Therapeutic outcome of active management in male patients with detrusor underactivity based on clinical diagnosis and videourodynamic classification

Detrusor underactivity (DU) could be resulted from many different etiologies. Patients with DU might have reduced bladder sensation, low detrusor contractility, and large post-void residual volume. This study analyzed therapeutic outcome of active management for male DU patients, based on clinical and urodynamic characteristics. Male DU patients aged > 18 years old were retrospectively reviewed from the videourodynamic study (VUDS) records in recent 10 years. The patients’ demographics, VUDS results, treatment modalities, and treatment outcome were analyzed. The treatment outcomes were compared among patients with different DU subgroups, clinical diagnosis and treatment modalities. Patients with voiding efficiency of > 66.7% were considered having a successful treatment outcome. For comparison, 30 men with normal VUDS finding served as the control arm. Most of the DU patients had reduced bladder sensation. The reduced bladder sensation is closely associated with low detrusor contractility. After active treatment, a successful outcome was achieved in 68.4% of patients after bladder outlet surgery, 59.1% after urethral botulinum toxin A injection, and 57.6% after medical treatment, but only 18.2% after conservative treatment. A successful treatment outcome was achieved in patients with an intact detrusor contractility, either low (69.2%) or normal voiding pressure (81.8%), and in patients with a normal or increased bladder sensation (78.1%). However, patients with detrusor acontractile (41.3%) or absent bladder sensation (17.9%) had less favorable treatment outcome after any kind of urological management. This study revealed that active management can effectively improve voiding efficiency in patients with DU. The normal bladder sensation, presence of adequate detrusor contractility, and bladder outlet narrowing during VUDS provide effective treatment strategy for DU patients. Among all management, BOO surgery provides the best treatment outcome.

A Case of Nasal Cavity and Laryngeal Involvement of Rosai–Dorfman Disease

Rosai–Dorfman disease (RDD) is a rare non-malignant disorder, characterized by painless multiple cervical lymphadenopathy, fever, and elevated inflammatory markers. Its diagnosis is difficult due to its rare incidence and various clinical presentations, especially in extranodal involvement. In this report, we demonstrate a patient with RDD who presented with a nasal septum and laryngeal tumor that caused dyspnea. We achieved a successful treatment outcome with combined surgical resection of the laryngeal mass and corticosteroid medication. The symptoms and tumors were resolved within 3 weeks after treatment. We reported our experiences with review of literatures.

Former inpatients’ narratives of substance use four years after substance use disorder treatment: A qualitative follow-up study

Aim: The aim of this study was to explore the narratives of former substance use disorder (SUD) inpatients about substance use after their discharge from long-term SUD treatment in 2017. Method: We conducted semi-structured in-depth interviews with 11 former inpatients of SUD treatment. The data were analysed using a qualitative, thematic analysis model. Findings: During the analysis, two main themes emerged pertaining to participant reflections on substance use – their experience of non-problematic substance use (that is, substance use without declining into pre-treatment levels of misuse behaviours) and problematic substance use (that is, substance use associated with destructive patterns). All participants except one had engaged in substance use after their discharge three to four years ago. The commonly used substance was alcohol, which also appeared to be the most common substance for which there was consensus among the informants regarding non-problematic use. Conclusions: Most of the participants continued to use substances in some way, and some reported that such use did not affect them negatively. Healthcare providers and therapists in SUD treatment should avoid defining a relapse or failed treatment outcome in concrete terms. What is perceived as an actual relapse or a failed treatment outcome is highly subjective. Furthermore, complete sobriety might not necessarily be the best or the only way to measure the SUD treatment stay. An improvement in the quality of life and well-being, even when core symptoms are still present, may be considered a successful treatment outcome.

