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Background: Young children (aged < 6 years) in contact with Sputum positive TB adults are often infected with Mycobacterium tuberculosis and once infected are at higher risk of progression to TB disease than adults. Objectives: The study was conducted To find out the proportion of < 6 years of age children having household contact of a pulmonary TB patient, screened, initiated, and completed IPT in the year 2019 and to find out the barriers for not completing/taking IPT. Methodology: A mixed-method study was conducted during July–September 2019 among household contacts of < 6 years of age of sputum positive pulmonary TB patients attending a DOT centre in South – East Delhi. Results: A total of 52 household contacts of less than 6 years of age were identified. Whereas 65% of the study population was aware of IPT, only 26.9% of individuals were on IPT out of the total study population and only 4 % had completed the IPT. On qualitative analysis, most of them informed that the DOTS provider didn’t emphasize them about IPT. Some of them felt that it isn’t required since the child does not have the disease. Conclusion: Adherence to IPT is low. The dearth of IEC activities in the study area adds to this burden. Hence prompt IEC activities and adequate training of DOT providers for initiation and adherence of IPT is the need of the time.

Introduction. Migraine is one of the most common disabling neurological disorders. Recently developed monoclonal antibodies to calcitonin gene-related peptide (CGRP) or its receptor are the first targeted medication for preventive therapy of both episodic and chronic migraine. They have been thoroughly investigated in clinical trials; however, there is little data from real-world clinical practice available to date. The aim of this study is to assess the efficacy and safety of 6 months of treatment with erenumab in real-world clinical practice and investigate the effect of the drug on the patients’ sensitivity to medicines for migraine headaches relief and patient satisfaction after treatment.Materials and methods. Our observational cohort prospective study included patients in our Headache Clinic prescribed monoclonal antibodies blocking the CGRP-receptor – erenumab. During the investigation, we evaluated the previous preventive therapy and its efficacy, the number of days with migraine per month, adverse events occurring during the erenumab treatment, depression and anxiety (HADS), migraine disability (MIDAS), the presence of allodynia (ACS-12) and improved response to acute therapy after treatment. A total of 42 patients participated in the study: 6 men, 36 women, the average age was 43.9 ± 12.2. Of them, 38 patients (90%) had chronic migraine. Thirty-two patients (76%) had previously been prescribed preventive therapy, which proved ineffective, and 10 patients (24%) had not once received any type of migraine prevention.Results. Among our patients, we identified 11 patients with resistant migraine and one patient with refractory migraine. During the study, two patients dropped out due to adverse events (constipation). Thirty patients continued the administration of erenumab 70 mg for at least six months. The average number of migraine days per month before treatment was 22.8, and after six months of treatment, it dropped to 7.3. Twenty-nine patients (72.5%) also noted that the response to acute headache treatment improved after the therapy.Conclusion. The results of our study are consistent with the international experience of using erenumab and confirm its effectiveness for migraine preventive therapy, including difficult-to-treat migraine cases. However, further studies with more participants and evaluation of predictors of successful monoclonal antibody therapy are still needed.

Trigeminal autonomic cephalalgias (TACs) are rare but are the most intense primary headaches that severely limit patients’ ability to work and be socially active. This article reviews the modern classification of TACs, based on the International Classification of Headache Disorders-3, and the key differences between TAC types, as well as the pathophysiological mechanisms – the role of the trigeminovascular system, autonomic nervous system, hypothalamus and vagus nerve – and their relation to circadian rhythms. The sleep disturbances that can occur in patients with TACs, exacerbating the course of the disease, and the role of melatonin, hypothalamus and suprachiasmatic nucleus in these conditions are also discussed. In addition, current therapies for cluster headache are described, which include acute therapy and prophylactic therapy, with recommendations regarding the timing of prophylactic therapy discontinuation. The review also includes the available data on melatonin as well as new therapies such as CGRP monoclonal antibodies and neuromodulation, which includes the two most promising techniques: non-invasive vagus nerve stimulation and sphenopalatine ganglion microstimulation. Furthermore, the authors present the clinical case of a patient with chronic cluster headache, which was significantly reduced in frequency and intensity when melatonin was added to the therapy.

Objectives In Brazil, annual tuberculin skin tests (TST) are recommended for people living with HIV (PLWH) with CD4>350, with tuberculosis preventive therapy (TPT) provided upon test conversion. We aimed to determine the yield of repeat TST for PLWH. Design Secondary analysis of the stepped-wedge, cluster-randomized THRio trial for isoniazid preventive therapy (IPT) to prevent tuberculosis (TB). Methods We analyzed data from newly registered PLWH with negative baseline TST results. We calculated the number of TST conversions after 1 and/or 2 years among patients eligible for follow-up TSTs; the proportion of converters initiating IPT; and incidence of TB/death. Results Among 1,770 PLWH with a negative baseline TST, 679 (38%) were female and median age was 36 years (IQR 29-43). Eighty-six (5%) developed TB or died within 1 year. Among 1,684 eligible for a follow-up 1-year TST, 582 (35%) were tested and 53 (9%) were positive. Forty-nine (92%) converters started IPT. Of 529 patients with a negative 1-year TST, 7 (1%) developed TB or died over the following year. Of 522 patients eligible for a 2-year TST, 158 (30%) were tested and 13 (8%) were positive. Ten (77%) converters started IPT. Of 1,102 patients who did not receive a 1-year TST, 33 (3%) developed TB or died. Of the 1,069 patients eligible for a 2-year TST, 259 (24%) were tested and 34 (13%) were positive. Thirty (88%) converters started IPT. Conclusions In this cohort of PLWH in Brazil, TST conversion was high among those re-tested, but only 48% received a follow-up TST within 2 years.

Patients with chronic migraine are characterized by frequent severe headache attacks, polypharmacy (painkillers), insufficient effect of preventive therapy, and a decrease in the quality of life. The aim of a prospective open-label study was the evaluation of the efficacy and tolerance of Erenumab (Irinex) in the treatment of patients with chronic migraine in real clinical practice.Material and methods. 48 patients with chronic migraine were clinically and neurologically examined (35.5 [19; 56]; diagnosis was established according to the criteria of ICHD classification and diagnosis of migraine. Medical monitoring period was 3 months. Clinical and neurological testing and subcutaneous administration of Erenumab (Irinex) 70 mg were performed once a month during the whole period.Results. Safety, good tolerance and an obvious significant clinical effect were noted when using Erenumab (Irinex) 70 mg. It led to a significant improvement in clinical score and the course of chronic migraine, the effectiveness of rapid relief of symptoms and significant reduction in the need for painkillers in most patients. The best results were found after 3 months of therapy.

Complementary and alternative medicine therapies can be used as adjuvant or preventive therapy, and have newer applications: cryotherapy, halotherapy, floatation therapy, and compression therapy. Nurse practitioners need to know about these therapies and their applicability to patient populations. Appropriate integration of these therapies is part of holistic care, which they strive to provide.

Development of epilepsy or epileptogenesis promotes recurrent seizures. As of today, there are no effective prophylactic therapies to prevent the onset of epilepsy. Contributing to this deficiency of preventive therapy is the lack of clarity in fundamental neurobiological mechanisms underlying epileptogenesis and lack of reliable biomarkers to identify patients at risk for developing epilepsy. This limits the development of prophylactic therapies in epilepsy. Here, neural network dysfunctions reflected by oscillopathies and microepileptiform activities, including neuronal hyperexcitability and hypersynchrony, drawn from both clinical and experimental epilepsy models, have been reviewed. This review suggests that epileptogenesis reflects a progressive and dynamic dysfunction of specific neuronal networks which recruit further interconnected groups of neurons, with this resultant pathological network mediating seizure occurrence, recurrence, and progression. In the future, combining spatial and temporal resolution of neuronal non-invasive recordings from patients at risk of developing epilepsy, together with analytics and computational tools, may contribute to determining whether the brain is undergoing epileptogenesis in asymptomatic patients following brain injury.

