Factors of Adherence to Concurrent Tuberculosis Treatment and Antiretroviral Therapy among HIV-TB Co-Infected Individuals in the East Region, Cameroon in the COVID-19 Era: A Retrospective Cohort Study

Context/Objectives: Tuberculosis (TB) and HIV co-infection is a serious health problem in Cameroon. The problems associated with poor adherence to treatment are on the increase worldwide. This problem can be observed in all situations where patients are required to administer their own medication, whatever the type of illness. The general objective of this study was to assess the factors affecting adherence to treatment among HIV-TB co-infected patients in health facilities in the East Region in the COVID context. Method: A retrospective cohort study before and during COVID-19 was conducted in HIV care units in 13 health districts in the East Region of Cameroon. Data were collected using a questionnaire recorded in the Kobo Collect android application, analyzed using SPSS version 25 software and plotted using Excel. Results: The pre-COVID-19 cohort compared to the during-COVID-19 cohort had a 1.90 risk of not adhering to treatment (OR: 1.90, CI {1.90 - 3.37}) and the difference was statistically significant at the 5% level (p-value = 0.029). Frequency of adherence was 65.4% (140/214). Adherence before COVID-19 was 56.9% whereas during COVID-19, it was 74.3%. Conclusion: The implementation of targeted interventions in the COVID-19 context, using evidence-based data and integrating the individual needs of HIV-TB co-infected patients, improved adherence to concurrent anti-tuberculosis treatment and antiretroviral therapy during the COVID-19 Era.

Study on Rural Domestic Waste Treatment in Loess Plateau Region——Taking Longfang Town in Shaanxi Province as Example

With the continuous development of economy and changes in people’s lifestyle,rural domestic waste brought about serious harm to water,air,human health,ecological landscape and so forth.In this paper,taking Longfang Town in Loess Plateau region as example,the source,amount and harms of rural domestic waste were analyzed firstly,as well as the current situation and existing problems of treatment,and then a suitable waste disposal technology for the town was chosen,finally the reasonable treatment methods combining new countryside and non-new countryside with township was summed up,so as to realize the reduction,harmless and resource treatment of rural domestic waste.

基于互联网医院区域一体化就医模式的探索与实践

随着国内医疗体制改革的日益深化,逐步形成“以患者为中心”的服务理念,互联网医院的应用创新重构医疗服务模式。然而,居民在一体化就医过程中仍存在一系列问题,如信息一体化支撑不足、就医流程不畅、医疗资源浪费等。本文结合国内外互联网医院现状及北京胸科医院互联网医院的建设情况,从区域一体化就医服务模式的现状及难点进行分析,梳理全流程就医模式的关键环节,将三级公立医院和医联体单位作为支撑,以首都医科大学附属北京胸科医院区域互联网医院服务专区的理念、技术、流程为创新点探索实践路径,探索和实践基于互联网医院区域一体化就医模式。为实现优质医疗资源有效下沉、推动分级诊疗、搭建胸部疾病全程管理体系、推动医院高质量发展提供有利依据。

“双中心”背景下5G远程机器人外科的发展机遇与挑战

近年来,我国医疗服务体系和医疗卫生基础设施持续完善,卫生与健康事业取得了显著进展。然而,医疗资源总量不足、区域分布不均及优质资源短缺等问题依然突出。为解决这些问题,国家相关部门联合出台了一系列政策,其中“双中心”建设在改善医疗服务集中化和优化资源配置方面发挥了重要作用。与此同时,5G通信技术和机器人手术系统等高端技术的迅猛发展,为远程机器人手术的实施提供了技术支持,并为“双中心”建设提供了新的技术手段。然而,5G远程机器人手术仍面临技术、基础设施、伦理和法律法规等诸多挑战。本研究从5G远程机器人外科的技术原理、应用现状等方面出发,探讨其在“双中心”建设中的发展机遇与挑战,并提出未来发展策略,以期为我国远程医疗服务的推广和深化“双中心”建设提供参考。

