Quality of Electronic TB Register Data Compared with Paper-Based Records in the Kyrgyz Republic.

This study evaluated the effectiveness of an electronic system for managing individuals with drug-sensitive pulmonary tuberculosis in the Kyrgyz Republic. This cohort study used programmatic data. The study included people registered on the paper-based system in 2019 and 302 people registered on both the electronic and the paper-based systems between June 2021 and May 2022. The data from the 302 individuals were used to assess the completeness of each form of record and the concordance of the electronic record with the paper-based system. This study showed that for most variables, the completeness and concordance were 85.3-93.0% and were lowest for nonmandatory fields such as medication side effects (26.8% vs. 13.6%). No significant difference was observed in the time taken from symptom onset to diagnosis and treatment initiation between the two systems. However, the electronic system had a significantly higher percentage of subjects who initiated treatment on the day of diagnosis (80.3% vs. 57.1%). The proportion with successful outcomes was similar in both groups, but the electronic system had a significantly lower proportion of individuals with outcomes that were not evaluated or recorded (4.8% vs. 14.3%, p < 0.001). This study highlights the potential advantages and gaps associated with implementing an electronic TB register system for improving records.

Helicobacter pylori World Gastroenterology Organization Global Guideline.

Helicobacter pylori remains a major health problem worldwide, causing considerable morbidity and mortality due to peptic ulcer disease and gastric cancer. The burden of disease falls disproportionally on less well-resourced populations. As with most infectious diseases, the largest impact on reducing this burden comes from improvement in socioeconomic status, which interrupts transmission. This has been observed in many regions of the world, but the prevalence of infection remains high in many regions where improvements in living standards are slow to occur. Meanwhile, the optimal clinical management and treatment pathways remain unsettled and are evolving with changing antimicrobial resistance patterns. Despite decades of research and clinical practice, major challenges remain. The quest for the most effective, safe, and simple therapy remains the major issue for clinicians. The search for an effective vaccine appears to be elusive still. Clinical guidelines do not infrequently proffer discordant advice. A major challenge for guidelines is for relevance across a variety of populations with a varying spectrum of disease, antimicrobial resistance rates, and vastly different resources. As local factors are central to determining the impact and management strategies for H. pylori infection, it is important that pathways are based on the best available local knowledge rather than solely extrapolating from guidelines formulated in other regions, which may be less applicable. To this end, this revision of the World Gastroenterology Organisation (WGO) H. pylori guideline uses a "Cascades" approach that seeks to summarize the principles of management and offer advice for pragmatic, relevant and achievable diagnostic and treatment pathways based on established key treatment principles and using local knowledge and available resources to guide regional practice.

Coil embolization of arterioportal fistula complicated by gastrointestinal bleeding after Caesarian section: A case report.

BACKGROUND: Most intrahepatic arterioportal fistulae (IAPF) are acquired. The few cases of congenital fistulae are diagnosed in infants and children. CASE SUMMARY: We report a 31-year-old female patient presenting with haematemesis and melena three weeks after delivering her second child. The patient had a 20-year history of abdominal distention and nausea. IAPF, along with splenomegaly and ascites, was found by Doppler sonography and confirmed by computed tomography angiography. The patient was treated with endovascular coil embolization, resulting in occlusion of the fistula. CONCLUSION: This was an unusual case of possible congenital IAPF that manifested during a second pregnancy and was complicated by portal hypertension.

Single and double endometrial scratching (ES) in infertile women with strict criteria of recurrent implantation failure (RIF).

Controversies surrounding the effect of ES on pregnancy outcome in women with RIF are mostly due to the poorly defined target population. We evaluated the effect of ES on clinical outcomes in women with strict criteria of RIF before IVF/ICSI. We also examined the effect of ES on the expression of markers of endometrial receptivity. Women with failed implantation after transfer of seven or more top quality day 3 embryos or three blastocysts underwent the scratch procedure on exact days of the cycle prior to IVF/ICSI. Results were compared to no scratch control group. Using histopathology, immunohistochemistry, and scanning electron microscopy, we also examined the effect of injury on the endometrial receptivity in a separate series of observations with double ES. Cumulative pregnancy rate was significantly higher in the study group as compared to control (54.8% vs. 29.0%; p < .05). The effect of ES on the clinical outcome was seen during fresh ET, but not on the next FET cycles. ES improves impaired endometrial receptivity by partially normalizing the expression of estrogen and progesterone receptors (ERs, PRs) and pinopodes. We concluded that in a well-defined subpopulation of infertile women with RIF, ES significantly enhances pregnancy rates. ES has a specific impact on endometrial receptivity normalizing the expression of some markers.

Prevalence of Helicobacter pylori infection and antibiotic resistance profile in Armenia.

