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Background Observational studies have shown promising therapeutic effects of long-pulsed neodymium-doped yttrium aluminum garnet (LP-Nd:YAG) laser on warts. Objective To evaluate whether LP-Nd:YAG laser was superior to cryotherapy for cutaneous warts. Methods In this study, 150 adult patients with warts were randomized equally to receive laser or cryotherapy every 3–4 weeks, a maximum of 4 sessions. The primary outcomes were cure rate at 16 weeks and 6 months; secondary outcomes included time to clearance of warts and treatment-related adverse effects. Results There was no difference in the cure rate for laser versus cryotherapy at 16 weeks (54.1% vs. 46.7%) and 6 months (59.5% vs. 57.3%). However, time to clearance of warts, up to 16 weeks and 6 months, tended to be shorter for laser versus cryotherapy ( P = .04 and .08, respectively). Post-hoc analyses showed a significantly higher cure rate for laser versus cryotherapy in 3 subgroups of HPV 2/27/57-induced recalcitrant warts, but not in their counterpart subgroups. Laser had more mild adverse effects. Limitations Single-center. Conclusions The overall therapeutic effects of LP-Nd:YAG laser were similar to cryotherapy, but laser may be more effective to relatively recalcitrant warts and may associate with shorter time to clearance of warts.

The use of population pharmacokinetics (PK) to optimize cefepime dosing could be an effective strategy, given the increasing prevalence of resistant gram-negative organisms. The objective of this study is to retrospectively compare dosing using PK approach (intervention) versus traditional dosing (control) for cefepime in patients with hospital-acquired pneumonia (HAP) or ventilator-associated pneumonia (VAP). Adult hospitalized patients with HAP or VAP receiving cefepime for ≥ 72 hours were screened first from August 2018 to January 2019 to be included in the intervention group, then screened during the pre-intervention period from August 2017 to July 2018 for the control group. Clinical improvement on day 7 of cefepime therapy was achieved in 72 % of the patients in the intervention group and 70 % of the patients in the control group (p = 0.8110). However, the clinical cure rate in the intervention group was higher than that of the control group (50 vs. 36.5 %, p = 0.0034). Cefepime dosing using population PK appears to be a novel, effective, and safe dosing strategy for patients with HAP or VAP. This article is protected by copyright. All rights reserved.

OBJECTIVE The lateral spread response (LSR) is an aberrant electrophysiological response in which a stimulus on one branch of the facial nerve spills over to other branches of the nerve, which can be captured by electrodes near each branch. The authors performed this study to evaluate the prognostic value of the follow-up LSR with a sufficient time interval from intraoperative LSR (IO-LSR) after microvascular decompression (MVD) for hemifacial spasm (HFS), excluding the interference of various intraoperative situations. METHODS A total of 247 patients treated with MVD for HFS between June 2011 and March 2019 were enrolled in this study. The IO-LSR was routinely evaluated in all patients. The LSR was checked again on postoperative day (POD) 2 after surgery (POD2-LSR). A total of 228 patients (92.3%) were considered cured at the last clinical follow-up. RESULTS The IO-LSR disappeared in 189 patients (76.5%), and among them, 181 patients (95.8%) were cured 1 year after surgery. The POD2-LSR disappeared in 193 patients (78.1%), and 185 patients (95.9%) among them were cured. Among the 189 patients in which the IO-LSR disappeared, the POD2-LSR reappeared in 26 patients (13.8%). In contrast, the POD2-LSR disappeared in 30 (51.7%) of 58 patients for whom the IO-LSR continued at the end of surgery. When classified into groups according to the status of the IO-LSR and POD2-LSR, in the group of patients in whom both LSRs disappeared, the cure rate was 98.2%, which was significantly higher than that of the other 3 groups (p < 0.05, Cochran-Armitage trend test). The use of both LSRs was found to be significantly associated with better predictability (p < 0.05, McNemar’s test). CONCLUSIONS Postoperative follow-up LSR examination may be beneficial in predicting clinical outcomes after MVD for HFS, especially when considered together with IO-LSR.

Tuberculosis is an important public health problem in the Eastern Mediterranean Region. It is crucial for each country to develop a national tuberculosis surveillance system. WHO has developed a standardized tuberculosis surveillance system through which two important indicators for tuberculosis control, a cure rate and a case detection rate, can be collected. The number of countries that have adopted the WHO tuberculosis surveillance system has been increasing in the Region. At the moment, 13 countries have reported a cure rate, which is the most important indicator for national tuberculosis control programmes. It is hoped that more countries will adopt this system.

Limited studies exist on the factors associated with a complete cure of onychomycosis in older adults.To determine the age and factors associated with a complete cure among older adults diagnosed with toenail onychomycosis.A retrospective cohort study was conducted of 95 older adult patients (aged ≥ 60 years) diagnosed with toenail onychomycosis between January 2016 and December 2017. Demographic data, mycological findings, treatments and durations to a complete cure were reviewed.The complete cure rates of the patients aged70 years and ≥70 years were 67.4% and 44.9%, respectively (P = 0.027). Patients aged ≥ 70 years were significantly higher in male gender, had higher history of smoking, peripheral arterial disease, impaired renal function, antihypertensive drug and amorolfine nail lacquer usage, and polypharmacy. A multivariate analysis revealed that being aged ≥70 years and having a nail thickness2 mm were associated with failure to achieve a complete cure. The median times to a complete cure for older adults aged70 years and ≥70 years were 20 months and 47 months, respectively (P = 0.007).An age ≥ 70 years was related to a lower cure rate and delays in achieving a complete cure. A nail thickness2 mm was a poor prognostic factor for a complete cure. Moreover, very old adults were more likely to suffer side effects arising from the use of systemic antifungal medications.

