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A history of atopy or allergy has been shown to be protective against the development of glioma, however the effect of atopy on patient outcomes, especially in conjunction with the survival benefit associated with IDH mutation, has not yet been investigated, and is the focus of the study we present here. Low grade glioma (LGG) data from the TCGA was downloaded, along with IDH, TERT, 1p/19q and ATRX mutational status and genetic alterations. History of asthma, eczema, hay fever, animal, or food allergies, as documented in TCGA, was used to determine patient atopy status. Patients with missing variables were excluded from the study. 374 LGG studies were included. Patients with a history of atopy demonstrated longer overall survival (OS) compared to those without (145.3 vs. 81.5 months, p = 00.0195). IDH mutant patients with atopy had longer OS compared those without atopy (158.8 vs. 85 months, p = 0.035). Multivariate cox regression analysis demonstrated that the effects of atopy on survival were independent of IDH and histological grade, (p = 0.002, HR 0.257, 95% 0.109–0.604), (p =

Glycogen storage disease type Ib (GSDIb) is characterized by hepatomegaly and fasting hypoglycaemia as well as neutropaenia and recurrent infections. We conducted a retrospective observational study on a cohort of patients with GSDIb across England. A total of 35 patients, with a median age of 9.1 years (range 1‐39 years), were included in the study. We examined the genotype and phenotype of all patients and reported 14 novel alleles. The phenotype of GSDIb in England involves a short fasting tolerance that extends into adulthood and a high prevalence of gastrointestinal symptoms. Growth is difficult to manage and neutropaenia and recurrent infections persist throughout life. Liver transplantation was performed in nine patients, which normalized fasting tolerance but did not correct neutropaenia. This is the first natural history study on the cohort of GSDIb patients in England.

Background The aim of the present study was to evaluate the mortality, morbidity, and readmissions associated with management of grade 3 cholecystitis in the elderly, vulnerable population. Methods This was a retrospective cohort study of non-elective admissions for acute cholecystitis from 2010 to 2015 using the nationwide readmissions database for adults ≥ 65 years with evidence of end-organ dysfunction (grade 3) who underwent percutaneous cholecystostomy (PC), laparoscopic (LC) or open cholecystectomy (OC). Index and readmission outcomes were analyzed using logistic regression and inverse probability treatment weight analysis. Results Of the estimated 358,624 patients, 14.9% underwent PC, 15.7% OC, and 69.4% LC. PC had significantly higher odds of mortality (AOR 5.8, 95%CI 5.1–6.6), composite morbidity (AOR 3.8, 95%CI 3.5–4.1), early (AOR 1.9, 95%CI 1.7–2.0) and intermediate (AOR 2.2, 95%CI 2.0–2.5) readmission compared to LC and OC. Conclusions Patients undergoing cholecystostomy had higher mortality, complications, and readmission rates warranting revaluation of criteria for cholecystostomy at initial presentation.

BACKGROUND: Dupilumab blocks the shared receptor component for IL-4 and IL-13, key drivers of type 2 inflammation, including IgE-mediated allergic inflammation in asthma. In the LIBERTY ASTHMA QUEST (NCT02414854) study, dupilumab reduced severe asthma exacerbations and improved forced expiratory volume in 1 second (FEV1) in patients with uncontrolled, moderate-to-severe asthma with greater efficacy observed in patients with elevated type 2 inflammatory biomarkers (blood eosinophils and fractional exhaled nitric oxide) at baseline. OBJECTIVE: We assessed dupilumab's effect on key asthma outcomes in QUEST patients with/without evidence of allergic patients with uncontrolled, moderate-to-severe asthma with greater efficacy observed in patients with elevated type 2 inflammatory biomarkers (blood eosinophils and fractional exhaled nitric oxide) at baseline. OBJECTIVE: We assessed dupilumab's effect on key asthma outcomes in QUEST patients with/without evidence of allergic asthma (total serum IgE >= 30 IU/mL and >= 1 perennial aeroallergen-specific IgE >= 0.35 kU/L at baseline). METHODS: Severe exacerbation rates and change from baseline in FEV1, asthma control, and markers of type 2 inflammation during the 52-week treatment period were assessed. RESULTS: In the allergic asthma subgroup (n = 1083), dupilumab 200/300 mg every 2 weeks versus placebo reduced severe asthma exacerbation rates (-36.9%/-45.5%; both P < .01), improved FEV1 at week 12 (0.13 L/0.16 L; both P < .001; improvements were evident by the first evaluation at week 2) with greater efficacy observed in patients with elevated type 2 inflammatory biomarkers at baseline, and improved asthma control. Dupilumab treatment also resulted in rapid and sustained reductions in type 2 inflammatory biomarkers. Comparable results were observed in patients without evidence of allergic asthma (n = 819). CONCLUSION: Dupilumab reduced severe exacerbation rates, improved FEV1 and asthma control, and suppressed type 2 inflammatory biomarkers in patients with uncontrolled, moderate-to-severe asthma with or without evidence of allergic asthma, highlighting the key role of IL-4 and IL-13 in airway inflammation. (C) 2019 The Authors. Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology

Background Dupilumab, a fully human monoclonal antibody, blocks the shared receptor component for interleukin-4 and interleukin-13, key drivers of type 2 inflammation. In the phase 3 LIBERTY ASTHMA QUEST trial (NCT02414854) in patients with uncontrolled, moderate-to-severe asthma, add-on dupilumab 200 mg or 300 mg every 2 weeks reduced exacerbations and improved forced expiratory volume in 1 s (FEV1) and quality of life over 52 weeks. This analysis evaluates dupilimab's effect on lung function in the overall population, and subgroups with baseline elevated type 2 inflammatory biomarkers. Methods Patients were randomised to 52 weeks of subcutaneous dupilumab 200 mg every 2 weeks, 300 mg every 2 weeks, or matched-volume placebos. Lung function outcomes were analysed in the overall population, in patients with ≥150 eosinophils·µL−1, ≥300 eosinophils·µL−1, ≥25 ppb fractional exhaled nitric oxide (FeNO), and both ≥150 eosinophils·µL−1 and ≥25 ppb FeNO, at baseline. Results Dupilumab treatment (200 mg and 300 mg every 2 weeks) resulted in significant improvements versus placebo after 52 weeks in pre-bronchodilator FEV1 (0.20 and 0.13 L, respectively, versus placebo) and post-bronchodilator FEV1 (0.19 and 0.13 L, respectively), forced vital capacity (FVC) (0.20 and 0.14 L, respectively), forced expiratory flow (0.19 and 0.13 L·s−1, respectively) and pre-bronchodilator FEV1/FVC ratio (1.75% and 1.61%, respectively) in the overall population (p, Dupilumab is a fully human monoclonal antibody that blocks the shared receptor component for interleukin-4 and interleukin-13, key drivers of type 2 inflammation, improving lung function outcomes in patients with uncontrolled, moderate-to-severe asthma http://bit.ly/2OhKMpi

