment for SS, thus the aim in the treatment of SS is to alleviate the symptoms.

COVID-19 in End-stage Renal Disease (ESRD) Patients Undergoing Hemodialysis: A Close Follow-up of Clinical Findings and Evolutions in Chest CT Imaging: A Retrospective Study

Background: Coronavirus disease 2019 (COVID-19) has infected millions and caused tens of thousands of casualties. Epidemiologic studies show that specific individuals with pre-existing conditions are prone to severe disease caused by the virus. Thus, it is necessary to determine clinical signs and symptoms and disease progression course in various pre-existing conditions, namely end-stage renal disease (ESRD) patients undergoing hemodialysis. Methods: The present retrospective study was conducted on 17 ESRD patients undergoing chronic hemodialysis. Clinical signs and symptoms were extracted, and laboratory test results and imaging findings were retrieved using the health information systems of the institute where the study was performed. Results: Of 17 patients in the study, six patients were females, and 11 were males. The mean age of the patients was 62.29 ± 15.6 years (22 - 82). The most common pre-existing conditions were hypertension and diabetes. The most common imaging signs were ground-glass opacities. The most common pattern of involvement was peripheral, bilateral, and multifocal involvement, and interestingly, uncommon imaging signs such as crazy-paving, peribronchovascular involvement, and reticulonodular pattern of involvement. The most common laboratory findings were lymphopenia, lymphocytosis, increased erythrocyte sedimentation rate, and positive C reactive protein. Conclusions: ESRD patients undergoing COVID-19 seem to have higher mortalities than the general public and show more significant lung involvement on chest CT imaging. Furthermore, uncommon imaging signs are more common in this group of patients.

Laboratory Examination in Hemophagocytic Lymphohistiocytosis

Hemophagocytic Lymphohistiocytosis (HLH) is derived from the word hemophagocytosis, in which macrophagesinfiltrate tissue extensively, and unspecifically phagocyte blood and bone marrow cells. The deviant activation of cytotoxicCD8+ T-cells causing the release of inflammatory cytokines is the core pathogenesis of HLH. Hemophagocyticlymphohistiocytosis is a regulatory disorder of the immune system, with clinical signs and symptoms of extremeinflammation and cytopenia, hepatitis, and severe and life-threatening central nervous system dysfunction. The name of theHLH disorder was recently proposed to be "Hyperinflammatory Lymphohistiocytosis" (also known as HLH). Enforcement ofHLH diagnosis by the Histiocyte Society based on HLH 2004 updated diagnostic criteria consists of five of the following eightdiagnostic criteria: fever, splenomegaly, cytopenia (two or more of three lineages in peripheral blood), hypertriglyceridemiaor hypofibrinogenemia, hyperferritinemia, hemophagocytes in the bone marrow/lien/lymph, the low or non-existentactivity of Natural Killer (NK) cells, increased sCD25. H-score, MH-score, and systemic Juvenile Idiopathic Arthritis(sJIA)/Macrophage Activated Syndrome (MAS) classification criteria are also used to enforce HLH diagnoses.Hemophagocytic lymphohistiocytosis is challenging to recognize and has a high mortality rate, especially in adults, rangingfrom 42 to 88%. Therefore, immediate diagnosis and therapy are essential. The introduction of HLH triggers is criticalbecause treatment is based on the underlying trigger. Cytokine storms due to Coronavirus Disease 19 (COVID-19) infectionhave significant similarities to the clinical and laboratory findings of HLH. Secondary HLH (sHLH) is suspected in severeCOVID-19 patients, so early diagnosis is potentially made based on the H-score.

Design and Evaluation of an Electronic Educational Multimedia Package for Patients with Pyelonephritis

Aim: Pyelonephritis is a subset of urinary tract infections that occurs by the ascent of bacteria from the lower urinary tract to the upper tract, such as kidneys. The purpose of this study is to create an introductory multimedia educational package for pyelonephritis. Method: The required information was retrieved from Medline (through PubMed), Web of sciences, Scopus, and Google Scholar databases by searching "Educational package" or "Training package" and "Pyelonephritis" keywords. In the next step, AutoPlay Media Studio software was selected to build an electronic educational multimedia package, considering the features of different Autoruns. In the usability evaluation stage, the isometric questionnaire 9241 part 10 was used. Four kidney and urinary tract specialists and eight experts in health information technology gave their views to us by completing the stated questionnaire. The results collected from the questionnaires were entered into SPSS-23 software for analysis using descriptive statistics. Results: The content of the educational multimedia package, i.e., the definition of pyelonephritis, types of pyelonephritis, the causes of pyelonephritis, the underlying factors, clinical signs and symptoms, and methods of diagnosis and treatment are presented on different pages of the electronic package, respectively. The results of this usability evaluation showed that the items; "after not using the system for a long time, it is easy for the user to re-learn how to use the system" and "the user can use the system properly without asking his/her colleagues for help" had the lowest mean value (4.2) and the item; "explanations provided help the user to use the system more skillfully" had the highest mean value (4.9). Conclusion: The use of educational multimedia packages by patients can improve awareness and affect public health. Our educational multimedia package is superior to traditional training due to easy access and not being limited to a specific time and place, increasing the quality of learning and awareness.

CONSERVATIVE MANAGEMENT OF ACUTE LUMBAR DISC HERNIATION WITH ASSOCIATED RADICULOPATHY: A STUDY

Objective: Acute disc herniation (DH) is a common cause of low back pain (LBP). It ranks fifth in the category of diseases in terms of cost of hospital care. It has higher indirect costs due to absenteeism from work and disability than any other disease. The present study was performed to assess the clinical outcomes of non-surgically treated LBP patients after 6 months of follow-up. Methods: The present study was prospective study which was performed on 450 lumbar radicular patients visiting the neurosurgery outpatient department having clinical signs and symptoms of acute lumbar DH of less than 3 month duration. Their diagnosis was confirmed by magnetic resonance imaging. The patients were treated conservatively during 6 months. Pain and disability were assessed by visual analog scale (VAS) and Oswestry disability questionnaire, respectively. Results: About 135 (30%) female and 315 (70%) male participated in the study. During the follow-up period, 27 (06%) patients (21 male and 6 female) showed poor response to conservative treatment and motor weakness and underwent surgical intervention. A significant improvement in the VAS Score was seen after 6 months of conservative treatment than initial evaluation of patients (3.12±1.84, 7.1±1.43, p=0.00). Furthermore, significant improvement in disability score of patients was seen in follow-up period (25.82±16.92, 53.66±17.66; p=0.00). Conclusion: Results of our study showed that conservative treatment in patients of acute lumbar DH have significant improvement in pain relief and disability without any notable side effect.