SD bioline malaria rapid diagnostic test performance and time to become negative after treatment of malaria infection in southwest Nigerian children

Context and Aim: Given the challenges of microscopy, we compared its performance with SD Bioline malaria rapid diagnostic test (MRDT) and polymerase chain reaction (PCR) and evaluated the time it took for positive results to become negative after treatment of children with acute uncomplicated malaria. Subjects and Methods: We present the report of 485 participants with complete MRDT, microscopy, and PCR data out of 511 febrile children aged 3­59 months who participated in a cohort study over a 12 month period in rural and urban areas of Ibadan, Nigeria. MRDT positive children received antimalaria and tested at every visit over 28 days. Speciation was also carried out by PCR. Results: With microscopy as the gold standard, SD-Bioline™ had 95.2% sensitivity, 66.4% specificity, 67.5% positive predictive value (PPV), and 94.9 negative predictive value (NPV), while with PCR the findings were 84.3% sensitivity, 66.5% specificity, 72.7% PPV, and 80.1% NPV. PCR speciation of malaria parasites revealed 91.6% Plasmodium falciparum, 18.9% Plasmodium malariae, and 4.4% Plasmodium ovale. Among the 47 children with P. malariae infections, 66.0% were coinfected with P. falciparum, while 54.6% cases of P. ovale occurred as coinfections with P. falciparum. The median time to a negative MRDT was 23.2 days, while the median time to a negative malaria microscopy was 3.8 days. The two survival curves were significantly different. Conclusions: The SD BiolineTM MRDT performed well, with remarkable persistence of rapid test-positive for an average of 23 days post treatment. The prevalence of P. malaria is somewhat greater than expected.

Comprendiendo las fracturas triplanares de la tibia distal / Understanding triplane distal tibia fractures

Abstract. Triplane fractures (TF) are a special type of fracture that typically occur in the distal tibia, in a specific age group, and require specific treatment. It should be diagnosed early to avoid complications and irreparable consequences. Imaging techniques play a fundamental role. A review of TF is performed, and cases are presented in order to understand how they occur, and thus diagnose them properly.

Resumen. Las fracturas triplanares (FT) son un tipo especial de fracturas que se producen clásicamente en la tibia distal, en un grupo etario acotado y que requieren un tratamiento específico. Su diagnóstico debe ser oportuno para evitar complicaciones y secuelas irreparables, por lo que las imágenes cumplen un rol fundamental. Se realiza una revisión sobre las FT y una muestra de casos para comprender cómo se generan y así realizar un adecuado diagnóstico de ellas.

Músculos accesorios de la muñeca: revisión pictográfica en us y rm / Accesory muscle of the wrist: a pictographic review

Although the accessories muscles are part of our nature, to recognize them allows us to avoid confusion with other pathologies. Even some accessories wrist muscles may be symptomatic and require surgical intervention. In this paper we present the anatomy and imaging aspects of ultrasound and magnetic resonance imaging of these muscles, so that the radiologist can become familiar with them, avoiding unnecessary interventions or diagnostic errors.

Si bien los músculos accesorios son parte de nuestra naturaleza, el saber reconocerlos nos permite evitar confusiones con otras entidades patológicas. Incluso algunos músculos accesorios en la muñeca pueden ser sintomáticos y requerir intervención quirúrgica. En este trabajo exponemos la anatomía y aspectos imaginológicos en ultrasonido y resonancia magnética de dichos músculos, para que el radiólogo esté familiarizado con ellos, evitando errores diagnóstico o intervenciones innecesarias.

Clinical care for sexual assault survivors: the use of a multimedia training tool

Introduction: Sexual assault rises as a global public health in conflict-affected populations where chaos prevails and gender based violence becomes as a strategy of war. The health effects of sexual violence include unwanted pregnancy, unsafe abortion, sexually transmitted infections [STIs], physical and psychological trauma, and social stigma. Training health care providers [HCPs] has been prioritized by humanitarian actors globally to improve the quality clinical care to survivors of sexual violence. However, few studies have evaluated the effectiveness of training interventions in refugee and post-conflict settings. Methods: A four to five days "training of trainers" [ToT] was provided to relevant community health workers, nurses, midwives, doctors and other relevant field workers working in conflict-affected environments in Jordan, Turkey, Syria and Lebanon using the "Clinical care for sexual assault survivors [CCSAS] multimedia training tool" developed by International Rescue Committee [IRC]

