Medizinischer und gesundheitsökonomischer Nutzen der Untersuchung auf Helicobacter pylori-Besiedlung mittels 13C-Harnstoff-Atemtest in der Primärdiagnostik im Vergleich zu invasiven und nichtinvasiven diagnostischen Verfahren

Hintergrund: Helicobacter pylori (H. pylori) zählt trotz abnehmender Inzidenz zu den häufigsten bakteriellen Infektionskrankheiten des Menschen. Die Infektion mit H. pylori ist ein Risikofaktor für Krankheiten wie gastroduodenale Geschwüre, Magenkarzinomen und MALT (Mucosa Associated Lymphoid Tissue)-Lymphomen. Zur Diagnostik von H. pylori stehen verschiedene invasive und nichtinvasive Verfahren zur Verfügung. Der 13C-Harnstoff-Atemtest wird zur Kontrolle einer Eradikationstherapie empfohlen, kommt in der Primärdiagnostik von H. pylori derzeit jedoch nicht standardmäßig in Deutschland zum Einsatz. Fragestellung: Welchen medizinischen und gesundheitsökonomischen Nutzen hat die Untersuchung auf H. pylori-Besiedlung mittels 13C-Harnstoff-Atemtest in der Primärdiagnostik im Vergleich zu invasiven und nichtinvasiven diagnostischen Verfahren? Methodik: Basierend auf einer systematischen Literaturrecherche in Verbindung mit einer Handsuche werden Studien zur Testgüte und Kosten-Effektivität des 13C-Harnstoff-Atemtests im Vergleich zu anderen diagnostischen Verfahren zum primären Nachweis von H. pylori identifiziert. Es werden nur medizinische Studien eingeschlossen, die den 13C-Harnstoff-Atemtest direkt mit anderen H. pylori-Testverfahren vergleichen. Goldstandard ist eines oder eine Kombination der biopsiebasierten Testverfahren. Für die gesundheitsökonomische Beurteilung werden nur vollständige gesundheitsökonomische Evaluationsstudien einbezogen, bei denen die Kosten-Effektivität des 13C Harnstoff-Atemtests direkt mit anderen H. pylori-Testverfahren verglichen wird. Ergebnisse: Es werden 30 medizinische Studien für den vorliegenden Bericht eingeschlossen. Im Vergleich zum Immunglobulin G (IgG)-Test ist die Sensitivität des 13C-Harnstoff-Atemtests zwölfmal höher, sechsmal niedriger und einmal gleich, und die Spezifität 13-mal höher, dreimal niedriger und zweimal gleich. Im Vergleich zum Stuhl-Antigen-Test ist die Sensitivität des 13C-Harnstoff-Atemtests neunmal höher, dreimal niedriger und einmal gleich, und die Spezifität neunmal höher, zweimal niedriger und zweimal gleich. Im Vergleich zum Urease-Schnelltest sind die Sensitivität des 13C-Harnstoff-Atemtests viermal höher, dreimal niedriger und viermal gleich und die Spezifität fünfmal höher, fünfmal niedriger und einmal gleich. Im Vergleich mit der Histologie ist die Sensitivität des 13C-Harnstoff-Atemtests einmal höher und zweimal niedriger und die Spezifität zweimal höher und einmal niedriger. In je einem Vergleich zeigt sich kein Unterschied zwischen 13C-Harnstoff-Atemtest und 14C-Harnstoff-Atemtest, sowie eine niedrigere Sensitivität und höhere Spezifität im Vergleich zur Polymerase-Kettenreaktion (PCR). Inwieweit die beschriebenen Unterschiede statistisch signifikant sind, wird in sechs der 30 Studien angegeben. Es werden neun gesundheitsökonomische Evaluationen in dem vorliegenden Bericht berücksichtigt. Die Test-and-Treat-Strategie