Virologic testing in bronchiolitis: does it change management decisions and predict outcomes?

The aim of this study was to evaluate the clinical, therapeutic, laboratory, and radiological differences between respiratory syncytial virus (RSV) and non-RSV bronchiolitis in order to assess if the prior knowledge of viral etiology changed management decisions and would be able to predict outcomes. Medical charts of children <1year admitted to the emergency department with bronchiolitis during two RSV seasons (2010-2012) were reviewed. We analyzed 221 episodes of bronchiolitis. The percentage of exams performed (95% confidence interval (CI) 0.74-2.52), abnormal laboratory and radiological findings (95% CI 0.53-16.89) did not differ between groups. RSV bronchiolitis had a more severe clinical course. However, virologic testing for RSV had low specificity in identifying at-risk patients for hospitalization, longer hospital length of stay, and need of oxygen therapy and nasogastric tube (44, 40, 42, and 35%, respectively), and while statistically significant, the positive likelihood ratios were only slightly greater than 1. Conclusion: Although RSV bronchiolitis has a more severe clinical course, virologic testing does not help in management decisions, and at an individual level, as a performance test, it seems insufficient to precisely predict outcomes

Perspectives from MSF snakebite programme implementation in Agok, Abyei region, South Sudan

Introduction: Snakebite is a neglected tropical disease affecting around five million people, causing more than 100,000 annual deaths, as well as serious disabilities; however, access to antivenom and high-quality programmatic care remain a global challenge.Objective: Due to the high burden of snakebite in South Sudan and the serious negative outcomes if left untreated, Médecins Sans&nbsp; Frontières (MSF) integrated snakebite care for the first time among its priorities and consolidated a programme in Agok Hospital.Method: We describe the history, implementation, and challenges of the MSF snakebite programme.Results: The number of snakebite patients at MSF Agok Hospital has increased each year. From 2013 to 2019, MSF treated 2,005&nbsp; snakebite patients. In 2019 there were 527 snakebite admissions, 47% presented with severe envenomation, and one death. Puff adders, vipers and various cobras were identified. Agok Hospital gained understanding on the barriers and facilitators for the population to access care after a snakebite. MSF developed “snakebite diagnosis and treatment” algorithms, and provided clinical&nbsp; training, with the validation of national health authorities. Preventive activities were reinforced. Integration of surgical services was an essential programmatic aspect to monitor and treat complications. Challenges for implementation included a lack of easily available antivenoms in the international market. and the need of a strong supply chain and procurement systems.Conclusion: The delivery of healthcare towards snakebite patients can be successfully implemented when prioritized. Global efforts to improve access and quality of antivenoms and snakebite care could help removing Snakebite Envenoming from the Neglected Tropical Diseases list. Keywords: snakebite, snake, envenoming, antivenom, implementation, humanitarianism, secondary care, South Suda

Bacterial sinusitis and its frightening complications: subdural empyema and Lemierre syndrome

The symptoms of a previously healthy 14-year-old female with an initial history of tooth pain and swelling of the left maxillary evolved to a progressive headache and altered neurological findings characterized by auditory hallucinations, sleep disturbances, and aggressiveness. She was brought to the emergency department after 21 days of the initial symptoms. An initial computed tomography (CT) scan showed frontal subdural empyema with bone erosion. The symptoms continued to evolve to brain herniation 24 hours after admission. A second CT scan showed a left internal jugular vein thrombosis. The outcome was unfavorable and the patient died on the second day after admission. The autopsy findings depicted rarefaction of the cranial bone at the left side of the frontal sinus, and overt meningitis. The severe infection was further complicated by thrombophlebitis of the left internal jugular vein up to the superior vena cava with septic embolization to the lungs, pneumonia, and sepsis. This case report highlights the degree of severity that a trivial infection can reach. The unusual presentation of the sinusitis may have wrongly guided the approach of this unfortunate cas

Molecular diagnosis and typing of Trypanosoma cruzi populations and lineages in cerebral Chagas disease in a patient with AIDS

