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1.
Eur J Orthop Surg Traumatol ; 34(1): 167-173, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37386190

RESUMO

PURPOSE: To assess proximal femoral replacement as a treatment solution for nonunion of pathologic subtrochanteric fractures after cephalomedullary nailing in patients with pathological fracture and previously irradiated bone. METHODS: Retrospective review of five patients with pathological subtrochanteric femoral fractures that were treated with cephalomedullary nailing and developed a nonunion, which was revised with conversion to a proximal endoprosthetic replacement. RESULTS: All five patients had previously been treated with radiation. One patient had the latest follow-up at 2 months postoperatively. At that time, the patient was walking with a walker for assistance, with no evidence of hardware failure or loosening on imaging. The remaining four patients had the latest follow-up ranging from 9 to 20 months after surgery. At their latest follow-up, three of the four patients were ambulatory with no pain, using only a cane for assistance with longer distances. The other patient demonstrated pain in his affected thigh, utilizing a walker for assistance with ambulation at latest follow-up, but not requiring further surgical interventions. There were no hardware failures or implant loosening through the follow-up period. None of the patients required revision, and there were no postoperative complications observed at their last follow-up. CONCLUSIONS: In patients with pathological fractures in the subtrochanteric region that is treated with cephalomedullary nailing and developed a nonunion, treatment with conversion to a proximal femoral replacement with a mega prosthesis is a valuable treatment with good functional results and low risk for complications. LEVEL OF EVIDENCE: Therapeutic level IV.


Assuntos
Fraturas do Fêmur , Fixação Intramedular de Fraturas , Fraturas Espontâneas , Fraturas do Quadril , Humanos , Fixação Intramedular de Fraturas/efeitos adversos , Fixação Intramedular de Fraturas/métodos , Fraturas do Quadril/cirurgia , Fraturas do Quadril/etiologia , Estudos Retrospectivos , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento , Fraturas do Fêmur/cirurgia , Fraturas do Fêmur/etiologia , Pinos Ortopédicos/efeitos adversos
2.
J Reconstr Microsurg ; 40(4): 302-310, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-37751885

RESUMO

BACKGROUND: Cryoanalgesia is a tool being used by interventional radiology to treat chronic pain. Within a certain cold temperature range, peripheral nerve function is interrupted and recovers, without neuroma formation. Cryoanalgesia has most often been applied to the intercostal nerve. Cryoanalgesia has applications to peripheral nerve surgery, yet is poorly understood by reconstructive microsurgeons. METHODS: Histopathology of nerve injury was reviewed to understand cold applied to peripheral nerve. Literature review was performed utilizing the PubMed and MEDLINE databases to identify comparative studies of the efficacy of intraoperative cryoanalgesia versus thoracic epidural anesthesia following thoracotomy. Data were analyzed using Fisher's exact and analysis of variance tests. A similar approach was used for pudendal cryoanalgesia. RESULTS: Application of inclusion and exclusion criteria resulted in 16 comparative clinical studies of intercostal nerve for this review. For thoracotomy, nine studies compared cryoanalgesia with pharmaceutical analgesia, with seven demonstrating significant reduction in postoperative opioid use or postoperative acute pain scores. In these nine studies, there was no association between the number of nerves treated and the reduction in acute postoperative pain. One study compared cryoanalgesia with local anesthetic and demonstrated a significant reduction in acute pain with cryoanalgesia. Three studies compared cryoanalgesia with epidural analgesia and demonstrated no significant difference in postoperative pain or postoperative opioid use. Interventional radiology targets pudendal nerves using computed tomography imaging with positive outcomes for the patient with pain of pudendal nerve origin. CONCLUSION: Cryoanalgesia is a term used for the treatment of peripheral nerve problems that would benefit from a proverbial reset of peripheral nerve function. It does not ablate the nerve. Intraoperative cryoanalgesia to intercostal nerves is a safe and effective means of postoperative analgesia following thoracotomy. For pudendal nerve injury, where an intrapelvic surgical approach may be difficult, cryoanalgesia may provide sufficient clinical relief, thereby preserving pudendal nerve function.


