A comparison of two in vitro bioassays to detect resistance of the cattle tick Rhipicephalus microplus to fipronil.

The aim of this work is to compare the sensitivity of two in vitro bioassays to detect resistant to fipronil in Argentinean populations of the cattle tick Rhipicephalus microplus. Two different larval bioassays prepared with technical grade (97%) fipronil were compared: larval immersion test (LIT) and larval packet test (LPT). Seven strains from different provinces were treated with both assays. Colonia Tabay, Colonia Benítez, Intiyaco and Quimili strains were considered resistant in both LIT and LPT bioassays. The 95% confidence intervals (IC95) for lethal concentration 50% (LC50) did not overlap with the susceptible reference strain (SRS) and all the values of RR50 obtained were higher than 2. Garabato and Federal strains were considered as susceptible for both techniques because the IC95 for the LC50 overlapped with those of the SRS and the RR50 values were lesser than 2. An ambiguous situation occurs with Reconquista strain. This strain was considered as susceptible with LPT and with incipient resistant after LIT trial. The analysis of the results indicates that both LIT and LPT trials have enough sensibility to differentiate resistant and susceptible strains, but LIT was more sensitive than LPT when the resistance is incipient.

In vitro diagnosis of resistance of the cattle tick Rhipicephalus (Boophilus) microplus to fipronil in Argentina.

The aim of this work was to adapt and apply the in vitro larval bioassay packet test (LPT) to diagnose resistance of Rhipicephalus microplus ticks to fipronil in Argentina. Ten serial dilutions of fipronil were included in the LPT bioassay. Seven populations of R. microplus from six Argentinean Provinces were evaluated. Samples from Colonia Benítez, Quimilí and Intiyaco were unambiguously classified in the category 'resistant'. In all these cases the 95% confidence intervals did not overlap with that of the susceptible reference strain and the slope values were lower than the slope value obtained for the susceptible reference strain. The resistance ratio (RR50) values of the populations from Colonia Benítez I and II, Quimilí and Intiyaco were 2.23, 3.49, 6.84 and 3.39, respectively. Populations from El Colorado I and II, Acambuco, Vera and Feliciano were classified as 'susceptible' because the 95% confidence intervals overlapped with that of the susceptible reference strain and the RR50 values never exceeded 1.32. The results of these LPT bioassays indicate the presence of fipronil resistant R. microplus populations in Argentina.

Resistance of the cattle tick Rhipicephalus (Boophilus) microplus to ivermectin in Argentina.

Resistance to ivermectin in populations of the cattle tick Rhipicephalus microplus in Argentina was diagnosed in this work. The in vitro larval immersion test (LIT) was used to determine quantitatively the levels of resistance to ivermectin in different populations of R. microplus. Additionally, field trials to control natural infestations of R. microplus on cattle with a commercial formulation of ivermectin 3.15% were carried and jointly analyzed with the in vitro assays. The phenotypic response of the populations analyzed was not uniform. Five of them were classified as susceptible, four populations as resistant, and one in the category "incipient resistance". Regarding the field trials, the therapeutic efficacy in a population classified with LIT as susceptible achieved values higher than 94% two weeks after treatment, and no reproductively viable females were observed after the second day post-treatment. Conversely, the values of efficacy percentage in a population (named as "San Martín") classified with LIT in the category "incipient resistance" never exceeded the 70.8%, and engorged females were collected in practically all counts. The population "San Martín" was classified in the category "incipient resistant" with LIT analysis, but the field trial unambiguously shows that this tick population is resistant. The comparison of the results obtained with LIT in vitro assays and through field trials shows that biased estimations of resistance levels may occur when resistance ratios (RR) values are ≤2, and additional field efficacy trials could be needed to know with precision the status of the tick populations evaluated.

A National Survey of Hearing Loss in the Philippines.

