جستجوی مقالات مرتبط با کلیدواژه « Treatment failure » در نشریات گروه « پزشکی »

Systemic or topical form of pentavalent antimony compounds such as Meglumine Antimoniate (MA) are used as Standard treatment for cutaneous leishmaniasis (CL). However an increasing number of studies demonstrate evidence of treatment failure with said drugs. The objective of this study was to determine the factors associated with systemic MA treatment failure in patients with acute cutaneous leishmaniasis. In this case-control study, patients with urban CL who were referred to leishmaniasis clinics in Mashhad from 2017 to 2018 were followed up 12 months after the start of treatment and were evaluated for improvement or failure according to the national leishmaniasis protocol. 112 cases of CL, 59 men and 53 women with a mean age of 23.3 ± 21.11 years were studied. The number of patients with clinical improvement was significantly higher in women (P = 0.005). Also age, BMI, occupation and education, the possible infection and living location, past medical, drug and leishmaniasis recurrence history, lesion’s characteristics, ulceration were also significantly different between the two groups of improved and unhealed patients. The results of this study showed that the male sex, age less than 18 years, receiving pentostam, previous treatment history, lymphadenopathy, urban leishmaniasis, duration of illness more than 4 months, having a single lesion especially on the face, BMI less than 18 and a lesion size of more than 3 cm is more common in patients with treatment failure.

Treatment failure of antimony drugs for anthroponotic cutaneous leishmaniasis (ACL) is rising. Recognizing predictive factors of unresponsiveness to treatment can substantially influence better ACL management. The goal of this study was to investigate predictive factors associated with treatment failure in ACL in Kerman, southeast Iran.

This case-control study was conducted retrospectively on 2,128 ACL cases in Kerman over ten years from 2011 to 2020. The case group included patients whose lesions failed to resolve after one treatment course. The control group included those whose lesions were cured after one treatment course.

Treatment failure was observed in 13.5% of cases (10.7% of systemic therapy and 16.7% of local therapy). No significant difference was reported between the type of treatment and treatment failure. The association of treatment failure with winter-onset (P = 0.001, OR = 1.39, CI = 1.23–1.56), face (P = 0.001, OR = 1.86, CI = 1.38–2.49), ulceration (P = 0.01, OR = 0.51, CI = 0.30– 0.85), small diameter (P = 0.005, OR = 0.57, CI = 0.38-0.84) and long duration of lesions (P = 0.01, OR = 1.57, CI = 1.11–2.21) was validated by multivariate logistic regression analysis.

Efficient detection and timely management of ACL cases are essential to reduce resistant cases, as lesions lasting longer than four months show poor response to treatment. Furthermore, early treatment of facial lesions with systemic therapy is suggested to optimize results and reduce the risk of disfiguring scars. Further surveys are required to determine the reason behind more treatment failure in winter-onset lesions.

Reinfection among COVID-19 patients is still a challenging issue in the medical literature. Therefore, the current meta-analysis was conducted to estimate the pooled incidence rate of reinfection among COVID-19 patients.

A comprehensive search was conducted in PubMed, Web of Science, and Scopus databases from July 1 to October 1, 2021. Original studies which estimated the incidence rate of COVID-19 reinfection were included. CASP (Critical Appraisal skills program) was used to assess the quality of studies. Data were analyzed by STATA statistical software Version 15 (StataCorp, College Station, TX, USA).

A total of 3803 articles were found, of which 16 articles remained after title, abstract, and full text screening. The minimum and maximum incidence rates of reinfection were 0.001 and 0.73%, respectively. The pooled estimated incidence rate of COVID-19 reinfection was 0.11% (95% confidence interval: 0.02-0.20, p< .001, I2 = 100.0). The highest pooled estimated incidence rate of reinfection was observed in people <50 years old (0.14%) (95% CI: 0.001-0.34, p<.001, I2 = 100). Regarding the time elapsed after the first infection, the highest reinfection rate occurred four months after the first infection (0.12%) (95% CI: 0.001-0.27, p< .001, I2 = 100).

The incidence rate of reinfection among COVID-19 patients is expected to be high. However, it seems that the influence of factors including the age of patients and the time elapsed after the first infection must be considered.

