Anti-SARS-CoV-2 inactivated vaccine in patients with ANCA-associated vasculitis: Immunogenicity, safety, antibody decay and the booster dose

Abstract Objective: To evaluate inactivated CoronaVac prime vaccination, antibody decay, booster dose, and safety in ANCA-Associated Vasculitis (AAV) patients. Methods: Fifty-three AAV patients and 106 Controls (CG) received CoronaVac on days: D0 (first dose), D28(second dose), and D210 (booster dose, 32 AAV: 32 CG). The primary outcome was immunogenicity after the second vaccine dose (day 69) assessed by Seroconversion Rates (SC) of anti-SARS-CoV-2 S1/S2 IgG and Neutralizing Antibodies (NAb). Secondary outcomes were safety, immunogenicity (D28/D240), 6-months antibody decay (D210) and the booster dose response (D240). Results: At D69 SC (65.1% vs. 96.8%, p = 0.0001), GMT (21.3 UA/mL vs. 67.7 UA/mL, p < 0.001) and NAb- positivity (53.7% vs. 80.6%, p = 0.001) were moderate but lower in naïve-AAV patients than CG. Patients without SC used more often IS (93.3% vs. 53.3%, p = 0.015), mycophenolate mofetil (20% vs. 0%, p = 0.037) and prednisone (60.0% vs. 28.6%, p = 0.057) than seroconverted. NAb negativity in AAV patients was associated with prednisone treatment (57.9% vs. 18.2%, p = 0.015) and IS (84.2% vs. 55.0%, p = 0.046). Logistic regression analysis models showed that only prednisone was associated with lower seroconversion (OR = 0.2, 0,95% CI 0.05-0.86, p = 0.030) and with lower NAb positivity (OR = 0.2, 0,95% CI 0.05-0.88, p = 0.034). After six months (D69-D210) a decrease in IgG positivity occurred in 32 AAV patients (15.7%, p = 0.074) and 32 CG (18.7%, p = 0.041). For the NAb positivity, the 6-month decrease was not significant (p = 0.114) whereas a major reduction occurred for CG (p < 0.001). A booster dose (D240) resulted in an increment in IgG-positivity (21.9%, p = 0.023) and NAb-positivity (34.4%, p = 0.006) in AAV patients. No moderate/severe adverse events attributable to the vaccine were observed. Conclusion: This study provides novel data on the excellent safety and moderate immunogenicity of CoronaVac in AAV patients. A six-month mild antibody waning was observed with a good response to the booster dose, although levels remained lower than CG (CoronavRheum-NCT04754698).

Determining Accessibility of Anterior Cervicothoracic Spine Based on Age and Gender: Radiographic Analysis of Computed Tomography Scans / Determinação da capacidade de acesso anterior à coluna cervicotorácica conforme idade e gênero: Análise radiográfica de imagens de tomografia computadorizada

Abstract Objective The approachability of the cervicothoracic region anteriorly based on age and gender, and the possibility of anatomic variances in different geographic populations have not been previously investigated. The aim of the present work was to perform a radiographic analysis of Brazilian patients to assess anterior approachability of the cervicothoracic junction based on age and gender. Methods Retrospective radiographic analysis of 300 computed tomography scans. Patients were separated based on age and gender. The radiographic parameters studied were: horizontal level above the sternum (HLS), vertebral body angle (VBA), intervertebral disc line (IDL), and intervertebral disc line angulation (IDLA). Results The most frequent HLS and IDL were T2 (34.3%) and C7-T1 (46%) respectively. Vertebral body angleand IDLA had average values of 18 ± 8.94 and 19 ± 7.9 degrees, respectively. Males had higher values in both IDLA (p= 0.003) and VBA (p= 0.02). Older groups had higher values in both IDLA (p= 0.01) and VBA (p= 0.001). No differences were observed in HLS between gender (p= 0.3) or age groups (p= 0.79). No differences were seen in IDL between gender groups (p= 0.3); however, the older group had a more caudal level than the younger groups (p= 0.12). ConclusionsCompared to other populations, our sample had a more cephalad IDL and HLS. Vertebral body angle and IDLA were higher in males and higher angles for VBA and IDLA were shown for older groups. Intervertebral disc line was more caudal with aging.

