RESUMO
PURPOSE: The purpose of this study was to study the incidence, demographic features, clinical course, profiling, and management of uncommon species of Pseudomonas keratitis (other than Pseudomonas aeruginosa ) at a tertiary eye care center. METHODS: Thirty cases of culture-proven uncommon species of Pseudomonas keratitis between January 2017 and December 2021 were retrospectively studied. The incidence, demographic and clinical profile, predisposing factors, microbial results, treatment, and visual outcomes were analyzed. We evaluated the risk factors for poor treatment outcomes. RESULTS: Among bacterial keratitis cases, uncommon species of Pseudomonas keratitis occurred at a rate of 2.2%. The mean age at presentation was 51.37 years, and the most common predisposing factor was corneal trauma (36.7%). The mean best corrected visual acuity (BCVA) [in log of minimum angle of resolution (logMAR)] at presentation was 1.99, and the mean ulcer size was 5.75 mm. On culture, 56.7% of the cases were identified as Pseudomonas putida , 26.7% as Pseudomonas stutzeri , 10% as Pseudomonas mendocina, and 3.3% each of Pseudomonas oryzihabitans and Pseudomonas alcaligenes . We recorded good treatment responses in 66.7% of cases with the medical therapy of a combination of broad-spectrum antibiotics, whereas 33.3% of cases required surgical intervention. The risk factors for poor clinical outcome were older age, ocular trauma, previous ocular surgeries, poor BCVA at presentation, large ulcer size, delayed treatment, hypopyon, and early complications such as perforation, limbal involvement, and total ulcer. CONCLUSIONS: Uncommon species of pseudomonas keratitis was more closely related to predisposing factors such as corneal trauma and other factors such as previous ocular surgeries, older age, large ulcers, longer duration of treatment, early surgical intervention in complicated cases, and poor visual outcome.
Assuntos
Lesões da Córnea , Úlcera da Córnea , Infecções Oculares Bacterianas , Ceratite , Humanos , Estudos Retrospectivos , Úlcera/tratamento farmacológico , Incidência , Ceratite/diagnóstico , Ceratite/tratamento farmacológico , Ceratite/epidemiologia , Antibacterianos/uso terapêutico , Infecções Oculares Bacterianas/diagnóstico , Infecções Oculares Bacterianas/tratamento farmacológico , Infecções Oculares Bacterianas/epidemiologia , Fatores de Risco , Pseudomonas aeruginosa , Lesões da Córnea/tratamento farmacológico , Úlcera da Córnea/diagnóstico , Úlcera da Córnea/tratamento farmacológico , Úlcera da Córnea/epidemiologiaRESUMO
BACKGROUND: We evaluated whether postinduction ulcer size and patient-reported outcome (PRO) severity are associated with the achievement of 1-year endoscopic remission (ER) in patients with Crohn's disease (CD). METHODS: This post hoc analysis combined data from several clinical trials including 283 patients with baseline ulcersâ ≥5 mm with repeat endoscopy after ustekinumab or adalimumab induction therapy. Patient-reported outcomes including stool frequency (SF) and abdominal pain (AP) were measured by the Crohn's Disease Activity Index. Thresholds of SF ≥4 and/or AP ≥2 indicated moderately to severely active CD. Endoscopic remission was defined as Simple Endoscopic Score for CD (SES-CD) <3. Multivariate logistic regression models adjusted for confounders (including disease duration and treatment allocation) evaluated the relationships between postinduction ulcer size, PRO symptoms, and achievement of 1-year ER. RESULTS: Among the 131 CD patients who continued to have ulcers ≥5 mm after induction therapy, 48 (36.6%) achieved 1-year ER. Patients with postinduction ulcers ≥5 mm were approximately 5 times less likely to achieve 1-year ER than the 152 individuals who had small or no postinduction ulcers (odds ratio [OR], 0.20; 95% CI, 0.08-0.51, P = .001). In patients with ulcers ≥5 mm after induction, postinduction PRO scores (including PRO2 and PRO3) did not predict 1-year ER. CONCLUSIONS: Crohn's disease patients with ulcers ≥5 mm after induction therapy are less likely to achieve 1-year ER. Postinduction PRO severity does not offer additional prognostic information. This may suggest that objective measures of disease such as endoscopic ulcer size should be considered over symptom assessments for determining clinical response to therapy and utilized in trials for maintenance therapy.