Assuntos
Dor Aguda , Analgesia , Humanos , Analgésicos Opioides , Dor Aguda/tratamento farmacológico , Crioterapia , Analgesia/métodos , Dor Pós-Operatória/terapia , Nervos Intercostais
3.
Hand (N Y) ; : 15589447231217763, 2023 Dec 30.
Artigo em Inglês | MEDLINE | ID: mdl-38159244

RESUMO

BACKGROUND: The purpose of this study is to evaluate the effects of Florida lae House Bill 21 (HB21) on opioid prescribing patterns by a single orthopedic hand surgeon after outpatient hand and upper extremity surgery. METHODS: The following variables were evaluated with retrospective chart review before and after implementation of HB21: type of opioid, number of pills, morphine milligram equivalents (MMEs), emergency department visits, and readmissions. In addition, the Florida Prescription Drug Monitoring Program (E-FORCSE [Electronic-Florida Online Reporting of Controlled Substance Evaluation]) was queried to determine the number of pills and MMEs prescribed and sold for the latter cohort. Student t tests, Fisher exact tests, and binary logistic regression were used for statistical analysis. P < .05 was considered significant. RESULTS: We reviewed 231 consecutive patients who underwent hand or upper extremity surgery from July 2017 to July 2018 and 207 consecutive patients from January 2020 to January 2021. The average age was significantly different between the cohorts (48.41 vs 44.98 years, P = .025); however, there were no significant differences across other demographic variables. After controlling for age, the average number of pills prescribed per patient decreased significantly after HB21 (25.11 vs 21.6 pills, P < .001). The number of MMEs prescribed per patient decreased as well, but the decrease was not statistically significant (167.8 vs 154.1 MMEs, P = .054). There was an association between preoperative opioid prescriptions filled and prolonged opioid use (odds ratio 6.438, P = .003). CONCLUSION: Florida law HB21 resulted in significantly fewer pills prescribed per patient, suggesting that legislation likely changed prescriber behavior and/or patient demand regarding postoperative opioid prescriptions after outpatient hand and upper extremity surgery.

4.
J Orthop Case Rep ; 13(8): 106-110, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37654762

RESUMO

Introduction: While commonly caused by traumatic injury and fracture, compartment syndrome can also result from reperfusion injury. Very few cases of prophylactic fasciotomy are mentioned when considering time to revascularization after prolonged vascular ischemia. We present a case of a patient who underwent multiple compartment prophylactic fasciotomies following reperfusion injury in the upper extremity. Case Report: We report a 72-year-old male that suffered from an anterior shoulder dislocation after a ground-level fall. After reduction, pulses were not measurable, and angiography indicated an axillary artery occlusion. Immediately after operative reperfusion, compartments became tense. Orthopedic surgeons subsequently performed arm anterior, posterior, and forearm volar and mobile wad compartment fasciotomies, after 13 h of ischemia. The patient tolerated the procedure, and at the latest follow-up, was working to improve strength in the extremity. Conclusion: Even when the circumstances of injury seem to be less traumatic as in this case of a ground-level fall, we document the importance of prompt recognition and intervention of suspected compartment syndrome following prolonged ischemia and revascularization of the upper extremity.

