Detection of genital tuberculosis among women with infertility using best clinical practices in India: An implementation study

BackgroundDiagnosis of genital tuberculosis (TB) as a cause of infertility still remains a diagnostic dilemma for clinicians, as no standard guidelines exist. The recently proposed best practices for genital TB diagnosis have not been evaluated yet in India.ObjectivesTo implement best practices to diagnose and treat likely genital TB as a cause of infertility.MethodsBetween April 2016 and June 2018, consenting women seen at a tertiary hospital infertility clinic were assessed by thorough TB related clinical history, ultrasonography, tuberculin skin test (TST), and ESR. Those with suspected genital TB underwent laparohysteroscopy. Clinical and laboratory characteristics were compared between likely (microbiologically confirmed or probable TB) and unlikely (possible and no genital TB) genital TB. Fertility outcome was assessed among women initiated on anti-TB treatment (ATT).ResultsOf 185 women seeking infertility care, likely genital TB was identified among 29 (15.7%) women, with 6 (21%) confirmed and 23 (79%) probable genital TB. Compared to unlikely genital TB cases, the likely genital TB group were found to have past history of TB (p < 0.001); positive TST (p = 0.002) and elevated ESR (p = 0.001). Among the likely genital TB group, all 6 confirmed genital TB were started on ATT and 2 (33.3%) conceived. Of 5 probable genital TB started on ATT, 3 (60%) conceived.ConclusionApproximately 1/6th of women seeking infertility care met the criteria for likely genital TB. Conception among over-half of treated probable genital TB cases provides preliminary evidence that best clinical practices can be utilized, but needs further confirmatory studies.     

Executive summary. Consensus document of GESIDA and SPNS (Spanish Secretariat for the National Plan on AIDS) regarding combined antiretroviral treatment in adults infected by the human immunodeficiency virus (January 2012)

In the present update of the guidelines, starting antiretroviral treatment is recommended in symptomatic patients, in pregnant women, in sero-discordant couples with high transmission risk, in patients co-infected with hepatitis B requiring treatment and in patients with HIV-related nephropathy. Guidelines on combined antiretroviral treatment (cART) are included in the event of concurrent HIV infection diagnosis with an AIDS-defining event. In asymptomatic naïve patients, cART will be based on CD4 lymphocyte count, plasma viral load (VL), patient age and patient comorbidity: (i) cART is recommended if CD4 count is lower than 350 cells/μL; (ii) cART is equally recommended if CD4 count is between 350 and 500 cells/μL and may only be deferred in the event of patient refusal with stable CD4 count and low VL; (iii) if CD4 count is higher than 500 cells/μL cART can be delayed, but it may be considered in patients with liver cirrhosis, chronic virus C hepatitis, high cardiovascular risk, VL >10⁵ copies/mL, CD4 proportion lower than 14% and age over 55 years. cART in naïve patients requires a combination of three drugs and its aim is to achieve undetectable VL. Treatment adherence plays a basic role in sustaining good response. cART could and should be changed if virologic failure occurs in order to achieve undetectable VL again. Approaches to cART in HIV acute infection, in women and pregnancy and post exposure prophylaxis are also commented on.     

Intestinal parasitic infections in suburban government schools,Lak Hok subdistrict,Muang Pathum Thani,Thailand

ObjectiveTo provide baseline information of parasitic infections in 3 suburban government schools, Lakhok subdistrict of Muang Pathum Thani, Thailand.MethodsThis study was conducted between May-June 2010 using simple direct smear and modified formalin ether and from a population of 1 253 in 3 suburban government schools.ResultsTotal samples of 202 registered and participated. The average of prevalence of infection from 3 schools was 13.9%, there were 13.7%, 14.3% and 13.9% in N, S and R school, respectively with no significant difference between schools (P>0.05). The infection rates did not show significant difference between genders (P>0.05). The highest rate of infection was 20.4% in Pathom 2 (8 years) students and the lowest was 4% in Pathom 1 (7 years) with statistically difference between age groups (P<0.05). The highest prevalence of pathogenic protozoa was Giardia lamblia (G. lamblia) which was found in 50% of infected cases, followed by 25% of Entamoeba histolytica (E. histolytica) and Blastocystis hominis (B. hominis). The highest prevalence of non-pathogenic protozoa was Endolimax nana (E. nana) which was found in 88.9%, followed by 11.1% of Entamoeba coli (E. coli). Mixed infections between Blastocystis hominis (B. hominis) and Endolimax nana (E. nana) were reported at 7.1%. The only helminthic infection found in this study area was hookworm, found in 1 student (3.8%). The formalin ether concentration technique showed a higher efficacy of detection (78%-100%) than the simple direct smear method (0%-50%).ConclusionsSurveillance of Protozoan infections may need to be focused on suburban areas.     

