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1.
In six months there were 1,704 attendances at the treatment room of a small health centre. The attendance rate for the population registered with the health centre doctors was 448 per 1,000 patients per year. Females between 15 and 44 years and males under 15 had the highest attendance rates. There were 256 casual attenders, 58 (23%) of whom were referred to a doctor or hospital for further advice or treatment.It is suggested that in a health centre treatment room about six hours of nursing time a week for every 1,000 patients is required, and that a case can be made out for some of the routine work of casualty departments being done in health centres.  相似文献   

2.
Goal and Scope A comparison of in situ and ex situ treatment scenarios for a diesel-contaminated site was performed using an evolutive LCA. Treatment time along with primary (residual contamination left in soil or groundwater after treatment) and secondary (impacts due to remediation) environmental impacts were considered. The site under study had a light Non Aqueous Phase Liquid (LNAPL) thickness of up to 1 m, a diesel soil concentration of 10,500 mg/kg and a residual contamination in groundwater. Methods Four treatment scenarios to remove LNAPL and to treat soil and groundwater were compared: 1) pump and treat 2) bioslurping, bioventing and biosparging 3) bioslurping, bioventing and chemical oxidation and 4) ex situ treatment using biopiles. The technologies’ design was performed using simulation tools and analytical equations. The LCA was evaluated for each year of treatment. Environmental impacts were assessed using the U.S. EPA Tool for the Reduction and Assessment of Chemical and Other Environmental Impacts (TRACI) method. Results and Discussion The biological in situ scenario (2) showed the least primary and secondary impacts but its treatment time was more than 4 times longer than that obtained for the ex situ scenario (4). The ex situ scenario showed the best treatment time but its secondary impacts were significantly higher than those found for the biological in situ scenario due to the pavement of the treatment area. The combined biological and chemical in situ scenario (3) was the worst in terms of secondary impacts while the pump and treat scenario (1) was the worst in terms of primary impacts. Two scenarios were selected: one based upon low environmental impacts and the other on the fastest treatment time. Conclusions Even without excavation, an in situ treatment can generate more secondary impacts than an ex situ treatment. Low environmental impact scenarios require time while rapid treatment scenarios generate high environmental impacts. The selection of the best remediation scenario will depend on the site owner’s priority. Recommendations Better characterization factors for aggregated substances are required. This paper is openly accessible!  相似文献   

3.
Lab-scale continuous flow activated sludge systems that were acclimated to 2,4-dichlorphenoxyacetic acid (2,4-D) under sole 2,4-D influent and without sludge wastage, were able to maintain successful 2,4-D treatment when both 2,4-D and a biogenic substrate were fed and the systems operated with finite mean cell residence times (theta(c)). When the systems were fed dual 2,4-D and biogenic substrates and operated with finite theta(c) from the start, treatment of 2,4-D fluctuated noticeably long after acclimation. At the reintroduction of 2,4-D after its absence from the influent for a period of time (2,4-D shock), the systems under both the sole and dual substrate conditions suffered similar treatment losses; the extent of treatment losses was related to the length of 2,4-D absence time. When shocked, systems with sole 2,4-D influent had a slight advantage over dual substrates by showing a faster recovery from shocks with the help of re-acclimation.  相似文献   

4.
Thirty-two patients reporting to the Lundu District Hospital, Sarawak, Malaysian Borneo, with uncomplicated falciparum malaria were recruited into a multifaceted study to assess treatment response. Following combined chloroquine and sulphadoxine/pyrimethamine treatment the patients were followed for 28 days according to the World Health Organisation in vivo drug response protocol. The in vivo study revealed that 13 (41%) of the patients had a sensitive response to treatment, five (16%) cleared asexual stage parasites but had persistent gametocytes, 11 (34%) had RI type resistance and three (9%) had RII type resistance requiring quinine intervention before day 7 for parasite clearance. Although clinically insignificant, patients with persistent gametocytes, surviving chloroquine and sulphadoxine/pyrimethamine treatment during maturation, were placed in the reduced response to treatment group for analysis. Allelic typing detected 100% prevalence of the pfcrt K76T marker associated with chloroquine resistance and 78% prevalence of the pfdhfr NRNL haplotype associated with sulphadoxine/pyrimethamine treatment failure. High serum chloroquine levels and pfdhfr haplotypes with 相似文献   