Resumo Objetivo A capacidade de acesso anterior à região cervicotorácica com base na idade e gênero do paciente e a possibilidade de variações anatômicas em diferentes populações geográficas ainda não foram investigadas. O objetivo deste trabalho foi realizar uma análise radiográfica de pacientes brasileiros para avaliar a acessibilidade anterior da junção cervicotorácica conforme idade e gênero. Métodos Análise radiográfica retrospectiva de 300 tomografias computadorizadas. Os pacientes foram separados por idade e gênero. Os parâmetros radiográficos estudados foram: nível horizontal acima do esterno (HLS, na sigla em inglês), angulação do corpo vertebral (VBA, na sigla em inglês), linha do disco intervertebral (IDL, na sigla em inglês) e angulação da linha do disco intervertebral (IDLA, na sigla em inglês). Resultados Os HLS e IDL mais frequentes foram T2 (34,3%) e C7-T1 (46%), respectivamente. Os valores médios de VBA e IDLA foram de 18 ± 8,94 e 19 ± 7,9 graus, respectivamente. Os homens apresentaram valores maiores de IDLA (p= 0,003) e VBA (p= 0,02). Os grupos de maior idade apresentaram valores maiores de IDLA (p= 0,01) e VBA (p= 0,001). Não houve diferenças de HLS entre os gêneros masculino e feminino (p= 0,3) ou faixas etárias (p= 0,79). Não foram observadas diferenças na IDL entre os gêneros masculino e feminino (p= 0,3); entretanto, o grupo mais velho apresentou nível mais caudal do que os grupos mais jovens (p= 0,12). ConclusõesEm comparação a outras populações, nossa amostra apresentou IDL e HLS mais cefálicos. AVBA e a IDLA foram maiores no gênero masculino, enquanto VBA e IDLA foram maiores em grupos mais velhos. A IDL era mais caudal em pacientes idosos.

Gathering patients and rheumatologists' perceptions to improve outcomes in idiopathic inflammatory myopathies

Abstract Objective Therapeutic targets in Idiopathic Inflammatory Myopathies (IIM) are based on the opinions of physicians/specialists, which may not reflect the main concerns of patients. The authors, therefore, assessed the outcome concerns of patients with IIM and compared them with the concerns of rheumatologists in order to develop an IIM outcome standard set. Methods Ninety-three IIM patients, 51 rheumatologists, and one physiotherapist were invited to participate. An open questionnaire was initially applied. The top 10 answers were selected and applied in a multiple-choice questionnaire, inquiring about the top 3 major concerns. Answers were compared, and the agreement rate was calculated. Concerns were gathered in an IIM outcome standard set with validated measures. Results The top three outcome concerns raised by patients were medication side effects/muscle weakness/prevention functionality loss. The top three concerns among rheumatologists were to prevent loss of functionality/to ensure the quality of life/to achieve disease remission. Other's outcomes concerns only pointed out by patients were muscle pain/diffuse pain/skin lesions/fatigue. The agreement rate between both groups was 41%. Assessment of these parameters guided the development of an IIM standard set which included Myositis Disease Activity Assessment Visual Analogue Scale/Manual Muscle Testing/fatigue and pain Global Visual Analogue Scale/Health Assessment Questionnaire/level of physical activity. Conclusion The authors propose a novel standard set to be pursued in IIM routine follow-up, which includes not only the main patients/rheumatologist outcome concerns but also additional important outcomes only indicated by patients. Future studies are necessary to confirm if this comprehensive approach will result in improved adherence and ultimately in better assistance.

