No abstract

We found a low S. aureus carriage rate with complete vancomycin susceptibility and high tetracycline resistance, which has important public health implications with regard to treatment. Additionally, the finding of PVL-positive MSSA isolates, including the expansion of a previously described limited 'divergent' clone, ST152, warrants further evaluation.

Patients with transportation costs greater than $2 were 1.9 times more likely to be lost to care compared with those who paid less for transportation. HIV treatment programs in resource-constrained settings may need to pay closer attention to issues related to transportation cost to improve patient retention.

Background: The availability of an anesthesiologist is often a limiting factor in the number of operations that can be performed by International Medical Surgical Response Teams (IMSuRT). Because emergency physicians (EPs) possess skills in airway control, management of moderate and deep sedation, and ventilator management, we propose that with proper training in general anesthesia, EPs can serve as anesthetists for IMSuRT with anesthesiologist supervision. Methods: During a 10-week period, a board-certified EP administered general anesthesia to 60 patients prior to a surgical medical mission trip. The breakdown of surgical cases was: 11 orthopedic, 2 genitourinary, 20 ear, nose, and throat, 8 obstetrics and gynecological, 13 general surgery, and 6 vascular. A simplified protocol for induction, maintenance, and emergence was adhered to for all cases. Results: Fourteen orthopedic cases using general anesthesia were performed in a one-week period in Haiti. These cases involved open reduction and internal fixation (ORIF), hemiarthoplasty, hardware removal, tendon transfer and external fixation of fractured bone. Conclusion: We demonstrate the feasibility of a model curriculum to train EPs in the basics of anesthesia. The EP can safely and effectively deliver general anesthesia for major cases on surgical medical mission trips under the auspices of an anesthesiologist in an austere environment.

Prior research in Milot, Haiti, documented that public water sources are commonly fecally contaminated, as indicated by the presence of Escherichia coli. However, the degree of contamination was not assessed. In this study, the degree of fecal contamination in public drinking water sources was determined. Further, the usefulness of sanitary inspection surveys to predict fecal contamination was evaluated. A convenience sample of public water sources was tested using a semi-quantitative assay, which estimates the most probable number (MPN) of E. coli/100 mL of water. Each source was evaluated using the World Health Organization sanitary inspection score and classified as improved or unimproved. Sixty-three water sources were tested, of which 27 (43%) had <1 MPN/100 mL, 19 (30%) were contaminated from 1 to 100 MPN/100 mL, and 17 (27%) were contaminated with >100 MPN/100 mL. Some improved water sources were contaminated with >100 MPN/100 mL. The sanitary inspection score did not distinguish between sources that were and were not contaminated with E. coli. In Milot, Haiti, public water sources can be highly contaminated with E. coli. Since neither the categorization of a water source as improved or unimproved nor the sanitary inspection score can predict contamination, routine microbiological testing is justified.