tetracycline and Hair-Diseases

To determine the effect of trichiasis surgery on visual acuity.. A total of 439 participants in the Surgery for Trichiasis, Antibiotics to Prevent Recurrence (STAR) trial had visual and subjective concerns measured before and 6 months after surgery. Trichiasis surgery was performed in at least 1 eye by integrated eye care workers. Visual acuity was measured using illiterate E versions of Early Treatment Diabetic Retinopathy Study charts with standardized, forced-choice procedures. Improvement was defined as improvement in visual acuity greater than 1 line (5 letters).. The mean improvement in visual acuity for the eyes that had surgery was 0.129 logMAR units (P < .001). Surgery was associated with improvement in visual acuity compared with no surgery (odds ratio, 1.68; 95% confidence interval, 1.04-2.70). Independent predictors of visual acuity improvement in the eyes that had surgery included the number of lashes touching the globe prior to surgery and baseline visual acuity. Among patients, 93.8% described significant pain and 90.4% significant photophobia at baseline compared with only 1.4% and 0.9%, respectively, following surgery.. Surgery to correct trichiasis appears to provide significant visual acuity improvement as well as a decrease in subjective concerns in patients with trachomatous trichiasis.. clinicaltrials.gov Identifier: NCT00347776.

Topics: Administration, Oral; Adult; Age Distribution; Anti-Bacterial Agents; Azithromycin; Ethiopia; Eyelashes; Eyelid Diseases; Female; Hair Diseases; Humans; Male; Middle Aged; Ophthalmologic Surgical Procedures; Sex Distribution; Single-Blind Method; Tetracycline; Trachoma; Visual Acuity

Trichiasis recurrence following surgery is a serious problem for trachoma programs.. To determine if postoperative treatment with azithromycin compared with topical tetracycline reduces recurrence up to 1 year, and if azithromycin treatment of household members provides additional benefit compared with treating only the surgical patient.. A randomized, single-masked, clinical trial was conducted in Ethiopia. A total of 1452 patients with trichiasis were randomized 1:1:1 to the following 3 arms: single-dose (1 g) oral azithromycin alone, single-dose azithromycin for household members (20 mg/kg up to 1 g) plus the patient, or topical tetracycline (twice per day for 6 weeks).. Trichiasis recurrence within 1 year following surgery.. The combined azithromycin groups had significantly fewer recurrences, 6.9 of 100 person-years overall, compared with topical tetracycline, 10.3 of 100 person-years (P = .047). There was no additional reduction in the arm that also treated household members, 8.1 of 100 person-years, compared with treating the surgical patients alone, 5.8 of 100 person-years (P = .19).. In trachoma-endemic areas, a single dose of azithromycin reduced postoperative trichiasis recurrence rates by one third compared with topical tetracycline. Application to Clinical Practice In countries where azithromycin is part of the Trachoma Control Program, patients with trachomatous trichiasis should be treated postoperatively to prevent recurrence.

Topics: Administration, Oral; Anti-Bacterial Agents; Azithromycin; Ethiopia; Eyelashes; Eyelid Diseases; Female; Hair Diseases; Humans; Male; Middle Aged; Postoperative Complications; Secondary Prevention; Single-Blind Method; Tetracycline

To test the validity and repeatability of a newly designed Trachoma Rapid Assessment (TRA) methodology.. Results from an initial TRA in 20 villages (TRA1) are compared with those of a second validation TRA (TRA2) after 6 weeks in 13 villages, randomly selected out of the original 20, conducted by different field staff. Findings of TRA1 and TRA2 are compared with those of a door-to-door survey of the entire population of all 13 villages.. There is a considerable amount of variation between the results of TRA1 and TRA2 and between the results of both TRA's and the door-to-door survey. Even indicators that should have remained the same, like distance to Primary Health Centre or distance to trichiasis surgery facility, scored differently.. The TRA methodology is easy to use and the results are quickly available. The scoring system indicates which intervention(s) of the SAFE strategy are needed and facilitates priority setting. The definition of some indicators, like availability and use of latrines, may need modification. In some cases, the scoring system seems to exaggerate differences between the actual findings. The consistency between two TRA's in the same village is low and the accuracy in measuring the actual situation is doubtful.

