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Thondoo M, Mogo ERI, Tatah L, Muti M, van Daalen KR, Muzenda T, Boscott R, Uwais O, Farmer G, Yue A, Dalzell S, Mukoma G, Bhagtani D, Matina S, Dambisya PM, Okop K, Ebikeme C, Micklesfield L, Oni T. Multisectoral interventions for urban health in Africa: a mixed-methods systematic review. Glob Health Action 2024; 17:2325726. [PMID: 38577879 PMCID: PMC11000616 DOI: 10.1080/16549716.2024.2325726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 02/25/2024] [Indexed: 04/06/2024] Open
Abstract
Increasing evidence suggests that urban health objectives are best achieved through a multisectoral approach. This approach requires multiple sectors to consider health and well-being as a central aspect of their policy development and implementation, recognising that numerous determinants of health lie outside (or beyond the confines of) the health sector. However, collaboration across sectors remains scarce and multisectoral interventions to support health are lacking in Africa. To address this gap in research, we conducted a mixed-method systematic review of multisectoral interventions aimed at enhancing health, with a particular focus on non-communicable diseases in urban African settings. Africa is the world's fastest urbanising region, making it a critical context in which to examine the impact of multisectoral approaches to improve health. This systematic review provides a valuable overview of current knowledge on multisectoral urban health interventions and enables the identification of existing knowledge gaps, and consequently, avenues for future research. We searched four academic databases (PubMed, Scopus, Web of Science, Global Health) for evidence dated 1989-2019 and identified grey literature from expert input. We identified 53 articles (17 quantitative, 20 qualitative, 12 mixed methods) involving collaborations across 22 sectors and 16 African countries. The principle guiding the majority of the multisectoral interventions was community health equity (39.6%), followed by healthy cities and healthy urban governance principles (32.1%). Targeted health outcomes were diverse, spanning behaviour, environmental and active participation from communities. With only 2% of all studies focusing on health equity as an outcome and with 47% of studies published by first authors located outside Africa, this review underlines the need for future research to prioritise equity both in terms of research outcomes and processes. A synthesised framework of seven interconnected components showcases an ecosystem on multisectoral interventions for urban health that can be examined in the future research in African urban settings that can benefit the health of people and the planet.Paper ContextMain findings: Multisectoral interventions were identified in 27.8% of African countries in the African Union, targeted at major cities with five sectors present at all intervention stages: academia or research, agriculture, government, health, and non-governmental.Added knowledge: We propose a synthesised framework showcasing an ecosystem on multisectoral interventions for urban health that can guide future research in African urban settings.Global health impact for policy and action: This study reveals a crucial gap in evidence on evaluating the long-term impact of multisectoral interventions and calls for partnerships involving various sectors and robust community engagement to effectively deliver and sustain health-promoting policies and actions.
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Affiliation(s)
- Meelan Thondoo
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
- Barcelona Institute for Global Health (ISGlobal), Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
| | - Ebele R. I. Mogo
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
- Barcelona Institute for Global Health (ISGlobal), Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
| | - Lambed Tatah
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Monica Muti
- SA MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Kim R. van Daalen
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
- Barcelona Supercomputing Center (BSC), Department of Earth Sciences, Barcelona, Spain
| | - Trish Muzenda
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Rachel Boscott
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Omar Uwais
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - George Farmer
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Adelaide Yue
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Sarah Dalzell
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Gudani Mukoma
- SA MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
- Department of Biokinetics, Recreation and Sport Science, Faculty of Health Sciences, University of Venda, Thohoyandou, South Africa
| | - Divya Bhagtani
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Sostina Matina
- SA MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Philip M. Dambisya
- Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Centre for Innovation in Learning and Teaching, University of Cape Town, Cape Town, South Africa
| | - Kufre Okop
- Chronic Disease Initiative for Africa (CDIA), Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Charles Ebikeme
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Lisa Micklesfield
- SA MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Tolu Oni
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
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Arcidiacono F, Anselmo P, Casale M, Zannori C, Loreti F, Italiani M, Enrico B, Fabiani S, Marchetti G, Tassi V, Mancioli F, Muti M, Guida A, Bracarda S, Ragusa M, Maranzano E, Trippa F. 126P Chemotherapy and stereotactic ablative radiotherapy in newly diagnosed and recurrent locally advanced non-small cell lung cancer patients unfit for concurrent radiochemotherapy: Sub-analysis and update of START-NEW-ERA non-randomised phase II trial. J Thorac Oncol 2023. [DOI: 10.1016/s1556-0864(23)00381-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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Muti M, Ware LJ, Micklesfield LK, Ramsay M, Agongo G, Boua PR, Kisiangani I, Cook I, Gómez-Olivé FX, Crowther NJ, Kabudula C, Norris SA, Chikowore T. Physical Activity and Its Association With Body Mass Index: A Cross-Sectional Analysis in Middle-Aged Adults From 4 Sub-Saharan African Countries. J Phys Act Health 2023; 20:217-225. [PMID: 36746155 DOI: 10.1123/jpah.2022-0539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/24/2022] [Accepted: 12/03/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND This study aimed to explore association of self-reported physical activity domains of work, leisure, and transport-related physical activity and body mass index (BMI) in 9388 adult men and women from the Africa-Wits-INDEPTH partnership for Genomic (AWI-Gen) study in Africa. Africa-Wits-INDEPTH partnership for Genomic is a large, population-based cross-sectional cohort with participants from 6 sites from rural and urban areas in 4 sub-Saharan African countries. METHODS A sex-stratified meta-analysis of cross-sectional data from men and women aged 29-82 years was used to assess the association of physical activity with BMI. RESULTS Overall, meeting physical activity guidelines of at least 150 minutes per week was associated with 0.82 kg/m2 lower BMI in men (β = -0.80 kg/m2; 95% confidence interval [CI], -1.14 to -0.47) and 0.68 kg/m2 lower BMI in women (β = -0.68 kg/m2; 95% CI, -1.03 to -0.33). Sex and site-specific differences were observed in the associations between physical activity domains and BMI. Among those who met physical activity guidelines, there was an inverse association between transport-related physical activity and BMI in men from Nanoro (Burkina Faso) (β = -0.79 kg/m2; 95% CI, -1.25 to -0.33) as well as work-related physical activity and BMI in Navrongo men (Ghana) (β = -0.76 kg/m2; 95% CI, -1.25 to -0.27) and Nanoro women (β = -0.90 kg/m2; 95% CI, -1.44 to -0.36). CONCLUSIONS Physical activity may be an effective strategy to curb rising obesity in Africa. More studies are needed to assess the impact of sex and geographic location-specific physical activity interventions on obesity.
