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1.
Australas Psychiatry ; : 1039856219889304, 2020 Jan 22.
Artículo en Inglés | MEDLINE | ID: mdl-31968993
2.
Lancet Infect Dis ; 2020 Jan 13.
Artículo en Inglés | MEDLINE | ID: mdl-31948767

RESUMEN

BACKGROUND: Ivermectin is a potential new vector control tool to reduce malaria transmission. Mosquitoes feeding on a bloodmeal containing ivermectin have a reduced lifespan, meaning they are less likely to live long enough to complete sporogony and become infectious. We aimed to estimate the effect of ivermectin on malaria transmission in various scenarios of use. METHODS: We validated an existing population-level mathematical model of the effect of ivermectin mass drug administration (MDA) on the mosquito population and malaria transmission against two datasets: clinical data from a cluster- randomised trial done in Burkina Faso in 2015 wherein ivermectin was given to individuals taller than 90 cm and entomological data from a study of mosquito outcomes after ivermectin MDA for onchocerciasis or lymphatic filariasis in Burkina Faso, Senegal, and Liberia between 2008 and 2013. We extended the existing model to include a range of complementary malaria interventions (seasonal malaria chemoprevention and MDA with dihydroartemisinin-piperaquine) and to incorporate new data on higher doses of ivermectin with a longer mosquitocidal effect. We consider two ivermectin regimens: a single dose of 400 µg/kg (1 × 400 µg/kg) and three consecutive daily doses of 300 µg/kg per day (3 × 300 µg/kg). We simulated the effect of these two doses in a range of usage scenarios in different transmission settings (highly seasonal, seasonal, and perennial). We report percentage reductions in clinical incidence and slide prevalence. FINDINGS: We estimate that MDA with ivermectin will reduce prevalence and incidence and is most effective in areas with highly seasonal transmission. In a highly seasonal moderate transmission setting, three rounds of ivermectin only MDA at 3 × 300 µg/kg (rounds spaced 1 month apart) and 70% coverage is predicted to reduce clinical incidence by 71% and prevalence by 34%. We predict that adding ivermectin MDA to seasonal malaria chemoprevention in this setting would reduce clinical incidence by an additional 77% in children younger than 5 years compared with seasonal malaria chemoprevention alone; adding ivermectin MDA to MDA with dihydroartemisinin-piperaquine in this setting would reduce incidence by an additional 75% and prevalence by an additional 64% (all ages) compared with MDA with dihydroartemisinin-piperaquine alone. INTERPRETATION: Our modelling predictions suggest that ivermectin could be a valuable addition to the malaria control toolbox, both in areas with persistently high transmission where existing interventions are insufficient and in areas approaching elimination to prevent resurgence. FUNDING: Imperial College Junior Research Fellowship.

3.
Clin Nephrol ; 93(2): 106-110, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31813414

RESUMEN

Renal manifestations of syphilis are variable, with membranous nephropathy being the most commonly described lesion. Rapidly progressive glomerulonephritis (RPGN) is rare and there is only one case report in the literature describing syphilis-associated crescentic glomerulonephritis. We report a rare case of RPGN secondary to latent syphilis, which resolved with penicillin treatment in the absence of immunosuppressive therapy. A 28-year-old Black male with a history of HIV was evaluated for severe acute kidney injury, nephrotic-range proteinuria, and active urine sediment. Serologies for glomerulonephritis were negative. Rapid plasma reagin and treponema pallidum particle agglutination assay were reactive, confirming syphilis diagnosis. Kidney biopsy revealed focal and segmental necrotizing and crescentic lesion. Patient received weekly benzathine penicillin (PCN) for 3 weeks, and renal function improved to baseline. This dramatic improvement happened with PCN alone, a finding which has not been previously reported. We recommend that syphilis be considered in the differential diagnosis of all patients with proteinuria or suspected glomerulonephritis.

