Search

BACKGROUND AND PURPOSE The incidence of epilepsy is decreasing among the working-aged in high-income countries, but previous studies have reported conflicting results in Finland. METHODS A nationwide population-based cross-sectional analysis was made of annual epilepsy drug reimbursement rights frequency data from the Social Insurance Institution of Finland, the national authority, between 1986 and 2019. All persons at least 20 years of age living in Finland during the study period were included. RESULTS Based on the analysis of 77,939 new reimbursement rights, crude incidence was 57.4/100,000 (95% confidence interval [CI] = 57.0-57.8) person-years, and age-standardized (to the European Standard Population 2013) incidence was 51.6/100,000 person-years. Both crude (r = 0.62, p = 0.00009) and standardized (r = 0.65, p = 0.00003) incidence increased over time. Incidence increased in both men (from 66.4 to 71.6/100,000, r = 0.51, p = 0.002) and women (from 51.5 to 55.3/100,000, r = 0.68, p

Background Despite the ubiquity of sleep disturbance in schizophrenia, it has generally been overlooked as a potential contributor to cognitive impairments. The main aim of this study was to find out if impaired sleep quality contributes to cognitive impairments in patients with a diagnosis of schizophrenia who are in remission. Methods The study was conducted at the University College Hospital, Ibadan and State Hospital, Ibadan, Nigeria. The Pittsburgh Sleep Quality Index (PSQI) and Screen for Cognitive Impairment in Psychiatry (SCIP) were applied in this cross-sectional study, to all consecutive and consenting remitted outpatients with schizophrenia (N = 130). Other instruments such as Hamilton Depression Rating Scale (HDRS), the Positive and Negative Syndrome Scale (PANSS), sociodemographic and clinical measures were also applied. Results There were 130 participants made up of 69 females (53.1%) and 61males(46.9%). The mean age of the participants was 38.5 ± 9.1 years. The prevalence of poor sleep quality in remitted patients with schizophrenia was 56.9%. Sleep quality was significantly negatively correlated with Verbal Learning Test-Immediate (VLT-I) (r(128) = -.18, P = .044) and Verbal Learning Test-Delayed (VLT-D) (r(128) = -.18, P = .037). The variables that independently predicted cognitive functioning were the VLT-I, odds ratio (OR) 0.66; 95% confidence interval ((CI) 0.49-0.88) and education (OR) 0.61;(CI) 0.40- 0.92). Conclusion Poor subjective sleep quality measured by the PSQI is linked to cognitive impairment in remitted patients with schizophrenia. We suggest that sleep quality in remitted patients with a diagnosis of schizophrenia should receive better attention by physicians.

В огляді літератури висвітлено сучасні аспекти патології опорно-рухового апарату у хворих на цукровий діабет 1-го та 2-го типу, а саме патофізіологічні механізми розвитку ушкоджень кісткової тканини під впливом гіперглікемії, оцінено ризики виникнення патологічних переломів у хворих на цукровий діабет за даними світової наукової літератури.

Background. Type 1 diabetes mellitus (DM) in children and adolescents is a complex problem throughout the world. The onset of the disease at an early age and development of acute and chronic complications already at young age encourage searching the most optimal methods for treating this serious disease. The purpose of the study was to assess the qua­lity of life in children and adolescents with type 1 DM on pump insulin therapy, considering the carbohydrate value in Uzbek national foods. Materials and methods . In the study, it was used a Russian version of a short form of the Diabetes Quality of Life for Youth (DQOLY-SF) questionnaire. Results . The results of the conducted study demonstrate reliably that the use of mo­dern technologies is accompanied by the improvement of not only glycemic control, but also the quality of life. The obtained data allow us to conclude that the use of structured training programs is effective for improving the degree of compensation of carbohydrate metabolism and increasing quality of life in patients using pump insulin therapy. Conclusions. The use of pump insulin therapy has a positive impact on all aspects of the quality of life registered by the DQOLY-SF questionnaire. With the use of the square bolus and double wave bolus, conside­ring the tables of bread units in dishes of Uzbek national cuisine, there was a tendency to improve the quality of life compared to those who used only a simple bolus.

Background. At present, data regarding the role of va­rious risk factors for the development of joint damage in patients with diabetes mellitus (DM) are extremely controversial. Particularly many questions remain regarding the clinical manifestations of this complication, since the development of diabetic arthropathies is a complex and multifaceted process that depends on the type of DM. The purpose of our study was to investigate the clinical features of diabetic arthropathy and to identify plausible risk factors for joint damage in patients with type 1 and 2 DM. Mate­rials and methods. Five hundred and fifty-six patients were divided into groups according to the type of DM, the presence and severity of diabetic arthropathy. Diagnosis of arthropathies was performed ­using the radiographic method and ultrasound of the joints. Results. In the group of patients with type 1 DM, arthropathy was diagnosed in 185 (74.5 %) cases, and in type 2 DM, joint lesions were detected in 241 (78.2 %) individuals. It was found that in the vast majority of patients with DM of both types, arthropathy was localized in the joints of the upper extremities. Most often, small distal or proximal joints of the hand and one of the large joints were involved in the pathological process. Oligoarthritis is characteristic of patients with type 1 DM, whereas polyarthritis is more common in patients with type 2 DM (t = 4.88, p ≤ 0.001). It was found that the risk of developing arthropathy in patients with type 1 DM increases significantly after 35 years, with body mass index (BMI) greater than 25.0 kg/m2, HbA1c levels higher than 8.0 %, and DM duration over 28 years. In patients with type 2 DM, the likelihood of developing arthropathy is increased in patients aged 61 years and older, with HbA1c levels greater than 8.2 %, BMI of 27.9 kg/m2 and above and the duration of diabetes more than 14 years. Conclusions. Preventive measures for diabetic arthropathy should be based on the maintenance of target HbA1c levels of less than 8 % for patients with type 1 DM and 8.2 % for people with type 2 DM, and BMI not higher than 25.0 kg/m2 for individuals with type 1 DM and 27.8 kg/m2 for those with type 2 DM.

