The COVID pandemic has troubled the world and disrupted the professional and personal lives of healthcare workers, putting their mental health at risk.Determine the prevalence of anxiety-depressive disorders among health personnel assigned to the COVID-19 circuit.Cross-sectional study carried out on healthcare personnel assigned to departments dedicated to the care of patients hospitalized for a SARS-COV2 infection. The study took place between March and September 2021. Data collection was done from a pre-established sheet. Anxiety-depressive disorders were screened using the HAD scale.The study included 140 health personnel. The sex ratio (M/W) was 0.62 with 54 men and 86 women. The mean age was 36.4±9 years. Nurses represented the largest professional category (64.6%). Professional seniority was 10 ± 9 years. Staff had been caring for patients with COVID for an average of 9 ±5 months. They worked an average of 4 days a week. The number of patients ranged from 1 to 55 per department. Psychiatric history was found in 29 participants, depression in 7% and anxiety in 2%. The workload was rated very hard at 42.1% and hard at 37.1%. Thirty percent of the population declared having received the moral support necessary to face the wave. The prevalence of anxiety and depression were 75.7% and 72.9% respectively. With 48.6% of patients presenting with definite anxiety and 27.1% with probable anxiety. Depression was certain in 40% of cases and doubtful in 32.9% of cases.Anxio-depressive disorders are common among healthcare staff assigned to the COVID circuit. Setting up listening cells with regular monitoring of these staff is very important to avoid psychologic impactNone Declared


Intussusception is a form of ileus of the intestines in which an oral intestinal segment slides into the adjacent aboral intestinal segment, causing obstruction of the bowel.We analysed the medical records of 126 cattle with intussusception of the small intestine.Demeanour and appetite were abnormal in 123 cattle. Non‐specific signs of pain occurred in 26.2%, signs of visceral pain in 46.8% and signs of parietal pain in 56.4%. Intestinal motility was decreased or absent in 93.7% of the cattle. The most common findings of transrectal palpation were rumen dilation (37.3%) and dilated small intestines (24.6%). In 96% of the cattle, the rectum was empty or contained little faeces. The principal laboratory findings were hypokalaemia (89.6%), hypocalcaemia (76.5%), base excess (72.9%), hypochloraemia (71.8%), azotaemia (62.1%) and haemoconcentration (61.1%). The main ultrasonographic findings were reduced or absent intestinal motility (98.2%) and dilated small intestines (96.0%). A diagnosis of ileus was made in 87.8% and a diagnosis of ileus attributable to intussusception was made in another 9.8%. Right‐flank laparotomy was carried out in 114 cattle. Fifty‐six (44.4%) cows were discharged.Clinical findings of intussusception in cattle are often non‐specific. Ultrasonography may be required to diagnose ileus. Intussusception is a form of mechanical ileus of the small or large intestine that occurs when an oral intestinal segment slides into an aboral segment in a telescope‐like fashion, causing obstruction of the bowel.Early clinical signs of intussusception include abdominal pain, progressive inappetence, listlessness, reduced or no faecal output, dilated abdomen and dehydration.Typical ultrasonographic findings are reduced or absent intestinal motility and dilated small intestines.Surgery is the treatment of choice for intussusception.The medical records of 126 cattle diagnosed with SII between January 1995 and December 2018 at the Veterinary College, University of Zurich, were analysed. The present work is based on two Master's theses.Only medical records of cattle that were at least 1 year of age and had SII, which involved the large colon in a few cases, were included provided that the diagnosis could be confirmed during laparotomy or postmortem examination.There were 75.4% cows, 21.4% heifers and 3.2% bulls between 1 and 13 years (mean ± SD = 4.9 ± 2.7 years) of age. Breeds included Swiss Braunvieh (81.8%), Holstein (7.9%), Swiss Fleckvieh (7.1%) and others (3.2%). Fifty of the 122 female cattle (41%) were pregnant (median 20.5 weeks). The last calving date of 45 cows was between 3 and 37 weeks. At the time of admission, the duration of illness ranged from 4 h to 7 days (median 24 h). All cattle had anorexia or reduced feed intake. Signs of abdominal pain had occurred in 64.3% of cattle before admission.Cattle underwent examination as previously described.Signs of pain were divided into non‐specific, somatic  and visceral . Non‐specific signs of pain included muscle fasciculations, bruxism and spontaneous grunting. Signs of somatic  pain were a tense abdominal wall, arching of the back and a tucked‐up abdomen. Visceral  signs consisted of shifting of weight in the hind limbs, lordosis, restlessness, kicking at the abdomen, sweating, tail swishing, frequent lying down and rising.The number and severity of signs of colic/abdominal pain were determined. Signs of mild colic included mild restlessness, shifting of weight in the hind limbs, looking at the flank, lifting the tail, lifting of individual limbs and tail swishing.Cattle were also assigned to colic, indolence and intoxication phases. The colic phase was the initial phase accompanied by the previously described signs of pain. The indolence phase followed the colic phase and was characterised by apathy and a markedly abnormal demeanour. The last phase was intoxication, in which cattle had tachycardia, congested scleral blood vessels, markedly pale mucous membranes, cool skin surface temperature, sunken eyes and a dry muzzle.Blood and rumen fluid samples were analysed as previously described.The abdomen of 123 cattle was scanned from the right side as previously described.A tentative diagnosis of ileus was made in cattle that had a history of abdominal pain or in which such signs were evident on admission, combined with little or no faeces in the rectum. Ileus was definitively diagnosed when dilated small intestines and/or taut bands of mesentery were palpated transrectally; ileus attributable to intussusception was diagnosed when an additional firm mass could be palpated.The ultrasonographic diagnosis of ileus was based on finding dilated loops of small intestines that had a diameter greater than 3.5 cm with absent or greatly reduced intestinal motility. The ultrasonographic diagnosis of ileus attributable to intussusception was based on the sonographic visualisation of the typical bowel‐within‐bowel pattern.A right‐flank laparotomy was carried out after a proximal paravertebral block of the last thoracic and the first two lumbar spinal nerves. Exploratory laparotomy was performed via an approximately 25–30 cm vertical incision placed in the mid‐paralumbar fossa. After routine exploration, the supraomental recess was carefully examined for dilated bowel parts, fibrin and signs of adhesion formation. A protective drape was placed in the laparotomy wound and then the affected bowel part was exteriorised if the location of the intussusception allowed it.When resection anastomosis was deemed possible, the resection sites were determined and local anaesthetic was injected close to the vessels of the respective mesentery. Vessels were then ligated with braided absorbable suture material and two bowel clamps were placed at the level of each resection site. The bowel was transected between the bowel clamps using a scalpel and the mesentery was transected with scissors. An end‐to‐end anastomosis was performed using size 2.0 monofilament suture material in a simple continuous pattern, which was interrupted at four sites to avoid a purse string effect. A second suture was usually placed using the same material in a Cushing or Lembert pattern. After anastomosis, the mesenteric defect was closed with a simple continuous suture pattern using an absorbable polyfilament material. After liberal lavage of the anastomosis site, the bowel was repositioned into the abdomen. Using sterile instruments, new gowns and fresh gloves, the abdomen was closed in a routine fashion.Cattle were fasted for at least 24 h postoperatively before feeding was gradually resumed. Medical treatment included antibiotics, fluid therapy, pain control and electrolyte replacement. Antibiotic treatment included penicillin G procaine  or amoxicillin (7 mg/kg BW) given intramuscularly for 1–9 days (median 4 days). Seventy‐six cattle received a daily injection of flunixin meglumine (1 mg/kg BW) or metamizole (35 mg/kg BW) for 1–6 days (median 3 days). All cattle received 10 L of a solution containing 50 g glucose and 9 g sodium chloride per litre daily for 1–12 days (median 3 days) administered as a slow intravenous drip via an indwelling jugular vein catheter. Forty‐eight cows with hypocalcaemia  received 500 mL of 40% calcium borogluconate intravenously for 1–6 days (mean 1 day). Hypokalaemia (potassium less than 4.0 mmol/L) was treated in 53 cattle with daily oral doses of 60–100 g of potassium chloride until normokalaemia occurred . Cows with hypophosphataemia (inorganic phosphorus less than 1.0 mmol/L) or hypomagnesaemia (magnesium less than 0.7 mmol/L) were treated orally with sodium dihydrogen phosphate and/or magnesium oxide.Prokinetic drugs were administered to 54 cattle for a duration of 1–9 days (median 4 days). Twenty‐eight cows received intramuscular metoclopramide and 26 received 40–45 mg neostigmine administered via continuous drip infusion. Seven cows received additional antiparasitic treatment.When indicated, cattle were slaughtered or they were euthanased using pentobarbital (80 mg/kg BW).All cattle that died or were euthanased underwent postmortem examination.p less than 0.05 was considered significant.The program SPSS Statistics 25.0  was used for analysis. Frequencies were determined for all variables and the Shapiro–Wilk test was used to test the data for normality. Means ± SDs were calculated for normally distributed data; medians (with 25th–75th percentiles) were calculated for non‐normally distributed data. The variables heart rate and rectal temperature over time (days 0–7) were analysed using the general linear model, choosing ANOVA with repeated measures and replacing polynomial contrasts with difference. Differences between the frequency distributions of the colic, indolence and intoxication phases were analysed using the chi‐square and the Bonferroni post hoc tests. Differences between the medians and means were analysed using the Kruskal–Wallis test (medians) and ANOVA (means). A value of The demeanour was mildly to severely abnormal in 97.6% of the cattle; 4% were recumbent and 16.7% had abdominal distension , tachycardia (38.1%) and tachypnoea 28.0%) (Table 8.0% (Tabn = 5) were caecal dilatation, dilatation of the spiral colon, taut bands of mesentery and juxtaposition of empty and dilated loops of small intestines. In most cattle (96.0%), the rectum contained only small amounts of faeces or was empty. Faecal colour was dark to black in 30.2% of the cattle and consistency varied from liquid to pulpy to thick pulpy. Abnormal faecal contents included blood, mucus and fibrin.Rumen motility was reduced or absent in 97.6% of the cattle Table . BallottOther clinical abnormalities were reduced skin elasticity (76.2%), sunken eyes (68.8%), hyperaemic scleral vessels (60.3%), reduced skin surface temperature (60.2%), dry cool muzzle (57.9%), prolonged capillary refill time (40.8%), ammonia‐like breath (25.4%), pale oral mucosa (23.2%), cold ears (11.4%) and droopy ears (6.3%).Urine pH ranged from 5.0 to 9.0 and was acidic (6.0 or less) in 29.7% and alkaline (greater than 8.0) in 22.5% of the cattle. The specific gravity ranged from 1.007 to 1.065; in 12.4%, it was less than 1.020 and in 17.1%, it was greater than 1.040. Glucosuria occurred in 49.5% of 111 cattle, haemoglobinuria/haematuria in 48.6%, proteinuria in 5.4% and ketonuria in 3.6%.Only the haematocrit, total protein concentration and venous blood pH were normally distributed Table . The prip < 0.01) in the colic phase  than in the indolence phase  and intoxication phase . Spontaneous grunting also occurred less frequently in the colic phase (1.7%) than in the indolence (3.4%) and intoxication (25.0%) phases. The median rectal temperature was 38.4°C in the colic phase, 38.3°C in the indolence phase and 37.5°C in the intoxication phase (p < 0.05) . The concentration of serum chloride  Figure  and pCO22 Figure  were lowe Figure  and urinThe principal findings were reduced or absent small intestinal motility (98.2%), dilated loops of small intestines (96.0%) and fluid between intestinal loops (65.9%) Table . In 8.1%A total of 29.4% of cattle had one (19.9%), two (6.3%) or three (3.2%) diseases. The most frequent were gastrointestinal parasitism, mastitis, claw lesions, enteritis and fascioliasis.n = 120) and provided a correct diagnosis of intussusception in 12 of these cattle.Based on the clinical findings alone, a tentative diagnosis of ileus was made in 70.6% of the cattle, a definitive diagnosis of ileus in 25.4% and a diagnosis of ileus attributable to intussusception in 0.8% (Table Eleven (8.7%) cows were euthanased or slaughtered after the diagnosis had been made because of a poor prognosis Figure . AnotherOf 114 cattle that underwent laparotomy, 38 were euthanased intraoperatively; the operation was completed successfully in the remaining 76 cattle. In two of the latter, the intussusception was reduced manually; the remaining 74 underwent bowel resection and anastomosis; all received medical postoperative treatment for 3–12 days (median 3–4 days). Fifteen cattle were euthanased or died postoperatively, 13 were operated on a second time and 56 were discharged.Thirteen cows did not eat or defaecate after surgery and therefore underwent relaparotomy; of these, five were euthanased during or after surgery and the remaining eight were discharged. Seven of the latter had intestinal atony and were treated by massaging the intestinal content from the non‐motile segments aborally; one underwent intestinal resection and anastomosis because of a recurring intussusception.In summary, 114 (90.5%) cattle were treated surgically and 13 of these were operated on twice. Seventy (55.6%) cattle were euthanased or slaughtered and 56 (44.4%) were treated successfully and discharged. Fifty percent of cattle in the colic and indolence phases survived and no cattle survived from the intoxication phase.The intussusception was jejunojejunal in 94.4% of the cattle and jejunoileal, jejunoileocaecal, ileocaecal or ileoileal in another 5.6% Figure . In the n = 23). Twenty cows had peritoneal effusion and another 20 had fibrinous adhesions. In six cattle, the mesentery or even the greater omentum was involved in the intussusception. Five cattle had a ruptured bowel and two cows had two or three intussusceptions.Intraoperative complications occurred in 39.5% of the 114 operated cattle and included cows becoming recumbent with subsequent contamination of the intestines, contamination of the abdominal cavity during resection, haemorrhage, rupture of the bowel during surgical manipulation and suboptimal anastomosis. Other findings were mesenteric lesions (n = 2), appetite (n = 5) and defaecation (n = 1) did not return to normal during hospitalisation.The demeanour and appetite of the successfully treated cattle returned to normal within 1–16 days Figure  and normp < 0.01, Figure The rectal temperature increased within 7 days from 38.3°C to 38.7°C . It failed to return to normal during hospitalisation in two cows (increased in one and decreased in one other).The median heart rate decreased within 7 days from 80 to 72 bpm , one animal had necrosis of the anastomosis and one other had bowel obstruction at the site of anastomosis. Fourteen cattle had unclotted or coagulated blood in the intestines and seven had enteritis. Five cattle had localised peritonitis, five had generalised peritonitis and three had fascioliasis.A protracted course is typical for intestinal intussusception, presumably because of progressive occlusion of the intestinal lumen and impaired flow of intestinal contents.Although many different disorders result in a positive BSA and/or PSA on the right side, this finding usually points to a serious gastrointestinal condition. Further diagnostic measures must be instituted if the aetiology cannot be determined. The results of BSA and/or PSA were positive on the right side in 65.9% of cattle with intussusception, which was much lower than test results in cows with abomasal volvulus (99.4%),3 and 100% in other studies.Transrectal palpation of dilated loops of small intestines supported a diagnosis of ileus in 24.6% of all cattle, while palpation of the actual intussusception was only possible in two cows. In contrast, a study of 48 cows with SII reported that dilated small intestines could be palpated transrectally in 50% of the cows and a firm mass that was thought to be the actual intussusception could be palpated in 22.9%.Characteristic ultrasonographic findings in cows with ileus are reduced or absent intestinal motility and dilated small intestines,Indications of intussusception include signs of protracted ileus, transrectal palpation of the intussusception (rare) and visualisation of the intussusception as a bowel‐within‐bowel structure via ultrasonography (rare). Based on a discharge rate of 44.4%, ileus attributable to intussusception had a guarded prognosis. The long‐term outcome was good in most successfully treated cows.Ueli Braun initiated, planned and supervised the study and prepared the manuscript. Christian Gerspach and Karl Nuss were involved in revising the manuscript. Surgical treatment was performed by Karl Nuss and his assistants. Monika Hilbe was responsible for the postmortem examinations. Claudia Volz and Muriel Boesiger analysed the medical histories of the cows as part of their master's theses. All authors read and approved the final manuscript.The authors declare they have no conflicts of interest.Not applicable since it was a retrospective analysis of medical records.Informed consent was gained from the owners of all cows before clinical, laboratory and ultrasonographic examinations were started.2 (C) and serum chloride (D) in the colic (n = 59), indolence (n = 59) and intoxication phases (n = 8).FIGURE S1 Rectal temperature (A), serum urea (B), pCOFIGURE S2 Ultrasonographic (A) and postmortem findings (B) in a 7‐year‐old Brown Swiss cow with jejunal intussusception.FIGURE S3 The location of the intussusception in 126 cattle.FIGURE S4 Rectal temperature of 56 cows after surgical treatment of small intestinal intussusception.Click here for additional data file.


The adrenal cortex tumors (ACT) include both malignant adrenal cortex cancers and benign masses that can be either secreting, of one of the hormones normally produced in the adrenal cortex or non-secretory. We describe clinical features and laboratory finding of patients with adrenal cortex tumors. This is a case series report. 29 cases of childhood with adrenal cortex tumors treated at the Vietnam National Hospital of Pediatrics in a period of 1995–2011 have been reviewed in detail the presenting features and laboratory. The study recruited 15 boys and 14 girls. The median age at diagnosis was 4.97 ± 3.61 yrs ; 19 patients were younger than 5 yrs. Hypertension and cushingoid features were common in patients , virilization was presenting feature in 44.8% of the group. An abdominal mass was palpable in 20.7 % of the patients. High level of testosterone was common in patients (94.1%). 30% of the patients had hypercotisonemia. All tumors were unilateral; the right adrenal glands predominated over left (1.9 :1). 62.5 % tumors over 4 cm. 22 patients had received operation to remove the tumors: 11 carcinoma, 2 adenocarcinoma. In conclusion, high percentage of patients had malignant tumors among ACT operated patients.


