Pralidoxime in Acute Organophosphorus Insecticide Poisoning-A Randomised Controlled Trial

Background: Poisoning with organophosphorus (OP) insecticides is a major global public health problem, causing an estimated 200,000 deaths each year. Although the World Health Organization recommends use of pralidoxime, this antidote's effectiveness remains unclear. We aimed to determine whether the addition of pralidoxime chloride to atropine and supportive care offers benefit. Methods and Findings: We performed a double-blind randomised placebo-controlled trial of pralidoxime chloride (2 g loading dose over 20 min, followed by a constant infusion of 0.5 g/h for up to 7 d) versus saline in patients with organophosphorus insecticide self-poisoning. Mortality was the primary outcome; secondary outcomes included intubation, duration of intubation, and time to death. We measured baseline markers of exposure and pharmacodynamic markers of response to aid interpretation of clinical outcomes. Two hundred thirty-five patients were randomised to receive pralidoxime (121) or saline placebo (114). Pralidoxime produced substantial and moderate red cell acetylcholinesterase reactivation in patients poisoned by diethyl and dimethyl compounds, respectively. Mortality was nonsignificantly higher in patients receiving pralidoxime: 30/121 (24.8%) receiving pralidoxime died, compared with 18/114 (15.8%) receiving placebo (adjusted hazard ratio HR] 1.69, 95% confidence interval CI] 0.88-3.26, p = 0.12). Incorporating the baseline amount of acetylcholinesterase already aged and plasma OP concentration into the analysis increased the HR for patients receiving pralidoxime compared to placebo, further decreasing the likelihood that pralidoxime is beneficial. The need for intubation was similar in both groups (pralidoxime 26/121 21.5%], placebo 24/114 21.1%], adjusted HR 1.27 95% CI 0.71-2.29]). To reduce confounding due to ingestion of different insecticides, we further analysed patients with confirmed chlorpyrifos or dimethoate poisoning alone, finding no evidence of benefit. Conclusions: Despite clear reactivation of red cell acetylcholinesterase in diethyl organophosphorus pesticide poisoned patients, we found no evidence that this regimen improves survival or reduces need for intubation in patients with organophosphorus insecticide poisoning. The reason for this failure to benefit patients was not apparent. Further studies of different dose regimens or different oximes are required

Co-authorship Network Analysis: A Powerful Tool for Strategic Planning of Research, Development and Capacity Building Programs on Neglected Diseases

The selection and prioritization of research proposals is always a challenge, particularly when addressing neglected tropical diseases, as the scientific communities are relatively small, funding is usually limited and the disparity between the science and technology capacity of different countries and regions is enormous. When the Ministry of Health and the Ministry of Science and Technology of Brazil decided to launch an R&D program on neglected diseases for which at least 30% of the Program's resources were supposed to be invested in institutions and authors from the poorest regions of Brazil, it became clear to us that new strategies and approaches would be required. Social network analysis of co-authorship networks is one of the new approaches we are exploring to develop new tools to help policy-/decision-makers and academia jointly plan, implement, monitor and evaluate investments in this area. Publications retrieved from international databases provide the starting material. After standardization of names and addresses of authors and institutions with text mining tools, networks are assembled and visualized using social network analysis software. This study enabled the development of innovative criteria and parameters, allowing better strategic planning, smooth implementation and strong support and endorsement of the Program by key stakeholders

O direito à matricula universitária de servidores estudantes redistribuídos de ofício

Analisa o direito à matrícula universitária de servidores estudantes redistribuídos de ofício à luz do regime de servidores públicos federais, civis ou militares

[Halle (Saale), Universitäts- und Landesbibliothek Sachsen-Anhalt, Morbio 20 (65)]

Handschrift DE-3, GND 2024680-8, Signatur: Morbio 20 (65)Die Illustrationen sind: Initiale, NotarszeichenÜberlieferungsart: originalBeschreibstoff: PergamentErhaltungszustand: schlechtHandschriftUrkund

Primæ [- Secvndæ] Secvndae Svmmae Theologiæ Sancti Thomae Aqvinatis Doctoris Angelici Formalis Explicatio : Qua omnia Argumenta, & Rationes, quæ in singulis Articulis tractantur, non modica claritate formantur, & explicantur, Argumentorumque responsiones explicatæ ad ipsorum partes aptè accomodantur

Auctore F. Hieronymo de Medicis à Camerino ...Kupfertitel in Band 1Zahlreiche PaginierfehlerPrimae Partis Summae Theologiae Sancti Thomae Aquinatis unter Signatur Ro 457Aus dem Vorbesitz des Klosters Rheinau. Mit handschr. Besitzvermerken auf den Titelblättern: Band 1: "1617 Anno Dni emptu[s] FF. Rhenoviensi. Mon[aste]rij in Rheinaw". Band 2: "Monasterij Rhenoviensis. Emptus Dilingae sub Abbate Eberhardo 1618. 23 die Septembris.