Per protocol analysis of therapeutic efficacy of chloroquine for the treatment of Plasmodium vivax malaria in children

2016-06-23T06-02-08Z
Source: International Journal of Contemporary Pediatrics
Leeha Singh, Surbhi Rathi, Santosh Kondekar, Alpana Kondekar, Swapnaja Dongare.
Background: High incidence of chloroquine-resistant vivax malaria has led to increasing case fatality and incidence of complicated malaria with Plasmodium vivax contributing to morbidity and mortality. Current guidelines recommend the use of chloroquine along with tissue schizontcides like primaquine for the treatment of Plasmodium vivax malaria. There were reports of increasing resistance to chloroquine in Plasmodium vivax species especially from Asia during the period when this study was taken up. Methods: Present study is a one arm, 28 day follow up, hospital based prospective observational study including 150 children aged 1 to 12 years with smear positive isolated Plasmodium vivax infections. Chloroquine was administered at the standard dose of 25 mg base/kg body weight over three days. Recurrence of parasitaemia and clinical conditions of patients were assessed on days 1, 2, 3, 7, 14, and 28 during the 28-day follow-up period. Results: All 150 children included in the study, completed their 28 day follow up. Mean age for enrolment was 5.96±2.38 years. The mean parasite index (%) on enrolment was 1.22±0.46. Based on the per protocol analysis, chloroquine efficacy (adequate clinical and parasitological response) was 92.7%. Treatment was well tolerated. Early treatment failure was seen in 2.7% of study population, late clinical failure in 2% and late parasitological failure in 2.7% of study population, suggesting that response to chloroquine was good in the study population. Conclusions: In the present study the chloroquine therapy showed high therapeutic efficacy (92.7%) in the treatment of uncomplicated vivax malaria. It was also well tolerated and equally safe when used in therapeutic doses. Regular monitoring of the pattern of resistance to chloroquine is needed in vivax malaria endemic areas of the country and measures are taken rapidly and effectively to control spread of resistance.


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A 5-year retrospective analysis of patients with primary vesicoureteral reflux undergoing open surgery; an assessment of 60 patients

2016-06-23T05-59-45Z
Source: Medicine Science | International Medical Journal
Mehmet Nuri Cevizci, Soner Sertan Kara, Alev Cansu Ayan, Abdlkadir Kaya, Hediye Cevizci.
Vesicoureteral reflux (VUR) describes the backward flow of urine from the bladder to the ureter and/or kidney. In this study, 60 patients below 18 years of age diagnosed with primary VUR in our clinic between 2010 and 2014 and undergoingureteroneocystotomy using various open surgery techniques were evaluated retrospectively. Diagnosis of VUR was based on voiding cystourethrography (VCUG). Urinary system ultrasonography (USG) was performed to exclude possible additional pathologies and to monitor the clinical course. Static renal scintigraphy (DMSA) was performed to determine preoperative renal scars and loss of function. Severity of reflux was divided into 5 degrees (1-5) following the criteria set out by the International Reflux Study Group. Patients were divided into 3 groups, mild (grade 1-2), moderate (grade 3) or severe (4-5) VUR. Females constituted 71.7% of the patients (n=43). Mean age at time of diagnosis of VUR was 6.25 years and mean age at time of surgery was 6.36 years. Fifteen percent of VURs were on the right side (n=9), 31.7% were on the left side (n=19) and 53.3% were bilateral (n=32). Advanced grade VUR (grade 4-5) was determined in 68.3% of patients. Loss of function was observed in 27.7% (n=16) of patients undergoing DMSA, and scar and loss of function were determined in 46.7% (n=28). The most common pathogen grown in preoperative urine cultures was Escherichia coli (65%). No significant difference was observed between the VUR grades in terms of age at time of diagnosis or age at time of surgery (p=0.682 and p=0.673, respectively). No statistically significant correlation was also determined between gender and VUR grade (p=0.859). No patient required a second surgical procedure. At postoperative follow-up, hypertension was observed in two patients, and these received antihypertensive therapy. Hypertension was observed over the long-term in one patient and was controlled with antihypertensive therapy. In conclusion, a high level of loss of renal function and scars was determined, in parallel with greater age at time of diagnosis of VUR and at time of surgery, in our region.


