RESUMO
Objectives: Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a global public health concern. Ceftriaxone is the last effective and recommended option for empirical gonorrhoea therapy worldwide, but several ceftriaxone-resistant cases linked to Asia have been reported internationally. During January 2022-June 2023, the WHO Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP) investigated N. gonorrhoeae AMR and epidemiological factors in patients from 10 clinical sentinel sites in Cambodia. Methods: Urethral swabs from males with urethral discharge were cultured. ETEST determined the MIC of five antimicrobials, and EGASP MIC alert values and EUCAST breakpoints were used. EGASP demographic, behavioural and clinical variables were collected using a standardized questionnaire. Results: From 437 male patients, 306 had positive N. gonorrhoeae cultures, AMR testing and complete epidemiological data. Resistance to ceftriaxone, cefixime, azithromycin and ciprofloxacin was 15.4%, 43.1%, 14.4% and 97.1%, respectively. Nineteen (6.2%) isolates were resistant to all four antimicrobials and, accordingly, categorized as XDR N. gonorrhoeae. These XDR isolates were collected from 7 of the 10 sentinel sites. No EGASP MIC alert values for gentamicin were reported. The nationally recommended cefixime 400â mg plus azithromycin 1â g (65.4%) or ceftriaxone 1â g plus azithromycin 1â g (34.6%) was used for treatment. Conclusions: A high prevalence of ceftriaxone-resistant, MDR and XDR N. gonorrhoeae in several cities of Cambodia were found during 2022-23 in WHO EGASP. This necessitates expanded N. gonorrhoeae AMR surveillance, revision of the nationally recommended gonorrhoea treatment, mandatory test of cure, enhanced sexual contact notification, and ultimately novel antimicrobials for the treatment of gonorrhoea.
RESUMO
Different patients want to take different roles in the treatment decision-making process; these roles can be classified as passive, collaborative, and active. The aim of this study was to investigate the correlation between decision-making preferences among patients with prostate cancer and personal, disease-related, and structural factors. In four survey studies, we asked 7169 prostate cancer patients about their decision-making preferences using the Control Preferences Scale (CPS) and collected clinical, psychological, and quality-of-life measures. Most patients (62.2%) preferred collaborative decision-making, while 2322 (32.4%) preferred an active role, and only 391 (5.5%) preferred a passive role. Age (p < 0.001), data collection mode (p < 0.001), peer-to-peer support (p = 0.018), treatment status (p < 0.001), performed or planned radical prostatectomy (p < 0.001), metastatic disease (p = 0.001), and quality of life (p < 0.001) showed significant associations with patients' preferred decision-making roles. Oncologic risk group, anxiety, and depression were not significant in the model. In particular, younger prostate cancer patients with higher quality of life completing an online survey want to play a more active role in treatment decision-making. Before treatment has started, patients tend to prefer collaborative decision-making. Few prostate cancer patients in Germany prefer a passive role. These patients are mostly older patients, patients with a metastatic disease, and patients who have opted for prostatectomy. Whether this finding reflects a generational effect or a tendency by age group and disease phase should be investigated. Further research is also needed to describe the causalities of these relationships. The CPS offers valuable information for personal counselling and should be applied in clinical routine. In a large group of patients with prostate cancer, we found that there is a strong desire for joint decision-making with the physician before the actual treatment. Especially younger men, men with active online behaviour, and men with a high quality of life want to be actively involved in therapy decision-making processes.
