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1.
Trop Anim Health Prod ; 53(1): 24, 2020 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-33219485

RESUMO

The rational of conservation and sustainable use of indigenous chicken (IC) resources requires their morphobiometrical characterisation. This study morphobiometrically characterised the IC ecotypes in Rwanda. The morphological features and zoometric measurement data were randomly collected on 1670 mature IC of both sexes from five ecotypes of Rwanda. The nonparametric Kruskal-Wallis and Mann-Whitney U test were used in evaluating the effect of ecotypes on the qualitative morphological variables. Zoometric measurements were analysed with the PROC GLM of SAS. The findings showed that the feather morphology and distribution were mainly normal (98.3 and 84.40%, respectively) while feather colour was dominated with multicoloured (38.10%). The majority of the birds had red earlobe (49.20%), yellow shanks (53.80%) and single comb-type (71.70%). These parameters were different (p < 0.05) between the ecotypes. Bodyweight and linear body measurements were highly different (P < 0.001) between ecotypes. Differences associated with sex (P < 0.001) were observed in body weight and linear body measurements. The interaction between ecotype and sex significantly (P < 0.001) influenced body weight, body length, shank length, comb length, comb height, wattle length, chest circumference, neck length and wingspan. The IC ecotypes in Rwanda were found to be diverse morphobiometrically both in quantitative and qualitative traits. These variations provide a foundation for classification of the chicken into breeds.


Assuntos
Biometria , Cruzamento , Galinhas/anatomia & histologia , Galinhas/fisiologia , Ecótipo , Animais , Feminino , Masculino , Modelos Biológicos , Ruanda
2.
Nutr Metab Cardiovasc Dis ; 29(2): 185-190, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30559043

RESUMO

BACKGROUND AND AIMS: Reduction of left ventricular mass index (LVMi) during antihypertensive treatment is less likely to occur in obese subjects. The aim of the study was to assess whether weight loss influences reduction of LVMi in treated, obese, hypertensive patients. METHODS AND RESULTS: From the Campania Salute Network registry, we identified 1546 obese hypertensive patients (50 ± 9 years, 43% women) with more than 12 months follow-up. Echocardiographic reduction of LVMi was considered as achievement of normal values (<47 g/m2.7 in women or <50 g/m2.7 in men) or a reduction of ≥10% during follow-up. Weight loss was considered as ≥5% reduction in body weight, and occurred in 403 patients (26%) during a median follow-up of 50 months (IQrange:31-93). Median weight loss was 8.6% (IQrange:6.5-12). Patients with weight loss had higher baseline body mass index (p < 0.05), while there was no difference in age, sex, duration of hypertension, prevalence of diabetes, metabolic syndrome and average blood pressure during follow-up. During follow-up, 152 patients (9.8%) exhibited reduction of LVMi. Reduction of LVMi was more frequent (12.9% vs 9.1%, p < 0.030) in patients losing weight than in those who did not. In logistic regression analysis, weight loss was associated with reduction of left ventricular mass index (OR 1.51 [95%CI 1.02-2.23], p = 0.039), independent of significant associations with younger age, lower average systolic blood pressure during follow-up, longer follow-up time and higher LVMi at baseline. CONCLUSION: In treated obese hypertensive patients, weight loss during follow-up promotes significant reduction of LVMi, independent of baseline characteristics and blood pressure control.


Assuntos
Pressão Sanguínea , Abordagens Dietéticas para Conter a Hipertensão , Hipertensão/terapia , Hipertrofia Ventricular Esquerda/fisiopatologia , Obesidade/dietoterapia , Função Ventricular Esquerda , Remodelação Ventricular , Redução de Peso , Adulto , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/epidemiologia , Itália/epidemiologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Obesidade/diagnóstico , Obesidade/epidemiologia , Obesidade/fisiopatologia , Sistema de Registros , Estudos Retrospectivos , Comportamento de Redução do Risco , Fatores de Tempo , Resultado do Tratamento , Função Ventricular Esquerda/efeitos dos fármacos , Remodelação Ventricular/efeitos dos fármacos
3.
Trop Med Int Health ; 22(4): 423-430, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28142216

RESUMO

OBJECTIVES: As neonatal care is being scaled up in economically poor settings, there is a need to know more on post-hospital discharge and longer-term outcomes. Of particular interest are mortality, prevalence of developmental impairments and malnutrition, all known to be worse in low-birthweight neonates (LBW, <2500 g). Getting a better handle on these parameters might justify and guide support interventions. Two years after hospital discharge, we thus assessed: mortality, developmental impairments and nutritional status of LBW children. METHODS: Household survey of LBW neonates discharged from a neonatal special care unit in Rural Burundi between January and December 2012. RESULTS: Of 146 LBW neonates, 23% could not be traced and 4% had died. Of the remaining 107 children (median age = 27 months), at least one developmental impairment was found in 27%, with 8% having at least five impairments. Main impairments included delays in motor development (17%) and in learning and speech (12%). Compared to LBW children (n = 100), very-low-birthweight (VLBW, <1500 g, n = 7) children had a significantly higher risk of impairments (intellectual - P = 0.001), needing constant supervision and creating a household burden (P = 0.009). Of all children (n-107), 18% were acutely malnourished, with a 3½ times higher risk in VLBWs (P = 0.02). CONCLUSIONS: Reassuringly, most children were thriving 2 years after discharge. However, malnutrition was prevalent and one in three manifested developmental impairments (particularly VLBWs) echoing the need for support programmes. A considerable proportion of children could not be traced, and this emphasises the need for follow-up systems post-discharge.