Background: SRD5A3-CDG is a rare N-glycosylation defect caused by steroid 5 alpha reductase type 3 deficiency. Its key feature is an early severe visual impairment with variable ocular anomalies often leading to diagnosis. Additional symptoms are still poorly defined. In this case study, we discuss 11 genetically confirmed cases, and report on emerging features involving other systems in addition to the eye phenotype.Methods: In total, 11 SRD5A3-CDG patients in five sets of sibships were included in the study. Data on 9 of 11 patients are as of yet unpublished. Patients’ results on biochemical and genetic investigations and on in-depth phenotyping are presented.Results: Key diagnostic features of SRD5A3-CDG are ophthalmological abnormalities with early-onset retinal dystrophy and optic nerve hypoplasia. SRD5A3-CDG is also characterized by variable neurological symptoms including intellectual disability, ataxia, and hypotonia. Furthermore, ichthyosiform skin lesions, joint laxity, and scoliosis have been observed in our cohort. We also report additional findings including dystonia, anxiety disorder, gastrointestinal symptoms, and MRI findings of small basal ganglia and mal-rotated hippocampus, whereas previous publications described dysmorphic features as a common finding in SRD5A3, which could not be confirmed in our patient cohort.Conclusion: The detailed description of the phenotype of this large cohort of patients with SRD5A3-CDG highlights that the key clinical diagnostic features of SRD5A3-CDG are an early onset form of ophthalmological problems in patients with a multisystem disorder with variable symptoms evolving over time. This should aid earlier diagnosis and confirms the need for long-time follow-up of patients.

Background Fluorescein is an agent that accumulates in areas of blood-brain barrier breakdown and is commonly used in neurosurgical oncology to assist with lesion localization and visualizing the extent of resection. It is considered to be cost-effective and has a favorable safety profile. Studies on the utilization of fluorescein demonstrate an improved extent of tumor resection and increased overall survival. Currently, fluorescein detection systems are all microscope based, leading to limitations such as decreased maneuverability, limited visualization of the entire operative field, and significant cost associated with obtaining and maintaining a neurosurgical operating microscope. Methods Three consecutive craniotomy patients for tumor resection were included, and surgery was carried out under loupe fluorescence guidance using the ReVeal 450 System, and also a surgical microscope for comparison. Results Loupe-mounted fluorescence system enabled excellent visualization of fluorescence in all three cases. Conclusions In this manuscript, we describe our experience with a loupe-mounted fluorescein detection system in 3 patients with malignant gliomas. We found that the loupe-mounted system offered excellent ability to visualize fluorescein fluorescence. Although loupe-mounted systems are not an alternative to surgical microscopes, they could be a useful surgical adjunct for superficial lesions and in low-middle income counties.

Background: Liver involvement in Coronavirus disease 2019 (COVID-19) has been recognised. We aimed to investigate the correlation of non-invasive surrogates of liver steatosis, fibrosis and inflammation using transient elastography (TE) and FibroScan-AST (FAST) score with (a) clinical severity and (b) 30-day composite outcome of mechanical ventilation (MV) or death among patients hospitalized due to COVID-19. Method: Patients with non-critical COVID-19 at admission were included. Liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) were assessed by TE. Clinical severity of COVID-19 was assessed by 4C Mortality Score (4CMS) and need for high-flow nasal cannula (HFNC) oxygen supplementation. Results: 217 patients were included (66.5% males, median age 65 years, 4.6% with history of chronic liver disease). Twenty-four (11.1%) patients met the 30-day composite outcome. Median LSM, CAP and FAST score were 5.2 kPa, 274 dB/m and 0.31, respectively, and neither was associated with clinical severity of COVID-19 at admission. In multivariate analysis FAST &gt, 0.36 (OR 3.19, p = 0.036), 4CMS (OR 1.68, p = 0.002) and HFNC (OR 7.03, p = 0.001) were independent predictors of adverse composite outcome. Conclusion: Whereas LSM and CAP failed to show correlation with COVID-19 severity and outcomes, FAST score was an independent risk factor for 30-day mortality or need for MV.

Background: Derangement of liver blood tests (LBT) is frequent in patients with Coronavirus disease 2019 (COVID-19). We aimed to evaluate (a) the prevalence of deranged LBT as well as their association with (b) clinical severity at admission and (c) 30-day outcomes among the hospitalized patients with COVID-19. Methods: Consecutive patients with COVID-19 hospitalized in the regional referral center over the 12-month period were included. Clinical severity of COVID-19 at hospital admission and 30-day outcomes (need for intensive care, mechanical ventilation, or death) were analyzed. Results: Derangement of LBT occurred in 2854/3812 (74.9%) of patients, most frequently due to elevation of AST (61.6%), GGT (46.1%) and ALT (33.4%). Elevated AST, ALT, GGT and low albumin were associated with more severe disease at admission. However, in multivariate Cox regression analysis, when adjusted for age, sex, obesity and presence of chronic liver disease, only AST remained associated with the risk of dying (HR 1.5081 and 2.1315, for elevations 1–3 × ULN and &gt, 3 × ULN, respectively) independently of comorbidity burden and COVID-19 severity at admission. Patients with more severe liver injury more frequently experienced defined adverse outcomes. Conclusions: Deranged LBTs are common among patients hospitalized with COVID-19 and might be used as predictors of adverse clinical outcomes.

Although short-term outcomes of endovascular and open infrainguinal revascularization in patients with peripheral arterial disease have been previously reported, 30-day readmission and resource utilization after these procedures remain unknown.We used the 2010-2014 Nationwide Readmissions Database and the International Classification of Diseases, Ninth Edition, to identify patients with peripheral arterial disease undergoing either in-hospital endovascular or open infrainguinal revascularization.Of an estimated 574,201 hospitalized patients treated for peripheral arterial disease, 308,056 and 266,145 underwent lower limb endovascular and open infrainguinal revascularization, respectively. Compared with patients who underwent open revascularization, endovascular patients were more commonly female (44.8% vs 36.7%, P.001) and older (69.5 vs 67.2 years, P.001). Moreover, they had higher rates of 30-day readmission (15.6% vs 13.5%, P.001), in-hospital complications (22.3% vs 20.9%, P.001), and in-hospital index mortality (2.1% vs 1.8%, P.001). In contrast, risk-adjusted multivariable analysis found open revascularization to be independently associated with increased odds of 30-day readmission (odds ratio, 1.13; 95% confidence interval 1.10-1.16), index complications (odds ratio, 1.23; 95% confidence interval 1.20-1.27), and mortality (odds ratio, 1.26; 95% confidence interval 1.16-1.36) compared with those who underwent endovascular revascularization. Trend analysis revealed an overall decrease in the utilization of both endovascular and open revascularization procedures in the inpatient setting.Despite lower rates of adverse events compared to endovascular, open infrainguinal revascularization is independently associated with increased risk of short-term readmission, complications, and mortality. These findings should be considered in the selection of appropriate surgical therapy for lower extremity arterial occlusive disease.

