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Implications of artificial intelligence in inflammatory bowel disease: Diagnosis, prognosis and treatment follow up

Multifocal motor neuropathy (MMN) is a rare disease with a prevalence of less than 1 per 100,000 people. Intravenous immunoglobulin (IVIG) therapy, performed for a long-term period, has been demonstrated able to improve the clinical picture of MMN patients, ameliorating motor symptoms and/or preventing disease progression. Treatment with subcutaneous immunoglobulin (SCIg) has been shown to be as effective as IVIG. However, previously published data showed that follow-up of MMN patients in treatment with SCIg lasted no more than 56 months. We report herein the results of a long-term SCIg treatment follow up (up to 96 months) in a group of 8 MMN patients (6 M; 2F), previously stabilized with IVIG therapy. Clinical follow-up included the administration of Medical Research Council (MRC) sum-score, the Overall Neuropathy Limitation Scale (ONLS) and the Life Quality Index questionnaire (LQI) at baseline and then every 6 months. Once converted to SCIg, patients’ responsiveness was quite good. Strength and motor functions remained stable or even improved during this long-term follow-up with benefits on walking capability, resistance to physical efforts and ability in hand fine movements.

Background:The patient's follow-up is a significant challenge for managing psychiatric illness, especially psychotic disorders. Although many factors affect patients' clinical non-attendance with psychosis, the approach of patients and their families toward medication influences treatment follow up. The study evaluates the patient's and family's approach regarding OPD follow up and the effect of SMS reminder on OPD follow up of patients with psychosis. Methodology:This study was conducted on a psychotic patient attending OPD at Karwan e Hayat, Karachi. A total of 248 patients were randomly divided into two groups, the SMS reminder group and the treatment-as-usual or control group. Computer-based SMS to improve patient's follow-up was sent in Urdu and English to the SMS group. A total of four reminder messages were sent to the SMS group within 15 days of each clinical appointment over a period of 24-weeks, while no message was sent to the control group. Results:All patients (Intervention & Control groups) were divided further into two groups based on the caring family approach reflected through several follow-ups, including a poor follow up group with less than five visits and an appropriate follow-up group having five or more than five visits. The impact of SMS follow-up reminders on both groups was observed through OPD follow-ups. At baseline, all groups were comparable, but after a 3-month appropriate group of intervention were found with a significant (p=0.053) increase in the number of follow-ups compared to patients with poor follow-up groups. Conclusion:It is concluded from the study results that the SMS reminders are an effective intervention in those psychotic patients and families who have a positive approach to illness. Link:http://aeirc-edu.com/ojs14/index.php/IJEHSR/article/view/404/645

Improvement of breast cancer (BC) patient's outcome is directly related to early detection. However, there is still a lack of reliable biomarkers for diagnosis, prognosis and, treatment follow up in BC, leading researchers to study the potential of liquid biopsy based on circulating microRNAs (c-miRNAs). These c-miRNAs can be cell-free or associated with extracellular vesicles (EVs), and have great advantages such as stability in biofluids, noninvasive accessibility compared to current techniques (core-biopsy and surgery), and expression associated with pathogenic conditions. Recently, a new promising field of EV-derived miRNAs (EV-miRNAs) as cancer biomarkers has emerged, receiving special attention due to their selective vesicle sorting which makes them accurate for disease detection. In this review, we discuss new findings about c-miRNA and their potential as biomarkers for BC diagnosis, prognosis, and therapy. Additionally, we address the impact of limitations associated with the standardization of analysis techniques and methods on the implementation of these biomarkers in the clinical setting.

Background: Anterior Cruciate Ligament (ACL) reconstruction is a standard technique for treatment of patients with an ACL tear. According to clinical observations, lateral knee pain is highly associated with a teared ACL, this correlation so far has remained unnoticed in the literature. In this study, we aim to investigate the relationship of lateral knee pain with diagnosis of torn ACL.Methods: This pilot study was conducted on 30 candidates of ACL reconstruction. The participants underwent surgical reconstruction of ACL; Then Visual Analogue Scale (VAS) was used to measure pain at three time points of preoperative, first and second postoperative visits. Results: A total of 26 participants (86.7%) were male with a mean age of 27.3±5.06 years. The results demonstrated that the intensity of lateral knee pain felt by the subjects significantly diminished during subsequent postoperative referrals (P-value0.05). Conclusions: Lateral knee pain is likely related with anterior cruciate ligament tear and favors its diagnosis. Also, the evaluation of lateral knee pain may contribute in Anterior Cruciate Ligament reconstruction (ACLR) monitoring in the follow-up stage.

Background: Advanced Glycation End products (AGEs) are products of a non-enzymatic reaction between sugars and free amino groups of protein. They are one of several molecules that play a role in the pathogenesis of Rheumatoid Arthritis (RA). A soluble subtype of the receptor for advanced glycation end products (sRAGE) which can be measured in serum has been gaining interest for its contribution in RA.Aim of Study: The aim of this work is to assess the role of sRAGE in monitoring disease activity, disease treatment and follow-up.Subjects and Methods: This retrospective case-control study was conducted on (50) patients with rheumatoid arthritis (group 1) and their age and sex matching (30) healthy controls (group 2). All subjects recruited in our study were subjected to measurement of serum soluble subtype of the receptor for advanced glycation end products (sRAGE) by ELISA tech-nique.Results: Results of our study shows significant statistical decrease in serum sRAGE levels among different studied disease activity score 28 (DAS28) 28 grades (H:6.02, p 0.05).Conclusion: Serum sRAGE level is strongly related to the disease activity in rheumatoid arthritis with its serum levels being lower in active disease. Our study could not prove its role in disease treatment follow-up.

