Duffy K.,International Medical Group |
Wooding N.,International Health Sciences University |
Dea M.,Centers for Disease Control |
Coutinho A.,Makerere University
PLoS ONE | Year: 2013
Introduction:Modelling, supported by the USAID Health Policy Initiative and UNAIDS, performed in 2011, indicated that Uganda would need to perform 4.2 million medical male circumcisions (MMCs) to reach 80% prevalence. Since 2010 Uganda has completed 380,000 circumcisions, and has set a national target of 1 million for 2013.Objective:To evaluate the relative reach and cost-effectiveness of PrePex compared to the current surgical SMC method and to determine the effect that this might have in helping to achieve the Uganda national SMC targets.Methods:A cross-sectional descriptive cost-analysis study conducted at International Hospital Kampala over ten weeks from August to October 2012. Data collected during the performance of 625 circumcisions using PrePex was compared to data previously collected from 10,000 circumcisions using a surgical circumcision method at the same site. Ethical approval was obtained.Results:The moderate adverse events (AE) ratio when using the PrePex device was 2% and no severe adverse events were encountered, which is comparable to the surgical method, thus the AE rate has no effect on the reach or cost-effectiveness of PrePex. The unit cost to perform one circumcision using PrePex is $30.55, 35% ($7.90) higher than the current surgical method, but the PrePex method improves operator efficiency by 60%, meaning that a team can perform 24 completed circumcisions compared to 15 by the surgical method. The cost-effectiveness of PrePex, comparing the cost of performing circumcisions to the future cost savings of potentially averted HIV infections, is just 2% less than the current surgical method, at a device cost price of $20.Conclusion:PrePex is a viable SMC tool for scale-up with unrivalled potential for superior reach, however national targets can only be met with effective demand creation and availability of trained human resource. © 2013 Galukande et al.
Uhlig C.,TU Dresden |
Uhlig C.,International Health Sciences University |
Bluth T.,TU Dresden |
Schwarz K.,TU Dresden |
And 8 more authors.
Anesthesiology | Year: 2016
Background: It is not known whether modern volatile anesthetics are associated with less mortality and postoperative pulmonary or other complications in patients undergoing general anesthesia for surgery. Methods: A systematic literature review was conducted for randomized controlled trials fulfilling following criteria: (1) population: adult patients undergoing general anesthesia for surgery; (2) intervention: patients receiving sevoflurane, desflurane, or isoflurane; (3) comparison: volatile anesthetics versus total IV anesthesia or volatile anesthetics; (4) reporting on: (a) mortality (primary outcome) and (b) postoperative pulmonary or other complications; (5) study design: randomized controlled trials. The authors pooled treatment effects following Peto odds ratio (OR) meta-analysis and network meta-analysis methods. Results: Sixty-eight randomized controlled trials with 7,104 patients were retained for analysis. In cardiac surgery, volatile anesthetics were associated with reduced mortality (OR = 0.55; 95% CI, 0.35 to 0.85; P = 0.007), less pulmonary (OR = 0.71; 95% CI, 0.52 to 0.98; P = 0.038), and other complications (OR = 0.74; 95% CI, 0.58 to 0.95; P = 0.020). In noncardiac surgery, volatile anesthetics were not associated with reduced mortality (OR = 1.31; 95% CI, 0.83 to 2.05, P = 0.242) or lower incidences of pulmonary (OR = 0.67; 95% CI, 0.42 to 1.05; P = 0.081) and other complications (OR = 0.70; 95% CI, 0.46 to 1.05; P = 0.092). Conclusions: In cardiac, but not in noncardiac, surgery, when compared to total IV anesthesia, general anesthesia with volatile anesthetics was associated with major benefits in outcome, including reduced mortality, as well as lower incidence of pulmonary and other complications. Further studies are warranted to address the impact of volatile anesthetics on outcome in noncardiac surgery. © 2016, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc.
