Umbilical cord mesenchymal stromal cells transplantation delays the onset of hyperglycemia in the RIP-B7.1 mouse model of experimental autoimmune diabetes through multiple immunosuppressive and anti-inflammatory responses.

Type 1 diabetes mellitus (T1DM) is an autoimmune disorder specifically targeting pancreatic islet beta cells. Despite many efforts focused on identifying new therapies able to counteract this autoimmune attack and/or stimulate beta cells regeneration, TD1M remains without effective clinical treatments providing no clear advantages over the conventional treatment with insulin. We previously postulated that both the inflammatory and immune responses and beta cell survival/regeneration must be simultaneously targeted to blunt the progression of disease. Umbilical cord-derived mesenchymal stromal cells (UC-MSC) exhibit anti-inflammatory, trophic, immunomodulatory and regenerative properties and have shown some beneficial yet controversial effects in clinical trials for T1DM. In order to clarify conflicting results, we herein dissected the cellular and molecular events derived from UC-MSC intraperitoneal administration (i.p.) in the RIP-B7.1 mouse model of experimental autoimmune diabetes. Intraperitoneal (i.p.) transplantation of heterologous mouse UC-MSC delayed the onset of diabetes in RIP-B7.1 mice. Importantly, UC-MSC i. p. transplantation led to a strong peritoneal recruitment of myeloid-derived suppressor cells (MDSC) followed by multiple T-, B- and myeloid cells immunosuppressive responses in peritoneal fluid cells, spleen, pancreatic lymph nodes and the pancreas, which displayed significantly reduced insulitis and pancreatic infiltration of T and B Cells and pro-inflammatory macrophages. Altogether, these results suggest that UC-MSC i. p. transplantation can block or delay the development of hyperglycemia through suppression of inflammation and the immune attack.

Need for systematic screening for IGD in adolescent psychiatric inpatients.

Psychiatric comorbidities are frequent in adolescents with internet gaming disorder (IGD). In contrast, the proportion of IGD among adolescents hospitalized for a psychiatric disorder has not been documented yet. In addition, parental ratings of IGD could be useful for diagnosis, but very few data exist on this issue. The objectives of this study were to: (1) assess the prevalence of IGD among adolescent psychiatric inpatients, using the Ten-Item Internet Gaming Disorder Test (IGDT-10), and (2) assess the parental version developed for this study (IGDT-10-P). A total of 102 patients, aged from 12 to 17 years old, were included from four psychiatric units of the French region Auvergne-Rhône-Alpes, during a 6-month inclusion period. Adolescents completed the IGDT-10 while one of their parents completed the IGDT-10-P. The inclusion rate among the eligible population was 57.95%. The prevalence of IGD in the sample, based on the IGDT-10 and IGDT-10-P, was 6.00% and 12.79%, respectively. Psychometric features of the IGDT-10-P indicated excellent internal consistency, a good model fit to the one factor model in confirmatory factor analysis, a strong correlation with gaming time, and a moderate correlation with the IGDT-10. Our results support the need for a systematic screening of IGD among adolescents hospitalized for a psychiatric disorder. Future studies should aim to confirm and explain the prevalence gap between self- and parent-reported criteria.

Growing research in global surgery with an eye towards equity.

BACKGROUND: Global surgery research is often generated through collaborative partnerships between researchers from both low- and middle-income countries (LMICs) and high-income countries (HICs). Inequitable engagement of LMIC collaborators can limit the impact of the research. METHODS: This article describes evidence of inequities in the conduct of global surgery research and outlines reasons why the inequities in this research field may be more acute than in other global health research disciplines. The paper goes on to describe activities for building a collaborative research portfolio in rural Rwanda. RESULTS: Inequities in global surgery research collaborations can be attributed to: a limited number and experience of researchers working in this field; time constraints on both HIC and LMIC global surgery researchers; and surgical journal policies. Approaches to build a robust, collaborative research portfolio in Rwanda include leading research trainings focused on global surgery projects, embedding surgical fellows in Rwanda to provide bidirectional research training and outlining all research products, ensuring that all who are engaged have opportunities to grow in capacities, including leading research, and that collaborators share opportunities equitably. Of the 22 published or planned papers, half are led by Rwandan researchers, and the research now has independent research funding. CONCLUSION: It is unacceptable to gather data from an LMIC without meaningful engagement in all aspects of the research and sharing opportunities with local collaborators. The strategies outlined here can help research teams build global surgery research portfolios that optimize the potential for equitable engagement.

Prevalence and predictors of surgical-site infection after caesarean section at a rural district hospital in Rwanda.