Background and Aims Osteoporosis in hemodialysed (HD) patients with Chronic Kidney Disease - Mineral Bone Disorder (CKD-MBD) is a debilitating clinical condition with complex therapeutic management. In fact, most of the drugs commonly used to counteract osteoporosis are generally contraindicated when Glomerular Filtration Rate (GFR) is lower than 30 ml/min. Denosumab (DMab) is a monoclonal antibody approved for the treatment of osteoporosis and does not require dose adjustment in case of impaired renal function. For this reason, since 2014 this drug has been used by nephrologists for the treatment of osteoporotic patients also in hemodialysis. Although the interest and diffusion in this specialized clinical field are growing, only few data are still available in literature. The aim of the study was to evaluate the efficacy and safety of denosumab in long-term therapies in hemodialysed patients. Method Since November 2013, a total of 19 hemodialysed patients have been treated with denosumab annually (4) or semi-annually (15) for up to 48 consecutive months. During the course of therapy, the laboratory parameters of osteo-mineral metabolism were monitored, and Qualitative UltraSonography (QUS) or Computerized Bone Mineralometry (CBM) were used alternatively, every 30 months and every 2 years, respectively (depending on guidelines recommendation for both radiological methods and timing). Results 7/19 patients completed at least 30 months of follow-up, observing a substantial stability of blood calcium and phosphorus values, against a reduction in the mean values of B-CrossLaps and ostase (respectively from 2975.32 to 1852.25 pg/ml and from 28.13 to 11.93 mcg/L). Comparison of QUS exams demonstrated improved T-score (-4.71 to -4.17) and reduced fracture risk (13% to 8%). The results of the CBMs confirmed the stability of the bone disease at the spine and the improvement of the Tscore at the femoral level (from -3.5 to -3). It should be noted that in our samples two patients achieved the longest observation period (48-month follow-up in continuous therapy), in which the stability of bone damage was observed at CBM compared to the start of treatment. Only one fracture has been recorded. Conclusion We underline that close biochemistry monitoring and careful evaluation of the therapeutic procedures before and after DMab administration helped us to minimise and promptly correct adverse effects due to hypocalcemia. In addition we are particularly satisfied to report in most patients a significant reduction of pain and an improvement of mobility. The results collected are consistent with acceptable safety and demonstrated efficacy of denosumab in hemodialysis patients.

Background Tuberculosis is the leading cause of infectious disease-related death, surpassing even the immunodeficiency virus. Treatment loss to follow up and irregular medication use contribute to persistent morbidity and mortality. This increases bacillus drug resistance and has a negative impact on disease control. Objective This study aims to develop a computational model that predicts the loss to follow up treatment in tuberculosis patients, thereby increasing treatment adherence and cure, reducing efforts regarding treatment relapses and decreasing disease spread. Methods This is a case-controlled study. Included in the data set were 103,846 tuberculosis cases from the state of Sao Paulo. They were collected using the TBWEB, an information system used as a tuberculosis treatment monitor, containing samples from 2006 to 2016. This set was later resampled into 6 segments with a 1-1 ratio. This ratio was used to avoid any bias during the model construction. Results The Classification and Regression Trees were used as the prediction model. Training and test sets accounted for 70% in the former and 30% in the latter of the tuberculosis cases. The model displayed an accuracy of 0.76, F-measure of 0.77, sensitivity of 0.80 and specificity of 0.71. The model emphasizes the relationship between several variables that had been identified in previous studies as related to patient cure or loss to follow up treatment in tuberculosis patients. Conclusion It was possible to construct a predictive model for loss to follow up treatment in tuberculosis patients using Classification and Regression Trees. Although the fact that the ideal predictive ability was not achieved, it seems reasonable to propose the use of Classification and Regression Trees models to predict likelihood of treatment follow up to support healthcare professionals in minimising the loss to follow up.

In vivo reflectance confocal microscopy (RCM) is a relatively novel noninvasive tool for real-time microscopic evaluation of the skin. The device is used prevalently for the diagnosis and management of skin tumor as melanoma and non-melanoma skin cancer.

Objective This study was performed to assess the changes in diameter of the superior mesenteric artery (SMA) in patients with spontaneous isolated SMA dissection (SISMAD) on nonenhanced multidetector computed tomography (MDCT) and determine the clinical value of follow-up MDCT after endovascular stent placement (ESP). Methods The diameters of the SMA and superior mesenteric vein (SMV) as measured on nonenhanced MDCT were compared between 20 patients with SISMAD and 20 control subjects. ESP was performed in 14 patients with SISMAD, and follow-up MDCT was performed after ESP. Results The mean diameter of the SMA in the SISMAD group and control group was 11.69 ± 1.26 and 7.10 ± 0.97 mm, respectively, with a statistically significant difference. The SMA diameters were even larger than the SMV diameters. Follow-up MDCT showed stent patency in 13 patients and occlusion in 1 patient. Conclusions An enlarged diameter of the SMA on nonenhanced MDCT is an important finding for diagnosis of SISMAD, and MDCT is a valuable follow-up method after ESP for SISMAD.

