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1.
J Hand Surg Asian Pac Vol ; 26(1): 84-91, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33559584

RESUMEN

Background: With the emergence of the COVID-19 pandemic, most health-care personnel and resources are redirected to prioritize care for seriously-ill COVID patients. This situation may poorly impact our capacity to care for critically injured patients. We need to devise a strategy to provide rational and essential care to hand trauma victims whilst the access to theatres and anaesthetic support is limited. Our center is a level 1 trauma center, where the pandemic preparedness required reorganization of the trauma services. We aim to summarise the clinical profile and management of these patients and highlight, how we modified our practice to optimize their care. Methods: This is a single-centre retrospective observational study of all patients with hand injuries visiting the Department of Plastic Surgery from 22nd March to 31st May 2020. Patient characteristics, management details, and outcomes were analysed. Results: A total of 102 hand injuries were encountered. Five patients were COVID-19 positive. The mean age was 28.9 ± 14.8 years and eighty-two (80.4%) were males. Thirty-one injuries involved fractures/dislocations, of which 23 (74.2%) were managed non-operatively. Seventy-five (73.5%) patients underwent wound wash or procedure under local anaesthetic and were discharged as soon as they were comfortable. Seventeen cases performed under brachial-plexus block, were discharged within 24 hours except four cases of finger replantation/ revascularisation and one flap cover which were discharged after monitoring for four days. At mean follow-up of 54.4 ± 21.8 days, the rates of early complication and loss to follow-up were 6.9% and 12.7% respectively. Conclusions: Essential trauma care needs to continue keeping in mind, rational use of resources while ensuring safety of the patients and health-care professionals. We need to be flexible and dynamic in our approach, by utilising teleconsultation, non-operative management, and regional anaesthesia wherever feasible.


Asunto(s)
/epidemiología , Traumatismos de la Mano/epidemiología , Traumatismos de la Mano/terapia , Adolescente , Adulto , Anestesia General/estadística & datos numéricos , Anestésicos Locales/administración & dosificación , Bloqueo del Plexo Braquial/estadística & datos numéricos , Femenino , Accesibilidad a los Servicios de Salud , Humanos , India/epidemiología , Perdida de Seguimiento , Masculino , Persona de Mediana Edad , Pandemias , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Centros Traumatológicos , Adulto Joven
2.
Am J Epidemiol ; 190(2): 251-264, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33524120

RESUMEN

Mortality assessment in cohorts with high numbers of persons lost to follow-up (LTFU) is challenging in settings with limited civil registration systems. We aimed to assess mortality in a clinical cohort (the Kilombero and Ulanga Antiretroviral Cohort (KIULARCO)) of human immunodeficiency virus (HIV)-infected persons in rural Tanzania, accounting for unseen deaths among participants LTFU. We included adults enrolled in 2005-2015 and traced a nonrandom sample of those LTFU. We estimated mortality using Kaplan-Meier methods 1) with routinely captured data (method A), 2) crudely incorporating tracing data (method B), 3) weighting using tracing data to crudely correct for unobserved deaths among participants LTFU (method C), and 4) weighting using tracing data accounting for participant characteristics (method D). We investigated associated factors using proportional hazards models. Among 7,460 adults, 646 (9%) died, 883 (12%) transferred to other clinics, and 2,911 (39%) were LTFU. Of 2,010 (69%) traced participants, 325 (16%) were found: 131 (40%) had died and 130 (40%) had transferred. Five-year mortality estimates derived using the 4 methods were 13.1% (A), 16.2% (B), 36.8% (C), and 35.1% (D), respectively. Higher mortality was associated with male sex, referral as a hospital inpatient, living close to the index clinic, lower body mass index, more advanced World Health Organization HIV clinical stage, lower CD4 cell count, and less time since initiation of antiretroviral therapy. Adjusting for unseen deaths among participants LTFU approximately doubled the 5-year mortality estimates. Our approach is applicable to other cohort studies adopting targeted tracing.


Asunto(s)
Infecciones por VIH/mortalidad , Perdida de Seguimiento , Población Rural/estadística & datos numéricos , Adolescente , Adulto , Antirretrovirales/uso terapéutico , Índice de Masa Corporal , Recuento de Linfocito CD4 , Femenino , Infecciones por VIH/tratamiento farmacológico , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Derivación y Consulta , Índice de Severidad de la Enfermedad , Factores Sexuales , Factores Socioeconómicos , Tanzanía/epidemiología , Adulto Joven
3.
Medicine (Baltimore) ; 99(50): e23183, 2020 Dec 11.
Artículo en Inglés | MEDLINE | ID: mdl-33327235