BACKGROUND Auricular pseudocysts are benign fluid accumulations of the ear of uncertain etiology. Little is known about the optimal modality to successfully treat these lesions. No systematic review addressing auricular pseudocysts have been published to date. OBJECTIVES The aim of this study is to summarize all the published data regarding diagnostic and therapeutic challenges of auricular pseudocysts. METHODS On May 28, 2020, a systematic search of Medline, Embase, and Cochrane databases was conducted. All the studies describing treatment of auricular pseudocysts, procedure description, outcome, and follow-up period were included in this review. RESULTS After full-text article review, 74 articles were included, representing a total of 1,011 lesions. The commonly used treatments for auricular pseudocysts were deroofing (493 lesions), aspiration (284 lesions), incision and drainage (171 lesions), intralesional steroids (53 lesions), and observation (10 lesions). The highest cure rate was found with the deroofing procedure (97.2%) followed by incision and drainage (95.9%). The mean follow-up period was 6.7 months. CONCLUSION Surgical procedures (anterior deroofing or incision and drainage) showed the highest cure rates and should be considered as first-line treatment for auricular pseudocysts. Future adequately designed randomized controlled trials are warranted to compare the efficacy of the techniques described.

The present study was designed to reintroduce an older antimicrobial nitrofurantoin to treat uncomplicated urinary tract infection and to explore the relationship between the reintroduction and corresponding shift in sensitivity pattern of the microbes. The microbial sensitivity against ciprofloxacin before intervention was 46.6%, which significantly increased after intervention (51.8%). Treatment with nitrofurantoin resulted in a total clinical cure rate of 80.6%, of which rate of clinical cure achieved in expected time was 66.1% and delayed was 14.5%. The rate of total clinical cure with nitrofurantoin corresponded closely with the proportion of urinary isolates sensitive to nitrofurantoin. i.e., 86.3%. This preliminary study revealed that revival might be an effective strategy to increase the sensitivity and to delay the emergence of resistance.

Deep venous thrombosis is one of the most common venous thromboembolic diseases and has a low cure rate and a high postoperative recurrence rate. Furthermore, emerging evidence indicates that microRNAs are involved in deep venous thrombosis. miR-296-5p is an important microRNA that plays a critical role in various cellular functions, and S100A4 is closely related to vascular function. miR-296-5p is downregulated in deep venous thrombosis patients, and its predicted target S100A4 is upregulated in deep venous thrombosis patients. Therefore, it was hypothesized that miR-296-5p may play a vital role in the development of deep venous thrombosis by targeting S100A4. An Ox-LDL-stimulated HUVEC and deep venous thrombosis mouse model was employed to detect the biological functions of miR-296-5p and S100A4. Dual luciferase reporter assays and pull-down assays were used to authenticate the interaction between miR-296-5p and S100A4. ELISA and Western blotting were employed to detect the protein levels of thrombosis-related factors and the endothelial-to-mesenchymal transition (EndMT)-related factors. The miR-296-5p levels were reduced, while the S100A4 levels were enhanced in deep venous thrombosis patients, and the miR-296-5p levels were negatively correlated with the S100A4 levels in deep venous thrombosis patients. miR-296-5p suppressed S100A4 expression by targeting the 3ʹ UTR of S100A4. MiR-296-5p knockdown accelerated ox-LDL-induced HUVEC apoptosis, oxidative stress, thrombosis-related factor expression, and EndMT, while S100A4 knockdown antagonized these effects in ox-LDL-induced HUVECs. S100A4 knockdown reversed the effect induced by miR-296-5p knockdown. Moreover, the in vivo studies revealed that miR-296-5p knockdown in deep venous thrombosis mice exacerbated deep venous thrombosis formation, whereas S100A4 knockdown had the opposite effect. These results indicate that elevated miR-296-5p inhibits deep venous thrombosis formation by inhibiting S100A4 expression. Both miR-296-5p and S100A4 may be potential diagnostic markers and therapeutic targets for deep venous thrombosis.

Objective: To analyze how the literature has addressed the tuberculosis health among indigenous children and adolescents. Method: An integrative review conducted with descriptors indexed in the Medline, Scopus, Embase, Web of Science, and Lilacs databases from primary studies, with complete texts, published in the period 2000 to 2020. Results: 726 publications were identified, and after the application of the previously established criteria, 10 articles were considered eligible, carried out exclusively in Brazil, between 2004 and 2019, with a higher incidence in children under 5 years old, a predominance of the male gender, clinical pulmonary form, being the chest radiography the clinical variable most explored in the studies, the low performance of the tuberculin skin test and nutritional assessment, in addition to a high cure rate. Conclusion: Diagnostic difficulties are evident, including the low exam performance, failure to systematize the search for clinical findings, absence of nutritional assessment, and investigation of contacts.

Background Fecal microbiota transfer (FMT) has become a standard of care in the prevention of multiple recurrent Clostridioides difficile (rCDI) infection. Aim While primary cure rates range from 70–80% following a single treatment using monodirectional approaches, cure rates of combination treatment remain largely unknown. Methods In a retrospective case-control study, outcomes following simultaneous bidirectional FMT (bFMT) with combined endoscopic application into the upper and lower gastrointestinal tract, compared to standard routes of application (endoscopy via upper or lower gastrointestinal tract and oral capsules; abbreviated UGIT, LGIT and CAP) on day 30 and 90 after FMT were assessed. Statistical matching partners were identified using number of recurrences ( Results Primary cure rates at D30 and D90 for bFMT were 100% (p=.001). The matched control groups showed cure rates of 81.3% for LGIT (p=.010), 62.5% for UGIT (p=.000) and 78.1% for CAP (p=.005) on D30 and 81.3% for LGIT (p=.010), 59.4% for UGIT (p=.000) and 71.9% for CAP (p=.001) on D90. Conclusion In our analysis, bFMT on the same day significantly increased primary cure rate at D30 and D90. These data require prospective confirmation but suggest that route of application may play a significant role in optimizing patient outcomes. ClinicalTrials.gov no: NCT02681068