Obtaining long term stability allied to functional and aesthetic balance is the main goal of any orthodontic-orthopedic therapy. This case report describes the orthodontic therapy applied to a 7-year-9-month old child, who presented a Class II, division 1 malocclusion associated to skeletal open bite. Functional and skeletal corrections (sagittally and vertically) were obtained by means of mandible advancement achieved with a closed Balter’s bionator appliance followed by a fixed appliance. This approach showed to be efficient in accomplishing both functional and aesthetic goals, that were kept stable five years after the treatment was finished. This case report was presented to the Board of Directors of the Brazilian Board of Orthodontics and Facial Orthopedics (BBO), as partial requirement to becoming a Diplomate of the BBO.

Objective: This study was reduction of a bilateral mandibular fracture through the installation of dental implants with immediate loading, re-establishing the stomatognathic function of the patient. Case Report: A 58-year-old male patient seek the emergency room from hospital after suffering a motorcycle accident. After physical and imaging examinations was diagnosed with bilateral mandibular fracture. The treatment of choice, once the patient was edentulous, was the reduction and stabilization of the fracture with the installation of 5 dental implants with immediate loading. After 1 year of postoperative follow-up, the facial contour along with the occlusion were reestablished. Radiographically, it was found the proper placement of plates and screws with correct baseline realignment and maintenance of implant-supported prosthesis. Conclusion: In this case report with follow-up of 18 months, the functional prosthetic rehabilitation and immediate aesthetic with immediate loading system, after reduction and fixation of mandibular fractures proved to be a good treatment option.

Aim: Evaluating yearly distribution of Directly Observed Therapy(DOT) and DOT variations through years at registered tuberculosis (TB) patients. Method: Retrospective analysis of TB patients’ files who registered Ankara 3rd TB Dispensary between 2012-2018 (Video Observed Therapy -VOT- was implemented at Ankara TB Dispensaries in 2012). Findings: In 7 years, 812 patients were registered. During treatment follow up, 38 patients who had diagnosis other than TB, excluded from study. Mean age was 47 (13-93). 51% were males and 49% were pulmonary TB. 15/774 cases who diagnosed TB after death and didn’t get any TB treatment, were excluded from DOT data. Files of 759 patients analyzed for DOT; only 2 of them treated without direct observation. During treatment, 78% (593) of cases were observed by health care workers (HCWs). Localization of HCWs and DOT type were: 63% (372) at Family Health Centers (FHC), 23% (138) VOT by TB Dispensary staff, 7% (40) at 3rd TB Dispensary, 6% (34) at other health care facilities and 1% (9) HCW who visits patient at home. In January 2018, Ministery of Family and Social Policies funding was started for native TB patients who need economical support. First rule of MoFSP funding is getting TB treatment under observation of TB Dispensary staff. 13 TB cases of 2017 and 37 cases of 2018 got this money support. Result and conclusion: In 7 years, total percentage of HCW-DOT is high in our region. Although 2/3 of HCW-DOT were done at PHCs between 2012-2016; this percentage decreased in last two years, VOT is preferred more. Increased VOT percentage (from 12% to 56%) is related with both common smart cell phone usage and MoFSP support with devoted effort of our TB Dispensary staff.

We investigated the efficiency of leukocyte, C-reactive protein (CRP), procalcitonin (PCT), neutrophil / lymphocyte ratio (NLR), platelet / lymphocyte ratio (PLR) on the diagnosis, severity of the disease, and response to treatment in patients with pneumonia. Sixty patients who were treated with pneumonia were included. CURB-65 and PSI scores were evaluated. CRP, PCT, uric acid values, leukocyte, neutrophil, lymphocyte, platelet, NLR and PLR levels were measured at the 1st, 3rd and 7th days. There was a positive correlation between leucocyte, neutrophil, NLR, PCT and uric acid levels on the 1st day with CURB-65 score and PSI score. No correlation was found between the CURB-65 score and the PSI score, and CRP, platelet and PLR on the 1st day. Decrease in CRP, PCT, leukocyte, neutrophil and NLR levels and increase in the levels of lymphocytes and platelets were found to be statistically significant at the 3rd and 7th days of treatment. It was seen that NLR showed a significant correlation with PSI score, leukocyte, neutrophil, lymphocyte, CRP, PCT and uric acid. It was observed that PCT, which was frequently used in the detection severity of patients with pneumonia and in the treatment follow-up, was correlated with NLR and CRP. Although there was no significant relationship between CURB-65 and PSI scores and CRP, there was a significant relationship between NLR and these scores. Leukocyte, NLR, CRP and PCT were found to be very useful in the follow-up of treatment response. Considering that PCT causes a higher cost than other measurements, it is concluded that CRP and especially NLR which is cheaper and reproducible, can be preferred.

