Superior mesenteric artery syndrome: a rare cause of duodenal obstruction. Cases reports and review of literature

The Superior Mesenteric Artery Syndrome is a rare cause of duodenal obstruction. We present two young Ethiopian female patients who were diagnosed with this rare condition. After a duodeno-jejunostomy, the patients showed significant improvement and were discharged in a very good condition. This is the first report of this rare case from Ethiopia and a brief literature review is also presented.     

Predictors of switch to and early outcomes on third-line antiretroviral therapy at a large public-sector clinic in Johannesburg,South Africa

Background

While efficacy data exist, there are limited data on the outcomes of patients on third-line antiretroviral therapy (ART) in sub-Saharan Africa in actual practice. Being able to identify predictors of switch to third-line ART will be essential for planning for future need. We identify predictors of switch to third-line ART among patients with significant viraemia on a protease inhibitor (PI)-based second-line ART regimen. Additionally, we describe characteristics of all patients on third-line at a large public sector HIV clinic and present their early outcomes.

Methods

Retrospective analysis of adults (≥?18 years) on a PI-based second-line ART regimen at Themba Lethu Clinic, Johannesburg, South Africa as of 01 August 2012, when third-line treatment became available in South Africa, with significant viraemia on second-line ART (defined as at least one viral load ≥?1000 copies/mL on second-line ART after 01 August 2012) to identify predictors of switch to third-line (determined by genotype resistance testing). Third-line ART was defined as a regimen containing etravirine, raltegravir or ritonavir boosted darunavir, between August 2012 and January 2016. To assess predictors of switch to third-line ART we used Cox proportional hazards regression among those with significant viraemia on second-line ART after 01 August 2012. Then among all patients on third-line ART we describe viral load suppression, defined as a viral load <?400 copies/mL, after starting third-line ART.

Results

Among 719 patients in care and on second-line ART as of August 2012 (with at least one viral load ≥?1000 copies/mL after 01 August 2012), 36 (5.0% over a median time of 54 months) switched to third-line. Time on second-line therapy (≥?96 vs.?<?96 weeks) (adjusted Hazard Ratio (aHR): 2.53 95% CI 1.03–6.22) and never reaching virologic suppression while on second-line ART (aHR: 3.37 95% CI 1.47–7.73) were identified as predictors of switch. In a separate cohort of patients on third-line ART, 78.3% (47/60) and 83.3% (35/42) of those in care and with a viral load suppressed their viral load at 6 and 12 months, respectively.

Conclusions

Our results show that the need for third-line is low (5%), but that patients’ who switch to third-line ART have good early treatment outcomes and are able to suppress their viral load. Adherence counselling and resistance testing should be prioritized for patients that are at risk of failure, in particular those who never suppress on second-line and those who have been on PI-based regimen for extended periods.

     

Breast carcinoma in a 7-years- old girl

This is a case report of a 7 years old female patient diagnosed to have secretory carcinoma of the breast and secondary axillary lymph nodes metastasis after she presented with compliant of left breast swelling that lasted for about 6 months. It is a rare (< 1%) type of breast carcinoma with distinct histologic features. Diagnosis of this carcinoma at fine needle aspiration cytology (FNAC) is quite difficult and it is not a particularly aggressive tumor with excellent prognosis even in the presence of metastasis. Axillary locoregional lymph node metastases are uncommon. Several authors, therefore, recommend a conservative and non-aggressive treatment as much as possible. In her case, modified radical mastectomy with level II axillary dissection was done without hormonal or chemotherapy. So far, the therapeutic approach tends to be fairly flexible.     

Infant responsiveness,alertness, haemoglobin and growth in rural Sidama,Ethiopia

Several recent studies have supported relations between infant behaviour (alertness and responsiveness) and nutrition in addition to investigating infant behaviour within the context of changes in iron status over time. Existing research is typically limited to the investigation of the effects of a single vitamin or mineral, and no studies have been found that examined the influence that early alertness and responsiveness have on growth in early infancy, despite the fact that relations between behaviour and nutritional status may be bidirectional. The current study used a sample of Ethiopian infants and investigated anthropometrics, haemoglobin, the frequency of alertness and the frequency of responsiveness at 6 and 9 months of age. Six‐month weight‐for‐age predicted 9‐month frequency of alertness, while 6‐month haemoglobin predicted 9‐month frequency of responsiveness. Compared with responsive infants, non‐responsive infants at 6 months remained more non‐responsive at 9 months, although weight‐for‐age for both groups converged at 9 months. Results support relations between nutrition and behaviour (alertness and responsiveness) and provide evidence of a potentially useful tool (the Laboratory Temperament Assessment Battery) that was adapted to evaluate these relations in Ethiopia.     

Real‐world evidence concerning clinical and economic outcomes of switching to insulin glargine 300 units/mL vs other basal insulins in patients with type 2 diabetes using basal insulin

This retrospective cohort study compared real‐world clinical and healthcare‐resource utilization (HCRU) data in patients with type 2 diabetes using basal insulin (BI) who switched to insulin glargine 300 units/mL (Gla‐300) or another BI. Data from the Predictive Health Intelligence Environment database 12 months before (baseline) and 6 months after (follow‐up) the switch date (index date, March 1, 2015 to May 31, 2016) included glycated haemoglobin A1c (HbA1c), hypoglycaemia, HCRU and associated costs. Baseline characteristics were balanced using propensity score matching. Change in HbA1c from baseline was similar in both matched cohorts (n = 1819 in each). Hypoglycaemia incidence and adjusted event rate were significantly lower with Gla‐300. Patients switching to Gla‐300 had a significantly lower incidence of HCRU related to hypoglycaemia. All‐cause and diabetes‐related hospitalization and emergency‐department HCRU were also favourable for Gla‐300. Lower HCRU translated to lower costs in patients using Gla‐300. In this real‐world study, switching to Gla‐300 reduced the risk of hypoglycaemia in patients with type 2 diabetes when compared with those switching to another BI, resulting in less HCRU and potential savings of associated costs.