Reduction in mortality from HIV-related CNS infections in routine care in Africa (DREAMM): a before-and-after, implementation study.

BACKGROUND: Four decades into the HIV epidemic, CNS infection remains a leading cause of preventable HIV-related deaths in routine care. The Driving Reduced AIDS-associated Meningo-encephalitis Mortality (DREAMM) project aimed to develop, implement, and evaluate pragmatic implementation interventions and strategies to reduce mortality from HIV-related CNS infection. METHODS: DREAMM took place in five public hospitals in Cameroon, Malawi, and Tanzania. The main intervention was a stepwise algorithm for HIV-related CNS infections including bedside rapid diagnostic testing and implementation of WHO cryptococcal meningitis guidelines. A health system strengthening approach for hospitals was adopted to deliver quality care through a co-designed education programme, optimised clinical and laboratory pathways, and communities of practice. DREAMM was led and driven by local leadership and divided into three phases: observation (including situational analyses of routine care), training, and implementation. Consecutive adults (aged ≥18 years) living with HIV presenting with a first episode of suspected CNS infection were eligible for recruitment. The primary endpoint was the comparison of 2-week all-cause mortality between observation and implementation phases. This study completed follow-up in September, 2021. The project was registered on ClinicalTrials.gov, NCT03226379. FINDINGS: From November, 2016 to April, 2019, 139 eligible participants were enrolled in the observation phase. From Jan 9, 2018, to March 25, 2021, 362 participants were enrolled into the implementation phase. 216 (76%) of 286 participants had advanced HIV disease (209 participants had missing CD4 cell count), and 340 (69%) of 494 participants had exposure to antiretroviral therapy (ART; one participant had missing ART data). In the implementation phase 269 (76%) of 356 participants had a probable CNS infection, 203 (76%) of whom received a confirmed microbiological or radiological diagnosis of CNS infection using existing diagnostic tests and medicines. 63 (49%) of 129 participants died at 2 weeks in the observation phase compared with 63 (24%) of 266 in the implementation phase; and all-cause mortality was lower in the implementation phase when adjusted for site, sex, age, ART exposure (adjusted risk difference -23%, 95% CI -33 to -13; p<0·001). At 10 weeks, 71 (55%) died in the observation phase compared with 103 (39%) in the implementation phase (-13%, -24 to -3; p=0·01). INTERPRETATION: DREAMM substantially reduced mortality from HIV-associated CNS infection in resource-limited settings in Africa. DREAMM scale-up is urgently required to reduce deaths in public hospitals and help meet Sustainable Development Goals. FUNDING: European and Developing Countries Clinical Trials Partnership, French Agency for Research on AIDS and Viral Hepatitis. TRANSLATIONS: For the French and Portuguese translations of the abstract see Supplementary Materials section.

Predicting Severe COVID-19 Infection on Initial Diagnosis: Comparison and Validation of CT Imaging Triage Tools.

BACKGROUND: Developing a reliable predictive tool of disease severity in COVID-19 infection is important to help triage patients and ensure the appropriate utilization of health-care resources. OBJECTIVE: To develop, validate, and compare three CT scoring systems (CTSS) to predict severe disease on initial diagnosis of COVID-19 infection. METHODS: One hundred and twenty and 80 symptomatic adults with confirmed COVID-19 infection who presented to emergency department were evaluated retrospectively in the primary and validation groups, respectively. All patients had non-contrast CT chest within 48 hours of admission. Three lobarbased CTSS were assessed and compared. The simple lobar system was based on the extent of pulmonary infiltration. Attenuation corrected lobar system (ACL) assigned further weighting factor based on attenuation of pulmonary infiltrates. Attenuation and volume-corrected lobar system incorporated further weighting factor based on proportional lobar volume. The total CT severity score (TSS) was calculated by adding individual lobar scores. The disease severity assessment was based on Chinese National Health Commission guidelines. Disease severity discrimination was assessed by the area under the receiver operating characteristic curve (AUC). RESULTS: The ACL CTSS demonstrated the best predictive and consistent accuracy of disease severity with an AUC of 0.93(95%CI:0.88-0.97) in the primary cohort and 0.97 (95%CI:0.91.5-1) in the validation group. Applying a TSS cut-off value of 9.25, the sensitivities were 96.4% and 100% and the specificities were 75% and 91% in the primary and validation groups, respectively. CONCLUSION: The ACL CTSS showed the highest accuracy and consistency in predicting severe disease on initial diagnosis of COVID-19. This scoring system may provide frontline physicians with a triage tool to guide admission, discharge, and early detection of severe illness.

