Typically gifts go under the Christmas Tree, but at the 2017 Festival of Trees Blue Sky Region, the tree is the gift that keeps on giving. A tree lighting ceremony at the North Bay Regional Health Centre launched this years festival which runs December 7th and 8th at the Davedi Club.
The purpose of this study is to describe the effectiveness of biosimilar filgrastim and original granulocyte colony-stimulating factors (G-CSFs), lenograstim and pegfilgrastim, in febrile neutropenia (FN) prevention in breast cancer patients receiving docetaxel/doxorubicin/cyclophosphamide (TAC) as adjuvant/neoadjuvant treatment and to analyze their treatment patterns.
A pharmacoepidemiology cohort study was developed in a university hospital (with 23 healthcare centers) with retrospective data collection (2012–2014). Effectiveness of G-CSFs was assessed by the FN incidence. Other parameters analyzed were as follows: moderate and severe neutropenia incidence, neutropenia-related hospitalizations, dosage, and duration. Data was analyzed using each cycle as a unit of analysis.
We identified 98 patients representing 518 chemotherapy cycles, 215 with original G-CSFs (35 lenograstim and 180 pegfilgrastim) and 303 with biosimilar filgrastim. The FN incidence was similar in both groups (3.7% original vs. 3.3% biosimilar; p = 0.79). No statistically significant differences were found in moderate and severe neutropenia incidence (4.7 vs. 6.3%; p = 0.43) or neutropenia-related hospitalizations (3.3 vs. 3.6%; p = 0.19). When the three drugs were evaluated separately, a higher FN incidence was observed with lenograstim than with pegfilgratim or biosimilar (p = 0.024). The dosage and duration of biosimilar were lower than lenograstim (4.9 vs. 5.7 μg/kg/day; 5 vs. 7 days; p < 0.001).
An abbreviated 5-day course of biosimilar filgrastim provided optimal primary prophylaxis against FN post-chemotherapy TAC in patients with breast cancer. The clinical relevance of the highest FN incidence in the lenograstim cohort needs further attention.
The Wiseman Company announced that Dr. Justin Jergensen has chosen Westside Professional Center at 2480 Hilborn Road in Fairfield to locate his state-of-the-art dental and orthodontic practice. Jergensen is a graduate of UCSF Dental School and the University of Maryland Orthodontic Residency.
Almost 50% of respondents to LMT's Subcontracting Services Survey say there's been an increase in the amount of work they've been sending out to be fabricated by other laboratories and/or manufacturers in the past five years. Much of this increase is the result of the growing demand for digitally fabricated restorations, and is coming from smaller laboratories.
To see the radiological anatomy of inner ear malformations in hearing impaired children. This study was a prospective observational study done at a tertiary care teaching hospital in north India. The included were children of 1–7 years with first time detected severe to profound SNHL. The evaluation of hearing was done by brainstem evoked response audiometry. Those with history of chronic suppurative otitis media and conductive hearing loss were excluded. The all included were undergone high resolution computed tomography of the tympano-mastoid region. A written informed consent was taken. The institutional ethics committee approved the study protocol. We screened 130 children of 1–7 years of age with complaints of severe to profound hearing impairment (SNHL) by BERA. We excluded 38 and 14 children who had conductive hearing loss with or without CSOM and did not give consent, respectively. Among recruited 78 children, 47 (60.3%) had severe (71–90 dB) and 31 (39.7%) had profound (> 90 dB) SNHL. The majority of children (60/78, 76.9%) had a bilateral hearing impairment, only 18 (23.1%) had unilateral hearing impairment. The mean ± SD of age was 3.9 ± 1.3 years (95% CI = 3.6–4.2). The incidence of severe to profound SNHL was higher, though not statistically significant among the girls. Only 7.7% children with severe to profound SNHL were detected within first 2 years of life. Most of the children (92.3%) with severe to profound SNHL were detected after 2 years of age. Among 78 with severe to profound SNHL, 16 (20.5%) children had structural anomalies in their internal ears. Only 2 (6.9%) ears had single anomaly, others (27, 93.1%) had multiple anomalies. A maximum number of anomalies found in one ear were 5. The most common anomalies were found in the vestibule. The total number of anomalies were 115. Five children (6.4%) with severe to profound SNHL had craniofacial dysmorphism. Approximately 20% of children with severe to profound SNHL have congenital anomalies in their internal ears. It is crucial to know these anomalies before planning of CI. HRCT of tympano-mastoid is the first modality to know these anomalies. MRI should also be included to know the details of vestibulocochlear nerve. Since, the neurocognitive outcome would be the best if CI will be done as early as possible preferably around 1 year of age. Therefore, children must be screened at the appropriate age, firstly by OAE followed by BERA.
