Household Financial Status and Gender Perspectives in Determining the Financial Impact of Foot and Mouth Disease in Lao PDR.

The socioeconomic impacts of foot and mouth disease (FMD) during 2011-12 outbreaks on large ruminant smallholders in Laos were investigated, including examination of data on gender, household financial status and farmer husbandry practices. A mix of participatory tools and survey questionnaires at the village and household level, respectively, were conducted, involving individual farmer interviews (n = 124) and group meetings with village elders to establish criteria for classification of household financial status as being 'poor, medium or well off' according to rice sufficiency, assets and household incomes. FMD-attributable financial losses were determined by inclusion of losses due to: mortality, morbidity and costs of treatments. The estimated mean financial losses due to FMD were USD 436 (±92) in the 'poor' and USD 949 (±76) in the 'well off' household categories (P < 0.001), being 128% and 49% of income from the sale of large ruminants, respectively. Variation in financial losses reflected differences in morbidity, farmer husbandry practices including frequency of observation of animals and thus recognition of FMD and choice of treatments. Of concern were adverse financial impacts of treatment especially where antibiotics were used; delays in reporting of FMD cases after observation of signs (mean of 2 days); admission that 10% of farmers had sold FMD-affected livestock; and that 22% of respondents claimed their large ruminants were cared for by females. The findings confirm that FMD has the most severe financial impact on poorer households and that females have a significant role in large ruminant production. It is recommended that livestock extension activities promote the benefits of prevention rather than treatment for FMD and encourage participation of women in biosecurity and disease risk management interventions including rapid reporting and regulatory compliance, particularly with animal movement controls and other biosecurity practices that reduce the negative impacts of FMD on regional food security and poverty reduction in rural communities.

Complications after patello-femoral versus total knee replacement in the treatment of isolated patello-femoral osteoarthritis. A meta-analysis.

PURPOSE: Both patellofemoral arthroplasty (PFA) and total knee arthroplasty (TKA) are successful in treating isolated patellofemoral osteoarthritis, but the complication rates after PFA are concerning. We performed a meta-analysis to compare the incidence of complications, re-operations, and revision following PFA and TKA for patellofemoral osteoarthritis. METHODS: We systematically identified publications with patients who underwent PFA or TKA for patellofemoral osteoarthritis with minimum 1.5 year follow-up. Demographics, implant (TKA, first [1G] or second-generation [2G] PFA), complications, and cause of re-operations were extracted. Random-effects meta-analysis was used to pool incidence data, which was compared between groups using logistic regression to adjust for length of follow-up. RESULTS: Twenty-eight observational studies and no randomized trials were included in this meta-analysis, which limits its generalizability. There was a higher likelihood of any re-operation (odds ratio 8.06) and revision (OR 8.11) in PFA compared to TKA. Re-operation (OR 4.33) and revision (OR 4.93) were more likely in 1G-PFA than 2G-PFA. When comparing 2G-PFA to TKA, there was no significant difference in re-operation, revision, pain, or mechanical complications. CONCLUSIONS: Patients who undergo PFA rather than TKA are more likely to experience complications and require re-operation or revision, but subgroup analysis suggests a relation to implant design. There is no significant difference in re-operation, revision, pain, or mechanical complications between 2G-PFA and TKA. LEVEL OF EVIDENCE: Systematic review of Level III therapeutic studies, Level III.

Monoamniotic twins discordant for anencephaly managed conservatively with good outcomes: two case reports and a review of the literature.

Monoamniotic twin pregnancy discordant for anencephaly (MATDA) is a rare occurrence with only seven prior reported cases. Selective termination has been advocated in managing discordant monoamniotic twins. We report two cases managed expectantly with good outcomes and review other previously reported cases. The first case was a primigravid woman diagnosed with MATDA at 18 weeks. She was managed expectantly until 32 + 5 weeks when a Cesarean section was performed for preterm labor. The surviving female infant weighed 1610 g. The second case was a multigravid woman who was diagnosed with MATDA at 17 + 5 weeks and was managed as an outpatient. An emergency Cesarean section was performed at 31 weeks for non-reassuring monitoring and the surviving male infant weighed 1790 g. In both cases, the survivors were discharged home in good condition. A review of these two cases and those in the literature suggests that expectant management should be considered among management options for this rare condition.

Lactase treated feeds to promote growth and feeding tolerance in preterm infants.

