Efficacy, Feasibility, and Safety of the X-Tack Endoscopic HeliX Tacking System: A Multicenter Experience.

BACKGROUND AND AIMS: The application of endoscopic suturing has revolutionized defect closures. Conventional over-the-scope suturing necessitates removal of the scope, placement of the device, and reinsertion. A single channel, single sequence, through-the-scope suturing device has been developed to improve this process. This study aims to describe the efficacy, feasibility, and safety of a through-the-scope suturing device for gastrointestinal defect closure. METHODS: This was a retrospective multicenter study involving 9 centers of consecutive adult patients who underwent suturing using the X-Tack Endoscopic HeliX Tacking System (Apollo Endosurgery). The primary outcomes were technical success and long-term clinical success. Secondary outcomes included adverse events, recurrence, and reintervention rates. RESULTS: In all, 56 patients (mean age 53.8, 33 women) were included. Suturing indications included fistula repair (n=22), leak repair (n=7), polypectomy defect closure (n=12), peroral endoscopic myotomy (POEM) site closure (n=7), perforation repair (n=6), and ulcers (n=2). Patients were followed at a mean duration of 74 days. Overall technical and long-term clinical success rates were 92.9% and 75%, respectively. Both technical and clinical success rates were 100% for polypectomies, POEM-site closures, and ulcers. Success rates were lower for the repair of fistulas (95.5% technical, 54.5% clinical), leaks (57.1%, 28.6%), and perforations (100%, 66.7%). No immediate adverse events were noted. CONCLUSION: This novel, through-the-scope endoscopic suturing system, is a safe and feasible method to repair defects that are ≤3 cm. The efficacy of this device may be better suited for superficial defects as opposed to full-thickness defects. Larger defects will need more sutures and probably a double closure technique to provide a reinforcement layer.

Haematological and biochemical pathology markers for a predictive model for ITU admission and death from COVID-19: A retrospective study.

Coronavirus disease (COVID-19) caused by SARS-CoV-2 has affected over 227 countries. Changes in haematological and biochemical characteristics in patients with COVID-19 are emerging as important features of the disease. This study aims to identify the pathological findings of COVID-19 patients at Bedford Hospital by analysing laboratory parameters that were identified as significant potential markers of COVID-19. Patients who were admitted to Bedford Hospital from March-July 2020 and had a positive swab for COVID were selected for this study. Clinical and laboratory data were collected using ICE system. Multiple haematological and biochemistry biomarkers were analysed using univariate and multivariate logistic regression to predict intensive therapy unit (ITU) admission and/or survival based on admission tests. Neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein were elevated in most patients, irrespective of ITU status, representing a common outcome of COVID-19. This was driven by lymphopenia in 80% and neutrophilia in 42% of all patients. Multivariate logistic regression identified an increase in mortality associated with greater age, elevated NLR, alkaline phosphatase activity and hyperkalaemia. With the area under the receiver operating characteristic (ROC) curve of 0.706 +/- 0.04117, negative predictive value (NPV) 66.7% and positive predictive value (PPV) 64.9%. Analysis also revealed an association between increases in serum albumin and potassium concentrations and decreases in serum calcium, sodium and in prothrombin time, with admission to ITU. The area under the ROC curve of 0.8162 +/- 0.0403, NPV 63.3% and PPV 80.5%. These data suggest that using admission (within 4 days) measurements for haematological and biochemical markers, that we are able to predict outcome, whether that is survival or ITU admission.

Access to community-based reproductive health services and incidence of low birthweight delivery among refugee and displaced mothers: a retrospective study in the Thailand-Myanmar border region.

OBJECTIVES: Over 2.4 million people have been displaced within the Thailand-Myanmar border region since 1988. The efficacy of community-driven health models within displaced populations is largely unstudied. Here, we examined the relationship between maternal healthcare access and delivery outcomes to evaluate the impact of community-provided health services for marginalised populations. SETTING: Study setting was the Thailand-Myanmar border region's single largest provider of reproductive health services to displaced mothers. PARTICIPANTS: All women who had a delivery (n=34 240) between 2008 and 2019 at the study clinic were included in the performed retrospective analyses. PRIMARY AND SECONDARY OUTCOME MEASURES: Low birth weight was measured as the study outcome to understand the relationship between antenatal care access, family planning service utilisation, demographics and healthy deliveries. RESULTS: First trimester (OR=0.86; 95% CI=0.81 to 0.91) and second trimester (OR=0.86; 95% CI=0.83 to 0.90) antenatal care visits emerged as independent protective factors against low birthweight delivery, as did prior utilisation of family planning services (OR=0.82; 95% CI=0.73 to 0.92). Additionally, advanced maternal age (OR=1.36; 95% CI=1.21 to 1.52) and teenage pregnancy (OR=1.27, 95% CI=1.13 to 1.42) were notable risk factors, while maternal gravidity (OR=0.914; 95% CI=0.89 to 0.94) displayed a protective effect against low birth weight. CONCLUSION: Access to community-delivered maternal health services is strongly associated with positive delivery outcomes among displaced mothers. This study calls for further inquiry into how to best engage migrant and refugee populations in their own reproductive healthcare, in order to develop resilient models of care for a growing displaced population globally.