A retrospective study was conducted to investigate the occurrence of Schistosomus reflexus in calves from January 2012 to December 2016. Occurrence of Schistosomus reflexus in neonatal calves was studied in relation to breed, sex and seasons of calving. Clinical signs were angulation of limbs and no abdominal closure. Results showed 8.41% Schistosomus reflexus in surgically intervened cows. The percentage of indigenous calves affected with Schistosomus reflexus was as high as 42.86%, and in crossbred this was 57.14%. The percent of female calves born with Schistosomus reflexus was higher (60.0%) than the males (40.0%). Maximum occurrence (42.86%) of Schistosomus reflexus was recorded in the summer followed by rainy (37.14%) and winter seasons (20.0%). Among the studied areas, highest occurrence was recorded in Mymensingh Sadar (68.57%) followed by in Patuakhali Sadar (17.14%) and Bauphal (14.29%) upazilla of Patuakhali district. However, this study provides some basic information to veterinarians, researchers and farmers about the occurrence of Schistosomus reflexus in calves.

Background We have completed an audit to review our current routine endocrine surveillance of a cohort of metabolic patients who have had a haematopoietic stem cell transplant (HSCT) and ensure relevant investigations are obtained, and appropriate referral to endocrine teams are made. Aim Describe long term outcome of HSCT in children at risk of long term endocrine problems. To review whether post-HSCT metabolic patients are having the required endocrine complication-surveillance investigations undertaken, and if not to correct the problem Methods All patients with confirmed diagnosis of MPS 1H from a single tertiary centre were included. 3 MPS2 & 1 Alpha Mannosidosis included. A retrospective case notes review was undertaken to assess the following outcome measures: Post HSCT growth parameters Thyroid function tests Sex hormone levels Specific endocrine issues. Discussion We have noted among 31 patients, 16 patients were referred to endocrine team. 7 patients are referred at or after the 10 years of age whilst the rest of the 9 patients had endocrine assessment at the mean age of 2–9 years. The endocrine referral done before 10 yrs of age was because of specific endocrine problems, not as a surveillance. Most of the patients had the growth parameters checked however it was not particularly focussed or had set points for regular monitoring. We have learnt that only 10% of patients had sex hormone levels checked at the adolescent age when the expected endocrine issues are anticipated. Conclusion Overall, we highlight that proper endocrine referral at the age of 10 years is required for the post HSCT MPS patients.

Correction: On 21st September 2018, the author 'Pravin Kumar Mishra' was changed to 'Pravin Mishra' - Editorial Board. The study has been directed to find out the occurrence of surgical affections in herbivorous zoo animals in National Zoological Garden, Dhaka, Bangladesh predicated on record books from 2012 to 2016. A total of 330 surgically affected animals were recorded. The overall occurrence of surgical affections was higher in Bovidae (34.85%) followed by Cervidae (25.45%), Equidae (13.94%), Cercopithecidae (10.61%), Giraffidae (4.85%), Elephantidae (4.55%) Hippopotamidae (4%), Rhinocerotidae (1.52%) and Macropodidae (0.61%). In this study, it is found a higher occurrence of surgically affected are male than female animals. The overall occurrence in male was 56.36% and those in female, it was 43.64%. In terms of different affections, the highest occurrence was wound (13.03% male, 16.67% female) and followed by lameness (14.55% in male, 11.82% in female), skin lesions (9.39% in male, 6.67% in female), myiasis (5.76% in male, 3.33% in female), Horn fracture 3.33% (Only in male), arthritis (2.42% male, 1.52% female), hoof injury (1.82% male, 1% female), abscess (1.52% male, 1.21% female), sore (0.61% male, 2.12% female), Fracture (1.21% male, 0.3% female), Paralysis (0.61% male, 0.3% female) and Corneal opacity (0.61% male, 0.3% female). This report may help to develop control strategies against major surgical affections reported in this study.Res. Agric., Livest. Fish.5(2): 209-214, August 2018

Background In this modern era, health care has been shifted from the hospital-based acute care to primary health care. The people are now more concern to get medical help as early as possible and Tele-medicine in the answer to this hunger. Objectives The aim of this study was to determine the Patient satisfaction over the Telemedicine service in The Dhaka City, Bangladesh. Methods A cross-sectional study was conducted in Synesis IT Bangladesh Ltd among 203 participants of all age group who have been contacted to telemedicine services from 1st November 2017 to 30th April 2018. Results The study found that majority participants (79.8%) were age group of 19-40, where most of them were housewife & privet job holders and most of them were married (72. 4%). It was observed that 76.7% of the patients took less than a minute to get a connection to a doctor over the phone. The study also found that 40.5% of the patients responded that the service was excellent and 22.5% of the patients said it was best in service. 97.5% patients said they will suggest others to call telemedicine service to get medical help. Conclusion Results of this study conclude that Telemedicine in Bangladesh is getting popular and well accepted now a day. It has earned the trust of the people and if continue like this, it will reduce the treatment dilemmas in Bangladesh. We recommend the telemedicine service providers to make them more visible and easily available, so more people will be engaged and benefited from their services. Keywords: Telemedicine, Patient satisfaction, Cross-sectional study, Bangladesh

Globally, breast cancer is the most common cancer and the second leading cause of cancer-related death among women. Surgery, chemotherapy, hormonal therapy, and radiotherapy are currently available treatment options for breast cancer therapy. However, chemotherapy, hormonal therapy, and radiotherapy are often associated with side effects and multidrug resistance, recurrence, and lack of treatment in metastasis are the major problems in the treatment of breast cancer. Recently, dietary phytochemicals have emerged as advantageous agents for the prevention and therapy of cancer due to their safe nature. Ellagic acid (EA), sulforaphane (SF), and ursolic acid (UA), which are found in widely consumed fruits and vegetables, have been shown to inhibit breast cancer cell proliferation and to induce apoptosis. This review encompasses the role of EA, SF, and UA in the fight against breast cancer. Both in vitro and in vivo effects of these agents are presented.

Bee Kim Tan,1,2 Seng Beng Tan,3 Li-Chia Chen,4 Kian Meng Chang,5 Siew Siang Chua,1,6 Sharmini Balashanker,7 Habiba Nazeera Begum Kamarul Jaman,5 Syed Carlo Edmund,8 Ping Chong Bee3 1Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; 2Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, UCSI University, Kuala Lumpur, Malaysia; 3Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; 4Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, UK; 5Department of Hematology, Ampang Hospital, Ampang, Selangor, Malaysia; 6School of Pharmacy, Faculty of Health and Medical Sciences, Taylor’s University, Lakeside Campus, Subang, Selangor, Malaysia; 7School of Pharmacy, University of Nottingham Malaysia Campus, Semenyih, Selangor, Malaysia; 8Clinical Research Center, Ampang Hospital, Ampang, Selangor, Malaysia Purpose: Poor adherence to tyrosine kinase inhibitors (TKIs) could compromise the control of chronic myeloid leukemia (CML) and contributes to poorer survival. Little is known about how medication-related issues affect CML patients’ adherence to TKI therapy in Malaysia. This qualitative study aimed to explore these issues.Patients and methods: Individual face-to-face, semistructured interviews were conducted at the hematology outpatient clinics of two medical centers in Malaysia from August 2015 to January 2016. CML patients aged ≥18 years who were prescribed a TKI were invited to participate in the study. Interviews were audio-recorded, transcribed verbatim, and thematically analyzed.Results: Four themes were identified from 18 interviews: 1) concerns about adverse reactions to TKIs, 2) personal beliefs regarding the use of TKIs, 3) mismanagement of TKIs in daily lives, and 4) financial burden in accessing treatment. Participants skipped their TKIs due to ineffective emesis control measures and perceived wastage of medication from vomiting. Participants also modified their TKI therapy due to fear of potential harm from long-term use, and stopped taking their TKIs based on belief in curative claims of traditional medicines and misconception about therapeutic effects of TKIs. Difficulty in integrating the dosing requirements of TKIs into daily lives led to unintentional skipping of doses, as well as the risk of toxicities from inappropriate dosing intervals or food interactions. Furthermore, financial constraints also resulted in delayed initiation of TKIs, missed clinic appointments, and treatment interruptions.Conclusion: Malaysian CML patients encountered a range of medication-related issues leading to a complex pattern of nonadherence to TKI therapy. Further studies should investigate whether regular contact with patients to improve understanding of treatment rationale, to elicit and address patients’ concerns about adverse reactions, and to empower patients with skills to self-manage their medications might promote better adherence to TKIs and improve CML patients’ outcome. Keywords: medication-related issues, adherence, tyrosine kinase inhibitors, chronic myeloid leukemia, qualitative study, thematic analysis