The hypertension that is caused directly by gravid state is known as Pregnancy Induced Hypertension (PIH). It has an association with increased maternal morbidity and mortality. In classical Unani literature, hypertension is referred as Hejan of blood. Ibn-e-Sina (Avicenna) wrote in his book Al-Qanoon Fit Tib (Alcanon) that few times pregnant women may complain Warm-e-Qadam (Pedal Oedema). During labour, Tashannuj wa Tamaddud (Convulsions) may occur. Ilaj-bil-Ghiza (Dietotherapy) is a method of Unani treatment in which a specific diet is given for a specific disease. Dietary supplement of 400 IU Vitamin E and 1000 mg Vitamin C per day as antioxidant resulted in reducing oxidative stress, decreased endothelial activation and reduction in the risk of PIH by 61%. Specific diets mentioned in Unani medicine which contains Vitamin E and Vitamin C can be beneficial in PIH.

Background: Young children (

The human immune deficiency virus (HIV) is the strongest risk factor for the incidence of tuberculosis (TB) by way of reactivation of latent or new infection. The provision of isoniazid preventive therapy (IPT) is one of the public health interventions for the prevention of TB. To date, there have been limited clinical data regarding the effectiveness of isoniazid preventive therapy (IPT) on TB incidence. This study aimed to assess the effect of isoniazid preventive therapy on the incidence of tuberculosis for seropositive children in Northwest Ethiopia. Methods. A facility-based retrospective follow-up was employed for reviewing 421 files from 1 January 2015 up to 30 December 2019. EpiData version 3.2 and Stata/14 software were used for data entry and analysis, respectively. Categorical variables at bivariable Cox regression were assessed for candidates transferred at P value P < 0.005 . Result. The overall incidence of TB was found to be 4.99 cases per 100 person-years at 95% CI (3.89–6.53). Missed IPT (AHR = 7.45, 95% CI: 2.96, 18.74, P < 0.001 ), missed cotrimoxazole preventive therapy (CPT) (AHR = 2.4, 95% CI: 1.84–4.74, P < 0.022 ), age ≥ 11 years (AHR = 4.2, 95% CI: 1.04–7.03, P < 0.048 ), MUAC ≤ 11.5 cm (AHR = 4.36, 95% CI: 1.97–9.97, P < 0.001 ), WHO stages III and IV (AHR = 2.04, 95% CI: 1.12–3.74, P < 0.022 ), and CD4 count ≤100 cells/μl (AHR = 3.96, 95% CI: 1.52–10.34, P < 0.005 ) were significantly associated with TB incidence. Conclusion. Concomitant administration of ART with IPT had demoted more than ninety-six percent of new TB incidences for this report. Undertaking in-depth TB screening and frequent follow-up among all these children is critical in order to prevent and control tuberculosis.

Contains fulltext : 248734.pdf (Publisher’s version ) (Open Access) Cardiovascular disease (CVD) is a major cause of morbidity and mortality worldwide. For many years guidelines have listed optimal preventive therapy. More recently, novel therapeutic options have broadened the options for state-of-the-art CV risk management (CVRM). In the majority of patients with CVD, risk lowering can be achieved by utilising standard preventive medication combined with lifestyle modifications. In a minority of patients, add-on therapies should be considered to further reduce the large residual CV risk. However, the choice of which drug combination to prescribe and in which patients has become increasingly complicated, and is dependent on both the absolute CV risk and the reason for the high risk. In this review, we discuss therapeutic decisions in CVRM, focusing on (1) the absolute CV risk of the patient and (2) the pros and cons of novel treatment options.

The article focuses on the basic principles of diagnosis and treatment of migraine at the stage of primary health care. The diagnostic criteria of migraine, common diagnostic errors and alarming symptoms that are indications for instrumental investigations are given. The main treatment strategies of migraine are described: behavioral therapy, attack relief, and preventive therapy. Special attention is being paid to the treatment of a migraine attack, depending on its severity, including the features of the use of simple analgesics and triptans – specific drugs that have a pathogenetic antimigrenous effect. The principles of the use of tryptans that provide a high effect of relieving a migraine attack are being listed. The advantages of eletriptan as a last‑generation triptan, which is highly effective in relieving migraine attacks and is safer than other drugs in this class, are highlighted. Among the modern classes of drugs that have an evidence base in migraine prevention, those that can be successfully used by general practitioners are indicated.

BACKGROUND: The WHO recommends TB symptom screening and TB preventive therapy (TPT) for latent TB infection (LTBI) in persons living with HIV (PLWH). However, TPT uptake remains limited. We aimed to characterize and contextualize gaps in the TPT care cascade among persons enrolling for antiretroviral therapy (ART).SETTING: Four PEPFAR‐supported facilities in Uganda.METHODS: We studied a proportionate stratified random sample of persons registering for ART when TPT was available. Patient‐level data on eligibility, initiation, and completion were obtained from registers to determine proportion of eligible patients completing each cascade step. We interviewed providers and administrators and used content analysis to identify barriers to guideline‐concordant TPT practices.RESULTS: Of 399 study persons, 309 (77%) were women. Median age was 29 (IQR 25–34), CD4 count 405 cells/µL (IQR 222–573), and body mass 23 kg/m2 (IQR 21–25). Of 390 (98%) screened, 372 (93%) were TPT‐eligible. Only 62 (17%) eligible PLWH initiated and 36 (58%) of 62 completed TPT. Providers reported hesitating to prescribe TPT because they lacked confidence excluding TB by symptom screening alone and feared promoting drug resistance. Although isoniazid was available, past experience of irregular supply discouraged TPT initiation. Providers pointed to insufficient TB‐dedicated staff, speculated that patients discounted TB risk, and worried TPT pill burden and side effects depressed ART adherence.CONCLUSIONS: While screening was nearly universal, most eligible PLWH did not initiate TPT. Only about half of those who initiated completed treatment. Providers feared promoting drug resistance, harbored uncertainty about continued availability, and worried TPT could antagonize ART adherence. Our findings suggest urgent need for stakeholder engagement in TPT provision.

BACKGROUND: TB is the leading cause of mortality among people living with HIV (PLHIV), for whom isoniazid preventive therapy (IPT) has a proven mortality benefit. Despite WHO recommendations, countries have been slow in scaling up IPT. This study describes processes, challenges, solutions, outcomes and lessons learned during IPT scale‐up in Kenya.METHODS: We conducted a desk review and analyzed aggregated Ministry of Health (MOH) IPT enrollment data from 2014 to 2018 to determine trends and impact of program activities. We further analyzed IPT completion reports for patients initiated from 2015 to 2017 in 745 MOH sites in Nairobi, Central, Eastern and Western Kenya.RESULTS: IPT was scaled up 75‐fold from 2014 to 2018: the number of PLHIV covered increased from 9,981 to 749,890. The highest percentage increases in the cumulative number of PLHIV on IPT were seen in the quarters following IPT pilot projects in 2014 (49%), national launch in 2015 (54%), and HIV treatment acceleration in 2016 (158%). Among 250,069 patients initiating IPT from 2015 to 2017, 97.5% completed treatment, 0.2% died, 0.8% were lost to follow‐up, 1.0% were not evaluated, and 0.6% discontinued treatment.CONCLUSIONS: IPT can be scaled up rapidly and effectively among PLHIV. Deliberate MOH efforts, strong leadership, service delivery integration, continuous mentorship, stakeholder involvement, and accountability are critical to program success.

