Management of patients presenting with diarrhoea to a regional emergency department in KwaZulu-Natal: Call for clearer, more relevant guidance

Background. HIV is prevalent throughout South Africa, and diarrhoea is a common presentation to the emergency department (ED) among both HIV-infected and -uninfected individuals. Method. We audited the management of diarrhoea against standard guidelines in the ED of a regional hospital in KwaZulu-Natal. Patients presenting with diarrhoea as their chief complaint were eligible and data were collected prospectively. Results. A total of 72 patients were included: 58 (81%) of patients were HIV-positive with an average CD4+ count of 180 cells/ μl. A total of 34 stool samples were sent for standard microscopy and culture (M&C), among which 26 were positive (76%). Forty-three patients (60%) received antibiotics, 15 of whom had positive stool M&C. In all cases, the final diagnosis was listed as acute gastroenteritis without further specification, and antibiotic use according to guidelines appeared inconsistent. Conclusion. Based on this audit, we suggest that current guidelines are not clear concerning management of acute diarrhoea in HIVinfected individuals, and that the lack of clear management strategies is likely to affect patient safety and increase antibiotic resistance

Biological activity of glucosinolate derived compounds isolated from seed meal of Brassica crops and evaluated as plant and food protection agents

Glucosinolates are amino acid derived allelochemicals characteristic of plants of the order Capparales. These compounds are present in seeds of agriculturally common Brassica crops in varying quantities depending on the species (ref). The use of the remaining seed cake after oil extraction has traditionally been limited by the concentration of these compounds. However, the extraction of glucosinolates from seed meal is nowadays possible and it further contributes to an increased quality of the seed meal for feed (Sørensen et al., this conference). Glucosinolates are hydrolysed by endogenous enzymes (myrosinases; EC 3.2.1.147) and a number of compounds are produced depending on the parent glucosinolate and the environmental conditions.1 Among these compounds, oxazolidine-2-thiones are known for their antinutritional effects on monogastric animals, whereas isothiocyanates are fungicidal, nematocidal and herbicidal.2,3 The possibility for using glucosinolates as precursors for environmental friendly biocides therefore exists, which could contribute to increase the value of the Brassica seed meal

An Integrated Weed Management framework: A pan-European perspective

Initiatives to reduce the reliance of agriculture on pesticides, including the European Union (EU) Directive 2009/ 128/EC on the sustainable use of pesticides (SUD), have yet to lead to widespread implementation of Integrated Pest Management (IPM) principles. Developments in weed management have strongly focused on increasing the efficiency of herbicides or substituting herbicides with other single tactics such as mechanical control. To in- crease sustainability of agricultural systems in practice, a paradigm shift in weed management is needed: from a single tactic and single growing season approach towards holistic integrated weed management (IWM) consid- ering more than a single cropping season and focusing on management of weed communities, rather than on control of single species. To support this transition, an IWM framework for implementing a system level approach is presented. The framework consists of five pillars: diverse cropping systems, cultivar choice and establishment, field and soil management, direct control and the cross-cutting pillar monitoring and evaluation. IWM is an integral part of integrated pest management (IPM) and adopting IWM will serve as a driver for the development of sustainable agricultural systems of the futur

Isabelle Lespinet-Moret, Vincent Viet (dir.), L’organisation internationale du travail. Origine, développement, avenir et Sandrine Kott, Joëlle Droux (éd.), Globalizing social rights. The International labour organization and beyond

Sandrine Kott et Isabelle Moret-Lespinet ont fait le choix de publier en deux volumes distincts les interventions du colloque « Politiques sociales transnationales, réseaux réformateurs et organisation internationale du travail » qui s’est tenu en 2009 à Genève à l’occasion du 90e anniversaire de l’Organisation internationale du travail (OIT). Vingt-huit des trente-deux contributions du colloque sont distribuées entre ces deux volumes : l’un, en français, qui reprend, à une exception près, de..