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Affiliation(s)
- Monica Muti
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg,South Africa
- Food and Nutrition Security Research Institute, Harare,Zimbabwe
| | - Lisa J Ware
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg,South Africa
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg,South Africa
| | - Lisa K Micklesfield
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg,South Africa
| | - Michele Ramsay
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg,South Africa
| | - Godfred Agongo
- Navrongo Health Research Centre, Ghana Health Service, Navrongo,Ghana
- Department of Biochemistry and Forensic Sciences, School of Chemical and Biochemical Sciences, C. K. Tedam University of Technology and Applied Sciences, Navrongo,Ghana
| | - Palwende R Boua
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg,South Africa
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro,Burkina Faso
| | | | - Ian Cook
- Physical Activity Epidemiology Laboratory (EDST), School of Education, Faculty of Humanities, University of Limpopo, Polokwane,South Africa
| | - Francesc Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg,South Africa
| | - Nigel J Crowther
- Department of Chemical Pathology, National Health Laboratory Service, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg,South Africa
| | - Chodziwadziwa Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg,South Africa
| | - Shane A Norris
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg,South Africa
- School of Human Development and Health, University of Southampton, Southampton,United Kingdom
| | - Tinashe Chikowore
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg,South Africa
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg,South Africa
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Noble C, Mooney C, Makasi R, Ntozini R, Majo FD, Church JA, Tavengwa NV, Prendergast AJ, Humphrey JH, Manges A, Mangwadu G, Maluccio JA, Mbuya MNN, Moulton LH, Stoltzfus RJ, Tielsch JM, Smith LE, Chasokela C, Chigumira A, Heylar W, Hwena P, Kembo G, Mutasa B, Mutasa K, Rambanepasi P, Sauramba V, Van Der Keilen F, Zambezi C, Chidhanguro D, Chigodora D, Chipanga JF, Gerema G, Magara T, Mandava M, Mavhudzi T, Mazhanga C, Muzaradope G, Mwapaura MT, Phiri S, Tengende A, Banda C, Chasekwa B, Chidamba L, Chidawanyika T, Chikwindi E, Chingaona LK, Chiorera CK, Dandadzi A, Govha M, Gumbo H, Gwanzura KT, Kasaru S, Matsika AM, Maunze D, Mazarura E, Mpofu E, Mushonga J, Mushore TE, Muzira T, Nembaware N, Nkiwane S, Nyamwino P, Rukobo SD, Runodamoto T, Seremwe S, Simango P, Tome J, Tsenesa B, Amadu U, Bangira B, Chiveza D, Hove P, Jombe HA, Kujenga D, Madhuyu L, Mandina-Makoni P, Maramba N, Maregere B, Marumani E, Masakadze E, Mazula P, Munyanyi C, Musanhu G, Mushanawani RC, Mutsando S, Nazare F, Nyarambi M, Nzuda W, Sigauke T, Solomon M, Tavengwa T, Biri F, Chafanza M, Chaitezvi C, Chauke T, Chidzomba C, Dadirai T, Fundira C, Gambiza AC, Godzongere T, Kuona M, Mafuratidze T, Mapurisa I, Mashedze T, Moyo N, Musariri C, Mushambadope M, Mutsonziwa TR, Muzondo A, Mwareka R, Nyamupfukudza J, Saidi B, Sakuhwehwe T, Sikalima G, Tembe J, Chekera TE, Chihombe O, Chikombingo M, Chirinda T, Chivizhe A, Hove R, Kufa R, Machikopa TF, Mandaza W, Mandongwe L, Manhiyo F, Manyaga E, Mapuranga P, Matimba FS, Matonhodze P, Mhuri S, Mike J, Ncube B, Nderecha WTS, Noah M, Nyamadzawo C, Penda J, Saidi A, Shonhayi S, Simon C, Tichagwa M, Chamakono R, Chauke A, Gatsi AF, Hwena B, Jawi H, Kaisa B, Kamutanho S, Kaswa T, Kayeruza P, Lunga J, Magogo N, Manyeruke D, Mazani P, Mhuriyengwe F, Mlambo F, Moyo S, Mpofu T, Mugava M, Mukungwa Y, Muroyiwa F, Mushonga E, Nyekete S, Rinashe T, Sibanda K, Chemhuru M, Chikunya J, Chikwavaire VF, Chikwiriro C, Chimusoro A, Chinyama J, Gwinji G, Hoko-Sibanda N, Kandawasvika R, Madzimure T, Maponga B, Mapuranga A, Marembo J, Matsunge L, Maunga S, Muchekeza M, Muti M, Nyamana M, Azhuda E, Bhoroma U, Biriyadi A, Chafota E, Chakwizira A, Chamhamiwa A, Champion T, Chazuza S, Chikwira B, Chingozho C, Chitabwa A, Dhurumba A, Furidzirai A, Gandanga A, Gukuta C, Macheche B, Marihwi B, Masike B, Mutangandura E, Mutodza B, Mutsindikwa A, Mwale A, Ndhlovu R, Nduna N, Nyamandi C, Ruvata E, Sithole B, Urayai R, Vengesa B, Zorounye M, Bamule M, Bande M, Chahuruva K, Chidumba L, Chigove Z, Chiguri K, Chikuni S, Chikwanda R, Chimbi T, Chingozho M, Chinhamo O, Chinokuramba R, Chinyoka C, Chipenzi X, Chipute R, Chiribhani G, Chitsinga M, Chiwanga C, Chiza A, Chombe F, Denhere M, Dhamba E, Dhamba M, Dube J, Dzimbanhete F, Dzingai G, Fusira S, Gonese M, Gota J, Gumure K, Gwaidza P, Gwangwava M, Gwara W, Gwauya M, Gwiba M, Hamauswa J, Hlasera S, Hlukani E, Hotera J, Jakwa L, Jangara G, Janyure M, Jari C, Juru D, Kapuma T, Konzai P, Mabhodha M, Maburutse S, Macheka C, Machigaya T, Machingauta F, Machokoto E, Madhumba E, Madziise L, Madziva C, Madzivire M, Mafukise M, Maganga M, Maganga S, Mageja E, Mahanya M, Mahaso E, Mahleka S, Makanhiwa P, Makarudze M, Makeche C, Makopa N, Makumbe R, Mandire M, Mandiyanike E, Mangena E, Mangiro F, Mangwadu A, Mangwengwe T, Manhidza J, Manhovo F, Manono I, Mapako S, Mapfumo E, Mapfumo T, Mapuka J, Masama D, Masenge G, Mashasha M, Mashivire V, Matunhu M, Mavhoro P, Mawuka G, Mazango I, Mazhata N, Mazuva D, Mazuva M, Mbinda F, Mborera J, Mfiri U, Mhandu F, Mhike C, Mhike T, Mhuka A, Midzi J, Moyo S, Mpundu M, Msindo