Assuntos
Mortalidade Infantil , Recém-Nascido de Baixo Peso , Desnutrição/epidemiologia , Transtornos do Neurodesenvolvimento/epidemiologia , Estado Nutricional , Alta do Paciente , Burundi/epidemiologia , Serviços de Saúde da Criança , Feminino , Seguimentos , Hospitais de Distrito , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Desnutrição/complicações , Prevalência , Serviços de Saúde Rural , População Rural
4.
Nutr Metab Cardiovasc Dis ; 27(10): 850-857, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28965797

RESUMO

BACKGROUND AND AIMS: The clustering of high levels of LDL cholesterol (LDL-C) and other risk factors represents a predisposing condition for atherosclerotic disease development. Cardiovascular prevention is based on effective control of these conditions. In adult subjects with mild hypercholesterolemia we compared in the real life the effects of a new combination of nutraceuticals on lipid and glucose metabolism and blood pressure with those of an established nutraceutical combination. METHOD AND RESULTS: This multicenter, controlled, randomized, single-blind trial was designed to compare the effect of Armolipid Plus® versus that of LopiGLIK® on lipid and glucose levels and blood pressure (BP) in subjects with mild hypercholesterolemia not on statin therapy. Primary outcome was the proportion of subjects achieving therapeutic targets of LDL-C (<130 mg/dl); secondary outcomes were the effects on HDL-C, glycated haemoglobin and insulin levels. Data from an overall sample of 359 adult individuals (age 55.2 ± 11.1 years, women 57.7%, LDL-C 157.3 ± 22.6 mg/dl, HDL-C 50.7 ± 13.0 mg/dl) are reported. 72% of subjects treated with LopiGLIK® and 43% treated with Armolipid Plus® achieved the primary endpoint (p < 0.0001). Both treatments reduced plasma levels of total and LDL-C and triglycerides (p < 0.001 for all comparisons). The treatments also reduced systolic and diastolic blood pressure, plasma levels of glycated haemoglobin, insulin and HOMA index. The changes induced by LopiGLIK® in all these metabolic parameters were greater than those obtained with Armolipid Plus®. CONCLUSIONS: The present analysis shows that LopiGLIK® may represent a more effective tool for clinical management of CV risk factors in subjects with mild hypercholesterolemia.


Assuntos
Doenças Cardiovasculares/prevenção & controle , LDL-Colesterol/sangue , Suplementos Nutricionais , Hipercolesterolemia/tratamento farmacológico , Hipolipemiantes/uso terapêutico , Morus , Extratos Vegetais/uso terapêutico , Adulto , Idoso , Biomarcadores/sangue , Glicemia/efeitos dos fármacos , Glicemia/metabolismo , Pressão Sanguínea/efeitos dos fármacos , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/etiologia , HDL-Colesterol/sangue , Suplementos Nutricionais/efeitos adversos , Feminino , Hemoglobinas Glicadas/metabolismo , Humanos , Hipercolesterolemia/sangue , Hipercolesterolemia/complicações , Hipercolesterolemia/diagnóstico , Hipolipemiantes/efeitos adversos , Insulina/sangue , Itália , Masculino , Pessoa de Meia-Idade , Morus/química , Fitoterapia , Extratos Vegetais/efeitos adversos , Extratos Vegetais/isolamento & purificação , Plantas Medicinais , Fatores de Risco , Método Simples-Cego , Fatores de Tempo , Resultado do Tratamento
5.
J Dairy Sci ; 100(1): 726-730, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27837983

RESUMO

Cows are probably the main source of contamination of raw milk with Staphylococcus aureus. Mammary glands with subclinical mastitis can shed large numbers of Staph. aureus in milk. Because of the risk of this pathogen to human health as well as animal health, the aim of this paper was to describe an outbreak of mastitis caused by methicillin-resistant Staph. aureus (MRSA), oxacillin-susceptible mecA-positive Staph. aureus (OS-MRSA), and methicillin-susceptible Staph. aureus (MSSA) on a dairy farm. Milk samples were obtained from all quarters, showing an elevated somatic cell count by the California Mastitis Test. The isolates were identified by phenotypic and genotypic methods. Staphylococcus spp. were isolated from 53% (61/115) of the milk samples, with 60 isolates identified as Staph. aureus (98.4%) and 1 isolate identified as Staphylococcus epidermidis (1.6%). The presence of the mecA gene was verified in 48.3% of Staph. aureus isolates. Of the Staph. aureus isolates, 23.3% were MRSA and 25.0% were OS-MRSA. The total of mastitis cases infected with MRSA was 12.2%. The detection of this large percentage of mastitis cases caused by MRSA and OS-MRSA is of great concern for the animals' health, because ß-lactams are still the most important antimicrobials used to treat mastitis. In addition, Staph. aureus isolates causing bovine mastitis represent a public health risk.


