Treatment outcome of tuberculosis patients at Gondar University Teaching Hospital, Northwest Ethiopia. A five - year retrospective study

<p>Abstract</p> <p>Background</p> <p>In Gondar University Teaching Hospital standardized tuberculosis prevention and control programme, incorporating Directly Observed Treatment, Short Course (DOTS) started in 2000. According to the proposal of World Health Organization (WHO), treatment outcome is an important indicator of tuberculosis control programs. This study investigated the outcome of tuberculosis treatment at Gondar University Teaching Hospital in Northwest Ethiopia.</p> <p>Methods</p> <p>We analyzed the records of 4000 tuberculosis patients registered at Gondar University Teaching Hospital from September 2003 to May 2008. Treatment outcome and tuberculosis type were categorized according to the national tuberculosis control program guideline. Multivariate analysis using logistic regression model was used to analyse the association between treatment outcome and potential predictor variables.</p> <p>Results</p> <p>From the total of 4000 patients, tuberculosis type was categorized as extrapulmonary in 1133 (28.3%), smear negative pulmonary tuberculosis in 2196 (54.9%) and smear positive pulmonary tuberculosis in 671 (16.8%) cases. Of all patients, treatment outcome was classified as successfully treated in 1181(29.5%), defaulted in 730 (18.3%), died in 403 (10.1%), treatment failed in six (0.2%) and transferred out in 1680 (42.0%) patients. Males had the trend to be more likely to experience death or default than females, and the elderly were more likely to die than younger. The proportion of default rate was increased across the years from 97(9.2%) to 228(42.9%). Being female, age group 15-24 years, smear positive pulmonary tuberculosis and being urban resident were associated with higher treatment success rate.</p> <p>Conclusion</p> <p>The treatment success rate of tuberculosis patients was unsatisfactorily low (29.5%). A high proportion of patients died (10.1%) or defaulted (18.3%), which is a serious public health concern that needs to be addressed urgently.</p

The peroxisome and the eye

Several childhood multisystem disorders with prominent ophthalmological manifestations have been ascribed to the malfunction of the peroxisome, a subcellular organelle. The peroxisomal disorders have been divided into three groups: 1) those that result from defective biogenesis of the peroxisome (Zellweger syndrome, neonatal adrenoleukodystrophy, and infantile Refsum's disease); 2) those that result from multiple enzyme deficiencies (rhizomelic chondrodysplasia punctata); and 3) those that result from a single enzyme deficiency (X-linked adrenoleukodystrophy, primary hyperoxaluria type 1). Zellweger syndrome, the most lethal of the three peroxisomal biogenesis disorders, causes infantile hypotonia, seizures, and death within the first year. Ophthalmic manifestations include corneal opacification, cataract, glaucoma, pigmentary retinopathy and optic atrophy. Neonatal adrenoleukodystrophy and infantile Refsum's disease appear to be genetically distinct, but clinically, biochemically, and pathologically similar to Zellweger syndrome, although milder. Rhizomelic chondrodysplasia punctata, a peroxisomal disorder which results from at least two peroxisomal enzyme deficiencies, presents at birth with skeletal abnormalities and patients rarely survive past one year of age. The most prominent ocular manifestation consists of bilateral cataracts. X-linked (childhood) adrenoleukodystrophy, results from a deficiency of a single peroxisomal enzyme, presents in the latter part of the first decade with behavioral, cognitive and visual deterioration. The vision loss results from demyelination of the entire visual pathway, but the outer retina is spared. Primary hyperoxaluria type 1 manifests parafoveal subretinal pigment proliferation. Classical Refsum's disease may also be a peroxisomal disorder, but definitive evidence is lacking. Early identification of these disorders, which may depend on recognizing the ophthalmological findings, is critical for prenatal diagnosis, treatment, and genetic counselling.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/29438/1/0000520.pd

Über die thermische, katalytische und photochemische Stickstoff-Eliminierung des 1-Diazo-3-(1-methylcyclopenta-2,4-dienyl)-2-propanons

The synthesis of the title compound 12 is described. This diazoketone, distinguished by its Cs-symmetry and by a built-in cisoid diene unit, gives 5-methyltricyclo[3.3.0.0²˙⁸]oct-6-ene-3-one (13) when subjected to thermal or catalytic denitrogenation with rhodium (II) acetate or copper (II) acetylacetonate. Direct irradiation of 12 at 350 nm causes Wolff rearrangement, whereas the benzophenone-sensitized photolysis gives again ketone 13. A 1,4-carbene or carbenoid addition was never observed under the conditions described. The ketone 13 equilibrates thermally or under base catalysis with 1-methyltricyclo[3.3.0.0²˙⁸]oct-6-ene-3-one (17). The key step of this apparent CH₃ migration is shown to be a Cope rearrangement of the corresponding enols (hydroxysemibullvalenes)

Décisions médicales en fin de vie dans six pays européens: Premiers résultats

En Suisse alémanique, les décisions d’assistance au décès jouent un rôle dans cinq décès sur dix, et dans sept sur dix décès attendus. L’euthanasie passive et l’assistance au suicide sont plus fréquents en Suisse que dans les autres pays. Ces résultats ressortent d’une étude internationale, qui a pour la première fois examiné la fréquence des diverses formes d’assistance au décès dans plus de 20 000 cas