Prevalence and determinants of contraceptive use in rural Northeastern Nigeria: Results of a mixed qualitative and quantitative assessment

Musa Abubakar Kana, Yetunde O Tagurum, Zuwaira I Hassan, Tolulope O Afolanranmi, Gabriel Ofikwu Ogbeyi, Joshua Abubakar Difa, Peter Amede, Olubunmi O Chirdan

Annals of Nigerian Medicine 2016 10(1):3-10

Background: Family planning is an effective intervention for promoting maternal health, but its acceptability and utilization are impeded by many factors in Northern Nigeria. This study aims to assess the prevalence and identify determinants of contraceptive use in a rural setting. Methods: A mixed method cross-sectional descriptive study was conducted in Gumau, a rural community of Bauchi State, Northeastern Nigeria. Quantitative data were collected using an interviewer-administered questionnaire while the qualitative data were collected using focus group discussions with selected women and their husbands, and key informant interviews with family planning service providers. Results: Family planning commodities were regularly available in the community and the prevalence of current contraceptive use was 26%. The main determinants included age <35 years (odds ratio [OR] = 3.0; confidence interval [CI] = 1.0–8.9; P = 0.028), Christian religious affiliation (OR = 2.4; CI = 1.1–4.9; P= 0.025), and spousal support (OR = 55.1; CI = 16.0–189.8; P = 0.000). The qualitative data also reinforced the crucial role of sociocultural factors, especially men in decision-making and contraceptive uptake. Conclusion: Sociodemographic factors, especially spousal support is a key determinant of contraceptive use that should be considered in the design of acceptable family planning intervention.

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The persistent problem of diagnostic errors

Dauda Eneyamire Suleiman

Annals of Nigerian Medicine 2016 10(1):1-2



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Prevalence of malaria among HIV patients on highly active antiretroviral therapy in Kogi State, North Central Nigeria

Frederick Olusegun Akinbo, Peter Joel Anate, David Bolaji Akinbo, Richard Omoregie, Stephen Okoosi, Abubakar Abdulsalami, Banabas Isah

Annals of Nigerian Medicine 2016 10(1):11-15

Background: Malaria and HIV diseases kill millions of people yearly, and they are the scourges of developing nations. This study was conducted to determine the coinfections of malaria and HIV, and the effect of demographic characters on HIV-infected patients receiving highly active antiretroviral therapy (HAART) in Kogi State, Nigeria. Methods: Five hundred and eleven participants consisting of 411 (51 males and 360 females) HIV-infected patients on HAART and 100 (8 males and 92 females) apparently healthy HIV-noninfected individuals who served as controls were enrolled in this study. Blood sample was collected from each participant and malaria was diagnosed using the standard procedure. Results: An overall prevalence of 7.8% and 2% of malarial infection was observed in HIV-infected patients on HAART and non-HIV participants, respectively. The prevalence of malaria among HIV patients on HAART differed signifi cantly (P < 0.0001) among the local government councils, with patients from Ogori-Magongo having the least prevalence (0.0%). Age, gender, type of occupation, clinical manifestations, anemia, and CD4+ T-cell count <200 cells/μL affected the prevalence of malarial infection (P < 0.05) in this study. Conclusion: Diagnosis of malaria among HIV patients on HAART is advocated.

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Factors associated with caregivers' knowledge about childhood asthma in Ilesa, Nigeria

