Patients experiences on the use of dihydroartemisinin piperaquine as an alternative first line artemisinin-based combination treatment for uncomplicated malaria in Northern Ghana

Background:Three different artemisinin-based combination therapies (ACTs) namely; artesunate-amodiaquine, artemether-lumefantrine and dihydroartemisinin-piperaquine (being the latest to be introduced) are concurrently being used forthe treatment of falciparummalaria in Ghana. This study assessed patients’ experience, perceptions and willingness to use dihydroartemisinin-piperaquine, brand name duo-cotecxin as an alternative first line ACT for the treatment of falciparummalaria in Northern Ghana.Methods:This was a qualitative study using phenomenology approach where sixty in-depth interviews were conducted with two groups; thirty patients who were given duo-cotecxin, one group and thirty interviews with patients who were given other ACTs (artesunate-amodiaquine, artemether-lumefantrine) as another group. The interviews were conducted between August and November, 2015 Purposive sampling technique was used to select study participants. The interviews were transcribed andcoded into themes using QSR NVivo 11 software for thematic content analysis.Results:All patients who used duo-cotecxin reported that the drug was very good in treating uncomplicated malaria compared to other ACTs they had used in the past. Some of the patients who used other ACTs could not complete their doses because of the side effects. However, none of the patients who used duo-cotecxin reported side effects. The findings revealed high acceptance and preference to use duo-cotecxin to treat uncomplicated malaria compared with other ACTs. All the participants were also willing to recommend duo-cotexcin to their relatives and friends to use. Conclusions: Duo-cotecxin as an alternative first line ACT for treatment of uncomplicated malaria is highly accepted, preferred and there was willingness to use it compared with other first line recommended ACTs.

Impact of training primary care physicians in behavioral counseling to reduce cardiovascular disease risk factors in Ecuador / Repercusión de la capacitación de médicos de atención primaria en orientación sobre el comportamiento para reducir los factores de riesgo de sufrir enfermedades cardiovasculares en Ecuador / Impacto da capacitação de médicos da atenção primária em orientação comportamental para reduzir os fatores de risco de doenças cardiovasculares no Equador

ABSTRACT Objective To assess the feasibility of implementing a physician-based, patient-centered counseling intervention model in Ecuador to improve the ability of primary care physicians (PCPs) to reduce cardiovascular disease (CVD) risk factors among patients. Methods This was a randomized clinical trial conducted in primary care clinics in Quito in 2014 - 2016. Participants included 15 PCPs and their adult patients at high risk of developing type-2 diabetes. A physician-based and patient-centered counseling program was delivered to eight PCPs. Seven PCPs who did not receive the training comprised the control group. The patient experience was assessed by a patient exit interview (PEI). Assessment of the patient's anthropometrics, blood pressure, and blood biochemistry parameters were conducted. Changes within and between groups were estimated utilizing chi-square, ANOVA, paired t-tests, and coefficient with intervention. Results A total of 197 patients participated, 113 in the intervention care group (ICG) and 84 in the usual care group (UCG); 99 patients (87.6%) in the ICG and 63 (75%) in the UCG completed the study. Counseling steps, measured by the PEI, were significantly higher in the ICG (8.9±1.6 versus 6.6±2.3; P = 0.001). Comparison of the estimated difference between the ICG and the UCG showed greater decreases in HbA1c and total cholesterol in the ICG. Within the ICG, there were significant improvements in weight, BMI, HbA1C, total cholesterol, and LDL-cholesterol. Conclusions Training PCPs in a patient-centered behavioral intervention for CVD risk factor reduction is feasible and efficacious for reducing CVD risk factors in Ecuador. Developed and developing countries alike could benefit from such an intervention.