Assuntos
Surtos de Doenças , Mastite Bovina/epidemiologia , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções Estafilocócicas/veterinária , Animais , Bovinos , Farmacorresistência Bacteriana Múltipla , Feminino , Técnicas de Genotipagem , Mastite Bovina/diagnóstico , Mastite Bovina/microbiologia , Leite/microbiologia , Oxacilina/farmacologia , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/epidemiologia
6.
Nutr Metab Cardiovasc Dis ; 24(4): 355-69, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24486336

RESUMO

Diabetic foot (DF) is a chronic and highly disabling complication of diabetes. The prevalence of peripheral arterial disease (PAD) is high in diabetic patients and, associated or not with peripheral neuropathy (PN), can be found in 50% of cases of DF. It is worth pointing out that the number of major amputations in diabetic patients is still very high. Many PAD diabetic patients are not revascularised due to lack of technical expertise or, even worse, negative beliefs because of poor experience. This despite the progress obtained in the techniques of distal revascularisation that nowadays allow to reopen distal arteries of the leg and foot. Italy has one of the lowest prevalence rates of major amputations in Europe, and has a long tradition in the field of limb salvage by means of an aggressive approach in debridement, antibiotic therapy and distal revascularisation. Therefore, we believe it is appropriate to produce a consensus document concerning the treatment of PAD and limb salvage in diabetic patients, based on the Italian experience in this field, to share with the scientific community.


Assuntos
Pé Diabético/terapia , Procedimentos Endovasculares/normas , Salvamento de Membro/normas , Doença Arterial Periférica/terapia , Procedimentos Cirúrgicos Vasculares/normas , Amputação Cirúrgica/normas , Angioplastia com Balão/normas , Fármacos Cardiovasculares/uso terapêutico , Consenso , Pé Diabético/diagnóstico , Pé Diabético/epidemiologia , Humanos , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/epidemiologia , Valor Preditivo dos Testes , Prevalência , Fatores de Risco , Resultado do Tratamento
7.
Lett Appl Microbiol ; 59(6): 665-9, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25236329

RESUMO

UNLABELLED: The objective of this study was to analyse the prevalence and molecular characteristics of methicillin-resistant Staphylococcus aureus (MRSA) in milk of cows with mastitis. The California mastitis test (CMT) was used to detect the presence of mastitis in all 100 cows of a farm in Brazil. The CMT was positive in milk of 115 mammary quarters from 36 cows (36%). MRSA isolates were recovered from 4 of these 36 cows with mastitis (11%), and they were further characterized (one MRSA/sample). The four MRSA isolates were typed as t011-ST398-agr1-SCCmecV and presented two different pulsed-field-gel-electrophoresis-ApaI patterns. These four MRSA isolates showed resistance to tetracycline, streptomycin and ciprofloxacin, carried the mecA, blaZ, tet(K), and tet(M) resistance genes, and presented the S84L and S80F amino acid substitutions in GyrA and GrlA proteins, respectively. Two ST398 isolates exhibited resistance to gentamicin and tobramycin [with aac(6)-aph(2") and ant(4)-Ia genes] and one isolate resistance to clindamycin [with lnu(B) and lsa(E) genes]; this latter isolate also carried the spectinomycin/streptomycin resistance genes spw and aadE. MRSA of lineage ST398 is worldwide spread, normally multidrug resistant and may be responsible for bovine mastitis. To our knowledge, this is the first detection of MRSA-ST398 in Brazil. SIGNIFICANCE AND IMPACT OF THE STUDY: Few studies on the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) from bovine isolates have been performed in Brazil. MRSA of lineage ST398 is worldwide spread and associated with farm animals. Multidrug-resistant MRSA-ST398 isolates were recovered in 11% of mastitic cows from a single farm, with one isolate carrying the unusual lsa(E), spw and aadE genes. To our knowledge, this is the first detection of MRSA-ST398 isolates in milk samples of cows with mastitis in Brazil.


Assuntos
Antibacterianos/farmacologia , Mastite Bovina/microbiologia , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Leite/microbiologia , Infecções Estafilocócicas/veterinária , Animais , Brasil , Bovinos , Farmacorresistência Bacteriana Múltipla/genética , Eletroforese em Gel de Campo Pulsado , Feminino , Genes Bacterianos , Staphylococcus aureus Resistente à Meticilina/classificação , Staphylococcus aureus Resistente à Meticilina/genética , Testes de Sensibilidade Microbiana , Tipagem Molecular , Reação em Cadeia da Polimerase/veterinária , Infecções Estafilocócicas/microbiologia
8.
Trop Med Int Health ; 18(8): 993-1001, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23682859

RESUMO

OBJECTIVES: In 2006, Médecins sans Frontières (MSF) established an emergency obstetric and neonatal care (EmONC) referral facility linked to an ambulance referral system for the transfer of women with obstetric complications from peripheral maternity units in Kabezi district, rural Burundi. This study aimed to (i) describe the communication and ambulance service together with the cost; (ii) examine the association between referral times and maternal and early neonatal deaths; and (iii) assess the impact of the referral service on coverage of complicated obstetric cases and caesarean sections. METHODS: Data were collected for the period January to December 2011, using ambulance log books, patient registers and logistics records. RESULTS: In 2011, there were 1478 ambulance call-outs. The median referral time (time from maternity calling for an ambulance to the time the patient arrived at the MSF referral facility) was 78 min (interquartile range, 52-130 min). The total annual cost of the referral system (comprising 1.6 ambulances linked with nine maternity units) was € 85 586 (€ 61/obstetric case transferred or € 0.43/capita/year). Referral times exceeding 3 h were associated with a significantly higher risk of early neonatal deaths (OR, 1.9; 95% CI, 1.1-3.2). MSF coverage of complicated obstetric cases and caesarean sections was estimated to be 80% and 92%, respectively. CONCLUSION: This study demonstrates that it is possible to implement an effective communication and transport system to ensure access to EmONC and also highlights some of the important operational factors to consider, particularly in relation to minimising referral delays.


