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2.
BMC Public Health ; 20(1): 254, 2020 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-32075630

RESUMO

BACKGROUND: Meningococcal serogroup A conjugate vaccine (MACV) was introduced in 2017 into the routine childhood immunization schedule (at 15-18 months of age) in Burkina Faso to help reduce meningococcal meningitis burden. MACV was scheduled to be co-administered with the second dose of measles-containing vaccine (MCV2), a vaccine already in the national schedule. One year following the introduction of MACV, an assessment was conducted to qualitatively examine health workers' perceptions of MACV introduction, identify barriers to uptake, and explore opportunities to improve coverage. METHODS: Twelve in-depth interviews were conducted with different cadres of health workers in four purposively selected districts in Burkina Faso. Districts were selected to include urban and rural areas as well as high and low MCV2 coverage areas. Respondents included health workers at the following levels: regional health managers (n = 4), district health managers (n = 4), and frontline healthcare providers (n = 4). All interviews were recorded, transcribed, and thematically analyzed using qualitative content analysis. RESULTS: Four themes emerged around supply and health systems barriers, demand-related barriers, specific challenges related to MACV and MCV2 co-administration, and motivations and efforts to improve vaccination coverage. Supply and health systems barriers included aging cold chain equipment, staff shortages, overworked and poorly trained staff, insufficient supplies and financial resources, and challenges with implementing community outreach activities. Health workers largely viewed MACV introduction as a source of motivation for caregivers to bring their children for the 15- to 18-month visit. However, they also pointed to demand barriers, including cultural practices that sometimes discourage vaccination, misconceptions about vaccines, and religious beliefs. Challenges in co-administering MACV and MCV2 were mainly related to reluctance among health workers to open multi-dose vials unless enough children were present to avoid wastage. CONCLUSIONS: To improve effective administration of vaccines in the second-year of life, adequate operational and programmatic planning, training, communication, and monitoring are necessary. Moreover, clear policy communication is needed to help ensure that health workers do not refrain from opening multi-dose vials for small numbers of children.


Assuntos
Atitude do Pessoal de Saúde , Programas de Imunização/organização & administração , Meningite Meningocócica/prevenção & controle , Vacinas Meningocócicas/administração & dosagem , Neisseria meningitidis Sorogrupo A , Burkina Faso , Humanos , Esquemas de Imunização , Lactente , Vacinas Conjugadas
3.
J Infect Dis ; 220(220 Suppl 4): S233-S243, 2019 10 31.
Artigo em Inglês | MEDLINE | ID: mdl-31671442

RESUMO

BACKGROUND: After successful meningococcal serogroup A conjugate vaccine (MACV) campaigns since 2010, Burkina Faso introduced MACV in March 2017 into the routine Expanded Programme for Immunization schedule at age 15-18 months, concomitantly with second-dose measles-containing vaccine (MCV2). We examined MCV2 coverage in pre- and post-MACV introduction cohorts to describe observed changes regionally and nationally. METHODS: A nationwide household cluster survey of children 18-41 months of age was conducted 1 year after MACV introduction. Coverage was assessed by verification of vaccination cards or recall. Two age groups were included to compare MCV2 coverage pre-MACV introduction (30-41 months) versus post-MACV introduction (18-26 months). RESULTS: In total, 15 925 households were surveyed; 7796 children were enrolled, including 3684 30-41 months of age and 3091 18-26 months of age. Vaccination documentation was observed for 86% of children. The MACV routine coverage was 58% (95% confidence interval [CI], 56%-61%) with variation by region (41%-76%). The MCV2 coverage was 62% (95% CI, 59%-65%) pre-MACV introduction and 67% (95% CI, 64%-69%) post-MACV introduction, an increase of 4.5% (95% CI, 1.3%-7.7%). Among children who received routine MACV and MCV2, 93% (95% CI, 91%-94%) received both at the same visit. Lack of caregiver awareness about the 15- to 18-month visit and vaccine unavailability were common reported barriers to vaccination. CONCLUSIONS: A small yet significant increase in national MCV2 coverage was observed 1 year post-MACV introduction. The MACV/MCV2 coadministration was common. Findings will help inform strategies to strengthen second-year-of-life immunization coverage, including to address the communication and vaccine availability barriers identified.


