Measuring ventilation and modelling M. tuberculosis transmission in indoor congregate settings, rural KwaZulu-Natal.

SETTING: Molecular epidemiology suggests that most Mycobacterium tuberculosis transmission in high-burden settings occurs outside the home. OBJECTIVE: To estimate the risk of M. tuberculosis transmission inside public buildings in a high TB burden community in KwaZulu-Natal, South Africa. DESIGN: Carbon dioxide (CO2) sensors were placed inside eight public buildings. Measurements were used with observations of occupancy to estimate infection risk using an adaptation of the Wells-Riley equation. Ventilation modelling using CONTAM was used to examine the impact of low-cost retrofits on transmission in a health clinic. RESULTS: Measurements indicate that infection risk in the church, classroom and clinic waiting room would be high with typical ventilation, occupancy levels and visit durations. For example, we estimated that health care workers in a clinic waiting room had a 16.9-24.5% annual risk of M. tuberculosis infection. Modelling results indicate that the simple addition of two new windows allowing for cross-ventilation, at a cost of US$330, would reduce the annual risk to health care workers by 57%. CONCLUSIONS: Results indicate that public buildings in this community have a range of ventilation and occupancy characteristics that may influence transmission risks. Simple retrofits may result in dramatic reductions in M. tuberculosis transmission, and intervention studies should therefore be considered.

Separation of the metallic and non-metallic fraction from printed circuit boards employing green technology.

The generation of electrical and electronic waste is increasing day by day; recycling is attractive because of the metallic fraction containing these. Nevertheless, conventional techniques are highly polluting. The comminution of the printed circuit boards followed by an inverse flotation process is a clean technique that allows one to separate the metallic fraction from the non-metallic fraction. It was found that particle size and superficial air velocity are the main variables in the separation of the different fractions. In this way an efficient separation is achieved by avoiding the environmental contamination coupled with the possible utilization of the different fractions obtained.

[Antitetanus vaccination in the adult: systematic offer in primary care as an effective approach]. / Vacunación antitetánica en el adulto: la oferta sistemática en atención primaria como un abordaje efectivo.

OBJECTIVE: To establish the effectiveness of a broad offer for tetanus vaccination (ATT), to any person visiting his general practitioner, by evaluating its coverage, acceptance by patients and final vaccination figures. DESIGN: Intervention study of nonrandom type. SETTING: Primary care. PATIENTS: 1349 people aged > or = 24 registered with a general practitioner, of which 1048 were user's people. MEASUREMENTS AND MAIN RESULTS: Find out all people seeking primary care if they has been vaccinated against tetanus, recording the next token dosage or inoculating it, according to the recommendations of the Centers for Disease Control. We offered vaccination to 90.7% of the user's people, without significant difference as to age and sex groups, and to 70.7% of the registered population. The proposal was rejected by 8.9% of people who need to initiate vaccination. The 17.1% of the population stated that they had been inoculated the whole vaccination cycle, and after the treatment the rate rose to 81.5% of intervener's people. CONCLUSION: The broad offer for ATT vaccination to people seeking primary care, whatever the reason is, the final result is 8 patients vaccinated out of 10 of the offer's people. This is an easily measurable example of what can be achieved both with registered population and people seeking primary care if we include preventive programmes and health promotion in the daily medical attention demanded by patients who go to primary care centers.

[The follow-up of a patient cohort with arterial hypertension in primary care]. / Seguimiento de una cohorte de pacientes con hipertensión arterial en atención primaria.

OBJECTIVE: To establish effectiveness of the hypertension program basing on the detection degree, decreasing of blood pressure and control of hypertension. DESIGN: Intervention study. SETTING: Primary care. PATIENTS: A group > or = 14 years of age, treated by the primary health care and selected at random (3,349). Here we found all the patients with hypertension (237). INTERVENTION AND MAIN RESULTS: Hypertension program approval of the public health department. Criteria followed are those suggested in report V of the Joint National COMMITTEE: Global prevalence of hypertension is 7.1% and in the group > or = 65 years of age 51.3%. Average decrease of the systolic blood pressure is 18.9 mmHg and that of the diastolic blood pressure 13.5 mmHg, both with p < 0.001. Decrease for patients with mild hypertension was 5.4-13.8 mmHg for systolic and 6.7-11.8 for diastolic. Patients with moderate hypertension 17.3-22.5 and 12.2-15.7 mmHg respectively and patients with severe hypertension 27.6-43.0 and 15.0-23.0 mmHg. The 39.7% of hypertensive patients have systolic < 140 mmHg and 70.0% have diastolic < 90 mmHg at the end of monitoring period. CONCLUSIONS: Actual application of hypertension program by our primary care system allows detection of elderly patients with high blood pressure, major decrease of blood pressure, together with a greater decrease even whether they high at the beginning of the monitoring.

Estenosis por acodadura y rizos de la arteria carotida interna extracraneal acompanantes de aneurismas intracraneales ipsolaterales. Presentacion de cinco casos. / Stenosis by bending of the ellow and curling of the extracranial internal carotid artery associated with intracraneal aneurysms.Report of 5 cases

Se evaluo la frecuencia de anomalias de la arteria carotida interna en su porcion cervical en 83 pacientes consecutivos portadores de aneurisma intracraneal, que se compararon como grupo con 100 pacientes sometidos a estudios por enfermedad no vascular. Cinco pacientes (6 por ciento), presentaron alteraciones carotideas extracraneales con estenosis secundaria, ipsolaterales al aneurisma intra craneal.Del grupo testigo solo 3 por ciento presentaron anormalidades carotideas a nivel del cuello. Se ha propuesto que las anomalias carotideas extracraneales tienen una funcion importante en la patogenesis de los aneurismas intracraneales, pero hasta el momento, los casos informados en la literatura son mas frecuentemente contralaterrales al sitio de la lesion, al parecer por aumento del esfuerzo hemodinamico. Se informan cinco casos de aneurismas intracraneales ipsolaterales a la lesion carotidea extracraneal, y lo que constituye una frecuencia dos veces mayor que en la poblacion normal, con la peculiaridad de que todos los casos fueron ipsolaterales a la lesion cervical

Tratamiento quirurgico de la compresion microvascular de los nervios craneales. / Surgical treatment of the microvascular compression of cranial nerves

Se presenta el resultado del tratamiento microquirurgico de once pacientes con compresion microvascular de los nervios trigemino, facial y glosofaringeo. Es un procedimiento no mutilante y con 100 por ciento de eficacia para tratar enfermedades como neuralgia del trigemino, neuralgia del glosofaringeo y espasmo hemifacial Se revisa la literatura mundial y se hacen consideraciones sobre la etiopatogenia de estas enfermedades