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Objectives: Data on triage practices of children admitted to Princess Marina Hospital in Gaborone, Botswana is limited. The inpatient triage, assessment, and treatment score was developed for low resource settings to predict mortality in children. We assess its performance among children admitted to Princess Marina Hospital and their demographic, clinical, and risk factors for death., Methods: This was a secondary data analysis of a prospective cohort study comprising 299 children ages 1 month to 13 years admitted June to September 2018. Descriptive statistics, bivariate analysis, and multivariate logistic regression were used. Sensitivity and specificity data were generated for the inpatient triage, assessment, and treatment score., Results: Thirteen children died (13/284, 4.6%). Comorbidity (adjusted odds ratio 4.0, p  = 0.020) and high inpatient triage, assessment, and treatment score (adjusted odds ratio 5.0, p  = 0.017) increased odds of death. The area under the receiver operating characteristic curve was 0.81. Using inpatient triage, assessment, and treatment cutoff of 4, the sensitivity, specificity, and likelihood ratio were 31%, 94%, and 5.0, respectively., Conclusion: Implementing the inpatient triage, assessment, and treatment score in low resource settings may improve identification, treatment, and evaluation of the sickest children., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Background: The Dominican Republic (DR) has some of the highest rates of sexually transmitted infections (STI) and adolescent pregnancy in the Caribbean. Well-designed comprehensive sexuality education programs (CSEP) can reduce risky sexual behavior. This study sought to evaluate the Módulo Anexo Materno Infantil (MAMI) adolescent clinic's CSEP in changing knowledge of STI and pregnancy and attitudes towards risky sexual behavior following implementation., Methods: A mixed methods study was conducted among students aged 11-25 years from three schools between September 2017 and February 2018. Participants in MAMI CSEP completed questionnaires, before, immediately following, and 3 months following the CSEP. Questions assessed knowledge, attitude, and sexual experience, and obtained program feedback. There was one eight-participant focus group discussion (FGD) per school. Descriptive statistics summarized sample demographics and cross-sectional responses. McNemar's test evaluated differences in the proportions of students selecting correct responses over time. Paired t-tests compared mean test scores across time., Result: Overall response rate was 98.7% (1414/1432), with 486 pre-tests, 448 initial post-tests, and 480 3-month post-tests. Respondents identified as 53.5% (321/600) female and 46.5% (279/600) male with mean age of 14.2 years. More males (63.4%) reported sexual experience than females (35.8%) (p < 0.001). Increases in mean scores from pre-test to post-test and pre-test to 3-month post-test were statistically significant (p < 0.001). Three themes arose from the FGDs: (1) expanding sexual and reproductive health knowledge, (2) perception of curricular content, structure and delivery, and (3) student-health educator dynamic., Conclusion: Improvement in test scores supports MAMI CSEP's efficacy in educating students and reinforcing positive attitudes to reduce risky sexual behavior. Utilizing an interactive health educator model provided students with clear, accurate information in a safe environment with mutual trust. Selecting health educators employed by an adolescent clinic allows them to connect students to preventive and treatment services during the CSEP., (© 2019 Walter de Gruyter GmbH, Berlin/Boston.)

Cervical cancer is the third leading cause of cancer-related death and the second most diagnosed cancer among women in developing countries. We determined the prevalence of abnormal Papanicolaou (Pap), high-risk HPV (hrHPV), and colposcopy among transactional female sex workers (FSWs) in La Romana, Dominican Republic. The results of 144 FSWs of ages 18-54 years who completed a demographic interview and Pap testing with hrHPV detection between June 2015 and April 2016 were analyzed. Women with abnormal results were referred for colposcopy. Risk factors for abnormal Pap were assessed through bivariate and multivariate analyses. Overall, 36.1% (52/144) of Paps were abnormal and 43.4% (62/143) had hrHPV. Of all women with hrHPV and/or abnormal Pap (68/144; 47.2%), 61 (89.7%) were referred and 16 (26.2) underwent colposcopy. HPV16 and/or 18/45 was detected in 33.3% (15/45) of low-grade Paps. Binge drinking, weekly (AOR 5.1, 95% CI: 1.8-14.5) or daily (AOR 4.9, 95% CI: 1.5-16.6), and age at first sexual relation (AOR 1.2, 95% CI: 1.0-1.5) were significantly associated ( p < 0.05) with abnormal Pap. Although almost half of participants had abnormal Pap or hrHPV, few underwent colposcopy. Improving access to cervical cancer screening and follow-up for FSWs is imperative.

