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7% vs 8.3% and partial response of 28.6% vs 33.3%, respectively). This study demonstrates that that the use of a weekly low-dose isotretinoin is an effective treatment for papulopustular rosacea, including among patients with severe disease.

To report on the effectiveness of a standardised core Maternity Waiting Home (MWH) model to increase facility deliveries among women living >10km from a health facility.

Quasi-experimental design with partial randomisation at the cluster level.

Seven rural districts in Zambia.

Women delivering at 40 health facilities between June 2016 and August 2018.

Twenty intervention and 20 comparison sites were used to test whether MWHs increased facility delivery for women living in rural Zambia. Difference-in-differences (DID) methodology was used to examine the effectiveness of the core MWH model on our identified outcomes.

Differences in the change from baseline to study period in the percentage of women living >10km from a health facility who (1) delivered at the health facility, (2) attended a postnatal care (PNC) visit and (3) were referred to a higher-level health facility between intervention and comparison group.

We detected a significant difference in the percentage of deliveries at intervention facilities with the core MWH model for all women living >10km away (DID 4.2%, 95% CI 0.6-7.6, P=0.03), adolescent women (<18years) living >10km away (DID 18.1%, 95% CI 6.3-29.8, P=0.002) and primigravida women living >10km away (DID 9.3%, 95% CI 2.4-16.4, P=0.01) and for women attending the first PNC visit (DID 17.8%, 95% CI 7.7-28, P<0.001).

The core MWH model was successful in increasing rates of facility delivery for women living >10km from a healthcare facility, including adolescent women and primigravidas and attendance at the first PNC visit.

A core MWH model increased facility delivery for women living >10km from a health facility including adolescents and primigravidas in Zambia.

10 km from a health facility including adolescents and primigravidas in Zambia.Toxoplasma gondii can cause severe opportunistic infection in immunocompromised individuals, but diagnosis is often delayed. We conducted a retrospective review of solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients with toxoplasmosis between 2002 and 2018 at two large US academic transplant centers. Patients were identified by ICD-9 or ICD-10 toxoplasmosis codes, positive Toxoplasma polymerase chain reaction test result, or pathologic diagnosis. Data were collected regarding transplant type, time from transplant to toxoplasmosis diagnosis, clinical and radiographic features, and mortality at 30 and 90 days. Twenty patients were identified 10 HSCT recipients (80% allogeneic HSCT) and 10 SOT recipients (60% deceased donor renal transplants). Rejection among SOT recipients (70%) and graft-versus-host disease (GVHD) prophylaxis among HSCT recipients (50%) were frequent. Median time from transplant to toxoplasmosis diagnosis was longer for SOT than HSCT (1385 vs. selleck compound 5 days, P-value .002). Clinical manifestations most commonly were encephalitis (65%), respiratory failure (40%), renal failure (40%), and distributive shock (40%). Cohort 30-day mortality was 45%, and 90-day mortality was 55%. Diagnosis was postmortem in 25% of the cohort. Further evaluation of toxoplasmosis screening is needed for noncardiac SOT recipients, HSCT recipients with GVHD, and periods of increased net immunosuppression.

Relative adrenal insufficiency (RAI) is frequently found in patients with liver cirrhosis, especially in critically ill conditions. However, the prognostic impact of RAI in non-critically ill cirrhosis remains controversial. The aim of the present study was to assess the prevalence of RAI and its prognostic implication in non-critically ill cirrhotic patients.

From December 2015 to November 2017, hospitalised non-critically ill cirrhotic patients admitted with hepatic decompensation were prospectively enrolled in this study. Within 24hours after admission, 250 mcg ACTH stimulation test was performed. RAI was defined as an increase in serum cortisol <9mcg/dL in patients with basal serum cortisol <35mcg/dL. Clinical outcomes were evaluated during admission and at 30-, 90-day visits.

One hundred and fifteen patients were included (66% male, mean age 59.9±16years, mean MELD 16.1±6.8, Child A/B/C 15.7%/53.9%/30.4%). The main indications for admission were bacterial infection (44.6%) and portal hypertennfluence on short-term outcomes.

Pre-existing chronic liver disease is currently considered a poor prognostic factor for coronavirus disease 2019 (COVID-19). The present study aimed to investigate the association of liver stiffness measurement (LSM) with disease severity and clinical course of COVID-19.

We prospectively recruited consecutive hospitalised adult patients with COVID-19 in a 3-month period. Demographic, laboratory, clinical and vibration-controlled transient elastography (VCTE) features were recorded at entry, and all patients were prospectively followed-up. Severe liver fibrosis was defined as an LSM value higher than 9.6 kPA. Multivariate logistic regression analysis was performed to reveal factors associated with disease severity and outcomes.

Out of 98 eligible patients with COVID-19, 12 (12.2%) had severe liver fibrosis. Patients with severe liver fibrosis had higher baseline disease severity (P=.022), more commonly required oxygen treatment at entry (P=.010), and had intensive-care unit (ICU) requirements during the 6 (1-39)-day median follow-up time (P=.017). The presence of severe liver fibrosis was independently associated with disease severity (odds ratio (OR) 7.685, 95% confidence interval (CI) 1.435-41.162, P=.017) and ICU requirement (OR 46.656, 95% CI 2.144-1015.090, P=.014). LSM was correlated with alanine aminotransferase levels (P=.005, r 0.283), but not with other markers of acute hepatic injury or inflammation.

Initial VCTE application might help physicians identify patients who are more likely to have severe illness or worse clinical outcomes, in addition to other well-established clinical and laboratory factors. Further multicentre prospective studies are warranted to validate our results.

Initial VCTE application might help physicians identify patients who are more likely to have severe illness or worse clinical outcomes, in addition to other well-established clinical and laboratory factors. Further multicentre prospective studies are warranted to validate our results.