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Follicular Variant of Papillary Thyroid Carcinoma: Hybrid or Mixture?

Follicular Variant of Papillary Thyroid Carcinoma: Hybrid or Mixture?:



Thyroid , Vol. 0, No. 0.

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Surgeon volume in thyroid surgery: Surgical efficiency, outcomes, and utilization

Surgeon volume in thyroid surgery: Surgical efficiency, outcomes, and utilization:

Objectives/Hypothesis

To test our hypothesis that high-surgeon volume is associated with improved surgical efficiency and 30-day outcomes, and lower hospital utilization.

Study Design

Retrospective observational cohort, 2008–2013.

Methods

A total of 3,135 patients with hemithyroidectomy or total thyroidectomy performed by a high-volume surgeon, propensity score-matched to 3,135 patients with the same procedure performed by a low-volume surgeon. All-cause 30-day complication, mortality, readmission, and emergency department visit rates, proportion of outpatient procedures, cut-to-close time, and length of stay were assessed.

Results

Hemithyroidectomies: Compared to low-volume surgeons, high-volume surgeons had fewer readmitted patients (2.7% vs. 7.0%, P < .05), more outpatient procedures (46% vs. 29%, P < .05), and shorter lengths of stay (mean [standard deviation] 16.6 [22.1] vs. 21.7 [27.5] hours, P < .05) and surgical (cut-to-close) times (1.7 [0.7] vs. 2.0 [1.1] hours, P < .05). Total thyroidectomies: High-volume surgeons had lower rates of all surgery-related complications (5.7% vs. 7.5%, P < .05), hypocalcemia (4.9% vs. 7.0%, P < .05), surgical site infections (0.3% vs. 1.0%, P < .05), more outpatient procedures (13% vs. 3%, P < .05), shorter lengths of stay (29.9 [32.8] vs. 39.8 [36.2] hours, P < .05), and cut-to-close times (2.4 [1.1] vs. 3.0 [1.7] hours, P < .05).

Conclusion

High-volume surgeons improve patient safety and have the potential to contribute to organizational efficiency that may be underutilized in some settings.

Level of Evidence

4. Laryngoscope, 2016

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Perceptual analysis of the male-to-female transgender voice after glottoplasty—the telephone test

Perceptual analysis of the male-to-female transgender voice after glottoplasty—the telephone test:

Objectives/Hypothesis

The aim of this investigation was to quantify gender perception in telephone communication as a situation of everyday life.

Study Design

Matched control study.

Methods

Speech samples were recorded of 18 male to female (MtF) after Wendler's glottoplasty, 18 male, and 18 female persons. After adaption of the frequency to the limited frequency transmission on the telephone (300–3,400 Hz), the speech samples were judged by 50 male and 50 female listeners. Parameters were the decision "male" or "female" and the decision time. The formant frequencies F1 to F3 for the vowel /a/ were extracted and compared between the speaker groups.

Results

There were 7/18 MtF perceived as female by the majority of listeners. A correlation between fundamental frequency and perceptions as female could be shown. The decision time needed was longer for MtF than for male or female speakers. Female listeners decided significantly faster than male listeners. Female listeners perceived the MtF more often as male speaker. For the MtF, the perception as female correlated with their individual voice satisfaction. Comparing the formant frequencies of male and MtF speakers, F2 was higher for MtF. Regarding female and MtF speakers, F1 and F2 were significantly lower for MtF speakers.