Infection with high-risk genotypes of human papillomavirus and cervical cytological findings among kidney transplant recipients in Kenya: a single centre experience

Background: High-risk human papillomavirus (hrHPV) infection is linked with uterine cervix premalignant lesions and invasive carcinoma of the uterine cervix. Methods: Descriptive cross sectional study carried out among female kidney transplant (KTx) recipients in Kenyatta National Hospital, Nairobi-Kenya. We studied the risk factors for acquisition of hrHPV, examined cervical cytology and assayed for 14 hrHPV DNA using Cervista® HPV HR test and Cervista® MTA (Hologic®) automated platforms. Results: The 14-hrHPV genotypes assayed were 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68 and the prevalence rate was 31.25 % (10/32). Abnormal cervical cytology was noted in 4/32 (12.5%) and included low-grade squamous intraepithelial lesion (2/32), atypical squamous cells of undetermined significance (1/32) and atypical glandular cells (1/32). The average age was 41.9years with mean age at first coitus being 20.4 years. Majority of the women 20(62.5%) were married while 8(25%) were single. About 18(56.3%) had only one sexual partner. About 20% of women were nulliparous and 4(12.5%) had a parity of five. Duration sincetransplantation ranged between 1-21 years. Conclusions: The burden of hrHPV and abnormal cervical cytology in our study seemed lower than that reported elsewhere and even in general population. This study may form basis for further studies about HPV infections and carcinoma of the uterine cervix among the kidney allograft recipients in our setting

COVID-19 autopsies from the Ga-East municipal and the 37 military hospitals, Accra, Ghana

Introduction: Since the declaration of COVID-19 by the World Health Organisation (WHO) as a global pandemic on 11th March 2020, the number of deaths continue to increase worldwide. Reports on its pathologic manifestations have been published with very few from the Sub-Saharan African region. This article reports autopsies on COVID19 patients from the Ga-East and the 37 Military Hospitals to provide pathological evidence for better understanding of COVID-19 in Ghana. Methods: Under conditions required for carrying out autopsies on bodies infected with category three infectious agents, with few modifications, complete autopsies were performed on twenty patients with ante-mortem and/or postmortem RT -PCR confirmed positive COVID 19 results, between April and June ,2020. Results: There were equal proportion of males and females. Thirteen (65%) of the patients were 55years or older with the same percentage (65%) having Type II diabetes and/or hypertension. The most significant pathological feature found at autopsy was diffuse alveolar damage. Seventy per cent (14/20) had associated thromboemboli in the lungs, kidneys and the heart. Forty per cent (6/15) of the patients that had negative results for COVID-19 by the nasopharyngeal swab test before death had positive results during postmortem using bronchopulmonary specimen. At autopsy all patients were identified to have pre-existing medical conditions. Conclusion: Diffuse alveolar damage was a key pathological feature of deaths caused by COVID-19 in all cases studied with hypertension and diabetes mellitus being major risk factors. Individuals without co-morbidities were less likely to die or suffer severe disease from SARS-CoV-2

Maternal mortality statistics and risk factors at a tertiary hospital in Makurdi, Nigeria

Background: To determine the magnitude of maternal mortality and its major causes including the trend and social demographic factors associated with the problem in our environment.Methods: A retrospective institutional review of all the case notes of maternal mortality at the Benue State University Teaching Hospital, Makurdi over a six-year study period, from July, 2012 to June, 2018 were computed and analyzed.Results: A total of 2,442 deliveries took place within the period under review, out of which 2,325 were live births. Total maternal deaths were 26, giving a total maternal mortality ratio (MMR) of 1,118 deaths per 100, 000. The major causes of maternal mortality during this period were unsafe abortion and its complications, hypertensive diseases in pregnancy, puerperal sepsis and obstetric hemorrhage.Conclusions: Maternal mortality remains very high at our facility          y, although with a declining trend. This may be a reflection of the situation in the general population. Increased coverage of the National Health Insurance Scheme, blood availability and utilization of antenatal services will further reduce maternal mortality in Nigeria.

Muscle biopsies in dermatomyositis and polymyositis: practical relevance of analyzing different levels of histological sections of the same muscular compartment / Biópsias musculares em dermatomiosite e polimiosite: relevância prática da análise de diferentes níveis de cortes histológicos de um mesmo compartimento muscular

