Re-infestation of houses by Triatoma dimidiata after intra-domicile insecticide application in the Yucatán peninsula, Mexico

In most countries, Chagas disease transmission control remains based on domestic insecticide application. We thus evaluated the efficacy of intra-domicile cyfluthrin spraying for the control of Triatoma dimidiata, the only Chagas disease vector in the Yucatán peninsula, Mexico, and monitored potential re-infestation every 15 days for up to 9 months. We found that there was a re-infestation of houses by adult bugs starting 4 months after insecticide application, possibly from sylvatic/peridomicile areas. This points out the need to take into account the potential dispersal of sylvatic/peridomestic adult bugs into the domiciles as well as continuity action for an effective vector control.

Local and regional drugs task forces: handbook.

This handbook has been developed within the context of the institutional structures recommended under the National Drugs Strategy 2009-2016 and within the overall framework of the National Social Inclusion Plan 2007-2016. It sets out the role of the Drugs Task Forces within the national and local framework required to address the existing and emerging problems associated with drug use for individuals, families and communities in the context of the long term development of the work of the Drugs Task Forces.This resource was contributed by The National Documentation Centre on Drug Use.

Management of a post-operative multi-resistant infectious spondylitis associated with a kyphotic deformity.

Anterior spinal infection (prevertebral abscess and/or discitis) after posterior instrumentation for vertebral fractures is a challenging complication, since a new implant may become necessary anteriorly, in a septic environment. Generally accepted management guidelines are yet to be established. The authors present a case of posterior instrumentation for fractures of T12 and L1, complicated after 9 months with an anterior infection (prevertebral abscess and discitis) with extended-spectrum beta-lactamase (ESBL) producing Escherichia coli (E. coli). This case is unique in that the multi-resistant organism was isolated only after the second stage of infection treatment, which consisted of anterior débridement and anterior implantation of titanium cages and rods. In this particular case, infection was controlled despite implantation of multiple cages, screws and rods, and fusion was achieved, by means of intravenous antibiotic treatment for 12 months. At the latest follow-up, 24 months post surgery, there was no evidence of infection. This problem case may be helpful for surgeons confronted with spinal deformities secondary to infections with multi-resistant organisms.

Variabilité intra/interobservateur du coefficient de diffusion apparente dans les lésions hépatiques malignes traitées

Objectifs : Le coefficient de diffusion apparente (ADC) est utilisé pour le suivi des lésions hépatiques malignes traitées. Cependant, l'ADC est généralement mesuré dans la lésion entière, alors que cela devrait être réalisé dans la zone la plus restreinte (ZLPR), cette dernière représentant potentiellement du résidu tumoral. Notre objectif était d'évaluer la variabilité inter/intraobservateur de l'ADC dans la tumeur entière et dans la ZLPR. Matériels et méthodes : Quarante patients traités par chimioembolisation ou radiofréquence ont été évalués. Après consensus, deux lecteurs ont indépendamment mesuré l'ADC de la lésion entière et de la ZLPR. Les mêmes mesures ont été répétées deux semaines plus tard. Le test de Spearman et la méthode de Bland-Altman ont été utilisées. Résultats : La corrélation interobservateur de l'ADC dans la lésion entière et dans la ZLPR était de 0,962 et de 0,884. La corrélation intraobservateur était de 0,992 et de 0,979, respectivement. Les limites de variabilité interobservateur (mm2/sec*10 - 3) étaient entre -0,25/+0,28 dans la lésion entière et entre -0,51/+0,46 dans la ZLPR. Les limites de variabilité intraobservateur étaient respectivement : -0,25/+0,24 et -0,43/+0,47. Conclusion : La corrélation inter/intraobservateur dans les mesures d'ADC est bonne. Toutefois, une variabilité limitée existe et doit être considérée lors de l'interprétation des valeurs d'ADC des tumeurs hépatiques.

