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1.
Circulation ; 140(17): 1426-1436, 2019 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-31634011

RESUMO

The complexity and costs associated with traditional randomized, controlled trials have increased exponentially over time, and now threaten to stifle the development of new drugs and devices. Nevertheless, the growing use of electronic health records, mobile applications, and wearable devices offers significant promise for transforming clinical trials, making them more pragmatic and efficient. However, many challenges must be overcome before these innovations can be implemented routinely in randomized, controlled trial operations. In October of 2018, a diverse stakeholder group convened in Washington, DC, to examine how electronic health record, mobile, and wearable technologies could be applied to clinical trials. The group specifically examined how these technologies might streamline the execution of clinical trial components, delineated innovative trial designs facilitated by technological developments, identified barriers to implementation, and determined the optimal frameworks needed for regulatory oversight. The group concluded that the application of novel technologies to clinical trials provided enormous potential, yet these changes needed to be iterative and facilitated by continuous learning and pilot studies.

2.
Contemp Clin Trials Commun ; 14: 100318, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30656241

RESUMO

Objectives: The advent of large databases, wearable technology, and novel communications methods has the potential to expand the pool of candidate research participants and offer them the flexibility and convenience of participating in remote research. However, reports of their effectiveness are sparse. We assessed the use of various forms of outreach within a nationwide randomized clinical trial being conducted entirely by remote means. Methods: Candidate participants at possibly higher risk for atrial fibrillation were identified by means of a large insurance claims database and invited to participate in the study by their insurance provider. Enrolled participants were randomly assigned to one of two groups testing a wearable sensor device for detection of the arrhythmia. Results: Over 10 months, the various outreach methods used resulted in enrollment of 2659 participants meeting eligibility criteria. Starting with a baseline enrollment rate of 0.8% in response to an email invitation, the recruitment campaign was iteratively optimized to ultimately include website changes and the use of a five-step outreach process (three short, personalized emails and two direct mailers) that highlighted the appeal of new technology used in the study, resulting in an enrollment rate of 9.4%. Messaging that highlighted access to new technology outperformed both appeals to altruism and appeals that highlighted accessing personal health information. Conclusions: Targeted outreach, enrollment, and management of large remote clinical trials is feasible and can be improved with an iterative approach, although more work is needed to learn how to best recruit and retain potential research participants. Trial registration: Clinicaltrials.govNCT02506244. Registered 23 July 2015.

3.
Indian Pediatr ; 55(9): 803-808, 2018 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-30345990

RESUMO

Ensuring quality in healthcare today has become extremely essential to ensure adequate utilization of healthcare services and improved outcomes. In addition to essential infrastructure in terms of safe and adequate space, knowledgeable and skilled health workers, and essential equipment and supply, the healthcare teams and administrators must also acquire knowledge and skills related to quality improvement (QI) methodologies. This review describes the role of learning platforms in teaching QI skills to the busy healthcare teams. Through Review of the published literature, we discuss challenges of learning and applying new skills of QI in day-to-day work by healthcare teams, and how learning platforms can assist in capacity building. There is a significant body of literature on the role of web-based teaching technology and learning platforms in medical education. Using modern communication technology, learning platforms can be established to bring together the healthcare teams, with QI experts to collaboratively learn, execute and share their experiences in improving quality of care in their own healthcare settings.


Assuntos
Educação a Distância/métodos , Educação Médica/métodos , Pessoal de Saúde/educação , Melhoria de Qualidade , Competência Clínica , Currículo , Humanos
4.
BMJ Open ; 8(7): e019079, 2018 07 30.
Artigo em Inglês | MEDLINE | ID: mdl-30061428