Bankole Peter Kuti, Kehinde Oluyori Omole

Annals of Nigerian Medicine 2016 10(1):30-36

Background: Children with asthma depend on their parents/caregivers for their asthma control. The level of knowledge of these caregivers has been found to affect the control of the disease. This study aims to assess the knowledge of parents/caregivers of children with asthma and to determine the factors associated with these levels of knowledge. Methods: Consecutive children aged 2–14 years with physician-diagnosed asthma and their caregivers who attend the pediatric chest clinic of the Wesley Guild Hospital, Ilesa, Nigeria, during a 6 months study period were recruited. Parental/caregiver's level of knowledge about childhood asthma was assessed using a 25-item Asthma Knowledge Questionnaire (AKQ) and knowledge levels were categorized into good and poor knowledge. Relevant history and examination findings were appropriately compared between those with good and poor knowledge. Results: Fifty-two caregiver–child pairs were participated in the study. The children age ranged from 2 to 13 years with mean (standard deviation [SD]) of 6.6 (3.6) years and male:female ratio of 1.7:1. Majority (88.5%) of the children had mild intermittent asthma. Mother is the caregiver in 48 (92.3%) of participants. The mean (SD) score from the AKQ was 11.2 (3.7) which ranged from 1 to 18. The scores were significantly higher in questions related to triggers of exacerbation and quality of life of asthmatics than those related to nature, diagnosis, and treatment of the disease (P < 0.05). Twenty (38.5%) caregivers had a good score (AKQ >12) and good knowledge correlated positively with duration of diagnosis of asthma (P < 0.05). Good childhood asthma knowledge was observed among caregivers with family history of asthma, previous asthma-related hospitalization in the child, and in those with postsecondary education significantly had better knowledge of childhood asthma. Conclusion: Caregivers' knowledge about childhood asthma in Ilesa is poor particularly as related to nature, diagnosis, and treatment. However, the presence of family history of asthma, previous asthma-related hospitalization, and high educational status in caregivers of children with asthma are significantly associated with increased knowledge about the condition. Attention should be placed on more comprehensive parental and child asthma education for successful asthma management.

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Assessment of Vitamin A supplementation coverage and associated barriers in Sokoto State, Nigeria

Mohammed Dantani Adamu, Nasiru Muhammad

Annals of Nigerian Medicine 2016 10(1):16-23

Aim: The aim of this study is to evaluate the Vitamin A supplement (VAS) and measles vaccination coverage in a district of Sokoto State, Nigeria. Objectives: To determine the VAS and measles coverage in the district among children aged 6 months to 59 months and factors associated with nonuptake/poor uptake from provider's perspective. Methodology: Mothers of children aged 6–59 months or their caretakers were interviewed for data on demography, socioeconomic status of the family, knowledge of Vitamin A, and receiving VASs and measles vaccination. Reasons for not receiving supplement and measles vaccine were sought from mothers and health care workers. Results: A total of 900 children were enrolled from 20 clusters, of which 61.6% of children had received at least 1 dose of VAS in the past 12 months. Only 41.6% of the children received the two annual recommended doses of VAS. The measles vaccine coverage was 42.1%. After multivariate regression analysis, fathers' education (none or Islamic), mother's education (none or Islamic), mothers' occupation (manual, homemaker), and the child being female gender were found to be predictors of poor uptake of VAS. Fathers' disapproval was the most common barrier to uptake of both measles vaccine (64.8%) and VAS (69%) from both mothers' and health care workers' perspective. Conclusion: This study showed poor coverage of both VAS and measles vaccination among children in Gwadabawa district and fathers' disapproval was the major reason for poor uptake

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Vulvar varicosities in pregnancy

Matthew Chum Taingson, Joel A Adze, Stephen B Bature, Durosinlorun M Amina, Mohammed Caleb, Abubakar Amina

Annals of Nigerian Medicine 2016 10(1):44-45

A case of vulval varicosities occurring during pregnancy that was managed conservatively and regressed completely postpartum is presented.

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Treatment of Ureteral Fibroepithelial Polyp by Ureteroscopy Combined with Holmium Laser or Thulium Laser: A Retrospective Study

Photomedicine and Laser Surgery , Vol. 0, No. 0.


