Clinical standards for drug-susceptible TB in children and adolescents.

BACKGROUND: These clinical standards aim to provide guidance for diagnosis, treatment, and management of drug-susceptible TB in children and adolescents.METHODS: Fifty-two global experts in paediatric TB participated in a Delphi consensus process. After eight rounds of revisions, 51/52 (98%) participants endorsed the final document.RESULTS: Eight standards were identified: Standard 1, Age and developmental stage are critical considerations in the assessment and management of TB; Standard 2, Children and adolescents with symptoms and signs of TB disease should undergo prompt evaluation, and diagnosis and treatment initiation should not depend on microbiological confirmation; Standard 3, Treatment initiation is particularly urgent in children and adolescents with presumptive TB meningitis and disseminated (miliary) TB; Standard 4, Children and adolescents should be treated with an appropriate weight-based regimen; Standard 5, Treating TB infection (TBI) is important to prevent disease; Standard 6, Children and adolescents should receive home-based/community-based treatment support whenever possible; Standard 7, Children, adolescents, and their families should be provided age-appropriate support to optimise engagement in care and clinical outcomes; and Standard 8, Case reporting and contact tracing should be conducted for each child and adolescent.CONCLUSION: These consensus-based clinical standards, which should be adapted to local contexts, will improve the care of children and adolescents affected by TB.

Integrated screening and testing for TB and COVID-19 in Peru.

We describe the experience of integrating COVID-19 screening and testing into a mobile TB screening unit in Lima, Peru. All attendees received chest radiographs, which were analysed using CAD4TB and CAD4COVID; Xpert MTB/RIF Ultra was used to test for TB, and antibody and polymerase chain reaction (PCR) for SARS-CoV-2. One Xpert-positive TB case was diagnosed per 168 people screened, one person with SARS-CoV-2 antibodies per 3 people screened, and one PCR-confirmed SARS-CoV-2 infection per 8 people screened. Integrated screening can help to avoid delays in the diagnosis of both TB and COVID-19.

Nous décrivons l'expérience de l'intégration du dépistage et du test COVID-19 dans une unité mobile de dépistage de la TB à Lima, au Pérou. Toutes les personnes présentes ont reçu des radiographies pulmonaires, qui ont été analysées à l'aide de CAD4TB et CAD4COVID ; Xpert® MTB/RIF Ultra a été utilisé pour le dépistage de la TB, et les anticorps et la réaction en chaîne par polymérase (PCR) pour le SARS-CoV-2. Un cas de TB Xpert-positif a été diagnostiqué pour 168 personnes dépistées, une personne présentant des anticorps du SARS-CoV-2 pour 3 personnes dépistées et une infection du SARS-CoV-2 confirmée par PCR pour 8 personnes dépistées. Le dépistage intégré peut contribuer à éviter les retards dans le diagnostic de la TB et du COVID-19.

Innovative approach to the design and evaluation of treatment adherence interventions for drug-resistant TB.

BACKGROUND: Drug-resistant tuberculosis (DR-TB) treatment is expensive, lengthy, and can cause severe side effects. Patients face socio-economic, psychosocial, and systemic barriers to adherence; poor adherence results in poor treatment outcomes. OBJECTIVE: To estimate the effects of the components of the information-motivation-behavioral skills model on DR-TB treatment adherence. DESIGN: We recruited 326 adults receiving DR-TB treatment and 86 of their health care service providers from 40 health centers in Lima, Peru. The main outcome was adherence (i.e., the proportion of prescribed doses taken by a patient). Exposure measures were adherence information, motivation, and behavioral skills; loss to follow-up during previous TB treatment(s); providers' work engagement; and patient-perceived support from his/her social network. RESULTS: Structural equation modeling revealed that adherence information and motivation had positive effects on adherence, but only if mediated through behavioral skills (ß = 0.02, P < 0.01 and ß = 0.07, P < 0.001, respectively). Behavioral skills had a direct positive effect on adherence (ß = 0.27, P < 0.001). Loss to follow-up during previous treatment had a direct negative effect, providers' work engagement had a direct positive effect, and perceived support had indirect positive effects on adherence. The model's overall R2 was 0.76. CONCLUSION: The components of the information-motivation-behavioral skills model were associated with adherence and could be used to design, monitor, and evaluate interventions targeting adherence to DR-TB treatment.