Assuntos
Serviços Médicos de Emergência/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde , Serviços de Saúde Materna/estatística & dados numéricos , Complicações do Trabalho de Parto/epidemiologia , Transferência de Pacientes/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Adulto , Ambulâncias/economia , Ambulâncias/organização & administração , Burundi/epidemiologia , Estudos Transversais , Sistemas de Comunicação entre Serviços de Emergência/economia , Serviços Médicos de Emergência/métodos , Feminino , Custos de Cuidados de Saúde , Humanos , Recém-Nascido , Agências Internacionais , Morte Materna/prevenção & controle , Serviços de Saúde Materna/métodos , Mortalidade Materna , Complicações do Trabalho de Parto/terapia , Procedimentos Cirúrgicos Obstétricos/estatística & dados numéricos , Transferência de Pacientes/economia , Transferência de Pacientes/métodos , Mortalidade Perinatal , Gravidez , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , População Rural/estatística & dados numéricos , Fatores de Tempo , Adulto Jovem
9.
Trop Med Int Health ; 18(2): 166-74, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23163431

RESUMO

OBJECTIVES: To estimate the reduction in maternal mortality associated with the emergency obstetric care provided by Médecins Sans Frontières (MSF) and to compare this to the fifth Millennium Development Goal of reducing maternal mortality. METHODS: The impact of MSF's intervention was approximated by estimating how many deaths were averted among women transferred to and treated at MSF's emergency obstetric care facility in Kabezi, Burundi, with a severe acute maternal morbidity. Using this estimate, the resulting theoretical maternal mortality ratio in Kabezi was calculated and compared to the Millennium Development Goal for Burundi. RESULTS: In 2011, 1385 women from Kabezi were transferred to the MSF facility, of whom 55% had a severe acute maternal morbidity. We estimated that the MSF intervention averted 74% (range 55-99%) of maternal deaths in Kabezi district, equating to a district maternal mortality rate of 208 (range 8-360) deaths/100,000 live births. This lies very near to the 2015 MDG 5 target for Burundi (285 deaths/100,000 live births). CONCLUSION: Provision of quality emergency obstetric care combined with a functional patient transfer system can be associated with a rapid and substantial reduction in maternal mortality, and may thus be a possible way to achieve Millennium Development Goal 5 in rural Africa.


Assuntos
Serviços Médicos de Emergência/métodos , Morte Materna/prevenção & controle , Serviços de Saúde Materna/métodos , Mortalidade Materna , População Rural/estatística & dados numéricos , Adolescente , Adulto , Burundi/epidemiologia , Centros Comunitários de Saúde , Serviços Médicos de Emergência/estatística & dados numéricos , Feminino , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Humanos , Morte Materna/estatística & dados numéricos , Serviços de Saúde Materna/normas , Pessoa de Meia-Idade , Complicações do Trabalho de Parto/prevenção & controle , Enfermagem Obstétrica/métodos , Enfermagem Obstétrica/normas , Gravidez , Estudos Retrospectivos , Saúde da Mulher , Adulto Jovem
10.
J Dairy Sci ; 96(11): 6856-6862, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24054305

RESUMO

Mastitis is an important disease for the dairy industry worldwide, causing economic losses and reducing milk quality and production. Staphylococcus aureus is a worldwide agent of this intramammary infection, which also causes foodborne diseases. The objective of this study was to determine the frequency of methicillin-susceptible Staphylococcus aureus (MSSA) isolates in milk of mastitis cows in Brazil and to analyze the genetic lineages and the content of antimicrobial resistance genes and virulence factors among these isolates. Fifty-six MSSA isolates were recovered from 1,484 milk samples (positive for the California mastitis test) of 518 cows from 11 different farms in Brazil (representing 51% of total Staph. aureus obtained), and they were further characterized. Methicillin-susceptible Staphylococcus aureus were isolated from 3.7% of California mastitis test-positive tested milk samples and from 6.2% of tested mastitic cows. Methicillin-susceptible Staphylococcus aureus isolates were characterized by spa typing, agr typing, and multilocus sequence typing, and resistance and virulence traits were investigated by PCR. Seven spa types were identified among MSSA (% of isolates): t127 (44.6), t605 (37.5), t002, t1784, t2066 (1.8), and 2 new ones: t10856 (10.7) and t10852 (1.8). Five distinct sequence types (ST) were detected (% of isolates): ST1 (46.4), ST126 (37.5), ST133 (10.7), ST5 (3.6), and a novel ST registered as ST2493 (1.8). Resistances were detected for streptomycin, chloramphenicol, and tetracycline. One strain contained the chloramphenicol resistance gene (fexA; included within transposon Tn558) and 3 strains contained the tetracycline resistance gene [tet(K)]. Methicillin-susceptible Staphylococcus aureus strains were susceptible to most of the antibiotics studied and lacked the virulence genes of Panton-Valentine leukocidin (lukF/S-PV), toxic shock syndrome toxin 1 (tst), exfoliative toxin A (eta), and exfoliative toxin B (etb), as well as the genes of the immune evasion cluster. Methicillin-susceptible Staphylococcus aureus isolates were detected in a relatively low proportion of cows with mastitis (6.2%) and recovered isolates presented high diversity of genetic lineages, with CC1 and CC126 the predominant clonal complexes, and CC133 also being detected. Larger epidemiological studies with molecular characterization of isolates are required to deepen the knowledge on the circulating genetic lineages among the cow population with mastitis.