Crohn's disease patients with ulcers ≥5 mm after induction therapy are less likely to achieve 1-year endoscopic remission. Postinduction patient-reported symptom severity does not offer additional prognostic information. Objective measures of disease such as endoscopic ulcer size should be considered over symptom assessments for determining clinical response to therapy.
Assuntos
Doença de Crohn , Humanos , Doença de Crohn/tratamento farmacológico , Doença de Crohn/diagnóstico , Úlcera/tratamento farmacológico , Úlcera/etiologia , Quimioterapia de Indução , Avaliação de Sintomas , Endoscopia Gastrointestinal , Dor Abdominal/tratamento farmacológico , Indução de RemissãoRESUMO
BACKGROUND: Most peptic ulcer cases are associated with Helicobacter pylori (H. pylori) infection or the use of nonsteroidal anti-inflammatory drugs (NSAIDs). H. pylori eradication therapy is recommended for the treatment of H. pylori-positive peptic ulcers. We aimed to assess and validate the cumulative economic and health effects of H. pylori eradication strategy for the treatment of peptic ulcers compared with PPI therapy strategy. MATERIALS AND METHODS: We developed a cohort state-transition model for H. pylori eradication strategy and PPI therapy strategy over a lifetime horizon from a healthcare payer perspective. We targeted two hypothetical cohorts of H. pylori-positive patients with gastric and duodenal ulcers aged 20, 30, 40, 50, 60, 70, and 80. The main outcomes were costs, quality-adjusted life-years (QALYs), life expectancy life-years (LYs), incremental cost-effectiveness ratios, ulcer recurrence cases, and ulcer-associated deaths. One-way and probabilistic sensitivity analyses were conducted to assess the impact of uncertainty. RESULTS: In the base-case analysis, H. pylori eradication strategy was less costly with greater benefits than PPI therapy strategy in all age groups. Cost-effectiveness was not sensitive to any variables in all age groups. Sensitivity analyses showed strong robustness of the results. From 2000 to 2020, H. pylori eradication strategy saved US$14.07 billion over a lifetime, increased 8.65 million QALYs and 1.23 million LYs over a lifetime, and prevented 551,298 ulcer recurrence cases and 59,465 ulcer-associated deaths, compared with PPI therapy strategy. CONCLUSIONS: H. pylori eradication strategy not only has contributed significantly to preventing ulcer recurrence and reducing ulcer-associated deaths but also has resulted in great cost savings. All over the world, H. pylori eradication strategy is likely to have yielded a comparable magnitude of economic and health benefits, depending on the epidemiology of H. pylori-related peptic ulcers and the healthcare environment in each country.