Introduction Dupilumab, a fully human interleukin (IL)-4 receptor-α monoclonal antibody inhibiting IL-4/IL-13 signaling pathways, key drivers of Type 2 inflammation, is approved for treating adults with inadequately controlled moderate-to-severe atopic dermatitis. In the phase 3 LIBERTY ASTHMA QUEST study (NCT02414854), dupilumab 200mg and 300mg administered every 2 weeks versus matched placebo reduced annualized severe exacerbation rates and improved pre-bronchodilator forced expiratory volume in 1 second (FEV1) and quality-of-life measures, and was generally well tolerated in patients with uncontrolled, moderate-to-severe asthma (≥12 years, without minimum baseline Type 2 inflammatory biomarkers). This post-hoc analysis assessed the efficacy of dupilumab in patients with and without allergic asthma. Methods Allergic asthma was defined as total serum IgE ≥30 kU/L and ≥1 positive perennial aeroallergen-specific IgE (≥0.35 kU/L) at baseline. Endpoints were annualized severe exacerbation rates over the 52-week treatment period and change from baseline to Week 12 in pre-bronchodilator FEV1 (L). Results 56% (n=1,066) of the intent-to-treat population met the criteria for allergic asthma. In patients with and without allergic asthma, dupilumab vs placebo significantly reduced annualized severe exacerbation rates during the treatment period (all P1 (L) at Week 12 (all PFigure). In both subgroups, improvements were greater with higher baseline blood eosinophil and FeNO levels. The most frequent adverse event in the dupilumab-treated groups versus placebo was injection-site reactions (15%/18% versus 5%/10%, respectively). Conclusions Add-on dupilumab reduced severe exacerbations and improved lung function in patients with allergic and non-allergic uncontrolled, moderate-to-severe asthma and was generally well tolerated. Figure. Change from baseline to Week 12 in pre-bronchodilator FEV1 (L) and annualized severe exacerbation rate during the 52-week treatment period in patients with and without allergic asthma and in subgroups defined by baseline blood-eosinophil counts and FeNO levels.

Background Endoscopic endonasal approaches have been shown to be as effective as transcranial approaches for sinonasal malignancies involving the skull base. Although they are associated with less risk than an open cranial resection, cerebrospinal fluid (CSF) leaks remain a main concern. Some drugs can raise the intracranial pressure and exacerbate the risk of a postoperative CSF leak. In this case report, we present a 32-year-old woman who was treated via endoscopic endonasal approach for an olfactory neuroblastoma and later underwent fertility preservation treatment with leuprolide, which likely led to a delayed CSF leak. Case Description A 32-year-old woman diagnosed with a large invasive olfactory neuroblastoma underwent resection via an endonasal transcribriform approach and repair of skull base defect using a pericranial flap. Forty-seven days post operation the patient returned, presenting with a clear nasal discharge. Magnetic resonance imaging raised concern for focal flap necrosis, while computed tomography cisternogram revealed a defect in the pericranial flap. The defect was debrided and repaired; a postoperative lumbar drain was placed and showed an opening pressure of 26 cm of water. Discussion with the patient revealed that she received fertility preservation treatment with leuprolide followed by oocyte retrieval 32 days before presentation of her delayed CSF leak. Conclusions Leuprolide or any drug that can potentially increase intracranial pressure should be held for 3 months after surgery or until after a skull base defect has fully healed.

Objectives/Hypothesis Establish treatment patterns and economic burden in US patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) versus without chronic rhinosinusitis (CRS). Determine comparative costs of subgroups with high clinical burden. Study Design Observational, retrospective, case-control study. Methods This study matched patients with CRSwNP to patients without CRS (1:1) using the Truven Health MarketScan US claims database. Categorical and continuous variables were compared using McNemar test and paired t test (normal distribution) or Wilcoxon signed rank tests (non-normal distribution). Within subgroups, chi(2) and Wilcoxon or t tests were used (normal distribution). Results There were 10,841 patients with CRSwNP and 10,841 patients without CRS included. Mean age in the CRSwNP cohort was 45.8 years; 56.2% were male. During follow-up, patients with CRSwNP had an increased diagnosis of asthma versus patients without CRS (20.8% vs. 8.1%, respectively; P < .001). Annual incremental costs were $11,507 higher for patients with CRSwNP versus those without CRS. Costs were higher in subgroups of patients with CRSwNP undergoing functional endoscopy sinus surgery (FESS), with a comorbid diagnosis of asthma, receiving oral corticosteroids, or macrolides versus the overall CRSwNP group. Patients with CRSwNP undergoing FESS had the highest costs of the four subgroups ($26,724, $22,456, $20,695, and $20,990, respectively). Conclusions Annual incremental costs were higher among patients with CRSwNP versus without CRS. Patients with CRSwNP with high clinical burden had higher overall costs than CRSwNP patients without. Level of Evidence NA Laryngoscope, 129:1969-1975, 2019

Patients with autoimmune connective tissue disease (CTD) are at higher risk for developing aortic valve pathology, but the safety and value of transcatheter aortic valve implantation (TAVI) in this population has not been investigated. This study evaluated mortality, complication, and readmission rates along with length of stay and total costs after TAVI in patients with CTD. We retrospectively reviewed 47,216 patients who underwent TAVI from the National Readmissions Database between January 2011 and September 2015. Patients with systemic lupus erythematosus, scleroderma, rheumatoid arthritis, and other autoimmune CTD comprised the cohort. The primary outcome was mortality at index hospitalization. The 2,557 CTD patients (5.4%) had a higher Elixhauser co-morbidity index (7.1 vs 6.1, p0.001) than non-CTD patients. CTD and non-CTD patients had similar mortality (2.8 vs 4.1%, p = 0.052), 30-day readmission (19.3 vs 17.0%, p = 0.077), length of stay (8.2 vs 8.3 days, p = 0.615), and total adjusted costs ($57,202 vs $58,309, p = 0.196), respectively. However, CTD patients were more frequently readmitted for postoperative infection (9.4 vs 5.6%, p = 0.042) and septicemia (8.2 vs 4.5%, p = 0.019). After multivariable adjustment, CTD patients faced lower mortality at index hospitalization (odds ratio [OR] 0.56 [0.38 to 0.82], p = 0.003) but were more frequently readmitted for septicemia (OR = 1.95 [1.10 to 3.45], p = 0.023) and postoperative infection (OR = 3.10 [1.01 to 9.52], p = 0.048) relative to non-CTD patients. In conclusion, CTD is not a risk factor for in-hospital mortality but is an independent risk factor for infectious complications post-TAVI.