Prevalence of obesity is rapidly rising. To reverse the obesity epidemic, efforts should be made to incorporate intensive weight loss programs into medical practice. The primary aim of this study was to change the behavior for achieving a mean weight loss of 5-10% of initial body weight over 6 months in overweight and obese adults.In this quasi-experimental study, 266 out of 533 subjects screened for coronary heart disease risk factors in Shiraz Healthy Heart House were overweight or obese. 140 individuals with BMI≥25 completed this study’s 6 month program. The subjects were visited on day 1 and at 2 week intervals and taught intensive lifestyle modification. The subjects who did not lose 5% of their initial body weight after 3 months were assigned to receive 120 mg orlistat three times daily for 3 months in addition to counseling sessions. The main outcome measures were body weight and BMI.The mean weight and BMI of participants were 78.6±10.7 kg and 30±0.2 kg/m2, respectively. Women included 58% of the sample. 110 subjects (78.5%) lost ≥5% of their initial body weight during 3 months. The Mean weight and BMI loss in these subjects were 7.6±0.8 kg and 2.4±0.3 kg/m2, respectively.Teaching of how to modify lifestyle and to gain more self-control with eating have the major role in reducing weight and BMI. So, training accompanied by continual follow up for performing the instructions could lead to favourable results. Obesity is a well-established risk factor for premature death , 2. An iDespite the steady progress in the management of obesity, its prevalence continues to rise. Considerable research on effective treatment options is required to optimize management and to prevent the increasing prevalence of overweight and obesity. This study aimed to evaluate the weight and BMI loss over 6 months in outpatients to follow intensive lifestyle instructions.According to the Canadian clinical practice guideline (CPG), in this quasi-experimental study (pre-post design), 266 out of 533 subjects screened for obesity in Shiraz Healthy Heart House were overweight (33.08% with BMI≥25 kg/m2) or obese (17.82% with BMI≥30). Exclusion criteria for the study included pregnancy, secondary obesity, drug abuse, thyroid disease and mal-absorption. In addition, all those who failed to appear for follow-up and further consultations and adhere to a diet and more exercise were excluded from the study. A total of 140 individuals with BMI≥25 completed the study’s 6 month program. We sought consent from all participants before conducting the study.Subjects were visited on day 1 and at 2 week intervals during 6 months. On day 1, the participants were taught weight loss related- behaviour change and instructed how to record them. Lifestyle counselling was delivered by a dietician, exercise specialist and physician in individual sessions. Height was measured once. Further visits began with a weighing and then a review of participants’ recording of food intake, physical activity, and other behaviors in sequential handouts.The main goal was to achieve a mean loss of 5-10% of the baseline weight. Diet was written somehow to decrease energy intake by 500-1000 kcal per day. Energy intake was calculated 25 kcal per kilogram of body weight. The base of dietary therapy in obese patients was on a low-carbohydrate diet and DASH Diet protocol with a diet enriched in vegetables, fruits, low-fat, low-fat dairy and grain. In this regimen, high consumption of fibre, potassium, calcium, magnesium and sodium reduction is considered.The participants were also recommended to change their lifestyle activity, for instance walking rather than riding, using stairs rather than elevators, and avoiding sedentary activities.Increased physical activity (PA) was recommended for 3-5 times a week, 30-45 minutes each time depending on the gender and BMI. Contraindications to moderate PA were assessed by the Physical Activity Readiness Questionnaire (PAR-Q). The participants were assessed for PA levels and patterns by Physical Activity Questionnaire. Then, they received a 9-week PA program. It varied from controlled individualized exercise programs to informal group sessions coupled with behavior therapy and dietary changes. The subjects received standard vitamin supplements throughout 6 months of the study.To avoid forgetting the subjects taught, the subjects were provided with an educational pamphlet about diet and increased physical activity. The subjects who did not lose 5% of their initial body weight after 3 months were assigned to receive 120 mg orlistat three times daily for 3 months in addition to counseling sessions (orlistat group). During the study to detect possible side effects of the drug, the liver enzymes were measured.The variables measured included: 1- height and weight to calculate BMI at baseline, 3 and 6 months; 2- sex and age.All data were analysed using SPSS version 17.0. Quantitative variables are expressed as mean±SD. Statistical analyses were performed using repeated measure ANOVA, Tuckey post hoc test and dependent t-test. The chi-square test was used for comparisons of qualitative data. A P value less than 0.05 was considered as statistically significant.The participants included 81 females (58%) and 59 males (42%), with a mean body weight of 78.6±10.7 kg and a mean BMI of 30±0.2. 110 subjects (78.5%) lost ≥5% of their initial body weight during 3 months. Of the remaining 30 subjects who received orlistat, 7 dropped out due to medication side effects including flatus, diarrhea, abdominal pain and fecal urgency. Mean weight loss at the end of 3 and 6 months was 3.7±0.15 and 7.6±0.8 kg compared with baseline weight, respectively (P<0.001 and 0.001). Mean weight loss in the orlistat group was 9.3±1.8 kg (P<0.001 compared with baseline weight) . Mean weMean BMI loss at the end of 3 and 6 months was 1 and 3 Kg/m2, respectively compared with the baseline BMI (P<0.001). Mean BMI loss in the orlistat group (3 months after consumption) was 3.4 compared to a mean loss of 2.4 kg/m2 for the counselling group. This difference was significant (P<0.0001) .Gradient of BMI and weight loss was insignificantly more among the women compared with the men .Orlistat had no adverse effect on SGOT and SGPT level at the end of the study.This is one of the few studies in IR Iran focusing on the training of lifestyle modification among overweight and obese subjects. The principal finding of this study was that a large percentage of participants 78.5%) who received intensive lifestyle counselling with follow up lost 5% or more of their initial weight within 3 months, an amount of weight loss that improves obesity-related risk factors, including lipid concentrations, blood pressure, and glycemic control .5% who r.Six months of therapy is accepted as a reasonable period for a 10 percent reduction in body weight. After 6 months, the rate of weight loss usually decreases and the weight plateaus because of a lesser energy wasting at the lower weight .In this study, 33.08% of the subjects were overweight  and 17.82% were obese (BMI≥30 kg/m2); the prevalence was higher in women. The prevalence of obesity in IR Iran has reached epidemic proportions and is specifically affecting women. In a study on Lipid and Glucose Study in Tehran, 40% of the study population in Tehran, IR Iran, were overweight and 23.1% of them were obese .In this study, the intensive lifestyle counselling produced an average weight loss of 7.6 kg at the end of the study, which was greater than that observed in other studies. Wadden et al randomly assigned 390 obese adults to one of three types of intervention. The results showed that the mean (±SE) weight loss with usual care, brief lifestyle counselling, and enhanced brief lifestyle counselling was 1.7±0.7, 2.9±0.7, and 4.6±0.7 kg, respectively. The initial weight decreased at least 5% in 21.5%, 26.0%, and 34.9% of the participants in the three groups, respectively .The results of this study showed that the effects of lifestyle modification and medication would be additive. Wadden et al found that the combination of lifestyle-modification counselling and pharmacotherapy resulted in an average loss of 12.1 kg at one year .The best strategy to prevent obesity is healthy lifestyle, with special emphasis on a balanced healthy diet, adequate physical activity and regular aerobic exercise, maintenance of ideal body weight, and weight reduction in overweight people .In summary, intensive lifestyle counselling helps more than two thirds of overweight or obese participants who attended individual sessions regularly to achieve a significant loss of weight, which may indicate the usefulness of these sessions. Adding orlistat was useful to produce clinically meaningful weight loss for treatment of obesity in few subjects with BMI more than 30.It is concluded that training accompanied by continual follow up for performing the instructions can lead to favourable results.


A cross sectional study to investigate HPV prevalence according to age and cytology.Women presenting to a gynaecological outpatient clinic for a Pap smear test were included in the study (n=3177). All women had cervical cytology and HPV testing.Overall prevalence of any 24 HPV type analysed was 33.1% (95% CI 31.5% to 34.7%) and HPV 16 and HPV 42 were the most frequent (6.7% (95% CI 5.8% to 7.6%), 6.8% (95% CI 5.9% to 7.6%)), in total samples. Multiple HPV infection rate was 12.9% (95% CI 11.8% to 14.1%). High risk HPV (hrHPV) types were present in 27.4% (95% CI 25.8% to 28.9%) of the samples.HPV prevalence was highest among 14 to 19 y.o (46.6% (95% CI 40.7%-52.4%)) and second highest among 30–34 y.o. . HPV 16 was highest among 20–24 (9.0% (95% CI 6.4%–11.6%)) and second highest among 50 to 54 y.o. (6.3% (95% CI 2.9% to 9.8%).In Low-grade Squamous Intraepithelial Lesions (LgSIL) cytology samples, the most frequently detected hrHPV types were: 16 (14.5% (95% CI 12.1% to 16.9%)), 51 (13.0% (95% CI 10.7% to 15.3%)) and 53 (9.1% (95% CI 7.2% to 11.1%)) and in High-grade Squamous Intraepithelial Lesions (HgSIL) were: HPV 16 (37.2% (95% CI 26.5% to 47.9%)), HPV 51 (17.9% (95% CI 9.4% to 26.5%)) and HPV 18 (12.8% (95% CI 5.4% to 20.2%)).In the population studied, HPV 16 and 51 were the most frequent detected hrHPV types. HPV positivity, hrHPV and multiple HPV types infections were higher in young women, while HPV prevalence declined with increasing age and presented two peaks a higher (14–19 y.o.) and a lower one (30–34 y.o.) These results may contribute to the creation of a national screening programme. Overall and age specific distribution of high risk HPV (hrHPV) and low risk HPV (lrHPV) types data across geographical regions is crucial for the optimization of prevention strategies in each country -4. Over HPV 16 and HPV 18 are the most common oncogenic types associated with cancer, and are targeted by recently developed vaccines [In order to improve the current cervical screening process, it is essential to combine cytology and HPV testing. Large scale randomized controlled studies need to be performed to establish the most efficient and cost effective cervical cancer screening programme. In Greece there are limited epidemiological data on HPV prevalence -12.The aim of this study is to describe the prevalence and age distribution of different HPV types among women presenting