Uso de la medicina tradicional y de la biomedicina por migrantes Q’ero en el distrito de San Sebastian, Cusco / Use of traditional medicine and biomedicine by Q\u27ero migrants in the district of San Sebastian, Cusco

An estimated 49% of the indigenous population of Latin America has migrated to cities in the past 50 years. In Peru, over 600,000 native Quechua speakers migrated to cities due solely to the terrorist conflicts of the 1980s. Many of these immigrants came from small towns with little to no infrastructure in terms of roads, schools, and hospitals or access to western biomedicine. In this study, semi-formal qualitative interviews were used to investigate whether migration from a small rural community to a city, specifically among the Queros people of Southern Peru, affected the use of traditional medicine and biomedicine. A combination of men and women who had migrated from small Queros communities to the city of Cusco and had been living in the city for varying lengths of time were interviewed, as well as a Queros shaman/healer and a doctor at the medical post of Santa Rosa, to which the interviewees were assigned through their public health insurance. The prevailing trend among the immigrants was that they would first try to cure themselves with traditionals medicinal plants and offerings to the earth, which was their only medical recourse in the rural communities, but in the city would then usually go directly to a pharmacy to buy pills rather than visiting a doctor. / Durante los últimos cincuenta años, un estimado 49% de la poblacion indigena en Latinoamérica ha migrado a las ciudades. En Perú, más que 600,000 personas Quechua-hablantes se mudaron a las ciudades solo por causa de los conflictos terroristas de los años 1980. Muchos de estos inmigrantes vienen de pueblos pequeños con muy poca infraestructura en términos de carreteras, escuelas, y acceso a la biomedicina occidental. En este estudio, entrevistas semi-formales cualitativas fueron conducidas para investigar si migración desde una comunidad rural pequeña a una ciudad, específicamente en la gente Queros del sur del Perú, afecta al uso de la medicina tradicional y la biomedicina. Una combinación de hombres y mujeres quienes habían migrado desde comunidades Queros pequeños a la ciudad de Cusco y habían estado varios periodos de tiempo en la ciudad fueron entrevistados, en conjunto con un chaman/curandero Queros y un doctor de la posta medica de Santa Rosa, a la cual pertenecían los entrevistados por su seguro médico público. La tendencia predominante entre los inmigrantes era que primero intentarían curarse con plantas medicinales tradicionales, lo cual era su único recurso en las comunidades rurales, pero en la ciudad irían después directo a una farmacia para comprar pastillas en vez de ir a un doctor

Post-mortem computed tomographic angiography in equine distal forelimbs: A feasibility study

In-depth understanding of pathophysiological processes occurring in the vasculature of the equine distal limb is of great importance to improve both diagnostic and therapeutic approaches to diseases. To gain further insights, a model allowing high-resolution 3D-visualization of the vasculature is necessary. This pilot study evaluated the feasibility of restoring vascular perfusion in frozen-thawed distal equine cadaver limbs without prior preparation using computer tomographic imaging (CT). Five frozen-thawed, radiographically normal forelimbs were perfused with a lipophilic contrast agent through the median artery and radial vein in three phases (arterial, venous, and arterial-venous combined (AVC) dynamic). For comparison, one additional limb was perfused with a hydrosoluble contrast agent. The CT-studies (16-slice MDCT, 140 kV, 200 mA, 2 mm slice thickness, 1 mm increment, pitch 0.688) were evaluated at 11 specified regions for visualization of the vasculature and presence of artifacts or anatomic variations. The protocol used in this study proved to be feasible and provided good visualization (93.1%) of vasculature with low rates of artifacts. During the different phases, vascular visualization was similar, but while filling defects decreased in the later phases, extravasation worsened in the 2 limbs where it was observed. Subjectively, the best quality of angiographic images was achieved during the AVC dynamic phase. Perfusion with hydrosoluble contrast resulted in significantly lower vascular visualization (74.0%) and higher artifact rates. This study shows that reperfusion of frozen-thawed equine distal limbs with a lipophilic contrast agent allows for high-quality 3D-visualization of the vasculature and may serve as a model for in situ vascular evaluation in the future