mittels 13C-Harnstoff-Atemtest wird in sechs Studien mit einem Test-and-Treat-Verfahren auf Basis der Serologie sowie in drei Studien mit einem Test-and-Treat-Verfahren auf Basis des Stuhl-Antigen-Tests verglichen. Dabei ist das Atemtestverfahren dreimal kosteneffektiv gegenüber der serologischen Methode und wird von der Stuhl-Antigen-Test-Strategie einmal dominiert. Vier Studien beinhalten einen Vergleich der Test-and -Treat-Strategie auf Basis des 13C-Harnstoff-Atemtests mit einer empirischen antisekretorischen Therapie, wobei sich das Atemtesverfahren zweimal als kosteneffektive Prozedur erweist und zwei Studien einen Vergleich mit einer empirischen Eradikationstherapie. In fünf Studien wird das Test-and-Treat-Verfahren mittels 13C-Harnstoff-Atemtest einer endoskopiebasierten Strategie gegenübergestellt. Zweimal dominiert die Atemteststrategie die endoskopische Prozedur und einmal wird sie von dieser Strategie dominiert. Diskussion:Sowohl die medizinischen als auch die ökonomischen Studien weisen mehr oder minder gravierende Mängel auf und liefern heterogene Ergebnisse. So werden in der Mehrzahl der medizinischen Studien keine Angaben zur statistischen Signifikanz der berichteten Unterschiede zwischen den jeweiligen Testverfahren gemacht. Im direkten Vergleich weist der 13C-Harnstoff-Atemtest überwiegend eine höhere Testgüte als der IgG und der Stuhl-Antigen-Test auf. Aus den Vergleichen mit dem Urease-Schnelltest lassen sich keine Tendenzen bezüglich der Sensitivität ableiten, wohingegen die Spezifität des 13C-Harnstoff-Atemtests höher einzuschätzen ist. Für die Vergleiche des 13C-Harnstoff-Atemtest mit der Histologie, dem 14C-Harnstoff-Atemtest und der PCR liegen zu wenige Ergebnisse vor. In der eingeschlossenen ökonomischen Literatur deuten einige Studienergebnisse auf eine Kosten-Effektivität der Test-and-Treat-Strategie mittels 13C-Harnstoff-Atemtest gegenüber dem Test-and-Treat-Verfahren auf Basis der Serologie und der empirischen antiskretorischen Therapie hin. Um Tendenzen bezüglich der Kosten-Effektivität der Atemteststrategie gegenüber der Test-and-Treat-Strategie mittels Stuhl-Antigen-Test sowie der empirischen Eradikationstherapie abzuleiten, mangelt es an validen Ergebnissen bzw. ökonomischer Evidenz. Die Untersuchungsresultate hinsichtlich eines Vergleichs mit endoskopiebasierten Verfahren fallen diesbezüglich zu heterogen aus. Insgesamt kann keines der ökonomischen Modelle der Komplexität des Managements von Patienten mit dyspeptischen Beschwerden gänzlich gerecht werden. Schlussfolgerungen/Empfehlungen: Zusammenfassend ist festzuhalten, dass die Studienlage zur medizinischen und ökonomischen Beurteilung des 13C-Harnstoff-Atemtests im Vergleich zu anderen diagnostischen Methoden nicht ausreichend ist, um den Atemtest als primärdiagnostisches Standardverfahren im Rahmen einer Test-and-Treat-Strategie beim Management von Patienten mit dyspeptischen Beschwerden für die deutsche Versorgungslandschaft insbesondere vor dem Hintergrund der Leitlinien der Deutschen Gesellschaft für Verdauungs- und Stoffwechselkrankheiten (DGVS) anstelle einer endoskopiebasierten Methode zu empfehlen.