Differential growth rates and in vitro drug susceptibility to currently used drugs for multiple isolates of Naegleria fowleri

The free-living amoeba, Naegleria fowleri, which typically dwells within warm, freshwater environments, can opportunistically cause Primary Amoebic Meningoencephalitis (PAM), a disease with a mortality rate of >98%, even with the administration of the best available drug regimens. The lack of positive outcomes for PAM has prompted a push for the discovery and development of more effective therapeutics, but most studies only utilize one or two clinical isolates in their drug discovery assays. The inability to assess possible heterogenic responses to drugs among isolates from varying geographical regions hinders progress in the field due to a lack of proven universal efficacy for novel therapeutics. Herein we conducted drug efficacy and growth rate determinations for 11 different clinical isolates, including one obtained from a successful treatment outcome, by applying a previously developed CellTiter-Glo 2.0 screening technique and flow cytometry. We found some significant differences in the susceptibility of these isolates to 7 of 8 different drugs tested, all of which comprise the cocktail that is recommended to physicians by the Centers for Disease Control. We also discovered significant variances in growth rates among isolates which draws attention to the dissidence among the amoebae populations collected from different patients. The findings of this study reiterate the need for inclusion of additional clinical isolates of varying genotypes in drug assays and highlight the necessity for more targeted therapeutics with universal efficacy across N. fowleri isolates. Our data establishes a needed baseline for drug susceptibility among clinical isolates and provides a segue for future combination therapy studies as well as research related to phenotypic or genetic differences that could shed light on mechanisms of action or predispositions to specific drugs.

Treatment Outcomes and Associated Factors in Tuberculosis Patients at Atwima Nwabiagya District, Ashanti Region, Ghana: A Ten-Year Retrospective Study

Introduction. Tuberculosis poses a great threat to public health around the globe and affects persons mostly in their productive age, notwithstanding; everyone is susceptible to tuberculosis (TB) infection. To assess the effectiveness and performance of the tuberculosis control program activities, the percentage of cases with treatment success outcome is key. To control tuberculosis, interrupting transmission through effective treatment cannot be overemphasized. The study was conducted to determine factors associated with TB treatment outcome, in the Atwima Nwabiagya District from 2007–2017. Method. A Retrospective review of routine/standard TB registers was carried out in five directly observed therapy short-course (DOTS) centres at the Atwima Nwabiagya District from January 2007 to December 2017. Demographic characteristics, clinical characteristics, and treatment outcomes were assessed. Bivariate and multivariate logistic regression was conducted to determine the predictors of successful treatment outcome. Results. Of the 891 TB client’s data that was assessed in the district, the treatment success rate was 68.46%. Patients, aged ≤ 20 years (adjusted odds ratio aOR = 4.74 , 95 % CI = 1.75 − 12.83 ) and 51-60 years ( aOR = 1.94 , 95 % CI = 1.12 − 3.39 ), having a pretreatment weight of 35-45 kg ( aOR = 2.54 , 95 % CI = 1.32 − 4.87 ), 46-55 kg ( aOR = 2.75 , 95 % CI = 1.44 − 5.27 ) and 56-65 kg ( aOR = 3.04 , 95 % CI = 1.50 − 6.14 ) were associated with treatment success. However, retreatment patients ( aOR = 0.31 , 95 % CI = 0.11 − 0.84 ) resulted in unsuccessful treatment outcome. Conclusion. Successful treatment outcome among TB patients was about 20.00% and 30.00% lower compared to the national average treatment success rate and WHO target, respectively. Active monitoring, motivation, and counselling of retreatment patients and patients with advanced age are key to treatment success.