NM, Msindo D, Mtisi C, Muchemwa G, Mujere N, Mukaro E, Muketiwa K, Mungoi S, Munzava E, Muoki R, Mupura H, Murerwa E, Murisi C, Muroyiwa L, Muruvi M, Musemwa N, Mushure C, Mutero J, Mutero P, Mutumbu P, Mutya C, Muzanango L, Muzembi M, Muzungunye D, Mwazha V, Ncube T, Ndava T, Ndlovu N, Nehowa P, Ngara D, Nguruve L, Nhigo P, Nkiwane S, Nyanyai L, Nzombe J, Office E, Paul B, Pavari S, Ranganai S, Ratisai S, Rugara M, Rusere P, Sakala J, Sango P, Shava S, Shekede M, Shizha C, Sibanda T, Tapambwa N, Tembo J, Tinago N, Tinago V, Toindepi T, Tovigepi J, Tuhwe M, Tumbo K, Zaranyika T, Zaru T, Zimidzi K, Zindo M, Zindonda M, Zinhumwe N, Zishiri L, Ziyambi E, Zvinowanda J, Bepete E, Chiwira C, Chuma N, Fari A, Gavi S, Gunha V, Hakunandava F, Huku C, Hungwe G, Maduke G, Manyewe E, Mapfumo T, Marufu I, Mashiri C, Mazenge S, Mbinda E, Mhuri A, Muguti C, Munemo L, Musindo L, Ngada L, Nyembe D, Taruvinga R, Tobaiwa E, Banda S, Chaipa J, Chakaza P, Chandigere M, Changunduma A, Chibi C, Chidyagwai O, Chidza E, Chigatse N, Chikoto L, Chingware V, Chinhamo J, Chinhoro M, Chiripamberi A, Chitavati E, Chitiga R, Chivanga N, Chivese T, Chizema F, Dera S, Dhliwayo A, Dhononga P, Dimingo E, Dziyani M, Fambi T, Gambagamba L, Gandiyari S, Gomo C, Gore S, Gundani J, Gundani R, Gwarima L, Gwaringa C, Gwenya S, Hamilton R, Hlabano A, Hofisi E, Hofisi F, Hungwe S, Hwacha S, Hwara A, Jogwe R, Kanikani A, Kuchicha L, Kutsira M, Kuziyamisa K, Kuziyamisa M, Kwangware B, Lozani P, Mabuto J, Mabuto V, Mabvurwa L, Machacha R, Machaya C, Madembo R, Madya S, Madzingira S, Mafa L, Mafuta F, Mafuta J, Mahara A, Mahonye S, Maisva A, Makara A, Makover M, Mambongo E, Mambure M, Mandizvidza E, Mangena G, Manjengwa E, Manomano J, Mapfumo M, Mapfurire A, Maphosa L, Mapundo J, Mare D, Marecha F, Marecha S, Mashiri C, Masiya M, Masuku T, Masvimbo P, Matambo S, Matarise G, Matinanga L, Matizanadzo J, Maunganidze M, Mawere B, Mawire C, Mazvanya Y, Mbasera M, Mbono M, Mhakayakora C, Mhlanga N, Mhosva B, Moyo N, Moyo O, Moyo R, Mpakami C, Mpedzisi R, Mpofu E, Mpofu E, Mtetwa M, Muchakachi J, Mudadada T, Mudzingwa K, Mugwira M, Mukarati T, Munana A, Munazo J, Munyeki O, Mupfeka P, Murangandi G, Muranganwa M, Murenjekwa J, Muringo N, Mushaninga T, Mutaja F, Mutanha D, Mutemeri P, Mutero B, Muteya E, Muvembi S, Muzenda T, Mwenjota A, Ncube S, Ndabambi T, Ndava N, Ndlovu E, Nene E, Ngazimbi E, Ngwalati A, Nyama T, Nzembe A, Pabwaungana E, Phiri S, Pukuta R, Rambanapasi M, Rera T, Samanga V, Shirichena S, Shoko C, Shonhe M, Shuro C, Sibanda J, Sibangani E, Sibangani N, Sibindi N, Sitotombe M, Siwawa P, Tagwirei M, Taruvinga P, Tavagwisa A, Tete E, Tete Y, Thandiwe E, Tibugari A, Timothy S, Tongogara R, Tshuma L, Tsikira M, Tumba C, Watinaye R, Zhiradzango E, Zimunya E, Zinengwa L, Ziupfu M, Ziyambe J. Antenatal and delivery practices and neonatal mortality amongst women with institutional and non-institutional deliveries in rural Zimbabwe: observational data from a cluster randomized trial. BMC Pregnancy Childbirth 2022; 22:981. [PMID: 36585673 PMCID: PMC9805263 DOI: 10.1186/s12884-022-05282-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 12/05/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Despite achieving relatively high rates of antenatal care, institutional delivery, and HIV antiretroviral therapy for women during pregnancy, neonatal mortality has remained stubbornly high in Zimbabwe. Clearer understanding of causal pathways is required to inform effective interventions. METHODS This study was a secondary analysis of data from the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial, a cluster-randomized community-based trial among pregnant women and their infants, to examine care during institutional and non-institutional deliveries in rural Zimbabwe and associated birth outcomes. RESULTS Among 4423 pregnant women, 529 (11.9%) delivered outside a health institution; hygiene practices were poorer and interventions to minimise neonatal hypothermia less commonly utilised for these deliveries compared to institutional deliveries. Among 3441 infants born in institutions, 592 (17.2%) were preterm (< 37 weeks gestation), while 175/462 (37.9%) infants born outside health institutions were preterm (RR: 2.20 (1.92, 2.53). Similarly, rates of stillbirth [1.2% compared to 3.0% (RR:2.38, 1.36, 4.15)] and neonatal mortality [2.4% compared to 4.8% (RR: 2.01 1.31, 3.10)] were higher among infants born outside institutions. Among mothers delivering at home who reported their reason for having a home delivery, 221/293 (75%) reported that precipitous labor was the primary reason for not having an institutional delivery while 32 (11%), 34 (12%), and 9 (3%), respectively, reported distance to the clinic, financial constraints, and religious/personal preference. CONCLUSIONS Preterm birth is common among all infants in rural Zimbabwe, and extremely high among infants born outside health institutions. Our findings indicate that premature onset of labor, rather than maternal choice, may be the reason for many non-institutional deliveries in low-resource settings, initiating a cascade of events resulting in a two-fold higher risk of stillbirth and neonatal mortality amongst children born outside health institutions. Interventions for primary prevention of preterm delivery will be crucial in reducing neonatal mortality in Zimbabwe. TRIAL REGISTRATION The trial is registered with ClinicalTrials.gov, number NCT01824940.
