Negligible risk of inducing resistance in Mycobacterium tuberculosis with single-dose rifampicin as post-exposure prophylaxis for leprosy

Post-exposure prophylaxis (PEP) for leprosy is administered as one single dose of rifampicin (SDR) to the contacts of newly diagnosed leprosy patients. SDR reduces the risk of developing leprosy among contacts by around 60 % in the first 2-3 years after receiving SDR. In countries where SDR is currently being implemented under routine programme conditions in defined areas, questions were raised by health authorities and professional bodies about the possible risk of inducing rifampicin resistance among the M. tuberculosis strains circulating in these areas. This issue has not been addressed in scientific literature to date. To produce an authoritative consensus statement about the risk that SDR would induce rifampicin-resistant tuberculosis, a meeting was convened with tuberculosis (TB) and leprosy experts. The experts carefully reviewed and discussed the available evidence regarding the mechanisms and risk factors for the development of (multi) drug-resistance in M. tuberculosis with a view to the special situation of the use of SDR as PEP for leprosy. They concluded that SDR given to contacts of leprosy patients, in the absence of symptoms of active TB, poses a negligible risk of generating resistance in M. tuberculosis in individuals and at the population level. Thus, the benefits of SDR prophylaxis in reducing the risk of developing leprosy in contacts of new leprosy patients far outweigh the risks of generating drug resistance in M. tuberculosis

Hyperhomocysteinemia - An unidentified risk factor for stroke in our population

Introduction: Various studies show that moderate elevation of plasma homocysteine level has been associated with increased risk for cardiovascular and cerebrovascular disease. Objective: To observe the frequency of increased homocysteine level in ischemic stroke patients; and its association with other risk factors. Methodology: Observational pilot study was conducted on a sample of 75 ischemic stroke patients, enrolled regardless of their age, gender and comorbidities, at Ziauddin university hospital, Karachi. Fasting serum homocysteine, folate and vitamin B12 levels were measured. Results were interpreted using spss 20.0. Results and Discussion: Mean homocysteine level in our population was 19.51 (SD: 11.47)micromol/l. It was higher in groups with vitamin B12 and folic acid deficiency, difference being statistically significant (p=0.013 and 0.017, respectively). Males had greater propensity to hyperhomocysteinemia; the mean homocysteine value being higher, and the difference, statistically significant (p=0.010). Other factors that affect homocysteine levels were also evaluated, that is hypertension, increased cholesterol levels and smoking. There was no significant statistical difference in the homocysteine value between the groups of patients who had these risk factors and the groups that did not (p=0.747, 0.252 and 0.565, respectively). Conclusion: It was speculated that hyperhomocysteinemia is an imperative risk factor for stroke

Insecticide space spraying for preventing malaria transmission (Protocol)

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: Primary objective To evaluate the impact of space spraying on malaria transmission and vector populations, or the incremental impact when applied in combination with other malaria control methods, in comparison to equivalent conditions with no space spraying intervention. Secondary objective To guide future evaluations of strategies for which there is currently insufficient evidence to reliably assess the impact on malaria transmission, by identifying the following. The range of space spraying strategies that have been trialled. Potentially promising strategies that have been used and warrant further evaluation. Strategies that have been used and appear unlikely to warrant further evaluation (for example, because they were found to be infeasible or unacceptable)

Relationship between fear, fall & balance in cummunity dwelling older adults

Background: In older population the risk of fall is always at high risk and there are many contributing factor which increase the prevalence of fall. The impaired balance leads to limited daily activities and confidence level. Purpose of the study: The main purpose of this study was to determine the relationship between fall, fear and balance in older population. Method & methodology: The descriptive cross sectional study design was used and a sample of 271 older adult were recruited through purpose sampling technique. The detail demographic was noted, history of fall and other related co-morbidities were mention in performa. The standardized test Activity based confidence scale (ABC) and Time up & go (TUG) were used for proper assessment. Results: The result shows that 72% sample were composed of females and 28% were male. Majority 71% belong to age bracket 65-74 years and 79% have no history of fall. Only 19% have high level of physical function on confidence scale, 36% and 45 % were in moderate and low level of physical functioning respectively. The ralationship shows that the older adults who have impaire mobility on TUG have 30% (82) and 11.43% (31) low and moderate level of physical functioning on ABC scale respectively. Conclusions: The findings indicate that majority of older adults have no fall history but still most of them have low level of confidence & physical functioning on ABC scale. The confidence balance is associated with the physical functioning in older adults and need to improve the balance training for proper functioning

Music therapy for people with substance use disorders (Protocol)

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: Main objective To assess the effects of music therapy, as a primary or a supportive intervention, compared to standard care, wait-list control or no treatment, for people with substance use disorders, to reduce substance use,the severity of substance dependence/abuse, psychological symptoms, and substance craving; to enhance motivation for change/treatment; and for retention in treatment. Secondary objective To assess the impact of the number of music therapy sessions on study outcome

Intervention Program based on Virtual Reality for Pediatric Burns

In this study, we propose an intervention program based on virtual reality (VR) for the treatment of pediatric patients who have suffered from burns, based on the scientific contributions that have shown the effectiveness of VR at reducing the pain caused by injuries. The program is structured in two phases: I) Information/Preparation. The process and expected effects will be explained to patients; and II) Intervention. In this phase, in order to observe the differential effects of virtual reality, patients will be divided into two groups: Group a) will receive training on imagination/distraction techniques and Group b) will be treated with VR. Based on the emotional effect caused by burns, the application of VR technology is expected to reduce the anxiety which young patients experience, favoring control and pain management during medical procedures and avoiding anticipation of pain

Interventions for the treatment of oral and oropharyngeal cancers: surgical treatment.