Nelson Oliveira has been back in full training ahead of this weekend`s Championship clash with Barnsley but James Maddison and Cameron Jerome are doubts. Speaking to the media on Friday lunchtime, this is some of what Daniel Farke had to say to the EDP Nelson Oliveira has used the international break to rest and train to try to put his recent injury problems behind him.
to test whether or not the use of a xenogeneic block loaded with recombinant human bone morphogenetic protein-2 (rhBMP-2) results in different bone quantity and quality compared to an autogenous bone block.
24 patients with insufficient bone volume for implant placement were randomly assigned to two treatment modalities: a xenogeneic bone block loaded with rhBMP-2 (test) or an autogenous bone block (control). The horizontal ridge width was evaluated prior to augmentation, after augmentation and at 4 months. Patient-reported outcome measures (PROMs) were assessed at suture removal and at 4 months. Biopsies were obtained at 4 months and histologically evaluated. Intergroup comparisons were tested by a two-sided Wilcoxon-Mann-Whitney test, intragroup comparisons were performed with Wilcoxon-signed rank test and all categorical variables were tested with chi-square tests.
One autogenous bone block failed. This patient was replaced and in all subsequently treated 24 patients, implant placement was possible 4 months later. The median ridge width increased from 4.0 mm (Q1 = 2.0; Q3 = 4.0) (test) and 2.0 mm (Q1 = 2.0; Q3 = 3.0) (control) to 7.0 mm (Q1 = 6.0; Q3 = 8.0) (test) and 7.0 mm (Q1 = 6.0; Q3 = 8.0) (control) at 4 months (intergroup p>0.05). A higher morbidity was reported at the augmented site in the control group during surgery. Sensitivity was more favorable in the test than in the control group at 4 months. The biopsies revealed more mineralized tissue in the control group (p<0.0043).
Both treatment modalities were successful in regenerating bone to place dental implants. PROMs did not reveal any significant differences between the groups except for pain during surgery at the recipient site (in favor of the test group). Histologically, a higher amount of mineralized tissue was observed for the control group at 4 months.
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We aimed to evaluate serum RBP4 levels before and after periodontal therapy in lean and obese subjects with chronic periodontitis (CP) in order to determine its possible association with periodontitis.
This is an interventional study for which a total of 112 lean and 119 obese subjects were recruited. Patients with CP were evaluated before and after three months of non-surgical periodontal treatment. Periodontal, anthropometric, biochemical parameters and serum levels of TNFα, IL-6, hsCRP and RBP4 were assessed.
Serum RBP4 levels were associated with an increased probability of periodontitis (OR= 1.60; 95% CI: 1.02-2.50), showing patients with CP to have higher RBP4 levels than those without CP in both lean and obese populations (3.35 vs 3.06 and 3.74 vs 3.21, respectively). Following periodontal treatment, RBP4 and TNFα decreased and all periodontal parameters improved to the same extent in both groups, except for number of teeth with probing depth (PD) ≥4 mm, which improved to a less extent in obese than in lean subjects. In the multivariable regression model, number of teeth with PD ≥4 mm was independently associated with RBP4 (β=0.192).
RBP4 was associated with chronic periodontitis before and after non-surgical periodontal treatment.