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Affiliation(s)
- Christie Noble
- grid.4868.20000 0001 2171 1133Blizard Institute, Queen Mary University of London, London, UK
| | - Ciaran Mooney
- Northern Ireland Medical and Dental Training Agency (NIMDTA), Beechill House, 42 Beechill Rd, Belfast, BT8 7RL UK
| | - Rachel Makasi
- grid.493148.3Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Robert Ntozini
- grid.493148.3Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Florence D. Majo
- grid.493148.3Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - James A. Church
- grid.4868.20000 0001 2171 1133Blizard Institute, Queen Mary University of London, London, UK ,grid.493148.3Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Naume V. Tavengwa
- grid.493148.3Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Andrew J. Prendergast
- grid.4868.20000 0001 2171 1133Blizard Institute, Queen Mary University of London, London, UK ,grid.493148.3Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe ,grid.21107.350000 0001 2171 9311Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Jean H. Humphrey
- grid.493148.3Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe ,grid.21107.350000 0001 2171 9311Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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Arcidiacono F, Anselmo P, Casale M, Italiani M, Terenzi S, Di Marzo A, Fabiani S, Draghini L, Muti M, Trippa F, Maranzano E. PO-1269 SABR in locally-advanced non-small-cell lung cancer elderly patients: little palliation or big cure? Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03233-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Arcidiacono F, Anselmo P, Casale M, Italiani M, Di Marzo A, Terenzi S, Draghini L, Muti M, Fabiani S, Maranzano E, Trippa F. PO-1244 Stereotactic Ablative Radiotherapy In Locally-Advanced Non-Small-Cell Lung Cancer: A Phase Ii Trial. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03208-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Di Marzo A, Trippa F, Anselmo P, Draghini L, Arcidiacono F, Terenzi S, Italiani M, Muti M, Casale M, Fabiani S, Maranzano E. PO-1340 Prostate cancer reirradiation with stereotactic V-MAT IGRT : interim analysis of a phase II trial. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07791-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hutton GB, Brugulat-Panés A, Bhagtani D, Mba Maadjhou C, Birch JM, Shih H, Okop K, Muti M, Wadende P, Tatah L, Mogo E, Guariguata L, Unwin N. A Systematic Scoping Review of the Impacts of Community Food Production Initiatives in Kenya, Cameroon, and South Africa. J Glob Health Rep 2021; 5:e2021010. [PMID: 33829114 PMCID: PMC7610539 DOI: 10.29392/001c.19468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Even before the COVID-19 pandemic, one in two people in Africa were food insecure. The burden of malnutrition remains high (e.g. childhood stunting, anaemia in women of reproductive age) or are increasing (e.g. overweight and obesity). A range of coordinated actions are required to improve this situation, including increasing local food production and consumption. The aim of this review was to provide a systematic and comprehensive overview of recently published research into the health, social, economic, and environmental impacts of community food production initiatives (CFPIs) in Kenya, Cameroon and South Africa. METHODS We searched eight electronic databases covering health, social, environmental, economic and agricultural sciences. Primary research studies published from 1 January 2014 to 31 December 2018 were considered. Data on geographic location, study design, type of CFPI and the impacts assessed were abstracted from eligible articles. FINDINGS We identified 4828 articles, 260 of which required full-text review and 118 met our eligibility criteria. Most research was conducted in Kenya (53.4%) and South Africa (38.1%). The categories of CFPIs studied were (in order of decreasing frequency): crop farming, livestock farming, unspecified farming, fisheries, home / school gardens, urban agriculture, and agroforestry. The largest number of studies were on the economic and environmental impacts of CFPIs, followed by their health and social impacts. The health impacts investigated included food security, nutrition status and dietary intake. One study investigated the potential impact of CFPIs on non-communicable diseases. Over 60% of studies investigated a single category of impact. Not one of the studies explicitly used a theoretical framework to guide its design or interpretation. CONCLUSIONS Our findings on research studies of CFPIs suggest the need for a greater focus on interdisciplinary research in order to improve understanding of the relationships between their health, environmental, economic, and social impacts. Greater use of explicit theoretical frameworks could assist in research design and interpretation, helping to ensure its relevance to informing coordinated intersectoral interventions and policy initiatives.
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Affiliation(s)
- Gráinne B Hutton
- Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | | | - Divya Bhagtani
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Camille Mba Maadjhou
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Jack M Birch
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Hueyjong Shih
- Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Kufre Okop
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Monica Muti
- MRC-Wits Developmental Pathways for Health Research Unit (DPHRU), University of the Witwatersrand, Johannesburg, South Africa
| | - Pamela Wadende
- School of Education and Human Resource Development (SEDHURED) Kisii University, Kenya
| | - Lambed Tatah
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Ebele Mogo
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Leonor Guariguata
- Faculty of Medical Sciences, University of the West Indies, Barbados
| | - Nigel Unwin
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
- European Centre for Environment and Human Health, University of Exeter
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Di Marzo A, Trippa F, Anselmo P, Arcidiacono F, Terenzi S, Draghini L, Italiani M, Casale M, Muti M, Fabiani S, Maranzano E. EP-1207 Fractionated stereotactic radiation therapy for resected brain metastases: a preliminary report. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31627-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Fabiani S, Italiani M, Casale M, Muti M, Maranzano E. 64. Skin dose in high dose rate brachytherapy for breast cancers: evaluation by in vivo dosimetry using TLD and MOSFET dosimeters. Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.04.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Casale M, Fabiani S, Italiani M, Muti M, Maranzano E. 190. Correlation between modulation degree and dosimetric accuracy of prostate VMAT treatment planning. Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.04.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Imenpour H, Muti M, Pastorino G. Oesophageal cavernous haemangioma. Pathologica 2018; 110:72-74. [PMID: 30259914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
Esophageal cavernous haemangioma is an uncommon benign neoplasm. These tumors are usually discovered incidentally as they are often asymptomatic. The symptoms, if present, are bleeding and dysphagia. Endoscopic and radiographic features are nonspecific and histopathologic examination is required for definitive diagnosis and appropriate treatment. We herein report a case of a 69-year old man who presented with complain of mild dysphagia for solid foods. Endoscopic evaluation with transesophageal ultrasonography and CT revealed a 5 cm intramural tumor in the posterior wall of the upper esophagus. The tumor was resected and histological examination showed an esophageal cavernous haemangioma.
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Affiliation(s)
- H Imenpour
- Surgical Pathology Department, Ospedale Villa Scassi, Genova, Italy
| | - M Muti
- Surgical Pathology Department, Ospedale Villa Scassi, Genova, Italy; Thoracic Surgery Department, Ospedale Villa Scassi, Genova, Italy
| | - G Pastorino
- Thoracic Surgery Department, Ospedale Villa Scassi, Genova, Italy
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Takarinda KC, Mutasa-Apollo T, Madzima B, Nkomo B, Chigumira A, Banda M, Muti M, Harries AD, Mugurungi O. Malnutrition status and associated factors among HIV-positive patients enrolled in ART clinics in Zimbabwe. BMC Nutr 2017. [DOI: 10.1186/s40795-017-0132-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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Aprile I, Roscetti M, Giulianelli G, Muti M, Ottaviano P. Cerebral MR Perfusion Imaging Analysis of Peritumoral Tissue. Neuroradiol J 2016; 20:656-61. [DOI: 10.1177/197140090702000609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2007] [Accepted: 09/16/2007] [Indexed: 11/16/2022] Open
Abstract
Highly malignant gliomas have an infiltrating growth making it impossible to establish the exact limits of the lesion with magnetic resonance images after contrast medium administration because the peripheral component of the lesion does not enhance. On the contrary, cerebral metastases have an expansive growth and therefore lack a peripheral component beyond the enhanced area. In some cases the MR perfusional technique can demonstrate neoplastic tissue even with little damage to the brain-blood barrier and therefore with no enhancement. Our study aimed to estimate in which cases the MR perfusion technique will characterize peripheral neoplastic tissue that fails to enhance in gliomas in order to make a differential diagnosis between gliomas and metastases. We studied 60 tumours in 53 patients with MR perfusion and conventional sequences. We evaluated the presence of hyperperfused tissue in CBV maps outside the enhanced area after contrast administration and estimated the tumoral tissue CBV. None of the metastases (24 cases) had hyperperfused peritumoural tissue which was present instead in 22/36 gliomas (infiltrating aspect in CBV maps). Moreover all the gliomas with infiltrating aspect had CBV values of the solid component of the lesion higher than gliomas with a non infiltrating aspect with a threshold value between 4.4 and 6.3. It was therefore possible to characterize 22 gliomas with infiltrating aspect in the perfusion maps and with CBV values higher than the threshold value. In addition, 17 metastases with a non infiltrating aspect were characterized with CBV values higher than the threshold. Fourteen gliomas and seven metastases both with a non infiltrating aspect in the perfusion maps and with CBV values below the threshold were not characterized. In conclusion, MR perfusion succeeded in characterizing 39 lesions out of 60.