Cellulitis is treated with antibiotics as routine management and based on the literature the cellulitis hospitalization can be avoided by 11% if appropriate antibiotics are used.1 Randomized clinical trials and Cochrane reviews have suggested that oral antibiotics are non-inferior to intravenous administration (1). We would like to highlight here the unrequired use of intravenous antibiotics in cellulitis. Intravenous antibiotics are recommended in patients with sepsis. This is supported by a study done on 1800 patients with cellulitis diagnosis, where one third of patients were hospitalized

Methotrexate (MTX) and actinomycin D (ActD) have been used as first-line chemotherapy agents in the treatment of low-risk gestational trophoblastic neoplasia (GTN). Although low-risk GTN is considered a curable disease, its reported primary remission rates of 49 to 93% reflect the difficulties of treatment and different factors influencing it. Hence, this study aimed to determine the remission rates and related factors of single-agent chemotherapy resistance in low-risk GTN patients.

This retrospective study included patients with diagnosed low-risk GTN who received either MTX once a week (IM, 30mg/m2) or ActD once every two weeks (pulsed IV, 1.25mg/m2). Then, the patients were followed-up until complete remission or single-agent treatment failure to assess resistance rate and related factors.  

Eighty-four patients were included in the study (18 patients were receiving MTX and 66 patients were receiving ActD). 85.7% of all participants achieved complete remission after first-line chemotherapy (72.2% in MTX vs 89.4% in ActD). There was a significant association for higher tumor size (P=0.046), the occurrence of metastasis (P=0.019), and pretreatment β-HCG levels (P=0.005) with resistance to treatment.

This study demonstrated higher tumor size, the occurrence of metastasis, and pretreatment β-HCG levels have been associated with increased resistance to first-line chemotherapy agents.

Several evidences have shown some synergistic effect of diabetes co-morbidity on the tuberculosis (TB) treatment results, while some other studies have not found such associations. This study aimed to investigate the relationship between TB-diabetes co-morbidity and outcomes of TB treatment.

The research population in this case control study were patients with smear positive tuberculosis. The cases were 158 patients with TB and diabetes selected by consensus method, while controls were 316 patients randomly selected from TB patients without diabetes.

Frequency of unfavorable outcome among cases was higher than among controls (7.6% vs 7.3% respectively, p-value =0.901). Multivariate logistic regression models showed that the odds ratios for adverse treatment outcome, death, treatment failure, positive smear after the intensive phase of treatment and high grade positivity (2+ & 3+) were 0.97(0.45- 2.06), 0.97(0.42-2.24), 0.91(0.17-4.85), 1.39(0.79- 2.44) and 2.57(0.83- 7.92) respectively. Moreover, treatment adverse outcomes among patients with drug complications (22.2% vs. 6.5%, p-value =0.010) and rural residents (10% vs 4.9% respectively, p-value =0.037) were significantly higher than those among patients without complication and urban residents respectively.

Although we did not observe any significant association between TB-diabetes co-morbidity and treatment results, there was a significant effect measure regarding the effect of smear positivity at the end of the intensive phase of treatment, especially high grade of smear positivity. Because of probable bias in the classification of the exposure, screening of TB patients regarding diabetes mellitus at the beginning of the treatment is recommended.

Treatment of hyperlipidemia, as a major risk factor of cardiovascular disease with the leading role in atherosclerosis and cardiovascular adverse effect, is now a medical dilemma worldwide. Notwithstanding the comprehensive knowledge about the impact of this factor on cardiovascular system, successful achievement of therapeutic goals of medical therapy still remains an unattained desire. The aim of this study is to evaluate the underlying causes apart from medication itself.

This study was performed cross-sectional. In this study, which was conducted for 6 months from March 2016, 50 patients were fully evaluated and followed up. Inclusion criteria for patients with acute myocardial infarction were newly diagnosed when the first full dose of statin (Atorvastatin 80 mg) was started for them. Exclusion criteria were history of taking fat-reducing drugs before the study. Predetermined data extraction forms including medical and laboratory variables and the Multidimensional Scale of Perceived Social Support Questionnaire (MSPSS) were completed for all patients at the first visit and after 6 months. Data were analyzed using SPSS software.

