Practice Patterns and Outcomes of Intravitreal Anti-VEGF Injection for Retinopathy of Prematurity: An International Multicenter Study.

PURPOSE: To report practice patterns of intravitreal injections of anti-VEGF for retinopathy of prematurity (ROP) and outcomes data with a focus on retreatments and complications. DESIGN: Multicenter, international, retrospective, consecutive series. SUBJECTS: Patients with ROP treated with anti-VEGF injections from 2007 to 2021. METHODS: Twenfty-three sites (16 United States [US] and 7 non-US) participated. Data collected included demographics, birth characteristics, examination findings, and methods of injections. Comparisons between US and non-US sites were made. MAIN OUTCOME MEASURES: Primary outcomes included number and types of retreatments as well as complications. Secondary outcomes included specifics of the injection protocols, including types of medication, doses, distance from limbus, use of antibiotics, and quadrants where injections were delivered. RESULTS: A total of 1677 eyes of 918 patients (43% female, 57% male) were included. Mean gestational age was 25.7 weeks (range, 21.2-41.5 weeks), and mean birth weight was 787 g (range, 300-2700 g). Overall, a 30-gauge needle was most commonly used (51%), and the quadrant injected was most frequently the inferior-temporal (51.3%). The distance from the limbus ranged from 0.75 to 2 mm, with 1 mm being the most common (65%). Bevacizumab was the most common anti-VEGF (71.4%), with a dose of 0.625 mg in 64% of cases. Overall, 604 (36%) eyes required retreatment. Of those, 79.8% were retreated with laser alone, 10.6% with anti-VEGF injection alone, and 9.6% with combined laser and injection. Complications after anti-VEGF injections occurred in 15 (0.9%) eyes, and no cases of endophthalmitis were reported. Patients in the United States had lower birth weights and gestational ages (665.6 g and 24.5 weeks, respectively) compared with non-US patients (912.7 g and 26.9 weeks, respectively) (P < 0.0001). Retreatment with reinjection and laser was significantly more common in the US compared with the non-US group (8.5% vs. 4.7% [P = 0.0016] and 55% vs. 7.2% [P < 0.001], respectively). There was no difference in the incidence of complications between the 2 geographic subgroups. CONCLUSIONS: Anti-VEGF injections for ROP were safe and well tolerated despite a variance in practice patterns. Infants with ROP receiving injections in the US tended to be younger and smaller, and they were treated earlier with more retreatments than non-US neonates with ROP.

How I Handle Retreatment of LUTS Following a Failed MIST.

PURPOSE OF REVIEW: The goal of this paper is to review retreatment management after failed minimally invasive treatment (MIST) of various technologies. RECENT FINDINGS: A failed MIST can be defined by the return, persistence, or worsening of LUTS, as documented by symptom scores. Persistence, development, or recurrence of comorbidities such as recurrent urinary tract infection (UTI), retention, stones, hematuria, and incontinence can also signal a failed MIST. The common etiology for MIST failure is the preoperative consequence of long-term bladder outlet obstruction (BOO) on the bladder function. Close monitoring of therapies with antimuscarinics or beta-agonists can be empirically utilized if post-void bladder residual (PVR) is low. If there is a high PVR, urodynamic studies and cystoscopy can be used to determine overactive bladder (OAB), BOO, or necrosis. Depending on the timing of the observed BOO/OAB, subsequent retreatments involving transurethral debridement, medical and behavioral therapies, or repeat surgical debulking can be employed.

Switch to miriplatin for multinodular hepatocellular carcinoma unresponsive to transarterial chemoembolization with epirubicin: a prospective study.

