Strengthening the evidence base for health programming in humanitarian crises.

Given the growing scale and complexity of responses to humanitarian crises, it is important to develop a stronger evidence base for health interventions in such contexts. Humanitarian crises present unique challenges to rigorous and effective research, but there are substantial opportunities for scientific advance. Studies need to focus where the translation of evidence from noncrisis scenarios is not viable and on ethical ways of determining what happens in the absence of an intervention. Robust methodologies suited to crisis settings have to be developed and used to assess interventions with potential for delivery at scale. Strengthening research capacity in the low- to middle-income countries that are vulnerable to crises is also crucial.

Manifestações clínicas na Policondrite Recidivante: relato de caso / Clinical manifestations of Relapsing Polychondritis: case report

A Policondrite Recidivante - PR é uma afecção sistêmica grave, de natureza imunológica, caracterizada por um processo inflamatório que acomete as estruturas cartilaginosas nasais e auriculares, vias aéreas superiores e articulações periféricas. O diagnóstico é basicamente clínico e as complicações otorrinolaringológicas podem ser as manifestações iniciais da doença. Tendo em vista a raridade da doença, objetivou-se descrever um caso de PR, atendida no Hospital das Clínicas da UFG em agosto de 2006. Para tanto, as etapas seqüenciais do atendimento foram descritas desde a consulta inicial, diagnóstico, tratamento até a alta hospitalar. As dificuldades vivenciadas pelos profissionais em dar seguimento ao tratamento, em função da resistência da paciente, provavelmente colaborou para agravamento da doença, culminando em seu óbito. O clínico deve estar atento frente a suspeita clínica de Policondrite Recidivante visando o seu diagnóstico precoce e tratamento.

The Relapsing Polychondritis - RP is a rare systemic affection, of immunological nature, characterize by an inflammatory process that affects cartilaginous structures, upper airway and peripheral articulation. The diagnosis is basically clinical and the otorhinolaryngological complications can be the initial manifestations of the illness. Having in view the rarity of the disease, it was objectified to describe a PR case attended at Hospital das Clínicas of UFG in august of 2006. Therefore, the sequential stages of the attendance had been described since the initial appointment, diagnosis, high treatment until the hospital one. The difficulties lived deeply for the professionals to proceed the treatment, in function of the resistance of the patient, probably collaborated for aggravation of the illness, culminating in its death. The physician must be alert in the presence of the clinical suspicion of Relapsing Polychondritis aiming at its precocious diagnosis and treatment.

La Policondrite Recidivante - PR es una afección sistémica grave, de naturaleza inmunológica. Caracterizada un proceso inflamatorio que acomete estructuras cartilaginosa nasales, vías aereas superiores y articulaciones periféricas. El diagnóstico es basicamente clínico y las complicaciones otorrinolaringológicas pueden ser las manifestaciones iniciales de la enfermedad. Esta enfermedad por ser rara, se objetivó describir un caso de PR, atendida en El Hospital de las Clínicas de La UFG en agosto de 2006. Para tanto, las etapas secuenciales del atendimiento fueron descritas desde la consulta inicial, diagnóstico, tratamiento hasta la alta hospitalar. Las dificultades vividas por los profesionales en dar seguimiento al tratamiento, en función de La resistencia de La paciente, probablemente colaboro para el agravamiento de la enfermedad, culminando en su óbito. El clínico debe estar atento frente a la sospecha clínica de Policondrite Recidivante visando su diagnóstico precoz y tratamiento.

A continuing outbreak of multidrug-resistant tuberculosis, with transmission in a hospital nursery.

We investigated an increase in cases of multidrug-resistant tuberculosis (MDRTB) at a large urban facility where a prior nosocomial outbreak of MDRTB had occurred. Nosocomial transmission appeared to account for this outbreak as well, including a cluster of cases in a newborn nursery. Seven of 24 patients (29%) described in this investigation may have been exposed in the hospital nursery during an approximately 2-week period. We believe this to be the first documented outbreak of MDRTB in a hospital nursery. The transmission in the nursery demonstrates that the possibility of exposure to unrecognized active tuberculosis in nursery and hospital personnel is always present. Infection and active disease in the infants developed after a relatively short period of exposure. These findings underscore the need for adherence to published infection control guidelines in health care settings.