Among 50 patients completely reviewed, 28 were men (56%) and 22 were women (44%) (P˃ 0.05), with the mean age of 60 (±10.19) years old. Only 20 patients (40%) could achieve therapeutic goal of LDL-c (˃ 70 mg/dl). Irregular drug consumption was the only factor significantly differed between patients who achieved the goals and those could not achieve (P= 0.034). Subgroup analysis among patients with regular and irregular drug consumption demonstrate that low educational level along with poor socio-economic support were significantly differed between these patients (P˃ 0.05).

There are some conditions independently influence the efficacy of a medical treatment to improve hyperlipidemia including educational and socio-economic determinants, apart from issues related to medication itself. Therefore, patient’s lifestyle and their condition have to be considered in planning a medical therapy.

The current status of medical malpractice in Tehran medical centers remains unclear. However, understanding the situation may help the authorities carefully plan, continuously monitor, and consequently be sensitive to eliminate the shortcomings. Thus, the present study aimed at investigating the existing problems in this respect.

In the present descriptive and cross-sectional study, all patients complaining of the medical staff of public hospitals affiliated to 3 Medical Sciences Universities (i.e., Tehran, Iran, Shahid Beheshti, & Baqiyatallah) were evaluated concerning demographic characteristics, physicians’ genders, the type of hospital, the type of specialty, the type of staff, and reason for complaint (disability, death). The necessary information was collected using a data collection form. The obtained results were analyzed in SPSS using the Chi-square and Fisher’s Exact tests. P<0.01 was considered significant.

Most filed complaints were against hospitals affiliated to Tehran and Shahid Beheshti Universities of Medical Sciences, and 66% against private centers. Most cases won in the court were against general practitioners, dentists, general surgeons, and hospital technicians. The number of malpractices proven for teaching hospitals was significantly lower than that of non-teaching ones. Given the prevalence of plastic surgery in Iranian society, the number of complaints filed from female patients was two-thirds of males, almost 50% aged 21-40 years. For some reason, more than three-fourths of wrongful death complaints concerned female patients.

The medical malpractice complaints in hospitals are an integral part of physicians and nursing staff’s work; as the saying goes: an oral dictation has no errors.

Tuberculosis (TB) is an infectious and communicable disease and one of the top ten causes of death throughout the world. Monitoring and evaluating TB treatment outcomes provides the required data for taking the necessary measures to control TB. Thus, this study was carried out to find determinants of treatment failure among patients with smear-positive pulmonary TB in Khuzestan province during 2006-2014

This retrospective cohort study was conducted over a 9-year period in Khuzestan province. Predictors of treatment failure were analyzed using multivariate logistic regression

Among 5342 patients, the cumulative incidence of unsuccessful TB treatment was 1.85%. More than half of TB patients (59.2%) enrolled in this study were male, and most of them were living in urban areas (79.8%). Significant predictors of treatment failure were age (p=·001), weight (p= ·039), number of delayed days in diagnosis (p=·01), isoniazid resistance (p≤·001), and number of bacilli in patients` sputum at the beginning of treatment (p≤·001).

In this study, the rate of successful treatment was quite high; nevertheless, new cases of treatment failure could be prevented with special efforts such as prompt diagnosis and precise follow-up under Direct Observation Treatment Short course (DOTS) strategy.

Revision surgery of spine can be a complex procedure and has known complications. It involves hardware revision, removal of scar/callus tissue, realignment of sagittal balance, and anterior augmentation. However, through this report, we aim to demonstrate that a stand-alone rod augmentation at the failure site without removal of scar/callus tissue and/or anterior fixation can achieve excellent results in select cases.

Case Report:

A 66-year-old woman underwent L2 pedicle subtraction osteotomy (PSO) + T9-iliac fixation for fixed sagittal imbalance and osteoporotic collapse of L3. One year later, she developed progressive axial lumbar pain and difficulty in mobilization. The patient was diagnosed with pseudoarthrosis and instrumentation failure and underwent revision spine surgery with stand-alone rod augmentation. She had an uneventful rehabilitation and showed complete radiographic union and excellent clinical outcome in the 2-year follow-up.

Stand-alone rod augmentation can provide stable posterior construct to prevent future pseudoarthrosis and/or instrumentation failure after revision spine surgery in selected cases. Anterior augmentation or resection dural scar tissue or dissection through callus tissue is not always necessary.