RESUMEN Objetivo Evaluar la factibilidad de implementar un modelo de intervención en el médico y centrado en el paciente en Ecuador a fin de mejorar la capacidad de los médicos de atención primaria (MAP) para reducir los factores de riesgo de enfermedades cardiovasculares (ECV) en los pacientes. Métodos Se llevó a cabo un ensayo clínico aleatorio en consultorios de atención primaria en Quito entre el 2014 y el 2016. Participaron 15 MAP y sus pacientes adultos con riesgo alto de padecer diabetes de tipo 2. Se proporcionó un programa médico orientativo centrado en el paciente a ocho MAP. Los siete que no recibieron la capacitación fueron el grupo testigo. Se evaluó la experiencia de los pacientes por medio de una encuesta de salida a los pacientes. Se evaluaron las medidas antropométricas, la presión arterial y los parámetros bioquímicos sanguíneos del paciente. Se calcularon los cambios entre los grupos y dentro de ellos por medio de pruebas de ji cuadrado, análisis de la varianza, pruebas t pareadas y coeficiente con intervención. Resultados En total participaron 197 pacientes, 113 en el grupo de atención con intervención (GAI) y 84 en el grupo de atención habitual (GAH); 99 pacientes (87,6 %) en el GAI y 63 (75 %) en el GAH completaron el estudio entre el 2014 y el 2016. Los pasos de orientación, según los resultados de la encuesta de salida, fueron significativamente mayores en el GAI (8,9±1,6 frente a 6,6±2,3; P = 0,001). Al comparar la diferencia estimada entre el GAI y el GAH, se encontraron mayores reducciones de HbA1c y del colesterol total en el GAI. Dentro del GAI, se encontraron mejoras considerables en el peso, IMC, HbA1C, colesterol total y C-LDL. Conclusiones La capacitación de los MAP mediante una intervención sobre el comportamiento centrada en el paciente para reducir los factores de riesgo de ECV es factible y eficaz para reducir los factores de riesgo de ECV en Ecuador. Los países desarrollados y en desarrollo podrían beneficiarse por igual de tal intervención.

RESUMO Objetivo Avaliar a viabilidade de implementar um modelo de intervenção do tipo orientação comportamental dirigida ao médico e centrada no paciente para melhorar a capacidade dos profissionais da atenção primária de reduzir os fatores de risco de doenças cardiovasculares nos pacientes. Métodos Estudo clínico randomizado conduzido em ambulatórios de atenção primária em Quito, no Equador, de 2014 a 2016. Participaram do estudo 15 médicos da atenção primária e os respectivos pacientes adultos com alto risco de diabetes tipo 2. Oito participantes fizeram parte de uma intervenção do tipo orientação comportamental dirigida ao médico e centrada no paciente. Os outros sete médicos fizeram parte do grupo de controle que não recebeu a capacitação. A experiência do paciente foi avaliada com uma entrevista de saída. Características antropométricas, medidas de pressão arterial e parâmetros bioquímicos foram avaliados nos pacientes. As mudanças dentro de um mesmo grupo e entre os grupos foram estimadas com o uso do teste do qui-quadrado, ANOVA, teste t pareado e coeficiente com intervenção. Resultados Participaram do estudo 197 pacientes ao todo, sendo 113 no grupo de intervenção (GI) e 84 no grupo de atenção de rotina (GR), e completaram o estudo 99 pacientes (87,6%) no GI e 63 (75%) no GR em 2014-2016. O GI recebeu um número significativamente maior (8.9±1.6 vs. 6.6±2.3; P = 0.001) de orientações, avaliadas na entrevista de saída. Uma comparação da diferença estimada entre o GI e o GR demonstrou maior redução no nível de hemoglobina glicosilada (HbA1c) e colesterol total no GI. Os pacientes do GI tiveram melhora significativa no peso corporal, índice de massa corporal (IMC), colesterol total e LDL. Conclusões Capacitar os médicos da atenção primária em uma intervenção comportamental centrada no paciente é uma opção viável e eficaz para reduzir os fatores de risco de doenças cardiovasculares no Equador. Ambos os países desenvolvidos e em desenvolvimento poderiam se beneficiar com esta intervenção.