Introduction This analysis evaluated the treatment satisfaction of Japanese patients receiving galcanezumab (GMB) as a preventive medication for episodic migraine (4–14 monthly migraine headache days). Methods This phase 2, randomized, double-blind, placebo-controlled study enrolled patients aged 18–65 years at 40 centers in Japan. Patients were randomized 2:1:1 to receive monthly subcutaneous injections of placebo (PBO, n = 230), GMB 120 mg (n = 115), or GMB 240 mg (n = 114) for 6 months. Patients’ experience with treatment was measured using the Patient Global Impression of Severity (PGI-S), Patient Global Impression of Improvement (PGI-I), and Patient Satisfaction with Medication Questionnaire-Modified (PSMQ-M) scales. PGI-S was administered at baseline and months 1–6, PGI-I at months 1–6, and PSMQ-M at months 1 and 6. Prespecified analyses were differences between GMB and PBO in PGI-I and the change from baseline in PGI-S, and evaluating positive responses for the PGI-I and PSMQ-M. Results Average change ± SE from baseline across months 1–6 was − 0.09 ± 0.05 (PBO), − 0.17 ± 0.07 (GMB 120 mg, p = 0.33), and − 0.30 ± 0.07 (GMB 240 mg, p = 0.013) for PGI-S. Average PGI-I across months 1–6 was 3.39 ± 0.05 (PBO), 2.55 ± 0.07 (GMB 120 mg, p

Background: The implementation of isoniazid preventive therapy (IPT) among children under five years old in close contact with sputum smear-positive TB patients is still low. Only 21,7% of children implemented the IPT in Central Java in 2017. Assessment of the barriers to IPT implementation needs to be carried out in the control of child TB cases.Objective: To analyze the barriers to IPT implementation among children under five years old in close contact with sputum smear-positive TB patients.Methods: A cross-sectional study was conducted among children (age

Migraine is a chronic neurologic disease estimated to affect approximately 50 million Americans. It is associated with a range of symptoms, which contribute to disability and substantial negative impacts on quality of life for many patients. Still, migraine continues to be underdiagnosed, undertreated, and optimising treatment for individual patients has proven difficult. As many migraine patients will be seen first in primary care settings, internists and other primary care providers are ideally positioned to improve diagnosis and migraine management for many patients. In this review, we discuss some of the challenges in diagnosing migraine and suggest strategies to overcome them, summarise the current understanding of migraine pathophysiology and clinical evidence on acute and preventive treatment options, and offer practical approaches to diagnosis and contemporary management of migraine in the primary care setting.Key messagesMigraine is a prevalent disease with substantial impact. Primary care providers are ideally positioned to improve care for migraine patients with streamlined approaches to diagnosis and management.A stepwise diagnostic approach to migraine involves taking a thorough headache history, excluding secondary headache, and identifying primary headache disorder using screening tools or ICHD-3 criteria.The FDA approved seven new migraine therapies from 2018 to 2020 (four monoclonal antibodies, two gepants, one ditan), expanding acute and preventive therapeutic options.

Headaches are common in primary care. The diagnosis is made by a careful history and physical examination. Imaging is generally not warranted. Several general principles underlie the acute treatment of headache: early initiation of therapy and adequate dosing at first dose. Careful attention to avoiding too frequent administration of acute therapy is important to avoid medication overuse headaches. Opioids should always be avoided. Preventive treatment is indicated for frequent headaches. Successful treatment entails low-dose medication with careful titration and monitoring of headache frequency. Behavioral strategies are important and should be part of any comprehensive headache management plan.

BACKGROUND To assist the Malawi Ministry of Health to evaluate 2 competing strategies for scale-up of isoniazid preventive therapy (IPT) among HIV-positive adults receiving antiretroviral therapy. SETTING Malawi. METHODS We used a multidistrict, compartmental model of the Malawi tuberculosis (TB)/HIV epidemic to compare the anticipated health impacts of 6-month versus continuous IPT programs over a 12-year horizon while respecting a US$10.8 million constraint on drug costs in the first 3 years. RESULTS The 6-month IPT program could be implemented nationwide, whereas the continuous IPT alternative could be introduced in 14 (of the 27) districts. By the end of year 12, the continuous IPT strategy was predicted to avert more TB cases than the 6-month alternative, although not statistically significant (2368 additional cases averted; 95% projection interval [PI], -1459 to 5023). The 6-month strategy required fewer person-years of IPT to avert a case of TB or death than the continuous strategy. For both programs, the mean reductions in TB incidence among people living with HIV by year 12 were expected to be

Background: Integrating and scaling up tuberculosis (TB) and HIV services are essential strategies to achieve the combined goals ending both TB and HIV, especially in TB and HIV high burden countries. This study aimed to examine the prevalence of TB and HIV co-infection and the implementation of collaborative services in Ethiopia.Methods: We used a national sentinel surveillance TB/HIV co-infection collected between 2010 and 2015. The Ethiopian Public Health Institute collected and collated the data quarterly from 79 health facilities in nine regional states and two city administrations.Results: A total of 55,336 people living with HIV/AIDS were screened for active TB between 2011 and 2015. Of these, 7.3% were found co-infected with TB, and 13% TB-negative PLWHA were on isoniazid preventive therapy. Nine out of ten (89.2%) active TB patients were screened for HIV counselling and 17.8% were found to be HIV positive; 78.2% and 53.0% of HIV/TB co-infected patients were receiving cotrimoxazole preventive therapy and antiretroviral treatment, respectively.Conclusion: This study showed that the prevalence of TB and HIV co-infection failed to decrease over the study period, and that, while there was an increasing trend for integration of collaborative services, this was not uniform over time. Aligning and integrating TB and HIV responses are still needed to achieve the target of ending TB and HIV by 2030.

Migraine is one of the most common types of headache, which can lead to a significant decrease in quality of life. Researchers identify migraine with aura, migraine without aura, and chronic migraine that substantially reduces the ability of patients to work and is frequently concurrent with mental disorders and drug-induced headache. The complications of migraine include status migrainosus, persistent aura without infarction, migrainous infarction (stroke), and a migraine aura-induced seizure. The diagnosis of migraine is based on complaints, past medical history, objective examination data, and the diagnostic criteria as laid down in the International Classification of Headache Disorders, 3 rd edition. Add-on trials are recommended only in the presence of red flags, such as the symptoms warning about the secondary nature of headache. Migraine treatment is aimed at reducing the frequency and intensity of attacks and the amount of analgesics taken. It includes three main approaches: behavioral therapy, seizure relief therapy, and preventive therapy. Behavioral therapy focuses on lifestyle modification. Nonsteroidal anti-inflammatory drugs, simple and combined analgesics, triptans, and antiemetic drugs for severe nausea or vomiting are recommended for seizure relief. Preventive therapy which includes antidepressants, anticonvulsants, beta-blockers, angiotensin II receptor antagonists, botulinum toxin type A-hemagglutinin complex and monoclonal antibodies to calcitonin gene-related peptide or its receptors, is indicated for frequent or severe migraine attacks and for chronic migraine. Pharmacotherapy is recommended to be combined with non-drug methods that involves cognitive behavioral therapy; progressive muscle relaxation; mindfulness; biofeedback; post-isometric relaxation; acupuncture; therapeutic exercises; greater occipital nerve block; non-invasive high-frequency repetitive transcranial magnetic stimulation; external stimulation of first trigeminal branch; and electrical stimulation of the occipital nerves (neurostimulation).

