Cloud-based applications for accessing satellite Earth observations to support malaria early warning.

Malaria epidemics can be triggered by fluctuations in temperature and precipitation that influence vector mosquitoes and the malaria parasite. Identifying and monitoring environmental risk factors can thus provide early warning of future outbreaks. Satellite Earth observations provide relevant measurements, but obtaining these data requires substantial expertise, computational resources, and internet bandwidth. To support malaria forecasting in Ethiopia, we developed software for Retrieving Environmental Analytics for Climate and Health (REACH). REACH is a cloud-based application for accessing data on land surface temperature, spectral indices, and precipitation using the Google Earth Engine (GEE) platform. REACH can be implemented using the GEE code editor and JavaScript API, as a standalone web app, or as package with the Python API. Users provide a date range and data for 852 districts in Ethiopia are automatically summarized and downloaded as tables. REACH was successfully used in Ethiopia to support a pilot malaria early warning project in the Amhara region. The software can be extended to new locations and modified to access other environmental datasets through GEE.

Remote revascularization of abdominal wall transplants using the forearm.

Primary abdominal wall closure following small bowel transplantation is frequently impossible due to contraction of the abdominal domain. Although abdominal wall transplantation was reported 10 years ago this, technique has not been widely adopted, partly due to its complexity, but largely because of concerns that storing the abdominal allograft until the end of a prolonged intestinal transplant procedure would cause severe ischemia-reperfusion injury. We report six cases of combined small bowel and abdominal wall transplantation where the ischemic time was minimized by remotely revascularizing the abdominal wall on the forearm vessels, synchronous to the intestinal procedure. When the visceral transplant was complete, the abdominal wall was removed from the forearm and revascularized on the abdomen (n = 4), or used to close the abdomen while still vascularized on the forearm (n = 2). Primary abdominal wall closure was achieved in all. Mean cold ischemia was 305 min (300-330 min), and revascularization on the arm was 50 min (30-60 min). Three patients had proven abdominal wall rejection, all treated successfully. Immediate revascularization of the abdominal wall allograft substantially reduces cold ischemia without imposing constraints on the intestinal transplant. Reducing storage time may also have benefits with respect to ischemia-reperfusion-related graft immunogenicity.

Neuroendoscopy in Jamaica.

This retrospective, descriptive study reviewed the patient profile, disease spectrum, indications for and results of treatment and complications of all 27 patients who had neuroendoscopy at the University Hospital of the West Indies (UHWI) over the three-year period between November 2000, when the service was first introduced, and November 2003. Nineteen (67.9%) were males and eight were females. Their mean age was 27.5 +/- 21.4 years with a range of four months to 70 years. Of the entire group, 20 had hydrocephalus with raised intracranial pressure, of which 15 had endoscopic third ventriculostomy (ETV) for the treatment of obstructive hydrocephalus, using two different techniques for ventricular floor fenestration. There was no demonstrable difference in outcome between the water jet and blunt forceps techniques. Three procedures failed to relieve the hydrocephalus, requiring subsequent ventriculo-peritoneal shunts. Three patients had successful cyst fenestrations. Six patients had endoscope assisted trans-sphenoidal resection for pituitary tumours. There were five complications and no deaths. Mean hospital stay was 18.4 +/- 16.7 days and mean follow-up was 29 weeks. There were no late failures. Neuroendoscopy is the treatment of choice for obstructive hydrocephalus due to aqueduct stenosis or posterior fossa tumours and has the advantage of avoiding shunt related complications. It is safe and effective for the majority of patients and has a significant role in the management of neurosurgical patients in the Caribbean.

Neuroendoscopy in Jamaica / Neuroendoscopía en Jamaica

This retrospective, descriptive study reviewed the patient profile, disease spectrum, indications for and results of treatment and complications of all 27 patients who had neuroendoscopy at the University Hospital of the West Indies (UHWI) over the three-year period between November 2000, when the service was first introduced, and November 2003. Nineteen (67.9) were males and eight were females. Their mean age was 27.5 +/- 21.4 years with a range of four months to 70 years. Of the entire group, 20 had hydrocephalus with raised intracranial pressure, of which 15 had endoscopic third ventriculostomy (ETV) for the treatment of obstructive hydrocephalus, using two different techniques for ventricular floor fenestration. There was no demonstrable difference in outcome between the water jet and blunt forceps techniques. Three procedures failed to relieve the hydrocephalus, requiring subsequent ventriculo-peritoneal shunts. Three patients had successful cyst fenestrations. Six patients had endoscope assisted trans-sphenoidal resection for pituitary tumours. There were five complications and no deaths. Mean hospital stay was 18.4 +/- 16.7 days and mean follow-up was 29 weeks. There were no late failures. Neuroendoscopy is the treatment of choice for obstructive hydrocephalus due to aqueduct stenosis or posterior fossa tumours and has the advantage of avoiding shunt related complications. It is safe and effective for the majority of patients and has a significant role in the management of neurosurgical patients in the Caribbean