RESUMEN

Most of the craniopharyngioma is considered to derive from residual epithelial cells during the craniopharyngeal canal degeneration. Meningioma accounting for the primary intracranial neoplasm is considered to be mainly derived from cells of arachnoid granulations. Nevertheless, rare cases show coexistence of craniopharyngioma and meningioma.Case 1: A 43-year-old male patient referred to the hospital due to paroxysmal headache combined with blurred vision for 1 month. On physical examination, the visual acuity of left eye was poorer than that of the right eye. The visual acuity of the right eye near the nasal part showed defect.MRI and pathological examination were performed. The patient received intracranial tumor resection. After surgery, the patient showed hormone disorder, followed by corresponding treatment. However, the patient was lost in the 6-month follow-up.Case 2: The 64-year-old male patient presented to our department due to decline of visual acuity within 1 year combined with polydipsia (5,000 ml per day), polyuria and fatigue for 6 months. On physical examination, the bilateral visual acuity showed decline, especially the temporal part which was nearly hemiscotosis. MRI was performed. The adamantinomatous craniopharyngioma was diagnosed with the HE staining findings. The patient received intracranial resection. After surgery, the patient was in a deep coma condition, and was lost in the follow-up.In this case study, we presented 2 patients with coexistence of craniopharyngioma and meningioma. In addition, a complete literature review was carried out to illustrate the studies on coexistence of craniopharyngioma and meningioma. Meanwhile, we tried to explain the possible mechanisms for such condition.


Asunto(s)
Craneofaringioma/complicaciones , Craneofaringioma/cirugía , Meningioma/complicaciones , Meningioma/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Craneofaringioma/diagnóstico por imagen , Fatiga/diagnóstico , Fatiga/etiología , Femenino , Cefalea/diagnóstico , Cefalea/etiología , Humanos , Perdida de Seguimiento , Imagen por Resonancia Magnética/métodos , Masculino , Neoplasias Meníngeas/patología , Meningioma/diagnóstico por imagen , Persona de Mediana Edad , Neoplasias Hipofisarias/patología , Polidipsia/diagnóstico , Polidipsia/etiología , Poliuria/diagnóstico , Poliuria/etiología , Trastornos de la Visión/diagnóstico , Trastornos de la Visión/etiología , Agudeza Visual
4.
Afr J AIDS Res ; 19(4): 296-303, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33337978

RESUMEN

HIV-incidence studies are used to identify at-risk populations for HIV-prevention trials and interventions, but loss to follow-up (LTFU) can bias results if participants who remain differ from those who drop out. We investigated the incidence of and factors associated with LTFU among Zambian female sex workers (FSWs) in an HIV-incidence cohort from 2012 to 2017. Enrolled participants returned at month one, month three and quarterly thereafter. FSWs were considered LTFU if they missed six consecutive months, or if their last visit was six months before the study end date. Of 420 FSWs, 139 (33%) were LTFU at a rate of 15.7 per 100 person years. In multivariable analysis, LTFU was greater for FSWs who never used alcohol, began sex work above the age of consent, and had a lower volume of new clients. Our study appeared to retain FSWs in most need of HIV-prevention services offered at follow-up.


Asunto(s)
Infecciones por VIH/epidemiología , Perdida de Seguimiento , Trabajadores Sexuales/estadística & datos numéricos , Adolescente , Adulto , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Infecciones por VIH/prevención & control , Humanos , Incidencia , Factores de Riesgo , Adulto Joven , Zambia/epidemiología
5.
PLoS One ; 15(12): e0243749, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33370313

RESUMEN

BACKGROUND: This study aimed to help the Namibian government understand the impact of Treat All implementation (started on April 1, 2017) on key antiretroviral therapy (ART) outcomes, and how this transition impacts progress toward the UNAIDS's 90-90-90 HIV targets. METHODS: We collected clinical records from two separate cohorts (before and after treat-all) of ART patients in 10 high- and medium-volume facilities in 6 northern Namibia districts. Each cohort contains 12-month data on patients' scheduled appointments and visits, health status, and viral load results. We also measured patients' wait time and perceptions of service quality using exit interviews with 300 randomly selected patients (per round). We compared ART outcomes of the two cohorts: ART initiation within 7 days from diagnosis, loss to follow-up (LTFU), missed scheduled appointments for at least 30 days, and viral suppression using unadjusted and adjusted analyses. RESULTS: Among new ART clients (on ART for less than 3 months or had not yet initiated treatment as of the start date for the ART record review period), rapid ART initiation (within 7 days from diagnosis) was 5.2 times higher after Treat All than that among clients assessed before the policy took effect [AOR: 5.2 (3.8-6.9)]. However, LTFU was higher after Treat All roll-out compared to before Treat All [AOR: 1.9 (1.3-2.8)]. Established ART clients (on ART treatment for at least three months at the start date of the ART record review period) had over 3 times greater odds of achieving viral suppression after Treat All roll-out compared to established ART clients assessed before Treat All [AOR: 3.1 (1.6-5.9)]. CONCLUSIONS AND RECOMMENDATIONS: The findings indicate positive effect of the "Treat All" implementation on ART initiation and viral suppression, and negative effect on LTFU. Additionally, by April 2018, Namibia seems to have reached the UNAIDS's 90-90-90 targets.


