Cutaneous leishmaniasis (CL) is a chronic skin infection caused by Leishmania parasites, causing single or multiple skin nodules and ulcers on the exposed body locations. Healing of lesions is ...followed by scar formation. Active and healed CL lesions may affect patient's health related quality of life (HRQL). The aim of this study was to determine whether the body location of the leishmaniasis lesions affects the HRQL of localized CL patients in Suriname. The HRQL of 163 patients with CL was assessed by Skindex-29 and EQ-5D/VAS questionnaires. Forty-six patients out of the total study population also participated in a qualitative anthropological study involving in depth interviews. All patients were allocated in 4 groups in the following hierarchy: head and face, upper limbs, lower limbs and trunk. Patients with lesions on the lower limbs had significantly higher Skindex-29 scores, indicating worse HRQL, in the symptom scale compared to lesions on head/face and trunk. The lower limb group was more likely to report problems in the dimensions self-care, mobility, daily activities and pain/discomfort of the EQ-5D. Little to no social stigma was reported in the in-depth interviews. The findings of this study indicate that Surinamese patients with CL lesions located on the lower limbs had more impairment in HRQL than on other body locations. Stigma related to CL seems to be virtually absent in Suriname.
Standard treatment of cutaneous leishmaniasis (CL) in Suriname entails three injections of pentamidine isethionate (PI) 4 mg/kg per injection in 7 days (7 day regimen). Compliance to treatment is low ...and may contribute to increasing therapy failure. A 3 day regimen, including 2 injections of 7 mg/kg in 3 days may increase compliance.
In a randomized, single-blinded non-inferiority trial conducted in Suriname, 84 CL patients received the 7 day regimen and 79 CL patients received the 3 day regimen. Primary objective was the proportion of patients clinically cured at 6 weeks follow-up. Secondary objectives were clinical cure at 12 weeks follow-up; parasitological cure at 6 and 12 weeks; adverse and drug related toxicity events recorded one week after the end of treatment and health related quality of life. The non-inferiority margin was set at 15%, 1 sided test, α = 0.1.
At 6 weeks follow-up 31 (39%) patients in the 3 day regimen and 41 (49%) patients in the 7 day regimen were clinically cured. Intention to treat (ITT) analyses showed that the difference in proportion clinically cured was -9.6% (90% Confidence Interval (CI): -22.3% to 3.2%). Per protocol (PP) analysis showed that the difference in proportion clinically cured was 0.2% (90% CI: -14.6% to 15.2%). ITT analysis showed that the difference in proportion parasitological cured at 6 weeks was -15.2% (90% CI:-28.0% to -2.5%). PP analyses showed similar results. Non-inferiority could not be concluded for all adverse and toxicological events.
We cannot conclude that the 3 day regimen is non-inferior to the 7 day regimen regarding proportion clinically and parasitological cured. Therefore there is no evidence to change the current standard practice of the 7 day regimen for the treatment of CL in Suriname.
The main causative agent of cutaneous leishmaniasis (CL) in Suriname is Leishmania (Viannia) guyanensis. This case report presents a patient infected with Leishmania (Viannia) braziliensis, a species ...never reported before in Suriname. This finding has clinical implications, because L. braziliensis has a distinct clinical phenotype characterized by mucocutaneous leishmaniasis, a more extensive and destructive form of CL that requires different treatment. Clinicians should be aware that chronic cutaneous ulcers in patients from the Guyana region could be caused by L. braziliensis.
Cutaneous leishmaniasis (CL) is a serious health problem in Suriname. To expand the diagnostic options, two newly developed diagnostic tests, i.e. the rapid diagnostic test CL Detect™ Rapid Test (CL ...Detect) and the Loopamp™ Leishmania Detection Kit (Loopamp) were evaluated.
Diagnostic test performance was compared to the routine diagnostic approach in place, i.e. clinical symptoms combined with microscopy, and to polymerase chain reaction (PCR), which was used as a reference standard. The study population (n = 93) was a typical representation of the CL affected population in Suriname and mainly infected with Leishmania guyanensis.
CL Detect had a very low sensitivity compared to microscopy (36.7%) or PCR (35.8%), due to a high number of false negative results. The specificity of the CL Detect compared to microscopy and PCR was 85.7 and 83.3% respectively. Loopamp sensitivity was 84.8% compared to microscopy and 91.4% compared to PCR. The Loopamp test had a moderate specificity (42.9%) compared to microscopy, but a good specificity compared to PCR (91.7%).
The CL Detect is not likely to be a good replacement for the routine diagnostic procedure for CL in Suriname. The high sensitivity of the easy to perform Loopamp enables the implementation of sensitive molecular diagnosis in resource limited settings.
