Coxlohse8596

Background Limited evidence suggests that the non-hormonal contraceptive copper intrauterine device (Cu-IUD) may increase bacterial vaginosis (BV) risk, possibly due to increased volume and duration of menses, a common side effect of Cu-IUD use. While increases in bleeding typically resolve within 6-12 months following initiation, evaluations of the association between Cu-IUD and BV have not included more than six months of follow-up. Methods This secondary analysis of an HIV-1 prevention trial included 2,585 African women ages 18-45 followed for up to 33 months. Women reported contraceptive use each month. BV was evaluated by Nugent score in six-monthly intervals and, if clinically indicated, by Amsel's criteria. Andersen-Gill proportional hazards models were used to (1) evaluate BV risk among Cu-IUD users relative to women using no/another non-hormonal contraceptive and (2) test changes in BV frequency before, while using, and following Cu-IUD discontinuation. Results BV frequency was highest among Cu-IUD users at 153.6 episodes per 100 person-years (95% CI 145.2, 162.4). In adjusted models, Cu-IUD users experienced 1.28-fold (95% CI 1.12, 1.46) higher BV risk relative to women using no/another non-hormonal contraception. Compared to the six months prior to initiation, BV risk was 1.52-fold (95% CI 1.16, 2.00) higher in the first six months of Cu-IUD use and remained elevated over eighteen months of use (p less then 0.05). Among women who discontinued Cu-IUD, BV frequency was similar to pre-initiation rates within one year. Conclusions Cu-IUD users experienced elevated BV risk that persisted throughout use. Women and their providers may wish to consider BV risk when discussing contraceptive options.Study objective To ascertain the presence of cognitive and attention problems in treatment naïve children with narcolepsy type 1 (NT1) and to explore whether children recently diagnosed with NT1 improve with respect to cognition and attention problems one year after regular treatment for NT1. Methods Fifteen treatment naïve children (7-15 years) with recently diagnosed NT1 were recruited from three sleep medicine centers in the Netherlands. The control group consisted of 15 healthy children, being frequency matched on age and gender. Both groups were investigated at baseline to examine intelligence profile (WISC III), attention problems and processing speed (Bourdon Vos and SART). These tests were repeated in children with NT1 one year after regular (behavioral and medication) treatment for NT1. Results Children with NT1 scored significantly lower on the verbal scale and processing speed subscale of the WISC III, showed more fluctuations in reaction time of the Bourdon Vos and made more mistakes during the SART than the healthy control group at baseline. Children with NT1 significantly improved on total IQ score, and on the WISC indices processing speed, and perceptual organization one year after treatment. At follow-up, test scores of treated children were largely comparable to those of the control group at baseline. Conclusions Children with NT1 show improvement in several cognitive domains one year after start of treatment. Our findings stress the need for early detection and treatment of narcolepsy in childhood.Background Tranexamic acid (TXA) can reduce intra- and postoperative bleeding as well as minimizing postoperative swelling and ecchymosis. It can be administered both intravenously and topically during surgery with minimal side effects. Objectives To assess the evidence of TXA use in aesthetic surgery and to complete a survey of current practice of full British Association of Aesthetic Plastic Surgeons (BAAPS) members. Methods The authors performed a literature review and online survey of full BAAPS members. Results There is an increased indication of TXA use in aesthetic surgery. It provides multiple surgeon and patient benefits. Conclusions TXA is a useful adjunct in aesthetic surgery.Background We compared effects of prior vaccination and added or lost protection from current season vaccination among those previously vaccinated. Methods Our analysis included data from the US Flu VE Network among participants ≥9 years old with acute respiratory illness from 2012-13 through 2017-18. Vaccine protection was estimated using multivariate logistic regression with an interaction term for effect of prior season vaccination on current season vaccine effectiveness. NSC187208 Models were adjusted for age, calendar time, high-risk status, site, and season for combined estimates. We estimated protection by combinations of current and prior vaccination compared to unvaccinated in both seasons or current vaccination compared to prior vaccinated. Results 31,819 participants were included. Vaccine protection against any influenza averaged 42% (38 to 47) among those vaccinated only the current season, 37% (33 to 40) among those vaccinated both seasons, and 26% (18 to 32) among those vaccinated only the prior season, compared to participants vaccinated neither season. Current season vaccination reduced the odds of any influenza among patients unvaccinated the prior season by 42% (37 to 46), including 57%, 27% and 55% against A(H1N1), A(H3N2) and influenza B, respectively. Among participants vaccinated the prior season, current season vaccination further reduced the odds of any influenza by 15% (7 to 23), including 29% against A(H1N1) and 26% against B viruses, but not against A(H3N2). Conclusion Our findings support ACIP recommendations for annual influenza vaccination. Benefits of current season vaccination varied among participants with and without prior season vaccination, by virus type/subtype and season.Background Direct-acting antivirals (DAAs) are becoming accessible in sub-Saharan Africa. This study examined the effectiveness of DAAs in patients treated through the Rwandan national health system and identified factors associated with treatment outcomes. Methods This retrospective study utilized data from the national HCV program for patients who initiated DAAs between November 2015 and March 2017. Sustained virological response at 12 weeks post-treatment (SVR12) was the primary outcome. Logistic regression models were fit to estimate the relationship between patients' clinical and demographic characteristics and treatment outcome. Results 894 patients initiated treatment during the study period; 590 completed treatment and had SVR12 results. Among the 304 patients without SVR12 results, 48 were lost to follow-up and 256 had no SVR12 results but clinical data indicated they likely completed treatment - these patients were classified as non-virological failure since viral clearance could not be determined. In a per-protocol analysis for 590 patients with SVR12 results, 540 (92%) achieved SVR12 and 50 (8%) experienced virological failure.