Very little is known about the diagnostic performance of the American Diabetes Association glycated haemoglobin (HbA1c) cut-off of 6.5% in resource-limited settings. This study, conducted between February 2023 and May 2023, aimed to determine the optimal HbA1c cut-off for the diagnosis of diabetes mellitus by measuring HbA1c and fasting plasma glucose levels in 120 adults attending care at a tertiary hospital in Harare, Zimbabwe. The optimal HbA1c cut-off was 6.1% and glucose levels were strongly correlated with HbA1c values. The prevalence of diabetes mellitus was higher (28.3%) at our derived HbA1c cut-off than with the American Diabetes Association criterion (21.6%). WHAT THIS STUDY ADDS: This study highlights the need for population-specific cut-off HbA1c values in the diagnosis of diabetes mellitus.

Using World Bank Development Indicators, it is shown that the use of energy is strongly related to almost every conceivable aspect of development. Wealth, health, nutrition, water, infrastructure, education, even life expectancy itself, are strongly and significantly related to the consumption of energy per capita. In general, the approach taken was to break the consumption of energy into three or more classes, to calculate the average value of the relevant indicator in each class, and to demonstrate that the average value in one class was statistically different, at above the 95% confidence level, from the average in adjacent classes. In the case of life expectancy, the change in expectancy was tracked against energy consumption over 40 or more years, in India, China, Indonesia and Brazil. It is concluded that energy is such a necessary element in development that it should be seen as a basic right. The impact of energy on development is felt strongly up to about 2 000 kg oil equivalent per capita, and is essentially saturated above that level. The data are qualitatively assessed using the environmental Kuznets curve. The OECD nations appear to have peaked, and emissions may continue to drop for the foreseeable future. However, emissions from the non-OECD nations have surged in this millennium, and are likely to exceed 40 000 Mt CO2 per annum before slowing. In this light, the intent of the Paris Agreement to constrain global temperature rise to less than 1.5 °C, seems unrealistic. Any hopes of reducing carbon dioxide emissions significantly, in the face of development by the developing nations, seems doomed to failure. Highlights • Many development indicators are strongly related to the per-capita energy consumption. • The impacts of increasing energy on development continues up to about 2000 kg oil equivalent per capita per year. • Over the past 50 years, increases in per-capita energy consumption correlate strongly with increases in life expectancy. • If all developing nations strive for 2000 kg per capita per year energy consumption, CO2 emissions will continue to rise.

The objective of the study was to record the tick species collected from three species of tortoise, each in a different province of South Africa. Ticks were collected from leopard tortoises, Stigmochyles pardalis, in the southern region of the Kruger National Park, Mpumalanga province; from hingeback tortoises, Kinixys zombensis, in the Enseleni Nature Reserve, KwaZulu-Natal province and from angulate tortoises, Chersina angulata, in the West Coast National Park, Western Cape province. Of the 63 leopard tortoises examined, 58 were infested with Amblyomma marmoreum and 49 with Amblyomma hebraeum, and all stages of development of both species were recovered. Amblyomma nuttalli was collected from 25 hingeback tortoises, and all stages of development were present. All 24 angulate tortoises examined were infested with Amblyomma sylvaticum, and large numbers of larvae, nymphs and adults were collected. Three snake species and a sand lizard were also infested with A. sylvaticum. The adults of A. marmoreum, A. nuttalli and A. sylvaticum were identified as specific parasites of the family Testudinidae, whereas all stages of development of A. hebraeum were classified as generalists.

The San Pedro Mártir kinematic catalogue of galactic planetary nebulae provides spatially resolved, long-slit, Echelle spectra for about 600 planetary nebulae. The data presented are wavelength calibrated and corrected for heliocentric motion. For most objects multiple spectra have been acquired and images with accurate slit positions on the nebula are also presented for each object. This is the most extensive and homogeneous single source of data concerning the internal kinematics of the ionized nebular material in planetary nebulae. Data can be retrieved for individual objects or selected by groups that share some common characteristic, such as morphological classes, galactic population, binary cores, presence of fast outflows, etc. The catalogue is available through the world wide web at http://kincatpn.astrosen.unam.mx.