Challenges in tackling tuberculosis on the Thai-Myanmar border: findings from a qualitative study with health professionals.

BACKGROUND: Myanmar and Thailand belong to the top 22 high burden countries for tuberculosis (TB). Health care organizations play an essential role in addressing TB control in the two bridging border jurisdictions, Tak province, Thailand and Myawaddy district, Kayin state, Myanmar. However, health professionals face difficulties in TB control effort due to the nature of fluid population movements, resource constraints and ambiguous mechanisms to implement collaboration along the border. The purpose of this study is to identify the challenges to TB control among Myanmar migrants faced by stakeholders, focusing on the area of collaboration and interaction along the border. METHOD: The study conducted in-depth interviews with health policy makers and health care providers responsible for developing and implementing policies and TB programs in Tak province, Thailand and Myawaddy district, Kayin state, Myanmar. The participants included members of government organizations, United Nations agencies, community based organizations, and international NGO. One or two key stakeholders from each organization were approached to participate in the study. We gathered baseline information to identify TB policies and programs available on websites, brochures, and publications. Observations including field notes were made on site. The data transcriptions were coded for qualitative data analysis. Coding also developed categories that led to key themes. RESULTS: A total of 31 respondents (18 in Thailand and 13 in Myanmar) participated in the study. The main theme reported by participants was challenges in limited corroboration and coordination among stakeholders. Unstructured information sharing and lack of communication hindered the stakeholders from engaging in TB control. The respondents stressed that referral mechanisms across the border need to be strengthened. Other challenges were associated with increasing loss to follow up and subsequent MDR cases, constraints of service delivery, shortage of human resources, limited staff capacities within organizations and poor socioeconomic status of patients. CONCLUSIONS: Health professionals face many challenges in effectively addressing TB control. Addressing the insufficient coordination and collaboration by strengthening bi-national collaborative mechanisms among health care organizations is an essential step in reducing the burden of disease. Additional support and resources from governmental and non-governmental agencies will be required to address the challenges.

Infectious Colitis Associated With Ipilimumab Therapy.

Ipilimumab is a monoclonal antibody against cytotoxic T lymphocyte-associated molecule-4 and is thought to promote anti-tumor activity by enhancing cell mediated immunity. It is one of the few therapies shown to improve overall survival in metastatic melanoma. Given its mechanism of action, the drug is associated with significant immune-related adverse events with the gastrointestinal system being commonly involved. Our patient is a 22-year-old female with stage IVA melanoma on ipilimumab therapy who presented with fever, diarrhea and abdominal pain. She gave a history of recent travel to a wedding where several other guests in attendance had also developed diarrheal illnesses. Her colonoscopy and pathology were consistent with ipilimumab-induced colitis. Her stool culture returned positive for Salmonella enteritides. She was treated with prednisone and ciprofloxacin with resolution of her symptoms. In our case, we describe ipilimumab-induced colitis where an infectious pathogen was identified with temporal relationship to symptoms and could be suggestive of a causal relationship.

Scaling and non-scaling of muscle activity, kinematics, and dynamics in sit-ups with different degrees of difficulty.

The purpose of this study was to investigate how the CNS adjusts motor patterns for variants of a complex axial movement-the sit-up. Adjustments were induced by changing the support surface contact and mass distribution of the body. Healthy adults performed straight-legged sit-ups, 3 s in duration, with support added to or removed from the lumbar trunk, or with mass added to the head or to the legs. Each of these interventions either increased or decreased the difficulty of the task. The study addressed the extent to which changes in sit-up difficulty are compensated by scaling of muscle activity, kinematics, and dynamics versus the extent to which they are compensated by changing discretely the motor pattern. The analysis of muscle activity, kinematics, and dynamics focused on the first 30-40% of the sit-up-the trunk flexion phase-since this is the most critical part of the movement. Our results demonstrate that, in some respects, sit-up kinematics and dynamics scaled with difficulty, but in other respects, they did not. Muscle activity also scaled, in many respects, but in more difficult sit-ups, abdominal flexor activity decreased instead of increased. Non-scaling changes in these parameters suggest that complex movements, such as the sit-up, may require discrete changes in motor pattern in order to deal with large loads, which challenge the available leverage.