Asunto(s)
Fármacos Anti-VIH/administración & dosificación , Erradicación de la Enfermedad/normas , Epidemias/prevención & control , Infecciones por VIH/tratamiento farmacológico , Implementación de Plan de Salud/estadística & datos numéricos , Adulto , Erradicación de la Enfermedad/métodos , Femenino , Infecciones por VIH/sangre , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Humanos , Estudios Longitudinales , Perdida de Seguimiento , Masculino , Persona de Mediana Edad , Namibia/epidemiología , Guías de Práctica Clínica como Asunto , Estudios Retrospectivos , Resultado del Tratamiento , Carga Viral/efectos de los fármacos
6.
PLoS One ; 15(10): e0238720, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33031440

RESUMEN

BACKGROUND: Global HIV funding cutbacks have been accompanied by the adoption of user fees to address funding gaps in treatment programs. Our objective was to assess the impact of user fees on HIV care utilization and medication adherence in Nigeria. METHODS: We conducted a retrospective analysis of patients enrolled in care before (October 2012-September 2013) and after (October 2014-September 2015) the introduction of user fees in a Nigerian clinic. We assessed pre- vs. post-user fee patient characteristics and enrollment trends, and determined risk of care interruption, loss to follow-up, and optimal medication adherence. RESULTS: After fees were instituted, there was a 66% decline in patient enrollment and 75% decline in number of ART doses dispensed. There was no difference in the proportion of female clients (64% vs 63%, p = 0.46), average age (36 vs. 37 years, p = 0.15), or median baseline CD4 (220/ul vs. 222/uL, p = 0.24) in pre- and post-fee cohorts. There was an increase in clients employed and/or had tertiary education (24% vs. 32%, p<0.001). Compared to pre-fee patients, the post-fee period had a 48% decreased risk of care interruption (aRR = 0.52, 95%CI:0.39-0.69), 22% decreased LTFU risk (aRR = 0.64, 95%CI:0.96), and 27% decreased odds of optimal medication adherence (aOR = 0.7, 3 95%CI 0.59-0.89). CONCLUSIONS: Patients enrolled in care after introduction of user fees in Nigeria were more likely to be educated or employed, and effectively retained in care after starting ART. However, fees were accompanied by a drastic reduction in new patient enrollment, suggesting that many patients may have been marginalized from HIV care.


Asunto(s)
Fármacos Anti-VIH/economía , Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/economía , Cumplimiento de la Medicación , Adulto , Instituciones de Atención Ambulatoria/economía , Estudios de Cohortes , Honorarios y Precios , Femenino , Gastos en Salud , Humanos , Perdida de Seguimiento , Masculino , Nigeria , Pacientes Desistentes del Tratamiento , Estudios Retrospectivos
7.
Eye Contact Lens ; 46(6): e66-e68, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33044373

RESUMEN

We report a rare case of dematiaceous fungus colonization in the therapeutic bandage contact lens (BCL), in an eye with peripheral ulcerative keratitis. Bandage contact lens removal and appropriate treatment resulted in improvement of the visual acuity and prevented the spread of fungus to the underlying ocular structures. Microbiological evaluation of the BCL showed dematiaceous fungal filaments, and the fungus was identified as Bipolaris species. In patients with pigmented plaque-like lesions, with BCL in situ, dematiaceous fungus on the undersurface of the BCL should be kept in mind. Patient education regarding the importance of frequent BCL replacement, proper ocular hygiene, and timely follow-up should be emphasized.


Asunto(s)
Ascomicetos/aislamiento & purificación , Betacoronavirus , Lentes de Contacto/microbiología , Úlcera de la Córnea/microbiología , Infecciones por Coronavirus/epidemiología , Infecciones Fúngicas del Ojo/microbiología , Micosis/microbiología , Neumonía Viral/epidemiología , Anciano , Antifúngicos/uso terapéutico , Vendajes , Carboximetilcelulosa de Sodio/uso terapéutico , Úlcera de la Córnea/diagnóstico , Úlcera de la Córnea/tratamiento farmacológico , Infecciones Fúngicas del Ojo/diagnóstico , Infecciones Fúngicas del Ojo/tratamiento farmacológico , Humanos , Perdida de Seguimiento , Masculino , Micosis/diagnóstico , Micosis/tratamiento farmacológico , Natamicina/uso terapéutico , Pandemias , Tomografía de Coherencia Óptica , Agudeza Visual
9.
PLoS One ; 15(9): e0239041, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32915923