Introduction and objectives Dupilumab, a fully human anti-interleukin (IL)−4α monoclonal antibody that inhibits IL-4 and IL-13, key drivers of Type 2 inflammation, is approved for treatment of adults with inadequately controlled moderate-to-severe atopic dermatitis. In a double-blind, placebo-controlled phase 3 study (NCT02414854), patients with asthma aged ≥12 years, without a minimum baseline eosinophil requirement and uncontrolled with medium-to-high-dose inhaled corticosteroids (ICS) plus up to two additional controllers, received add-on dupilumab 200 mg or 300 mg or matched placebo every 2 weeks (q2w) for 52 weeks. In the overall intent-to-treat population, both dupilumab doses significantly reduced annualized severe exacerbation rates during the 52 week treatment period, improved pre-bronchodilator forced expiratory volume in 1 s (FEV1), improved quality of life measures, and were generally well tolerated. This pre-specified analysis assessed the efficacy of dupilumab by disease severity determined by baseline ICS dose (high/medium). Methods Annualized severe exacerbation rates during the 52 week treatment period and change from baseline in pre-bronchodilator FEV1 at Week 12 were analyzed by baseline ICS dose (high/medium) subgroup. These parameters were further analyzed by subgroups defined by baseline levels of eosinophils (≥300 cells/µL) and fractional exhaled nitric oxide levels (FeNO;≥25 ppb). Results Both dupilumab q2w doses significantly reduced annualized severe exacerbation rates over the 52–week treatment period (p Conclusions Add-on dupilumab significantly reduced the rate of severe exacerbations, and improved FEV1 in patients with moderate or severe asthma (as assessed by medium or high ICS dose at baseline). Dupilumab demonstrated increased efficacy in patients with higher levels of Type 2 inflammation, as defined by elevated baseline eosinophil counts and FeNO levels. Dupilumab was generally well tolerated. Please refer to page A265 for declarations of interest related to this abstract.

Introduction and objectives Dupilumab, a fully human anti-interleukin (IL)−4Rα monoclonal antibody that inhibits IL-4 and IL-13, key drivers of Type 2 inflammation, is approved for treatment of adults with inadequately controlled, moderate-to-severe atopic dermatitis. In the double-blind, placebo-controlled LIBERTY ASTHMA QUEST phase 3 study (NCT02414854), patients with asthma aged ≥12 years, without a minimum baseline eosinophil requirement, uncontrolled with medium-to-high-dose inhaled corticosteroids plus up to two additional controllers, received add-on dupilumab 200 mg or 300 mg or matched placebo every 2 weeks (q2w) for 52 weeks. For the intent-to-treat population, both dupilumab regimens significantly reduced annualized severe exacerbation rates during the 52 week treatment period, improved pre-bronchodilator forced expiratory volume in 1 s (FEV1) at Week 12, improved asthma symptoms/quality of life measures, and were generally well tolerated. This post hoc analysis assessed the efficacy of dupilumab by the number of exacerbations experienced prior to the study. Methods Annualized severe exacerbation rates during the 52 week treatment period and change from baseline in pre-bronchodilator FEV1 (L) at Week 12 and Week 24 were analyzed by subgroups of patients with ≥1,≥2,≥3, or ≥4 exacerbations in the prior year. Results Both dupilumab q2w doses vs placebo reduced severe exacerbations over the 52 week treatment period (p Conclusions Dupilumab significantly reduced severe exacerbations and improved FEV1 regardless of exacerbation history, with greater improvements observed with higher numbers of prior exacerbations, in patients with uncontrolled, moderate-to-severe asthma, and was generally well tolerated. Please refer to page A267 for declarations of interest related to this abstract.

Investigations have also reported that the efficacy of telemedicine in the easy delivery of information and provision of regular patient-doctor interaction and therefore, enhancing the quality of care of diabetics and reducing the risk of developing severe complications. In the present study, we aimed to discuss telemedicine use in the management of diabetic complications, depending on information from studies within the literature. Overall, telemedicine assists patients to properly maintain basic and adequate levels of blood glucose levels through continuous reminders. Therefore, the application of this modality requires patients to have home-based assessment devices for the regular monitoring of the blood glucose levels. Moreover, the modality also enhances the connection between the patient and the physicians which make the patient at an ease of being able to communicate with the doctor whenever necessary and therefore, this might have a positive psychological impact on these patients. Moreover, telemedicine can provide patients with adequate treatment schedules that might help patients comply with their drugs. Additionally, it can provide the most appropriate dietary components that can also help in achieving the best intervention, with the necessary supervision. Although there is good evidence about the efficacy of telemedicine as an efficacious modality in the treatment of diabetes and management of complications, the evident application in the healthcare settings is still poor. The main reason behind such lack of proper application is the potential lack of adequate financial support, lack of experienced staff dealing with the modalities and maintaining the best quality of care for the patients.

Congenital contractural arachnodactyly, commonly known as Beal's syndrome, is an extremely rare genetic disorder caused by mutations in the fibrillin-2 (FBN2) gene located on chromosome 5q23. It is an autosomal dominant inherited connective tissue disorder characterised by a Marfan-like body habitus, contractures, abnormally shaped ears and kyphoscoliosis. We report a seven-year-old Omani male who presented to the Sultan Qaboos University Hospital, Muscat, Oman, in 2014 with seizures. He was noted to have certain distinctive facial features and musculoskeletal manifestations; he was subsequently diagnosed with Beal's syndrome. Sequencing of the FBN2 gene revealed that the patient had a novel mutation which was also present in his mother; however, she had only a few facial features indicative of Beal's syndrome and no systemic involvement apart from a history of childhood seizures. To the best of the authors' knowledge, this is the first report of Beal's syndrome with seizure symptoms as a potential feature.