Assuntos
Meningite Meningocócica/epidemiologia , Meningite Meningocócica/prevenção & controle , Vacinas Meningocócicas/administração & dosagem , Neisseria meningitidis Sorogrupo A/imunologia , Vacinas Conjugadas/administração & dosagem , Adolescente , Adulto , Feminino , Humanos , Programas de Imunização , Esquemas de Imunização , Lactente , Masculino , Vacinação em Massa , Meningite Meningocócica/microbiologia , Vacinas Meningocócicas/imunologia , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Cobertura Vacinal , Vacinas Conjugadas/imunologia , Adulto Jovem
4.
Opt Express ; 27(18): 25515-25530, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31510423

RESUMO

We study the optical transmission characteristics of coupled spinning optomechanical resonators with pump-probe driven lasers. Under the steady-state conditions, we focus on how changing the optical Sagnac effect due to same or opposite spinning directions of the resonators can give rise to non-reciprocal and delayed probe light transmission. We find that coupled resonators can exhibit distinct transmission features, can generate negative group delays (slow as well as fast light) and offer additional control of the probe light transmission as compared to the case of a single spinning resonator. Our results can be useful in achieving chiral light propagation in quantum communication technologies without using traditional magneto-optical means.

5.
Pak J Pharm Sci ; 32(6): 2751-2756, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31969311

RESUMO

Avian influenza or bird flu is a common problem of domestic and wild birds. Some of its strains are able to cross the species barrier and cause infection in various members of class Mammalia. In view of relatively lesser efficacy of vaccines, antiviral therapies remain the only choice for the sustenance of mammals acquiring this highly devastating infection. This study is based on the evaluation of antiviral potential of methanol extracts of eleven selected Cholistani plants. The methanol extracts were prepared by using dried plants material followed by concentrating in a rotary evaporator and finally air dried before dissolving in nanopure water. The suspension was filter sterilized and subjected to in ovo antiviral assays. The allantoic fluids were harvested and haemagglutinin (HA) titers were determined. Among the eleven plants evaluated all methanol extracts were found effective against AIV H9N2 except S. baryosma extract. The medicinal plants O. compressa, N. procumbens, and S. surattense were found to be more effective than others and they retained HA titers at 0 after challenge. The next in order were extracts of O. esculentum, H. salicornicum and S. fruticosa which kept HA titers at 4, 8 and 16 respectively. The extracts of H. recurvum, P. antidotale, S. icolados and A. aspera were found less effective than above mentioned plant extracts and they kept the HA titers at 32, 64, 128 and 256 respectively. These results led us to conclude that the medicinal plants of Cholistan region are a rich source of antiviral agent(s) against AIV H9N2 and could be a source of cost effective alternate therapeutics.


Assuntos
Antivirais/farmacologia , Extratos Vegetais/farmacologia , Plantas Medicinais/química , Animais , Antivirais/isolamento & purificação , Galinhas/virologia , Etnobotânica , Testes de Hemaglutinação , Influenza Aviária/tratamento farmacológico , Influenza Aviária/virologia , Paquistão , Extratos Vegetais/isolamento & purificação , Doenças das Aves Domésticas/tratamento farmacológico , Doenças das Aves Domésticas/virologia
6.
Arch Pathol Lab Med ; 142(10): 1223-1232, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30124328

RESUMO

CONTEXT.­: The health care industry is growing rapidly and is continually seeking more-innovative ways to deliver patient care. The growing demands of clinicians seeking faster and more-efficient ways of providing care to their patients presents challenges to clinical laboratory services. Point-of-care testing (POCT) is frequently seen as a viable solution to address this dilemma. The role of POCT is widely established and accepted in many circumstances provided certain criteria are met. OBJECTIVES.­: To discuss the Cleveland Clinic Abu Dhabi experience-the challenges faced and the solutions found-during the process of establishing a POCT service in a greenfield hospital, and to share this experience to support health care professionals wishing to establish or expand POCT services. DATA SOURCE.­: First-hand expert opinion relating to setting up a POCT service, which was guided and informed by national and international standards and regulatory bodies, provide the basis for this review. CONCLUSIONS.­: Point-of-care testing is a fast growing and unique discipline of pathology. The establishment of a new POCT service creates distinctive and unique challenges compared with traditional laboratory services. The difficulties experienced are compounded in a greenfield hospital but the process of multidisciplinary collaboration and information exchange among peer groups allows the efficient development of a highly effective POCT department.