Trypanosoma cruzi DNA was amplified from an intracranial biopsy and peripheral blood of an HIV patient with encephalitis; this episode was indicative of AIDS and congenital Chagas disease. The analysis of a microsatellite locus revealed a multiclonal parasite population at the brain lesion with a more complex minicircle signature than that profiled in blood using restriction fragment length polymorphism (RFLP)-PCR and low stringency single primer (LSSP) PCR. Interestingly, different sublineages of T. cruzi II were detected in blood and brain by means of spliced-leader and 24s ribosomal-DNA amplifications. Quantitative-competitive PCR monitored the decrease of parasitic load during treatment and secondary prophylaxis with benznidazole. The synergy between parasiticidal plus antiretroviral treatments probably allowed the patient a longer survival than usually achieved in similar episodes. This is the first case report demonstrating a differential distribution of natural parasite populations and sublineages in Chagas disease reactivation, showing the proliferation of cerebral variants not detectable in peripheral blood.Fil: Burgos, Juan Miguel. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr. Héctor N. Torres"; ArgentinaFil: Bergher, Sandra B.. Gobierno de la Ciudad de Buenos Aires. Hospital "Ignacio Pirovano"; ArgentinaFil: Freitas, Jorge M.. Universidade Federal de Minas Gerais; BrasilFil: Bisio, Margarita María Catalina. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr. Héctor N. Torres"; ArgentinaFil: Altcheh, Jaime Marcelo. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; ArgentinaFil: Teijeiro, Ricardo. Gobierno de la Ciudad de Buenos Aires. Hospital "Ignacio Pirovano"; ArgentinaFil: Begher, Sandra B.. Gobierno de la Ciudad de Buenos Aires. Hospital "Ignacio Pirovano"; ArgentinaFil: Freilij, Hector León. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; ArgentinaFil: Deccarlini, Florencia. Gobierno de la Ciudad de Buenos Aires. Hospital "Ignacio Pirovano"; ArgentinaFil: Levalle, Jorge. Gobierno de la Ciudad de Buenos Aires. Hospital "Ignacio Pirovano"; ArgentinaFil: Lopez Alcoba, Horacio. Gobierno de la Ciudad de Buenos Aires. Hospital "Ignacio Pirovano"; ArgentinaFil: Burgos, Juan Miguel. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr. Héctor N. Torres"; Argentina. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Fisiología, Biología Molecular y Celular; ArgentinaFil: Levin, Mariano Jorge. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr. Héctor N. Torres"; ArgentinaFil: Duffy, Tomás. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr. Héctor N. Torres"; ArgentinaFil: Macedo, Andrea M.. Universidade Federal de Minas Gerais; BrasilFil: Schijman, Alejandro Gabriel. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr. Héctor N. Torres"; Argentin

Bacterial sinusitis and its frightening complications: subdural empyema and Lemierre syndrome

The symptoms of a previously healthy 14-year-old female with an initial history of tooth pain and swelling of the left maxillary evolved to a progressive headache and altered neurological findings characterized by auditory hallucinations, sleep disturbances, and aggressiveness. She was brought to the emergency department after 21 days of the initial symptoms. An initial computed tomography (CT) scan showed frontal subdural empyema with bone erosion. The symptoms continued to evolve to brain herniation 24 hours after admission. A second CT scan showed a left internal jugular vein thrombosis. The outcome was unfavorable and the patient died on the second day after admission. The autopsy findings depicted rarefaction of the cranial bone at the left side of the frontal sinus, and overt meningitis. The severe infection was further complicated by thrombophlebitis of the left internal jugular vein up to the superior vena cava with septic embolization to the lungs, pneumonia, and sepsis. This case report highlights the degree of severity that a trivial infection can reach. The unusual presentation of the sinusitis may have wrongly guided the approach of this unfortunate cas

Recognizability, Perception and the Distribution of the Sensible: Honneth, Rancière and Butler

This paper explores the relation between perception and recognizability in the work of Honneth, Rancière and Butler. Recognizability is the term employed here to indicate the perceptual process that necessarily occurs prior to a normative or ethical act of recognition and that provides the conditions that make recognition possible. The notion of recognizability points to the fact that perception is not merely a disinterested surveying of the perceptual field but indicates that it is already evaluative in the sense that others are immediately distinguishable from other objects. When recognizability fails, it is not because the other has not been seen in a literal sense but instead that she has been intentionally ignored or invisibilized. The suggestion made here is that despite their different approaches, a comparison and dialogue between these three thinkers highlights the importance of this constellation of issues for critical theory.Este artigo explora a relação entre percepção e reconhecibilidade nos trabalhos de Honneth, Rancière e Butler. O termo reconhecibilidade é utilizado para indicar o processo perceptivo que necessariamente antecede um ato normativo ou ético de reconhecimento e que fornece as condições que tornam o reconhecimento possível. A noção de reconhecibilidade aponta o fato de que a percepção não corresponde a uma mera observação desinteressada do campo perceptivo e indica que tal apreensão já é valorativa, uma vez que outras pessoas são imediatamente distinguíveis de outros objetos. Quando a reconhecibilidade fracassa, não é porque a outra pessoa não foi vista no sentido literal, mas sim porque ela foi intencionalmente ignorada ou invisibilizada. A sugestão que faço aqui é a de que, embora possuam abordagens distintas, uma comparação e um diálogo entre esses três pensadores explicita a importância dessa constelação de questões para a teoria crítica.Este artículo explora la relación entre percepción y reconocibilidad en las obras de Honneth, Rancière y Butler. El término reconocibilidad es utilizado para indicar el proceso perceptual que necesariamente precede a un acto normativo o ético de reconocimiento, y que proporciona las condiciones que hacen posible el reconocimiento. La noción de reconocibilidad muestra que la percepción no corresponde a una mera aprehensión desinteresada del campo perceptivo e indica que ella ya es evaluativa, en el sentido que otras personas se distinguen inmediatamente de otros objetos. Cuando falla la reconocibilidad, no es porque la otra persona no haya sido vista en el sentido literal, sino, por el contrario, porque ha sido intencionalmente ignorada o invisibilizada. Sugiero aquí que, aunque tienen enfoques diferentes, una comparación y un diálogo entre estos tres pensadores explica la importancia de esta constelación de temas para la teoría crítica

Vulnerability to snakebite envenoming: a global mapping of hotspots.