4.
Ann Vasc Surg ; 2019 Oct 31.
Artículo en Inglés | MEDLINE | ID: mdl-31678546

RESUMEN

BACKGROUND: The treatment of venous thoracic outlet syndrome (VTOS) requires surgical decompression often combined with catheter-directed thrombolysis and venoplasty. Surgical options include transaxillary, supraclavicular, or infraclavicular approaches to first rib resection. The optimal method, however, has yet to be defined. The purpose of this study is to compare the outcomes of patients who underwent infraclavicular versus supraclavicular surgical decompression for VTOS. METHODS: A retrospective review of patients who underwent surgical management for VTOS from December 2010 to November 2017 was performed. During the study period, supraclavicular and infraclavicular approaches were chosen according to surgeon preference. Patient demographics, pre- and postdecompression interventions, perioperative outcomes for each group of patients were analyzed. RESULTS: Thirty patients underwent surgical management of VTOS, of which 15 (50%) underwent infraclavicular decompression and 15 (50%) supraclavicular decompression. The mean age of patients was 32.1 ± 13.6 years and 80% were male. Twenty-six patients (86.7%) presented with thrombotic VTOS. Acute axillosubclavian vein thrombosis was present in 20 (76.9%) of these patients, 10 patients in each group. Subacute or chronic thrombosis was encountered in the remaining 6 (23%) patients, 2 patients in the infraclavicular group and 4 patients in the supraclavicular group. Preoperative thrombolysis was utilized in 7 (46.7%) and 6 (40%) patients in the infraclavicular and supraclavicular groups, respectively (P = 1.00). Patients without postdecompression venography were removed from analysis and included 1 patient in the infraclavicular group and 5 patients in the supraclavicular group. Initial postdecompression venogram, prior to any endovascular intervention, demonstrated a residual axillosubclavian vein stenosis of greater than 50% in 6 (42.9%) patients in the infraclavicular decompression group and 7 (70%) patients in the supraclavicular decompression group (P = 0.24). Crossing the stenosis after surgical decompression was more easily accomplished in the infraclavicular group, 14 (100%) versus 5 (50%), (P = 0.01). Following endovascular venoplasty, calculated residual stenosis greater than 50% was found in 0 (0%) and 3 (30%) patients in the infraclavicular and supraclavicular approaches, respectively (P = 0.047). Infraclavicular thoracic outlet decompression was associated with fewer patients with postoperative symptoms, 0 of 15 (0%) versus 8 of 15 (53.3%), (P = 0.0022), and infraclavicular thoracic outlet decompression demonstrated improved patency, 15 of 15 (100%) versus 8 of 15 (53.3%), (P = 0.028) at a mean combined follow-up of 8.47 ± 10.8 months. CONCLUSIONS: Infraclavicular thoracic outlet decompression for the surgical management of VTOS was associated with fewer postoperative symptoms and improved axillosubclavian vein patency compared to the supraclavicular approach. Prospective analysis is warranted to determine long-term outcomes following infraclavicular decompression.

5.
Lancet Glob Health ; 7(12): e1695-e1705, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31708150

RESUMEN

BACKGROUND: More timely estimates of malaria prevalence are needed to inform optimal control strategies and measure progress. Since 2014, Tanzania has implemented nationwide malaria screening for all pregnant women within the antenatal care system. We aimed to compare malaria test results during antenatal care to two population-based prevalence surveys in Tanzanian children aged 6-59 months to examine their potential in measuring malaria trends and progress towards elimination. METHODS: Malaria test results from pregnant women screened at their first antenatal care visits at health-care facilities (private and public) in all 184 districts of Tanzania between Jan 1, 2014, and Dec 31, 2017, were collected from the Health Management Information Systems and District Health Information System 2. We excluded facilities with no recorded antenatal care attendees during the time period. We standardised results to account for testing uptake and weighted them by the timing of two population-based surveys of childhood malaria prevalence done in 2015-16 (Demographic and Health Survey) and 2017 (Malaria Indicator Survey). We assessed regional-level correlation using Spearman's coefficient and assessed the consistency of monthly district-level prevalence ranking using Kendall's correlation coefficient. FINDINGS: Correlation between malaria prevalence at antenatal care and among children younger than 5 years was high (r≥0·83 for both surveys), although declines in prevalence at antenatal care were generally smaller than among children. Consistent heterogeneity (p<0·05) in antenatal care prevalence at the district level was evident in all but one region (Kilimanjaro). Data from antenatal care showed declining prevalence in three regions (Arusha, Kilimanjaro, and Manyara) where surveys estimated zero prevalence. INTERPRETATION: Routine antenatal care-based screening can be used to assess heterogeneity in transmission at finer resolution than population-based surveys, and provides sample sizes powered to detect changes, notably in areas of low transmission where surveys lack power. Declines in prevalence at antenatal care might lag behind those among children, highlighting the value of monitoring burden and continuing prevention efforts among pregnant women as transmission declines. The pregnancy-specific benefits and cost-effectiveness of antenatal care-based screening remain to be assessed. FUNDING: None.