Brazinova A.,International Health Sciences University |
Majdan M.,International Health Sciences University
Traffic Injury Prevention | Year: 2016
Objective: Road traffic mortality takes an enormous toll in every society. Transport safety interventions play a crucial role in improving the situation. In the period 1996–2014 several road safety measures, including a complex new road traffic law in 2009, were implemented in the Slovak Republic, introducing stricter conditions for road users. The aim of this study is to describe and analyze the trends in road user mortality in the Slovak Republic in individual age groups by sex during the study period 1996–2014. Methods: Data on overall mortality in the Slovak Republic for the period 1996–2014 were obtained from the Statistical Office of the Slovak Republic. Mortality rates were age-adjusted to the European standard population. Joinpoint regression was used to assess the statistical significance of change in time trends of calculated standardized mortality rates. Results: Mortality rates of all types of road users as well as all age groups and both sexes in the Slovak Republic in the period 1996–2014 are decreasing. The male : female ratio decreased from 4:1 in 1996 to 2:1 in 2014. Motor vehicle users (other than motorcyclists) and pedestrians have the highest mortality rates among road user groups. Both of these groups show a significant decline in mortality rates over the study period. Within the age groups, people age 65 years and over have the highest mortality rates, followed by the age groups 25–64 and 15–24 years old. Joinpoint regression confirmed a steady, significant decline in all mortality rates over the study period. A statistically significant decrease in mortality rates in the last years of the study period was observed in the age group 25–64 and in male motorcycle users. Assessing the impact of the 2009 road traffic law, a drop was observed in the average standardized mortality rate of all road traffic users from 14.56 per 100,000 person years in the period 1996–2008 to 7.69 per 100,000 person years in the period 2009–2014. A similar drop in the average standardized mortality rate was observed in all individual road user groups. Conclusions: The implementation of the new traffic regulations may have contributed significantly to the observed decrease in mortality rates of road users in the Slovak Republic. A significant decrease in mortality was observed in all population groups and in all groups of road users. The introduction of a new comprehensive road traffic law may have expedited the decrease of road fatalities, especially in the age group 25–64 years old. This type of evidence-based epidemiology data can be used for improved targeting of future public health measures for road traffic injury prevention. 2016 © Taylor & Francis Group, LLC
Clausen L.N.,Copenhagen University |
Clausen L.N.,International Health Sciences University |
Astvad K.,Copenhagen University |
Ladelund S.,Copenhagen University |
And 3 more authors.
AIDS | Year: 2012
Objective: We hypothesized that hepatitis C virus (HCV) load and genotype may influence all-cause mortality in HIV-HCV-coinfected individuals. DESIGN AND Methods: Observational prospective cohort study. Mortality rates were compared in a time-updated multivariate Poisson regression analysis. Results: We included 264 consecutive HIV-HCV-coinfected individuals. During 1143 person years at risk (PYR) 118 individuals died [overall mortality rate 10 (95% confidence interval; 8, 12)/100 PYR]. In multivariate analysis, a 1 log increase in HCV viral load was associated with a 30% higher mortality risk [adjusted mortality rate ratio (aMRR): 1.30 (1.10,1.54)] when adjusted for sex, age, HIV exposure group, CD4+ cell count, HIV RNA, HCV genotype and interleukin (IL)-28B genotype. Further, HCV genotype 3 vs. 1 [aMRR: 1.83 (1.12, 2.98)] and HIV RNA [aMRR: 3.14 (1.37,7.17) for undetectable vs. just detectable HIV RNA] were independent predictors of mortality, whereas a higher CD4+ cell count was associated with a 41% reduction in mortality rate per 50 cell increase between 0 and 200cells/μl [aMRR: 0.59 (0.48, 0.72)] and a 10% reduction for increases above 200cells/μl [aMRR: 0.90 (0.82-0.98)]. IL28B) CC genotype was associated with 54% higher mortality risk [aMRR: 1.54 (0.89, 3.82] compared to TT genotype. Conclusion: High-HCV viral load, HCV genotype 3 and IL28B genotype CC had a significant influence on the risk of all-cause mortality among individuals coinfected with HIV-1. This may have consequences for the management of HIV-HCV-coinfected individuals. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Panthi S.,Travel and Mountain Medicine Center |
Basnyat B.,International Health Sciences University
Journal of Association of Physicians of India | Year: 2013
Increasing number of Hindu pilgrims visit the Himalayas where some of them suffer from high altitude illness including the life threatening forms, high altitude pulmonary oedema (HAPE) and high altitude cerebral oedema. Compared to tourists and trekkers, pilgrims are usually ignorant about altitude illness. This is a case of a pilgrim who suffered from HAPE on his trip to Kailash-Mansarovar and is brought to a tertiary level hospital in Kathmandu. This report emphasises on how to treat a patient with HAPE, a disease which is increasingly being seen in the high altitude pilgrim population. © JAPI.
