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Manual of infection prevention and control
\"It has been estimated that in developed countries up to 10% of hospitalized patients develop infections every year. Not only is there a substantial cost to healthcare systems, but some healthcare associated infections (HCIAs) can be fatal. Since the majority of HCIAs are preventable, reducing HCIAs is now considered to be an integral part of patient safety and quality of care provided by all healthcare institutions worldwide. Unlike other books on infection control, the main strength of this book is to provide clear, up-to-date and practical guidance in infection control in an easy to read format which can act as a quick source of reference on all aspects of HCIA for healthcare workers who are either directly or indirectly involved in prevention and control of HCIAs. Although the book's main audience is infection control practitioners such as doctors, nurses, public health physicians, it is also a valuable reference for environmental health officers, health educators, practice managers in GP surgeries, and health service managers\"-- Provided by publisher.
Book
Timing of Initiation of Antiretroviral Therapy in Human Immunodeficiency Virus (HIV)—Associated Tuberculous Meningitis
Background. The optimal time to initiate antiretroviral therapy (ART) in human immunodeficiency virus (HIV)—associated tuberculous meningitis is unknown. Methods. We conducted a randomized, double-blind, placebo-controlled trial of immediate versus deferred ART in patients with HIV-associated tuberculous meningitis to determine whether immediate ART reduced the risk of death. Antiretroviral drugs (zidovudine, lamivudine, and efavirenz) were started either at study entry or 2 months after randomization. All patients were treated with standard antituberculosis treatment, adjunctive dexamethasone, and prophylactic co-trimoxazole and were followed up for 12 months. We conducted intention-to-treat, perprotocol, and prespecified subgroup analyses. Results. A total of 253 patients were randomized, 127 in the immediate ART group and 126 in the deferred ART group; 76 and 70 patients died within 9 months in the immediate and deferred ART groups, respectively. Immediate ART was not significantly associated with 9-month mortality (hazard ratio [HR], 1.12; 95% confidence interval [CI],.81-1.55; P = .50) or the time to new AIDS events or death (HR, 1.16; 95% CI,.87-1.55; P = .31). The percentage of patients with severe (grade 3 or 4) adverse events was high in both arms (90% in the immediate ART group and 89% in the deferred ART group; P = .84), but there were significantly more grade 4 adverse events in the immediate ART arm (102 in the immediate ART group vs 87 in the deferred ART group; P = .04). Conclusions. Immediate ART initiation does not improve outcome in patients presenting with HIV-associated tuberculous meningitis. There were significantly more grade 4 adverse events in the immediate ART arm, supporting delayed initiation of ART in HIV-associated tuberculous meningitis.
Journal Article
Photovoltaic science and technology
\"Discusses the principles of operation of photovoltaic devices, their limitations, choice of materials and maximum efficiencies\"-- Provided by publisher.
Book
General catalogue of variable stars: Version GCVS 5.1
Work aimed at compiling detailed catalogs of variable stars in the Galaxy, which has been carried out continuously by Moscow variable-star researchers since 1946 on behalf of the International Astronomical Union, has entered the stage of the publication of the 5th, completely electronic edition of the General Catalogue of Variable Stars (GCVS). This paper describes the requirements for the contents of the 5th edition and the current state of the catalog in its new version, GCVS 5.1. The complete revision of information for variable stars in the constellation Carina and the compilation of the 81st Name-list of Variable Stars are considered as examples of work on the 5th edition. The GCVS 5.1 is freely accessible on the Internet. We recommend the present paper as a unified reference to the 5th edition of the GCVS.
Journal Article
Three phylogenetic groups have driven the recent population expansion of Cryptococcus neoformans
Cryptococcus neoformans
(
C. neoformans
var.
grubii
) is an environmentally acquired pathogen causing 181,000 HIV-associated deaths each year. We sequenced 699 isolates, primarily
C. neoformans
from HIV-infected patients, from 5 countries in Asia and Africa. The phylogeny of
C. neoformans
reveals a recent exponential population expansion, consistent with the increase in the number of susceptible hosts. In our study population, this expansion has been driven by three sub-clades of the
C. neoformans
VNIa lineage; VNIa-4, VNIa-5 and VNIa-93. These three sub-clades account for 91% of clinical isolates sequenced in our study. Combining the genome data with clinical information, we find that the VNIa-93 sub-clade, the most common sub-clade in Uganda and Malawi, was associated with better outcomes than VNIa-4 and VNIa-5, which predominate in Southeast Asia. This study lays the foundation for further work investigating the dominance of VNIa-4, VNIa-5 and VNIa-93 and the association between lineage and clinical phenotype.
Cryptococcus neoformans
is an opportunistic fungal pathogen which primarily affects people with immune defects including those living with HIV. Here, the authors sequence and analyze genomes of 699 isolates, and identify recent population expansion driven by three phylogenetic groups.
Journal Article
Dexamethasone for the Treatment of Tuberculous Meningitis in Adolescents and Adults
Even with antituberculosis therapy, tuberculous meningitis causes death or severe disability in more than half of affected adults. In this double-blind, placebo-controlled trial, conducted in Vietnam, dexamethasone treatment was associated with a reduced risk of death as compared with placebo (31.8 percent vs. 41.3 percent).
Dexamethasone treatment was associated with a reduced risk of death but the proportion of survivors with severe disability is not reduced.
Tuberculous meningitis is the severest form of infection with
Mycobacterium tuberculosis,
causing death or severe neurologic deficits in more than half of those affected in spite of antituberculosis chemotherapy.
1
,
2
Attenuation of the inflammatory response in bacterial and mycobacterial meningitis may improve outcome by reducing the likelihood or severity of neurologic complications. Early studies suggested that corticosteroids reduced cerebrospinal fluid inflammation and time to recovery in patients with tuberculous meningitis, but the studies were too small to confirm any effect on survival.
3
–
7
Concern remained that corticosteroids might reduce the case fatality rate but increase the number of disabled patients. . . .
Journal Article
A smart tele-cytology point-of-care platform for oral cancer screening
Early detection of oral cancer necessitates a minimally invasive, tissue-specific diagnostic tool that facilitates screening/surveillance. Brush biopsy, though minimally invasive, demands skilled cyto-pathologist expertise. In this study, we explored the clinical utility/efficacy of a tele-cytology system in combination with Artificial Neural Network (ANN) based risk-stratification model for early detection of oral potentially malignant (OPML)/malignant lesion. A portable, automated tablet-based tele-cytology platform capable of digitization of cytology slides was evaluated for its efficacy in the detection of OPML/malignant lesions (n = 82) in comparison with conventional cytology and histology. Then, an image pre-processing algorithm was established to segregate cells, ANN was trained with images (n = 11,981) and a risk-stratification model developed. The specificity, sensitivity and accuracy of platform/ stratification model were computed, and agreement was examined using Kappa statistics. The tele-cytology platform, Cellscope, showed an overall accuracy of 84-86% with no difference between tele-cytology and conventional cytology in detection of oral lesions (kappa, 0.67-0.72). However, OPML could be detected with low sensitivity (18%) in accordance with the limitations of conventional cytology. The integration of image processing and development of an ANN-based risk stratification model improved the detection sensitivity of malignant lesions (93%) and high grade OPML (73%), thereby increasing the overall accuracy by 30%. Tele-cytology integrated with the risk stratification model, a novel strategy established in this study, can be an invaluable Point-of-Care (PoC) tool for early detection/screening in oral cancer. This study hence establishes the applicability of tele-cytology for accurate, remote diagnosis and use of automated ANN-based analysis in improving its efficacy.
Journal Article