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Evaluation of outcome after curative treatment for sinonasal mucosal melanoma, focused on the effect of adjuvant radiotherapy on recurrence and survival. Design. Retrospective chart analysis. Setting. Tertiary referral hospital. Participants. 51 patients with primary sinonasal mucosal melanoma who underwent surgical resection with curative intention between 1980 and 2016 at Erasmus Medical Center Rotterdam. Main outcome measures. Patients were categorised into two groups: surgery alone and surgery with adjuvant radiotherapy. Log-rank test was used to compare rates of recurrence and survival between treatment groups. Predictors for treatment modality, recurrence and survival were assessed with multivariate statistical analysis.
Of all patients, 23.5% developed local recurrence and 47.1% developed distant metastasis. Estimated 5-year disease free survival was 25.2% and 5-year overall survival was 38.1%. 43 patients (84.3%) were treated with postoperative radiotherapy. Patients who underwent surgery with adjuvant radiotherapy presented more often with high tumour stage, tumour involving multiple sites and positive margins. Postoperative radiotherapy seemed to be associated with better local control (p=0.549). No effect was found on occurrence of distant metastasis and overall survival. Positive margin status was an independent negative predictor for distant metastasis-free survival and overall survival
Our treatment outcomes are consistent with literature. Postoperative radiotherapy seems to be associated with improved local control despite advanced disease and positive margin status in this treatment group.
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Only a minority of patients referred to specialists with sinonasal symptoms have clear evidence of chronic rhinosinusitis. This study aims to estimate the prevalence of and associations between (i) general illness factors (fatigue, autonomic dysfunction) and (ii) psychological factors (anxiety, depression, somatisation, personality traits) in patients presenting with sinonasal symptoms.
The following validated questionnaires were administered to patients: the Sino-Nasal Outcome Test-22 (SNOT-22) to identify symptom burden, Composite Autonomic Symptom Score-31 (COMPASS-31) measuring autonomic function, Chalder fatigue questionnaire, Patient Health Questionnaire-15 (PHQ-15) addressing somatisation symptoms, Hospital Anxiety and Depression Scale (HADS), and the International Personality Item Pool-50 (IPIP-50). Comparisons were made with normative and general population data, and relationships were analysed using nonparametric correlation.
Secondary care ENT outpatients.
Adults referred with chronic sinonasal symptoms.
SNOT-22, COMPASS-31, Chalder, PHQ-15, HADS, and IPIP-50 questionnaire scores.
Sixty-one patients were included. There was a high prevalence of all general and psychological factors assessed compared with controls. Total SNOT-22 scores showed significant correlation with Chalder fatigue scores, total autonomic dysfunction score, anxiety, depression, somatisation tendencies, and the emotionally unstable personality trait. Emotional instability and psychological dysfunction correlated significantly with sleep and psychological subscales of SNOT-22 but not the rhinological or ear/facial subscales.
Patients with sinonasal symptoms demonstrate high prevalence and complex associations of general illness factors, psychological distress and certain personality traits. The SNOT-22 is a valuable tool, but it's utility is limited by correlations with these confounding factors (e.g. psychological factors) that may exaggerate the total score. Use of the SNOT-22 component subscales is likely to provide more clinically meaningful and discriminant information.
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After 28 years as a physical therapist in Richmond, Virginia, Sharik Peck had seen his fair share of patients with everything from recurring migraines to fibromyalgia. His wife, Cheryl Peck, was one of them.
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MRI-based determination of occlusal splint thickness for temporomandibular joint disk derangement: a randomized controlled clinical trial.
Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Oct 12;:
Authors: Hegab AF, Youssef AH, Hameed HIAA, Karam KS
Abstract
OBJECTIVE: This prospective study examined a method using magnetic resonance imaging (MRI) to assess the appropriate effective occlusal splint vertical thickness in the management of disk derangement.