Background. Joint damage in patients with diabetes mellitus is a common complication and is associated with degenerative dystrophic changes in the periarticular structures. The purpose of our work was to study insulin and leptin hormone levels in patients with diabetic osteoarthritis and to investigate their possible influence on the development of this complication. Materials and methods. Seventy­seven patients were examined, they were divided into groups by the type of diabetes mellitus, the presence and severity of diabetic arthropathy. The content of insulin and leptin in the blood serum was determined by enzyme­linked immunosorbent assay. Results. Diabetic arthropathy was diagnosed in more than 70 % of patients. In persons with diabetic arthropathy, insulin levels were significantly elevated (for type 1 diabetes mellitus — by 38.5 %, for type 2 diabetes mellitus — by 55.6 %), as well as leptin content (for type 1 diabetes mellitus — by 43.8 %, for type 2 diabetes mellitus — by 53.7 %). There is a direct correlation between the severity of joint damage and the levels of insulin and leptin. The severity of arthropathy in patients with type 2 diabetes mellitus directly correlates with insulin resistance. Conclusions. Risk of developing arthropathy in type 1 diabetes mellitus with elevated insulin levels is increased by 3.8 times, with elevated leptin content — by 1.3 times, in patients with type 2 diabetes mellitus — by 2.6 and 1.2 times, respectively. For this sample, it was found that the development of arthropathy does not depend on the type of diabetes mellitus. In women with type 2 diabetes, the risk of developing arthropathy is 6.4­time higher than in men. Thus, an increased insulin and leptin levels can be markers of the presence and progression of arthropathy in patients with diabetes mellitus.

Purpose Although multiple factors influencing return to work after a carpal tunnel release (CTR) have been identified, little is known about the influence of psychological patient factors on return to work. Therefore, this study aimed to identify the psychological factors that play a role in the return to work after a CTR surgery. Methods Patients who planned to undergo a CTR were asked to fill out the Brief Illness Perception Questionnaire and the Patient Health Questionnaire before surgery to measure their illness perceptions and mental health status, respectively. Return to work was defined as the time until returning to work for 50% of normal hours and was measured using a questionnaire at 6 weeks, 3 months, and 6 months. To identify associations between nonpsychological and psychological patient factors and the return to work after CTR surgery, a Cox proportional hazards model was constructed. Results In total, 615 patients were included in our study. Six months after surgery, 91% of the patients returned to work. For the psychological patient factors, we found that increases of 1 point on the items of worrying about carpal tunnel syndrome and having faith preoperatively in a beneficial effect of the CTR surgery were associated with hazard ratios of 0.92 (95% confidence interval, 0.88–0.96) and 1.10 (95% confidence interval, 1.02–1.19), respectively, for returning to work in the first 6 months after surgery. An increase of 1 point on the depression subscale of the Patient Health Questionnaire was associated with a hazard ratio of 0.88 (95% confidence interval, 0.78–0.99) for returning to work in the first 6 months after surgery. Conclusions Our study showed that multiple psychological patient factors are associated with return to work after a CTR surgery. Addressing these psychological factors before surgery might be a low-cost intervention to improve return to work after the CTR surgery. Type of study/level of evidence Prognostic II.

The article provides data on the current epidemiological situation on the incidence of echinococcosis in residents of Bishkek, Kyrgyz Republic (KR). The long-term dynamics of the incidence of echinococcosis for the period 2000 - 2020 has been analyzed. According to official data, the incidence has decreased, if in 2000 the PI was 15,1, then in 2020 – 3,6. 2000 to 2020 the average long-term intensive indicator was 7,350 per 10 thousand population, the minimum – 3,6 per 10 thousand population (2020) and the maximum – 15,10 per 10 thousand population (2000). Key words: echinococcosis, alveococcosis (multi-chamber echinococcosis), retrospective analysis, epidemiological situation, morbidity, invasion, damage, Bishkek.

The aim of this study was to focus on the MRONJ-related pathologic fractures, their incidence, and to analyze possible causative factors for their occurrence. Pathologic fracture in patients suffering frm MRONJ were identified, examined in detail, and the patient characteristics were evaluated. In 116 patients (73 female and 43 male; mean age 62.08 ± 13.6 years), pathologic fracture incidence was found to be 4.31%. Zoledronic acid was the most commonly used anti-resorptive drug (77.8%). Median antiresorptive usage was 24 months. Five patients had pathologic fractures in the mandible. Four fracture patients had metastatic prostate cancer, and one had metastatic renal cell cancer. This case series study can provide clinical insight into which factors are associated with pathologic fractures. Cancer type, medical comorbidities, additive toxicity of the combination of antiresorptive and antiangiogenic drugs, specific pathogens, and dento-alveolar surgical procedures may be some of the important factors that need to be considered. Since MRONJ-related pathologic fracture management can be complicated, it may be good to focus on the causative factors and prevent occurrence with regular follow-up as often as possible in line with these factors.

OBJECTIVES Surgery is the standard treatment in early-stage non-small-cell lung cancer and select cases of small-cell lung cancer, but gender differences in its use and outcome are poorly known. Gender differences in surgical resection rates and long-term survival after lung cancer surgery were therefore investigated. METHODS In Finland, 3524 patients underwent resection for primary lung cancer during 2004–2014. Surgical rate and mortality data were retrospectively retrieved from 3 nationwide compulsory registries. Survival was studied by comparing propensity-matched cohorts. Median follow-up was 8.6 years. RESULTS Surgery rate was higher in women (15.9% vs 12.3% in men, P CONCLUSIONS Surgery is performed for lung cancer more often in women. Women have more favourable short- and long-term outcome after lung cancer surgery. Gender discrepancy in survival continues to increase beyond the first year after surgery.