Background The main purpose is to investigate the effect of LiCO3 as an add-on therapy with radioactive iodine in increasing the cure and decreasing the T4 level compared to radioactive iodine alone. The primary outcome is the cure rate as defined by the number of hyperthyroid patients who became euthyroid or hypothyroid. The secondary outcome is the T4 level. Methods Four databases were searched (PubMed, Scopus, Web of Science, and Cochrane central library). The inclusion criteria were randomized and non-randomized clinical trials of hyperthyroidism patients receiving LiCO3 with radioiodine compared with hyperthyroidism patients receiving radioactive iodine alone. Included studies were appraised with the risk of bias version 2 tool, according to the Cochrane Handbook for Systematic Reviews of Interventions 5.1.0. Results Nine studies were eligible for inclusion in the study, six randomized control trials and three non-randomized control trials. There were 477 patients in the intervention group and 451 patients in the control group. The cure rate was not significantly different between the two groups, while it was significantly increased with 5000 to 6500 mg optimized cumulative dose of LiCO3 compared with the control group, P = 0.0001. The T4 level showed no significant difference between the two groups, P = 0.13. Conclusions LiCO3 adjunct to radioactive iodine did not show significant differences compared with radioactive iodine alone in terms of cure rate or decreasing T4 level. However, the dose of 5000 to 6000 mg of LiCO3 may increase the cure rate.

Vertical transmission of Trypanosomacruzi is the cause of congenital Chagas disease, a re-emerging infectious disease that affects endemic and nonendemic regions alike. An early diagnosis is crucial because prompt treatment achieves a high cure rate, precluding evolution to symptomatic chronic Chagas disease. However, early diagnosis involves low-sensitive parasitologic assays, making necessary serologic confirmation after 9 months of life. With the aim of implementing early diagnostic strategies suitable for minimally equipped laboratories, a T. cruzi-loop-mediated isothermal amplification (LAMP) prototype was coupled with an automated DNA-extraction device repurposed from a three-dimensional printer (PrintrLab). The whole process takes3 hours to yield a result, with an analytical sensitivity of 0.1 to 2 parasite equivalents per milliliter, depending on the T. cruzi strain. Twenty-five blood samples from neonates born to seropositive mothers were tested blindly. In comparison to quantitative real-time PCR, the PrintrLab-LAMP dual strategy showed high agreement, while both molecular-based methodologies yielded optimal sensitivity and specificity with respect to microscopy-based diagnosis of congenital Chagas disease. PrintrLab-LAMP detected all 10 congenitally transmitted T. cruzi infections, showing promise for point-of-care early diagnosis of congenital Chagas disease.

The aim of this study was to evaluate the efficacy and safety of outpatient antimicrobial therapy with piperacillin-tazobactam in continuous infusion using elastomeric pumps and to evaluate the economic impact compared with conventional hospital treatment in patients with Pseudomonas aeruginosa (PA) infections. This is an observational study. Patients with PA infection treated with continuous piperacillin-tazobactam infusion using elastomeric pumps in our hospital between January 2015 and December 2017 were included. Primary outcomes were mortality during antibiotic treatment and mortality at 30 days. Secondary outcomes were reinfection or relapse at 30 days and clinical cure rate. The cost of each episode was compared with theoretical cost of the same treatment using conventional hospitalization. 35 patients were included. One patient (2.9%) died during the treatment. Overall 30-day mortality was 5.7%. No death was related to infection by PA. One patient (2.9%) had a reinfection at 30 days. Cure was achieved in 93% of patients at the end of treatment. There were no severe complications related to elastomeric pumps. Treatment cost with outpatient antimicrobial therapy was 67% lower than theoretical cost with conventional hospital treatment. Oupatient antimicrobial therapy with piperacillin-tazobactam in continuous infusion using elastomeric pumps in patients with PA infections is safe and effective with lower costs.

Objective: The study aims to evaluate the efficacy of whole-body versus lesional application of 5% permethrin cream for scabies eradication. Design: This quasi-experimental study was conducted on September-October 2018 at boarding schools in Bogor and East Jakarta, Indonesia. Subjects were randomized into two groups, 51 students each. Interventions: The first group received a whole-body application while the second group received lesional application of 5% permethrin cream. Evaluation was performed after 7 and 28 days. Main outcome measures: Proportion of lesions cured following the intervention Results: The prevalence of scabies was 41% and 33% at the boarding schools in Bogor and East Jakarta, respectively. Subjects from both groups had similar lesion distributions at baseline (p>0.05). Following intervention, the number of lesions reduced significantly (p0.05]. Conclusion: Lesional application of 5% permethrin is proven to be equally effective in treating scabies with higher cure rate. This method shows advantage for scabies treatment. In addition to reduce the unwanted side effects, it is more cost-effective and convenient. Further studies with larger sample size and randomized controlled trial design are warranted. Keywords: scabies, permethrin, whole-body application, lesional application, cure rate

Treatment failure to intralesional sodium stibogluconate (IL-SSG) is a health challenge for cutaneous leishmaniasis (CL) in Sri Lanka. A randomized controlled proof of principle clinical trial, with two arms (viz., radio frequency–induced heat therapy [RFHT] by a ThermoMed™ device (Model 1.8, Thermosurgery Technologies, Inc., Phoenix, AZ) and thermotherapy by a handheld exothermic crystallization thermotherapy for CL [HECT-CL] device) was conducted on 40 CL treatment failures to IL-SSG, from three hospitals in Tangalle, Hambantota, and Anuradhapura, from January 2017 to January 2018, followed up for 180 days post-thermotherapy with a final follow-up in February 2020. Intention-to-treat cure rates were calculated at day 90 (initial cure rate) and at day 180 (final cure rate) posttreatment. Radio frequency–induced heat therapy group: the initial cure rate was 100% (20/20) and the final cure rate was 95% (19/20), with one patient relapsing. The HECT-CL group: both the initial and final cure rates were 80% (16/20), with no relapses and one excluded from the trial. In February 2020 (1.6–3 years posttreatment), 27 traceable patients (RFHT = 16, HECT-CL = 11) remained healed. Second-degree burns were observed with RFHT in 65% (13/20), with HECT-CL in 15% (3/20), which completely resolved subsequently. The cure rates between the two treatment groups were comparable (P = 0.15). Radio frequency–induced heat therapy consumed less time and required only a single hospital visit. Handheld exothermic crystallization thermotherapy for CL is potentially usable at community settings with both being less costly than IL-SSG. This study is the first proof that thermotherapy is an efficacious and safe treatment for CL patients in Sri Lanka, complicated by treatment failure to IL-SSG.