This study aimed to estimate the prevalence of hearing loss in the Philippines using a nationally representative sample. A cross-sectional national survey was undertaken utilizing a 3-stage stratified cluster design. Participants in the present study comprised 2275 adults and children with pure tone hearing assessment results. Prevalence of moderate or worse hearing loss, defined as 4FA ≥41 dBHL, was 7.5% in children <18 years, 14.7% in adults between 18 and 65 years, and 49.1% in adults >65 years. Factors associated with greater risk of moderate hearing loss in the better ear were presence of a middle ear condition (adjusted odds ratio = 2.39, 95% confidence interval = 1.49-3.85) and socioeconomic status (household income; adjusted odds ratio = 1.64, 95% confidence interval = 1.23-2.19). Age was also associated with increased risk, with adjusted odds ratios varying with age category. Prevalence of wax occlusion and outer and middle ear disease was 12.2% and 14.2%, respectively. Prevalence of hearing loss, outer, and middle ear disease appear comparatively high in the Philippines when compared with rates reported in high-income countries. Higher proportions of severe to profound hearing loss were also identified, indicating that there is both an increased prevalence and severity of hearing loss in this population.

Expanding Access: Cost-effectiveness of Cochlear Implantation and Deaf Education in Asia.

OBJECTIVE: To determine the cost-effectiveness of cochlear implantation (CI) with mainstream education and deaf education with sign language for treatment of children with profound sensorineural hearing loss in low- and lower-middle income countries in Asia. STUDY DESIGN: Cost-effectiveness analysis. SETTING: Bangladesh, Cambodia, India, Indonesia, Nepal, Pakistan, Philippines, and Sri Lanka participated in the study. SUBJECTS AND METHODS: Costs were obtained from experts in each country with known costs and published data, with estimation when necessary. A disability-adjusted life-years model was applied with 3% discounting and 10-year length of analysis. A sensitivity analysis was performed to evaluate the effect of device cost, professional salaries, annual number of implants, and probability of device failure. Cost-effectiveness was determined with the World Health Organization standard of cost-effectiveness ratio per gross domestic product (CER/GDP) per capita <3. RESULTS: Deaf education was cost-effective in all countries except Nepal (CER/GDP, 3.59). CI was cost-effective in all countries except Nepal (CER/GDP, 6.38) and Pakistan (CER/GDP, 3.14)-the latter of which reached borderline cost-effectiveness in the sensitivity analysis (minimum, maximum: 2.94, 3.39). CONCLUSION: Deaf education and CI are largely cost-effective in participating Asian countries. Variation in CI maintenance and education-related costs may contribute to the range of cost-effectiveness ratios observed in this study.

Pneumococcal conjugate vaccine (Non-Typeable Haemophilus influenzae (NTHi) protein D, diphtheria or tetanus toxoid conjugates) in prevention of acute otitis media in children: A cohort study

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To compare the incidence of acute otitis media among children aged 2 to 6 months old in Sampaloc, Manila who were previously given 3 doses of pneumococcal conjugate vaccine (Non-Typeable Haemophilus influenzae (NTHi) protein D, diphtheria or tetanus toxoid conjugates) and those who did not receive the vaccine over a period of one year.<br /><strong>METHODS:</strong> <br /><strong>Design:</strong> Cohort Study<br /><strong>Setting:</strong> Primary Health Center in Sampaloc, Manila, Philippines<br /><strong>Participants:</strong> Medical records of well children aged 2 to 6 months were reviewed for inclusion. Participants were categorized into vaccinated and unvaccinated groups. Both groups underwent baseline history and physical examination including otoscopy and any signs and symptoms of active ear infection were noted. Subjects were followed up for a period of one year on a monthly basis for signs or symptoms of acute otitis media. <br /><strong>RESULTS:</strong> A total of 176 subjects participated in the study. The overall incidence of AOM among participants was 5.11% (9 out of 176). An AOM incidence of 3.75% (3 out of 80) and 6.25% (6 out of 96) was found among the exposed and unexposed groups, respectively. Fisher's exact test (one-tailed) p value= .34, relative risk (RR) .6 (95% Cl 0.155, 2.323).<br /><strong>CONCLUSION:</strong> The results of this study showed no difference in the development of AOM in the two groups. However, based on the relative risk, Pneumococcal conjugate vaccine is still beneficial in preventing AOM in children.</p>