The toxic effect of the aqueous extract of the bark of the root of Morinda morindoides was studied in 24 sexually matured, male Wistar rats weighing between 150-200g. The rats were randomly divided into four groups (I-IV). Rats in groups I, II and III received 400 mg/kg, 800 mg/kg and I,600 mg/kg of 50mg/ml of the aqueous extract respectively once daily for 28 days while the control group (Group IV) was given distilled water (5ml/kg) once daily for 28 days after which the rats were euthanized. Following euthanasia, about 3 ml of blood was collected and was divided into 1.5ml each for haematology and serum chemistry. In addition, samples of the kidney, liver, heart, lungs and spleen were also harvested for histopathology. Haematological and serum biochemical values were expressed as mean ± standard error of mean and were analyzed using One-way Analysis of Variance (ANOVA) followed by Duncan’s multiple range test. Lesions observed in histopathology were scored as mild, moderate or severe. Results were considered statistically significant at 95% confidence interval (P

Ticks are important to the Nigerian livestock industry because of their ability to cause huge economic loss directly or indirectly. Chemical acaricides have played important roles in control of tick infestation for many years but development of acaricide resistance as being reported worldwide is a huge problem facing the livestock industry and the veterinarians. Thus, this study evaluated the efficacy of available commercial acaricides on Rhipicephalus (Boophilus) annulatus. Using Adult Immersion Test (AIT): the LC50, inhibition of oviposition, control and resistance rates, gradation of tarsal reflexes were determined for ticks treated with different acaricides at five different concentrations the discriminating dose (DD) (the manufacturer’s recommended dose) and four other different concentrations of two below and two above the DD with the aid of prohibit regression. The association between weight and number of eggs laid was analyzed by linear correlation. Macrocyclic lactone(66.7%), Phenylpyrazole (62.5%), Cypermethrin (62.5%), Formamidine(33.3%) and Phenylpyrazole(13% egg production), Macrocyclic lactone (18% egg production), Cypermethrin(20% egg production), Formamidine(49% egg production) have the highest to lowest percentage control and oviposition inhibition values respectively. The LC50 of (Formamidine), (Phenylpyrazole), (Synthetic pyrethroids), (Macrocyclic lactone) against adult R. (B.) annulatus were 100, 8000, 2300 and 6000ppm respectively.The demonstration of acaricide resistancedevelopmentas demonstrated by the ticks in laying of eggs after dipping in acaricideis a call to the need for discovery and use of alternative tick control methods with good therapeutic dose and the need for continuous evaluation of available acaricide.

Objectives: Previous data on the trends of surgical treatment of vesicoureteral reflux outside USA are scarce. The aim of this study was to clarify the national trends of operative treatment of vesicoureteral reflux (VUR) in Finland. Methods: We analyzed national data from Finnish Care Register for Health Care on children ( Results: Endoscopic injections of the ureteral orifices were primarily performed for 1212 and open ureteral reimplantation for 272 children. The use of both types of surgery decreased during the study period (p = 0.0043 and p

Background: Diabetes mellitus is a global health problem leading to an increase in the search for herbal normoglycaemic agents as alternative to the synthetic ones. Aqueous extract of Parkia biglobosa leaves was assessed for normoglycaemic effects in alloxan-induced diabetic rats. The study aim at providing scientific evidence to authenticate the traditional use of Parkia biglobosa leaves in the treatment of diabetes. Methodology: The plant was extracted using aqueous to obtain Parkia biglobosa Leaf Extract (PbLE), qualitative phytochemical analysis was determined using standard methods. Diabetes was induced in albino rats by intraperitoneal injection of 5% solution of alloxan (150 mg/kg bw). The rats were grouped into 5 groups (A, B, C, D and E) of 5 animals each. Group A consisted of non-diabetic rats which served as the control, Group B consisted of diabetic rats that were left untreated and served as negative control, Group C were given glucophage (reference) at a dose level of 7 mg/kg bw, Groups D and E were administered PbLE at the doses of 250 and 500 mg/kg bw respectively. Results: The glucose levels in the blood of rats were checked with a glucometer using the blood from the tail of the rats. Serum (proteins, lipid profiles, urea and creatinine), ALT, AST and ALP were all determined using standard procedures. The extract and the glucophage reduced the blood glucose level significantly (p < 0.05) from day 3 till the termination of the experiment. Conclusion: Aqueous extract of Parkia biglobosa leaves possess antidiabetic activity and also the extract is relatively safe. Hence the leaves of Parkia biglobosa can be explored in producing alternative antidiabetic drugs.