STUDY DESIGN: Patients were diagnosed as having internal disk displacement of the temporomandibular joint and were divided into 2 groups. Group I (disk displacement with reduction) was subdivided randomly into 2 subgroups: subgroup IA (control group) comprising patients treated with 3-mm-thick splints; and subgroup IB (study group) comprising patients treated with MRI-based splint thickness. Group II (disk displacement without reduction) was subdivided randomly into 2 subgroups: subgroup IIA (control group) comprising patients treated with 3-mm-thick splints; and subgroup IIB (study group) comprising patients treated with MRI-based splint thickness. The primary outcome variables were maximum voluntary mouth opening and visual analogue scale scores for pain. The secondary outcome variable was joint sound. The final sample was composed of 162 patients (Group I = 90 and Group II = 72).
RESULTS: Statistical analysis showed significant improvement of the clinical outcomes in subgroups IB and IIB compared with that in subgroups IA and IIA.
CONCLUSIONS: On the basis of MRI measurements and clinical outcome, the present study we recommend 4-mm and 6-mm vertical splint thickness for disk displacement with reduction and disk displacement without reduction, respectively, for 1 year.
PMID: 29146196 [PubMed - as supplied by publisher]
The temporomandibular joint (TMJ) is a complex joint, and it allows bilateral synchronous rotatory and translatory movements. TMJ reconstruction has evolved as an important step in the management of conditions affecting the TMJ like ankylosis, traumatic injuries and congenital deformities. Distraction osteogenesis (DO) is a biological process of forming new bone and adjacent soft tissues by gradual and controlled traction applied on osteotomized bone segments.
Here is a case report of bilateral TMJ ankylosis which was managed effectively by resection of ankylotic mass and reconstruction of TMJ by transport distraction osteogenesis with preoperative vector planning using a 3D printed model.
Distraction osteogenesis can be considered as an effective means of condylar reconstruction for an anatomical and functional TMJ with minimal complications. Use of 3D models can help making such complex TMJ reconstruction procedures simpler.
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Association between a single-nucleotide polymorphism in the GREM1 gene and nonsyndromic orofacial cleft in the Chinese population.
J Oral Pathol Med. 2017 Nov 17;:
Authors: Wang X, Song H, Jiao X, Hao Y, Zhang W, Gao Y, Li Y, Mi N, Yan J
Abstract
BACKGROUND: Nonsyndromic orofacial cleft (NSOC) is a common craniofacial deformity among newborns. The GREM1 gene is correlated with orofacial development. The aim of our study was to investigate the association between a single-nucleotide polymorphism in the GREM1 gene and this malformation in the Chinese population.
METHODS: The SNaPshot mini sequencing technique was used to genotype the locus rs1258763 of the GREM1 gene in 331 patients with NSOC and 271 individuals in a control group.
RESULTS: For GREM1 rs1258763, there was a significant difference between the NSOC case group and control group (P=0.022). Children carrying GA and GA/AA genotypes had an increased risk of NSOC (OR=1.62, 95%CI: 1.15-2.30; OR=1.52, 95%CI: 1.09-2.12). In the cleft subgroup, we found that the GREM1 rs1258763 GA genotype might contribute to the elevated risk of the cleft lip with or without cleft palate (CL/P) (P=0.029). Nonsignificant differences were found between the cleft palate only (CPO) and control groups (P=0.077).
CONCLUSION: Our findings revealed that the GREM1 polymorphism was significantly associated with the risk of NSOC in the Chinese population. This article is protected by copyright. All rights reserved.
PMID: 29149498 [PubMed - as supplied by publisher]
From bench to almost bedside: the long road to a licensed Ebola virus vaccine.
