Since 2011 Médecins sans Frontières together with the eSwatini Ministry of Health have been managing patients with multi-drug resistant tuberculosis (MDR-TB) at Matsapha and Mankayane in Manzini ...region. This analysis describes the model of care and outcomes of patients receiving a 20 months MDR-TB treatment regimen between 2011 and 2013.
We conducted a retrospective observational cohort study of MDR-TB patients enrolled for treatment between May 2011 and December 2013. An extensive package of psychological care and socio-economic incentives were provided including psychological support, paid treatment supporters, transport fees and a monthly food package. Baseline demographic details and treatment outcomes were recorded and for HIV positive patient's univariate analysis as well as a cox regression hazard model were undertaken to assess risk factors for unfavorable outcomes.
From the 174 patients enrolled, 156 (89.7%) were HIV co-infected, 102 (58.6%) were female, median age 33 years old (IQR: 28-42), 55 (31.6%) had a BMI less than 18 and 86 (49.4%) had not been previously treated for any form of TB. Overall cohort outcomes revealed a 75.3% treatment success rate, 21.3% mortality rate, 0.6% failure and 0.6% lost to follow-up rate. In the adjusted multivariate analysis, low BMI and low CD4 count at treatment initiation were associated with an increased risk of unfavorable outcome.
A model of care that included psychosocial support and patient's enablers led to a high level of treatment success with a very low lost to follow up rate. Limiting the overall treatment success was a high mortality rate which was associated with advanced HIV and a low BMI at presentation. These factors will need to be addressed in order to improve upon the overall treatment success rate in future.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
In the last two decades, migraine research has greatly advanced our current knowledge of the genetic contributions and the pathophysiology of this common and debilitating disorder. Nonetheless, this ...knowledge still needs to grow further and to translate into more effective treatments. To date, several genes involved in syndromic and monogenic forms of migraine have been identified, allowing the generation of animal models which have significantly contributed to current knowledge of the mechanisms underlying these rare forms of migraine. Common forms of migraine are instead posing a greater challenge, as they may most often stem from complex interactions between multiple common genetic variants, with environmental triggers. This paper reviews our current understanding of migraine genetics, moving from syndromic and monogenic forms to oligogenic/polygenic migraines most recently addressed with some success through genome-wide association studies. Methodological issues in study design and future perspectives opened by biomarker research will also be briefly addressed.
Arthroscopic rotator cuff repair is among the most painful of orthopedic surgeries. Liposomal bupivacaine is Food and Drug Administration approved for administration into surgical sites to provide ...postsurgical analgesia and has been used to address postoperative pain after many types of surgery, including total shoulder arthroplasty. However, its efficacy for pain control after rotator cuff repair is unclear.
In this randomized, double-blind, placebo-controlled trial, we compared liposomal bupivacaine with an equivalent volume of saline injected into the subacromial space and arthroscopy portal sites in patients undergoing rotator cuff repair under the interscalene block with sedation. The primary outcome measure was numeric rating pain score at the time of block resolution, as reported during the follow-up phone call on postoperative day 1. Secondary outcomes included mean pain scores at rest as well as oral morphine equivalent requirements on postoperative days 1, 2, and 3. This study provides Level 1 evidence.
There were no statistically significant differences in the primary outcome of numeric rating pain scores on resolution of the interscalene nerve block, nor in those reported on postoperative day 1 or 2. There was a minor but statistically significant difference in mean resting pain scores on day 3, though opioid consumption and patient satisfaction score did not differ between groups. In those instructed to perform passive range-of-motion exercises, there was no difference in reported mean pain scores among the groups.
In this study of patients undergoing arthroscopic rotator cuff repair, we found no statistically significant difference in mean pain scores on interscalene block resolution, a result consistent with a number of studies investigating liposomal bupivacaine for total shoulder arthroplasty. A modest reduction in pain was evident only on day 3, and there was no impact on perioperative opioid requirements, opioid-related side effects, or pain with motion. Liposomal bupivacaine, when injected into the subacromial space and the tissues around the arthroscopy port sites, provided minimal improvement in pain control in this patient population.
Background
Today, we do not have a universally accepted evidence on how to treat peritoneal carcinomatosis (PC) from colorectal cancer (CRC) in international guidelines.
Methods
The present study is ...a review of the literature investigating current strategies to treat CRC PC.
Results
Despite the progresses of systemic chemotherapy, the presence of PC among patients with metastatic CRC reduces the overall survival to 30 %, and only 4 % of patients with PC from CRC treated are alive for 5 years. Many trials evaluate the combined treatment of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for CRC PC, suggesting a survival benefit in highly selected patients. Only one trial is randomized and presents some biases. The two main prognostic factors are Peritoneal Cancer Index (PCI) and completeness of cytoreduction score (CC score). There is no universal agreement on how to approach the synchronous presence of PC and liver metastasis with a curative intent during the same procedure. A growing interest among the scientific community has arisen about systematic second-look surgery and HIPEC treatment in high-risk patients.
Conclusion
Current evidences suggest that CRS and HIPEC might be beneficial in highly selected patients affected with PC from CRC. Anyway, today, there is a shortage of well-designed phase 3 trials.
In this article we further study the notion of proper costratifying systems, defined in
10
. We give sufficient conditions for their existence, and investigate the relation between the stratifying ...systems defined by K. Erdmann and C. Sáenz in
7
and the proper costratifying systems.
