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BACKGROUND: A refugee shelter that is treated with insecticide during manufacture would be useful for malaria control at the acute stage of an emergency, when logistic problems, poor co-ordination and insecurity limit the options for malaria control. METHODS: Tents made of untreated canvas with deltamethrin-treated polyethylene threads interwoven through the canvas during manufacture, 'pre-treated tents', were tested in Pakistan for their impact on malaria vectors. Fixed-time contact bioassays tested the insecticidal activity of the material over 3 months of outdoor weathering. Unweathered tents were erected under large trap-nets on outdoor platforms and tested using wild-caught, host-seeking mosquitoes and insectary-reared mosquitoes released during the night into the trap-nets. RESULTS: The insecticide-treated tents were effective both in killing mosquitoes and reducing blood-feeding. Mean 24 hour mortality was 25.7% on untreated tents and 50.8% on treated tents (P = 0.001) in wild anophelines and 5.2% on untreated tents and 80.9% on treated tents (P < 0.001) in insectary-reared Anopheles stephensi. Blood-feeding of wild anophelines was reduced from 46% in the presence of an untreated tent to 9.2% (P < 0.001) in the presence of treated tents and from 51.1% to 22.2% (P < 0.001) for insectary-reared An. stephensi. In contact bioassays on tents weathered for three months there was 91.3% mortality after 10-minute exposure and a 24 h holding period and 83.0% mortality after 3-minute exposure and a 24 h holding period. CONCLUSION: The results demonstrate the potential of these pre-treated canvas-polyethylene tents for malaria control. Further information on the persistence of the insecticide over an extended period of weathering should be gathered. Because the epidemiological evidence for the effectiveness of pyrethroid-treated tents for malaria control already exists, this technology could be readily adopted as an option for malaria control in refugee camps, provided the insecticidal effect is shown to be sufficiently persistent.
OBJECTIVE: Apical residual air space and prolonged air leak are not uncommon entities following resection of upper lobe of the lung. This study was carried out to observe the efficacy of pleural tenting in preventing these problems. METHODS: This is a prospective randomised study. Pleural tenting after upper or upper and middle lobectomies was performed in 20 patients. In another 20 patients who underwent upper lobectomy or bilobectomy, pleural tenting was not performed. Both groups were compared in respect to durations of postoperative chest tube drainage and hospital stay, amount of total pleural drainage, and the presence of need for any additional intervention for prolonged air leak. RESULTS: Age, sex, pathology and pulmonary function tests of two groups were similar. Duration of chest tube drainage was shorter in whom pleural tenting was performed when compared to whom pleural tenting was not performed (4.3+/-0.16 days versus 7.40+/-0.68 days, P<0.0001). Mean hospital stay was shorter in tented group (7.60+/-0.4 days versus 9.35+/-0.6 days, P=0.024). Although the mean amount of total pleural drainage was less in tented group (667.5+/-57.7 ml versus 802.5+/-83.3 ml, P=0.1911), the difference was not statistically significant. Three (15%) patients in non-tented group needed an apical chest tube insertion in postoperative period for prolonged air leak with an apical pleural space. Asymptomatic apical residual space was observed in 3 patients in tented group. There was no morbidity in patients in tented group. CONCLUSION: Pleural tenting following upper lobectomy or bilobectomy of the lung shortens the duration of chest tube drainage and hospital stay, and it prevents apical residual air spaces and related complications. Pleural tenting is safe and relatively simple procedure, which has no associated morbidity.
In 53 women admitted for first-trimester abortion, the cervical canal was dilated with laminaria tents prior to vacuum aspiration. Before insertion of the tents, endocervical specimens were taken for microbiological investigations, including Chlamydia trachomatis, and both aerobic and anaerobic microorganisms. The laminaria tents, widened by their hygroscopic properties, were removed just before the vacuum aspiration and sent for cultivation of aerobic and anaerobic microorganisms. The Gram-positive aerobic cocci, Staph. epidermidis, Strept. faecalis and Strept. agalactiae as well as Escherichia coli and Klebsiella/Enterobacter were the most frequent microorganism among the aerobic isolates from the endocervices as well as from the laminaria tents. These microorganisms were identified on the tents in greater numbers than in the cervices. Staph. aureus was isolated from three laminaria tents, but only one of these 3 women was proved to be primarily colonized endocervically. Among the anaerobes, Bacteroidaceae followed by peptococci and peptostreptococci were the predominant genera found in the cervix as well as on the removed laminaria tents. These three groups of anaerobic microorganisms were found markedly less frequently on the laminaria tents than in the endocervix. On the other hand, Strept. intermedius, another anaerobe of possible enteric origin, was recovered from 9 laminaria tents but not in the cervices. Since no cases of clinically verified endometritis/salpingitis were registered in the present study it is concluded that the risk of a pelvic inflammatory disease (PID) due to the laminaria tent is negligible as long as the laminaria treatment does not exceed 24 hours.
