Household fish preparation hygiene and cholera transmission in Monrovia, Liberia.

Background: In the 1980s Vibrio cholerae was found to be an autochthonous resident of aquatic environments. As result, ingestion of undercooked, contaminated fish has been associated with cholera transmission. An alternative mechanism of transmission associated with fish was hypothesised by Schürmann et al.

Financial access to health care in Karuzi, Burundi: a household-survey based performance evaluation.

Background: In 2003, Médecins Sans Frontières, the provincial government, and the provincial health authority began a community project to guarantee financial access to primary health care in Karuzi province, Burundi. The project used a community-based assessment to provide exemption cards for indigent households and a reduced flat fee for consultations for all other households.

Methods: An evaluation was carried out in 2005 to assess the impact of this project.

Operational research in low-income countries: what, why, and how?

Operational research is increasingly being discussed at institutional meetings, donor forums, and scientific conferences, but limited published information exists on its role from a disease-control and programme perspective. We suggest a definition of operational research, clarify its relevance to infectious-disease control programmes, and describe some of the enabling factors and challenges for its integration into programme settings. Particularly in areas where the disease burden is high and resources and time are limited, investment in operational research and promotion of a culture of inquiry are needed so that health care can become more efficient.

Stavudine- and nevirapine-related drug toxicity while on generic fixed-dose antiretroviral treatment: incidence, timing and risk factors in a three-year cohort in Kigali, Rwanda.

This cohort study was conducted to report on the incidence, timing and risk factors for stavudine (d4T)- and nevirapine (NVP)-related severe drug toxicity (requiring substitution) with a generic fixed-dose combination under program conditions in Kigali, Rwanda. Probability of 'time to first toxicity-related drug substitution' was estimated using the Kaplan-Meier method and Cox-proportional hazards modeling was used to identify risk factors. Out of 2190 adults (median follow-up: 1.

The National Stroke Strategy - is it achievable?

Introduction: Timing of intervention in symptomatic carotid disease is critical. The UK Department of Health's National Stroke Strategy published in December 2007 recommends urgent carotid intervention within 48 h, in appropriate patients, who have suffered a transient ischaemic attack (TIA), amaurosis fugax or minor stroke. Despite the running of a rapid-access clinic for patients with symptoms of TIA, the time from symptom to surgery is rarely less than 2 weeks.

Resection of hepatic metastasis after 5-fluorouracil and cofactor for colon cancer.

Hepatic metastases are common in colorectal cancer. However, only a small percentage of patients are candidates for resection. Neoadjuvant chemotherapy is used to downstage tumors so surgical resection becomes a viable option.

Treating 4,000 diabetic patients in Cambodia, a high-prevalence but resource-limited setting: a 5-year study.

Background: Despite the worldwide increasing burden of diabetes, there has been no corresponding scale-up of treatment in developing countries and limited evidence of program effectiveness. In 2002, in collaboration with the Ministry of Health of Cambodia, Médecins Sans Frontières initiated an outpatient program of subsidized diabetic care in two hospital-based chronic disease clinics in rural settings. We aimed to describe the outcomes of newly and previously diagnosed diabetic patients enrolled from 2002 to 2008.

Selenium functionalized intraocular lenses inhibit posterior capsule opacification in an ex vivo canine lens capsular bag assay.

The purpose of this study was to determine the inhibitory effect of selenocystamine coated intraocular lenses (IOLs) on the formation of posterior capsule opacification (PCO) in an ex vivo canine lens capsular bag assay. Selenocystamine was covalently bound to the surface of poly(2-hydroxyethyl methacrylate) (poly(HEMA)) discs. Three groups of canine lens capsules (6 coated IOLs (SeIOLs), 7 non-coated control IOLs and 8 empty capsules) were cultured for 10 days.

The science of pterygia.

Pterygium is an ocular surface disease of humans attributed to chronic ultraviolet-B exposure. Clinically, the condition involves invasive centripetal growth with associated inflammation and neovascularisation. Previous clinical studies focused primarily on the clinical characteristics and surgical management of pterygia and, because of this, the pathogenesis of pterygia remains incompletely understood.

Features at diagnosis of 324 patients with acromegaly did not change from 1981 to 2006: acromegaly remains under-recognized and under-diagnosed.

Background: Traditionally, acromegaly evaded diagnosis until in its clinically obvious later stages when treatment is more difficult. Over the last 25 years diagnostic tests have improved, but whether clinical disease detection also improved was unknown, so we tested if disease severity at diagnosis had changed from 1981 to 2006.

Methods: Data on 324 consecutive acromegaly patients presenting from 1981 to 2006 at two New York City hospitals were collected by retrospective review (n = 324) and by interview (n = 200).