Expert Opin Biol Ther. 2017 Nov 17;:1-15
Authors: Wong G, Mendoza EJ, Plummer FA, Gao GF, Kobinger GP, Qiu X
Abstract
INTRODUCTION: The Ebola virus (EBOV) disease epidemic during 2014-16 in West Africa has accelerated the clinical development of several vaccine candidates that have demonstrated efficacy in the gold standard nonhuman primate (NHP) model, namely cynomolgus macaques. Areas covered: This review discusses the pre-clinical research and if available, clinical evaluation of the currently available EBOV vaccine candidates, while emphasizing the translatability of pre-clinical data generated in the NHP model to clinical data in humans. Expert opinion: Despite the existence of many successful EBOV vaccine candidates in the pre-clinical stages, only two platforms became the focus of Phase 2/3 efficacy trials in Liberia, Sierra Leone, and Guinea near the peak of the epidemic: the Vesicular stomatitis virus (VSV)-vectored vaccine and the chimpanzee adenovirus type 3 (ChAd3)-vectored vaccine. The results of three distinct clinical trials involving these candidates may soon pave the way for a licensed, safe and efficacious EBOV vaccine to help combat future epidemics.
PMID: 29148858 [PubMed - as supplied by publisher]
Exacerbation of Behçet's syndrome and familial Mediterranean fever with menstruation.
Clin Exp Rheumatol. 2017 Oct 24;
Authors: Guzelant G, Ozguler Y, Esatoglu SN, Karatemiz G, Ozdogan H, Yurdakul S, Yazici H, Seyahi E
Abstract
OBECTIVES: Menstruation triggers several conditions such as migraine, recurrent aphthous stomatitis and acne vulgaris in healthy individuals. There is evidence that Behçet's syndrome (BS) and familial Mediterranean fever (FMF) may exacerbate during menstruation. The aim is to assess whether BS and FMF patients experience menstrual flares.
METHODS: Females of reproductive age with BS and FMF seen consecutively at the outpatient clinic of Cerrahpasa Medical Faculty at Istanbul, as well as apparently healthy hospital workers were studied using a standardised questionnaire. BS patients were asked whether they experienced increased skin-mucosa lesions during the menstrual period. A similar questionnaire assessing this time the frequency of abdominal pain, chest pain and fever attacks was given to the patients with FMF. The healthy controls received both questionnaires.
RESULTS: A total of 200 BS patients, 240 FMF patients and 250 healthy controls were studied. The most commonly reported symptom among both BS patients (51%) and healthy controls (62%) was the acneiform lesion. At least 79% patients with FMF reported attacks with menstruation, notably abdominal pain which, majority thought, could be differentiated from dysmenorrhea. Additionally, 76% of healthy controls reported having abdominal pain consistent most probably with dysmenorrhea.
CONCLUSIONS: This survey showed that, in 68% of the patients with BS at least one skin mucosa lesion was exacerbated with menstruation, this was most commonly acneiform lesion. Menstruation had a slightly stronger effect on FMF, triggering at least one symptom in 79%. The main limitation of the study was the self-reported assessment methodology.
PMID: 29148415 [PubMed - as supplied by publisher]
Primary peri-implant oral intra-epithelial neoplasia/carcinoma in situ: a case report considering risk factors for carcinogenesis.
Int J Implant Dent. 2017 Nov 16;3(1):47
Authors: Noguchi M, Tsuno H, Ishizaka R, Fujiwara K, Imaue S, Tomihara K, Minamisaka T
Abstract
BACKGROUND: Major risk factors for oral squamous cell carcinoma (SCC) are tobacco smoking, a betel quid chewing habit, and heavy alcohol consumption. However, around 15% of oral SCCs cannot be explained by these risk factors. Although oral SCC associated with dental implants is quite rare, there has been a recent gradual accumulation of reports about it. Here, we report a case of primary peri-implant oral intra-epithelial neoplasia/carcinoma in situ (OIN/CIS) in a woman without the major risk factors for oral SCC.