5.
Eur J Orthop Surg Traumatol ; 33(7): 2793-2803, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37014447

RESUMO

PURPOSE: Clavicle fractures are among the most common orthopedic fractures, and treatment methods, operative versus nonoperative, have been a point of contention. The purpose of this study was to evaluate the 50 most influential articles regarding clavicle fractures to better understand past focuses of research and to identify any gaps in knowledge. METHODS: A review of the most cited articles related to clavicle fractures was conducted using Web of Science database. A search was conducted in April 2022 by one trained researcher. Two independent researchers evaluated each article based on relevance to clavicle fracture. RESULTS: The mean number of citations was 179.1, ranging from 576 to 81 citations, and collectively cited 8954 times. The decade from 2000 to 2009 contributed the greatest portion of articles, with only a small portion coming from before 1980. The Journal of Bone and Joint Surgery-American Volume contributed the greatest number of articles (20%). The majority of the articles were therapeutic (n = 37) and focused on treatment and outcome (n = 32). Most of the clinically focused articles had a level of evidence of IV (n = 26). CONCLUSION: There is an increased influence of recent articles focused on clavicle fracture and management, due to the idea that conventional nonoperative treatment has a high rate of nonunion. Many of the most influential studies evaluate the outcomes of various treatments. Many of these studies, however, are lower levels of evidence, leaving a paucity of high level of evidence articles to support these conclusions. LEVEL OF EVIDENCE: V.


Assuntos
Clavícula , Fraturas Ósseas , Humanos , Clavícula/cirurgia , Consolidação da Fratura , Resultado do Tratamento , Fraturas Ósseas/cirurgia , Fixação de Fratura/métodos
6.
J Orthop ; 38: 53-61, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-37008450

RESUMO

Background: Curative treatment of bone sarcoma is primarily based on operative management. The Orthopedic Oncology approach towards this disease has evolved greatly to the breakthrough in systemic treatment options as well as unique implant designs favoring limb salvage over amputations. The purpose of this study was to perform a bibliometric analysis of the top 50 most cited papers related to the orthopedic the approach to bone sarcomas. Methods: We queried the ISI Web of Knowledge database in July 2022. Keywords utilized were: ""Bone Sarcoma" OR "Osteosarcoma" OR "Ewing Sarcoma" OR "Chondrosarcoma" OR "Chordoma". The top 50 articles pertaining to the orthopedic approach to bone sarcoma were included for analysis and included manuscript title, authors, citation count, journal and publication year. Results: The mean number of citations are 187.06 (Range 125-400; SD 67.83). The average citations per year is 10.03 (Range 47.86-3.43; SD 8.05). Many articles were published from 2000 to 2009 (n = 20) and 1990-1999 (n = 13). The majority of the articles were published by institutions within the United States (n = 32). The most common level of evidence was level IV (n = 37). Majority of the articles focused on treatment outcome (n = 22). Conclusion: This study offers a comprehensive review of the most cited literature regarding orthopedic approaches to bony sarcomas. Modern treatment approaches for bone sarcoma has resulted in an increased focus within the literature on achieving disease free survival wide tissue margins. Understanding the trends of available studies allows for physicians and researchers to target and innovate future areas of study.

8.
World Neurosurg ; 172: e250-e255, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-36610642

RESUMO

OBJECTIVE: The Internet is a source of health information for patients. Quality of information available to patients is varied and uncontrolled. Physicians should be familiar with the overall quality of the information. This review provides an evaluation of YouTube's current patient accessible health information on the topic of lumbar disc herniation (LDH). METHODS: YouTube was queried using 3 different search strings: (1) "disc herniation", (2) "lumbar disc herniation", or (3) "lower back disc herniation". Video duplicates, non-English, or those that contained no audio or were not relevant to LDH were excluded. The first 50 videos per search string were evaluated. Two reviewers independently assessed videos. Parameters included duration, upload date, number of views, number of likes, views per day, and likes per day. A scoring system was used to grade the videos for their performance on diagnosis and treatment of LDH. RESULTS: The first 50 videos produced a total number of hits of 50,500, 29,100, and 22,100, respectively. Strong agreement, assessed using intraclass correlation coefficient (ICC), was demonstrated between readers for both diagnostic scores (ICC 0.921, 95% CI 0.866-0.953) and treatment scores (ICC 0.916, 95% CI 0.855-0.951). Educational Physician videos had significantly greater diagnostic and treatment scores compared to non-physician videos (9.54 vs. 7.05, P = 0.048, and 6.53 vs. 5.3, P = 0.004). CONCLUSIONS: YouTube videos pertaining to LDH were found to have low overall quality. Physicians should be cognizant about information sources readily available to patients as they may influence patient expectations and preconceptions.