6.
Kidney Int ; 96(6): 1400-1407, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31668630

RESUMEN

Intravascular hemolysis is relatively rare but can lead to acute kidney injury (AKI), from increased destruction of erythrocytes and release of free hemoglobin. Since hemolysis and hemoglobinuria are known causes of acute kidney injury we sought to define clinicopathologic findings and outcomes of patients with hemolysis-associated hemoglobin cast nephropathy through a retrospective analysis of 27 cases. The mean patient age was 47 years (range 19-79) and the female-to-male ratio was 1.3:1. All patients presented with AKI with a mean serum creatinine of 8.0 (range 2.9-17.0) mg/dL. Etiologies included autoimmune hemolytic anemia (30%), medication (26%), paroxysmal nocturnal hemoglobinuria (7%), procedural/mechanical causes (7%), transfusion of incompatible blood (4%), toxin ingestion (4%), disseminated intravascular coagulation (4%), and hemoglobinopathy (4%). All biopsies showed acute tubular injury and pigmented, proteinaceous casts characterized by positive hemoglobin immunohistochemistry. After a mean follow-up of nine months (range 0.5-26), the mean serum creatinine was 1.3 (range 0.6-3.3) mg/dL, with 78% of patients returning to normal kidney function. Thus, based on our clinicopathologic case series, hemolysis-associated hemoglobin cast nephropathy is an important entity for clinicians and pathologists to recognize as treatment hinges upon elimination of the pathogenic driver of intravascular hemolysis.

7.
Clin Kidney J ; 12(4): 476-482, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31384437

RESUMEN

Background: We present the largest clinicopathologic case series to date of dense deposit disease (DDD) in an Indian population and compare the renal biopsy incidence rate to that seen in a large renal laboratory in USA. Methods: Cases of DDD were identified and evaluated from native kidney biopsies reported at Renopath, India and at Arkana Laboratories, in the USA. Renopath receives biopsies from four states, located in the South and Eastern part of India. Arkana Laboratories' biopsies came from 37 states across the USA. Results: During the study period, there were a total of 25 patients diagnosed with DDD among the 7335 native kidney biopsies at Renopath. Thus, the biopsy incidence rate (cases of DDD/total renal biopsies/year) is 0.0034. By comparison, there were 10 cases of DDD diagnosed among 26 319 native kidney biopsies at Arkana Laboratories during the same time period, with a renal biopsy incidence rate of 0.00038. Conclusions: DDD in this Indian subpopulation has similar clinical and pathologic characteristics when compared to previously reported studies. However, the biopsy incidence rate is about 890% or 8.9 times more common in this subset of the Indian population when compared with a broad cross-section of the US population. In addition to potential genetic factors, environmental conditions and chronic infections likely contribute to the markedly higher biopsy incidence rate. Given the much greater number of patients with DDD in this population, further retrospective and prospective studies would allow more rapid progress in understanding the pathogenesis of DDD and thus potential treatment of patients with DDD.

8.
Trends Parasitol ; 35(9): 677-686, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31395496

RESUMEN

Women attending antenatal care (ANC) are a generally healthy, easy-access population, contributing valuable data for infectious disease surveillance at the community level. ANC-based malaria surveillance would provide a routine measure of the malaria burden in pregnancy, which countries lack, whilst potentially improving pregnancy outcomes. It could also offer contemporary information on temporal trends and the geographic distribution of malaria burden as well as intervention coverage in the population to guide resource allocation and to assess progress towards elimination. Here, we review the factors underlying the relationship between Plasmodium falciparum in pregnancy and in the community, and outline strengths and limitations of an ANC-based surveillance in sub-Saharan Africa, its potential role within wider malaria surveillance systems, and subsequent programmatic applications.