Therapeutic role of antioxidant against lipid profile and lipoprotein (choline) was observed by the different researchers, but clinical evidences required about the use of antioxidant vitamins against the lipoproteins. Patients with clinical evidence of cardiovascular disease (CVD) confirmed by standard diagnostic techniques were followed. Newly or recently, diagnosed case subjects were recruited wherever possible. At least 120 cases, subjects both male and female with CVD were selected from a local hospital. Four groups developed on the base of antioxidant therapy and blood samples were collected at zero day, 20 days, 40 days and 60 days. vitamins C and E are the major dietary cellular and lipid antioxidants, respectively; we found no evidence to support the use of vitamin or antioxidant supplements in the reduction of mortality. However, they are helpful in the management of prevention of cardiovascular disease.

Background. Children are highly susceptible to Mycobacterium tuberculosis infection, and about 70% of children living in the same households with pulmonary tuberculosis-positive patients will become infected. However, pulmonary positive tuberculosis is a common phenomenon and the implementation of the recommended contact screening and initiation of isoniazid preventive therapy is very low. Therefore, this study is aimed at assessing contact screening practice and initiation of isoniazid preventive therapy of under-five children among pulmonary tuberculosis-positive patients in Bahir Dar, northwest Ethiopia. Methods. A facility-based cross-sectional study was conducted from March 1 to 30, 2016. A total of 267 pulmonary tuberculosis-positive patients were included in this study. To identify independent predictors of contact screening and isoniazid preventive therapy initiation, we performed multivariable logistic regression analyses using SPSS version 20 with CI of 95% at p value < 0.05. Results. A total of 230 (90.2%) pulmonary tuberculosis-positive patients had single contacts with their under-five children. One hundred nine (64.8%) children were screened. From those screened, 11 (7.4%) developed tuberculosis disease and started antituberculosis treatment. Forty-four (31.9%) children started isoniazid preventive therapy. Sex of the participants, place of service delivery, relationship with contacts, HIV status, and attitude of PTB+ cases were significant predictors of contact screening (p<.05). Participant’s knowledge, attitude of participants, and relationship of the child with participant were significant predictors of isoniazid preventive therapy initiation (p<0.05). Conclusion. Contact screening practice and isoniazid preventive therapy initiation of children under the age of 5 in Bahir Dar zone were very low. Intimate family contact with pulmonary tuberculosis-positive patients, place of service delivery, and attitude towards screening are the key factors of contact screening. Participant’s knowledge, attitude of participants, and relationship of the child with participant are the key factors of isoniazid preventive therapy initiation. Therefore, household contact screening and isoniazid preventive therapy initiation should be paid attention to reduce transmission.

Tuberculosis (TB) preventive therapy (TPT), including isoniazid preventive therapy (IPT), has been implemented within the Nigerian human immunodeficiency virus (HIV) programme since 2014. However, drug procurement and logistic support has remained the responsibility of the National Tuberculosis and Leprosy Control Programme. The US President's Emergency Plan for AIDS Relief-Nigeria (PEPFAR Nigeria) reviewed the key bottlenecks to TPT implementation in 2016.The logistics of delivery of isoniazid (INH) were integrated with the antiretroviral (ARV) logistics management and information system (LMIS). Drug order and requisition forms at the facility level were revised to include INH, along with training on appropriate quantification and requisition of INH with ARVs. Support was provided for last mile delivery of INH directly to every implementing site, alongside ARV.We observed an increasing trend in TPT uptake between the pre-and-post intervention periods: 6% in fiscal year (FY) 2015, 7% in FY2016 and 12% in FY2017. Overall, the logistical changes in the LMIS to include INH in 2016 led to a 69% increase in TPT by the end of FY2017; this was statistically significant.Addressing logistical challenges to TPT implementation will ensure that the TB and HIV programmes can tackle the increasing burden of TB infection in people living with HIV. We recommended that the provider-to-client stage of TPT implementation be driven by the HIV programme and that cross-communication between the two programmes be improved.L’expansion du traitement préventif par isoniazide (TPI), est restée lente au cours des dernières années au Nigeria. Le TPI est mis en œuvre au sein du programme VIH mais l’approvisionnement en médicaments et le soutien logistique ont été la responsabilité du programme TB pendant des années. Ceci a eu un impact sur l’appropriation et l’obligation de rendre des comptes du programme et est resté un frein à l’expansion du TPI dans le pays.Le plan d’urgence du Président des Etats-Unis pour la lutte contre le Sida (PEPFAR-Nigeria) a revu les principales entraves à la mise en oeuvre du TPI en 2016 et a intégré la logistique de l’isoniazide (INH) à la gestion de la logistique des antirétroviraux (ARV) et au système d’information (LMIS). Les formulaires de commande de médicaments et de réquisition au niveau des structures ont été révisés afin d’inclure l’INH à la formation sur les dosages appropriés et la réquisition de l’INH avec les ARV. Un soutien a été fourni pour la distribution la plus éloignée de l’INH directement dans chaque site de mise en œuvre parallèlement à celle des ARV.La modification du LMIS pour l’INH en 2016 a abouti à une augmentation de 69% de l’achèvement du TPI à la fin de la période de rapport de 2017, montrant une modification statistiquement significative du profil de la couverture du TPI entre les périodes avant et après l’intervention.Un changement stratégique du système logistique de l’INH a abouti à une augmentation significative de la couverture du TPI parmi les personnes infectées par le VIH qui sont éligibles.La ampliación de escala del tratamiento preventivo con isoniazida ha sido lenta durante los últimos años en Nigeria. El tratamiento preventivo de la tuberculosis (TPT) se aplica en el marco del programa contra la infección por el virus de la inmunodeficiencia humana (VIH), pero el suministro de medicamentos y el apoyo logístico ha permanecido a cargo del programa contra la tuberculosis (TB), lo cual tiene consecuencias sobre la apropiación y la rendición de cuentas y constituye un obstáculo a la expansión del TPT en el país.En el Plan de Emergencia del Presidente (de los Estados Unidos) para el Alivio del Sida en Nigeria (PEPFAR-Nigeria) se analizaron las principales barreras a la ejecución del TPT en el 2016 y se integró la organización de la distribución de la isoniazida (INH) en los sistemas de gestión de información logística (LMIS) de los antirretrovíricos (ARV). Se modificaron los formularios de pedido y de solicitud de pedido en los establecimientos a fin de incluir la INH y se impartió capacitación sobre la cuantificación y los pedidos de INH con los ARV. Se respaldó la distribución de la INH con los ARV hasta el final del trayecto, directamente a cada centro que ejecutaba el tratamiento.Con la modificación en el 2016 de los LMIS para incluir la INH, se logró un aumento de 69% de la compleción del TPT al final del período de notificación del 2017, con una evolución significativa de la aceptación del TPT entre el período anterior a la intervención y el período posterior a la misma.Una modificación estratégica en el sistema de distribución de la INH dio lugar a un aumento considerable de la aceptación del TPI en las personas infectadas por el VIH que cumplían los criterios para recibir el tratamiento.

