Current Issue : April-June Volume : 2025 Issue Number : 2 Articles : 5 Articles
Providing tuberculosis preventive treatment (TPT) to close contacts of persons with TB is a core strategy recommended by WHO for the prevention and control of TB. Nigeria rolled out the 3-month Isoniazid-Rifampicin (3HR) shorter regimen TPT as a pilot for use among eligible adult and child contacts. This study assesses acceptance and completion rates of 3HR TPT among contacts and determines the perspectives of healthcare workers (HCWs) and contacts on acceptance and completion of 3HR TPT in Nigeria. In this cross-sectional descriptive study using mixed methods, records of TPT-eligible clients were retrospectively reviewed, while 18 purposely selected HCWs and 18 contacts on 3HR were interviewed. Of the 30,012 eligible contacts, 12,040 (40.1%) were initiated on TPT. Among these, 8213 (68%) were enrolled on 3HR, and 6972 (84.7%) of them completed treatment. Perceived facilitators include belief in its effectiveness, training among HCWs, and a good understanding of TPT from HCW counseling sessions. Barriers reported were linked to stockouts, misconceptions about side effects, non-disclosures, and disincentive follow-up strategies. The acceptance and completion rate for 3HR TPT was good. Scaling up 3HR TPT will require redesigning policies towards addressing identified barriers and utilizing interventions linked to capabilities, opportunities, and motivations among contacts of TB patients and HCWs....
Audits allow analysis of the delivery of care and the prevalence of diseases. This study investigated kidney diseases’ impact on end-stage renal disease (ERSD) in patients younger than 30 years. Methods: This analysis is retrospectively conducted on young dialysis-dependent patients included in the Sicilian Registry of Nephrology, Dialysis and Transplantation Participants. It evaluated patients who started dialysis before the age of 30 retrieved in the mentioned registry. The sample was divided into two groups, according to the presence or absence of a specific diagnosis. Baseline features were reported as mean ± sd, median [IQR] and n (%). A Student T-test, Mann–Whitney test or Pearson Chi-Square test was performed. Logistic regression analysis detected the association between the variables and the unknown diagnosis, and variables with a p-value < 0.2 were added to the multivariate model. ROC curves were drawn including this multivariate prediction. Results: In total, 145 patients started dialysis before the age of 30 years. Between patients with and without a diagnosis, the intake of renin–angiotensin–aldosteron system inhibitors (RAASIs) and blood pressure differed enough to be considered as possibly confounding. Logistic regression showed that blood pressure and RAASIs seemed to be related to the unknown diagnosis. ROC curves adjusted for RAASIs and blood pressure provided an AUC = 0.689. Conclusions: Although Kidney Disease Improving Global Outcomes (KDIGO) did not include hypertension among biopsy indications, our data suggest that performing renal biopsy in young patients with hypertension and worsening renal function could improve kidney diagnosis management....
Background: Primary immunodeficiency disorders (PIDs) or inborn errors of immunity (IEI) are inherited disorders that impair the immune response in children. PIDs are much more common than it was previously estimated. Unfortunately, the majority of these patients remain undiagnosed and untreated. Objective: To assess the demography, clinical profiles, and sub-types of PID cases. Method: It was a retrospective study conducted in the pediatric rheumatology division of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from July 2012 to June 2020. All the diagnosed immune-deficient patients who fulfilled the inclusion criteria were included in this study. The PID patients were screened for CBC, serum immunoglobulin classes and subset of lymphocytes, including the T-B-NK cell markers, detected by flow cytometric analysis. Result: Among twenty-five PID cases included in this study, majority were antibody deficiency (40%) and combined immunodeficiency disorders (32%), followed by complement deficiencies, NK cell defect, and autoinflammatory disorders (CANDLE syndrome). Recurrent respiratory tract infection, ear infection, sinusitis and skin infection were the common clinical manifestations of this cohort. Late presentation and late diagnosis were found in almost every case. A comparison with PIDs reported from other countries showed that predominantly antibody deficiency cases were more common in those countries, but combined immunodeficiency was the most common (32%) sub-type in our country. Conclusion: Antibody deficiency and combined immune deficiency disorders were the predominant types of PIDs in this cohort. Late presentation and late diagnosis with different systemic infections in the disease course were observed....
Background: The aim of this study is to assess the impact of disability on participation in CRC screening and to determine the overall effect size. Methods: We conducted a systematic review and meta-analysis to compare CRC screening participation in individuals with and without disabilities. The search encompassed five databases (PubMed, EMBASE, Scopus, Google Scholar, medRxiv). Pooled estimates were calculated for each type of CRC screening and disability categories to synthesize the findings. The participation in CRC screening was derived using a random effects model. Results: A total of 20 articles were included, most of them from the USA. Based on pooled estimates, individuals with disabilities have lower odds of undergoing CRC screening versus those without disabilities (OR = 0.80, 95%CI 0.73–0.87). Analysis by screening type indicated that individuals with a disability have lower odds of a fecal occult blood test or a fecal immunochemical test (OR: 0.72, 95%CI 0.65–0.81), with no significant difference for a colonoscopy. Individuals with intellectual disabilities had significantly lower rates of CRC screening participation (OR = 0.65, 95%CI 0.53–0.79), especially for FOBT/FIT (OR = 0.58, 95%CI 0.49–0.69). Conclusions: Disparities exist for CRC screening participation in people with disabilities. Further research and coordinated efforts are essential to develop interventions for improving early cancer diagnosis for this non-negligible patient group....
Background and objectives: Liver cirrhosis is a chronic, progressive condition characterized by fibrosis and architectural distortion of the liver, leading to impaired liver function and severe complications. Accurately predicting these complications is crucial to the improvement of patient outcomes. Therefore, this study aimed to evaluate the accuracy of various non-invasive biomarkers and clinical scores in assessing the risk of complications among cirrhotic patients. Materials and methods: We conducted an observational retrospective study involving 236 cirrhotic patients from two tertiary care hospitals in Italy and Romania, in a timespan ranging from January 2021 to March 2024. Data on clinical characteristics, liver function tests, hematological indices, various non-invasive biomarkers, and clinical scores were collected and analyzed. Receiver operating characteristic analysis was performed to assess the accuracy of these biomarkers and clinical scores in predicting complications, including the presence of varices and hepato-renal syndrome. Results: The Child–Pugh score showed the highest accuracy for cirrhosis-related complications, with an area under curve (AUC) = 0.667. The red cell distribution width coefficient of variation followed closely with an AUC = 0.646. While the Child–Pugh score had a high specificity (85.42%), its sensitivity was low (37.97%). In patients with varices, non-invasive scores such as platelet distribution width (PDW) and the RDW-to-platelet ratio (RPR) showed modest predictive ability, with an AUC = 0.594. For hepatorenal syndrome, the Model for End-Stage Liver Disease (MELD) score showed the highest diagnostic accuracy with an AUC = 0.758. Conclusions: The most reliable biomarkers for detecting complications, varices, and hepato-renal syndrome, are, respectively, the Child–Pugh Score, PDW along with RPR, and the MELD score. However, while these scores remain valuable, the moderate diagnostic accuracy of other indices suggests the need for a more integrated approach to risk stratification. Future research should focus on validating these tools across different populations and incorporating emerging biomarkers to enhance predictive accuracy and inform more effective clinical decision-making....
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