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Affiliation(s)
- I. Aprile
- Magnetic Resonance Unit, S. Maria Hospital; Terni, Italy
- Oncologic Radiotherapy Unit, S. Maria Hospital; Terni, Italy
| | - M. Roscetti
- Magnetic Resonance Unit, S. Maria Hospital; Terni, Italy
- Oncologic Radiotherapy Unit, S. Maria Hospital; Terni, Italy
| | - G. Giulianelli
- Magnetic Resonance Unit, S. Maria Hospital; Terni, Italy
- Oncologic Radiotherapy Unit, S. Maria Hospital; Terni, Italy
| | - M. Muti
- Magnetic Resonance Unit, S. Maria Hospital; Terni, Italy
- Oncologic Radiotherapy Unit, S. Maria Hospital; Terni, Italy
| | - P. Ottaviano
- Magnetic Resonance Unit, S. Maria Hospital; Terni, Italy
- Oncologic Radiotherapy Unit, S. Maria Hospital; Terni, Italy
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Anselmo P, Chirico L, Muti M, Basagni M, Trippa F, Rossi R, Draghini L, Arcidiacono F, Italiani M, Casale M, Fabiani S, Giorgi C, Maranzano E. PO-0642: Radiosurgery without whole brain radiotherapy in brain metastases from non-small cell lung cancer. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31892-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Muti M, Direnzo A, Caproni S, Principi M, Piccolini C. Brain size bias correction method in a volumetric group analysis: Theory and normalization. Phys Med 2016. [DOI: 10.1016/j.ejmp.2016.01.454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Muti M, Tshimanga M, Notion GT, Bangure D, Chonzi P. Prevalence of pregnancy induced hypertension and pregnancy outcomes among women seeking maternity services in Harare, Zimbabwe. BMC Cardiovasc Disord 2015; 15:111. [PMID: 26431848 PMCID: PMC4592567 DOI: 10.1186/s12872-015-0110-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 09/23/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pregnancy induced hypertension (PIH) is one of the most common causes of both maternal and neonatal morbidity, affecting about 5 - 8 % of pregnant women. It is associated with adverse pregnancy outcomes as well as maternal morbidity and mortality. Harare City experienced an increase in referrals due to PIH to central hospitals from 2009 to 2011. We conducted a study to determine the prevalence of PIH and pregnancy outcomes among women with PIH. METHODS An analytic cross sectional study was conducted. Interviewer administered questionnaires were used to capture demographic data, obstetric history and knowledge on PIH management. Records were reviewed for pregnancy outcomes while key informants were also interviewed on patient management. RESULTS PIH prevalence was 19.4 %. Women with PIH were three times more likely to deliver a low birth weight baby (OR 3.00, p = 0.0115), 4.3 times more likely to have still birth (OR 4.34, p = 0.0517) and four times more likely to have a baby with low Apgar score at 5 minutes (OR 4.47, p = 0.0155) compared to women without PIH. There was no statistically significant difference in delivery before 37 weeks gestation between women with PIH and those without (OR 1.70, p = 0.1251). 12,5 % of the women delivered by caesarean section. Methyldopa was the drug of choice for management of PIH. Less than half of the health workers had sufficient knowledge on definition or management of PIH. Delay in seeking care and shortage of resources were the major reported challenges in the proper management of PIH. CONCLUSION PIH prevalence was high. Women with PIH were at higher risk of adverse pregnancy outcomes than those without. Poor knowledge of management of PIH and inadequate resources are a threat to the proper management of PIH. This underscores the need for increased human resources and capacity building as well as resource mobilisation for proper management of pregnant women. Urinalysis must be routinely done for all pregnant women regardless of their blood pressure.
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Affiliation(s)
- Monica Muti
- Department of Community Medicine, University of Zimbabwe, P.O. Box A178, Avondale, Harare, Zimbabwe.
| | - Mufuta Tshimanga
- Department of Community Medicine, University of Zimbabwe, P.O. Box A178, Avondale, Harare, Zimbabwe.
| | - Gombe T Notion
- Department of Community Medicine, University of Zimbabwe, P.O. Box A178, Avondale, Harare, Zimbabwe.
| | - Donewell Bangure
- Department of Community Medicine, University of Zimbabwe, P.O. Box A178, Avondale, Harare, Zimbabwe.
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Muti M, Gombe N, Tshimanga M, Takundwa L, Bangure D, Mungofa S, Chonzi P. Typhoid outbreak investigation in Dzivaresekwa, suburb of Harare City, Zimbabwe, 2011. Pan Afr Med J 2014; 18:309. [PMID: 25469202 PMCID: PMC4247891 DOI: 10.11604/pamj.2014.18.309.4288] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 07/23/2014] [Indexed: 11/18/2022] Open
Abstract
Introduction Typhoid fever is a systemic infection caused by a Gram negative bacterium, Salmonella typhi. Harare City reported 1078 cases of suspected typhoid fever cases from October 2011 to January 2012. We initiated an investigation to identify possible source of transmission so as to institute control measures. Methods An unmatched 1:1 case-control study was conducted. A questionnaire was administered to study participants to identify risk factors for contracting typhoid. A case was a resident of Dzivaresekwa who presented with signs and symptoms of typhoid between October and December 2011. Water samples were collected for microbiological analysis. Results 115 cases and 115 controls were enrolled. Drinking water from a well (OR= 6.2 95% CI (2.01-18.7)), attending a gathering (OR= 11.3 95% CI (4.3-29.95)), boiling drinking water (OR= 0.21 95% CI (0.06-0.76)) and burst sewer pipe at home (OR= 1.19 95% CI (0.67-2.14)) were factors associated with contracting typhoid. Independent risk factors for contracting typhoid were drinking water from a well (AOR = 5.8; 95% CI (1.90-17.78)), and burst sewer pipe at home (AOR = 1.20; 95% CI (1.10-2.19)). Faecal coli forms and E. coli were isolated from 8/8 well water samples. Stool, urine and blood specimens were cultured and serotyped for Salmonella typhi and 24 cases were confirmed positive. Shigella, Giardia and E coli were also isolated. Ciprofloxacin, X-pen and Rocephin were used for case management. No complications were reported. Conclusion Contaminated water from unprotected water sources was the probable source of the outbreak. Harare City Engineer must invest in repairing water and sewage reticulation systems in the city.