Isoniazid Preventive Therapy (IPT) involves use of isoniazid by People Living with HIV (PLWHIV) who have latent TB for a period not less than six months to prevent active TB infection. Despite the critical role of IPT in reducing HIV/TB co-infection related morbidity and deaths, not much has been done to examine why its full implementation has not been achieved and the probable solution. The objective of this study was to determine uptake of isoniazid preventive therapy and its associated factors among people living with HIV in Kajiado County, Kenya. Analytical Cross-sectional study was carried out in purposely selected four Hospitals. Two hundred and seventy two (272) study participants were recruited through systematic sampling with 100% response rate. Data were collected using structured questionnaires. Cross tabulation, bivariate and multivariate analysis was carried out to identify factors influencing IPT uptake. The study found out that IPT uptake was at 72%. Logistic regression analysis, established the existence of a significant positive association (p-value=0.000, βii=1.729) between patient knowledge among PLHIV and IPT uptake. A correlation analysis outcome shows the existence of a significant positive relationship (r=0.332, sig. =0.000) between patients knowledge and having ever used IPT at 0.01 level in a two tailed. The 72% of IPT uptake was sufficient. Patient knowledge factors had the highest influence on IPT amongst PLWHIV. The role of health care givers and health centers as IPT information disseminators and IPT knowledge source respectively, was invaluable in this study.

Contact investigation is the search for secondary cases of tuberculosis (TB) or latent tuberculosis infection (LTBI) among contacts of patients with a transmissible form of TB, usually smear-positive pulmonary disease. The aim is to detect those who have already started developing TB in order to initiate treatment as soon as possible and prevent further transmission of the disease, and also to detect those who have been infected and could benefit from a preventive treatment before the development of TB. The implementation of preventive therapy for persons with the highest risk of developing TB, that is the reduction of the pool of future cases of TB, is now considered one of the activities able to support a decline in the prevalence of TB. This implies that the search for infected contacts and the prevention of TB should be performed in parallel with diagnostic and curative activities. The implementation of screening activities, at least for exposed children and immunocompromised persons, seems to be feasible without unaffordable costs, even in high TB burden settings. Keywords: Tuberculosis, Contact investigation, Latent TB infection, LTBI

Pediatric low-grade gliomas (pLGGs) are almost universally driven by abnormal activation of RAS-mediated MEK-ERK/MAPK signaling pathway. pLGGs predominantly occur in children, suggesting that they originate in an ERK-dependent neural stem/progenitor population(s) transiently present in the developing brain. Our recent preclinical study reveals a cell-lineage-of-origin and develops a chemopreventative therapeutic strategy.

The World Health Organization estimated that a quarter of the global population is infected by Mycobacterium tuberculosis (Mtb). A better control of tuberculosis (TB) is based on the ability to detect Mtb infection, identifying the progressors to TB disease, undergoing to preventive therapy and implementing strategies to register the infections and treatment completion.we reviewed the literature regarding the tests available for TB infection diagnosis, the preventive therapies options and the cascade of care for controlling TB at a public health level.current tests for TB infection diagnosis as IFN-γ release assays or tuberculin skin tests are based on the detection of an immune response to Mtb in the absence of clinical disease. The main limit is their low accuracy to detect progressors to disease. New preventive treatments are available with short duration that are associated with better adherence. Options to register TB infections are presented.Tests to diagnose TB infection are available but they lack accuracy to identify the progressors from infection to TB disease. Shorter preventive TB therapy are available but need to be implemented worldwide. A TB infection registry is crucial for improving the cascade of care leading to a better TB control.

BACKGROUND: High-dose isoniazid (INHH) (15–20 mg/kg/day) could be administered to overcome low-level INH resistance, but pharmacokinetic data are sparse.METHODS: This observational study included South African children (H as preventive therapy, or treatment for multidrug-resistant TB (MDR-TB) exposure or disease. Pharmacokinetic sampling was performed after an INH dose of 20 mg/kg. Non-compartmental analysis and multivariable regression models were used to evaluate associations of key covariates with area under the curve (AUC0–24) and maximum concentration (Cmax). AUC and Cmax values were compared against proposed adult targets.RESULTS: Seventy-seven children were included, with median age of 3.7 years; 51 (66%) had MDR-TB disease and 26 (34%) had MDR-TB exposure. Five were HIV-positive, of whom four were ≥5 years old. The median AUC0–24 was 19.46 µgh/mL (IQR 10.76–50.06) and Cmax was 5.14 µg/mL (IQR 2.69–13.2). In multivariable analysis of children aged 0–24 (geometric mean ratio GMR 0.19, 95% CI 0.15–0.26; P < 0.001) and Cmax (GMR 0.20, 95% CI 0.15–0.26; P < 0.001).CONCLUSIONS: INH concentrations in children with MDR-TB disease were much lower than expected, but comparable to previous reports in children with MDR-TB exposure. Further studies should confirm these findings and explore possible causes.

Objective: To evaluate whether co-trimoxazole preventive therapy (CPT) and other contributing factors, among people living with HIV/AIDS (PLWHA) on antiretroviral (ARV) are effective to reduce active pulmonary tuberculosis (APT) at Wangaya Hospital, Denpasar, Bali, Indonesia. Methodology: A prospective cohort study was conducted to evaluate the use of CPT in reducing APT. In this study, 403 PLWHA on ARV 151 participants accepted CPT as the first group and 252 PLWHA refused CPT as the second group. Eight participants among the first group and 48 participants among the second group were confirmed APT. Revisits were scheduled every a month to replenish pills and to confirm APT. The CPT effectiveness, sociodemography and laboratory, and reducing APT risk after prospective cohort entry were analyzed using Chi-square with significant p

Aim: to identify new prognostic criteria of potential preeclampsia (PE) in pregnant women after assisted reproductive technologies (ART) for timely PE prophylaxis.Materials and methods. A prospective study of 85 patients who entered the program of ART was conducted. All patients were examined for possible hemostatic abnormalities (genetic thrombophilia and chronic hypercoagulation) and also for granulocytemacrophage colony-stimulating factor (GM-CSF) in the serum during the most critical periods (4–6, 12–14, 22–24 и and 30–32 weeks) of the fetoplacental complex formation.Results. The lowest level of GM-CSF was observed in patients with hemostatic disorders. Thus, in pregnant women who later developed PE, there was a decrease in GM-CSF level below the physiological: in those diagnosed with genetic thrombophilia – by 79.4 %, and those with hypercoagulation – by 63.6 %.Conclusion. The determination of serum GM-CSF and identification of hemostatic abnormalities in pregnant women after ART has a prognostic importance for potential PE. This result is significant for the understanding of the pathogenesis of PE and also has a practical value: it allows the doctor to attribute the patient to a high risk group from the first trimester of her pregnancy and start preventive therapy rather early.

Currently, the diagnosis of Parkinsons disease is carried out mainly on the ground of clinical picture. However, long before the development of motor disorders, a number of signs characteristic of parkinsonism can be detected. The review of the literature presents methods to detect non-motor disorders that can be considered as predictors of the disease and it also discusses the issue of the laboratory studies of specific biomarkers for early diagnosis. We suggested to use the combination of olfactory test and questionnaire about vegetative disorders as the most relevant solution for clinical practice. It is recommended to interpret the test data as a sign of extremely high probability of the development of clinical manifestations of Parkinsons disease, and, therefore, as a reason to start preventive therapy.