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Fracture Resistance of Endodontically Retreated Roots After Retreatment Using Self-Adjusting File, Passive Ultrasonic Irrigation, Photon-Induced Photoacoustic Streaming, or Laser

Photomedicine and Laser Surgery , Vol. 0, No. 0.


http://ift.tt/2c2UTLq

Novel Treatment Approach for Deep Palmoplantar Warts Using Long-Pulsed 1064-nm Nd:YAG Laser and a Moisturizing Cream Without Prior Paring of the Wart Surface

Photomedicine and Laser Surgery , Vol. 0, No. 0.


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A bootstrap approach to implementation science

A troubling gap exists between scientific breakthroughs and clinical practice. New discoveries and evidence-based guidelines are typically slow to fully penetrate all levels of health care delivery. The long-standing assumption that interventions tested in randomized clinical trials (RCTs) will disseminate into day-to-day practice is largely incorrect; only 14% of new scientific information becomes part of widespread clinical practice within 17 years after its discovery.1,2 Even where evidence-based guidelines are available, they are often underused in primary care.

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Annatto seed hypersensitivity in a pediatric patient

Food allergy is of increasing concern and prevalence, particularly in children younger than 5 years who reside in urbanized areas of developed countries.1 In response to this trend, The Food Allergy Labeling and Consumer Protection Act of 2004 (Public Law 108-282, Title II) was passed, requiring that the 10 most common food allergens be listed on nutrition labels. This legislation, although progressive, does not capture other allergens such as food additives that can cause near-fatal reactions.1

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Severe adverse drug reactions induced by hydrochlorothiazide

Hydrochlorothiazide has been used for years alone or in combination with other antihypertensive drugs in the treatment of hypertension. Although severe adverse reactions with systemic involvement may occur with its administration, in most cases, these reactions are not initially attributed to this drug.1

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Exploring asthma control cutoffs and economic outcomes using the Asthma Control Questionnaire

Understanding the effect of worsening asthma control on expenditures and health resource utilization (HRU) is important.

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Table of Contents

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Ataxia telangiectasia presenting as hyper IgM syndrome without neurologic signs

A 3-year-old girl of Iraqi descent was well until late infancy, when she developed frequent wheezing and recurrent infections, including otitis media, sinusitis, and pneumonia, for which she was treated with monthly oral antibiotics. She was diagnosed as having asthma and treated with bronchodilators, budesonide, and multiple courses of oral steroids. She had a history of mild eczema and red eyes, diagnosed as an allergy by an ophthalmologist. At 2 years of age, tympanostomy tubes were placed.

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Instructions for Authors

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Erratum

In the article entitled "A systematic review of epinephrine degradation with exposure to excessive heat or cold" (Ann Allergy Asthma Immunol 2016;117:79-87), there was an error in Table 6. The correct table appears below.

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Efficacy of the novel nasal steroid S0597 tested in an environmental exposure unit

S0597 is a novel glucocorticosteroid that was formulated as an intranasal spray to treat seasonal allergic rhinitis (SAR). In a previous phase 2 study, doses of 100 to 400 μg twice daily were well tolerated and more effective than placebo for improving nasal symptoms induced by grass pollen.

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Allergy test outcomes in patients self-reported as having penicillin allergy

Penicillin allergy is associated with increased antibiotic resistance and health care costs. However, most patients with self-reported penicillin allergy are not truly allergic.

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The effect of a holding chamber on albuterol metered-dose inhaler product differences

Three albuterol sulfate metered-dose inhaled (MDI) products (Ventolin HFA, Proventil HFA, and ProAir HFA) are marketed in the United States to provide the same total dose of albuterol sulfate. However, it is widely known that the fine particle dose (<5 μm) is the portion of the particle distribution that actually reaches the lungs and provides therapeutic benefit.

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Outcomes of corticosteroid prophylaxis for hypersensitivity reactions to low osmolar contrast media in high-risk patients

Corticosteroid prophylaxis has been widely adopted for the prevention of acute allergic-like reactions to iodinated contrast media, but its use is still controversial because there is no strong evidence supporting its efficacy before administration of nonionic low osmolar contrast media (LOCM).

