Non-nucleoside reverse transcriptase inhibitors (NNRTIs)-induced Stevens-Johnson syndrome and gynecomastia in an HIV-infected child: A case report.

BACKGROUND: Non-nucleoside reverse transcriptase inhibitors (NNRTIs) are antiretroviral drugs often used in the first-line treatment regimen of HIV1 infection worldwide. We report a case of successive gynecomastia and Stevens-Johnson syndrome (SJS) respectively induced by efavirenz and nevirapine in a single patient. CASE REPORT: A 16-year-old boy, HIV1-infected since birth, was started on antiretroviral treatment (ART) in August 2015 and was taking a regimen comprising abacavir, lamivudine and efavirenz. In April 2016, when his weight reached 35kg, abacavir was replaced with tenofovir. Bilateral breast enlargement, previously hidden by the patient, was diagnosed two years after the start of ART. History-taking, physical examination and laboratory tests ruled out known causes of gynecomastia, and efavirenz was thus considered the most likely cause. This drug was then withdrawn and replaced with nevirapine in July 2017. Thirty-three days after the patient started nevirapine treatment, a skin rash appeared. Physical examination revealed erythematous macules and flaccid bullae with estimated skin detachment of 10%. There were also conjunctival, buccal and genital lesions. A diagnosis was made of SJS induced by nevirapine. Three months after withdrawal of efavirenz, breast size decreased by 3cm on the left breast and 2cm on the right breast; two months after the SJS, cutaneous sequelae alone persisted, such as diffuse hyperchromic macules. DISCUSSION: Recognition of gynecomastia as a side-effect of efavirenz is important to allow the condition to be treated while it is still potentially reversible. Moreover, when efavirenz is replaced, a protease inhibitor should be preferred to nevirapine.

Epidural Spinal Cord Stimulation for Spinal Cord Injury in Humans: A Systematic Review.

(1) Background: Spinal cord injury (SCI) represents a major health challenge, often leading to significant and permanent sensorimotor and autonomic dysfunctions. This study reviews the evolving role of epidural spinal cord stimulation (eSCS) in treating chronic SCI, focusing on its efficacy and safety. The objective was to analyze how eSCS contributes to the recovery of neurological functions in SCI patients. (2) Methods: We utilized the PRISMA guidelines and performed a comprehensive search across MEDLINE/PubMed, Embase, Web of Science, and IEEE Xplore databases up until September 2023. We identified studies relevant to eSCS in SCI and extracted assessments of locomotor, cardiovascular, pulmonary, and genitourinary functions. (3) Results: A total of 64 studies encompassing 306 patients were identified. Studies investigated various stimulation devices, parameters, and rehabilitation methods. Results indicated significant improvements in motor function: 44% of patients achieved assisted or independent stepping or standing; 87% showed enhanced muscle activity; 65% experienced faster walking speeds; and 80% improved in overground walking. Additionally, eSCS led to better autonomic function, evidenced by improvements in bladder and sexual functions, airway pressures, and bowel movements. Notable adverse effects included device migration, infections, and post-implant autonomic dysreflexia, although these were infrequent. (4) Conclusion: Epidural spinal cord stimulation is emerging as an effective and generally safe treatment for chronic SCI, particularly when combined with intensive physical rehabilitation. Future research on standardized stimulation parameters and well-defined therapy regimens will optimize benefits for specific patient populations.

Factors affecting the prevalence of chronic diseases in Palestinian people: an analysis of data from the Palestinian Central Bureau of Statistics.

This study determined whether there are significant differences in the prevalence of diabetes, hypertension, cardiovascular disease (CVD) and cancer among Palestinians with respect to different demographic variables using secondary data from the Palestinian Central Bureau of Statistics. Living in the Gaza Strip was a protective factor, with this group being 21% less likely to have diabetes, 35% less likely to have hypertension, and 48% less likely to have CVD than those living in the West Bank. No significant difference was found for cancer. Being a refugee was a significant risk factor for diabetes and CVD while being married/engaged or divorced/ separated/widowed was a risk factor for diabetes and hypertension. Gender was a risk factor for hypertension with females being 60% more likely to have hypertension than males. Living in a rural setting was protective against hypertension. As expected, age was a risk factor for diabetes, hypertension and CVD; the magnitude of this increased risk was alarming, 36 to 434 times greater in those aged 40-65 years compared with those aged 0-19 years.

Effects of T-2 Toxin on Turkey Herpesvirus-Induced Vaccinal Immunity Against Marek's Disease.