Results: Overall, six ToTs took place; they included general practitioners, obstetrician/gynecologists, pediatricians, psychologist, forensic physicians, nurses, social workers, midwifes, and program officers. In Jordan, 50 participants [two groups of 25] have completed the training; the group improved by 142% on average at post-test in knowledge and attitudes to care for survivors [25% on average of correct answers at pretest, 60.5% on average at posttest]. A second ToT in Jordan included 22 participants who have improved by 57.6% on average [50.3% vs. 79.3%]. The third ToT in Turkey included 13 participants who have improved by 47% on average [38.5% vs. 56%]. A forth ToT took place in Lebanon where 19 participants have improved by 62.5% on average [56% vs. 91%]. The fifth ToT in Syria, included 18 participants who have improved by 46.2% on average [52% vs. 76%]. And the sixth ToT took place in Turkey where nine participants have improved by 82.6% on average [46% on vs. 84%]

Discussion: All participants have successfully completed the training and showed improvement at the posttests. However, key challenges and limitations identified included logistics at the preparation and recruitment stages, language barrier and differences in cultural or religious views. Key barriers to quality care identified included poor or lack of access to services, lack of trained staff, lack of privacy and confidentiality and lack of essential resources and treatment including emergency contraception and HIV post-exposure prophylaxis [PEP] as well as unclear referral mechanism. Action plans were developed by participants to address these barriers and follow-up to evaluate progress was planned

Conclusion:The CCSAS multimedia training tool showed an initial positive impact and has demonstrated effectiveness in promoting compassion and competence among trained HCPs and improving quality of clinical care for sexual assault survivors in such humanitarian settings. On-going technical and psychosocial support, long-term behavior change interventions, supply chain management, monitoring and evaluation, and interventions to raise awareness and identify survivors of sexual assault are needed in addition to the training to ensure quality clinical care is delivered to sexual assault survivors

A mimic of soft tissue infection: intra-arterial injection drug use producing hand swelling and digital ischemia / 世界急诊医学杂志（英文）

BACKGROUND: Inadvertent intra-arterial injection of illicit substances is a known complication of injection drug use and can lead to severe complications, including infection, ischemia and compartment syndrome. Identifying complications of intra-arterial injection can be difficult, as clinical manifestations overlap with other more common conditions such as cellulitis and soft tissue infection, and a history of injection drug use is frequently not disclosed. METHODS: A 37-year-old male patient presented with 24 hours of right hand pain, erythema and swelling. Despite classic "track marks", he denied a history of injection drug use, and vascular insults were not initially considered. After failing to respond to three days of aggressive treatment for suspected deep-space infection, an arteriogram demonstrated findings consistent with digital ischemia of embolic etiology. RESULTS: As a result of the delay in diagnosis, the lesion was not amenable to reperfusion and the patient required amputation of the distal digit. CONCLUSION: Practitioners should be alert to the possibility of intra-arterial injection and resulting complications when evaluating unusual extremity infections or unexplained ischemic symptoms, even in the absence of a definite history of injection drug use.

Artefacto de centelleo en ultrasonido Doppler color: más que un incomprendido, un signo de utilidad / Twinkling artifact in color Doppler ultrasound: a misunderstood and useful sign

The scintillation or twinkling artifact is a not fully understood phenomenon that appears in Color Doppler Ultrasound (U.S.) examinations as a rapid alternation of color immediately behind a stationary echogenic object, giving it a false appearance of movement. This sign is useful in some clinical conditions, especially in urolithiasis, since it increases diagnostic accuracy and sensitivity; therefore, every radiologist should be fully acquainted with this radiologic sign.

El artefacto de centelleo en Doppler color es un fenómeno de origen no bien precisado, que se genera detrás de algunas estructuras ecogénicas y que se manifiesta por una alternancia de colores, sin existir movimiento. Este signo es de utilidad en algunas condiciones clínicas, especialmente en la urolitiasis, aumentando la sensibilidad diagnóstica, por lo que debe ser parte del conocimiento de todo radiólogo.

El signo de la cáscara de manzana en vólvulo de intestino medio / The apple-peel syndrome in midgut volvulus

The apple-peel sign represents an image visualized on oral contrast-enhanced examination of the upper gastrointestinal tract in patients with midgut volvulus. Its recognition is vital for a timely diagnosis to prevent treatment delay, since this condition represents a true surgical emergency.

El signo de la cáscara de manzana corresponde a una imagen visualizada en el estudio con contraste oral del tubo digestivo alto en pacientes que presentan vólvulo del intestino medio. Su reconocimiento es fundamental para hacer el diagnostico de manera oportuna, sin retrasar el tratamiento, ya que se considera una emergencia quirúrgica.

