Introduction: Formative research can inform country-level HPV vaccine delivery strategies, communication messages, and advocacy plans. This paper describes our formative research's conceptual framework; details our applied methodology; summarizes our field experience and challenges; and outlines best practices for formative research in vaccine introduction. Methods: From 2006-2008, literature reviews, stakeholder mapping, sociocultural studies, health system assessments, and policy reviews were conducted. Data collection at individual, interpersonal, community, institutional, and policy levels included in-depth interviews, focus groups, surveys, observations, secondary data, and facility audits. Data were analyzed thematically using an iterative process. Discussion: Integrated formative research can be implemented in low-resource settings, but may require overcoming operational challenges. Best practices in applied formative research include a conceptual framework, multidisciplinary approach, and rapid dissemination of results. Conclusions: Formative research informs effective health program planning by examining complex and interrelated factors surrounding vaccination. Methodologically sound formative research provides valid and reliable evidence for country-level vaccine introduction.

This paper presents findings from a study conducted in 2007 and 2008 in two states in India: Andhra Pradesh and Gujarat. The objectives of the study were to: (i) design effective and appropriate HPV vaccine delivery systems for 10-to 14-year-old girls; (ii) design a communication strategy for HPV vaccine delivery; and (iii) devise an HPV vaccine advocacy strategy.The study populations included girls, parents, and local-, district-, and national-level stakeholders. A mixture of group discussions, visual representation techniques, face-to-face interviews, desk and health facility record reviews, field observations, and consultative workshops were used to collect the data.Study findings showed that the policymakers, health care providers, parents, and adolescents were aware and concerned about cervical cancer; would welcome vaccination if safe, effective, affordable, and accessible. Health systems did not require large infrastructure investments to introduce HPV vaccine; basic cold chain and logistic equipment were available. New outreach systems for adolescent girls need to be tested through demonstration projects. No policies would compromise the introduction of HPV vaccination.An HPV vaccine program, requiring public education and provider training, could be delivered. Policymakers' safety and vaccine efficacy concerns can be addressed through targeted advocacy efforts. Three broad approaches were suggested: (i) merge HPV vaccination with already established immunization services; (ii) package HPV immunization with adolescent health services or as a part of a cancer control service; and (iii) deliver HPV vaccinations through either routine immunization services or a campaign using schools as sites for school-going girls and anganwadi or village health centers for non-school-going girls.

We report a case of pseudomyiasis (accidental myiasis) in a 52-year-old man who had previously undergone surgery and placement of a tracheostomy tube for laryngeal cancer. The patient presented to our outpatient department with a foul-smelling, bloodstained discharge and frequent and severe episodic pain at the site of the tracheostomy. He also reported the discharge of many whitish larvae from the site. On clinical examination, 3 of these larvae were removed from the tracheostomy wound and later identified as Musca domestica (housefly) larvae. The patient underwent further mechanical removal twice daily for 3 days, during which time 23 more larvae, or maggots, were removed. His condition improved, and he returned for regular follow-up with no recurrence or complications. Myiasis is an infestation of humans and vertebrate animals by insect larvae that feed on both dead and living tissue. Myiasis is most common in hot and humid climates in tropical and subtropical regions, such as the underdeveloped areas of India, Africa, and Southeast Asia, which provide favorable breeding grounds for flies. Myiasis is classified as specific, semispecific, or accidental, depending on whether the fly larvae require a host in order to develop. We review the literature on myiasis and its entomologic aspects in general. We also discuss the need for the proper care of tracheostomy wound myiasis because the site of such an infestation is close to vital organs in the neck. To the best of our knowledge, only 3 cases of tracheostomy wound myiasis have been previously reported in the English-language literature; 2 of them involved infestation with Chrysomyia bezziana larvae and 1 with Lucilia caesar larvae. We believe our case is the first case of tracheostomy wound pseudomyiasis attributable to M domestica larvae.

Histologic abnormalities of the ascending aorta and pulmonary trunk in patients with bicuspid aortic valve disease: clinical relevance to the Ross procedure.

ABSTRACT:The present study was executed to determine the magnitude of bovine tuberculosis (BTB) in buffaloes in native type of husbandry practices and impact of certain factors in the prevalence of bovine tuberculosis in buffaloes in the Punjab, Pakistan. Three year cross sectional study was carried out on female population of Nili Ravi buffaloes (n = 2526) maintained at 10 Government Livestock Experimental Stations, and peri urban areas of the three major cites i.e., Lahore, Faisalabad and Okara. These animals were screened with comparative intradermal tuberculin test (CIDT) by using two types of tuberculins i.e., mammalian and avian. The reaction of tuberculins injected was interpreted after 72 hours post injection. The data were analyzed by Chi-square test and Pearson correlation. Relative risk and other associated factors were calculated to describe the association with prevalence of tuberculosis in buffaloes. The prevalence of bovine tuberculosis on the basis of CIDT was 12.72%. The BTB among different livestock farms varied significantly (P<0.001) from 8.52 to 19.04%. The results of epidemiological factors revealed a significantly (P<0.001) greater percentage of tuberculin reactors in >8 years old age, body weight >550 kg, 3-6 parity, pregnant animals, and animals with >7 liters milk yield. The husbandry factors which greatly influence the prevalence was poor feeding (RR=2.615), high fly density (RR= 1.3474), poor management (RR=1.315), contact with wildlife (RR=1.4507), poor farm conditions (RR=1.4708), quarantine measures (RR=1.1557) and poor sanitation of farm (RR= 1.3701).

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Although daily dosing overall was more effective for treatment of SHPT, dialysis dosing was effective in patients with less severe SHPT. This warrants a larger study considering the limitations of this pilot trial. In the meantime, dialysis dosing can be considered in non-compliant patients with less severe SHPT.

Accurate assessment of renal function is of key importance, given its prognostic value. However, gold standard measures are cumbersome, and serum creatinine itself is an insensitive predictor, especially in renal transplant recipients. Though GFR-estimating formulae have been relied upon, they do have their own limitations. Nevertheless, renal biomarkers such as neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C, among others, are now emerging as potentially useful indicators of GFR. We aimed to evaluate the diagnostic performance of NGAL versus cystatin C and eGFR using CKD-EPI, MDRD and cystatin C in renal transplant recipients and non-transplant CKD patients. We found a significant correlation between NGAL, serum creatinine, cystatin C and eGFR. The latter parameters were also strong predictors of serum NGAL levels. However, performance of NGAL, based on receiver operating characteristic curves, was inferior to that of the reference tests. It appears that in renal transplant recipients NGAL correlates well with cystatin C and eGFR, most strongly with cystatin-based formula. Though this suggests potential use of NGAL as a screening test, its weaker diagnostic performance raises some concern about its clinical usefulness. Larger studies are needed to explore this further.