Assuntos
Mídias Sociais , Humanos , Fonte de Informação , Gravação em Vídeo , Pacientes , Disseminação de Informação
9.
Niger Med J ; 64(6): 759-772, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-38979052

RESUMO

Background: The activities of Health maintenance organizations (HMO) are central to the achievement of universal health coverage. This study sought to examine the number of HMOs actively operating in the FCT and to determine whether the HMOs are promoting or inhibiting universal coverage and proffer recommendations for the overall progress of the scheme. Methodology: A descriptive prospective cross-sectional study design was used and mixed (qualitative and quantitative) methods A pre-tested interviewer-administered questionnaire make was used to collect quantitative data while qualitative data were collected through a review of literature and in-depth interviews to examine the roles of HMOs from stakeholders' points of view. A total of 250 participants comprised predominantly 230 enrollees into three major programs of the NHIS that is the formal sector social insurance program (FS-SHIP), tertiary institution social health insurance program (TI-SHIP), and community-based social health insurance program (CB-SHIP). The remaining 20 (twenty) enrollees comprised NHIA desk officers, HMO managers, community-based representatives, and healthcare providers. Results: The majority of the respondents (64.8%) reported a high level of awareness of the knowledge of NHIS, while fewer than 19% indicated a lack of awareness as compared to 17% who did not respond to the question. Similarly, most of the respondents (62.2%) reported having satisfactory knowledge of the structure-function modalities of HMOs, while 20.4% were not aware of the mode of operation of HMOs.Contrasting contributions of HMOs to NHIS implementation, approximately half of the respondents (50%) reported dissatisfaction. Likewise, about 50% of the study subjects were of the view that HMOs are not putting the desired commitment towards achieving this goal of universal health coverage. The report from the in-depth interview reiterated that the enrollees were not well satisfied due to the perceived poor and inadequate operational mechanisms of both the HMOs and NHIS. Conclusions: The study revealed a high level of awareness of the knowledge of NHIS and good working knowledge of the structure and function of the HMOs. However, this study demonstrated a low understanding of the working interactions between the NHIS and HMO, among the respondents. Understanding HMOs and how they work is critical for choosing a health plan during open enrollment, hence, there is a need for more client enlightenment.

10.
J Orthop ; 34: 80-83, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36035198

RESUMO

Introduction: Septic arthritis is an orthopaedic emergency, with permanent cartilage damage possible within hours of the onset of symptoms. Diagnostic criteria for septic arthritis in immunocompetent patients are well established, however, there is a paucity of literature evaluating diagnostic criteria in immunocompromised patients. The purpose of this retrospective case-control study was to evaluate the laboratory and clinical information of immunocompromised patients with septic arthritis and compare them to immunocompetent patients with septic arthritis to enable physicians to diagnose septic arthritis more accurately in this population. Methods: All patients at our institution, a level I trauma center, with a clinical diagnosis of septic arthritis between January 1, 2006 and November 1, 2021 were identified and reviewed retrospectively. Patients 18 years old or older were screened for immunocompromised status and those meeting criteria were included for review. The control cohort was matched by the joint affected and age. Data were analyzed using the Shapiro-Wilk test, Turkey's test, Mann-Whitney U test, independent sample t-test, and chi-square analysis. A p-value of <0.05 was considered significant. Results: A total of 36 patients with positive joint aspirate cultures were compared (18 immunocompetent and 18 immunocompromised). The immunocompromised group had a significantly longer length of hospital stay than the immunocompetent group (p = 0.044). There was no significant difference in erythrocyte sedimentation rate (ESR) (p = 0.852), peripheral white blood cell count (pWBC) (p = 0.696), joint aspirate white blood cell count (aWBC) (p = 0.901), polymorphonuclear cell percentage (PMN%) (p = 0.325), or total operations performed per patient (p = 0.365). Conclusion: At our institution, immunocompromised patients with septic arthritis did not have significantly different diagnostic laboratory values when compared to immunocompetent patients. This suggests that immunocompromised patients with suspicion of septic arthritis can be assessed with similar diagnostic criteria as immunocompetent individuals; however, a larger cohort study is needed to assess the difference more precisely in laboratory values.