Metastatic prostate cancer in the modern era of PSA screening

ABSTRACT Introduction To characterize initial presentation and PSA screening status in a contemporary cohort of men treated for metastatic prostate cancer at our institution. Materials and methods We reviewed records of 160 men treated for metastatic prostate cancer between 2008-2014 and assessed initial presentation, categorizing patients into four groups. Groups 1 and 2 presented with localized disease and received treatment. These men suffered biochemical recurrence late (>1 year) or earlier (<1 year), respectively, and developed metastases. Groups 3 and 4 had asymptomatic and symptomatic metastases at the outset of their diagnosis. Patients with a first PSA at age 55 or younger were considered to have guideline-directed screening. Results Complete records were available on 157 men for initial presentation and 155 men for PSA screening. Groups 1, 2, 3 and 4 included 27 (17%), 7 (5%), 69 (44%) and 54 (34%) patients, respectively. Twenty (13%) patients received guideline-directed PSA screening, 5/155 (3%) patients presented with metastases prior to age 55 with their first PSA, and 130/155 (84%) had their first PSA after age 55, of which 122/130 (94%) had metastasis at the time of diagnosis. Conclusion Despite widespread screening, most men treated for metastatic prostate cancer at our institution presented with metastases rather than progressed after definitive treatment. Furthermore, 25 (16%) patients received guideline-directed PSA screening at or before age 55. These data highlight that, despite mass screening efforts, patients treated for incurable disease at our institution may not have been a result of a failed screening test, but a failure to be screened.

Effect Of Different Beverages On The Physical Properties Of Sonicfill Dental Composite

Objective: To evaluate the effect of several beverages on the physical properties of SonicFill (Kerr Corp.,USA), a new bulk-fill dental composite, over a period of time. Methods: A total of 28 discs (10 mm x 2mm) were prepared and randomly assigned into 4 groups (n=7) according to the beverages they wouldbe immersed in. The beverages chosen were Coca-Cola?, Nescafe? coffee, Lipton tea? and distilledwater (control). Surface roughness, microhardness and colour stability were evaluated using 3D opticalsurface texture analyser, Vickers microhardness tester and spectrophotometer respectively. Readingswere recorded at the time intervals of 24 hours, 1 week and 1 moth after immersion. The data obtainedwere analysed using one-way ANOVA, repeated measures ANOVA and MANOVA. Results: There weresignificant differences in surface roughness for only two pairs of groups (distilled water and Coca-Cola,distilled water and coffee). However, there was no significant difference between the groups within thechosen time. Statistical analysis showed significant difference in microhardness between time only forCoca-Cola, with significant differences between 24 hours and 1 week; and 24 hours and 1 month. Forthe colour evaluation, there was significant difference between the groups within time. Conclusions:All the beverages chosen were able to affect the physical properties of the SonicFill. However, noparticular beverage had a higher or lower impact on the surface roughness than the other beverages.Microhardness was affected by distilled water and Coca-Cola, in ascending order. Colour was affectedmost by coffee, followed by tea and Coca-Cola.

Keratoconjunctivitis caused by an unusual retained conjunctival foreign body: A frequently unrecognized entity.

Purpose: The purpose of this study is to describe a case series of keratoconjunctivitis caused by a retained bindi (dot) in six children who presented to a tertiary eye care facility in Southern India. Patients and Methods: Over a period of 11 years (January 2000 and January 2012), six children (all female, ranging in age from 6 months to 3 years) were diagnosed with ocular manifestations subsequent to a retained bindi. Results: All patients presented with redness, photophobia, extensive lacrimation, and blepharospasm. Two patients presented with mucopurulent conjunctivitis, three patients with suppurative keratitis and one patient presented with corneal epithelial defect. After removal of the foreign body the response to topical antibiotics was good in fi ve of six cases, whereas one patient required therapeutic keratoplasty. Conclusions: Young children presenting with unilateral keratitis and conjunctivitis should alert the clinician to the possibility of a retained foreign body in the eye.

Scleral- fixated intraocular lens implantation in microspherophakia.

Background: In microspherophakia, abnormal laxity of the lenticular zonules leads to development of a spherical lens and possible subluxation. We evaluated long-term results of lens removal with scleral-fi xated intraocular lens (SFIOL) implantation in microspherophakia. Materials and Methods: Case series. SF IOLs were implanted in four consecutive patients with bilateral microspherophakia (eight eyes [three with pupillary block and secondary glaucoma who underwent immediate surgery and fi ve with only subluxation who underwent elective surgery]). Post-operative best-corrected visual acuity (BCVA), intraocular pressure (IOP) and lens position were evaluated periodically from day 1 to 18 months. Results: All patients were females (mean age 28 ± 7.03 years). In group 1 eyes (three eyes that presented with pupillary block), the mean BCVA improved from 0.008 decimals (preoperative) to 0.50 decimals (fi nal post-operative visit); in group 2 eyes (the other fi ve eyes), the mean BCVA improved from 0.12 ± 0.21 decimals to 0.73 ± 0.14 decimals. The preoperative mean IOP (54.53 ± 7.33 mmHg) in group 1 eyes was signifi cantly (P = 0.03) higher than that (16 ± 4.30 mm Hg) in group 2 eyes. At fi nal post-operative visit, the mean IOP (11.67 ± 2.88 mmHg) in group 1 eyes was not signifi cantly diff erent from that in group 2 eyes (13.0 ± 3.08 mmHg). All SFIOLs were well- centred at the fi nal visit. None of the patients encountered any peroperative or postoperative complications. Conclusions: SFIOLs may be an option for surgical management of microspherophakia.