BACKGROUND: There are few prospective studies of outcomes following surgery in rural district hospitals in sub-Saharan Africa. This study aimed to estimate the prevalence and predictors of surgical-site infection (SSI) following caesarean section at Kirehe District Hospital in rural Rwanda. METHODS: Adult women who underwent caesarean section between March and October 2017 were given a voucher to return to the hospital on postoperative day (POD) 10 (±3 days). At the visit, a physician evaluated the patient for an SSI. A multivariable logistic regression model was used to identify risk factors for SSI, built using backward stepwise selection. RESULTS: Of 729 women who had a caesarean section, 620 were eligible for follow-up, of whom 550 (88·7 per cent) returned for assessment. The prevalence of SSI on POD 10 was 10·9 per cent (60 women). In the multivariable analysis, the following factors were significantly associated with SSI: bodyweight more than 75 kg (odds ratio (OR) 5·98, 1·56 to 22·96; P = 0·009); spending more than €1·1 on travel to the health centre (OR 2·42, 1·31 to 4·49; P = 0·005); being a housewife compared with a farmer (OR 2·93, 1·08 to 7·97; P = 0·035); and skin preparation with a single antiseptic compared with a combination of two antiseptics (OR 4·42, 1·05 to 18·57; P = 0·043). Receiving either preoperative or postoperative antibiotics was not associated with SSI. CONCLUSION: The prevalence of SSI after caesarean section is consistent with rates reported at tertiary facilities in sub-Saharan Africa. Combining antiseptic solutions for skin preparation could reduce the risk of SSI.

Outcomes of decentralizing hypertension care from district hospitals to health centers in Rwanda, 2013-2014.

SETTING: Three district hospitals (DHs) and seven health centers (HCs) in rural Rwanda. OBJECTIVE: To describe follow-up and treatment outcomes in stage 1 and 2 hypertension patients receiving care at HCs closer to home in comparison to patients receiving care at DHs further from home. DESIGN: A retrospective descriptive cohort study using routinely collected data involving adult patients aged ⩾18 years in care at chronic non-communicable disease clinics and receiving treatment for hypertension at DH and HC between 1 January 2013 and 30 June 2014. RESULTS: Of 162 patients included in the analysis, 36.4% were from HCs. Patients at DHs travelled significantly further to receive care (10.4 km vs. 2.9 km for HCs, P < 0.01). Odds of being retained were significantly lower among DH patients when not adjusting for distance (OR 0.11, P = 0.01). The retention effect was consistent but no longer significant when adjusting for distance (OR 0.18, P = 0.10). For those retained, there was no significant difference in achieving blood pressure targets between the DHs and HCs. CONCLUSION: By removing the distance barrier, decentralizing hypertension management to HCs may improve long-term patient retention and could provide similar hypertension outcomes as DHs.

Assessing the cost of laparotomy at a rural district hospital in Rwanda using time-driven activity-based costing.

BACKGROUND: In low- and middle-income countries, the majority of patients lack access to surgical care due to limited personnel and infrastructure. The Lancet Commission on Global Surgery recommended laparotomy for district hospitals. However, little is known about the cost of laparotomy and associated clinical care in these settings. METHODS: This costing study included patients with acute abdominal conditions at three rural district hospitals in 2015 in Rwanda, and used a time-driven activity-based costing methodology. Capacity cost rates were calculated for personnel, location and hospital indirect costs, and multiplied by time estimates to obtain allocated costs. Costs of medications and supplies were based on purchase prices. RESULTS: Of 51 patients with an acute abdominal condition, 19 (37 per cent) had a laparotomy; full costing data were available for 17 of these patients, who were included in the costing analysis. The total cost of an entire care cycle for laparotomy was US$1023·40, which included intraoperative costs of US$427·15 (41·7 per cent) and preoperative and postoperative costs of US$596·25 (58·3 per cent). The cost of medicines was US$358·78 (35·1 per cent), supplies US$342·15 (33·4 per cent), personnel US$150·39 (14·7 per cent), location US$89·20 (8·7 per cent) and hospital indirect cost US$82·88 (8·1 per cent). CONCLUSION: The intraoperative cost of laparotomy was similar to previous estimates, but any plan to scale-up laparotomy capacity at district hospitals should consider the sizeable preoperative and postoperative costs. Although lack of personnel and limited infrastructure are commonly cited surgical barriers at district hospitals, personnel and location costs were among the lowest cost contributors; similar location-related expenses at tertiary hospitals might be higher than at district hospitals, providing further support for decentralization of these services.

An innovative method to quantitate tissue integration of hyaluronic acid-based dermal fillers.

BACKGROUND/PURPOSE: Following intradermal injection, hyaluronic acid (HA)-based fillers tend to spread within the reticular dermis and to distribute between the dermal fibers. This biointegration is commonly measured qualitatively using histological methods. We developed a "toolbox" consisting of a visual scoring and a semi-automatic image analysis method using internal developed algorithm to quantitate the biointegration of Restylane® in histological sections. METHODS: Restylane® was injected intradermally in the abdominal skin of 10 healthy human subjects scheduled for abdominoplasty. The injections were performed either in vivo before surgery or ex vivo on samples taken post-surgery at different time points. The samples were processed for histology by visual scoring and image analysis using algorithms developed in Definiens to assess biointegration. RESULTS: The image analysis segmentation was accurate with <5% manual changes. Furthermore, the results calculated with the semi-automatic method were consistent with the visual scores obtained on injected human skin samples by means of a 5-grade photographic scale. A modified hematoxylin-eosin staining was found adequate to visualize both, the filler and the general morphology, on the same section. An excellent correlation was observed between the integration results obtained with PAS/Alcian Blue and HE-stained slides, allowing for a single staining in future studies. CONCLUSION: We developed a modified HE staining histological method and a new histomorphometric image analysis tool to quantitate biointegration of HA-based fillers in human skin. The results obtained in this study confirmed the known intermediate biointegration properties of Restylane®, thus validating these innovative methods.