RESUMO

OBJECTIVE: To assess the extent to which Integrated Management of Childhood Illness (IMCI) has been adopted and scaled up in countries. SETTING: The 95 countries that participated in the survey are home to 82% of the global under-five population and account for 95% of the 5.9 million deaths that occurred among children less than 5 years of age in 2015; 93 of them are low-income and middle-income countries (LMICs). METHODS: We conducted a cross-sectional self-administered survey. Questionnaires and data analysis focused on (1) giving a general overview of current organisation and financing of IMCI at country level, (2) describing implementation of IMCI's three original components and (3) reporting on innovations, barriers and opportunities for expanding access to care for children. A single data file was created using all information collected. Analysis was performed using STATA V.11. PARTICIPANTS: In-country teams consisting of representatives of the ministry of health and country offices of WHO and Unicef. RESULTS: Eighty-one per cent of countries reported that IMCI implementation encompassed all three components. Almost half (46%; 44 countries) reported implementation in 90% or more districts as well as all three components in place (full implementation). These full-implementer countries were 3.6 (95% CI 1.5 to 8.9) times more likely to achieve Millennium Development Goal 4 than other (not full implementer) countries. Despite these high reported implementation rates, the strategy is not reaching the children who need it most, as implementation is lowest in high mortality countries (39%; 7/18). CONCLUSION: This survey provides a unique opportunity to better understand how implementation of IMCI has evolved in the 20 years since its inception. Results can be used to assist in formulating strategies, policies and activities to support improvements in the health and survival of children and to help achieve the health-related, post-2015 Sustainable Development Goals.


Assuntos
Saúde da Criança/normas , Assistência à Saúde/organização & administração , Avaliação de Programas e Projetos de Saúde , Saúde Pública/métodos , Criança , Serviços de Saúde da Criança/organização & administração , Estudos Transversais , Gerenciamento Clínico , Saúde Global , Pessoal de Saúde/educação , Humanos , Inquéritos e Questionários , Organização Mundial da Saúde
5.
JAMA ; 320(2): 146-155, 2018 07 10.
Artigo em Inglês | MEDLINE | ID: mdl-29998336

RESUMO

Importance: Opportunistic screening for atrial fibrillation (AF) is recommended, and improved methods of early identification could allow for the initiation of appropriate therapies to prevent the adverse health outcomes associated with AF. Objective: To determine the effect of a self-applied wearable electrocardiogram (ECG) patch in detecting AF and the clinical consequences associated with such a detection strategy. Design, Setting, and Participants: A direct-to-participant randomized clinical trial and prospective matched observational cohort study were conducted among members of a large national health plan. Recruitment began November 17, 2015, and was completed on October 4, 2016, and 1-year claims-based follow-up concluded in January 2018. For the clinical trial, 2659 individuals were randomized to active home-based monitoring to start immediately or delayed by 4 months. For the observational study, 2 deidentified age-, sex- and CHA2DS2-VASc-matched controls were selected for each actively monitored individual. Interventions: The actively monitored cohort wore a self-applied continuous ECG monitoring patch at home during routine activities for up to 4 weeks, initiated either immediately after enrolling (n = 1364) or delayed for 4 months after enrollment (n = 1291). Main Outcomes and Measures: The primary end point was the incidence of a new diagnosis of AF at 4 months among those randomized to immediate monitoring vs delayed monitoring. A secondary end point was new AF diagnosis at 1 year in the combined actively monitored groups vs matched observational controls. Other outcomes included new prescriptions for anticoagulants and health care utilization (outpatient cardiology visits, primary care visits, or AF-related emergency department visits and hospitalizations) at 1 year. Results: The randomized groups included 2659 participants (mean [SD] age, 72.4 [7.3] years; 38.6% women), of whom 1738 (65.4%) completed active monitoring. The observational study comprised 5214 (mean [SD] age, 73.7 [7.0] years; 40.5% women; median CHA2DS2-VASc score, 3.0), including 1738 actively monitored individuals from the randomized trial and 3476 matched controls. In the randomized study, new AF was identified by 4 months in 3.9% (53/1366) of the immediate group vs 0.9% (12/1293) in the delayed group (absolute difference, 3.0% [95% CI, 1.8%-4.1%]). At 1 year, AF was newly diagnosed in 109 monitored (6.7 per 100 person-years) and 81 unmonitored (2.6 per 100 person-years; difference, 4.1 [95% CI, 3.9-4.2]) individuals. Active monitoring was associated with increased initiation of anticoagulants (5.7 vs 3.7 per 100 person-years; difference, 2.0 [95% CI, 1.9-2.2]), outpatient cardiology visits (33.5 vs 26.0 per 100 person-years; difference, 7.5 [95% CI, 7.2-7.9), and primary care visits (83.5 vs 82.6 per 100 person-years; difference, 0.9 [95% CI, 0.4-1.5]). There was no difference in AF-related emergency department visits and hospitalizations (1.3 vs 1.4 per 100 person-years; difference, 0.1 [95% CI, -0.1 to 0]). Conclusions and Relevance: Among individuals at high risk for AF, immediate monitoring with a home-based wearable ECG sensor patch, compared with delayed monitoring, resulted in a higher rate of AF diagnosis after 4 months. Monitored individuals, compared with nonmonitored controls, had higher rates of AF diagnosis, greater initiation of anticoagulants, but also increased health care resource utilization at 1 year. Trial Registration: ClinicalTrials.gov Identifier: NCT02506244.


