Cost-effectiveness of voluntary HIV-1 counseling and testing in reducing sexual transmission of HIV-1 in Kenya and Tanzania.

Background Access to HIV-1 voluntary counseling and testing (VCT) is severely limited in less-developed countries. We undertook a multisite trial of HIV-1 VCT to assess its impact, cost, and cost-effectiveness in less-developed country settings.\ud Methods\ud The cost-effectiveness of HIV-1 VCT was estimated for a hypothetical cohort of 10 000 people seeking VCT in urban east Africa. Outcomes were modelled based on results from a randomised controlled trial of HIV-1 VCT in Tanzania and Kenya. Our main outcome measures included programme cost, number of HIV-1 infections averted, cost per HIV-1 infection averted, and cost per disability-adjusted life-year (DALY) saved. We also modelled the impact of targeting VCT by HIV-1 prevalence of the client population, and the proportion of clients who receive VCT as a couple compared with as individuals. Sensitivity analysis was done on all model parameters.\ud Findings\ud HIV-1 VCT was estimated to avert 1104 HIV-1 infections in Kenya and 895 in Tanzania during the subsequent year. The cost per HIV-1 infection averted was US$249 and$346, respectively, and the cost per DALY saved was $12·77 and$17·78. The intervention was most cost-effective for HIV-1-infected people and those who received VCT as a couple. The cost-effectiveness of VCT was robust, with a range for the average cost per DALY saved of $5·16-27·36 in Kenya, and$6·58-45·03 in Tanzania. Analysis of targeting showed that increasing the proportion of couples to 70% reduces the cost per DALY saved to $10·71 in Kenya and$13·39 in Tanzania, and that targeting a population with HIV-1 prevalence of 45% decreased the cost per DALY saved to $8·36 in Kenya and$11·74 in Tanzania.\ud Interpretation\ud HIV-1 VCT is highly cost-effective in urban east African settings, but slightly less so than interventions such as improvement of sexually transmitted disease services and universal provision of nevirapine to pregnant women in high-prevalence settings. With the targeting of VCT to populations with high HIV-1 prevalence and couples the cost-effectiveness of VCT is improved significantly

Selection Criteria for Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) Treatment in Patients with Peritoneal Metastases.

The standard treatment protocol for PIPAC consists of three procedures. Completion of treatment has been shown to be prognostic of improved survival. The aim of this study was to identify predictors for completion of treatment. Retrospective multicentric cohort study of patients with peritoneal metastases undergoing PIPAC in three PIPAC expert centers. Per protocol (PP) treatment was defined as patients receiving ≥3 PIPACs and was compared to patients receiving <3. Overall, 183 patients had 517 PIPACs. The main reasons for stopping PIPAC were disease progression in 50% patients, bowel obstruction in 15%, patient's refusal to pursue in 10%, conversion to cytoreductive surgery in 7%, and medical reasons in 8%. Overall, 95 patients (52%) had PP treatment. The PP median OS was 17 vs. 7 months, p = 0.001. PP patients had r ascites (410 ± 100 mL vs. 960 ± 188 mL, p = 0.001), no prior history of bowel obstruction (12% vs. 24%, p = 0.028), and more bimodal treatment (39% vs. 13%, p < 0.001). After multiple regression, bimodal treatment was found as an independent predictive factor for completing PP (OR = 4.202, 95%CI [1.813, 10.630], p < 0.001), along with prior bowel obstruction (OR = 0.389, 95%CI [0.153, 0.920], p = 0.037). The absence of ascites and prior bowel obstruction can help to select patients suitable for PIPAC. Best results seem to be achieved when PIPAC is combined with systemic chemotherapy

Cardiac output measurement in children: comparison of Aesculon® cardiac output monitor and thermodilution