Rural veterinarian's perception and practices in terms of biosecurity across three European countries.

The implementation of biosecurity measures in the animal health and production context is quite broad and aims at limiting the risk of introduction and spread of diseases. Veterinarians play a major role in biosecurity as key informants on the subject for cattle holders, key players in terms of disease prevention/control and eradication programs, as well as key risk factor in terms of disease dissemination. Many biosecurity studies have highlighted professional visitors such as veterinary practitioners as representing a high-risk factor in terms of disease introduction in animal facilities but, to date, very few studies have focused on the implementation level of biosecurity measures by veterinarians. An online survey was implemented in three European countries (Belgium, France and Spain) to assess the behaviour of rural veterinarians towards biosecurity, as well as their implementation level of the biosecurity measures. A descriptive analysis of data and a scoring system were applied to assess the implementation level of measures. The influence of different factors on the implementation level of biosecurity measures was investigated through a negative binomial regression model. The study identified different strengths, weaknesses, possible constraints and solutions in terms of veterinary perspectives. Veterinarians are considered as key informants by the farmers and could therefore play a more active role in terms of guidance and improvement of biosecurity at farm level. Based on the survey outcomes, two factors seemed to influence significantly the implementation level of measures: the country where he/she practices and the veterinarian's perception level of biosecurity. The biosecurity stages with the lowest application level, therefore representing the biggest threats, were bio-exclusion (increasing the risk of disease introduction) and biocontainment (increasing the risk of inter-herd transmission).

Treating persistent asthma in rural Rwanda: characteristics, management and 24-month outcomes.

SETTING: In 2007, the Rwandan Ministry of Health, with support from Partners In Health, introduced a district-level non-communicable disease programme that included asthma care. OBJECTIVE: To describe the demographics, management and 24-month outcomes of asthma patients treated at three rural district hospitals in Rwanda. DESIGN: We retrospectively reviewed electronic medical records of asthma patients enrolled from January 2007 to December 2012, and extracted information on demographics, clinical variables and 24-month outcomes. RESULTS: Of the 354 patients, 66.7% were female and 41.5% were aged between 41 and 60 years. Most patients (53.1%) were enrolled with moderate persistent asthma, 40.1% had mild persistent asthma and 6.8% had severe persistent asthma. Nearly all patients (95.7%) received some type of medication, most commonly a bronchodilator. After 24 months, 272 (76.8%) patients were still alive and in care, 21.1% were lost to follow-up, 1.7% had died and 0.3% had transferred out. Of the 121 patients with an updated asthma classification at 24 months, the severity of their asthma had decreased: 17.4% had moderate and 0.8% had severe persistent asthma. CONCLUSION: Our findings show improvements in asthma severity after 24 months and reasonable rates of loss to follow-up, demonstrating that asthma can be managed effectively in rural, resource-limited settings.

The burden of road traffic injuries in an emergency department in Addis Ababa, Ethiopia.

SETTING: The emergency department (ED) of Zewditu Memorial Hospital, Addis Ababa, Ethiopia. OBJECTIVE: To document the proportion, trend, characteristics and outcomes of road traffic injury (RTI) related ED admissions (⩾15 years) between 2014 and 2015. DESIGN: A retrospective, cross-sectional study using routinely collected ED data. RESULTS: Of 10 007 ED admissions, 779 (8%) were RTI cases; this proportion peaked in the month of January (11%). Medical records were available for 522 (67%) of these RTI cases. The median age was 28 years and 69% were males. The majority were pedestrians (69%) injured by an automobile (78%). On triage, 32% were classified as needing urgent/immediate intervention. Head injuries (20%) were the second most common injury after lower limb injuries (36%). ED outcomes were as follows: discharged (68%), hospitalised (17%), referred (17%) and died (1%). Among the 78 hospitalised cases, respectively 62% and 16% were admitted to the surgical and orthopaedic departments. Of 146 RTI cases with head injuries, 25% were hospitalised, of whom 82% were admitted to the surgical department. CONCLUSION: Our findings can guide policy makers in referral hospitals in improving the planning of hospital resources and the prioritisation of public health needs linked to further urban development. A comprehensive plan to prevent RTIs, particularly among pedestrians in Addis Ababa, is urgently needed.

Contexte : Le service des urgences de l'hôpital Zewditu Memorial, Addis-Abeba, Ethiopie.Objectif : Documenter la proportion, la tendance, les caractéristiques et le devenir des patients (âgés ⩾15 ans) admis pour des blessures de la route (RTI) entre 2014 et 2015.Schéma : Une étude rétrospective transversale basée sur des données recueillies en routine par le service des urgences.Résultats : Sur 10 007 admissions aux urgences, 779 (8%) étaient des cas de RTI; cette proportion culminait au mois de janvier (11%). Les dossiers médicaux ont été disponibles pour 522 (67%) de ces cas de RTI. Leur âge médian était de 28 ans et 69% étaient des hommes. La majorité était des piétons (69%) blessés par une automobile (78%). Lors du triage, 32% ont été classés comme ayant besoin d'une intervention urgente/immédiate. Les traumatismes crâniens (20%) étaient au deuxième rang, suivant les blessures des membres inférieurs (36%). Le devenir des patients a été le suivant : sortie (68%), hospitalisation (17%), référence (17%) et décès (1%). Parmi les 78 cas hospitalisés, respectivement 62% et 16% ont été admis dans les services de chirurgie et d'orthopédie. Sur les 146 cas de RTI ayant eu un traumatisme crânien, 25% ont été hospitalisés, dont 82% ont été admis en service de chirurgie.Conclusion : Nos résultats peuvent guider les décideurs des hôpitaux de référence dans l'amélioration de la répartition des ressources et le choix de priorités en matière de besoins de santé publique liés au développement urbain ultérieur. Il y a un besoin urgent d'un plan complet de prévention des RTI, particulièrement parmi les piétons à Addis-Abeba.