BACKGROUND: Surgery is an important part of the management of oral cavity cancer with regard to both the removal of the primary tumour and removal of lymph nodes in the neck. Surgery is less frequently used in oropharyngeal cancer. Surgery alone may be treatment for early stage disease or surgery may be used in combination with radiotherapy, chemotherapy and immunotherapy/biotherapy. There is variation in the recommended timing and extent of surgery in the overall treatment regimens of people with these cancers. OBJECTIVES: To determine which surgical treatment modalities for oral cavity and oropharyngeal cancers result in increased overall survival, disease free survival, progression free survival and reduced recurrence. SEARCH STRATEGY: The following electronic databases were searched: the Cochrane Oral Health Group Trials Register (to 17 February 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 1), MEDLINE via OVID (1950 to 17 February 2011) and EMBASE via OVID (1980 to 17 February 2011). There were no restrictions regarding language or date of publication. SELECTION CRITERIA: Randomised controlled trials where more than 50% of participants had primary tumours of the oral cavity or oropharynx, and which compared two or more surgical treatment modalities or surgery versus other treatment modalities. DATA COLLECTION AND ANALYSIS: Data extraction and assessment of risk of bias was undertaken independently by two or more review authors. Study authors were contacted for additional information as required. Adverse events data were collected from published trials. MAIN RESULTS: Seven trials (n = 669; 667 with cancers of the oral cavity) satisfied the inclusion criteria, but none were assessed as low risk of bias. Trials were grouped into three main comparisons. Four trials compared elective neck dissection (ND) with therapeutic neck dissection in patients with oral cavity cancer and clinically negative neck nodes, but differences in type of surgery and duration of follow-up made meta-analysis inappropriate. Three of these trials reported overall and disease free survival. One trial showed a benefit for elective supraomohyoid neck dissection compared to therapeutic ND in overall and disease free survival. Two trials found no difference between elective radical ND and therapeutic ND for the outcomes of overall survival and disease free survival. All four trials found reduced locoregional recurrence following elective ND.A further two trials compared elective radical ND with elective selective ND and found no difference in overall survival, disease free survival or recurrence. The final trial compared surgery plus radiotherapy to radiotherapy alone but data were unreliable because the trial stopped early and there were multiple protocol violations.None of the trials reported quality of life as an outcome. Two trials, evaluating different comparisons reported adverse effects of treatment. AUTHORS' CONCLUSIONS: Seven included trials evaluated neck dissection surgery in patients with oral cavity cancers. The review found weak evidence that elective neck dissection of clinically negative neck nodes at the time of removal of the primary tumour results in reduced locoregional recurrence, but there is insufficient evidence to conclude that elective neck dissection increases overall survival or disease free survival compared to therapeutic neck dissection. There is very weak evidence from one trial that elective supraomohyoid neck dissection may be associated with increased overall and disease free survival. There is no evidence that radical neck dissection increases overall survival compared to conservative neck dissection surgery. Reporting of adverse events in all trials was poor and it was not possible to compare the quality of life of patients undergoing different surgeries

The effect of exercise on behavioural and psychological symptoms of dementia: the EVIDEM-E randomised controlled clinical trial.

OBJECTIVE: The objective of this study is to evaluate the effectiveness of a simple dyadic (person with dementia and their main carer) exercise regimen as a therapy for the behavioural and psychological symptoms of dementia. METHOD: A two arm, pragmatic, randomised, controlled, single-blind, parallel-group trial of a dyadic exercise regimen (individually tailored walking regimen designed to become progressively intensive and last between 20-30 min, at least five times per week).Community-dwelling individuals with ICD-10 confirmed dementia with the following: clinically significant behavioural and psychological symptoms, a carer willing and able to co-participate in the exercise regimen, and no physical conditions or symptoms that would preclude exercise participation were invited by mental health or primary care services into the study. RESULTS: One hundred and thirty-one dyads were recruited to this study. There was no significant difference in Behavioural and Psychological Symptoms as measured by the Neuropsychiatric Inventory at week 12 between the group receiving the dyadic exercise regimen and those that did not (adjusted difference in means (intervention minus control) = -1.53, p = 0.6, 95% CI [-7.37, 4.32]). There was a significant between-group difference in caregiver's burden as measured by the Zarit Caregiver Burden Inventory at week 12 (OR = 0.18, p = 0.01, CI [0.05, 0.69]) favouring the exercise group. CONCLUSIONS: This study found that regular simple exercise does not appear to improve the behavioural and psychological symptoms of dementia, but did seem to attenuate caregiver burden. Further study to improve exercise uptake are needed