Assuntos
Variação Genética , Mastite Bovina/microbiologia , Leite/microbiologia , Infecções Estafilocócicas/veterinária , Staphylococcus aureus/genética , Animais , Antibacterianos/farmacologia , Técnicas de Tipagem Bacteriana , Brasil , Bovinos , Farmacorresistência Bacteriana/genética , Feminino , Testes de Sensibilidade Microbiana , Tipagem de Sequências Multilocus , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/classificação , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/isolamento & purificação , Fatores de Virulência/genética
11.
Trop Med Int Health ; 17(11): 1356-60, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22882628

RESUMO

Using routine data from three clinics offering care to survivors of sexual violence (SV) in Monrovia, Liberia, we describe the characteristics of SV survivors and the pattern of SV and discuss how the current approach could be better adapted to meet survivors' needs. There were 1500 survivors seeking SV care between January 2008 and December 2009. Most survivors were women (98%) and median age was 13 years (Interquartile range: 9-17 years). Sexual aggression occurred during day-to-day activities in 822 (55%) cases and in the survivor's home in 552 (37%) cases. The perpetrator was a known civilian in 1037 (69%) SV events. Only 619 (41%) survivors sought care within 72 h. The current approach could be improved by: effectively addressing the psychosocial needs of child survivors, reaching male survivors, targeting the perpetrators in awareness and advocacy campaigns and reducing delays in seeking care.


Assuntos
Atenção à Saúde/métodos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Delitos Sexuais/psicologia , Sobreviventes/psicologia , Crimes de Guerra/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Libéria , Masculino , Pessoa de Meia-Idade , Guerra , Adulto Jovem
12.
Trop Med Int Health ; 17(9): 1156-62, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22845678

RESUMO

OBJECTIVES: In a district hospital in conflict-torn Somalia, we assessed (i) the impact of introducing telemedicine on the quality of paediatric care, and (ii) the added value as perceived by local clinicians. METHODS: A 'real-time' audio-visual exchange of information on paediatric cases (Audiosoft Technologies, Quebec, Canada) took place between clinicians in Somalia and a paediatrician in Nairobi. The study involved a retrospective analysis of programme data, and a perception study among the local clinicians. RESULTS: Of 3920 paediatric admissions, 346 (9%) were referred for telemedicine. In 222 (64%) children, a significant change was made to initial case management, while in 88 (25%), a life-threatening condition was detected that had been initially missed. There was a progressive improvement in the capacity of clinicians to manage complicated cases as demonstrated by a significant linear decrease in changes to initial case management for meningitis and convulsions (92-29%, P = 0.001), lower respiratory tract infection (75-45%, P = 0.02) and complicated malnutrition (86-40%, P = 0.002). Adverse outcomes (deaths and lost to follow-up) fell from 7.6% in 2010 (without telemedicine) to 5.4% in 2011 with telemedicine (30% reduction, odds ratio 0.70, 95% CI: 0.57-0.88, P = -0.001). The number needed to be treated through telemedicine to prevent one adverse outcome was 45. All seven clinicians involved with telemedicine rated it to be of high added value. CONCLUSION: The introduction of telemedicine significantly improved quality of paediatric care in a remote conflict setting and was of high added value to distant clinicians.


Assuntos
Hospitais de Distrito/estatística & dados numéricos , Pediatria/organização & administração , Pediatria/estatística & dados numéricos , Consulta Remota/organização & administração , Consulta Remota/estatística & dados numéricos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos , Somália/epidemiologia , Telemedicina/organização & administração , Telemedicina/estatística & dados numéricos , Resultado do Tratamento
13.
Eur J Vasc Endovasc Surg ; 43(1): 73-80, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22078294