Marco de referencia: El servicio de urgencias del Zewditu Memorial Hospital de Adís Abeba, en Etiopía.Objetivo: Verificar la proporción de los pacientes (⩾15 años de edad) que ingresaron al servicio de urgencias (ED) por traumatismos causados por el tránsito (RTI) y analizar las tendencias, las características y los desenlaces de estos casos del 2014 al 2015.Método: Fue este un estudio transversal realizado a partir de los datos corrientes recogidos retrospectivamente en el ED.Resultados: De los 10 007 ingresos al ED, 779 correspondieron a casos de RTI (8%); esta proporción fue más alta durante el mes de enero (11%). De estos casos, se pudo recuperar la historia clínica de 522 pacientes (67%). La mediana de la edad fue 28 años y el 69% de los pacientes era de sexo masculino. La mayoría de los pacientes eran peatones (69%) y la causa del accidente había sido un automóvil (78%). Tras la clasificación de los pacientes al ingreso, se consideró que el 32% precisaba una intervención urgente o inmediata. El traumatismo craneoencefálico fue la segunda lesión más frecuente (20%) después de las lesiones de los miembros inferiores (36%). Los desenlaces clínicos del ED fueron como sigue: alta (68%), hospitalización (17%), remisión (17%) y muerte (1%). De los 78 pacientes hospitalizados, el 62% ingresó al servicio de cirugía y el 16% al servicio de ortopedia. De los 146 casos de RTI con trauma craneoencefálico, 25% de los pacientes se hospitalizaron, de los cuales el 82% en el servicio de cirugía.Conclusión: Estos resultados pueden orientar a las instancias normativas de los hospitales de referencia a mejorar la planificación de los recursos hospitalarios y a priorizar las necesidades de salud pública en relación con el futuro desarrollo urbano. En Adís Abeba se precisa con urgencia un plan de prevención de los RTI a los peatones.

Dental caries management at a rural district hospital in northern Rwanda: a neglected disease.

SETTING: While some studies have reported the prevalence of dental caries in sub-Saharan Africa, little is known about care-seeking behavior or how dental caries are managed, particularly at rural district hospitals. OBJECTIVE: To describe the management of patients seeking care for dental caries at Butaro District Hospital (BDH) in rural Rwanda. DESIGN: This cross-sectional descriptive study was conducted in BDH, in northern Rwanda. A sample of 287 patient encounters for dental caries between January and December 2013 was randomly selected and stratified by age group (⩽5 years, 6-21 years and >21 years). We estimated the treatment received with 95% confidence intervals in each age group, and differences between age groups were assessed using Fisher's exact test. RESULTS: Nearly all patients (97.6%) underwent tooth extraction, and this did not vary significantly by age group (P = 0.558). In addition to dental caries, most patients also had chronic pulpitis (74.9%). CONCLUSION: Caries prevention and care should be prioritized through a developed community program on oral health. We recommend introducing advanced training, equipment and materials for dental caries management other than tooth extraction, and increasing the number of qualified dentists.

Contexte : Si certaines études rapportent des taux de prévalence des caries dentaires en Afrique sub-saharienne, on sait peu de choses sur le comportement en termes de recherche de soins ni de prise en charge des caries, surtout dans les hôpitaux de district ruraux.Objectif : Décrire la prise en charge des patients sollicitant des soins pour caries dentaires à l'Hôpital de District de Butaro (BDH) en zone rurale du Rwanda.Schéma : Cette étude descriptive transversale a été réalisée au BDH, au nord du Rwanda. Un échantillon de 287 consultations de patients pour caries dentaires entre janvier et décembre 2013 a été sélectionné de façon aléatoire et stratifié sur l'âge (⩽5 ans, 6­21 ans et >21 ans). Nous avons estimé le traitement reçu avec des intervalles de confiance de 95% dans chaque tranche d'âge et les différences entre les groupes d'âge ont été évaluées grâce au test exact de Fisher.Résultats : Presque tous les patients (97,6%) ont eu une extraction de la dent cariée et cela n'a pas varié de façon significative en fonction du groupe d'âge (P = 0,558). En plus des caries, la majorité des patients avait également une pulpite chronique (74,9%).Conclusion : La prévention des caries et les soins conservateurs devraient être une priorité grâce à un programme de santé orale communautaire. Nous recommandons l'introduction d'une formation avancée, d'équipement et de matériels de prise en charge des caries dentaires autres que l'extraction des dents et l'augmentation du nombre de dentistes qualifiés.