The prognosis of elderly patients diagnosed with diffuse large B cell lymphoma (DLBCL) is considered to be clearly inferior to that of younger patients. Besides tumor biology and comorbidities, treatment selection due to an assumed reduced tolerability may contribute to this difference. With increasingly more patients diagnosed at advanced age, current treatment selections need to be reviewed carefully. Hence, we analyzed the results of patients above the age of 70 in whom a diagnosis of DLBCL was made. Whereas patients up to 80 were frequently selected for and were able to tolerate standard treatment (86% intended use, 74% completion), patients above the age of 80 years were not only treated more cautiously (67 and 60%, respectively) but did show inferior response to treatment with standard treatment (CR rate for intended R-CHOP use 64% vs. 43%). However, on an individual level, patients receiving and completing standard treatment obtained results that resemble the results of younger patients, irrespective if aged more than 80 and impose superior to prior reports in this age cohort. Median PFS for the entire group of patients was 3.44 years, with 4.83 years for patients below 80 and only 1.09 years for patients above the age of 80. The corresponding figures for OS were 7.38 years (estimated); after 2 years, OS was 81% in the younger cohort in contrast to 68% in patients > 80 years. However, for patients not planned to receive or not tolerating R-CHOP, results remain poor; tailored approaches for these patients are required.

[Image: see text] As the spread of infections caused by hepatitis B virus (HBV) threatens public health worldwide, investigations from multiple perspectives and of various mechanisms of action are urgently required to increase the HBV cure rate. Targeting the encapsidation of the nuclear capsid protein (core protein, HBc) has emerged as an attractive strategy for inhibiting the viral assembly process; however, a drug targeting this mechanism has not yet been approved. We synthesized novel sulfamoylbenzamides (SBAs) as capsid assembly modulators of HBV and found that the effects and safety profiles of compounds 3 and 8 have potential therapeutic applicability against HBV. The formation of tubular particles was time-dependent in the presence of 3, indicating a new mode of protein assembly by SBA compounds. Our findings provide a new entity for developing safe and efficient treatments for HBV infection.

Pankaj Garg,1,2 Baljit Kaur,3 Konica Singla,2 Geetha R Menon,4 Vipul D Yagnik5 1Department of Colorectal Surgery, Indus International Hospital, Mohali, India; 2Department of Colorectal Surgery, Garg Fistula Research Institute (GFRI), Haryana, India; 3Department of Radiology, SSRD Imaging Centre, Chandigarh, India; 4Department of Biostatistics, Indian Council of Medical Research, New Delhi, India; 5Department of Surgical Gastroenterology, Nishtha Surgical Hospital and Research Centre, Patan, Gujarat, IndiaCorrespondence: Pankaj GargGarg Fistula Research Institute (GFRI), H.no- 1042, Sector-15, Panchkula, Haryana, 134113, IndiaFax +91 9501522000Email drgargpankaj@yahoo.comPurpose: In some anal fistulas, the internal/primary opening cannot be located even after examination and assessment on MRI or transrectal ultrasound. The efficacy of a simple new protocol to manage such therapeutically challenging fistulas was tested.Patients and Methods: All anal fistula patients operated consecutively over 7 years were included in the study. A simple two-step protocol was followed for fistulas in which the internal opening was not locatable after clinical examination and MRI assessment. First, the MRI was reassessed. The site where the fistula was closest to the internal sphincter was noted. It was assumed that the internal-opening was located at that position and the fistula was treated accordingly. Second, in horseshoe anal fistulas with no apparent internal opening, it was assumed that the internal opening was located in the midline. Low fistulas were treated by fistulotomy and high fistulas by a sphincter-sparing procedure. Incontinence was evaluated by objective incontinence scores (Vaizey scores).Results: A total of 757 patients were operated (median follow-up-33 months). Of these, 57 patients were excluded due to short or inadequate follow-up. In 154/700 (22%) patients, the internal opening could not be located while in 546/700 (78%), the internal opening was found. Both the groups were similar in all parameters. In the “internal-opening found” group, the fistula healed completely in 486/546 (89%) and in the ‘internal-opening not found group’, the fistula healed in 140/156 (90.9%) (p=1.01). The objective continence scores did not change significantly after surgery in both the groups.Conclusion: This new protocol seems effective as a high cure rate could be achieved in ‘internal-opening not found’ fistulas which was comparable to fistula healing in the ‘internal-opening found’ group.Keywords: anal fistula, internal opening, horseshoe, MRI, recurrence, fistula-in-ano

Background Endogenous Cushing syndrome (CS) can be caused by ectopic corticotropin-producing tumors of known (EK) and unknown origin (EU). Bilateral adrenalectomy (BA) can be used as definite treatment of hypercortisolism in such cases. This study compared patients undergoing BA for CS secondary to EK vs EU. Methods Retrospective review (1995–2017) of patients undergoing BA due to EK or EU. We analyzed demographic characteristics, laboratory values, intraoperative variables, surgical outcomes, and survival. Results 48 patients (26 EU, 22 EK) were identified. Serum cortisol and ACTH concentrations were similar. 92% of BA for EU were performed minimally invasively vs 77% for EK, P = 0.22. Complications occurred in 19% of EU and 4.5% EK, P = 0.2. Mean survival was 4.3 years for EU and 4.0 years for EK without difference in all-cause mortality P = 0.63. Conclusion BA cure rate was 100% for CS in EU and EK. Morbidity, long term and all-cause mortality differences were not statistically significant between EK and EU.