The Innovative Socio-economic Interventions Against Tuberculosis (ISIAT) project: an operational assessment.

SETTING: Tuberculosis (TB) affected households in impoverished shantytowns, Lima, Peru. OBJECTIVE: To evaluate socio-economic interventions for strengthening TB control by improving uptake of TB care and prevention services. DESIGN: Barriers to TB control were characterised by interviews with TB-affected families. To reduce these barriers, a multidisciplinary team offered integrated community and household socio-economic interventions aiming to: 1) enhance uptake of TB care by education, community mobilisation and psychosocial support; and 2) reduce poverty through food and cash transfers, microcredit, microenterprise and vocational training. An interim analysis was performed after the socio-economic interventions had been provided for 2078 people in 311 households of newly diagnosed TB patients for up to 34 months. RESULTS: Poverty (46% earned

Presence of the most abundant ionic species and their contribution to PM2.5 mass, in the city of Guadalajara, Jalisco (Mexico).

Ambient PM2.5 samples were taken at 24 h intervals at two sites (Centro and Miravalle) in the city of Guadalajara from January to June 2008. The Centro site is located in the downtown, while the Miravalle site is located in an industrial zone south of the downtown. For both sites the higher concentrations of PM2.5 were between January and May. High correlation coefficients between sulfate, nitrate and ammonium of 0.95, 0.92 and 0.91, respectively, showed low variations in the concentrations of these species in the city. It was estimated that sulfate, nitrate and ammonium represented almost 47% of the PM2.5 mass in June at the Centro site, but in general the contributions in the other months were less than 21%, while at Miravalle this percentage was between 7.7% and 27.6%.

Temporal variation of nitro-polycyclic aromatic hydrocarbons in PM10 and PM2.5 collected in Northern Mexico City.

With the aim to determine the presence of individual nitro-PAH contained in particles in the atmosphere of Mexico City, a monitoring campaign for particulate matter (PM(10) and PM(2.5)) was carried out in Northern Mexico City, from April 2006 to February 2007. The PM(10) annual median concentration was 65.2µgm(-3) associated to 7.6µgm(-3) of solvent-extractable organic matter (SEOM) corresponding to 11.4% of the PM(10) concentration and 38.6µgm(-3) with 5.9µgm(-3) SEOM corresponding to 15.2% for PM(2.5). PM concentration and SEOM varied with the season and the particle size. The quantification of nitro-polycyclic aromatic hydrocarbons (nitro-PAH) was developed through the standards addition method under two schemes: reference standard with and without matrix, the former giving the best results. The recovery percentages varied with the extraction method within the 52 to 97% range depending on each nitro-PAH. The determination of the latter was effected with and without sample purification, also termed fractioning, giving similar results. 8 nitro-PAH were quantified, and their sum ranged from 111 to 819pgm(-3) for PM(10) and from 58 to 383pgm(-3) for PM(2.5), depending on the season. The greatest concentration was for 9-Nitroanthracene in PM(10) and PM(2.5), detected during the cold-dry season, with a median (10th-90th percentiles) concentration in 235pgm(-3) (66-449pgm(-3)) for PM(10) and 73pgm(-3) (18-117pgm(-3)) for PM(2.5). The correlation among mass concentrations of the nitro-PAH and criteria pollutants was statistically significant for some nitro-PAH with PM(10), SEOM in PM(10), SEOM in PM(2.5), NO(X), NO(2) and CO, suggesting either sources, primary or secondary origin. The measured concentrations of nitro-PAH were higher than those reported in other countries, but lower than those from Chinese cities. Knowledge of nitro-PAH atmospheric concentrations can aid during the surveillance of diseases (cardiovascular and cancer risk) associated with these exposures.