OBJECTIVE: The aim of this prospective study was to evaluate the efficacy of transarterial chemoembolization using miriplatin, a platinum-based anticancer drug, as a retreatment regimen for hepatocellular carcinoma (HCC) unresponsive to chemoembolization using epirubicin. METHODS: Between April 2013 and December 2014, we enrolled 57 consecutive chamoembolization-naïve patients with unresectable HCC, and performed chemoembolization with epirubicin. Treatment effect, necrotizing rate of the target nodules, was evaluated at 1-3 months after treatment using contrast-enhanced CT or MRI. We subsequently included retreatment chemoembolization with miriplatin for patients whose treatment effect was <50% after chemoembolization with epirubicin. The treatment effect after chemoembolization with miriplatin and the liver function before and after chemoembolization were evaluated. RESULTS: Eighteen patients of the 57 showed a treatment effect <50% after chemoembolization with epirubicin, and were switched to chemoembolization with miriplatin. The treatment effect after chemoembolization with miriplatin was ≥50% in four (22%) patients. Four of the remaining 14 (78%) patients who had <50% necrosis exhibited deterioration of the liver function after chemoembolization with miriplatin. Univariate analysis indicated that an alpha-fetprotein-L3 level <10% and a serum albumin level ≥3.6 g/dl were predictive factors of therapeutic response after chemoembolization with miriplatin (P < 0.05). However, there was no predictive factor regarding the deterioration of liver function after chemoembolization with miriplatin. CONCLUSIONS: In unresectable HCC patients who were unresponsive to chemoembolization with epirubicin, switching the chemotherapeutic regimen to a platinum-based anticancer drug in retreatment chemoembolization should be considered as a treatment option. Trial registration: UMIN 000015887.

Efficacy and tolerability of treatment with single doses of diethylcarbamazine (DEC) and DEC plus albendazole (ABZ) for three consecutive years in lymphatic filariasis: a field study in India.

Lymphatic filariasis (LF) affects 73 countries, causes morbidity and impedes socioeconomic development. We had found no difference in safety and micro (Mf) and macro filarial action of single-dose diethylcarbamazine (DEC) and DEC + albendazole (ABZ) in an F01 study done in India (year 2000). There was a programmatic need to evaluate safety and efficacy of multiple annual treatments (F02). Subjects (155) from the F01 study, meeting inclusion-exclusion criteria, were enrolled in F02 and treated with further two annual doses of DEC or DEC + ABZ. Efficacy was evaluated for Mf positivity by peripheral smear (PS) and nucleopore (NP) filter, circulating filarial antigen (CFA) and filarial dance sign (FDS) positivity and Mf count at yearly follow-up. Safety was assessed for 5 days after drug administration. Total of 139 subjects evaluated for efficacy (69 DEC and 70 DEC + ABZ group). Mf positivity prevalence declined progressively by 95% (PS), 66% (NP), and 95% (PS) and 86% (NP); CFA positivity prevalence declined by 15% and 9%; FDS by 100% each; Mf count declined by 75.5 and 76.9% with three annual treatment of DEC and DEC + ABZ, respectively. Addition of ABZ did not show any advantage over DEC given as three annual rounds for LF. DEC and DEC + ABZ were well tolerated. There was no correlation between result of CFA and FDS, (both claimed to be indicative of adult worm). Analysis of published studies and our data indicate that macrofilaricidal effect of DEC/DEC + ABZ may be seen in children and not adults, with three or more annual dosing.

Multidrug-resistant TB in Zambia: review of national data from 2000 to 2011.

BACKGROUND: Multidrug-resistant tuberculosis (MDR-TB) is posing a great threat to global TB control. The burden in Zambia is not well defined because routine surveillance data are scarce. We reviewed national MDR-TB data for the last decade to inform future public health policy with respect to MDR-TB in Zambia. METHOD: Retrospective review of national surveillance of MDR-TB data, TB programme and laboratory reports between 2000 and 2011. RESULTS: The total number of DSTs performed during this 11-year period was 2,038 and accounted for 2.6% (2,038/78,639) of all the retreatment cases notified. The total number of diagnosed MDR-TB cases for this period was 446, of which 56.3% (251/446) were male and 41.7% (186/446) female. Only one child was found to have MDR-TB. Poly-drug resistance accounted for 18.9% (172/911) of the DR-TB cases and 8.4% of the total DSTs. 8.8% (80/911) of the DR-TB cases showed either rifampicin mono- or poly-resistance other than MDR-TB. No XDR-TB was reported. There were no data available on DR-TB and HIV co-infection. Only 65 MDR-TB patients were notified and put on second-line treatment according to WHO guidelines. CONCLUSIONS: Multidrug-resistant tuberculosis may be an emerging challenge in Zambia. There is a need to invest in improving the capacity of the TB programme to detect and manage MDR-TB.

