Post-treatment follow-up study of abdominal cystic echinococcosis in Tibetan communities of northwest Sichuan Province, China

Background: Human cystic echinococcosis (CE), caused by the larval stage of Echinococcus granulosus, with the liver as the most frequently affected organ, is known to be highly endemic in Tibetan communities of northwest Sichuan Province. Antiparasitic treatment with albendazole remains the primary choice for the great majority of patients in this resource-poor remote area, though surgery is the most common approach for CE therapy that has the potential to remove cysts and lead to complete cure. The current prospective study aimed to assess the effectiveness of community based use of cyclic albendazole treatment in Tibetan CE cases, and concurrently monitor the changes of serum specific antibody levels during treatment. Methodology/Principal Findings: Ultrasonography was applied for diagnosis and follow-up of CE cases after cyclic albendazole treatment in Tibetan communities of Sichuan Province during 2006 to 2008, and serum specific IgG antibody levels against Echinococcus granulosus recombinant antigen B in ELISA was concurrently monitored in these cases. A total of 196 CE cases were identified by ultrasound, of which 37 (18.9%) showed evidence of spontaneous healing/involution of hepatic cyst(s) with CE4 or CE5 presentations. Of 49 enrolled CE cases for treatment follow-up, 32.7% (16) were considered to be cured based on B-ultrasound after 6 months to 30 months regular albendazole treatment, 49.0% (24) were improved, 14.3% (7) remained unchanged, and 4.1% (2) became aggravated. In general, patients with CE2 type cysts (daughter cysts present) needed a longer treatment course for cure (26.4 months), compared to cases with CE1 (univesicular cysts) (20.4 months) or CE3 type (detached cyst membrane or partial degeneration of daughter cysts) (9 months). In addition, the curative duration was longer in patients with large (.10 cm) cysts (22.3 months), compared to cases with medium (5– 10 cm) cysts (17.3 months) or patients with small (,5 cm) cysts (6 months). At diagnosis, seven (53.8%) of 13 cases with CE1 type cysts without any previous intervention showed negative specific IgG antibody response to E. granulosus recombinant antigen B (rAgB). However, following 3 months to 18 months albendazole therapy, six of these 7 initially seronegative CE1 cases sero-converted to be specific IgG antibody positive, and concurrently ultrasound scan showed that cysts changed to CE3a from CE1 type in all the six CE cases. Two major profiles of serum specific IgG antibody dynamics during albendazole treatment were apparent in CE cases: (i) presenting as initial elevation followed by subsequent decline, or (ii) a persistent decline. Despite a decline, however, specific antibody levels remained positive in most improved or cured CE cases. Conclusions: This was the first attempt to follow up community-screened cystic echinococcosis patients after albendazole therapy using ultrasonography and serology in an endemic Tibetan region. Cyclic albendazole treatment proved to be effective in the great majority of CE cases in this resource-poor area, but periodic abdominal ultrasound examination was necessary to guide appropriate treatment. Oral albendazole for over 18 months was more likely to result in CE cure. Poor drug compliance resulted in less good outcomes. Serology with recombinant antigen B could provide additional limited information about the effectiveness of albendazole in CE cases. Post-treatment positive specific IgG antibody seroconversion, in initially seronegative, CE1 patients was considered a good indication for positive therapeutic efficacy of albendazole

Giant primary adrenal hydatid cyst presenting with arterial hypertension: a case report and review of the literature

<p>Abstract</p> <p>Introduction</p> <p>A primary hydatid cyst of the adrenal gland is still an exceptional localization. The adrenal gland is an uncommon site even in Morocco, where echinococcal disease is endemic.</p> <p>Case presentation</p> <p>We report the case of a 64-year-old Moroccan man who presented with the unusual symptom of arterial hypertension associated with left flank pain. Computed tomography showed a cystic mass of his left adrenal gland with daughter cysts filing the lesion (Type III). Despite his negative serology tests, the diagnosis of a hydatid cyst was confirmed on surgical examination. Our patient underwent surgical excision of his left adrenal gland with normalization of blood pressure. No recurrence has occurred after 36 months of follow-up.</p> <p>Conclusion</p> <p>There are two remarkable characteristics of this case report; the first is the unusual location of the cyst, the second is the association of an adrenal hydatid cyst with arterial hypertension, which has rarely been reported in the literature.</p