Conclusions

Using the telephone test, MtF individuals misperceived as male can be identified even if they reached a vocal pitch in the female frequency range. The strong correlation of the perceptions as female in the telephone test and the personal satisfaction shows the power of this instrument for evaluation of therapy success. It should be utilized to compare different techniques of gender voice surgery.

Level of Evidence

NA Laryngoscope, 2016

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The microbiome of otitis media with effusion

The microbiome of otitis media with effusion:

Objectives/Hypothesis

The adenoid pad has been considered a reservoir for bacteria in the pathogenesis of otitis media with effusion. This study aimed to characterize the middle ear microbiota in children with otitis media with effusion and establish whether a correlation exists between the middle ear and adenoid microbiota.

Study Design

Prospective, controlled study.

Methods

Middle ear aspirates adenoid pad swabs were collected from 23 children undergoing ventilation tube insertion. Adenoid swabs from patients without ear disease were controls. Samples were analyzed using 16S rRNA sequencing on the Illumina MiSeq platform.

Results

Thirty-five middle ear samples were collected. The middle ear effusion microbiota was dominated by Alloiococcus otitidis (23% mean relative abundance), Haemophilus (22%), Moraxella (5%), and Streptococcus (5%). Alloiococcus shared an inverse correlation with Haemophilus (P = .049) and was found in greater relative abundance in unilateral effusion (P = .004). The microbiota of bilateral effusions from the same patient were similar (P < .001). However, the otitis media with effusion microbiota were found to be dissimilar to that of the adenoid (P = .01), whereas the adenoid microbiota of otitis media with effusion and control patients were similar (P > .05) (permutational multivariate analysis of the variance).

Conclusions

Dissimilarities between the local microbiota of the adenoid and the middle ear question the theory that the adenoid pad is a significant reservoir to the middle ear in children with otitis media with effusion. A otitidis had the greatest cumulative relative abundance, particularly in unilateral effusions, and shares an inverse correlation with the relative abundance of Haemophilus.

Level of Evidence

NA Laryngoscope, 2016

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Palliative head and neck radiotherapy with the RTOG 8502 regimen for incurable primary or metastatic cancers.

Authors: Lok BH, Jiang G, Gutiontov S, Lanning RM, Sridhara S, Sherman EJ, Tsai CJ, McBride SM, Riaz N, Lee NY

Abstract

OBJECTIVES: To report on our institutional experience of palliative radiotherapy (RT) of cancers in the head and neck by the RTOG 8502 'QUAD SHOT' regimen.

METHODS: Seventy-five patients completed at least 1 cycle of palliative RT to the head and neck for primary or metastatic disease based on the RTOG 8502 regimen (3.7 Gy twice daily over 2 consecutive days at 4 week intervals per cycle) between 2/2005 and 7/2014.

RESULTS: Median patient age was 76 years (range 23-97). The most common histologies were squamous cell carcinoma (55%), non-anaplastic thyroid carcinoma (10%) and salivary gland carcinoma (9%). Thirty patients (40%) received prior RT at the palliative site. Twenty-eight patients (37%) completed at least three RTOG 8502 cycles. Sixty-five percent of all patients had a palliative response. Median overall survival was 5.67 months (range, 0.20-34.5). Grade 3 toxicity in 4 patients (5%) consisted of acute dermatitis and functional mucositis. Palliative response was significantly correlated with increasing number of RTOG 8502 cycles (p = 0.012), but not KPS, prior RT, palliative chemotherapy, prior surgery, histology or stage. On survival analysis, palliative response (p < 0.001), KPS ⩾ 70 (p = 0.001), and greater number of RTOG 8502 cycles (p = 0.022) remained independent predictors of improved survival.

CONCLUSIONS: For patients with incurable malignant disease in the head and neck, the palliative RTOG 8502 'QUAD SHOT' regimen provides excellent rates of palliative response with minimal associated toxicity. Patients who are able to complete greater number of RT cycles have higher rates of palliative response and overall survival.

PMID: 26282714 [PubMed - indexed for MEDLINE]

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