Background We compared cardiac output (CO) measurements by the non-invasive electrical velocimetry (Aesculon®) monitor with the pulmonary artery catheter (PAC) thermodilution method in children. Methods CO values using the Aesculon® monitor and PAC thermodilution were simultaneously recorded during cardiac catheterization in children. Measurements were performed under general anaesthesia. To compare, three consecutive measurements for each patient within 3 min were obtained. The means of the three values were compared using simple regression and Bland-Altman analysis. Data were presented as mean (sd). A mean percentage of <30% was defined to indicate clinical useful reliability of the Aesculon® monitor. Results A total of 50 patients with a median (range) age of 7.5 (0.5-16.5) yr were enrolled in the study. Mean CO values were 3.7 (1.5) litre min−1 (PAC thermodilution) and 3.1 (1.7) litre min−1 (Aesculon® monitor). Analysis for CO measurement showed a good correlation between the two methods (r=0.894; P<0.0001). The bias between the two methods was 0.66 litre min−1 with a precision of 1.49 litre min−1. The mean percentage error for CO measurements was 48.9% for the Aesculon® monitor when compared with PAC thermodilution. Conclusions Electrical velocimetry using the Aesculon® monitor did not provide reliable CO values when compared with PAC thermodilution. Whether the Aesculon® monitor can be used as a CO trend monitor has to be assessed by further investigations in patients with changing haemodynamic

Trypanosoma brucei gambiense group 1 is distinguished by a unique amino acid substitution in the HpHb receptor implicated in human serum resistance

Trypanosoma brucei rhodesiense (Tbr) and T. b. gambiense (Tbg), causative agents of Human African Trypanosomiasis (sleeping sickness) in Africa, have evolved alternative mechanisms of resisting the activity of trypanosome lytic factors (TLFs), components of innate immunity in human serum that protect against infection by other African trypanosomes. In Tbr, lytic activity is suppressed by the Tbr-specific serum-resistance associated (SRA) protein. The mechanism in Tbg is less well understood but has been hypothesized to involve altered activity and expression of haptoglobin haemoglobin receptor (HpHbR). HpHbR has been shown to facilitate internalization of TLF-1 in T.b. brucei (Tbb), a member of the T. brucei species complex that is susceptible to human serum. By evaluating the genetic variability of HpHbR in a comprehensive geographical and taxonomic context, we show that a single substitution that replaces leucine with serine at position 210 is conserved in the most widespread form of Tbg (Tbg group 1) and not found in related taxa, which are either human serum susceptible (Tbb) or known to resist lysis via an alternative mechanism (Tbr and Tbg group 2). We hypothesize that this single substitution contributes to reduced uptake of TLF and thus may play a key role in conferring serum resistance to Tbg group 1. In contrast, similarity in HpHbR sequence among isolates of Tbg group 2 and Tbb/Tbr provides further evidence that human serum resistance in Tbg group 2 is likely independent of HpHbR functio

Biodiversität im Kulturland – vom Nebenprodukt zum Marktvorteil

Zusammenfassung Die in der Schweiz getroffenen Maßnahmen gegen den Rückgang der Biodiversität im Kulturland zeigen wenig Erfolg. Die Gründe dürften einerseits in der gängigen Subventionspolitik, andererseits beim ökologischen Wissen der Landwirte liegen. Das 2008 gestartete Projekt „Mit Vielfalt punkten – Bauern beleben die Natur“ will an diesen beiden Punkten ansetzten. Vorerst wurde ein Punktesystem entwickelt, mit dem die Leistungen der Betriebe für die Biodiversität ermittelt werden können. Der Zusammenhang Punkte – Biodiversität wird geprüft. In Zukunft werden 30 Betriebe intensiv mit dem Ziel beraten, dass mehr Maßnahmen zu Gunsten der Biodiversität umgesetzt werden. Für die Beratung werden Leitartenkarten entwickelt, denn es hat sich gezeigt, dass Landwirte besser auf konkrete Arten ansprechen als auf theoretische Konzepte. Die Auswirkungen der Beratung werden geprüft, sowohl auf der Ebene Biodiversität als auch auf der sozio-ökonomischen Ebene. Bereits zu Beginn des Projektes hat die IP-SUISSE (Verein der integriert produzierenden Landwirte) das Punktesystem in ihre Richtlinien aufgenommen und mit einer Mindestpunktezahl versehen. Die Migros (Vermarkter) übernimmt einen großen Teil dieser Produkte und zahlt den Landwirten einen Bonus aus. Sie gibt die Produkte unter dem Label TerraSuisse den Konsumierenden weiter. So wird die Biodiversität zu einem Marktfaktor