11.
Pak J Biol Sci ; 24(2): 193-198, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33683048

RESUMO

BACKGROUND AND OBJECTIVE: The global antibiotic resistance threat posed by ESBL and AmpC-producing Gram-Negative Bacteria (GNB) is a public health menace that rolls back the gains of 'One Health'. This study investigated the antibiogram and prevalence of AmpC and ESBL genes in Escherichia coli, Klebsiella spp. and Pseudomonas spp. from poultry and abattoir milieus in Enugu and Ebonyi States, Nigeria. MATERIALS AND METHODS: Isolation, identification and characterization of GNB from samples (150 abattoirs and 300 poultry) were done using standard microbiological techniques. Antimicrobial Susceptibility Testing (AST), as well as phenotypic screening for ESBL and AmpC enzymes, was performed using the Kirby-Bauer disc diffusion technique. PCR technique was used to screen isolated GNB for AmpC and ESBL genes. RESULTS: Exactly 42 E. coli and 8 Klebsiella spp. isolate from poultry samples and another 5 P. aeruginosa isolates from abattoir samples were phenotypically confirmed to be ESBL-producers. AmpC enzymes were phenotypically detected in 8 E. coli and 13 P. aeruginosa isolates from poultry samples. All ESBL and AmpC-positive bacteria exhibited high resistance frequencies to tested antibiotics, especially to the carbapenems and cephalosporins. ESBL genes (CTX-M, SHV-1, TEM) and AmpC genes (ACC-M, MOX-M, DHA-M) were harbored by the isolated GNB in this study. Overall, the DHA-M and CTX-M genes, mediating AmpC and ESBL production respectively were the most prevalent genes harbored by the tested GNB. CONCLUSION: This study reported that AmpC and ESBL genes are harbored by Gram-negative bacteria (E. coli, Klebsiella species and P. aeruginosa) that emanated from poultry and abattoir milieus.


Assuntos
Matadouros , Proteínas de Bactérias/metabolismo , Microbiologia de Alimentos , Bactérias Gram-Negativas/enzimologia , Carne/microbiologia , Aves Domésticas/microbiologia , beta-Lactamases/metabolismo , Animais , Antibacterianos/farmacologia , Proteínas de Bactérias/genética , Farmacorresistência Bacteriana , Escherichia coli/efeitos dos fármacos , Escherichia coli/enzimologia , Escherichia coli/genética , Escherichia coli/isolamento & purificação , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Negativas/genética , Bactérias Gram-Negativas/isolamento & purificação , Klebsiella/efeitos dos fármacos , Klebsiella/enzimologia , Klebsiella/genética , Klebsiella/isolamento & purificação , Testes de Sensibilidade Microbiana , Nigéria , Pseudomonas aeruginosa/efeitos dos fármacos , Pseudomonas aeruginosa/enzimologia , Pseudomonas aeruginosa/genética , Pseudomonas aeruginosa/isolamento & purificação , beta-Lactamases/genética
12.
J Trop Med ; 2020: 8017187, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33061994