T-2 toxin, a very potent immunotoxic Type A trichothecene, is a secondary metabolite produced primarily by Fusarium spp., which grows on cereal grains and can lead to contaminated livestock feed. Repeated exposure to T-2 toxin has been shown to cause immunosuppression and decrease the resistance of exposed animals to a variety of infectious diseases; however, the effects of T-2 toxin on Marek's disease (MD) vaccinal immunity have not been reported. Four trials were conducted to determine the effects of T-2 toxin on vaccinal immunity against MD. Day-old, white leghorn chicks of Avian Disease and Oncology Laboratory line 15I5 × 71 were treated daily for 7 days via crop gavage with T-2 toxin at a sublethal dose of 1.25 mg/kg body weight. Treated and untreated chicks were also vaccinated with turkey herpesvirus (HVT) at hatch and were challenged with the JM strain of MD virus (MDV) at 8 days of age. Chickens were tested for HVT viremia at 1 wk postvaccination immediately before challenge, and for HVT and MDV viremia at 3 wk postchallenge. Chickens were observed for the development of MD lesions and mortality within 8 wk of age. T-2 toxin significantly reduced body weight and titers of HVT viremia within 7 days after hatch. T-2 toxin shortened the incubation period for the development of MD lesions and mortality, but only in unvaccinated chickens. The percent MD protection in T-2-toxin-treated, HVT-vaccinated chickens ranged from 82% to 96% and was comparable to that in HVT-vaccinated untreated control chickens (89%-100%). The data suggest that exposure of chickens to sublethal doses of T-2 toxin for 7 consecutive days after hatch may influence the development of 1) HVT viremia; and 2) MD lesions and mortality, but only in unvaccinated chickens.

A comparison between emergency diagnostic and treatment unit and inpatient care in the management of acute asthma.

BACKGROUND: Emergency diagnostic and treatment units (EDTUs) may provide an alternative to hospitalization for patients with reversible diseases, such as asthma, who fail to adequately respond to emergency department therapy. OBJECTIVE: To evaluate the medical and cost-effectiveness, patient satisfaction, and quality of life of patients receiving EDTU care for acute asthma compared with inpatient care. METHODS: A prospective, randomized clinical trial performed at 2 urban public hospitals enrolled patients with acute asthma (age range, 18-55 years) not meeting discharge criteria after 3 hours of emergency department therapy. Patients were treated with inhaled adrenergic agonists and steroids in an EDTU for up to 9 hours after randomization or with routine therapy in a hospital ward. Patients were followed up for 8 weeks. MAIN OUTCOME MEASURES: Discharge rate from the EDTU, length of stay, relapse rates, days missed from work or school, days incapacitated during waking hours, symptom-free days and nights, nocturnal awakenings, direct medical costs, patients satisfaction, and patient quality of life. RESULTS: The study consisted of 222 patients with asthma. Sixty-five patients (59%) treated in an EDTU were discharged home; the remainder were admitted to the hospital. There were no differences during the follow-up period in relapse rates (P = .74) or in any other morbidities between the EDTU and inpatient groups. There were significant differences in the length of stay, patient satisfaction, and quality of life favoring EDTU care. The mean (+/-SD) cost per patient in the EDTU group was $1202.79 +/- $1343.96, compared with $2247.32 +/- $1110.18 for the control group (P < .001). CONCLUSIONS: Treatment of selected patients with asthma in an EDTU results in the safe discharge of most such patients. This study suggests that quality gains and cost-effective measures can be achieved by the use of such units.

[Perineoscrotal gangrene after a snake bite: a case report]. / Un cas de gangrène périnéoscrotale consécutive à une morsure de serpent.

The authors describe a case of perinoscrotal gangrene in a patient who had been bitten by a snake. He was treated with antivenom immunotherapy and surgery. The outcome was good. They present a brief review of the literature regarding the epidemiological, clinical, and treatment issues.

Gender differences and practice implications of risk factors for frequent hospitalization for heart failure in an urban center serving predominantly African-American patients.