Assuntos
Antiulcerosos , Infecções por Helicobacter , Helicobacter pylori , Úlcera Péptica , Antiulcerosos/uso terapêutico , Análise Custo-Benefício , Infecções por Helicobacter/complicações , Humanos , Úlcera Péptica/tratamento farmacológico , Úlcera Péptica/prevenção & controle , Úlcera/tratamento farmacológicoRESUMO
BACKGROUND: Patients with Crohn's disease (CD) undergo frequent endoscopic procedures, with visualization of the gastrointestinal mucosa central to treatment decision-making. Subsequently, a noninvasive alternative to optical colonoscopy (OC) would be welcomed. One such technology is capsule endoscopy, including the PillCam COLON 2 (PCC2), though research validating its use in ileocolonic CD is limited. This study aims to compare PCC2 with ileocolonoscopy (OC) in assessing mucosal CD through use of a standardized scoring system. METHODS: At an Australian tertiary hospital, same-day PCC2 and ileocolonoscopy results of 47 CD patients, with known nonstricturing disease, were prospectively collected and analyzed for correlation and agreement. Deidentified recordings were reported by a single expert gastroenterologist. Mucosal disease was quantified using the Simple Endoscopic Score for Crohn's Disease (SES-CD). The SES-CD results of paired endoscopic modalities were compared in total per bowel segment and per SES-CD variable. RESULTS: Of 47 PCC2 recordings, 68% were complete, fully assessing terminal ileum to rectum, and OC was complete in 89%. Correlation (r) between total SES-CD scores was strongest in the terminal ileum (râ =â 0.77, Pâ < .001), with the SES-CD variable of "ulcer detection" showing the strongest agreement. The PCC2 (vs OC) identified additional ulcers in the terminal ileum; ascending, transverse, and descending colon; and rectum; scores were 5 (1), 5 (3), 1 (1), 2 (1), and 2 (2), respectively. CONCLUSIONS: The PCC2 shows promise in assessing ileocolonic mucosa, especially in proximal bowel segments, with greater reach of visualization in the small bowel. Given the resource and safety considerations raised by the Coronavirus disease 2019 pandemic, capsule endoscopy has particular significance.This article aims to contribute to the limited body of research surrounding the validity of capsule endoscopy technology in assessing ileocolonic mucosa in Crohn's Disease patients. In doing so, an alternative option for patients enduring frequent endoscopies is given potential.
Assuntos
Endoscopia por Cápsula/métodos , Colo/diagnóstico por imagem , Colonoscopia/métodos , Doença de Crohn/diagnóstico por imagem , Mucosa Intestinal/diagnóstico por imagem , Úlcera/diagnóstico por imagem , Cicatrização , Austrália , COVID-19 , Cápsulas Endoscópicas , Colo/efeitos dos fármacos , Humanos , Imunossupressores/uso terapêutico , Mucosa Intestinal/efeitos dos fármacos , SARS-CoV-2 , Índice de Gravidade de Doença , Resultado do Tratamento , Úlcera/tratamento farmacológico , Cicatrização/efeitos dos fármacos , Cicatrização/fisiologiaRESUMO
This industry update covers the period from 1 to 31 October 2018 and is based on information sourced from company press releases, scientific literature, patents and various news websites. With the expiry in Europe of AbbVie's (IL, USA) principal patent on Humira this month, the first biosimilar versions of the drug have been launched. AstraZeneca (Cambridge, UK) announced that is has out-licensed two none core drugs to Grunenthal (Aachen, German), while Pfizer (NY, USA) announced the creation of a new company, set up in collaboration with Bain Capital (MA, USA) to exploit Pfizer's clinical and preclinical assets in the neuroscience field. In digital health, 23andMe (CA, USA) announced that the US FDA has authorized marketing of one of its consumer genetic tests, that assesses the genetic factors that affect drug metabolization, hence the safety and efficacy of some drugs. Novartis (Basel, Switzerland) continued to grow its activities in digital health with the creation of the Novartis Biome, an incubator and support program for early-stage companies in this area. Novartis also announced that it has filed applications in the EU and USA for the approval of siponimod, a drug targeting secondary progressive multiple sclerosis and Roche (Basel, Switzerland) gained FDA approval for an antiviral treatment for influenza. Janssen (Beerse, Belgium) announced it had won a label extension for its blood glucose-lowering drug, Invokana®, for the reduction of cardiovascular events in diabetes. Roche presented data at ECTRIMS, a major annual conference on multiple sclerosis (MS), held in Berlin, Germany this month (10-12 October 2018), showing the potential benefits of administering its drug, Ocrevus, earlier in the treatment pathway for MS compared with other standard treatment. At the same event, Celgene (NJ, USA) presented results from a survey that showed MS patients' concern around brain atrophy and cognitive loss in MS, highlighting that the disease has a neurodegenerative as well as an inflammatory component. Novartis also presented a significant amount of data supporting its marketed drugs as well as its development pipeline in the disease. This month, presentation of data from two studies at the American Academy of Ophthalmology annual meeting (27-30 October 2018, Chicago, IL, USA) further supporting the potential of eye scans in the early detection of Alzheimer's. A paper by a research team at the University of Rochester (NY, USA) demonstrated the feasibility of a new mechanism to transport drugs across the blood-brain barrier, which could help development more effective CNS drugs.