Purpose: This paper evaluates the outcomes of parathyroidectomy for primary hyperparathyroidism with negative localization studies. Methods: All patients with primary hyperparathyroidism with negative preoperative ultrasound and MIBI scan who underwent parathyroidectomy were retrospectively included. Three groups were defined. Group 1 included the patients with negative ultrasound and MIBI. Group 2 included the patients with negative ultrasound and positive MIBI. Group 3 included the patients with positive ultrasound and negative MIBI. Results: In Group 1, 51% and 86% of patients had one adenoma and atypical localizations respectively. Unique adenoma and atypical localizations were showed in 87% and 93% of patients in Group 2 respectively. In Group 3, 83% and 17% of patients had one adenoma and atypical localizations respectively. No cervical hematoma was noted. Transient recurrent laryngeal nerve palsy occurred in 2 patients. Seven patients required postoperative calcium supplementation for 2 to 5 months, and one had recurrent hypercalcemia at follow-up. Cure rate was 98,3%. Conclusion: When US and MIBI were negative, multiple lesions and atypical localizations were frequent. The success rate and postoperative complications were not affected with this event.

As a novel method of ivermectin (IVM) administration for the treatment of scabies, we devised a whole-body bathing (WBB), in which patients are immersed in a fluid that contains IVM. A multi-institutional trial for elderly patients with scabies was conducted to investigate the efficacy and safety of IVM-WBB. Seven elderly patients with scabies were enrolled and received IVM-WBB up to four times at 1-week interval. The cure for scabies was defined as the absence of mites in two consecutive microscopic or dermoscopic examinations at weekly intervals and the absence of new skin lesions indicative of scabies. Consequently, the cure rate on day 22, the primary end-point, was 71.4%, and all patients had been cured until day 29. Additionally, neither significant adverse events nor clinically problematic abnormal blood test values were obtained. Furthermore, no IVM was detected in the optional plasma (five cases) collected for IVM measurement after bathing. These results suggest that IVM-WBB was effective to treat scabies, causing no serious adverse events and with a very low internal exposure of IVM.

Objective: To assess and compare the clinical application value of nursing risk management in the diagnosis and treatment of severe peptic ulcer bleeding. Methods: A total of 70 patients with severe peptic ulcer bleeding were selected as the research objects, randomly divided into observation group and control group, 35 cases for each. The nursing risk management and conventional nursing management were implemented for the two groups, respectively. The success rate of hemostasis, average length of stay, cure rate, complication rate, dyspnea rate, nursing dispute rate, SAS score, and SDS score were compared between the two groups. Patients’ satisfaction with nursing quality was also compared. Results: After the implementation of two different nursing management methods, all the above-mentioned metrics were better in the observation group than in the control group, and the differences were statistically significant (P < 0.01 or P < 0.05). Conclusion: The application of nursing risk management in the nursing intervention process of patients with severe peptic ulcer bleeding can effectively reduce the probability of nursing risk events, increase the cure rate, shorten the patient’s hospital stay, but also improve the patients’ psychological state and increase the patient’s satisfaction with nursing quality, which is worth clinical promotion.

Background Dyspepsia (Amlapitta) is the commonest ailment found in the present time. Nowadays due to unawareness about Prakriti (psychosomatic constitution) people are practising inappropriate diet and lifestyle which leads to disturbances in digestive system. Due to this pitta is imbalanced and common consequences are Amlapitta. If this pitta takes an upward course, then it is called Urdhwaga Amlapitta. Objective This study was conducted to assess the effectiveness of Ayurveda treatment for Urdhwaga Amlapitta in terms of improvement in symptoms, cure rate, satisfaction and side effects if any. Material and methods This was a single-arm exploratory open-label clinical trial. Patient with symptom of Urdhwaga Amlapitta were diagnosed as per Rome IV criteria and were further assessed as per eligibility criteria. Thirty patients were enrolled. They were given different herbo-mineral preparation as per ones Prakriti. These drugs were given for 28 days and patients were followed weekly in OPD for assessment of their symptom severity scores. Result Tiktamlodgar (acid eructation) and Gurukoshthatva (heaviness in abdomen) was the most commonly occurring symptom in 93% (n = 28) of participants. Seventy Percent (n = 21) of participants had Avipak severity of grade 2 or 3 followed by Gaurav in 50%. The patient was symptomatically relieved by all the symptoms of Urdhwaga Amlapitta by 3rd visit (21st day) and the difference in score was statistically significant. All participants express willingness take Ayurveda medicine in future. Conclusion Combination of Ayurveda drugs as per ones Prakriti and severity of symptoms, given to the patient of Urdhwaga Amlapitta was found to effectively cure patients within 28 days. These drugs were found to be well-tolerated, safe and acceptable.

Urogenital fistulas in women are an urgent problem in modern urology, gynecology and surgery. Several decades earlier, iatrogenic damage was the main reason for their development. The aim of this review was to analyze the etiology, characteristics and results of treatment of fistulas in women in Russia and the CIS countries. A systematic analysis of the articles in the PubMed and eLibrary databases dedicated to etiology, treatment technique and postoperative results of treatment of urogenital fistulas in women was carried out. The results were compared with European data. A total of 16 articles were selected over a 20-year period that met the inclusion criteria. Iatrogenic injury resulted in the fistula formation in 40.54% (373/920) of cases. The majority of fistulas were caused by radiation therapy (58.91%, 542/920). According to the results, 84.02% (773/920) of fistulas were successfully healed. Cure rate of patients with post-radiation fistulas was 75.83% (411/542). Comparison of surgical techniques was difficult, since in most cases the preference of the surgeon was main determinant factor.

Las glándulas de Bartolino, también conocidas como glándulas vestibulares mayores, son responsables de un gran número enfermedades ginecológicas de la vulva.; Los quistes y abscesos de la glándula de Bartolino pueden presentarse con síntomas diferentes y el manejo quirúrgico requerido debe ser marsupialización y no incisión y drenaje. Aunque se demostró que el procedimiento de incisión y drenaje es relativamente rápido y fácil de realizar y que la tasa de curación es rápida entre los pacientes que reciben este tipo de técnica quirúrgica, sin embargo se ha demostrado que la tendencia de recurrencias ha aumentado. Objetivo: realizar una revisión bibliográfica actualizada sobre el tema y su mejor manejo. Fuente de Datos: se realizó una búsqueda bibliográfica sistemática en la base de datos PubMed, Hinari y google académico desde el año 1985 al año 2020. Conclusiones: El mejor nivel de atención para las mujeres con quistes o abscesos de la glándula de Bartolino nunca podría lograrse sin la colaboración interprofesional.