Diagnostic value of computerized dynamic posturography in the assessment of peripheral vestibular disorders

@#<p style="text-align: justify;"><strong>OBJECTIVES:</strong> This study aims to determine the sensitivity, specificity, positive predictive value and negative  predictive  value  of  Computerized  Dynamic  Posturography  (CDP)  in  properly  labeling patients with peripheral vestibular disorders by Videonystagmography (VNG) as having vestibular dysfunction.<br /><strong>METHODS:</strong><br /><strong>Design:</strong> Case - Control Study<br /><strong>Setting:</strong> Tertiary Private Hospital<br /><strong>Subjects:</strong> Twenty-three (23) patients aged 18 and above with no history of hypertension or cardiovascular disease and no intake of anti-vertigo medications for at least 48 hours prior to testing and with complete VNG and CDP results obtained on the same day or at least  two  days  apart  were  included  in  the  study. Cases were defined as those  diagnosed with a peripheral  vestibular  disorder  by VNG  while  controls  were  defined as those with  normal VNG results.  Sensitivity, specificity, positive predictive value and negative  predictive value of CDP in labeling those with peripheral vestibular disorders as vestibular were determined using VNG as gold standard.<br /><strong>RESULTS:</strong> There were 11 cases  (4  males, 7 females) and 12 controls (8  males,  4  females).  Using VNG  as  the  gold  standard  for  diagnosing  peripheral  vestibular  disorders,  CDP  had  a  sensitivity of 45.45% and specificity of 66.67% with Positive Predictive Value(PPV) of 55.56% and Negative Predictive Value(NPV) of 57.14%  in  assessing  peripheral vestibular disorders among the adults tested.  Interestingly, 33.33% of patients with normal VNG may actually have had a vestibular dysfunction that could be detected by CDP.<br /><strong>CONCLUSION:</strong> Prospective studies with larger sample sizes utilizing VNG and CDP are recommended in order to verify our findings.</p>

By pass arterial femorodistal bajo anestesia local / Distal femoral bypass under local anaesthesia

Introducción: El objetivo de este trabajo es transmitir nuestra experiencia en by pass arterial femorodistal bajo anestesia local para pacientes de alto riesgo. Material y métodos De enero a mayo de 2010 hasta 8 pacientes han sido intervenidos en nuestro centro de cirugía de revascularización en miembros inferiores bajo anestesia local. Las características comunes de los pacientes eran la edad avanzada, cardiopatía isquémica crónica en tratamiento con antiagregantes plaquetarios y la enfermedad pulmonar obstructiva crónica (EPOC).Resultados Los 8 pacientes (100%) toleraron de forma adecuada el procedimiento sin recurrir a sedación ni a procedimientos anestésicos invasivos. La arteria receptora fue la tibial posterior en 6 de ellos (75%) y la poplítea y peronea en uno (12%). En 7 casos logramos permeabilidad precoz del injerto y uno presentó trombosis precoz con amputación supracondílea; la técnica empleada fue femoropoplíteo en un caso, femorotibial posterior en 6 casos y poplíteo-peroneo en otro. El injerto utilizado fue la vena safena mayor, invertida en un paciente (12%) e in situ en 7 (88%) con valvulotomo BARD™, 3mm. Las complicaciones postoperatorias fueron del 0% para hemorragia, infección y muerte; en 3 pacientes (37%) amputación menor y, tras un periodo de seguimiento medio de 3 meses (1-4 meses), 7 casos están libres de amputación mayor. Conclusiones La revascularización del territorio distal de los miembros inferiores puede llevarse a cabo mediante anestesia local de forma segura y eficaz, sin necesidad de retirar antiagregantes ni asumir los riesgos de la anestesia general. La anatomía desfavorable (obesidad) puede limitar el procedimiento (AU)