To identify the clinical correlates of recurrent heart failure hospitalization in a large urban hospital serving predominately African-American patients, and to provide further insight into modifiable risks for heart failure readmissions, a retrospective period prevalence review of the records of all adult patients admitted with a primary diagnosis of heart failure (International Classification of Diseases-9 code 428.0) between January and December 1995 was performed. The main outcome was the number of heart failure hospitalizations over 12 months. Twelve hundred patients were identified. Mean age was 64 +/- 16 years, 94% were black, 57% were women, and 40% were > or = 65 years old. Ninety-eight percent had a history of systemic hypertension and 55% had uncontrolled hypertension. Other comorbidities were left ventricular (LV) hypertrophy (64%), coronary artery disease (52%), and tobacco abuse (28%). Sixty-five percent of patients were on angiotensin-converting enzyme (ACE) inhibitors, 51% on calcium antagonists, and 8% on beta blockers. Most patients had suboptimal dosing of ACE inhibitors and there was inappropriate use of calcium antagonists in 56% of patients with moderate or severe systolic dysfunction. Diabetes mellitus and echocardiographic wall motion abnormality were independently associated with frequent admissions for women but not for men. Medication-related increase in heart failure hospitalization was seen for calcium antagonists in patients with severe LV dysfunction (odds ratio 2.24, 95% confidence intervals 1.0 to 5.03; p <0.03). Uncontrolled hypertension, underdosing of ACE inhibitors, and overuse of calcium antagonists in patients with significant LV dysfunction are potential targets for intervention.

Effect of a cancer screening intervention conducted by lay health workers among inner-city women.

INTRODUCTION: We conducted a randomized controlled trial to determine if an in-home educational intervention conducted by lay health workers (LHWs) could increase adherence among low-income, inner-city, African-American women to breast and cervical cancer screening schedules. METHODS: We recruited 321 African-American women from diverse inner-city sources. After baseline interviews, they were randomly assigned to either the intervention (n = 163) or the control (n = 158) group. Those in the intervention group were visited in their homes up to three times by LHWs who provided a culturally sensitive educational program that emphasized the need for screening. RESULTS: Ninety-three (93) women in the intervention group and 102 in the control group completed the postintervention interview. For Pap smears, the increase in screening was similar in both groups. For clinical breast exams (CBEs), however, there was a modest increase in the intervention group. The improvement was greatest for mammography, for which there was a 10% to 12% increase. Among women who were not on recommended schedules at baseline, the improvement was substantial and greater in the intervention group. CONCLUSIONS: LHWs' intervention appeared to improve the rate at which inner-city women obtained CBEs and mammograms, but had no effect on Pap smears. A high attrition rate weakened our ability to make conclusive statements about the exact impact of the intervention.

Entonox as an analgesic agent during panretinal photocoagulation.

BACKGROUND/AIMS: Panretinal photocoagulation (PRP) reduces the risk of visual loss in proliferative diabetic retinopathy but some patients cannot tolerate PRP because of pain. Inhaled Entonox was evaluated as an analgesic during PRP. METHODS: A randomised, crossover, double masked pilot study was performed. Patients inhaled either air or Entonox and half the PRP was applied. The treatment was completed with the alternate inhaled gas. Patients graded pain experienced during both stages of the treatment using a visual analogue scale. Pain scores were compared using a paired t test. RESULTS: 20 patients participated. Mean pain scores from the Entonox and air treatments were 2.94 (SD 2.73) versus 3.73 (SD 3.20) respectively (p<0.03). CONCLUSION: Entonox can be used as a safe and effective analgesic agent during PRP treatment.

Opposite effects of metallothionein I and spermine on mitochondrial function.

Previously, we reported that the stress-induced protein metallothionein I (MT) modulated the oxygen consumption (VO2) of isolated rat liver mitochondria [Life Sci. 55 221-226, 1994]. We now present confirmation of this finding, and the additional observations that in rat liver mitochondria, MT caused swelling and depolarization. These actions of MT were inhibited by the aliphatic polyamine, spermine. Our findings suggest that mitochondrial function could be influenced by the balance between MT and spermine.

Is there a difference in hypertensive claim rates among Medicaid recipients?

The purpose of this study was to determine whether there are racial differences in the rates of prevalence and new claims to Medicaid for hypertension treatment in a population of uniformly low economic status--i.e., Georgia Medicaid recipients. Age-specific and age-adjusted prevalence rates of hypertension in 1991 and the first 1991 claim rates by race and gender were calculated. Gender-specific black-to-white risk ratios, using the Mantel-Haenszel pooled point estimate (RMH) and the corresponding test-based 95 percent confidence interval (CI) were also calculated. African-American females were more likely than African-American males, or whites of either sex to have hypertension diagnoses. For newly claimed cases, the gender-specific black-to-white risk ratios were significant in malignant hypertension for both females (RMH = 1.9, 95 percent CI 1.4-2.5) and males (RMH = 2.0, 95 percent CI 1.2-3.7) and in unspecified hypertension for females (RMH = 1.5, 95 percent CI 1.4-1.6), but were less significant in unspecified hypertension for males, and in benign hypertension for both sexes. Using Medicaid data may have caused underestimation of the prevalence and incidence of hypertension among Medicaid recipients; however, significant racial differences in the "occurrence" of hypertension still existed among them. Factors other than the household income status may be responsible for much of the excess risk of hypertension in the black Medicaid population.