Introduction 18FDG PET-CT and cardiac MR (CMR) are described in the diagnosis of cardiac sarcoidosis (CS), each identifying different aspects of the disease. We compared PET-CT and CMR in the follow-up of patients with suspected CS. Methods 31 patients with proven extra-cardiac sarcoidosis and possible CS were identified from the local sarcoidosis registry. All had combined PET-CT and CMR on two occasions. Selected patients had not received immunosuppressants for at least 6 months before the initial combined study. 22 patients were treated with immunosuppressants for 3 months or longer. In 9, the clinician chose not to treat or the patient refused treatment. Follow-up PET-CT and CMR were done 102-770 days later (median 228). Results Significant myocardial FDG uptake was shown on visit 1 in 17 treated patients (myocardial SUVmax >3.6). Myocardial SUVmax fell significantly on follow-up (p Conclusion Myocardial FDG uptake in CS represents active inflammation. When treated, this resolved or regressed on follow up with an improvement in LVEF and FDG avid thoracic disease. There was no change in extent of LGE. Untreated patients showed no change.

There is an expanding research interest in high-grade gliomas because of their significant population burden and poor survival despite the extensive standard multimodal treatment. One of the obstacles is the lack of individualized monitoring of tumor characteristics and treatment response before, during and after treatment. We have developed a two-stage semi-automatic method to co-register MRI scans at different time points before and after surgical and adjuvant treatment of high-grade gliomas. This two-stage co-registration includes a linear co-registration of the semi-automatically derived mask of the preoperative contrast-enhancing area or postoperative resection cavity, brain contour and ventricles between different time points. The resulting transformation matrix was then applied in a non-linear manner to co-register conventional contrast-enhanced T-1-weighted images. Targeted registration errors were calculated and compared with linear and non-linear co-registered images. Targeted registration errors were smaller for the semi-automatic non-linear co-registration compared with both the non-linear and linear co-registered images. This was further visualized using a three-dimensional structural similarity method. The semi-automatic non-linear co-registration allowed for optimal correction of the variable brain shift at different time points as evaluated by the minimal targeted registration error. This proposed method allows for the accurate evaluation of the treatment response, essential for the growing research area of brain tumor imaging and treatment response evaluation in large sets of patients. Copyright (c) 2016 John Wiley & Sons, Ltd.

Difficulty in adhering to the recommended diet is a common problem in individuals with diabetes mellitus (DM). Dietary non-adherence among diabetic individuals leads to diabetes related complication and death. As far as our search established, there is a scarcity of scientific evidence of dietary non-adherence of individuals with diabetes to the recommended diet in Ethiopia, specifically in the Northwest part of the country. Hence, this study aims to assess the dietary non-adherence and associated factors among individuals with diabetes at Felege-Hiwot Referral Hospital, Bahir Dar city, Northwest Ethiopia. An institution-based cross-sectional study was conducted on 385 systematically selected individuals with diabetes following their treatment from March to April 2017. Quantitative data were collected using a pre-tested and structured questionnaire. The dependent variable association with explanatory variables was determined using logistic regression. Statistical significance was considered at p-value, Diet; Endocrine system; Food toxicology; Metabolism; Nutrition; Poultry products; Public health; Qualitative research in nutrition; Seafood; Diabetes, Dietary non-adherence, Ethiopia

Background: Depression among epileptic patients has multiple effects: poor quality of life, increased seizure frequency, risk of suicide, increased health care cost and worsened side effects of anti-epileptic medications. It is often under recognized and untreated among these patients.Objective: To assess the prevalence of depression and associated factors among epileptic patient on treatment follow up at selected public health facilities of Bench Maji zone, south west Ethiopia, 2017.Methods: Cross-sectional study was conducted in selected public health facilities of Bench Maji zone from March 3- April 3/2017. Simple random sampling was used. Data was collected through face to face interview and analyzed using frequency, percentage and binary logistic.Result: In this study a total of 244 participants were involved, and the response rate was 98.8%. The overall prevalence of depression was 51.2%. Of these, 60%, 36%, and 4% of the patients were found to have mild, moderate and severe depression respectively. Low educational status (AOR=2.5, CI (1.32, 4.78)), Seizure frequencies ≥ 3 per month (AOR=3.06, CI (1.412, 6.65)), Age onset of epilepsy ≤ 11 years (AOR=4.58, CI (1.94, 10.82)), low anti-epileptic drug adherence (AOR=4.81, CI (2.32, 9.97)) and poor knowledge about epilepsy (AOR=2.77, CI (1.5,5.12)) were found to be independent predictors of depression among epileptic patients.Conclusion and recommendation: Considerable amount of epileptic patients had depression that may predispose them to different health related problems. Low educational status, seizure frequencies, age at onset of the epilepsy, low antiepileptic drug adherence and poor knowledge about epilepsy were found to be contributing factor to the depression.