Comércio de répteis exóticos: as suas implicações para a conservação da natureza

O comércio de espécies selvagens tem crescido bastante ao longo das últimas décadas. Atualmente é considerado o quarto maior tráfico ilegal no mundo, logo seguido da transação de drogas, de armas e de humanos. Estima-se que o comércio de espécies selvagens pode ultrapassar os 12 milhões de euros por ano na UE. Abrange tanto as plantas como os animais vivos; mas, nestes últimos, incluem-se também os seus derivados, tais como sejam as peles, os ossos, alimento, entre outros. O uso das espécies selvagens é bastante vastos, as espécies são utilizadas para alimentação, uso medicinal, investigação científica, comércio de peles, alimentação e o mais comum é para animais de estimação. As espécies exóticas muitas vezes tornam-se espécies exóticas invasoras, começam a ser um perigo para a biodiversidade e para as espécies nativas. O processo de invasão apresenta-se por quatro fases: dispersão ou transporte, estabelecimento, naturalização e por fim dispersão geográfica e/ou invasão. Vários são os mecanismos para combater as espécies exóticas invasoras, sendo que o mecanismo mais radical a erradicação de espécimes. Em Lisboa, estão descritas três espécies exóticas invasoras: a tartaruga da Florida Trachemys scripta, a tartaruga de Nelson Pseudemys nelsoni e a tartaruga corcunda do Mississipi Graptemys pseudogeographica; ABSTRACT: The wildlife trade is growing fast over the last decades. It is now considered the fourth largest illegal trade in the world, followed by the drugs, weapons and humans. It is estimated that trade with species can exceed 12 million € per year in the EU. This trade comprises plants or live animals; but also is derivatives, such as skins, bones, food, and others. The use of wildlife is diverse, can be for food, medical, scientific research, trade of skins, but the most common is for pets. Alien species can become invasive alien species and so they become a threat to biodiversity and for native species. The process of invasion has four phases: dispersion or transport, establishment, naturalization and geographic dispersion and/or invasion. There are several mechanisms to combat such invasive alien species: the most radical mechanism is eradication of specimens. In Lisbon, are described three invasive alien species: the red-eared slider turtle Trachemys Florida, the Florida red-bellied turtle Pseudemys nelsoni and the false map turtle Graptemys psedogeographica.

Análisis del tratamiento informativo realizado por los diarios El Mercurio, El Comercio y El Universo a las noticias sobre los casos de femicidio de Cristina Suquilanda, Karina del Pozo y Edith Bermeo, "Sharon"

Los medios de comunicación tienen un gran potencial para influir en los temas que la población comenta. Es así que con el presente estudio se pretende conocer cómo los medios construyen los discursos sobre las muertes violentas de mujeres, en tanto que si lo hacen desde una perspectiva educativa y preventiva podrían contribuir a la erradicación de la violencia contra las mujeres, pero si por el contrario lo hacen de manera sensacionalista ayudarán a reproducir estereotipos acerca del rol que la mujer debe cumplir dentro de la sociedad. Esta investigación tiene como objetivo principal examinar el tratamiento periodístico que realizaron los diarios El Mercurio, El Comercio y El Universo sobre los casos de femicidio de Cristina Suquilanda, Karina del Pozo y Edith Bermeo, respectivamente. Para determinar si el abordaje fue sensacionalista o por el contrario se incluyó una perspectiva de género, se utilizó la metodología del Análisis Crítico de Discurso que permitió develar las construcciones discursivas que se hacen alrededor de las muertes violentas de mujeres. De esta manera se encontró que no existe una perspectiva de género en las noticias sobre femicidios.

Trombose dos seios laterais como complicação de otite média : do diagnóstico ao tratamento

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Bia’s smile: an health education instrument on cleft lip and palate

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original work is properly cited.

Primary Antibiotic Resistance to Helicobacter pylori Strains Isolated From Children in Northern Iran: A Single Center Study

Background: Initial resistance to antibiotics is the main reason for the failure of Helicobacter pylori (H. pylori) eradication in children. Objectives: As we commonly face high antibiotic resistance rates in children, we aimed to determine the susceptibility of H. pylori to common antibiotics. Patients and Methods: In this cross-sectional in vitro study, 169 children younger than 14 years with clinical diagnosis of peptic ulcer underwent upper gastrointestinal endoscopy. Biopsy specimens from stomach and duodenum were cultured. In isolated colonies, tests of catalase, urease, and oxidase as well as gram staining were performed. After confirming the colonies as H. pylori, the antibiogram was obtained using disk diffusion method. Results: Culture for H. pylori was positive in 12.3% of the specimens, urease test in 21.3%, serological test in 18.9% and stool antigen test was positive in 21.9%. We could show high specificity but moderate sensitivity of both histological and H. pylori stool antigen tests to detect H. pylori. The overall susceptibility to metronidazole was 42.9%, amoxicillin 95.2%, clarithromycin 85.7%, furazolidone 61.9%, azithromycin 81.0%, and tetracycline 76.2% with the highest resistance to metronidazole and the lowest to clarithromycin. Conclusions: In our region, there is high resistance of H. pylori to some antibiotics including metronidazole and furazolidone among affected children. To reduce the prevalence of this antibiotic resistance, more controlled use of antibiotics should be considered in children.