ABSTRACT Introdution: It is frequent in medical practice to have findings with normal aspects in histological muscle biopsies from patients with dermatomyositis (DM) or polymyositis (PM). This happens because, for example, the inflammatory infiltrate occurs in foci. Objectives: To evaluate the morphological and histological inflammatory infiltrate in various histological section levels. In addition, to correlate these findings with patients' clinical, laboratory and therapeutic data. Methods: Cross-sectional study in which muscle biopsies from 34 patients were evaluated (DM and PM). From each muscle/patient biopsy block, three levels of histological sections were made (I, II, III) with 400-µm interval between adjacent levels (I × II, and II × III). Semi-quantitative analyses were performed in the following parameters between the adjacent levels: muscle fiber features, conjunctive tissue, vessels, presence of inflammatory cell infiltration. Results: Time spans between muscle biopsy and symptom onset of DM and PM patients were 5.5 and 3.5 months, respectively. All histological parameters analyzed varied between levels and did not correlate with the demographic, clinical, laboratory and therapeutic data before muscle biopsy (p > 0.05). Conclusion: Our results stress the importance of evaluating different levels of histological sections from the same muscle biopsy block, in order to minimize possible false-negative results. In addition, the data reinforce that besides the inflammatory infiltrate, the other histological parameters analyzed also occur in foci, justifying the dissociation between these parameters and clinical patients.

RESUMO Introdução: É frequente na prática médica encontrar achados histológicos com aspectos dentro da normalidade em biópsias musculares de pacientes com dermatomiosite (DM) ou polimiosite (PM). Isso se deve ao fato de, por exemplo, o infiltrado inflamatório ocorrer em focos. Objetivos: Avaliar os aspectos morfológicos e o infiltrado inflamatório em diversos níveis histológicos, bem como correlacionar esses achados com os dados clínicos, laboratoriais e terapêuticos dos pacientes. Métodos: Estudo transversal no qual foram avaliadas biópsias musculares de 34 pacientes (DM e PM). Para cada bloco de biópsia muscular/paciente, foram realizados três níveis de cortes histológicos (I, II e III), com intervalos de 400 µm entre os níveis adjacentes (I × II e II × III). Foram analisados semiquantitativamente os seguintes parâmetros entre os níveis adjacentes: características das fibras musculares, tecido conjuntivo, vasos e presença de infiltrado de células inflamatórias. Resultados: O tempo entre a realização da biópsia muscular e o início de sintomas dos pacientes com DM e PM foi, respectivamente, de 5,5 e 3,5 meses. Todos os parâmetros histológicos analisados variaram entre os níveis e não se correlacionaram com os dados demográficos, clínicos, laboratoriais e terapêuticos pré-biópsia muscular (p > 0,05). Conclusão: Nossos resultados reforçam a importância de avaliar diferentes níveis de cortes histológicos de um mesmo bloco de biópsia muscular com o objetivo de minimizar eventuais resultados falso negativos. Além disso, os dados evidenciam que, além do infiltrado inflamatório, os demais parâmetros histológicos analisados também ocorrem em focos, justificando a dissociação entre esses parâmetros e a clínica dos pacientes.

Trend of Fire Outbreaks in Ghana and Ways to Prevent These Incidents

BACKGROUND: In Ghana, fire incidents have become a regular occurrence, with thousands of lives and millions of dollars lost every year. Hardly a day passes without news of a fire outbreak in some part of Ghana, causing fear and panic among the people. This generates much discussion centering on rumors relating to politics, sabotage, misfortune, religious differences, etc. This article seeks to discuss the trend of fire incidents occurring in Ghana from 2000 to 2013 and the different ways to prevent these incidents. METHODS: The pattern of fire incidence in Ghana as a whole as well as in each region is discussed. The study took into consideration the causes, mechanisms, as well as preventive measures against the fire menace. Data were obtained from the head office of Ghana's national fire service. RESULTS: It was noticed that in general the rate of fire incidence increased each year. This increase was attributed to several factors: rate of population growth and industrialization, unstable electricity, urbanization, negligence, illegal electrical connection, etc. The cause of fire was categorized into domestic, industrial, vehicular, institutional, electrical, commercial, bush, and others. Among these causes, domestic fire accounted for 41% of the total number of fire incidents in the country. CONCLUSION: Finally, this study presents several recommendations to help prevent and mitigate fire incidents in Ghana.