RESUMEN

BACKGROUND: In 2013, the Indonesian government launched the strategic use of antiretroviral therapy (SUFA) initiative with an aim to move closer to achieving the UNAIDS 90-90-90 target. This study assessed the impact of SUFA on the cascade of HIV care. METHODS: We performed a two-year retrospective population-based cohort study of all HIV positive individuals aged ≥ 18 years residing in two cities where SUFA was operational using data from HIV clinics. We analysed data for one-year pre- and one-year post-SUFA implementation. We assessed the rates of enrolment in care, assessment for eligibility for antiretroviral therapy (ART), treatment initiation, loss to follow-up (LTFU) and mortality. Multivariate Cox regression was used to determine the pre-to-post-SUFA hazard ratio. RESULTS: A total of 2,292 HIV positive individuals (1,085 and 1,207 pre and post-SUFA respectively) were followed through their cascade of care. In the pre-SUFA period, 811 (74.6%) were enrolled in care, 702 (86.6%) were found eligible for ART, 485 (69.1%) initiated treatment, 102 (21%) were LTFU and 117 (10.8%) died. In the post-SUFA period, 930 (77%) were enrolled in care, 896 (96.3%) were found eligible for ART, 627 (70%) initiated treatment, 100 (16%) were LTFU and 148 (12.3%) dead. There was an 11% increase in the rate of HIV linkage to care (HR = 1.11; 95% CI 1.001, 1.22 p<0.05), a 13% increase in the rate of eligibility for ART (HR = 1.13, 95% CI 1.02,1.25, p<0.01) and a 27% reduction in LTFU (HR = 0.73, 95%CI 0.55, 0.97, p<0.05). Rates of ART initiation and mortality did not change. CONCLUSION: SUFA was effective in improving HIV care in relation to linkage to care, eligibility and ART retention. Therefore, the scale up across the whole of Indonesia of the SUFA currently in the form of a test and treat policy, with improvement in testing and treatment strategies is justified.


Asunto(s)
Continuidad de la Atención al Paciente/tendencias , Infecciones por VIH/diagnóstico , Infecciones por VIH/tratamiento farmacológico , Adulto , Fármacos Anti-VIH/uso terapéutico , Estudios de Cohortes , Femenino , Infecciones por VIH/mortalidad , Humanos , Indonesia/epidemiología , Perdida de Seguimiento , Masculino , Modelos de Riesgos Proporcionales , Estudios Retrospectivos
10.
PLoS One ; 15(9): e0238687, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32911516

RESUMEN

OBJECTIVES: We assessed cumulative incidence rates of and factors associated with re-engagement in HIV care for PLHIV lost to follow-up in Mali. METHODS: HIV-1-infected individuals lost to follow-up before 31/12/2013, ≥ 18 years old, who started ART from 2006 to 2012 at one of 16 care centres were considered. Loss to follow-up (LTFU) was defined as an interruption of ≥ 6 months during follow-up. The re-engagement in care in PLHIV lost to follow-up before 31/12/2013 was defined as having at least one clinical visit after LTFU. The cumulative incidence rates of re-engagement in care was estimated by Kaplan-Meier and its predictive factors were assessed using Cox models. Socio-demographic characteristics, clinical and immune status, period, region, centre expertise level, and distance from home at the start of ART plus a combined variable of duration of ART until LTFU and 12-month change in CD4 count were assessed. Multiple imputation was used to deal with missing data. RESULTS: We included 3,650 PLHIV lost to follow-up before December 2013, starting ART in nine outpatient clinics and seven hospitals (5+2 in Bamako and 4+5 in other regions): 35% male, median (IQR) age 35 (29-43), and duration of ART until LTFU 11 months (5-22). Among these PLHIV, 1,975 (54%) were definitively LTFU and 1,675 (46%) subsequently returned to care. The cumulative incidence rates of re-engagement in care rose from 39.0% at one year to 47.0% at three years after LTFU. Predictors of re-engagement in care were starting ART with WHO stage 1-2 and CD4 counts ≥ 200 cells/µL, being treated for ≥ 12 months with CD4 count gain ≥ 50 cells/µL, or being followed in Bamako. People followed at regional hospitals or outpatient clinics ≥ 5 km away, or being treated for ≥ 12 months with CD4 count gain < 50 cells/µL were less likely to return to care. CONCLUSIONS: Starting ART with a higher CD4 count, better gain in CD4 count, and being followed either in Bamako or close to home in the regions were associated with re-engagement in care.


Asunto(s)
Antirretrovirales/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Perdida de Seguimiento , Atención al Paciente , Adulto , Recuento de Linfocito CD4 , Femenino , Geografía , Infecciones por VIH/sangre , Humanos , Masculino , Malí , Modelos de Riesgos Proporcionales
11.
PLoS One ; 15(9): e0239013, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32931502