Gesellschaftliche Leistungen der biologischen Landwirtschaft

Zusammenfassuung: In diesem Bericht werden die wissenschaftlichen Ergebnisse nationaler und internationaler Studien zu den gesellschaftlichen Leistungen des Biolandbaus zusammengefasst. Als Referenzen werden dabei sowohl die konventionelle wie auch die integrierte Landwirtschaft herangezogen. Es ist den Autoren bewusst, dass alle Landwirtschaftsmethoden in der Schweiz und im Ausland eine grosse Streubreite aufweisen, da der Einfluss der regionalen sozioökonomischen Rahmenbedingungen, der Standortfaktoren, der Betriebsleiter und der unterschiedlichen staatlichen und privaten Regulierungen gross ist. Trotzdem ergeben sich für die verschiedenen Landwirtschaftsmethoden klare Unterschiede, die bei den agrarpolitischen Massnahmen berücksichtigt werden müssen. Bezüglich der positiven Externalitäten weist der Biolandbau klare Mehrleistungen in der Biodiversität auf. Dies sowohl auf der Ebene der Genetik, der Arten und besonders auch der Habitate. Deutlich sind die Mehrleistungen des Biolandbaus auch im Bereich des Humusaufbaus, was eine höhere CO2-Sequestrierung zur Folge hat. Obwohl eine dauerhafte Honorierung der Vermeidung negativer Externalitäten im bisherigen Konzept der Weiterentwicklung des Direktzahlungssystems (WDZ) nicht vorgesehen ist, sind hier die Vorteile der biologischen Landwirtschaft beträchtlich. Dies betrifft die Nährstoff- und Pflanzenschutzmittelverluste in Grund- und Oberflächengewässer sowie in andere Umweltkompartimente, der Verbrauch von nicht erneuerbarer Energie, die Emissionen von Klimagasen und die Belastungen mit Tiermedikamenten. Die nationalen und internationalen Studien zeigen auf, dass der Biolandbau sich besonders durch Systemwirkungen auszeichnet: erhöhte Biodiversität, verbesserter Schutz des Bodens, wirksame Vermeidung von Umweltbelastungen, effiziente Nutzung von natürlichen Ressourcen, geringer Verbrauch nicht erneuerbarer Energie und verbessertes Tierwohl. Dies sind die Effekte von komplexen Response-Massnahmen der Betriebsleiter auf einfach zu kontrollierende Einschränkungen und Verbote. Dadurch entstehen nicht zu unterschätzende Zusatzleistungen und Synergien bei der Erreichung der vom Bund definierten Ziele. Um den Mehrleistungen des Biolandbaus gerecht zu werden, schlagen die Autoren zwei neue Massnahmen vor: 1) Biodiversitätsbeitrag für Acker, Sonderkulturen und intensive Wiesen und 2) CO2-Sequestrationsbeiträge. Damit sind aber die gesellschaftlich wichtigen Mehrleistungen des Biolandbaus noch nicht abgegolten. Bei der Vermeidung negativer Externalitäten werden höhere umweltschutzrelevante Effekte erzielt. Diese können i) durch die Einführung eines negativen Anreizsystems nach dem Polluter-Pays-Principle (z.B. Stickstoffsteuer, CO2 - Abgabe), ii) durch ein höheres Einstiegsniveau bei den Cross-Compliance-Massnahmen für alle Betriebe (ÖLNplus) oder iii) durch einen finanziellen Ausgleich für die Mehrleistungen des Biolandbaus abgegolten werden. Die „Förderung des Biolandbaus“ als systemorientierte Massnahme macht auch nach dem Grundsatz des effizienten Einsatzes von Steuermitteln Sinn und stellt eine kosteneffektive Massnahme dar. Einerseits können damit die deutlich höheren positiven Externalitäten abgegolten werden, andererseits wird die stärkere Vermeidung von negativen Externalitäten genügend berücksichtigt

