The utility of pharmacy dispensing data for ART programme evaluation and early identification of patient loss to follow-up

No abstract Southern African Journal of HIV Medicine Vol. 9 (2) 2008: pp. 44-4

The effect of end-range cervical rotation on vertebral and internal carotid arterial blood flow and cerebral inflow: a sub analysis of an MRI study

Introduction: Cervical spine manual therapy has been associated with a small risk of serious adverse neurovascular events, particularly to the vertebral arteries. Sustained end-range rotation is recommended clinically as a pre-manipulative screening tool; however ultrasound studies have yielded conflicting results about the effect of rotation on blood flow in the vertebral arteries. There has been little research on internal carotid arterial flow or utilising the reference standard of angiography. Objectives: To evaluate the mean effect of cervical rotation on blood flow in the craniocervical arteries and blood supply to the brain, as well as individual variation. Design: This was an observational study. Method: Magnetic resonance angiography was used to measure average blood flow volume in the vertebral arteries, internal carotid arteries, and total cerebral inflow, in three neck positions: neutral, end-range left rotation and end-range right rotation in healthy adults. Results: Twenty participants were evaluated. There was a decrease in average blood flow volume in the vertebral and internal carotid arteries on contralateral rotation, compared to neutral. This was statistically significant on left rotation only. Ipsilateral rotation had no effect on average blood flow volume in any artery. Total cerebral inflow was not significantly affected by rotation in either direction. Conclusions: It appears that in healthy adults the cerebral vasculature can compensate for decreased flow in one or more arteries by increasing flow in other arteries, to maintain cerebral perfusion. Sustained end-range rotation may therefore reflect the compensatory capacity of the system as a whole rather than isolated vertebrobasilar function

Persistent intestinal abnormalities and symptoms in cystic fibrosis: The underpinning mechanisms impacting gut health and motility. Protocol for a systematic review.

Background Patients with cystic fibrosis (CF) are characterised by abnormalities of the intestinal tract relating to gut motility and physiological issues, with daily symptoms of disease including abdominal pain, flatulence, bloating, and constipation. With improvements in respiratory outcomes, a shift in disease manifestations has highlighted the prevalence of the gastrointestinal-related problems associated with CF, yet most therapies currently in clinical use for the gut symptoms of CF have been repurposed from other disease indications and have not been developed with a knowledge of the mechanisms underpinning gastrointestinal disease in CF. Increased attention towards the role of intestinal inflammation and microbial dysbiosis in the CF population warrants a comprehensive knowledge of these aspects alongside the increased luminal fat content, dysmotility, and small intestinal bacterial overgrowth (SIBO) resultant of the primary consequences of CFTR dysfunction (disrupted fluid secretion and pancreatic insufficiency), and how they contribute towards the intestinal complications of CF disease. Methods and Study Design We will conduct a systematic review to comprehensively address our current understanding of the primary consequences of CFTR dysfunction, and their subsequent secondary effects that contribute towards the disruption of gut motility, health, and associated symptoms in the CF intestine. Databases searched will include PubMed, CINAHL, MEDLINE and the Cochrane library from 1939 until a specified date of last search, alongside clinical trial databases for ongoing studies. Search strategies will include various terminology that relates to the primary mechanistic defects of CF, postulated secondary effects of such defects, and symptoms experienced in patients. A full search strategy is outlined in Appendix B. One reviewer will apply an inclusion criterion to obtained abstracts. Following agreement from a second reviewer, full-text articles will be sought, and data will be extracted from relevant articles. Disagreements will be resolved with a third reviewer. The quality of data will be assessed by the GRADE criteria. Data will be used to present a narrative, and where possible, quantitative synthesis. Discussion This systematic review will discuss our current understanding of the underpinning mechanisms of the persisting abnormalities in gut health and motility within CF, addressing potential intricate relationships that further contribute to disease progression within the intestinal tract. Furthermore, we will identify current gaps in the literature to propose directions for future research. A comprehensive understanding of these aspects in relation to intestinal abnormalities will aid future clinical directions

Modelo de avaliação da disfunção arterial na região cervical, pré-­‐intervenção com Terapia Manual Ortopédica (TMO)

Tradução do documento “International Framework for Examination of the Cervical Region for potential of Cervical Arterial Dysfunction prior to Orthopaedic Manual Therapy Intervention" por Diogo Pires, Eduarto Brazete Cruz, Isabel Bastos de Almeida, João Filipe Vasconcelos Abreu, Lúcia Domingues e Susana Duarteinfo:eu-repo/semantics/publishedVersio

Exploratory study of Polycyclic Aromatic Hydrocarbon (PAH) contributions to household air pollution arising from improved cookstove use in rural Malawi