for a Pap smear in an outpatient clinic in Greece.st Department of Obstetrics and Gynaecology, University of Athens, ‘Alexandra’ Hospital (participation rate 33%), between January 2007 and November 2010 in order to have their annual test Pap.The study group consisted of a consecutive sample of 3177 Caucasian women between 14 and 70 years old who proceeded to the Outpatient Gynaecological Clinic of Regional Anticancer Oncology Hospital of Athens “St. Savvas” (participation rate 67%) and 1The patients were also offered HPV test with the knowledge that it is not part of the screening. Women were eligible if they were no pregnant and had no history of HPV cervical disease. All patients included in the study have been only checked once throughout these years. Adequate specimens had been obtained from all of them, except 7, which were excluded. All patients included in the study gave their written informed consent after discussing with gyneacologists that there would be no implications to their health. Sexually active adolescents attended either an adolescent health clinic or an adolescent gynecology clinic in order to have gyneacological tests, such as conventional genital cultures, and were offered cervical screening and HPV typing as part of a sexual health prevention protocol. All adolescents and their guardians gave their written informed consent prior to being examined after discussing with gynaecologists that it would have no impact on their well being. Ethical approval was granted by the ethics committee of Regional Anticancer Oncology Hospital of Athens “St. Savvas”.The studied population was divided into three age groups according to the biological alterations in women’s reproductive system , in order to facilitate the recognition of specific differences in the biological and clinical behaviour of HPV infection across the years. Cervical cell scrapings were collected by a gynaecologist with a cytobrush  from the ecto- and endo-cervix of the uterus. A slide was prepared for conventional cytology and the cytobrush was then placed in specimen transport medium  and stored at 4°C until prepared for HPV molecular analysis. Cytological findings were classified in line with the 2001 Bethesda classification system. The smears were submitted to two cytopathologists who worked separately and the results were discussed. In rare cases of discrepancy the smear was submitted to the Head of the Cytopathology department. The Cytopathology department has established an internal and also external quality control based on international external quality assurance tests  5 ml of Thin Prep samples were used for DNA isolation. They were centrifuged, diluted into lysis buffer  and finally subjected to the NucliSENS® easyMAG®platform (bioMérieux Hellas S.A) for automated extraction, according to manufacturer’s instructions. Nucleic acids were eluted in 55 μl of elution buffer. DNA quality test was carried out using Human Globin, Beta, Primer set kit  according to manufacturer’s instructions. Aliquots were stored appropriately for further processing.The PapilloCheck® HPV-Screening  was used. This technology is based on a DNA chip for the type-specific identification of 24 HPV types  [Data were analysed using SAS v9.0. Absolute and relative frequencies were used to present the HPV types distribution according to age and cytology. The HPV prevalence and 95% confidence intervals were calculated using binomial methods and stratified by cytology report and HPV category. Chi-squared tests were performed to assess statistical significance of any differences in prevalence. 2 × 2 contingency tables Fisher’s exact test was performed along with Odds Ratio and 95% confidence intervals calculation. Pearson’s Chi Square test was used in cases of contingency tables bigger than 2 × 2. Cochran-Armitage test for trend was used to investigate trend in distribution of certain types and multiple HPV infection according to escalation of age. 2-independent samples t-test was used, along with relevant descriptive statistics  to compare average age among patients depending on presence of specific types and multiple infections. 5% level of statistical significance and 95% confidence intervals were used.The response rate was 62% 3177/5124) and the final sample consisted of 3170 women with complete cytological and HPV-DNA testing results. The majority of them were Greek  and a 5.6% (177/3170) were Caucasian immigrants living in Greece. Women were 14–70 years old (mean age 34.2) and were divided according to their age in three groups: 14-25 , 26–46 y.o.  and 47-70 y.o . Their cytology results and distribution by age group are shown in Table 77/5124 aOverall, 1049 of the 3170 (33.1% (95% CI 31.5% to 34.7%)) samples were found to harbour an HPV infection. We examined HPV prevalence in 5-year periods in order to assess age trends in relation to HPV infection in more detail. HPV prevalence exhibited a peak of 46.6% (95% CI 40.7%–52.4%) at 14–19 y.o. and a second peak at the age group 30-34 y.o.  which decreased thereafter , 34% , 74.4%  and 92.3% , respectively . Overall, HPV 16 was the most common high risk HPV type present with a prevalence of 6.7% (95% CI 5.8% to 7.6%), followed by HPV 51 , HPV 53 , HPV 56  and HPV 31  , 51  and 53 . Among ASCUS cytology samples, only hrHPV types were detected; HPV 16 was once more the most frequent type  followed by HPV 51  and HPV 45 . The three most frequently detected hr HPV types were 16 , 51  and 53  in LSIL. In HSIL the most common hrHPV types were 16 , 51  and 18  , followed by HPV 44  and HPV 6 . These three lrHPV types were detected in this order in women with normal cytology (3.6% (95% CI 2.8% to 4.4%), 0.9% (95% CI 5.0% to 13.0%) and 0.6% (95% CI 3.0% to 10.0%) respectively). HPV 42 was the most frequent lrHPV type detected in LSIL  followed by HPV 6  and HPV 44   and HPV 16 prevalence remained relatively high until the age of 35-39 y.o. and decreased sharply thereafter. A second peak of 6.3% (95% CI 2.9%–9.8%) was present at women aged 50–54 y.o and the prevalence dropped in older women  of all samples and 39.1%  of the HPV infected samples ) than in ASCUS , Fisher’s exact test p value p<0.001) or normal , Fisher’s exact test p value p<0.001).Among women with multiple infections, 66.8% (95% CI 62.3% to 71.4%) were infected with two HPV types; the most common combination was of 16 with 51, 56 with 66 and 6 with 42. There were 22.6% (95% CI 18.6% to 26.7%) of infected women with three HPV types, the most common combinations of which were 11 with 33 and 45 and the combination of 16 with 42 and 45. There were also cases with 4 HPV types , 5 HPV types  and 6 HPV types .We present a large study of HPV prevalence in women of different ages in the area of Athens, from which interesting conclusions can be drawn. As HPV DNA typing is gradually incorporated in national screening programmes knowledge of HPV type variations in different geographical regions is useful information. Similarly, as HPV vaccination is introduced as a means of primary cervical cancer prevention, better prediction models of its efficacy specific for each area can be made .In our study and in concordance with what is seen in the general population, normal cytology dominated all age groups. The highest LgSIL rates appeared among women aged 14–25 years. Only a minority (1.5%) of young girls had a high grade lesion and this is again consistent with what is seen in the literature. It also justifies the current American and British screening programme that suggest smear testing after the age of 21 and 25 respectively .In our study, the HPV prevalence in normal samples was 15.7%. For Eastern Europe, HPV prevalence in a meta-analysis of 4053 samples tested with normal cytology was 21.4% ,12 whichIn an attempt to compare our results with other countries’ epidemiological data, we presented an age-related prevalence curve of HPV infection. This curve showed a peak at the 14–19 age group, a second one at 30–34 y.o. and then dropped. Although the study by Coupe et al conducted in the Netherlands demonstrated an association between age and HPV prevalence , others As expected, HPV prevalence, increased as lesions progressed to higher grade ones. The same trend was observed in hrHPV positivity in relation to cytological status. Investigating the results per age group, we observed that hrHPV infection dominated in 14-25 year old women irrespective of cytology. However young women are less likely to present cancerous lesions as in the majority of cases the lesion regresses after 2–3 years ,22.Previously, in a 1636 women cohort study conducted by this group, where the prevalence of subtypes 6, 11, 16, 18, 31 and 33 was tested, HPV 11 was found to be the most frequent . In the HrHPV distribution in Mediterranean countries like Italy, Portugal, Spain -26 is siMultiple infections were found in 12.9% of Greek population. Multiple HPV positivity was more common in younger women. In addition, women with cervical lesions had a higher rate of multiple infections compared to those who had normal cytology. Multiple infections might be a risk factor for development of cytological abnormalities. The majority of multi-HPV infected women harboured at least one hrHPV type and the majority of those carried two types, which is consistent with other epidemiological studies [Although this study presented here included a large number of women of a broad age range, it has some limitations. Our sample is representative of women presenting for smear testing. However, as smear taking in Greece is done on an ad hoc basis rather through an organised screening system, our sample cannot be considered representative of the Athenian population. These data may give us important information regarding regional HPV prevalence but large epidemiological studies from different regions of our country are needed.HPV 16 and 51 were the most commonly identified hrHPV types, present in 6.7% and 5.7% overall and 37.2% and 17.9% in HgSIL cytology samples, respectively. Multi infection was present in 39.1% of infected cytology samples. Our results were comparable with what has been found in other Mediterranean countries.HPV positivity, hrHPV and multiple HPV types infections were higher in young women. HPV prevalence declined with increasing age and presented two peaks a higher (14–19 y.o.) and a lower one (30–34 y.o.). HPV 16 prevalence remained high until 35-39 y.o. and presented a second peak in women aged 50–54 y.o. These results may contribute to the creation of a national screening programme.The authors declare that there are no competing interests.EA carried out the molecular tests, participated in the statistical analysis and drafted the manuscript. SP and ET carried out the molecular tests, participated in the statistical analysis and helped to draft the manuscript. LM and EM performed gynaecologic examinations and helped to draft the manuscript. IP participated in the statistical analysis and helped to draft the manuscript. DD performed the cytologic analysis. IT and GM performed gynaecologic examinations. EP designed and coordinated the study and helped to draft the manuscript. All authors read and approved the final manuscript.The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2334/13/53/prepubHPV type distribution according to the cytology subgroups.Click here for fileHPV type distribution according to the age groups.Click here for file