Marco de referencia: Algunos estudios han notificado la prevalencia de caries dental en África subsahariana, pero se conoce poco sobre el comportamiento de búsqueda de atención o el tratamiento de la caries dental, sobre todo en los hospitales distritales de las zonas rurales.Objetivo: Describir el tratamiento de los pacientes que buscan atención por caries dental en el Hospital Distrital de Butaro, en una zona rural de Rwanda.Métodos: El presente estudio transversal se llevó a cabo en el Hospital Distrital de Butaro en el norte de Rwanda. Se escogió una muestra aleatoria de 287 citas de pacientes que acudían por caries dental de enero a diciembre del 2013 y se estratificó por grupos de edad (⩽5 años, 6 a 21 años y >21 años). Se evaluaron las proporciones del tipo de tratamiento recibido con un intervalo de confianza del 95% en cada grupo etario y las diferencias entre los grupos se analizaron con una prueba exacta de Fisher.Resultados: En casi todos los pacientes se practicó la extracción (97,6%) y no se observaron diferencias significativas en los grupos de edad (P = 0,558). Además de la caries, la mayoría de pacientes presentaba pulpitis crónica (74,9%).Conclusión: Es preciso priorizar la prevención y el tratamiento de la caries mediante un programa comunitario de salud bucodental. Se recomienda introducir una capacitación avanzada, suministrar equipos y materiales de tratamiento de la caries dental diferente de la extracción y aumentar la cantidad de odontólogos calificados.

Oral toxicity of Miglyol 812(®) in the Göttingen(®) minipig.

Miglyol 812(®), a mixture of medium-chain triglycerides, has been identified as an oral vehicle that could improve the solubility and possibly the bioavailability of orally administered drugs during the non-clinical safety assessment. The toxicity of Miglyol was assessed in Göttingen(®) minipigs upon daily oral administration (gavage) for six weeks, at dosing-volumes of 0.5 and 2 mL/kg/day, compared to controls receiving 0.5% CarboxyMethylCellulose/0.1% Tween(®) 80 in water at 2 mL/kg/day. The control vehicle did not induce any findings. Miglyol at 0.5 and 2 mL/kg/day induced transient tremors, abnormal color of feces and increase in triglycerides. Miglyol at 2 ml/kg/day also induced reduced motor activity, decreased food intake, respiratory signs (2/6 animals) and increased total and LDL-cholesterol. At necropsy, the lung of 3/6 animals treated at 2 mL/kg/day presented abnormal color and/or irregular surface correlated with a chronic bronchiolo-alveolar inflammation. This finding is probably due to aspiration pneumonia in relation to the administration method and the high viscosity of Miglyol. Overall, the oral administration of pure Miglyol 812(®) for six weeks up to 2 mL/kg was less tolerated than that of the control vehicle. Miglyol as vehicle for sub-chronic oral toxicity studies in minipigs should be used with a limited dosing-volume.

HIV testing and retention in care of infants born to HIV- infected women enrolled in 'Option B+', Thyolo, Malawi.

Prevention of mother-to-child transmission 'Option B+' originated in Malawi in 2011 to prevent new infections in infants exposed to the human immunodeficiency virus (HIV). We assessed 12-month programme retention and HIV testing uptake among infants born to HIV-infected mothers from September 2011 to June 2012 in Thyolo District Hospital. Of 513 infants, 368 (71.7%) remained in care at 12 months. Altogether, 412 (80.3%) underwent HIV DNA polymerase chain reaction testing, with 267 (52.0%) tested at 6-12 weeks, and 255 (49.7%) underwent rapid HIV testing, with 144 (28.1%) tested at 12 months. Eighty-eight (17.2%) infants had both tests as scheduled. Measures are needed to improve adherence to national testing protocols.

L'option B+ de la prévention de la transmission mère-enfant a débuté au Malawi en 2011 afin de prévenir de nouvelles infections chez les enfants exposés au virus de l'immunodéficience humaine (VIH). Nous avons évalué un programme de 12 mois de rétention et de réalisation du test VIH parmi les bébés nés de mères VIH-positives de septembre 2011 à juin 2012 à l'hôpital de district de Thyolo. Sur 513 nourrissons, 368 (71,7%) sont restés en soins pendant 12 mois. Au total, 412 bébés (80,3%) ont bénéficié d'une recherche de VIH par ADN-PCR ; 267 (52%) ont été testés entre 6 et 12 semaines et 255 (49,7%) ont eu un test rapide, dont 144 (28,1%) testés à 12 mois. Quatre-vingt-huit bébés (17,2%) ont eu deux tests comme prévu. Il est nécessaire d'améliorer l'adhésion aux protocoles nationaux de dépistage.

En el 2011 se puso en marcha en Malawi la estrategia Opción B+ de prevención de la transmisión maternoinfantil, con el fin de evitar nuevas infecciones por el virus de la inmunodeficiencia humana (VIH) en los lactantes expuestos. Se evaluó durante un período de 12 meses, entre septiembre del 2011 y junio del 2012, la fidelización al programa y la práctica de la prueba diagnóstica del VIH a los lactantes de madres infectadas por el VIH en el Hospital Distrital de Thyolo. De los 513 lactantes expuestos atendidos durante el período del estudio, 368 continuaban en el programa a los 12 meses (71,7%). En total, se practicó la prueba del VIH mediante la reacción en cadena de la polimerasa (PCR-ADN) a 412 lactantes (80,3%); en 267 niños la prueba se realizó entre las 6 y las 12 semanas de edad (52,0 %). La prueba serológica rápida del VIH se practicó en 255 lactantes (49,7%) y en 144 de estos casos a los 12 meses (28,1%). Ochenta y ocho niños recibieron ambas pruebas, en conformidad con las pautas del programa. Es preciso adoptar medidas encaminadas a mejorar el cumplimiento de los protocolos nacionales en materia de pruebas diagnósticas del VIH.