Flora terrestre de la isla Malpelo (Colombia), Pacífico Oriental Tropical / Terrestrial flora of Malpelo Island, Colombia, Eastern Tropical Pacific

Malpelo Island is located 380km off the mainland continental coast of Colombia, in the Pacific Ocean. Several geological, ecological, and zoological studies, both marine and terrestrial, have been conducted in this island. Despite some marginal comments on some publications, no single specific survey has been devoted to botany so far. In order to make a floristic inventory of the terrestrial flora of this island, three field trips were made in 2010 to collect vascular plants, mosses, and lichens, as well as data on their distribution within the island. We collected and identified 25 species of lichens, two species of vascular plants and one moss. Lichens were the most diverse group found, including records of four new genera (Endocarpon, Fuscidea, Lecanographa and Verrucaria) and 13 new species for Colombia. The high lichen richness on Malpelo might be explained by their efficient form of asexual reproduction (soredia and isidia), that may have facilitated their transport to the island by migrating birds or wind. Once on the island, it is possible that lichens persist by being chemically protected against herbivores. The great number of new generic and species records for Colombia is explained by the low number of studies in saxicolous lichens conducted so far in the country, particularly on coastal areas and remote islands. Only two species of vascular plants were collected, a grass, Paspalum sp., and a fern, Pityrogramma calomelanos, and both of them correspond to new determinations for Malpelo. A moss species previously reported but with no positive identification was collected and identified as Octoblepharum albidum. Other species previously reported, for example, some species of shrubs, were not observed. The low number of vascular plants is probably due to a combination of soil conditions and herbivory by land crabs. This study is the first complete inventory of the flora of Malpelo and is a starting and reference point for future comparisons among islands in the Eastern Tropical Pacific. Rev. Biol. Trop. 62 (1): 327-336. Epub 2014 March 01.

La isla Malpelo se encuentra en el Pacífico colombiano, a unos 380km de la costa continental. La Isla ha sido objeto de algunos estudios geológicos, ecológicos y faunísticos, tanto marinos como terrestres, pero ningún estudio estrictamente botánico. Con el fin de realizar un inventario de la flora terrestre de Malpelo, se realizaron tres salidas de campo durante el 2010, en las que se recolectaron plantas vasculares, musgos y líquenes, y se tomaron datos sobre su distribución en la Isla. El grupo más diverso correspondió a los líquenes, con 25 especies, incluidos cuatro nuevos géneros para Colombia, Endocarpon, Fuscidea, Lecanographa y Verrucaria, y 15 nuevos registros de especies para Colombia. La alta riqueza de especies de líquenes en la Isla puede deberse a la forma de reproducción asexual de estos organismos, que pudieron haber sido transportados hasta Malpelo por aves migratorias o por viento; además, pueden estar protegidos químicamente de la herbivoría por cangrejos terrestres. La gran cantidad de registros nuevos para Colombia se explica por la poca cantidad de trabajos en líquenes saxícolas en el país, sobre todo en zonas costeras e insulares. Solo se registraron dos especies de plantas vasculares, una gramínea, Paspalum sp., y un helecho, Pityrogramma calomelanos. También se recolectó una especie de musgo, Octoblepharum albidum. La escasez de plantas vasculares probablemente se deba a la combinación de condiciones de los suelos y a la herbivoría por cangrejos terrestres. El presente estudio es el primero en darle relevancia a la flora terrestre de Malpelo y constituye un punto de referencia y comparación para estudios semejantes en otras islas del Pacífico Oriental Tropical.

Comparative evaluation of optical coherence tomography in glaucomatous, ocular hypertensive and normal eyes.