Schistosoma mansoni infection.In schistosomiasis control programmes using mass chemotherapy, epidemiological and morbidity aspects of the disease need to be studied so as to monitor the impact of treatment, and make recommendations accordingly. These aspects were examined in the community of Musoli village along Lake Victoria in Mayuge district, highly endemic for S. mansoni was 88.6% (95% CI: 85.6–91.5). The geometric mean intensity (GMI) of S. mansoni was 236.2 (95% CI: 198.5–460.9) eggs per gram (epg) faeces. Males had significantly higher GMI (370.2 epg) than females (132.6 epg) and age was also significantly associated with intensity of infection. Levels of water contact activities significantly influenced intensity of infection and the highest intensity of infection was found among people involved in fishing. However, organomegaly was not significantly associated with S. mansoni except for very heavy infection (>2000 epg). Liver image patterns C and D indicative of fibrosis were found in only 2.2% and 0.2%, respectively. S. mansoni intensity of infection was associated with portal vein dilation and abnormal spleen length. Anaemia was observed in 36.4% of the participants but it was not associated with S. mansoni infection intensity. Considering growth in children as one of the morbidity indicators of schistosomiasis, intensity of S. mansoni was significantly associated with stunting.A cross sectional descriptive study was undertaken in a randomly selected sample of 217 females and 229 males, with a mean age of 26 years . The prevalence of S. mansoni infections were highly prevalent, the two were only associated for individuals with very high infection intensities. These results contrast starkly with reports from Ugandan Lake Albert fishing communities in which periportal fibrosis is more prevalent.Although organ-related morbidity, with the exception of periportal fibrosis, and  Schistosoma mansoni infection is one of the Neglected Tropical Diseases (NTDs) that perpetuate poverty, especially in Sub Saharan Africa. It is associated with hepatomegaly, splenomegaly or hepatosplenomegaly, liver fibrosis and anaemia. Control of schistosomiasis is now a priority in most endemic countries in Africa as a component of integrated control of NTDs using mass drug administration (MDA). Other than the new WHO strategic plan to eliminate schistosomiasis as a public health problem in WHO Africa region by 2020, the major target in the control of schistosomiasis has for a long time been reduction of its related morbidity. Epidemiological and morbidity studies are key in monitoring the impact of an intervention. However, epidemiology of schistosomiasis and its related morbidity have been shown to vary in different endemic areas and communities. We report on the epidemiology of S. mansoni infection and related morbidity in a community in Mayuge District along Lake Victoria in Uganda. Schistosoma mansoniIn Uganda, schistosomiasis is mainly caused by Schistosome eggs trapped in the host tissue are the major cause of morbidity. Eggs trapped in the liver cause granulomatous reactions and lead to formation of fibrotic lesions with hepatosplenic enlargement which may in turn cause portal hypertension and hepatosplenic schistosomiasis S. mansoni infection and its related morbidity among communities living along Lake Victoria.Previously, epidemiological and morbidity data have been reported from the Lake Albert region The study was conducted in Musoli village along Lake Victoria, Mayuge district in South East Uganda. The district lies at an altitude of 1161 m above sea level, with temperatures ranging from 19–27°C and receives annual rainfall in the range of 600–1100 mm This was a baseline cross sectional descriptive part of a longitudinal study of randomly selected sample of people stratified by age and sex. Power calculations for multivariate analysis indicated that a minimum sample size of 156 individuals were required. In order to cater for loss to follow up, a higher sample size was selected.S. mansoni, hookworms and malaria.Children 6 years or below were excluded. The study included anthropometric measurements, clinical and ultrasound examinations, haemoglobin assessment and parasitological examinations for S. mansoni. Hookworm infection was only reported as positive or negative. Intensity of S. mansoni infection, described as eggs per gram of stool (epg) was categorised as low: 1–99 epg; moderate: 100–399 epg and heavy: ≥400 epg On three consecutive days, early morning stool specimens were collected from each participant. From each specimen; two slides each containing 50 mg were prepared using the modified Kato Katz thick smear technique + Analyser,Quest Diagnostics Company, Norrköping - Sweden). Anaemia was defined as: Hb<11.5 g/dL for children 5–11 years; Hb<12.0 g/dL for children 12–14 years; Hb<12.0 g/dL for non-pregnant women ≥15 years; Hb<11.0 g/dL for pregnant women; Hb<13.0 g/dL for men ≥15 years, A finger prick blood sample was taken from each study subject and a thick blood smear prepared and stained with Giemsa for diagnosis of malaria parasites. The slides were read on a microscope under an oil-immersion objective 40×. A blood slide was considered negative if 100 fields were read and no malaria parasites seen. Malaria parasites were counted against 200 white blood cells (wbc). Assuming a wbc count of 8000/µL the parasite count was multiplied by 40 (8000/200) to calculate number of parasites/µL. Another drop of blood was absorbed into a micro-cuvette, inserted into a portable photometer . In our study, BMI<15 kg/m2 was considered as underweight, otherwise BMI beyond 15 kg/m2 would have rendered all the children in our study to be underweight.Height was measured to the nearest 0.1 centimetres using a portable stadiometer and weight measured to the nearest 0.1 kg using a Seca portable digital scale. Z scores of height-for-age (HAZ) and weight-for-age (WAZ) were calculated using Nutritional Index Calculator, EpiInfo, Version 6.04 . HAZ and WAZ values less than -2 were considered as stunting and wasting respectively as described by WHO Each individual was clinically and independently examined by three experienced examiners, i.e. one physician and two nurses. The obtained measurements from all the examiners were discussed and a final measurement agreed upon. If the measurements of the three examiners varied greatly, all the examiners repeated the examination.Abdominal palpations were performed as previously described Ultrasonography was performed by two experienced ultrasonographers using a portable ultrasound machine (SSD 500 Aloka with 3.5 MHz curvilinear - 60% probe). Each individual was examined by one ultrasonographer, who would consult another examiner in case of need. The subjects were examined in a supine position lying with their legs stretched on an examination coach. The portal vein diameter was measured at the porta hepatis at the ventral lower end of the caudate lobe as previously described Schistosoma mansoni egg counts and malaria parasite counts were analysed in relation to various predictors using negative binomial regression S. mansoni egg counts were summed for all slides  and total faeces examined ( = no. of slides*0.05 g) was entered as an offset. Similarly, prevalence of infection by S. mansoni, malaria or hook worm infections and of various morbidity indicators  was analysed using logistic regression The data were double entered in Microsoft Excel and analysis performed using Stata 11.0 . Ethical approval was obtained from the Higher Degrees Research and Ethics Committee of the School of Public Health, Makerere University. Ethical clearance was granted by the Uganda National Council of Science and Technology and the Danish National Committee on Biomedical Research Ethics in Denmark. Written in the local language, consent forms were used to obtain individual adult participants' consent while parents or guardians consented on behalf of participants less than 15 years. Participants suffering any minor ailment like clinical malaria, anaemia, diarrhoea and others were treated according to the Uganda national guidelines. Following the National Schistosomiasis Control Programme guidelines, all study participants were treated with 40 mg/kg body weight of praziquantel (Distocide 600 mg) and one tablet of albendazole  all manufactured by Shin Poong Pharmaceuticals, Seoul Republic of Korea, irrespective of their infection status. The rest of the community were treated following the National guidelines.A total of 446 people, 229 males and 217 females, with a mean age of 25.8 years (range 7–68 years) for males and 25.2 years (range 7–76 years) for females, were examined. There were 161 (36.1%) farmers, 70 (15.7%) fishermen, 177 (39.7%) students, while 38 (8.5%) were of other occupations. With regard to ethnicity, 241 (54.0%) were Bantu of the following major tribes: Baganda, Basoga, Basamia and Bagwere. The other 205 (46.0%) were Nilotics . The water contact activities reported in this study were washing clothes or utensils, fetching water, swimming, bathing and fishing. Fishing was reported as the only activity by 4.0%, fetching water as only activity by 26.3%, swimming, washing clothes and fetching water by 53.3% and all  activities were reported by 16.3%. Considering the frequency of exposure, 73.4% of the people reported to go to the lake more than 5 days in a week while 13.0% and 13.6% went there 3–4 days and 1–2 days in a week respectively.S. mansoni was 88.6%. The overall GMI for positives only was 236.3 epg (95% CI: 198.5–460.9) and overall proportions of heavily, moderately and lightly infected persons were 39.0%, 22.2% and 27.4% respectively. Males generally had higher prevalence of infection than females in all age groups, and the interaction between sex and age group was significant (p<0.001). Basically, all males in the age range 7 to 29 years were infected and prevalence of infection among females was high in the age range from 7 to 19 years while prevalence among females aged 20 years and above was low , age group(<0.01), the interaction between gender and age group (<0.001), being a student , having stayed in the area 1–2 years (OR = 0.07 p<0.001) or 3–4 years (OR = 0.2 p<0.01) compared to people having stayed 5 or more years; and engagement in fishing  were all significant. The sample size was reduced to 381, since some people did not report on water contacts (frequencies and type of activity).Intensity of infection varied greatly among individuals with a maximum egg count of 7083 epg. Males had on average 3.40 times higher egg counts than females ; Table 1The following factors tested individually after adjusting for age, sex, and clustering within households were significant: occupation , water contact activity , frequency of visiting the lake , and duration of stay (<0.01). Egg counts as percentage of egg counts among people having stayed 15 or more years were 38.5% (p<0.01), 55.5% (n.s.) and 61.4% for people having stayed 1–2 years, 3–4 years and 5–9 years respectively after adjusting for gender and age group and clustering within households. The final model showed that males had higher egg counts than females, and lower egg counts were associated with people who reported to