Planning approaches for sanitation systems in peri-urban areas: a case study from Tanzania

The planning and improvement of sanitation systems represents a critical problem for low - income countries, in particular in rapid growing periurban areas. This paper illustrates the assessment of the Community - Led Urban Environmental Sanitation (CLUES) and the Sanitation Safety Planning (SSP) approaches, tested for the design of an improved sanitation system in periurban areas of Iringa Municipality, in Tanzania. The application in field of the two approaches permitted to evidence and analyse their strengths and weaknesses, and possibilities to increase their potentials with an integrated use . The experience, applied to a case study, aims to be an example of application for ractitioners dealing with sanitation planning in context showing similar characteristics

Laparoscopic removal of mullerian duct remnants in boys

Abstract: Purpose: Mullerian duct remnants (MDRs) are present in a male pseudohermaphroditic form characterized by failure of the mullerian duct to regress due to insufficient production or peripheral action of mullerian inhibiting substance. The MDR can be asymptomatic but it often results in infections, stones and voiding troubles. Furthermore, it may develop into a neoplasm. Therefore, surgery is mandatory for large MDRs and symptomatic patients. Laparoscopic removal is described. Materials and Methods: Six males were treated from February 1998 to February 2003. Age at surgery was between 3 and 18 years (mean 8.6). All patients showed severe hypospadias and 2 had mixed gonadal dysgenesis with ambiguous genitalia. Three patients presented with urogenital infections and all had a large MDR. Laparoscopic procedures, which were preceded by cystoscopy, were performed using a 10 mm umbilical trocar for the camera and 3, 5 mm trocars for instruments placed in the suprapubic region and iliac fossa bilaterally. The remnants were ligated with endoscopic loops or an endoscopic GIA stapler and cut. Results: Mean operative time was 2 hours. We noted no complications. In 2 cases there was deferential ectopia and in another of mixed gonadal dysgenesis bilateral gonadectomy was performed because of the risk of degeneration. Feeding started on postoperative day I and the patients were discharged home on day 5. After a followup of 8 months to 4 years all boys were healthy. Conclusions: Multiple approaches are used in traditional surgery, often leading to complications. Laparoscopy improves the view, decreases surgical risk and operative time, avoids large scars and allows more rapid hospital discharge

Working length transfer in the endodontic clinical practice: A comparative study

8The present paper evaluated the accuracy of two different methods for transferring working length (WL) between manual endodontic instruments and nickel–titanium (NiTi) shaping files. Thirty root canals of extracted permanent teeth were used. Root canals were divided according to canal length (CL) and canal curvature (CC). The reference cusp and the root end were flattened to provide reproducible and accurate measurements. During shaping, the WL measurements were obtained with manual k-files (KF) and transferred to WaveOne (W1) NiTi reciprocating files using the traditional method with the endodontic ruler (method I) and an alternative clinical procedure based on the comparison of the instruments side by side from tip to shank (method II). For each file and each tested method, two measures were taken by two examiners using Rhino (ver. 4.0, McNeel, Seattle, WA, USA) software for a total of 360 (30 × 3 × 2 × 2) measures. Analysis of variance was performed by taking the difference in length (Delta WL, DWL) between files used for the same canal. The difference between methods I and II for WL transfer was found to be statistically significant (df = 1; F = 71.52; p < 0.001). The DWL absolute values obtained with method II were found to be closer to 0 mm (i.e., same length as corresponding KF) than those obtained with method I. Both CL (df = 2; F = 1.27; p = 0.300) and CC (df = 1; F = 2.22; p = 0.149) did not significantly influence WL measurements. With respect to WL transfer, method II seemed to better preserve the correct WL transfer between instruments during the clinical endodontic procedures.openopenMario Alovisi; Mario Dioguardi; Massimo Carossa; Giuseppe Troiano; Maria Chiara Domini; Davide Salvatore Paolino; Giorgio Chiandussi; Elio BeruttiAlovisi, Mario; Dioguardi, Mario; Carossa, Massimo; Troiano, Giuseppe; Chiara Domini, Maria; Paolino, DAVIDE SALVATORE; Chiandussi, Giorgio; Berutti, Eli

Electrochemically reduced graphene oxide-based screen-printed electrodes for total tetracycline determination by adsorptive transfer stripping differential pulse voltammetry

Disposable electrochemically reduced graphene oxide-based (ERGO) screen-printed electrodes (SPE) were developed for the determination of total tetracyclines as a sample screening approach. To this end, a selective adsorption-detection approach relied on adsorptive transfer stripping differential pulse voltammetry (AdTDPV) was devised, where the high adsorption capacity and the electrochemical properties of ERGO were simultaneously exploited. The approach was very simple, fast (6 min.), highly selective by combining the adsorptive and the electrochemical features of tetracyclines, and it used just 10 μL of the sample. The electrochemical sensor applicability was demonstrated in the analysis of environmental and food samples. The not-fully explored AdTDPV analytical possibilities on disposable nanostructured transducers become a new tool in food and environmental fields; drawing new horizons for “in-situ” analysis.Fil: Lorenzetti, Anabela Silvana. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Bahía Blanca. Instituto de Química del Sur. Universidad Nacional del Sur. Departamento de Química. Instituto de Química del Sur; Argentina. Universidad de Alcalá; EspañaFil: Sierra, Tania. Universidad de Alcalá; EspañaFil: Domini, Claudia Elizabeth. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Bahía Blanca. Instituto de Química del Sur. Universidad Nacional del Sur. Departamento de Química. Instituto de Química del Sur; ArgentinaFil: Lista, Adriana Guillermina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Bahía Blanca. Instituto de Química del Sur. Universidad Nacional del Sur. Departamento de Química. Instituto de Química del Sur; ArgentinaFil: Crevillen, Agustin G.. Universidad Nacional de Educación a Distancia; EspañaFil: Escarpa Miguel, Jesús Alberto. Universidad de Alcalá; España. Instituto de Investigaciones Químicas “Andrés M. del Río”; Españ

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised