Rationing tests for drug-resistant tuberculosis - who are we prepared to miss?

BACKGROUND: Early identification of patients with drug-resistant tuberculosis (DR-TB) increases the likelihood of treatment success and interrupts transmission. Resource-constrained settings use risk profiling to ration the use of drug susceptibility testing (DST). Nevertheless, no studies have yet quantified how many patients with DR-TB this strategy will miss. METHODS: A total of 1,545 subjects, who presented to Lima health centres with possible TB symptoms, completed a clinic-epidemiological questionnaire and provided sputum samples for TB culture and DST. The proportion of drug resistance in this population was calculated and the data was analysed to demonstrate the effect of rationing tests to patients with multidrug-resistant TB (MDR-TB) risk factors on the number of tests needed and corresponding proportion of missed patients with DR-TB. RESULTS: Overall, 147/1,545 (9.5%) subjects had culture-positive TB, of which 32 (21.8%) had DR-TB (MDR, 13.6%; isoniazid mono-resistant, 7.5%; rifampicin mono-resistant, 0.7%). A total of 553 subjects (35.8%) reported one or more MDR-TB risk factors; of these, 506 (91.5%; 95% CI, 88.9-93.7%) did not have TB, 32/553 (5.8%; 95% CI, 3.4-8.1%) had drug-susceptible TB, and only 15/553 (2.7%; 95% CI, 1.5-4.4%) had DR-TB. Rationing DST to those with an MDR-TB risk factor would have missed more than half of the DR-TB population (17/32, 53.2%; 95% CI, 34.7-70.9). CONCLUSIONS: Rationing DST based on known MDR-TB risk factors misses an unacceptable proportion of patients with drug-resistance in settings with ongoing DR-TB transmission. Investment in diagnostic services to allow universal DST for people with presumptive TB should be a high priority

Taking tadpole biology into the 21st century: a consensus paper from the First Tadpoles International Workshop

Although tadpoles are common, frequently encountered vertebrates, their natural history is poorly known. Despite the fact that Brazil harbors the highest anuran diversity in the world, with almost a thousand known species (Segalla et  al., 2014), the larvae of many species remain undescribed. The problem is not unique to Brazil. At the turn of the century, approximately ⅔ of almost 3,300 anuran species with a larval stage lacked tadpole descriptions (McDiarmid & Altig, 1999). The proportion of neotropical anurans with free-swimming larvae that are not described is estimated to be around 40% (Provete et al., 2012).Fil: Rossa Feres, Denise de C.. Universidade Estadual Paulista Julio de Mesquita Filho; BrasilFil: Venesky, Matthew. Allegheny College; Estados UnidosFil: Nomura, Fausto. Universidade Federal de Goias; BrasilFil: Eterovick, Paula C.. Pontifícia Universidade Católica de Minas Gerais; BrasilFil: Vera Candioti, María Florencia. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Menin, Marcelo. Universidade Federal do Amazonas; BrasilFil: Juncá, Flora A.. Universidade Estadual de Feira de Santana; BrasilFil: Schiesari, Luis C.. Universidade de Sao Paulo; BrasilFil: Haddad, Celio F. B.. Universidade Estadual Paulista Julio de Mesquita Filho; BrasilFil: Garey, Michel V.. Universidade Federal da Integração Latino-Americana; BrasilFil: dos Anjos, Luciano A.. Universidade Estadual Paulista Julio de Mesquita Filho; BrasilFil: Wasserug, Richard. Dalhousie University Halifax; Canadá. University Of British Columbia; Canad

Mortality reduction with use of oral beta-blockers in patients with acute coronary syndrome

OBJECTIVES: Recent studies have revealed a relationship between beta-blocker use and worse prognosis in acute coronary syndrome, mainly due to a higher incidence of cardiogenic shock. However, the relevance of this relationship in the reperfusion era is unknown. The aim of this study was to analyze the outcomes of patients with acute coronary syndrome that started oral beta-blockers within the first 24 hours of hospital admission (group I) compared to patients who did not use oral beta-blockers in this timeframe (group II). METHODS: This was an observational, retrospective and multicentric study with 2,553 patients (2,212 in group I and 341 in group II). Data regarding demographic characteristics, coronary treatment and medication use in the hospital were obtained. The primary endpoint was in-hospital all-cause mortality. The groups were compared by ANOVA and the chi-square test. Multivariate analysis was conducted by logistic regression and results were considered significant when

Clinical manifestations and diagnosis of arrhythmogenic right ventricular dysplasia in sexagenary patient

A displasia arritmogênica de ventrículo direito (DAVD) é uma das principais causas de morte súbita em indivíduos jovens. Suas manifestações e consequente diagnóstico costumam ser precoces ainda na adolescência ou no adulto jovem. Nesse contexto, o diagnóstico em doente sexagenário sem história familiar sugestiva ou sintomas prévios e com possibilidade de tratamento torna esse caso único na literatura.Arrhythmogenic right ventricular dysplasia is one of the major causes of death in younger patients and its manifestations and diagnosis used to be early. In this context, diagnosis in a sexagenary patient without famylial history or previous symptoms and with possibility of correct treatment make this case unique

Un análisis exploratorio de la relación entre pobreza multidimensional y conflicto armado : el caso de Antioquia en Colombia

RESUMEN: Este artículo analiza la relación entre pobreza y conflicto armado en Antioquia, Colombia. El análisis de la pobreza está enmarcado en el enfoque de las capacidades de Sen, el cual conforma la base conceptual del índice de pobreza multidimensional (IPM) desarrollado por Alkire y Foster. El IPM es calculado con información derivada de la base de datos Sisbén, la cual se utiliza para seleccionar la población atendida por los programas de asistencia social del Gobierno colombiano. Este artículo consideró tres dimensiones de pobreza: estándares de vida, salud, y educación. El conflicto armado fue medido por medio de datos de conteo acerca de la ocurrencia de eventos de violencia registrados entre 1996 y 2010 en cada municipalidad de Antioquia. Luego, la relación entre la pobreza y el conflicto armado se analizó mediante métodos exploratorios y no paramétricos como las distribuciones kernel. Los resultados sugieren que el IPM es robusto con respecto a la elección del umbral de pobreza multidimensional. Los mapas de caja y bigotes sugieren que los pobres están localizados en las regiones periféricas de Antioquia. Las distribuciones kernel muestran que las áreas más afectadas por el conflicto, usualmente, tienen altos niveles de pobreza multidimensional.ABSTRACT: This paper analyses the relationship between poverty and armed conflict in Antioquia, Colombia. The poverty analysis it uses is framed according to Sen’s capability approach, which constitutes the conceptual basis for the Multidimensional Poverty Index (MPI) subsequently developed by Alkire and Foster. The MPI is measured employing data from the government database SISBEN, which is used by the Colombian authorities to identify beneficiaries of social assistance programmes. The paper considers three poverty dimensions: living standards, health, and education. Armed conflict is measured using count data on violent events recorded for every municipality in the Department of Antioquia between 1996 and 2010. The relationship between poverty and armed conflict is then analysed using exploratory and non-parametric methods such as kernel distributions. Results suggest that the MPI is robust when compared multidimensional cutoffs. The MPI box-plot maps suggest that poor people are located in Antioquia’s peripheral areas. Kernel distributions show that areas most affected by conflict tend to show higher levels of multidimensional poverty