Barbourvincent1230
gal protections for PLHIV.
To describe the process of updating the People Living with HIV (PLHIV) Stigma Index (Stigma Index) to reflect current global treatment guidelines and to better measure intersecting stigmas and resilience.
Through an iterative process driven by PLHIV, the Stigma Index was revised, pretested, and formally evaluated in three cross-sectional studies.
Between March and October 2017, 1153 surveys (n = 377, Cameroon; n = 390, Senegal; n = 391, Uganda) were conducted with PLHIV at least 18 years old who had known their status for at least 1 year. PLHIV interviewers administered the survey on tablet computers or mobile phones to a diverse group of purposively sampled respondents recruited through PLHIV networks, community-based organizations, HIV clinics, and snowball sampling. Sixty respondents participated in cognitive interviews (20 per country) to assess if questions were understood as intended, and eight focus groups (Uganda only) assessed relevance of the survey, overall.
The Stigma Index 2.0 performed wa-free lives.
Cervical stenosis can jeopardize adequate posttreatment cytologic follow-up of patients treated for high-grade cervical intraepithelial lesions. An impact on human papillomavirus (HPV) testing has not been described.
We describe 2 patients with cervical stenosis, followed by cytology and HPV co-testing after excisions of high-grade cervical intraepithelial lesions. Each had 1 or more co-test "double-negative" results. Hysterectomies revealed unexpected cervical carcinomas.
In case 1, an 80-year-old woman with complete cervical stenosis and earlier high-grade squamous dysplasia presented with abdominal pain, nausea, and an enlarged uterus. Attempted endometrial biopsy was unsuccessful. Cytology and HPV tests 9 months earlier were negative. Hysterectomy revealed a cervical squamous carcinoma. In case 2, a 40-year-old woman followed conservatively after excision of endocervical adenocarcinoma in situ had 5 follow-up cytology and HPV co-tests. All were HPV negative. Elective hysterectomy revealed cervical adenocarcinoma. Both carcinomas tested HPV positive.
Cervical stenosis in women developing cervical cancer can cause misleading sampling and false-negative HPV test results.
Cervical stenosis in women developing cervical cancer can cause misleading sampling and false-negative HPV test results.
The aims of the study were to identify whether obese women are less appropriately screened for cervical cancer before diagnosis and to explore related cancer outcomes.
We retrospectively reviewed all cervical cancer patients at a single institution between 1986 and 2016 and collected demographic information including age, cancer stage, body mass index (BMI), screening information, and cancer outcomes. Morbid obesity was defined as BMI of 40 kg/m or greater, obesity as BMI of 30 to less than 40 kg/m, and nonobese as BMI of less than 30 kg/m. χ, Fisher exact, and Wilcoxon rank sum tests were used to compare variables between BMI categories. Cox regression models were used to evaluate recurrence-free survival and overall survival (OS).
A total of 1,080 patients were reviewed, of whom 311 (29.4%) were obese and 107 (10.1%) morbidly obese. A significant association between BMI and cytology screening was evidenced with morbidly obese women having the highest incorrect rate (64.4%), followed by obese (51.5%) and nonobese women (46.0%, p < .01). There was no significant difference in presence of symptoms at presentation (p = .12) or stage (p = .06) between BMI categories. In multivariable analysis of cancer outcomes, higher BMI was associated with worse OS (p < .01) with a hazard ratio of 1.25 (95% CI = 0.92-1.69) for obese women and hazard ratio 2.27 (95% CI = 1.56-3.31) for morbidly obese women relative to normal weight but recurrence-free survival did not differ between BMI groups (p = .07).
Our study strengthens evidence that obese and morbidly obese women have disproportionate inappropriate screening before cervical cancer diagnosis, and morbidly obese women have worse OS than their counterparts.
Our study strengthens evidence that obese and morbidly obese women have disproportionate inappropriate screening before cervical cancer diagnosis, and morbidly obese women have worse OS than their counterparts.
The aim of this survey was to evaluate the different surgical approaches for women with high-grade vaginal intraepithelial neoplasia (HG-VaIN) used in 8 hospitals in central and northern Italy in the last 20 years. In particular, the baseline characteristics of the patients and factors potentially leading to excisional treatment rather than ablation were considered. Moreover, the clinical outcome of patients treated for HG-VaIN (disease persistence or recurrence and progression toward invasive vaginal cancer) was analyzed.
The medical records of all women initially diagnosed with HG-VaIN and subsequently treated in 8 Italian hospitals from January 1996 to December 2016 were analyzed in a multicenter retrospective case series.
Among the 226 women included, 116 (51.3%) underwent ablative procedures and 110 underwent excisional surgery (48.7%). An ablative procedure was preferred in cases where multiple lesions were found on colposcopic examinations. Physicians decided more frequently to perform excisionalIn any case, long-term follow-up is advisable in women treated for HG-VaIN.
To investigate the dilated choroidal veins (DCVs) at or around myopic macular neovascularizations (MNVs) and to determine whether there is a hemodynamic relationship between them.
58 eyes of 57 patients with myopic MNVs were examined. DCVs were defined as choroidal veins whose diameter was 2X larger than adjacent veins. Indocyanine green angiography and swept-source OCT images were reviewed to detect DCVs that crossed the subfoveal area. The filling sequence of the DCVs and MNVs was determined.