One group of 10 male albino rats was given partial reinforcement while the other 10 rats received continuous reinforcement in a straight alley. Subjects then experienced five consecutive stages of Extinction 1, Continuous Reinforcement 1, Extinction 2, Continuous Reinforcement 2, and finally, Extinction 3. Analysis showed the partial reinforcement effect in extinction was sustained over two stages of extinction and two stages of continuous reinforcement, since subjects receiving partial reinforcement ran faster than rats given continuous reinforcement throughout all three of the extinction periods. The results seem to support those of Amsel's (1967) and Cabpaldi's (1967) theoretical formulations of the partial reinforcement effect in extinction.

Laser surgery on the paediatric larynx requires cooperation between the surgeon and anaesthetist to carry out the procedure in the safest manner possible. Over a period of 3 years, 45 laser procedures have been undertaken on the upper airway of 14 patients at our institution. All procedures were performed with volatile gas anaesthesia supplied via a nasopharyngeal tube in a spontaneously ventilating patient, thus allowing the surgeon an unobstructed view of the larynx. In only one case, was a problem experienced with the technique, that of laryngospasm. The technique provides an unrivalled view of the larynx whilst allowing safe anaesthesia.

Otoplasty surgery carries a high satisfaction rate for participants (96%). Surgeons are more critical of the results of otoplasty than the participants or parents (92% satisfied). There is no statistical difference in qualitative results with different surgical techniques when comparing the published data. Data on otoplasty surgery is numerous, but quantitative assessment of surgical outcome is rare. The authors propose the measurement of cephaloauricular distance to allow comparison between studies.

In this paper two cases are reported in which spontaneous entry of air into the head appears to have occurred through a hypercellular mastoid air cell system. In both these cases forceful sneezing and nose blowing were considered contributory factors. They underwent surgical repair of the bony defects which, combined with less vigorous nose blowing, has affected a successful repair. The aetiology of pneumocephalus is discussed and a review of the pertinent literature is also presented.

This prospective study assessed the results of a custom-made thermoplastic splint for treatment of mallet finger deformity. From April 1999 to April 2000, 42 patients with mallet finger deformity were recruited. All patients were seen within 1 week and treated with a thermoplastic splint custom-made by the hand therapy department. The splint was simple to make, easy to fit and suitable for all finger shapes and sizes. It improved the deformity in 30 out of 34 cases, and caused no skin irritation.

Knowledge of the particle size distribution is required in order to predict ultrasonic absorption in polydisperse particulate suspensions. This paper shows that the method used to measure the particle size distribution can lead to important differences in the predicted absorption. A reverberation technique developed for measuring ultrasonic absorption by suspended particles is used to measure the absorption in suspensions of nonspherical particles. Two types of particulates are studied: (i) kaolin (china clay) particles which are platelike in form; and (ii) calcium carbonate particles which are more granular. Results are compared to theoretical predictions of visco-inertial absorption by suspensions of spherical particles. The particle size distributions, which are required for these predictions, are measured by laser diffraction, gravitational sedimentation and centrifugal sedimentation, all of which assume spherical particles. For a given sample, each sizing technique yields a different size distribution, leading to differences in the predicted absorption. The particle size distributions obtained by gravitational and centrifugal sedimentation are reinterpreted to yield a representative size distribution of oblate spheroids, and predictions for absorption by these spheroids are compared with the measurements. Good agreement between theory and measurement for the flat kaolin particles is obtained, demonstrating that these particles can be adequately represented by oblate spheroids.

Isolated unilateral hypoglossal nerve palsy after fracture of the occipital condyle is rare. It usually occurs after major trauma, such as high-speed deceleration injuries following road traffic accidents. We describe a case that resulted from minor trauma. An underlying skull base malformation may have been a predisposing factor.

Primary biliary cirrhosis (PBC) is a liver disease characterized by serum autoantibodies against the pyruvate dehydrogenase complex (PDC) located in the inner mitochondrial membrane. The predominant target in PDC has previously been localized to the inner lipoyl domain (ILD) of the E2 subunit. The etiology of PBC is unknown, although molecular mimicry with bacterial PDC has been proposed. Here, we have investigated the etiology of PBC and nature of the autoimmune response by analyzing the structure of a human monoclonal antibody with ILD specificity. Mutants of the monoclonal antibody, which was originally isolated from a patient with PBC, were expressed as Fab by phage display, and tested for reactivity against recombinant domains of the E2 subunit. Fab in which the V(H)-encoded portions were reverted to germline lost reactivity against the ILD alone, but recognized a different epitope in a didomain construct encompassing the ILD, hinge region and E1/E3 binding domain. The complete V(H) and V(L )germline revertant was unreactive with the human ILD and didomain, the Escherichia coli didomain, and whole PDC. We hypothesize that the IgM on the surface of the naïve B-cell first recognizes an as yet unidentified antigen, and that accumulation of somatic mutations results in an intermolecular epitope shift directed towards an epitope involving the E1/E3 binding domain. Further mutations result in the specificity being redirected to the ILD. These findings also suggest that bacterial molecular mimicry is not involved in initiating disease., (Copyright 2001 Academic Press.)

