Definitive Management of Failure After Pyeloplasty

Introduction: Failure after pyeloplasty is difficult to manage. We report our experience managing pyeloplasty failures. Methods: We retrospectively reviewed the case log of a single surgeon, from August 1996 to August 2014, to identify all patients undergoing a surgical procedure after failed pyeloplasty. We excluded patients without follow-up exceeding 1 year from initial postpyeloplasty procedure. Failure was defined as a need for additional definitive intervention. Results: Of 247 laparoscopic pyeloplasties, 68 endopyelotomies and 305 simple laparoscopic nephrectomies reviewed, 41 were performed after previous pyeloplasty and had sufficient follow-up. Laparoscopic nephrectomy was performed in nine patients. All three secondary laparoscopic pyeloplasties were successful. Of 29 secondary endopyelotomies, 10 (34%) were successful. Of the 19 failures after secondary endopyelotomy, 12 patients had tertiary pyeloplasty (5 laparoscopic and 7 open surgical), 5 (26%) underwent tertiary endopyelotomy, and 2 (11%) required nephrectomy. Our overall endopyelotomy success rate was 38% (13/34) vs 100% (11/11) for secondary or tertiary pyeloplasty (4 patients lost to follow-up). Median time to failure was 5 months for endopyelotomy. Median follow-up for patients free from intervention was 40.2 months. Conclusions: Secondary pyeloplasty (including both laparoscopic and open surgical approach) is more than twice as successful as endopyelotomy after failed pyeloplasty. Secondary pyeloplasty is an excellent alternative to endopyelotomy in select patients with failure after initial pyeloplasty.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140085/1/end.2015.0837.pd

CSRD Technical Exchange: ICPAC and National Climate Maprooms – Existing and New Tools for Drought Monitoring and Forecasting in Eastern Africa

In 2005, the International Research Institute for Climate and Society published its assessment of key gaps in the use of climate information for health, agriculture, water and other sectors in countries across Africa. The results from the report were less than stellar. After an extensive review of use of climate information in the development sectors of Africa, the authors concluded that the continent suffered from “market atrophy” – the reinforcing effect of inadequate effective supply of climate information and weak effective demand. Twelve years later, organizations such as the IRI, CSRD program, CCAFS, ICPAC, and UKMO have made enormous strides at increasing both climate information supply and effective demand through the implementation of climate data platforms and the organizing of capacity-building seminars. In order to capitalize on the presence of the many climate and sector experts from across the IGAD region, the organizations above held a joint event, the CSRD Technical Exchange: ICPAC and National Climate Maprooms – Existing and New Tools for Drought Monitoring and Forecasting in Eastern Africa, in Zanzibar on August 23-25, 2017, immediately after the 47th Greater Horn of Africa Climate Outlook Forum (GHACOF47). The workshop was designed to offer potential and existing users a platform to voice their needs for the development and better use of historical, monitored and forecast information for the management of drought across climate-sensitive sectors

Healthcare providers as patients: COVID-19 experience

There is compelling evidence for the psychological effects of the COVID-19 pandemic and earlier epidemics. However, fewer studies have examined the subjective meaning experience of healthcare providers who have survived COVID-19 as patients. This qualitative study aimed to understand further and describe the life experiences of healthcare providers who have survived COVID-19 as patients in Saudi Arabia. Data was collected using unstructured in-depth individual interviews among n = 10 healthcare providers from public hospitals in Saudi Arabia. Data were analyzed based on a phenomenological approach, which resulted in five themes: (i) physical and psychological signs and symptoms; (ii) self-healing, hiding pain, and family; (iii) fear of complications; (iv) disease stigma & long-term psychological outcomes; (v) emotional support, mental well-being & resignation. The overall synthesis showed that healthcare providers, as patients, experience the same difficulties and stressors as the general public. In some cases, these factors are even worse, as family members, colleagues, and employers develop a new type of stigma. Given the impact of social media and the flow of information of any type, more research is needed to examine the sources used to obtain information by the general public, whether these sources are reliable, and how the public can be taught to use only scientific data and not social data. Understanding the experience of healthcare providers as patients during the pandemic has allowed to look at the feelings and needs of people during illness from a new perspective. As expressed by participants, being a healthcare provider does not reduce the fear of the disease and does not mitigate its consequences in the form of stigmatization and isolation