Assuntos
Medicamentos Biossimilares/economia , Indústria Farmacêutica , Marketing/economia , Artrite Reumatoide/tratamento farmacológico , Medicamentos Biossimilares/uso terapêutico , Aprovação de Drogas/economia , Regulamentação Governamental , Humanos , Inibidores da Bomba de Prótons/economia , Inibidores da Bomba de Prótons/uso terapêutico , Telemedicina , Úlcera/tratamento farmacológico , Estados Unidos , United States Food and Drug AdministrationRESUMO
OBJECTIVE: Up to one-third of patients with gastroesophageal reflux disease (GERD) in primary care have residual symptoms despite proton pump inhibitor (PPI) therapy. We aimed to characterize partial response to PPIs among adult patients in UK primary care. MATERIAL AND METHODS: Newly diagnosed GERD patients aged 20-79 years who were prescribed PPI for treatment of GERD were identified in The Health Improvement Network. Those with a treatment change suggesting partial response to PPIs (new treatment added to PPI, increased PPI dose, or switching PPI) during the subsequent 6 months were identified as potential cases and confirmed after manual review of each patient's complete computer medical record including free-text comments. Patients without these treatment changes were study controls. A nested case-control analysis was conducted using logistic regression. RESULTS: The proportion of newly diagnosed GERD patients with partial response to PPI therapy was 18.6% (1201/6453). Partial response was associated with female gender (odds ratio [OR]: 1.20; 95% confidence interval [CI]: 1.05-1.37), anxiety or depression (OR: 1.15; 95% CI: 1.00-1.31), and prescription of ≥ 6 drugs in the month before GERD diagnosis (OR: 1.42; 95% CI: 1.14-1.78). Among new PPI users (n = 2907), partial response was associated with esophageal ulcer or Barrett's esophagus at initial diagnosis (OR: 3.14; 95% CI: 1.60-6.17). CONCLUSIONS: Approximately one in five newly diagnosed patients with GERD appear to have a partial response to PPI therapy. Female gender, polymedication, and a severe initial diagnosis may be associated with partial response.
Assuntos
Esôfago de Barrett/tratamento farmacológico , Esofagite Péptica/tratamento farmacológico , Refluxo Gastroesofágico/tratamento farmacológico , Inibidores da Bomba de Prótons/uso terapêutico , Úlcera/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/epidemiologia , Esôfago de Barrett/etiologia , Estudos de Casos e Controles , Comorbidade , Intervalos de Confiança , Depressão/epidemiologia , Prescrições de Medicamentos , Registros Eletrônicos de Saúde , Esofagite Péptica/etiologia , Esôfago , Feminino , Refluxo Gastroesofágico/epidemiologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Atenção Primária à Saúde , Inibidores da Bomba de Prótons/administração & dosagem , Fatores Sexuais , Resultado do Tratamento , Úlcera/etiologia , Adulto JovemRESUMO
BACKGROUND: Chronic ulcer of the lower extremities amounts for a grave and serious problem for public health. Western medicine focuses on controlling infection, improving blood circulation, surgical debridement, skin grafting, etc, but there are bottlenecks in the treatment. Traditional Chinese medicine (TCM) has a long history and a legacy of sound clinical efficacy in this area. TCM has developed a unique, effective external theory, and a large number of topical prescriptions and external technology. Through this research, a safe and effective treatment protocol of TCM for chronic ulcer of the lower extremities can be formed. To this end, during China's "Eleventh Five-Year" Plan, special research committees and projects on TCM external treatments and external technologies were established. This study on ulcer of the lower extremities constitutes one of the major research topics. METHODS AND DESIGN: Clinical information of patients with chronic ulcer of the lower extremities