Secular Trend and Risk Factors for Antimicrobial Resistance in Escherichia coli Isolates in Switzerland 1997-2007

Abstract : Background: : Antibacterial resistance in Escherichia coli isolates of urinary infections, mainly to fluoroquinolones, is emerging. The aim of our study was to identify the secular trend of resistant E. coli isolates and to characterize the population at risk for colonization or infections with these organisms. Patients and Methods: : Retrospective analysis of 3,430 E.coli first isolates of urine specimens from patients admitted to the University Hospital Basel in 1997, 2000, 2003, and 2007. Results: : Resistance to ciprofloxacin, trimethoprim/sulfamethoxazole, and amoxicillin/clavulanate has increased over the 10-year study period (from 1.8% to 15.9%, 17.4% to 21.3%, and 9.5% to 14.5%, respectively). A detailed analysis of the 2007 data revealed that independent risk factors for ciprofloxacin resistance were age (5.3% 75 years; odds ratio [OR] 1.29 per 10 years, 95% confidence interval [CI] 1.15-1.45, p < 0.001) and male gender (OR 1.59, 95% CI 1.05-2.41, p = 0.04). In contrast, nosocomial E. coli isolates were associated with lower odds of ciprofloxacin resistance (OR 0.51, 95% CI 0.28-0.67, p < 0.001). The frequency of resistant isolate rates was not influenced by the clinical significance (i.e., colonization vs urinary tract infection, UTI) or by whether the urine was taken from a urinary catheter. Importantly, the increase in ciprofloxacin resistance paralleled the increase in ciprofloxacin consumption in Switzerland (Pearson's correlation test R2= 0.998, p = 0.002). Of note, resistance was less frequent in isolates sent in by general practitioners. However, after adjustment for age and gender, only resistance against amoxicillin/clavulanate was found to be less frequent (OR 0.34, 95% CI 0.16-0.92, p = 0.03). Conclusion: : Our study reveals that resistance rates have been increasing during the last decade. Published resistance rates may lack information due to important differences regarding age, gender, and probable origin of the isolates. Empirical therapy for UTI should be guided more on individual risk profile and local resistance data than on resistance data bank

Project Opti-Milk: Optimisation and Comparison of High Yield and Low Input Milk Production Strategies on Pilot Farms in the Lowlands of Switzerland

Compared to other European countries milk production costs in Switzerland are high. Therefore Swiss milk producers must drastically reduce their costs. The high yield strategy (HY) and the full grazing (FG) or low-cost strategy appear most promising, at least for the lowland regions. Although the basic knowledge is available for both strategies, they have been applied very little in Switzerland in a consistent and optimised form

The most plausible explanation of the cyclical period changes in close binaries: the case of the RS CVn-type binary WW Dra

We searched the orbital period changes in 182 EA-type (including the 101 Algol systems used by \cite{hal89}), 43 EB-type and 53 EW-type binaries with known both the mass ratio and the spectral type of their secondary components. We reproduced and improved the same diagram as Hall's (1989) according to the new collected data. Our plots do not support the conclusion derived by \cite{hal89} that all cases of cyclical period changes are restricted to binaries having the secondary component with spectral types later than F5. The presence of period changes also among stars with secondary component of early type indicates that the magnetic activity is one cause, but not the only one, for the period variation. It is discovered that cyclic period changes, likely due to the presence of a third body are more frequent in EW-type binaries among close binaries. Therefore, the most plausible explanation of the cyclical period changes is the LTTE via the presence of a third body. By using the century-long historical record of the times of light minimum, we analyzed the cyclical period change in the Algol binary WW Dra. It is found that the orbital period of the binary shows a $\sim112.2 \textbf{\textrm{yr}}$ cyclic variation with an amplitude of $\sim0.1977\textbf{\textrm{days}}$. The cyclic oscillation can be attributed to the LTTE via a third body with a mass no less than $6.43 M_{\odot}$. However, no spectral lines of the third body were discovered indicating that it may be a candidate black hole. The third body is orbiting the binary at a distance shorter than 14.4 AU and it may play an important role in the evolution of this system.Comment: 9 pages, 5 figures, published by MNRA