Around three million premature deaths annually are ascribed to household air pollution (HAP) arising from inefficient burning of biomass and emissions of products of incomplete combustion. The developing-world response has been widespread adoption of improved cookstove (ICS) technologies. This exploratory study evaluates variation in polycyclic aromatic hydrocarbon (PAH) attached to inhalable particulate matter (PM) in rural Malawi households adopting ICS use. PM literature supports HAP exposure to inhalable PM is lowered, albeit variably, compared to traditional fires, but remains significant. Similar is expected for PAH; however, datasets lack discerning PAH chemical-specific contributions to risks. The study introduces the Malawian context, invokes a PAH reconnaissance approach sampling kitchen soot ‘spots’ and residential dusts, and relates PAH occurrence to the two sample types collected and ICS types surveyed. The total PAH for dusts was low (c. 2 μg/g mean), with volatile 2-ring naphthalene dominant. Soot total PAH was much higher (c. 200 μg/g mean to a maximum of 815 μg/g). Soot from PM emissions poses a major primary health concern. Despite PAH trends not being obvious with ICS type (limited sample size) and the wide range in soot total PAH, soot PAH fingerprints were well constrained with low variation of diagnostic PAH ratios, exhibiting n-ring fingerprints close to the soot median (0.1% 2-ring, 20% 3-ring, 61% 4-ring, 14% 5-ring, 5% 6-ring PAH). These corroborate the expected wood-related combustions sources, but also point to the needs to understand factors that control wide variations in PM and (total) PAH emitted as these control variations in HAP and differing risks posed to individual households. Further household-based research is thus recommended discerning relationships between PM emissions and PAH contents, driving the chemical composition health risks. These should establish influences on PAH exposure arising from ICS type/model selected, operational modes, building/ventilation conditions, variable fuel sources and nonoptimal ICS use

Application of different measures of skeletal maturity in initiating weaning from a brace for scoliosis: two case reports

<p>Abstract</p> <p>Introduction</p> <p>Various measures of skeletal maturity are used to initiate weaning from a brace in patients suffering from idiopathic scoliosis, resulting in different outcomes. We present two cases with double major curves, treated with the Rigo System Cheneau brace, and weaned using different criteria.</p> <p>Case presentation</p> <p>Case 1 was a South African, Caucasian girl who was initially treated with a brace at 14.75 years and who began weaning at 16.25 years on the basis of the Greulich and Pyle Index. She was out of her brace in 6 months, at least 11 months before reaching skeletal maturity as shown by the Risser Sign. Case 2 was a South African, Caucasian girl, initially treated with a brace at 14.25 years and who began the weaning process at 17.67 years on the basis of skeletal maturity according to the Risser Sign and static height for a period of 6 months. She was out of the brace 12 months later. In Case 1, the thoracic Cobb angle progressed during weaning and scoliometer readings deteriorated. The iliac apophysis fused 11 months after the wrist. In Case 2, the therapeutic gains made during the period of bracing were maintained during weaning, that is the improvement in the lumbar Cobb angle was maintained until the brace was removed, and scoliometer readings improved. The iliac apophysis fused 8.5 months after the wrist.</p> <p>Conclusions</p> <p>In patients with idiopathic scoliosis, it would seem to be more appropriate to base the timing of weaning on the Risser Sign and static height measurements rather than on traditional methods such as the Greulich and Pyle Index.</p

Nitrogen processes in aquatic ecosystems

Executive summary Nature of the problem (science/management/policy) • Freshwater ecosystems play a key role in the European nitrogen (N) cycle, both as a reactive agent that transfers, stores and processes N loadings from the atmosphere and terrestrial ecosystems, and as a natural environment severely impacted by the increase of these loadings. Approaches • This chapter is a review of major processes and factors controlling N transport and transformations for running waters, standing waters, groundwaters and riparian wetlands. Key findings/state of knowledge • The major factor controlling N processes in freshwater ecosystems is the residence time of water, which varies widely both in space and in time, and which is sensitive to changes in climate, land use and management. • The effects of increased N loadings to European freshwaters include acidification in semi-natural environments, and eutrophication in more disturbed ecosystems, with associated loss of biodiversity in both cases. • An important part of the nitrogen transferred by surface waters is in the form of organic N, as dissolved organic N (DON) and particulate organic N (PON). This part is dominant in semi-natural catchments throughout Europe and remains a significant component of the total N load even in nitrate enriched rivers. • In eutrophicated standing freshwaters N can be a factor limiting or co-limiting biological production, and control of both N and phosphorus (P) loading is oft en needed in impacted areas, if ecological quality is to be restored. Major uncertainties/challenges • The importance of storage and denitrifi cation in aquifers is a major uncertainty in the global N cycle, and controls in part the response of catchments to land use or management changes. In some aquifers, the increase of N concentrations will continue for decades even if efficient mitigation measures are implemented now. • Nitrate retention by riparian wetlands has oft en been highlighted. However, their use for mitigation must be treated with caution, since their effectiveness is difficult to predict, and side effects include increased DON emissions to adjacent open waters, N2O emissions to the atmosphere, and loss of biodiversity. • In fact, the character and specific spatial origins of DON are not fully understood, and similarly the quantitative importance of indirect N2O emissions from freshwater ecosystems as a result of N leaching losses from agricultural soils is still poorly known at the regional scale. • These major uncertainties remain due to the lack of adequate monitoring (all forms of N at a relevant frequency), especially – but not only – in the southern and eastern EU countries. Recommendations (research/policy) • The great variability of transfer pathways, buffering capacity and sensitivity of the catchments and of the freshwater ecosystems calls for site specific mitigation measures rather than standard ones applied at regional to national scale. • The spatial and temporal variations of the N forms, the processes controlling the transport and transformation of N within freshwaters, require further investigation if the role of N in influencing freshwater ecosystem health is to be better understood, underpinning the implementation of the EU Water Framework Directive for European freshwaters