will be first collected in a large, multicenter, epidemiological survey. Concurrently, a large multicenter, randomized, parallel-group, prospective study will be launched based on evidence-based medical principles to evaluate the efficacy and safety of external methods for removing carrion, dissolving stasis, reinforcing deficiency and promoting tissue regeneration. The evaluated indexes will include the wound healing percentage for primary outcome, wound healing time, wound healing rate, time and rate of removal of necrotic tissue, and TCM syndromes for secondary outcomes and routine blood test, routine urine test, liver and kidney function, blood mercury content and finally urine mercury content for adverse events. DISCUSSION: In this trial, the authors will evaluate the efficacy and safety of external methods for removing carrion, dissolving stasis, reinforcing deficiency and promoting tissue regeneration in cases of chronic ulcer of the lower extremities for standardizing external therapy of TCM for treatment of this condition, and establishing the clinical assessment system for TCM. TRIAL REGISTRATION NUMBER: The research program was registered in the Chinese Clinical Trial Registry in both English and Chinese in June 2011. REGISTRATION NUMBER: ChiCTR-TRC-11001365.
Assuntos
Extremidade Inferior/patologia , Medicina Tradicional Chinesa/métodos , Úlcera/terapia , Protocolos Clínicos , Medicamentos de Ervas Chinesas/uso terapêutico , Humanos , Fitoterapia , Estudos Prospectivos , Úlcera/tratamento farmacológicoAssuntos
Aciclovir/administração & dosagem , Antivirais/administração & dosagem , Herpes Genital/tratamento farmacológico , Herpesvirus Humano 1/efeitos dos fármacos , Herpesvirus Humano 2/efeitos dos fármacos , Úlcera/tratamento farmacológico , Aciclovir/economia , Aciclovir/uso terapêutico , Antivirais/economia , Antivirais/uso terapêutico , Esquema de Medicação , Feminino , Herpes Genital/virologia , Humanos , Masculino , Guias de Prática Clínica como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo , Úlcera/etiologia , Organização Mundial da SaúdeRESUMO
BACKGROUND: Herpes simplex virus-2, the most common cause of genital ulcer disease (GUD) globally, is a cofactor in human immunodeficiency virus type-1 (HIV-1) acquisition and transmission. Current World Health Organization guidelines for sexually transmitted infections recommend acyclovir as first-line syndromic treatment of GUD in countries with high herpes simplex virus-2 prevalence (> or =30%). OBJECTIVE: To assess the extent of adoption of acyclovir as syndromic treatment for GUD, and describe procurement, distribution, and cost of acyclovir in the public and private sectors of 8 sub-Saharan African countries. METHODS: We conducted standardized interviews with Ministry of Health (MoH) officials, pharmacists, and other pharmacy workers based in the public and private sectors. Interviews were conducted in Botswana, Kenya, Malawi, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe. Price comparisons were conducted using the 2007 median international reference price (IRP) for acyclovir. RESULTS: Of the 8 African countries, 4 surveyed had adopted acyclovir as first-line syndromic GUD treatment in both their essential medical lists and sexually transmitted infection guidelines. Country-specific acquisition prices for acyclovir 200 mg were comparable to the median IRP and ranged from 0.74 to 1.95 times the median IRP. The median retail cost of acyclovir in the private sector ranged from 5.85 to 9.76 times the median IRP. Public health facilities faced cost and regulatory barriers that impeded the requisitioning of acyclovir from the central medical stores. CONCLUSIONS: Systems for drug procurement, distribution, and access in sub-Saharan African countries need strengthening for a GUD treatment policy using acyclovir to be effective.