Decision Making Algorithm for Adult Spinal Deformity Surgery

Adult spinal deformity (ASD) is one of the most challenging spinal disorders associated with broad range of clinical and radiological presentation. Correct selection of fusion levels in surgical planning for the management of adult spinal deformity is a complex task. Several classification systems and algorithms exist to assist surgeons in determining the appropriate levels to be instrumented. In this study, we describe our new simple decision making algorithm and selection of fusion level for ASD surgery in terms of adult idiopathic idiopathic scoliosis vs. degenerative scoliosis.

Pseudarthrosis of the Cervical Spine: Risk Factors, Diagnosis and Management

Cervical myelopathy and radiculopathy are common pathologies that often improve with spinal decompression and fusion. Postoperative complications include pseudarthrosis, which can be challenging to diagnose and manage. We reviewed the literature with regard to risk factors, diagnosis, controversies, and management of cervical pseudarthrosis.

A Call for Action to Improve Occupational Health and Safety in Ghana and a Critical Look at the Existing Legal Requirement and Legislation

Occupational health and safety (OHS) is a broad field of professional practice, which involves specialists from different disciplines including but not limited to engineers, occupational health physicians, physical and biological scientists, economists, and statisticians. The preventive systems required to ensure workers are protected from injuries and illnesses dwell heavily on engineers; however, the extent to which the engineer can go regarding planning and implementing preventive measures is dependent on specific legal requirements, leadership commitment from the company, organization, and nation. The objective of this paper is to identify the areas of opportunities for improvements in OHS management in Ghana with regard to the nation's legal requirements, commitment of the Ghana government, and Ghanaian leadership as well as appropriate structuring of Ghanaian institutions responsible for monitoring and managing OHS in Ghana. This paper identified Ghana's fragmented legal requirements concerning OHS, which are under different jurisdictions with unclear responsibilities and accountabilities. The paper also highlights the training needs of Ghanaian academic institutions regarding OHS. Among other recommendations made including structuring of Ghanaian institutions to manage OHS in line with the ILO-OSH 2001, this paper aligns the recommendations with the articles and elements of International Labour Organization convention number 155 and OHSAS 18001 elements.

Pedicle Screw Placement in the Thoracolumbar Spine Using a Novel, Simple, Safe, and Effective Guide-Pin : A Computerized Tomography Analysis

OBJECTIVE: To improve pedicle screw placement accuracy with minimal radiation and low cost, we developed specially designed K-wire with a marker. To evaluate the accuracy of thoracolumbar pedicle screws placed using the novel guide-pin and portable X-rays. METHODS: Observational cohort study with computerized tomography (CT) analysis of in vivo and in vitro pedicle screw placement. Postoperative CT scans of 183 titanium pedicle screws (85 lumbar and 98 thoracic from T1 to L5) placed into 2 cadavers and 18 patients were assessed. A specially designed guide-pin with a marker was inserted into the pedicle to identify the correct starting point (2 mm lateral to the center of the pedicle) and aiming point (center of the pedicle isthmus) in posteroanterior and lateral X-rays. After radiographically confirming the exact starting and aiming points desired, a gearshift was inserted into the pedicle from the starting point into the vertebral body through the center of pedicle isthmus. RESULTS: Ninety-nine percent (181/183) of screws were contained within the pedicle (total 183 pedicle screws : 98 thoracic pedicle screws and 85 lumbar screws). Only two of 183 (1.0%) thoracic pedicle screws demonstrated breach (1 lateral in a patient and 1 medial in a cadaver specimen). None of the pedicle breaches were associated with neurologic or other clinical sequelae. CONCLUSION: A simple, specially designed guide-pin with portable X-rays can provide correct starting and aiming points and allows for accurate pedicle screw placement without preoperative CT scan and intraoperative fluoroscopic assistance.