Cutaneous leishmaniasis (CL) is a vector borne disease predominantly found in tropical and subtropical countries, including Iran. For more than 6 decades, pentavalent antimonials have been used successfully worldwide for the treatment of leishmaniasis, but over the past few years, clinical resistance to these medications has increased. In this study, we evaluated CL patients who did not show any desirable responses to the anti-leishmanial treatment within a 10-year period (2008 to 2017).

All patients from different parts of Iran suspected of having cutaneous leishmaniasis, who were referred to the laboratory of leishmaniosis in Tehran University of Medical Sciences from 2008–2017 were parasitological exam ined.

During this period, a total of 1480 suspected CL patients were referred to the laboratory of leishmaniosis. Samples from 655 patients (70.8%) suspected of having CL were positive microscopically. The failure rate in patients treated with anti-leishmaniasis medications for a minimum of three complete treatment periods was 1.83% (12 cases). There was no association between the number and size of skin lesions and patient characteristics. Also, the route of drug administration had no significant effect on the number and size of lesions.

In the present study, treatment failure was found in some confirmed CL patients treated with meglu mine antimoniate. Over the past few years, it seems that had been increased in resistance to these medications. So, a review of the correct implementation of the treatment protocol and/or a combination therapy may be helpful in prevent ing an increase in the rate of treatment failure.

Context:

 It is thought that social support plays a key role in ensuring adjustment for women as a result of failed infertility treatment. Social support and infertility issues are discussed in the literature. However, a relationship between infertility treatment failure and adjustment to infertility was not detected in studies.

The purpose of this study was to examine the relationships between the perceived social support and adjustment to infertility in women with unsuccessful infertility treatments. Settings and Design: This was a cross-sectional, descriptive-analytic study performed in a university hospital in Eastern Turkey between September 2016 and September 2017.

The study participants consisted of primary infertile women admitted to the clinic with at least one failed treatment experience. Two hundred and six infertile women were included in the research sample by convenience method. A demographic data form, the Multidimensional Scale of Perceived Social Support, and the Fertility Adjustment Scale were used. Statistical Analysis Used: Data were analyzed using in descriptive statistics (mean, standard deviation, and frequency). The Pearson’s correlation was used and P < 0.05 was considered to be statistically significant.

There was a significant positive correlation between the perceived social support from family, friends, and significant others and adjustment to infertility (r = 0.17, P < 0.05; r = 0.35, P < 0.01; and r = 0.23, P < 0.01, respectively).

There was a significant positive correlation between the adjustment to infertility and perceived social support from the family, friends, and the special someone of the women undergoing failed infertility treatments.

To evaluate the outcome of retrograde endopyelotomy as a minimally invasive option for management of failed open pyeloplasty in children and assess how the duration of post-procedural stenting may affect the endopyelotomy outcome.

A total of 15 patients with secondary UPJO (Ureteropelvic junction obstruction) underwent retrograde endopyelotomy.  The procedure was done using low-energy monopolar electrocautery hook under direct vision of pediatric ureteroscope and control of fluoroscopy. Double J stent was placed after the operation in all cases. Stent was removed in another session, 8 weeks (Group A, n=7) vs. 12 weeks (Group B, n=8) after endopyelotomy. Patients in both Groups were followed one, six and twelve months after the stent removal, and the anteroposterior renal pelvis diameter (APD), renal cortical thickness (CT) and degree of hydronephrosis (HDN) were recorded using the repeated measure test. P-value less than 0.05 were significant. We analyzed the data using SPSS software, version 20.

The median interquartile range (IQR) age at time of surgery for group A and B were 24 (62) months and 12 (50) months respectively. Median (IQR) times between previous pyeloplasty and endopyelotomy were 6 (6) months and 12 (8.5) months in groups A and B, respectively. The success rate of endopyelotomy after 12 months was 57.1% in group A and 87.5% in group B. The resolution of HDN was more prominent in the 12 week stenting group compared to the 8 week group during the 12 months follow-up period (p=0.030). The APD and CT in group B compared to group A was improved during follow-up period.

A higher one-year success rate of retrograde endopyelotomy in terms of improvements in the degree of HDN, APD and CT was observed when the double j stent was remained for 12-weeks rather than 8-weeks. This observation need to be validated in a large cohort study with a long term post procedural follow up.

Chlamydia Trachomatis is one of the most common pathogens transmitted through the genital tract in humans that leads to urogenital infection. 

