Household versus incentive-based contact investigation for tuberculosis

alexandrossfakianakis shared this article with you from Inoreader Household versus incentive-based contact investigation for tuberculosis in rural South Africa: a cluster-randomized trial via Clinical Infectious Diseases Advance Access Abstract Background Household contact investigation for people newly diagnosed with tuberculosis (TB) is poorly implemented, particularly in low- and middle-income countries. Conditional cash incentives may improve uptake. Methods We conducted a pragmatic, cluster randomized cross-over trial of two TB contact investigation approaches (household-based and incentive-based) in 28 public primary care clinics in South Africa. Each clinic used one approach for 18 months, followed by a six-month washout period, after which the opposite approach was used. Fourteen clinics were randomized to each approach. In the household-based arm, we conducted TB screening and testing of contacts at the household. In the incentive-based arm, both index patients and up to ten of their close contacts (either within or outside the household). were given small cash incentives for presenting to study clinics for tuberculosis screening. The primary outcome was the number of people with incident tuberculosis who were diagnosed and started on treatment at study clinics. Results From July 2016 to January 2020, we randomized 28 clinics to each study arm, and enrolled 782 index tuberculosis patients and 1882 contacts in the household-based arm, and 780 index patients and 1940 contacts in the incentive-based arm. 1,413 individuals started on tuberculosis treatment in the household-based arm, and 1,510 in the incentive-based arm. The adjusted incidence rate ratio of tuberculosis treatment initiation in the incentive versus household-based arm was 1.05 (95% CI:0.97-1.13). Conclusion Incentive-based contact investigation for tuberculosis has similar effectiveness to traditional household-based approaches and may be a viable alternative or complementary approach to household-based investigation. View on Web

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Killian Jamieson Diverticulum, the Great Mimicker: A Case Series and Contemporary Review

alexandrossfakianakis shared this article with you from Inoreader Killian Jamieson Diverticulum, the Great Mimicker: A Case Series and Contemporary Review via The Laryngoscope Prospective, multicenter cohort study of individuals enrolled in the Prospective OUtcomes of Cricopharyngeus Hypertonicity (POUCH) Collaborative. Killian Jamieson diverticula (KJD) are rare and represent 5% of hypopharyngeal diverticula undergoing surgical intervention. Open transcervical surgery significantly improves symptoms of dysphagia and reflux. Barium esophagram has high specificity but low sensitivity in detecting KJD. The interpretation of barium fluoroscopy is likely another limitation to not only this study, but our overall understanding of KJD, the great mimicker. Objective To assess barium esophagram (BAS) as a diagnostic marker for patients with Killian Jamieson diverticula (KJD). Methods Prospective, multicenter cohort study of individuals enrolled in the Prospective OUtcomes of Cricopharyngeus Hypertonicity (POUCH) Collaborative. Patient demographics, comorbidities, radiographic imaging reports, laryngoscopy findings, patient-reported outcome measures (PROM), and operative reporting were abstracted from a REDCap database and summarized using means, medians, percentages, frequencies. Paired t-tests and Wilcoxon Signed Rank test were used to test pre- to post-operative differences in RSI, EAT-10, and VHI-10 scores. Diagnostic test evaluation including sensitivity, specificity, positive, and negative predictive value with 95% confidence intervals were calculated comparing BAS findings to operative report. Results A total of 287 persons were enrolled; 13 (4%) patients were identified with confirmed KJD on operative reports. 100% underwent open transcervical excision. BAS has a 46.2% (95% confidence interval [CI]: 23.2, 70.9) sensitivity and 97.8% (95% CI: 95.3, 99.0) specificity in detecting a KJD and 50% (95% CI: 25.4, 74.6) positive predictive value but 97.4% (95%CI: 94.8, 98.7) negative predictive value. Preoperatively, patients reported mean (SD) RSI and EAT-10 of 19.4 (9) and 8.3 (7.5) accordingly. Postoperatively, patients reported mean (SD) RSI and EAT-10 as 5.4 (6.2) and 2.3 (3.3). Both changes in RSI and EAT-10 were statistically significant (p = 0.008, p = 0.03). Conclusion KJD are rare and represent <5% of hypopharyngeal diverticula undergoing surgical intervention. Open transcervical surgery significantly improves symptoms of dysphagia. BAS has high specificity but low sensitivity in detecting KJD. Level of Evidence Level 4 Laryngoscope, 2022 View on Web