R. Dummer1, A. Hauschild2, N. Lindenblatt3, G. Pentheroudakis4 & U. Keilholz5, on behalf of the ESMO Guidelines Committee* Department of Dermatology, University Hospital Zurich, Zurich, Switzerland; Department of Dermatology, University Hospital Schleswig-Holstein, Kiel, Germany; Division of Plastic and Reconstructive Surgery, University Hospital Zurich, Zurich, Switzerland; Ioannina University Hospital, Ioannina, Greece; Charite Comprehensive Cancer Center, Charite-Universitatsmedizin, Berlin, Germany

The purpose of the present study was to rate the level of spread of asthma-induced bronchial morphological changes on chest X-ray (CXR), using the modified Shwachman–Kulczycki (S–K) rating scale as predicted by the dynamic of blood cell count (CBC). A sample of 40 asthma patients’ records was classified into 4 groups based on their clinical presentations and frequency of their visits to the hospital; Group-1 ⩽2 visits per week with reversible symptoms, Group-2 ⩾2 visits per week with irreversible symptoms, Group-3: ⩾3–4 visits per week with irreversible symptoms; Group-4: patients with severe shortness of breath in whom SaO2 was threatening, hence were admitted as inpatients. Patients’ CXR were scored based on the modified Shwachman–Kulczycki (S–K) scale rating. Blood analysis showed that RBC and their indices (HCT, HGB, MCH, RDW) were highest in group-2. White blood cells and their derivatives (NEU, EOS and LYM) were highest in group 4. CXR for group-2 showed bilateral increased bronchovascular markings but normal both lung fields and ruled out for costo-phrenic angles type of fever. Chest X-ray for group-3 showed hyperinflation, perihilar marking associated with bronchial thickening and unfolding aorta. In patients in group-4 development of broncho-pneumonic infiltration type of SOB and some evidence of bronchial edema with significant (p

Lack of appropriate follow-up of HIV Exposed Infants (HEIs) after delivery contributes to suboptimal access and uptake of HIV Early Infant Diagnosis (EID) interventions. This could result in unidentified HEIs and potentially HIV-infected infants who are at risk of morbidity and mortality where interventions such as Anti-Retroviral Therapy (ART) are not commenced. Biometric identification of infants has been used successfully to increase immunization coverage. This study investigated the feasibility and acceptability of using biometrics for unique identification during EID follow-up of HEIs at the Kenyatta National Hospital (KNH) High-risk Clinic.

Objective To examine the safety and re-intervention rates following magnetic resonance-guided focused ultrasound (MRgFUS) for uterine fibroids at 5 years. To assess how the non-perfused volume (NPV), fibroid signal intensity and use of gonadotrophin-releasing hormone analogues (GnRHa) affect the re-intervention rates. Study design Cohort study of women undergoing MRgFUS for treatment of their uterine fibroids between 2003 and 2010. Results Of 280 women undergoing MRgFUS the rate of minor complications was 3.9% and there were 3 serious complications (1.1%) including one skin burn, a fibroid expulsion and one case of persistent neuropathy. The NPVs achieved following MRgFUS have increased as the experience with this treatment has grown. In a 5-year follow-up study of 162 women, the overall re-intervention rate was 58.64%, but in those treatments with greater than 50% NPV the re-intervention rate was 50%. Conclusion MRgFUS treatment of uterine fibroids is a safe treatment for uterine fibroids. The re-intervention rate at 5 years is high, but the improvements in NPVs achieved may further improve the long term results.

Purpose: Only an endophytic growth pattern in juxtapapillary retinal hemangioblastoma (JRH) is an indication for surgical treatment, but classification of growth types is difficult using conventional imaging techniques. This case report describes the use of optical coherence tomography angiography (OCT-A) features for classification and treatment follow-up in a case with JRH. Observations: The JRH of this patient was easily detected with two different OCT-A methods in both en-face and cross-sectional B-scan images, and was classified as a sessile growth type. This growth type excluded the treatment option of vitreoretinal surgery with excision of the lesion or ligation of the feeder vessels. The patient was treated multiple times with intravitreal bevacizumab. Treatment follow-up with OCT-A initially revealed a stable extent of the JRH, with some slight flow deviations in en-face visualization, followed by a period of progressive growth of the lesion. Conclusions: OCT-A revealed the depth localization of the JRH and seems to be a valuable tool for JRH classification. Detailed classification may be useful when surgery is considered as a treatment strategy. Furthermore, treatment follow-up is possible with OCT-A, although imaging artifacts should be taken into account. Keywords: Juxtapapillary retinal hemangioblastoma, Optical coherence tomography angiography, Doppler OCT, Intravitreal bevacizumab, Sessile

Objective: To evaluate whether the concomitant consumption of Cod liver oil can reduce the daily dose of Diclofenac Sodium and probably the risk of the side effects which are associated with it in Rheumatoid Arthritis patients. Material and Methods: This longitudinal, prospective, open label study was conducted from April to September 2012 at Mahatma Gandhi Medical College and Hospital, Jaipur, India. 30 Rheumatoid Arthritis patients who were aged between 19 to 60 years, who fulfilled the inclusion criteria, were enrolled. Each patient was given five Cod liver oil capsules twice a day, for a period of 24 weeks. Each capsule which contained 300 mg of Cod liver oil had Eicosapentaenoic acid-20 mg and Docosahexaenoic acid-30 mg. The patients who took different Nonsteroidal anti-inflammatory drugs daily were switched over to Diclofenac Sodium 50 mg as a single dose, up to a maximum dose of 200 mg per day. The dose of Diclofenac Sodium which was consumed per day and the average daily requirement at different visits were recorded in each patient and they were compared. The patients were assessed for their pain scores by using the Visual Analogue Scale (VAS) at different weeks. In addition, the ‘Subjective Response’ to the pain was evaluated in each patient at the respective visits. The Student’s “t”-test was applied for the analysis of the VAS pain score and for the evaluation of the reduction in the mean daily dose of the Diclofenac Sodium consumption. A probability value of less than 0.05 (p< 0.05) was considered to be statistically significant. Moreover, the results of the ‘Subjective Response’ to the pain were expressed as percentage. Results: A significant decrease (p< 0.05) in the mean VAS pain score from 80.38 ± 6.4 at week 0 to 67.30 ± 5.3 at week 24 was noted in the patients. There was a significant reduction (p