Organoselenium coating on cellulose inhibits the formation of biofilms by Pseudomonas aeruginosa and Staphylococcus aureus.

Among the most difficult bacterial infections encountered in treating patients are wound infections, which may occur in burn victims, patients with traumatic wounds, necrotic lesions in people with diabetes, and patients with surgical wounds. Within a wound, infecting bacteria frequently develop biofilms. Many current wound dressings are impregnated with antimicrobial agents, such as silver or antibiotics.

Attribution of Campylobacter infections in northeast Scotland to specific sources by use of multilocus sequence typing.

We show that a higher incidence of campylobacteriosis is found in young children (age, <5 years) living in rural, compared with urban, areas. Association of this difference with particular animal sources was evaluated using multilocus sequence typing. This evaluation was achieved by comparing Campylobacter isolates originating from these children, retail poultry, and a range of animal sources by use of source attribution and phylogenetic analysis methods.

Oncolytic virotherapy for advanced liver tumours.

Primary and metastatic neoplasms of the liver account for more than a million deaths per year worldwide. Despite decades of research, effective novel therapies for these cancers are urgently needed. Oncolytic virotherapeutics represent a novel class of pharmacophore that holds promise for the treatment of hepatic neoplasms.

HIV-1 viral load monitoring: an opportunity to reinforce treatment adherence in a resource-limited setting in Thailand.

This paper describes a program to increase patients' treatment literacy regarding viral load (VL) monitoring through patient education materials and a counseling protocol, implemented by peer counselors, in order to reinforce adherence to first-line treatment. VL monitoring and second-line antiretroviral treatment were introduced into an established first-line treatment program in a rural district hospital in Thailand. All patients (171 adults and 14 children) taking antiretroviral treatment for more than 6 months participated and those with detectable VL were targeted for additional adherence support.

Use of sibling pairs to determine the familial searching efficiency of forensic databases.

Pairs of individuals tested at the 13 CODIS core STR loci to determine sibship were used as a source of familial data that was seeded into a larger data set of 12,000 plus DNA profiles simulating a CODIS-like offender database. To determine whether known sibs could be found in the larger database two methods were used: degree of allele sharing and a kinship matching approach. The allele sharing method detected 62 of 109 of the known sib pairs (57%) while kinship matching detected 90 of the sib pairs (83%).

Analysis of mutations in father-son pairs with 17 Y-STR loci.

We have examined 389 father/son sample pairs from U.S. Caucasians, African Americans, Hispanics and Asians using the 17 Y-STR loci in the Yfilertrade mark kit and observed a total of 24 differences between father and son.

Antimicrobial activities of jadomycin B and structurally related analogues.

Natural products are leads for new antibiotics as a result of their structural complexity and diversity. We have isolated a series of structurally related polyketide-derived natural products from Streptomyces venezuelae ISP5230. The most active of these jadomycin analogues showed good activity against a variety of staphylococci, including methicillin-resistant Staphylococcus aureus.

Efficacy of methylcobalamin and folinic acid treatment on glutathione redox status in children with autism.

Background: Metabolic abnormalities and targeted treatment trials have been reported for several neurobehavioral disorders but are relatively understudied in autism.

Objective: The objective of this study was to determine whether or not treatment with the metabolic precursors, methylcobalamin and folinic acid, would improve plasma concentrations of transmethylation/transsulfuration metabolites and glutathione redox status in autistic children.

Design: In an open-label trial, 40 autistic children were treated with 75 microg/kg methylcobalamin (2 times/wk) and 400 microg folinic acid (2 times/d) for 3 mo.

Providing HIV care in the aftermath of Kenya's post-election violence Medecins Sans Frontieres' lessons learned January - March 2008.

Kenya's post-election violence in early 2008 created considerable problems for health services, and in particular, those providing HIV care. It was feared that the disruptions in services would lead to widespread treatment interruption. MSF had been working in the Kibera slum for 10 years and was providing antiretroviral therapy to 1800 patients when the violence broke out.

Implementation of a comprehensive program including psycho-social and treatment literacy activities to improve adherence to HIV care and treatment for a pediatric population in Kenya.

Background: To achieve good clinical outcomes with HAART, patient adherence to treatment and care is a key factor. Since the literature on how to care for pediatric HIV patients is limited, we describe here adherence interventions implemented in our comprehensive care program in a resource-limited setting in Kenya.

Methods: We based our program on factors reported to influence adherence to HIV care and treatment.

Local anesthetic hernia repair in overweight and obese patients.

Background: Inguinal hernia repair under local anesthesia (LA) has many advantages and is associated with high patient satisfaction. However, there are concerns of exceeding the maximum safe dose of LA agents in overweight and obese patients. The aim of the present study was to establish whether inguinal hernia repair could be safely performed under LA in overweight and obese patients.