The objective of this paper is to discuss the dynamics of an HIV pathogenesis model with full logistic target cell growth of uninfected T cells and cure rate of infected T cells. Local and global dynamics of both infection-free and infected equilibrium points are rigorously established. It is found that if basic reproduction number R 0 ≤1, the infection is cleared from T cells and if R 0 >1, the HIV infection persists. Also, we have carried out numerical simulations to verify the results. The existence of non-trivial periodic solution is also studied by means of numerical simulation. Therefore, we find a parameter region where infected equilibrium point is globally stable to make the model biologically significant. From the overall study, it is found that proliferation of T cells cannot be ignored during the study of HIV dynamics for better results and we can focus on a treatment policy which can control the parameters of the model in such a way that the basic reproduction number remains less than or equal to one.

With the efficient development of social economy, as well as the acceleration of the pace of life, the incidence of hemorrhoids remains high all year round, occupying a relatively high incidence of anorectal diseases. The author will sort out the four most representative theories of pathogenesis, and summarize and analyze them. Understanding the pathogenesis of hemorrhoids can give a deeper understanding of the nature of the disease, and it will help improve the accuracy of clinical diagnosis and treatment, which in turn is beneficial to the improvement of the cure rate.

Background Methylene blue-mediated photodynamic therapy as an antimicrobial has been reported to improve onychomycosis. Objectives To compare the short-term efficacy of methylene blue-mediated photodynamic therapy (MB-PDT) and 5% amorolfine nail lacquer (AMO) for toenail onychomycosis using higher intensity and shorter total treatment period than previously reported. Methods Twenty-seven toenails with onychomycosis were randomized to receive either six biweekly sessions of MB-PDT or AMO for twelve weeks. Dermoscopic photography was used for onychomycosis severity index assessment under a dermoscopic inspection (d-OSI) at baseline, weeks 6, 10, 14 and 22 as well as microscopic and microbiological tests. Adverse events were recorded. Results All subjects completed the study. Causative organisms found were exclusively non-dermatophytes including Fusarium spp., Asperillus spp.,and yeasts. Fifteen toenails received MB-PDT, whilst 12 received AMO. D-OSI showed greater improvement in MB-PDT than in AMO groups at weeks 6, 10, 14 as well as 22, with median changes of -2, -3, -4 (P = .055). and - 3 respectively in the MB-PDT group. The AMO group displayed the median d-OSI change of 0 throughout the study period. Mycological cure rate at 22 weeks in MB-PDT and AMO group was 73.3% and 66.67% (P > .05). Clinical cure rate at 22 weeks in MB-PDT (26.7%) was higher than AMO (16.7%), (P > .05). All patients only felt comfortably warm during the MB-PDT treatment. No major adverse events were found in both groups. Conclusions MB-PDT appeared to be more efficacious for non-dermatophyte onychomycosis than AMO particularly in a limited period and moderately severe onychomycosis.

India is the largest milk producer in the world with 22 percent of the global share and engages around 6.3 crore rural households. The cost and availability of animal health services for small dairy holders in a country like India has always been a cause of concern. There is a growing apprehension about the presence of drug residues in milk and milk products as well emergence of drug resistant bacteria and its associated health risks due to indiscriminate use of these products. The cost of therapeutic medicines, antimicrobial resistance and the residues in milk, meat and other animal products have forced the animal health sector to look for alternate forms of therapy to overcome these deficiencies. The new alternatives should be affordable, farmer friendly and lead to minimal or no residues in milk and other products. Practice of Ethno-Veterinary Medicine (EVM) is an approach that fulfils the above criteria. However, animal health service providers have very limited knowledge about EVM which in India is largely based on Veterinary Ayurveda. EVM has been used throughout the world by traditional animal rearing communities. EVM has been used for most common ailments in almost all domestic animal species. While there are efforts to document these practices, such documents are not widely available. Only recently, scientific scrutiny of these treatments for efficacy, mode of action and active ingredients has been initiated. National Dairy Development Board (NDDB) along with Sabarkantha District Cooperative Milk Producers Union, Sabarkantha, Gujarat and Trans-Disciplinary University, Bengaluru, evaluated the use of EVM initially for management of bovine mastitis and subsequently for management of other common ailments of dairy animals. It was observed that EVM was helpful in successfully managing mastitis (85%), diarrhoea (86%), fever (85%), indigestion (87%), anoestrus (77%), worm infestation (89%), wound healing (79%) and ecto-parasite infestation (87%) with high clinical cure rate. It was economical compared to conventional allopathic treatment. A reduction in residues of common antibiotics (quinolones, tetracycline, sulphonamide, s-lactam) in milk was observed in the area of operation. Drug resistant bacteria ( S. aureus including methicillin resistant S. aureus – MRSA; and E. coli including Extended Spectrum Beta Lactamase producing – E. coli - ESBL), were isolated from the milk of bovines suffering from mastitis. EVM was able to cure even these animals. However, awareness about EVM is limited among animal health service providers and other stakeholders. EVM needs to be given adequate focus and mainstreamed. This would entail concerted efforts and initiatives in policy, research and development and infrastructure.

