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Previous research suggests that dog mass vaccination campaigns can eliminate rabies locally, resulting in large human and animal life gains. Despite these demonstrated benefits, dog vaccination programs remain scarce on the African continent. We conducted a benefit-cost analysis to demonstrate that engaging into vaccination campaigns is the dominant strategy for most countries even in the absence of coordinated action between them. And quantify how coordinated policy measures across countries in Africa could impact rabies incidence and associated costs. We show that coordinated dog mass vaccination between countries and PEP would lead to the elimination of dog rabies in Africa with total welfare gains of USD 9.5 billion (95% CI: 8.1 - 11.4 billion) between 2024 and 2054 (30 years). Coordinated disease control between African countries can lead to more socially and ecologically equitable outcomes by reducing the number of lost human lives to almost zero and possibly eliminating rabies.

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The vast empirical material on pathogenesis of diseases has thus far been accumulated. However, its systematization and philosophical interpretation have not been given due attention since the time of I.V. Davydovsky. The value and topicality of I.V. Davydovsky' ideas need a fresh view andfurther development in the context of knowledges of the XXI century. The analysis of the selected provisions of I.V. Davydovsky offered in the article will hopefully contribute to their introduction into applied medicine.

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The author presents the clinical and methodological analysis of the problem of medical errors based on the empirical data obtained in the 20 century. Relevant theoretical premises having applied implications are substantiated.

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INTRODUCTION: and objectives. Most of modern endoscopic procedures (e.g., TURP) are only confined to small and medium-sized glands (up to 80 cm3), but not HoLEP, which allows to enucleate large and extremely large prostates (200 cm3). The aim of the study was to compare the efficiency of HoLEP for prostates of different sizes. METHOD: s. A total of 459 patients were divided into three groups: Group 1 included 278 patients (prostate volume <100 cm3); mean prostate volume, 70.8+/-16.1 cm3; IPSS, 18.7+/-5.5; QoL, 4.1+/-0.5; Qmax, 6.2+/-1.5 mL/s; post-voided residual volume, 64.2+/-30.5 mL. Group 2 included 169 patients (prostate volume 100-200 cm3); mean prostate volume, 148.1+/-25.2 cm3; IPSS, 19.7+/-3.3; QoL, 4.2+/-0.7; Qmax, 5.9+/-0.7 mL/s; post-voided residual volume, 70.9+/-20.1 mL. Group 3 included 12 patients (prostate volume >200 cm3); mean prostate volume, 230.1+/-18.1 cm3; IPSS, 19.5+/-4.5; QoL, 4.1+/-0.3; Qmax, 4.7+/-0.9 mL/s; post-voided residual volume, 72.3+/-10.9 mL. All the patients underwent HoLEP from 2013 to 2015. For the prostate to be enucleated, a 100-W laser system, 550-micron end-fire fiber, and a morcellator for tissue evacuation were used. RESULTS: The average duration of surgery in Group 1 was 56.5+/-10.7 min; in group 2, 96.4+/-24.9 min; in Group 3, 120.9+/-35 min. The average duration of morcellation in Group 1 was 37.5+/-7.3 min; in Group 2, 63.3+/-11.2 min; in Group 3, 84.0+/-25.6 min. The efficiency of enucleation in Group 3 (1.70 g/min) was significantly higher (p < 0.05) than in Group 1 (1.05 g/min) and Group 2 (1.23 g/min). Similar results were obtained for the efficiency of morcellation. It was lower in Group 1 and Group 2 (1.58 and 1.87 g/min, respectively) than in Group 3 (2.45 g/min) (p<0.05). In order to compare the long-term results of HoLEP for prostates of different sizes, all the 459 patients were followed up for 18 months. IPSS, Qmax, QoL, and post-voided residual volumes were measured. There were no significant differences (p>0.05) in the postoperative outcomes for 1, 3, 6, 12, and 18 months after surgery. CONCLUSIONS: It follows from our two years experience that HoLEP is a safe, highly efficacious and a size-independent procedure, which is why it has become a new gold standard for treatment of extremely large prostatic hyperplasia in our clinic.

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Social aspects of the concept of disease are considered in the context offurther development of philosophical tenets of V.Kh. Vasilenko. Biological aspects were discussed in earlier publications (see <> No 3, 4, 2014). The essence of human being is a socio-biological unity; the same is true of the human life and diseases viewed as biopsycho-socialphenomena. It is proposed to regard them as a result of incompatibility of two self-organizing systems, general (the environment or noosphere) and its part (an individuum). The disease is a consequence of the loss (impairment) of biological and social adaptability of organism to environmental changes ("reverse" natural selection) with the primacy of the social sphere.