Introduction: The aim of this article is to present our experience in performing distal femoralby pass under local anaesthesia for high risk patients. Material and methods: Lower limb revascularisation surgery under local anaesthesia was performed on 8 patients in our centre between January and May 2010. The common characteristics of the patients were, advanced age, chronic is chaemic heart disease on antiplatelet treatment, and chronic obstructive pulmonary disease (COPD). Results: All 8 patients (100%) tolerated the procedure well without having to resort to sedation or invasive an aesthetic procedures. The receiving artery was the posterior tibialin 6 cases (75%) and the popliteal and peroneal in 1 (12%). Early patency of the graft was achieved 7 patients and 1 had early thrombosis with a supracondylar amputation. The technique used was femoral-popliteal in 1 case, femoral-posterior tibial in 6 cases, and popliteal-peroneal in 1 case. The saphenous vein was the graft used, inverted in 1 patient(12%), and in situ in 7 (88%) with a 3 mm BARDTM valvotomy. There were no post-operative complications as regards haemorrhage, infections or death. A minor amputation was performed on 3 patients (37%), and after a mean of 3 months (1-4 months) follow-up,7 cases were free of major amputation. Conclusions: Revascularisation of the distal zone of the lower limbs can be safely and effectively performed using local anaesthesia, avoiding the risks of general anaesthesia and without the need to stop antiplatelet treatment. Anatomical problems (obesity) may limit the procedure (AU)

[Distal femoral bypass under local anaesthesia]. / By pass arterial femorodistal bajo anestesia local.

INTRODUCTION: The aim of this article is to present our experience in performing distal femoral bypass under local anaesthesia for high risk patients. MATERIAL AND METHODS: Lower limb revascularisation surgery under local anaesthesia was performed on 8 patients in our centre between January and May 2010. The common characteristics of the patients were, advanced age, chronic ischaemic heart disease on antiplatelet treatment, and chronic obstructive pulmonary disease (COPD). RESULTS: All 8 patients (100%) tolerated the procedure well without having to resort to sedation or invasive anaesthetic procedures. The receiving artery was the posterior tibial in 6 cases (75%) and the popliteal and peroneal in 1 (12%). Early patency of the graft was achieved 7 patients and 1 had early thrombosis with a supracondylar amputation. The technique used was femoral-popliteal in 1 case, femoral-posterior tibial in 6 cases, and popliteal-peroneal in 1 case. The saphenous vein was the graft used, inverted in 1 patient (12%), and in situ in 7 (88%) with a 3mm BARD™ valvotomy. There were no post-operative complications as regards haemorrhage, infections or death. A minor amputation was performed on 3 patients (37%), and after a mean of 3 months (1-4 months) follow-up, 7 cases were free of major amputation. CONCLUSIONS: Revascularisation of the distal zone of the lower limbs can be safely and effectively performed using local anaesthesia, avoiding the risks of general anaesthesia and without the need to stop antiplatelet treatment. Anatomical problems (obesity) may limit the procedure.

Undifferentiated nasopharyngeal malignancy with immunohistochemical features of diffuse large B cell lymphoma and undifferentiated carcinoma: A collision tumor?

@#p style=text-align: justify;strongOBJECTIVE:/strong To describe an unusual presentation of undifferentiated nasopharyngeal malignancy with immunohistochemical features of both diffuse B-cell lymphoma and undifferentiated carcinomastrong./strongbr /br /strongMETHODS:/strongbr /strongDesign:/strong Case Reportbr /strongSetting/strong: Tertiary Private University Hospital br /strongPatient:/strong Onebr /br /strongRESULTS:/strong A 49-year-old female whose initial nasopharyngeal biopsy interpretation was diffuse large B-cell lymphoma underwent three cycles of Rituximab, Cyclophosphamide, Hydroxydaunomycin, Oncovin and Prednisone (R-CHOP). Post-chemotherapy Computed Tomography (CT) scan of the nasopharynx revealed no change in tumor size or appearance. Repeat nasopharyngeal (NP) biopsy findings suggested an epithelial tumor lineage or post-chemotherapy reactive mucosal epithelial cells. No residual lymphoma was noted and immunostaining was positive for cytokeratin. The patient underwent 35 fractions of radiotherapy. Re-evaluation by Magnetic Resonance Imaging (MRI) with contrast after four months showed significant tumor shrinkage. Repeat NP biopsy revealed necrotic tissues with foci of high-grade squamous cell carcinoma. Two months after the biopsy, repeat MRI with contrast of the nasopharynx and neck showed increase in the bulk of the nasopharyngeal tumor with inferior extension to the level of the orophaynx and possible contralateral involvement. A nasopharyngectomy via left maxillary swing was performed and the final histopathology was undifferentiated carcinoma.br /br /strongCONCLUSION:/strong Undifferentiated malignancies of the nasopharynx may contain lymphoma or carcinoma and rarely, both lineages in coexistence. In such cases, the possibility of a collision tumor should be considered. Immunohistochemical distinction is important for treatment and prognostication./p