Lack of adequate attention to elevated blood pressure in an urban hypertensive population.

BACKGROUND: Efforts directed at improving blood pressure (BP) control and outcomes of hypertension require insight into how physicians diagnose and manage hypertension in various practice settings, especially in the non-continuity setting. METHODS: Retrospective, cross-sectional study. Chart review of records of hypertensive patients, and patients with elevated BP, who visited the Urgent Care Center (UCC) of an urban teaching hospital. We examined patients' characteristics associated with the diagnosis and treatment of hypertension. RESULTS: Complaint of hypertension, request for medication refill, history of hypertension and high stages of hypertension, were associated with attention to BP. Complaint of hypertension and request for medication refill were associated with prescription for antihypertensive medications. Eighty percent of stage I, 50% of stage II, and 30% of stage III levels of BP did not have their BP addressed. Attention to the blood pressure reading was significantly associated with referral for follow-up care. CONCLUSIONS: Providers do not adequately acknowledge elevated BP in the UCC. Progress in the fight against hypertension will require a change in the practice of hypertension care in the non-continuity setting to recognize elevated blood pressures during patient encounters.

Interactive effect of race and marital status in low birthweight.

Although unmarried mothers are at risk of delivering low-birthweight (LBW) infants, the meaning and significance of this variable need to be explored in depth. With data on 216,285 infants born to white and black mothers aged 10 to 49 years in Atlanta, Georgia, between 1980 and 1987, we examined the association of LBW and marital status and the effect of race on the association. Education and age were controlled in the analysis in an attempt to isolate the effect of race on the marital status and birthweight association. The crude LBW rate among infants born to unmarried mothers was about twice the rate among infants born to married mothers (132.8 vs 63.9 per 1000 live births). Adjustment singly for maternal race, age, and education gave risk ratios (unmarried vs married) of 1.50, 2.03, and 1.78, respectively. Simultaneous control for all factors led to a hierarchy of education-adjusted risk: unmarried black adult mothers had the highest risk of delivering an LBW infant (2.49), followed by married black adults (1.93), unmarried black teenagers (1.90), married black teenagers (1.67), unmarried white adults (1.65), unmarried white teenagers (1.35), married white teenagers (1.08), and married white adults (1.0; reference group, with an LBW rate of 51.2/1000 live births). Thus, these data demonstrate both a consistently higher risk for black women and an interactive effect of age on the association of marital status and LBW: unmarried status appears to increase the risk of LBW much more among adult women than among younger women. This finding has implications for research and prevention of LBW.

Knowledge, beliefs, attitudes, and cancer screening among inner-city African-American women.

Three hundred twenty-one inner-city African-American women were interviewed to determine their knowledge, attitudes, and beliefs regarding cancer and cancer screening, and their cancer screening histories. The women were recruited from a variety of sources in Atlanta and were interviewed in their homes by trained lay health workers. Half of the subjects had an annual household income of < $15,000. About half had received a Pap smear and clinical breast examination within the year preceding the interviews. For women > 35 years old, 35% had received a mammogram within the recommended interval. Younger women and women with higher incomes were more likely than older women and those with lower incomes to have received a Pap test and clinical breast examination within the preceding year, but income was not significantly associated with mammography histories. In general, women who were more knowledgeable about cancer and its prevention were more likely to have been appropriately screened. However, various attitudes and beliefs regarding cancer generally were not associated with screening histories. We conclude that cancer screening programs for inner-city minority women should focus on improving knowledge levels among older women rather than attempting to alter attitudes and beliefs.

An Indicator of Solid Waste Generation Potential for Illinois Using Principal Components Analysis and Geographic Information Systems.