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V.Kh.Vasilenko paid much attention to the development of philosophical aspects of the concept of disease and left the rich intellectual legacy and a number of advisory instructions that allow the main challenge in modern medicine (the definition of the notion of disease) to be addressed. One of his principal messages is the necessity of generalization and synthesis of facts. Following Vasilenko's instructions, Part 1 of this review is devoted to systematization of modern views of general features of pathogenesis of internal diseases for obtaining a deeper insight into the essence of the disease.

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Empirical data on the nature of disease were systematized and summarized in Part 1. In Part 2 the same problem is addressed by the deductive method from the general biological and philosophical standpoint. Methodological assessment of the most popular definitions of the disease is undertaken along with expanded medico-philosophical interpretation of the notion of disease as an anthropological phenomenon including its applied aspects.

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The authors discuss I.V. Davydovsky's views expounded in his book "Problems of causality in medicine, Etiology" (1962) where the philosophical method was applied for the first time for the solution of fundamental problems of medicine, such as etiology and pathogenesis. The main provisions of Davydovsky's concept of etiology of internal organ diseases are considered, an attempt is undertaken to develop and apply them in the present-day context.

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Scientific (analytical) approach directs researcher to the study of nosology in isolated native view. The phenomenon under consideration- comorbidity becomes significant and to a substantial degree is able to affect all aspects of the process of medical care. This is shown in this review along such directions as frequency of overt or concealed comorbidity or real state of the problem; magnitude of intracardiac and extracardiac comorbidity; difficulties of diagnostics and treatment arising with comorbidity; problems of validity of statistical (and epidemiological) side of the matter; value of social and organizational aspects of patients care in situations when comorbidity is present.

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This review considers the views of I.V. Davydovsky expounded in his book The Problems of Causality in Medicine. Etiology (1962). The author was the first to apply the philosophical method to address such fundamental medical concepts as etiology and pathogensis. The most important issues concerning diseases of internal organs are reviewed with special reference to their etiology; an attempt is undertaken to further develop and update them.

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The scope of knowledge in medical ethics continues to extend. Deontology as a science needs systematization of the accumulated data. This review may give impetus to classification of problems pertaining to this important area of medical activity.

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OBJECTIVES: Objective of the study was to examine patients with fistula preoperatively with MRI and then compare with operative findings. BACKGROUND: Most common cause of perianal suppuration is infection of cryptoglandular origin. This results in simple intersphincteric abscess, or spreading of infection in cranial or caudal direction, horizontally or circulary. To choose the correct surgical therapy, sufficient diagnostic is necessary. This includes clinical examination, endorectal ultrasonography, rectoscopy with fistula injection with hydrogen peroxide or dye. More and more often MRI is used. METHODS: In 2007 19 patients with perianal fistula were operated on. In 14 patients, preoperative MRI was done without contrast dye or probing. Fistulas were classified on 5-grade scale. We treated simple fistulas with fistulectomies, in three cases of complicated fistulas cutting setons were used. RESULTS: We examined 14 patients and confronted preoperative MRI result with operative findings. In 12 patients results matched, in two patients peroperatively diagnosed and treated fistula did not show on MRI. One was transsphincteric fistula with abscess and one was simple transsphincteric fistula.Because of low number of patients, statistical interpretations are not significant. CONCLUSIONS: Results are preliminary, we continue in prospective analysis. MRI may be useful for successful treatment by correct assessment of the extent of disease. It is necessary to consider cost-effectiveness when indicating MRI (Tab. 6, Fig. 3, Ref. 11). Full Text (Free, PDF) www.bmj.sk.

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Objective causes of fatal extramural pneumonia, such as social factors and the severity of the disease, should be considered along with subjective medical errors. Clinical and deontological analysis of lethal cases revealed a number of defects in providing medical care for such patients especially in terms of correction of cardiovascular disorders. Special analysis of 51 medical histories from the ethical viewpoint indicated that 4/5 of the patients had good reasons to set up deontological claims against their doctors.

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The aim of this study is to assess the physical properties of a recently installed digital fluoroscopy unit, Axiom Iconos R200 unit (Siemens, Germany), including image quality and patient dose. Image quality parameters and patient doses were measured at various fields of view (FOV) and frame rates. The entrance surface dose rate (ESDR) was measured using standard 30 x 30 cm2 polymethylmethacrylate (PMMA) phantom with different thicknesses. The ESDR was measured using a 20 cm PMMA and largest FOV ranged from 1.1 to 8.2 mGy min(-1) for different frame rates available. The low-contrast sensitivity varied from 1.8 to 6.6%, as the limiting spatial resolution changes from 1.25 to 2.24 ln mm(-1) for the different magnifications, frame rates and phantom thicknesses. This study shows the weak points of the standard quality control protocols. The additional image quality and dose assessments revealed the existing potential for optimisation of the system.