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Affiliation(s)
- Monica Muti
- Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
| | - Notion Gombe
- Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
| | - Mufuta Tshimanga
- Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
| | - Lucia Takundwa
- Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
| | - Donewell Bangure
- Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
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Italiani M, Casale M, Chirico L, Draghini L, Buono E, Muti M, Basagni L, Maranzano E. PO-325 HIGH-DOSE RATE BRACHYTHERAPY FOR EARLY BREAST CANCER: DOSIMETRIC DATA AND COSMETIC EFFECT. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)72291-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Aprile I, Torni C, Fiaschini P, Muti M. High-Grade Cerebral Glioma Characterization: Usefulness of MR Spectroscopy and Perfusion Imaging Associated Evaluation. Neuroradiol J 2012; 25:57-66. [PMID: 24028877 DOI: 10.1177/197140091202500108] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 01/14/2012] [Indexed: 11/17/2022] Open
Abstract
The aim of our study was to evaluate if both spectroscopy and perfusion magnetic resonance (MR) imaging are necessary to differentiate high grade gliomas from low grade tumour, or if only one of these techniques is sufficient. Sixty-five patients with cerebral glioma were retrospectively evaluated. All patients were studied both with spectroscopy and perfusion imaging. In 43 cases histological examination showed a high grade glioma while a low grade glioma was found in 22 patients. For every patient spectroscopic maximum Cho/NAA ratio and lactate presence was established maximum relative CBV value was evaluated by perfusion MR. Both for Cho/NAA and rCBV threshold values were obtained by means of ROC curves. Then diagnostic sensitivity and specificity for high grade gliomas identification was evaluated for spectroscopic data only (Cho/NAA and lactate presence that was considered a high grade glioma marker), for perfusional data only (rCBV) and finally for both spectroscopic and perfusional data together. Sensitivity was significantly highest evaluating both spectroscopic and perfusional data together (89.7%) in comparison with spectroscopy (74.4%) or perfusion (79.4%) alone. Instead specificity was slightly lower with all data (91.7%) in comparison with spectroscopy (95.8%) and perfusion (95.8%) alone. In conclusion, to characterize high grade gliomas it is more useful to evaluate spectroscopic and perfusional data together with respect only one of these techniques alone.
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Affiliation(s)
- I Aprile
- Department of Neuroradiology, S. Maria General Hospital; Terni, Italy -
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Paul KH, Muti M, Khalfan SS, Humphrey JH, Caffarella R, Stoltzfus RJ. Beyond food insecurity: how context can improve complementary feeding interventions. Food Nutr Bull 2011; 32:244-53. [PMID: 22073798 DOI: 10.1177/156482651103200308] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The role of context has not been elaborated with respect to current recommendations for complementary feeding interventions, apart from a gross distinction based on food security. OBJECTIVE Our objective was to compare two food-insecure settings in sub-Saharan Africa to determine how context (i.e., the set of local social, cultural, and physical circumstances) influences complementary feeding practices and nutrient intakes and how the results can help in the design of a suitable intervention strategy. METHODS We conducted formative research using 24-hour dietary recalls, household interviews, and focus group discussions with mothers of 6- to 12-month-old infants in rural Zimbabwe (n = 32) and Pemba Island, Zanzibar, Tanzania (n = 44). RESULTS In both settings, many infants had suboptimal nutrient intakes, poor dietary diversity, and poor hygiene. Breastfeeding practices were poor in Pemba, and the infants' diet had low energy density in Zimbabwe. Beyond food insecurity, contextual determinants of practices included inaccurate indigenous knowledge, time-consuming maternal livelihoods, family eating behaviors, local agriculture, and the local ecosystem. Both settings would require nutrition education, but it should target the broader indigenous ways of learning and family eating behaviors in order to achieve the necessary behavior change. A home-based fortificant would probably be enough for Pemban children, because the ecosystem of the island provides sufficient sources of macronutrients. However, Zimbabwean children appear to need a fortified food-based supplement to overcome the poor agricultural and economic context. CONCLUSIONS Assessing context was essential to intervention design. A framework to guide future formative research is proposed.
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Muti M, Pergentini I, Corsi M, Viaggi C, Caramelli A, Musetti L, Corsini G, Dell’Osso L. Lithium and valproate combination: Therapeutic strategies in a sample of patients with bipolar disorder. Eur Psychiatry 2011. [DOI: 10.1016/s0924-9338(11)71946-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
IntroductionLithium is the agent that has shown more efficacy for the treatment of Bipolar Disorder (BD), anyway a single agent isn’t effective to control all aspects of the syndrome.The mood-stabilizer frequently used, in combination with Lithium, is Valproate which presents different methabolism and side effects. Further both molecules are glycogen synthase kinase-3 (GSK-3b) inhibitors and have synergistic neuroprotective action.ObjectivesWe underline the need to better investigate Lithium and Valproate combination therapy in BD.AimsObservation of Lithium and Valproate combination therapy in a sample of patients with BD, considering doses and serum levels.Methods56 patients with BD (mean age 38 ± 0,02), followed at the day hospital of the Psychiatric Clinic, University of Pisa, were studied. Serum levels evaluated at the Section of Pharmacology, Department of Neuroscience, University of Pisa.ResultsWe identified 5 comparison groups depending on the dose intake of Lithium (11 subjects: 300 mg /die, 9: 450 mg/die, 19: 600 mg/die, 7: 750 mg/die, 10: 900 mg/die) with increased serum levels of the medication (0.27 mEq/l, 0.37 mEq/l, 0.50 mEq/l, 0.52 mEq/l, 0,70 mEq/l). There are not significant differences between groups related to both, the mean dose intake of Valproate (772 mg/die, 744.4 mg/die, 867.5 mg/die, 821.4 mg/die, 845 mg/die) and its serum levels (45.2 mg/L, 46.6 mg/L, 53.2 mg/L, 47.4 mg/L, 48.4 mg/L).ConclusionsThis study aims to identify the effective dose of Lithium in combination with Valproate able to determine the prevention of relapse in BD patients. The use of the lower dose of Lithium maintaining therapeutic effectivness, means reducing side effects, toxicity and the need for constant monitoring.
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Paul KH, Muti M, Chasekwa B, Mbuya MNN, Madzima RC, Humphrey JH, Stoltzfus RJ. Complementary feeding messages that target cultural barriers enhance both the use of lipid-based nutrient supplements and underlying feeding practices to improve infant diets in rural Zimbabwe. Matern Child Nutr 2010; 8:225-38. [PMID: 22405701 DOI: 10.1111/j.1740-8709.2010.00265.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Supplementation with lipid-based nutrient supplements (LiNS) is promoted as an approach to prevent child undernutrition and growth faltering. Previous LiNS studies have not tested the effects of improving the underlying diet prior to providing LiNS. Formative research was conducted in rural Zimbabwe to develop feeding messages to improve complementary feeding with and without LiNS. Two rounds of Trials of Improved Practices were conducted with mothers of infants aged 6-12 months to assess the feasibility of improving infant diets using (1) only locally available resources and (2) locally available resources plus 20 g of LiNS as Nutributter®/day. Common feeding problems were poor dietary diversity and low energy density. Popular improved practices were to process locally available foods so that infants could swallow them and add processed local foods to enrich porridges. Consumption of beans, fruits, green leafy vegetables, and peanut/seed butters increased after counselling (P < 0.05). Intakes of energy, protein, vitamin A, folate, calcium, iron and zinc from complementary foods increased significantly after counselling with or without the provision of Nutributter (P < 0.05). Intakes of fat, folate, iron, and zinc increased only (fat) or more so (folate, iron, and zinc) with the provision of Nutributter (P < 0.05). While provision of LiNS was crucial to ensure adequate intakes of iron and zinc, educational messages that were barrier-specific and delivered directly to mothers were crucial to improving the underlying diet.