CASE PRESENTATION: A 65-year-old woman was referred to our clinic with a tumor in the right lower gingiva. She had no history of tobacco smoking and only drank socially. Ten years previously, mandibular right posterior teeth had been replaced with an implant-supported porcelain-fused-to-metal restoration in a dental clinic. About 7 years later, she noticed swelling on the lingual side of the gingiva around the implant-supported restoration, and was eventually referred to our clinic with the suspicion of a neoplasia around the dental implant. The upper part of the implant body was exposed on the implant corresponding to the first molar of the right side of the mandible; this was associated with painless, elastic soft, and relatively well circumscribed gingival swelling on the lingual site. A panoramic radiograph showed slight vertical bone resorption around the implants. An incisional biopsy was conducted under the suspicion of neoplasia. Pathological microscopic examination of the biopsy specimen revealed thickened squamous epithelia with slight nuclear atypism and disorders of the epithelial rete pegs. Immunohistochemical findings showed positive staining for keratin 17 and a negative staining mosaic pattern for keratin 13. High p53, p63, and Ki-67 reactivity was also observed. From these findings, OIN/CIS of the gingiva was pathologically diagnosed, and a wide local excision with rim resection of the mandible, including the implants, was performed. The pathological findings for the resected specimen were same as those for the biopsy specimen. After 1 year of follow-up, there was no evidence of recurrence.
CONCLUSION: In this case, prolonged peri-implant mucositis or peri-implantitis may have been a plausible risk factor for carcinogenesis.
PMID: 29147823 [PubMed]
Evaluation of Acute Toxicity and Early Clinical Outcome in Head and Neck Cancers Treated With Conventional Radiotherapy and Simultaneous Integrated Boost Arc Radiotherapy.
World J Oncol. 2017 Aug;8(4):117-121
Authors: Bahl A, Oinam AS, Kaur S, Verma R, Elangovan A, Bhandari S, Bakshi J, Panda N, Ghoshal S
Abstract
Background: Chemoradiotherapy plays an important role in management of locally advanced head and neck cancers. This retrospective analysis was done to evaluate and compare acute toxicity profiles and early clinical outcomes in patients treated with conventional and arc techniques.
Methods: Fifty-five patients of head and neck cancers were evaluated. Thirty patients received conventional radiotherapy with 6 MV or cobalt 60 and 25 patients were treated with simultaneous integrated boost-volumetric modulated arc radiotherapy (SIB-VMAT) with dose prescription of 66 - 70 Gy. Concurrent chemotherapy was given as cisplatin injection at 40 mg/m(2) weekly or 100 mg/m(2) thrice weekly.
Results: The incidence of grade 3-4 mucositis was 56% versus 83.3% with SIB-VMAT and conventional treatments (P = 0.026). The incidence of grade 2-3 xerostomia was 44% versus 80% (P = 0.006) in the two groups. Grade 2 dysphagia was seen in 40% versus 80% (P = 0.008) favoring the arc treatments. Seventeen patients undergoing arc treatment had complete response compared to 14 in the conventional group (P = 0.040). The median disease-free survival (median ± standard error) was 16 months (11 ± 1.987 months) in the conventional and arc groups (P = 0.073).
Conclusion: SIB-VMAT shows a better toxicity profile and a trend towards better disease-free survival when compared to conventional radiotherapy in head and neck cancers.
PMID: 29147446 [PubMed]
Management of Adverse Events Associated with Cabozantinib Therapy in Renal Cell Carcinoma.
Oncologist. 2017 Nov 16;:
Authors: Schmidinger M, Danesi R
Abstract
Cabozantinib was recently approved for the treatment of advanced renal cell carcinoma (RCC) after treatment with vascular endothelial growth factor (VEGF)-targeted therapy. Cabozantinib is a multikinase inhibitor targeting VEGF receptor (VEGFR) 2, mesenchymal-epithelial transition receptor, and "anexelekto" receptor tyrosine kinase. A 60-mg daily dose led to improved overall survival and progression-free survival (PFS) versus everolimus in advanced RCC patients as a second- or later-line treatment in the METEOR trial. Improved PFS with cabozantinib versus sunitinib has also been demonstrated in the first-line setting in CABOSUN. However, cabozantinib, like other VEGFR inhibitors, is associated with toxicity that may affect the patient's quality of life. The most frequent adverse events (AEs) are diarrhea, fatigue, hypertension, hand-foot syndrome, weight loss, nausea, and stomatitis. This article summarizes the safety profile of cabozantinib in RCC patients and offers guidance for the management of these AEs. We discuss the underlying mechanisms of these AEs and, based on our experiences with cabozantinib and other multikinase inhibitors, we present approaches to manage toxicity. Prophylactic and therapeutic solutions are available to help with the management of toxicity associated with cabozantinib, and adequate interventions can ensure optimum adherence and maximize patient outcomes.