Ghaneian M.T.,University of Yazd |
Ghanizadeh G.,Baqiyatallah Medical Sciences University |
Alizadeh M.T.H.,International Health Sciences University |
Ehrampoush M.H.,University of Yazd |
Said F.M.,Universiti Malaysia Pahang
Environmental Technology (United Kingdom) | Year: 2014
Pyrolysis of fresh sheep bone led to the formation of bone charcoal (BC). The structural characteristics of BC and surface area were determined by X-ray diffraction (XRD) and scanning electron microscopy (SEM). N2 gas adsorption-desorption was analysed by Brunauer-Emmett-Teller isotherm model. The prepared BC was used as an effective sorbent for the removal of phosphate from aqueous solutions. The effect of major parameters, including initial phosphorous concentration, sorbent dosage, pH and temperature, was investigated in this study. Furthermore, adsorption isotherms and kinetics were evaluated. BC was an effective sorbent in phosphate removal from aqueous solution especially in phosphate concentration between 2 and 100 mg/L. The maximum amount of sorption capacity was 30.21 mg/g, which was obtained with 100 mg/L as the initial phosphate concentration and 0.2 g as the sorbent dosage. Best reported pH in this study is 4; in higher pH, adsorption rate decreased dramatically. By increasing the temperature from 20 to 40°C sorption capacity increased; this phenomenon described that adsorption is endothermic. Equilibrium data were analysed by Langmuir, Freundlich and Temkin isotherms. Pseudo first-and second-order and Elovich models were used to determine the kinetics of adsorption in this study. Collected data highly fitted with Freundlich isotherms and pseudo second-order kinetics. Achieved results have shown well the potentiality for the BC to be utilized as a natural sorbent to remove phosphorous from water and wastewater. © 2013 Taylor & Francis.
PubMed | University of Hamburg, Innsbruck Medical University, Charité - Medical University of Berlin, International Health Sciences University and 3 more.
Type: Journal Article | Journal: Tumour biology : the journal of the International Society for Oncodevelopmental Biology and Medicine | Year: 2016
Patients with epithelial ovarian cancer (EOC) are at high risk of tumor recurrence. Human epididymis protein 4 (HE4) has been shown to be overexpressed in EOC. The primary aim of our study was to evaluate the role of HE4 in predicting recurrence in EOC patients. Furthermore, we assessed the role of HE4 in predicting recurrence after second-line chemotherapy. We retrospectively analyzed data of 92 out of 275 primary EOC patients of the multicenter project Ovarian Cancer: Diagnosis of a silent killer (OVCAD). The concentrations of HE4 and CA125 were determined preoperatively and 6months after the end of platinum-based first-line chemotherapy (FU) using ELISA and Luminex technique, respectively. The role of HE4 and CA125 for prediction of recurrence was determined using receiver operating characteristics (ROC) curves. Out of 92 patients included, 70 (76%) were responders and 22 (23%) non-responders in terms of response to platinum-based first-line chemotherapy. Median HE4 concentrations at follow-up (FU) differed between responders and non-responders (60.5 vs. 237.25pM, p=0.0001), respectively. The combined use of HE4 and CA125 at FU with cut-off values of 49.5pM and 25U/ml for HE4 and CA125, respectively, for predicting recurrence within 12months after first-line chemotherapy performed better than HE4 or CA125 alone (area under the curve (AUC) 0.928, 95% confidence intervals (CI) 0.838-1, p<0.001). HE4 at FU could predict recurrence within 6months after second-line chemotherapy (AUC 0.719, 95% CI 0.553-0.885, p=0.024). The combination of both elevated biomarkers revealed significantly worse estimated median progression-free survival (PFS; hazard ratio (HR) 8.14, 95% CI 3.75-17.68, p<0.001) and slightly worse PFS in those in whom only one biomarker was elevated (HR 1.46, 95% CI 0.72-2.96, p=0.292) compared to those patients in whom no biomarker was elevated. For the estimated median overall survival (OS), our analysis revealed similar results. HE4 in combination with CA125 performed better than CA125 and HE4 alone in predicting recurrence within 12months after first-line chemotherapy.