El catálogo cinemático de nebulosas planetarias galácticas de San Pedro Mártir provee espectros Echelle de rendija larga, resueltos espacialmente, para casi 600 nebulosas planetarias. Los datos se presentan calibrados en longitud de onda y corregidos por movimiento heliocéntrico. Para la mayoría de los objetos se han obtenido múltiples espectros y para cada objeto se presentan imágenes donde las posiciones de las rendijas han sido indicadas con precisión. Esta es la fuente individual más grande y homogénea de datos relacionada con la cinemática interna del material nebular ionizado en nebulosas planetarias. Los datos se pueden obtener para objetos individuales o seleccionar grupos de objetos que comparten alguna característica, como es la clase morfológica, la población galáctica, núcleos binarios, presencia de flujos de alta velocidad, etc. El catálogo está disponible en la dirección http://kincatpn.astrosen.unam.mx.

Background: The purpose of the study is to review a consecutive series of acetabular reconstructions using the Slooff technique, and to establish its usefulness in different types of acetabular defects. Methods: The study group included 61 revisions in 60 patients. Mean follow up was 68 months (60-120); mean age: 66 years (39-88); 17 males (28.33%) and 43 females (81.66%). The Merle d'Aubigne and Postel scale was used for clinical assessment. Each case was classified according to Paprosky's acetabular defects classification. Non-irradiated frozen impacted allograft and cemented acetabular components were used, according to the original Slooff technique. Horizontal and vertical migration was evaluated on the tear drop image. Radiographs were taken immediately after surgery and 1, 3, 6 months and annually post-op. Allograft incorporation criteria were established as: trabecular remodeling, and architecture and density similar to native bone. Reconstruction failure was considered as: 4 mm cup migration or 5° angulation. Results: Of the 61 cups reviewed on 60 patients, 48 (78.6%) were type II defects (IIA 11 cases - IIB 10 cases- IIC 27 cases); allograft healing with trabecular remodeling was seen in 46 cases (96%) between the third and sixth month post-op. The pre-op mean clinical assessment was 9.2 ± 0.6, and changed to 16.1 ± 0.9 after the procedure. Thirteen cases (21%) were classified as Paprosky type III defects (IIIA 8 cases - IIIB 5 cases). Radiological failure was detected in ten. In most of the cases graft resorption was noted between months 12 and 24, with construction collapse. The mean clinical assessment before surgery was 5.3± 0.4 and changed to 9.3 ± 1.17 after the procedure. Conclusions: Paprosky classification separates bony type II defects from type III based on acetabular migration. Those whose migration exceeds 2 cm are classified as type III. Acetabular reconstruction with impacted morselized cancellous bone graft and cement, used on Paprosky type II defects achieved excellent results. The same surgical technique for Paprosky type III defects resulted in high failure rate, without the use of a reinforcement ring.

