Obstetric vesico-vaginal fistulae seen in the Northern Democratic Republic of Congo: a descriptive study

Background: The Democratic Republic of Congo (DRC) is a developing country with poor obstetric indicators. Despite ongoing efforts to improve care, women continue to suffer multiple complications of child birth including vesico-vaginal fistulae (VVF).Objective: To describe socio-demographic and clinical characteristics of VVF patients in Northern DRC.Methods: Women presenting at two VVF mobile surgical campaign missions in the province of Equateur in Northern DRC in August 2012 and October 2013 were examined and treated for VVF. We collected socio-demographic data, including marital status, education, and accompaniment by husbands for treatment, as a proxy for marital support, and clinical data related to characteristics of VVF in patients, duration of illness, and the outcome of treatment surgery.Results: Out of 163 VVF patients, 100 (61.3%) were less than 35 years old, 102 had no formal education ( 62.6%), and 100 were married ( 61.3%). The mean duration of illness before surgery was 8.4 years. Successful surgery rate for VVF was 87.1% (142/163). A majority of patients who were married, were accompanied to the hospital by their husbands for treatment (56/100; 56.00%). Association analysis revealed age was the only variable that maintained significant association with duration of illness after multivariate analysis (p-value <0.0001). Marital status was the only variable associated with surgical outcome (0.334, 95% CI 0.125- 0.847, p-value = 0.021).Conclusion: We found that most VVF patients were young adults, not educated, and married. Marital status and age may have important roles in outcome of VVF surgery and duration of illness, respectively.Keywords: Obstetric vesico-vaginal fistulae, Northern Democratic Republic of Cong

Obstetric vesico-vaginal fistulae seen in the Northern Democratic Republic of Congo: a descriptive study

Background: The Democratic Republic of Congo (DRC) is a developing country with poor obstetric indicators. Despite ongoing efforts to improve care, women continue to suffer multiple complications of child birth including vesico-vaginal fistulae (VVF). Objective: To describe socio-demographic and clinical characteristics of VVF patients in Northern DRC. Methods: Women presenting at two VVF mobile surgical campaign missions in the province of Equateur in Northern DRC in August 2012 and October 2013 were examined and treated for VVF. We collected socio-demographic data, including marital status, education, and accompaniment by husbands for treatment, as a proxy for marital support, and clinical data related to characteristics of VVF in patients, duration of illness, and the outcome of treatment surgery. Results: Out of 163 VVF patients, 100 (61.3%) were less than 35 years old, 102 had no formal education ( 62.6%), and 100 were married ( 61.3%). The mean duration of illness before surgery was 8.4 years. Successful surgery rate for VVF was 87.1% (142/163). A majority of patients who were married, were accompanied to the hospital by their husbands for treatment (56/100; 56.00%). Association analysis revealed age was the only variable that maintained significant association with duration of illness after multivariate analysis (p-value <0.0001). Marital status was the only variable associated with surgical outcome (0.334, 95% CI 0.125- 0.847, p-value = 0.021). Conclusion: We found that most VVF patients were young adults, not educated, and married. Marital status and age may have important roles in outcome of VVF surgery and duration of illness, respectively

The state of the Martian climate

60°N was +2.0°C, relative to the 1981–2010 average value (Fig. 5.1). This marks a new high for the record. The average annual surface air temperature (SAT) anomaly for 2016 for land stations north of starting in 1900, and is a significant increase over the previous highest value of +1.2°C, which was observed in 2007, 2011, and 2015. Average global annual temperatures also showed record values in 2015 and 2016. Currently, the Arctic is warming at more than twice the rate of lower latitudes

Diagnostic utility of snail in metaplastic breast carcinoma

Metaplastic breast carcinoma (MBC) is a rare subtype of breast cancer characterized by coexistence of carcinomatous and sarcomatous components. Snail is a nuclear transcription factor incriminated in the transition of epithelial to mesenchymal differentiation of breast cancer. Aberrant Snail expression results in lost expression of the cell adhesion molecule E-cadherin, an event associated with changes in epithelial architecture and invasive growth. We aimed to identify the utility of Snail, and of traditional immunohistochemical markers, in accurate MBC classification and to evaluate clinicopathologic characteristics and outcome

Post-intervention Status in Patients With Refractory Myasthenia Gravis Treated With Eculizumab During REGAIN and Its Open-Label Extension

OBJECTIVE: To evaluate whether eculizumab helps patients with anti-acetylcholine receptor-positive (AChR+) refractory generalized myasthenia gravis (gMG) achieve the Myasthenia Gravis Foundation of America (MGFA) post-intervention status of minimal manifestations (MM), we assessed patients' status throughout REGAIN (Safety and Efficacy of Eculizumab in AChR+ Refractory Generalized Myasthenia Gravis) and its open-label extension. METHODS: Patients who completed the REGAIN randomized controlled trial and continued into the open-label extension were included in this tertiary endpoint analysis. Patients were assessed for the MGFA post-intervention status of improved, unchanged, worse, MM, and pharmacologic remission at defined time points during REGAIN and through week 130 of the open-label study. RESULTS: A total of 117 patients completed REGAIN and continued into the open-label study (eculizumab/eculizumab: 56; placebo/eculizumab: 61). At week 26 of REGAIN, more eculizumab-treated patients than placebo-treated patients achieved a status of improved (60.7% vs 41.7%) or MM (25.0% vs 13.3%; common OR: 2.3; 95% CI: 1.1-4.5). After 130 weeks of eculizumab treatment, 88.0% of patients achieved improved status and 57.3% of patients achieved MM status. The safety profile of eculizumab was consistent with its known profile and no new safety signals were detected. CONCLUSION: Eculizumab led to rapid and sustained achievement of MM in patients with AChR+ refractory gMG. These findings support the use of eculizumab in this previously difficult-to-treat patient population. CLINICALTRIALSGOV IDENTIFIER: REGAIN, NCT01997229; REGAIN open-label extension, NCT02301624. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that, after 26 weeks of eculizumab treatment, 25.0% of adults with AChR+ refractory gMG achieved MM, compared with 13.3% who received placebo

Early role of vascular dysregulation on late-onset Alzheimer's disease based on multifactorial data-driven analysis

Multifactorial mechanisms underlying late-onset Alzheimer's disease (LOAD) are poorly characterized from an integrative perspective. Here spatiotemporal alterations in brain amyloid-β deposition, metabolism, vascular, functional activity at rest, structural properties, cognitive integrity and peripheral proteins levels are characterized in relation to LOAD progression. We analyse over 7,700 brain images and tens of plasma and cerebrospinal fluid biomarkers from the Alzheimer's Disease Neuroimaging Initiative (ADNI). Through a multifactorial data-driven analysis, we obtain dynamic LOAD–abnormality indices for all biomarkers, and a tentative temporal ordering of disease progression. Imaging results suggest that intra-brain vascular dysregulation is an early pathological event during disease development. Cognitive decline is noticeable from initial LOAD stages, suggesting early memory deficit associated with the primary disease factors. High abnormality levels are also observed for specific proteins associated with the vascular system's integrity. Although still subjected to the sensitivity of the algorithms and biomarkers employed, our results might contribute to the development of preventive therapeutic interventions