Assuntos
Fibrilação Atrial/diagnóstico , Eletrocardiografia Ambulatorial/instrumentação , Dispositivos Eletrônicos Vestíveis , Idoso , Anticoagulantes/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/epidemiologia , Estudos de Coortes , Comorbidade , Feminino , Recursos em Saúde/estatística & dados numéricos , Humanos , Incidência , Análise de Intenção de Tratamento , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Fatores de Risco , Dispositivos Eletrônicos Vestíveis/efeitos adversos
6.
Depress Anxiety ; 35(10): 946-952, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29734486

RESUMO

BACKGROUND: Naturalistic and small randomized trials have suggested that pharmacogenetic testing may improve treatment outcomes in depression, but its cost-effectiveness is not known. There is growing enthusiasm for personalized medicine, relying on genetic variation as a contributor to heterogeneity of treatment effects. We sought to examine the relationship between a commercial pharmacogenetic test for psychotropic medications and 6-month cost of care and utilization in a large commercial health plan. METHODS: We performed a propensity-score matched case-control analysis of longitudinal health claims data from a large US insurer. Individuals with a mood or anxiety disorder diagnosis (N = 817) who received genetic testing for pharmacokinetic and pharmacodynamic variation were matched to 2,745 individuals who did not receive such testing. Outcomes included number of outpatient visits, inpatient hospitalizations, emergency room visits, and prescriptions, as well as associated costs over 6 months. RESULTS: On average, individuals who underwent testing experienced 40% fewer all-cause emergency room visits (mean difference 0.13 visits; P < 0.0001) and 58% fewer inpatient all-cause hospitalizations (mean difference 0.10 visits; P < 0.0001) than individuals in the control group. The two groups did not differ significantly in number of psychotropic medications prescribed or mood-disorder related hospitalizations. Overall 6-month costs were estimated to be $1,948 (SE 611) lower in the tested group. CONCLUSIONS: Pharmacogenetic testing represents a promising strategy to reduce costs and utilization among patients with mood and anxiety disorders.


Assuntos
Ansiolíticos/uso terapêutico , Antidepressivos/uso terapêutico , Transtornos de Ansiedade/tratamento farmacológico , Transtorno Depressivo/tratamento farmacológico , Serviços de Saúde Mental/estatística & dados numéricos , Testes Farmacogenômicos/estatística & dados numéricos , Adulto , Transtornos de Ansiedade/economia , Estudos de Casos e Controles , Transtorno Depressivo/economia , Feminino , Custos de Cuidados de Saúde , Hospitalização , Humanos , Masculino , Serviços de Saúde Mental/economia , Pessoa de Meia-Idade , Farmacogenética , Pontuação de Propensão , Estudos Retrospectivos
7.
Indian J Dermatol ; 63(1): 41-46, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29527024

