Outcome of childhood malignancies at the University of Port Harcourt Teaching Hospital: a call for implementation of palliative care.

Background: Cancers in children are yet to be recognised as an important cause of childhood morbidity and mortality in developing countries where more than 70% of the world annual cases occur. Despite the limited resources and whatever the projected outcome, children with cancer need treatment, be it curative or palliative. Objectives: To determine outcome of cancers in children at the UPTH; identify factors that influence outcome, highlight the need for palliative care. Method: A retrospective study of cases of childhood malignancies admitted into Paediatric Oncology unit of UPTH over a two year period. Clinical profile of patients and outcome were analyzed using SPSS version 20.0. Results: Sixty cases were analysed: 35(58.3%) males, 25(41.7%) females giving a M:F ratio of 1.4:1. Under-fives constituted 55%. Twenty-seven (45%) patients presented within 4 weeks of onset of symptoms. Median duration of symptoms before presentation was 8 weeks while 36 (60%) had metastatic disease at diagnosis. Twenty patients (33.3%) defaulted with or without specific treatment. Mortality was recorded in 26(43.4%) of cases. Conclusion: There were more cases of cancer amongst under-fives with male preponderance. Late presentation, financial constraints and high default rate were contributory factors to poor outcome in most cases. Lack of palliative care left many families to face their sufferings.

Differentiated thyroid cancer with liver metastases: lessons learned from managing a series of 14 patients

International audience

SEMIPARAMETRIC METHODS IN THE ESTIMATION OF TAIL PROBABILITIES AND EXTREME QUANTILES

In quantitative risk analysis, the problem of estimating small threshold exceedance probabilities and extreme quantiles arise ubiquitously in bio-surveillance, economics, natural disaster insurance actuary, quality control schemes, etc. A useful way to make an assessment of extreme events is to estimate the probabilities of exceeding large threshold values and extreme quantiles judged by interested authorities. Such information regarding extremes serves as essential guidance to interested authorities in decision making processes. However, in such a context, data are usually skewed in nature, and the rarity of exceedance of large threshold implies large fluctuations in the distribution's upper tail, precisely where the accuracy is desired mostly. Extreme Value Theory (EVT) is a branch of statistics that characterizes the behavior of upper or lower tails of probability distributions. However, existing methods in EVT for the estimation of small threshold exceedance probabilities and extreme quantiles often lead to poor predictive performance in cases where the underlying sample is not large enough or does not contain values in the distribution's tail. In this dissertation, we shall be concerned with an out of sample semiparametric (SP) method for the estimation of small threshold probabilities and extreme quantiles. The proposed SP method for interval estimation calls for the fusion or integration of a given data sample with external computer generated independent samples. Since more data are used, real as well as artificial, under certain conditions the method produces relatively short yet reliable confidence intervals for small exceedance probabilities and extreme quantiles.

Animal Models of Friedreich Ataxia

Friedreich ataxia (FRDA) is the most common form of autosomal-recessive ataxia. Common nonmotor features include cardiomyopathy and diabetes mellitus. At present, no effective treatments are available to prevent disease progression. Age of onset varies from infancy to adulthood. In the majority of patients, FRDA is caused by intronic GAA expansions in FXN, which encodes a highly-conserved small mitochondrial matrix protein, frataxin. A mouse model of FRDA has been difficult to generate because complete loss of frataxin causes early embryonic lethality. Although there are some controversies about the function of frataxin, recent biochemical and structural studies have confirmed that it is a component of the multiprotein complex that assembles iron-sulfur clusters in the mitochondrial matrix. The main consequences of frataxin deficiency are energy deficit, altered iron metabolism, and oxidative damage.

OPA1-related disorders: Diversity of clinical expression, modes of inheritance and pathophysiology

International audience

Microbiology of chronic suppurative otitis media at Queen Elizabeth Central Hospital, Blantyre, Malawi: A cross-sectional descriptive study