Ozonation of DNA forms adducts: a 32P-DNA labeling and thin-layer chromatography technique to measure DNA environmental biomarkers.

Little direct documented evidence of ozone's genotoxicity exists. Deoxyribonucleic acid (DNA) adducts are produced by environmental toxic agents, including ozone. We have described a modified thin-layer chromatography (TLC) technique that can assess adduct formation as a biomarker of ozone injury. This requires 32P-labeling DNA, digestion of deoxynucleotides (dNMPs), and separation in two-dimensional PEI-cellulose TLC. We have applied this technique to control DNAs, to control DNA in solution exposed to acute ambient ozone, and to control DNA exposed to acute bubbled-through ozone (2 ppm for 24 h). We detected stable DNA adducts, including hydroxymethyluracil (HMU), thymine glycol (TG), 8-hydroxyguanine (8-OHG), and demonstrated, as yet, unidentified adducts that may serve as a "fingerprint" pattern of DNA adduction. This technique quantifies low-molecular-mass DNA adducts, both in vivo and in vitro, with potential applications to environmental toxicology.

[Contraception and tubal sterility of infective origin]. / Contraception et stérilité tubaire d'origine infectieuse.

A series of 89 caucasian women, who had been operated on for non-infectious tubal infertility were studied to find out what contraceptive methods they had used before they became infertile (oral contraception, intra-uterine contraceptive device and other methods). A matched series of 178 fertile women were used as a control group. The numbers who had chlamydia were studied as a function of the method of contraception in the group of infertile women. This work shows that women with tubal infertility due originally to infection had less often used oral contraception than the matched group of fertile women had. One can conclude that oral contraception acts as a prevention against this cause of infertility. The role played by intra-uterine contraceptive devices is difficult to establish. All the same, there is a significant relationship between the use of intra-uterine devices and tubal infertility of infectious origin, whether we look at multiparae or women between 25 and 34 years of age. This study also shows that chlamydia is not associated with the use of combined preparation oral contraceptives, nor with the use of the intra-uterine device in women who have tubal factor infertility. This study all the same shows that it does seem to be important to advise oral contraception in preference to the intra-uterine device in women who are still wanting to have a pregnancy, even if they are multiparae or multigravidae.

PIP: The relationship between IUD and oral contraceptive (OC) use and tubal infertility of infectious origin was retrospectively studied in 89 French women undergoing operations for tubal infertility between 1978- 87, 178 women who had spontaneously become pregnant regardless of outcome formed the control group, which was matched for age, socioprofessional status, and ethnic origin. Chlamydia trachomatis was responsible for 73% of cases of tubal infertility. 22 of the 89 women had a history of diagnosed salpingitis and 20 had had abdominal pain of unknown origin. 47 had had no symptoms of salpingitis. The average age was 29.68 years for the tubal infertility group and 29.7 for the fertile women. The socioprofessional status of the 2 groups was similar and higher than that of the general French population. 58% in the tubal infertility group and 36% in the fertile group were nulligestes. 60.1% of fertile vs. 47.2% of infertile women had used OCs. More infertile (22.5%) than fertile (14.6%) women had used IUDs, but the difference was not statistically significant. 45% of infertile women who had used IUDs had a history of diagnosed salpingitis, vs. 19% of pill and 18.5% of other contraceptive method users. The rate of chlamydia infection was similar for OC, IUD, and other method users. The rate of use of IUDs was similar for nulliparous fertile and infertile women, but for multiparous women it was significantly higher among infertile women. The finding that the infertile group had used OCs less often than controls suggest that OCs have a protective effect against this type of infertility. The role of the IUD is harder to establish, but a significant relationship was found between infectious tubal infertility and IUD use among multiparas and among women aged 25-34 years. The study also demonstrated that chlamydia infections are not related to contraceptive method used. In the light of this study it appears important to advise OCs rather than IUDs for women who are likely to desire a future pregnancy, even for multiparous women.