BACKGROUND: Successful transition from parenteral nutrition to full enteral feedings during the immediate neonatal period is associated with improved growth in preterm infants. Lactase is the last of the major intestinal disaccharidases to develop in preterm infants. Because of inadequate lactase activity, preterm infants are unable to digest lactose. Lactase preparations could potentially be used to hydrolyze lactose in formulas and breast milk to minimize lactose malabsorption in preterm infants. OBJECTIVES: To assess the effectiveness and safety of the addition of lactase to milk compared to placebo or no intervention for the promotion of growth and feeding tolerance in preterm infants. PRIMARY OUTCOMES: Weight gain expressed as g/kg/day, growth expressed as weight, length and head circumference percentile for gestational age, assessed at birth and at 40 weeks post-menstrual age, days to achieve full enteral feeds. SECONDARY OUTCOMES: Several common outcomes associated with preterm birth, and adverse effects. SEARCH STRATEGY: Electronic and manual searches were conducted in January 2005 of Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 4, 2004), MEDLINE (1966-Jan 2005), EMBASE (1980-Jan 2005) and CINAHL (1982-Jan 2005), personal files, bibliographies of identified trials and abstracts by the Pediatric Academic Societies' and the European Society of Pediatric Research Meetings published in Pediatric Research. SELECTION CRITERIA: Types of studies: Randomized or quasi-randomized controlled trials. PARTICIPANTS: Preterm infants < 37 weeks gestational age. INTERVENTION: Addition of lactase to milk versus placebo or no intervention. DATA COLLECTION AND ANALYSIS: The standard methods of the Cochrane Neonatal Review Group were followed independently by the reviewers to assess study quality and report outcomes. Treatment effects, calculated using RevMan 4.2, included relative risk (RR), risk difference (RD) and mean difference (MD), all with 95% confidence intervals (CI). A fixed effect model was used for meta-analyses. Heterogeneity tests were not performed as only one study was identified. MAIN RESULTS: One study enrolling 130 infants of 26 - 34 weeks postconceptual age (mean postnatal age at entry 11 days) was identified and no identified study was excluded. The study was a double blind randomized controlled trial of high quality. Lactase treated feeds were initiated when enteral feedings provided > 75% of daily intake. None of the primary outcomes outlined in the protocol for this review and only one of the secondary outcomes, necrotizing enterocolitis (NEC), were reported on. The RR for NEC was 0.32 (95% CI 0.32 (0.01, 7.79); the RD was -0.02 (95% CI -0.06, 0.03) (a reduction which was not statistically significant). There was a statistically significant increase in weight gain at study day 10 in the lactase treated feeds group but not at any other time points. Overall, there ws not a statistically significant effect on weight gain. No adverse effects were noted. AUTHORS' CONCLUSIONS: The only randomized trial to date provides no evidence of significant benefit to preterm infants from adding lactase to their feeds. Further research regarding effectiveness and safety are required before practice recommendations can be made. Randomized controlled trials comparing lactase vs placebo treated feeds and enrolling infants when enteral feeds are introduced are recommended. The primary and secondary outcomes for effectiveness and safety should include those identified in this review.

Postoperative radical radiotherapy with concurrent weekly intra-arterial cis-platinum for treatment of malignant glioma: a pilot study.

Twelve patients with histologically proven malignant glioma have been treated with a combination of intra-arterial (IA) cis-platinum (CDDP) and radical radiation therapy (RT). Chemotherapy consisted of intracarotid (IC) CDDP, 40-60 mg/m2, weekly, repeated for 3-5 treatments. Radiation therapy consisted of whole-brain irradiation 5000 cGy in 5 weeks, plus a cone-down boost (1000 cGy in one week) to the primary tumour lesion. Ocular toxicity derived from IC chemotherapy was observed in 3 out of 41 procedures analyzed (7%). Results in tumour response assessed by computed tomography (CT) showed 5 complete remissions, 6 partial remissions and one patient was not evaluable. The median survival time for the entire group was 10 months. Median survival time in patients with complete response is 17 months, and 10 months in patients with partial response. Four patients are still alive with a follow-up ranging from 6+ to 27+ months.

Undifferentiated epithelial-rich invasive malignant thymoma: complete response to cisplatin, vinblastine, and bleomycin therapy.

Two cases of complete remission plus one almost complete and another partial response of undifferentiated, invasive epithelial malignant thymoma using the combination of cisplatin, vinblastine, and bleomycin (PVB), are reported in four patients treated with this combination. Radiotherapy was instituted after completing the fourth course of chemotherapy in three patients. One patient died from intercurrent infection after the fourth cycle of combination chemotherapy. Three patients remain free of disease at the end of the treatment program. PVB appears to be highly active in this disease and deserves more extensive evaluation in multicenter clinical trials.