Patient mean age was 71.4±10.6 years. Mean axial length was 29.3±1.8 mm. DCVs below or around the MNV were found in 17 eyes (29.3%). Emissaries of the short posterior ciliary arteries (SPCAs) were seen at or around MNVs in 8 of the 17 eyes. In these eyes, the SPCA was filled first or almost simultaneously with the filling of the MNV followed by a laminar filling of the DCVs. In one eye, afferent arterioles from the SPCAs and efferent venules connected to DCVs were seen.
DCVs are present below or around MNVs in about 30% of eyes with myopic MNV. Our findings suggest that a MNV might be a vascular unit consisting of SPCAs, afferent arterioles, efferent venules, and DCVs.
DCVs are present below or around MNVs in about 30% of eyes with myopic MNV. Our findings suggest that a MNV might be a vascular unit consisting of SPCAs, afferent arterioles, efferent venules, and DCVs.
To describe a surgical technique utilizing the structural advantages of beveled tip cutters.
The introduction of beveled tips has been one of the few modifications that have been done to vitrectomy probes since first described by Machemer in 1972. Shovel and cut technique, uses this incredible modification to access tighter planes and remove broad diabetic membranes.
The shovel and cut technique can be used with any gauge probe to which the bevel tip is applied. The beveled tip of the cutter is used in a shovel manner to create a tissue plane between the diabetic plaque and the retina. As the beveled tip of the cutter moves parallel to the underlying retina, scar tissue naturally feeds into the cutting port where it is cut and aspirated with low flow rates.
Shovel and Cut technique takes advantage of beveled tip technological innovation to allow easy access and tissue dissection of the most difficult plaques in diabetic membranes. This technique allows us to remove these plaques in a safer more controlled manner than previous described techniques.
Shovel and Cut technique takes advantage of beveled tip technological innovation to allow easy access and tissue dissection of the most difficult plaques in diabetic membranes. This technique allows us to remove these plaques in a safer more controlled manner than previous described techniques.
There is very limited information regarding the effectiveness of electroconvulsive therapy (ECT) as a treatment for major depressive disorder in transgender patients. This population is also at risk for comorbid conditions, such as posttraumatic stress disorder and substance use that could impact the outcome of ECT. We report our experience with the use of ECT in this population. Clinical and response characteristics of 7 consecutive cases are described in this series. All patients had multiple psychiatric diagnoses and were refractory to pharmacologic intervention. Pretreatment Beck Depression Inventory-II scores were 45.5 ± 3.2 SEM and posttreatment scores were 21.2 ± 6.4 [P < 0.01]. Suicidality scores reduced by greater than 60%, whereas remission of depression was obtained for 2 of 7, and 4 of 7 showed greater than 50% reduction in depression scores. Treatments were tolerated well using conventional treatment procedures. This case series suggests that ECT can be effective for depressed transgender pa ECT can be effective for depressed transgender patients with multiple clinical comorbidities.
Eliciting a generalized seizure is essential to electroconvulsive therapy (ECT), but there is still a need to understand how patient and session variables interact to generate a seizure of adequate quality. Here, we investigate factors associated with motor seizure length as a measure of quality in a large database of patients who underwent ECT.
This is a retrospective cohort including data from all adult inpatients who underwent ECT at a university hospital in Brazil from 2009 to 2015. We used linear mixed models to investigate the effects of patient, session, and medication on seizure length.
Session information was available for 387 patients, a total of 3544 sessions and 4167 individual stimulations. Multiple stimulations were necessary in 12.4% of sessions. Median seizure length was 30 seconds. Seizure length was directly correlated with stimulus dosage and inversely correlated with the session number, patient age, prescription of anticonvulsants in the day before and β-blockers during the session, and the thiopental dose. Use of benzodiazepines was not associated with a shorter seizure duration, irrespective of dose.
We demonstrate here how motor seizure length evolves during a course of ECT. With a large number of sessions, we are able to integrate a host of factors in a prediction model. Seizure quality was influenced by a number of the studied factors, many of which are potentially modifiable and could be assessed before initiating and handled during treatment.
We demonstrate here how motor seizure length evolves during a course of ECT. With a large number of sessions, we are able to integrate a host of factors in a prediction model. Seizure quality was influenced by a number of the studied factors, many of which are potentially modifiable and could be assessed before initiating and handled during treatment.
Therapeutic drug monitoring (TDM) involves the measurement of serum drug concentrations to optimize pharmacotherapy. Traditionally, blood pressure measurements alone, and not TDM, have been used to evaluate the antihypertensive drug response. However, approximately 50% of hypertensive patients treated with lifestyle changes and antihypertensive drugs fail to achieve blood pressure control. Serum drug concentration measurements could be useful to select the optimal drugs in adjusted doses and to identify nonadherence. Implementation of TDM in clinical routine for antihypertensive drugs depends on established serum reference ranges.
Commonly used antihypertensive drugs were identified based on prescription data. The authors performed a review of authoritative literature on reported serum drug concentrations and calculated expected concentrations from previously reported pharmacokinetic parameters with commonly prescribed daily doses. see more Finally, serum drug concentrations in samples from patients undergoing antihypertensive treatment were measured.