Low yield of endoscopy in patients with persistent dyspepsia taking proton pump inhibitors.

BACKGROUND: Options for the evaluation of dyspepsia include a Helicobacter pylori test-and-treat strategy, empiric acid suppression, and initial endoscopy. The aim of this study was to determine the yield of endoscopy in patients in whom empiric therapy is unsuccessful compared with patients who received no empiric therapy and to identify factors associated with endoscopic findings. METHODS: A total of 100 patients with dyspepsia referred for endoscopy completed a questionnaire that included a query concerning response to therapy. EGD findings were compared in patients taking an H2-receptor antagonist, patients taking a proton pump inhibitor, and those not receiving empiric therapy. RESULTS: There were fewer endoscopic findings in patients being treated with a proton pump inhibitor compared with those taking an H2-receptor antagonist or those not receiving therapy (p < 0.01). Fewer proton pump inhibitor recipients had esophagitis or ulcer compared with patients in the no therapy group. Lack of symptom relief (<20%) by acid suppression was highly associated with a normal endoscopy (17/17). CONCLUSIONS: Patients with persistent dyspepsia being treated with a proton pump inhibitor have fewer endoscopic abnormalities compared with patients with dyspepsia taking an H2-receptor antagonist and those receiving no therapy. For patients with partial symptom relief, proton pump inhibitor therapy may mask endoscopic findings, particularly esophagitis. Interruption of proton pump inhibitors before endoscopy may increase diagnostic yield. Endoscopy is unlikely to yield a positive finding in patients who experience no symptom relief while taking a proton pump inhibitor or H2-receptor antagonist.

La mortalidad por tétanos neonatal en Veracruz, México, en 1989 / Neonatal tetanus mortality in Veracruz, México, 1989

Este artículo describe una encuesta realizada en el estado de Veracruz, México, para estimar la mortalidad por tétanos neonatal. La encuesta, que entraño visitas a 72 720 familias, generó datos sobre 8401 nacidos vivos y 209 defunciones neonatales de abril de 1988 a mayo de 1989. De las 209 defunciones, 26 se ajustaban a la definición de la OMS de casos de defunción por tétanos neonatal. La mortalidad estimada por esta enfermedad fue de 3,1 defunciones por 1000 niños nacidos vivos (IC95 por ciento=1,7 a 4,5). La comparación de esta tasa con las cifras notificadas sugiere que por cada defunción por tétanos neonatal registrada en Veracruz durante el período de estudio, otros 50 o más no se notificaron. Además de la encuesta se efectuó un estudio de casos y testigos para evaluar los factores de riesgo de tétanos neonatal que pueden prevenirse. Datos limitados sobre 13 casos de defunción por tétanos neonatal y 217 testigos mostraron un riesgo aumentado en niños que nacieron en el hogar y cuyos padres descendían de indios mexicanos. A cinco de los trece niños fallecidos se les había cortado el cordón umbilical con un instrumento de uso doméstico o un instrumento tradicional con filo, como una caña vegetal, en comparación con ninguno de los 217 testigos. La eficacia observada de la vacunación con dos o más dosis de toxoide tetánico fue de 70 por ciento (IC95 por ciento=52 a 100). Tanto las madres de los neonatos que murieron de tétanos como la de los testigos habían desaprovechado un promedio de cinco oportunidades de recibir toxoide tetánico. Estos resultados subrayan la necesidad de establecer un programa de salud perinatal orientado a las poblaciones mexicanas de alto riesgo

Neonatal tetanus mortality in Veracruz, Mexico, 1989

This article describes a survey conducted in the State of Veracruz, Mexico, to estimate neonatal tetanus (NNT) mortality. The survey, which entailed visits to 72 720 households, collected data on 8 401 live births and 209 infants deaths ocurring between April 1988 and May 1989. Twenty-six of the 209 fatalities conformed to a WHO standard case definition of death from neonatal tetanus. The estimated neonatal tetanus mortality was thus 3.1 deaths per 1 000 live births (95 percent confidence limits = 1.7,4.5). Comparison of this rate to reported figures suggests that for every NNT death recorded in Veracruz during the study period, as many as 50 others went unreported. A case-control study nested within the survey was conducted to assess preventable NNT risk factors. Limited information on 13 NNT deaths and 217 controls showed an increased risk for neonates who were delivered at home and whose parents' ethnic background was Mexican Indian. Five of the 13 fatalities had their umbilical cords cut with a domestic or traditional cutting tool such as a reed cane, as compared to none of the 217 controls. The observed vaccine efficacy of 2 = doses of tetanus toxoid was 70 percent (95 percent confidence limits = 52,100). Both the mothers of neonates who died of NNT and their controls missed an average of five opportunities to receive tetanus toxoid. These findings underscore the need to launch a perinatal health program serving Mexico's high-risk poulations (AU)