高寒区野战条件下单兵便携式口腔治疗装置的设计及应用

目的 :针对高寒区野战条件下口腔诊疗难的问题,设计一款高寒区野战条件下单兵便携式口腔治疗装置。方法:该装置采用拉杆箱式结构,由外箱、内框架和操作面板组成,外箱采用低密度聚乙烯材料,通过一次性滚塑工艺成型;内框架上集成高原特制压缩机、独立负压压缩机、可编程逻辑控制器(programmable logic controller,PLC)集成控制系统以及便携式高原单兵呼吸同步脉冲供氧模块;操作面板上配置三用枪、高速涡轮手机、电动变速手机、水控开关、光固化机、超声洁牙手机等治疗用设备。为验证该装置的性能,在高寒区对试验阶段样机进行测试。结果:测试结果表明,试验阶段样机机动性高、功能多样、压力足,能够满足在高寒区口腔诊疗动力气源极限连续工作且运转良好的目标。结论:该装置解决了便携式口腔治疗装置在高原气压不足且不稳定、控制系统集成化低、不易携带以及医护人员缺氧问题,提高了高寒区口腔诊疗远程机动能力,提升了我军口腔移动卫勤保障能力和装备水平。

细银质针治疗脑卒中后复杂性区域性疼痛综合征Ⅰ型患者的临床研究

目的:探讨细银质针治疗脑卒中后复杂性区域性疼痛综合征Ⅰ型(complex regional pain syndrome type Ⅰ,CRPS-Ⅰ)患者的效果,通过检测血浆中降钙素基因相关肽(calcitonin gene-related peptide,CGRP)、P物质(substance P,SP)含量,探讨其可能的作用机制。方法:选择2022年1—12月在珠海市斗门区侨立中医院针灸康复门诊及住院,且被确诊为脑卒中后CRPS-Ⅰ的110例患者作为研究对象,将患者按就诊顺序随机分为细银质针组(治疗组)和普通针刺组(对照组),各55例。对照组采用传统针刺治疗,治疗组采用细银质针导热疗法治疗。比较两组临床疗效、血浆中CGRP、SP及视觉模拟评分法(visual analogue scale,VAS)评分。结果:治疗组总有效率高于对照组,差异有统计学意义(P<0.05);治疗后,两组CGRP水平高于治疗前,治疗组高于对照组,两组SP水平、VAS评分低于治疗前,且治疗组低于对照组,差异有统计学意义(P<0.05)。结论:细银质针治疗脑卒中后CRPS-Ⅰ型患者效果显著,缓解疼痛及相关炎症反应。

Influence of flux treatment on the glass forming ability of Pd-Si binary alloys

Pd81Si19 amorphous alloys were prepared by combination methods of melt spinning and B2O3 flux treatment. A compari- son between the ribbons prepared from the fluxed ingots and the non-fluxed ones has been carried out. The result reveals that after fluxing treatment the glass transition temperature of the as-prepared glassy ribbons is reduced while the initial crystallization tem- perature is enhanced. It results in that the supercooled liquid region (defined as the difference between the initial crystallization tem- perature and the glass transition temperature) of the glassy alloy treated with fluxing technology has been increased from 31 to 42 K. This shows that fluxing technique can enhance the glass forming ability (GFA) of the binary alloy and improve the thermal stability of supercooled liquid of the glassy alloy.

百色市重型地中海贫血患儿治疗依从性影响因素调查

目的探究重型地中海贫血患儿治疗依从性的高低,分析影响地贫患儿治疗依从性的因素,为提高地贫患儿治疗依从性给出相应解决策略。方法主要采用问卷调查法和访谈法,从输血治疗依从性、去铁剂使用依从性、检查项目依从性、家长对患儿身体的关注度4个方面,对百色地区部分患儿及其家属进行调查研究。结果百色地区重型地中海贫血患儿治疗依从性不良达60.71%,其中30.36%患者未能定期接受输血治疗,生存质量较低。此外大多数患儿的检查项目依从性低于标准。家长关注患儿身体健康的态度差异大,部分家长在明确的健康指导上表现出较高依从性。单因素分析发现性别和年龄影响治疗依从性。结论本研究发现输血治疗依从性不良主要原因是经济压力和血源紧张。去铁治疗方面部分家长误认为在不输血的情况下可以停药。此外,许多家长在未察觉孩子有明显身体问题时,往往避免额外的检查以节省费用。家属对患儿的长期生活习惯关注不足。建议政府优化帮扶政策、医院加强高质量护理、患儿家庭积极配合治疗,实行综合干预以提高治疗依从性。