Safety and efficacy of arimoclomol for inclusion body myositis: a multicentre, randomised, double-blind, placebo-controlled trial

BACKGROUND: Inclusion body myositis is the most common progressive muscle wasting disease in people older than 50 years, with no effective drug treatment. Arimoclomol is an oral co-inducer of the cellular heat shock response that was safe and well-tolerated in a pilot study of inclusion body myositis, reduced key pathological markers of inclusion body myositis in two in-vitro models representing degenerative and inflammatory components of this disease, and improved disease pathology and muscle function in mutant valosin-containing protein mice. In the current study, we aimed to assess the safety, tolerability, and efficacy of arimoclomol in people with inclusion body myositis. METHODS: This multicentre, randomised, double-blind, placebo-controlled study enrolled adults in specialist neuromuscular centres in the USA (11 centres) and UK (one centre). Eligible participants had a diagnosis of inclusion body myositis fulfilling the European Neuromuscular Centre research diagnostic criteria 2011. Participants were randomised (1:1) to receive either oral arimoclomol 400 mg or matching placebo three times daily (1200 mg/day) for 20 months. The randomisation sequence was computer generated centrally using a permuted block algorithm with randomisation numbers masked to participants and trial staff, including those assessing outcomes. The primary endpoint was the change from baseline to month 20 in the Inclusion Body Myositis Functional Rating Scale (IBMFRS) total score, assessed in all randomly assigned participants, except for those who were randomised in error and did not receive any study medication, and those who did not meet inclusion criteria. Safety analyses included all randomly assigned participants who received at least one dose of study medication. This trial is registered with ClinicalTrials.gov, number NCT02753530, and is completed. FINDINGS: Between Aug 16, 2017 and May 22, 2019, 152 participants with inclusion body myositis were randomly assigned to arimoclomol (n=74) or placebo (n=78). One participant was randomised in error (to arimoclomol) but not treated, and another (assigned to placebo) did not meet inclusion criteria. 150 participants (114 [76%] male and 36 [24%] female) were included in the efficacy analyses, 73 in the arimoclomol group and 77 in the placebo group. 126 completed the trial on treatment (56 [77%] and 70 [90%], respectively) and the most common reason for treatment discontinuation was adverse events. At month 20, mean IBMFRS change from baseline was not statistically significantly different between arimoclomol and placebo (-3·26, 95% CI -4·15 to -2·36 in the arimoclomol group vs -2·26, -3·11 to -1·41 in the placebo group; mean difference -0·99 [95% CI -2·23 to 0·24]; p=0·12). Adverse events leading to discontinuation occurred in 13 (18%) of 73 participants in the arimoclomol group and four (5%) of 78 participants in the placebo group. Serious adverse events occurred in 11 (15%) participants in the arimoclomol group and 18 (23%) in the placebo group. Elevated transaminases three times or more of the upper limit of normal occurred in five (7%) participants in the arimoclomol group and one (1%) in the placebo group. Tubulointerstitial nephritis was observed in one (1%) participant in the arimoclomol group and none in the placebo group. INTERPRETATION: Arimoclomol did not improve efficacy outcomes, relative to placebo, but had an acceptable safety profile in individuals with inclusion body myositis. This is one of the largest trials done in people with inclusion body myositis, providing data on disease progression that might be used for subsequent clinical trial design. FUNDING: US Food and Drug Administration Office of Orphan Products Development and Orphazyme

Leveraging research partnerships to achieve the 2030 agenda : experiences from North-South cooperation

Transnational research partnerships are considered fundamental for supporting research and creating shared knowledge for sustainable development. They enable the acquisition and global sharing of high-quality information and create shared knowledge and capacity. This paper aimed to identify the enabling factors of such partnerships. In a survey carried out by the authors of this article, partnerships were perceived most beneficial when they provided access to new key features such as funding, technology and training. Compliance with research partnership principles, combined with funds and shared interests, was seen to further enhance the longevity of partnerships. Upon consulting the recent peer-reviewed literature, it became clear that research was lacking with regard to optimising the framework and performance of research partnerships, despite galloping technological progress in other areas of sustainable development. We believe that technological opportunities could be better harnessed to enable the concept of partnership to evolve and move towards transformative research for the advancement of sustainable development