RESUMO

BACKGROUND: Insecticide resistance among the vector population is the main threat to existing control tools available. The current vector control management options rely on applications of recommended public health insecticides, mainly pyrethroids through long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS). Regular monitoring of insecticide resistance does not provide information on important factors that affect parasite transmission. Such factors include vector longevity, vector competence, feeding success, and fecundity. This study investigated the impacts of insecticide resistance on longevity, feeding behaviour, and egg batch size of Anopheles gambiae s.l. METHOD: The larval sampling was conducted in rice fields using a standard dipper (350 ml) and reared to adults in field insectary. A WHO susceptibility test was conducted using standard treated permethrin (0.75%) and deltamethrin (0.05%) papers. The susceptible Kisumu strain was used for reference. Feeding succession and egg batch size were monitored for all survivors and control. RESULTS: The results revealed that mortality rates declined by 52.5 and 59.5% for permethrin and deltamethrin, respectively. The mortality rate for the Kisumu susceptible strain was 100%. The survival rates of wild An. gambiae s.l. was between 24 and 27 days. However, the Kisumu susceptible strain blood meal feeding was significantly higher than resistant colony (t = 2.789, df = 21, P=0.011). Additionally, the susceptible An. gambiae s.s. laid more eggs than the resistant An.gambiae s.l. colony (Χ2 = 1366, df = 1, P ≤ 0.05). CONCLUSION: It can, therefore, be concluded that the wild An. gambiae s.l. had increased longevity, blood feeding, and small egg batch size compared to Kisumu susceptible colonies.

13.
Cureus ; 12(4): e7598, 2020 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-32399332

RESUMO

Background It is generally believed that trauma to fat grafts is detrimental and affects the survival of the graft. In addition, it has been shown that smaller fat particle size corresponds to better survival; however, smaller cannula openings correspond to slower and more difficult fat graft harvesting. Objectives This study documents the relationship between cannula size, harvested fat cell size, and injection needle size. A means of reducing fat particle size following aspiration with larger diameter cannulas is also discussed. Methods Fat was harvested from five patients undergoing elective liposuction. Each fat sample was placed in a syringe and injected through progressively smaller needles until obstruction under low pressure was obtained. The minimal needle size was documented for each sample. Results Fat harvested with a liposuction cannula results in different size fat particles ranging up to the size of the cannula. Particles obtained from 3- and 4-mm cannulas can be injected without obstruction through a 16-gauge needle. Particles obtained from a 2-mm cannula can be injected without obstruction through an 18-gauge needle. Particles obtained from a 1-mm cannula can be injected without obstruction through a 20-gauge needle. Particles obtained from a 1-mm cannula could not be injected without obstruction through a 22-gauge needle. Conclusions There is a relationship between cannula opening size and the resultant fat graft size. Fat particles are somewhat compressible but should not be forced through needles or cannulas that are too narrow. It may be beneficial to harvest fat with larger cannulas and cut the particles to smaller sizes for injection.

14.
Afr Health Sci ; 19(2): 2026-2035, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31656486

RESUMO

OBJECTIVE: The objective of this study was to isolate and phenotypically characterize methicillin-resistant Staphylococcus aureus (MRSA)from clinical and community samples in Abakaliki, Nigeria. METHODS: A total of 709 clinical (303) and community samples (406) samples were obtained for this study. MRSA isolates were detected using Kirby-Bauer disc diffusion method with the inclusion of 1 µg oxacillin and cefoxitin antibiotic disc. The isolates were screened for the ß-lactamase production using nitrocefin sticks. RESULTS: A total of 44 MRSA isolates were obtained from the samples with prevalence frequency of 22.6 % and 20.8 % from clinical and community samples respectively. The clinical isolates were completely resistant (100 %) to ceftazidime, tetracycline and penicillin. Gentamicin and ciprofloxacin were the most effective antibiotics against the clinical and community isolates respectively with a susceptibility frequency of 63.2 % and 80 %. Exactly 38.1 % and 24.2 % of the clinical and community S. aureus isolates were positive for beta-lactamase production respectively. The HA-MRSA and CA-MRSA isolates had MARI values within the range of 0.3 to 1.0. CONCLUSION: This present findings of multi-drug resistance MRSA is very worrisome as it further highlights the pressing need to keep a strict watch on MRSA emerging from this study area.