Integrated weed management systems with herbicide-tolerant crops in the European Union: lessons learnt from home and abroad

Conventionally bred (CHT) and genetically modified herbicide-tolerant (GMHT) crops have changed weed management practices and made an important contribution to the global production of some commodity crops. However, a concern is that farm management practices associated with the cultivation of herbicide-tolerant (HT) crops further deplete farmland biodiversity and accelerate the evolution of herbicide-resistant (HR) weeds. Diversification in crop systems and weed management practices can enhance farmland biodiversity, and reduce the risk of weeds evolving herbicide resistance. Therefore, HT crops are most effective and sustainable as a component of an integrated weed management (IWM) system. IWM advocates the use of multiple effective strategies or tactics to manage weed populations in a manner that is economically and environmentally sound. In practice, however, the potential benefits of IWM with HT crops are seldom realized because a wide range of technical and socio-economic factors hamper the transition to IWM. Here, we discuss the major factors that limit the integration of HT crops and their associated farm management practices in IWM systems. Based on the experience gained in countries where CHT or GMHT crops are widely grown and the increased familiarity with their management, we propose five actions to facilitate the integration of HT crops in IWM systems within the European Union

Gender difference in left atrial appendage occlusion outcomes: Results from the Amplatzer™ Amulet™ Observational Study

Background: Percutaneous LAAO represents an alternative for stroke prevention in patients not tolerating anticoagulation. While women are at higher risk of complications during percutaneous coronary or valvular interventions, the impact of gender on LAAO outcomes is not well characterized. The current study assessed potential gender-related differences in procedural and long-term outcomes following left atrial appendage occlusion (LAAO).Methods: 1088 AF patients were enrolled in the prospective, multicenter, Amplatzer™ Amulet™ Observational Study and followed for 2 years with scheduled adverse event assessments. The prespecified primary outcome was ischemic stroke, systemic embolism or cardiovascular (CV) death at 2 years. We also compared the rate of procedural success, device-related thrombus (DRT) and major bleeding between genders.Results: 702 men and 386 women underwent LAAO. Implant successwas high, and similar between men and women (98.9 vs 99.5%, p = 0.58). Similarly, no difference was observed in the primary outcome (12.0 vs 12.5%, p = 0.82). Compared to the CHA2DS2-VASc predicted rate, we observed a numerically greater absolute risk reduction of ischemic stroke in women (from 7.6 to 2.1%/year) than men (from 6.2 to 2.2%/year). DRT through 2 years was similar between groups (1.6%, p = 0.96). We found no significant gender difference in terms of periprocedural or long-term (7.1 vs 7.6%/year) major bleeding.Conclusions: In this large group of patients undergoing LAAO using the Amplatzer™ Amulet™ device we found no significant gender difference in terms of procedural or long-term clinical outcomes. Similarly to oral anticoagulation, device-based LAA occlusion renders AF-related stroke risk similar in women and men.</p

Defining malnutrition: a plea to rethink

In a recent consensus report in Clinical Nutrition the undernourished category of malnutrition was proposed to be defined and diagnosed on the basis of a low BMI or unintentional weight loss combined with low BMI or FFMI with certain cut off points. The definition was endorsed by ESPEN despite recent endorsement of a very different definition. The approach aims to assess whether nutritional intake is sufficient but is imprecise because a low BMI does not always indicate malnutrition and individuals with increasing BMI's may have decreasing FFM's. The pathophysiology of individuals, considered to be malnourished in rich countries and in areas with endemic malnutrition, results predominantly from deficient nutrition combined with infection/inflammation. Both elements jointly determine body composition and function and consequently outcome of disease, trauma or treatment. When following the consensus statement only an imprecise estimate is acquired of nutritional intake without knowing the impact of inflammation. Most importantly, functional abilities are not assessed. Consequently it will remain uncertain how well the individual can overcome stressful events, what the causes are of dysfunction, how to set priorities for treatment and how to predict the effect of nutritional support. We therefore advise to consider the pathophysiology of malnourished individuals leading to inclusion of the following elements in the definition of malnutrition: a disordered nutritional state resulting from a combination of inflammation and a negative nutrient balance, leading to changes in body composition, function and outcome. A precise diagnosis of malnutrition should be based on assessment of these element