BACKGROUND: The prevalence of Helicobacter pylori infection was never assessed in Armenia, nor was the prevalence of H. pylori resistance against the main antibiotics concerned, despite the fact that these data are fundamental to establish evidence-based recommendations for management of this infection. We aimed to fill this gap by assessing prevalence of H. pylori among adult population in Armenia and resistance of H. pylori strains to clarithromycin and levofloxacin. METHODS: Helicobacter pylori seroprevalence was determined in 217 asymptomatic adult subjects submitted to a health checkup using an ELISA. Molecular methods were used to detect H. pylori in gastric biopsies from 91 adult dyspeptic patients [55 (60.4%) were positive] as well as the mutations associated with clarithromycin resistance by real-time PCR and with levofloxacin by sequencing the gyrA QRDR. RESULTS: Helicobacter pylori seropositivity was found to be 41.5% globally and increased with age from 13.6% (age 18-25 years) to 83.3% (age > 65 years). Only two cases were found with a A2142/43G mutation causing clarithromycin resistance, and 6 cases showed mutations associated with levofloxacin resistance. CONCLUSIONS: Helicobacter pylori infection is estimated to be about 42% among adults in Armenia and the low clarithromycin resistance allows the use of the standard triple therapy as a first line therapy.

Long-term familial Mediterranean fever remission on successful hepatitis C virus treatment in a patient not responding to colchicine: a case report.

BACKGROUND: Familial Mediterranean fever is an autosomal recessive disorder characterized by periodic febrile attacks of aseptic serositis and/or arthritis. The main treatment is colchicine which prevents attacks in the majority of patients except for a group of colchicine-resistant cases. Chronic hepatitis C is a viral infection causing chronic inflammation of liver tissue (hepatitis) which ultimately progresses to fibrosis and liver cirrhosis with a high chance of hepatocellular carcinoma. However, we found no data in the literature concerning the impact of hepatitis C on the course of attacks of familial Mediterranean fever. CASE PRESENTATION: We report a case of a 21-year-old white woman with familial Mediterranean fever who had not been responding to a high dose of colchicine (2 mg/day). She presented to our clinic with a finding of chronic hepatitis C genotype 3 infection. After successful antiviral therapy with peginterferon and ribavirin, she became attack-free for 2 years and went on to a lower dose of colchicine. CONCLUSIONS: This unusual case illustrates complete resolution of attacks of autoinflammatory disease after drug-induced clearance of chronic hepatitis C infection. Coexisting infections should be viewed as potentially altering the course of autoinflammatory disorders, and any attempt to cure the infections should be made in order to gain an added value of benefiting the chronic disease. This case highlights the interrelation of external pathogen-related and genetically inherited alterations in immunity and the importance of considering the whole spectrum of possible causative factors rather than implementing separate guidelines in order to achieve best quality of medical care in any given patient.

CHOROIDAL THICKNESS IN RELATION TO ETHNICITY MEASURED USING ENHANCED DEPTH IMAGING OPTICAL COHERENCE TOMOGRAPHY.

PURPOSE: To investigate the posterior choroidal thickness in healthy subjects of three different ethnicities. METHODS: In this prospective cross-sectional study, the choroidal thickness of 88 individuals (176 eyes) was measured using enhanced depth imaging-spectral domain optical coherence tomography. Subfoveal choroidal thickness was measured between the retinal pigment epithelium-Bruch membrane complex and chorioscleral interface. Nasal, temporal, superior, and inferior choroidal thicknesses at 0.5, 1.5, and 3.0 mm locations from the fovea were evaluated as well. RESULTS: Males and females were perfectly matched by number in all groups. The mean age of the entire study population was 27.43 ± 1 years. Mean subfoveal choroidal thicknesses of whites, Africans, Asians, and entire study population were 403.62 ± 37.4 µm, 372.47 ± 31.4 µm, 383.64 ± 40 µm, 386.64 ± 10.5 µm, respectively. Mean spherical error of the entire study population was -1.2685 diopter. Whites had the longest eyes on average 24.17 mm > 24.08 mm (Africans) > 23.86 mm (Asians), with the statistical mean of 24.04 mm for the entire study population. Subfoveal choroidal thickness was not significantly correlated with ethnicity in either ethnic group (P > 0.05). Subfoveal choroid thinned by 2.51 µm per 1 year increase in age (P = 0.282). Subfoveal choroidal thickness and sex were not significantly correlated to (P = 0.402). Subfoveal choroidal thickness was in strong negative correlation only with refractive error (P = 0.01) and axial length (P = 0.008). The intereye difference in subfoveal choroidal thickness was not statistically significant (P = 0.845). CONCLUSION: Enhanced depth imaging-spectral domain optical coherence tomography is a productive imaging method to study the choroidal thickness. Subfoveal choroidal thickness is not significantly correlated with ethnicity. The study reproduced previously found relations between thinner choroids and longer axial lengths, and increasing myopic refraction and showed no significant associations between subfoveal choroidal thickness and age and sex. Either the right or left eye can be used in future studies.

Barriers to antihypertensive medication adherence among adults--United States, 2005.

Antihypertensive agents are one of the most commonly prescribed classes of medications in the country, but patient adherence rates are low. To better understand why rates are low, the authors used data from the 2005 HealthStyles survey and found that among the 1432 respondents who received prescriptions for antihypertensive medications, 407 (28.4%) reported having difficulty taking their medication. "Not remembering'' was the most common reason reported (32.4%), followed by cost (22.6%), having no insurance (22.4%), side effects (12.5%), other reasons (12.3%), not thinking there is any need (9.3%), and having no health care provider (4.7%). In a multivariate model, younger age, lower income, having mental function impairment, and having had a blood pressure check more than 6 months earlier were factors significantly associated with reporting difficulty taking prescribed antihypertensive drugs. Control of hypertension is a significant public health issue, and alleviating barriers to medication adherence should be a major goal toward hypertension management.