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Social Perception of External Laryngeal Anatomy Related to Gender Expression

alexandrossfakianakis shared this article with you from Inoreader Social Perception of External Laryngeal Anatomy Related to Gender Expression in a Web‐based Survey via The Laryngoscope Here we detail an original study examining the social perception of laryngeal contour, specifically as it relates to chondrolaryngoplasty and providing gender-affirming care to transgender patients. Over 1,000 study participants were divided into five cohorts, ranking their perceptions of images of graded laryngeal prominence sizes associated with perceived gender expression. This study provides new insights into maximizing ideal social perception of laryngeal contour as it relates to gender perception, while also balancing the essential consideration of preserving necessary thyroid cartilage to maintain laryngeal function. Objective(s) To quantify the effect of laryngeal prominence size on socially perceived attributes relating to gender expression. Chondrolaryngoplasty ("tracheal shave") is a common procedure performed for transgender women to feminize neck appearance. The extent of thyroid cartilage resection needed to convey socially-perceived feminine gender expression without destabilizing the voice is incompletely understood. Methods Cross-sectional evaluation of a randomized allocation of images of varying laryngeal prominence to a non-repeated, random sample from November 2021 to December 2021. Photos of laryngeal prominence were isolated against a constant neck baseline with lateral, oblique, and frontal views. The images were embedded into a web-based survey with visual analog scales to capture perceived scaled gender expression (masculinity, femininity) and social traits (e.g., attractiveness, friendliness, leadership). We performed bivariate and multivariate analyses relating the laryngeal prominence to perceived gender expression and social traits. Results The analytic sample included 1,026 respondents. Laryngeal grades similar to the demonstrated "grade M" in this study and smaller demonstrated similar perceptions of increased femininity and decreased masculinity. Grades larger than M demonstrate significantly increased perceived masculinity and significantly decreased perceived femininity. The lateral and oblique views of the neck appear to be the most gender-informative. Conclusion This crowd-sourced analysis of external laryngeal anatomy by a large population of observers provides clear, reproducible insights into social perceptions of gender identity and specifically femininity. These data will meaningfully inform patient counseling and surgical planning for gender-affirming interventions by establishing normative data representing the general public's perceptions. Level of Evidence N/A Laryngoscope, 2022 View on Web

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Current role of tailored therapy in treating Helicobacter pylori infections. A systematic review, meta‐analysis and critical analysis

alexandrossfakianakis shared this article with you from Inoreader Current role of tailored therapy in treating Helicobacter pylori infections. A systematic review, meta‐analysis and critical analysis via Helicobacter Abstract Background and Aims Recent guidelines dictate that all Helicobacter pylori (H. pylori) infected subjects should receive curative therapy. The efficacy of empirical regimens for H. pylori eradication might decline with bacterial, drug, and host factors. The necessity of a tailored therapy still remains controversial. Here we provide a meta-analysis of the current status of susceptibility-based (tailored) therapy in which susceptibility-based therapies were compared to the currently accepted choice of empiric therapy. In this rapidly closing era, neither the susceptibility nor empiric therapies were routinely optimized, such that we report the outcome of comparisons on the efficacy of unoptimized tailored vs. locally preferred empiric treatments. Methods PubMed, Medline, and Embase databases were searched using suitable keywords. Individual and pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using the fixed- or random-effects model as appropriate. Heterogeneity was calculated employing the Cochrane Q test and I 2 values, whereas the possibility of publication bias was examined by constructing funnel plots. Additionally, subgroup and sensitivity analyses were performed. Results Thirty-four studies were included with a total of 9613 patients. Tailored therapy proved superior to empiric treatment [OR 2.07 (95% CI 1.53–2.79)]. However, tailored therapy achieved eradication rates >90% in only 15 (44%) studies and >95% in only 6 (17.6%). Conclusions Although tailored therapy performed better than empiric treatment, the lack of optimization of therapies failed to reliably achieve high cure rates (>90%). These results emphasize that H. pylori infection, like other infectious diseases, should utilize the principles of antimicrobial stewardship in relation to treatment guidance. View on Web

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