Introducción: Evaluación retrospectiva de una serie consecutiva de reconstrucciones acetabulares con técnica de injerto óseo molido e impactado, intentando determinar su utilidad en distintos defectos acetabulares. Materiales y métodos: El grupo de estudio comprendió 61 revisiones acetabulares en 60 pacientes. El tiempo de seguimiento promedio fue de 68 meses (60 a 120 meses). La media de edad de los pacientes fue de 66 años (rango 39 a 88 años); 17 (28,33%) fueron varones y 43 (81,66%), mujeres. Los defectos acetabulares se evaluaron mediante la clasificación de Paprosky. En todos los casos se utilizó injerto óseo molido criopreservado no irradiado con copa acetabular cementada y aletada sin anillo de refuerzo, según la técnica original de Slooff. Se realizó la evaluación radiológica, determinándose la migración horizontal y vertical del cotilo con respecto a la imagen en lágrima. Se consideró incorporación ósea del injerto al observar su remodelación trabecular y cuando la densidad y la arquitectura eran semejantes a las del hueso nativo. La falla radiológica se determinó cuando se demostró migración acetabular igual o mayor de 4 mm o angulación de 5°. Resultados: De 61 cotilos evaluados en 60 pacientes, 48 (78,6%) pertenecieron a defectos de tipo II; se observó incorporación y trabeculado del injerto en 46 (96%) cotilos entre el tercero y el sexto mes posoperatorio. La evaluación clínica preoperatoria fue, en promedio, de 9,2 ± 0,6 y la posoperatoria, de 16,1 ± 0,9. Trece casos (21%) fueron defectos de tipo III. En 10 de ellos se determinó falla radiológica. La evaluación clínica preoperatoria fue, en promedio, de 5,3 ± 0,4 y la posoperatoria, de 9,3 ± 1,17. Conclusiones: En la clasificación de Paprosky la diferencia entre los defectos de tipos II y III se basa, fundamentalmente, en la migración acetabular mayor de 2 cm. El injerto molido e impactado sin utilizar anillo de refuerzo en defectos de tipo II de Paprosky nos ha dado excelentes resultados. En los defectos de tipo III la utilización de injerto molido con copas cementadas, sin anillo de refuerzo, presenta un índice de fracaso inaceptable.

OBJECTIVE: To evaluate the consistency and quality of immunization monitoring systems in 27 countries during 2002-03 using standardized data quality audits (DQAs) that had been launched within the framework of the Global Alliance for Vaccines and Immunization. METHODS: The consistency of reporting systems was estimated by determining the proportion of third doses of diphtheria-tetanus-pertussis (DTP-3) vaccine reported as being administered that could be verified by written documentation at health facilities and districts. The quality of monitoring systems was measured using quality indices for different components of the monitoring systems. These indices were applied to each level of the health service (health unit, district and national). FINDINGS: The proportion of verified DTP-3 doses was lower than 85% in 16 countries. Difficulties in verifying the doses administered often arose at the peripheral level of the health service, usually as the result of discrepancies in information between health units and their corresponding districts or because completed recording forms were not available from health units. All countries had weaknesses in their monitoring systems; these included the inconsistent use of monitoring charts; inadequate monitoring of vaccine stocks, injection supplies and adverse events; unsafe computer practices; and poor monitoring of completeness and timeliness of reporting. CONCLUSION: Inconsistencies in immunization data occur in many countries, hampering their ability to manage their immunization programmes. Countries should use these findings to strengthen monitoring systems so that data can reliably guide programme activities. The DQA is an innovative tool that provides a way to independently assess the quality of immunization monitoring systems at all levels of a health service and serves as a point of entry to make improvements. It provides a useful example for other global health initiatives.