Caring for patients with surgically resectable cancers: experience from a specialised centre in rural Rwanda.

SETTING: Butaro Cancer Centre of Excellence (BCCOE), Burera District, Rwanda. OBJECTIVES: To describe characteristics, management and 6-month outcome of adult patients presenting with potentially surgically resectable cancers. DESIGN: Retrospective cohort study of patients presenting between 1 July and 31 December 2012. RESULTS: Of 278 patients, 76.6% were female, 51.4% were aged 50-74 years and 75% were referred from other district or tertiary hospitals in Rwanda. For the 250 patients with treatment details, 115 (46%) underwent surgery, with or without chemotherapy/radiotherapy. Median time from admission to surgery was 21 days (IQR 2-91). Breast cancer was the most common type of cancer treated at BCCOE, while other forms of cancer (cervical, colorectal and head and neck) were mainly operated on in tertiary facilities. Ninety-nine patients had no treatment; 52% of these were referred out within 6 months, primarily for palliative care. At 6 months, 6.8% had died or were lost to follow-up. CONCLUSION: Surgical care was provided for many cancer patients referred to BCCOE. However, challenges such as inadequate surgical infrastructure and skills, and patients presenting late with advanced and unresectable disease can limit the ability to manage all cases. This study highlights opportunities and challenges in cancer care relevant to other hospitals in rural settings.

Contexte : Centre anticancéreux d'excellence de Butaro (BCCOE), District de Butera, Rwanda.Objectifs : Décrire les caractéristiques, la prise en charge et les résultats à 6 mois de patients adultes se présentant avec des cancers potentiellement extirpables par chirurgie.Schema : Etude rétrospective de cohorte des patients admis entre le 1er juillet et le 31 décembre 2012.Resultats : Sur 278 patients, 76,6% étaient des femmes, 51,4% étaient âgés entre 50 et 74 ans et 75% étaient référés d'un autre district ou d'un hôpital tertiaire du Rwanda. Parmi les 250 patients dont les traitements étaient connus, 115 (46%) ont bénéficié d'une intervention chirurgicale avec ou sans chimiothérapie/radiothérapie. Le temps médian écoulé entre l'admission et la chirurgie était de 21 jours (IQR 2 à 91). Le cancer du sein était le plus fréquent des cancers traités au BCCOE, tandis que les autres cancers (col utérin, colorectal et tumeur cérébrale ou cervicale) étaient généralement opérés dans des hôpitaux tertiaires. Quatre-vingt-dix-neuf patients n'ont eu aucun traitement ; 52% ont été référés à l'extérieur dans les 6 mois, généralement pour un traitement palliatif. A 6 mois, 6,8% étaient décédés ou perdus de vue.Conclusion : De nombreux patients référés au BCCOE pour cancer ont bénéficié d'une intervention chirurgicale. Cependant la prise en charge de tous les cas est confrontée à la limite de capacité chirurgicale et au problème des patients admis tardivement avec un cancer avancé et non extirpable. Cette étude met en lumière les opportunités et les défis de la prise en charge des cancers pour les hôpitaux situés en zone rurale.

Marco de Referencia: El Centro Butaro de Excelencia en Cáncer (BCCOE) del distrito de Burera, en Ruanda.Objetivos: Describir las características, el manejo y el desenlace clínico a los 6 meses de pacientes adultos que se presentaron con cánceres cuyo tratamiento quirúrgico podía ser viable.Métodos: Fue este un estudio retrospectivo de cohortes de los pacientes que acudieron al centro entre el 1° de julio y el 31 de diciembre del 2012.Resultados: Se incluyeron en el estudio 278 pacientes, de los cuales 76,6% eran de sexo femenino, 51,4% tenían entre 50 y 74 años de edad y 75% habían sido remitidos de otro hospital distrital o de centros de atención terciaria de Ruanda. De los 250 expedientes que contaban con detalles sobre el tratamiento, en 115 casos (46%) los pacientes recibieron tratamiento quirúrgico con o sin quimioterapia o radioterapia. La mediana del lapso entre la hospitalización y la cirugía fue 21 días (intervalo intercuartil de 2 a 91). El cáncer de mama fue el tipo más frecuente de cáncer que se trató en el BCCOE y la cirugía de otras formas de cáncer (cuello uterino, colorrectal y de cara y cuello) se realizó principalmente en centros de atención terciaria. Noventa y nueve pacientes no recibieron tratamiento; el 52% de estos se remitió a otras instituciones en los primeros 6 meses, esencialmente con el propósito de recibir tratamiento paliativo. A los 6 meses, el 6,8% de los pacientes había fallecido o se habían perdido durante el seguimiento.Conclusión: Muchos de los pacientes remitidos recibieron tratamiento quirúrgico en el BCCOE. Sin embargo, la posibilidad de tratar todos los casos se ve limitada por obstáculos como una capacidad quirúrgica inadecuada y el hecho de que los pacientes acuden tarde, en una fase avanzada de la enfermedad, con un cáncer inoperable. El presente estudio pone de relieve oportunidades y dificultades en el tratamiento del cáncer que son pertinentes para otros centros hospitalarios en un entorno rural.