Operational, real-time rainfall estimation on a daily timescale is potentially of great benefit for hydrological forecasting in African river basins. Sparseness of ground-based observations often ...means that only methodologies based predominantly on satellite data are feasible. An approach is presented here in which Cold Cloud Duration (CCD) imagery derived from Meteosat thermal infrared imagery is used in conjunction with numerical weather model analysis data as the input to an artificial neural network. Novel features of this approach are the use of principal component analysis to reduce the data requirements for the weather model analyses and the use of a pruning technique to identify redundant input data. The methodology has been tested using 4 yr of daily rain gauge data from Zambia in central Africa. Calibration and validation were carried out using pixel area rainfall estimates derived from daily rain gauge data. When compared with a standard CCD approach using the same dataset, the neural network shows a small but consistent improvement over the standard method. The improvement is greatest for higher rainfalls, which is important for hydological applications.
Celotno besedilo
Dostopno za:
BFBNIB, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
The term now cast in hydro meteorology reflects the need for timely and accurate predictions of risky environmental situations, which are related to the development of severe meteorological events at ...short time scales. The objective of this paper is to apply a fully neural-network approach to the rainfall field now casting from infrared (IR) and microwave (MW) passive-sensor imagery aboard, respectively, geostationary Earth orbit (GEO) and low Earth orbit (LEO) satellites. The multisatellite space-time prediction procedure, which is named Neural Combined Algorithm for Storm Tracking (NeuCAST), consists of two consecutive steps. First, the IR radiance field measured from a geostationary satellite radiometer (e.g., Meteosat) is projected ahead in time (e.g., 30 min); second, the projected radiance field is used in estimating the rainfall field by means of an MW-IR combined rain retrieval algorithm exploiting GEO-LEO observations. The NeuCAST methodology is extensively illustrated and discussed in this paper. Its accuracy is quantified by means of quantitative error indexes, which are evaluated on selected case studies of rainfall events in Southern Europe in 2003 and 2005.
Floods and flash floods are complex events, depending on weather dynamics, basin physiographical characteristics, land use cover and water management. For this reason, the prediction of such events ...usually deals with very accurate model tuning and validation, which is usually site-specific and based on climatological data, such as discharge time series or flood databases. In this work, we developed and tested two hydrological-stress indices for flood detection in the Italian Central Apennine District: a heterogeneous geographical area, characterized by complex topography and medium-to-small catchment extension. The proposed indices are threshold-based and developed considering operational requirements of National Civil Protection Department end-users. They are calibrated and tested through the application of signal theory, in order to overcome data scarcity over ungauged areas, as well as incomplete discharge time series. The validation has been carried out on a case study basis, using flood reports from various sources of information, as well as hydrometric-level time series, which represent the actual hydrological quantity monitored by Civil Protection operators. Obtained results show that the overall accuracy of flood prediction is greater than 0.8, with false alarm rates below 0.5 and the probability of detection ranging from 0.51 to 0.80. Moreover, the different nature of the proposed indices suggests their application in a complementary way, as the index based on drained precipitation appears to be more sensitive to rapid flood propagation in small tributaries, while the discharge-based index is particularly responsive to main-channel dynamics.
Nerve blocks are frequently performed by anesthesiologists to control pain. For sciatic nerve blocks, the optimal placement of the needle tip between its paraneural sheath and epineurial covering is ...challenging, even under ultrasound guidance, and frequently results in nerve puncture. We performed needle penetration tests on cadaveric isolated paraneural sheath (IPS), isolated nerve (IN), and the nerve with overlying paraneural sheath (NPS), and quantified puncture force requirement and fracture toughness of these specimens to assess their role in determining the clinical risk of nerve puncture. We found that puncture force (123 ± 17 mN) and fracture toughness (45.48 ± 9.72 J m−2) of IPS was significantly lower than those for NPS (1440 ± 161 mN and 1317.46 ± 212.45 Jm−2, respectively), suggesting that it is not possible to push the tip of the block needle through the paraneural sheath only, without pushing it into the nerve directly, when the sheath is lying directly over the nerve. Results of this study provide a physical basis for tangential placement of the needle as the ideal situation for local anesthetic deposition, as it allows for the penetration of the sheath along the edge of the nerve without entering the epineurium.
ABSTRACTIn the interscalene groove, nerve structures are in close proximity and may not be visible as separate structures, increasing the risk of insertion of the needle tip within the epineurium. We ...evaluated whether experienced regional anesthesiologists can distinguish between nerve elements lying in close proximity on ultrasound images.Brachial plexus elements from 4 nonpreserved cadavers were arranged in a water bath. Ultrasound images of the nerve roots and trunks were taken. Regional anesthesiologists and residents were asked whether they could distinguish the nerves as 2 separate structures and if they could identify a pair of nerve roots versus a single trunk.Attending anesthesiologists reported the ability to discriminate 2 nerve structures when a 2-mm space was arranged between them in 54% of images; however, when in direct contact, this recognition was significantly lower. The residents reported a higher ability to discriminate the 2 nerves in all scenarios. In addition, the attending anesthesiologists successfully identified paired nerve roots versus nerve trunks in 70% of the images, significantly higher than chance (P = 0.01), whereas the fraction of correct resident responses was not significantly different from guessing.When nerves were placed in close proximity, experienced regional anesthesiologists had difficulty identifying them as separate structures and were incorrect nearly one-third of the time in discriminating 2 closely positioned roots versus a nerve trunk. This underscores the importance of cautious needle insertion into the interscalene groove, where nerve elements are often juxtaposed one to another.
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