RESUMO

Background: The diagnosis of cutaneous adversities in the cancer patient is especially difficult, given the complexity of their illness and combination protocols used for the treatment. The present study was undertaken to know the spectrum of cutaneous adversities in patients undergoing chemotherapy and the drug(s) most commonly associated with it. Materials and Methods: A total of 1000 patients with malignancies under chemotherapy in the oncology ward and outpatient department were screened in this observational study from January 2013 to February 2015. Relevant investigations for diagnosis of malignancies under chemotherapy and dermatological disorders were carried out. Results: Three hundred and eighty-four patients presented with cutaneous adversities of chemotherapy. The most common was anagen effluvium (78.6%), followed by xerosis (4.4%), thrombophlebitis (3.1%), generalised pruritus (2.9%), melanonychia (2.9%), hand-foot syndrome (2.6%), extravasation reactions (1.8%), flagellate dermatosis (1.3%), prurigo nodularis (0.8%), exfoliation (0.5%), ichthyosis (0.5%), papulopustular rash (0.3%), bullous photodermatitis (0.3%), and Sweet's syndrome (0.3%). Chemotherapeutic drugs were mostly given in combinations. Most common drugs to cause anagen effluvium were alkylating agents in combinations, hand-foot syndrome by taxanes (docetaxel), flagellate dermatoses by antitumour antibiotics (bleomycin), and exfoliation by antimetabolites (methotrexate). The limitation of this study was to imply a specific drug as the causation of the cutaneous adversities since the chemotherapy mostly consisted of combination protocols. Therefore, we have tried to associate the drug combination itself. Conclusion: Chemotherapeutic drugs produce a range of cutaneous adversities, certain specific adversities pertaining to drugs, and their combinations have been implicated which should be looked for and managed accordingly. Knowledge of the adverse effects of anticancer drugs will help reduce the psychological trauma and improve the quality of life.

8.
PLoS One ; 12(10): e0185739, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29040336

RESUMO

BACKGROUND: The Chiranjeevi Yojana (CY) is a Public-Private-Partnership between the state and private obstetricians in Gujarat, India, since 2007. The state pays for institutional births of the most vulnerable households (below-poverty-line and tribal) in private hospitals. An innovative remuneration package has been designed to disincentivise unnecessary cesareans. This study examines characteristics of private facilities which participated in the program. METHODS: We conducted a cross-sectional survey of all facilities which had conducted any births between June 2012 and April 2013 in three districts. We identified 111 private and 47 public facilities. Ninety of the 111 private facilities did caesarean sections in the last three months and were eligible to participate in the CY program. Of these, 40 (44%) participated in the CY program. We conducted descriptive and bivariate analyses followed by a Poisson regression model to estimate prevalence ratios of facility characteristics that predicted participation. RESULTS: We found that facilities participating in the CY program had a significantly higher likelihood of being general facilities (PR 1.9, 95% CI 1.3-2.9), or conducting lower proportion of cesarean births (PR 2.1, 95% CI 1.2-3.5) or having obstetricians new in private practice (PR 1.9, 95% CI 1.2-3.1) or being less expensive (PR 1.8, 95% CI 1.1-3.0). But none of these factors retained significance in a multi variable model. CONCLUSION: Private obstetricians who participate in the CY program tend to be new to private practice, provide general services, conduct fewer caesareans and are also less expensive. This is advantageous to the PPP and widens the target beneficiary groups that can be serviced by the PPP. The state should design remuneration packages with the aim of attracting relatively new obstetricians to set up practices in more remote areas. It is possible that the CY remuneration package design is effective in keeping caesarean rates in check, and needs to be studied further.


Assuntos
Cesárea/estatística & dados numéricos , Parto Obstétrico/tendências , Serviços de Saúde Materna/estatística & dados numéricos , Parcerias Público-Privadas/estatística & dados numéricos , Cobertura Universal do Seguro de Saúde/estatística & dados numéricos , Adulto , Análise de Variância , Cesárea/economia , Estudos Transversais , Parto Obstétrico/economia , Feminino , Instalações de Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde , Humanos , Índia , Serviços de Saúde Materna/economia , Pobreza , Gravidez , Parcerias Público-Privadas/economia , Cobertura Universal do Seguro de Saúde/economia
9.
Am Heart J ; 175: 77-85, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-27179726

RESUMO

Efficient methods for screening populations for undiagnosed atrial fibrillation (AF) are needed to reduce its associated mortality, morbidity, and costs. The use of digital technologies, including wearable sensors and large health record data sets allowing for targeted outreach toward individuals at increased risk for AF, might allow for unprecedented opportunities for effective, economical screening. The trial's primary objective is to determine, in a real-world setting, whether using wearable sensors in a risk-targeted screening population can diagnose asymptomatic AF more effectively than routine care. Additional key objectives include (1) exploring 2 rhythm-monitoring strategies-electrocardiogram-based and exploratory pulse wave-based-for detection of new AF, and (2) comparing long-term clinical and resource outcomes among groups. In all, 2,100 Aetna members will be randomized 1:1 to either immediate or delayed monitoring, in which a wearable patch will capture a single-lead electrocardiogram during the first and last 2 weeks of a 4-month period beginning immediately or 4 months after enrollment, respectively. An observational, risk factor-matched control group (n = 4,000) will be developed from members who did not receive an invitation to participate. The primary end point is the incidence of new AF in the immediate- vs delayed-monitoring arms at the end of the 4-month monitoring period. Additional efficacy and safety end points will be captured at 1 and 3 years. The results of this digital medicine trial might benefit a substantial proportion of the population by helping identify and refine screening methods for undiagnosed AF.