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Erratum

In the article entitled "Outcomes before and after treatment escalation to Global Initiative for Asthma steps 4 and 5 in severe asthma" (Ann Allergy Asthma Immunol 2015;114:462–469), there are two mentions of "expenditures per HRU" in the abstract. The correct text should be "expenditures and HRU."

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Influence of health literacy and trust in online information on food allergy quality of life and self-efficacy

Health literacy among caregivers of food allergic individuals (FAIs) is poorly described, as are the information sources sought regarding food allergy.

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Prevalence of fish and shellfish allergy

Accurate information on the prevalence of food allergy facilitates a more evidence-based approach to planning of allergy services and can identify important geographic variations.

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Telemedicine is as effective as in-person visits for patients with asthma

Access to asthma specialists is a problem, particularly in rural areas, thus presenting an opportunity for management using telemedicine.

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Omalizumab and allergen immunotherapy in a patient with asthma and inhaled corticosteroid–induced adrenal suppression

Inhaled corticosteroids (ICSs) represent the mainstay of long-term treatment for asthma.1 With long-term use, even this cornerstone of asthma management has the potential for corticosteroid-induced adverse effects, such as decrease in linear growth and, more rarely, adrenal suppression.2,3 When patients experience these adverse effects, clinicians must seek and are confronted by alternative management approaches that may control asthma symptoms with little to no corticosteroid use. Allergen immunotherapy (AIT) is a viable treatment option for asthma in patients whose asthma is associated with allergic sensitization.

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Association of TG2 from mast cells and chronic spontaneous urticaria pathogenesis

Mast cells and their mediators play important roles in chronic spontaneous urticaria (CSU) pathogenesis. Transglutaminase 2 (TG2) is expressed in activated mast cells and contributes to airway inflammation in allergic asthma.

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Information for Readers

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Editorial Board

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In vitro assays suggest Shenqi Fuzheng Injection has the potential to alter melanoma immune microenvironment

Publication date: 24 December 2016
Source:Journal of Ethnopharmacology, Volume 194
Author(s): Juan Du, Brian Chi Yan Cheng, Xiu-Qiong Fu, Tao Su, Ting Li, Hui Guo, Su-Mei Li, Jin-Feng Wu, Hua Yu, Wen-Hua Huang, Hui Cao, Zhi-Ling Yu
Ethnopharmacological relevanceA modern agent Shenqi Fuzheng Injection (SFI), prepared from Codonopsis Radix and Astragali Radix, has been commonly used as a supplementary therapy for cancers including melanoma. This agent was derived from a formula documented in the "National Collection of Chinese Medicine Prescriptions". The formula has long been used as a remedy for Qi deficiency that is closely associated with cancer-related fatigue and poor quality of life. However, the antimelanoma mechanisms of SFI remain unclear. Here we tested if SFI exerted antimelanoma effects by reprograming the tumour immune microenvironment using in vitro assays.Materials and methodsThe cytotoxic activities of Jurkat T cells when co-cultured with A375 cells were determined in the presence or absence of SFI. The migratory activities of Jurkat T cells were examined in the transwell assay system. The mRNA expression and production of cytokines (IL-10, TGF β and VEGF) in A375 cells in the presence or absence of SFI were determined by real-time PCR and ELISA, respectively.ResultsWhen A375 cells were co-cultured with Jurkat T cells in the presence of SFI (220µg/mL), a potent cytotoxicity effect against A375 cells was observed. Supernatants from A375 cells that were treated with SFI (110 and 220µg/mL) significantly increased the migratory capacity of Jurkat T cells in transwell assays. SFI also markedly reduced the mRNA expression levels and the release of immunosuppressive cytokines IL-10, TGF-β and VEGF in A375 cells in a concentration-dependent manner.ConclusionsSFI enhanced the cytotoxic and migratory activities of Jurkat T cells towards A375 melanoma cells. The effects were associated with SFI's suppression on immunosuppressive cytokines for their release from and gene expressions in A375 melanoma cells. These in vitro findings suggested that SFI might reprogramme the immunosuppressive melanoma microenvironment in vivo to enhance the cytotoxicity of tumour-infiltrating immune cells. This study provides a pharmacological basis for the adjunctive use of SFI in melanoma treatment.