Testicular Disease: A Clinico-Pathological Report from a Nigerian Tertiary Health Center.

Background: The testes are the male reproductive glands and the homolog of the ovary in females performing critical functions. Pathologic conditions could arise from the testes and blunt or completely obliterate these functions leading to clinically overt or covert sequelae. The aim of this research is to study the pattern of histologically diagnosed testicular disease in relation to clinical features at the Jos University Teaching Hospital between January 2012 and December 31st, 2021. Methodology: This study is a retrospective analysis of all cases of testicular biopsies. All histologically diagnosed testicular lesions were identified from the departmental records and clinical data obtained further from the patients' folder at the Medical Records Department. Results: Four hundred and thirty (430) biopsies were seen, of which 304 (70.7%) were orchidectomy specimens. The commonest histological diagnosis was testicular atrophy accounting for 328(76.3%) cases. Testicular torsion is followed by 42(9.8%) cases. Together, inflammatory conditions accounted for 36(8.4%) cases out of which granulomatous inflammation made up 52.3% of cases. There were 16(3.7%) neoplastic conditions all of which were malignant, out of which 6(37.5%) were seminomas. The age range, mean, median and modal age was 1-90 years, 53.4 +21.3years, 60 years and 70 years respectively. Prostatic carcinoma therapy in the form of bilateral orchidectomy was the major indication for surgery. Conclusion: The majority of testicular lesions in our locality are atrophies and most of these lesions are obtained as orchidectomies for therapy of prostatic cancer.

Ultrasound-guided fine needle aspiration cytology and ultrasound examination of thyroid nodules in the UAE: A comparison.

BACKGROUND: Thyroid nodules are a common clinical finding and most are benign, however, 5-15% can be malignant. There is limited regional data describing the accuracy of ultrasound-guided fine needle aspiration (FNA) cytological examination compared to ultrasound examination of thyroid in patients who have undergone thyroid surgery. METHODS: A retrospective analysis of ultrasonographic (US) reports, FNA cytology reports and histopathology reports of 161 thyroid nodules presented at the endocrine center at Tawam hospital in Al Ain city, the United Arab Emirates during the period 2011-2019 was performed. US reports and images with FNA cytopathology reports and slides were reviewed by an independent radiologist and pathologist. RESULTS: In total, 40 nodules were reported as benign by US examination, while very low suspicious, low suspicious, intermediate suspicious and highly suspicious categories were reported in 21, 41, 14 and 45 nodules respectively. In addition, 68 nodules were reported as benign (Bethesda category II), while atypical follicular cells of unknown significance (Bethesda category III), follicular neoplasm (Bethesda category IV), suspicious for malignancy (Bethesda category V), and malignant (Bethesda category VI) categories were reported in 33, 9, 24 and 27 nodules respectively. The risk of malignancy for US benign nodules was 5%, while the risks of malignancy in very low suspicious, low suspicious, intermediate suspicious and highly suspicious nodules were 52%, 36%, 100% and 87%, respectively. The risk of malignancy for Bethesda category II was 3%, while the risks of malignancy in category III, IV, V and VI were 58%, 67%, 96% and 100%, respectively. CONCLUSION: Thyroid FNA cytological examination and ultrasonography are key tools in predicting malignancy in thyroid nodules. Thyroid nodules with the diagnosis of Bethesda category III & IV run a high risk of malignancy thus more vigilance is required.

Hyaluronic acid treatment outcome on the post-extraction wound healing in patients with poorly controlled type 2 diabetes: A randomized controlled split-mouth study

BACKGROUND: Hyaluronic acid is widely used in the medical field. However, there is a lack of research about its effect on patients with certain risks, such as compromised wound healing commonly found in patients with poorly controlled type 2 diabetes. The aim of this study is to investigate the efficacy of hyaluronic acid on the post-extraction wound healing and pain in patients with poorly controlled type 2 diabetes. MATERIAL AND METHODS: The randomized controlled split-mouth study was designed, which included 30 patients with poorly controlled type 2 diabetes with a bilaterally same teeth in the lower jaw for extraction. The sockets treated with 0.8% hyaluronic acid represented the study group, while the sockets where hyaluronic acid was not applied represented the control group. Wound closure rate (WCR), clinical scores in wound healing scale (WHS) and pain intensity in Visual analogue scale (VAS) were recorded. Patients were followed up on 5th, 10th, 15th, 20th, 25th day after tooth extraction. RESULTS: The results showed a higher WCR at the extraction site where hyaluronic acid was applied. Also, statistically significant difference was found (p < 0.001). In regards to WHS, the sockets treated with hyaluronic acid showed better healing, especially on day 10 (p = 0.006) and day 15 (p = 0.021). However, there were no statistically significant differences in VAS scores between groups. CONCLUSIONS: Hyaluronic acid placed in post-extraction socket in patients with poorly controlled diabetes may improve wound healing, especially in the first days after application

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Rhodolith primary and carbonate production in a changing ocean: The interplay of warming and nutrients.