Moving from the margins: The role of narrative and metaphor in health literacy

Narrative and metaphor are now recognised to be central to thought, language and communication, and consequently have relevance to discourse and action in many areas including health and wellbeing. In this paper, narrative and metaphor are examined in relation to areas relevant to health literacy. The ways in which narrative and metaphor relate to dimensions of health literacy identified by Zarcadoolas et al. (Zarcadoolas C, Pleasant A, Greer D. Advancing health literacy – a framework for understanding and action. San Francisco: John Wiley & Sons Inc; 2006.); fundamental, scientific, cultural, and civic are analysed. The work aims to provide a rationale for greater incorporation of narrative and metaphor in discussions and activities related to health literacy

Formulating 'principles of procedure' for the foreign language classroom: A framework for process model language curricula

This article aims to apply Stenhouse's process model of curriculum to foreign language (FL) education, a model which is characterized by enacting principles of procedure which are specific to the discipline which the school subject belongs to. Rather than to replace or dissolve current approaches to FL teaching and curriculum development, this article seeks to improve and enrich communicative and task-based orientations with an additional criterion for assessing the educational worth of the tasks through which these orientations are developed. Unlike the objectives and competences models, principles of procedure provide an intrinsic justification of school curriculum by enacting the epistemological structure of any given area of knowledge in the educational process. Accordingly, the article will first justify the need to come up with a process model of curriculum for FL education which is built around such principles; then, it will formulate a basic framework that reflects the logical structure, concepts and epistemological perspectives of the language studies, as a first step to allowing these to enter the FL classroom and orient the teaching conducted in it; finally, it will present three tasks whose design was inspired by the abovementioned framework, and which were put into practice with Primary education English as a Foreign Language learners during the 2013 2014 and 2014 2015 academic years

Thrombosed Popliteal Artery Pseudoaneurysm as Herald of Tibial Osteochondroma

Background: Osteochondroma is the most common non-malignant tumour of bone, accounting for approximately one third of benign lesions in the skeleton. They often develop around the knee in the distal femur and in the proximal tibia and fibula. They present as a painless slow growing mass during adolescence and have been reported to cause damage to adjacent structures such as blood vessels; arterial damage is more common than venous injury and is usually a result of compression, stretching, and rubbing of the arterial wall. Such lesions include stenosis, thrombosis, and pseudoaneurysm formation possibly causing lower limb claudication or acute limb ischemia. Methods: An 18 year old male patient with a 4 week history of pain, hematoma, and oedema of the left calf without previous trauma is reported. A computed tomography scan (CT) revealed a large popliteal artery pseudoaneurysm and its close relationship to a protrusion of the proximal tibia. Results: The popliteal artery was repaired by an external saphenous patch and the exostosis was removed. The patient had palpable popliteal and distal pulses after surgery and during the first year follow-up. Conclusions: Tibial osteochondroma should be considered in the differential diagnosis in young patients, among the potential causes of pseudoaneurysm of the femoral or popliteal artery. Surgical repair should be performed to restore normal blood flow with resection of the exostosis to prevent recurrence. Keywords: Popliteal artery, Pseudoaneurysm, Tibial exostosis, Osteochondrom

Proteína C reactiva como factor pronóstico de mortalidad en los aneurisma de aorta abdominal rotos

