The earlier the diagnosis of acute type A aortic dissection is made, the more frequent the complications of aortic root destruction and/or a compromised coronary artery are encountered. Only aortography is diagnostic in these lesions, however, recently this modality tends to be avoided in order to try to improve the survival rate of the patients by obtaining diagnosis by noninvasive modalities. Therefore, contrast-enhanced CT scans in 49 patients with aortic dissection were analyzed in order to detect the slightest signs suggesting aortic root lesions. In 4 of the 6 cases in which intimal flap was detected in the aortic root by CT and in 2 of the 14 cases with an aortic root more than 35mm in diameter, aortic root reconstruction and/or concomitant CABG were neccessary for the repair of the destroyed aortic root. The aortic root diameter was more than 40mm in 8 of 9 patients with aortic root destruction, with a mean value of 45.6±3.6mm (p<0.01). In summary, detection of a septum in the aortic root and/or an aortic root dilated more than 40mm on CT were important signs suggesting the dissection extending to the aortic sinus combined with aortic root destruction. In such cases aortic root reconstruction and/or concomitant CABG may be necessary.

Objectives  The authors conducted a technical assistance project on tuberculosis (TB) control in Bauleni, Chelston, and Chilenje, Lusaka, Zambia in 2012-2015. Herein we describe the project activities and achievements. Methods  We trained community health volunteers (CHVs) and organized their activities. We evaluated the project considering the trends of TB cases, particularly the percent of bacteriologically confirmed TB cases among the presumptive (suspected) TB cases, and treatment outcomes.Results  We organized training for the CHVs of three areas. The CHVs conducted a total of 160 community sensitizations attended by over 50 000 community members. They visited their assigned patients 23 716 times. At Bauleni, the number of bacteriologically positive (bac+) cases exhibited a decreasing trend (r = −0.55, p=0.03), whereas that of the presumptive TB cases exhibited an increasing trend (r = 0.70, p = 0.004). At Chelston, both the numbers of bac+ cases and the presumptive TB cases exhibited increasing trends (r = 0.52, p = 0.046 and r = 0.68, p = 0.005, respectively). At Chilenje, the number of bac+ TB cases exhibited a decreasing trend (r = −0.84, p < 0.001), whereas that of the presumptive TB cases did not change (r = 0.09, p = 0.76). In all three areas, the proportions of the bac+ cases among the presumptive TB cases exhibited decreasing trends (p < 0.0001 at all three clinics). The treatment success rates improved in Chelston and Chilenje from 50.7% and 61.9%, respectively, in early 2011 to 78.3% and 97.0%, respectively, in late 2014 (both p < 0.001). The treatment success rates of Bauleni maintained at over 85% in most quarters. Conclusion  The activities of the project contributed to the strengthened local national TB programme, resulting in the decreased burden of TB in the areas.