Dihydrolipoamide dehydrogenase (E3) from Escherichia coli, an FAD-linked homodimer, can be fully reconstituted in vitro following denaturation in 6 m guanidinium chloride. Complete restoration of activity occurs within 1-2 h in the presence of FAD, dithiothreitol, and bovine serum albumin. In the absence of FAD, the dihydrolipoamide dehydrogenase monomer forms a stable folding intermediate, which is incapable of dimerization. This intermediate displays a similar tryptic resistance to the native enzyme but is less heat-stable, because its ability to form native E3 is lost after incubation at 65 degrees C for 15 min. The presence of FAD promotes slow, additional conformational rearrangements of the E3 subunit as observed by cofactor-dependent decreases in intrinsic tryptophan fluorescence. However, after 2 h, the tryptophan fluorescence spectrum and far UV CD spectrum of E3, refolded in the absence of FAD, are similar to that of the native enzyme, and full activity can still be recovered on addition of FAD. Cross-linking studies show that FAD insertion is necessary for the monomeric folding intermediate to attain an assembly competent state leading to dimerization. Thus cofactor insertion represents a key step in the assembly of this enzyme, although its initial presence appears not to be required to promote the correct folding pathway.

Respiration and suck are gestational age-dependent reflexes modulated in the brain stem. To determine if the suck reflex pattern could be used to predict apnea, the relationship between the two was examined in 28 neonates. The suck reflex was quantified with respect to burst-pause rhythm, amplitude of negative suck pressure, and synchrony of the negative-positive pressure. Apneas were counted 5 days prior to and following measurement of the suck reflex pattern. Increasing gestational age correlated with a lower frequency of apnea (P < .01) and higher suck scores (P < .01). A mature suck reflex pattern, however, failed to predict the occurrence of apnea.

We examined six polymorphic elements in the tumor necrosis factor (TNF) locus and determined their allelic distribution in 98 Caucasian rheumatoid arthritis patients in comparison with 91 ethnically-matched controls. Polymorphic elements at four biallelic sites were distributed similarly between patients and controls, irrespective of the presence or absence of DR4. Differences were observed between the two groups at the TNFa and TNFe loci, but these were consistent with extended MHC haplotypes known to be present in rheumatoid arthritis patients. Therefore, this study suggests that there is little, if any, independent contribution of the TNF locus to the genetic background for rheumatoid arthritis susceptibility.

We examined the distribution of polymorphic elements within the tumor necrosis factor (TNF) gene cluster in 105 unrelated individuals and determined their relationship to class I and class II major histocompatibility complex (MHC) antigens, and to the highly polymorphic microsatellites TNFa and TNFb. The data demonstrate the contribution of elements within the TNF cluster to two extended haplotypes which are recognized to straddle the MHC. The A1.B8.DR3 haplotype appears to contain the TNF alleles TNFa2, TNFb3, LT.Nco-1.B*1, and TNF-308.2, while the A3.B7.DR2 haplotype is associated with the TNF alleles TNFa11, TNFb6, TNFc1, LT.Nco-1.B*2, LT.AspH1.1, TNF-308.1, and TNFe1. The presence of other extended associations which covered smaller parts of the MHC was also suggested. In most cases, the associations described here were in keeping with previously described extended haplotypes which dominate the structure of the MHC, but these did not always match completely. Taken together, these data suggest that the structure of the TNF locus is well integrated into the rest of the MHC but that important ethnic differences may exist.

Right ventricular infarction is often associated with myocardial infarction located in the inferior or posterior left ventricular wall. It should be suspected if a patient has distended neck veins with Kussmaul's sign, ST-segment elevation in the V4R precordial lead, possible heart block, and extreme sensitivity to preload reducers such as nitroglycerin and diuretics (administration of which may lead to hypotension). Measures such as administration of fluid (with Swan-Ganz monitoring), inotropic support with dobutamine (Dobutrex), and atrioventricular sequential pacing may be of benefit in hypotensive patients. Mortality can be significant, especially when there is hemodynamic compromise; however, reperfusion as a result of thrombolytic therapy or angioplasty may have a salutary effect. Early investigations imply that long-lasting benefit is obtained from opening an infarct-related artery.

Atypical pain in the chest accounts for many visits to physicians. Possible sources of the pain include the pericardium, the pulmonary system, the aorta, the gastrointestinal tract, the chest wall, the mitral apparatus, and psychogenic factors. Identifying the source primarily involves taking an accurate history and understanding the prevalence of coronary artery disease in various patient populations. Electrocardiography chest films, and stress testing may help identify the source of pain. Cardiac catheterization should be reserved for patients with abnormal findings on non-invasive tests, those with unclear test results, and, rarely, as reassurance for patients with frequent episodes of atypical chest pain or their caregivers.