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Medical reports of 8,768 patients with various diseases of thyroid gland were analyzed. There were 1,563 (17.8) male and 7,201 (82.2%) female patients aged 6 to 86 years. One-nodular goiter was diagnosed at 13.85% patients, multinodular goiter - at 67.2%, diffuse toxic goiter - at 5.85%, thyreotoxic adenoma - at 4.91%, Hashimoto's thyroiditis - at 8.16% patients. Thyroid cancer was revealed at 1.56 patients with nodular goiter, at 8.45% - with multinodular goiter, at 2.72% - with diffuse toxic goiter, at 3.71% - with thyreotoxic adenoma, and at 27.09% patients with Hashimoto's thyroiditis. Totally thyroid cancer was diagnosed at 741 (8.45%) patients including 71.12% papillary cancer, 26.47% follicular cancer and 2.42% medullar (anablastic) cancer. Some patients had metastases. It is concluded that all the patients with goiter should be operated. At diffuse toxic goiter the surgical treatment is indicated at the patients with recurrences or after 6 - 12 months of conservative treatment without clinical improvement.

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BACKGROUND AND OBJECTIVE: Some anticancer drugs can result in increased production of reactive oxygen species (ROS). Alkylating agents are the most frequently used drugs in chemotherapeutic regimens for the treatment of malignant melanoma. It is known that triazenes exhibit in vivo activity by alkylation of nucleic acids and proteins, but there is no data about ROS formation during oxidative metabolism. Single agents of most interest for treatment of malignant melanomas include 5-(3,3-dimethyltriazene-1-yl)-imidazole-4-carboxamide (DTIC) and nitrosoureas such as 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea (CCNU), but complete response to these drugs is rare. The present study aimed to determine whether an oxidative stress occurs during the clinical course of melanoma and the influence of therapy on the antioxidant status of patients with melanoma. For this purpose, we investigated plasma concentrations of MDA as indices of the levels of lipid peroxidation products. In addition, we studied the activities of the antioxidant enzymes superoxide dismutases (SOD) and catalase (CAT) in patients with melanoma before any treatment, after surgical removal of melanoma, and after chemotherapy with DTIC or in combination with CCNU of the operated patients. METHODS: Twenty one patients with melanoma were studied. Patients were operated prior to chemotherapy. After recovery for 10-20 days postoperatively, they were studied again for MDA, SOD and CAT activity. The patients were divided into two groups according to the chemotherapy (3-7 treatment cycles): with DTIC-given orally daily for 5 days, every 3 weeks as a single 2200 mg/kg dose and with the combination-DTIC (the same dose) + CCNU-administered orally at a dosage of 120 mg/m(2) once every 40 days in accordance with protocols, approved by the Bulgarian Ministry of Health. The total amount of lipid peroxidation products in plasma was assayed. RESULTS AND DISCUSSION: Plasma levels of MDA and CAT activity were significantly higher, and erythrocyte SOD activity significantly lower, in patients with melanoma, than in control healthy volunteers (P < 0.0001). Ten to twenty days after surgery, oxidative stress decreased but levels of MDA increased as a result of therapy. Important sources of increased ROS production may be the monocytes, phagocytosis of tumour cells and the cancer tissues. Plasma MDA in patients treated with DTIC + CCNU were significantly higher (P < 0.001), but erythrocyte SOD statistically lower (P < 0.00001), compared with patients treated with DTIC only. However, a combination of DTIC + CCNU did not attenuate oxidative stress, or reduced antioxidant status. Patients treated with this combination are at bigger risk of oxidative injury. Therefore, this disturbance might be due to augmented generation of toxic ROS, possibly from the metabolism of CCNU. CONCLUSION: Increased oxidative stress follows an imbalance in antioxidant defence in non-treated patients with melanoma. The impaired antioxidant system favours accumulation of ROS, which may promote the cancer process. After complete removal of melanoma tissues, oxidative stress decreased. The antioxidant status of melanoma patients operated on was influenced by the different chemotherapeutic regimens used and may play an important role in the response. Patients on DTIC + CCNU are at higher risk of oxidative injury. This drug combination probably exerts its toxic activity by ROS, which could be products of the metabolism of CCNU.

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