Determinar si el valor plasmatico preoperatorio de diversos marcadores biologicos de inflamacion .proteina C reactiva (PCR), leucocitos y fibrinogeno. se asocia a la mortalidad de los pacientes con rotura de aneurisma de aorta bdominal (AAA). Pacientes y metodos. Estudio prospectivo de 37 pacientes intervenidos uirurgicamente de AAA roto. Se extrajo una muestra de sangre periferica a cada uno de ellos para el estudio preoperatorio de los biomarcadores de inflamacion. Ademas, se recogieron datos correspondientes a variables clinicas pre, intra y postoperatorias. Para el analisis de los valores plasmaticos de PCR se utilizo un test convencional (Tina-Quant). Resultados. De los marcadores biologicos de inflamacion estudiados, solo la PCR fue un factor pronostico de mortalidad perioperatoria, y la mediana fue significativamente superior en los fallecidos en comparacion con los supervivientes (p = 0,021). Se categorizo la PCR en dos grupos con la utilizacion como punto de corte el valor obtenido en la curva ROC (3,2 mg/dL) para la maxima sensibilidad y especificidad de esta variable con relacion a la mortalidad. Los pacientes cuya PCR al ingreso fue . 3,2 mg/dL tuvieron una mortalidad significativamente mayor que aquellos cuya cifra era < 3,2 mg/dL (71 frente a 10%) (p = 0,002). En el analisis multivariante, las variables pronosticas de mortalidad fueron: valor preoperatorio de PCR, duracion del pinzamiento aortico e inestabilidad hemodinamica durante la intervencion. Conclusiones. La elevacion de la PCR preoperatoria es un factor pronostico de mortalidad en los AAA rotos, por lo que puede ser, junto a otros factores previamente identificados, util para la estratificacion del riesgo quirurgico de estos pacientes

Implementing translanguaging pedagogies in an English medium instruction course

English medium education at university level is widely used in different contexts and it poses a challenge for students who are not used to studying through the medium of English. This study was carried out in a university in the Basque Country in Spain and it focuses on a course where students who are mostly Basque–Spanish bilinguals are taught through the medium of English. The course teacher applies a flexible language policy allowing for the use of three languages in the class. The aim of this study is to analyse the languages used by the teacher and the students and the students’ reactions towards the use of three languages. The instruments used were a background questionnaire, classroom observations, focus group discussions and students’ journals. The results indicate that there are important differences between the language used by the teacher and the students and also that most students responded positively to the flexible language use.This work was supported by the Agencia Estatal de Investigacion, Spain [Grant Number FEDER-PID2019-105818GB-100] and the Basque Government [Grant Number DREAM IT-1225-19]

Antibioterapia empírica en el pie diabético y no diabético

Introducción. La neuropatía, la isquemia y la infección son los tres factores directamente relacionados con la aparición y desarrollo de las úlceras en los pacientes diabéticos. La infección definida mediante parámetros clínicos y apoyada por cultivos microbiológicos es el principal factor pronóstico de la lesión. Objetivo. Estudiar la etiología infecciosa de las úlceras en pacientes diabéticos y no diabéticos, así como la sensibilidad in vitro a antimicrobianos de los microorganismos aislados, nos permitirá establecer la mejor pauta antibiótica empírica en nuestro medio asistencial. Pacientes y métodos. Estudio observacional, transversal y prospectivo de 200 pacientes consecutivos, diabéticos y no diabéticos, ingresados por la presencia de úlceras isquémicas o neuropáticas con signos locales de infección. Toma de tres muestras microbiológicas el día del ingreso previa administración del tratamiento empírico (ciprofloxacino + clindamicina) y valoración de su respuesta clínica y sus modificaciones a específico por resistencia de los microorganismos. Resultados. En la mayoría de los cultivos se aisló microbiota polimicrobiana con predominio de aerobios-anaerobios gramnegativos y aerobios grampositivos. Staphylococcus aureus (10,6%), Pseudomonas aeruginosa y Bacteroides fragilis fueron los microorganismos más frecuentemente aislados. La terapia empírica tuvo que modificarse en más del 50% de los casos por resistencia. La mayor sensibilidad in vitro para los microorganismos grampositivos fue para la vancomicina, seguida de cloxacilina y amoxicilina/clavulánico. En el caso de aerobios-anaerobios gramnegativos, fue para meropenem, tobramicina e imipenem, y para los anaerobios, imipenem, cefoxitina y amoxicilina/clavulánico. Conclusiones. La administración de amoxicilina/clavulánico solo o asociado a tobramicina constituye una pauta antibiótica con amplio espectro para los pacientes ambulatorios. En régimen de ingreso el antibiótico de elección sería imipenem, seguido de piperacilina/tazobactam