5.
Objective: To provide a preliminary assessment of the orodental status and dental treatment requirements of a group of elderly in-patients. Design: Cross-sectional. Setting: Acute Care of the Elderly and Stroke Rehabilitation units at teaching hospitals in Merseyside. Subject: 150 patients aged 58 to 94 years, in which a history could be validated at interview. Intervention: Questionnaire administered by dentist and clinical examination. Main outcome measures: Registration with a dentist, prosthetic status and difficulties with dentures, denture hygiene and identification marking, dental treatment needs and evidence of mucosal pathology. Results: Only 27% of patients claimed registration with a dentist. Three quarters of the patients were edentulous and 66 patients wore full dentures; 18 had no prostheses. Difficulties were experienced by one quarter of patients with upper dentures, compared with a half of lower denture wearers. Of the dentures available for inspection, 61 % had removable soft debris, 66% were left out at night and 75% were cleaned by the patient, whilst on the ward. No dentures had evidence of identification marking. Of the 39 partially dentate patients, 75% required interventive dental treatment. Denture stomatitis was diagnosed in 29% of patients and 19 had evidence of benign mucosal pathology. Conclusions: The orodental status of this group of elderly in-patients was poor, with a high proportion being edentulous. Few were registered with a dentist and denture hygiene was inadequate. Lack of identification marking is a matter of concern. Closer liaison between hospital staff responsible for elderly in-patients is required, to improve the orodental health and quality of life of this medically compromised group of patients.  相似文献   

6.
Fourteen patients with longstanding lipodermatosclerosis of their lower legs, secondary to venous disease in 11, were treated for three months with stanozolol, a drug that enhances fibrinolytic activity. No other treatment was given and no change made in existing treatment. All the patients improved. Two were cured in three months, three were able to stop treatment in the next three to 11 months, and the other nine continued to improve. Fibrinolytic enhancement, with stanozolol, seems to be a worthwhile addition to the treatment of venous liposclerosis and deserves further study.  相似文献   

7.
大鼠子宫内膜炎模型复制及其中西药复方乳剂治疗   总被引:2,自引:0,他引:2  
目的人工复制大鼠子宫内膜炎模型;应用自制中西药复方乳剂对子宫内膜炎模型大鼠进行治疗。方法对实验大鼠子宫眼观病变、子宫内容物及单侧子宫指数进行检查,对实验大鼠子宫进行病理组织学检查。结果应用3%冰乙酸对大鼠子宫进行刺激,第4天对大鼠子宫接种混合病原菌,能够稳定复制大鼠子宫内膜炎模型;中西药复方乳剂能明显降低大鼠子宫内细菌浓度、种类及单侧子宫系数,能明显减轻子宫的病理变化。结论中西药复方乳剂对子宫内膜炎模型大鼠有良好的治疗作用。  相似文献   

8.
9.
目的:探讨依达拉奉(edaravone)对肺型氧中毒的保护作用及其机制。方法:30只C57BL/6雄性小鼠,随机分成3组(n=10):空气对照组、高压氧暴露组及依达拉奉预防组,干预组腹腔注射依达拉5 mg/(kg·d), 连续3 d后,暴露于2.3 ATA,≥95% 氧气中6 h,出舱后收集肺组织,检测肺湿干比。肺组织经苏木素-伊红染色后行病理分析。ELISA检测肺组织中细胞因子、抗氧化酶表达变化。Western检测凋亡基因。结果:依达拉奉注射后可明显减轻高压氧导致的肺损伤,降低肺湿干比,减少细胞因子IL-1β及凋亡蛋白cleaved-caspase3的表达,但对抗氧化酶无明显影响。结论:依达拉奉预防性应用可通过减轻炎症及凋亡对肺型氧中毒起到保护作用。  相似文献   

10.
We evaluated a multicomponent treatment program for IBS that had been adapted to a small-group format. Patient acceptance was satisfactory with 14 of 17 potential patients completing treatment. No reductions of GI symptoms were noted in a 12-week symptom-monitoring baseline phase; diarrhea became significantly worse. Treatment led to significant (p less than .05) reductions in abdominal pain and diarrhea. Nine of 14 (64.3%) patients were clinically improved.  相似文献   

11.

Background

India carries one quarter of the global burden of multi-drug resistant TB (MDR-TB) and has an estimated 2.5 million people living with HIV. Despite this reality, provision of treatment for MDR-TB is extremely limited, particularly for HIV-infected individuals. Médecins Sans Frontières (MSF) has been treating HIV-infected MDR-TB patients in Mumbai since May 2007. This is the first report of treatment outcomes among HIV-infected MDR-TB patients in India.

Methods

HIV-infected patients with suspected MDR-TB were referred to the MSF-clinic by public Antiretroviral Therapy (ART) Centers or by a network of community non-governmental organizations. Patients were initiated on either empiric or individualized second-line TB-treatment as per WHO recommendations. MDR-TB treatment was given on an ambulatory basis and under directly observed therapy using a decentralized network of providers. Patients not already receiving ART were started on treatment within two months of initiating MDR-TB treatment.