RESUMEN

BACKGROUND: Although antiretroviral therapy (ART) significantly improves the survival status and quality of life among human immunodeficiency virus (HIV)-infected children, loss to follow-up (LTFU) from HIV-care profoundly affecting the treatment outcomes of this vulnerable population. For better interventions, up-to-date information concerning LTFU among HIV-infected children on ART is vital. However, only a few studies have been conducted in Ethiopia to address this concern. Thus, this study aims to identify the predictors of LTFU among HIV-infected children receiving ART at Debre Markos Referral Hospital. METHODS: An institution-based retrospective follow-up study was done among 408 HIV-infected children receiving ART at Debre Markos Referral Hospital between 2005 and March 15, 2019. Data were abstracted from the medical records of HIV-infected children using a standardized data abstracted checklist. We used Epi-Data Version 3.1 for data entry and Stata Version 14 for statistical analysis. The Kaplan-Meier survival curve was used to estimate the survival time. A generalized log-rank test was used to compare the survival curves of different categorical variables. Finally, both bi-variable and multivariable Cox proportional hazard regression models were used to identify the predictors of LTFU. RESULTS: Of 408 HIV-infected children included in the final analysis, 70 (17.1%) children were LTFU at the end of the study. The overall incidence rate of LTFU among HIV-infected children was found to be 4.5 (95%CI: 3.5-5.7) per 100-child years of observation. HIV-infected children living in rural areas (AHR: 3.2, 95%CI: 2.0-5.3), having fair or poor ART drug adherence (AHR: 2.3, 95%CI: 1.4-3.7), children started ART through test and treat approach (AHR: 2.7, 95%CI: 1.4-5.5), and children started protease inhibiter (PI)-based ART regimens (AHR: 2.2, 95%CI: 1.1-4.4) were at higher risk of LTFU. CONCLUSION: This study found that one in every six HIV-infected children lost form ART follow-up. HIV-infected children living in rural areas, having fair or poor ART drug adherence, started ART based on test and treat approach, and taking PI-based ART regimens were at higher risk of LTFU.


Asunto(s)
Infecciones por VIH/epidemiología , Perdida de Seguimiento , Adolescente , Antirretrovirales/uso terapéutico , Niño , Preescolar , Etiopía/epidemiología , Femenino , Estudios de Seguimiento , Infecciones por VIH/tratamiento farmacológico , Humanos , Incidencia , Estimación de Kaplan-Meier , Masculino , Modelos de Riesgos Proporcionales , Derivación y Consulta , Estudios Retrospectivos , Factores de Riesgo
12.
PLoS One ; 15(8): e0237166, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32745148

RESUMEN

This study aims to clarify the factors associated with the gradual withdrawal from society in older adults. We defined the stages of follow-up difficulty based on four follow-up surveys on non-respondents of longitudinal mail surveys in community-dwelling older adults to examine the main factors associated with the stages of follow-up difficulty. We conducted a follow-up mail survey (FL1) with respondents of a baseline survey, and three more follow-up surveys with the non-respondents of each previous survey: simplified mail (FL2), postcard (FL3), and home visit surveys (FL4). The respondents of each follow-up survey were defined as a stage of follow-up difficulty; their characteristics concerning social participation and interaction at baseline in each stage were analyzed. The number of respondents in the FL1, FL2, FL3, and FL4 stages and non-respondents (NR) were as follows: 2,361; 462; 234; 84; and 101, respectively. Participation in hobby groups in FL2 and FL3, sports groups in FL4, and neighborhood association and social isolation in NR were significantly associated with the stage of follow-up difficulty. Based on these results, we conclude that the following factors are associated with each stage of follow-up difficulty: 1) a decline in instrumental activities of daily living in the FL2 and FL3 stages, 2) dislike for participating in physical activity such as sports in the FL4 stage, and 3) social isolation, not even belonging to a neighborhood association due to low social interaction in the NR group.


Asunto(s)
Actividades Cotidianas , Envejecimiento/psicología , Vida Independiente/estadística & datos numéricos , Perdida de Seguimiento , Conducta Social , Anciano , Anciano de 80 o más Años , Envejecimiento/fisiología , Participación de la Comunidad , Femenino , Estudios de Seguimiento , Humanos , Estudios Longitudinales , Masculino , Encuestas y Cuestionarios/estadística & datos numéricos
13.
PLoS One ; 15(8): e0237993, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32822388

RESUMEN

INTRODUCTION: Complete follow-up of human immunodeficiency virus (HIV)-exposed infants (HEI) is crucial for a successful prevention of mother-to-child HIV transmission. This study analyzed the HEI follow-up and factors associated with loss to follow-up (LTFU) in southern Mozambique. METHODS: This retrospective cohort study used the data of HEI enrolled between June 2017 and June 2018, followed-up for 18 months. The outcomes were the proportion of infants with completed follow-up and a definitive diagnosis, and the presence of clinical events. Kaplan-Meier survival analysis was used to calculate the cumulative probability of LTFU and of clinical events. Factors associated with LTFU and clinical events were analyzed using Cox regression to calculate the hazard ratio (HR) and adjusted HR (AHR), with a 95% confidence interval (CI) and a significance cutoff of p<0.05. RESULTS: 1413 infants were enrolled (49% males) at a median age of 32 days (IQR 31-41); the median follow-up time was 12 months (IQR 8.2-14.2); 1129 (80%) completed follow-up and had a definitive diagnosis, 58 (4%) were HIV-positive, 225 (16%) were LTFU; 266 (19%) presented a clinical event. Factors associated with LTFU were: age >2 months at entry (AHR, 1.58; 95% CI, 1.12-2.23), non-exclusive breastfeeding (AHR, 1.44; 95% CI, 1.01-2.06), poor cotrimoxazole adherence (AHR, 3.42; 95% CI, 1.59-7.35), and clinical events (AHR, 0.51; 95% CI, 0.34-0.77). Factors associated with clinical events were: malnutrition (AHR, 10.06; 95% CI, 5.92-17.09), non-exclusive breastfeeding (AHR, 1.98; 95% CI, 1.34-2.93), no nevirapine prophylaxis (AHR, 1.67; 95% CI, 1.18-2.36), and poor cotrimoxazole adherence (AHR, 2.62; 95% CI, 1.10-6.22). CONCLUSION: The high rate of HEI LTFU, associated with delayed linkage to postnatal care, poor prophylaxis adherence, non-exclusive breastfeeding, indicates the need to design a differentiated service delivery model that is tailored to the mothers' and infants' specific needs.