Background Data on the epidemiology and prognosis of Wilson's disease are scarce, and no clinical data are available from Finland. Methods All persons diagnosed and treated for Wilson's disease in Finnish hospitals in 1998 to 2017 were identified. Data were collected from national registries and patient charts. Results The point prevalence was 0.45/100,000 (95% confidence interval, 0.29-0.67) on December 31, 2017, but no more than 0.35/100,000 (95% confidence interval, 0.21-0.55) among native Finns. Annual incidence was 0.016/100,000 (95% confidence interval, 0.0093-0.026). Median age at diagnosis was 15.8 years (interquartile range, 8.3-32.2; range, 3.8-48.1 years). Upon presentation, liver damage was observed in 58%, neurological signs and symptoms (most often tremor and dysarthria) in 40%, and 32% of patients were asymptomatic. Patients had poorer long-term survival (hazard ratio, 2.92 for death; P = 0.005) compared with matched controls. Conclusions Wilson's disease is very rare in Finland. Patients have an increased risk of death indicating an unmet treatment need. © 2020 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Background The use of biologic prosthesis is increasing in surgical aortic valve replacement (SAVR). Recent US guidelines recommend either biologic or mechanical prosthesis for SAVR in patients aged 50 to 70 years. We set out to study long-term outcomes of mechanical versus biologic prosthetic valves in this patient group. Methods All patients (excluding infective endocarditis and concomitant surgery other than coronary artery bypass grafting) aged 50 to 70 with first-time SAVR in Finland between 2004 and 2014 were retrospectively studied (N = 2928). Propensity score matching (1:1) was used to identify patients with comparable baseline features (n = 1152). Outcomes were 10-year all-cause mortality, aortic valve reoperation, major bleeding, ischemic stroke, and infective endocarditis. Mean follow-up was 6.7 years. Results Ten-year all-cause mortality was 18.6% with mechanical valves and 27.6% with biologic valves (hazard ratio [HR], 0.72; 95% confidence interval [CI], 0.54-0.97; P = .028). Prosthetic valve reoperation was performed in 1.4% with mechanical valves and in 8.5% with bioprosthetic valves (HR, 0.30; 95% CI, 0.12-0.74; P = .009). Major bleeding occurred in 21.5% with mechanical valves and in 16.9% with biologic prostheses (HR, 1.19; P = .402). Rates of intracranial bleeding were also comparable. Ischemic stroke rates within 10 years were 12.7% with mechanical valves and 9.3% with biologic valves (HR, 1.29; P = .316). Infective endocarditis occurred in 3.7% of mechanical valves and in 7.3% of biologic valves (HR, 0.46; 95% CI, 0.24-0.88; P = .018). Conclusions Mechanical valve prostheses were associated with lower mortality, lower rates of reoperation, and lower occurrence of infective endocarditis compared with bioprostheses within 10 years after SAVR in matched patients aged 50 to 70 years. Our results do not support the routine use of biologic valve prostheses in this patient group.

PURPOSE OF THE STUDY The hyperacute care of ischemic stroke has evolved markedly. It is unclear to which level stroke centre patients should primarily be taken so information of intravenous thrombolysis (IVT) outcomes in smaller centres are needed. METHODS All IVT episodes in North Karelia Central hospital in 2016-2017 were analysed retrospectively using hospital registries and individual medical records. RESULTS IVT had been given to 75 patients (47% women) whose median age was 74 years [IQR 64, 81; no gender difference (p = 0.70)]. Median NIHSS on admission was 6 (IQR 4, 10) and onset-to-treatment time (OTT) 125 min (95% CI 112-138 min). Two intracranial bleeding complications were observed. Clinical status improved following IVT and 53.4% were independent at six months (85% were independent before the stroke). In a multivariate analysis the NIHSS score was the only predictor (B = 0.12, R2=0.34, p = 0.0001) of modified Rankin Scale (mRS). Large-vessel occlusion (LVO) was identified in 27% (35% women). Their median mRS was 2.0 (25% had died). Endovascular thrombectomy had followed IVT in 30% of the LVO-patients. CONCLUSIONS IVT results were generally in this peripheral PSC-level hospital without advanced imaging capabilities, but LVO outcomes need improvement. A mothership strategy should be evaluated.

Genitourinary fistulas usually have devastating consequences on a woman's reproductive health. vesicouterine fistulae though uncommon variant of genitourinary fistula, are usually due to iatrogenic etiologies. The case reported was diagnosed after second caesarean section when she was being evaluated for secondary infertility. Keywords: Youseff 'syndrome, Amenorrhea, Caesarean Section, Fistula

At the present stage, the problem of the association of common rheumatic diseases, such as rheumatoid arthritis, osteoarthrosis and osteoporosis with diabetes mellitus, is relevant. To date, there is no single view on the role of biochemical and immunological factors that cause joint damage in conditions of comorbidity. The aim of thestudy was to evaluate the biochemical rheumatological parameters in patients with type 1 and type 2 diabetes with diabetesassociated osteoarthritis. Material and methods. The study involved 105 patients who were divided into groups by type of diabetes, the presence and severity of diabetic arthropathy. Patients were diagnosed with arthropathy using ultrasound of the joints, rheumatic tests were determined by immunoturbodimetric method. Results. In the group of patients with type 1 diabetes, arthropathy was found in 64.4% of patients, in the group of patients with type 2 diabetes — in 80.0% (t=1.8; p=0.07). Patients with arthropathy revealed a direct correlation between the stages of arthropathy and the factors «antistreptolysin» (r=0.33; p

Introduction: Mental illness in a family member can be a huge burden and problematic on the care givers and family. The study was conducted with the aim of assessing the psychological distress and caregiver burden among care givers of schizophrenia patients. Materials and Methods: In this cross-sectional study, detailed history, relevant sociodemographic details, clinical and psychological assessment findings were documented in a structured proforma in all the subjects. Burden assessment schedule (BAS) was administered to assess caregiver burden, Self-reporting questionnaire 20 (SRQ 20) to assess psychological distress among the caregivers and Positive and Negative symptom scale (PANSS) for severity of symptoms in schizophrenic patients. Results: A total of 40 subjects were included in the study. The mean age of the study population was 44.08 ± 12.12, 12(30%) participants were males and 28(70%) were females. The mean total caregiving time of study population was 7.63 ± 2.37 with the range 3 to 12 hours/days. 15 caregivers (37.50%) had psychological distress, and 25(62.50%) had no psychological distress. On univariate analysis, age, caregiver burden, total caregiving time (hours/day), negative symptoms and total PANSS score were found to be significantly associated with psychological distress among caregivers. After adjusting for the effect of other variables in the equation, it was found that the odds of psychological distress increased 1.09 times (95% CI 1.108 to 1.186, P value 0.015) with one unit increase in severity of caregiver burden. Conclusion: The most important predictive factor of psychological distress in caregivers was the severity caregiving burden. Keywords: Family, Caregivers, Psychological stress, Schizophrenia.