Covid-19 is a disease caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) virus. data as of July 27, Covid 19 sufferers in Papua reached 2130 cases. The research objective was to determine the pattern of the spread of Covid 19 infection in Papua Province in 2020. The descriptive research method was cross-sectional design, using secondary data obtained from the Covid 19 Task Force Team of the Papua Provincial Health Office. The results showed the increase in May as many as 533 cases. The highest number of people with Covid-19 based on age is 20-60 years old. Based on sex, the highest percentage is male, this is due to the natural immune response and the immune response acquired during viral infection between women and men. Based on the evidence that shows that Covid 19 infection attacks many non-Papuan tribes compared to Papuans. The incidence of Covid 19 cases of ethnicity related to socio-economic, cultural, genetic factors, vulnerability to susceptibility or response to infection. The number of cases recovered against Covid 19 for the period March 22 to July 22 2020 the number of cases was 1956, while the number of cases died was 23 people. The cure rate is the result of many factors, which indicate the patient's physiological ability to attack Coronavirus. Conclusion; The highest number of males in May was 533 people, the age range of sufferers was 20 - 60 years, more men than women, less ethnic Papuans than non-Papuan ethnics, 27 July the number of people who recovered in 1956 while 23 people died.

BACKGROUND: Trichuris trichiura infections treatment using albendazole or mebendazole as a single dose is rated unsatisfactory. The combination of albendazole-mebendazole is viewed to have better efficacy against T. trichiura infections due to the nature of each drug. AIM: This study compared the efficacy of albendazole and albendazole-mebendazole for T. trichiura infection treatment in Talawi, Batu Bara, North Sumatra, among primary school children. METHODS: An open randomized clinical trial was carried out in Talawi, Batu Bara. The efficacy of albendazole as a single dose and albendazole-mebendazole as a single dose was compared. Research subjects were school children aged 6–12 years old with T. trichiura infections. Chi-square test was performed to compare the cure rate and unpaired t-test was done to compare the number of eggs per gram (epg) in both groups. RESULTS: From a total of 463 children, 235 of them suffered from T. trichiura infections. The cure rate of the group with 400 mg albendazole as a single dose was 52.5%, while the other group with albendazole 400 mg – mebendazole 500 mg as a single dose was at 71.1% cure rate. The cure rate of the two groups showed a significant difference with p = 0.011. Both groups were observed to have a significant reduction in the number worm eggs with p = 0.04. CONCLUSION: Albendazole 400 mg – mebendazole 500 mg combination as a single dose treatment has better efficacy than albendazole 400 mg alone, where the drug combination gave a higher cure rate and greater reduction in the number of T. trichiura eggs.

Around 60–70% of the world population are residing in Asia and each year approximately 200,000–250,000 children and young adolescents aged less than 20 years are expected to develop cancer. The Asian continental branch of the International Society of Pediatric Oncology (SIOP Asia) was founded in 1995 and its first meeting was held in Singapore in 2000. Since the SIOP Asia is an academic society under the umbrella of SIOP, foundation of its action team named as Asian Pediatric Hematology and Oncology Group (APHOG) was proposed and agreed to be built by the representatives from many Asian countries in 2012 at the time of the 7th SIOP Asia congress in Yogyakarta. APHOG is an Asian children’s cancer clinical study group which works as one of the two wheels of a cart with SIOP Asia. One of its new missions is to support the WHO Global Initiative for Childhood Cancer which was declared in 2018. The aim is to increase the cure rate of children with cancer up to more than 60% by 2030. The fundraising system for APHOG is now being established.

Introduction: COVID-19 has become a global health security issue, it has caused more than half a million deaths worldwide so far, the treatment strategies are the most concerned issues for clinicians. In this study, the treatments and outcomes in 40 pediatric patients diagnosed with COVID-19 and treated with different drugs were evaluated. Methodology: All cases were diagnosed with COVID-19 nucleic acid positive by using RT-PCR or clinical manifestations, imaging specific characteristics and epidemiological clinical diagnosis. The biological information and first symptom of all cases were collect. A variety of treatments were employed and the outcomes were evaluated by Cox regression analysis. Multivariable analysis was performed to evaluate cure rate at 14 days with different drug treatment. Results: The average length of hospital stay was 10.4 days. The cure rate was increased with the treatment time extended and 90% of pediatric patients were cured and discharged after 14 days’ treatment. And multivariable analysis results proved that none of the covariates were related to the cure rate at 14 days with different drug treatment since p values were over 0.05. Conclusions: Multivariable analysis suggested that the present drug treatments cannot significantly shorten the clinical cure time and improve the cure rate of children with COVID-19.

Tremendous endeavors have been made to improve the sensitivity of brain tumor detection and the efficacy of treatment in the past decades. However, the cure rate of brain tumor patients is not sign...

Treatment of cutaneous leishmaniasis (CL) continues to be a health concern, and alternative therapies with fewer side effects are substantially needed. This study aimed to determine the efficacy of intense pulsed light (IPL) with wavelength spectrum affecting vascular lesions on acute cutaneous leishmaniasis. In this randomized clinical trial study, 30 patients with acute CL were enrolled. Baseline clinical and demographic data were recorded in the checklist after obtaining written informed consent. Patients were randomly allocated to receive either IPL fortnightly (intervention group) or intralesional meglumine antimoniate (MA) weekly (control group) over 10 weeks. Patients were assessed every 2 weeks to determine the size of induration and improvement rate of lesions. Follow-up visits were arranged at 3rd and 6th months. Overall, 15 patients (21 lesions) in the intervention group and 15 patients (22 lesions) in the control group were studied. The size of lesions in the control group was significantly higher at the baseline (P = 0.014) and the second week (P = 0.034), and significantly lower in the eighth week (P = 0.009), compared with the intervention group. The size of lesions in the control group changed during the study (P

Schistosomiasis is a frequent parasitic disease in tropical and subtropical countries. The objective of this research was to analyze the spatiotemporal dynamics of schistosomiasis mansoni in the state of Alagoas, from 2007 to 2017. This is a mixed ecological, with statistical treatment performed in three steps: temporal modeling; simple descriptive analysis (absolute and relative frequencies); spatial modeling. 827 new cases of mansonic schistosomiasis were reported in Alagoas, with an incidence rate of 2.37 / 100 thousand inhabitants. Over the time series, the regression model showed two distinct behaviors, the first of which declined between 2007 and 2012, whose incidence rate decreased from 5.75 / 100 thousand to 0.88 / 100 thousand (APC-29.78 %; p

Purpose To determine the clinical efficacy of endoscopic transurethral incision (TUI) for boys with refractory daytime incontinence due to a posterior urethral valve with or without nocturnal enuresis. Patients and methods A total of 20 boys with daytime incontinence were assessed. Twelve boys underwent TUI (TUI+ group) and eight boys continued receiving oral drugs (TUI- group). The primary endpoint was the cure rate associated with TUI or NE in both groups. Results Only two boys achieved daytime continence 6 months after TUI, but no boys were cured of nocturnal enuresis 6 months after TUI. The median time to daytime continence was significantly longer in the TUI+ than in the TUI- group (52 vs 27 months, respectively; log rank P = 0.041) and the median time to dry nights was significantly longer in the TUI+ than in the TUI- group (56 vs 36 months, respectively; log rank P = 0.021). Conclusion TUI might be not effective in boys with refractory daytime incontinence.