Monophasic synovial sarcoma of the pharynx: a case report

Synovial sarcomas are a rare form of soft tissue sarcomas. We present a case of a 62 year-old male presenting with a left thyroid lump initially though to be a thyroid adenoma but subsequently diagnosed as a monophasic synovial sarcoma of the pharynx. We discuss the diagnosis and treatment of this case

Plasmodium falciparum importation does not sustain malaria transmission in a semi-arid region of Kenya

Human movement impacts the spread and transmission of infectious diseases. Recently, a large reservoir of Plasmodium falciparum malaria was identified in a semi-arid region of northwestern Kenya historically considered unsuitable for malaria transmission. Understanding the sources and patterns of transmission attributable to human movement would aid in designing and targeting interventions to decrease the unexpectedly high malaria burden in the region. Toward this goal, polymorphic parasite genes (ama1, csp) in residents and passengers traveling to Central Turkana were genotyped by amplicon deep sequencing. Genotyping and epidemiological data were combined to assess parasite importation. The contribution of travel to malaria transmission was estimated by modelling case reproductive numbers inclusive and exclusive of travelers. P. falciparum was detected in 6.7% (127/1891) of inbound passengers, including new haplotypes which were later detected in locally-transmitted infections. Case reproductive numbers approximated 1 and did not change when travelers were removed from transmission networks, suggesting that transmission is not fueled by travel to the region but locally endemic. Thus, malaria is not only prevalent in Central Turkana but also sustained by local transmission. As such, interrupting importation is unlikely to be an effective malaria control strategy on its own, but targeting interventions locally has the potential to drive down transmission

Coexistence of a colon carcinoma with two distinct renal cell carcinomas: a case report

<p>Abstract</p> <p>Introduction</p> <p>We present the case of a patient with two tumors in his left kidney and a synchronous colon cancer. While coexisting tumors have been previously described in the same kidney or the kidney and other organs, or the colon and other organs, to the best of our knowledge no such concurrency of three primary tumors has been reported in the literature to date.</p> <p>Case presentation</p> <p>A 72-year-old man of Greek nationality presenting with pain in the right hypochondrium underwent a series of examinations that revealed gallstones, a tumor in the hepatic flexure of the colon and an additional tumor in the upper pole of the left kidney. He was subjected to a right hemicolectomy, left nephrectomy and cholecystectomy, and his postoperative course was uneventful. Histopathology examinations showed a mucinous colon adenocarcinoma, plus two tumors in the left kidney, a papillary renal cell carcinoma and a chromophobe renal cell carcinoma.</p> <p>Conclusion</p> <p>This case underlines the need to routinely scan patients pre-operatively in order to exclude coexisting tumors, especially asymptomatic renal tumors in patients with colorectal cancer, and additionally to screen concurrent tumors genetically in order to detect putative common genetic alterations.</p

Normocalcemic pseudohypoparathyroidism (Type II)

This article does not have an abstract

Extreme rainfall and flooding over central Kenya including Nairobi City during the long-rains Season 2018: causes, predictability, and potential for early warning and actions