Greywater Treatment by High Rate Algal Pond under Sahelian Conditions for Reuse in Irrigation

High Rate Algal Pond (HRAP) was constructed and operated using a mixer device to investigate its capability in treating greywater for reuse in gardening. Physico-chemical and microbiological parameters were monitored. With a hydraulic retention time of 7.5 days and a solid retention time of 20 days, the average removal efficiencies (ARE) were 69% and 62% for BOD5 and COD respectively. The ARE for , and were 23%, 52% and 43% respectively. The removal of suspended solids (SS) was unsatisfactory, which could be attributed to the low average algal settling efficiencies of 9.3% and 16.0% achieved after 30 and 60 minutes respectively. The ARE of fecal coliforms, Escherichia coli and enterococci were 2.65, 3.14 and 3.17 log units respectively. In view of the results, the HRAP technology could be adapted for greywater treatment in sahelian regions. However, further studies on the diversity of the algal species growing in the HRAP unit are necessary in order to increase the removal of SS. Hazards of a reuse of the effluents are discussed on the basis of the various qualitative parameters. The residual content of E. coli was varying from 4 CFU per 100 mL. Based on WHO guidelines for greywater reuse in irrigation, the effluents could be used for restricted irrigation (E. coli < 105 CFU per 100 mL). Furthermore, the reuse potential is discussed on the basis of FAO guidelines using SAR (3.03 to 4.11), electrical conductivity (482 to 4500 μS/cm) and pH values (6.45 to 8.6).

高寒地区污水厂升级改造中技术分析及应用

北方某县级污水厂原设计规模为1.0×10^(4)m^(3)/d,原有CASS工艺难以满足水量增倍、排放标准由《城镇污水处理厂污染物排放标准》(GB 18918-2002)一级B标准提标至一级A标准的要求。在现有工程的基础上,将原有的CASS工艺改造为改良AO工艺+磁混凝多效沉淀系统,实现了出水水质稳定达到一级A标准,高寒气温下稳定的脱氮效率。该提标改造方式具有不需扩大占地、原有土建改动小、出水效果好等优势,减少工程投资和运行成本,可为高寒地区污水厂的升级改造提供参考。

Assessment of Health-Related Quality of Life of Tuberculosis Patients in Fako Division, South-West Region of Cameroon

Background: Tuberculosis (TB) caused by Mycobacterium tuberculosis is one of the top 10 causes of death worldwide. Despite the global impact of TB and treatment received, a gap persists between treatment and quality of life of the patients especially in resource limited countries. This study therefore evaluated the health related quality of life of TB patients and the different factors influencing their quality of life at the post intensive phase of their treatment in the Fako division of the South-West Region of Cameroon. Methods: A hospital based cross sectional study was carried out in 4 tuberculosis treatment centers, namely two regional (Buea and Limbe) and two district (Tiko and Muyuka) hospitals in Fako Division between June and July 2017. One hundred and sixty-seven TB patients were enrolled in the study and relevant information from them was gathered using the SF-36 questionnaire. Various aspects such as their perception of the disease, their socio-demographics and socio-economics conditions were evaluated. Results: Of the 167 participants enrolled in the study, 95 (56.9%) were male and 72 (43.1%) were female. One hundred and thirty-three (79.6%) of the 167 participants were affected by pulmonary tuberculosis and 34 (20.4%) by extra-pulmonary tuberculosis. Fifty-five (32.9%) were HIV positive and 90 (53.9%) had been receiving treatment for 4 - 6 months, 73 (43.7%) for 1 - 3 months and 4 (2.4%) for 7 - 9 months. The lowest and highest scores were recorded on the role limitation due to emotional problems scale (30.54 ± 35.36), and on the social functioning scale (47.68 ± 16.33) respectively. There was a significant difference (p = 0.021), between pulmonary and extra pulmonary tuberculosis (49.15 ± 16.08 vs. 41.91 ± 16.25) on the social functioning. Financial difficulty restraining drug collection affected the general health perception (p = 0.003), vitality (p = 0.007), emotional well-being (p < 0.001) and social functioning (p = 0.05) of the patients. Low income affected the vitality (p = 0.039), emotional well-being (p = 0.015), role limitations due to physical (p = 0.046) and emotional (p = 0.003) problems of the patients. Equally, the HIV status affected their vitality (p < 0.001) and emotional well-being (p = 0.011). Conclusion: The quality of life of the TB patients in the study area was generally poor. Counselling of diagnosed TB patients and provision of financial assistance through a social package can improve the acceptance of the disease during their treatment period to avoid default and relapse.