Fostering interest in research: evaluation of an introductory research seminar at hospitals in rural Rwanda.

SETTINGS: Partners In Health Rwanda, in collaboration with the Ministry of Health, leads a multipronged approach to develop research capacity among health workers, particularly in rural areas. OBJECTIVES: To describe the characteristics of participants and to assess the impact of an introductory research seminar series in three district hospitals in rural Rwanda. DESIGN: This was a retrospective cohort study of seminar participants. Data were sourced from personnel records, assessment sheets and feedback forms. RESULTS: A total of 126 participants, including 70 (56%) clinical and 56 (44%) non-clinical staff, attended the research seminar series; 61 (48%) received certification. Among those certified, the median assessment score on assignments was 79%. Participants read significantly more articles at 6 and 12 months (median 2 and 4 respectively, compared to 1 at baseline, P < 0.01). There was also a significant increase (P ⩽ 0.05) in self-reported involvement in research studies (28%, baseline; 59%, 12 months) and attendance at other research training (36%, baseline; 65%, 12 months). CONCLUSION: The introductory research seminar series provided an important opportunity for engagement in research among clinical and non-clinical staff. Such an activity is a key component of a comprehensive research capacity building programme at rural sites, and serves as an entry point for more advanced research training.

Contexte : Partners In Health Rwanda, en collaboration avec le Ministère de la Santé, mène une approche multiple afin de développer les capacités de recherche du personnel de santé, surtout dans les zones rurales.Objectifs : Décrire les caractéristiques des participants et évaluer l'impact d'une série de séminaires d'introduction à la recherche dans trois hôpitaux de district ruraux du Rwanda.Schéma : Etude rétrospective de cohorte des participants au séminaire. Les données ont été recueillies à partir de dossiers personnels, de formulaires d'évaluation et de rétroaction.Résultats : Des 126 participants qui ont assisté à la série de séminaires de recherche, 70 (56%) étaient cliniciens et 56 (44%) personnel non-clinicien. Soixante et un (48%) ont obtenu leur certificat. Parmi ces derniers, le score médian d'évaluation des travaux était de 79%. Les participants lisaient beaucoup plus d'articles à 6 et 12 mois (médiane = 2 et 4 respectivement, comparé à 1 au départ, P < 0,01). On notait également une augmentation significative (P ⩽ 0,05) de l'implication dans des travaux de recherche rapportée par les intéressés eux-mêmes (28% au départ contre 59% à 12 mois) ainsi que de la participation à d'autres formations relatives à la recherche (36% au départ contre 65% à 12 mois).Conclusion : La série de séminaires d'introduction à la recherche a fourni une opportunité majeure d'engagement dans la recherche du personnel clinicien et non clinicien. Une telle activité est un élément clé d'un programme complet de renforcement des capacités de recherche dans les zones rurales et sert de point d'entrée pour des formations à la recherche plus avancées.

Marco de referencia: La organización Partners In Health de Rwanda, en colaboración con el Ministerio de Salud, dirige un proyecto multidimensional de creación de capacidad de investigación, dirigida a los profesionales que se ocupan de la salud, especialmente en las zonas rurales.Objetivos: Describir las características de los participantes y evaluar el efecto de la realización de una serie de seminarios introductorios a la investigación, en tres hospitales distritales de zonas rurales en Rwanda.Método: Fue este un estudio retrospectivo de cohortes de los participantes a los seminarios. Se obtuvieron datos a partir de los registros personales, las hojas de evaluación y los formularios de retroalimentación.Resultados: Participaron a la serie de seminarios 126 personas, de las cuales 70 pertenecían al personal asistencial (56%) y 56 a personal de otras esferas (44%). Sesenta y un participantes recibieron la certificación (48%). De las personas certificadas, la mediana de puntuación de la evaluación fue 79%. Los participantes leyeron más artículos a los seis y a los doce meses de la intervención (mediana = 1 y 4 respectivamente; P < 0,01) que al comienzo de la misma (mediana = 1; P ⩽ 0,05). Se observó además un aumento significativo de la intervención autorreferida en estudios de investigación (28% al comienzo y 59% a los 12 meses) y de la participación en otras capacitaciones científicas (36% al comienzo y 65% a los 12 meses).Conclusión: La serie de seminarios introductorios a la investigación ofreció al personal asistencial y a otros miembros del personal una importante oportunidad de participar en las actividades científicas. Este tipo de intervención constituye un componente primordial del programa integral de creación de capacidad de investigación en los centros rurales y representa una puerta de entrada a las capacitaciones científicas más avanzadas.

Childhood immunisation in Bungoma County, Kenya, from 2008 to 2011: need for improved uptake.

Uptake of immunisations in children aged 1-2 years in Bungoma County, Kenya, was determined as part of the 6-monthly Health and Demographic Surveillance System surveys. A total of 2699 children were assessed between 2008 and 2011. During this time period, full immunisation declined significantly from 84% to 58%, and measles vaccine declined uptake from 89% to 60% (P < 0.001). Each year there was a significant fall-off for the third doses of the oral polio and pentavalent vaccines (P < 0.001). These findings are of concern, as low immunisation coverage may lead to vaccine-preventable disease outbreaks. Further investigations into the reasons for declining immunisation trends are required.