9.
Artículo en Inglés | MEDLINE | ID: mdl-31462405

RESUMEN

OBJECTIVE: To evaluate the effectiveness of intermittent pulse oximetry in guiding oxygen therapy in neonates in a low-resource setting. DESIGN AND SETTING: Prospective validation study at three hospitals in southwest Nigeria. We performed concealed continuous pulse oximetry on participants to evaluate intermittent SpO2 monitoring. PATIENTS: We recruited all preterm or low birthweight neonates, and all term neonates who required oxygen therapy, who were admitted to the neonatal ward(s) of the study hospitals during the study period. MAIN OUTCOME MEASURES: Proportion of time preterm/low birthweight neonates on oxygen spent within, above and below the target SpO2 range of 90%-95%; and the proportion of time term neonates and neonates not on oxygen spent within and below the target range of 90%-100%. RESULTS: Preterm/low birthweight neonates receiving oxygen therapy (group A) spent 15.7% (95% CI 13.3 to 18.9) of time in the target SpO2 range of 90%-95%. They spent 75.0% (63.6-81.1) of time above 95%, and 2.7% (1.7-5.6) of time below 85%. Term neonates and all neonates not receiving oxygen (group B) spent 97.3% (95% CI 96.4 to 98.6) of time within the target range of 90%-100%, and 0.9% (0.3-1.4) of time below 85%. Guidelines recommended SpO2 monitoring 3 times per day for all patients, however neonates in groups A and B were monitored an average of 4.7 and 5.3 times per day, respectively. CONCLUSIONS: To better maintain SpO2 within the target range, preterm/low birthweight neonates on oxygen should have their SpO2 monitored more frequently than the current 4.7 times per day. In all other neonates, however, monitoring SpO2 5.3 times per day appears suitable.

10.
J Clin Invest ; 129(6): 2251-2265, 2019 04 29.
Artículo en Inglés | MEDLINE | ID: mdl-31033479

RESUMEN

Systemic lupus erythematosus (SLE) is a complex autoimmune disease with genetic and environmental contributions. Hallmarks of the disease are the appearance of immune complexes (IC) containing autoreactive Abs and TLR-activating nucleic acids, whose deposition in kidney glomeruli is suspected to promote tissue injury and glomerulonephritis (GN). Here, using a mouse model based on the human SLE susceptibility locus TNFAIP3-interacting protein 1 (TNIP1, also known as ABIN1), we investigated the pathogenesis of GN. We found that GN was driven by TLRs but, remarkably, proceeded independently of ICs. Rather, disease in 3 different mouse models and patients with SLE was characterized by glomerular accumulation of patrolling monocytes (PMos), a cell type with an emerging key function in vascular inflammation. Consistent with such function in GN, monocyte-specific deletion of ABIN1 promoted kidney disease, whereas selective elimination of PMos provided protection. In contrast to GN, PMo elimination did not protect from reduced survival or disease symptoms such as IC generation and splenomegaly, suggesting that GN and other inflammatory processes are governed by distinct pathogenic mechanisms. These data identify TLR-activated PMos as the principal component of an intravascular process that contributes to glomerular inflammation and kidney injury.

11.
Malar J ; 18(1): 122, 2019 Apr 08.
Artículo en Inglés | MEDLINE | ID: mdl-30961603

RESUMEN

BACKGROUND: A core set of intervention and treatment options are recommended by the World Health Organization for use against falciparum malaria. These are treatment, long-lasting insecticide-treated bed nets, indoor residual spraying, and chemoprevention options. Both domestic and foreign aid funding for these tools is limited. When faced with budget restrictions, the introduction and scale-up of intervention and treatment options must be prioritized. METHODS: Estimates of the cost and impact of different interventions were combined with a mathematical model of malaria transmission to estimate the most cost-effective prioritization of interventions. The incremental cost effectiveness ratio was used to select between scaling coverage of current interventions or the introduction of an additional intervention tool. RESULTS: Prevention, in the form of vector control, is highly cost effective and scale-up is prioritized in all scenarios. Prevention reduces malaria burden and therefore allows treatment to be implemented in a more cost-effective manner by reducing the strain on the health system. The chemoprevention measures (seasonal malaria chemoprevention and intermittent preventive treatment in infants) are additional tools that, provided sufficient funding, are implemented alongside treatment scale-up. Future tools, such as RTS,S vaccine, have impact in areas of higher transmission but were introduced later than core interventions. CONCLUSIONS: In a programme that is budget restricted, it is essential that investment in available tools be effectively prioritized to maximize impact for a given investment. The cornerstones of malaria control: vector control and treatment, remain vital, but questions of when to scale and when to introduce other interventions must be rigorously assessed. This quantitative analysis considers the scale-up or core interventions to inform decision making in this area.