Epidemiology of HIV-negative Rifampicin Resistance /Multidrug-Resistant Extrapulmonary Tuberculosis: 5 Years-experience From a National Tuberculosis Clinical Research Center in China

Background: China is a region with a high global burden of Rifampicin Resistance ／Multidrug-Resistant tuberculosis (RR/MDR-TB) and low HIV incidence. Our aim was to assess the epidemiological and clinical characteristics of RR/MDR-extrapulmonary tuberculosis (EPTB) over the past five years in China to inform national TB control programmes.Methods: We investigated the epidemiological and clinical datas of all MDR/RR-EPTB cases in a TB specialized hospitals in China over a five-year period and compared cases with a cohort of MDR/RR-PTB patients over the same period.Results: Of the 1,700 RR/MDR-TB patients enrolled, 17.76% were EPTB. The incidence of RR／MDR-EPTB were increasing.The most common anatomical site was pleura/chest wall (20.20%). Compared with RR／MDR-Pulmonary tuberculosis (PTB），RR/MDR-EPTB were were predominately female (50.66%, P< 0.01) 、more prone to delay (P<0.01) in RR/ MDR-EPTB detection with the median time of 145（14 ,341）days since first visit、more less likely to develop diabetes (22.85 %, P<0.01) 、more likely to be newly diagnosed ( 56.95%, P<0.01) 、lower successful treatment outcome（69.56%，p <0.01）、more dependent on Xpert (93.71%) for resistance detection、lower culture positive rate (56.95% , P< 0.01). RR/ MDR-EPTB also showed a significantly higher rate of pre-XDR/XDR (32.45%, P <0.01) . Conclusion: RR/MDR-EPTB is different from RR-MDR/PTB in both epidemiology and clinical. Clinicians should recommend Xpert in early stage and use fluoroquinolones cautiously in cases suspected TB.

Spatiotemporal Patterns of Tuberculosis in Hunan Province, China

Tuberculosis (TB) is the leading cause of death from a bacterial pathogen worldwide. China has the third highest TB burden in the world, with a high reported burden in Hunan Province (amongst others). This study aimed to investigate the spatial distribution of TB and identify socioeconomic, demographic, and environmental drivers in Hunan Province, China. Numbers of reported cases of TB were obtained from the Tuberculosis Control Institute of Hunan Province, China. A wide range of covariates were collected from different sources, including from the Worldclim database, and the Hunan Bureau of Statistics. These variables were summarized at the county level and linked with TB notification data. Spatial clustering of TB was explored using Moran’s I statistic and the Getis–Ord statistic. Poisson regression models were developed with a conditional autoregressive (CAR) prior structure, and with posterior parameters estimated using a Bayesian approach with Markov chain Monte Carlo (MCMC) simulation. A total of 323,340 TB cases were reported to the Hunan TB Control Institute from 2013 to 2018. The mean age of patients was 51.7 years (SD + 17.6 years). The majority of the patients were male (72.6%, n = 234,682) and had pulmonary TB (97.5%, n = 315,350). Of 319,825 TB patients with registered treatment outcomes, 306,107 (95.7%) patients had a successful treatment outcome. The annual incidence of TB decreased over time from 85.5 per 100,000 population in 2013 to 76.9 per 100,000 population in 2018. TB case numbers have shown seasonal variation, with the highest number of cases reported during the end of spring and the beginning of summer. Spatial clustering of TB incidence was observed at the county level, with hotspot areas detected in the west part of Hunan Province. The spatial clustering of TB incidence was significantly associated with low sunshine exposure (RR: 0.86; 95% CrI: 0.74, 0.96) and a low prevalence of contraceptive use (RR: 0.88; 95% CrI: 0.79, 0.98). Substantial spatial clustering and seasonality of TB incidence were observed in Hunan Province, with spatial patterns associated with environmental and health care factors. This research suggests that interventions could be more efficiently targeted at locations and times of the year with the highest transmission risk.