have water contact 1–2 days per week, those reporting to only fetch water and those having stated only for 1–2 years in the area .The overall prevalence of hookworm infection was 43.3% and did not differ significantly between sexes. Prevalence of hookworm infection increased with age group up to the age group 20–24 years while differences between this age group and those older were not significant. Odds ratios for the age groups 7–9 years, 10–14 years and 15–19 years compared to all older age groups combined were 0.25 (p<0.001), 0.21 (p<0.001) and 0.49 (p<0.05), respectively. Prevalence of infection was not related to the following factors tested individually after adjusting for age effects and clustering within villages: ethnic group, occupation, frequency of water contact, water contact activities or malaria prevalence.S. mansoni and malaria while 106 (23.8%) had S. mansoni, hookworm and malaria.Malaria parasitaemia was found in 291 (65.2%) of the participants with a mean parasite density of 571.4 parasites/µL (95% CI: 430.8–712.1). Prevalence of malaria parasitemia declined with increasing age (p<0.001) from age group 7–9 years to the age group 20–24 years, while differences between the latter and the older age groups were not significant. Odds ratios for the age groups 7–9 years, 10–14 years and 15–19 years compared to all older age groups combined were 9.91 (p<0.001), 5.82 (p<0.001) and 2.86 (p<0.05), respectively. Prevalence of malaria parasitemia was not related to the following factors tested individually after adjusting for age effects and clustering within households: ethnic group, frequency of water contact, water contact activities or malaria prevalence, while occupation was significant (p<0.05) with students having slightly higher levels of infection. A total of 246 people (59.4%) were co-infected with Malaria parasite density did not differ significantly between sexes when after adjusting for age group, while density decreased with increasing age from 5–9 years to the 15–19 years age group (p<0.001). Density did not differ significantly between the 15–19 years age group and those older. Parasite count ratios for the age groups 7–9 years and 10–14 years compared to all older age groups combined were 6.20 (p<0.001) and 3.70 (p<0.001), respectively. Parasite counts in the 10–14 years age group was 60% of those in the 7–9 years age group, while in the 15–19 years age group it was 24% of that in the 7–9 years age group. Malaria parasite density of positives only was 884.8 parasites/µL (95% CI: 600.3–1169.3) in children aged 7–14 years and 303.9 parasites/µL in adults 15 years or older (95% CI: 226.4–381.5).From clinical examinations, after analysing each organomegaly indicators separately, levels of hepatomegaly, splenomegaly and hepatosplenomegaly were moderate. Overall presence of hepatomegaly was 24.2%, splenomegaly 4.9% and hepatosplenomegaly 30.3%.S. mansoni intensity category, malaria or hookworm infection. S. mansoni intensity category tested as the only predictor after adjusting within households was not significant. Length of stay was not associated with hepatomegaly when adjusting for age group.Hepatomegaly did not differ between sexes after adjusting for age groups, while variation across age groups was significant (p<0.05) with adults having slightly lower prevalence of hepatomegaly. None of the following factors were significant when tested individually after adjusting for age category: ethnicity, occupation, water contact activities, Splenomegaly did not differ between sexes or among age groups and none of the factors listed above for hepatomegaly were significant. Length of stay was not associated with splenomegaly when adjusting for age group.Hepatosplenomegaly did not differ among sexes when adjusting for age group, while it varied among age groups (p<0.01) with age groups 15–19 years and older having less hepatosplenomegaly than the 7–9 year class. The odds ratio for adults (15 years and above) compared to children was 0.44. Among other factors tested individually after adjusting for age group and clustering within households only malaria infection was associated (p<0.05) with increased hepatosplenomegaly .S. mansoni and having enlarged spleens and livers, majority had firm organs (92.7% and 89.9% respectively). Length of stay was not associated with hepatosplenomegaly.The odds of having hepatosplenomegaly among the very heavily infected (n = 41) was 3.39 times higher than among people with no infection or with less than 2000 epg (p<0.01) when adjusting for age class. This category of very heavy infections, however, was not associated with splenomegaly or hepatomegaly. Of those infected with Periportal fibrosis (PPF) was rare. A total of 423 (94.8%) and 3 (0.7%) had normal livers with patterns A and B respectively, while ten (2.2%) and one (0.2%) people had liver image patterns C and D respectively. Patterns Z and Y, associated to alcoholic-related liver damage, were observed in 1 (0.2%) and 8 (1.8%) people respectively.S. mansoni infection were not related to portal vein dilatation. However, the odds of having dilated portal vein among the very heavily infected (n = 41) was 4.49 (p<0.001) times higher than among people with no infection or with less than 2000 epg after adjusting for age. Length of stay in the villages was not associated with dilated portal vein prevalence after adjusting for age and clustering within households.A total of 48 people (10.8%) had dilated portal vein diameters. Portal vein dilatation differed significantly between sexes (p<0.05) and among age groups (p<0.05). There was, however, a significant interaction between sex and age group . Apart fS. mansoni intensity category, malaria infection and hookworm infection. Overall 36.4% (95% CI: 31.7–41.1) of the people were anaemic but it was not associated with sex, age group, intensity of infection by S. mansoni, malaria nor hook worm infection.Haemoglobin (Hb) level,  differed between sexes and across age groups, but there was a significant interaction these two variables (p<0.001). None of the other factors evaluated individually after adjusting for sex, age group, the interaction between these two factors and possible clustering within villages were significantly associated with haemoglobin levels, i.e. ethnic group, occupation, water contact, S. mansoni significantly affected the level of stunting (p<0.01). However, there was no evidence of the effect of schistosomiasis on wasting and underweight  with high intensity of infection in this Victoria Lake shore community and infection is related to water contact. The high infection level is typical for endemic areas around Lake Victoria S. mansoni infection intensity occurred in the 15–19 year age group, similar to observations elsewhere S. mansoni infection by reducing cercarial penetration The peak S. mansoniS. mansoni. Our findings are comparable to those among Kenyan school children where no significant difference in hepatosplenomegaly between S. mansoni infected and un-infected children was found S. mansoni infection was further categorised, hepatosplenomegaly showed an association with very heavy intensity. This is in agreement with earlier studies in Uganda The most common observed morbidity indicator in our study, hepatosplenomegaly without fibrosis, concurs with observations from a Kenyan study S. mansoni infection intensity was the same as what we obtained in our study Our study was carried out in a community with more or less similar living conditions as those in a study conducted along Lake Victoria in Tanzania S. mansoni parasites in Lake Albert from those of Lake Victoria In one of the studies along Lake Albert, a lower prevalence of PPF was attributed to shorter duration of exposure to infection S. mansoni was observed and this was attributed to low intensity of S. mansoni infection S. mansoni intensity of infection than the Kenyan study, levels of infection had no effect on anaemia. It should be noted that schistosomiasis may not be the only predictor but other parasitic infections such as malaria and hookworms may cause anaemia Anaemia levels were mild and comparable with findings from other studies S. mansoni infection was observed Growth parameters were computed for only children below 15 years of age because this age group is most susceptible to debilitating effects of schistosomiasis infection S. mansoni infection is highly prevalent in Mayuge district. Whereas there is evidence from this study that an individual's age, sex and occupation influence the level of S. mansoni intensity of infection, only severe heavy intensity of infection has an influence on morbidity. Furthermore, the schistosomiasis specific periportal fibrosis was practically absent. These results indicate that organ related morbidity cannot solely be used as an indicator of successful morbidity reduction when monitoring the impact of a schistosomisis control programme. This is clearly illustrated by this study in combination with previous reports which show that morbidity differs between endemic areas with similar exposure patterns. There is a complex relationship between intensity and organ related morbidity, with these currentresults contrasting starkly with reports from Ugandan Lake Albert fishing communities where periportal fibrosis was more prevalent.In conclusion, Checklist S1STROBE Checklist.(DOC)Click here for additional data file.


Botulinum toxin type A (BOTOX) is licensed for the prophylaxis of headaches in adults with chronic migraine (CM). A prospective study was performed to examine the change in frequency of CM symptoms before and after treatment with BOTOX in the real-life setting.Adults with CM were offered BOTOX after discussion of treatment options. Patients were injected intramuscularly as per PREEMPT, and maintained a headache diary for 30 days before/after BOTOX treatment. Data were collected for the number of headache, migraine and crystal clear (headache free) days. A responder was defined as 50% reduction in headache or migraine days, or an increment in crystal clear days twice that of the baseline in a 30-day period.Full data were available on 67 patients ; 51 females  who received BOTOX. 57/67 (85%) tried 3 preventive treatments and 36/67 (53.7%) were overusing analgesics. The median number of headache days reduced from 27 before BOTOX to 18 after BOTOX(p<0.001); the median number of migraine days reduced from 12 before to 7 after (p<0.001); the median number of crystal clear days increased from 3 before to 12 after (p<0.001). Of the cohort, 34% reported 50% reduction in headache days, 48% a 50% reduction in migraine days and 54% a 50% reduction in crystal clear days. Triptan days reduced from 8 before BOTOX to 3 after (p<0.001). Data on days off work was available for 17/67 patients; in these, the median number of days off work per month reduced from 6 before to 3 after BOTOX(0.004). 13/67(19.4%) reported adverse events; 8 with pain at injection sites, 1 with worsening headache, 3 could not frown and 1 fainted during Rx.BOTOX is a valuable addition to preventive treatment options in patients with CM. It significantly reduces the number of headache and migraine days, and significantly increases the number of crystal clear days in a real-life setting.FA received honorarium as advisory board member from Allergan.