Assuntos
Testes Imediatos/organização & administração , Hospitais , Humanos , Ohio , Emirados Árabes Unidos
7.
Arch Pathol Lab Med ; 142(9): 1036-1046, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30141989

RESUMO

CONTEXT: - The Department of Anatomic Pathology is a division of the Pathology & Laboratory Medicine Institute at Cleveland Clinic Abu Dhabi. The hospital offers the same model of care as its US-based counterpart the Cleveland Clinic, established in 1921 in Cleveland, Ohio. Pathology services at Cleveland Clinic are internationally acclaimed: the endeavor for Cleveland Clinic Abu Dhabi was to create a parallel facility, with the same standards in a greenfield start-up environment. OBJECTIVE: - To narrate how we addressed challenges customary in any laboratory start-up and issues distinctive to our setting with the aim to provide a model for others involved in a similar undertaking. DATA SOURCES: - All information in this article is based on published literature obtained by search on internet-based search engines, Clinical and Laboratory Standards Institute, and the authors' firsthand experience. CONCLUSIONS: - Key considerations in establishing an anatomic pathology laboratory are careful planning and design, adherence to local and international regulatory standards, selection of equipment and supplies, appropriate staffing, development of a laboratory information system, and sound test validation. In addition to meeting our clinical needs, alliance with the US Cleveland Clinic had an integral role in establishing our laboratory and regional reputation.


Assuntos
Serviços de Laboratório Clínico/organização & administração , Patologia Clínica/organização & administração , Humanos , Ohio , Emirados Árabes Unidos
9.
Arch Pathol Lab Med ; 142(9): 1023-1035, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30141998

RESUMO

CONTEXT: - This review chronicles the establishment of a clinical laboratory in Cleveland Clinic Abu Dhabi, a greenfield tertiary/quaternary care hospital in the United Arab Emirates. It discusses the challenges faced, solutions sought, and lessons learned and shares insights and pitfalls that may be encountered in such an undertaking. OBJECTIVES: - To share our experience in building a clinical laboratory in a start-up, multispecialty hospital and how we provided support and managed people, processes, and technology for building and making operational the Cleveland Clinic Abu Dhabi. DATA SOURCES: - The Medline (PubMed, National Center for Biotechnology Information, Bethesda, Maryland) database was used to review this topic as well as other journals, books, and Google (Mountain View, California) search engine. CONCLUSIONS: - To deliver on the promise of quality healthcare in a culturally appropriate setting close to home, Cleveland Clinic Abu Dhabi proved to be an unprecedented and ambitious project, jointly carried out by Mubadala Investment Corporation and the Cleveland Clinic Foundation. Cognizant of the scale of this task, hospital leadership engaged closely with staff and stakeholders through motivational techniques and effective communication. Excellent project planning and execution of complex tasks were required for initiation of services. Establishing the clinical laboratory served as an instructive model in fostering multidisciplinary teamwork by highlighting ways to manage operational roadblocks and opportunities in the planning, commissioning, and activation phases. Throughout the activation process, all efforts were directed to create a patient-safety culture within an intentional-learning organization.


Assuntos
Serviços de Laboratório Clínico/organização & administração , Assistência à Saúde/organização & administração , Patologia Clínica/organização & administração , Hospitais , Humanos , Ohio , Emirados Árabes Unidos
10.
Arch Pathol Lab Med ; 142(10): 1233-1241, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30102069

RESUMO

CONTEXT.­: Opening a new hospital is a once in a lifetime experience and can be very inspiring for those involved in its activation. However, establishing a safe transfusion practice in a greenfield environment comes with unique challenges and opportunities. OBJECTIVE.­: To highlight critical activation components such as on-boarding of new personnel, establishing clinical practices, and integrating critical laboratory software. DESIGN.­: Our staff initially faced challenges in standardizing transfusion medicine clinical practice inside the laboratory. Our efforts were mainly focused on the appropriate use of various transfusion orders, creating comprehensive policies for type and screening, cost effective utilization of blood products, and establishment of the maximum surgical blood order schedule. The transfusion service was launched with 2 information technology programs that separately facilitated steps in the transfusion process, but did not provide centralized access to the entire process. In these circumstances, we partnered with the laboratory information system team to create a series of interfaces that streamlined each system's functionality and implemented the existing infrastructure with upgrades that enable remote location and management of blood products. RESULTS.­: The transfusion medicine team spent more than a year training and monitoring workflows to avoid individual variations between technologists and to adopt our own standards of practice. Participation in a structured training plan was also necessary between clinical caregivers to know the safe and efficient use of these standards. CONCLUSIONS.­: Although laboratory and clinical staff are knowledgeable in care delivery, it is always a learning experience to establish a new system because of the natural tendency of resorting to previous practices and resistance to new approaches.