Topics: Anti-Bacterial Agents; Blindness; Child; Child, Preschool; Diagnostic Techniques, Ophthalmological; Eyelashes; Gambia; Hair Diseases; Health Surveys; Humans; Infant; Prevalence; Reproducibility of Results; Rural Population; Tetracycline; Trachoma

The fight against blinding trachoma is being addressed with an integrated strategy of surgery, antibiotics, hygiene promotion, and environmental improvement-the SAFE strategy, but its cost-effectiveness is largely unknown. This paper estimates the cost effectiveness of surgery and antibiotics in trachoma-endemic areas in seven world regions.. A population model was applied to follow the lifelong impact on individuals receiving trachoma control. Intervention costs and effectiveness estimates were based on a combination of primary data collection and literature review.. Providing trichiasis surgery to 80% of those who need it would avert over 11 million DALYs per year globally, with cost effectiveness ranging from I$13 to I$78 per DALY averted across regions. Mass antibiotic treatment of all children using azythromycin at prevailing market prices would avert more than 4 million DALYs per year globally with cost-effectiveness ranging between I$9,000 and I$65,000 per DALY averted. The intervention is only cost-effective if azythromycin is donated or becomes available at reduced prices. Mass treatment of all children with tetracycline and targeted treatment with azythromycin are not cost-effective.. As individual components of the SAFE strategy, trichiasis surgery for trachoma is a cost-effective way of restoring sight in all epidemiological sub-regions considered, as is the use of azythromycin, if donated or at reduced prices. Large study uncertainties do not change study conclusions. The results should be interpreted in the context of the overall SAFE strategy to address issues of sustainability.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Azithromycin; Blindness; Combined Modality Therapy; Cost-Benefit Analysis; Eyelid Diseases; Female; Geography; Global Health; Hair Diseases; Humans; Male; Middle Aged; Ophthalmologic Surgical Procedures; Tetracycline; Trachoma

Trachoma is the leading infectious cause of blindness worldwide. Surgery is available to correct trichiasis, which results from repeated episodes of infection with C. trachomatis. However, trichiasis recurrence rates post-surgery are very high. Methods for reducing post-surgical trichiasis recurrence need to be explored. This paper outlines the design of the Surgery for Trichiasis, Antibiotics to prevent Recurrence (STAR) Clinical Trial currently underway in Ethiopia. The STAR trial, funded by The National Eye Institute, is a randomized, controlled clinical trial of antibiotic use at time of trichiasis surgery, comparing topical tetracycline to single-dose azithromycin for the surgical patient and single-dose azithromycin for the surgical patient and all household members. The primary outcome is trichiasis recurrence at one-year. Data from this trial will be critical in helping to determine future policy on antibiotic treatment for C. trachomatis following surgery.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Azithromycin; Chlamydia trachomatis; Combined Modality Therapy; Ethiopia; Eyelashes; Eyelid Diseases; Hair Diseases; Humans; Ophthalmologic Surgical Procedures; Randomized Controlled Trials as Topic; Secondary Prevention; Single-Blind Method; Tetracycline; Trachoma

This community-based cross-sectional study was conducted to determine the prevalence of trachoma in Dalocha District, Central Ethiopia.. A multistage sampling method was used to identify the peasant associations and households included in the study. The WHO clinical grading method for trachoma was used.. Of the 619 sampled persons, 302 (48.8%) males and 317 (51.2%) females, 564 people were available for examination, yielding a response rate of 91.1%. More than half (51.1%) of the children aged 10 years or less had active trachoma (trachomatous inflammation, TI, in 16.5% and trachomatous follicles, TF, in 34.6%). On the other hand, active trachoma and trachomatous trichiasis (TT) were each found in 5.5% of individuals older than 10 years of age.. According to the WHO, the findings of TI and TF in more than 5% and 20%, respectively, of children aged 10 years or less and TT in more than 1% of older individuals indicate that trachoma is a major public health problem in Dalocha community.

Topics: Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Anti-Bacterial Agents; Child; Child, Preschool; Cross-Sectional Studies; Ethiopia; Eyelashes; Female; Hair Diseases; Health Surveys; Humans; Infant; Male; Middle Aged; Prevalence; Sex Distribution; Tetracycline; Trachoma