Safety and efficacy of olesoxime in patients with type 2 or non-ambulatory type 3 spinal muscular atrophy: A randomised, double-blind, placebo-controlled phase 2 trial

Background: Spinal muscular atrophy (SMA) is a progressive motor neuron disease causing loss of motor function and reduced life expectancy, for which limited treatment is available. We investigated the safety and efficacy of olesoxime in patients with type 2 or non-ambulatory type 3 SMA. Methods: This randomised, double-blind, placebo-controlled, phase 2 study was done in 22 neuromuscular care centres in Belgium, France, Germany, Italy, Netherlands, Poland, and the UK. Safety and efficacy of olesoxime were assessed in patients aged 3-25 years with genetically confirmed type 2 or non-ambulatory type 3 SMA. A centralised, computerised randomisation process allocated patients (2:1 with stratification by SMA type and centre) to receive olesoxime (10 mg/kg per day) in an oral liquid suspension or placebo for 24 months. Patients, investigators assessing outcomes, and sponsor study personnel were masked to treatment assignment. The primary outcome measure was change from baseline compared with 24 months between the two treatment groups in functional domains 1 and 2 of the Motor Function Measure (MFM D1 + D2) assessed in the full analysis population. A shorter, 20-item version of the MFM, which was specifically adapted for young children, was used to assess patients younger than 6 years. Safety was assessed in the intention-to-treat population. The trial is registered with ClinicalTrials.gov, number NCT01302600. Findings: The trial was done between Nov 18, 2010, and Oct 9, 2013. Of 198 patients screened, 165 were randomly assigned to olesoxime (n=108) or placebo (n=57). Five patients in the olesoxime group were not included in the primary outcome analysis because of an absence of post-baseline assessments. The change from baseline to month 24 on the primary outcome measure was 0\ub718 for olesoxime and -1\ub782 for placebo (treatment difference 2\ub700 points, 96% CI -0\ub725 to 4\ub725, p=0\ub70676). Olesoxime seemed to be safe and generally well tolerated, with an adverse event profile similar to placebo. The most frequent adverse events in the olesoxime group were pyrexia (n=34), cough (n=32), nasopharyngitis (n=25), and vomiting (n=25). There were two patient deaths (one in each group), but these were not deemed to be related to the study treatment. Interpretation: Olesoxime was safe at the doses studied, for the duration of the trial. Although the primary endpoint was not met, secondary endpoints and sensitivity analyses suggest that olesoxime might maintain motor function in patients with type 2 or type 3 SMA over a period of 24 months. Based on these results, olesoxime might provide meaningful clinical benefits for patients with SMA and, given its mode of action, might be used in combination with other drugs targeting other mechanisms of disease, although additional evidence is needed. Funding: AFM T\ue9l\ue9thon and Trophos SA

Uncertainties and controversies in axillary management of patients with breast cancer

The aims of this Oncoplastic Breast Consortium and European Breast Cancer Research Association of Surgical Trialists initiative were to identify uncertainties and controversies in axillary management of early breast cancer and to recommend appropriate strategies to address them. By use of Delphi methods, 15 questions were prioritized by more than 250 breast surgeons, patient advocates and radiation oncologists from 60 countries. Subsequently, a global virtual consensus panel considered available data, ongoing studies and resource utilization. It agreed that research should no longer be prioritized for standardization of axillary imaging, de-escalation of axillary surgery in node-positive cancer and risk evaluation of modern surgery and radiotherapy. Instead, expert consensus recommendations for clinical practice should be based on current evidence and updated once results from ongoing studies become available. Research on de-escalation of radiotherapy and identification of the most relevant endpoints in axillary management should encompass a meta-analysis to identify knowledge gaps, followed by a Delphi process to prioritize and a consensus conference to refine recommendations for specific trial designs. Finally, treatment of residual nodal disease after surgery was recommended to be assessed in a prospective register