Assuntos
Aciclovir/uso terapêutico , Antivirais/uso terapêutico , Política de Saúde , Acessibilidade aos Serviços de Saúde , Herpes Genital/tratamento farmacológico , Úlcera/tratamento farmacológico , Aciclovir/economia , África Subsaariana/epidemiologia , Antivirais/economia , Feminino , Doenças dos Genitais Femininos/tratamento farmacológico , Doenças dos Genitais Femininos/virologia , Doenças dos Genitais Masculinos/tratamento farmacológico , Doenças dos Genitais Masculinos/virologia , Herpes Genital/virologia , Herpesvirus Humano 2 , Humanos , Entrevistas como Assunto , Masculino , Guias de Prática Clínica como Assunto , Setor Privado , Setor Público , Úlcera/virologiaAssuntos
Antiulcerosos/uso terapêutico , Cimetidina/uso terapêutico , Descoberta de Drogas/história , Úlcera/tratamento farmacológico , Antiulcerosos/farmacocinética , Antiulcerosos/farmacologia , Cimetidina/farmacocinética , Cimetidina/farmacologia , Descoberta de Drogas/economia , História do Século XX , História do Século XXI , Humanos , Úlcera/economia , Úlcera/históriaRESUMO
OBJECTIVES: To investigate if the reclassification of omeprazole from a prescription only medicine to pharmacy sale status had an impact on the prescribing and sales of ulcer-healing drugs and whether deprivation had any influence on this. SETTING: Primary care, Wales, UK. METHOD: Retrospective analysis (March 2002 to February 2005) of prescription data and pharmacy sales data. MAIN OUTCOME MEASURE: Number of items per 1,000 population. RESULTS: The number of prescription items for ulcer-healing drugs across Wales increased in each year of the study. The number of items per 1,000 population for proton pump inhibitors increased by 12.4% (473.3 to 531.8 items) in 2003/04 and 13.8% (531.8 to 605.1 items) in 2004/05, whereas the number of items per 1,000 population for H2 antagonists fell by 6.2% (149.1 to 139.9 items), and 5.7% (139.9 to 131.9 items) during 2003/04 and 2004/05, respectively. The sale of items per 1,000 population of H(2) antagonists increased by 34.3% (19.8 to 26.6 items) in 2003/04, but fell by 8.6% (26.6 to 24.3 items) in 2004/05. In February 2005, 12 months after reclassification, omeprazole accounted for 7.6% (2.0 items per 1,000 population) of the total sales (26.3 items per 1,000 population) of ulcer-healing drugs from pharmacies in Wales. Areas with high multiple deprivation and unemployment were significantly associated with the prescribing of ulcer-healing drugs, H2 antagonists and proton pump inhibitors. Multiple deprivation, unemployment and low income explained 21% of the variation in prescribing of ulcer-healing drugs. The sale of omeprazole through pharmacies was not related to these deprivation characteristics. CONCLUSION: Twelve months after the reclassification of omeprazole the market growth of H2 antagonists sold from pharmacies was halted although there was no apparent impact on the prescription of ulcer-healing drugs. As a consequence there was no saving to the health service drug budget associated with the reclassification of omeprazole.