Cases of PML should be evaluated according to predisposing factors, as these subgroups differ by incidence rate, clinical course, and prognosis. The three most significant groups at risk of PML are patients with hematological malignancies mostly previously treated with immunotherapies but also untreated, patients with HIV infection, and patients using monoclonal antibody (mAb) treatments. Epidemiological data is scarce and partly conflicting, but the distribution of the subgroups appears to have changed. While there is no specific anti-JCPyV treatment, restoration of the immune function is the most effective approach to PML treatment. Research is warranted to determine whether immune checkpoint inhibitors could benefit certain PML subgroups. There are no systematic national or international records of PML diagnoses or a risk stratification algorithm, except for MS patients receiving natalizumab (NTZ). These are needed to improve PML risk assessment and to tailor better prevention strategies.

Background Biologic prostheses are preferred for surgical aortic valve replacement (SAVR) in patients more than 70 years of age in clinical practice. This study investigated differences in long-term outcomes between SAVR-treated patients more than 70 years of age who received mechanical or biologic prosthetic valves. Methods All patients (excluding those with endocarditis) who were more than 70 years of age and who underwent isolated first-time SAVR (with or without coronary artery bypass grafting) in Finland between 2004 and 2014 were retrospectively studied (n = 4227). Propensity score matching (1:3) was used to account for baseline differences (n = 296 with mechanical prostheses and n = 888 with biologic prostheses). Outcomes were 10-year survival, major bleeding (all, gastrointestinal, intracranial), ischemic stroke, infective endocarditis, and aortic valve reoperation. Mean age was 75.8 years, and mean follow-up was 8.3 years. Results Survival at 10 years was 46.1% with mechanical prostheses and 57.8% with biologic prostheses (hazard ratio [HR], 1.48; 95% confidence interval [CI], 1.21 to 1.80; P Conclusions Mechanical aortic valve prosthesis is associated with worse long-term survival and increased bleeding after SAVR in patients more than 70 years old. The study results suggest caution when considering mechanical aortic valve prostheses in elderly patients.

Aims: To assess the family functioning and identify its determinants among adult PLWHA at Bowen University Teaching Hospital, Ogbomoso. Study Design: The study is a descriptive cross-sectional study. Place and Duration of the Study: The study was conducted in the Antiretroviral (ARV) Clinic of the Bowen University Teaching Hospital, Ogbomoso, Nigeria from January 2014 to March 2014. Methodology: Sixty-one HIV-infected patients aged 18 years and older were selected using the systematic random sampling. Data were collected using a pre-tested, structured, researcher-administered questionnaire which had a section on respondents’ socio-demographic characteristics and incorporated the General Functioning scale of the Family Assessment Device to assess their family functioning. The data were analysed using SPSS and presented as descriptive and inferential statistics. Results: The mean age of the 61 respondents was 37.1±8.1 years and 43 (70.5%) of them were females. Most of the respondents were married (65.6%) and the proportion of those with primary education (37.7%) was highest. A mean General Functioning (GF) score of 1.8±0.6 indicated an overall healthy family functioning. The proportion of respondents with healthy family functioning was highest for the married among all marital categories and decreased with increasing level of education. These associations of marital status and level of education with family functioning were statistically significant (P = 0.02 and 0.04, respectively) based on the result of Fisher’s exact test. Conclusion: The fact that larger proportions of the respondents were married and had low education level was found to have influenced the finding of a high rate of healthy family functioning in this study. Therefore, regular family functioning assessment as part of routine evaluation of PLWHA is suggested, and interventions that can temper the dysfunctional influences of formal education on family functioning should be incorporated into HIV/AIDS care.

OBJECTIVES Few population-based studies reporting trends in oesophageal cancer surgery exist. The aim of this study was to assess the incidence of oesophageal cancer, changes in resection rates, patient demographics and short- and long-term outcomes of oesophagectomy at the population level in Finland. METHODS All Finnish patients diagnosed with cancer of the oesophagus or gastrooesophageal junction between 1 January 2004 and 31 December 2014 identified from the nationwide registries were included. The follow-up ended on 31 December 2016. For evaluation of changes in demographics and treatment, data were divided into 2 periods: 2004–2009 and 2010–2014. For comparison of short-and long-term outcomes, adjustments for age, sex, comorbidity, tumour stage and histology were used. RESULTS The number of diagnosed oesophageal cancers was 4266. Of these, 740 underwent oesophagectomy. Resection rate increased from 15.2% in 2004–2009 to 19.6% in 2010–2014. The median number of oesophagectomies in Finnish hospitals increased from 1.9 to 3.7 per hospital per year. At the same time, minimally invasive surgery became more common (6.3% vs 35.1%, P CONCLUSIONS This nationwide population-based study demonstrates an increase in resection rate, use of neoadjuvant treatment and minimally invasive surgery together with an improvement in long-term outcome after oesophageal cancer surgery.

Fasciola, Fascioloides, and Dicrocoelium cause liver fluke diseases in ruminants and are of zoonotic and economic importance. This cross-sectional study aimed to determine the prevalence of liver fluke egg infection in White Fulani Cattle slaughtered in Wukari Cattle market abattoir in Wukari, Taraba State. A total of 262 gallbladders were collected and their contents were analyzed for the presence of eggs of liver flukes using sedimentation technique. Descriptive analysis was done using SPSS version 20 for window and Pearson’s Chi-Square (χ2) was used to evaluate the association between variables. Fasciola and Dicrocoelium eggs were encountered. Only 74 (28.2%) samples were positive for Fasciola egg and 211 (80.5%) for Dicrocoelium. The prevalence of liver fluke infection revealed 25% and 28.6% Fasciola eggs for male and female animals, respectively, while lancet fluke had 83.3% for male and 80.3% for female. Fasciola eggs were recovered in 20.8% of animals aged less 3 years ( Dicrocoelium eggs. The body condition score-based prevalence for Fasciola yielded 38.1%, 26.8%, and 14% for poor, average, and good, respectively, while Dicrocoelium yielded 85.7%, 79.3%, and 85.7%. There was a significant difference between the body condition scores for fasciolosis. Only 59% harboured single infection with eggs of Dicrocoelium (P< 0.05) while 6.9% harboured Fasciola eggs. Mixed infection associating Fasciola and Dicrocoelium was observed in 21.4% of the sample cattle. Liver fluke infections: fasciolosis and dicrocoeliosis occur among White Fulani cattle in Wukari and these infections are associated with the body condition score of the animals. This greatly affects the cattle production. There is a need to institute adequate control programmes complemented with good well-planned management practices in any production system involving cattle in Wukari.