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In vitro and in silico antioxidant and toxicological activities of Achyrocline satureioides

Publication date: 24 December 2016
Source:Journal of Ethnopharmacology, Volume 194
Author(s): Andréia C.F. Salgueiro, Vanderlei Folmer, Hemerson S. da Rosa, Márcio T. Costa, Aline A. Boligon, Fávero R. Paula, Daniel H. Roos, Gustavo O. Puntel
Ethnopharmacological relevanceAchyrocline satureioides ("macela or marcela") is a medicinal plant, traditionally collected in "Good Friday" before sunrise. In traditional medicine, dried flowers of A. satureioides are used as anti-dyspeptic, antispasmodic and anti-inflammatory.Aim of the studyTo evaluate the phytochemical profile and to present an in vitro and in silico approach about toxicity and antioxidant potential of A. satureioides flowers extract and its major phytoconstituents.Materials and methodsPlant were collected according to the popular tradition. Extract were obtained by infusion and analyzed from high-performance liquid chromatography. Toxicity was evaluated in Artemia salina and human lymphocytes. Extract antioxidant activity was determined with total antioxidant capacity, DPPH^• and ABTS^+• scavenging, ferric reducing antioxidant power, deoxyribose degradation assay, and thiobarbituric acid reactive substances (TBA-RS) assay. TBA-RS inhibitions were evaluated in brain of rats for A. satureioides extract and its major phytoconstituents. Predictions of activity spectra for substances and in silico toxicity evaluation from major phytoconstituents were performed via computer simulation.ResultsChromatographic data indicated isoquercitrin, quercetin and caffeic acid as main compounds in flowers extract. Toxicity tests demonstrated a very low toxic potential of A. satureioides. Extract exhibited antioxidant activities in low concentrations. Both extract and major phytochemicals standards showed protection against lipid peroxidation in brain of rats. Computer simulations pointed some biological activities in agreement with traditional use, as well as some experimental results found in this work. Moreover, in silico toxic predictions showed that the A. satureioides major compounds had low probability for toxic risk.ConclusionOur results indicate that A. satureioides infusion possesses low toxicological potential and an effective antioxidant activity. These findings confirm the traditional use of this plant in the folk medicine.

Graphical abstract

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We Just Made Publishing Even Easier: Introducing the New Cureus Publishing Process

After months of hard work, we're very excited to introduce the brand new Cureus publishing system! Are you ready to submit your next (or your first) article to Cureus? Well, there's no time like the present – the new publishing system is live right now. We've collected your feedback over the past few years and […]

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Bilateral Oophorectomy and Breast Cancer Risk in BRCA1 and BRCA2 Mutation Carriers

Background: Whether oophorectomy reduces breast cancer risk among BRCA mutation carriers is a matter of debate. We undertook a prospective analysis of bilateral oophorectomy and breast cancer risk in BRCA mutation carriers.

Methods: Subjects had no history of cancer, had both breasts intact, and had information on oophorectomy status (n = 3722). Women were followed until breast cancer diagnosis, prophylactic bilateral mastectomy, or death. A Cox regression model was used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of breast cancer associated with oophorectomy (coded as a time-dependent variable). All statistical tests were two-sided.