Assuntos
Doenças Assintomáticas/epidemiologia , Fibrilação Atrial , Eletrocardiografia Ambulatorial/métodos , Programas de Rastreamento , Acidente Vascular Cerebral/prevenção & controle , Idoso , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/fisiopatologia , Redução de Custos , Feminino , Humanos , Incidência , Masculino , Programas de Rastreamento/economia , Programas de Rastreamento/instrumentação , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Telemedicina/métodos , Estados Unidos/epidemiologia
10.
Vaccine ; 34(4): 474-478, 2016 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-26706276

RESUMO

INTRODUCTION: Pneumococcal conjugate vaccines (PCV) have indirect effects due to decreased Streptococcus pneumoniae colonization in vaccine recipients. We sought to determine whether the introduction of PCV13 in children led to changes in the epidemiology and clinical manifestations of invasive pneumococcal disease (IPD) in adults. METHODS: We described demographics, comorbidities, clinical manifestations, and serotypes of IPD in Utah adults before (November 2009-February 2010) and after (March 2010-March 2012) the introduction of PCV13 in children. We also compare serotypes causing IPD in Utah adults and children. RESULTS: After the introduction of PCV13 in the childhood vaccine program, the proportion of IPD due to PCV13 exclusive serotypes decreased significantly in Utah adults (64-40%, p=0.009), primarily due to a decline in serotype 7F (36-15%, p=0.008). There were non-significant increases in IPD due to Pneumococcal polysaccharide 23 (PPV23) unique serotypes and non-vaccine serotypes, most notably serotype 22F. Changes in the proportions of vaccine and non-vaccine serotypes were similar in adults and children. Meningitis was more commonly due to non-vaccine serotypes relative to non-meningitis cases (47% vs. 18%, p=0.007). When stratified by sex, decreases in PCV13 serotype IPD were only noted in men (76-33%, p=0.001). CONCLUSIONS: Serotype epidemiology of IPD in adults closely follows that of children in the PCV13 era. Continued surveillance is needed to confirm whether replacement serotypes will lead to increases in pneumococcal meningitis and whether there are sex differences in the indirect effects of PCV vaccination in children.


Assuntos
Infecções Pneumocócicas/epidemiologia , Vacinas Pneumocócicas/administração & dosagem , Streptococcus pneumoniae/classificação , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Programas de Imunização , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Infecções Pneumocócicas/microbiologia , Sorogrupo , Utah/epidemiologia , Vacinas Conjugadas/administração & dosagem
11.
PLoS One ; 9(1): e87378, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24498089

RESUMO

OBJECTIVE: To evaluate the effects of an intervention comprising surveillance and an organisational change called Appreciative Inquiry on puerperal infections in hospitals in Gujarat state, India. METHODS: This longitudinal cohort study with a control group was conducted over 16 months between 2010 and 2012. Women who delivered in six hospitals were followed-up. After a five month pre-intervention period, the intervention was introduced in three hospitals. Monthly incidence of puerperal infection was recorded throughout the study in all six hospitals. A chi-square test and logistic regression were used to examine for associations, trends and interactions between the intervention and control groups. FINDINGS: Of the 8,124 women followed up, puerperal infections were reported in 319 women (3.9%) over the course of the study. Puerperal sepsis/genital tract infections and urinary tract infections were the two most common puerperal infections. At the end of the study, infection incidence in the control group halved from 7.4% to 3.5%. Levels in the intervention group reduced proportionately even more, from 4.3% to 1.7%. A chi-square test for trend confirmed the reduction of infection in the intervention and control groups (p<0.0001) but the trends were not statistically different from one another. There was an overall reduction of infection by month (OR = 0.94 95% CI 0.91-0.97). Risk factors like delivery type, complications or delivery attendant showed no association with infection. CONCLUSION: Interruption of resource flows in the health system occurred during the intervention phase, which may have affected the findings. The incidence of infection fell in both control and intervention groups during the course of the study. It is not clear if appreciative inquiry contributed to the reductions observed. A number of practical and methodological limitations were faced. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN03513186.