Comparison of saccade, smooth pursuit and optokinetic nystagmus among Filipino patients diagnosed with schizophrenia, their siblings without schizophrenia and controls using the electronystagmogram: a pilot study at the Santo Tomas Hospital

Objectives: The structural abnormality implicated in schizophrenia was supported by eye movement abnormalities, which were considered biological or trait markers of this psychiatric disorder. We aimed to establish the presence of these changes in schizophrenia by comparing the smooth pursuit eye movement latency, fixed amplitude saccade latency and symmetry of optokinetic nystagmus using the electronystagmogram among Filipino patients diagnosed with schizophrenia, their siblings without schizophrenia and controls who were neither related to the patient nor diagnosed with schizophrenia. Methods: Included were twenty patients 18-40 years old diagnosed of schizophrenia based on the DSM-IV Criteria, their siblings and twenty controls. All subjects underwent electronystagmography at the Ear Center, University of Santo Tomas Hospital where the following were measured: fixed amplitude saccade latency; horizontal smooth pursuit latency and symmetry of optokinetic nystagmus. The values obtained were then analyzed using paired t-test and two way ANOVA. Results: There was a significant difference in the latency of the fixed amplitude saccade and horizontal smooth pursuit among the three groups. PAtients with schizophrenia had the most delayed latency followed by their siblings. No delay was noted in controls. Significant asymmetry of the optokinetic nystagmus in schizophrenic patients was noted. Abnormalities present in the healthy siblings of patients indicated their latent vulnerability towards this disease. Conclusion: The findings of the study further strengthened the anatomical substrate of schizophrenia. These eye movement abnormalities are localized in the parietal and frontal cortex. These are the same areas that are necessary for attentional symmetry, for minimizing distractibility and maintaining the focus of attention on task relevant stimuli which are impaired in patients with schizophrenia.

Progress towards early detection services for infants with hearing loss in developing countries.

BACKGROUND: Early detection of infants with permanent hearing loss through infant hearing screening is recognised and routinely offered as a vital component of early childhood care in developed countries. This article investigates the initiatives and progress towards early detection of infants with hearing loss in developing countries against the backdrop of the dearth of epidemiological data from this region. METHODS: A cross-sectional, descriptive study based on responses to a structured questionnaire eliciting information on the nature and scope of early hearing detection services; strategies for financing services; parental and professional attitudes towards screening; and the performance of screening programmes. Responses were complemented with relevant data from the internet and PubMed/Medline. RESULTS: Pilot projects using objective screening tests are on-going in a growing number of countries. Screening services are provided at public/private hospitals and/or community health centres and at no charge only in a few countries. Attitudes amongst parents and health care workers are typically positive towards such programmes. Screening efficiency, as measured by referral rate at discharge, was generally found to be lower than desired but several programmes achieved other international benchmarks. Coverage is generally above 90% but poor follow-up rates remain a challenge in some countries. The mean age of diagnosis is usually less than six months, even for community-based programmes. CONCLUSION: Lack of adequate resources by many governments may limit rapid nationwide introduction of services for early hearing detection and intervention, but may not deter such services altogether. Parents may be required to pay for services in some settings in line with the existing practice where healthcare services are predominantly financed by out-of-pocket spending rather than public funding. However, governments and their international development partners need to complement current voluntary initiatives through systematic scaling-up of public awareness and requisite manpower development towards sustainable service capacities at all levels of healthcare delivery.