Assuntos
Antibacterianos/farmacologia , Farmacorresistência Bacteriana Múltipla , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Humanos , Testes de Sensibilidade Microbiana , Nigéria , Fenótipo , Prevalência
15.
Public Health Action ; 9(Suppl 1): S38-S42, 2019 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-31579648

RESUMO

SETTING: Gulf Province, a rural area of mainland Papua New Guinea, is known to have one of the highest burdens of tuberculosis (TB) in the country. OBJECTIVES: To describe the characteristics and outcomes of TB patients registered for first-line treatment in Kerema General Hospital in Gulf Province between January and December 2016. DESIGN: This was a retrospective cohort study using routinely collected programme data. RESULTS: Of 347 cases with a recorded TB site, 54% were male and 32% were aged <15 years. No human immunodeficiency virus (HIV) status was recorded for 51% of cases. TB was bacteriologically confirmed in 23% of cases. Among the cohort, there were 145 extrapulmonary TB cases (42%); the site of disease was unknown in 56% of these cases. Of the 297 cases with treatment outcome evaluated, 56% had a favourable outcome and 26% were lost to follow-up. On multivariable analysis, extrapulmonary TB (adjusted OR [aOR] 0.51, 95%CI 0.30-0.88, P = 0.02) and bacteriologically confirmed TB (aOR 0.40, 95%CI 0.21-0.77, P < 0.01) were associated with decreased odds of an unfavourable treatment outcome. CONCLUSION: The study findings highlight the need to improve TB diagnosis, access to HIV testing, treatment adherence, patient support and the quality of TB programme data in Gulf Province.

16.
Public Health ; 141: 245-254, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27932010

RESUMO

OBJECTIVE: The aim of this work is to describe application of a data-driven approach (bottleneck analysis [BNA] approach process) to accelerate newborn care services in two regions and what effect it had on national-level newborn care interventions in Ghana. STUDY DESIGN: A mixed-method approach was used for the study. The BNA tool generated quantitative data and group discussions provided phenomenological explanations to identified service gaps. METHODS: Regional newborn care health service assessments were conducted in November 2013 through desk reviews, field and health facility visits and coaching/mentorship. The BNA tool (an excel-based tool) directly utilized service coverage data and programme monitoring and review reports in Ghana. Outputs were generated based on service coverage indicators: supply side/health system factors (commodities, human resource and access), demand side (service utilization) and quality/effective coverage. National targets were used as benchmarks to assess gaps in coverage indicators. RESULTS: Key health system bottlenecks included absence/stock-out of essential newborn care commodities/resuscitation kits and absence of updated policies at services delivery points. In both regions, less than 55% of health facilities had at least 80% of midwives trained to provide essential obstetric and newborn care, management of preterm babies, resuscitation and inpatient paediatric care. In addition, less than 35% of pregnant women were assisted by a skilled birth attendant (midwife) and monitored with a partograph in the two regions. Demand-side bottlenecks included cultural preference for home deliveries, limited knowledge on importance of postnatal care and poor community involvement.The BNA approach in the two regions resulted in the development of national and other regional operational plans and monitoring and evaluation framework for newborn care services in Ghana over the period 2012-2016, and a relative improvement in neonatal mortality at the regional and national level. CONCLUSION: The BNA tool and approach provided data-driven planning for newborn care service delivery in a low-income setting. It identified gaps in service coverage based on empirical data at lower levels of the health system and garnered strategies in addressing bottlenecks to newborn care services at the national level.


Assuntos
Planejamento em Saúde/organização & administração , Pesquisa sobre Serviços de Saúde/métodos , Cuidado do Lactente/organização & administração , Feminino , Gana , Humanos , Recém-Nascido , Serviços de Saúde Materna/estatística & dados numéricos , Áreas de Pobreza , Gravidez
17.
Pest Manag Sci ; 69(8): 911-8, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23239649