Assuntos
Medicina Transfusional/organização & administração , Hospitais , Humanos , Ohio , Emirados Árabes Unidos
11.
Vaccine ; 36(23): 3260-3268, 2018 05 31.
Artigo em Inglês | MEDLINE | ID: mdl-29731113

RESUMO

BACKGROUND: Delivering vaccination services during the second year of life (2YL)1 provides countries with an opportunity to achieve greater coverage, to provide booster doses and vaccines missed during the first year of life, as well as contribute towards disease control and elimination goals. METHODS: Using data from demographic health surveys (DHSs) conducted during 2010 to 2016, this paper explores the proportion of missed opportunities for vaccinations generally provided during routine immunization among children in their 2YL. RESULTS: DHS data in 46 countries surveyed 478,737 children, from which 169,259 children were 12-23 months old and had vaccination/health cards viewed by surveyors. From this group, 69,489 children aged 12-23 months had contact with health services in their 2YL. Three scenarios for a missed opportunity for vaccinations were analysed: (1) a child received one vaccine in the immunization schedule and was eligible for another vaccine, but did not receive any further vaccination, (2) a child received a vitamin A supplementation (VAS) and was due for a vaccine, but did not receive vaccines that were due, and (3) a child was taken to a health facility for a sick visit and was due (and eligible) for a vaccine, but did not receive the vaccine. A total of 16,409 (24%) children had one or more missed opportunities for vaccinations. CONCLUSION: This analysis highlights the magnitude of the problem of missed opportunities in the 2YL. The global community needs to provide better streamlined guidance, policies and strategies to promote vaccination screenings at well-child and sick child visits in the 2YL. Where they do not exist, well-child visits in the 2YL should be established and strengthened.


Assuntos
Programas de Imunização/estatística & dados numéricos , Esquemas de Imunização , África , Ásia Sudeste , Europa (Continente) , Inquéritos Epidemiológicos , Humanos , Lactente , Vitamina A/administração & dosagem
12.
Int J Infect Dis ; 70: 36-37, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29452247

RESUMO

In this case, we report an elderly patient with multiple chronic conditions and prolonged intensive care unit (ICU) stays who had recurrent Candida auris (C. auris) in blood despite antifungal therapy. C. auris was misidentified using conventional automated identification system as Candida haemulonii resulting in delayed diagnosis. The isolate showed increasing minimum inhibitory concentrations (MICs) to different antifungal drugs and persisted in the patient's blood before the patient deceased. This is the first case of C. auris reported from the United Arab Emirates (UAE); laboratories should be aware of this Candida species and should confirm suspected cases since it is an emerging multi-drug resistant and health-care associated Candida.


Assuntos
Antifúngicos/administração & dosagem , Antifúngicos/uso terapêutico , Candida/isolamento & purificação , Candidemia/tratamento farmacológico , Candidemia/microbiologia , Candidíase/tratamento farmacológico , Candidíase/microbiologia , Farmacorresistência Fúngica/efeitos dos fármacos , Idoso de 80 Anos ou mais , Antifúngicos/efeitos adversos , Antifúngicos/farmacologia , Candidíase/sangue , Erros de Diagnóstico , Feminino , Humanos , Testes de Sensibilidade Microbiana , Especificidade da Espécie , Emirados Árabes Unidos
13.
Arch Pathol Lab Med ; 142(9): 1047-1053, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-28857610

RESUMO

CONTEXT: - This review examines challenges and opportunities in preparing laboratories in a startup phase for accreditation by both the College of American Pathologists (CAP) and International Organization for Standardization (ISO) 15189 in an international setting as it relates to our experience at Cleveland Clinic Abu Dhabi Laboratory. It also discusses some of the strategies used in executing those projects and the added advantages in pursuing both types of accreditations. OBJECTIVES: - To share our experience with CAP and ISO 15189 accreditations in a startup international operation in relation to the challenges encountered and implementation strategy success factors. DATA SOURCES: - MEDLINE (PubMed) database was used to review this topic as well as peer-reviewed articles and World Health Organization publications on the topic. CONCLUSIONS: - Accreditation is a perfect means toward building quality medical laboratories in a diverse workforce environment and improving patient safety. Further, it establishes a strong foundation on which any new operation can build a sustainable quality improvement culture. Accreditations by CAP and/or ISO are among the most reputable and well-established accreditation systems that clinical laboratories could aim for. As a result of both accreditations offering synergistic and complementing features, we recommend that any laboratory seeking excellence in quality and performance should consider exploring both. Key elements to success include having dedicated project management and change management support while preparing for accreditation. Laboratories seeking accreditation in early operational stages may face a number of challenges; however, significant opportunities will also be present to optimize various operational components from the beginning.