Determinación de la eficacia analgésica de los bloqueos del ganglio estrellado en el síndrome doloroso regional complejo con dolor mediado por el sistema nervioso simpático: estudio preliminar / Study of the analgesic efficacy of stellate ganglion blockade in the management of the complex regional pain syndrome in patients with pain mediated by sympathetic nervous system: preliminary study

Objetivo: Este estudio fue realizado con el propósito de determinar la eficacia analgésica de los bloqueos del ganglio estrellado, en el alivio del dolor mediado por el sistema nervioso simpático, en pacientes con síndrome doloroso regional complejo. Pacientes y métodos: Se realizó un ensayo clínico controlado con asignación aleatoria y enmascaramiento simple. Treinta y nueve pacientes fueron tratados con una serie de bloqueos de ganglio estrellado, terapia física y tratamiento farmacológico, mientras que treinta y dos pacientes fueron tratados con fisioterapia y el mismo esquema farmacológico. Para determinar la asociación entre las variables se utilizó el riesgo relativo con sus respectivos intervalos de confianza. Resultados: En la evaluación clínica realizada un mes postratamiento se encontró alivio del dolor en 84,6% de los pacientes del grupo de intervención y en 78,1% de los controles (RR= 1,08; I.C. 95%=0,8-1,4; p=0.48), sin encontrarse diferencias estadísticamente significativas. No se encontró asociación entre la eficacia analgésica y tabaquismo, dominancia, género, tipo de SDRC, causa desencadenante y nivel educativo (AU)

Objective: The purpose of this study was to determine the analgesic efficacy of stellate ganglion blockade in pain mediated by the sympathetic nervous system in patients with Complex Regional Pain Syndrome (CRPS). Patients and methods: A randomized, simple-blinded controlled clinical trial was conducted. Thirty nine patients were randomly assigned to an intervention group which was treated with a series of stellate ganglion blockades, physical therapy and pharmacological treatment, and thirty two to a control group which was treated with physical therapy and the same pharmacological treatment. Risk ratio was used to evaluate outcome and determine association with predictor variables. Results: At the end of the first month post treatment, it was found that 84.6% of patients in the intervention group had alleviation of their pain while 78.1% of the control group had alleviation of their pain; there was not a statistically significant difference (RR=1.08; C.I. 95%=0.8-1.4; p=0.48). We found no association between analgesic efficacy, smoking, dominance, gender, and type of CRPS, unleashing cause or educational level (AU)

Effects of sublethal concentrations of Vectobac on biological parameters of Aedes aegypti.

The effect of sublethal concentrations (30% lethal concentration [LC30] = 0.41 ppm, LC50 = 1.04 ppm, and LC70 = 2.60 ppm) of VectoBac 12 aqueous suspension (AS, Bacillus thuringiensis var. israelensis H-14, 600 ITU/mg) on life parameters of Aedes aegypti and its F1 progeny (not exposed) was assessed in laboratory tests. Based on the data, it was clear that concentrations of 0.41 ppm of VectoBac significantly shortened the duration of the developmental cycle of the exposed mosquitoes, but not that of the F1 (not exposed). Significant differences were found among the proportions of the age-specific survival between each toxic level, whereas the control did not differ from the treated individuals at the LC50 and LC70. The survival curves of the F1 showed significant differences among the different treatments and with the control. A significant effect was found on the fecundity of adults. Age-specific fecundity was markedly lower for the LC50 and LC70 treatments compared to the LC30 treatment and the control. In general, life parameters were affected inversely and significantly at higher concentrations of VectoBac, both in the exposed population of Ae. aegypti and in the F1 (not exposed).

Vector-field classification in magnetic-resonance angiography.

Phase-contrast magnetic-resonance angiography (PC MRA) generates images of vascular structures as three-dimensional maps of the blood-flow velocity in a volume of interest. To improve visualization methods for PC MRA, radiologists can benefit from image-processing algorithms that can classify flow and stationary tissue. In this paper, I describe a vector-difference distribution (VDD): a statistical model of noisy PC MRA that allows us to compute a measure of probability of flow for each voxel, based on the expected mixed distribution of flow and background samples. The estimates of flow probability form an image that can be used as a mask with, or as a surrogate for, the standard images for further processing and display. The implementation demonstrates that VDD (1) can classify probabilistically PC MRA images into flow and stationary tissue, and (2) can extract reliably first- and second-order statistical measures for flow and noise (background). A comparison of MIP images with and without a VDD-based probability mask demonstrates a 30-to-56-percent improvement in contrast-to-noise ratio.