Objective To investigate the long-term outcomes of coronary artery bypass grafting surgery (CABG) in patients with rheumatoid arthritis (RA). Methods Patients with RA (n = 378) were retrospectively compared to patients without RA (n = 7560), all treated with CABG in a multicentre, population-based cohort register study in Finland. The outcomes were studied with propensity score-matching adjustment for baseline features. The median follow-up was 9.7 years. Results Diagnosis of RA was associated with an increased risk of mortality after CABG compared to patients without RA (HR 1.50; CI 1.28-1.77; p < .0001). In addition, patients with RA were in higher risk of myocardial infarction during the follow-up period (HR 1.61; CI 1.28-2.04; p < .0001). Cumulative rate of repeated revascularization after CABG was 14.4% in RA patients and 12.0% in control patients (p = .060). Duration of RA before CABG (p = .011) and preoperative corticosteroid usage in RA (p = .041) were independently associated with higher mortality after CABG. There were no differences between the study groups in 30-d mortality or in the post-operative usage of cardiovascular medications. Conclusions RA is independently associated with worse prognosis in coronary artery disease treated with CABG. Preoperative corticosteroid use and longer RA disease duration are additional risk factors for mortality. Key messages Patients with rheumatoid arthritis (RA) have impaired long-term outcomes after coronary artery bypass surgery (CABG). Glucocorticoid use before CABG and duration of RA are associated with higher mortality. Special attention should be paid in secondary prevention of cardiovascular disease in RA patients after CABG.

Infective endocarditis (IE) is associated with high mortality. However, data on factors associated with length of stay (LOS) in hospital due to IE are scarce. In addition, long-term mortality of more than 1 year is inadequately known. In this large population-based study we investigated age and sex differences, temporal trends, and factors affecting the LOS in patients with IE and in-hospital, 1-year, 5-year and 10-year mortality of IE. Data on patients (≥18 years of age) admitted to hospital due to IE in Finland during 2005–2014 were collected retrospectively from nationwide obligatory registries. We included 2166 patients in our study. Of the patients 67.8% were men. Women were older than men (mean age 63.3 vs. 59.5, p

We investigated the association between the widening of a nationwide restaurant smoking ban, enacted on 1 June 2007, and stroke admissions. All acute stroke admissions between 1 May 2005 and 30 June 2009 were retrieved from a mandatory registry covering mainland Finland. Patients aged ≥18 years were included. One annual admission per patient was included. Negative binomial regression accounting for the at-risk population was applied. We found no difference in stroke occurrence before and after the smoking ban within 7 days (p = 0.217), 30 days (p = 0.176), or the whole study period (p = 0.998). Results were comparable for all stroke subtypes (ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage). There was no sign of decreased occurrence in June 2007 compared to June in 2005–2006, and all subtypes of stroke occurred at least as frequently in both May and June of 2008 as in May and June of 2007. In conclusion, the nationwide restaurant smoking ban Finland enacted in June 2007 was not associated with any immediate reduction in stroke occurrence.

Background Case-fatality of Intracerebral hemorrhage (ICH) has been reported to have improved in some areas recently. Previous reports have shown that in Finland ICH survival has improved already from the 1980s. We aimed to investigate if this trend has continued and to assess possible predictors for death. Methods All patients hospitalized for ICH in Finland in 2004–2018 over 16 years of age were identified from a national registry. Survival was analyzed using the national causes of death registry with median follow-up of 5.1 years (max 15.0 years). Results 20,391 persons with ICH (53.5% men) were identified. Patient age increased during the study period with men being younger than women. One-month case-fatality was 28.4% and decreased during the study period. One-month and long-term case-fatality increased with patient age. Five-year survival was over 64% in patients 75 years of age. In a multivariate analysis patient age, sex, comorbidity burden and diagnoses of atrial fibrillation, hypertension and coagulopathy were all independently associated with both 30-day and long-term survival. Survival was better in men than women at all time points but in the multivariate analysis male sex was associated with a slightly higher risk (hazard ratio 1.10, 95% CI 1.06–1.14) of death in the long-term follow-up. Compared to general population, excess case-fatality was high and highly age-dependent in both sexes. Conclusions Case-fatality of hospital-treated ICH has continued to decrease in Finland. Prognosis is strongly associated with patient age and more modestly with patient sex and comorbidities.

A study of environmental attributes of HIV/AIDS affected households in Ijesa region, Nigeria (N = 297). Data from both primary and secondary sources were used to establish the relationship between socio-economic and environmental characteristics at different rural community zones; namely traditional core, post traditional and contemporary. There were more female HIV/AIDS patients, located in traditional core zones (78.1%) with high house density, living in shared apartments where residents shared sleeping and bath/toilet rooms. Thus, rape was significantly associated with the design and habitation density of households. In addition, widowhood, young age, informal education, menial jobs and unemployment of patients did not correlate with most environmental variables related to HIV/AIDS in contemporary zone compared with traditional zone. However, wealth status and quality education in relation to good housing environment and decent house density were significant in contemporary zone respectively. The study concluded that policies on HIV/AIDS prevalence at rural community level should focus more on high density areas having poor socio-economic and environmental characteristics.