Background Chronic suppurative otitis media (CSOM) is still a significant health problem in developing countries. Therefore, it was pertinent to determine the local Malawian microbiology in order to guide adequate treatment, avoid complications, and provide records for future reference. Aim The study sought to determine the CSOM-causing microorganisms at Queen Elizabeth Central Hospital in Blantyre, Malawi, and establish their relationship signs and symptoms, and with the demographic pattern of the study. Methods This was a hospital-based cross-sectional descriptive study carried out at the ENT outpatient clinic and the Microbiology Department of Queen Elizabeth Central Hospital.The sample comprised 104 patients with unilateral or bilateral active CSOM, who met the inclusion criteria. All patients were evaluated through a detailed history and clinical examination. Pus samples from draining ears were collected by aspiration with a sterile pipette. The specimens were immediately sent for microbiological analysis. Data were analyzed using SPSS.version 20. Results The study found that Proteus mirabilis , Pseudomonas aeruginosa , and Staphylococcus aureus were the most prevalent aerobic bacteria, while Bacteroides spp. and Peptostreptococcus spp. were the commonest anaerobic bacteria causing CSOM. These CSOM-causing microorganisms were predominant among males aged 18 years and below. Some CSOMcausing microorganisms were—significantly more so than the others— characteristically associated with each of the following clinical features: quantity of pus drainage, mode of onset, otalgia, hearing loss, location of tympanic membrane perforation, and mucosal appearance.

Bayesian analysis of a mastitis control plan to investigate the influence of veterinary prior beliefs on clinical interpretation

The fundamental objective for health research is to determine whether changes should be made to clinical decisions. Decisions made by veterinary surgeons in the light of new research evidence are known to be influenced by their prior beliefs, especially their initial opinions about the plausibility of possible results. In this paper, clinical trial results for a bovine mastitis control plan were evaluated within a Bayesian context, to incorporate a community of prior distributions that represented a spectrum of clinical prior beliefs. The aim was to quantify the effect of veterinary surgeons’ initial viewpoints on the interpretation of the trial results. A Bayesian analysis was conducted using Markov chain Monte Carlo procedures. Stochastic models included a financial cost attributed to a change in clinical mastitis following implementation of the control plan. Prior distributions were incorporated that covered a realistic range of possible clinical viewpoints, including scepticism, enthusiasm and uncertainty. Posterior distributions revealed important differences in the financial gain that clinicians with different starting viewpoints would anticipate from the mastitis control plan, given the actual research results. For example, a severe sceptic would ascribe a probability of 0.50 for a return of <£5 per cow in an average herd that implemented the plan, whereas an enthusiast would ascribe this probability for a return of >£20 per cow. Simulations using increased trial sizes indicated that if the original study was four times as large, an initial sceptic would be more convinced about the efficacy of the control plan but would still anticipate less financial return than an initial enthusiast would anticipate after the original study. In conclusion, it is possible to estimate how clinicians’ prior beliefs influence their interpretation of research evidence. Further research on the extent to which different interpretations of evidence result in changes to clinical practice would be worthwhile.

Blame Attributions Among Child Sexual Abuse Survivors and Disclosure of the Abuse

Child sexual abuse (CSA) disclosure is critical for survivor´s psychosocial adjustment later in life. The aim of the present study was to analyze the relationship between attributions of blame for child sexual abuse by the victim and the disclosure of the abuse to parents or caregivers while controlling for characteristics of the abuse. Female college students between 17 and 24 years of age (M = 19.44, SD = 1.64) from a southern Spanish University were surveyed. Of 1547 respondents, 153 (9.90%) reported having suffered some form of CSA before the age of 15. Information about the characteristics of abuse (age of onset, type of abuse suffered, continuity of abuse, and relationship with and age of the perpetrator) and the existence of abuse disclosure by the survivor was obtained from a self-reported questionnaire developed for the present study. The Attributions of Responsibility and Blame Scale (McMillen & Zuravin, 1997) was used to assess attributions made about CSA (self-blame, perpetrator blame and family blame). The results of a logistic regression model was statistically significant, χ² (9) = 43.856, p < .001. The model explained 41% (Nagelkerke R²) of the variance of abuse disclosure and correctly classified 85.6% of cases. Survivor disclosure was 5.50 times more likely to occur when the perpetrator was not a family member (Wald = 8.14, p < .01) and 3.95 times more likely to occur when there was not physical contact with the perpetrator (Wald = 4.30, p < .05). The occurrence of disclosure was also related to increased perpetrator age (Wald = 4.83, p < .05). With regard to the attributions of blame, the occurrence of disclosure was related to lower scores on self-blame (Wald = 6.78, p < .01) and higher scores on family blame (Wald = 9.67, p < .001). However, no relationship was found between perpetrator blame and disclosure of abuse. The results confirm the idea that not only self-blame attributions, but also family blame attributions are critical to the decision of a CSA victim to disclose abuse. The possibility that children who do not disclose abuse have a greater need to deny the occurrence of abuse, or have more confusion about being abused is discussed. Attributions of blame should be taken into serious consideration when evaluating children for possible sexual abuse.