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Affiliation(s)
- Keriann H Paul
- Division of Nutritional Sciences, Cornell University, 120 Savage Hall, Ithaca, New York 14853, USA.
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Mbuya MNN, Humphrey JH, Majo F, Chasekwa B, Jenkins A, Israel-Ballard K, Muti M, Paul KH, Madzima RC, Moulton LH, Stoltzfus RJ. Heat treatment of expressed breast milk is a feasible option for feeding HIV-exposed, uninfected children after 6 months of age in rural Zimbabwe. J Nutr 2010; 140:1481-8. [PMID: 20573941 PMCID: PMC3140214 DOI: 10.3945/jn.110.122457] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In the context of a prevention of mother to child transmission of HIV program promoting exclusive breast-feeding (EBF) to 6 mo and offering HIV-PCR testing at approximately 6 mo, we ascertained the feasibility of expressing and heat-treating (EHT) all breast milk fed to HIV-exposed, uninfected infants following 6 mo of EBF. Twenty mother-baby pairs were enrolled from a hospital in rural Zimbabwe. Research nurses provided lactation, EHT, and complementary feeding counseling through 21 home visits conducted over an 8-wk period and collected quantitative and qualitative data on the mothers' EHT experiences, children's diets, and anthropometric measurements. Mothers kept daily logs of EHT volumes and direct breast-feeding episodes. Mothers successfully initiated and sustained EHT for 4.5 mo (range, 1-11 mo), feeding 426 +/- 227 mL/d (mean +/- SD). By wk 2 of follow-up, children were receiving EHT and Nutributter-enriched complementary foods that satisfied 100% of their energy requirements. During the 8-wk follow-up period, no growth faltering was experienced [changes in weight-for-age, weight-for-length, and length-for-age Z scores = +0.03 +/- 0.50; +0.77 +/- 1.59; and +0.02 +/- 0.85 (mean +/- SD), respectively]. Stigma was not a major deterrent, likely due to a social marketing campaign for EBF that promoted EHT as a practice to sustain breast-feeding for all women. This study provides evidence that resource-poor rural women can initiate and sustain EHT given family and health systems support. EHT provides a strategy for improving the diets of HIV-exposed but uninfected children after direct breast-feeding has ceased.
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Affiliation(s)
- Mduduzi N. N. Mbuya
- Zvitambo Project, Harare, Zimbabwe; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205; PATH, Seattle, WA 98107; Ministry of Health and Child Welfare, Harare, Zimbabwe; and Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853
| | - Jean H. Humphrey
- Zvitambo Project, Harare, Zimbabwe; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205; PATH, Seattle, WA 98107; Ministry of Health and Child Welfare, Harare, Zimbabwe; and Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853,To whom correspondence should be addressed. E-mail:
| | - Florence Majo
- Zvitambo Project, Harare, Zimbabwe; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205; PATH, Seattle, WA 98107; Ministry of Health and Child Welfare, Harare, Zimbabwe; and Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853
| | - Bernard Chasekwa
- Zvitambo Project, Harare, Zimbabwe; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205; PATH, Seattle, WA 98107; Ministry of Health and Child Welfare, Harare, Zimbabwe; and Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853
| | - Alison Jenkins
- Zvitambo Project, Harare, Zimbabwe; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205; PATH, Seattle, WA 98107; Ministry of Health and Child Welfare, Harare, Zimbabwe; and Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853
| | - Kiersten Israel-Ballard
- Zvitambo Project, Harare, Zimbabwe; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205; PATH, Seattle, WA 98107; Ministry of Health and Child Welfare, Harare, Zimbabwe; and Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853
| | - Monica Muti
- Zvitambo Project, Harare, Zimbabwe; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205; PATH, Seattle, WA 98107; Ministry of Health and Child Welfare, Harare, Zimbabwe; and Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853
| | - Keriann H. Paul
- Zvitambo Project, Harare, Zimbabwe; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205; PATH, Seattle, WA 98107; Ministry of Health and Child Welfare, Harare, Zimbabwe; and Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853
| | - Rufaro C. Madzima
- Zvitambo Project, Harare, Zimbabwe; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205; PATH, Seattle, WA 98107; Ministry of Health and Child Welfare, Harare, Zimbabwe; and Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853
| | - Lawrence H. Moulton
- Zvitambo Project, Harare, Zimbabwe; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205; PATH, Seattle, WA 98107; Ministry of Health and Child Welfare, Harare, Zimbabwe; and Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853
| | - Rebecca J. Stoltzfus
- Zvitambo Project, Harare, Zimbabwe; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205; PATH, Seattle, WA 98107; Ministry of Health and Child Welfare, Harare, Zimbabwe; and Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853
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Paul KH, Khalfan SS, Muti M, Humphrey JH, Stoltzfus RJ. Beyond food insecurity: How context can help improve complementary feeding interventions. FASEB J 2010. [DOI: 10.1096/fasebj.24.1_supplement.334.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Monica Muti
- Ministry of Health and Child WelfareHarareZimbabwe
| | - Jean H. Humphrey
- ZVITAMBOHarareZimbabwe
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMD
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Paul K, Muti M, Madzima R, Humphrey JH, Stoltzfus RJ. Counseling on mashing local foods for infants increases nutrient intakes but less than supplementation with a fortified spread in rural Zimbabwe. FASEB J 2009. [DOI: 10.1096/fasebj.23.1_supplement.916.9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Keriann Paul
- Division of Nutritional SciencesCornell UniversityIthacaNY
| | - Monica Muti
- National Nutrition Unit, Ministry of Health and Child WelfareHarareZimbabwe
| | - Rufaro Madzima
- National Nutrition Unit, Ministry of Health and Child WelfareHarareZimbabwe
| | - Jean H Humphrey
- ZVITAMBOHarareZimbabwe
- International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
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Pini S, Chelli B, Abelli M, Muti M, Gesi C, Cardini A, Lari L, Cassano G, Lucacchini A, Martini C. Platelet 18 kDa translocator protein density is reduced in depressed patients with adult separation anxiety. Eur Psychiatry 2008. [DOI: 10.1016/j.eurpsy.2008.01.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Principi M, Italiani M, Guiducci A, Aprile I, Muti M, Giulianelli G, Ottaviano P. Perfusion MRI in the evaluation of the relationship between tumour growth, necrosis and angiogenesis in glioblastomas and grade 1 meningiomas. Neuroradiology 2003; 45:205-11. [PMID: 12687302 DOI: 10.1007/s00234-002-0937-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2002] [Accepted: 11/14/2002] [Indexed: 11/25/2022]
Abstract
Angiogenesis is a common characteristic of tumours, and it is reasonable to assume that it has an influence on tumour growth, depending on the grade of malignancy. We therefore studied angiogenesis in 25 patients: 14 with glioblastoma multiforme and 11 with grade I meningioma. Our aim was to assess how angiogenesis conditions growth and necrosis. The patients underwent MRI with standard and perfusion sequences. We calculated the volume of each tumour; for the glioblastomas the solid portion was taken as the difference between the overall volume and the volume of any necrotic portion. In the glioblastomas, we found an inverse relationship between blood volume and the size of the tumour, whereas in the meningiomas there was of a direct relationship. These correlations confirm in vivo the knowledge about necrosis in glioblastomas and its relationship to their inadequate vascular network. On the contrary, grade 1 meningiomas show an equilibrium between their microcirculation and the cellular component.