Simultaneous radiotherapy and cis-platinum for the treatment of brain metastases. A pilot study.

Thirteen patients with the established diagnosis of brain metastases were treated with weekly intravenous or intra-arterial cis-platinum (40-60 mg/m2) during whole-brain irradiation (5,000 cGy over 5 weeks). Objective tumor response was observed in 12 patients (seven complete responses [CRs] and five partial responses [PRs]), and one patient showed stable disease (NC) following treatment. Chemotherapy- and radiation therapy-related toxicity was mild. There was no enhanced radiation therapy side effects on the normal tissues. Intracarotid cis-platinum with radiotherapy resulted in five CRs, two PRs, and one NC. Intravenous cis-platinum with conventional radiation therapy resulted in two CRs and three PRs. Responses according to tumor type were as follows: lung cancer (three adenocarcinoma, one mixed type, and one small-cell anaplastic carcinoma), two CRs and three PRs; breast cancer, one CR; thyroid cancer, one CR; unknown primary cancer, one CR; and melanoma, one NC. These results represent a relatively high CR rate (53.8%) for an otherwise barely manageable complication of malignant disease. Further controlled studies are recommended.

Combination chemotherapy of cisplatin and 5-FU in advanced colorectal carcinoma.

Thirty-two patients with advanced colorectal carcinoma were treated with cisplatin (100 mg/m2) by infusion over 24 hours on Day 1 and 5-FU (1000 mg/m2/day) by infusion over 24 hours on Days 2-6 every 28 days. Ten of the 32 patients had received prior chemotherapy consisting of either 5-FU alone or 5-FU combination regimens. Objective response was observed in 13 patients (two complete and 11 partial responses). Another 11 patients had stabilization of disease. The overall median survival time in this study was 9.53 months. Toxicity was generally mild and tolerable. The response rate found in this study indicated that continuous infusion of cisplatin-5-FU administered at this dose and schedule was moderately active in advanced colorectal carcinoma.

Functional and ultrastructural studies of granulocyte adherence in the newborn.

Polymorphonuclear leukocyte (PMN) adherence to nylon was studied in the umbilical cord blood of 33 full-term, healthy newborns (NBs) during delivery. The results were compared to the adherence of PMN of peripheral blood in 50 healthy adult blood bank donors. PMN adherence in the NBs (56.64 +/- 3.24) was found to be significantly higher (p less than or equal to 0.01) than in the adults (47.03 +/- 2.01). PMN adherence, either in adults or NBs, is not related to leukocytes, platelets or hematocrit values. It was found to be related only to the percentage of total leukocyte adherence. Also using scanning electron microscopy (SEM), the ultrastructure of the adherence process was analyzed. In these studies we observed a higher tendency to adopt fusiform disposition in the PMN of the adult population. These results suggest that NB PMNs are hyperadherent and that they show a cellular rigidity and a resistance to deformation that could be responsible for the chemotactic alterations previously described in neonates.

Intra-arterial and intravenous chemotherapy for the treatment of malignant glioma. Preliminary results.

Twenty-one patients with malignant glioma were treated with cis-diamminedichloroplatinum II (CDDP II) 60-90 mg/m2 intra-arterial (I.A.) bolus on day 1 and Carmustine (BCNU) 100 mg/m2 intravenously (I.V.) on days 1 and 2. Three patients received additional Aziridinylbenzoquinone (AZQ) 7 mg/m2 (I.V.) on days 1 and 2. At the time of this treatment, seven patients had local recurrence after previous surgery and radiotherapy. Nine patients had subtotal tumor resection or biopsy, one patient had macroscopic tumor resection, and four patients had no previous surgery because of medical contraindication. Six patients received five or more courses of I.A. and I.V. chemotherapy. Five of these patients showed complete remission (CR) and one had a partial remission (PR) by brain computerized tomography (CT scan). Another 15 patients treated with two to four courses of I.A., and I.V. chemotherapy showed eight partial responses (PR), and seven showed no changes (NC) by brain CT scan. Five patients died with disease. Patients who achieved CR also received radical radiotherapy for remission consolidation. Sixteen patients are still alive; five patients are off treatment, four of these with no evidence of disease (NED), one alive with disease (AWD); and the remaining 11 patients are still on treatment. Toxicity, symptomatic neurological recovery, disease stabilization, and causes of death will be discussed.