The Long-Rains wet season of March-May (MAM) over Kenya in 2018 was one of the wettest on record. This paper examines the nature, causes, impacts, and predictability of the rainfall events, and considers the implications for flood risk management. The exceptionally high monthly rainfall totals in March and April resulted from several multi-day heavy rainfall episodes, rather than from distinct extreme daily events. Three intra-seasonal rainfall events in particular resulted in extensive flooding with the loss of lives and livelihoods, a significant displacement of people, major disruption to essential services, and damage to infrastructure. The rainfall events appear to be associated with the combined effects of active Madden-Julian Oscillation (MJO) events in MJO phases 2-4, and at shorter timescales, tropical cyclone events over the southwest Indian Ocean. These combine to drive an anomalous westerly low-level circulation over Kenya and the surrounding region, which likely leads to moisture convergence and enhanced convection. We assessed how predictable such events over a range of forecast lead times. Long-lead seasonal forecast products for MAM 2018 showed little indication of an enhanced likelihood of heavy rain over most of Kenya, which is consistent with the low predictability of MAM Long-Rains at seasonal lead times. At shorter lead times of a few weeks, the seasonal and extended-range forecasts provided a clear signal of extreme rainfall, which is likely associated with skill in MJO prediction. Short lead weather forecasts from multiple models also highlighted enhanced risk. The flood response actions during the MAM 2018 events are reviewed. Implications of our results for forecasting and flood preparedness systems include: (i) Potential exists for the integration of sub-seasonal and short-term weather prediction to support flood risk management and preparedness action in Kenya, notwithstanding the particular challenge of forecasting at small scales. (ii) We suggest that forecasting agencies provide greater clarity on the difference in potentially useful forecast lead times between the two wet seasons in Kenya and East Africa. For the MAM Long-Rains, the utility of sub-seasonal to short-term forecasts should be emphasized; while at seasonal timescales, skill is currently low, and there is the challenge of exploiting new research identifying the primary drivers of variability. In contrast, greater seasonal predictability of the Short-Rains in the October-December season means that greater potential exists for early warning and preparedness over longer lead times. (iii) There is a need for well-developed and functional forecast-based action systems for heavy rain and flood risk management in Kenya, especially with the relatively short windows for anticipatory action during MAM

Extreme Rainfall and Flooding over Central Kenya Including Nairobi City during the Long-Rains Season 2018: Causes, Predictability, and Potential for Early Warning and Actions

The Long-Rains wet season of March–May (MAM) over Kenya in 2018 was one of the wettest on record. This paper examines the nature, causes, impacts, and predictability of the rainfall events, and considers the implications for flood risk management. The exceptionally high monthly rainfall totals in March and April resulted from several multi-day heavy rainfall episodes, rather than from distinct extreme daily events. Three intra-seasonal rainfall events in particular resulted in extensive flooding with the loss of lives and livelihoods, a significant displacement of people, major disruption to essential services, and damage to infrastructure. The rainfall events appear to be associated with the combined effects of active Madden–Julian Oscillation (MJO) events in MJO phases 2–4, and at shorter timescales, tropical cyclone events over the southwest Indian Ocean. These combine to drive an anomalous westerly low-level circulation over Kenya and the surrounding region, which likely leads to moisture convergence and enhanced convection. We assessed how predictable such events over a range of forecast lead times. Long-lead seasonal forecast products for MAM 2018 showed little indication of an enhanced likelihood of heavy rain over most of Kenya, which is consistent with the low predictability of MAM Long-Rains at seasonal lead times. At shorter lead times of a few weeks, the seasonal and extended-range forecasts provided a clear signal of extreme rainfall, which is likely associated with skill in MJO prediction. Short lead weather forecasts from multiple models also highlighted enhanced risk. The flood response actions during the MAM 2018 events are reviewed. Implications of our results for forecasting and flood preparedness systems include: (i) Potential exists for the integration of sub-seasonal and short-term weather prediction to support flood risk management and preparedness action in Kenya, notwithstanding the particular challenge of forecasting at small scales. (ii) We suggest that forecasting agencies provide greater clarity on the difference in potentially useful forecast lead times between the two wet seasons in Kenya and East Africa. For the MAM Long-Rains, the utility of sub-seasonal to short-term forecasts should be emphasized; while at seasonal timescales, skill is currently low, and there is the challenge of exploiting new research identifying the primary drivers of variability. In contrast, greater seasonal predictability of the Short-Rains in the October–December season means that greater potential exists for early warning and preparedness over longer lead times. (iii) There is a need for well-developed and functional forecast-based action systems for heavy rain and flood risk management in Kenya, especially with the relatively short windows for anticipatory action during MAM