Este estudio retrospectivo y descriptivo, examinó el perfil del paciente, el espectro de la enfermedad, las indicaciones y resultados del tratamiento, así como las complicaciones de un total de 27 pacientes sometidos a neuroendoscopía en el Hospital Universitario de West Indies (UHWI) por un período de tres años, de noviembre de 2000 de noviembre - cuando se introdujo el servicio por primera vez - hasta noviembre de 2003. Diecinueve (67.9%) eran hombres y ocho mujeres. Su edad promedio fue de 27.5 ± 21.4 años con un rango de cuatro meses a 70 años. De la totalidad del grupo, 20 presentaban hidrocéfalo con presión intracraneal alta, y de ellos 15 tuvieron ventriculostomía endoscópica del tercer ventrículo (VET) para el tratamiento de hidrocéfalo obstructivo, usando dos técnicas diferentes para la fenestración del piso ventricular. No hubo diferencia demostrable en cuanto a resultados, entre la técnica de chorro de agua y la de fórceps romos. Tres procedimientos no lograron aliviar el hidrocéfalo, haciéndose necesarios subsiguientes derivaciones ventrículo-peritoneales. Tres pacientes tuvieron fenestraciones de quiste exitosas. Seis pacientes fueron sometidos a resección trans-esfenoidal con asistencia endoscópica para los tumores pituitarios. Se presentaron cinco complicaciones y no hubo muertes. La estancia promedio en el hospital fue de 18.4±16.7 días y el seguimiento medio fue de 29 semanas. No hubo ningún fallo a última hora. La neuroendoscopía es el tratamiento elegido para el hidrocéfalo obstructivo debido a estenosis del acueducto o tumores en la fosa posterior, y tiene la ventaja de evitar complicaciones relacionadas con las derivaciones. La neuroendoscopía es segura y efectiva para la mayoría de los pacientes, y desempeña un papel significativo en el tratamiento de los pacientes neuroquirúrgicos en el Caribe

Hydrocephalus at the University Hospital of the West Indies

OBJECTIVES: To define the aetiology of hydrocephalus and to investigate the presumed high frequency of post meningitic hydrocephalus at the University Hospital of the West Indies (UHWI). To study whether the pattern of hydrocephalus seen at UHWI may be amenable to alternative treatment (neuroendoscopy). METHODS: A retrospective review was carried out between August 2000 and July 2001. The department of Surgery's operative audit and admissions database along with the personal database of one of the authors (IC) were accessed. From this, we were able to retrieve 100 patient logs from the records department of UHWI. RESULTS: The male to female ratio was 1:1 and the age range was from one day to 70 years (mean 15 years). The leading causes of hydrocephalus were aqueduct stenosis (20), and tumour associate hydrocephalus (17). These were followed by post haemorrhagic (14), post meningitic (9) and communicating hydrocephalus not otherwise specified. The more common presenting complaints were enlarging head (32), headache (22), vomiting (21), seizures (11), papilloedema (9), ataxia (9) and neck stiffness (3). CONCLUSION: Aqueductal stenosis was the most common aetiological factor giving rise to hydrocephalus whereas post meningitic hydrocephalus was not very common. Neuroendoscopy is now well accepted in the management obstructive hydrocephalus. Given the frequency of aqueductal stenosis, neuroendoscopy maybe a feasible alternative in the treatment of hydrocephalus at UHWI. (AU)

Dengue in Trinidad: a survey of knowledge, attitudes, practices and beliefs in two communities in Trinidad, West Indies

This study was conducted to test the Health Belief Model as it relates to dengue fever in two urban communities, namely Curepe and Woodbrook, Trinidad using a knowledge, attitude, practices and beliefs questionnaire and entomological investigations. The knowledge of dengue symptomatology, its prevention and control suggested a high level of awareness about dengue and its aetiological agents among residents of both commuities, but the connection between the vector Aedes aegypti (L.) and dengue fever transmission was poorly understood. The major determinants for cues to action were demographics, prevention of water treatment and garbage collection and disposal. Data from the present study gave clear indications of the need for health education programs, defining what garbage is and the further studies using the transtheoretical model of change (Prochaska Model). With these tools a holistic approach to vector control using community participation, health education and conventional vector control strategies may be adopted for the prevention and control of dengue and its vector. Ae. aegypti, on a sustained basis in Trinidad and, possibly, the Caribbean region.(AU)