Regional Interdependence: A Practical Guidance in Rehabilitation Clinic—Part 2

Background: This work has the purpose of describing a well standardized therapeutic path in reference to the article “Regional Interdependence: A model that needs to be integrated in the functional evaluation and Physiotherapy treatment—Part. 1,(doi.org/10.4236/ojtr.2016.43010)” in the form of practical guidance in reference to Figure A1. The approach we describe provides standardized techniques for each joint regional quadrant in order to be used in rehabilitation clinic. Therapeutic techniques will also be classified according to the type of maneuver as classified in the literature.

甘孜地区27例皮肤炭疽诊治分析

目的分析皮肤炭疽的流行病学特征、临床特点和治疗,探讨炭疽的预防和控制措施。方法回顾性分析2020年11月至2023年11月四川省甘孜县人民医院感染科收治住院的27例皮肤炭疽患者的临床表现、实验室检查、治疗及预后。结果27例均为皮肤炭疽,炭疽杆菌培养阳性,患者发病前均参与屠宰、剥皮、切割病死牲畜,这一过程中损伤皮肤,发病后皮肤破损处呈焦痂溃疡,伴周围组织脓肿,经过治疗后27例患者均康复出院。3个月后随访,患者无不适,创面愈合良好。结论皮肤炭疽患者均有病、死畜接触史,临床表现以发热、皮肤病变为主,实验室检查炭疽杆菌培养阳性,白细胞计数升高。皮肤炭疽治疗的关键是早期、足量使用抗菌药物,疾病防治须做好预防宣教工作。

Effect of treatment failure on the Cag A EPIYA motif in Helicobacter pylori strains from Colombian subjects

AIM To evaluate effect of treatment failure on cag A and vac A genotypes in Helicobacter pylori(H. pylori) isolates from Colombia.METHODS One hundred and seventy-six participants infected with H. pylori from Colombia were treated during 14 d with the triple-standard therapy. Six weeks later, eradication was evaluated by 13C-Urea breath test. Patients with treatment failure were subjected to endoscopy control; biopsies obtained were used for histopathology and culture. DNA from H. pylori isolates was amplified using primers specific for cag A and vac A genes. The phylogenetic relationships among isolates obtained before and after treatment were established by conglomerate analysis based on random amplified polymorphic DNA(RAPD) fingerprinting.RESULTS Treatment effectiveness was at 74.6%. Of the par-ticipants with treatment failure, 25 accepted subjected to a second endoscopy. Prevalence of posttreatment infection was 64%(16/25) and 40%(10/25) by histology and culture, respectively. Upon comparing the cag A and vac A genotypes found before and after therapy, multiple cag A genotypes(cag A-positive and cag A-negative) were found before treatment; in contrast, cag A-negative genotypes decreased after treatment. vac A s1m1 genotype was highly prevalent in patients before and after therapy. The 3'cag A region was successfully amplified in 95.5%(21/22) of the isolates obtained before and in 81.8%(18/22) of the isolates obtained after treatment. In the isolates obtained from patients with treatment failure, it was found that 72.7%(16/22) presented alterations in the number of EPIYA motifs, compared to isolates found before treatment.CONCLUSION Unsuccessful treatment limits colonization by lowvirulence strains resulting in partial and selective eradication in mixed infections, and acts on the cag A-positive strains inducing genetic rearrangements in cag A variable region that produces a loss or gain of EPIYA repetitions.