Assuntos
Acreditação/métodos , Acreditação/normas , Serviços de Laboratório Clínico/normas , Patologia Clínica/normas , Humanos , Emirados Árabes Unidos
14.
Pak J Pharm Sci ; 30(5(Supplementary)): 2025-2029, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29105639

RESUMO

Tuberculosis (TB) is a life threatening infectious disease which is prevalent throughout the world. Mycobacterium bovis based Bacille Calmette-Gue´rin (BCG) is the only vaccine available against TB however, this (single) vaccine is not enough to eradicate it. Furthermore, numbers of researches from different parts of the World have shown its efficacy as variable. Hence other (better) vaccines like DNA vaccines are needed in addition to BCG in order to achieve desired goal of TB eradication. The current study was aimed to develop subunit based DNA vaccines against TB and to check their efficacy. Two constructs Bfrb-pND14 and Mpt32-pND14 were made and used as DNA vaccines. Endotoxin free DNA preparations were made and used in immunization studies. Twenty Balb/c female mice of age eight weeks were used in trial. Two experimental groups each comprising eight animals were used to inoculate Mpt32-pND14 and Bfrb-pND14 vaccines respectively. A group of four animals was used as negative control. Animals were bled through tail periodically and finally through cardiac puncture before euthanization. Antibodies were confirmed through dot blot and Agar Gel Immuno Diffusion test (AGID). All the animals immunized with both vaccines were found positive as tested through dot blot and AGID. The results of this study have indicated that both the M. tb genes have produced strong immune response in mice model through pND14 vector and proved themselves as good subunit based DNA vaccines.


Assuntos
Proteínas de Bactérias/administração & dosagem , Ferritinas/administração & dosagem , Mycobacterium tuberculosis/genética , Vacinas contra a Tuberculose/administração & dosagem , Tuberculose/prevenção & controle , Vacinas de DNA/administração & dosagem , Animais , Anticorpos Antibacterianos/sangue , Proteínas de Bactérias/genética , Proteínas de Bactérias/imunologia , Feminino , Ferritinas/genética , Ferritinas/imunologia , Imunização , Imunogenicidade da Vacina , Camundongos Endogâmicos BALB C , Mycobacterium tuberculosis/imunologia , Tuberculose/imunologia , Tuberculose/microbiologia , Vacinas contra a Tuberculose/imunologia , Vacinas de DNA/imunologia
15.
Int J Infect Dis ; 62: 39-43, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28610832

RESUMO

OBJECTIVE: This study compared the activity of ceftolozane-tazobactam and ceftazidime-avibactam against 120 bacterial strains, including extended-spectrum beta-lactamase (ESBL) producers, carbapenem-resistant Enterobacteriaceae (CRE), and Pseudomonas aeruginosa, isolated from patients admitted to Cleveland Clinic Abu Dhabi, United Arab Emirates. METHODS: In vitro susceptibility was tested using the Etest strip minimum inhibitory concentration (MIC) method, and PCR was used to characterize the carbapenemase enzymes produced by CRE strains. RESULTS: All 29 ESBL isolates were susceptible to ceftazidime-avibactam (MIC50 0.125µg/ml), whereas all but one were susceptible to ceftolozane-tazobactam (MIC50 0.38µg/ml). Twenty-seven (45%) CRE isolates were susceptible to ceftazidime-avibactam (MIC50 ≥256µg/ml), whereas only six (10%) isolates were susceptible to ceftolozane-tazobactam (MIC50 ≥256µg/ml). Very few NDM-1 isolates were susceptible to ceftazidime-avibactam, whereas the majority of OXA-48 isolates were susceptible. Twenty-nine (94%) P. aeruginosa isolates were susceptible to ceftazidime-avibactam (MIC50 1.5µg/ml), whereas 30 (97%) isolates were susceptible to ceftolozane-tazobactam (MIC50 0.75µg/ml). CONCLUSIONS: Ceftolozane-tazobactam and ceftazidime-avibactam showed comparable activity against ESBL and P. aeruginosa, with ceftazidime-avibactam having lower MICs against ESBL isolates and ceftolozane-tazobactam having lower MICs against P. aeruginosa. Ceftazidime-avibactam showed better activity against all CRE isolates except for those carrying the NDM-1 enzyme.