RESUMO

BACKGROUND: Critical hand ischaemia (CHI) due to pure below-the-elbow (BTE) artery obstruction is a disabling disease and there is still no consensus concerning the most appropriate revascularisation strategy. The aim of this study was to assess the feasibility, safety and outcomes of percutaneous transluminal angioplasty (PTA) in the treatment of CHI due to pure BTE artery disease. METHODS AND RESULTS: Twenty-eight patients (age 62 ± 11 years; three females) with a total of 34 hands affected by CHI (one pain at rest; 18 non-healing ulcer; 15 gangrene) due to pure BTE artery disease underwent PTA. Most of the patients were males with a long history of diabetes mellitus, end-stage renal disease (ESRD) on haemodialysis and systemic atherosclerosis. The interosseous artery was free of disease in all cases, whereas the radial and ulnar arteries were simultaneously involved in 31/34 hands with long stenosis/occlusions (91%; mean length 155 ± 64 mm). The technical success rate was 82% (28/34), with only three minor complications. In the three cases with a functioning radial arteriovenous fistula, we successfully treated the ulnar artery. PTA was unsuccessful in 18% (6/34) hands due to inability to cross severely calcified lesions. The hand-healing rate was 65% (22/34). The predictors of hand healing were PTA technical success (odds ratio (OR) 0.5, confidence interval (CI) 0.28-0.88; p ≤ 0.0001) and digital run-off (OR 0.37, CI 0.19-0.71; p ≤ 0.003). The mean follow-up period was 13 ± 9 months. Six patients (18%) underwent secondary procedures due to symptomatic restenosis. In all these cases, a successful re-PTA was performed at a mean 6 months after the index procedure, and there were no major procedure-related events. Ten patients (36%) died during follow-up. CONCLUSIONS: Angioplasty of BTE vessels for CHI is a feasible and safe procedure with acceptable rates of technical success and hand healing. Poor digital run-off due to obstructive disease of the digital vessels can reduce the hand-healing rate after a successful PTA. Pure isolated BTE vessel disease seems to characterise patients with ESRD and diabetes mellitus.


Assuntos
Angioplastia com Balão , Angiopatias Diabéticas/terapia , Mãos/irrigação sanguínea , Isquemia/terapia , Idoso , Amputação Cirúrgica , Angioplastia com Balão/efeitos adversos , Angioplastia com Balão/mortalidade , Estado Terminal , Angiopatias Diabéticas/diagnóstico por imagem , Angiopatias Diabéticas/etiologia , Angiopatias Diabéticas/mortalidade , Angiopatias Diabéticas/fisiopatologia , Estudos de Viabilidade , Feminino , Humanos , Isquemia/diagnóstico por imagem , Isquemia/etiologia , Isquemia/mortalidade , Isquemia/fisiopatologia , Itália , Falência Renal Crônica/complicações , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Prospectivos , Radiografia , Recidiva , Fluxo Sanguíneo Regional , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Cicatrização
14.
Trop Med Int Health ; 16(11): 1380-3, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21831116

RESUMO

Using data of human immunodeficiency virus-positive patients with tuberculosis from three primary care clinics in Kibera slums, Nairobi, Kenya, we report on the proportion that started antiretroviral treatment (ART) and attrition (deaths, lost to follow-up and stopped treatment) before and while on ART. Of 427 ART eligible patients, enrolled between January 2004 and December 2008, 70% started ART, 19% were lost to attrition and 11% had not initiated ART. Of those who started ART, 14% were lost to attrition, making a cumulative pre-ART and ART attrition of 33%. ART uptake among patients with TB was relatively good, but programme attrition was high and needs urgent addressing.


Assuntos
Antirretrovirais/uso terapêutico , Soropositividade para HIV/tratamento farmacológico , Cooperação do Paciente , Tuberculose/complicações , Adulto , Estudos Transversais , Feminino , Soropositividade para HIV/complicações , Humanos , Quênia , Masculino , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Atenção Primária à Saúde/métodos , Estudos Retrospectivos , Saúde da População Urbana
15.
Trop Med Int Health ; 16(5): 579-84, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21306485

RESUMO

Using routine data from HIV-positive adult patients eligible for antiretroviral therapy (ART), we report on routinely collected demographic characteristics and opportunistic diseases associated with pre-ART attrition (deaths and loss to follow-up). Among 2471 ART eligible patients, enrolled between January 2005 and November 2008, 446 (18%) were lost to attrition pre-ART. Adjusted risk factors significantly associated with pre-ART attrition included age <35 years (Odds Ratio, OR 1.4, 95% Confidence Interval, CI 1.1-1.8), severe malnutrition (OR 1.5, 95% CI 1.1-2.0), active pulmonary tuberculosis (OR 1.6, 95% CI 1.1-2.4), severe bacterial infections including severe bacterial pneumonia (OR 1.9, 95% CI 1.2-2.8) and prolonged unexplained fever (>1 month), (OR 2.6, 95% CI 1.3-5.2). This study highlights a number of clinical markers associated with pre-ART attrition that could serve as 'pointers' or screening tools to identify patients who merit fast-tracking onto ART and/or closer clinical attention and follow-up.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Adolescente , Adulto , Terapia Antirretroviral de Alta Atividade , Feminino , Infecções por HIV/epidemiologia , Humanos , Quênia/epidemiologia , Masculino , Seleção de Pacientes , Pneumonia Bacteriana/epidemiologia , Atenção Primária à Saúde , Fatores de Risco , Tuberculose Pulmonar/epidemiologia , Adulto Jovem
16.
Public Health Action ; 11(1): 5-11, 2021 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-33777715