Results: Over a mean follow-up of 5.6 years, 350 new breast cancers were diagnosed. Among women with a BRCA1 or BRCA2 mutation, oophorectomy was not associated with breast cancer risk compared with women who did not undergo an oophorectomy. The age-adjusted hazard ratio associated with oophorectomy was 0.96 (95% CI = 0.73 to 1.26, P = .76) for BRCA1 and was 0.65 (95% CI = 0.37 to 1.16, P = .14) for BRCA2 mutation carriers. In stratified analyses, the effect of oophorectomy was statistically significant for breast cancer in BRCA2 mutation carriers diagnosed prior to age 50 years (age-adjusted HR = 0.18, 95% CI = 0.05 to 0.63, P = .007). Oophorectomy was not associated with risk of breast cancer prior to age 50 years among BRCA1 mutation carriers (age-adjusted HR = 0.79, 95% CI = 0.55 to 1.13, P = .51).

Conclusions: Findings from this large prospective study support a role of oophorectomy for the prevention of premenopausal breast cancer in BRCA2, but not BRCA1 mutation carriers. These findings warrant further evaluation.

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A Lesion-Based Response Prediction Model Using Pretherapy PET/CT Image Features for Y90 Radioembolization to Hepatic Malignancies

We present a probabilistic approach to identify patients with primary and secondary hepatic malignancies as responders or nonresponders to yttrium-90 radioembolization therapy. Recent advances in computer-aided detection have decreased false-negative and false-positive rates of perceived abnormalities; however, there is limited research in using similar concepts to predict treatment response. Our approach is driven by the goal of precision medicine to determine pretherapy fluorine-18-2-fluoro-2-deoxy-d-glucose positron emission tomography and computed tomography imaging parameters to facilitate the identification of patients who would benefit most from yttrium-90 radioembolization therapy, while avoiding complex and costly procedures for those who would not. Our algorithm seeks to predict a patient's response by discovering common co-occurring image patterns in the lesions of baseline fluorine-18-2-fluoro-2-deoxy-d-glucose positron emission tomography and computed tomography scans by extracting invariant shape and texture features. The extracted imaging features were represented as a distribution of each subject based on the bag-of-feature paradigm. The distribution was applied in a multinomial naive Bayes classifier to predict whether a patient would be a responder or nonresponder to yttrium-90 radioembolization therapy based on the imaging features of a pretherapy fluorine-18-2-fluoro-2-deoxy-d-glucose positron emission tomography and computed tomography scan. Comprehensive published criteria were used to determine lesion-based clinical treatment response based on fluorine-18-2-fluoro-2-deoxy-d-glucose positron emission tomography and computed tomography imaging findings. Our results show that the model is able to predict a patient with liver cancer as a responder or nonresponder to yttrium-90 radioembolization therapy with a sensitivity of 0.791 using extracted invariant imaging features from the pretherapy fluorine-18-2-fluoro-2-deoxy-d-glucose positron emission tomography and computed tomography test. The sensitivity increased to 0.821 when combining extracted invariant image features with variable features of tumor volume.

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Toxins, Vol. 8, Pages 263: A Tricky Trait: Applying the Fruits of the “Function Debate” in the Philosophy of Biology to the “Venom Debate” in the Science of Toxinology

The "function debate" in the philosophy of biology and the "venom debate" in the science of toxinology are conceptually related. Venom systems are complex multifunctional traits that have evolved independently numerous times throughout the animal kingdom. No single concept of function, amongst those popularly defended, appears adequate to describe these systems in all their evolutionary contexts and extant variations. As such, a pluralistic view of function, previously defended by some philosophers of biology, is most appropriate. Venom systems, like many other functional traits, exist in nature as points on a continuum and the boundaries between "venomous" and "non-venomous" species may not always be clearly defined. This paper includes a brief overview of the concept of function, followed by in-depth discussion of its application to venom systems. A sound understanding of function may aid in moving the venom debate forward. Similarly, consideration of a complex functional trait such as venom may be of interest to philosophers of biology.

