Attrition during pre-ART and ART time periods among adolescents enrolled in Integrated HIV Care Programme in Myanmar, 2005-2017.

Retaining adolescents (aged 10-19 years), living with HIV (ALHIV) on antiretroviral therapy (ART) is challenging. In Myanmar, 1269 ALHIV were under an Integrated HIV Care (IHC) Programme by June 2017 and their attrition (death and lost to follow-up) rates were not assessed before. We undertook a cohort study using routinely collected data of ALHIV enrolled into HIV care from July 2005 to June 2017 and assessed their attrition rates in June 2018 by time-to-event analysis. Of 1269 enrolled, 197(16%) and of 1054 initiated ART, 224 (21%) had an attrition defining event. The pre-ART and ART attrition rates were 21.8 (95% CI 19.0-25.1) and 6.4 (95% CI 5.6-7.3) per 100 person-years follow-up, respectively. The factors 'at enrolment' that were associated with higher hazards of attrition were: (1) WHO stage 3 or 4; (2) haemoglobin <10 gm/dl; (3) no documented CD4 cell counts, hepatitis B and C test results; and (4) injection drug use. Baseline hazards were high during the initial 1-2 years and after 5-6 years. The pre-ART and ART attrition rates in ALHIV were lower than those in Africa but higher than the children under IHC. This warrants designing and implementing additional care tailored to the needs of ALHIV under IHC.

Epineurial sheath tube (EST) technique: an experimental peripheral nerve repair model.

OBJECTIVE: Here we present the epineurial sheath tube (EST) technique as a modified microsurgical rat sciatic nerve model. The EST technique provides a cavity or pouch consisting of an outer epineurial sleeve that has been freed from nerve fascicles. This cavity may be appropriate to test the effectiveness and biocompatibility of implanted growth factors, cell suspensions (embedded in solutions or gels), or bioartificial nerve guide constructs. METHODS: A total number of 10 rats underwent the surgical procedure for the EST technique. Cylinders made of fibrin gel served as implants and place-holders. Three animals were euthanized directly after operation, while the others survived for 6 weeks. After immersion fixation (3·9% glutaraldehyde), both conventional histology [semi-thin sections (1 µm), toluidine blue] and scanning electron microscopy were performed. RESULTS: Conventional histology and scanning electron microscopy of samples that had been fixed directly after the surgical procedure displayed the integrity of the closed epineurial tube with the fibrin cylinder in its center. Even after 6 weeks, the outer epineurium was not lacerated, the stitches did not loosen, and the lumen did not collapse, but remained open. DISCUSSION: The practicability of the EST technique could be verified regarding feasibility, reproducibility, mechanical stability, and openness of the lumen. The EST technique can be adapted to other nerve models (e.g. median or facial nerve). It provides a cavity or pouch, which can be used for different neuroscientific approaches including concepts to improve the therapeutic benefit of autologous nerve grafting or therapies to be used as an alternative to autologous nerve grafting.

[Disruption of the arteria nutricia tibiae by reamed and unreamed intramedullary nailing. Study of the vascular architecture of the human tibial intramedullary cavity]. / Beeinträchtigung der Arteria nutricia tibiae durch die aufgebohrte und die unaufgebohrte Marknagelung. Untersuchung zur Gefässarchitektur der humanen Tibiamarkhöhle.

AIM: By reason of the pseudarthrotic healing of fractures due to vascular complications after reamed and unreamed intramedullary nailing, the intraosseous course and branching of the tibial nutrient artery and its impairment by nailing procedures needs an actual analysis. METHOD: The nutrient vessel of 24 tibiae taken from fresh corpses were prepared by injection of Technovit and lead oxide. After this procedure the medullary cavities of 12 bones were opened by a frontal cut. These specimens were subjected to routine maceration. The other 12 tibiae were naed with the unreamed (6) and the reamed nailing (6) techniques. X-rays were also taken routinely. RESULTS: After penetration of the tibial compact bone the main trunk of the nutrient vessel runs through a perforated osseous tunnel (pars tecta arteriae nutriciae tibiae). At its end the vessel divides into a descending branch (obligate) and two ascending branches (facultative). The descending branch lies near to the centromedial region of the medullary cavity which is termed as the pars liberal arteriae nutriciae tibiae. All branches pass through supporting horizontal osseous lamellas. Due to this topography the reamed nailing technique destroyed the nutrient vessel completely in all specimens. In contrast to this observation the unreamed nailing destroyed the vessel completely only in 1 (16.7%) and partially in 3 (50%) bones; 2 (33.3%) specimens exhibited no destruction of the vessel. CONCLUSION: The unreamed as well as the reamed nailing technique can destroy the intramedullary course of the tibial nutrient artery. Fractures as well as displacement osteotomies or corticotomies are able to diminish the medullary blood supply seriously, if they are localised within the area of the tactic an of the tibial nutrient artery.