RESUMO

SETTING: Hypertension, diabetes mellitus and asthma are on the rise in developing countries, including Rwanda; there is thus a need to ensure uninterrupted drug availability. OBJECTIVES: To assess 1) the frequency and duration of drug stock-outs; 2) lead time duration 3) monthly stock levels; and 4) drug quantities requested vs. quantity delivered for captopril, metformin and inhaled salbutamol between January and December 2018 Kirehe District, Rwanda. DESIGN: This was a cross-sectional study using secondary programme data. RESULTS: The median annual stock-outs for captopril, metformin and inhaled salbutamol were respectively 4 (IQR 3-4), 3 (IQR 2-3) and 4 (IQR 4-5) at rural health facilities (RHCs); no stock-outs occurred at the district hospital. For all three drugs, the median lead time was 7.5 days (IQR 5.5-11.5) at the hospital vs. 5 days (IQR 3-6) in RHCs. Stock status for captopril was below the 4-week minimum stock level for 2/12 months at the hospital vs. 7/12 months at the RHCs, while metformin and inhaled salbutamol were below the 4-week minimum stock levels for respectively 1/12 and 4/12 months at both hospital and RHCs. Total drug quantities delivered were less than the combined total quantities requested in respectively 8/12, 5/12 and 8/12 months for captopril, metformin and inhaled salbutamol. CONCLUSION: There is a need to regularly and effectively monitor drug stock levels and ensure timely and sufficient stock replenishment to avert stock-outs.


CONTEXTE: L'hypertension, le diabète sucré et l'asthme augmentent progressivement dans les pays en développement, y compris le Rwanda ; il est donc nécessaire d'assurer une disponibilité ininterrompue des médicaments. OBJECTIFS: Évaluer 1) la fréquence et la durée des ruptures de stock de médicaments ; 2) durée du délai d'approvisionnement ; 3) niveaux de stock mensuels ; et 4) quantités de médicaments demandées par rapport aux quantités livrées pour le captopril, la metformine et le salbutamol inhalé ; entre janvier et décembre 2018 dans le district rural de Kirehe, au Rwanda. METHODE: Il s'agissait d'une étude transversale utilisant des données secondaires de programme. RÉSULTATS: Les ruptures de stock annuelles médianes pour le captopril, la metformine et le salbutamol inhalé étaient respectivement de 4 (intervalle interquartile [IQR] 3­4), 3 (IQR 2­3) et 4 (IQR 4­5) dans les Centre de Santé ruraux et aucune rupture de stock n'est survenue à l'hôpital de district. Pour les trois médicaments, le délai d'approvisionnement médian était de 7,5 jours (IQR 5,5­11,5) à l'hôpital contre 5 jours (IQR 3­6) dans les services sanitaires ruraux. L'état des stocks de captopril était inférieur au niveau de stock minimum de 4 semaines pendant 2/12 mois à l'hôpital contre 7/12 mois aux services sanitaires ruraux, tandis que pour la metformine et le salbutamol inhalé ils étaient inférieurs aux niveaux de stock minimum de 4 semaines pour 1/12 et 4/12 mois à l'hôpital et dans les Centre de Santé ruraux, respectivement. Les quantités totales de médicaments livrées étaient inférieures aux quantités totales combinées et demandées en 8/12, 5/12 et 8/12 mois pour le captopril, la metformine et le salbutamol inhalé, respectivement. CONCLUSION: Il est indispensable de surveiller régulièrement et convenablement les niveaux des stocks de médicaments et d'assurer un réapprovisionnement en temps propice et en quantité appropriée pour éviter les ruptures de stock.

17.
Indian J Med Res ; 132: 683-9, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21245615

RESUMO

BACKGROUND AND OBJECTIVES: Information available on HIV-2 and dual infection (HIV-1/2) is limited. This study was carried out among HIV positive individuals in an urban referral clinic in Khar, Mumbai, India, to report on relative proportions of HIV-1, HIV-2 and HIV-1/2 and baseline characteristics, response to and outcomes on antiretroviral treatment (ART). METHODS: Retrospective analysis of programme data (May 2006-May 2009) at Khar HIV/AIDS clinic at Mumbai, India was done. Three test algorithm was used to diagnose HIV-1 and -2 infection. Standard ART was given to infected individuals. Information was collected on standardized forms. RESULTS: A total of 524 individuals (male=51%; median age=37 yr) were included in the analysis over a 3 year period (2006-2009) - 489 (93%) with HIV-1, 28 (6%) with HIV-2 and 7(1%) with dual HIV-1/2 infection. HIV-2 individuals were significantly older than HIV-1 individuals (P<0.001). A significantly higher proportion of HIV-2 patients and those with dual infections had CD4 counts <200 cells/µl compared to HIV-1. HIV-2 individuals were more likely to present in WHO Clinical Stage 4. Of the 443 patients who were started on ART, 358 (81%) were still alive and on ART, 38 (8.5%) died and 3 were transferred out. CD4 count recovery at 6 and 12 months was satisfactory for HIV-1 and HIV-2 patients on protease inhibitor based regimens while this was significantly lower in HIV-2 individuals receiving 3 nucleoside reverse transcriptase inhibitors. INTERPRETATION AND CONCLUSIONS: In an urban HIV clinic in Mumbai, India, HIV-2 and dual infections are not uncommon. Adaptation of the current national diagnostic and management protocols to include discriminatory testing for HIV types and providing access to appropriate and effective ART regimens will prevent the development of viral resistance and preserve future therapeutic options.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , HIV-1 , HIV-2 , Inibidores de Proteases/uso terapêutico , Inibidores da Transcriptase Reversa/uso terapêutico , Adulto , Contagem de Linfócito CD4 , Cidades , Feminino , Humanos , Imunoensaio , Índia/epidemiologia , Masculino , Prevalência , Estudos Retrospectivos , Resultado do Tratamento
18.
J Cardiovasc Surg (Torino) ; 51(4): 567-71, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20671641

RESUMO

In the last years the development of new techniques and technologies for the endovascular treatment of peripheral arterial occlusive disease has allowed to treat a vast array of lesions with high technical success and low complications. Despite these advances, restenosis, and in particular in-stent restenosis, is a problem that significantly affects middle and long-term results and remains to be solved. Drug-eluting balloons (DEB) have shown good results in the treatment of coronary in-stent restenosis in experimental and clinical trials, but only few experimental and clinical trials focus on the peripheral district. This review summarizes the available experimental and clinical data in support of DEB in the treatment of ISR in the peripheral district. Larger clinical trials focused on paclitaxel-coated balloon in the treatment of ISR in the peripheral arteries will be necessary to provide definitive evidence of clinical benefit.