Introduction: Diabetes mellitus has long been associated with perinatal morbidity and mortality. It complicates 2% to 3% of all pregnancies; 90% of these cases present with gestational diabetes mellitus. In our population Gestational diabetes mellitus develops among 6.7% of all pregnancies. Macrosomia (28%), hypocalcaemia (22%), hyperbillirubinaemia (19%), polycythemia (34%), perinatal asphyxia, birth injury and congenital anomaly (6-9%) are the complications of infant of diabetic mother (IDM).Materials and Methods: This prospective observational study was done in the newly established Special Care Neonatal Unit (SCANU) to determine the morbidities and mortalities among IDM babies admitted in to Mymensingh Medical College Hospital (MMCH), Bangladesh from January to March 2015. A total 50 IDM patients who admitted during this period were recruited in the study irrespective of their gestational age, birth weight, pattern and duration of maternal diabetes.Results: Male and female patients were 29 (58%) and 21 (42%). Caesarian and vaginal delivery were 43 and seven cases. Gestational and pre-gestational diabetes mothers were 35 (70%) and 15 (30%) respectively. The important morbidities in order of frequency were found perinatal asphyxia (50%), macrosomia (48%), neonatal jaundice (44%), hypoglycaemia (40%), hypocalcaemia (36%), polycythemia (28%), CHD (20%), neonatal sepsis (20%), birth trauma (12%), TTN (6%), RDS (6%), GIT problem (2%) respectively. Mortality was recorded in three patients. Conclusion: Our observations show the high prevalence of IDM (24/1000 live birth) and their various complications. Mortality and morbidity is a bit higher in IDM. Our health policy maker should give adequate emphasis on management of IDM babies.J Nepal Paediatr Soc 2015;35(3):253-256

Background and Objective: Dengue, an acute viral disease, transmitted by Aedes mosquitoes, has a variable clinical spectrum ranging from asymptomatic infection to life-threatening dengue hemorrhagic fever and dengue shock syndrome. However, neurological complications, in general, are unusual but have been observed more frequently in the recent past, and some studies highlighted varied neurological complications during the course of illness. Although dengue is classically considered a nonneurotropic virus, there is increasing evidence for dengue viral neurotropism. In this study, we have evaluated clinico-radiological profile and outcome of nine serologically confirmed dengue patients having varied manifestations of central nervous system (CNS) involvement. Materials and Methods: All the consecutive patients presented with neurological complications with positive serology for dengue infection (IgM positivity) in Department of Medicine, in a tertiary care hospital in Eastern India from August 2013 to October 2014 were included in the study. These patients were subjected to a detailed clinical evaluation, laboratory assessment including complete hemogram, coagulation profile, liver function test, serum electrolytes, and routine CSF (Cerebrospinal Fluid) study with the exclusion of other common neuroinvasive pathogens. Results: Out of 9 patients with neurological complications associated with confirmed dengue infection, 2 (22%) patients had dengue encephalopathy, 5 (56%) patients have dengue encephalitis, 1 (11%) patient had dengue meningitis, and 1 (11%) patient had postdengue immune-mediated CNS involvement. Conclusion: This case series reaffirms the occurrence of varied CNS manifestations in dengue virus infection and underlines the importance of inclusion of dengue in the differential diagnosis of acute encephalitis syndrome.

Hashimoto’s thyroiditis (HT) is an organ-specific autoimmune disorder characterized by progressive thyroid failure. Th1 and Treg subset of CD4+ cells have been implicated in the pathogenesis; however, less is known about their respective roles across the spectrum of HT clinical presentations. To shed more light on CD4+ subsets role in HT, we investigated the mRNA expression levels of several Th1/Treg-associated transcription factors (T-bet/ETS1, HIF1α/BLIMP1/FOXP3) in peripheral blood T cells of 10 hypothyroid, untreated HT patients, 10 hypothyroid patients undergoing hormone replacement therapy, 12 euthyroid HT subjects, and 11 healthy controls by the qRT-PCR. Compared to euthyroid HT patients and controls, both hypothyroid (2.34-fold difference versus controls, P<0.01) and thyroxine-supplemented patients (2.5-fold, P<0.001) showed an increased FOXP3 mRNA expression in T cells. Similarly, mRNA expression levels of T-bet were upregulated in severely affected but not in euthyroid HT subjects (2.37-fold and 3.2-fold, hypothyroid and thyroxine-supplemented HT patients versus controls, resp., P<0.01). By contrast, no differences in mRNA expression levels of ETS1, BLIMP1, and HIF1α were observed across the study groups. In summary, severe but not euthyroid HT was associated with robust upregulation of T-bet and FOXP3 mRNA in peripheral T cells, independent of the thyroid hormone status but proportional to disease activity.

Background: Dupilumab (DPL), a fully human anti-IL-4Rα mAb that inhibits IL-4/IL-13, is approved for treatment of adults with inadequately controlled moderate-to-severe atopic dermatitis. In a phase 3 study (NCT02414854), asthma patients (pts) aged ≥12 years, with no minimum baseline (BL) eosinophil requirement, uncontrolled with medium-to-high-dose ICS, plus 1 or 2 controllers received DPL 200/300mg or placebo (PBO) every 2 weeks for 52 weeks. DPL reduced severe exacerbations, improved FEV1 and quality of life measures, and was generally well tolerated. Asthma pts with the common comorbidities CRS/NP are often more difficult to treat. Aim: Assess DPL efficacy in asthma pts with CRS/NP. Methods: 382/1902 pts reported CRS/NP medical history. Endpoints: annualized rate of severe exacerbations during the 52-week treatment period and change from BL in FEV1 at Week 12. Results: CRS/NP pts had higher BL severe exacerbations than non-CRS/NP pts. DPL vs PBO reduced severe exacerbations and improved FEV1 in difficult-to-treat CRS/NP pts and was equally effective in non-CRS/NP pts (Table). Most common AE, with higher rates in 200/300mg DPL vs PBO, was injection-site reactions (21%/24% vs 6%/14%). Conclusion: DPL improved FEV1 and reduced severe exacerbations in uncontrolled, moderate-to-severe asthma pts with and without comorbid CRS/NP, and was generally well tolerated.

People who experience panic attacks are frequent utilisers of hospital Emergency Departments (EDs). The ED setting provides an opportunity to provide ultra-brief interventions, specifically by referring these patients to specialist mental health care. This study attempted to evaluate the effectiveness of an ultra-brief psycho-education and referral intervention, a panic information card (PIC), currently distributed at three Victorian EDs. Participants were a convenience sample of 72 individuals (20 males and 51 females, 1 unspecified) who had presented to an ED for panic symptoms in the past 12 months. Individuals self-identified as either a card receiver (CR) or a non-card receiver (NCR). Two senior ED staff members were interviewed regarding their evaluation of the effectiveness of the PIC. It was hypothesised that CRs would; (1) review the PIC favourably; (2) be more likely to seek help for PA than NCRs; (3) seek help sooner than NCRs; and (4) seek help on fewer occasions post-intervention than NCRs. S...