Patient- and provider-related factors in the success of multidrug-resistant tuberculosis treatment in Colombia

Objective. To identify patient- and provider-related factors associated with the success of multidrug-resistant tuberculosis (MDR-TB) treatment in the six municipalities of Colombia with the highest number of MDR-TB cases. Methods. Bivariate and multivariate logistic regressions were used to analyze the association between treatment success (cure or treatment completion) and characteristics of the patients and physicians, nursing professionals, and psychologists involved in their treatment. The importance of knowledge in the management of MDR-TB cases was explored through focus groups with these providers. Results. Of 128 cases of TB-MDR, 63 (49.2%) experienced treatment success. Only 52.9% of the physicians and nursing professionals had satisfactory knowledge about MDR-TB. Logistic regression showed that being HIV negative, being affiliated with the contributory health insurance scheme, being cared for by a male physician, and being cared for by nursing professionals with sufficient knowledge were associated with a successful treatment outcome (p ≤ 0.05). Qualitative analysis showed the need for in-depth, systematic training of health personnel who care for patients with MDR-TB. Conclusion. Some characteristics of patients and healthcare providers influence treatment success in MDR-TB cases. Physicians’ and nurses’ knowledge about MDR-TB must be improved, and follow-up of MDR-TB patients who are living with HIV and of those affiliated with the subsidized health insurance scheme in Colombia must be strengthened, as these patients have a lower likelihood of a successful treatment outcome.

Carbon Based Nanodots in Early Diagnosis of Cancer

Detection of cancer at an early stage is one of the principal factors associated with successful treatment outcome. However, current diagnostic methods are not capable of making sensitive and robust cancer diagnosis. Nanotechnology based products exhibit unique physical, optical and electrical properties that can be useful in diagnosis. These nanotech-enabled diagnostic representatives have proved to be generally more capable and consistent; as they selectively accumulated in the tumor site due to their miniscule size. This article rotates around the conventional imaging techniques, the use of carbon based nanodots viz Carbon Quantum Dots (CQDs), Graphene Quantum Dots (GQDs), Nanodiamonds, Fullerene, and Carbon Nanotubes that have been synthesized in recent years, along with the discovery of a wide range of biomarkers to identify cancer at early stage. Early detection of cancer using nanoconstructs is anticipated to be a distinct reality in the coming years.

437 Efficacy of a novel oral appliance and the influence of OSA pathophysiological traits on treatment response

Introduction Oral appliance therapy is a recommended alternative to CPAP for OSA. Approximately 50% of patients have a major reduction in OSA severity but successful treatment outcome remains challenging to predict. Previous prediction methods have focused on clinical variables which have poor predictive value. OSA is recognised as a heterogenous disorder caused by 4 pathophysiological traits. The influence of OSA pathophysiological traits on oral appliance treatment outcome has been explored in recent physiological studies using simplified phenotyping methods. In this preliminary report, we prospectively compared differences in the 4 OSA phenotypes between responders and incomplete responders to a novel oral appliance with built in oral airway using gold standard phenotyping methodology. Methods Data from 22 people with OSA (AHI&gt;10events/h) have been analysed to date. A diagnostic in-laboratory PSG was initially conducted to confirm OSA. A detailed physiology PSG was carried out prior to commencement of oral appliance therapy. For this study night participants were instrumented with standard PSG equipment, nasal mask, pneumotachograph, epiglottic pressure catheter and intramuscular electrodes inserted perorally into the genioglossus to quantify baseline OSA phenotypic traits. Pcrit was quantified via CPAP dial downs and the non-anatomical traits were quantified from naturally occurring apneas and hypopneas. Participants were then fitted with a next generation novel oral appliance with a built-in oral airway (Oventus O2Vent Optima™) and titrated to at least 75% of maximum mandibular advancement. After acclimatization to therapy, participants were invited to undergo a treatment efficacy PSG. Results Oral appliance therapy reduced the AHI by 52% (21[15,31] vs. 11[7,16] events/h, p&lt;0.001). 46% of participants responded to oral appliance therapy based on the definition of AHI &lt; 10events/h. Preliminary analyses indicated that estimates of baseline upper airway collapsibility tended to be different in responders versus non-responders (responders have less collapsible airways). Conclusion The novel oral appliance reduced OSA severity by 50% with resolution of OSA in half of participants. Baseline pharyngeal collapsibility may be an important physiological predictor of treatment outcome. Support (if any):