PubMed | International Health Sciences University
Type: Journal Article | Journal: Medicine | Year: 2016
The aim of this study was to evaluate the efficacy of plasmapheresis in patients with lupus nephritis-combined thrombotic microangiopathy (TMA) in a Chinese cohort.Clinical and therapeutic data of patients with lupus nephritis-combined TMA were collected retrospectively. A comparison between those with and without plasmapheresis was performed.Seventy patients with renal biopsy-proven TMA in lupus nephritis were treated with conventional combined corticosteroid and immunosuppressive agents as induction therapy, 9 of the 70 patients received additional plasmapheresis. The plasmapheresis group presented with more severe SLE and renal activity indices, including a significant higher ratio of neurologic disorder (P=0.025), lower level of platelet count (P=0.009), higher value of serum creatinine (P=0.038), higher percentage of anti-cardiolipin antibodies positive (P=0.001), and higher Systemic Lupus Erythematosus Disease Activity Index scores (P=0.012), than that of the nonplasmapheresis group. However, the plasmapheresis group had a significant higher rate of remission and a lower ratio of treatment failure than that of the nonplasmapheresis group (P=0.03). As the baseline data were significantly different between the 2 groups, the propensity score match was further designed to avoid retrospective bias. After re-analysis, the plasmapheresis group still had a significant higher rate of remission and a lower ratio of treatment failure than that of the nonplasmapheresis group (P=0.018). More importantly, the plasmapheresis group had significant less composite endpoints than that of the nonplasmapheresis group (P=0.005).Our study suggested that additional plasmapheresis on conventional induction therapy may benefit patients with lupus nephritis-combined TMA, which warrants further explorations.
PubMed | International Health Sciences University, University of Buenos Aires and Technical University of Denmark
Type: Journal Article | Journal: Journal of immunology (Baltimore, Md. : 1950) | Year: 2016
Binding of peptides to MHC class I (MHC-I) molecules is the most selective event in the processing and presentation of Ags to CTL, and insights into the mechanisms that govern peptide-MHC-I binding should facilitate our understanding of CTL biology. Peptide-MHC-I interactions have traditionally been quantified by the strength of the interaction, that is, the binding affinity, yet it has been shown that the stability of the peptide-MHC-I complex is a better correlate of immunogenicity compared with binding affinity. In this study, we have experimentally analyzed peptide-MHC-I complex stability of a large panel of human MHC-I allotypes and generated a body of data sufficient to develop a neural network-based pan-specific predictor of peptide-MHC-I complex stability. Integrating the neural network predictors of peptide-MHC-I complex stability with state-of-the-art predictors of peptide-MHC-I binding is shown to significantly improve the prediction of CTL epitopes. The method is publicly available at http://www.cbs.dtu.dk/services/NetMHCstabpan.
PubMed | Catalan Institution for Research and Advanced Studies, International Health Sciences University, Germans Trias i Pujol Health Science Research Institute IGTP Badalona, University of Barcelona and University Of Barcelonabarcelona
Type: | Journal: Frontiers in cell and developmental biology | Year: 2017
[This corrects the article on p. 131 in vol. 4, PMID: 27900319.].