This article focuses on the most important issues of perioperative antimicrobial prophylaxis (PAP) in pediatric colorectal surgery. We have analyzed currently available Russian and foreign documents on PAP and its specific characteristics in pediatric practice and colorectal surgery. We have provided the most up-to-date recommendations on perioperative prevention of enterocolitis and strictures in children with Hirschsprung's disease. Key words: antibacterial preventive therapy, colorectal surgery, pediatric surgery, surgical wound infection

Five human immunodeficiency virus (HIV) care facilities in Eswatini.To identify critical factors that enabled persons living with HIV to successfully complete a 6-month course of isoniazid preventive therapy (IPT) provided through a choice of facility-based or community-based delivery, coordinated with antiretroviral therapy (ART) refills.This was a mixed methods, retrospective cross-sectional study.Between June and October 2017, we interviewed 150 participants who had completed IPT in the previous year. Fourteen participants did not recall being offered a choice, and were excluded from the analysis. Of the remaining 136, 56.6% were female and 64.7% chose facility-based care; the median age was 42.5 years. Most participants reported that having a choice was important to their treatment completion (87.7%) and that linking IPT and ART refills facilitated undergoing IPT (98.5%). Participants were knowledgeable about the benefits of IPT and valued the education received from their providers. Participants also reported a high rate of IPT disclosure (95%) to friends and family members.Offering patients a choice of IPT delivery, linking IPT with ART refills, emphasizing patient education and engagement with healthcare workers, and supporting disclosure of IPT are critical factors to enabling IPT completion. These interventions should be incorporated throughout Eswatini and in similar high tuberculosis and HIV burden settings.Cinq structures de prise en charge du virus de l'immunodéficience humaine (VIH) au Swaziland (Eswatini).Identifier les facteurs cruciaux qui ont permis aux personnes vivant avec le VIH d'achever avec succès un traitement préventif de 6 mois par isoniazide (TPI) fourni par une sélection de systèmes de fourniture en structures de santé ou en communautés, en coordination avec un renouvellement du traitement antirétroviral (TAR).Etude rétrospective transversale à méthodes mixtes.Entre juin et octobre 2017, nous avons interviewé 150 participants qui avaient achevé le TPI au cours de l'année précédente. Quatorze participants ne se souvenaient pas avoir pu choisir et ont été exclus de l'analyse. Sur les 136 participants restants, 56,6% ont été des femmes, 64,7% ont choisi des soins basés en structure de santé et l'âge médian a été de 42,5 ans. La majorité des participants ont déclaré qu'avoir le choix avait été important pour l'achèvement du traitement (87,7%) et que lier le TPI et le renouvellement du TAR facilitait la prise du TPI (98,5%). Les participants ont acquis des connaissances relatives aux bénéfices du TPI et ont apprécié l'éducation reçue de leurs prestataires de soins. Les participants ont également rapporté un taux élevé de divulgation du TPI (95%) à leurs amis et à leurs familles.Offrir aux patients le choix du mode de fourniture du TPI, lier le TPI avec le renouvellement du TAR, mettre l'accent sur l'éducation du patient et l'engagement avec les travailleurs de santé et soutenir la divulgation du TPI sont des facteurs cruciaux favorisant l'achèvement du TPI. Ces interventions devraient être étendues à tout le Swaziland et dans des contextes similaires durement frappés par la tuberculose et l'infection par le VIH.Cinco establecimientos de atención de la infección por el virus de la inmunodeficiencia humana (VIH) en Eswatini.Reconocer en las personas con infección por el VIH los principales factores que favorecen la compleción satisfactoria del tratamiento preventivo con isoniazida (TPI) de 6 meses, al ofrecer la opción de suministro institucional o comunitario, coordinado con las reposiciones del tratamiento antirretroviral (TAR).Fue este un estudio transversal retrospectivo.Entre junio y octubre del 2017 se entrevistaron 150 participantes que habían completado el TPI en el año anterior. Catorce de ellos no recordaron que se les hubiese ofrecido una opción de suministro y se excluyeron del análisis. De los 136 restantes, el 56,6% era de sexo femenino, 64,7% había escogido el suministro institucional y la mediana de la edad era 42,5 años. La mayoría de los participantes afirmó que el hecho de tener la posibilidad de escoger el tipo de suministro había sido importante para completar el tratamiento (87,7%) y que coordinar el TPI con la reposición del TAR facilitaba la ingestión del TPI (98,5%). Los participantes conocían los beneficios del TPI y apreciaban la educación que habían recibido de sus prestadores de atención de salud. También refirieron una tasa alta de revelación del TPI a los amigos y los miembros de la familia (95%).Los factores primordiales que facilitan la compleción del TPI son el hecho de ofrecer a los pacientes una opción para el suministro del TPI, la coordinación del TPI con la reposición del TAR, el hincapié en la educación de los pacientes, la comunicación con los profesionales de salud y el apoyo a la revelación de estar recibiendo el TPI. Sería importante incorporar estas intervenciones en la atención en toda la provincia de Eswatini y en otros entornos con carga de morbilidad alta por tuberculosis e infección por el VIH.

Introduction: Tuberculosis (TB) is among the top ten leading cause of morbidity and mortality globally, and studies have shown that adherence to a six Month course of Isoniazid Preventive Therapy (IPT) reduces the incidence of TB disease in HIV-negative/positive populations at risk of developing active TB disease. Objective: This study was carried out to identify active TB cases among children aged 0-5 years who are in close contact with adult cases of pulmonary TB (PTB), to determine the adherence rate to IPT among these close contacts that do not have active TB and to identify factors associated with non adherence if any. Methodology: This study was a prospective descriptive study carried out in Rivers state, Nigeria in two health facilities that offers services for TB diagnosis and treatment. Ethical approval for the study was obtained from the Rivers State Ministry of Health while verbal consent was obtained from the parents/caregivers of the children. Children aged 0-5 years who were in close contact with newly diagnosed PTB cases were recruited for the study. They were screened for HIV and evaluated for TB using clinical features and standard laboratory investigations. Those without active TB disease were commenced on isoniazid preventive therapy (IPT) for six months at a daily dose of 5mg/kg after adherence counselling and followed up at the health centres. Obtained data was analysed using Epi Info Version 7.2.3.1 statistical software. Descriptive statistics was used while the test for association between variables was done with chi-square test at p ≤ 0.05 level of significance. Frequency tables were used for presentation of results. Results: A total of Sixty three children were recruited for the study 37 (58.7%) were males while 26 (41.3%) were females. Thirty two (50.8%) were children of index PTB patients while 29 (46.1%) belonged to lower socio-economic class. Their age ranged from 4 months to 4 years with a mean age of 2.84years ±1.27years. Six (16.2%) out of the 37 males and 2 (7.7%) out of the 26 females were confirmed to have active TB, giving a TB prevalence of 12.7%. The gender difference was not statistically significant (p= 0.32). Of the fifty five children that commenced INH in the first Month, only twenty four of them completed the six Month course of INH, giving an IPT adherence rate of 49.6%. Identified reasons for non adherence includes ‘My child is not sick’, ‘No transport Money’, ‘My child is writing exams”. “My child is tired of the drugs”, “the Health workers are not friendly’ and ‘long waiting time before collecting medications”. Conclusion: Early contact tracing is important for early detection of TB cases in children. Adherence to IPT in this study is low and strategies like community tracing of defaulters using trained social workers and community nurses as well as use of well-supervised and convenient ambulatory treatment centres that are manned by trained lower cadre health staff can improve adherence.

Breast cancer is the most common cancer across the globe occurring commonly in women population, and it is one of the main causes of mortality in women. In 2018, 1,62,468 new cases and 87,090 death cases of breast cancer were registered in India. In these recent years, lots of studies were conducted in breast cancer related to treatment and management, but in spite of getting so much advancement in the treatment of breast cancer still, the mortality rate of women is increasing day by day. Numerous factors are acting as barriers or challenges in breast cancer preventive therapy. It includes lack of knowledge regarding the treatment of cancer and patient getting insecure about treatment, fear of having side effects, cost of treatment and the efficacy of the drugs being prescribed. The study intended to determine the perceived insights and barriers to treatment of breast cancer.