REASONS FOR PERFORMING STUDY: Dehydration and heat stress are serious welfare issues for equids working in developing countries. There is a lack of any standardised method or validated interpretation of the skin tent test in horses and donkeys. Owners of dehydrated and heat-stressed animals often depend on veterinary examination for identification of these conditions, leading to delays in treatment and unnecessary reliance on external sources to effect welfare improvement. OBJECTIVES: To validate a standardised skin tent test for dehydration and a behavioural measure of heat stress in working equids; and to examine the effect of heat stress and dehydration on tripping and staggering behaviour. METHODS: The study was carried out on 130 working horses and donkeys in Pakistan. Associations between skin tent and blood parameters (packed cell volume [PCV], serum total protein [TP], serum osmolality), clinical parameters, resting and drinking behaviour were examined. Heat stress behaviour (increased respiratory rate and depth, head nodding, flared nostrils, apathy) was observed in conjunction with rectal temperature. Tripping and staggering were assessed using a simple obstacle course. RESULTS: In both species, heat stress behaviour was significantly associated with increased rectal temperature (P<0.001). A positive skin tent test was not significantly associated with PCV or TP, although in donkeys it was significantly associated with lower serum osmolality (P<0.001). More animals age >15 years had a positive skin tent than those in younger age groups (P = 0.037). Very thin horses were more likely to have a positive skin tent than those in thin or moderate condition (P = 0.028). There was no significant correlation between skin tent and tripping or staggering in either species. CONCLUSIONS AND POTENTIAL RELEVANCE: Heat stress behaviour is related to increased body temperature in working horses and donkeys. Owners may use this to make judgements regarding rest and cooling, precluding the need to seek veterinary attention. The skin tent test for dehydration used in this study did not show a significant relationship with PCV or TP. However, the use of blood parameters to validate the skin tent test may be confounded by anaemia, hypoproteinaemia or electrolyte depletion. Alternative methods are needed to confirm or refute the validity of the skin tent test in working equids.
OBJECTIVES: We sought to investigate the geometric changes of the mitral leaflets and annulus, clarify the maximum tenting site of the leaflets, and quantify the valve tenting in ischemic mitral regurgitation (MR) using three-dimensional (3D) echocardiography. BACKGROUND: Although the understanding of the mechanisms of ischemic MR has advanced recently, the geometric changes of the mitral leaflets and annulus have been assessed by two-dimensional echocardiography in the clinical setting, despite the unique configuration of the leaflets and annulus. METHODS: Utilizing real-time 3D echocardiography, we obtained transthoracic volumetric images in 12 patients with ischemic MR presenting with global left ventricular dysfunction and in 10 controls. Original software was used to crop the 3D data into 18 radial planes, and we marked the mitral annulus and leaflets in each plane in mid-systole. The 3D images of the leaflets and annulus were reconstructed for the quantitative measurements. RESULTS: In ischemic MR, the annulus flattened with apparent tenting of the leaflets. Maximum and mean tenting length were longer and tenting volume was larger in ischemic MR than control subjects (maximum tenting length: 9.8 +/- 2.0 mm vs. 3.1 +/- 1.2 mm, p < 0.0001, mean tenting length: 3.7 +/- 0.9 mm vs. 0.7 +/- 0.5 mm, p < 0.0001, tenting volume: 4.09 +/- 1.22 ml vs. 0.45 +/- 0.29 ml, p < 0.0001). The maximum tenting site was located in anterior leaflet in all patients. CONCLUSIONS: We clearly demonstrated 3D geometric deformity of the mitral leaflets and annulus in ischemic MR using novel software for creating images by 3D echocardiography. This technique will be helpful in making a proper decision for the surgical strategy in each patient.
