Multiple Myeloma: A Rare Presentation As Unilateral Pleural Effusion.

Multiple myeloma (MM) is a hematologic malignancy characterized by the clonal proliferation of plasma cells in the bone marrow. It commonly presents with bone pain, anemia, renal failure, and hypercalcemia. Pleural effusion in MM usually has multiple causes, but it is rare for the effusion to be due to myelomatous deposition of the pleura. Here, we present a rare case in which the patient presented to the outpatient department with a dry cough, breathlessness, and generalized weakness. The patient was diagnosed with MM with myelomatous pleural effusion (MPE), highlighting the importance of considering MM as a differential diagnosis in patients with atypical presentations. MPE indicates a poor prognosis, and early consideration of MPE can lead to an earlier diagnosis and a more effective treatment of MM.

Satisfaction in conventional acrylic complete denture patient with and without denture liners - a systematic review.

To make a new complete denture, a series of steps is needed, and it is a time-consuming process. Which is not possible in every patient due to financial and medical reasons. The old denture can be relined by denture liners in less clinical and laboratory steps and can successfully increase the efficiency of ill-fitting dentures however, patient satisfaction with denture liners is doubtful. This systematic review was organized from the preferred reporting items for systematic reviews' checklist, and the methods were registered on the international prospective register of systematic reviews (PROSPERO- CRD42020210227). The main systematic review is to assess satisfaction in convectional acrylic complete denture with or without denture liners. Search engines such as PubMed, Science Direct, Cochrane, Ovid, and Google Scholar were used to extract information. The risk of bias was measured with the help of the Cochrane collaboration tool. Initially we found 1711 articles out of which 6 were finalised as per PICO criteria. Patient satisfaction was evaluated by using a visual analogue scale and questionnaire method, which shows denture liners group has more patient satisfaction. Acrylic denture liner and silicon denture liner shows better patient satisfaction compared to the conventional acrylic denture. Among denture liners, there is no significant difference.

Genome sequencing and analysis of a psychrotrophic methanogen Methanosarcina sp. nov. MSH10X1 cultured from methane hydrate deposits of Krishna Godavari Basin of India.

Methanosarcina sp. strain MSH10X1, a psychrotrophic methanogen, was isolated from sub-seafloor methane hydrate deposits of Krishna Godavari Basin on India's east coast. The strain could grow from 5 to 40 °C following all three i.e. methylotrophic, acetoclastic, and hydrogenotrophic modes of methanogenesis utilizing different substrates like methanol, trimethylamine, H2/CO2 (80/20), acetate, valerate, isobutyrate, isopropanol, and isobutanol. The genome sequencing and analysis of this strain revealed a circular chromosome of 3,557,383 bp length having 42.47 mol% G + C content, which consisted of 3110 coding genes, 58 tRNA genes, and 3 rRNA operons. The KEGG analysis highlighted the presence of genes responsible for all three modes of methanogenesis. The presence of genes like mtaB, mtaC, and mttB in the genome provided evidence for possible adaptation of strain MSH10X1 in the deep sea's low-temperature conditions.

Health Care Costs Associated with Addition, Titration, and Switching Antihypertensive Medications After First-Line Treatment: Results from a Commercially Insured Sample.

