Robot-assisted vs. Laparoscopic Partial Nephrectomy: utilization rates and perioperative outcomes

Objectives To examine the effect of surgical approach on perioperative morbidity and mortality after partial nephrectomy. Materials and Methods Within the Nationwide Inpatient Sample, patients who underwent RAPN or LPN between October 2008 and December 2009 were identified. Propensity-based matching was performed to adjust for potential baseline differences between the two groups. The rates of intraoperative and postoperative complications, blood transfusions, prolonged length of stay, and in-hospital mortality, stratified according to RAPN vs. LPN, were compared. Results Overall, 851 (72.5%) patients underwent RAPN and 323 (27.5%) underwent LPN. For RAPN and LPN respectively, the following rates were recorded in the propensity-score matched cohort: blood transfusions, 4.5 vs. 6.8% (p = 0.223); intraoperative complications, 5.2 vs. 2.6% (p = 0.096); postoperative complications, 10.6 vs. 13.5% (p = 0.268); prolonged length of stay, 6.8 vs. 9.4% (p = 0.238); in-hospital mortality, 0.0 vs. 0.0%. Conclusions RAPN has supplanted LPN as the predominant minimally invasive surgical approach for renal masses. Perioperative outcomes after RAPN and LPN are comparable. Interpretation of these findings needs to take into account the lack of adjustment for case complexity and surgical expertise. .

Scepticism towards Insecticide Treated Mosquito Nets for Malaria Control in Rural Community in North-Western Tanzania

Abstract:Despite existence of effective tools for malaria control; malaria continues to be one of the leading killer diseases especially among under-five year children and pregnant women in poor rural populations of Sub Saharan Africa. In Tanzania Mainland the disease contributes to 39.4 of the total OPD attendances. In terms of mortality; malaria is known to be responsible for more than one third of deaths among children of age below 5 years and also contributes for up to one fifth of deaths among pregnant women. This paper is based on a study conducted in a rural community along the shores of Lake Victoria in Mwanza region; North-Western Tanzania. The study explores reasons for scepticism and low uptake of insecticide treated mosquito nets (ITNs) that were promoted through social marketing strategy for malaria control prior to the introduction of long lasting nets (LLN). The paper breaks from traditional approach that tend to study low uptake of health interventions in terms of structural practical constraints - cost; accessibility; everyday priorities - or in terms of cognition - insufficient knowledge of benefits e.g. ignorance of public health messages. This paper has shown that; the majority of people who could afford the prices of ITNs and who knew where to obtain the insecticides did not necessarily buy them. This suggests that; although people tend to report costrelated factors as a barrier against the use of ITNs; there are other critical concerns at work. Without underestimating the practical factors; our study have recommended to consider critical examinations of those other concerns that hinder optimal utilization of ITN for malaria control; and the basis for those concerns

Local perceptions and practices in regard to opisthorchiasis in two villages in Lao PDR.

The aim of the present study was to assess local perceptions and practices in regard to opisthorchiasis in a village receiving treatment and health education compared to a village where no intervention was offered. The study was conducted two years after a health education campaign had been carried out. Focus group discussions and semi-structured interviews were performed among 68 men and women. The results of the study show there were distinct differences in perceptions about opisthorchiasis when comparing the two villages. It appears that introducing health education alongside treatment does have an effect on knowledge and change in behavior. Eating raw fish was mainly practiced by men, however women were not aware they were exposed to opisthorchiasis while preparing food. Although there is no locally derived term, a medically appointed term for opisthorchiasis was acknowledged. Due to the vague disease symptoms, no treatment seeking behavior was found in relation to the disease. Further studies are needed to shed light on gender differences in regard to eating behavior and to assess infection risk among different Lao dishes containing freshwater fish.

Traditional Bhutanese medicine (gSo-BA Rig-PA): an integrated part of the formal health care services.

Traditional medicine in Bhutan is known as gSo-ba Rig-pa and is one of the oldest surviving medical traditions in the world. Other medical systems, such as Chinese medicine, Indian Ayurvedic medicine, Unani medicine, Greco-Roman medicine and the country's rich cultures and traditions have greatly influenced the way traditional Bhutanese medicine evolved. However, Buddhist philosophy remains the mainstream of this medical system. gSo-ba Rig-pa's principles are based on the perception the human body is composed of three main elements: rLung ('Air'), mKhris-pa ('Bile') and Bad-kan ('Phlegm'). When these three elements are balanced in the body a person is said to be healthy. The pathophysiology is also different from other medical systems, and the close link to Buddhism is reflected in the spiritual dimensions and the perception that all suffering is caused by ignorance. The treatment of diseases includes behavioral modification, physiotherapy, herbal medicines, minor surgery and spiritual healing. This makes the traditional Bhutanese medicine a unique and holistic health care system. The traditional medicine is an integrated and recognized part of the formal health care services in Bhutan under the auspices of the Ministry of Health. The article highlights three main points which can be learned from the Bhutanese experience: (1) the strong tradition of herbal medicines within gSo-ba Rig-pa forms a unique opportunity to prospect for new leads for development of pharmaceuticals, (2) the availability of the traditional medicine along with biomedicine broadens the health care choices for patients, and (3) the experiences of integrating two conceptually very different health care systems within one ministry contains important managerial lessons to be learned.

Plant resistance to cold stress: mechanisms and environmental signals triggering frost hardening and dehardening.

This introductory overview shows that cold, in particular frost, stresses a plant in manifold ways and that the plant's response, being injurious or adaptive, must be considered a syndrome rather than a single reaction. In the course of the year perennial plants of the temperate climate zones undergo frost hardening in autumn and dehardening in spring. Using Scots pine (Pinus sylvestris L.) as a model plant the environmental signals inducing frost hardening and dehardening, respectively, were investigated. Over 2 years the changes in frost resistance of Scots pine needles were recorded together with the annual courses of day-length and ambient temperature. Both act as environmental signals for frost hardening and dehardening. Climate chamber experiments showed that short day-length as a signal triggering frost hardening could be replaced by irradiation with far red light, while red light inhibited hardening. The involvement of phytochrome as a signal receptor could be corroborated by respective night-break experiments. More rapid frost hardening than by short day or far red treatment was achieved by applying a short period (6 h) of mild frost which did not exceed the plant's cold resistance. Both types of signals were independently effective but the rates of frost hardening were not additive. The maximal rate of hardening was - 0.93 degrees C per day and frost tolerance of less than < - 72 degrees C was achieved. For dehardening, temperature was an even more effective signal than day-length.