Background Skin cancer is common, growing, challenging, and in need of progress in early‐stage treatment. 20 MHz high‐intensity focused ultrasound (HIFU) is new and applied to actinic keratosis (AK) and skin cancers for the first time. HIFU of lower frequency is already used in the treatment of internal cancers. Materials and Methods Eight patients with 201 AK lesions, one patient with 7 basal cell carcinomas (reoccurrences after PDT), and one patient with 7 Kaposi sarcoma lesions (4 treated with radiotherapy in the past) were given 1‐3 HIFU treatments. Twenty megahertz HIFU was dosed as 150 ms at 0.6‐1.2 J/shot applied to target lesions. Probes with different target depths were available. The preferred shot energy and focal depth in AK were 0.9 J and 1.3 mm. A “Sandwich” strategy with HIFU applied in two depths were tried in cancers. The follow‐up period was 3‐6 months. Results All AK cleared except 5, giving a cure rate of 97%. Post‐treatment lesion healed in 1‐2 weeks with no scar. VAS pain was from 1 to 8, and in any case less than experienced with previous PDT. In both basal cell carcinoma (BCC) and sarcoma, healing was confirmed by histological verification. Discussion/conclusion 20 MHz HIFU was an effective and safe treatment of AK. This new treatment, applicable to any anatomical site, has promising advantages relative to PDT and has the potential to replace or supplement PDT in future. Case‐observations indicated that HIFU can be useful in skin cancers as well.

Cryosurgery techniques has been used in the ancient period. Cryosurgery employs the high rate of freezing rate to destroy the undesirable tissues. The cryosurgery techniques is a minimal invasive techniques applied in various clinical aspects. The cryosurgery techniques has advantages over the normal surgical procedures. It has high cure rate in some disease states. Development of the cryosurgery is in slow manner due to the lack of clear knowledge of the techniques. The Cryosurgery has to be expanded to the all the clinical aspects with better understanding and better curing of the diseases.

Medulloblastoma (MB) is the most common CNS embryonal tumor. While the overall cure rate is around 70%, patients with high‐risk disease continue to have poor outcome and experience long‐term morbidity. MB is among the tumors for which diagnosis, risk stratification, and clinical management has shown the most rapid advancement. These advances are largely due to technological improvements in diagnosis and risk stratification which now integrate histomorphologic classification and molecular classification. MB stands as a prototype for other solid tumors in how to effectively integrate morphology and genomic data to stratify clinicopathologic risk and aid design of innovative clinical trials for precision medicine. This review explores the current diagnostic and classification of MB in modern neuropathology laboratories.

Background: Compared with conventional closed therapy, acupotomy has the advantages of lower cost, convenient application, and better single and long-term effects. The aim of this study was to explore the clinical effect of acupotomy in the treatment of Tarsal Tunnel syndrome.Methods: There were 80 patients enrolled into the study who were randomly assigned to either the acupotomy or closed therapy group, with 40 patients in each group. The acupotomy group was treated once every 6 days, on 3 occasions for the duration of treatment, and the closed therapy group was treated twice a week, for 3 weeks as the course of treatment. The effects of treatment were analyzed and evaluated according to the standard of curative effect.Results: The “cure rate” of the number of patients in the acupotomy group whose symptoms had completely disappeared (13 patient out of 39) was higher than the closed therapy group (1 patient out of 39), and this difference was significant (p < 0.01). The number of patients in the acupotomy group who did not benefit from the therapy (5 patients) was significantly lower than the closed therapy group (15 patients; p < 0.05). The total number of patients in the acupotomy group who benefitted from the therapy (34 patients) resulted in an effective rate of 87.18%, which was higher than the closed therapy group (24 patients; 61.53%). The difference was statistically significant (p < 0.05).Conclusion: Acupotomy is effective in the treatment of Tarsal Tunnel syndrome, was superior to traditional closed therapy, and is worthy of clinical application.

Giardia lamblia, protozoan intestinal flagellate, is the causative agent of human giardiasis. Currently used therapeutic agents have significant side effects or contraindicated in some clinical conditions and show failure due to drug resistance. This study evaluated the probiotic in vivo-therapeutic efficacy; potent Acidophillus probiotics versus metronidazole againstgiardiasis in experimentally infected mice, by histopathological changes of intestinal mucosa, and their impact on the ultrastructure of the pathogenic trophozoites. Forty seven Swiss albino mice were divided into groups: GI: 2 mice non-infected, nontreated mice. GII: 15 mice only infected with G. lamblia cysts, (non-treated). GIII: 15 mice infected and treated orally with potent Acidophillus probiotics. G IV: 15 mice infected with G. lamblia cysts and treated orally with metronidazole. All mice were subjected to parasitological, histo-pathological, goblet cells mucous secreting activity and trophozoite ultrastructural studies. There was high significant difference between the infected non-treated controls and potent Acidophillus-treated group concerning; patent period, infection intensity, reduction percentage of cyst shedding and cure rate, but without significant difference between potent Acidophillus-of treated group and metronidazole-treated group.

Introduction: Uterine cancer is the most common gynecologic malignancy with a high cure rate for early stage disease. Surgical and standard chemotherapy have provided modest results. Precision ther...