Following the production of Syrian gel, the scientists from Atomic Energy Commission of Syria, researchers in Yazd Atomic Energy Commission Radiation Processing Center in Iran, have manufactured a hydrogel wound dressing. This study was conducted to evaluate and compare the efficacy of these two hydrogels.In this study, 32 male Wistar rats underwent a full thickness circular skin wound on the dorsum under light anesthesia. Animals were divided into two groups. Wounds in the 1st group were dressed by the Syrian hydrogel and in the 2nd group by Iranian gel. Wound contraction rate was determined on days 1, 3, 7 and 12 for comparing the wound healing rate in two groups. Laboratory investigation of blood samples, skin tensile strength and histopathology of repaired skins were also evaluated.Wound contraction ratio on 7th and 12th days in Iranian gel was significantly greater than Syrian gel group. According to histopathological evaluations, wound repair in 63.6% of specimens in Iranian gel group was excellent and in 35.5% good while in Syrian gel group, 54.5% of repaired wounds were graded as excellent and 1 case showed to be in a weak repairing state. A significant difference was noticed in wound repair patterns between the two groups. The differences in skin tensile strength in two groups on days 15 and 30 were not significant.According to our findings Iranian and Syrian hydrogels did not show any adverse effects on wound healing in rats and could be easily removed from the wound area without any trauma. However Iranian hydrogel dressings were more effective in wound repair regarding wound contraction rate and histopathological evaluation of the skin specimens in the region of healed wounds. Following the production of hydrogel wound dressings in USA and European countries,2] inves inves2] Thirty two male Wistar rats weighting 200–250 g were provided by the Shaheed Sadughi Medical University Animal House. For experimental procedures we got the permission of the Animal Ethics Committee of Shahid Sadughi Medical University . Experimental procedures were exactly similar to those described in our previous work. Blood Blood8] During the experimental evaluation there was no sign of wound infection and no significant changes in mean body temperature among the Syrian and Iranian gel groups . Mean percentage of wound contraction on 3rd, 7th and 12th days in Syrian and Iranian gel groups were 18.8±11.4 vs. 22.4±12.8, 54.4±24.6 vs. 70.7±14.6 and 88.3±12.6 vs. 95.5±9.7, respectively and there was a significant difference among two groups in 7th and 12th days (p=0.015 and p=0.036 respectively).In the evaluation of tensile strength, the mean maximum possible tensile length of healed wounds (breakdown length) on day 15 was 26.2±4.1 mm in the Syrian gel group and 27.8±9.8 mm in the Iranian gel group and the difference was not significant (p=0.421). On day 30, also there was no significant deference in the index of tensile strength among Syrian gel and Iranian gel groups. Healed wound specimens were histologically examined and graded into 3 different categories, excellent, good or weak repair. Wound repair in 54.5% of specimens in Syrian gel group and 63.6% in Iranian gel group were excellent and only 1 case (9.1%) in Syrian group showed to be in a weak repairing state. Statistical analysis using Chi-Square test showed a significant difference in wound repairing pattern between the two groups (p=0.008) . Blood sAccording to this study, wound contraction ratio in Iranian gel group on 7th and 12th days were significantly greater than that of Syrian gel group (p=0.015 and p=0.036 respectively). The histopathological evaluation also revealed a significant difference in wound repairing pattern between two groups (p=0.008). Although, some characteristics of hydrogel dressings are evaluated (mainly by the manufacturers), there isThe manufacturers of new Iranian hydrogel indicated that its gel fraction is generally lower than the Syrian gel but their maximum swelling rate is identical. However


Objective: To evaluate the surgical outcomes and complications after laparoscopic adjustable gastric banding (LAGB) in obese patients.Methods: This retrospective study included 228 patients  who underwent LAGB at the Changhai Hospital of the Second Military Medical University from June 2003 to June 2011. The body weight and postoperative complications were followed up.Results: The pre-operative mean body mass index (BMI) was 39.5 ± 6.3 kg/m2. Except in one case of inadequate exposure of the stomach, all laparoscopic procedures were successfully accomplished, with no conversion to open surgery. The mean operation time was 65.0 ± 20.3 min. The mean hospital stay was 2.7 ± 0.9 days. Early postoperative complications (<30 days) occurred in five cases (2.2%) and late complications (>30 days) occurred in 75 cases (32.9%), including 56 cases (24.6%) with band-associated complications. The percentage of excess weight loss (EWL%) at 1, 3 and 5 years was 40.5 ± 30.5%, 59.5 ± 41.5% and 58.9 ± 46.4%, respectively. The percentages of patients with EWL% >25%, >50% and >75% were, respectively, 60%, 33% and 0% at 1 year follow-up, 43%, 39%, and 16% at 3 years follow-up and 40%, 34% and 16% at 5 years follow-up.Conclusion Although LAGB has low peri-operative mortality and morbidity rates, it is associated with a high late complication rate and unsatisfactory weight loss. It may be optional, but not the first choice, for the treatment of obesity. With social development and changes in diet, obesity has become a major public health problem worldwide, with increasing incidence. Currently, surgical treatment is considered to be the only effective method for long-term control of body weight. Laparoscopic adjustable gastric banding (LAGB) has been one of the first and most popular surgical methods to treat simple obesity worldwide. LAGB is widely used because it is a simple surgical procedure and associated with a low surgical risk . In the 2 (range: 28–57.2 kg/m2). All patients had undergone conservative treatments, which failed to reduce body weight. Prior to the operation, all patients were examined in the Departments of Endocrinology, Anesthesia and Nutrition to exclude contra-indications to surgery. The clinical data were collected, including patient’s demographics, routine examinations, pre-operative examinations, pre-operative comorbidities and early postoperative complications. Patients were followed up for periods of 3–70 months. Their BMI, percentage of excess weight loss (EWL%), late complications, band replacement or removal and conversion of band to other surgical approaches were followed up. EWL% was calculated using the normal BMI (<23 kg/m2) for the Asian population [This study included 228 obese patients , who underwent LAGB from June 2003 to June 2011. Their average age was 32.5 ± 10.3 years (range: 14–65 years). Their mean body weight was 113.5 ± 20.4 kg (range: 72–188 kg). Mean body mass index (BMI) was 39.5 ± 6.3 kg/mAll patients had placement of gastric tube and urinary catheter before operation. Under general anesthesia, patients were placed in a reverse Trendelenburg position with 70 degrees of abduction of the lower extremities. Prophylactic intravenous antibiotics were administered during induction of anesthesia. The four- or five-port method was used for LAGB. The pneumoperitoneum pressure was set to 15 mmHg. Swedish Adjustable Gastric Bands (SAGB) were used for all patients. After retraction of the left lobe of the liver and exposure of the left border of the gastric cardia, the superficial serosa at the angle of His was dissected form the left crus of diaphragm to expose the lesser omentum. After the avascular zone of the hepatogastric ligament was cut open, the dissection continued toward the cardiac notch at the posterior wall of the stomach. The retrogastric tunnel was created behind the stomach using the Goldfinger™ dissector  by passing from the posterior wall of the lesser curvature to the loose serosa at the angle of His. After expansion of the main operating port (located in the upper abdomen) to 1.5 cm in diameter, the band was inserted into the abdominal cavity, grasped by the Goldfinger and passed through the retrogastric tunnel. Both ends of the band were jointed and secured outside the gastric wall below the cardia of the stomach. The seromuscular layer at the greater curvature of the stomach was fixed to the left crus of diaphragm with sutures. Two or three seromuscular sutures, above and below the band, were applied to fix the band to the anterior wall of the stomach. The band catheter was withdrawn from the abdominal cavity via the main operating port. After the port incision was expanded to 3–4 cm in diameter to expose the external oblique fascia, the band catheter was connected to an adjustable pump, which was subsequently fixed on the surface of the external oblique fascia. All incisions were closed.Antibiotics were used routinely to prevent postoperative infection. On the second postoperative day, patients underwent upper gastro-intestinal radiography by taking iodine contrasts. Management included a clear liquid diet on the second postoperative day, followed by full liquids from the third postoperative days to the fourth week. The first band fill started on the first month postoperatively with the injection volume <4 ml  under the supervision of X-ray. Based on change in body weight, the injection volume increased by 0.5–1 ml on each occasion and the total injection volume was less than 9 ml. The patients were regularly followed up. The patient’s particulars were examined, including body weight, waist circumference, hip circumference, diet and quality of life. Upper gastrointestinal radiology or endoscopy was performed if the body weight loss was abnormal.t-tests were used to compare the differences between the pre-operative and postoperative data. Probability values less than 0.05 were considered statistically significant.All statistical analysis was conducted using SPSS 19.0 version . Data are presented as A total of 228 patients underwent LAGB. Except in one case of inadequate exposure of the stomach, all laparoscopic procedures were successfully accomplished, with no conversion to open surgery. The mean operation time was 65.0 ± 20.3 min (range: 45–185 min). The mean hospital stay was 2.7 ± 0.9 days (range: 2–6 days). No deaths occurred during the peri-operative period. Early postoperative complications (<30 days) occurred in five cases (2.2%) due to port site infection. All patients were healed after local dressing changes and treatment with antibiotics.Late complications (>30 days) occurred in 75 cases (32.9%) . Band-asFor the rate of loss of follow-up, not all the patients have finished the 5-year follow-up. There were 195, 134, 114, 95 and 42 patients followed up at 1, 2, 3, 4 and 5 years after surgery, respectively. The body weight, BMI and EWL% of these patients are shown in At 1 year follow-up, 64 patients (32.8%) had EWL% >50%, but none of them had EWL% >75%. At 3 years follow-up, 62 patients (54.4%) had EWL% >50%, including 18 patients (15.8%) with EWL% >75. At 5 years follow-up, 23 patients (54.8) had WEL >50%, including 9 patients (21.4%) with EWL% >75 .Figure Obesity has become a serious public health issue worldwide. It has been reported that in 35–74-year-old Chinese adults, approximately 26.9% of men and 31.1% of woman are obese [et al. reported that the late complication rate was 33.6%, which is similar to 32.9% in the present study [et al. [et al. reported that band re-adjustment during the follow-up period significantly influences the effects of LAGB on weight loss [With the increase in the number of procedures and the follow-up period in obese patients after LAGB, a new comprehensive re-evaluation has been made worldwide. It has been reported that LAGB has low mortality and early complication rates, compared with other surgical procedures, in the treatment of obesity . Consistnt study . In addi [et al. . In the ght loss .2 [2 according to the 2000 Asia-Pacific Workshop on Obesity. In the present study, we used BMI ≥ 23 kg/m2 as the definition of overweight to calculate the EWL%. In this way, EWL% can objectively reflect body weight change in Asian people. In a retrospective study, LAGB has been reported to be associated with a high late complication rate and an unsatisfactory weight loss [et al. reported that EWL% at 5 years follow-up was 58.4% [et al. found that EWL% was 54.2% in obese patients with a long follow-up period after LAGB [In China, EWL% was previously calculated, based on the definition of obesity as BMI ≥ 25 kg/m2 . Becauseght loss . Becauseas 58.4% . Similarter LAGB . In the LAGB has been demonstrated to have some advantages, such as ease of operation, low risk and low early complication rate. However, LAGB is associated with a high late complication rate and a requirement of a high level of follow-up management. Although LAGB is efficient in reducing body weight in obese patients, the percentage of patients with successful and perfect weight loss is unsatisfactory. With advances in laparoscopic skills and improvement in other surgical procedures, there is a trend towards replacing LAGB in the treatment of obesity . We beliConflict of interest: none declared.