OBJECTIVE: A prolonged air leak after an upper lobectomy is a major determinant of morbidity and hospital stay. Creation of a pleural tent after upper lobectomy was used to investigate whether obliterating the usual postoperative intrapleural apical space with the parietal pleura would help shorten chest tube time. METHODS: From August, 1994, through January, 1997, 48 consecutive patients undergoing an isolated upper lobectomy for a neoplasm were reviewed. Twenty-eight patients had creation of a pleural tent and 20 patients did not. Demographic and clinical profiles of both groups were not significantly different. Chest tubes were removed when there was no air leak for 48 hours and chest tube drainage was less than 75 ml per 8 hours. RESULTS: The tented patients had significantly shorter mean air leak (tented 1.6 +/- 0.3 days vs nontented 3.9 +/- 1.2 days, p = 0.04), mean chest tube total drainage (tented 1619.5 +/- 95.5 ml vs nontented 2476.3 +/- 346.4 ml, p = 0.009), mean chest tube duration (tented 4.0 +/- 0.2 days vs nontented 6.6 +/- 1.0 days, p = 0.004), mean total hospitalization time (tented 6.4 +/- 0.4 days vs nontented 8.6 +/- 1.0 days, p = 0.02). No operative deaths occurred. Morbidity was not significantly different between groups. CONCLUSIONS: (1) Creation of a pleural tent at the time of upper lobectomy appears to significantly reduce chest tube time and shorten hospitalization. (2) No morbidity or mortality was associated with this simple, quick procedure. (3) Surgeons should consider creation of a pleural tent at the time of upper lobectomy.
A tent treated with an oil-based 1% permethrin formulation (0.936 g AI/m2) was evaluated for protection against Aedes spp. Mosquito biting assessment was conducted in the field using 8 human subjects positioned inside and outside tents. Subjects inside tents received 66.8% fewer bites than subjects outside tents prior to treatment. Following treatment, subjects inside the treated tent had significant (P < or = 0.05) protection (84-94% bite reduction) for 42 days. Subjects outside the treated tent experienced 43-82% fewer biting mosquitoes than subjects outside the untreated tent. The treated tent remained lethal > or = 42 days to mosquitoes exposed to the tent fabric in field bioassays.
Field trials were undertaken in the North West Frontier Province of Pakistan to determine the effects of pyrethroid-sprayed tents on feeding success, mortality and biting-rates of wild mosquitoes attracted to bait cows confined within the tents. Under natural conditions, endophagic mosquitoes rested only briefly in untreated tents during the night, followed by complete exodus at dawn. In tents sprayed on the interior surface with permethrin 0.5 mg/m2 or with deltamethrin 0.03 g/m2 the biting rate of Anopheles stephensi was reduced by about 40%; deterrency against culicines and other anophelines was much less. Mortality-rates of bloodfed mosquitoes from the treated tents were 75% An.stephensi, 65% An.subpictus but only 10% of culicines. Outer fly-sheets prolonged the effective life of the treatment; bioassays on the sprayed inner-sheets showed that insecticidal efficacy remained high for over a year, whereas on tents without fly-sheets permethrin residual efficacy declined rapidly 20-40 weeks post-treatment. It is concluded that tent-spraying with fast-acting photostable residual pyrethroid insecticide would probably provide effective protection against malaria transmission for the inhabitants of tents in any part of the world where the vector mosquitoes are endophilic and susceptible to pyrethroids.
Tests were conducted to determine the persistence of compounds applied to tents to protect against mosquitoes. Interiors of 2 camping tents were treated by the manufacturer--one with the repellent dimethyl phthalate (DMP) and one with the insecticide permethrin. A third tent was untreated. Tents were set up outdoors and exposed to weathering for one year. Weekly tests were conducted by releasing Aedes aegypti into the tents, then recording knockdown (KD) and biting behavior during a 3-h period. Weather data were collected 24 h/day during the study. Year-long mean KD of mosquitoes exposed in the tent to permethrin was 58.6%, to DMP 2.7% and the control 0.9%. Mean biting was 11.9, 43.8 and 58%, respectively. Under constant exposure to weathering, the permethrin-treated tent gave best results with average protection from bites greater than 96% for 9 months (DMP was less than 31%). Although preliminary, the data suggest permethrin would be effective as a tent treatment to reduce annoyance of mosquitoes.