OBJETIVO: Evaluar la coherencia y calidad de los sistemas de monitoreo de la inmunización en 27 países durante 2002-2003, usando para ello auditorías normalizadas de la calidad de los datos emprendidas en el marco de la Alianza Global para las Vacunas y la Inmunización. MÉTODOS: La coherencia de los sistemas de notificación se estimó determinando la proporción de terceras dosis de la vacuna contra difteria, tétanos y tos ferina (DTP-3) cuya administración previamente notificada pudo verificarse mediante documentación escrita en establecimientos y distritos de salud. La calidad de los sistemas de monitoreo se midió usando índices de calidad para distintos componentes de los sistemas de monitoreo. Estos índices se aplicaron a cada nivel del servicio de salud (puestos de salud, distrito y ámbito nacional). RESULTADOS: La proporción de dosis de DTP-3 verificadas fue inferior al 85% en 16 países. La comprobación de las dosis administradas tropezó a menudo con dificultades en la periferia del servicio de salud, generalmente como resultado de discrepancias entre la información de los puestos de salud y la de sus correspondientes distritos, o porque los puestos de salud no aportaban formularios de registro completos. Todos los países presentaban puntos débiles en sus sistemas de monitoreo, como por ejemplo el uso incoherente de gráficos de monitoreo; una vigilancia inadecuada de las reservas de vacuna, los suministros de inyección y los eventos supuestamente atribuibles a la vacunación o la inmunización; la baja seguridad de las prácticas de computación; y un escaso monitoreo de la integralidad y puntualidad de los informes. CONCLUSIÓN: Los datos de inmunización adolecen de incoherencia en muchos países, lo cual limita la capacidad de éstos para gestionar sus programas de inmunización. Los países deberían usar estos resultados para fortalecer los sistemas de monitoreo de modo que los datos puedan orientar de manera fiable las actividades programáticas. La auditoría de la calidad de los datos es un instrumento innovador que permite evaluar independientemente la calidad de los sistemas de monitoreo de las inmunizaciones a todos los niveles de un servicio de salud y sirve de punto de entrada para introducir mejoras. Además, constituye un valioso ejemplo para otras iniciativas de salud mundiales.

OBJECTIF: Évaluer la cohérence et la qualité des systèmes de vaccinovigilance dans 27 pays pendant la période 2002-2003 à travers des contrôles de la qualité des données (DQA) normalisés, lancés dans le cadre de l'Alliance mondiale pour les vaccins et la vaccination. MÉTHODES: On a estimé la cohérence des systèmes de notification en déterminant la proportion de troisièmes doses de vaccin diphtérie-tétanos-coqueluche (DTC3) rapportées comme ayant été administrées, dont l'administration peut être confirmée par des documents écrits tenus par les installations de santé et les districts. On a mesuré la qualité des systèmes de vaccinovigilance à l'aide d'indices de qualité s'appliquant aux différents composants de ces systèmes. Ces indices ont été appliqués à chaque niveau de service de santé (niveau de la formation sanitaire ou du district ou encore niveau national). RÉSULTATS: La proportion de doses de DTC3 vérifiées était inférieure à 85 % dans 16 pays. Les difficultés pour vérifier les doses administrées se rencontrent souvent au niveau périphérique du service de santé et résultent habituellement de divergences dans les informations détenues par les formations sanitaires et les districts correspondants ou de l'impossibilité d'obtenir, auprès de ces formations sanitaires, des formulaires d'enregistrement remplis. Les systèmes de vaccinovigilance de tous les pays présentent des points faibles : incohérences dans l'utilisation des tableaux de contrôle, surveillance insuffisante des stocks de vaccins, matériel d'injection et manifestations postvaccinales indésirables, pratiques informatiques peu sûres et suivi insuffisant de l'exhaustivité et de la promptitude des notifications. CONCLUSION: Les données de vaccination présentent des incohérences dans de nombreux pays, ce qui compromet leurs possibilités d'utilisation pour gérer les programmes de vaccination. Il faudrait que les pays utilisent ces résultats pour renforcer leurs systèmes de vaccinovigilance, de manière à ce que les données qu'ils fournissent puissent guider de façon fiable les activités des programmes. Le DQA est un outil novateur permettant d'évaluer de manière indépendante la qualité des réseaux de vaccinovigilance à tous les niveaux de service de santé et servant de point d'entrée pour introduire des améliorations. Il fournit un exemple utile pour d'autres initiatives mondiales dans le domaine sanitaire.

Rupture of the left ventricle following mitral valve replacement is a catastrophic complication with deadly consequences. We report here the case of a 75-year-old man who underwent elective mitral valve replacement for severe mitral regurgitation. Delayed type 1 rupture of the left ventricle developed 3 hours postoperatively in the intensive care unit. A salvaging maneuver was used, which gained time, allowing reoperation and successful intraventricular repair.