IMPLICATIONS FOR PRACTICE: Cabozantinib leads to improved survival outcomes in renal cell carcinoma patients compared with everolimus. However, management of the adverse event profile is crucial to achieve optimum adherence and outcomes with the use of cabozantinib. This review aims to provide appropriate guidance that will minimize the impact of adverse events and help to maximize the utility of this agent in patients with advanced renal cell carcinoma.
PMID: 29146618 [PubMed - as supplied by publisher]
The aim of this study was to identify risk factors of asthma among children < 6 years old (preschool age) for predicting asthma during the preschool age and early school age (≤ 10 years of age).
MEDLINE, Cochrane, EMBASE, and Google Scholar databases were searched until June 30, 2017. Prospective or retrospective cohort and case-control studies were included. Studies had to have evaluated risk factors or a predictive model for developing asthma in children ≤ 6 years of age or persistent asthma in early school age.
A total of 17 studies were included in the analysis. Factors associated with developing asthma in children ≤ 10 years of age (both pre-school and early school age) included male gender (pooled OR = 1.70, P < 0.001), atopic dermatitis (pooled OR = 2.02, P < 0.001), a family history of asthma (pooled OR = 2.20, P < 0.001), and serum IgE levels ≥ 60 kU/l or having specific IgE (pooled OR = 2.36, P < 0.001). A history of exposure to smoke or wheezing was also associated with persistent asthma in early school age (pooled OR = 1.51, P = 0.030 and pooled OR = 2.59, P < 0.001, respectively). In general, asthma predictive models (e.g., API, PIAMA, PAPS) had relatively low sensitivity (range, 21% to 71.4%) but high specificity (range, 69% to 98%).
The study found that male gender, exposure to smoke, atopic dermatitis, family history of asthma, history of wheezing, and serum IgE level ≥ 60 kU/l or having specific IgE were significantly associated with developing asthma by either preschool or early school age. Asthma predictive models can be developed by those risk factors.
Publication date: Available online 17 November 2017
Source:The Lancet Infectious Diseases
Author(s): Chunqing Lin, Silvia Franceschi, Gary M Clifford
BackgroundData on carcinogenicity of human papillomavirus (HPV) types in the anus are needed to inform anal cancer prevention through vaccination and screening. This is particularly the case for people infected with HIV, who are at an increased risk of anal cancer.MethodsWe did a systematic review of studies published from January, 1986, to July, 2017, in MEDLINE, Embase, and the Cochrane Library on anal HPV infection, without any language restrictions. Eligible studies reported type-specific HPV prevalence by strata of cytopathological or histopathological anal diagnosis, sex, and HIV status. Data requests were made to authors when necessary. We did a meta-analysis of type-specific HPV prevalence across the full spectrum of anal diagnoses, from normal cytology to anal cancer. We assessed the main outcome of type-specific HPV prevalence ratios [PR], calculated across strata of anal diagnoses, gender, or HIV status, by use of generalised linear models.Findings95 studies were identified from the search, published between 1992–2017, from which 18 646 individuals fulfilled the criteria for inclusion in the analyses: 8534 people with normal cytology, 5730 with low-grade lesions, 2024 with high-grade lesions, and 2358 with anal cancer. HPV prevalence varied in normal cytology from 42% in HIV-negative women to 76% in HIV-positive men and, for each diagnosis, was higher in individuals who were HIV positive than those who were HIV negative. HPV16 positivity increased with diagnosis severity, being the only HPV type accounting for more HPV infection in anal cancer than normal cytology, both in individuals who were HIV negative (PR 5·0, 95% CI 3·8–6·6, p<0·0001) and those who were