Engineering antibody fragments: replicating the immune system and beyond / La ingeniería de fragmentos de anticuerpos: imitando y expandiendo el sistema inmune

Since genetic engineering of humanized murine monoclonal antibodies was first demonstrated over two decades ago, antibody engineering technologies have evolved based upon an increasing understanding of the mechanisms involved in antibody generation in vivo, and a constant search for alternative routes to evolve and exploit the characteristics of antibodies. As a result, antibody engineers have devised innovative strategies for the rapid evolution and selection of antibodies and novel antibody designs (i.e., antibody fragments). Phage display, cell display and ribosome display technologies, which comprise the core of the currently available technologies for the discovery and preparation of such antibodies, are reviewed herein. This article intends to communicate the state-of-the-art technology available for the engineering of antibodies to a general readership interested in this important field. Therefore, important immunology concepts are introduced before detailed descriptions of the three antibody engineering technologies are presented in later sections. A comparison of these methodologies suggests that despite the predominance of phage display for the engineering of antibody fragments in the past 20 years, cell display and ribosome display will likely gain importance in the selection and discovery of the antibody fragments in the future. Finally, these technologies are likely to play an important role in the production of the next generation of antibody-based therapeutics.

Las tecnologías para la ingeniería de anticuerpos han evolucionado durante las últimas dos décadas, desde la demostración de la posibilidad de humanizar anticuerpos monoclonales de ratón mediante ingeniería genética, apoyadas en el creciente entendimiento de los mecanismos involucrados en la generación de anticuerpos in vivo, y en una búsqueda constante de rutas alternativas para evolucionar y explotar sus características. Es así como los ingenieros de anticuerpos han desarrollado estrategias innovadoras para la evolución y selección de anticuerpos y de novedosos diseños de anticuerpos conocidos como fragmentos de anticuerpos. Esta revisión se enfoca en tres tecnologías que comprenden el núcleo de las tecnologías actualmente disponibles para el descubrimiento y preparación de tales anticuerpos: la presentación en fagos, la presentación en células, y la presentación en ribosomas. Este artículo busca presentar el estado del arte de estas tecnologías a un grupo general de lectores interesados en este campo, por lo que inicialmente se introducen importantes conceptos de inmunología requeridos para comprender en detalle las tecnologías discutidas. Una comparación de estas metodologías para la ingeniería de anticuerpos sugiere que a pesar del dominio de las tecnologías basadas en la presentación en fagos durante los últimos 20 años, en los próximos años la presentación en células y la presentación en ribosomas probablemente ganarán importancia para la selección y descubrimiento de fragmentos de anticuerpos. Finalmente, es probable que estas tecnologías jueguen un papel importante en la producción de la siguiente generación de terapéuticos basados en anticuerpos.

Engineering antibody fragments: replicating the immune system and beyond: [review] / La ingeniería de fragmentos de anticuerpos: imitando y expandiendo el sistema inmune: [revisión]

Since genetic engineering of humanized murine monoclonal antibodies was first demonstrated over two decades ago, antibody engineering technologies have evolved based upon an increasing understanding of the mechanisms involved in antibody generation in vivo, and a constant search for alternative routes to evolve and exploit the characteristics of antibodies. As a result, antibody engineers have devised innovative strategies for the rapid evolution and selection of antibodies and novel antibody designs (i.e., antibody fragments). Phage display, cell display and ribosome display technologies, which comprise the core of the currently available technologies for the discovery and preparation of such antibodies, are reviewed herein. This article intends to communicate the state-of-the-art technology available for the engineering of antibodies to a general readership interested in this important field. Therefore, important immunology concepts are introduced before detailed descriptions of the three antibody engineering technologies are presented in later sections. A comparison of these methodologies suggests that despite the predominance of phage display for the engineering of antibody fragments in the past 20 years, cell display and ribosome display will likely gain importance in the selection and discovery of the antibody fragments in the future. Finally, these technologies are likely to play an important role in the production of the next generation of antibody-based therapeutics.

Las tecnologías para la ingeniería de anticuerpos han evolucionado durante las últimas dos décadas, desde la demostración de la posibilidad de humanizar anticuerpos monoclonales de ratón mediante ingeniería genética, apoyadas en el creciente entendimiento de los mecanismos involucrados en la generación de anticuerpos in vivo, y en una búsqueda constante de rutas alternativas para evolucionar y explotar sus características. Es así como los ingenieros de anticuerpos han desarrollado estrategias innovadoras para la evolución y selección de anticuerpos y de novedosos diseños de anticuerpos conocidos como fragmentos de anticuerpos. Esta revisión se enfoca en tres tecnologías que comprenden el núcleo de las tecnologías actualmente disponibles para el descubrimiento y preparación de tales anticuerpos: la presentación en fagos, la presentación en células, y la presentación en ribosomas. Este artículo busca presentar el estado del arte de estas tecnologías a un grupo general de lectores interesados en este campo, por lo que inicialmente se introducen importantes conceptos de inmunología requeridos para comprender en detalle las tecnologías discutidas. Una comparación de estas metodologías para la ingeniería de anticuerpos sugiere que a pesar del dominio de las tecnologías basadas en la presentación en fagos durante los últimos 20 años, en los próximos años la presentación en células y la presentación en ribosomas probablemente ganarán importancia para la selección y descubrimiento de fragmentos de anticuerpos. Finalmente, es probable que estas tecnologías jueguen un papel importante en la producción de la siguiente generación de terapéuticos basados en anticuerpos.

