Good Shepherd College

Background: In a resource-constrained environment, selective laser trabeculoplasty (SLT) is an attractive option. This study’s primary objective is to report real-world outcomes in terms of reduction in intraocular pressure, reduction in topical treatment and further surgery required.Methods: A retrospective case series of consecutive patients who received SLT between 01 January 2017 and 31 December 2018 was conducted. Patient data were captured for up to 21 months.Results: In all, 59 eyes of 36 patients were analysed. The mean patient age was 57.8 years (± 10.0). Sixty four per cent of the patients had SLT on both eyes. 83% of the patients were black ethnicity or of mixed race ethnicity. There was a significant and sustained intraocular pressure reduction (median reduction = 25.8%, IQR = 5.3%, 40.4%) from pre-SLT to 10–15 months (Wilcoxon T = 27.5, p = 0.002). The Kaplan-Meier survival analysis estimated that 60% of patients required no treatment escalation for up to 21 months. Neither cup-disc ratio nor pre-treatment intraocular pressure were found to be a predictive factor of treatment success or failure (p = 0.675 and p = 0.128).Conclusion: The results of this study support the use of SLT for patients with not only mild to moderate glaucoma but also advanced glaucoma in a Southern African, resource-limited context. The results demonstrate ongoing benefit for these patients up to 21 months following a single treatment.Contribution: This research provides, for the first time, long-term data from a low-resourced setting on the use of SLT in the treatment of glaucoma in Eswatini.

Physicians were most likely to recommend primary medical therapy upon diagnosis of glaucoma. Laser therapy was underutilized where they were available. Physicians were more likely to recommend surgery in severe glaucoma, laser therapy in mild glaucoma, while recommendation of medical therapy did not depend on glaucoma severity. To characterize treatment patterns for newly diagnosed glaucoma in sub-Saharan Africa (SSA). This was a multicenter cross-sectional study of adults newly diagnosed with glaucoma at 27 eye care centers in 10 African countries. In addition to demographic and clinical data, physician treatment recommendations (medication, laser, surgery, or no treatment) were recorded. Statistical analyses were performed using STATA version 14.0. Data from 1201 patients were analyzed. Physicians were most likely to recommend primary medical therapy upon diagnosis of glaucoma (69.4%), with laser (13.2%), surgery (14.9%), and no treatment (2.5%) recommended to the remaining patients. All sites had medical therapy available and most (25/27, 92.6%) could provide surgical treatment; only 16/27 (59.3%) sites offered laser, and at these sites, 30.8% of eyes were recommended to undergo primary laser procedures. As glaucoma severity increased, the laser was recommended less, surgery more, and medications unchanged. Patient acceptance of medical therapy was 99.1%, laser 88.3%, and surgery 69.3%. Medical therapy for first-line glaucoma management is preferred by most physicians in SSA (69%). Laser therapy may be underutilized at centers where it is available. These findings underscore the need for comparative studies of glaucoma treatments in SSA to inform the development of evidence-based treatment guidelines and of programs to reduce glaucoma blindness in SSA. Strategic approaches to glaucoma therapy in SSA must address the question of whether medical therapy is the most optimal first-line approach in this setting.

IntroductionTo reduce malaria transmission in very low-endemic settings, screening and treatment near index cases (reactive case detection (RACD)), is widely practised, but the rapid diagnostic tests (RDTs) used miss low-density infections. Reactive focal mass drug administration (rfMDA) may be safe and more effective.MethodsWe conducted a pragmatic cluster randomised controlled trial in Eswatini, a very low-endemic setting. 77 clusters were randomised to rfMDA using dihydroartemisin–piperaquine (DP) or RACD involving RDTs and artemether–lumefantrine. Interventions were delivered by the local programme. An intention-to-treat analysis was used to compare cluster-level cumulative confirmed malaria incidence among clusters with cases. Secondary outcomes included safety and adherence.ResultsFrom September 2015 to August 2017, 222 index cases from 47 clusters triggered 46 RACD events and 64 rfMDA events. RACD and rfMDA were delivered to 1455 and 1776 individuals, respectively. Index case coverage was 69.5% and 62.4% for RACD and rfMDA, respectively. Adherence to DP was 98.7%. No serious adverse events occurred. For rfMDA versus RACD, cumulative incidences (per 1000 person-years) of all malaria were 2.11 (95% CI 1.73 to 2.59) and 1.97 (95% CI 1.57 to 2.47), respectively; and of locally acquired malaria, they were 1.29 (95% CI 1.00 to 1.67) and 0.97 (95% CI 0.71 to 1.34), respectively. Adjusting for imbalance in baseline incidence, incidence rate ratio for rfMDA versus RACD was 0.93 (95% CI 0.54 to 1.62) for all malaria and 0.84 (95% CI 0.42 to 1.66) for locally acquired malaria. Similar results were obtained in a per-protocol analysis that excluded clusters with <80% index case coverage.ConclusionIn a very low-endemic, real-world setting, rfMDA using DP was safe, but did not lower incidence compared with RACD, potentially due to insufficient coverage and/or power. To assess impact of interventions in very low-endemic settings, improved coverage, complementary interventions and adaptive ring trial designs may be needed.Trial registration numberNCT02315690.