HIV positive (2·3, 1·9–2·7, p<0·0001). HPV16 positivity increased even between high-grade lesions and anal cancer, whereas other high-risk HPV types accounted for high proportions of low-grade or high-grade lesions but their prevalence decreased in anal cancer. However, HPV16 was less frequent in HIV-positive than HIV-negative anal cancer, both in men (PR 0·8, 95% CI 0·7–0·9, p<0·0001) and women (0·8, 0·6–1·0, p=0·063), and in HIV-positive versus HIV-negative high-grade lesions in women (0·6, 0·5–0·9, p=0·0077). Type-specific attribution of the non-HPV16 fraction of HIV-positive anal cancer is hindered by a high prevalence of multiple HPV infections.InterpretationHPV16 is by far the most carcinogenic HPV type in the anus, with enrichment of HPV16 even from high-grade lesions to anal cancer, both in individuals who are HIV negative and those who are HIV positive. Nevertheless, the fraction of anal cancer attributable to HPV16 is smaller in the HIV-positive population.FundingInternational Agency for Research on Cancer.
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Publication date: Available online 17 November 2017
Source:The Lancet Infectious Diseases
Author(s): Lucas E Hermans, Michelle Moorhouse, Sergio Carmona, Diederick E Grobbee, L Marije Hofstra, Douglas D Richman, Hugo A Tempelman, Willem D F Venter, Annemarie M J Wensing
BackgroundAntiretroviral therapy (ART) that enables suppression of HIV replication has been successfully rolled out at large scale to HIV-positive patients in low-income and middle-income countries. WHO guidelines for these regions define failure of ART with a lenient threshold of viraemia (HIV RNA viral load ≥1000 copies per mL). We investigated the occurrence of detectable viraemia during ART below this threshold and its effect on treatment outcomes in a large South African cohort.MethodsIn this observational cohort study, we included HIV-positive adults registered between Jan 1, 2007, and May 1, 2016, at 57 clinical sites in South Africa, who were receiving WHO-recommended ART regimens and viral load monitoring. Low-level viraemia was defined as the occurrence of at least one viral load measurement of 51–999 copies per mL during ART. Outcomes were WHO-defined virological failure (one or more viral load measurement of ≥1000 copies per mL) and switch to second-line ART. Risks were estimated with Cox proportional hazard models.Findings70 930 patients were included in the analysis, of whom 67 644 received first-line ART, 1476 received second-line ART, and 1810 received both. Median duration of follow-up was 124 weeks (IQR 56–221) for patients on first-line ART and 101 weeks (IQR 51–178) for patients on second-line ART. Low-level viraemia occurred in 16 013 (23%) of 69 454 patients, with an incidence of 11·5 per 100 person-years of follow-up (95% CI 11·4–11·7), during first-line ART. Virological failure during follow-up occurred in 14 380 (22%) of 69 454 patients on first-line ART. Low-level viraemia was associated with increased hazards of virological failure (hazard ratio [HR] 2·6, 95% CI 2·5–2·8; p<0·0001) and switch to second-line ART (HR 5·2, 4·4–6·1; p<0·0001]) compared with virological suppression of less than 50 copies per mL. Risk of virological failure increased further with higher ranges and persistence of low-level viraemia.InterpretationIn this large cohort, low-level viraemia occurred frequently and increased the risk of virological failure and switch to second-line ART. Strategies for management of low-level viraemia need to be incorporated into WHO guidelines to meet UNAIDS-defined targets aimed at halting the global HIV epidemic.FundingNone.
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Most of us don't look forward to going to the dentist, but this story could relieve some fears about your next visit. When retired Staff Sergeant David Tyler Harmon and dentist, Dr. David Nguyen, met at their local gym, Harmon decided to book a cleaning.