Episodic migraine is a debilitating condition. Preventive therapy is used to reduce frequency, duration, or severity of attacks. This review discusses principles of preventive treatment with a focus on preventive treatment options for people with episodic migraine. Specifically discussed is evidence and use of new migraine-specific treatment options for episodic migraine, such as calcitonin gene-related peptide monoclonal antibodies, a noninvasive transcutaneous electrical nerve stimulation device, and a single-pulse transcranial magnetic stimulator device. Also discussed are evidence-based updates from the 2012 American Academy of Neurology and the American Headache Society guidelines regarding major medication classes recommended for preventive episodic migraine treatment.

BACKGROUND: The safety, efficacy, and appropriate timing of isoniazid therapy to prevent tuberculosis in pregnant women with human immunodeficiency virus (HIV) infection who are receiving antiretroviral therapy are unknown. METHODS: In this multicenter, double-blind, placebo-controlled, noninferiority trial, we randomly assigned pregnant women with HIV infection to receive isoniazid preventive therapy for 28 weeks, initiated either during pregnancy (immediate group) or at week 12 after delivery (deferred group). Mothers and infants were followed through week 48 after delivery. The primary outcome was a composite of treatment-related maternal adverse events of grade 3 or higher or permanent discontinuation of the trial regimen because of toxic effects. The noninferiority margin was an upper boundary of the 95% confidence interval for the between-group difference in the rate of the primary outcome of less than 5 events per 100 person-years. RESULTS: A total of 956 women were enrolled. A primary outcome event occurred in 72 of 477 women (15.1%) in the immediate group and in 73 of 479 (15.2%) in the deferred group (incidence rate, 15.03 and 14.93 events per 100 person-years, respectively; rate difference, 0.10; 95% confidence interval [CI], −4.77 to 4.98, which met the criterion for noninferiority). Two women in the immediate group and 4 women in the deferred group died (incidence rate, 0.40 and 0.78 per 100 person-years, respectively; rate difference, −0.39; 95% CI, −1.33 to 0.56); all deaths occurred during the postpartum period, and 4 were from liver failure (2 of the women who died from liver failure had received isoniazid [1 in each group]). Tuberculosis developed in 6 women (3 in each group); the incidence rate was 0.60 per 100 person-years in the immediate group and 0.59 per 100 person-years in the deferred group (rate difference, 0.01; 95% CI, −0.94 to 0.96). There was a higher incidence in the immediate group than in the deferred group of an event included in the composite adverse pregnancy outcome (stillbirth or spontaneous abortion, low birth weight in an infant, preterm delivery, or congenital anomalies in an infant) (23.6% vs. 17.0%; difference, 6.7 percentage points; 95% CI, 0.8 to 11.9). CONCLUSIONS: The risks associated with initiation of isoniazid preventive therapy during pregnancy appeared to be greater than those associated with initiation of therapy during the postpartum period. (Funded by the National Institutes of Health; IMPAACT P1078 TB APPRISE ClinicalTrials.gov number, .)

Introduction Non-invasive vagus nerve stimulation (nVNS; gammaCore®) has the potential to prevent migraine days in patients with migraine on the basis of mechanistic rationale and pilot clinical data. Methods This multicentre study included a 4-week run-in period, a 12-week double-blind period of randomised treatment with nVNS or sham, and a 24-week open-label period of nVNS. Patients were to administer two 120-second stimulations bilaterally to the neck three times daily (6–8 hours apart). Results Of 477 enrolled patients, 332 comprised the intent-to-treat (ITT) population. Mean reductions in migraine days per month (primary outcome) were 2.26 for nVNS (n = 165; baseline, 7.9 days) and 1.80 for sham (n = 167; baseline, 8.1 days) ( p = 0.15). Results were similar across other outcomes. Upon observation of suboptimal adherence rates, post hoc analysis of patients with ≥ 67% adherence per month demonstrated significant differences between nVNS (n = 138) and sham (n = 140) for outcomes including reduction in migraine days (2.27 vs. 1.53; p = 0.043); therapeutic gains were greater in patients with aura than in those without aura. Most nVNS device-related adverse events were mild and transient, with application site discomfort being the most common. Conclusions Preventive nVNS treatment in episodic migraine was not superior to sham stimulation in the ITT population. The “sham” device inadvertently provided a level of active vagus nerve stimulation. Post hoc analysis showed significant effects of nVNS in treatment-adherent patients. Study identification and registration: PREMIUM; NCT02378844; https://clinicaltrials.gov/ct2/show/NCT02378844

Review article is devoted to the main directions of prevention of diabetes, which remains one of the main causes of death and disability in most countries of the world. Prevention of 2 type diabetes requires a modifying effect on the pathological processes leading to diabetes in order to slow down, stop or reverse the development of p-cell dysfunction and insulin resistance of the tissues. In the absence of a clinical effect from non-drug methods of prevention, it is advisable to use drugs that reduce insulin resistance and dysfunction of p-cells. The results of research indicate that biguanides, а-glucosidase inhibitors, orlistat, thiazolidinediones reduce the risk of developing T2D to varying degrees. Metformin has the largest evidence base, and its prolonged form is a registered indication in the Russian Federation as a drug therapy for patients with prediabetes. For other drugs we need to consider cost, side effects and long-term efficacy. The questions about the possibility of personalization of treatment-and-prophylactic measures based on algorithms, including phenotypic, genetic and microbiome features of patients with prediabetes, are discussed now.

Background Migraine is a primary headache disorder that has a great impact on quality of life of patients. Pharmacologic therapy may be given in acute or abortive form and in the form of preventive therapy. In what form is preventive therapy to be given? Whether monotherapy is to be used or combination therapy? In what cases does combination therapy fare better than monotherapy? These queries are still unanswered. Materials and Methods All patients with headache reporting to the outpatient department were screened, and those fulfilling inclusion criteria were included in the study. Those patients who had chronic daily headache (headache for 15 or more days in a month) or who had other comorbidities and those who were taking any other drugs and were pregnant were excluded from the study. Baseline parameters, duration of headache, frequency of attacks, severity, and location of headache, triggers, and aggravating factors were recorded. Then, patients were started on abortive and preventive therapy. The follow-up was done at 3 and 6 months and if required earlier. At each follow-up, data regarding frequency, severity, and adverse effects were recorded and analyzed. Results We studied 105 patients of migraine, out of which 15 (14.3%) were males and 90 (85.7%) were females. Moreover, most (72%) of the patients were of the age group of 30 to 49 years. Only 11 (10.5%) patients required three or more preventive medicines for the control of headache and rest 94 (89.5%) patients were controlled on single (49 patients, i.e., 46.7%) or two 45, that is, 42.9% preventive medicines 49. Conclusion For the newly diagnosed migraine cases, the single-drug preventive therapy is more useful than the combination of drugs.

Rates of IPT completion remain low in programmatic settings in sub-Saharan Africa. Differentiated HIV care, a patient-centered adaptive care model scaling-up throughout sub-Saharan Africa, may improve IPT completion by addressing joint barriers to IPT and HIV treatment. However, the impact of differentiated care on IPT completion remains unknown. In a cross-sectional study of people living with HIV (PLWH) on antiretroviral therapy (ART) in care in 5 communities in rural Uganda we sought to: (1) compare IPT completion between PLWH on ART receiving HIV care via a differentiated care model versus a standard HIV care model delivered in the same health center, (2) assess individual, interpersonal, and structural predictors of IPT completion by survey interviews of patients enrolled in each care model, and (3) investigate the mechanisms underlying potential differences in IPT between care models via multivariable regression modeling. A total of 103/144 (72%) of HIV-positive patients who received differentiated care and 85/161 (53%) who received standard care completed IPT (p

Migraine is a common, highly disabling disorder. Its treatment involves acute and preventive therapy. Many of available preventive medications are not well tolerated, which results in poor compliance and limited effectiveness. Cannabinoids have been proposed for the treatment of migraine but their efficacy and tolerability are controversial.Cannabinoids modulate functions and activity of signaling pathways that have a key role in pain control. Growing preclinical evidence and initial clinical findings suggest that modulation of the endocannabinoid system, via endogenous or exogenous cannabinoids may be relevant for migraine via multiple mechanisms.The endocannabinoid system qualifies as an interesting area of research worth exploration in the quest for therapeutic targets for the treatment of migraine.