Multiple randomised trials have shown efficacy and safety of endovascular thrombectomy in patients with large ischaemic stroke. The aim of this study was to evaluate long-term (ie, at 1 year) ...evidence of benefit of thrombectomy for these patients.
SELECT2 was a phase 3, open-label, international, randomised controlled trial with blinded endpoint assessment, conducted at 31 hospitals in the USA, Canada, Spain, Switzerland, Australia, and New Zealand. Patients aged 18–85 years with ischaemic stroke due to proximal occlusion of the internal carotid artery or of the first segment of the middle cerebral artery, showing large ischaemic core on non-contrast CT (Alberta Stroke Program Early Computed Tomographic Score of 3–5 range 0–10, with lower values indicating larger infarctions) or measuring 50 mL or more on CT perfusion and MRI, were randomly assigned, within 24 h of ischaemic stroke onset, to thrombectomy plus medical care or to medical care alone. The primary outcome for this analysis was the ordinal modified Rankin Scale (range 0–6, with higher scores indicating greater disability) at 1-year follow-up in an intention-to-treat population. The trial is registered at ClinicalTrials.gov (NCT03876457) and is completed.
The trial was terminated early for efficacy at the 90-day follow-up after 352 patients had been randomly assigned (178 to thrombectomy and 174 to medical care only) between Oct 11, 2019, and Sept 9, 2022. Thrombectomy significantly improved the 1-year modified Rankin Scale score distribution versus medical care alone (Wilcoxon-Mann-Whitney probability of superiority 0·59 95% CI 0·53–0·64; p=0·0019; generalised odds ratio 1·43 95% CI 1·14–1·78). At the 1-year follow-up, 77 (45%) of 170 patients receiving thrombectomy had died, compared with 83 (52%) of 159 patients receiving medical care only (1-year mortality relative risk 0·89 95% CI 0·71–1·11).
In patients with ischaemic stroke due to a proximal occlusion and large core, thrombectomy plus medical care provided a significant functional outcome benefit compared with medical care alone at 1-year follow-up.
Stryker Neurovascular.
Global Oceans Johnson, G. C; Lumpkin, R; Atkinson, C ...
Bulletin of the American Meteorological Society,
09/2023, Letnik:
104, Številka:
9
Journal Article
The original and definitive reference on surgery of the craniovertebral junction, now in an updated second edition. The craniovertebral junction, with a significant range of pathologies and ...anatomical complexities, continues to be a challenging area for surgeons. This new edition of Surgery of the Craniovertebral Junction focuses on surgical decision making and technological advances in the treatment modalities for this region. Written and edited by senior surgeons at University Hospitals Case Medical Center in Cleveland, Ohio, and the world-renowned Barrow Neurological Institute in Phoenix, Arizona, this is a comprehensive text that spine and skull base surgeons will refer to often. A content-rich, interactive DVD containing cadaveric dissections, animations of surgical approaches and techniques, and a selection of short, narrated cases, is included with the book. Key Features: * Contains new chapters on stereotactic radiosurgery, endovascular surgery, and endoscopic skull base techniques, ensuring that surgeons stay current * Includes an interactive DVD with high-quality, compelling videos on anatomy and surgical methods, providing readers with visuals to aid in interpretation of the text * Reflects the technological advances and innovative treatment modalities that have improved patient safety and efficacy rates for surgery involving this highly complex area * Covers both open and minimally invasive surgical methods, enabling surgeons to hone their skills in both areas Surgery of the Craniovertebral Junction, Second Edition is the surgical resource every spine and skull base surgeon should have on their bookshelf.
The DO central track trigger Olsen, J.; Anderson, J.; Angstadt, R. ...
IEEE transactions on nuclear science,
2004-June, 2004-06-00, 20040601, Letnik:
51, Številka:
3
Journal Article
Recenzirano
Odprti dostop
An overview of the system architecture and algorithms used for the DO Central Track Trigger (CTT) in the Run 2 of the Fermilab Tevatron Proton-Antiproton Collider is presented. This system uses ...information from the newly commissioned Central Fiber Tracker and Preshower Detectors to generate Level 1 trigger decisions. It also generates lists of seed tracks and preshower clusters that are sent to the Level 1 Muon Trigger, L2 Silicon Track Trigger, and Central and Forward Preshower Level 2 preprocessors. The system consists of modular boards which utilize field-programmable gate arrays (FPGAs) to implement trigger algorithms. The system delivers trigger decisions every 132 ns, based on input data flowing at a maximum sustained rate of 475 gigabits per second. The first results of trigger efficiency studies are presented.
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