Assuntos
Infecção Puerperal/epidemiologia , Adulto , Feminino , Humanos , Incidência , Índia , Estudos Longitudinais , Fatores de Risco , Adulto Jovem
12.
Am J Trop Med Hyg ; 89(1): 111-5, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23716414

RESUMO

Cutaneous leishmaniasis is endemic to the Thar Desert of Rajasthan, Bikaner, India. The present study describes clinico-epidemiologcial data of all cases of cutaneous leishmaniasis CL in this region during 2001-2011. A total of 1,379 patients with 2,730 lesions were reported during the study period. Ages of patients ranged from 3 months to 86 years, and there was a predominance of infections in males. Most patients were from urban areas and lower middle socioeconomic groups. Lesions were dry, ulcerated nodules or plaques of different sizes commonly over face and upper limb. Skin smears were positive for parasites in 958 (69.5%) patients, and the remaining 45.8% (193 of 421) patients were positive by skin biopsy. Histopathologic analysis of the skin showed mixed granulomas consisting of macrophages, lymphocytes, epitheloid, and plasma cells. Species identification was conducted for 45 randomly selected patients by polymerase chain reaction, the infective species was Leishmania tropica. Most patients were treated with intra-lesional injections of sodium stibogluconate.


Assuntos
Leishmaniose Cutânea/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Índia/epidemiologia , Lactente , Leishmaniose Cutânea/tratamento farmacológico , Leishmaniose Cutânea/patologia , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Fatores Sexuais , Pele/patologia , Fatores Socioeconômicos , Adulto Jovem
13.
Asian J Psychiatr ; 6(1): 42-5, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23380316

RESUMO

BACKGROUND: Bipolar affective disorder may be associated with alterations in thyroid function. A comprehensive thyroid assessment is important for assessing clinical and sub-clinical imbalances linked to a variety of mood disorders like bipolar affective disorder. AIM: To find out the association between bipolar affective disorder and thyroid dysfunction. MATERIALS AND METHOD: The present cross-sectional study was conducted at Government District Wenlock Hospital, Mangalore (GDWH), India. A total of 50 newly diagnosed bipolar affective disorder patients and 50 age and sex matched controls without bipolar affective disorder as confirmed by the application of Bipolar Spectrum Diagnostic Scale were included in the study. Thyroid function was assessed among the patients and control group to study the association between bipolar affective disorder and thyroid dysfunction. Odds ratio was calculated to find out the strength of association between thyroid gland dysfunction and bipolar affective disorder. RESULTS: The mean Bipolar Spectrum Diagnostic Scale score among patients diagnosed with bipolar affective disorder was 20.84 and that of the control group was 1.98. The proportion of thyroid dysfunction among bipolar affective disorder patients and among control group was 14% and 6% respectively. The odds ratio was calculated to be 2.55. Mean T3 values were higher in the bipolar affective disorder patients than the control group and this association was found to be statistically significant (p=0.031). Mean T4 and TSH values were higher among the bipolar affective disorder patients but did not show any significant differences when compared with the control group. CONCLUSION: The present study concludes that a statistically significant association exists between elevated T3 hormone and bipolar affective disorder and observes that the patients with bipolar affective disorder are 2.55 times more commonly associated with thyroid dysfunction.


Assuntos
Transtorno Bipolar/complicações , Doenças da Glândula Tireoide/complicações , Glândula Tireoide/fisiopatologia , Adulto , Transtorno Bipolar/sangue , Estudos Transversais , Feminino , Humanos , Masculino , Doenças da Glândula Tireoide/sangue , Tireotropina/sangue , Tiroxina/sangue , Tri-Iodotironina/sangue
15.
Australas J Dermatol ; 54(4): 307-9, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23127158

RESUMO

Current treatments for warts induce significant local tissue damage and do not prevent recurrence. We evaluated the efficacy of localised radiofrequency heat (RFH) therapy in inducing the long-term resolution of common and palmo-plantar warts in a placebo-controlled randomised single blind trial. Our data show that RFH therapy is a safe, cosmetically acceptable and long-term effective treatment for warts.