Given the high prevalence of chlamydia infection and its adverse effects on the health of women and men, the present meta-analysis was conducted to determine the rate of treatment failure with azithromycin.

Databases including MEDLINE, ISI - Web of Science, PubMed, EMBASE, Scopus, ProQuest, and Science Direct were searched for articles published between 1991 and 2018. The quality of the selected articles was assessed using the Cochrane risk of bias assessment tool. Heterogeneity was determined using the I2 and Cochrane Q-Test. Subgroup analysis and meta-regression were used to compare the prevalence rates on different levels of the variables. 

A total of 21 articles that met the inclusion criteria were ultimately assessed. The pooled estimate of azithromycin failure rate was 11.23% (CI 95%: 8.23%-14.24%). Also, the azithromycin failure rate was 15.87% (CI 95%: 10.20%-21.54%) for the treatment of urethritis, 7.41% (CI 95%: 0.60%-14.22%) for cervicitis, and 7.14% (CI 95%: 10.90%-3.39%) for genital chlamydia. The pooled estimate of failure rate difference was 2.37% (CI 95%: 0.68%-4.06%), which shows that azithromycin has a higher failure rate in the treatment of chlamydia compared to doxycycline and other examined medications. The meta-regression results showed that the patient's age contributes significantly to the heterogeneity for azithromycin treatment failure rate (β = 0.826; p = 0.017).

Azithromycin has a higher failure rate than doxycycline and other studied medications in treating urogenital chlamydia infections. 

Key words: Azithromycin, Chlamydia trachomatis, Urogenital, Treatment failure, Meta-analysis. 
Abstract

Chlamydia Trachomatis is one of the most common pathogens transmitted through the genital tract in humans that leads to urogenital infection. 

Given the high prevalence of chlamydia infection and its adverse effects on the health of women and men, the present meta-analysis was conducted to determine the rate of treatment failure with azithromycin.

Databases including MEDLINE, ISI - Web of Science, PubMed, EMBASE, Scopus, ProQuest, and Science Direct were searched for articles published between 1991 and 2018. The quality of the selected articles was assessed using the Cochrane risk of bias assessment tool. Heterogeneity was determined using the I2 and Cochrane Q-Test. Subgroup analysis and meta-regression were used to compare the prevalence rates on different levels of the variables. 

A total of 21 articles that met the inclusion criteria were ultimately assessed. The pooled estimate of azithromycin failure rate was 11.23% (CI 95%: 8.23%-14.24%). Also, the azithromycin failure rate was 15.87% (CI 95%: 10.20%-21.54%) for the treatment of urethritis, 7.41% (CI 95%: 0.60%-14.22%) for cervicitis, and 7.14% (CI 95%: 10.90%-3.39%) for genital chlamydia. The pooled estimate of failure rate difference was 2.37% (CI 95%: 0.68%-4.06%), which shows that azithromycin has a higher failure rate in the treatment of chlamydia compared to doxycycline and other examined medications. The meta-regression results showed that the patient's age contributes significantly to the heterogeneity for azithromycin treatment failure rate (β = 0.826; p = 0.017).

Azithromycin has a higher failure rate than doxycycline and other studied medications in treating urogenital chlamydia infections.

Inability to have a child is stressful and affects all aspects of couples’ lives. Infertility diagnosis, duration and reason of infertility, treatment failure, and frequent pregnancy tests are among the stress-inducing factors in couples. The current study aimed to compare infertility-related stress among couples and evaluate its relationships with infertility factors. This cross-sectional study was performed on 150 infertile couples (300 individuals) visiting infertility centers of Tehran. The data were collected using the Fertility Problem Inventory (FPI) and fertility and demographic characteristics form. The subjects were selected through convenience sampling method. The data were analyzed through inferential statistics, including paired samples t-test, independent samples t test, ANOVA, and linear regression. According to the results, the mean stress score of women was significantly higher than that of the men (P = 0.007). There was a significant difference between males and females regarding the mean scores of social concern and need for parenthood (P = 0.005). The mean score of infertility-related stress was also significantly higher in women with treatment failure than in men (P = 0.01). Based on the findings of the present study, infertile women experienced greater stress than males. Furthermore, infertility-related stress increased in women due to treatment failure. Therefore, it is recommended that women who have experienced treatment failure be subjected to precise psychological evaluations before undergoing the treatment process.