The base rates of Australia’s working-age social security payments are below the poverty line, and have been for some time. Additionally, people who receive payments are often required to undertake various ‘mutual obligations’ such as 'Work for the Dole.' In response to the COVID-19 pandemic, the Australian Government introduced a $550 per fortnight Coronavirus Supplement (‘the Supplement’) from 27 April 2020 for a period of six months and temporarily suspended mutual obligations. As states and territories were able to control the spread of the virus and ease restrictions, the Australian Government began to reduce the Supplement and re-introduce mutual obligations. Even with the Australian Government’s recently legislated permanent increase to the base rate of payments of $50 per fortnight, people receiving these payments will continue to live in poverty. This study used an online survey to examine how people receiving social security payments used the $550 Coronavirus Supplement (‘the Supplement’) and their time as a result of the temporary suspension of mutual obligations. The authors were also able to compare whether these changes differed from people who did not receive the Supplement, either because their payment did not include the Supplement or because they did not receive social security payments.

In 2019, the FDA Oncology Center of Excellence launched Project Orbis, a global collaborative review program to facilitate faster patient access to innovative cancer therapies across multiple countries. Project Orbis aims for concurrent submission, review, and regulatory action for high-impact clinically significant marketing applications among the participating partner countries. Current Project Orbis partners (POP) include the regulatory health authorities (RHA) of Australia, Brazil, Canada, Singapore, and Switzerland. Project Orbis leverages the existing scientific and regulatory partnerships between the various RHA under mutual confidentiality agreements. While FDA serves as the primary coordinator for application selection and review, each country remains fully independent on their final regulatory decision. In the first year of Project Orbis (June 2019 to June 2020), a total of 60 oncology marketing applications were received, representing 16 unique projects, and resulting in 38 approvals. New molecular entities, also known as new active substances, comprised 28% of the received marketing applications. The median time gap between FDA and Orbis submission dates was 0.6 months with a range of -0.8 to 9.0 months. Across the program, the median time-to-approval was similar between FDA (4.2 months, range 0.9-6.9, N = 18) and the POP (4.4 months, range 1.7-6.8, N = 20). Participating countries have signified a strong commitment for continuation and growth of the program. Project Orbis expansion considerations include the addition of more countries and management of more complex applications.