Climatic fluctuations and homogenization of Northeast Brazil using precipitation data.

Before using the basic precipitation data in any agroclimatic study to assess the productivity it is important to check the data series for homogeneity. For this purpose data of 105 locations for the period 1912-1981 over northeast Brazil were used. The preliminary study indicate nonhomogeneity in the time series during 1940's at few locations. The amplitude of variation of time series when taken as 10-year moving average show quite different for different regions. It appears that this amplitude is related to time of onset of effective rains in some extent. There is also great diversity in the fluctuations. They present a great regional diversity. Some diversity. Some of the data in the low latitudes indicate presence of four cycles namely 52, 26, 13 & 6.5. years. The 52-year cycle is also evident in the case of onset of southwest Monsoon over a low latitude zone (Kerala Coast) in India. In the case of south Africa the prominent cycles are 60, 30, 15 & 10 similar situation appears to be present in the higher latitudes of northeast Brazil.

The economics of credit markets: theory and evidence.

Doutoramento em Economia.

Reliability of infrared thermography in skin temperature evaluation of wheelchair users

To examine the reliability of infrared thermography (IRT) in wheelchair users (WCUs), as a noninvasive and risk-free technique to detect the natural thermal radiation emitted by human skin and to allow subsequent interpretations of temperature distributions.

The SHIVir Survey: A Dynamical Catalogue of Virgo Cluster Galaxies and their Scaling Relations

By virtue of its proximity and richness, the Virgo galaxy cluster is a perfect testing ground to expand our understanding of structure formation in the Universe. Here, we present a comprehensive dynamical catalogue based on 190 Virgo cluster galaxies (VCGs) in the "Spectroscopy and H-band Imaging of the Virgo cluster" (SHIVir) survey, including kinematics and dynamical masses. Spectroscopy collected over a multi-year campaign on 4-8m telescopes was joined with optical and near-infrared imaging to create a cosmologically-representative overview of parameter distributions and scaling relations describing galaxy evolution in a rich cluster environment. The use of long-slit spectroscopy has allowed the extraction and systematic analysis of resolved kinematic profiles: Halpha rotation curves for late-type galaxies (LTGs), and velocity dispersion profiles for early-type galaxies (ETGs). The latter are shown to span a wide range of profile shapes which correlate with structural, morphological, and photometric parameters. A study of the distributions of surface brightnesses and circular velocities for ETGs and LTGs considered separately show them all to be strongly bimodal, hinting at the existence of dynamically unstable modes where the baryon and dark matter fractions may be comparable within the inner regions of galaxies. Both our Tully-Fisher relation for LTGs and Fundamental Plane analysis for ETGs exhibit the smallest scatter when a velocity metric probing the galaxy at larger radii (where the baryonic fraction becomes sub-dominant) is used: rotational velocity measured in the outer disc at the 23.5 i-mag arcsec^{-2} level, and velocity dispersion measured within an aperture of 2 effective radii, respectively. Dynamical estimates for gas-poor and gas-rich VCGs are merged into a joint analysis of the stellar-to-total mass relation (STMR), stellar TFR, and Mass-Size relation. These relations are all found to contain strong bimodalities or dichotomies between the ETG and LTG samples, alluding to a "mixed scenario'' evolutionary sequence between morphological/dynamical classes that involves both quenching and dry mergers. The unmistakable differentiation between these two galaxy classes appears robust against different classification schemes, and supports the notion that they are driven by different evolutionary histories. Future observations using integral field spectroscopy and including lower-mass galaxies should solidify this hypothesis.

¬FISH DISTRIBUTIONS IN LAKE ONTARIO’S EASTERN BASIN AND THE UPPER ST. LAWRENCE RIVER: AN ANALYSIS USING GIS AND OCCUPANCY MODELLING TECHNIQUES

Predictive models of species distributions are important tools for fisheries management. Unfortunately, these predictive models can be difficult to perform on large waterbodies where fish are difficult to detect and exhaustive sampling is not possible. In recent years the development of Geographic Information Systems (GIS) and new occupancy modelling techniques has improved our ability to predict distributions across landscapes as well as account for imperfect detection. I surveyed the nearshore fish community at 105 sites between Kingston, Ontario and Rockport, Ontario with the objective of modelling geographic and environmental characteristics associated with littoral fish distributions. Occupancy modelling was performed on Round Goby, Yellow perch, and Lepomis spp. Modelling with geographic and environmental covariates revealed the effect of shoreline exposure on nearshore habitat characteristics and the occupancy of Round Goby. Yellow Perch, and Lepomis spp. occupancy was most strongly associated negatively with distance to a wetland. These results are consistent with past research on large lake systems indicate the importance of wetlands and shoreline exposure in determining the fish community of the littoral zone. By examining 3 species with varying rates of occupancy and detection, this study was also able to demonstrate the variable utility of occupancy modelling.