Asunto(s)
Control de Enfermedades Transmisibles/economía , Análisis Costo-Beneficio , Erradicación de la Enfermedad/economía , Malaria Falciparum/prevención & control , Control de Enfermedades Transmisibles/métodos , Erradicación de la Enfermedad/métodos , Humanos , Modelos Teóricos
12.
J Surg Res ; 235: 34-43, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-30691815

RESUMEN

BACKGROUND: Colorectal cancer is a common and potentially deadly diagnosis. Surgery is the treatment of choice. Data of outcomes beyond 10 y are sparse. This study attempts to identify factors influencing long-term survival. METHODS: This cohort study examines a prospectively collected database of patients undergoing colorectal resections from January 1996 to May 2006. Variables were analyzed by plotting Kaplan-Meier survival curves and Cox regression analysis to identify independent predictors of survival. RESULTS: Six hundred fifty-seven patients were included in this analysis. Three hundred sixty underwent resection for rectal cancer. Median follow-up time was 11.7 y (interquartile range 2.8-15.4). Metachronous cancers occurred following 5.4% (confidence intervals [CI] 3.4-8.4) of resections for colorectal malignancy at 15 y. Mean age at death was higher in patients with higher Australian clinicopathological score (A: 82.4, B: 78.9, C: 75.5, D: 68.9). Multivariable analysis revealed age at diagnosis (hazard ratio [HR] 1.02, CI 1.01-1.03), Australian clinicopathological score (B: HR 1.47, CI 1.08-2.01; C: 2.11, CI 1.51-2.93; D: HR 11.12, CI 8.12-15.13), American Society of Anesthesiology score (ASA2: HR 1.66, CI 1.03-2.67; ASA3: HR 2.00, CI 1.20-3.34; ASA4: HR 3.39, CI 1.95-6.25), and operating for locoregional recurrence (HR 1.82, CI 1.21-2.76) to be associated with increased mortality. Adjuvant chemotherapy was associated with improved survival (HR 0.64, CI 0.49-0.84). CONCLUSIONS: Age at diagnosis, American Society of Anesthesiology score, and stage of disease were the principal predictors of long-term survival. Adjuvant chemotherapy was found to improve survival. Metachronous cancers occurred in a minority of patients.


Asunto(s)
Neoplasias Colorrectales/mortalidad , Neoplasias Colorrectales/cirugía , Anciano , Quimioterapia Adyuvante , Neoplasias Colorrectales/tratamiento farmacológico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/mortalidad , Neoplasias Primarias Secundarias/mortalidad , Modelos de Riesgos Proporcionales , Estudios Prospectivos
13.
Nagoya J Med Sci ; 80(4): 465-473, 2018 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-30587861

RESUMEN

To minimise the global burden of diabetes, the awareness of appropriate intervention methods for diabetes education and practice is essential. This project is the first international interprofessional education (IIPE) for the awareness of diabetes, with a focus on patient-centred care wherein three medical and four pharmacy students from Japan and one medical, two pharmacy, two nutrition and one occupational therapy (OT) student from Scotland participated. We described IIPE effects using interdisciplinary education perception scale (IEPS) before and after the programme among Scottish and Japanese students. University of Aberdeen/ Robert Gordon University and Nagoya University developed and established a shared online platform that provided knowledge to students on diabetes in both languages. We developed a case-based scenario that reflected diabetes care in each country using a standardised patient (SP). Lastly, a student-led live webinar was conducted on 14 November 2014 (the World Diabetes Day) to discuss and exchange care methods for SP. Each participating national team presented their care plan and all students discussed the diabetic care plan online. Both Japanese and Scottish teams were able to accurately assess the patient's condition and empathise with the SP. In conclusion, all participants learned that interprofessional collaboration was clearly required for diabetes management focused on patient-centred care. All participants appreciated the differences in the approach of the two countries involved because of the cultural- and health related differences. This programme was significant in raising awareness regarding the need for international interprofessional intervention on diabetes towards developing a model for live webinar IIPE.