The efficacy of internet-based interventions to improve hypertension management is not established. We evaluated the therapeutic benefit of e-counseling by adapting best evidence guidelines for behavioral counseling. This multicenter double-blind randomized controlled trial included assessments at baseline, 4 months, and 12 months. Participants were 35 to 74 years of age and diagnosed with hypertension: systolic/diastolic blood pressure (BP) 130 to 180/85 to 110 mm Hg. BP was assessed by automated office measurement. E-Counseling used multimedia and interactive tools to increase motivation and skill for self-care (exercise, diet, medication adherence, and smoking cessation). Control used self-care education. Frequency of contact by our e-platform was equal for both trial arms. Primary end points were change at 4 and 12 months in systolic BP, diastolic BP, pulse pressure, total lipoprotein cholesterol, low-density lipoprotein cholesterol, total lipoprotein cholesterol/high-density lipoprotein cholesterol ratio, non-high-density lipoprotein cholesterol, and Framingham 10-year cardiovascular risk index. Intention-to-treat analysis used generalized linear models adjusted for baseline measures, sex, and medications. Among 264 participants, mean age was 57.6 years (SE, 0.6), 58% were women, with 83% on antihypertensive medications. At 12 months, e-counseling versus control evoked greater reduction in systolic BP (-10.1 mm Hg [95% confidence interval (CI), -12.5, -7.6] versus -6.0 mm Hg [95% CI, -8.5, -3.5]; P=0.02); pulse pressure (-5.2 mm Hg [95% CI, -6.9, -3.5] versus -2.7 mm Hg [95% CI, -4.5, -0.9]; P=0.04), and Framingham risk index (-1.9% [95% CI, -3.3, -0.5] versus -0.02% [95% CI, -1.2, 1.7]; P=0.02), respectively. Among males in e-counseling versus control, 12-month end points included lower diastolic BP (P=0.01), non-high-density lipoprotein cholesterol (P=0.04), total lipoprotein cholesterol (P=0.03), and a trend for total lipoprotein cholesterol/high-density lipoprotein cholesterol ratio (P=0.07). To our knowledge, this is the first double-blind randomized trial of e-counseling for hypertension. Added benefit for medical therapy was achieved by combining available technology with a clinically organized protocol of motivational and cognitive-behavioral counseling. https://www.clinicaltrials.gov; Unique identifier: NCT01541540.

Angiomyofibroblastoma represents a rare, benign mesenchymal tumor with a predilection for the vulvovaginal region. Lipomatous change may occur but rarely comprises a substantial component of the lesion. There are only eight reports in the English language literature describing the lipomatous variant of this tumor. We describe a further lipomatous angiomyofibroblastoma that occurred on the labium majus of a 49-year-old woman. The histopathologic and immunohistochemical features are described, and the collective experience in the literature is reviewed.

This nationally representative study, encompassing all single youth (15-24 years), was carried out on the subpopulation of Ethiopia DHS 2000 to determine the influences of socio-demographic characteristics on sexual behaviour, and assess the knowledge and awareness of HIV/AIDS and other STIs. There were a total of 890 male and 3,988 female youth. 25.5% of males and 16.1% of females ever had sexual intercourse. Among these, 65.8% males and 24.6% females had two or more sexual partners in the last 12 months. Condom use in the last sexual act was reported by 22.7% and 10% of male and female youth. 19.4% of male and 22.2% of female youth who ever had sexual intercourse ever used family planning method. Although the majority of youth is aware of HIV/AIDS, awareness about other STIs is low. On binary logistic regression analysis, the odds of ever having sexual intercourse were higher for the employed and older youth. Male urban youth was more likely to ever have sexual intercourse than male rural youth (Adjusted OR 4.2; 95% CI 1.8-9.5). Male youth with some form of education were more likely to use condom (Adjusted OR 4.9; 95% CI 1.01-24.7). Female youth with some form of education, the risk of ever having sexual intercourse was reduced by 50% but they were more likely to report having 2 sexual partners in the last 12 months (Adjusted OR 2.1; 95% CI 1.1-4.1). Female youth who had media exposure were more likely to report having 2 sexual partners in the last 12 months (Adjusted OR 2.9; 95% CI 1.3-6.8) but more likely to use condom during last sexual intercourse (Adjusted OR 15.7; 95% CI2.2-117). Among single Ethiopian youth the overall sexual activity is relatively lower than reported from other African countries but high risk sexual behaviour is common. Socio-demographic factors influence youth sexual behaviour.