Factors associated with Taenia solium cysticercosis: analysis of nine hundred forty-six Peruvian neurologic patients. Cysticercosis Working Group in Peru (CWG).

In most developing countries, 10% of acute neurologic cases are patients with neurocysticercosis (NCC). Determining specific factors associated with contracting NCC will facilitate its diagnosis and prevention. We examined multiple socioeconomic, demographic, environmental, medical, and behavioral characteristics of 946 Peruvian neurologic patients for a correlation with NCC, which was diagnosed by the highly specific and sensitive electroimmunotransfer blot (EITB) or immunoblot assay. Eighteen percent (172 of 932) of serum samples and 28% (101 of 362) of cerebrospinal fluid samples were EITB-positive. The proportion of EITB-positive persons was similar for all socioeconomic levels. Significant factors associated with NCC were: 1) being born outside Lima, 2) having raised pigs, 3) more than 20 years of age, 4) a history of seizures, and 5) a history of taeniasis. Of these factors, raising pigs is the only one that is amenable to intervention, via improvements in animal husbandry.

Augmenting reality in rehabilitation medicine.

Virtual reality comprises the computer-based generation of realistic three-dimensional visual, auditory, and tactile environments in which a user can explore and interact with virtual objects. Although traditionally used for input devices to virtual worlds, the instrumented glove and sensor technologies of virtual reality may provide a dramatic new method for the measurement and amplification of human motion. This paper discusses some potential uses of virtual reality technology to support and augment routine activities for people who have physical disabilities. We present two different but related applications of this technology.

The design and implementation of a ventilator-management advisor.

VentPlan is an implementation of the architecture developed by the qualitative-quantitative (QQ) research group for combining qualitative and quantitative computation in a ventilator-management advisor (VMA). VentPlan calculates recommended settings for four controls of a ventilator by evaluating the predicted effects of alternative ventilator settings. A belief network converts clinical diagnoses to distributions on physiologic parameters. A mathematical-modeling module applies a patient-specific mathematical model of cardiopulmonary physiology to predict the effects of alternative ventilator settings. A decision-theoretic plan evaluator ranks the predicted effects of alternative ventilator settings according to a multiattribute-value model that specifies physician preferences for ventilator treatments. Our architecture allows VentPlan to interpret quantitative observations in light of the clinical context (such as the clinical diagnosis). We report a retrospective study of the ventilator-setting changes encountered in postoperative patients in a surgical intensive-care unit (ICU). We conclude that the QQ architecture allows VentPlan to apply a patient-specific physiologic model to calculate ventilator settings that are optimal with respect to a decision-theoretic value model describing physician preferences for setting the ventilator.

[The relationship between intestinal metaplasia and gastric carcinoma: a study of 722 biopsies]. / Relación entre metaplasia intestinal y carcinoma gástrico: estudio de 722 biopsias.

Intestinal metaplasia has been shown by many investigators to be a premalignant state. Considering this fact, 722 gastric biopsies were studied, a 24% of association was found between gastric carcinoma and intestinal metaplasia and 27% of the cases with metaplasia were found in "apparently normal" or with benign stomach lesions. The group most affected was males over 61 years. Control endoscopy and biopsy was practiced in 17 patients with previously diagnosed intestinal metaplasia and in 11.7% gastric carcinoma with metaplasia was found. Therefore, it cannot be concluded that intestinal metaplasia is a premalignant condition, but its frequent association with gastric adenocarcinoma advises periodical examination by endoscopy in every patient over 40 years in which it is determined by biopsy.

The design of a user interface for a ventilator-management advisor.

The lack of user acceptance for many medical decision-support systems should force medical software developers to rethink strategies for user interaction with decision-support programs. Participatory design is an emerging method for the development for computer applications that emphasizes user involvement in both the design and implementation phases. We have applied participatory design to the development of a user interface for VentPlan, an application that assists physicians in the management of artificial respiration of critically ill patients. In this paper, we present a case history of the participatory design process and describe the resulting interface for the VentPlan program. As a result of applying participatory design ideas, we gained insight as to how to implement VentPlan more effectively.