OBJECTIVE: To compare thick laminaria tents with two synthetic osmotic devices for softening and dilating the cervix before abortions. METHODS: This was a randomized clinical trial comparing cervical dilation by thick laminaria tents with two commercially made devices, 3-mm Hypan and 3-mm anhydrous magnesium sulfate-impregnated plastic tents, used for 6 hours. Subjects were 7-14 weeks pregnant, and all 93 were assigned to devices in permuted randomized groups of three. Physicians and patients were not blinded to the type of device used. Need for a tenaculum for insertions, ease of introduction, cramps, removal ease, hourglassing, achieved dilation, and ease of forced dilation were compared. The effects of parity and gestational length on achieved dilation were also analyzed. RESULTS: Parity did not affect dilation. Significant positive, linear slopes of regression were found for achieved dilation versus weeks of gestation for thick laminaria tents and magnesium sulfate devices but not for Hypan tents. Forcible dilation was easiest with thick laminaria tents and most difficult with magnesium sulfate devices. CONCLUSION: All devices provided safe cervical dilation and softening, but thick tents were most effective.
BACKGROUND: The object of this study was to assess the efficay and maximum duration of effect of the pleural tent in reducing the incidence of air leak after upper lobectomy. METHODS: Two hundred patients who underwent upper lobectomy were prospectively randomized into two groups: 100 patients who underwent an upper lobectomy and a pleural tent procedure (group 1; tented patients) and 100 patients who underwent only an upper lobectomy and not a pleural tent procedure (group 2; untented patients). The preoperative, operative, and postoperative characteristics of both groups were compared. Then multivariate analyses were used to identify factors predictive of prolonged air leaks and their duration. The reduction of incidences of air leak in the two groups was subsequently compared during successive postoperative periods. RESULTS: No differences were detected between the two groups in terms of preoperative and operative characteristics. A significant reduction occurred in group 1 patients for the mean duration of air leak in days (2.5 vs 7.2 days; p < 0001), the number of days a chest tube was required (7.0 vs 11.2 days; p < 0.0001), the length of postoperative hospital stay in days (8.2 vs 11.6 days; p < 0.0001), and the hospital stay cost per patient (4,110 dollars vs 5,805 dollars; p < 0.0001). Logistic regression analyses showed that not having undergone a pleural tent procedure was the most significant predictive factor of the occurrence and duration of prolonged air leaks. A greater reduction in the duration of air leaks was observed before postoperative day 4 in group 1, and logistic regression analysis showed that having undergone a pleural tent procedure was the most significant predictive factor of air leaks that persisted for less than 4 days. CONCLUSIONS: Pleural tenting after upper lobectomy was a safe procedure that reduced the duration of air leaks and the hospital stay costs. The benefit from that procedure was achieved before postoperative day 4.
OBJECTIVE: The aim of this study is to assess the role of the pleural tent in prophylactics of prolonged alveolar air leakage and apical residual pleural cavity formation after upper lobectomy/bilobectomy. METHODS: A total of 40 patients, who underwent upper lobectomy/bilobectomy were prospectively randomized into two homogeneous groups: (1) with pleural tent--20 pts and (2) control group without pleural tent--20 pts. The multivariate analyses were used to compare the chest tubes duration, the length of the hospital stay, the mean quantity of postoperative extravasation and the need of additional interventions to treat the persistent postoperative alveolar leak. RESULTS: No differences were detected between the two groups in terms of preoperative and operative characteristics. No 30-day operative death was faced. A significant reduction (p=0.001) of the number of days the chest tubes were required (7.7 days vs 12.38 days) and the length of the postoperative in-hospital stay (9.7 days vs 13.75 days) was found in pleural tent group compared to control group. The mean quantity of postoperative extravasation in pleural tent group was less compared to control group (1553 ml vs 1722 ml) without statistical significance (p=0.5485). Asymptomatic residual apical pleural cavities were found in 1 patient of pleural tent group and 2 patients of control group. In other 3 patients of the latter group an additional tube drainage was required to treat a residual apical cavity. CONCLUSIONS: Pleural tenting after upper lobectomy/bilobectomy reduces significantly the duration of the intrapleural drainages and the length of the in-hospital stay. It is simple, safe and effective additional method in the prophylactics of persistent alveolar air leakage and apical residual pleural cavity formation.
