Learning curve and interobserver reproducibility evaluation of liver stiffness measurement by transient elastography

BACKGROUND/AIMS: Fibroscan allows liver stiffness examination (LSE) that is well correlated with fibrosis stages. Our main objective was to evaluate LSE learning curve. METHODS: LSE results of five novice observers with different medical status were compared with those of five expert observers (physicians with >100 examinations) in 250 patients with chronic liver disease. Each novice-expert pair had to blindly examine 50 consecutive patients divided into five consecutive subgroups of 10 patients. RESULTS: In each observer group, novice-expert agreement [intraclass correlation coefficient (Ric)] for LSE results was excellent from the first to the last subgroup. Novice-expert agreement for LSE results varied with liver stiffness level: <9 kPa: Ric=0.49; >or=9 kPa: Ric=0.87. Relative difference (%) between novice and expert LSE results was independently associated with the number of valid LSE measurements, and stabilizes around 20-30% after the fourth valid measurement. In each observer group, novice-expert agreement (Ric) for LSE success rate progressively increased as a function of time. CONCLUSION: LSE requires no learning curve: a novice is able to obtain a reliable result after a single training session, whatever the professional status. However, success rate will progressively increase. An LSE with less than four valid measurements should not be considered as reliable.     

Piloting an intervention to improve microbiological food safety in Peri-Urban Mali

Introduction

Diarrhoeal diseases remain a major cause of preventable death among children under five years old in developing countries. Studies related to infant diarrhoea causation have demonstrated a higher level of faecal contamination in weaning foods than in drinking water. Many studies have examined the microbiological quality of such foods, but few of them have resulted in an intervention. The present study builds upon an experiment in which the HACCP approach was applied to preparation of two common weaning foods (moni and fish soup) and used to develop simple hygiene measures which mothers could take in preparing and serving foods to their children, to prevent contamination.

Methods

A randomly selected sample of 60 volunteer mothers was split into two groups of 30, the first receiving messages promoting implementation of the hygiene measures, and the second as a control. Samples of the food were taken in all 60 households at the point where they would have been served to a child. These were examined microbiologically, and physical parameters were measured. The process was repeated after the mothers had received three weeks’ training in the preventive measures, and again three months later on an unannounced visit.

Results

Before the intervention, thermotolerant coliform (TTC) contamination levels exceeded 100 per gram in 55% of food samples cooled after cooking (prior to child service) and in 86% of samples of food stored prior to child service. After the intervention, the contamination was detected (i.e. >10 TTC/g) in less than 17% of food samples cooled (prior to child service) after cooking and in only 4% of food samples reheated after storage and cooled prior to child service. The reduction in faecal contamination was highly significant (P < 0.0001). The follow-up visit three months later produced still better results; only 0% to 17% of food samples failed to meet our standard of <10 TTC/g.

Conclusion

The HACCP approach can lead to effective measures for improving home food safety, and is applicable with modest resources for promotion of food hygiene and safety in a low-income community.     

New vaccine adoption: qualitative study of national decision-making processes in seven low- and middle-income countries

As more new and improved vaccines become available, decisions on which to adopt into routine programmes become more frequent and complex. This qualitative study aimed to explore processes of national decision-making around new vaccine adoption and to understand the factors affecting these decisions. Ninety-five key informant interviews were conducted in seven low- and middle-income countries: Bangladesh, Cameroon, Ethiopia, Guatemala, Kenya, Mali and South Africa. Framework analysis was used to explore issues both within and between countries. The underlying driver for adoption decisions in GAVI-eligible countries was the desire to seize GAVI windows of opportunity for funding. By contrast, in South Africa and Guatemala, non-GAVI-eligible countries, the decision-making process was more rooted in internal and political dynamics. Decisions to adopt new vaccines are, by nature, political. The main drivers influencing decisions were the availability of funding, political prioritization of vaccination or the vaccine-preventable disease and the burden of disease. Other factors, such as financial sustainability and feasibility of introduction, were not as influential. Although GAVI procedures have established more formality in decision-making, they did not always result in consideration of all relevant factors. As familiarity with GAVI procedures increased, questioning by decision-makers about whether a country should apply for funding appeared to have diminished. This is one of the first studies to empirically investigate national processes of new vaccine adoption decision-making using rigorous methods. Our findings show that previous decision-making frameworks (developed to guide or study national decision-making) bore little resemblance to real-life decisions, which were dominated by domestic politics. Understanding the realities of vaccine policy decision-making is critical for developing strategies to encourage improved evidence-informed decision-making about new vaccine adoptions. The potential for international initiatives to encourage evidence-informed decision-making should be realised, not assumed.     