Assuntos
Participação do Paciente , Neoplasias da Próstata , Tomada de Decisões , Humanos , Masculino , Neoplasias da Próstata/psicologia , Neoplasias da Próstata/terapia , Qualidade de Vida , Inquéritos e QuestionáriosAssuntos
Balanite (Inflamação)/etiologia , Balanite (Inflamação)/terapia , Doença Aguda , Balanite (Inflamação)/diagnóstico , Doença Crônica , Dermatite Alérgica de Contato/diagnóstico , Diagnóstico Diferencial , Humanos , Higiene , Masculino , Dermatopatias Infecciosas/diagnóstico , Dermatopatias Infecciosas/tratamento farmacológicoAssuntos
Granuloma Inguinal/diagnóstico , Granuloma Inguinal/tratamento farmacológico , Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Chlamydia trachomatis/isolamento & purificação , Ciprofloxacina/uso terapêutico , Eritromicina/uso terapêutico , Granuloma Inguinal/epidemiologia , Humanos , Ofloxacino/uso terapêuticoAssuntos
Transtornos Mentais/epidemiologia , Transtornos Mentais/prevenção & controle , Doenças Profissionais/epidemiologia , Doenças Profissionais/prevenção & controle , Transtornos Psicofisiológicos/epidemiologia , Transtornos Psicofisiológicos/prevenção & controle , Adolescente , Adulto , Medicina Baseada em Evidências , Feminino , Alemanha , Humanos , Masculino , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Doenças Profissionais/psicologia , Medicina Preventiva/métodos , Medicina Preventiva/tendências , Transtornos Psicofisiológicos/psicologia , Resultado do Tratamento , Local de Trabalho , Adulto JovemRESUMO
BACKGROUND: Successful treatment in psychosomatic medicine requires intrinsic motivation of the patient and the belief that the chosen therapeutic option can help. Depression, somatization disorder and generalized anxiety disorder (GAD) are frequent mental disorders in the elderly population. Finding a suitable and successful treatment for elderly people with mental disorders is often difficult. Undertreatment and the utilization of inappropriate healthcare services are frequent. OBJECTIVE: Treatment preferences of elderly patients with mental disorders were ascertained in order to evaluate the motivation for psychotherapy or other therapeutic measures. MATERIAL AND METHODS: The data were derived from the 8-year follow-up of the epidemiological study on chances of prevention, early recognition and optimized therapy of chronic diseases in the elderly population (ESTHER), a population-based cohort study in Saarland, Germany. A total of 3124 patients aged 55-84 years were included in this analysis. The treatment preferences were documented using a questionnaire with 12 different answer categories. The occurrence of depression, somatization disorder and GAD was collated using the patient health questionnaire (PHQ-D). RESULTS: Physiotherapy and inpatient rehabilitation were the most frequently named treatment preferences in all three subgroups of patients with mental disorders. Psychotherapy was the preferred treatment for 18.3 % of depressive patients, for 15.0 % of somatization patients and for 15.7 % of GAD patients. CONCLUSION: Mentally ill elderly patients in Germany preferred physical treatment techniques, such as physiotherapy and inpatient rehabilitation over psychotherapy. Discussion is needed over the reasons for these findings and the clinical implications.
Assuntos
Depressão/epidemiologia , Depressão/terapia , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Participação do Paciente/estatística & dados numéricos , Preferência do Paciente/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Depressão/psicologia , Feminino , Seguimentos , Alemanha/epidemiologia , Humanos , Masculino , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Avaliação das Necessidades , Participação do Paciente/psicologia , Preferência do Paciente/psicologia , Modalidades de Fisioterapia/estatística & dados numéricos , Prevalência , Psicoterapia/estatística & dados numéricos , Reabilitação/estatística & dados numéricos , Estudos Retrospectivos , AutorrelatoRESUMO
Until recently, pharmacologic molecules have been the only available treatments for onychomycosis. Laser treatments were introduced for recurrent or resistant cases or in patients in whom oral treatments are contra-indicated. Some devices were approved by the Food and Drug Administration (FDA). Neodymium yttrium aluminium garnet (Nd:YAG) is used for onychomycosis as a short-pulse or a long-pulse system. We aim to evaluate the efficacy of the short-pulse Nd:YAG in treating onychomycosis, its side effects, cure rates, and 12-month recurrence rates. Efficacy was evaluated based on a subjective measure of patient satisfaction on a scale from 1 to 10, and an objective measure based on the results of the mycologic cultures. Medical records of 30 patients were reviewed. Ages ranged from 22 to 85, with a mean of 44. Mycologic cure at 12 months was not achieved in 5 patients (16.67%) who had received laser treatment. None of these patients showed any signs of clinical improvement. Twenty patients (66.67%) were completely cured at 12 months, with corroborating negative mycologic cultures. The remaining five patients (16.67%) had discordance between their clinical cure status and their mycologic cultures. Side effects were reported by 7 patients out of 30 (33%): pain within 48 hours of the treatment session, burning sensation in the treated nail bed area. Our primary end point of negative mycologic cultures at 12 months was seen in 24 out of 30 (80%) of our patients. Similar culture cure rates have not been reported before, not even with systemic treatments with oral antifungals. However, few limitations should warrant us (False-negative results in fungal cultures; time limitation; sample size ). Still, we propose that this alternative should be offered for patients in whom antifungals are contraindicated or for patients previously treated, but not cured by oral antifungals, and in elderly and polymedicated patients.