Asunto(s)
Diabetes Mellitus , Estudios Interdisciplinarios , Atención Dirigida al Paciente/métodos , Humanos , Japón , Grupo de Atención al Paciente , Escocia , Difusión por la Web como Asunto
14.
PLoS One ; 13(11): e0208249, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30496326

RESUMEN

Beyond its anti-fibrinolytic mechanism, tranexamic acid has been suggested to have anti-inflammatory properties which may contribute to the survival benefit it provides to trauma patients. The objective of this study was to assess possible immunomodulatory effects of tranexamic acid as well as potential amelioration of end-organ injury in a rodent hemorrhagic shock model. Controlled hemorrhagic shock was induced in adult Sprague Dawley rats to a mean arterial pressure of 30 mmHg. Groups of 10 rats were administered intravenous tranexamic acid (300mg/kg) or vehicle control (normal saline) intravenously 15 minutes after the induction of shock. After 60 minutes of hemorrhagic shock, resuscitation was started. Animals were euthanized at six, 24, or 72 hours from the start of shock. Serum laboratory values to include inflammatory biomarkers were measured, and end organ histology was evaluated. Tranexamic acid treatment was associated with a significant decrease in serum IL-1ß at six and 24 hours and IL-10 at 24 hours from start of shock compared to vehicle control. Histologic analysis demonstrated mild decreases in both perivascular pulmonary edema and follicular mesenteric lymph node hyperplasia in the tranexamic acid treatment group but also increased myocardial lymphocytic infiltration with necrosis and degeneration. Tranexamic acid was also associated with a small but significant increase in peripheral neutrophil count as well as a significant decrease in neutrophil aggregation in pulmonary tissue at six hours post-injury. These data thus demonstrate a mixed effect of tranexamic acid. While there was an improvement in pulmonary edema and a suppressive effect on several key inflammatory mediators, there was also increased myocardial degeneration and necrosis, which is possibly related to the pro-thrombotic effect of tranexamic acid.


Asunto(s)
Antifibrinolíticos/uso terapéutico , Inflamación/tratamiento farmacológico , Choque Hemorrágico/tratamiento farmacológico , Ácido Tranexámico/uso terapéutico , Animales , Inflamación/sangre , Inflamación/etiología , Inflamación/patología , Pulmón/efectos de los fármacos , Pulmón/patología , Ganglios Linfáticos/efectos de los fármacos , Ganglios Linfáticos/patología , Masculino , Miocardio/patología , Ratas Sprague-Dawley , Resucitación/métodos , Choque Hemorrágico/sangre , Choque Hemorrágico/complicaciones , Choque Hemorrágico/patología
16.
Am Surg ; 84(8): 1355-1362, 2018 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-30185316

RESUMEN

The intent of this study was to characterize the management and subsequent complications of combat injury tube thoracostomies and to determine risk factors for the development of pneumonia (PNA) and retained hemothorax (RH). One hundred fifteen patients with 173 tube thoracostomies met the inclusion criteria and were analyzed. The mean injury severity score was 30.8 + 11.6, 23.5 per cent had traumatic amputations, 49.7 per cent had a hemothorax, and 50.3 per cent had a pneumothorax as indications for tube thoracostomy (TT) placement. Within 24 hours of injury, 89.6 per cent were intubated, the majority (54%) were injured by improvised explosive devices, 35.6 per cent sustained rib fractures, and 12.2 per cent had a diaphragm injury. A mean of 1.5 + 0.7(range 1-4) tube thoracostomies were placed, 18.3 per cent of patients had bilateral tube thoracostomies, and the average TT duration was 6.7 + 3.9 days. The incidence of PNA was 27 per cent (n = 31), RH was 9.6 per cent (n = 11), and empyema was 1.7 per cent (n = 2). Multivariable analysis identified the duration of ventilation [OR 1.2, 95% confidence interval (CI): 1.097-1.313, P < 0.001] as independently associated with the development of PNA. Bilateral TT placement (OR 3.848, 95% CI: 1.219-12.143, P = 0.0216) and injury severity score (OR 1.050, 95% CI: 1.001-1.102, P = 0.0443) were independently associated with PNA development when a patient was intubated for eight days or less. The number of tube thoracostomies placed (OR 3.08, 95% CI: 1.03-9.18, P = 0.0439) was independently associated with the development of RH. Further research is warranted to identify modifiable risk factors to reduce the incidence of PNA and RH in patients with TT placed for traumatic injuries.