BACKGROUND Snakebite envenoming is a frequently overlooked cause of mortality and morbidity. Data for snake ecology and existing snakebite interventions are scarce, limiting accurate burden estimation initiatives. Low global awareness stunts new interventions, adequate health resources, and available health care. Therefore, we aimed to synthesise currently available data to identify the most vulnerable populations at risk of snakebite, and where additional data to manage this global problem are needed. METHODS We assembled a list of snake species using WHO guidelines. Where relevant, we obtained expert opinion range (EOR) maps from WHO or the Clinical Toxinology Resources. We also obtained occurrence data for each snake species from a variety of websites, such as VertNet and iNaturalist, using the spocc R package (version 0.7.0). We removed duplicate occurrence data and categorised snakes into three groups: group A (no available EOR map or species occurrence records), group B (EOR map but <5 species occurrence records), and group C (EOR map and ≥5 species occurrence records). For group C species, we did a multivariate environmental similarity analysis using the 2008 WHO EOR maps and newly available evidence. Using these data and the EOR maps, we produced contemporary range maps for medically important venomous snake species at a 5 × 5 km resolution. We subsequently triangulated these data with three health system metrics (antivenom availability, accessibility to urban centres, and the Healthcare Access and Quality [HAQ] Index) to identify the populations most vulnerable to snakebite morbidity and mortality. FINDINGS We provide a map showing the ranges of 278 snake species globally. Although about 6·85 billion people worldwide live within range of areas inhabited by snakes, about 146·70 million live within remote areas lacking quality health-care provisioning. Comparing opposite ends of the HAQ Index, 272·91 million individuals (65·25%) of the population within the lowest decile are at risk of exposure to any snake for which no effective therapy exists compared with 519·46 million individuals (27·79%) within the highest HAQ Index decile, showing a disproportionate coverage in reported antivenom availability. Antivenoms were available for 119 (43%) of 278 snake species evaluated by WHO, while globally 750·19 million (10·95%) of those living within snake ranges live more than 1 h from population centres. In total, we identify about 92·66 million people living within these vulnerable geographies, including many sub-Saharan countries, Indonesia, and other parts of southeast Asia. INTERPRETATION Identifying exact populations vulnerable to the most severe outcomes of snakebite envenoming at a subnational level is important for prioritising new data collection and collation, reinforcing envenoming treatment, existing health-care systems, and deploying currently available and future interventions. These maps can guide future research efforts on snakebite envenoming from both ecological and public health perspectives and better target future estimates of the burden of this neglected tropical disease

A fotografia como observação no estágio supervisionado em filosofia

Within the perspective of the teaching internship as a field of research, this article intends to think on the conditions under which the proposal, the research and the accomplishment of an internship of observation in the teaching degree in philosophy occur. From a discussion on the clichés images of the school environment, we opted to problematize the observation by stimulating the production of photographs that escaped common sense and captured the singularities of the observed school.Dentro da perspectiva do estágio docente enquanto campo de pesquisa, o presente artigo pretende refletir sobre as condições em que se deram a proposta, a pesquisa e a realização de um estágio de observação na licenciatura em filosofia. A partir de uma discussão sobre as imagens clichês do ambiente escolar, optou-se por problematizar a observação estimulando a produção de fotografias que escapassem do senso comum e captassem as singularidades da escola observada

"Kala-Azar is a Dishonest Disease": Community Perspectives on Access Barriers to Visceral Leishmaniasis (Kala-Azar) Diagnosis and Care in Southern Gadarif, Sudan

Early diagnosis and treatment is the principal strategy to control visceral leishmaniasis (VL), or kala-azar in East Africa. As VL strikes remote rural, sparsely populated areas, kala-azar care might not be accessed optimally or timely. We conducted a qualitative study to explore access barriers in a longstanding kala-azar endemic area in southern Gadarif, Sudan. Former kala-azar patients or caretakers, community leaders, and health-care providers were purposively sampled and thematic data analysis was used. Our study participants revealed the multitude of difficulties faced when seeking care. The disease is well known in the area, yet misconceptions about causes and transmission persist. The care-seeking itineraries were not always straightforward: "shopping around" for treatments are common, partly linked to difficulties in diagnosing kala-azar. Kala-azar is perceived to be "hiding," requiring multiple tests and other diseases must be treated first. Negative perceptions on quality of care in the public hospitals prevail, with the unavailability of drugs or staff as the main concern. Delay to seek care remains predominantly linked to economic constraint: albeit treatment is for free, patients have to pay out of pocket for everything else, pushing families further into poverty. Despite increased efforts to tackle the disease over the years, access to quality kala-azar care in this rural Sudanese context remains problematic. The barriers explored in this study are a compelling reminder of the need to boost efforts to address these barriers