This study reports on the use of surface-enhanced Raman scattering (SERS) detection and follow-up treatment of Paracoccidioides brasiliensis (Pb) infection in lung's mice. We also reports on the introduction of a new drug carrier system [nanoparticle-Amphotericin B (NP-AmB)], comprising magnetic NP surface functionalized with AmB, and its use in the treatment of infected and non-infected mice. SERS was successfully used to monitor the efficacy of the mice's treatment using the new NP-AmB, while free AmB (F-AmB), considering the current drug of choice for treatment of Pb infection, was also used and taken as reference for the treatment. We found SERS provides a robust platform to discriminate infected lung tissues from non-infected ones based on fingerprints assessed via SERS spectra and focused on the redox state of heme groups present in the collected biological material. Finally, SERS data reported in this study indicated that the new NP-AmB formulation provides similar clinical response as the F-AmB, although incorporating 40% lower content of AmB and administered in a time interval schedule (every 72 h) three times longer than F-AmB (every 24 h). Copyright © 2013 John Wiley & Sons, Ltd.

The objective of this study is to characterise the functionally relevant minor lymphocyte subpopulations in whole blood of multiple sclerosis (MS) patients and their potential utility as biomarkers for treatment follow up.Peripheral blood from 40 healthy donors (HD) and 66 MS patients [23 relapsing-remitting (RRMS) without treatment, 27 RRMS undergoing treatment (16 IFN-β, 11 natalizumab), and 16 progressive forms (eight secondary progressive and eight primary progressive)] was analysed by multiparametric flow cytometry.Untreated MS patients showed a decrease in early effector memory (CD45RA(-)CCR7(-)CD27(+)) CD4(+) and CD8(+) T cells and an increase in Th17 lymphocytes in peripheral blood compared with HD. Regarding the effect of treatment, whereas no differences in relative percentages of cellular subpopulations were observed in patients under IFN-β treatment, those under treatment with natalizumab had an increased percentage of early effector memory CD4(+) (CD45RA(-)CCR7(-)CD27(+)), central memory CD8(+) (CD45RA(-)CCR7(+)CD27(+)) T cells, recent thymic emigrants (CD4(+) CD45RA(+)CCR7(+)CD27(+)CD31(+)PTK7(+)) and transitional B cells (CD19(+)CD27(-)CD24(hi)CD38(hi)).Multiparametric flow cytometry analysis of whole blood is a robust, reproducible, and sensitive technology to monitor the effect of MS treatments even in minor lymphocyte subpopulations that might represent useful biomarkers of treatment response.

Diffuse Subendocardial Vasculitis (DSV), either primary or secondary, may occur during autoimmune diseases and lead to high mortality and morbidity. Recently, Cardiovascular Magnetic Resonance (CMR), a non-invasive, nonradiating technique, capable to perform tissue characterization has been used in the evaluation of cardiac vasculitis in the autoimmune diseases. CMR by performing tissue characterisation can detect diffuse, subendocardial oedema during the acute phase of DSV. To assess oedema, T2STIR images, T2 mapping and native T1 mapping can be used. Furthermore, diffuse subendocardial fibrosis can be also detected in both acute and chronic DSV. For this purpose, Late Enhanced Images (LGE) should be taken 15 minutes after the intravenous injection of the paramagnetic contrast agent gadolinium. Diffuse, subendocardial scar can be quantified and expressed as percentage of LV mass and this index have an important clinical value together with the LV ejection fraction in both ischemic and nonischemic cardiomyopathy. DSV can be identified by CMR in both acute and chronic autoimmune diseases. Acute DSV has the potential to be reversed completely by autoimmune and cardiac treatment modification. CMR is a powerful tool to early diagnose DSV and guide therapeutic decisions. However, further studies are needed to establish its impact in the patients’ risk stratification and treatment follow up.

Objectives To evaluate persistence of several Plasmodium antigens in pregnant women after treatment and compare diagnostics during treatment follow-up. Methods Thirty-two pregnant women (N = 32) with confirmed malaria infection by a histidine-rich protein 2 (HRP2)-based rapid diagnostic test (RDT) and microscopy were followed for 28 days after artemisinin-based combination therapy (ACT). A Plasmodium lactate dehydrogenase (pLDH)-based RDT and two ELISAs based on the detection of dihydrofolate reductase–thymidylate synthase (DHFR-TS) and haeme detoxification protein (HDP) were compared with each other and to RT-PCR at each visit. Results The mean visit number (95% confidence interval) on which the HRP2-based RDT was still positive after treatment was 3.4 (2.7–4.1) visits with some patients still positive at day 28. This is significantly later than the pLDH-based RDT [0.84 (0.55–1.1)], microscopy (median 1, range 1–3), DHFR-TS-ELISA [1.7 (1.1–2.3)] and RT-PCR (median 2, range 1–5) (P

OBJECTIVE. The purpose of this article is to review the role of imaging in the diagnosis, treatment, and follow-up of patients with sport-related flow limitations in the iliac arteries. CONCLUSION. Endurance athletes can develop flow restriction during exercise because of endofibrosis or kinking of the iliac arteries. Knowledge of this entity and the use of appropriate imaging techniques are crucial for diagnosis. Imaging plays an important role in the assessment of the underlying lesion and its location as well as in posttreatment follow-up.

Diffusion-weighted imaging relies on the detection of the random microscopic motion of free water molecules known as Brownian movement. With the development of new magnetic resonance (MR) imaging technologies and stronger diffusion gradients, recent applications of diffusion-weighted imaging in whole-body imaging have attracted considerable attention, especially in the field of oncology. Diffusion-weighted imaging is being established as a pivotal aspect of MR imaging in the evaluation of specific organs, including the breast, liver, kidney, and those in the pelvis. When used in conjunction with apparent diffusion coefficient mapping, diffusion-weighted imaging provides information about the functional environment of water in tissues, thereby augmenting the morphologic information provided by conventional MR imaging. Detected changes include shifts of water from extracellular to intracellular spaces, restriction of cellular membrane permeability, increased cellular density, and disruption of cellular membrane depolarization. These findings are commonly associated with malignancies; therefore, diffusion-weighted imaging has many applications in oncologic imaging and can aid in tumor detection and characterization and in the prediction and assessment of response to therapy.

289 Background: One of the more challenging aspects of managing patients receiving chemotherapy is to reduce Emergency Room (ER) visits and ultimately hospital readmissions. Patients may not understand who or when to call with issues and may be concerned about reaching their physician or receiving a call back in a reasonable amount of time. Methods: C1/D1 calls were initiated with the Medical Oncology Care Coordinator (CC) staff in August 2017. All patients receiving a C1/D1 dose of a new treatment and change in regimen were called by the CC. During this call, the patient is asked several questions including how they are currently feeling, if they are having any issues as well as reviewing contact information and direction regarding if they have a fever. Re-education was provided to the staff in January 2018 regarding the importance of the calls. Also at this time, the CC were asked to do Nadir calls (repeat call 7-10 days after D1) for those patients who were determined to be high risk (percentage calculated using a toxicity formula). Results: Initially the % of ER visits were reduced after the C1/D1 calls were initiated but then began trending upward again. After re-education and the initiation of the Nadir calls, ER visits again trended down. Conclusions: Increased touch points with patients, including C1/D1 follow up calls, Nadir calls and toxicity checks for high risk patients contributed to a downward trend of treatment patients visiting the ER.[Table: see text]

Fil: Fernandez, Marisa. Gobierno de la Ciudad de Buenos Aires. Hospital de Infecciosas "Dr. Francisco Javier Muniz"; Argentina

Resume Le monde intrapsychique a besoin de continuite dans l’enfance pour que des liens internes et externes se construisent chez l’adolescent. Si l’adolescence normale se caracterise par une transformation des liens, l’adolescence pathologique peut se comprendre comme un echec partiel ou plus global des capacites de transformation de ces liens bien ou moins bien etablis au cours de l’enfance. Les soins qui en decoulent necessitent de prendre en compte cette maniere de definir la pathologie a cet âge et bien evidemment de ne pas, de facon iatrogene, renforcer l’echec de la transformation de ces liens ou de leur mise en place.

Ophthalmic cysticercosis (OCC) caused by Taenia solium larval infection in eye, is emerging as a far commoner disease in the tropics. There is a scarcity in sero diagnostics to aid its laboratory diagnosis; thereby management still continues to pose a serious challenge. Presently serum IgG-ELISAs were performed on 40 consecutive clinically diagnosed OCC cases. Extra ocular muscle was found to be the predominant site of infection where ocular motility disorder was the major clinical presentation. ELISA using larval somatic and excretory secretory (ES) antigens was positive in 32.5% and 45% cases respectively. Anti-ES antibodies were detected more frequently in cases having extra ocular cysts compared to intraocular location. Differential levels of antibodies specific to above two antigens were estimated during the course of parasite degeneration as evident from findings following treatment. These indigenous serum IgG ELISAs might be useful as an adjunct to existing tools for diagnosis of OCC with a more promising application in post treatment follow up of extra ocular form of cysticercosis in particular.

This study reports on the improvements in IQ scores and maintenance of the gains following EEG biofeedback with identical twin girls with mild developmental delay and symptoms suggestive of Attention Deficit Hyperactivity Disorder (ADHD). Full Scale IQ scores increased 22 and 23 points after treatment and were maintained at three follow-up retests over a 52-month period. ADHD symptom checklists completed by their mother showed a similar pattern of improvement and maintenance of gains. The extent of improvement is supported by anecdotal reports of behavioral changes. The results are discussed in the context of other studies of EEG biofeedback also showing improved intelligence following EEG biofeedback.