Este artículo se encuentra disponible en la página web de la revista en la siguiente URL: https://www.mdpi.com/2076-0817/10/7/899 Este artículo pertenece al número especial "Emerging and Neglected Viruses and Zoonoses". West Nile virus (WNV) is an emerging and re-emerging zoonotic flavivirus first identified in and endemic to Africa. The virus is transmitted between birds by biting mosquitoes, with equids and humans being incidental hosts. The majority of infected incidental hosts display no or only mild clinical signs, but a fraction develop encephalitis. The aim of this scoping review was to identify and evaluate primary research on the presence of antibodies to WNV among African equids. Three bibliographic databases and the grey literature were searched. Of 283 articles identified, only 16 satisfied all the inclusion criteria. Data were collated on study design and outcomes. The overall seroprevalence reported ranged from 17.4 to 90.3%, with 1998 (35%) of the 5746 horses, donkeys and mules having screened positive for WNV antibodies. Several articles determined that seroprevalence increased significantly with age. Due to co-circulation of other flaviviruses in Africa, in the majority of studies that screened samples by ELISA, positive results were confirmed using a more specific neutralization test. However, only eight studies tested against other flaviviruses, including Potiskum, Uganda S, Wesselsbron and yellow fever virus in one, Japanese encephalitis and Usutu virus (USUV) in one, tick-borne encephalitis and USUV in one and USUV only in three. Equids are regarded as useful sentinel animals for WNV, but variation in study design poses challenges when trying to determine risk factors for, and trends in, WNV seroprevalence.

BACKGROUND The transition to dolutegravir-containing antiretroviral therapy (ART) in low- and middle-income countries (LMICs) was complicated by an initial safety signal in May 2018 suggesting that exposure to dolutegravir at conception was possibly associated with infant neural tube defects. On the basis of additional evidence, in July 2019, the World Health Organization recommended dolutegravir for all adults and adolescents living with HIV. OBJECTIVE To describe dolutegravir uptake and disparities by sex and age group in LMICs. DESIGN Observational cohort study. SETTING 87 sites that began using dolutegravir in 11 LMICs in the Asia-Pacific; Caribbean, Central and South America network for HIV epidemiology (CCASAnet); and sub-Saharan African regions of the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. PATIENTS 134��672 patients aged 16 years or older who received HIV care from January 2017 through March 2020. MEASUREMENTS Sex, age group, and dolutegravir uptake (that is, newly initiating ART with dolutegravir or switching to dolutegravir from another regimen). RESULTS Differences in dolutegravir uptake among females of reproductive age (16 to 49 years) emerged after the safety signal. By the end of follow-up, the cumulative incidence of dolutegravir uptake among females 16 to 49 years old was 29.4% (95% CI, 29.0% to 29.7%) compared with 57.7% (CI, 57.2% to 58.3%) among males 16 to 49 years old. This disparity was greater in countries that began implementing dolutegravir before the safety signal and initially had highly restrictive policies versus countries with a later rollout. Dolutegravir uptake was similar among females and males aged 50 years or older. LIMITATION Follow-up was limited to 6 to 8 months after international guidelines recommended expanding access to dolutegravir. CONCLUSION Substantial disparities in dolutegravir uptake affecting females of reproductive age through early 2020 are documented. Although this disparity was anticipated because of country-level restrictions on access, the results highlight its extent and initial persistence. PRIMARY FUNDING SOURCE National Institutes of Health.

Background Alemtuzumab is an effective disease-modifying therapy (DMT) for highly active multiple sclerosis (MS). However, safety concerns limit its use in clinical practice. Objectives To evaluate the safety of alemtuzumab in a nationwide cohort of Finnish MS patients. Methods In this retrospective case series study, we analyzed the data of all but two MS patients who had received alemtuzumab in Finland until 2019. Data were systematically collected from patient files. Results Altogether 121 patients were identified, most of whom had received previous DMTs (82.6%). Median follow-up time after treatment initiation was 30.3 months and exceeded 24 months in 78 patients. Infusion-associated reactions (IARs) were observed in 84.3%, 57.3%, and 57.1% of patients during alemtuzumab courses 1–3, respectively. Serious adverse events (SAEs) were observed in 32.2% of patients, serious IARs in 12.4% of patients, and SAEs other than IARs in 23.1% of patients. Autoimmune adverse events were observed in 30.6% of patients. One patient died of hemophagocytic lymphohistiocytosis, and one patient died of pneumonia. A previously unreported case of thrombotic thrombocytopenic purpura was documented. Conclusions SAEs were more frequent in the present cohort than in previous studies. Even though alemtuzumab is a highly effective therapy for MS, vigorous monitoring with a long enough follow-up time is advised.

Background and Purpose: Epidemiology of cerebral venous thrombosis (CVT) has been reported to be changing. Because long-term nationwide data are needed to confirm this, we studied CVT occurrence between 2005 and 2014 in Finland. Methods: All acute CVT admissions were retrieved from a mandatory registry covering mainland Finland. Patients aged ≥18 years were included. One admission per patient was allowed. Results: We identified 563 patients with CVT (56.5% women). Overall incidence was 1.32/100 000 (95% CI, 1.21–1.43) per year with a 5.0% annual increase. In people Conclusions: Overall incidence of CVT in Finland was similar to that reported in the Netherlands and in Australia. There was a 5.0% yearly increase in the rate of admissions while in-hospital mortality was low. Sex-specific incidence rates differed markedly between younger and older people. Long-term mortality increased with age and was higher in men.