BACKGROUND: Treatment modifications are necessary for addressing issues related to efficacy and tolerance of first-line monotherapy, but they increase the economic burden on patients and their health plans. Understanding the differences in costs between alternative treatment modification strategies, if any, can serve as a guideline for clinical decision making and for designing cost-containment strategies. OBJECTIVE: To compare the health care utilization costs between (a) addition (i.e., use of free-pill combinations [FPCs] or fixed-dose combinations [FDCs]) and uptitration as alternatives for addressing efficacy issues and (b) switching and downtitration as alternatives for addressing tolerance issues with first-line antihypertensive monotherapy. METHODS: This is a retrospective cohort study that used the 2008-2012 BlueCross BlueShield of Texas claims database. Patients who had a treatment modification within 12 months of initiating antihypertensive monotherapy were identified. All-cause and disease-related health care utilization costs and drug costs were estimated from the BlueCross BlueShield health plan's perspective over a 12-month period, starting from the date of treatment modification. Propensity score-adjusted generalized linear models were used to compare costs between alternative treatment modification strategies. RESULTS: We identified 5,998 patients who met study criteria and had a modification of treatment: FPC (n = 1,395), FDC (n = 1,207), uptitration (n = 1,659), switching (n = 1,282), and downtitration (n = 455). All-cause and disease-related health services utilization costs were estimated for 12 months following treatment modification. Mean annual drug utilization costs were highest for the FDC strategy. All-cause inpatient and outpatient services utilization costs were significantly different between strategies used for addressing issues of tolerance and efficacy, respectively. Disease-related inpatient services utilization costs were lower for the FDC strategy compared with the uptitration strategy. However, disease-related inpatient services utilization costs were not significantly different for the downtitration strategy compared with the switch strategy. CONCLUSIONS: Health care costs following treatment modifications vary by type of strategy. The high costs of FDCs may be offset by the reduction of inpatient services utilization costs. Careful consideration should be given to the differences in costs between alternative strategies. DISCLOSURES: No outside funding supported this study. The dataset used in this study was created for dissertational research on the patterns and outcomes of treatment modification in hypertensive patients. Data and database support were provided by University of Texas School of Public Health/BlueCross BlueShield of Texas research program in payment systems and policy. Sonawane Deshmukh was an employee of Anthem BlueCross BlueShield from August 2015 to August 2016. Hansen has received consulting funds from Daichii Sankyo and has provided expert testimony for Allergan and Boehringer Ingelheim. All other authors have no known conflicts of interest. Study concept and design were contributed by Sonawane Deshmukh, Garza, Wright, and Hansen. Sonawane Deshmukh and Ganduglia Cazaban collected the data, and data interpretation was performed by Sonawane Deshmukh, Qian, Wright, and Zeng. The manuscript was written primarily by Sonawane Deshmukh, along with Qian and Garza, and revised by Sonawane Deshmukh, Qian, Ganduglia Cazaban, and Hansen.

Prevalence and Risk of Penile Human Papillomavirus Infection: Evidence From The National Health and Nutrition Examination Survey 2013-2014.

BACKGROUND: The epidemiology of penile human papillomavirus (HPV) infection is not well understood. Our objective was to determine the prevalence of penile HPV infection in the United States. METHODS: We analyzed a nationally representative sample of civilian noninstitutionalized US men from the National Health and Nutritional Examination Survey (NHANES) 2013-2014. Penile swab samples were collected from men aged 18-59 years. For detection of HPV types, a Roche Linear Array test was performed. We used NHANES sampling weights to estimate the population prevalence of penile HPV infection. RESULTS: The overall prevalence of any HPV infection was 45.2% (95% confidence interval [CI], 41.3%-49.3%). The prevalence of any high-risk HPV types and low-risk HPV types (mutually exclusive of high-risk HPV) was 30.5% (95% CI, 28.0%-33.0%) and 14.8% (95% CI, 12.7%-17.2%), respectively. Overall HPV prevalence increased with increasing age: the prevalence was lowest among 18- to 24-year-old men (33.8%) and highest among 55- to 59-year-old men (53.4%). HPV types 16 and 18 were detected in 4.3% (95% CI, 3.2%-5.7%) and 1.7% (95% CI, 1.1%-2.6%) of men, respectively. The prevalence of any HPV infection was almost 80% among men who reported having ≥16 lifetime sexual partners and using condoms intermittently. CONCLUSIONS: Our findings indicate that penile HPV is common among men in the United States. Almost one-third of all men are infected with high-risk HPV. Prevalence of penile HPV infection increases with increasing age.

Achieving Adherence After First-Line Antihypertensive Treatment: Should Fixed-Dose Combinations Receive Priority?

Data on the long-term outcomes of the use of fixed-dose combinations (FDCs) or free-pill combinations (FPCs), titration of doses, and switching are currently unavailable for identifying a preferred strategy for adherence. In the lack of these evidences, adherence can be a useful guiding criteria. The authors conducted a retrospective cohort study using the BlueCross BlueShield of Texas (2008-2012) database to compare adherence among 5998 patients who received treatment modifications (TMs). Results of the propensity score-adjusted model indicate that FDC and uptitration strategies have higher odds of adherence compared with the switch strategy (P<.05). Among patients with a history of poor adherence, the odds of adherence were up to 26% higher for the FDC strategy compared with alternative strategies (P<.05). Factors including age, number of comedications, first-line drug class, and health services utilization are associated with adherence. In conclusion, FDCs should be prioritized for TM, particularly if the patient has a history of poor adherence.