Assuntos
Prescrições de Medicamentos/estatística & dados numéricos , Omeprazol/uso terapêutico , Úlcera/tratamento farmacológico , Antiulcerosos/classificação , Antiulcerosos/uso terapêutico , Indústria Farmacêutica , Prescrições de Medicamentos/economia , Revisão de Uso de Medicamentos/economia , Revisão de Uso de Medicamentos/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde , Antagonistas dos Receptores H2 da Histamina/economia , Antagonistas dos Receptores H2 da Histamina/uso terapêutico , Humanos , Marketing/economia , Marketing/estatística & dados numéricos , Medicamentos sem Prescrição/economia , Omeprazol/classificação , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/estatística & dados numéricos , Inibidores da Bomba de Prótons , Estudos Retrospectivos , Comprimidos , Fatores de Tempo , Úlcera/economia , Desemprego , País de GalesRESUMO
The purpose of this study is to assess the efficiency of the anti-ulcer therapy taking into account the economic aspects of treatment. We have examined 708 HP-positive(+) patients with stomach ulcers (SU) and duodenal ulcers (DU). Various schemes of anti-helicobacter and anti-secretory therapy were administered to them. Positive dynamics of some clinical data (local palpatory tenderness and abdominal wall resistance) and gastritis (gastroduodenitis) activity was discovered in all groups of patients. The cost of the treatment was determined with the help of marketing studies by taking the lowest price of drugs. There were no statistically reliable differences found groups of traditional treatment regimens by both results of HP eradication and the cost of eradicative and anti-secretory therapy. All drugs under study are highly effective for rapid relief of symptoms at an exacerbation of stomach ulcer associated with HP as well as the decrease of gastritis (gastroduodenitis) activity. It is possible to recommend them for both eradicative therapy and prolonged treatment.
Assuntos
Antiulcerosos/uso terapêutico , Úlcera/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Antiulcerosos/economia , Análise Custo-Benefício , Úlcera Duodenal/tratamento farmacológico , Feminino , Gastrite/tratamento farmacológico , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori/isolamento & purificação , Humanos , Masculino , Pessoa de Meia-Idade , Úlcera Gástrica/tratamento farmacológico , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVE: To assess whether syndromic management of genital ulcer disease was sound, if based on the premise that men with genital ulcers rarely have a concomitant urethral infection. METHODS: Specimens were taken in 1998 from 186 mine workers in Carletonville, South Africa, who were seen consecutively with genital ulcers. The specimens comprised a swab from the ulcer, a urethral swab for a Gram stained smear, and 10-15 ml of a first catch urine sample. The latter was tested by ligase chain reaction assays for Neisseria gonorrhoeae and Chlamydia trachomatis specific DNA sequences and by a polymerase chain reaction (PCR) assay for Mycoplasma genitalium. Ulcer inducing micro-organisms were detected either by a multiplex PCR assay, or in the case of lymphogranuloma venereum (LGV) serologically, and human immunodeficiency virus (HIV) infection was detected by an enzyme linked immunosorbent assay (ELISA) test. RESULTS: Most (54%) of the ulcers were chancroidal, 18% were herpetic (HSV type 2), 6.5% primary syphilitic, and 3.2% due to LGV. More than one micro-organism was detected in 9.1% of the ulcers and less than 10% were undiagnosed. Microscopic examination of the urethral smears showed that 99 (53%) of the men had urethritis, of whom 45 (45%) were infected with N gonorrhoeae. Of the 54 men (55%) who had non-gonococcal urethritis (NGU), 11 (19.6%) harboured C trachomatis or M genitalium. Almost two thirds (64.5%) of the men had HIV infection, but this did not seem to have influenced the aetiology of the ulcers. Nor was a particular ulcer associated with one type of urethritis more than the other. Neither C trachomatis nor M genitalium was associated significantly with non-gonococcal urethritis (NGU) in either HIV positive or HIV negative men. CONCLUSION: The combination of antibiotics used for the management of genital ulcer disease in men in this South African mining population needs to be widened to encompass frequently occurring concomitant gonococcal urethritis and NGU infections. This means treatment with long acting penicillin, combined with ciprofloxacin and azithromycin or erythromycin. A similar situation may exist in other geographical locations with a need to provide appropriate antimicrobial combinations depending on the patterns of infection detected.