Assuntos
Dermatoses do Pé/cirurgia , Dermatoses da Mão/cirurgia , Lasers de Estado Sólido/uso terapêutico , Onicomicose/cirurgia , Adulto , Feminino , Humanos , Lasers de Estado Sólido/efeitos adversos , Masculino , Estudos RetrospectivosAssuntos
Balanite (Inflamação)/diagnóstico , Balanite (Inflamação)/microbiologia , Candida albicans/isolamento & purificação , Streptococcus pyogenes/isolamento & purificação , Amoxicilina/uso terapêutico , Antibacterianos/uso terapêutico , Antifúngicos/uso terapêutico , Balanite (Inflamação)/tratamento farmacológico , Candida albicans/efeitos dos fármacos , Candidíase/diagnóstico , Candidíase/microbiologia , Diabetes Mellitus , Fluconazol/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Sexualmente Transmissíveis , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/microbiologia , Streptococcus pyogenes/efeitos dos fármacos , Resultado do TratamentoAssuntos
Neuropatias Diabéticas/complicações , Dermatoses do Pé/radioterapia , Lasers de Estado Sólido/efeitos adversos , Onicomicose/radioterapia , Infecções Estafilocócicas/etiologia , Amputação Cirúrgica , Feminino , Dermatoses do Pé/complicações , Humanos , Pessoa de Meia-Idade , Necrose/etiologia , Necrose/cirurgia , Onicomicose/complicações , Infecções Estafilocócicas/tratamento farmacológico , Dedos do Pé/cirurgiaRESUMO
BACKGROUND: Vitiligo is an acquired disorder of the skin and mucous membranes. Many patients with vitiligo remain in the refractory state despite the availability of numerous potential treatments. To the best of our knowledge, only one trial considers ablative fractional CO2 laser in the treatment of vitiligo. OBJECTIVE: To investigate the effects of fractional CO2 laser followed by systemic sun exposure on non-segmental vitiligo (NSV). METHODS: Ten patients presenting refractory NSV were enrolled in this study. The patients underwent three sessions, one month apart, of fractional CO2 laser therapy on the affected areas of the skin (L-group). Five days after each laser treatment, patients were asked to expose themselves to the sun for 2 hours on a daily basis. Objective and subjective clinical assessments were performed at the beginning and at the end of the treatment. The L-group was then compared to a control group (C-group) that consisted of vitiligo lesions in the same patients but with sun exposure as the exclusive therapy. RESULTS: Compared to the C-group, the L-group showed better improvement in both objective and subjective assessments. There were no noticeable adverse events in terms of scarring and Koebner phenomenon among others. CONCLUSIONS: All patients treated with both, laser sessions and sun exposure, improved their chronic NSV lesions. Improvement was less significant in patients who exhibited vitiligo lesions over articular surfaces such as elbows and underarms. The best results were observed in vitiligo plaques located on the face, neck and legs. Consequently, fractional CO2 laser followed by sun exposure could be considered as an alternative modality for the treatment of refractory vitiligo, especially in sunny regions.