RESUMO

BACKGROUND: Cashew, Anacardium occidentale, is an economically important cash crop for more than 300 000 rural households in Tanzania. Its production is, however, severely constrained by infestation by sap-sucking insects such as Helopeltis anacardii, H. schoutedeni and Pseudotheraptus wayi. The African weaver ant, Oecophylla longinoda, is an effective biocontrol agent of hemipteran pests in coconuts in Tanzania, but its efficacy in the control of Helopeltis spp. and P. wayi in Tanzanian cashew has not been investigated so far. The aim of this study was therefore to evaluate the efficacy of O. longinoda in the management of these insect pests in the cashew crop at different sites of the Coast region of Tanzania. RESULTS: Colonisation levels of O. longinoda, expressed as weaver ant trails, varied from 57.1 to 60.6% and from 58.3 to 67.5% in 2010 and 2011 respectively. The mean number of leaf nests per tree varied from five to eight nests in 2010 and from five to nine nests in 2011. There was a negative correlation between numbers of nests and pest damage. Oecophylla longinoda-colonised cashew trees had the lowest shoot damage by Helopeltis spp. of 4.8 and 7.5% in 2010 and 2011, respectively, as opposed to uncolonised cashew trees with 36 and 30% in 2010 and 2011 respectively. Similarly, nut damage by P. wayi was lowest in O. longinoda-colonised trees, with only 2.4 and 6.2% in 2010 and 2011 as opposed to uncolonised trees with 26 and 21%. CONCLUSION: Oecophylla longinoda is an effective biocontrol agent of the sap-sucking pests of cashew in the Coast region of Tanzania and should be considered as an important component of IPM.


Assuntos
Anacardium/parasitologia , Formigas/fisiologia , Hemípteros/fisiologia , Controle Biológico de Vetores/métodos , Doenças das Plantas/parasitologia , Animais , Tanzânia
18.
J Porphyr Phthalocyanines ; 15(5-6): 412-420, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21822371

RESUMO

Various dipyrroles possess important motifs for construction of pyrrole-containing pigments. A series of 1,2-dipyrrolylethynes (4a-d) has been efficiently synthesized using an improved one-pot double Sonagashira coupling from trimethylsilylethyne and various 2-iodopyrroles. The resulting 1,2-dipyrrolylethynes were further transformed into novel indolyl-, ethenyl- and carboranyl-dipyrroles (5-7) using the Larock indole synthesis, stereoselective catalytic hydrogenation, or B(10)H(14). Indolyl-dipyrroles were found to selectively bind fluoride ions using one pyrrolic and the indolyl NHs, whereas the carboranyl- and ethenyl-dipyrroles are potentially valuable precursors for the synthesis of porphyrin isomers and expanded pigments.

19.
J Gen Microbiol ; 133(6): 1453-9, 1987 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-2822838

RESUMO

Cell-free extracts of Ureaplasma urealyticum strains Pi and T960 (CX8) (serovars 6 and 8, respectively) metabolized inorganic pyrophosphate (PPi). The inorganic pyrophosphatase (PPase) activity was greatest with Mg2+ as cofactor, but Mn2+ acted as a poor substitute. The PPases of the two serovars differed electrophoretically. Although the highest PPase activity was obtained using PPi as substrate, the enzyme could also utilize to a lesser degree both tripolyphosphate and trimetaphosphate. No activity was observed against beta-glycerophosphate, naphthyl phosphates, glucose 6-phosphate, fructose 6-phosphate, fructose 1,6-bisphosphate, thiamin pyrophosphate, phosphoribosylpyrophosphate, ADP or ATP. Acid- and alkaline-phosphatase activities were observed with naphthyl phosphates as substrates, but they did not have the same electrophoretic mobility on gels as the PPase activity. U. urealyticum PPase was inhibited by oxidized glutathione, 1-ethyl-3-(3-dimethylaminopropyl)carbodiimide, phenylglyoxal, p-chloromercuribenzoic acid, Mn2+, Zn2+ and Ca2+. Neither reduced glutathione, L-cysteine nor Co2+ enhanced activity. PPi can act as a substrate or regulator of certain metabolic reactions, and PPi metabolism can function in bacterial bioenergetics; its role in ureaplasmas is presently unclear.


Assuntos
Pirofosfatases/metabolismo , Ureaplasma/enzimologia , Cátions Bivalentes/farmacologia , Inibidores Enzimáticos/farmacologia , Pirofosfatases/antagonistas & inibidores
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