Asunto(s)
Infecciones por VIH/diagnóstico , Transmisión Vertical de Enfermedad Infecciosa/estadística & datos numéricos , Antirretrovirales/uso terapéutico , Lactancia Materna , Femenino , Infecciones por VIH/tratamiento farmacológico , Humanos , Lactante , Perdida de Seguimiento , Masculino , Cumplimiento de la Medicación , Diagnóstico Erróneo/estadística & datos numéricos , Mozambique , Nevirapina/uso terapéutico , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Combinación Trimetoprim y Sulfametoxazol/uso terapéutico
14.
J Fr Ophtalmol ; 43(8): 774-778, 2020 Oct.
Artículo en Francés | MEDLINE | ID: mdl-32800414

RESUMEN

INTRODUCTION: In an environment where strabismus is poorly understood and management centers rare, we studied the epidemiological, clinical and therapeutic aspects of neglected childhood strabismus. MATERIALS AND METHODS: This was a retrospective study carried out from March 1st, 2013 to September 30, 2018. Neglected childhood strabismus was defined as strabismus occurring in the first 5 years of life, for which the patient was over 7-years-old at the time of first consultation. The variables studied were age at first consultation, gender, age of onset, type of strabismus, etiology of strabismus, angle of deviation and rate of surgery. RESULTS: We found 113 cases of neglected childhood strabismus among the 430 cases of strabismus seen during the study period. There were more females (n=64) than males. The mean age was 17.7±10.5 years. There were 73 exotropias (64.6 %). The mean angle of deviation was 41.2±12.2PD. Strabismus was early in 70.8 % of cases. Innervational strabismus accounted for 86.7 % of cases. The most frequent refractive error was hyperopic astigmatism (55.3 %). Of the 45 patients who were seen again after full-time wear of their full cycloplegic correction, 2 were orthotropic. Surgery was performed in 60.5 % of cases. The average postoperative angle of deviation was 6.6±9.4PD. CONCLUSION: Management of neglected childhood strabismus provides good results and should therefore be encouraged in order to improve the quality of life of affected patients.


Asunto(s)
Diagnóstico Tardío , Estrabismo/diagnóstico , Estrabismo/epidemiología , Estrabismo/terapia , Adolescente , Adulto , Edad de Inicio , Niño , Maltrato a los Niños/estadística & datos numéricos , Estudios Transversales , Diagnóstico Tardío/estadística & datos numéricos , Esotropía/diagnóstico , Esotropía/epidemiología , Esotropía/terapia , Exotropía/diagnóstico , Exotropía/epidemiología , Exotropía/terapia , Femenino , Humanos , Perdida de Seguimiento , Masculino , Procedimientos Quirúrgicos Oftalmológicos/estadística & datos numéricos , Calidad de Vida , Estudios Retrospectivos , Adulto Joven
15.
Medicine (Baltimore) ; 99(32): e21410, 2020 Aug 07.
Artículo en Inglés | MEDLINE | ID: mdl-32769871

RESUMEN

It is often assumed that children and their caregivers either stay in care together or discontinue together, but data is lacking on caregiver-child retention concordance. We sought to describe the pattern of care among a cohort of human immunodeficiency virus (HIV) infected children and mothers enrolled in care at the Manhiça District Hospital (MDH).This was a retrospective review of routine HIV clinical data collected under a larger prospective HIV cohort study at MDH. Children enrolling HIV care from January 2013 to November 2016 were identified and matched to their mother's HIV clinical data. Retention in care for mothers and children was assessed at 24 months after the child's enrolment. Multinomial logistic regression was performed to evaluate variables associated with retention discordance.For the 351 mother-child pairs included in the study, only 39% of mothers had concordant care status at baseline (23% already active in care, 16% initiated care concurrently with their children). At 24-months follow up, a total of 108 (31%) mother-child pairs were concordantly retained in care, 88 (26%) pairs were concordantly lost to follow up (LTFU), and 149 (43%) had discordant retention. Pairs with concurrent registration had a higher probability of being concordantly retained in care. Children who presented with advanced clinical or immunological stage had increased probability of being concordantly LTFU.High rates of LTFU as well as high proportions of discordant retention among mother-child pairs were found. Prioritization of a family-based care model that has the potential to improve retention for children and caregivers is recommended.


