Severe Antiretroviral Therapy-Induced Toxic Epidermal Necrolysis in a Child

Toxic epidermal necrolysis (TEN) is a rare and life-threatening condition characterised by extensive epidermal detachment and mucosal erosion. Adverse drug reaction is a strongly correlated causative factor and TEN is currently considered the most severe end of a spectrum of drug-induced mucocutaneous diseases, including Stevens-Johnson syndrome. Attaining an accurate and detailed patient history is critical for identifying potential causative agents, which can prove challenging; particularly in cultures such as that of Malawi. TEN lacks definitive management and the use of immunomodulation, such as with corticosteroids and intravenous immunoglobulin, remains controversial. We report a fascinating case of TEN associated with antiretroviral therapy. A 10-year-old female was given a combination of antiretroviral drugs (lamivudine, nevirapine and stavudine) as postexposure prophylaxis, having been raped. The child subsequently developed TEN and presented to our remote hospital in Malawi, where she was treated entirely with supportive therapy. This is an excellent example of difficult disease management in a limited-resource setting and provides reassuring evidence to clinicians of similar circumstance. To our knowledge, this is the first case report of antiretroviral therapy-induced TEN in a child

Clinical Ethics in Gabon: The Spectrum of Clinical Ethical Issues Based on Findings from In-Depth Interviews at Three Public Hospitals

Introduction Unlike issues in biomedical research ethics, ethical challenges arising in daily clinical care in Sub-Saharan African countries have not yet been studied in a systematic manner. However this has to be seen as a distinct entity as we argue in this paper. Our aim was to give an overview of the spectrum of clinical ethical issues and to understand what influences clinical ethics in the Sub-Saharan country of Gabon. Materials and Methods In-depth interviews with 18 health care professionals were conducted at three hospital sites in Gabon. Interview transcripts were analyzed using a grounded theory approach (open and axial coding),giving a qualitative spectrum of categories for clinical ethical issues. Validity was checked at a meeting with study participants and other health care experts in Gabon after analysis of the data. Results Twelve main categories (with 28 further-specified subcategories) for clinical ethical issues were identified and grouped under three core categories: A) micro level: "confidentiality and information","interpersonal, relational and behavioral issues","psychological strain of individuals",and "scarce resources";B) meso level: "structural issues of medical institutions","issues with private clinics","challenges connected to the family",and "issues of education, training and competence";and C) macro level: "influence of society, culture, religion and superstition","applicability of western medicine","structural issues on the political level",and "legal issues". Discussion Interviewees reported a broad spectrum of clinical ethical issues that go beyond challenges related to scarce financial and human resources. Specific socio-cultural, historical and educational backgrounds also played an important role. In fact these influences are central to an understanding of clinical ethics in the studied local context. Further research in the region is necessary to put our study into perspective. As many participants reported a lack of awareness of ethical issues amongst other health care professionals in daily clinical practice, we suggest that international organizations and national medical schools should consider infrastructure and tools to improve context-sensitive capacity building in clinical ethics for Sub-Saharan African countries like Gabon

Marine Biodiversity in South Africa: An Evaluation of Current States of Knowledge

Continental South Africa has a coastline of some 3,650 km and an Exclusive Economic Zone (EEZ) of just over 1 million km2. Waters in the EEZ extend to a depth of 5,700 m, with more than 65% deeper than 2,000 m. Despite its status as a developing nation, South Africa has a relatively strong history of marine taxonomic research and maintains comprehensive and well-curated museum collections totaling over 291,000 records. Over 3 million locality records from more than 23,000 species have been lodged in the regional AfrOBIS (African Ocean Biogeographic Information System) data center (which stores data from a wider African region). A large number of regional guides to the marine fauna and flora are also available and are listed

O Programa de Ajustamento Estrutural na República da Guiné-Bissau: Uma avaliação política e Ética

Os guineenses assumiram o desenvolvimento como uma das metas a atingir e a estabilização e o ajustamento foi-lhes imposta como solução para os problemas estruturais existentes. No entanto, a forma como têm vindo a ser concebidos pelo Banco Mundial e pelo Fundo Monetário Internacional, direccionada sobretudo para a área económica, acabou por limitar o papel dos Programas de Ajustamento Estrutural (PAE) tidos como indutores do desenvolvimento, tornando-os num agregado de premissas austeras, com resultados não esperados. As propostas do FMI e do BM, tendendo para a liberalização económica e estímulo dos mercados em detrimento da intervenção estatal, traduzem-se em medidas de redução de taxas de utilização dos serviços públicos, supressão de subsídios, redimensionamento da administração pública, cortes, congelamentos salariais e privatizações. Os resultados destas reformas foram catastróficos, porquanto não só não melhoraram o défice orçamental, como os efeitos negativos das restrições orçamentais sobre o bem-estar, geraram um ambiente de promiscuidade social e o agravamento do sector informal como estratégia de sobrevivência Tendo em conta o objecto em estudo, isto é, a relação de forças que encontrámos entre o relacionamento entre os actores políticos guineenses e as Instituições Financeiras Internacionais, notámos que a ausência de comportamentos éticos também influiu nos resultados. Por um lado, o BM e o FMI, perante um Estado fragilizado, apresentaram condicionalismos à obtenção de empréstimos e ajudas, por outro lado, os actores guineenses, mesmo perante este dilema, não se coibiram do exercício da corrupção, do clientelismo e do neo-patrimonialismo, como estratégia para o enriquecimento fácil.Instituto Superior de Ciências do Trabalho e da Empres

Reducing Motor Variability Enhances Myoelectric Control Robustness Across Untrained Limb Positions

AuthorsThe limb position effect is a multi-faceted problem, associated with decreased upper-limb prosthesis control acuity following a change in arm position. Factors contributing to this problem can arise from distinct environmental or physiological sources. Despite their differences in origin, the effect of each factor manifests similarly as increased input data variability. This variability can cause incorrect decoding of user intent. Previous research has attempted to address this by better capturing input data variability with data abundance. In this paper, we take an alternative approach and investigate the effect of reducing trial-to-trial variability by improving the consistency of muscle activity through user training. Participants underwent 4 days of myoelectric training with either concurrent or delayed feedback in a single arm position. At the end of training participants experienced a zero-feedback retention test in multiple limb positions. In doing so, we tested how well the skill learned in a single limb position generalized to untrained positions. We found that delayed feedback training led to more consistent muscle activity across both the trained and untrained limb positions. Analysis of patterns of activations in the delayed feedback group suggest a structured change in muscle activity occurs across arm positions. Our results demonstrate that myoelectric user-training can lead to the retention of motor skills that bring about more robust decoding across untrained limb positions. This work highlights the importance of reducing motor variability with practice, prior to examining the underlying structure of muscle changes associated with limb position