Tracheal tube-tip displacement in children during head-neck movement—a radiological assessment

Background. Aims of this study were to assess the maximum displacement of tracheal tube tip during head-neck movement in children, and to evaluate the appropriateness of the intubation depth marks on the Microcuff Paediatric Endotracheal Tube regarding the risk of inadvertent extubation and endobronchial intubation. Methods. We studied children, aged from birth to adolescence, undergoing cardiac catheterization. The patients' tracheas were orally intubated and the tracheal tubes positioned with the intubation depth mark at the level of the vocal cords. The tracheal tube tip-to-carina distances were fluoroscopically assessed with the patient supine and the head-neck in 30° flexion, 0° neutral position and 30° extension. Results. One hundred children aged between 0.02 and 16.4 yr (median 5.1 yr) were studied. Maximum tracheal tube-tip displacement after head-neck 30° extension and 30° flexion demonstrated a linear relationship to age [maximal upward tube movement (mm)=0 0.71×age (yr)+9.9 (R2=0.893); maximal downward tube movement (mm)=0.83×age (yr)+9.3 (R2=0.949)]. Maximal tracheal tube-tip downward displacement because of head-neck flexion was more pronounced than upward displacement because of head-neck extension. Conclusions. The intubation depth marks were appropriate to avoid inadvertent tracheal extubation and endobronchial intubation during head-neck movement in all patients. However, during head-neck extension the tracheal tube cuff may become positioned in the subglottic region and should be re-adjusted when the patient remains in this position for a longer tim

Efficacy of triclabendazole and albendazole against Fasciola spp. infection in cattle in Côte d'Ivoire: a randomised blinded trial

Triclabendazole is the anthelminthic of choice for the treatment of fascioliasis, however, it is not yet registered in many countries. Therefore, we investigated the efficacy of a single-dose of triclabendazole (12 mg/kg) or albendazole (15 mg/kg) against Fasciola spp. infection in cattle on farms in the northern part of Cote d'Ivoire in a randomized clinical trial. Faecal samples were obtained from 196 cattle, of which 155 (79.1%) were found positive for Fasciola spp. by the sedimentation technique. Cattle infected with Fasciola spp. were randomly allocated (3:3:1) to receive triclabendazole (n=66), albendazole (n=67) or left untreated to serve as control (n=22). Follow-up faecal samples were collected on days 21, 28, 90 and 188 post-treatment. No adverse events were observed as reported by the farmer in any of the treatment groups. The proportion of non-egg shedding cattle (PNES), assessed at day 21 (primary outcome), was significantly higher in cattle treated with triclabendazole (95.4%) compared to those receiving albendazole (70.3%; odds ratio [OR] 0.11, 95% confidence interval [CI] 0.03-0.39, p <0.001). The egg reduction rate (ERR) expressed as number of eggs per gram of faeces (epg), a secondary endpoint assessed at day 21 post-treatment, was significantly higher in the triclabendazole arm (arithmetic mean (AM) ERR=99.8%) than in the albendazole arm (AM ERR=92.2%), with a difference of 7.6%-points (95% CI: 0.9-14.5%-points, p=0.03). Reinfection rates at days 90 and 188 post-treatment (secondary endpoint) were lower in the triclabendazole arm (5.3% and 18.5%) compared to the albendazole arm (23.5% and 33.3%). This is the first report of efficacy of triclabendazole against Fasciola spp. in naturally infected cattle in Cote d'Ivoire. Our results confirm that triclabendazole is the most effective treatment of fascioliasis and therefore, should be considered for the control of livestock fascioliasis; if resources allow in combination with intermediate host snail control and raising farmers awareness of pasture and livestock management to avoid reinfection

Population genetic structure of Schistosoma haematobium and Schistosoma haematobium x Schistosoma bovis hybrids among school-aged children in Côte d'Ivoire