Assuntos
Angioplastia com Balão/instrumentação , Arteriopatias Oclusivas/terapia , Fármacos Cardiovasculares/administração & dosagem , Stents Farmacológicos , Extremidade Inferior/irrigação sanguínea , Paclitaxel/administração & dosagem , Animais , Constrição Patológica , Medicina Baseada em Evidências , Humanos , Desenho de Prótese , Prevenção Secundária , Resultado do Tratamento
19.
Public Health Action ; 10(3): 124-130, 2020 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-33134127

RESUMO

SETTING: In 1995, a rapid response project for humanitarian and medical emergencies, including outbreak responses, named 'Pool d'Urgence Congo' (PUC), was implemented in the Democratic Republic of Congo by Médecins Sans Frontières. OBJECTIVE: To assess the outcomes of cholera and measles outbreak alerts that were received in the PUC surveillance system between 2016 and 2018. DESIGN: This was a retrospective cross-sectional study. RESULTS: Overall, 459 outbreak alerts were detected, respectively 69% and 31% for cholera and measles. Of these, 32% were actively detected and 68% passively detected. Most alerts (90%) required no intervention and 10% of alerts had an intervention. There were 25% investigations that were not carried out despite thresholds being met; 17% interventions were not performed, the main reported reason being PUC operational capacity was exceeded. Confirmed cholera and measles outbreaks that met an investigation threshold comprised respectively 90% and 76% of alerts; 59% of measles investigations were followed by a delayed outbreak response of ⩾14 days (n = 10 outbreaks). CONCLUSION: Some alerts for cholera and measles outbreaks that were detected in the PUC system did not lead to a response even when required; the main reported reason was limited operational capacity to respond to all of them.

20.
J Cardiovasc Surg (Torino) ; 50(3): 331-7, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19543193

RESUMO

AIM: Recent registries and randomized trials support the role of percutaneous revascularization in patients with critical limb ischemia (CLI) due to below-the-knee (BTK) atherosclerotic disease, as percutaneous transluminal angioplasty (PTA) for BTK disease has shown to be feasible and safe in this setting. Nonetheless, succes rates remain suboptimal with current techniques. The authors aimed to appraise clinical results following PTA of foot vessels exploiting a novel technique, based on the recanalization of both pedal and plantar arteries and their anatomical anastomosis in order to restore direct arterial in-flow from both anterior and posterior tibial vessels, defined as the pedal-plantar loop technique. METHODS: Baseline, procedural and mid-term outcome data of all consecutive patients with CLI due to BTK disease in which PTA was attempted using the pedal-plantar loop technique were prospectively collected between January 2007 and September 2008. The primary end-point was acute success (i.e. the composite of technical, angiographic and procedural success). Secondary end-points included limb salvage rate, major (above the ankle) and minor (below the ankle) amputation, change in Rutherford class and transcutaneous oxygen tension, reocclusion/restenosis, rehospitalization, and repeat revascularization after 12 months. RESULTS: A total of 1331 consecutive patients with CLI were treated using BTK PTA and 135 (10.1%) were approached with the pedal-plantar loop technique in order to recanalize the foot arteries. Target lesions were mostly occlusive and diffusely diseased, involving in most cases the tibial arteries as well as the in-flow and out-flow vessels. Acute success was achieved for tibial PTA in 100% of the cases, with ability to position and inflate the balloon and achieve adequate angiographic results without peri-procedural complications in all, whereas acute success for the pedal-plantar loop technique was 85%. Clinical improvement in functional status was obtained and maintained after an average of 12 months, with a significant improvement of transcutaneous oxygen tension after 15 days, 59+/-16 mmHg in the group of patients in which the foot arteries revascularization was successfully feasible, versus 42+/-12 mmHg in patients achieving patency of two BTK vessels at the ankle level with partial out-flow in the foot (P<0.001). CONCLUSIONS: Percutaneous revascularization of foot arteries in patients with CLI is feasible and safe, and appears to provide positive clinical results at both acute and mid-term follow-up.


Assuntos
Angioplastia com Balão , Arteriopatias Oclusivas/terapia , Pé/irrigação sanguínea , Isquemia/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Amputação Cirúrgica , Angioplastia com Balão/efeitos adversos , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/fisiopatologia , Monitorização Transcutânea dos Gases Sanguíneos , Constrição Patológica , Estado Terminal , Estudos de Viabilidade , Feminino , Humanos , Isquemia/diagnóstico por imagem , Isquemia/fisiopatologia , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Oxigênio/sangue , Estudos Prospectivos , Radiografia , Recidiva , Reoperação , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
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