Meniscorresis en pacientes con rodilla estable / Meniscal repair in stable knee

Objectives: The objective of the present study is to describe the functional outcome of a group of patients treated with meniscal suture in a stable knee. Materials and Methods: Retrospective study. 21 patients with unstable meniscal lesions and stable knees. A minimum follow up of 6 months. Lysholm and Cincinnati functional scales were applied to all of them. Failure of a meniscal suture was defined as the need of redoing the meniscal suture or the need of a meniscectomy right at the previous meniscal suture. Results: The average age was 29.6 years, 87.5 percent men. The time between lesion and surgery was 43.2 days. In 13 patients the compromised meniscus was the medial. Outside-in technique was used in 13 patients (62 percent); inside-out in 7(33 percent) and all inside in one patient (4.8 percent). 4 patients (20 percent) developed a meniscal suture failure so they were subjected to a partial arthroscopic meniscectomy. The average follow up was 43.5 months with a median of 42.8 months. In terms of the functional evaluation, the average Lysholm score was 92.4 and the EVA was 88.7. Conclusion: In our group of patients, good functional results were achieved for this follow up period The rate of failure was similar to the one described in the literature for meniscal sutures concomitant with LCA reconstruction.

Objetivos: Describir los resultados funcionales de los pacientes sometidos a una meniscorresis en rodillas estables. Materiales y Métodos: Estudio retrospectivo de 21 pacientes sometidos a meniscorresis en lesiones periféricas inestables. Todos los casos en rodillas consideradas estables. Se definió un seguimiento mínimo de 6 meses. Los pacientes fueron evaluados con las escalas de Lysholm y Cincinnati, y evaluación de calidad de vida (EuroQi). Falla de la meniscorresis se definió a la necesidad de nueva meniscorresis y/o a la meniscectomía en el sitio de la meniscorresis realizada inicialmente. Resultados: El promedio de edad fue de 29,6 años, mayoría hombres (87,5 por ciento). El promedio de tiempo entre la lesión y la cirugía fue de 43,2 días (1 a 158). En 13/21 pacientes el menisco comprometido fue el medial. La técnica quirúrgica utilizada fue artroscópica en todos los casos: afuera-dentro en 13 pacientes (62 por ciento), dentro-afuera en 7 (33 por ciento) y dentro-dentro en un paciente (4,8 por ciento). Cuatro pacientes (20 por ciento) presentaron clínica de falla de la meniscorresis por lo que fueron re-operados realizándose una meniscectomla parcial. El seguimiento promedio del grupo estudiado fue de 43,5 meses con una mediana de 42,8 meses. En relación a la evaluación funcional, el promedio de la escala de Lyshoim fue de 92,4 y el promedio de EVA de percepción de bienestar del paciente fue de 88,7. Conclusión: En nuestro grupo de pacientes se lograron buenos resultados funcionales a mediano plazo, con una tasa de falla similar a la descrita previamente para meniscorresis concomitantes con una reconstrucción del LCA.

Drug selection in ventricular tachycardia electrophysiologic VS. holter approach

Twenty one patients with symptomatic sustained ventricular tachycardia [VT] all males [with mean age of 55 years], and largely with prior myocardial infarction [93%] underwent serial electrophysiologic drug testing. All patients had at least one electrocardiographically documented attack of V.T. All patients were subjected to a complete control EPS. Reproducible induction of VT was the rule in all patients having documented sustained VT, but in none of a control group of 10 patients with similar ischemic heart disease but with no documented V.T. Inducible sustained VT could be ultimately prevented in 16 pts. [76%] [gpA] after a mean of 3 +/- 3 tests. During a mean follow-up of 16 +/- 36 months 15 patients in gp A [93.7%] had no recurrence of VT. On the other hand of the 5 pts discharged on drug which did not prevent sustained VT induction [gp.B], only one had recurrence of VT [20%]. Holter monitoring revealed persistence of malignant ventricular arrhythmia [couplets. triplets and multifocal VPB] in 6 pts. in gp A. However, only 1/16 had recurrence [16%]. Serial EP testing had high predictive value for long term efficacy of antiarrhythmic drug therapy [93.7%] but low predictive value for recurrence [20%]. Thus, inefficacy as shown by inducibility of sustained VT or positive holter recording of malignant ventricular arrhythmias did not preclude a good clinical outcome. For successful therapy of life -threatening VT particularly in the selling of ischemic heart disease and post-myocardial infarction phase, rational rather than empiric pharmacologic drug selection is highly justified. PES was shown by our study to be an effective method to guide drug selection