Chronic idiopathic urticaria (CIU) is a common cutaneous disorder but the influence of initial treatment modality on long-term control is not known. The aim of this study was to evaluate clinical features, and the influence of initial treatment modality on long-term control.641 CIU patients were enrolled from the allergy clinic in a tertiary referral hospital. Disease duration, aggravating factors and treatment modality at each visit were evaluated. Times required to reach a controlled state were analyzed according to initial treatment modality, using Kaplan-Meier survival curves, the Cox proportional-hazards model, and propensity scores. Female to male ratio was 1.7: 1; mean age at onset was 40.5 years. The most common aggravating factors were food (33.5%), stress (31.5%) and fatigue (21.6%). Most patients (82.2%) used H1-antihistamines alone as initial treatment while 17% used a combination treatment with oral corticosteroids. There was no significant difference in the time taken to reach a controlled state between patients treated with single vs multiple H1-antihistamines or between those who received H1-antihistamine monotherapy vs. a combination therapy with oral corticosteroids.The time required to control CIU is not reduced by use of multiple H1-antihistamines or oral corticosteroids in the initial treatment. Chronic idiopathic urticaria (CIU) has symptoms that occur daily or almost daily, usually with no obvious stimulus, and that last for more than 6 weeks 2LEN)/European Dermatology Forum (EDF)/World Allergy Organization (WAO) recommend non-sedating H1-antihistamine as the first-line treatment and a four-fold increase in dosage of non-sedating H1-antihistamine for patients who do not respond to the standard dose Current guidelines from the European Academy of Allergy and Clinical Immunology (EAACI)/Global Allergy and Asthma European Network , duration of symptoms, presence of angioedema, atopic status, aggravating factors, history and response to previous treatment. Laboratory investigations were: complete blood count with differential counts, erythrocyte sedimentary rate (ESR), antinuclear antibodies (ANA), and serum level of complement and total IgE. A skin prick test was performed on patients who reported that food was a possible aggravating factor; they were tested for 32 items to evaluate sensitization to food allergens. The urticaria activity score (UAS) ranged from 0 to 6, depending on the number of wheals (0–3 points) and the intensity of pruritus (0–3 points). In our medical center, the UAS has been included in the electronic medical records since July 2010 according to the current guidelines from EAACI/GA1-antihistamine agent vs. multiple H1-antihistamines; group II: H1-antihistamine monotherapy vs. combination therapy with oral corticosteroids. The disease was clinically classified as controlled when the symptoms were completely resolved or much improved without changing the treatment (either by increasing the dose or adding another agent) at the next outpatient visit. Finally, we analyzed the time taken to control the disease, according to the initial treatment modality.The treatment modality and therapeutic response at each visit were also evaluated by reviewing the medical records. We divided the patients into two study groups according to the initial treatment modality. Group I: single H2 tests were used to compare categorical variables, and independent Student’s t-tests were used to compare continuous variables. We used a Kaplan-Meier analysis to determine the probability of symptom control at each point in time, and the log-rank test to compare the time to control according to the initial treatment modality. The subjects in each treatment group were matched on a propensity score to minimize the baseline differences in time to control between the groups p<0.05.Descriptive statistics  were used to describe the demographic data, laboratory findings and aggravating factors. Fisher’s exact tests and χOf the 641 patients with CIU, 407 (63.5%) were females, and the female to male ratio was 1.7: 1. The mean age at onset was 40.54 years and the mean duration of symptoms before evaluation was 3.76 years . 433 (67.6%) of the 641 patients had urticaria alone; 190 patients (29.6%) had urticaria with angioedema; and 18 patients (2.8%) had only angioedema. 150 patients (23.5%) had a history of atopy. Of these, 99 patients (15.5%) had allergic rhinitis alone, 4.2% had asthma, 1.7% had allergic rhinitis and asthma, and 1.7% had atopic dermatitis. A total of 131 (20.4%) CIU patients underwent diagnostic test for Helicobacter pylori (HP) infection and 83 (63.3%) of them accompanied by HP infection. Some of the subjects had concomitant autoimmune diseases such as Grave’s disease (0.8%), Hashimoto’s thyroiditis (0.2%), rheumatoid arthritis (1.1%), and systemic lupus erythematosus (0.3%). The UAS for assessing CIU activity was measured in 106 patients at the first visit and the mean value was 4.02±1.71 .3  and the eosinophil percentage was 2.9±3.18% . 126 of 438 patients (28.77%) who were tested for ESR had elevated values (>20 mm/h). Serum total IgE level was measured in 458 patients and the mean total IgE level was 278.74±393.54 kU/L . The mean absolute eosinophil count in peripheral blood was 175.75±181.88 cell/mm.9±3.18% .1-antihistamines alone and 103 patients (17%) used a combination treatment with oral corticosteroids. However, 96 (15.8%) of the patients treated with oral corticosteroids received corticosteroid therapy for a short time . Only 7 patients (1.2%) used steroids continuously. Other agents such as a leukotriene antagonist, amitriptyline or dapsone were used in addition to H1-antihistamines in 5 patients (0.8%). Levocetirizine, fexofenadine, and ebastine were the most frequently used H1-antihistamines  received Hstamines . There wstamines . As the t visits . The tim1-antihistamines for the initial treatment, but there was no significant difference in UAS   .1-antihistamine reached a controlled state one month after initial treatment, compared with 52% of patients who received multiple H1-antihistamines. After 3 months, 85% of the single H1-antihistamine group and 78.3% of the multiple H1-antihistamine group were controlled; after 6 months, these figures were 93.2% and 89.1% respectively. There was no significant difference between the two treatment groups in the time taken to reach control (p = 0.142)  .1-antihistamines; 139 pairs of patients were identified. There was still no significant difference in the disease control in the two treatment groups (p = 0.450). When the UAS values were adjusted, although only 12 matched pairs of patients were identified, the result did not change significantly (p = 0.660) (Propensity scores were used to adjust for differences in baseline characteristics between patients treated with single vs. multiple H= 0.660) .vs. 4.58, p = 0.191) (p = 0.764)  . 56.6% o= 0.764) .p = 0.336)  . Howeveret al. reported in 1983 that 8.8% of 147 chronic urticaria patients who visited a tertiary hospital had a history of atopic disease et al. reported that 21.2% of 113 patients with chronic urticaria had atopic diathesis, and that 18.6% of these had allergic rhinitis and 1.8% asthma This is a retrospective observational single-center study of the patients with CIU in Korea. The predominance of women in our study corresponds with that in US, European and Asian studies et al. found that patients with CIU were 1.89 times more likely to have a current diagnosis of posttraumatic stress disorder (PTSD) than the control group Five hundreds of 639 patients with CIU (78.2%) had one or more aggravating factors. This finding is consistent with the result of a previous study in Korea showing that 70.1% of patients reported aggravation of their symptoms by one or more eliciting factors, but the major factors in the two studies are different. In the previous study conducted in another tertiary hospital in Korea, the common aggravating factors were stress or nervousness (40.1%), exposure to heat (33.3%), exposure to cold (18.4%), and sweating (15%) 1-antihistamine is the main treatment in most patients. However, treatment with licensed doses of H1-antihistamines relieves the symptoms in fewer than 50% of patients 1-antihistamine was used in 44.2% of the study population as the initial treatment, 38% of the population used two or more H1-antihistamine agents, and 17% of the patients used oral corticosteroids in bursts or continuously. A study conducted at Beth Israel Deaconess Medical Center reported that H1-antihistamine monotherapy was administered to 37% of CIU patients and corticosteroid or cyclosporine was used in 28% of the study population. These data show that corticosteroid or cyclosporine is more likely to be used in the first 6 months or after 5 years of the disease  Symptomatic therapy with a non-sedating H1-antihistamine agents or a short course of oral corticosteroids at the start of treatment is often prescribed in tertiary hospitals because patients require faster relief of symptoms. Corticosteroids may help reduce the duration of acute urticaria 1-antihistamines or oral corticosteroids to a single H1-antihistamine in the initial treatment. There may be some advantages in use single H1-antihistamine modality in the initial treatment of CIU. First, this strategy could reduce medication cost. Second, this could prevent the patients from undergoing potential adverse effects by taking high doses of antihistamines. In addition, overuse of oral corticosteroids in the initial treatment can be reduced through our study, because many practitioners tend to use oral corticosteroids for the purpose of quick relief of symptoms. However, we don’t mean that oral corticosteroids should not be used even in cases of severe or exacerbated CIU. We tried to investigate whether it is reasonable or not to use multi-modality drugs as initial treatment of CIU in aspect of long-term prognosis. And, our findings cannot be applied for use of other agents such as cyclosporine, leukotriene antagonist, amitriptyline, or dapsone.A combination of more H1-antihistamine or oral corticosteroids. To our knowledge, this is the first study concerning the influence of initial treatment modality on the long-term control of CIU.To overcome the limitations of a retrospective observational study, and to reduce the impact of treatment-selection bias, we applied propensity scores. However, we still found that control of the disease was not affected by initial combination therapy with additional HOne limitation of the study was the lack of UASs for assessing CIU activity in patients and monitoring their response to treatment. Also, because we had to evaluate the patients during clinic visits, we could not detect changes in the disease between visits.1-antihistamines, or oral corticosteroids, in patients who have CIU, unless they present with very severe symptoms. Additional well-designed prospective randomized control studies are needed to provide robust evidence of the therapeutic efficacy of each treatment modality, and this may contribute to the development of practical treatment strategies for CIU.In conclusion, this study provides insight into the clinical features of CIU patients in a tertiary referral hospital in Korea. Our data suggest that physicians should not routinely prescribe multiple HTable S1Non-sedating H1-antihistamines used as initial treatment.(DOCX)Click here for additional data file.Table S2The rate of maintenance, addition of other agents, and switching to a different H1-antihistamine in the most commonly used H1-antihistamines.(DOCX)Click here for additional data file.Table S3The time from initial treatment to control chronic idiopathic urticaria according to initial treatment modalities.(DOCX)Click here for additional data file.