BACKGROUND We wanted to investigate the influence of native-valve infective endocarditis (IE) on long-term outcomes of surgical aortic valve replacement (SAVR). METHODS Native-valve patients with IE (n = 191) were compared to propensity score-matched patients without IE (n = 191), all treated with SAVR, in a multicentre, population-based cohort register study in Finland. The median follow-up was 6.2 years. RESULTS Infective endocarditis as the indication for SAVR was associated with an increased hazard of 10-year mortality (37.1% vs 24.2%; HR 1.83; CI 1.03-3.26; P = .039). Ischaemic stroke was also more frequent in IE patients during 10-year follow-up (15.8% vs 7.5%; HR 3.80; CI 1.42-10.18; P = .008). Major bleeding within first year after SAVR was more frequent in patients with IE (7.0% vs 2.9%; P = .038). Ten-year major bleeding rate was 32.4% in IE vs 24.5% in non-IE groups (P = .174). Aortic valve re-operation rate was 4.3% in IE vs 8.4% in non-IE groups (P = .975). Admission duration after SAVR was longer in IE (median 29 vs 9 days; P

The objectives of this study were to investigate the outcome differences between ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) patients treated with coronary artery bypass grafting surgery (CABG). We conducted a multicenter, retrospective cohort follow-up study of consecutive patients with STEMI (surgery ≤48 hours of admission; n = 348) or NSTEMI (n = 1,160) revascularized with first-time isolated CABG in Finland using nationwide registries (median age 68 years, 24% women). The short- and long-term (10-year) outcomes were studied with inverse propensity probability weight adjustment for baseline features. The median follow-up was 5.2 years. In-hospital mortality (11.4% vs 5.3%; adj. odds ratio [OR] 2.27; confidence interval [CI] 1.41 to 3.66; p = 0.001) and re-sternotomy rates (6.9% vs 3.5%; adj. OR 2.07; CI 1.22 to 3.51; p = 0.007) were higher in STEMI patients. Long-term all-cause mortality did not differ between STEMI and NSTEMI patients among all operated patients (30.2% vs 28.3%; adj. HR 1.30; CI 0.97 to 1.75; p = 0.080) or hospital survivors (21.6 vs 24.3%; HR 0.93; CI 0.64 to 1.36; p = 0.713). Occurrence of major adverse cardiovascular event in hospital survivors within 10 years was 34.7% in STEMI versus 29.6% in NSTEMI (adj. HR 1.24; CI 0.88 to 1.76; p = 0.220). Occurrences of cardiovascular death (14.6% vs 14.4%; p = 0.773), myocardial infarction (MI; 15.2% vs 10.3%; p = 0.203), and stroke (10.8% vs 14.8%; p = 0.242) were also comparable. In conclusion, patients with STEMI have poorer short-term outcome compared to NSTEMI patients after revascularization by CABG, but the long-term outcomes are comparable regardless of MI type. Thus, both short- and long-term risks should be considered when evaluating patient´s for CABG eligibility by MI type.

Objectives Studies on the east-west gradient of multiple sclerosis (MS) are scarce. In Finland, epidemiological differences have been only partially elucidated, but the MS risk is high, and it has been claimed that the occurrence follows a longitudinal gradient. In this register-based study, we updated the MS epidemiology in southwest Finland (SwF) and compared it to the easternmost hospital district, North Karelia (NK), for which no previous data exist. Materials and methods Patients with ICD-10 code G35 were identified from hospital district administrative data. Patient records were reviewed to include only cases with a definitive diagnosis. Incidence period covered 5 years (2012-2016), and the prevalence date was December 31, 2016. Results were standardized using the direct method. Results A total of 1184 persons had MS in SwF and 253 persons in NK at the end of 2016. The prevalence was 280/100 000 (95% CI 264-296) in SwF and 168/100 000 (95% CI 148-190) in NK (age-standardized for the European standard population 2013). During the incidence period, 211 new MS diagnoses were made in SwF and 49 in NK. The annual age-standardized (ESP 2013) incidence was 12.1/100 000 person-years (95% CI 10.5-13.8) in SwF and 8.6/100 000 person-years (95% CI 6.4-11.2) in NK in the age-group 10-69 years. Conclusions There are regional differences in MS epidemiology in Finland, possibly related to demographic, social, and genetic circumstances, but the retrospective nature and limited sample size of this study might introduce some uncertainty to the calculations. SwF is a region with a globally very high risk for MS.

Objective To investigate if progressive multifocal leucoencephalopathy (PML) incidence has increased in Finland like in the neighbouring Sweden. Methods National administrative registries were searched for all PML admissions aged 16 years or more in 2004–2014 on all neurological and internal medicine wards in Finland. The mortality data of the patients was extracted from the national causes of death registry. National level data on annual predisposing drug use was obtained from the national pharmaceutical authority. Results We identified 35 PML cases (57% male) with a peak in 2010–2011 that amounted to 49% of all cases. The annual incidence for the entire study period was 0.072/100,000 person-years (95% CI 0.050–0.10) with no temporal trend (p = 0.18). Mean age was 57 years (22–88 years) with no sex difference (p = 0.42). Neoplasms (60%), HIV infection (17%) and systemic connective tissue disorders (CTD, 14%) were the most common predisposing conditions. MS was recorded in three cases (9%). The national level use of drugs that predispose to PML increased during the study period, with the exceptions of alemtuzumab and fludarabine. Overall survival was 85% at 90 days, 79% at 1 year, and 66% at 5 years. Survival was worst in patients with malignancy and best in patients with CTD. Conclusions PML most often occurs in patients with malignancies and patients with HIV or CTD cover a third. PML incidence in Finland is lower than in Sweden and shows no temporal trend despite increasing use of predisposing drugs. Mortality after PML varies according to the predisposing condition. Electronic supplementary material The online version of this article (10.1007/s00415-018-09167-y) contains supplementary material, which is available to authorized users.

Background Advances in the treatment of Parkinson's disease (PD) and changes in general life expectancy may have improved survival in patients with PD. Objective The objective of this study was to investigate recent trends in PD mortality. Methods In total, 1521 patients with PD in local and national registries were followed for 11 years (2006-2016) from diagnosis until exit date or death, and the causes of death were recorded. Results The survival of men with PD improved during the follow-up period, but no change was observed in women (2-year postdiagnosis survival in men, 79.0%-86.3%, P = 0.03; 2-year postdiagnosis survival in women, 82.8%-87.5%, P = 0.42). Pneumonia was the most common immediate cause of death. Discussion The survival of men with PD has improved in Finland without a similar change in women. Because changes in treatment likely affect both sexes similarly, the results may reflect the decreasing sex gap in life expectancy. This phenomenon will likely increase the already high male-to-female prevalence ratio of PD.