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Affiliation(s)
- M Principi
- Operative Unit of Neuroradiology, Azienda Ospedaliera Santa Maria, Via T. Di Joannuccio 1, 05100, Terni, Italy.
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Muti M, Aprile I, Principi M, Italiani M, Guiducci A, Giulianelli G, Ottaviano P. Study on the variations of the apparent diffusion coefficient in areas of solid tumor in high grade gliomas. Magn Reson Imaging 2002; 20:635-41. [PMID: 12477560 DOI: 10.1016/s0730-725x(02)00594-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Present knowledge suggests that in glioblastoma multiforme the value of the apparent diffusion coefficient (ADC) is elevated in the solid part and hyperintense in T1, in spite of the elevated cellularity, and also in areas where peritumoral vasogenic edema is present. The purpose of our study has been to verify in vivo if the ADC increases in areas of solid tumor because of an increased presence of edema, like it happens in areas surrounding the tumor. Sixteen patients with histologically verified glioblastoma multiforme underwent a magnetic resonance (MR) examination with sequences: T1-weighted pre and post contrast, diffusion-weighted at b = 0 and b = 1000 s/mm(2), perfusion-weighted. One hundred sixty-five regions of interest (ROI) have been obtained for all set of patients. In each ROI we have estimated 4 parameters: ADC, intensity of T2-signal normalised to the white matter (SI(T2W)(n)), regional cerebral blood volume (rCBV), T1-signal enhancement (E%). With the SI(T2W)(n) the presence of edema was estimated. For each pair of measured parameters a statistical test of linear regression on the set of all ROI was made. A directed linear correlation between: ADC and SI(T2W)(n) (p <or= 0.001; r = 0.26), E% and SI(T2W)(n) (p <or= 0.001; r = 0.35), E% and ADC (p <or= 0.001; r = 0.33) is present. Also present is an inverse linear correlation between: ADC and rCBV (p <or= 0.05; r = 0.18). Any significant linear correlation between: E% and rCBV (r = 0.01), SI(T2W)(n) and rCBV (r = 0.13) was not found. In areas of solid tumor the increment of the ADC is correlated with the increment of edema: this result can be explained if we assume a three-dimensional diffusion. Furthermore, the increase of ADC is inversely correlated to the rCBV. The E% and the rCBV are statistically independent.
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Affiliation(s)
- M Muti
- Department of Radiotherapy, Hospital "S Maria" of Terni, Terni, Italy.
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Aprile I, Muti M, Principi M, Bartolini N, Zenoni A, Tazza G, Italiani M, Ottaviano P. A Magnetic Resonance comparative study between enhancement, rCBV and ACD in brain glioblastomas. Radiol Med 2002; 104:87-91. [PMID: 12386559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
PURPOSE Perfusion and diffusion Magnetic Resonance Imaging (MRI) studies allow us to quantitatively evaluate the vascularisation and anaplastic grade of glioblastomas based on the regional cerebral blood volume (rCBV) and apparent diffusion coefficient (ADC) values. The aim of our study was to compare these values and enhancement % in order to determine whether enhancement of glioblastomas depends mainly on their vascularisation or anaplastic grade. MATERIALS AND METHODS Seventeen patients with brain glioblastomas were studied with perfusion, diffusion and T1-weighted Spin-Echo MR sequences, with and without contrast medium. The quantitative evaluations were made on solid tumour tissue regions of interest (ROI), and the high vascularisation (high rCBV) and low anaplastic grade (high ADC) ROI group was separated from the low vascularisation (low rCBV) and high anaplastic grade (low ADC) group. The mean enhancement % values of the two groups were compared by using statistical METHODS. RESULTS In 14 patients there were no statistically significant differences between the two groups. In one patient, the enhancement of high anaplastic grade and low vascularisation ROIs was significantly higher, whereas in two patients, the enhancement of high vascularisation and low anaplastic ROIs clearly prevailed. CONCLUSIONS Given that the anaplastic grade is proportional to blood-brain barrier (BBB) impairment, our results show that, in most cases, enhancement of glioblastomas is equally dependent on vascularisation and BBB impairment.
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Affiliation(s)
- I Aprile
- Unità Operativa di Neuroradiologia e Risonanza Magnetica, Modulo di Fisica Sanitaria, Azienda Ospedaliera S. Maria, Terni, Italy.
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Abstract
BACKGROUND The aim of the present study was to assess the cost/efficacy of the pleural tent procedure after upper lobectomy. METHODS A prospective randomized analysis was performed on 50 patients submitted to upper lobectomy and divided into two groups: group 1 (25 patients) with pleural tent; group 2 (25 patients) without pleural tent. RESULTS The univariate comparison between the two groups did not show any significant difference in terms of age, gender, spirometry, smoking history, chronic obstructive pulmonary disease index, side of tumor, arterial oxygen tension, arterial carbon dioxide tension, size and location of tumor, presence of pleural adhesions, length of the stapled parenchyma, and operative time. Pleural tent significantly reduced the days of postoperative air leak (1.2 versus 5.8, p = 0.01), chest tubes (5.4 versus 10.4, p = 0.01), and hospital stay (6.9 versus 10.8, p = 0.01). Moreover, no difference was noted between the two groups in terms of pleural effusion in the first postoperative 48 hours, need of postoperative blood transfusion, and occurrence of other complications. CONCLUSIONS Pleural tenting after upper lobectomy is a safe and effective procedure and its routine use is warranted.
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Affiliation(s)
- A Brunelli
- Department of Thoracic Surgery, University of Ancona, Italy.
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Abstract
We describe a variation of the technique of transthoracic forequarter amputation, consisting of a completely anterior approach, removal of the left forequarter en bloc with the chest wall and lung, and sparing of the scapula. This latter bone is mobilized and is used, along with the transposition of the lower ribs, to stabilize the chest wall.
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Affiliation(s)
- A Fianchini
- Department of Thoracic Surgery, University of Ancona, Italy
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Muti M. [Representation of death in schizophrenics]. Riv Sper Freniatr Med Leg Alien Ment 1972; 96:129-42. [PMID: 5030110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Buffa B, Cotta Ramusino M, Muti M. [Mental deterioration in arteriosclerotic subjects before and after treatment with SP 54 and with a placebo]. Riv Sper Freniatr Med Leg Alien Ment 1969; 93:209-18. [PMID: 5402879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Buffa B, Cotta Ramusino M, Muti M. [Haloperidol in states of psychomotor excitation and in anxiety states secondary to acute cardiocirculatory insufficiency]. Riv Sper Freniatr Med Leg Alien Ment 1966; 90:1595-601. [PMID: 5999621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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