Influenza is prevalent in Bangladesh among both adults and children. This observation is proved by recent population-based estimates. A hospital based surveillance study was conducted under the supervision of ICDDRB at Community Based Medical College Hospital, Bangladesh (CBMCH,B). To explore the epidemiology and seasonality of influenza throughout the Mymensingh region and all age groups, we analyzed the data collected during the period of May 2007 to May 2012 for a period of 5 years. The result revealed that out of 1014 patients, 140(14%) were influenza positive by real time RT-PCR. Among the sample-positive patients, 90(64%) were type A and 50(36%) type B. Hemagglutinin subtyping of type A virus detected 7(8%) A/H1 and 42(47%) A/H3, 41(46%) H1N1 pdm09 but no A/H5 or other novel influenza strains. The frequency of influenza cases was highest among children aged under 5 year 44%, while the laboratory confirmed cases were highest among patients aged under 1 year to 30 years 54%. We identified a distinct influenza peak during the rainy season (May to September), highest in July and August. There is a very low presence of influenza in the month of October, November and December (2, 1, 2 flu positive cases in 5 year period respectively). Our surveillance data confirms that influenza is prevalent throughout Mymensingh, affecting a wide range of ages and causing considerable morbidity and hospital care. A unimodal influenza seasonality may allow Mymensingh, Bangladesh to time annual influenza prevention messages and vaccination campaigns to reduce the national influenza burden. To scale-up such national interventions, we need to quantify the national rates of influenza and the economic burden associated this disease through further studies. CBMJ 2015 January: Vol. 04 No. 01 P: 03-12

Introduction: Allergic rhinitis (AR) is a common type 2/Th2 comorbidity in asthma patients (pts). Besides having higher exacerbation rates and health-care costs, asthma pts with AR (vs those without AR) have worse asthma disease control, symptoms, and quality of life (QoL). In a pivotal phase 2b study (NCT01854047), dupilumab (DPL), a fully human anti-IL-4Rα monoclonal antibody that inhibits IL-4 and IL-13 signaling, improved lung function and QoL measures, reduced severe asthma exacerbations, and was generally well tolerated in adults with uncontrolled persistent asthma on medium-to-high-dose ICS+LABA. Aims: This post hoc analysis assessed patient-reported outcomes (PROs) in asthma pts with self-reported ongoing comorbid AR. Methods: Pts received DPL 200/300 mg every 2 weeks (q2w; currently investigated in phase 3 [NCT02414854]) or q4w, or placebo (PBO). PROs up to Week 24 are reported. Results: DPL 200 and 300 mg q2w resulted in significant improvements vs PBO ( P Conclusions: In asthma patients with ongoing AR, DPL added to ICS+LABA improved asthma control, symptoms, and asthma-related QoL. Future studies are required to investigate the benefit of DPL in this subgroup.

Introduction: Allergic rhinitis (AR) is a common type 2/Th2 comorbidity in asthma patients (pts). Besides having higher exacerbation rates and health-care costs, asthma pts with AR (vs those without AR) have worse asthma disease control, symptoms, and quality of life (QoL). In a pivotal phase 2b study (NCT01854047), dupilumab (DPL), a fully human anti-IL-4Rα monoclonal antibody that inhibits IL-4 and IL-13 signaling, improved lung function and QoL measures, reduced severe asthma exacerbations, and was generally well tolerated in adults with uncontrolled persistent asthma on medium-to-high-dose ICS+LABA. Aims: This post hoc analysis assessed efficacy findings in asthma pts with self-reported ongoing comorbid AR. Methods: Pts received DPL 200/300 mg every 2 weeks (q2w; currently investigated in phase 3 [NCT02414854]) or q4w, or placebo (PBO). Change from baseline to Weeks 12 and 24 in FEV 1 (L and %) and annualized severe asthma exacerbation rate over the 24-week treatment period are reported. Results: DPL 200 and 300 mg q2w improved FEV 1 (L) ( P P Table ). Conclusions: In asthma patients with ongoing AR, DPL added to ICS+LABA improved FEV 1 and reduced severe asthma exacerbations. Future studies are required to investigate the benefit of DPL in this subgroup.

Diabetes & metabolism 43(5), 453-459 (2017). doi:10.1016/j.diabet.2017.01.004, Published by Elsevier Masson, Issy-les-Moulineaux

Objetivo: develar las experiencias de mujeres chilenas con cáncer en tratamiento con quimioterapia. Materiales y método: estudio de investigación cualitativa fenomenológica según el pensamiento filosófico de Martín Heidegger. Se entrevistaron en profundidad a 10 mujeres entre 45 y 64 años, con diferentes diagnósticos de cáncer en tratamiento con quimioterapia. El análisis se realizó basado en el método de Streubert y Carpenter, triangulando con un investigador experto. Resultados: la experiencia de vivir con cáncer y con quimioterapia significa estar "viviendo con un tratamiento que provoca cambios profundos en la vida de las mujeres", siendo esta una categoría comprensiva esencial del estudio que contiene cuatro unidades de significados: 1) cambios en todas las dimensiones del "ser" de las mujeres tanto a nivel corporal como emocional y espiritual; 2) cambios en el "ser-sí-misma": antes y durante la quimioterapia; 3) cambios de "ser" en el mundo; 4) cambios en la familia. Conclusiones: la comprensión en profundidad de lo vivido por las mujeres de este estudio confirma lo publicado en la literatura, y se constituye en un saber comprensivo que puede servir de guía para realizar cuidados de enfermería oncológicos humanos y personalizados basados en las necesidades de cada persona. Objective: To show the experiences of Chilean women with cancer who are undergoing chemotherapy. Materials and methods: This is a phenomenological qualitative study developed pursuant to the philosophical thinking of Martin Heidegger. In-depth interviews were conducted with 10 women between 45 and 64 years of age who have been diagnosed with different types of cancer and are undergoing chemotherapy. The analysis was based on the Streubert-Carpenter method and triangulated by a practiced researcher. Results: The experience of living with cancer and chemotherapy means "living with a treatment that causes profound changes in women's lives," this being an essential, comprehensive category of the study that contains four units of meaning: 1) changes in all the dimensions of "being" a woman; that is, at the corporal, emotional and spiritual level, 2) changes in "being oneself" before and during chemotherapy, 3) changes to "being" in the world, and 4) changes in the family. Conclusions: An in-depth understanding of the experiences of the women in this study confirms the reports in literature and constitutes a comprehensive body of knowledge that can serve as a guide to humane and tailored cancer nursing care based on each person's needs. Objetivo: revelar as experiências de mulheres chilenas com câncer em tratamento com quimioterapia. Materiais e método: estudo de pesquisa qualitativa fenomenológica segundo o pensamento filosófico de Martín Heidegger. Entrevistaram-se em profundidade 10 mulheres entre 45 e 64 anos, com diferentes diagnósticos de câncer em tratamento com quimioterapia. A análise foi realizada com base no método de Streubert e Carpenter, e triangulada com um pesquisador especialista. Resultados: a experiência de viver com câncer e com quimioterapia significa estar "vivendo com um tratamento que provoca mudanças profundas na vida das mulheres", e esta é uma categoria compreensiva essencial do estudo que contém quatro unidades de significados: 1) mudanças em todas as dimensões do "ser" das mulheres, tanto corporal quanto emocional e espiritualmente; 2) mudanças no "ser-si-mesma": antes e durante a quimioterapia; 3) mudanças de "ser" no mundo; 4) mudanças na família. Conclusões: a compreensão em profundidade do vivido pelas mulheres deste estudo confirma o publicado na literatura e constitui-se em um saber compreensivo que pode servir de guia para realizar cuidados de enfermagem oncológicos humanos e personalizados baseados nas necessidades de cada pessoa.