Neonatal tetanus mortality in Veracruz, Mexico, 1989

This article describes a survey conducted in the State of Veracruz, Mexico, to estimate neonatal tetanus (NNT) mortality. The survey, which entailed visits to 72 720 households, collected data on 8 401 live births and 209 infants deaths ocurring between April 1988 and May 1989. Twenty-six of the 209 fatalities conformed to a WHO standard case definition of death from neonatal tetanus. The estimated neonatal tetanus mortality was thus 3.1 deaths per 1 000 live births (95 percent confidence limits = 1.7,4.5). Comparison of this rate to reported figures suggests that for every NNT death recorded in Veracruz during the study period, as many as 50 others went unreported. A case-control study nested within the survey was conducted to assess preventable NNT risk factors. Limited information on 13 NNT deaths and 217 controls showed an increased risk for neonates who were delivered at home and whose parents' ethnic background was Mexican Indian. Five of the 13 fatalities had their umbilical cords cut with a domestic or traditional cutting tool such as a reed cane, as compared to none of the 217 controls. The observed vaccine efficacy of 2 = doses of tetanus toxoid was 70 percent (95 percent confidence limits = 52,100). Both the mothers of neonates who died of NNT and their controls missed an average of five opportunities to receive tetanus toxoid. These findings underscore the need to launch a perinatal health program serving Mexico's high-risk poulations (AU)

This article will also be published in Spanish in the BOSP. Vol. 119, 1995

La mortalidad por tétanos neonatal en Veracruz, México, en 1989 / Neonatal tetanus mortality in Veracruz, México, 1989

Este artículo describe una encuesta realizada en el estado de Veracruz, México, para estimar la mortalidad por tétanos neonatal. La encuesta, que entraño visitas a 72 720 familias, generó datos sobre 8401 nacidos vivos y 209 defunciones neonatales de abril de 1988 a mayo de 1989. De las 209 defunciones, 26 se ajustaban a la definición de la OMS de casos de defunción por tétanos neonatal. La mortalidad estimada por esta enfermedad fue de 3,1 defunciones por 1000 niños nacidos vivos (IC95 por ciento=1,7 a 4,5). La comparación de esta tasa con las cifras notificadas sugiere que por cada defunción por tétanos neonatal registrada en Veracruz durante el período de estudio, otros 50 o más no se notificaron. Además de la encuesta se efectuó un estudio de casos y testigos para evaluar los factores de riesgo de tétanos neonatal que pueden prevenirse. Datos limitados sobre 13 casos de defunción por tétanos neonatal y 217 testigos mostraron un riesgo aumentado en niños que nacieron en el hogar y cuyos padres descendían de indios mexicanos. A cinco de los trece niños fallecidos se les había cortado el cordón umbilical con un instrumento de uso doméstico o un instrumento tradicional con filo, como una caña vegetal, en comparación con ninguno de los 217 testigos. La eficacia observada de la vacunación con dos o más dosis de toxoide tetánico fue de 70 por ciento (IC95 por ciento=52 a 100). Tanto las madres de los neonatos que murieron de tétanos como la de los testigos habían desaprovechado un promedio de cinco oportunidades de recibir toxoide tetánico. Estos resultados subrayan la necesidad de establecer un programa de salud perinatal orientado a las poblaciones mexicanas de alto riesgo

Se publica en inglés en el Bull. PAHO. Vol. 29(2), 1995

Status report on the sewerage sector in Grenada

Gives general background information on economic, health and environmental conditions in Grenada. In so far, as the sewerage sector is concerned, data indicates that approximately fifty (50) percent of households use pit latrines, six (6) percent are linked to the only sewerage system in St. George's and forty (40) per cent use septic tanks. Details of the operation, maintenance, technology and financing of the sector are outlined. Identifies a number of projects that should be given serious consideration for implementation , including a sewerage system for the Grand Anse area