Assuntos
Técnicas de Ablação , Diatermia , Verrugas/cirurgia , Adolescente , Adulto , Feminino , Seguimentos , Dermatoses do Pé/cirurgia , Dermatoses da Mão/cirurgia , Humanos , Masculino , Método Simples-Cego , Adulto Jovem
16.
BMJ Case Rep ; 20122012 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-23097577

RESUMO

We describe a non-smoker who presented with a persistent cough, weight loss and general malaise, and had a medical history of bladder carcinoma that had been successfully treated with intravesical BCG immunotherapy. Radiology revealed hilar lymphadenopathy, a predominantly mid-zone and lower-zone lung parenchymal nodular pattern with a perilymphatic distribution, a few thickened interlobular septae, and small pleural effusions bilaterally. The T-SPOT.TB blood test was negative. Video-assisted thoracoscopic surgery showed multiple pleural nodules, the histopathology of which showed multiple well-defined non-caseating granulomata. The patient was started on antituberculosis medication for presumed BCGosis--a systemic complication of previous BCG immunotherapy--and the patient showed an excellent clinical and radiological response. This case further adds to previous reports and reinforces the recommendation that all patients should be made fully aware of the potential systemic and delayed complications of BCG immunotherapy when they are consented for treatment.


Assuntos
Vacina BCG/efeitos adversos , Tosse/etiologia , Imunoterapia/efeitos adversos , Pneumopatias/etiologia , Mycobacterium bovis , Neoplasias da Bexiga Urinária/terapia , Adjuvantes Imunológicos/efeitos adversos , Adjuvantes Imunológicos/uso terapêutico , Administração Intravesical , Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , Vacina BCG/uso terapêutico , Carcinoma de Células de Transição/imunologia , Carcinoma de Células de Transição/terapia , Tosse/tratamento farmacológico , Tosse/microbiologia , Feminino , Granuloma/etiologia , Granuloma/microbiologia , Humanos , /microbiologia , Pulmão/microbiologia , Pneumopatias/tratamento farmacológico , Pneumopatias/microbiologia , Doenças Linfáticas/etiologia , Doenças Linfáticas/microbiologia , Pessoa de Meia-Idade , Neoplasias da Bexiga Urinária/imunologia
17.
Am J Trop Med Hyg ; 87(2): 261-3, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22855755

RESUMO

Canine cutaneous leishmaniasis (CCL) is a significant veterinary problem. Infected dogs also serve as parasite reservoirs and contribute to human transmission of cutaneous leishmaniasis (CL). Current treatments for CCL are cumbersome and toxic because they are prolonged and involve multiple injections of antimonials. Radio-frequency induced heat (RFH) therapy has been found to be highly effective against CL in humans. Here, we examined the efficacy of topical RFH therapy in the treatment of CL in two pet dogs. We found that RFH therapy induced complete clinical cure and lesion healing within 45 days and both dogs have remained disease free for the last 16 months. This report is the first to demonstrate that a single topical application of RFH therapy is safe and effective in inducing long-term cure of CCL.


Assuntos
Doenças do Cão/parasitologia , Doenças do Cão/terapia , Hipertermia Induzida/veterinária , Leishmania/isolamento & purificação , Leishmaniose Cutânea/veterinária , Zoonoses/parasitologia , Animais , Cães , Feminino , Hipertermia Induzida/métodos , Leishmaniose Cutânea/parasitologia , Leishmaniose Cutânea/terapia , Ondas de Rádio
18.
Vaccine ; 29(49): 9123-6, 2011 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-22001280