Asunto(s)
Medicina Familiar y Comunitaria , Infecciones por VIH/psicología , Infecciones por VIH/terapia , Perdida de Seguimiento , Madres/psicología , Cooperación del Paciente/psicología , Adulto , Fármacos Anti-VIH/uso terapéutico , Niño , Preescolar , Estudios de Cohortes , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Mozambique
16.
S Afr Med J ; 110(4): 284-290, 2020 Mar 30.
Artículo en Inglés | MEDLINE | ID: mdl-32657739

RESUMEN

BACKGROUND: Patients diagnosed with spinal tuberculosis (TB) at a major tertiary hospital in Western Cape Province, South Africa, are required to attend regular follow-up at the hospital's outpatient spine clinic and to remain on TB treatment for at least 9 months. This follow-up and lengthy treatment is intended to allow for specialist monitoring of TB treatment response and early identification of secondary complications, and to reduce the risk of recurrence. However, little is known about adherence to these recommendations. OBJECTIVES: The main objectives were to describe (i) loss to spine clinic follow-up (LTFU), and (ii) TB treatment duration among patients diagnosed with spinal TB at the hospital. Secondary objectives were to investigate (i) the association between LTFU and treatment duration, and (ii) factors associated with LTFU. METHODS: This retrospective cohort study included 173 adults diagnosed with spinal TB between 2012 and 2015 and investigated follow-up within 2 years from diagnosis. Clinical, demographic and appointment data were obtained from hospital records and a dataset provided by the provincial Department of Health. LTFU was presented as frequency (%) and as a survival analysis. TB treatment duration was reported as frequency <9 months or ≥9 months, and the association between LTFU and <9 months of treatment was investigated using relative risk (RR) with 95% confidence intervals (CIs). Univariate associations between explanatory variables and LTFU were investigated using simple logistic regression analysis. RESULTS: Patients had a median (interquartile range) age of 36 (29 - 48) years and included 98 females (57%) and 151 individuals (87%) residing <50 km from the hospital. Primary outcomes were that 129 patients (75%) were LTFU within 2 years of diagnosis and 45 (30%) completed <9 months of treatment. The RR of <9 months of treatment was 1.62 (95% CI 1.39 - 1.88) among those LTFU compared with those retained in follow-up. LTFU was not associated with any of the clinical or demographic variables investigated. CONCLUSIONS: Three-quarters of the patients did not complete follow-up at the tertiary hospital spine clinic, and almost one in three received <9 months of TB treatment. Remaining in spine clinic follow-up was significantly associated with receiving at least the minimum duration of TB treatment. However, LTFU could not be predicted from routine clinical and demographic information and is likely to be related to factors not accounted for in the current analysis.


Asunto(s)
Antituberculosos/uso terapéutico , Duración de la Terapia , Perdida de Seguimiento , Procedimientos Ortopédicos , Viaje , Tuberculosis de la Columna Vertebral/terapia , Adulto , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Servicio Ambulatorio en Hospital , Características de la Residencia , Estudios Retrospectivos , Factores de Riesgo , Sudáfrica , Centros de Atención Terciaria , Adulto Joven
17.
Am J Trop Med Hyg ; 103(3): 1050-1056, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32618243

RESUMEN

Identifying predictors of loss to follow-up (LTFU; treatment lapse ≥ 2 months) among people with tuberculosis (TB) may assist programmatic efforts in controlling the spread of TB. Newly diagnosed smear-positive TB patients were enrolled in the Regional Prospective Observational Research for TB study in Puducherry and Tamil Nadu, India. Treatment records were used to identify LTFU of those who were enrolled from May 2014 through December 2017. This nested case-control study evaluated male TB patients. Predictors were assessed using multivariable logistic regression. Of 425 men with TB, 82 (19%) were LTFU. In the adjusted analyses of males, divorced/separated marital status (adjusted odds ratio [aOR] 3.80; 95% CI: 1.39-10.38) and at-risk alcohol use (aOR 1.92; 95% CI: 1.12-3.27) were significant predictors for increased risk of LTFU, and diabetes was a significant predictor for decreased risk of LTFU (aOR 0.52; 95% CI: 0.29-0.92). Of 53 men with recorded date of last treatment visit, 23 (43%) and 43 (81%) had LTFU within the first 2 and first 4 months of treatment, respectively. Addressing at-risk alcohol use and providing more intensive follow-up could lead to improved treatment completion.