Treatment of strip perforation using cold ceramic.

Root perforation may occur at any stage of endodontic treatment and is mostly due to iatrogenic injury and may compromise the outcome of endodontic treatment. Repairing a perforation is difficult and the prognosis depends on various factors such as time, site and size of perforation, and the patient's overall health status. Hence, choosing the most appropriate material can be critical for the dentist. In this case report of a strip-perforation repair, an mineral trioxide aggregate-like material (cold ceramic) that has been shown in previous studies to have favorable properties, was successfully used.

Neurological Outcomes and the Need for Retreatments Among Multiple Myeloma Patients With High-Grade Spinal Cord Compression: Radiotherapy vs Surgery.

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: Up to 30% of Multiple Myeloma (MM) patients are expected to experience Epidural Spinal Cord Compression (ESCC) during the course of their disease. To prevent irreversible neurological damage, timely diagnosis and treatment are important. However, debate remains regarding the optimal treatment regimen. The aim of this study was to investigate the neurological outcomes and frequency of retreatments for MM patients undergoing isolated radiotherapy and surgical interventions for high-grade (grade 2-3) ESCC. METHODS: This study included patients with MM and high-grade ESCC treated with isolated radiotherapy or surgery. Pre- and post-treatment American Spinal Injury Association (ASIA) impairment scale and retreatment rate were compared between the 2 groups. Adjusted multivariable logistic regression was utilized to examine differences in neurologic compromise, pain, and retreatments. RESULTS: A total of 247 patients were included (Radiotherapy: n = 154; Surgery: n = 93). After radiotherapy, 82 patients (53%) achieved full neurologic function (ASIA E) at the end of follow-up. Of the surgically treated patients, 67 (64%) achieved full neurologic function. In adjusted analyses, patients treated with surgery were less likely to experience neurologic deterioration within 2 years (OR = .15; 95%CI .05-.44; P = .001) and had less pain (OR = .29; 95%CI .11-.74; P = .010). Surgical treatment was not associated with an increased risk of retreatments (OR = .64; 95%CI .28-1.47; P = .29) or death (HR = .62, 95%CI .28-1.38; P = .24). CONCLUSIONS: After adjusting for baseline differences, surgically treated patients with high-grade ESCC showed better neurologic outcomes compared to patients treated with radiotherapy. There were no differences in risk of retreatment or death.

Clinical Outcomes of Endodontic Treatments and Restorations with and without Posts Up to 18 Years.

BACKGROUND: The aim of this study was to collect long-term restorative and endodontic outcomes of endodontically treated teeth (ETT). METHODS: 298 teeth were included in the study and were recalled up to 18 years with a media of 10.2 years. At baseline, 198 sample teeth (66.44%) showed symptoms and 164 (55%) had periapical radiolucency. The most frequently used obturation techniques were warm gutta-percha in 80% of cases, and by carrier in 20%. A total of 192 ETT were restored by direct resin composite restorations, and 106 posts were luted. Moreover, 75 (25.16%) direct restorations remained as final restorations, 137 single crowns (45.97%), 42 (14.09%) partial adhesive crowns, and 42 (14.09%) abutments of fixed bridges were the final treatments. Descriptive and inferential statistics were performed (α = 0.05). A Cox regression model was made. RESULTS: results showed success for 92.6% of ETT up to 18 years, 2.68% (8 ETT) showed irreversible failures, and 14 (4.69%) reversible complications. Four ETT (1.34%) failed because of root fracture and the other four (1.34%) because of endodontic complications. Eight ETT (2.69%) showed non-irreversible periodontal complications and the other six (2.01%) prosthodontic complications. Accordingly, with Kaplan-Meier analysis, the survival rate after 18 years was 97.3% (Interval of Confidence (IC) 95.1-98.3). The presence of a short or long (at least 1 mm related to radiographic apex) quality endodontic filling displayed a statistically significant higher risk of complication (hazard ratio (HR) = 17.00 (IC 5.68-56.84). Furthermore, a clinically detectable not precise coronal margins predicts the presence of any clinical complication with a hazard ratio almost seven times higher than endodontically treated teeth with a proper margin (HR = 6.89 (IC 2.03-23.38), while the presence of lucency at the baseline did not affect the risk of complication (HR = 0.575 (IC 0.205-1.61). The presence of post, tooth position in the arch, and the type of it did not show a high-risk rate (HR = 1.85, 1.98, and 2.24, respectively). CONCLUSIONS: a correct filling (at the apex) of root canals combined with proper coronal margins allow obtaining a long-term high success rate in teeth with a periapical lesion at the baseline. The use of a post or not, when its placement is related to the residual amount of the crown, does not change the final outcome of the ETT.