Anti-biofilm and antimicrobial activity of Mentha pulegium L essential oil against multidrug-resistant Acinetobacter baumannii

Purpose: To investigate the antimicrobial and anti-biofilm activities of essential oil from Mentha pulegium L. (EOMP) on multi-drug resistant (MDR) isolates of A. baumannii , as well as its phytochemical composition, antioxidant properties and cytotoxic activity. Methods: The phytochemical composition of EOMP was analyzed by gas chromatography, while its antimicrobial activities were determined by disc diffusion and broth micro-dilution methods. Minimal biofilm inhibition concentration (MBIC) and minimal biofilm eradication concentration (MBEC) tests were used for assessment of its anti-biofilm properties. Viability in the biofilm was studied using 2,3-bis (2- methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide (XTT) assay, while colorimetric assay was used to assess its cytotoxicity on L929 cells. Results: D-isomenthone, pulegone, isopulegone, menthol and piperitenone were the major components of the plant extract. EOMP produced > 22 mm inhibition zone for the isolates, with minimum inhibitory concentration (MIC) and MBIC of 0.6 - 2.5 and 0.6 - 1.25 μL/mL, respectively, while MBEC was ≥ 10 μL/msL. EOMP damaged biofilm structures formed by A. baumannii strains at MIC by 26 – 91 %. Conclusion: These results suggest that EOMP contains agents that may be useful in the development of new drugs against A. baumannii infections.

Ocorrência e tratamento de monogenoides em alevinos de pampo (Trachinotus carolinus) cultivados experimentalmente na região norte do estado de São Paulo

This work had as objective tests therapeutic treatments seeking the monogenea eradication in fingerlings Florida Pompano (Trachinotus carolinus) servants in cage net in the area of Ubatuba, State of São Paulo. The fingerlings presented an accentuated weigh loss and strong discoloration and through observation of scraped of gills under light microscope were identified a high amount of monogenea. Three treatments were tested in form of baths: T1 (fresh water for 5 minutes); T2 (formalin: 1: 1.000 for 20 minutes) and T3: (formalin: 1:4.000 for 30 minutes). The treatments were appraised through scraped of gills, mounted among you laminate and laminulas and observed to the light microscope. It was observed that in the tested conditions all of the treatments were efficient in the elimination of the monogenea without presenting lethality to the fish. The treatment is recommended T I (take a bath in fresh water for 5 minutes) for the facility in the application and for the absence of use of chemical products.

O processo de urbanização de Mossorò: dos processos históricos à estrutura urbana atual

The general objective of this academic work is to analyze the relationship between the territorial division and the urban expansion process of Mossoró city, understood here as the production and occupation of space. The urban expansion in Mossoró, since its formation as settlement in 1772 until current days, identifies with the Brazilian urbanization process whose growth is determined by the capitalist development. Thus, the expansion was determined by several economical specializations imposed by the territorial division of work which occurs at an interregional level, and, sometimes at an international level. Then, each specialization determined a moment of the urban expansion of the city, as follows: a) The cattle farmer specialization, between 1772 and 1857, when the urban expansion was shy, is summarized to a commercial square that received goods from Aracati aiming to cover a wide rural area; b) The commercial emporium specialization, between 1857 and 1930, when the urban expansion took an important impulse with the concentration of public and private capitals; c) The salt industry and the agricultural-industrial exporter specialization inside a state of development policy, between 1930 and 1970, when the urban expansion, joined to the settlement of the working class in the urban soil, developed along an important axis -the railway; d) The render of services specialization inside a state of intervention policy, between 1970 and 1990, when the urban expansion was characterized by the accelerated growth rhythm, by the reuse of some spaces, and by space segregation of demanding people; e) The render of services policy inside a neoliberal state policy, since 1990 until current days, when the urban expansion reduced its rhythm abruptly, when only small alterations occurred in the existing spaces. It focused on social policies and on several slums eradication programs. Finally, the territorial structure is deeply articulated with others, no territorial, but economical, social and political, which happens at a national, regional and local rate. Only within a historical and conceptual panorama, it was possible to explain the urban expansion in Mossoró from its formation in 1772 until current days. Therefore, this work is a several discipline analysis of the urbanization process existing in Mossoró