Asunto(s)
Tubos Torácicos , Hemotórax/etiología , Personal Militar , Neumotórax/etiología , Traumatismos Torácicos/terapia , Toracostomía , Adulto , Femenino , Hemotórax/terapia , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Neumotórax/terapia , Estudios Retrospectivos , Traumatismos Torácicos/etiología , Traumatismos Torácicos/patología , Adulto Joven
17.
Malar J ; 17(1): 312, 2018 Aug 29.
Artículo en Inglés | MEDLINE | ID: mdl-30157850

RESUMEN

BACKGROUND: The number of clinical cases of malaria is often recorded in resource constrained or conflict settings as a proxy for disease burden. Interpreting case count data in areas of humanitarian need is challenging due to uncertainties in population size caused by security concerns, resource constraints and population movement. Malaria prevalence in women visiting ante-natal care (ANC) clinics has the potential to be an easier and more accurate metric for malaria surveillance that is unbiased by population size if malaria testing is routinely conducted irrespective of symptoms. METHODS: A suite of distributed lag non-linear models was fitted to clinical incidence time-series data in children under 5 years and ANC prevalence data from health centres run by Médecins Sans Frontières in the Democratic Republic of Congo, which implement routine intermittent screening and treatment alongside intermittent preventative treatment in pregnancy. These statistical models enable the temporal relationship between the two metrics to be disentangled. RESULTS: There was a strong relationship between the ANC prevalence and clinical incidence suggesting that both can be used to describe current malaria endemicity. There was no evidence that ANC prevalence could predict future clinical incidence, though a change in clinical incidence was shown to influence ANC prevalence up to 3 months into the future. CONCLUSIONS: The results indicate that ANC prevalence may be a suitable metric for retrospective evaluations of the impact of malaria interventions and is a useful method for evaluating long-term malaria trends in resource constrained settings.


Asunto(s)
Malaria/epidemiología , Atención Prenatal/estadística & datos numéricos , Preescolar , República Democrática del Congo/epidemiología , Humanos , Incidencia , Lactante , Recién Nacido , Modelos Estadísticos , Prevalencia , Sistemas de Socorro
18.
Nat Commun ; 9(1): 3300, 2018 08 17.
Artículo en Inglés | MEDLINE | ID: mdl-30120250

RESUMEN

Plasmodium vivax poses unique challenges for malaria control and elimination, notably the potential for relapses to maintain transmission in the face of drug-based treatment and vector control strategies. We developed an individual-based mathematical model of P. vivax transmission calibrated to epidemiological data from Papua New Guinea (PNG). In many settings in PNG, increasing bed net coverage is predicted to reduce transmission to less than 0.1% prevalence by light microscopy, however there is substantial risk of rebounds in transmission if interventions are removed prematurely. In several high transmission settings, model simulations predict that combinations of existing interventions are not sufficient to interrupt P. vivax transmission. This analysis highlights the potential options for the future of P. vivax control: maintaining existing public health gains by keeping transmission suppressed through indefinite distribution of interventions; or continued development of strategies based on existing and new interventions to push for further reduction and towards elimination.


Asunto(s)
Malaria Vivax/prevención & control , Malaria Vivax/parasitología , Modelos Biológicos , Plasmodium vivax/fisiología , Adolescente , Calibración , Simulación por Computador , Geografía , Humanos , Estudios Longitudinales , Malaria Vivax/epidemiología , Malaria Vivax/transmisión , Papúa Nueva Guinea/epidemiología , Reproducibilidad de los Resultados , Adulto Joven
19.
Nat Commun ; 9(1): 2476, 2018 06 26.
Artículo en Inglés | MEDLINE | ID: mdl-29946060

RESUMEN

In 2016 the World Health Organization identified 21 countries that could eliminate malaria by 2020. Monitoring progress towards this goal requires tracking ongoing transmission. Here we develop methods that estimate individual reproduction numbers and their variation through time and space. Individual reproduction numbers, Rc, describe the state of transmission at a point in time and differ from mean reproduction numbers, which are averages of the number of people infected by a typical case. We assess elimination progress in El Salvador using data for confirmed cases of malaria from 2010 to 2016. Our results demonstrate that whilst the average number of secondary malaria cases was below one (0.61, 95% CI 0.55-0.65), individual reproduction numbers often exceeded one. We estimate a decline in Rc between 2010 and 2016. However we also show that if importation is maintained at the same rate, the country may not achieve malaria elimination by 2020.