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Single dose hepatitis A immunisation: 7{middle dot}5 year observational pilot study in Nicaraguan children to assess protective effectiveness and humoral immune memory response

Background. Universal two-dose hepatitis A virus (HAV) vaccination of toddlers effectively controls hepatitis A. High vaccine costs impede, however, implementation in endemic countries. To test single-dose vaccination as a possible alternative, we initiated an observational, longitudinal study in Nicaragua, to assess protective effectiveness and - through challenge vaccination - humoral immune memory response.

Methods. Following a 2003 serosurvey, 130 originally seronegative children received 2005 one dose virosomal HAV vaccine, followed by yearly serological and clinical assessments until 2012. After 7.5 years, a vaccine booster was administered. Concurrent antibody screening of patients presenting with hepatitis symptoms documented persistent HAV circulation in the communities studied.

Results. Between serosurvey and vaccination, 25 children contracted hepatitis A subclinically (>8,000 mIU/mL anti-HAV). In the remaining 105 children, immunisation resulted in 17-572 mIU/mL anti-HAV. Under the ≥15% annual infection risk, an estimated 60% of children were exposed to HAV encounters during follow-up. No child presented with hepatitis symptomatology. Serological breakthrough infection (7106 mIU/mL) was documented in one child, representing an estimated 98.3% (95%CI, 87.9-99.8) protective effectiveness. Boosting elicited an average 29.7-fold increase of anti-HAV levels.

Conclusions. In children living in hyperendemic settings, one dose of virosomal HAV vaccine is sufficient to activate immune memory and may provide long-term protection.

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A Subset of Neutrophils Expressing Markers of Antigen Presenting Cells in Human Visceral Leishmaniasis

Background. Visceral leishmaniasis (VL) is a potentially fatal parasitic disease associated with fever, cachexia and impaired protective T cell responses against the parasite.

Methods. Peripheral blood leukocytes from 105 subjects with VL and healthy control subjects from the endemic region of Muzaffarpur, Bihar, India were compared using flow cytometry and RT-qPCR. Findings were correlated with clinical data.

Results. An expanded population of low density neutrophils that expressed HLA-DR, CD80 and CD86 was observed in subjects with VL. This neutrophil population contracted after successful treatment of disease. Plasma from patients with acute VL was able to induce similar high-level HLA-DR expression in neutrophils from healthy subjects. HLA-DR positive neutrophils of VL subjects did not uniquely stimulate T cell proliferation, but they did express higher PDL1 than other neutrophils, and lymphocytes of the same subjects expressed high surface PD1.

Conclusions. Patients with acute VL have expanded circulating low-density neutrophils expressing markers of antigen presentation, which diminish after treatment. Development of HLA-DR+ neutrophils is stimulated, at least in part, by components of plasma from patients with acute disease. Although we found no evidence they act as antigen presenting cells, these neutrophils expressed markers implicating a role in T cell exhaustion.

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Ebola Virus Replication and Disease Without Immunopathology in Mice Expressing Transgenes to Support Human Myeloid and Lymphoid Cell Engraftment

The study of Ebola virus (EBOV) pathogenesis in vivo has been limited to nonhuman primate models or use of an adapted virus to cause disease in rodent models. Herein we describe wild-type EBOV (Makona variant) infection of mice engrafted with human hematopoietic CD34⁺ stem cells (Hu-NSG™-SGM3 mice; hereafter referred to as SGM3 HuMice). SGM3 HuMice support increased development of myeloid immune cells, which are primary EBOV targets. In SGM3 HuMice, EBOV replicated to high levels, and disease was observed following either intraperitoneal or intramuscular inoculation. Despite the high levels of viral antigen and inflammatory cell infiltration in the liver, the characteristic histopathology of Ebola virus disease was not observed, and this absence of severe immunopathology may have contributed to the recovery and survival of some of the animals. Future investigations into the underlying mechanisms of the atypical disease presentation in SGM3 HuMice will provide additional insights into the immunopathogenesis of severe EBOV disease.