In 2011, the South African government began to offer isoniazid preventive therapy (IPT) through the public health system to presumptively treat latent tuberculous infection (LTBI) among people living with human immunodeficiency virus.To describe IPT perceptions and experiences in three Zulu communities in KwaZulu-Natal Province, South Africa.Using a combination of community-based research and ethnographic methods, we undertook 17 individual and group interviews between October 2014 and May 2015. Interviews transcripts were analysed using qualitative content analysis and validated with grass-roots community advisors.Participants reported multiple ways in which IPT was perceived as dangerous: when costs related to pill collection or consumption were unsustainable, or when daily pill consumption resulted in stigma or was seen to introduce excess dirt or toxins, 'Implementing IPT without understanding the realities of community stakeholders can unintentionally undermine TB control efforts by worsening the situation for people who already encounter numerous daily problems.En 2011, le gouvernement d’Afrique du Sud a commencé à offrir le traitement préventif par isoniazide (IPT) à travers le système de santé publique pour traiter de manière préventive l’infection tuberculeuse latente parmi les personnes vivant avec le virus de l’immunodéficience humaine.Décrire les perceptions et les expériences relatives au traitement préventif par isoniazide dans trois communautés Zulu de la province du KwaZulu-Natal.En utilisant un hybride de recherche en communautés et de méthodes ethnographiques, nous avons réalisé 17 entretiens individuels et en groupe entre octobre 2014 et mai 2015. Les transcriptions des entretiens ont été analysées par analyse qualitative du contenu et validées par des conseillers communautaires de base.Les participants ont fait état de nombreuses occasions où l’IPT a été perçu comme dangereux : quand les coûts liés à la collecte des comprimés ou à leur consommation n’ont plus pu être assumés, ou quand la consommation quotidienne des comprimés a entraîné une stigmatisation ou a été considérée comme introduisant un surplus de saleté ou des toxines, «Mettre en œuvre l’IPT sans comprendre les réalités de la communauté peut involontairement saper les efforts en ajoutant un fardeau supplémentaire à des personnes qui font déjà face à de nombreuses difficultés quotidiennes.Desde el 2011, el gobierno de Suráfrica ofrece el tratamiento preventivo con isoniazida (IPT) en el sistema de salud pública, como tratamiento presuntivo de la infección tuberculosa latente a las personas con infección por el virus de la inmunodeficiencia humana.Describir la percepción y las experiencias relacionadas con el IPT en tres comunidades Zulu de la provincia KwaZulu-Natal.Mediante métodos híbridos de investigación comunitaria y etnográfica se emprendieron 17 entrevistas individuales y en grupo entre octubre del 2014 y mayo del 2015. En la evaluación de las transcripciones de las entrevistas se aplicó el método de análisis cualitativo de contenido y fue validada por asesores de investigación en las comunidades de base.Los participantes refirieron diversas circunstancias en las cuales el IPT se percibe como peligroso, a saber: cuando los costos relacionados con la recogida de los comprimidos o su consumo resultaban insostenibles o cuando la toma diaria de los comprimidos daba lugar a estigmatización o se percibía como la introducción al organismo de un exceso de impurezas o toxinas ‘Introducir el IPT sin comprender las realidades de los interesados directos en las comunidades socava sin intención los esfuerzos, al generar cargas excesivas a personas que ya afrontan numerosas dificultades en su vida diaria.

Objectives The goal of this study was to assess the utility of a genetic risk score (GRS) in targeted coronary artery calcium (CAC) screening among young individuals. Background Early CAC screening and preventive therapy may reduce long-term risk of a coronary heart disease (CHD) event. However, identifying younger individuals at increased risk remains a challenge. GRS for CHD are age independent and can stratify individuals on various risk trajectories. Methods Using 142 variants associated with CHD events, we calculated a GRS in 1,927 individuals in the CARDIA (Coronary Artery Risk Development in Young Adults) cohort (aged 32 to 47 years) and 6,600 individuals in the MESA (Multi-Ethnic Study of Atherosclerosis) cohort (aged 44 to 87 years). We assessed GRS utility to predict CAC presence in the CARDIA cohort and stratify individuals of varying risk for CAC presence over the lifetime in both cohorts. Results The GRS predicted CAC presence in CARDIA males. It was not predictive in CARDIA females, which had a CAC prevalence of 6.4%. In combined analysis of the CARDIA and MESA cohorts, the GRS was predictive of CAC in both males and females and was used to derive an equation for the age at which CAC probability crossed a predetermined threshold. When assessed in combination with traditional risk factors, the GRS further stratified individuals. For individuals with an equal number of traditional risk factors, probability of CAC reached 25% approximately 10 years earlier for those in the highest GRS quintile compared to the lowest. Conclusions The GRS may be used to target high-risk younger individuals for early CAC screening.

Background A 12-dose, once-weekly regimen of isoniazid and rifapentine (3HP) is effective in preventing tuberculosis (TB) among people living with HIV (PLHIV). We sought to identify potential barriers to and facilitators of acceptance and completion of 3HP treatment from the perspective of people living with HIV (PLHIV) and health workers in a routine HIV care setting in Kampala, Uganda. Methods We conducted semi-structured interviews with 25 PLHIV and 10 health workers at an HIV/AIDS clinic in Kampala, Uganda. For both groups, we explored their understanding and interpretations of TB and TB preventive therapy (TPT), and perceptions about social and contextual factors that might influence the willingness of PLHIV to initiate and complete 3HP. We analyzed the data using an inductive thematic approach and aligned the emergent themes to the Behavior Change Wheel framework to identify sources of behavior and targeted behavior change interventions. Results Facilitators of acceptance and completion of 3HP treatment among PLHIV were fear of contracting TB, awareness of being at risk of getting TB, willingness to take TPT, trust in health workers, and the perceived benefits of directly observed therapy (DOT) and self-administered therapy (SAT) 3HP delivery strategies. Barriers included inadequate understanding of TPT, fear of potential side effects, concerns about the effectiveness of 3HP, and the perceived challenges of DOT or SAT. Among health workers, perceived facilitators included knowledge that TB is a common cause of mortality for PLHIV, fear of getting TB, and trust in the health workers by PLHIV, the advantages of once-weekly 3HP dosing, and the benefits of DOT and SAT 3HP delivery strategies. Health worker-reported barriers for PLHIV included inadequate understanding of TB and benefits of TPT, TB-associated stigma, potential side effects pill burden, and challenges of DOT and SAT 3HP delivery strategies. Lack of experience in the use of digital technology to monitor patient care was identified as a health worker-specific barrier. Identified intervention functions to address the facilitators or barriers included education, persuasion, environmental restructuring, enablement, and training. Conclusions Using a formative qualitative and comprehensive theoretical approach, we identified key barriers, facilitators, and appropriate interventions, including patient education, enhancing trust, and patient-centered treatment support that could be used to optimize the delivery of 3HP to PLHIV in our setting. These interventions are likely generalizable to other clinical interventions in similar populations in sub-Saharan Africa and other TB high-burden settings.