The Journal of Bone and Joint Surgery. British volumeVol. 88-B, No. 8 CorrespondenceFree AccessThe Oxford medial unicompartmental knee replacement using a minimally-invasive approachE. S. B. SAWEERESE. S. B. SAWEERESSearch for more papers by this authorPublished Online:1 Aug 2006https://doi.org/10.1302/0301-620X.88B8.18225AboutSectionsPDF/EPUB ToolsDownload CitationsTrack CitationsPermissionsAdd to Favourites ShareShare onFacebookTwitterLinked InRedditEmail Sir,I read with great interest the paper by Pandit et al1 in the January 2006 issue entitled ‘The Oxford medial unicompartmental knee replacement using a minimally-invasive approach’. I wish to congratulate the authors on such a large series of Oxford unicompartmental knee replacements, followed up for a good period of time, with excellent survivorship and clinical results.Although it may not be very obvious in the manuscript (it occupies only one sentence), the way in which the authors reported the Oxford knee score (OKS) deserves careful consideration. The long story of the OKS lies behind that sentence.Since its first description, the OKS has been the subject of rigorous validation, which demonstrated the score to be a short, practical, reliable and valid outcome measure for knee arthroplasty that is also sensitive to clinically-important changes over time. The layout remained essentially the same; 12 questions with five possible answers for each, covering aspects of knee pain and function. The scoring system, however, has kept changing over the past two decades. In its original version as described by the Oxford group, the responses to each question were marked on a scale of 1 to 5. Adding up the marks yields a score of 60 for the worst possible knee, and a score of 12 for the normal, or best possible knee.My first encounter with the OKS was during my work and research at Oswestry, where the scoring system was different. Each question was marked on a scale of 0 to 4, and the total score ranged from 0 to 48. The worst knee therefore attracted a score of 0, and the best score of 48, was achieved by the normal or best possible knee. In their reply to a letter to the editor of the Journal of Bone and Joint Surgery [Br] about this specific scoring method, authors White, Jones and Harcourt commented that they preferred to use the scoring system along a conventional scale, and that this format of scoring the OKS was widely used. They also stressed that authors using the OKS should clearly describe how they use this instrument to avoid any confusion. By reading only the abstract, it was not possible to tell which scale was used in 16 of 24 references which studied or used the OKS. Four papers obviously used the score in its original form, and another four papers, including this one by Pandit et al,1 used it along the conventional scale. It was interesting to see two papers from Oxford, again including this paper, using the OKS in its ‘Oswestry’ form.In an annotation published in this journal, Pynsent stated that once an outcome measure is chosen, its scoring system should not be changed as attempts at change or modification will make comparison with other studies valueless. However, four years later Pynsent himself was one of the authors of a ‘Birmingham’ initiative to modify the Oxford knee score. Nevertheless, to give the Birmingham group the credit they deserve, they repeated the process of validation and testing of reliability, a prerequisite for any modification of outcome measures according to Pynsent’s annotation. In their recent paper they suggested changes in the layout, enabling patients to record pain and function for each knee separately. They described techniques for dealing with and recording scores for incomplete questionnaires. They also suggested an alternative scoring system, in which each question was scored between four and zero and the final index was expressed as a percentage. Only one other paper followed the same lines and reported normalised medians for the OKS, expressing it as a percentage.Despite the definite improvements suggested by the Birmingham group, which were welcomed but not adopted by the originators of the score, they still retained the inverted scale of the original score. The worst possible joint thus scored 100% and a healthy joint scored nought. The difficulty with this scale became obvious when the authors tried to categorise results, thus designating a knee with a score above 90% as poor and below 10% as excellent. Most of the other general health questionnaires (Short Form (SF) 12 and SF 36) and disease/site specific scores (Harris hip score and American Knee Society score) use a conventional scale with a higher score indicating a better and more normal knee.It is therefore clear that we have at least three versions of the OKS and that simply quoting a mean ‘Oxford score’ does not tell the reader if results were good or bad, unless the specific scale is indicated. Furthermore, this complicates any attempt at comparing different studies. It is time that a single method is agreed on by the originators and users’ groups together. If I may suggest an ‘Egyptian’ initiative to reconcile Oxford, Oswestry and Birmingham, I think that a score expressed as a percentile, which follows a conventional scale, from 0 to 100, would be most appropriate. Thus the worst knee would score a 0 and the normal knee would achieve a 100% score. This is easily understandable and would bring the OKS in line with other commonly-used scores. Finally, a modification of the OKS name would indicate to the reader that it was the final modification/version of the score which was used.A fully referenced version of this letter is available on our website at www.jbjs.org.uk References 1 Pandit H, Jenkins C, Barker K, Dodd CAF, Murray DW. The Oxford medial uni-compartmental knee replacement using a minimally-invasive approach. J Bone Joint Surg [Br] 2006;88-B:54–60. Link, Google ScholarFiguresReferencesRelatedDetails Vol. 88-B, No. 8 Metrics History Published online 1 August 2006 Published in print 1 August 2006 InformationCopyright © 2006, The British Editorial Society of Bone and Joint Surgery: All rights reservedPDF download