Rhodolith beds, like many other marine ecosystems, are affected by climate change that is causing an increase in the magnitude and frequency of extreme high temperature events (heat waves). Unfortunately, this does not represent the sole peril for these communities, as coastal urbanization in conjunction with altered precipitation patterns can increase terrestrial-derived nutrient input. In Brazil, rhodolith beds are among the most extensive coastal benthic ecosystems, but despite their vast distribution and great ecological and economic importance, studies on the productivity of these communities and the impact of changing environmental conditions are almost non-existent. This study addressed the individual and combined effects of increases in temperature and nutrient concentration on the physiological performance of two widely distributed rhodolith species, Lithothamnion crispatum and Melyvonnea erubescens. The results showed species-specific responses in net photosynthetic performance, with no response in L. crispatum, while M. erubescens responded negatively to both increase in temperature and nutrients. In contrast, calcification in both species showed a significant decline at high temperature. No interactive effects were found between temperature and nutrients, yet their combined negative effects were additive, resulting in negative daily-integrated net productivity and a large decline in daily carbonate production in both species. This has strong implications for rhodolith bed primary productivity and carbonate production, as heat waves may potentially cause a strong decline in carbonate production (ca. 50% loss), accompanied by a severe drop in primary productivity that will be even more pronounced under high-nutrient conditions. Also, the species-specific responses to changes in temperature and nutrient concentration suggest that the magnitude of impact of these factors on rhodolith bed productivity will depend on the species dominating the community and may finally result in changes in rhodolith community composition.

Biochars and hydrochars prepared by pyrolysis and hydrothermal carbonisation of pig manure.

Pyrolysis of organic wastes for biochar preparation has been proved as a useful way of waste management. However, the elevated water content of some organic wastes precludes its use without a drying step before pyrolysis treatment. For this reason, hydrothermal carbonization (HTC) of wet biomass could be an inexpensive alternative management method. The main objective of the present work is to compare the properties of biochars and hydrochars obtained from thermal treatment of pig manure. Biochars were prepared at 300 °C (BPM300), 450 °C (BPM450) and 600 °C (BPM600) and hydrochars were obtained using a pig manure solution (ratio 30:70) that was heated at 200 °C (HPM200), 220 °C (HPM220) and 240 °C (HPM240) during 2 h. Characterization of biochar and hydrochar samples showed that pyrolysis led to chars with more aromatic structures and high thermal stability while HTC process originated chars with more aliphatic structures. HPM220 and HPM240 showed the highest values of field capacity water content and available water probably due to their higher O/C ratios and the macroporosity development in the range from 200 to 30,000 nm. These results suggested that HTC could be an interesting method to obtain soil growing media or green roof materials with adequate hydrophysical properties.

A case of lymphocytic variant hypereosinophilic syndrome with sub-diagnostic systemic mastocytosis

No abstract available.

Subjetividad en agrupaciones de personas en situación de discapacidad: explorando la dualidad sujeción-agencia y la visión de discapacidad desde la propia vivencia / Subjectivity in groups of people with disabilities: exploring the subjection - agency duality and the vision of the disabilities from the own living experience

La discapacidad como constructo social está compuesta por corporalidad, estereotipos y conductas de auto aceptación o negación. La discapacidad tiene implicancias a nivel personal y colectivo, demandando un perfeccionamiento en las perspectivas actuales de acción y comprensión por parte de los profesionales vinculados con esta realidad. Esta investigación se realizó con dos propósitos: explorar las construcciones subjetivas de personas en situación de discapacidad que forman parte de agrupaciones de personas con discapacidad; y describir cómo éstas influyen en su forma de organizarse y en sus ocupaciones. El contacto con los y las participantes se realizó mediante la estrategia de informantes clave, la recolección de datos a través de una entrevista semiestructurada y el método de análisis mediante la técnica de análisis de contenido (categorial). Los resultados muestran dos tendencias de funcionamiento en las agrupaciones que pueden llegar a coexistir en un mismo período. La primera de corte reivindicativo (demandar lo que se considera derecho propio) y la segunda tendencia problematizadora (poner en discusión lo que parece una idea irrefutable). Finalmente, la construcción de las personas se comprende desde la tensión existente entre las prácticas de sujeción y agencia relacionadas a la discapacidad, como la sumisión frente a modelos normativos y/o la crítica a la infantilización y asistencialismo.