The past 15 years have seen a dramatic increase in syphilis diagnoses in several regions including China, North America, Western Europe and Australia. Worldwide, the disease remains prevalent, contributing to substantial adult morbidity and neonatal mortality. Testing and treatment strategies are largely informed by data from the early antibiotic era, but increasing use of molecular diagnostics and new screening strategies could improve the management of syphilis substantially.The review explores new testing strategies for syphilis, including the importance of screening test selection and advances in point-of-care diagnostics. It then examines molecular studies of Treponema pallidum, covering typing; macrolide resistance; association between genotype and phenotype and the use of PCR in testing and monitoring strategies.Clinicians should be aware of testing strategies employed by their laboratories to ensure optimal sensitivity and specificity. Locally available T. pallidum PCR assays may improve the diagnosis of early disease and inform antibiotic choice. Robust serologic follow-up is still required, but predictors of potential treatment failure, including PCR-measured bacterial load, have been identified. Re-treatment should be considered for patients in the serofast state. The publication of T. pallidum genomes would allow further and more detailed study of strains and disease pathogenesis.

Rapid and effective diagnosis of brucellosis is a challenge for clinicians. Even when diagnosis is on time and therapy is initiated, meticulous follow-up appointments are crucial for ensuring the efficacy of the treatment. Due to shortcomings of serological methods, molecular diagnosis, especially real-time PCR, is becoming a main approach in laboratory diagnostics. Thus, the development of efficient procedures and standardization of the PCR tests will have a great impact on the precise detection and quantification of bacterial DNA loads, which is valuable for the medical management of brucellosis patients. We developed a new TaqMan real-time PCR directed to bcsp31 , a shared gene of the brucellae. The bcsp31 gene fragment was cloned into pJET1.2. Recombinant pJET1.2- bcsp31 was linearized by HindIII digestion, and the product was used for the preparation of a standard curve. A panel of Brucella spp. and non- Brucella pathogens was tested. No bacterial genomes other than those of the brucellae were detected. According to the results, specificity of the method was 100%. In a clinical assessment, the positive-control group comprised 37 patients with microbiologically confirmed brucellosis, and 25 healthy individuals served as the negative-control group. By the end of the treatment period, there was a significant decrease in the DNA load of the 37 brucellosis patients, which persisted for the 4 weeks of monitoring after treatment, suggesting that our proposed method is an efficient monitoring tool. Serum samples prior to any treatment were collected from the 25 serologically suspicious patients and assessed by our method; 72% of these patients tested positive for brucellosis.

Filariasis caused by Brugia malayi and Brugia timori affects ~13 million Asians. In order to ensure elimination of these infections in the context of the Global Programme for Elimination of Lymphatic Filariasis (GPELF), assays which are more sensitive than night blood examination must be employed. IgG4 assay using BmR1 recombinant antigen has been shown to be highly specific and sensitive for diagnosis of brugian filariasis. To provide further evidence of the diagnostic value of this assay, treatment follow-up study was performed on B. malayi microfilaraemic and amicrofilaraemic individuals who were positive by the BmR1-based IgG4-ELISA. Group 1 comprised 22 treated microfilaraemic individuals; group 2A comprised 13 treated amicrofilaraemic individuals and group 2B (control group) comprised 16 untreated amicrofilaraemic individuals. Group 1 individuals demonstrated decline in IgG4 levels with treatment and all participants were negative by the end of the 21 months study period. Group 2A also demonstrated IgG4 decline to negativity by 21 months, with re-treatment at 12 months performed on 3 individuals. In group 2B untreated individuals, at 21 months seven participants remained IgG4 positive while nine individuals were IgG4 negative, possibly through spontaneous death of adult worms. Significant difference (p=0.008) was observed when proportions between group 2A and group 2B were compared. This study showed decline of filaria-specific IgG4 post-treatment in both microfilaria positive and microfilaria negative individuals. In addition amicrofilaraemic IgG4 positive individuals were shown to be infected as evidenced by the significant difference between treated and untreated groups of individuals. Therefore, this study strengthened the reported findings that IgG4 assay based on BmR1 recombinant antigen is a good diagnostic tool for brugian filariasis.

A cross-sectional study was initiated in Burkina Faso's National Tuberculosis Programme to confirm successful treatment results within 3 months of completing treatment and to characterise longer-term outcomes 12-24 months after completion. The sample (n = 278) included 91 patients who had completed treatment 0-3 months earlier ('short-term' sample) and 187 patients who had completed treatment 12-24 months earlier ('long-term' sample). All sputum specimens from the short-term sample were confirmed as negative. In the long-term sample, among 154 patients with available information, 13 (8%) had died, 24 were not traced, and 117 (76%) were interviewed and had sputum examinations, of which 2 (2%) were smear-positive. Recording of successful treatment outcomes shows good validity.Une étude transversale a été conduite sur le Programme National Tuberculose du Burkina Faso afin de confirmer les résultats du traitement avec succès dans les 3 mois après l’achèvement du traitement et caractériser les résultats à long terme du traitement 12–24 mois après l’achèvement du traitement. L’échantillon (En el marco del Programa Nacional contra la Tuberculosis de Burkina Faso se llevó a cabo un estudio transversal, con el fin de confirmar los resultados de tratamiento exitoso, hasta 3 meses después de haber completado la pauta terapéutica y de caracterizar los desenlaces clínicos a largo plazo, 12 meses y 24 meses después de la compleción. Conformaron la muestra (