La couverture vaccinale des enfants de âgés de 1 à 2 ans dans la conté de Bungoma au Kenya a été déterminée dans le cadre d'un enquête du Système de surveillance sanitaire et démographique. Au total 2699 enfants ont été évalués de 2008 à 2011. Au cours de cette période, le taux de vaccination complète a diminué de façon significative, de 84% à 58%, et celui de la vaccination contre la rougeole de 89% à 60% (P < 0,001). Chaque année, on a constaté une chute de l'administration de la 3e dose du vaccin polio oral et du vaccin pentavalent (P < 0,001). Ces résultats sont préoccupants car cette faible couverture vaccinale pourrait conduire à des épidémies de maladies évitables. Il est nécessaire de faire d'autres investigations à la recherche des causes de ce déclin de la vaccination.

La vacunación de los niños de 1 a 2 años de edad en el condado de Bungoma, en Kenia, se investigó como parte de las encuestas semestrales del Sistema de Vigilancia Sanitaria y Demográfica. Se evaluaron 2699 niños del 2008 al 2011. Durante este período se observó una disminución considerable de la administración de un esquema completo de vacunación, de 84% a 58%, y la aplicación de la vacuna antisarampionosa disminuyó de 89% a 60% (P < 0,001). En cada año, se redujo de manera notable la administración de la tercera dosis de la vacuna antipoliomielítica oral y la vacuna pentavalente (P < 0,001). Estas observaciones son fuente de preocupación, pues una baja cobertura de vacunación puede dar origen a brotes epidémicos de enfermedades prevenibles. Se justifica la realización de nuevas investigaciones que aclaren las razones de esta tendencia decreciente de las vacunaciones.

Field veterinary survey on clinical and economic impact of Schmallenberg virus in Belgium.

We implemented a questionnaire-based methodology targeting veterinary field practitioners to evaluate clinical and economic impact of Schmallenberg virus in Belgium. First suspicious cases were detected as soon as July 2011. The mean cost for individual symptomatic treatment was 65 or 107 Euros, in case of fatal outcome or apparent recovery, respectively.

Early assessment of glucose abnormalities during continuous glucose monitoring associated with lung function impairment in cystic fibrosis patients.

BACKGROUND: Cystic fibrosis-related diabetes (CFRD) is correlated with a decline in lung function. Under certain circumstances, oral glucose tolerance test (OGTT) screening, used to diagnose CFRD, fails to reveal early glucose tolerance abnormalities. In this situation, continuous glucose monitoring (CGM) could be a useful tool for evaluating early abnormalities of glucose tolerance in CF patients. We aimed to study the CGM glucose profile in CF patients with normal OGTT screening results and to evaluate lung function and nutritional status according to the CGM glucose profile. METHODS: We assessed glycemic control, the CGM glucose profile, nutritional status, lung function antibiotic courses and colonization (P. aeruginosa and S. aureus) in CF patients, aged 10 years and over, with normal screening OGTT results (blood glucose at T120 min < 7.8 mmol/l). Two groups were identified according to the max CGM glucose value: Group 1<11 mmol/l and Group 2 ≥ 11 mmol/l. RESULTS: Among the 38 patients with normal OGTT, 12 (31.6%) were in Group 2. Compared to Group 1, Group 2 patients exhibited a significant impairment in lung function: FEV1, 68.2 ± 25.6% vs. 87.3 ± 17%, p = 0.01 and FVC, 86.1% ± 19.4% vs. 99.3% ± 13.4%, p=0.021, as well as a higher rate of colonization by P. aeruginosa: 83.3% vs. 44%, p=0.024. Nevertheless, there were no differences in nutritional status (BMI standard deviation score: p = 0.079; prealbumin: p = 0.364). CONCLUSIONS: CGM reveals early abnormalities of glucose tolerance that remain undiagnosed by OGTT screening and are associated with worse lung function and a higher prevalence of P. aeruginosa colonization in patients with CF. CLINICAL TRIAL REGISTRATION NUMBER: NCT00476281.

Assessing and improving data quality from community health workers: a successful intervention in Neno, Malawi.

SETTING: A community health worker (CHW) program was established in Neno District, Malawi, in 2007 by Partners In Health in support of Ministry of Health activities. Routinely generated CHW data provide critical information for program monitoring and evaluation. Informal assessments of the CHW reports indicated poor quality, limiting the usefulness of the data. OBJECTIVES: 1) To establish the quality of aggregated measures contained in CHW reports; 2) to develop interventions to address poor data quality; and 3) to evaluate changes in data quality following the intervention. DESIGN: We developed a lot quality assurance sampling-based data quality assessment tool to identify sites with high or low reporting quality. Following the first assessment, we identified challenges and best practices and followed the interventions with two subsequent assessments. RESULTS: At baseline, four of five areas were classified as low data quality. After 8 months, all five areas had achieved high data quality, and the reports generated from our electronic database became consistent and plausible. CONCLUSION: Program changes included improving the usability of the reporting forms, shifting aggregation responsibility to designated assistants and providing aggregation support tools. Local quality assessments and targeted interventions resulted in immediate improvements in data quality.