More productive in vitro culture of Cryptosporidium parvum for better study of the intra- and extracellular phases

The great difficulties in treating people and animals suffering from cryptosporidiosis have prompted the development of in vitro experimental models. Due to the models of in vitro culture, new extracellular stages of Cryptosporidium have been demonstrated. The development of these extracellular phases depends on the technique of in vitro culture and on the species and genotype of Cryptosporidium used. Here, we undertake the molecular characterization by polymerase chain reaction-restriction fragment lenght polymorphism of different Cryptosporidium isolates from calves, concluding that all are C. parvum of cattle genotype, although differing in the nucleotide at positions 472 and 498. Using these parasites, modified the in vitro culture technique for HCT-8 cells achieving greater multiplication of parasites. The HCT-8 cell cultures, for which the culture had not been renewed in seven days, were infected with C. parvum sporozoites in RPMI-1640 medium with 10% IFBS, CaCl2 and MgCl2 1 mM at pH 7.2. Percentages of cell parasitism were increased with respect to control cultures (71% at 48 h vs 14.5%), even after two weeks (47% vs 1.9%). Also, the percentage of extracellular stages augmented (25.3% vs 1.1% at 96 h). This new model of in vitro culture of C. parvum will enable easier study of the developmental phases of C. parvum in performing new chemotherapeutic assays.

The Intra-Alpine terrain: A Paleotethyan remnant in the Alpine Variscides

A Cordilleran type evolution is proposed for the Variscan orogen of middle Europe. This orogenesis is regarded as mainly evolving through terrain accretion and subsequent collapse of the overthickened crust. A major terrain accretion took place between late Devonian and early Carboniferous when the Intra-Alpine terrain collided with the Ligerian-Moldanubian active margin. This terrain is regarded as being a segment of the northern margin of Paleotethys. Oblique subduction of Paleotethys under the newly accreted terrain is responsible for the voluminous calc-alkaline magmatism in late Carboniferous. The Paleotethys subduction has generated a lateral displacement of the eastern part of the Intra-Alpine terrain inducing a duplication of its western end. The late Carboniferous closure of Paleotethys in middle Europe is not found eastward where this closure happened only in early-Triassic times, following the simultaneous opening of the Neotethys ocean and the Meliata back-arc. Palinspastic models of the western Tethyan realm are proposed from the Carboniferous to early Jurassic.

A survey on the enlistment of pharmacists in a hospital battalion of the Swiss Armed Forces

Background: Pharmacists, mainly militiamen, are incorporated in the Swiss Armed Forces, for instance in hospital battalions to supply drugs and medical devices, as well as to coordinate hygiene service. Presently, their duties are only very globally defined. Aims: The objective of this survey was to investigate the tasks that were actually assumed by the military pharmacy of the 2nd Hospital Battalion. Methods: Two types of commitments, offering military and civilian interest's convergence, were considered between 2005 and 2011: (1) army camps for the disabled and (2) operations and supports provided to two nursing homes. While relieving the civil caregiver usually involved with disabled or elderly people, such missions offer indeed the possibility to the army medical service to train its care and logistical processes with real patients, even in the absence of any sanitary crisis or war in the country. Results: Two basis activities have been assumed: (1) centralized supply of drugs and medical devices and (2) coordination of hygiene monitoring and disinfection operations. New tasks were also performed: (3) support to the management of ward-based pharmacies, (4) pillboxes preparation, (5) medication review and (6) selective participation in clinical rounds. The last two were integrated in an interdisciplinary education process. Conclusions: Results shows that, apart from traditional duties, new clinical-oriented activities have been evenly developed and assumed by militia pharmacists. They call thus for a possible renewed definition of the tasks of military hospital pharmacists and of their related military education. A wider study in all hospital battalions is yet mandatory.

Retroperitoneoscopy to extract dropped gallstones after laparoscopic cholecystectomy

Complications resulting from gallstones left in the peritoneal cavity are most often reported after laparoscopic treatment of cholelitiasis. Gallstones are frequently dropped in the posterior subhepatic space, which can lead to the development of abscesses that usually require laparotomy for extraction of the stones. We present a novel technique for treating collections associated with dropped gallstones, using retroperitoneoscopy with two 10-mm ports after ultrasound localization of the abscess. We carried out this procedure in two patients and successfully extracted the gallstones without postoperative complications or recurrences. We consider this approach to be technically feasible, safe, and effective. It avoids the usual inefficacy of simple percutaneous drainage of these collections and the complications associated with the drainage of intra-abdominal abscesses by laparotomy.