Mesenteric myofibroblastic tumor: NSAID therapy after incomplete resection

Myofibroblastic tumors are inflammatory tumors that arise in viscera and soft tissue; their etiopathology is poorly understood. They are capable of infiltration of adjacent organs, local recurrence after surgical resection, and even of distant metastasis. These characteristics result in persistent debate as to the nature of these lesions - whether they are inflammatory or neoplastic, benign or malignant lesions? Diagnosis is almost always made based on histopathological findings. Traditional management is complete surgical excision, but this may be difficult or impossible when the lesion develops in proximity to vital structures. We report the case of a 59-year-old man who was treated in our institution for mesenteric myofibroblastic tumor. Complete resection was not possible due to local infiltration of the mesentery. Recurrence was noted 3?months after surgery; treatment with steroidal and then non-steroidal anti-inflammatory medications (NSAIDs) resulted in clinical and radiologic regression of the tumor.     

Toxicity assessment and analgesic activity investigation of aqueous acetone extracts of Sida acuta Burn f. and

ABSTRACT: BACKGROUND: Sida acuta Burn f. and Sida cordifolia L. (Malvaceae) are traditionally used in Burkina Faso to treat several ailments, mainly pains, including abdominal infections and associated diseases. Despite the extensive use of these plants in traditional health care, literature provides little information regarding their toxicity and the pharmacology. This work was therefore designed to investigate the toxicological effects of aqueous acetone extracts of Sida acuta Burn f. and Sida cordifolia L. Furthermore, their analgesic capacity was assessed, in order to assess the efficiency of the traditional use of these two medicinal plants from Burkina Faso. METHOD: For acute toxicity test, mice were injected different doses of each extract by intraperitoneal route and the LD50 values were determined. For the subchronic toxicity evaluation, Wistar albinos rats were treated by gavage during 28 days at different doses of aqueous acetone extracts and then haematological and biochemical parameters were determined. The analgesic effect was evaluated in mice by the acetic-acid writhing test and by the formalin test. RESULTS: For the acute toxicity test, the LD50 values of 3.2 g/kg and 3.4 g/kg respectively for S. acuta Burn f. and S. cordifolia L. were obtained. Concerning the haematological and biochemical parameters, data varied widely (increase or decrease) according to dose of extracts and weight of rats and did not show clinical correlations. The extracts have produced significant analgesic effects by the acetic acid writhing test and by the hot plate method (p <0.05) and a dose-dependent inhibition was observed. CONCLUSION: The overall results of this study may justify the traditional uses of S. acuta and S. cordifolia .     

Une ascite chyleuse au décours d’une exérèse d’une tumeur vulvaire : un piège

Chylous ascites is a rare condition, linked to lymphatic duct obstruction. We report a case of chylous ascites in a young woman operated for a vulvar tumour. Following surgery, the patient presented ascites, inguinal adenopathies and subcutaneous nodular formations. An abdominal ultrasound scan revealed the ascites and deep adenopathies. Such cases suggest the diffusion of a malignant process aided by surgical aggression. CAS The diagnosis of lymphatic node tuberculosis was confirmed by the histology which showed a granuloma with caseous necrosis. Tuberculosis treatment resulted in good progress. We recommend that in cases of chylous ascites in a tropical country, testing for tuberculosis is carried out in view of the effectiveness of the specific treatment.