Management of Post Endodontic Retreatment Pain With Low Level Laser Therapy.

Introduction: Pharmacotherapy with analgesics and non-steroidal anti-inflammatory drugs has been traditionally used to relief post-operative pain of endodontic treatments. However, due to the side effects reported for these drugs, some efforts have been made to decrease the post-operative pain of the endodontic treatments through laser irradiation. The present study aimed to evaluate the effects of low level laser therapy (LLLT) on the reduction of pain after root canal retreatment. Methods: In this clinical trial, 61 patients requiring endodontic retreatments in posterior teeth were selected. A single visit endodontic retreatment was performed. After biomechanical preparation, low level laser was irradiated to the buccal and lingual mucosa overlying the apices of the target tooth in the experimental group. In the control group patients received placebo laser to eliminate the probable psychological effects of laser. Laser irradiation was done with a single dose of 808 nm wavelength (Whitening Lase II- Laser DMC, Samsung, Korea) with 100 mW power, and dose of 70 J/cm2 for 80 seconds. Pain severity was recorded before, immediately after and 4, 8, 12, 24 and 48 hours after the treatment by visual analogue scale (VAS). The pain scores were statistically analyzed by chi-square test between 2 groups. The effects of different variables on the post-operative pain experience were also studied by means of Logistic regression. Results: Pain scores decreased significantly through time until 48 hours after treatment. No significant differences were observed between the 2 modalities regarding pain scores at any time. According to regression analysis, pain severity scores were lower in the laser-irradiated specimens than control groups (OR = 5.69); however, this difference was not statistically significant. Consumption of analgesics after the treatment had significant effect in decreasing post-operative pain experience (OR = 56) while factors of age, gender, laser irradiation, pre-treatment pain scores and education level did not. Conclusion: Low level laser irradiation had limited effects to decrease pain associated with the endodontic retreatments in the first and second molars; however, more studies are required to assess the effects of different parameters of low level laser in this regard.

Retratamientos endodónticos: una realidad que preocupa / Endodontic retreatment: a worrying reality

Las evaluaciones radiográficas de tratamientos endodón- ticos realizadas por graduados muestran un alto porcentaje de procedimientos incorrectos. Esta circunstancia lleva a la rea- lización de un elevado número de retratamientos ortógrados y retrógrados, con los inconvenientes y desventajas que conlle- va recurrir a una reintervención endodóntica. Es responsabili- dad de los profesionales, docentes y autoridades universitarias y gubernamentales revertir esta situación que afecta a la salud bucal de la sociedad. En el presente editorial se proponen di- ferentes alternativas para intentar modificar este preocupante panorama (AU)

Radiographic evaluations of endodontic treatments per- formed by graduates show a high percentage of incorrect procedures. This circumstance leads to the performance of a high number of orthograde and retrograde retreatments, with the inconveniences and disadvantages that entails resorting to an endodontic reintervention. It is the responsibility of pro- fessionals, teachers, university and government authorities to reverse this situation that affects the oral health of society. In this editorial, different alternatives are proposed to try to modify this worrying outlook (AU)