头颈部血管瘤及脉管畸形手术治疗专家共识

血管瘤及脉管畸形是头颈部常见的良性脉管源性疾病,随着对非手术治疗方案的深入研究与广泛应用,大量患者在微创或无创情况下得以改善或治愈疾病,但在特定情况下,手术依然是血管瘤及脉管畸形综合序列治疗中不可替代的治疗手段。然而,针对头颈部血管瘤及脉管畸形,如何选择和应用手术诊疗技术,学术界尚未形成规范和共识。为进一步提高国内同行对头颈部血管瘤及脉管畸形的治疗水平,规范和统一手术治疗策略,本文汇集全国多所医学院校及附属医院相关专家的讨论意见,借鉴和参考国内外相关最新成果与诊治经验,从头颈部血管瘤及脉管畸形的临床诊断及术前准备、手术适应证及策略、术后护理及观察、术后常见并发症及处理、随访及社会心理支持等方面,制定此专家共识,以帮助和指导相关专业的医师开展规范化手术治疗。

高海拔严寒地区隧道冻害研究现状及展望

针对高海拔严寒地区隧道冻害问题,结合隧道冻害的相关研究,从冻害类型及原因分析、冻害机制、温度场、处置措施等4个方面的现状进行阐述和分析,对当前研究存在的不足和未来的发展方向进行探讨。主要成果为:1)通过对高海拔严寒地区隧道工程实例进行分析,总结4种冻害类型及4种冻害原因;2)基于含水风化层冻胀理论、整体性围岩冻胀理论、衬砌背后积水冻胀理论、裂隙水冻胀理论等4种冻胀理论,建立多年冻土区以整体性围岩冻胀理论为主、季冻区以裂隙水冻胀理论为主的多理论联合分析的方法;3)温度场研究方法分为现场监测、理论解析、模型试验、数值模拟等4种,其中现场监测是对洞内外温度进行监测,而理论分析、模型试验、数值模拟则是对监测结果进行验证分析;4)冻害处置措施有防排水措施、保温防寒措施、抗冻措施等3种,防冻的关键是将三者相结合进行综合治理;5)指出冻害机制适用性、温度场研究方法现状、处置措施适用性等方面的不足,未来应在高海拔严寒地区建立多种冻胀理论、多种研究方法综合应用的研究体系,并在隧道防排水、保温防寒、抗冻等方面给出处置措施。

川北医学院附属医院医联体协同平台建设与应用

目的:建设医联体平台,实现川北地区区域内医疗数据信息互联互通,促进分级诊疗服务有效落地。方法:基于标准体系及安全体系,结合各医疗卫生机构信息系统情况,建设以川北医学院附属医院为牵头单位、覆盖南充市10家县域医院的医联体平台。结果:川北医联体平台具备双向转诊、就诊预约、标本送检、基础数据管理四大业务功能。平台的构建和应用,规范了医疗服务行为,提升了区域医疗服务能力,提高了群众接受医疗卫生服务的可及性、便捷性。结论:建设区域医疗信息共享与服务协同平台、覆盖远程医疗服务的协作网络有助于区域医疗一体化发展体系的建立,是对分级诊疗、区域医疗一体化发展的有益尝试。