Assuntos
Antibacterianos/farmacologia , Compostos Azabicíclicos/farmacologia , Ceftazidima/farmacologia , Cefalosporinas/farmacologia , Escherichia coli/efeitos dos fármacos , Ácido Penicilânico/análogos & derivados , Pseudomonas aeruginosa/efeitos dos fármacos , Combinação de Medicamentos , Farmacorresistência Bacteriana , Humanos , Klebsiella pneumoniae/efeitos dos fármacos , Testes de Sensibilidade Microbiana , Ácido Penicilânico/farmacologia , Tazobactam , Emirados Árabes Unidos
16.
Opt Lett ; 41(11): 2422-5, 2016 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-27244379

RESUMO

We theoretically investigate the emission spectrum of an optomechanical Tavis-Cummings model: two dipole-dipole interacting atoms coupled to an optomechanical cavity (OMC). In particular, we study the influence of dipole-dipole interaction (DDI) on the single-photon spectrum emitted by this hybrid system in the presence of a strong atom-cavity as well as strong optomechanical interaction (hereafter called the strong-strong coupling). We also show that our analysis is amenable to inclusion of the mechanical losses (under the weak mechanical damping limit) and single-photon loss through spontaneous emission from the two-level emitters under a nonlocal Lindblad model.

17.
Leuk Res ; 45: 47-52, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-27092851

RESUMO

Most guidelines suggest that only the bone marrow aspirate (BMA) is necessary to assess residual disease following intensive chemotherapy for Acute Myeloid Leukemia (AML) with the bone marrow trephine biopsy (BMTB) recommended in cases of a poor quality BMA. We performed a retrospective study evaluating this in a cohort of patients receiving intensive chemotherapy for AML. Residual disease was assessed by morphological examination of the BMA and BMTB±immunohistochemistry. Of the 647 marrows 32.6% were interim marrows performed prior to peripheral count recovery, 41.7% were end of induction (EOI) marrows and the remaining were 'other marrows'. The BMA and BMTB findings were concordant in 92.8% of cases. The BMTB led to a change in diagnosis from 'no leukemia' to 'residual leukemia' in 5.2% of interim, 3.7% of EOI and 2.4% of 'other' marrows. The BMA alone had a sensitivity of 86.8% in detecting residual leukemia and of 82.3%, 82.5% and 94.2% for interim, EOI and 'other marrows', respectively. Despite the high concordance between the BMA and the BMTB the poor sensitivity of the BMA in detecting residual leukemia, particularly at EOI, may lead to an overestimation of the complete remission rates which may have therapeutic and clinical trial implications.


Assuntos
Biópsia/métodos , Exame de Medula Óssea/normas , Leucemia Mieloide Aguda/diagnóstico , Neoplasia Residual/diagnóstico , Adolescente , Adulto , Idoso , Biópsia/normas , Biópsia por Agulha , Estudos de Coortes , Feminino , Humanos , Imuno-Histoquímica , Leucemia Mieloide Aguda/tratamento farmacológico , Leucemia Mieloide Aguda/patologia , Masculino , Pessoa de Meia-Idade , Neoplasia Residual/patologia , Estudos Retrospectivos , Sensibilidade e Especificidade , Adulto Jovem
18.
Parasit Vectors ; 8: 415, 2015 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-26259616