The concept of disability, defined as a social construct, comprises corporality, stereotypes, and behaviors of self-acceptance or rejection. Subsequent implications of disability at the personal and collective level demand an improvement in its professional comprehension and action. This study’s purposes are to explore the subjective constructions of people with disabilities who are members of groups of people with disabilities; and to describe how these constructions influence both occupations and the way people organize as members of groups of people with disabilities. Contact with participants, data collection, and data analysis were completed through key informants, semi-structured interviews, and the Categorical Content Analysis method, respectively. Results revealed two tendencies of group function that may coexist; the first relates to a demanding standpoint - that is, claiming what is believed to be a right; and the second to a problem-causing standpoint - or arguing what seems to be irrefutable -. Finally, subjective construction of individuals was understood as the fine line existing between the subjection agency practices related to their disability, as well as the submission to normative models and/or the criticism towards infantilization and assistencialism.

Human organ and tissue transplantation in Pakistan; when a regulation makes a difference

Organ transplantation must be viewed in relation to the prevailing cultural, religious and socio-economic conditions of a nation. Over the past two decades, Pakistan has emerged as one of the largest centres for commercial renal transplantation. Government efforts, supported by professional associations, civil society organizations and the media, along with World Health Organization technical assistance, have led to the development of legislation regulating this practice and curbing organ trade in conformity with international guidelines. Although only two years have passed since the enactment of the law, there is evidence that conditions have significantly improved, raising hopes for ethical and safe organ transplantation in Pakistan. This study reviews the salient features of the legislation and lists the foreseeable evolving challenges and opportunities

Identification of motile Aeromonas strains with the MicroScan WalkAway system in conjunction with the combo negative type 1S panels.

This study was performed to compare the MicroScan WalkAway automated identification system in conjunction with the new MicroScan Combo Negative type 1S panels with conventional biochemical methods for identifying 85 environmental, clinical, and reference strains of eight Aeromonas species.

Evaluation of the MicroScan system for identification of staphylococci.

Conventional biochemical tests were compared with reactions in a multiple test system, MicroScan Walkaway (Dade Diagnostic Inc. MicroScan Divison, West Sacramento, California) in conjugation with the Combo Pos ID Panels (Dade Diagnostic Inc. MicroScan Divison, West Sacramento, California), in order to evaluate the accuracy for the identification of 99 clinical isolates of Staphylococcus spp. and five reference strains. False-negative or positive reactions were detected from Voges-Proskauer, urease and mannose tests. A good correlation was found among the two identification systems for the fermentation of trehalose, lactose, raffinose, as well as for arginine dyhydrolase, esculin hydrolisis and nitrate reduction. From the results of the present study, it is concluded that the MicroScan Walkaway system is a reliable method for identification of staphylococci (94.23%), although 8.2% could be identified to the species level only after use of additional test.

Pregnancies following transfer of human frozen--thawed embryos in Colombia, South America.

The surplus of fresh embryos obtained at our laboratory within the in-vitro fertilization programme led us to implement human embryo freezing--thawing techniques from August, 1985. Thus far, 20 freezing cycles (45 embryos) have been carried out using this method. Two fast-freezing techniques were used and one fast-thawing method in 1 M sucrose. In the first freezing technique, dimethyl sulphoxide (DMSO; 1.5 M) was added in a step-wise fashion and seeding was done directly on the embryo compartment. In the second, DMSO (1.5 M) was added in one step and seeding was carried out away from the embryo compartment. In both techniques, embryos were stored in 0.25-ml plastic straws in phosphate-buffered saline (PBS) containing 15% maternal serum. Embryos were replaced during the natural cycle, 48-50 h following the LH peak. Three pregnancies were obtained from six transfer cycles. Both freezing techniques were successful, but stepwise addition of DMSO and seeding the embryo compartment directly appeared to be more successful. One pregnancy was a pre-clinical abortion, the second a clinical abortion at 8 weeks, and the third is ongoing at 19 weeks. These are the first pregnancies in the American continent achieved with frozen embryos.