Micro-climate tents (pulsed filtered air) are frequently used in burns departments. In the Surgical and Traumatological Intensive Care Unit of the Department of Anaesthesia and Intensive Care of the Henri Mondor Hospital, these tents are used in two types of indications: --placing of a tent over the head end of patients following tracheotomy with free spontaneous ventilation;--placing tents over irregular wounds. In these two categories of use, the aim is to isolate the zone under the tent by protecting it against secondary infection, but also to limit to this micro-climate any possible dissemination from the injured individual placed under the tent. Comparative study of the bacterial flora of the biotopes thus enclosed by micro-climate tents has been attempted.
The purpose of this study was to evaluate the efficacy of adding laminaria tents to sequential intravaginal prostaglandin E2 (PGE2) gel for cervical ripening. A prospective, randomized study was conducted from October 1994 to May 1995. Pregnant women with maternal or fetal indications for induction of labor at > or = 37 weeks gestation and a Bishop score of < or = 4 were eligible. Nineteen patients received laminaria tents in addition to 4 mg PGE2 gel, while 25 patients received PGE2 gel alone. After 4 hr, the laminaria tents were removed and the gel was continued in both groups at 4-hr intervals. Induction with oxytocin was initiated after a Bishop score of > or = 5 was achieved. The groups were comparable with respect to maternal age, parity, gestational age, reason for induction, and initial Bishop score. The addition of laminaria tents to sequential PGE2 gel did not statistically improve the time to a favorable cervix (control group 12.7 +/- 8.5 hr (95% CI, 9.1-16.3) and study group 10.9 +/- 7.1 hr (95% CI, 7.5-14.3) (P = 0.59). The 6-hr difference from the time of the initial PGE2 gel placement to delivery was not detected (control group 22.4 +/- 11.2 hr, 95% CI 17-27 and study group 23.4 +/- 13.1 hr, 95% CI 17-29.6 (P = 0.79). The combination approach of laminaria tents and PGE2 gel did not have a significant impact on the vaginal delivery rate, with 28.0% of patients in the control group and 26.3% of patients in the study group undergoing cesarean section (P = 0.90). Maternal and neonatal complications were rare in both groups. We had insufficient evidence to show that the addition of laminaria tents to PGE2 gel improved cervical ripening, the induction to delivery interval, or the cesarean section rate in patients at term undergoing induction of labor.
OBJECTIVE: To quantify the cervical dilation achieved from multiple medium-thick laminaria tents used for 16-26 hours in single applications before abortion. METHODS: In a practice setting, cervical dilation was studied from all abortions done at greater than 8 weeks in which one or more medium-thick laminaria tents were used in a single application for 16-26 hours. Multiple regression analysis was used to quantify results. RESULTS: There was a positive linear regression of dilation against weeks of gestation for all numbers of tents. The more tents, the greater the dilation; the more weeks, the greater the dilation. CONCLUSION: Approximate cervical circumferential dilation from medium-thick laminaria tents under the constraints listed is provided by the formula: Pratt dilation = 12.36 + (2.35 x tents) + (1.79 x weeks).
The cyclic population dynamics of western tent caterpillars, Malacosoma californicum pluviale, are associated with epizootics of a nucleopolyhedrovirus, McplNPV. Given the dynamic fluctuations in host abundance and levels of viral infection, host resistance and virus virulence might be expected to change during different phases of the cycle. As a first step in determining if McplNPV virulence and population structure change with host density, we used restriction fragment length polymorphism (RFLP) analysis to examine the genetic diversity of McplNPV infecting western tent caterpillar populations at different spatial scales. Thirteen dominant genetic variants were identified in 39 virus isolates (individual larvae) collected from field populations during one year of low host density, and another distinct variant was discovered among nine additional isolates in two subsequent years of declining host density. The distribution of these genetic variants was not random and indicated that the McplNPV population was structured at several spatial levels. A high proportion of the variation could be explained by family grouping, which suggested that isolates collected within a family were more likely to be the same than isolates compared among populations. Additionally, virus variants from within populations (sites) were more likely to be the same than isolates collected from tent caterpillar populations on different islands. This may indicate that there is limited mixing of virus among tent caterpillar families and populations when host population density is low. Thus there is potential for the virus to become locally adapted to western tent caterpillar populations in different sites. However, no dominant genotype was observed at any site. Whether and how selection acts on the genetically diverse nucleopolyhedrovirus populations as host density changes will be investigated over the next cycle of tent caterpillar populations.