Asunto(s)
Malaria/transmisión , Número Básico de Reproducción , El Salvador/epidemiología , Enfermedades Endémicas/prevención & control , Monitoreo Epidemiológico , Humanos , Incidencia , Funciones de Verosimilitud , Malaria/epidemiología , Malaria/prevención & control , Malaria Falciparum/epidemiología , Malaria Falciparum/prevención & control , Malaria Falciparum/transmisión , Malaria Vivax/epidemiología , Malaria Vivax/prevención & control , Malaria Vivax/transmisión , Factores de Riesgo , Factores de Tiempo
20.
Lancet Infect Dis ; 18(4): e119-e132, 2018 04.
Artículo en Inglés | MEDLINE | ID: mdl-29395997

RESUMEN

Malaria remains one of the most preventable causes of adverse birth outcomes. Intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine is used to prevent malaria, but resistance to this drug combination has decreased its efficacy and new alternatives are needed. In Africa, a meta-analysis showed three-course or monthly IPTp with sulfadoxine-pyrimethamine to be safe and more effective than the original two-course sulfadoxine-pyrimethamine strategy, prompting WHO to update its policy in 2012. Although resistance to sulfadoxine-pyrimethamine reduces the parasitological efficacy of IPTp, this drug combination remains associated with reduced incidence of low birthweight in areas where prevalence of parasites with quintuple Plasmodium falciparum dihydrofolate reductase (Pfdhfr) and dihydropteroate synthetase (Pfdhps) mutations is greater than 90%. Nevertheless, its effectiveness is compromised in women infected with sextuple mutant parasites. Six trials of IPTp showed that neither amodiaquine, mefloquine, nor chloroquine-azithromycin are suitable replacements for sulfadoxine-pyrimethamine because of poor tolerability. Furthermore, four trials showed that intermittent screening and treatment with the current generation of malaria rapid diagnostic tests was not a suitable alternative strategy to IPTp with sulfadoxine-pyrimethamine, even in areas with high prevalence of quintuple mutations. Two trials showed that IPTp with dihydroartemisinin-piperaquine was well tolerated, effective, and acceptable for IPTp, with monthly regimens being the most effective. Coverage of IPTp and insecticide-treated nets continues to lag behind targets. The key barriers to uptake are well documented, and many are open to intervention. Outside of Africa, a single trial suggests a potential role for integrated approaches that combine sulfadoxine-pyrimethamine with azithromycin for IPTp in areas of Papua New Guinea where malaria transmission is high. Modelling analysis suggests the importance of the prevention of malaria early in pregnancy and the need to protect pregnant women declines more slowly than the rate at which transmission declines. Improved funding has led to an increase in the number of prevention trials in the past decade, showing the value of more sustained protection with monthly IPTp regimens. There is a need for confirmatory trials of the safety, efficacy, and feasibility of IPTp with dihydroartemisinin-piperaquine, for studies of intermittent screening and treatment with more sensitive rapid diagnostic tests, for studies of integrated strategies for malaria and other co-infections, and for studies of prevention strategies for malaria in pregnant women who are HIV-positive and living outside of Africa. Additional research is required on how to improve uptake of WHO's updated policy on IPTp with sulfadoxine-pyrimethamine and insecticide-treated nets.


Asunto(s)
Antimaláricos/administración & dosificación , Quimioprevención/métodos , Transmisión de Enfermedad Infecciosa/prevención & control , Malaria Falciparum/prevención & control , Complicaciones Infecciosas del Embarazo/prevención & control , África , Ensayos Clínicos como Asunto , Resistencia a Medicamentos , Quimioterapia Combinada/métodos , Femenino , Humanos , Papúa Nueva Guinea , Embarazo
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