MDR/XDR-TB management of patients and contacts: Challenges facing the new decade. The 2020 clinical update by the Global Tuberculosis Network.

The continuous flow of new research articles on MDR-TB diagnosis, treatment, prevention and rehabilitation requires frequent update of existing guidelines. This review is aimed at providing clinicians and public health staff with an updated and easy-to-consult document arising from consensus of Global Tuberculosis Network (GTN) experts. The core published documents and guidelines have been reviewed, including the recently published MDR-TB WHO rapid advice and ATS/CDC/ERS/IDSA guidelines. After a rapid review of epidemiology and risk factors, the clinical priorities on MDR-TB diagnosis (including whole genome sequencing and drug-susceptibility testing interpretations) and treatment (treatment design and management, TB in children) are discussed. Furthermore, the review comprehensively describes the latest information on contact tracing and LTBI management in MDR-TB contacts, while providing guidance on post-treatment functional evaluation and rehabilitation of TB sequelae, infection control and other public health priorities

Growing skull fractures in a developing country: a case series

Background: Growing Skull Fracture (GSF) is a very rare complication of skull fractures. Different types have been described and because presentation may be delayed with neurological sequelae, diagnosis and prompt intervention are key to achieving good outcome.Objective: This study seeks to highlight the features and the technical peculiarities in management of growing skull fractures in low resource settings.Methodology: A retrospective study of patients who were managed in Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria, January 2006–October 2015. Relevant data were retrieved from patients’ medical records and analyzed.Results: Seven patients were managed over the period under review, but complete records were found in only 4 cases. The age range was 6weeks- 48years, and 6 patients (85.7%) were in the paediatric age group (6weeks- 16months), with a mean age of 6.25months. All the paediatric patients were less than 2years of age. Three patients (42.9%) were females and four (57.1%) were males, giving a M: F ratio of 1.3:1. The aetiological factor in six of the patients (85.7%, all the paediatric cases) was road traffic accident. One patient (14.3%, the only adult) was assaulted, had a porencephalic cyst (type III GSF). One other patient had type-I GSF and was treated with cysto-peritoneal shunting, five had type-II GSF, four were managed operatively with craniotomy and duroplasty, while, one was lost to follow-up. Surgical outcomes were adjudged as good in all patients, but, anaemia was a problem in the paediatric patients.Conclusion: Growing skull fracture is predominantly a disease of the paediatric age group which may, nevertheless, be seen in adults. Prompt and appropriate surgical intervention has a good outcome.Keywords: Craniotomy, duroplasty, good outcome, surgical managemen

Traumatic tension pneumocephalus: A series of 4 cases managed in Zaria

Tension pneumocephalus is the accumulation of air in the intracranial cavity with attendant neurological changes. Though a neurosurgical emergency, it could present in a delayed form requiring a high index of suspicion. We report a series of four cases; two of which were managed operatively and two non-operatively with good outcome.Keywords: Aerocele, imaging, otorrhoea, outcome, rhinorrhoea, traum

Chronic Subdural Haematoma in Zaria

Objective: To determine the demographic pattern, risk factors, clinical presentation, imaging pattern and outcome of surgical management of chronic subdural haematoma (CSDH) in Ahmadu Bello University Teaching Hospital, Zaria, North-West Nigeria.Methodology: A retrospective study of case notes, operation registers and operation notes of 30 patients with CSDH, who had surgical treatment at Ahmadu Bello University Teaching Hospital, Zaria, from May 2007 to April, 2015.Results: The series included 24 males (80%) and 6 females (20%), age range 7months-90years and mean age 45years. History of trauma to the head was obtained in 27 patients (90%), and mean interval from trauma to appearance of symptoms was 15.5days. The most common risk factor, besides trauma, was hypertension (23.3%). The principal symptoms were headache (53.3%) and altered consciousness (50%). The CSDH was left-sided in 12 patients (40%), right-sided in 8 (26.7%), and bilateral in the remaining 10 patients (33.3%). Post-operative complications occurred in 4 patients (13.3%), and were successfully treated, while 5 patients (16.7%) died in the hospital.Conclusion: Chronic subdural haematoma presents at a relatively younger age in our centre than generally documented elsewhere; and the most common cause is trauma, particularly from motorcycle-related accidents. No statistically significant relationship was established between age and outcome, or between GCS at presentation and outcome.Keywords: Burr hole, head trauma, hypertension, intracranial haemorrhag

Dynamic System Development: an Approach for Land Re-adjustment in Managing Slum Areas

Land re-adjustment (LR) is a practical model in the management of land development in the urban development process. One of the most prominent issues in the management of slum improvement is the multiple ownership of the land. Most cities in developing countries, relocate and provide apartments for the inhabitants in handling a slum area. Tangerang City also has its problems in handling slums. In order to achieve sustainable development, we attempt to develop slum areas by considering three aspects: social acceptability, affordability, and environmental sustainability. The environmental aspect is analyzed by considering carbon footprint generated by community activities in the area with and without land re-adjustment. The Dynamics model then is chosen to formulate the relation between the availability of land, water resources, landfill capacity (landfill) and electricity supply capacity with consumption pattern of carbon footprint. There are major dynamic loops, namely: utility, population and housing causal loops. The dynamic model shows a causal link that population has generated the most variable loops, which then contribute to housing and utility needs. In managing slum areas, Land re-adjustment model is able to reduce carbon emissions to about 40 % compared to the other model from business as usual scenario.     Keywords: land re-adjustment, eco-design, social acceptability, affordability and environmental sustainability, dynamic model, carbon footprin

Tartu Ülikooli Õppe- ja Katsemetskonna Kastre Peravalla metsandike plaanid (kvartalid nr 200-293)

PlaanidTartu Ülikooli Õppe- ja Katsemetskonna Kastre Peravalla metsandike takseerkirjeldused aastatest 1922, 1923. Kvartalite nr 200-293 käsikirjalised originaalplaanid on mõõtkavas 1:2500. Koloreeritud plaanid sisaldavad kvartalite numbreid, leppemärkide seletusi, ilmakaari, graafilist mõõtkava, autorite nimesid. Autorite nimedes võib esineda eksimusi. Loetamatud nimed puuduvad autorite loendis