Results

Between May 2007 and May 2011, 71 HIV-infected patients were suspected to have MDR-TB, and 58 were initiated on treatment. MDR-TB was confirmed in 45 (78%), of which 18 (40%) were resistant to ofloxacin. Final treatment outcomes were available for 23 patients; 11 (48%) were successfully treated, 4 (17%) died, 6 (26%) defaulted, and 2 (9%) failed treatment. Overall, among 58 patients on treatment, 13 (22%) were successfully treated, 13 (22%) died, 7 (12%) defaulted, two (3%) failed treatment, and 23 (40%) were alive and still on treatment at the end of the observation period. Twenty-six patients (45%) experienced moderate to severe adverse events, requiring modification of the regimen in 12 (20%). Overall, 20 (28%) of the 71 patients with MDR-TB died, including 7 not initiated on treatment.

Conclusions

Despite high fluoroquinolone resistance and extensive prior second-line treatment, encouraging results are being achieved in an ambulatory MDR-T- program in a slum setting in India. Rapid scale-up of both ART and second-line treatment for MDR-TB is needed to ensure survival of co-infected patients and mitigate this growing epidemic.  相似文献   

12.
13.
We evaluated a multicomponent treatment program for IBS that had been adapted to a small-group format. Patient acceptance was satisfactory with 14 of 17 potential patients completing treatment. No reductions of GI symptoms were noted in a 12-week symptom-monitoring baseline phase; diarrhea became significantly worse. Treatment led to significant (p<.05) reductions in abdominal pain and diarrhea. Nine of 14 (64.3%) patients were clinically improved.  相似文献   

14.
This study examined the effectiveness of a portable Respiratory Sinus Arrhythmia (RSA) biofeedback device as an adjunct to CBT in persons with anxiety disorders and other disorders associated with autonomic dysfunction attending outpatient treatment. Participants were 24 individuals attending outpatient cognitive behavioral treatment for a range of anxiety disorders. Participants were assessed over a 3 week period. Outcomes included measures of anxiety (STAI-Y), sleep disturbances (PSQI), anger (STAEI), and subjective questions about the effectiveness of the device as a treatment adjunct. Significant reductions were found for anxiety and anger and for certain sleep variables (e.g. sleep latency). There was a significant dos–effect in that those who were more compliant had significantly greater reductions in most domains including sleep, anger and trait anxiety. Overall, participants found the device more helpful than other relaxation techniques such as mediation, yoga and unassisted breathing techniques but less helpful than exercise. The most frequently endorsed side effects were dizziness (15%) and sleepiness (55%). These preliminary results suggest that portable RSA biofeedback appears to be a promising treatment adjunct for disorders of autonomic arousal and is easily integrated into treatment. Results support the need for further investigation with more rigorous experimental designs. This study was conducted at the Behavioral Associates and The CBT Institute in New York, NY from 6/06 through 8/06.  相似文献   

15.
Pituitary-testicular function was studied in 15 dogs following treatment with a sustained-release formulation of a GnRH agonist, leuprolide acetate (LA). Adult male dogs were treated with a single subcutaneous injection of microencapsulated LA (0.1 or 1 mg/kg). Treatment with LA at a dose of 1 mg/kg resulted in decreased (P<0.001) ejaculatory volume and disappearance of morphologically normal spermatozoa within 8 wk and the effect persisted for 6 wk, while the 0.1 mg/kg dose was not adequate to effect suppression of spermatogenesis. The larger dose treatment (1 mg/kg) caused a transient rise in plasma levels of LH and testosterone followed by a marked decline to below the normal level by 2 wk, the low levels being maintained for at least 5 wk, indicating a prolonged effect of LA treatment on pituitary-gonadal axis. Twenty weeks after treatment with LA, a complete return to normal spermatogenesis was observed. The full reversibility of spermatogenesis in the dog after LA treatment suggests that this peptide could be used as a reversible method of male contraception.  相似文献   

16.
The records of the first 805 patients who had been referred by general practitioners at this health centre to the attached physiotherapist were examined in November 1985, three years after the physiotherapy department was opened. Seventy per cent (549) of the patients had been treated within one week, treatment having started on the same day for 8.5% (67) of the patients. This compares with a mean of six weeks for direct access to a district general hospital that is eight miles away and between six and 13 months for the three nearest orthopaedic consultants who are 13 miles away. The most common conditions treated were knee injuries (16.5%), followed by cervical (15.5%) and shoulder (13.8%) injuries. Surprisingly, only 9% were back injuries. The non-attendance rate was 2.2% and only 7% of patients failed to complete treatment. Nearly all the patients were able to attend the clinic, only 4% requiring home treatment. By March 1986, 90 treatments a week were being carried out at a cost of 6.11 pounds per patient. Compared with official hospital figures, this represents a savings of 21,500 pounds a year for a practice of 12,000 patients.  相似文献   

17.
Liu CH  Li L  Chen Z  Wang Q  Hu YL  Zhu B  Woo PC 《PloS one》2011,6(4):e19399

Background

Information on treatment outcomes among hospitalized patients with multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) are scarce in China.