Crimes de maio : estigmas e memórias da democracia das chacinas

Dissertação (mestrado)—Universidade de Brasília, Instituto de Ciências Sociais, Centro de Pesquisa e Pós-Graduação sobre as Américas, Programa de Pós-Graduação em Estudos Comparados sobre as Américas, 2016.

Stop jumping the gun : a call for evidence-based invasive predator management

Invasive mammalian predators are major drivers of species extinctions globally. To protect native prey, lethal control is often used with the aim of reducing or exterminating invasive predator populations. The efficacy of this practice, however, is often not considered despite multiple practical and ecological factors that can limit success. Here, we summarize contemporary knowledge regarding the use and challenges of both lethal control and alternative approaches for reducing invasive predator impacts. As the prevailing management approach, we outline four key issues that can compromise the effectiveness of lethal control: release of herbivore and mesopredator populations, disruption of predator social systems, compensatory predator immigration, and ethical concerns. We then discuss the relative merits and limitations of four alternative approaches that may enhance conservation practitioner's ability to effectively manage invasive predators: top-predator conservation or reintroduction, maintaining habitat complexity, exclusion fencing, and behavioral and evolutionary ecology. Considerable uncertainty remains regarding the effectiveness of management approaches in different environmental contexts. We propose that the deficiencies and uncertainties outlined here can be addressed through a combination of adaptive management, expert elicitation, and cost-benefit analyses. Improved management of invasive predators requires greater consideration and assessment of the full range of management approaches available.

Modernizing Mount Royal Park : Montréal’s Jungle in the 1950s

Durant les années 1950, les autorités municipales, sous la pression du département de la police, ont demandé le déboisement d’une section du parc du Mont-Royal. Cette section, communément appelée la « Jungle » et principalement composée de broussailles, de buissons et d’arbres, était fréquentée par une clientèle considérée comme indésirable. Cette dernière comprenait, essentiellement, des alcooliques, des voyous, des pervers, et, surtout, des homosexuels. Leur éradication s’est alors déployée selon un plan en trois étapes qui avait pour objectif de simplifier les techniques de surveillance utilisées par le département de la police. D’abord, une augmentation de l’éclairage, puis, le déboisement de la « Jungle », et, finalement, la construction d’une route, aujourd’hui connue sous le nom de Camillien-Houde. Le parc devenait ainsi plus accessible et plus sécuritaire. Les coupes, que l’on a appelées les « coupes de la moralité », ont eu un effet considérable sur l’environnement et la composition écologique du parc, donnant, entre autres, aux Montréalais, l’impression que le parc était devenu chauve (ce qui lui conféra d’ailleurs le surnom de Mont Chauve). Les transformations du parc du Mont-Royal n’étaient cependant pas limitées à sa Jungle. En fait, des modifications furent aussi mises en application dans d’autres sections considérées comme sous-développées. La métamorphose du parc et de sa « Jungle » était un acte de développement caractéristique de l’ère moderniste de la planification du Montréal d’après-guerre. La re-planification du parc du Mont-Royal témoigne ainsi d’une volonté sans bornes des autorités d’instaurer la moralité et la modernité dans la ville, volonté qui aura pour conséquence d’altérer la composition écologique du parc. C’est ce qui sera à l’origine d’une campagne nommée « Save-the-Mountain Movement », qui a cherché à empêcher la modernisation de l’espace et milité pour la réhabilitation du parc en tant que boisé paisible.