Productive performance of sows fed increasing levels of distillers dried grains with solubles (DDGS) across parities / Comportamiento productivo de cerdas alimentadas con niveles crecientes de granos secos de destilería con solubles (DDGS) durante varios partos / Desempenho produtivo de porcas alimentadas com níveis crescentes de grãos secos de destilaria com solúveis (DDGS) durante vários partos

Background: of distillers dried grains with solubles (DDGS) in lactation diets may contribute to productive performance of lactating sows of different parities. Objective: the objective of this study was to determine the effects of feeding diets containing different levels of DDGS on productive performance of lactating sows of different parities. Methods: a total of 245 sows were divided into 3 parity groups of 1 to 2, 3 to 5, and over 5 parities. Within each parity group, sows were allotted to 1 of 4 dietary treatments that were prepared by inclusion of 0, 10, 20, and 30% DDGS in lactation diets. Diets were fed to sows during the whole lactation period. Results: average piglet weaning weight tended (quadratic, p<0.10) to increase by feeding diets containing increasing levels of DDGS to lactating sows of 3 to 5 and over 5 parities. Likewise, increasing levels of DDGS in diets tended (quadratic, p<0.10) to increase average piglet weight gain in all sow parity groups. The improvement of average piglet weaning weight and average piglet weight gain was the greatest when sows of 3 to 5 parities were fed diets containing 20% DDGS or when sows of over 5 parities were fed diets containing 10% DDGS compared with other dietary treatments. Feeding diets containing different levels of DDGS had no negative effects on other productive performance of lactating sows, regardless of parity. Conclusions: DDGS can be included up to 30% in diets fed to lactating sows of different parities.

Antecedentes: la inclusión de granos secos de destilería con solubles (DDGS) en las dietas de lactancia puede contribuir al desempeño productivo entre cerdas lactantes de diferentes partos. Objetivo: determinar los efectos de varios niveles dietarios de DDGS en el comportamiento productivo de cerdas lactantes de diferentes partos. Métodos: un total de 245 cerdas fueron divididas en 3 grupos según el número de partos: de 1 a 2, 3 a 5, y más de 5 partos. Dentro de cada grupo de partos, las cerdas se asignaron a 1 de 4 tratamientos dietarios que incluían 0, 10, 20, o 30 % de DDGS en la dieta de lactancia. Las dietas fueron administradas a las cerdas durante todo el período de lactancia. Resultados: el peso al destete de los lechones tendió (cuadrática, p<0,10) a aumentar con el consumo creciente de DDGS por cerdas lactantes de 3 a 5 o de más de 5 partos. Del mismo modo, los niveles crecientes de DDGS tendieron (cuadrática, p<0,10) a aumentar la ganancia media de peso de los lechones en todos los partos. La mejora del peso promedio al destete y ganancia de peso de los lechones fue mayor para las cerdas de 3 a 5 partos que consumieron 20 % de DDGS, o para cerdas de más de 5 partos consumiendo 10 % de DDGS. Las dietas con diferentes niveles de DDGS no tuvieron efectos negativos sobre otros parámetros productivos de las cerdas lactantes, independientemente de la paridad. Conclusiones: los DDGS se pueden incluir hasta un 30% en las dietas de cerdas lactantes de diferente orden de parto.

Antecedentes: a inclusão de grãos secos de destilaria com solúveis (DDGS) em dietas de amamentação pode contribuir para o desempenho produtivo de porcas lactantes com diferentes partos. Objetivo: determinar os efeitos de diferentes níveis dietéticos de DDGS no desempenho produtivo de porcas em lactação com diferente número de partos. Métodos: um total de 245 fêmeas foram divididas em três grupos segundo seu número de partos: 1-2, 3-5, e mais de 5 partos. Dentro de cada grupo de parição, as porcas foram designadas para um de quatro tratamentos de diferentes dietas que forneciam 0, 10, 20, ou 30% de DDGS na dieta de amamentação. As dietas foram fornecidas às porcas durante o período de lactação. Resultados: o peso ao desmame dos leitões tendeu (quadrática, p<0,10) a incrementar com o aumento do consumo de DDGS das porcas lactantes dos grupos 3-5 e mais de 5 partos. Do mesmo jeito, os níveis crescentes de DDGS (quadrática, p<0,10) aumentaram o ganho de peso médio dos leitões das porcas dos três grupos avaliados. A melhora do peso médio a desmama e o ganho de peso médio dos leitões foi maior nas porcas de 3-5 partos que consumiram 20% de DDGS e nas porcas de mais de 5 partos que consumiram 10% de DDGS. As dietas com diferentes níveis de DDGS não tiveram efeitos negativos sobre os outros parâmetros produtivos das porcas em lactação, independentemente do número de partos. Conclusões: os DDGS se podem incluir nas dietas das porcas com diferentes números de partos até num 30%.