现阶段卫生发展与社会环境的互动关系分析

在考虑卫生发展的过程中 ,应该将卫生放在更大的社会环境中去系统考虑 ,研究制约和影响卫生发展的各种宏观因素。该文主要是从卫生发展与有关社会环境要素的互动影响的角度出发 ,探讨卫生发展与社会环境的关系 ,为加快卫生发展提供更为广阔的分析背景。     

The use of external skeletal fixation in the treatment of fractures of the humeral shaft

A method of external fixation is presented which has been applied in 8 patients with a fracture of the humeral shaft. The indications and technique are described.     

第三次分配视角下网络公益众筹助力医疗救助的发力点及监管重点

网络公益众筹是多层次医疗保障体系的一项有益补充,可缓解因病致贫、因病返贫现象。推动健康中国建设,需要做好第二次分配与第三次分配、医疗救助与网络公益众筹有效衔接。本文在对医疗救助体系进行分析的基础上,厘清现有框架存在的短板和痛点,并提出网络公益众筹助力医疗救助的发展定位和发力点,以及政府对网络公益众筹的监管策略。     

美英法生物安全领域基金资助布局

目的：探讨发达国家在生物安全相关领域的主要发展。方法：从美、英、法3国政府资助平台获取信息,分析生物安全相关领域的基金资助情况。结果：美国于2001年以后对生物安全研究的资助力度显著增加,双重布局基础研究与防控措施研究。英国原RCUK近5年对传染病的检测与预防,以及水产养殖的生物安全等的资助力度逐年加大。法国生物安全资助项目较少,主要为传染病传播机制与防治研究。结论：美国2001年的炭疽事件引发生物安全研究的投入大幅增加,英、法的研究晚于美国,且资助力度远不及美国。     

Development of a multi stakeholder partnership to improve access to and delivery of neurosurgical services in Ontario

Neurosurgical emergencies require expedient access to definitive care at neurosurgical centers. Neurosurgical resources in province of Ontario are highly centralized, and subsequently, most patients with neurosurgical emergencies will present to non-neurosurgical centers. From 2000–2010, metrics demonstrated the organization of neurosurgical resources might not be optimal. In response to this a program entitled Provincial Neurosurgery Ontario (PNO)- was formed to address these issues in cooperation with neurosurgeons, hospitals and the provincial government.PNO worked with multiple stakeholders to implement interventions to not only prevent out of country transfer, but to also improve the flow of neurosurgical patients in the province and potentially improve outcome. The main interventions undertaken by PNO were: 1) implementation and development of a province-wide tele-radiology system; 2) development of neurosurgery as a provincially-funded program; 3) significant outreach to non-neurosurgical centers; and 4) specialized funding packages for highly specialized level care.This report provides background on the challenges faced by neurosurgery in the province of Ontario and the process developed to address these challenges. Finally, we describe the impact provincial strategies have had on improving access to emergency neurosurgical care in the Ontario.     

21st Century Cures Act: Patient-Facing Implications of Information Blocking

The information-blocking provision of the Cures Act is designed to promote interoperability of health IT systems and mandates immediate access and portability of personal electronic health information for patients, providers and payers. In essence, this legislation requires no delay in access to clinical information including radiology reports once entered into the electronic health record. This is at odds with the current settings of many electronic health record systems, which employ time-delayed releases (embargo) of radiology reports. In such systems, there is a predetermined delay, such as days to weeks, between when a radiology report is signed off by the radiologist and when the report becomes available for patient access via the online patient portal. The idea behind this practice is that the delay allows time for the referring provider to read the report and coordinate care for the patient before the patient becomes aware of potentially abnormal and anxiety-provoking imaging findings. At the time of this writing, it is unclear whether such embargo programs will meet information-blocking definitions and thereby be subject to financial disincentives. Many provider groups are preparing for enforcement of the information-blocking by removing their report embargo programs. This article describes the challenges and opportunities created by the immediate release of radiology reports to patients via online patient portals and suggests strategies that groups may consider to ease their transition to this model of care delivery.