Hdl Levels And Oxidizability During Myocardial Infarction Are Associated With Reduced Endothelial-mediated Vasodilation And Nitric Oxide Bioavailability.

Acute phase response modifies high-density lipoprotein (HDL) into a dysfunctional particle that may favor oxidative/inflammatory stress and eNOS dysfunction. The present study investigated the impact of this phenomenon on patients presenting ST-elevation myocardial infarction (STEMI). Plasma was obtained from 180 consecutive patients within the first 24-h of onset of STEMI symptoms (D1) and after 5 days (D5). Nitrate/nitrite (NOx) and lipoproteins were isolated by gradient ultracentrifugation. The oxidizability of low-density lipoprotein incubated with HDL (HDLaoxLDL) and the HDL self-oxidizability (HDLautox) were measured after CuSO4 co-incubation. Anti-inflammatory activity of HDL was estimated by VCAM-1 secretion by human umbilical vein endothelial cells after incubation with TNF-α. Flow-mediated dilation (FMD) was assessed at the 30(th) day (D30) after STEMI. Among patients in the first tertile of admission HDL-Cholesterol (<33 mg/dL), the increment of NOx from D1 to D5 [6.7(2; 13) vs. 3.2(-3; 10) vs. 3.5(-3; 12); p = 0.001] and the FMD adjusted for multiple covariates [8.4(5; 11) vs 6.1(3; 10) vs. 5.2(3; 10); p = 0.001] were higher than in those in the second (33-42 mg/dL) or third (>42 mg/dL) tertiles, respectively. From D1 to D5, there was a decrease in HDL size (-6.3 ± 0.3%; p < 0.001) and particle number (-22.0 ± 0.6%; p < 0.001) as well as an increase in both HDLaoxLDL (33%(23); p < 0.001) and HDLautox (65%(25); p < 0.001). VCAM-1 secretion after TNF-a stimulation was reduced after co-incubation with HDL from healthy volunteers (-24%(33); p = 0.009), from MI patients at D1 (-23%(37); p = 0.015) and at D30 (-22%(24); p = 0.042) but not at D5 (p = 0.28). During STEMI, high HDL-cholesterol is associated with a greater decline in endothelial function. In parallel, structural and functional changes in HDL occur reducing its anti-inflammatory and anti-oxidant properties.

Comparação da eficácia da ropivacaína 1% quando associada ou não à hialuronidase na anestesia peribulbar para cirurgia de catarata

Purpose: To evaluate the onset time and quality of peribulbar anesthesia with 1% ropivacaine associated or not with hyaluronidase 100 tru/ml for cataract extraction. Methods: Prospective, randomized, double-blind and controlled study including fifty-seven patients, scheduled to undergo peribulbar anesthesia for cataract extraction, allocated to two groups. Group C: 1% ropivacaine with addition of 100 tru/ml hyaluronidase, and Group S 1% ropivacaine, without hyaluronidase. The onset time for globe akinesia was studied at intervals of 2 minutes, using Nicoll's score. We evaluated pain by analogic score during the surgery and the necessity of complementing the anaesthesia. The peribulbar block was considered satisfactory when the Nicoll's score was less than 4. Results: The mean time of onset of block in group C was 4.07 minutes (± 3.24), and in group S 5.03 (± 3.28). There was no statistically significant difference between the groups. Both were similar regarding pain score, no pain was observed in 57.14% of group C, and in 68.97% of group S. The supplementary anesthetic was necessary in 2 cases of group C and in 3 cases of group S. Two cases of bradycardia (heart rate < 50 bpm) were observed during the surgery, and in one case administration of atropine IV was necessary. Conclusion: 1% ropivacaine provided a good quality of anesthesia for cataract extraction, with a faster onset of action in the group with hyaluronidase 100 iu/ml, although without significant difference.