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(最多只允许输入30个字)"Efficacy and effectiveness of artemether-lumefantrine after initial an" by B.E. Ngasala, M. Malmberg et al.
<meta name="bepress_citation_title" content="Efficacy and effectiveness of artemether-lumefantrine after initial and repeated treatment in children
Efficacy and effectiveness of artemether-lumefantrine after initial and repeated treatment in children < 5 years of age with acute uncomplicated plasmodium falciparum malaria in rural Tanzania: A randomized trial
Document Type
Department
Pathology (East Africa)
Background. We assessed the efficacy, effectiveness and safety of artemether-lumefantrine, which is the most widely used artemisinin-based combination therapy in Africa, against Plasmodium falciparum malaria during an extended follow-up period after initial and repeated treatment. Methods. We performed an open-label randomized trial of artemether-lumefantrine with supervised (n = 180) and unsupervised intake (n = 179) in children <5 years of age with uncomplicated falciparum malaria in rural Tanzania. Recurrent infections between day 14 and day 56 were retreated within the same study arm. Main end points were polymerase chain reaction (PCR)-corrected cure rates by day 56 and day 42 after initial and repeated treatment, respectively, as estimated by survival analysis. Results. The PCR-corrected cure rate after initial treatment was 98.1% (95% confidence interval [CI], 94.2%-99.4%) after supervised and 95.1% (95% CI, 90.7%-98.1%) after unsupervised intake (P =. 29). After retreatment of recurrent infections, the cure rates were 92.9% (95% CI, 81.8%-97.3%) and 97.6% (95% CI, 89.3%-98.8%), respectively (P =. 58). Reinfections occurred in 46.9% (82 of 175) versus 50.9 % of the patients (relative risk [RR], 0.92 [95% CI, 0.74-1.14]; P =. 46) after initial therapy and 32.4% (24 of 74) versus 39.0% (32 of 82) (RR, 0.83 [95% CI, 0.54-1.27]; P =. 39) after retreatment. Median blood lumefantrine concentrations in supervised and unsupervised patients on day 7 were 304 versus 194 ng/mL (P <. 001) after initial treatment and 253 versus 164 ng/mL (P =. 001) after retreatment. Vomiting was the most commonly reported drug-related adverse event (in 1% of patients) after both initial and repeated treatment. Conclusions. Artemether-lumefantrine was highly efficacious even after unsupervised administration, despite significantly lower lumefantrine concentrations, compared with concentration achieved with supervised intake, and was well-tolerated and safe after initial and repeated treatment. (C) 2011 The Author.
Publication
Clinical Infectious Diseases
Recommended Citation
Ngasala, B.,
Malmberg, M.,
Carlsson, A.,
Ferreira, P.,
Petzold, M.,
Blessborn, D.,
Bergqvist, Y.,
Premji, Z.,
Bjorkman, A.,
Martensson, A.
(2011). Efficacy and effectiveness of artemether-lumefantrine after initial and repeated treatment in children < 5 years of age with acute uncomplicated plasmodium falciparum malaria in rural Tanzania: A randomized trial. Clinical Infectious Diseases, 52(7), 873-882.
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across all repositoriesCurative effect analysis on Latarjet procedure in treatment of epileptic patients of recurrent anterior dislocation of shoulder with severe osseous deficiency with 3-5years follow-up--《Chinese Journal of Shoulder and Elbow(Electronic Edition)》2014年02期
Curative effect analysis on Latarjet procedure in treatment of epileptic patients of recurrent anterior dislocation of shoulder with severe osseous deficiency with 3-5years follow-up
Yang GXiang MChen HHu XTang HDepartment of Upper Extremity,Sichuan Provincial Orthopadic H
Background Shoulder instability affects the young population and causes serious labor loss.High-energy injuries can cause fractures around the shoulder girdle,such as coracoid fractures.Individuals with an epileptic seizure disorder and anterior glenohumeral instability frequently have severe anteroinferior glenoid osseous deficiency and a posterior humeral head defect.The risk of a subsequent osseous deficiency among recurrent unstable shoulders in patients with seizure disorders is very high.Therefore,this is clinically important as patients with a seizure disorder and glenohumeral instability frequently require a primary osseous reconstructive procedure,such as coracoid osteotomy and transfer to the anterior glenoid rim(the Latarjet procedure),to address glenoid osseous deficiency.The aim of this study is to assess the effects of Latarjet procedure on the radiological and clinical results in cases with severe glenoid osseous deficiency accompanied with epileptic seizure disorders and recurrent anterior dislocation of shoulder.Methods The study included 7patients with severe glenoid osseous deficiency accompanied with epileptic seizure disorders and recurrent anterior dislocation.The cases were reviewed at a mean post-operative follow-up duration was 46.3months(range from 36to60months)from 2006 to 2009.The average age of the patients was 27.5years old(range:20to 49 years old),including 4males and 3females.The average time between the first-time dislocation and operation was 