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Human infections by non-rodent associated hantaviruses in Africa

Various hantaviruses have been discovered in unconventional hosts (shrews and bats) in Africa. Up to now, it was unknown whether these viruses pose a threat for human health. Here, by use of newly established serological assays, we show evidence for shrew-borne hantavirus infections in humans from Côte d'Ivoire and Gabon.

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Letter from Turco Regarding Article, "Ablation Versus Amiodarone for Treatment of Persistent Atrial Fibrillation in Patients With Congestive Heart Failure and an Implanted Device: Results From the AATAC Multicenter Randomized Trial".

Author: Turco, Pietro MD

Page: e179-e180

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Letter from Willey and Biviano Regarding Article, "Ablation Versus Amiodarone for Treatment of Persistent Atrial Fibrillation in Patients With Congestive Heart Failure and an Implanted Device: Results From the AATAC Multicenter Randomized Trial".

Author: Willey, Joshua Z. MD, MS; Biviano, Angelo MD

Page: e181-e182

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Letter from Kosiuk et al Regarding Article, "Ablation Versus Amiodarone for Treatment of Persistent Atrial Fibrillation in Patients With Congestive Heart Failure and an Implanted Device: Results From the AATAC Multicenter Randomized Trial".

Author: Kosiuk, Jedrzej MD; Hindricks, Gerhard MD; Bollmann, Andreas MD, PhD

Page: e183-e184

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Letter from Liu and Yang Regarding Article, "Ablation Versus Amiodarone for Treatment of Persistent Atrial Fibrillation in Patients With Congestive Heart Failure and an Implanted Device: Results From the AATAC Multicenter Randomized Trial".

Author: Liu, Wei MD; Yang, Xiao-jie MM

Page: e185-e186

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Letter from Skolnik Regarding Article, "Ablation Versus Amiodarone for Treatment of Persistent Atrial Fibrillation in Patients With Congestive Heart Failure and an Implanted Device: Results From the AATAC Multicenter Randomized Trial".

Author: Skolnik, Neil MD

Page: e187-e188

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Response by Di Biase et al to Letter Regarding Article, "Ablation Versus Amiodarone for Treatment of Persistent Atrial Fibrillation in Patients With Congestive Heart Failure and an Implanted Device: Results From the AATAC Multicenter Randomized Trial".

Author: Di Biase, Luigi MD, PhD; Mohanty, Prasant MBBS, MPH; Mohanty, Sanghamitra MD; Santangeli, Pasquale MD; Trivedi, Chintan MD, MPH; Lakkireddy, Dhanunjaya MD; Reddy, Madhu MD; Jais, Pierre MD; Themistoclakis, Sakis MD; Dello Russo, Antonio MD; Casella, Michela MD; Pelargonio, Gemma MD; Narducci, Maria Lucia MD; Schweikert, Robert MD; Neuzil, Petr MD; Sanchez, Javier MD; Horton, Rodney MD; Beheiry, Salwa RN; Hongo, Richard MD; Hao, Steven MD; Rossillo, Antonio MD; Forleo, Giovanni MD; Tondo, Claudio MD; Burkhardt, J. David MD; Haissaguerre, Michel MD; Natale, Andrea MD

Page: e189-e190

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Correction to: Very Long-Term Results (More Than 20 Years) of Valve Repair With Carpentier's Techniques in Nonrheumatic Mitral Valve Insufficiency.

Author:

Page: e191

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Correction to: 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention, 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery, 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients W

Author:

Page: e192-e194

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Correction to: Duration of Dual Antiplatelet Therapy: A Systematic Review for the 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.

Author:

Page: e195-e197

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Letter to the Editor: Concerning "Xenograft Model for Therapeutic Drug Testing in Recurrent Respiratory Papillomatosis"

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Meta-Analysis: Dichorionic Twins Should Be Delivered at 37 Weeks (FREE)

By Kelly Young Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM Delivery of dichorionic twins should be considered at 37 weeks' gestation, suggests a BMJ meta-analysis. For monochorionic twins, there is not enough evidence supporting …

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