RESUMO

BACKGROUND: Surra, a vector borne disease caused by Trypanosoma (T.) evansi, affects the health, productivity and working capacity of camels. Since clinical signs are not pathognomonic, diagnosis must be confirmed by laboratory methods. This is a first study on the prevalence of surra in Cholistan Desert, Pakistan using a broad variety of diagnostic tests thereby emphasizing it as a risk for the dromedaries of Pakistan. METHODS: In a cross sectional study, 1005 dromedary camels from three districts in the Cholistan Desert were sampled to assess the prevalence of trypanosomosis due to T. evansi by means of parasitological (Giemsa stained thin smear), serological (formol gel test, CATT/T. evansi, ELISA/VSG RoTat 1.2, immune trypanolysis) and molecular tests (TBR1/2 PCR and RoTat 1.2 PCR). Kappa was calculated to assess the degree of agreement between different tests whereas chi-square test along with odds ratios and their 95% confidence intervals were used to study influence of breed, gender, age and locality on disease prevalence. RESULTS: Overall prevalence was 0.7% with Giemsa stained thin smears (GST), 40.1% with formol gel test (FGT), 47.7% with CATT/T. evansi, 44.2% with ELISA/VSG RoTat 1.2, 39.9 % with immune trypanolysis (TL), 31.9 % with TBR1/2 PCR and 30.5% with RoTat1.2 PCR. Based on these results, the Cholistan Desert appears to be a high risk area for surra. According to TL and TBR1/2 PCR, camels at Bahawalpur are approximately two times more likely to be infected than those in Bahawalnagar (OR = 1.8; 95% CI: 1.38-2.42) and Rahim Yar Khan (OR = 1.9; 95% CI: 1.30-2.75). Test agreement of TL was moderate with CATT/T. evansi (k = 0.43; 95% CI: 0.378-0.489) and ELISA/VSG RoTat 1.2 (k = 0.54; 95% CI: 0.489-0.594) and poor with the other tests. Test agreement between TBR1/2 PCR and RoTat1.2 PCR was almost perfect (k = 0.96; 95% CI: 0.950-0.984). We didn't find evidence for the presence of T. evansi type B in the studied population. CONCLUSION: Our study supports using antibody detection tests, rather than parasitological and molecular examination, to assess surra prevalence in camels. It also calls for implementation of measures to control surra in the Cholistan Desert.


Assuntos
Camelus/parasitologia , Trypanosoma/isolamento & purificação , Tripanossomíase/veterinária , Animais , Antígenos de Protozoários/sangue , Camelus/sangue , Estudos Transversais , Clima Desértico , Ensaio de Imunoadsorção Enzimática , Feminino , Masculino , Paquistão/epidemiologia , Reação em Cadeia da Polimerase , Prevalência , Trypanosoma/genética , Trypanosoma/imunologia , Tripanossomíase/sangue , Tripanossomíase/epidemiologia , Tripanossomíase/parasitologia
19.
Cardiol Res ; 6(3): 292-296, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28197244

RESUMO

Heart tumors are rare occurrences. They can present diagnostic challenges and severe complications especially in pregnant women. We report a rare case of angiosarcoma (AS) cordis of the right atrium in a young healthy pregnant female. Her diagnosis remained elusive for some time until development of advanced disease symptomatology. The diagnosis was unfortunately clinched when her tumor grew to be detected by imaging modalities. An emergency cesarean section was performed delivering a healthy baby. The patient was aggressively treated with chemotherapy to no avail. She passed away 2 months after her diagnosis was established. Only few cases of the occurrence of aggressive cardiac AS and human pregnancy are documented. The course of this disastrous combination is usually marked by severe complications, difficult therapeutic options and ultimately fast demise. Physicians need to be more aware of such diagnosis and diligently try to diagnose it as early as possible.

20.
J Infect Dis ; 205 Suppl 1: S126-33, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-22315380

RESUMO

Somalia, one of the most unstable countries in the world, has been without a permanent government for nearly 2 decades. With a health system in total disarray, coverage of basic health interventions remains low and, maternal and child mortality is among the highest in the world. Health partners jointly outlined an integrated package of critical child survival interventions to be delivered through a population-based delivery strategy known as Child Health Days (CHDs), to reduce child mortality. Using this strategy, key child survival interventions are delivered to the community with an objective of reaching children <5 years and women of childbearing age in all districts of Somalia every 6 months. Through this strategy, immunization services were reached in remote areas, and coverage disparity between the urban and rural areas was reduced from 17% (42% urban and 25% rural) to 10% (50% urban and 60% rural). In addition, infants were reached with a third dose of diphtheria-pertussis-tetanus vaccine, achieving 51% coverage during 2009 and 66% in 2010. This paper summarizes the challenges of scaling up child interventions in the troubled context of Somalia by reviewing the planning, implementation, and achievements of CHDs as well as reflecting on challenges for the future of child survival in Somalia.


Assuntos
Serviços de Saúde da Criança , Pré-Escolar , Vacina contra Difteria, Tétano e Coqueluche/imunologia , Humanos , Imunização , Lactente , Recém-Nascido , Vacina contra Sarampo/imunologia , Somália
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