4years(range:2.5to 9years).In addition to conventional anteroposterior and axillary radiographs,all patients underwent computed tomography(CT)as part of our routine protocol.Threedimensional reformatting of these images enabled assessment of the degree of glenoid and humeral head bone loss and the post-operative bone healing.All scans were examined by a single observer.Further information specifically relating to previous shoulder injuries and seizures was obtained from patients.Symptoms previously described in association with shoulder dislocation,including anterior shoulder pain,weakness,and restricted shoulder motion,were specifically sought.Functional assessment was obtained using the parameters of three types of functional assessment systems(the American Shoulder and Elbow Surgeons Assessment(ASES),the Constant-Murley Score and the Rowe Score).All patients underwent elective anterior shoulder stabilization(a standard Bristow-Latarjet procedure)performed by the same senior surgeon.The fragment was secured with two lag screws through the graft to obtain rotational control of the fragment to the glenoid rim.Then a special rehabilitation protocol and power recovery exercise was administered in all patients 2 weeks after surgery.All patients were followed with radiographic and functional evaluations.Results On the basis of preoperative CT scans and the arthroscopic appearances,all shoulders showed a severe glenoid-rim defect and Hill-Sachs lesions pre-operatively.Osteo-arthritic changes of the glenohumeral joint were seen in two shoulders(28.6%)pre-operatively and in four shoulders(57.1%)post-operatively.And the mean dislocation time was 17.5(range:13to 28times).These patients shared the common features of recurrent anterior instability in association with epileptic seizures and a severe osseous deficiency that was detectable on preoperative CT scans and was confirmed at surgery.The post-operative radiographic evaluations showed that all bone grafts healed without evidence of secondary displacement according to the three dimensional CT scan.The coracoid transposition bone and scapular neck paring the pre-operation condition with the final follow-up,forward elevation improved from 150.5±20.9preoperatively to 169.0±13.5postoperatively,while the average external rotational limitation measured in the neutral position of the arm decreased from 54.2±11.2to 42.2±6.8(t=2.827,P 0.05).ASES score improved from 81.1±15.7to 92.3±6.7(t=1.736,P 0.05),Constant-Murley score from 79.4±11.4to 92.2±4.2(t=-2.788,P 0.05).The mean Rowe score was 76(range,45 to 100)at the final follow-up.Re-dislocation during a seizure occurred in two shoulders(28.6%).And three patients had mild pain at the position of maximal abduction or external rotation.Secondary osteoarthritic changes of the glenohumeral joint were seen in two shoulders postoperatively.None of the patients had immediate postoperative complications.None had developed recurrent glenohumeral instability after surgery and only one person still had a passive apprehension sign at the time of the latest follow-up,ranging between thirty-six and sixty months postoperatively.On routine radiographs after surgery,there was no evidence of fixation failure or graft resorption in the shoulders.No one underwent revision surgery.Overall,most of the patients had satisfactory pain relief and daily living activities postoperatively at the time of the latest follow-up.Conclusions The anterior dislocation of the shoulder in the epileptic patients is really uncommon.The treatment of the secondary recurrent anterior dislocations of the shoulder associated with severe osseous deficiency is quite difficult,due to the unacceptably high rate of re-dislocation after the open or arthroscopic reconstruction surgery of the Bankart lesion.Our study assessed the effects of Latarjet procedure on the radiological and clinical results in seven cases with severe glenoid osseous deficiency accompanied with epileptic seizure disorders and recurrent anterior dislocation of shoulder.The results suggested that when treating patients with an epileptic seizure disorder and recurrent anterior glenohumeral instability,effective control of the epileptic seizures is one of the most important methods to reduce the incidence of post-operative recurrent dislocation,because a compliant patient was very important for a successful clinical outcome.The Latarjet procedure can provide a satisfied reconstruction of shoulder stability,but the possibility of re-dislocation and osteoarthritis should be also noticed.We recommend a high index of suspicion when treating patients with a seizure disorder who have anterior shoulder instability,and we recommend making apreoperative CT scan,if there is a strong likelihood that a coracoid transfer will be used at surgery.This enables the diagnosis of a coracoid fracture nonunion to be made prior to surgery and helps to determine whether there is sufficient bone to allow a Latarjet procedure to be performed.However,it needs further investment to choose an appropriate surgery procedure for the untreated epileptic patients.
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