Treatment of phosphate retention: The earlier the better?

Over the last 15 years, our knowledge and understanding of the underlying mechanisms involved in the regulation of calcium and phosphate homeostasis in chronic kidney disease have advanced dramatically. Contrary to general opinion in the 20th century that moderate hypercalcemia and hyperphosphatemia were acceptable in treating secondary hyperparathyroidism, the calcium and phosphate load is increasingly perceived to be a major trigger of vascular and soft tissue calcification. The current treatment options are discussed in view of historical developments and the expectations of the foreseeable future, focusing on the early treatment of hyperphosphatemia. At present, we lack in disputable evidence that active intervention using currently available drugs is of benefit to patients in chronic kidney disease stages 3 and 4.

Rodentborne fungal pathogens in wetland agroecosystem

The past few decades have witnessed an overwhelming increase in the incidence of fungal infections, particularly in immunocompromised individuals. Consequently, zoonotic diseases, especially through rodents constitute a prominent group among the emerging diseases. Rodents are commensal to man and related health risks are common. Water rats (Rattus norvegicus) are typical to Vembanadu-Kol wetland agroecosystems, where they can act as a good carrier nexus for pathogens. The present study evaluates the carrier status of water rats with respect to fungal pathogens. A total of fifty two fungi covering eighteen families were isolated. Among the isolates, eight were dermaptophytes and Chrysosporium sp. (89.18%) was the frequent isolate. The source-wise analyses showed an increased isolation from ventral hair (67 isolates). Water rats of Vembanadu-Kol wetland agroecosystem are potent carrier of dermaptophytes and other opportunistic fungi, and strong carrier paths are existing too.

History of Spinal Deformity Surgery Part I: The Pre-modern Era

Spinal deformity is one of the oldest known diseases that date back thousands of years in human history. It appears in fairy tales and mythologies in association with evil as its dramatic appearance in patients suffering from the disease easily lent itself to be thought of as a form of divine retribution. The history of spinal deformity dates back to prehistoric times. The early attempts to treat patients suffering from this disease started from Hippocrates age. Side traction or axial traction and cast immobilization were the only possible option prior to the discovery of anesthesia. The first surgical attempts to correct scoliosis occurred in the mid 19th century with percutaneous myotomies of the vertebral musculature followed by postoperative bracing, which outcomes were very quite horrifying. Hibbs' fusion operation had become a realistic treatment option to halt the progression of deformity in the early 20th century. Harrington's introduction of the internal fixation device to treat paralytic scoliosis in 1960's started revolution on deformity correction surgery. Luque developed a segmental spinal using sublaminar wiring technique in 1976 and Cotrel developed Cotrel-Dubousset (CD) instrumentation, which was a posterior segmental instrumentation system that used pedicle and laminar hooks on either thoracic or lumbar spine and pedicle screws on the lumbar spine.

History of Spinal Deformity Surgery Part II: The Modern Era

Following Dwyer introduction of anterior spinal instrumented fusion surgery, Zielke, Moss-Miami, and Kaneda had made a significant progression on anterior spinal instrumented fusion which allowed excellent correction without significant loss of correction or implant failure. King and Moe deveoped classification of thoracic major curve following Harrington rod intrumentation. King classification presented a stable vertebra concept and selective fusion concept. Surgical classification of Adolescent Idiopathic Scoliosis (AIS) developed by Harms study group provided a more sophisticated two dimensional understanding of curve nature. Surgical intervention of adult scoliosis and sagittal imbalance is still challenging and evolving. Several evidences such as sacropelvic fixation and bone morphogenetic protein helped us to deal with adult deformity. The surgical decision making on spinal deformity surgery is still yet evolving.