An indicator of solid waste generation potential (SWGP) is proposed as a versatile means to assist the development of integrated solid waste (SW) management plans. The proposed indicator is based on key sodoeconomic variables for the State of Illinois which were found to be highly correlated with variables describing the SW stream of the State. The proposed indicator was derived by applying the principal components analysis (PCA) technique. The technique is used to merge the rank transformed socioeconomic variables into a single variable, the SWGP indicator, while maintaining the regional information of the original variables. An innovative aspect of this indicator approach is the use of the ordinal scale for all these diverse variables. The validity of this approach was assessed and the proposed indicator was found to be directly proportional to a composite variable describing the SW stream for the State of Illinois. The use of Geographic Information Systems (GIS) to depict the spatial distribution of the SWGP will help planners visualize the expected overall refuse generation pattern and to identify critical regions. In addition, the proposed indicator could be used as an instrument to validate the solid waste generation (SWG) quantities reported by counties to state agencies.

Stapling and Section of the Nasogastric Tube during Sleeve Gastrectomy: How to Prevent and Recover?

Bariatric surgery has become an integral part of morbid obesity treatment with well-defined indications. Some complications, specific or not, due to laparoscopic sleeve gastrectomy (LSG) procedure have recently been described. We report a rare complication unpublished to date: a nasogastric section during great gastric curve stapling. A 44-year-old woman suffered of severe obesity (BMI 36.6 kg/m2) with failure of medical treatments for years. According to already published technique, a LSG was performed. Six hours postoperatively, a nurse removed the nasogastric tube according to the local protocol and the nasogastric tube was abnormally short, with staples at its extremity. Surgery was performed with peroperative endoscopy. In conclusion, this is the first publication of a nasogastric section during LSG. Therefore we report this case and propose a solution to prevent its occurrence. To avoid this kind of accident, we now systematically insert the nasogastric tube by mouth through a Guedel cannula. Then, to insert the calibrating bougie, we entirely withdraw the nasogastric tube.

A guide to interpreting economic studies in infectious diseases.

Healthcare providers continue to seek improved methods for preventing, detecting and treating diseases that affect human survival and quality of life. At the same time, there will always be financial constraints because of limited societal resources. Many of the discussions on how to provide economically sound solutions to this challenge have not fully engaged the input of clinicians in the field. The purpose of this review is to increase economic knowledge for clinicians. We cover healthcare cost elements and methods used to assign value to a health outcome. We outline the challenges in conducting economic studies in the field of infectious diseases. Finally, we discuss the meaning of efficiency from multiple perspectives, and how the concept of economic externalities applies to infectious diseases.

Assesssing herbal medical practitioners in professional qualifying examination in Ghana, a model.

About 70% of Ghanaians depend on Alternative health practice for their primary health care needs. Hence, there is the need to streamline and regulate these practices. Graduates from the Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology (K.N.U.S.T), Kumasi-Ghana were assessed by the Professional Qualifying Examination Board of the Traditional Medicine Practice Council (TMPC), Ghana, after two years of internship training. A model of assessment took into consideration, the scope of the university training, internship and the primary health care needs of the society.

Preliminary investigation of bovine tuberculosis in suspected beef from a metropolitan abattoir in Ghana with Ziehl-Neelsen microscopy.

Bovine tuberculosis is an important zoonotic disease transmissible through aerosols inhalation and the ingestion of contaminated milk and meat from cattle. Abattoirs in Ghana mainly depend on post-mortem examinations as means of diagnosing the presence of mycobacterium in meat (beef). A Ziehl-Neelsen microscopy was used to investigate the presence of Mycobacterium bovis as Acid-Fast Bacilli (AFBs) in beef samples from the Kumasi Metropolitan abattoir; thereby vetting post-mortem examinations at the abattoir. Lesioned lung tissues and calcified or puss-filled thoracic lymph nodes were collected at post-mortem as directed by an expert veterinarian. A total of 159 samples from 130 cattle (bulls and cows) were used in this study from April to July 2006. Ninety-five (i.e., 73.1%) of the 130 cattle sampled were positive for AFBs, whilst the remaining thirty-five (26.9%) were negative. Out of the total 159 individual samples specimen collected, 114 (71.7%) were found with AFBs. A total of 64 lung tissues and 95 lymph nodes were collected, respectively. Interestingly, 70.3% of the lung tissues were AFB-positive with 69 (72.6%) out of the 95 lymph nodes, also being positive. The ZN microscopy was effective in detecting the presence of mycobacteria, as 73.1% of the suspected samples were AFB-positive. It presupposes that, abattoir post-mortem examinations were also efficient however; the lapses of non-detection of asymptomatic carcasses could also pose a serious health risk to consumers. Also, lack of a functional on-site laboratory and a practical monitoring system was found to be unfavourable to the maintenance of meat quality. Detailed laboratory examinations (such as culture, PCR and other biochemical tests) to augment ZN microscopy is recommended for thorough detection of bovine tuberculosis.