Asunto(s)
Perdida de Seguimiento , Mycobacterium tuberculosis/patogenicidad , Tuberculosis Pulmonar/microbiología , Adulto , Consumo de Bebidas Alcohólicas/fisiopatología , Antituberculosos/uso terapéutico , Estudios de Casos y Controles , Femenino , Estudios de Seguimiento , Humanos , India , Modelos Logísticos , Masculino , Estado Civil , Persona de Mediana Edad , Mycobacterium tuberculosis/aislamiento & purificación , Factores de Riesgo , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/patología
19.
PLoS Med ; 17(5): e1003107, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32401797

RESUMEN

BACKGROUND: Men in sub-Saharan Africa have lower engagement and retention in HIV services compared to women, which may result in differential survival. However, the true magnitude of difference in HIV-related mortality between men and women receiving antiretroviral therapy (ART) is incompletely characterized. METHODS AND FINDINGS: We evaluated HIV-positive adults ≥18 years old newly initiating ART in 4 Zambian provinces (Eastern, Lusaka, Southern, and Western). In addition to mortality data obtained from routine electronic medical records, we intensively traced a random sample of patients lost to follow-up (LTFU) and incorporated tracing outcomes through inverse probability weights. Sex-specific mortality rates and rate differences were determined using Poisson regression. Parametric g-computation was used to estimate adjusted mortality rates by sex and age. The study included 49,129 adults newly initiated on ART between August 2013 and July 2015; overall, the median age among patients was 35 years, the median baseline CD4 count was 262 cells/µl, and 37.2% were men. Men comprised a smaller proportion of individuals starting ART (37.2% versus 62.8%), tended to be older (median age 37 versus 33 years), and tended to have lower CD4 counts (median 220 versus 289 cells/µl) at the time of ART initiation compared to women. The overall rate of mortality among men was 10.3 (95% CI 8.2-12.4) deaths/100 person-years (PYs), compared to 5.5 (95% CI 4.3-6.8) deaths/100 PYs among women (difference +4.7 [95% CI 2.3-7.2] deaths/100 PYs; p < 0.001). Compared to women in the same age groups, men's mortality rates were particularly elevated among those <30 years old (+6.7 deaths/100 PYs difference), those attending rural health centers (+9.4 deaths/100 PYs difference), those who had an initial CD4 count < 100 cells/µl (+9.2 deaths/100 PYs difference), and those who were unmarried (+8.0 deaths/100 PYs difference). After adjustment for potential confounders and mediators including CD4 count, a substantially higher mortality rate was predicted among men <30 years old compared to women of the same age, while women ≥50 years old had a mortality rate similar to that of age-matched men, but considerably higher than that predicted among young women (<30 years old). No clinically significant differences were evident with respect to rates of facility transfer or care disengagement between men and women. The main study limitations were the inability to successfully ascertain outcomes in all patients selected for tracing and missing clinical and laboratory data due to the use of medical records. CONCLUSIONS: In this study, we found that among HIV-positive adults newly initiating ART, mortality among men exceeded mortality among women; disparities were most pronounced among young patients. Older women, however, also experienced high mortality. Specific interventions for men and older women at highest mortality risk are needed to improve HIV treatment outcomes.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Registros Electrónicos de Salud , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/mortalidad , Adulto , Distribución por Edad , Anciano , Antirretrovirales/uso terapéutico , Estudios de Cohortes , Femenino , Humanos , Perdida de Seguimiento , Masculino , Persona de Mediana Edad , Caracteres Sexuales , Adulto Joven , Zambia/epidemiología
20.
Trop Med Int Health ; 25(8): 936-943, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32406961

RESUMEN

BACKGROUND: Estimates of retention in antiretroviral treatment (ART) programmes may be biased if patients who transfer to healthcare clinics are misclassified as lost to follow-up (LTFU) at their original clinic. In a large cohort, we estimated retention in care accounting for patient transfers using medical records. METHODS: Using linked electronic medical records, we followed adults living with HIV (PLWH) in Cape Town, South Africa from ART initiation (2012-2016) through database closure at 36 months or 30 June 2016, whichever came first. Retention was defined as alive and with a healthcare visit in the 180 days between database closure and administrative censoring on 31 December 2016. Participants who died or did not have a healthcare visit in > 180 days were censored at their last healthcare visit. We estimated the cumulative incidence of retention using Kaplan-Meier methods considering (i) only records from a participant's ART initiation clinic (not accounting for transfers) and (ii) all records (accounting for transfers), over time and by gender. We estimated risk differences and bootstrapped 95% confidence intervals to quantify misclassification in retention estimates due to patient transfers. RESULTS: We included 3406 PLWH initiating ART. Retention through 36 months on ART rose from 45.4% (95% CI 43.6%, 47.2%) to 54.3% (95% CI 52.4%, 56.1%) after accounting for patient transfers. Overall, 8.9% (95% CI 8.1%, 9.7%) of participants were misclassified as LTFU due to patient transfers. CONCLUSIONS: Patient transfers can appreciably bias estimates of retention in HIV care. Electronic medical records can help quantify patient transfers and improve retention estimates.


Asunto(s)
Antirretrovirales/uso terapéutico , Registros Electrónicos de Salud/estadística & datos numéricos , Infecciones por VIH/tratamiento farmacológico , Perdida de Seguimiento , Transferencia de Pacientes/estadística & datos numéricos , Retención en el Cuidado/estadística & datos numéricos , Adolescente , Adulto , Estudios de Cohortes , Bases de Datos Factuales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Sudáfrica , Adulto Joven
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