The determinant spectra coupled with laboratory parameters of cutaneous tuberculosis in patients attending the Department of Dermatology and VD of the Community Based Medical College, Mymensingh, Bangladesh were studied for a period of over four years. A total of 110 patients (males, 75 and females, 35) having ages between 1 to 60 years were detected to infected. The result evidenced that skin tuberculosis is becoming mostly a disease of young patients between the ages of 16 to 30 years (44.55 %). There was a trend of appearance of Lupus vulgaris as the most common variant (49.09%) followed by Tuberculosis verrucosa cutis (29.09%). Skin tuberculosis was found more frequently in males than females (ratio 15: 7) and all patients belonged to lower socio-economic class. In 64 cases (58.18%) BCG vaccination coverage could not yield protection against cutaneous tuberculosis. Abnormal chest x-ray reports were available in 12 patients. It is interesting to note that enlargement of hilar lymph nodes, pleural effusion, ascites and generalized lymphadenopathy were not detected. Mantoux test revealed positive reactors in 100 patients (90.90%). Raised ESR (>20) was found in all patients. The validity of histopathology associated with FNAC was confirmed in 95 cases of patients (86.36%). There was evidence of Scrofuloderma in 20 patients and ICT indicated 74 positive cases. Bacteriological examination generated negative results in all cases. The response to antitubercular therapy was excellent except in 3 cases which required further monitoring of using additional drug and took much more time. The coexistence of pulmonary tuberculosis was determined in 2 patients.DOI: http://dx.doi.org/10.3329/cbmj.v1i1.13817 Community Based Medical Journal Vol.1(1) 2012 3-7

A centralized data management system was developed for data collection and processing for the Aetiology of Neonatal Infection in South Asia (ANISA) study. ANISA is a longitudinal cohort study involving neonatal infection surveillance and etiology detection in multiple sites in South Asia. The primary goal of designing such a system was to collect and store data from different sites in a standardized way to pool the data for analysis.We designed the data management system centrally and implemented it to enable data entry at individual sites. This system uses validation rules and audit that reduce errors. The study sites employ a dual data entry method to minimize keystroke errors. They upload collected data weekly to a central server via internet to create a pooled central database. Any inconsistent data identified in the central database are flagged and corrected after discussion with the relevant site. The ANISA Data Coordination Centre in Dhaka provides technical support for operations, maintenance and updating the data management system centrally. Password-protected login identifications and audit trails are maintained for the management system to ensure the integrity and safety of stored data.Centralized management of the ANISA database helps to use common data capture forms (DCFs), adapted to site-specific contextual requirements. DCFs and data entry interfaces allow on-site data entry. This reduces the workload as DCFs do not need to be shipped to a single location for entry. It also improves data quality as all collected data from ANISA goes through the same quality check and cleaning process.

Introduction Although reduced lung function is associated with quality of life impairment and increased mortality risk, limited real-world evidence exists on the impact of forced expiratory volume in one second percent predicted (FEV1pp) on exacerbations among moderate-to-severe asthma patients. Methods Data from the Clinical Practice Research Datalink was used to identify adult patients with clinical diagnosis codes for asthma and having prescription utilization patterns indicative of moderate-to-severe asthma (Step 3–5 per British Thoracic Society 2011 guidelines). The date of first asthma prescription during 01JAN2010–31DEC2012 was the index date. Patients had 12-months pre-index and 36-months post-index date data. Additionally, patients having baseline FEV1pp results were selected to assess the relationship between FEV1pp and follow-up severe asthma exacerbations. Severe asthma exacerbations were identified by asthma-related emergency room visits, inpatient admissions, or acute oral corticosteroid use. Patients were stratified by baseline FEV1pp (nearest FEV1pp result ±180 days of index date): Group 1 (G1), ≥80%; G2, 50–79%; G3, Results Overall, 36,614 patients were identified of which 1,865 had baseline FEV1pp results. Patients with lower baseline FEV1pp (G2 and G3) had a significantly greater risk for and higher incidence of exacerbations compared with G1 (see Table). Conclusions Lower baseline FEV1pp levels are associated with a higher risk of severe exacerbations suggesting that baseline lung function is an important predictor of future asthma exacerbations. Table. Severe exacerbation risk over the follow-up period categorized by baseline FEV1pp group in patients with moderate-to-severe asthma

Introduction Elevated eosinophils (EOS) are one marker for Type 2 asthma. We assessed the association between baseline EOS and severe asthma exacerbations. Methods Data from the Clinical Practice Research Datalink identified adult patients with clinical diagnosis codes for asthma and prescription utilization patterns indicative of moderate-to-severe asthma (Step 3–5 per British Thoracic Society 2011 guidelines). Date of first asthma prescription during 01JAN2010–31DEC2012 was the index date. Patients had 12-months pre-index and 36-months post-index data. Patients were stratified by baseline EOS (nearest EOS result ±180 days of index date): Level 1 (L1), 3; L2, 150–299 cells/mm3; L3, 300–499 cells/mm3; L4, ≥500 cells/mm3. Risk of severe exacerbations during the post-index period was reported using hazard ratios (HRs) and incident rate ratios (IRRs). Results Overall, 36,614 patients were identified, of which 12,155 had baseline EOS measurements. There were no significant differences in HRs for time to first exacerbation in L2 and L3 patients compared with L1; however, patients in L4 had a significantly greater risk of exacerbations. Unadjusted exacerbation rates per patient per year by EOS category were: L1 (0.42), L2 (0.41), L3 (0.44), and L4 (0.50). IRRs for exacerbations were similar in L2 and L3 patients compared with L1; however, L4 patients had significantly higher exacerbation rates (see Table). Conclusions Given that severe exacerbation rates were not associated with baseline EOS levels except for EOS ≥500 cells/mm3, baseline EOS may not be a consistent predictor of exacerbations; therefore, other potential predictors of exacerbations should be explored. Table. Severe exacerbation risk over the follow-up period categorized by baseline eosinophil level in patients with moderate-to-severe asthma

Background Dupilumab, an anti–IL-4 receptor α mAb, inhibits IL-4/IL-13 signaling, key drivers of type 2/TH2 immune diseases (eg, atopic/allergic disease). In a pivotal, phase 2b study (NCT01854047), dupilumab reduced severe exacerbations, improved lung function and quality of life, and was generally well tolerated in patients with uncontrolled persistent asthma despite using medium-to-high-dose inhaled corticosteroids plus long-acting β2-agonists. Objective To examine dupilumab's effect on the 22-item Sino-Nasal Outcome Test (SNOT-22) total score and its allergic rhinitis (AR)-associated items in asthma patients with comorbid perennial allergic rhinitis (PAR). Methods A post hoc analysis reporting data from the phase 2b study for the 200 and 300 mg every 2 week (q2w) doses under investigation in phase 3 (NCT02414854) was carried out. PAR was defined at study entry as a specific response to typical perennial antigens (IgE ≥0.35 Ku/L). Results Overall, 241 (61%) patients had PAR. In asthma patients with PAR, dupilumab 300 mg q2w versus placebo significantly improved SNOT-22 total score (least squares mean difference, −5.98; 95% CI, −10.45 to −1.51; P = .009) and all 4 AR-associated symptoms evaluated (nasal blockage, −0.60; 95% CI, −0.96 to −0.25; runny nose, −0.67; 95% CI, −1.04 to −0.31; sneezing, −0.55; 95% CI, −0.89 to −0.21; postnasal discharge, −0.49; 95% CI, −0.83 to −0.16; all P Conclusions Dupilumab 300 mg q2w significantly improved AR-associated nasal symptoms in patients with uncontrolled persistent asthma and comorbid PAR.