BACKGROUND: To correlate the findings of optical coherence tomography (OCT) evaluation of retinal nerve fiber layer (RNFL) thickness with visual field changes in glaucomatous, ocular hypertensive and normal eyes. MATERIALS AND METHODS: Thirty consecutive normal, 30 consecutive ocular hypertensive and 30 consecutive glaucomatous eyes underwent a complete ophthalmic examination, including applanation tonometry, disc evaluation, (30-2) Humphrey field analyzer white on white (W/W) perimetry and short- wavelength automated perimetry. Thickness of the RNFL around the optic disc was determined with 3.4 mm diameter-wide OCT scans. Average and segmental RNFL thickness values were compared among all groups. A correlation was sought between global indices of perimetry and RNFL thickness. RESULTS: Of the 90 eyes enrolled (mean age of patients 52.32+/-10.11 years), the mean RNFL thickness was significantly less in ocular hypertensive (82.87+/-17.21 mm; P =0.008 and glaucomatous eyes (52.95+/-31.10 microm; P < 0.001), than in normals (94.26+/-12.36 microm). The RNFL was significantly thinner inferiorly in glaucomatous eyes (64.41+/-43.68 microm; P<0.001). than in normals (120.15+/-14.32 microm) and ocular hypertensives (107.87+/-25.79 microm; P<0.001). Ocular hypertensives had thinner RNFL in the nasal, inferior and temporal quadrants (P<0.001) when compared to normals. Global indices in ocular hypertensives on SWAP showed Mean Deviation (MD) of 5.32+/-4.49, Pattern Standard Deviation (PSD) 3.83+/-1.59 and Corrected Pattern Standard Deviation (CPSD) 2.84+/-1.85. The RNFL thickness could not be significantly correlated with global indices of visual fields in ocular hypertensives. CONCLUSION: Optical coherence tomography is capable of detecting changes at the level of RNFL in ocular hypertensive eyes with normal appearance of discs and W/W perimetry fields.

Bilateral Pseudomonas keratitis without predisposing factors.

Bilateral keratitis usually occurs in predisposed individuals such as contact lens wearers, those suffering from malnutrition and immunodeficiency or patients undergoing bilateral refractive corneal surgery. We report a 30-year-old man without any obvious predisposing factors who presented with complaints of pain and decreased vision in both eyes. Examination revealed corneal ulcers in both eyes, which on microbiological culture grew Pseudomonas aeruginosa. The patient underwent a therapeutic keratoplasty in the right eye while the left eye was managed medically. Bilateral Pseudomonas keratitis can develop in the absence of any obvious predisposing factors.

Comparison of in vitro characteristics of and experimental lesions produced by a clinical and an environmental isolate of Aspergillus flavus.

In the present study, two strains of Aspergillus flavus (one from a human corneal ulcer and one from the environment) were found to be strikingly similar in vitro in terms of thermotolerance, inability to grow in an anaerobic environment and in secreting proteinases; however, one obvious difference was that the clinical isolate produced 120 ppb of aflatoxin B1 in glucose salt medium while the environmental isolate did not produce this toxic metabolite. Alterations in the activities of acid phosphatase (ACP), alkaline phosphatase (ALP), lactate dehydrogenase (LDH) and glutathione-S-transferase were observed in the liver, kidney and serum in an experimental rat model, irrespective of whether the animal had been challenged with the clinical isolate or the environmental isolate of A. flavus. In rats that had been challenged with the clinical isolate, a significant decrease in the activity of kidney ALP was noted, whereas in rats that had been challenged with the environmental isolate, the reverse was observed. While these differential alterations may have occurred due to differences in the toxin-producing ability of the two isolates, further investigation is warranted to clarify whether other phenotypic, or genotypic, differences are also involved.

Protemblemaria perla, a new species of tube blenny (Perciformes: Chaenopsidae) from the tropical eastern Pacific

Protemblemaria perla, from Isla del Rey, Islas Perlas, Panama, is distinctive in having a long unbranched cirrus on the posterior nostril, a U-shaped fleshy ridge bearing fleshy flaps and a pair of papillae on the nape, a relatively high number (18) of segmented dorsal-fin rays, and small rust-colored spots on the dorsal fin. Protemblemaria perla and P. punctata, from the southern Caribbean, share several morphological features and form a transisthmian species pair. Although the degree of color variation is unknown in P. perla, color varies greatly in P. bicirris and P. punctata, both of which have an orange morph.