RESUMO

While heptavalent pneumococcal conjugate vaccine (PCV) has decreased vaccine type invasive pneumococcal disease (IPD) nationwide, rapid serotype replacement and increasing parapneumonic empyema, has been reported in Utah children. The effect of pediatric vaccination on adults in this population is unknown. We identified 117 adults with IPD from the Intermountain Healthcare Central Laboratory between November 2009 and October 2010. We serotyped 61 (52%) stored isolates. We compared the serotype distribution of adult IPD isolates with that of pediatric isolates collected in 2009-2010. PCV7 serotypes were rare in adults (3%) and children (3%). Emerging 13-valent PCV serotypes 3, 7F, and 19A caused the majority of IPD in adults (63%) and children (56%). Fifty-one (84%) adult isolates were serotypes included in 23-valent polysaccharide vaccine and 66% in PCV13. Adult and pediatric IPD serotypes are closely associated in Utah. PCV13 vaccination in Utah children is likely to significantly impact IPD in Utah adults.


Assuntos
Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/microbiologia , Vacinas Pneumocócicas/administração & dosagem , Streptococcus pneumoniae/classificação , Vacinação/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Vacina Pneumocócica Conjugada Heptavalente , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pneumonia Pneumocócica/epidemiologia , Pneumonia Pneumocócica/microbiologia , Sorotipagem , Utah/epidemiologia , Vacinas Conjugadas/administração & dosagem , Adulto Jovem
19.
Am J Trop Med Hyg ; 85(1): 64-5, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21734126

RESUMO

Opportunistic parasitic infections such as leishmaniasis are common in human immunodeficiency virus (HIV)-infected patients and are usually acquired several days after initial diagnosis of HIV infection. Here, we report on a patient who presented with diffuse cutaneous leishmaniasis (DCL) caused by Leishmania tropica as the first and only clinical manifestation of HIV infection. To the best of our knowledge, this is the first case that illustrates that DCL could be the first clinical indicator of HIV infection. Cutaneous leishmaniasis (CL) and DCL are becoming frequent opportunistic infections in HIV-infected individuals throughout the world. To date, all documented cases of CL and HIV coinfections have been reported in patients who were known cases of HIV and who subsequently developed CL. In this report, we present a case that illustrates that DCL could be the first clinical indicator of HIV infection.


Assuntos
Infecções por HIV/etiologia , Leishmaniose Cutânea/complicações , Adulto , Feminino , Humanos , Índia
20.
BMC Pregnancy Childbirth ; 11: 37, 2011 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-21599924

RESUMO

BACKGROUND: Increasingly, women in India attend health facilities for childbirth, partly due to incentives paid under government programs. Increased use of health facilities can alleviate the risks of infections contracted in unhygienic home deliveries, but poor infection control practices in labour and delivery units also cause puerperal sepsis and other infections of childbirth. A needs assessment was conducted to provide information on procedures and practices related to infection control in labour and delivery units in Gujarat state, India. METHODS: Twenty health care facilities, including private and public primary health centres and referral hospitals, were sampled from two districts in Gujarat state, India. Three pre-tested tools for interviewing and for observation were used. Data collection was based on existing infection control guidelines for clean practices, clean equipment, clean environment and availability of diagnostics and treatment. The study was carried out from April to May 2009. RESULTS: Seventy percent of respondents said that standard infection control procedures were followed, but a written procedure was only available in 5% of facilities. Alcohol rubs were not used for hand cleaning and surgical gloves were reused in over 70% of facilities, especially for vaginal examinations in the labour room. Most types of equipment and supplies were available but a third of facilities did not have wash basins with "hands-free" taps. Only 15% of facilities reported that wiping of surfaces was done immediately after each delivery in labour rooms. Blood culture services were available in 25% of facilities and antibiotics are widely given to women after normal delivery. A few facilities had data on infections and reported rates of 3% to 5%. CONCLUSIONS: This study of current infection control procedures and practices during labour and delivery in health facilities in Gujarat revealed a need for improved information systems, protocols and procedures, and for training and research. Simply incentivizing the behaviour of women to use health facilities for childbirth via government schemes may not guarantee safe delivery.


Assuntos
Infecção Hospitalar/prevenção & controle , Parto Obstétrico/normas , Desinfecção/normas , Instalações de Saúde/normas , Determinação de Necessidades de Cuidados de Saúde , Desinfecção/métodos , Reutilização de Equipamento , Luvas Cirúrgicas , Desinfecção das Mãos , Humanos , Índia , Parto , Guias de Prática Clínica como Assunto , Registros
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