Assuntos
Antibacterianos , Quimioterapia Combinada/uso terapêutico , Doenças dos Genitais Masculinos/complicações , Úlcera/complicações , Uretrite/complicações , Adulto , Atenção à Saúde , Ensaio de Imunoadsorção Enzimática , Doenças dos Genitais Masculinos/tratamento farmacológico , Doenças dos Genitais Masculinos/microbiologia , Herpes Simples/complicações , Herpes Simples/tratamento farmacológico , Humanos , Linfogranuloma Venéreo/complicações , Linfogranuloma Venéreo/tratamento farmacológico , Masculino , Mineração , África do Sul , Sífilis/complicações , Sífilis/tratamento farmacológico , Migrantes , Úlcera/tratamento farmacológico , Úlcera/microbiologia , Uretrite/tratamento farmacológico , Uretrite/microbiologiaRESUMO
Only in Saint Petersburg the application of omeprazole, hiconcil and fromilid in the treatment of adult patients with duodenal ulcer could save up to 26 million rubles per year due to the decrease in the number of recurrences. Yet these funds are still wasted with the persistence worthy of better application, since most general practitioners do not realize either economic or even clinical value of eradication. The above-mentioned calculations provide a ground for reflections on the improvement of methods of advanced training for specialists with the use of pharmacoepidemiological and pharmacoeconomic grounds for the selection of optimum remedies for the treatment of duodenal ulcer. A thorough clinical and economic evaluation of our actions, methods and preparations for treatment will make it possible to enhance the efficiency and quality of treatment, to avoid not only considerable undesirable drug reactions but also unjustified social costs in the way it is done in many countries.
Assuntos
Farmacoeconomia , Úlcera/tratamento farmacológico , Úlcera/economia , Federação RussaRESUMO
This study aimed to describe the quality and costs of sexually transmitted disease (STD) case management in urban pharmacies in The Gambia, and explore pharmacy workers' (PWs) willingness to improve the STD care they provide. PWs from 24 registered pharmacies were interviewed in order to collect information on their knowledge and practices regarding management of STDs. The same pharmacies were visited by a male 'simulated client' (SC) to ascertain how urethral discharge syndrome (UDS) cases were managed in practice. Fifteen (63%) pharmacies were equipped for treatment of UDS, pelvic inflammatory disease (PID) and genital ulcer syndrome (GUS), according to national guidelines. Appropriate syndromic management for UDS was mentioned by 11% of PWs but actually given to 4.4% of the SC visits. None of the PID or GUS cases would be treated correctly. Forty-two per cent of PWs advised on partner notification, 38% on safe sex and 29% on treatment compliance in the SC visits. The reported costs for treatment of UDS, PID and GUS ranged from $2.5-$15.0. The cost of treatment actually purchased by the SC averaged $3.5 (range $1.5-$9.6) for UDS. Excluding the pharmacy sector from interventions will limit the impact of STD control measures. Regular training in syndromic management and rational drug use, with a concise manual for reference are recommended. Strategies to lower the cost of drugs should be explored.
Assuntos
Antibacterianos/uso terapêutico , Administração de Caso/normas , Serviços Comunitários de Farmácia/normas , Doenças Urogenitais Femininas/tratamento farmacológico , Doenças Urogenitais Masculinas , Infecções Sexualmente Transmissíveis/tratamento farmacológico , População Urbana , Adulto , Antibacterianos/provisão & distribuição , Administração de Caso/estatística & dados numéricos , Serviços Comunitários de Farmácia/economia , Custos e Análise de Custo , Aconselhamento , Feminino , Gâmbia , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/educação , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Simulação de Paciente , Doença Inflamatória Pélvica/tratamento farmacológico , Úlcera/tratamento farmacológicoRESUMO
In a study of 877 patients with disorders of the vulva seen at a vulva clinic, 375 (43%) presented with an erosion or ulceration or a condition in which an erosion or ulceration developed as a complicating feature. One hundred sixty-one of these patients had a sexually transmitted disease. This report identifies the conditions associated with erosions and ulcerations of the vulva by incidence and provides a simple clinical classification of them as an aid in diagnosis. Methods of study of this group of diseases and their management are discussed.