A Review of UNGASS-Based Outcomes and Impact of HIV/AIDS Programs in Eight sub-Saharan Countries / 国際保健医療

<B>Introduction</B><br>Whereas the numbers of new HIV infections and deaths due to AIDS have been reduced or stabilized, they remain high in sub-Saharan Africa. To further control the generalized epidemics and their consequences, countries have continued strengthening their programs to prevent new infections and deaths: however, program outcomes and impact at the national level are not well understood. The purpose of the review was to describe the country-level outcomes and impact of HIV/AIDS programs in eight sub-Saharan African countries in order to highlight future action agenda to meet universal access and policies related to Millennium Development Goals (MDGs).<br><B>Methods</B><br>The review used 16 of the 25 program outcome and impact indicators prescribed by the United Nations General Assembly Special Session (UNGASS). The review reported on the percentages accomplished by each country in their programs, categorized these figures into high (80% and higher), moderate (50-79%) and low (below 50%), and highlighted the domains in which outcomes and impact were high.<br><B>Results</B><br>Across countries, with the exception of Tanzania, programs had achieved nearly universal or universal outcomes and impact, but their coverage was limited to 2-5 program domains. Moreover, in domains with multiple target groups, such as in the provision of antiretroviral therapy and in the promotion and distribution of condom use, the programs were unable to produce high-end results for the affected populations. To further reduce their infections and deaths and to advance towards universal access and MDGs, countries must make their program outcomes and impact comprehensive and equitable.<br><B>Conclusion</B><br>Almost all national programs have high level accomplishments, but they must broaden their domain and audience coverage to further control the generalized epidemics and deaths in the eight countries. National responses must collect and analyze all the UNGASS data systematically and regularly in order to determine current HIV/AIDS knowledge and behaviors, ascertain program effects, and inform future actions.

Factors influencing contraceptive choice and discontinuation among HIV-positive women in Kericho, Kenya

This study explored perceptions towards and utilization of contraception among HIV-positive, reproduction-age women in Kericho, Kenya, an area with high HIV and low contraceptive prevalence rates. Qualitative methods were used in three focus group discussions and 15 in-depth interviews to gather data from 46 HIV-positive women ages 18 to 45, purposively selected by age strata. Analysis was performed using ATLAS-ti (ATLAS-ti Center, Berlin). Most participants reported familiarity with modern contraceptives. Participants generally perceived that men opposed contraception. Some women indicated that their HIV status dictated contraceptive decisions, particularly with regard to abstinence. Women reported method discontinuation because of side effects, having met desired parity, and menstrual changes. Findings suggested that perceptions about side effects, opinions of the male partner, and HIV disease progression play important roles in contraceptive decisions. Counseling can dispel incorrect information and optimize contraceptive practice in this setting (Afr J Reprod Health 2010; 14[4]: 103-114)

Attitudes toward hepatitis B and liver cancer prevention among Chinese Americans in the San Francisco Bay Area, California.

BACKGROUND: Chronic hepatitis B and associated liver cancer constitute important health threats with disparity among Asian/Pacific Islander Americans (APIs). However, many APIs are unaware of and unprotected against these diseases. METHODS: To inform the development of community-based programs to increase hepatitis B and liver cancer awareness and prevention among APIs, we conducted a series of qualitative focus groups in 2007 to identify motivations and deterrents related to hepatitis B education, testing, and vaccination among San Francisco Bay Area Chinese Americans. Six focus groups were held in Cantonese, English, or Mandarin for women or men, respectively. Recorded transcripts were transcribed, translated, and then coded by consensus. RESULTS: Factors that motivated individuals to be tested for hepatitis B included peace of mind, prevention of transmission to others, informed decision-making ability, convenience, and pre-vaccination screening. Primary motivations for hepatitis B vaccination were protection of future health and avoidance of hepatitis B. However, factors that discouraged people from testing or vaccination included costs, lack of health insurance, fear of side effects, worries about reliability or efficacy, poor patient-doctor communication, reliance on professional opinion, apparent good health, inconvenience, and personal preference. Individuals were generally in favor of informing relatives and friends about hepatitis B testing and vaccination, and offered several reasons for and against educating others about these activities. CONCLUSIONS: In summary, our study identifies common attitudes and influences regarding the decision to take preventive action against hepatitis B and liver cancer. These findings can be applied toward the design of more effective educational and outreach materials and programs for Chinese Americans and possibly other APIs.