While population genetics of Schistosoma haematobium have been investigated in West Africa, only scant data are available from Cote d'Ivoire. The purpose of this study was to analyze both genetic variability and genetic structure among S. haematobium populations and to quantify the frequency of S. haematobium x S. bovis hybrids in school-aged children in different parts of Cote d'Ivoire. Urine samples were subjected to a filtration method and examined microscopically for Schistosoma eggs in four sites in the western and southern parts of Cote d'Ivoire. A total of 2692 miracidia were collected individually and stored on Whatman((R)) FTA cards. Of these, 2561 miracidia were successfully genotyped for species and hybrid identification using rapid diagnostic multiplex mitochondrial cox1 PCR and PCR Restriction Fragment Length Polymorphism (PCR-RFLP) analysis of the nuclear ITS2 region. From 2164 miracidia, 1966 (90.9%) were successfully genotyped using at least 10 nuclear microsatellite loci to investigate genetic diversity and population structure. Significant differences were found between sites in all genetic diversity indices and genotypic differentiation was observed between the site in the West and the three sites in the East. Analysis at the infrapopulation level revealed clustering of parasite genotypes within individual children, particularly in Duekoue (West) and Sikensi (East). Of the six possible cox1-ITS2 genetic profiles obtained from miracidia, S. bovis cox1 x S. haematobium ITS2 (42.0%) was the most commonly observed in the populations. We identified only 15 miracidia (0.7%) with an S. bovis cox1 x S. bovis ITS2 genotype. Our study provides new insights into the population genetics of S. haematobium and S. haematobium x S. bovis hybrids in humans in Cote d'Ivoire and we advocate for researching hybrid schistosomes in animals such as rodents and cattle in Cote d'Ivoire

Prevalence and distribution of livestock schistosomiasis and fascioliasis in Côte d'Ivoire: results from a cross-sectional survey

BACKGROUND: Schistosoma and Fasciola are zoonotic parasites of public health and veterinary importance. However, while the epidemiology of schistosomiasis in humans is well studied, little is known about fascioliasis and schistosomiasis in livestock in Cote d'Ivoire. This study aimed to determine the prevalence and the distribution of livestock schistosomiasis and fascioliasis across Cote d'Ivoire. In 2018, we conducted a cross-sectional survey in abattoirs and farms in 13 departments of Cote d'Ivoire. In abattoirs, the mesenteric veins and livers of slaughtered cattle, sheep and goats were examined for adult Schistosoma and Fasciola flukes. Faeces from live cattle, goats and sheep were collected and examined for Schistosoma and Fasciola eggs using a sedimentation technique. RESULTS: A total of 386 cattle, 174 goats and 151 sheep from abattoirs and 435 cattle, 22 goats and 176 sheep from farms were sampled. The observed prevalence of schistosomiasis was higher in slaughtered animals. Fascioliasis was more prevalent in farm animals. The prevalence of schistosomiasis in slaughtered cattle varied between 5.9% (95% confidence interval (CI): 0.7-19.7%) and 53.3% (95% CI: 37.9-68.3%) with the highest prevalence observed in Ouangolodougou in the North. Cattle from farms had a relatively low prevalence of schistosomiasis, with the highest prevalence found in Ouangolodougou (2.4%, 95% CI: 0.7-6.1%). The prevalence of fascioliasis varied considerably from one department to another, ranging from nil (95% CI: 0.0-18.5%) to 50.8% (95% CI: 43.4-58.2%), with the highest prevalence found in farm cattle in Dikodougou in the North. Sheep and goats had a lower prevalence of schistosomiasis and fascioliasis than cattle. In slaughtered animals, cattle aged 4 years and older were at highest risk for schistosomiasis (odds ratio (OR): 2.4; 95% CI: 1.0-5.6) and fascioliasis (OR: 2.1; 95% CI: 1.1-3.9). In farm animals, male cattle had higher odds of being infected with Schistosoma (OR: 4.3; 95% CI: 0.7-26.9) than females. CONCLUSIONS: Our study confirms that schistosomiasis and fascioliasis are endemic in livestock across Cote d'Ivoire. A strategic control programme should be considered, especially for cattle, including providing drinking water in troughs to reduce faecal contamination of water sources by cattle