台湾地区居民法律地位:三重面向、内容构造与优化路径

台湾地区居民法律地位问题,是防范与遏制“台独”分裂活动、推动两岸融合发展、推进国家完全统一进程中必须面对的重大现实问题。在法律实践中,台湾地区居民地位具有“待解放的中国人民”“特殊的中国公民”“同等待遇的中国居民”三重面向。相关立法坚持目标和问题导向,逐渐趋向具体化、同等化和常态化。当前,台湾地区居民法律地位的主要问题是如何推动落实同等待遇,这在一定程度上影响了其内容构造。其中,“居住地”标准是优化落实台湾地区居民法律地位的基础,权利义务是其规范内核,政策则对法律规定起着引领、实施和补充的重要作用。为切实提升台湾地区居民国家认同,建议接续推进身份管理模块化、推动同等待遇实质化、逐步实现权利义务体系化,形成优化台湾居民法律地位的系统方案。

A Toxicological Assessment of Endocrine Disrupting Chemicals Found in the BMW (Border, Midland and Western) Region of Ireland

A battery of tests was established to determine the oestrogenic, mutagenic and genotoxic potential of two categories of endocrine disrupting chemicals (EDCs), phthalates and alkylphenols. Diisononylphthalate (DINP), diethylhexylphthalate (DEHP), dibutylphthalate (DBP), diisododecylphthalate (DIDP) and 4-nonylphenol (4-NP) were oestrogenic in the yeast estrogen screen (YES) assay and potently oestrogenic in the MVLN and E-SCREEN assays at environmentally relevant concentrations. DINP and 4-NP were mutagenic in the Ames assay and also induced significant levels of unscheduled DNA synthesis and DNA strand breakage. Significant induction in the percentage of cells containing micronuclei was observed after treatment with DINP, DEHP and 4-NP. In addition, sewage effluents from sewage treatment plants (STPs) in the Border, Midlands and Western (BMW) region of Ireland were significantly oestrogenic in the YES assay. Moreover, analysis of levels of phthalates and alkylphenol identified in Irish rivers receiving treated effluent showed potent oestrogenicity in the YES assay. The proliferative and genotoxic ability of the phthalates and alkylphenol, and the oestrogenicity of the treated effluents reported here, is significant as these EDCs and EDCs within the effluent may play a role in the etiology of human abnormalities.

西南欠发达地区社区医疗服务建设对慢性病患者就医选择的影响

目的:分析西南欠发达地区社区医疗服务建设内容对慢性病患者就医选择的影响,并探讨社区医疗服务各项建设内容的边际影响和贡献程度。方法:在西南欠发达地区采取分层整群随机的抽样方法抽取20个社区(村)1205名慢性病患者进行问卷调查,采用描述性分析、无序多分类Logistic回归和Shapley值分解法进行统计对比和因素分析。结果:1205名调查对象中,776名慢性病居民选择社区医院就诊(64.4%)。Logistic回归结果显示,社区医院的隐私保护(OR=0.789;95%CI:0.543~0.818)、医疗设备(OR=0.736;95%CI:0.599~0.903)、医学检查(OR=0.559;95%CI:0.381~0.680)建设对慢性病居民由省市级医院流向社区医院有积极影响;社区医院的隐私保护(OR=0.806;95%CI:0.629~0.910)、专家坐诊(OR=0.741;95%CI:0.575~0.954)、医疗设备(OR=0.690;95%CI:0.533~0.785)、护理服务(OR=0.630;95%CI:0.443~0.894)、医学检查(OR=0.611;95%CI:0.452~0.792)、服务态度(OR=0.499;95%CI:0.356~0.741)和收费标准(OR=0.499;95%CI:0.385~0.648)建设对慢性病居民由县区级医院流向社区医院有积极影响。Shapley值分析结果显示,社区医院的隐私保护、医学检查、服务态度、诊疗成本和护理服务建设对慢性病居民就医选择的影响贡献率最大,分别为38.91%,12.44%,11.70%,9.84%和7.15%。结论:加强西南欠发达地区社区医疗服务建设对慢性病居民由省市级医院、县区级医院流向社区医院的促进作用明显。当地政府应加大社区医院在医疗设备、医学检查和专家坐诊方面的投入,发挥医保的杠杆作用,降低社区医院收费标准,提升社区医院服务水平,进一步落实分级诊疗政策。