Methodology/Principal Findings

We conducted this retrospective study to analyze the characteristics and treatment outcomes in MDR- and XDR-TB patients in the 309 Hospital in Beijing, China during 1996–2009. Socio-demographic and clinical data were retrieved from medical records and analyzed. Logistic regression analysis was performed to identify risk factors associated with poor treatment outcomes and Cox proportional hazards regression model was further used to determine risk factors associated with death in TB patients. Among the 3,551 non-repetitive hospitalized TB patients who had drug susceptibility testing (DST) results, 716 (20.2%) had MDR-TB and 51 (1.4%) had XDR-TB. A total of 3,270 patients who had medical records available were used for further analyses. Treatment success rates (cured and treatment completed) were 90.9%, 53.4% and 29.2% for patients with non-MDR-TB, patients with MDR-TB excluding XDR-TB and patients with XDR-TB, respectively. Independent risk factors associated with poor treatment outcomes in MDR-TB patients included being a migrant (adjusted OR = 1.77), smear-positivity at treatment onset (adjusted OR = 1.94) and not receiving 3 or more potentially effective drugs (adjusted OR = 3.87). Independent risk factors associated with poor treatment outcomes in XDR-TB patients were smear-positivity at treatment onset (adjusted OR = 10.42) and not receiving 3 or more potentially effective drugs (adjusted OR = 14.90). The independent risk factors associated with death in TB patients were having chronic obstructive pulmonary disease (adjusted HR = 5.25) and having hypertension (adjusted HR = 4.31).

Conclusions/Significance

While overall satisfactory treatment success for non-MDR-TB patients was achieved, more intensive efforts should be made to better manage MDR- and XDR-TB cases in order to improve their treatment outcomes and to minimize further emergence of so-called totally drug-resistant TB cases.  相似文献   

18.
In a paradigmatic approach we identified cross-reactive plant allergens for allergy diagnosis and treatment by screening of a tobacco leaf complementary DNA (cDNA) library with serum IgE from a polysensitized allergic patient. Two IgE-reactive cDNA clones were isolated which code for proteins with significant sequence similarity to the actin-binding protein, villin. Northern- and Western-blotting demonstrate expression of the villin-related allergens in pollen and somatic plant tissues. In addition, villin-related proteins were detected in several plant allergen sources (tree-, grass-, weed pollen, fruits, vegetables, nuts). A recombinant C-terminal fragment of the villin-related protein was expressed in Escherichia coli, purified and shown to react specifically with allergic patients IgE. After profilin, villin-related proteins represent another family of cytoskeletal proteins, which has been identified as cross-reactive plant allergens. They may be used for the diagnosis and treatment of patients suffering from multivalent plant allergies.  相似文献   

19.
This study evaluated the effect of prostaglandin E1 (PGE1) on the stability of atherosclerotic plaque. A vulnerable plaque model was established in rabbits, using balloon injury combined with a high-cholesterol diet. The rabbits were distributed into a control group, a low-dose PGE1 treatment group, a moderate-dose PGE1 treatment group, a high-dose PGE1 treatment group, and a simvastatin treatment group, with treatments lasting for 4?weeks. At week 13 (at the end of the experiments), atherosclerotic plaque was triggered by injection of Russell's viper venom (Chinese) and histamine. Serological, pathological, immunohistochemical, and gene-expression studies were subsequently performed. PGE1 treatment did not alter serum lipid levels; however, PGE1 dose-dependently increased the thickness of the fibrous caps, and decreased the plaque vulnerability index. The plaque contents of macrophage- and the mRNA levels of monocyte-chemotactic protein-1, matrix metalloproteinase-1, and matrix metalloproteinase-9 were markedly reduced in all of the PGE1 treatment groups, with the high-dose of PGE1 being more effective than the simvastatin treatment. These findings suggest that PGE1 dose-dependently enhances the stability of atherosclerotic plaque. The high-dose of PGE1 presented more protection in terms of inhibiting macrophage accumulation and inflammatory expression in plaque. Our findings suggest a novel drug for the treatment of atherosclerosis.  相似文献   

20.
In a double-blind trial of the effect of zimelidine on weight and appetite 24 obese patients were allocated at random to receive either zimelidine or placebo for eight weeks followed by the alternative treatment for eight weeks. Possible adverse effects were elicited by asking patients at weekly intervals whether they had experienced any symptoms or ailments and recording all such "events" on a special form. A conventional checklist of symptoms was also used. Among 19 patients who completed the trial the two methods of recording yielded similar patterns of events. Of symptoms not on the checklist, insomnia was more common during treatment with zimelidine. Event recording was found to be a practicable and convenient method of detecting possible adverse effects.  相似文献   

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