SIMULATING LARGE DEFORMATION OF INTRANEURAL GANGLION CYST USING FINITE ELEMENT METHOD

Intraneural Ganglion Cyst is disorder observed in the nerve injury, it is still unknown and very difficult to predict its propagation in the human body so many times it is referred as an unsolved history. The treatments for this disorder are to remove the cystic substance from the nerve by a surgery. However these treatments may result in neuropathic pain and recurrence of the cyst. The articular theory proposed by Spinner et al., (Spinner et al. 2003) considers the neurological deficit in Common Peroneal Nerve (CPN) branch of the sciatic nerve and adds that in addition to the treatment, ligation of articular branch results into foolproof eradication of the deficit. Mechanical modeling of the affected nerve cross section will reinforce the articular theory (Spinner et al. 2003). As the cyst propagates, it compresses the neighboring fascicles and the nerve cross section appears like a signet ring. Hence, in order to mechanically model the affected nerve cross section; computational methods capable of modeling excessively large deformations are required. Traditional FEM produces distorted elements while modeling such deformations, resulting into inaccuracies and premature termination of the analysis. The methods described in research report have the capability to simulate large deformation. The results obtained from this research shows significant deformation as compared to the deformation observed in the conventional finite element models. The report elaborates the neurological deficit followed by detail explanation of the Smoothed Particle Hydrodynamic approach. Finally, the results show the large deformation in stages and also the successful implementation of the SPH method for the large deformation of the biological organ like the Intra-neural ganglion cyst.

African swine fever virus transmission cycles in Central Europe: evaluation of wild boar-soft tick contacts through detection of antibodies against Ornithodoros erraticus saliva antigen.

BACKGROUND African swine fever (ASF) is one of the most complex viral diseases affecting both domestic and wild pigs. It is caused by ASF virus (ASFV), the only DNA virus which can be efficiently transmitted by an arthropod vector, soft ticks of the genus Ornithodoros. These ticks can be part of ASFV-transmission cycles, and in Europe, O. erraticus was shown to be responsible for long-term maintenance of ASFV in Spain and Portugal. In 2014, the disease has been reintroduced into the European Union, affecting domestic pigs and, importantly, also the Eurasian wild boar population. In a first attempt to assess the risk of a tick-wild boar transmission cycle in Central Europe that would further complicate eradication of the disease, over 700 pre-existing serum samples from wild boar hunted in four representative German Federal States were investigated for the presence of antibodies directed against salivary antigen of Ornithodoros erraticus ticks using an indirect ELISA format. RESULTS Out of these samples, 16 reacted with moderate to high optical densities that could be indicative of tick bites in sampled wild boar. However, these samples did not show a spatial clustering (they were collected from distant geographical regions) and were of bad quality (hemolysis/impurities). Furthermore, all positive samples came from areas with suboptimal climate for soft ticks. For this reason, false positive reactions are likely. CONCLUSION In conclusion, the study did not provide stringent evidence for soft tick-wild boar contact in the investigated German Federal States and thus, a relevant involvement in the epidemiology of ASF in German wild boar is unlikely. This fact would facilitate the eradication of ASF in the area, although other complex relations (wild boar biology and interactions with domestic pigs) need to be considered.

Evaluation of the risk factors contributing to the African swine fever occurrence in Sardinia, Italy

This study assesses the relation between hypothesized risk factors and African swine fever virus (ASFV) distribution in Sardinia (Italy) after the beginning of the eradication program in 1993, using a Bayesian multivariable logistic regression mixed model. Results indicate that the probability of ASFV occurrence in Sardinia was associated to particular socio-cultural, productive and economical factors found in the region, particularly to large number of confined (i.e., closed) farms (most of them backyard), high road density, high mean altitude, large number of open fattening farms, and large number of pigs per commune. Conversely, large proportion of open farms with at least one census and large proportion of open farms per commune, were found to be protective factors for ASFV. Results suggest that basic preventive and control strategies, such as yearly census or registration of the pigs per farm and better control of the public lands where pigs are usually raised, together with endanced effords of outreach and communication with pig producers should help in the success of the eradication program for ASF in the Island. Methods and results presented here will inform decision making to better control and eradicate ASF in Sardinia and in all those areas with similar management and epidemiological conditions.