Actual Burden Of Disease Research Articles

Discordance Between Human Papillomavirus Twitter Images and Disparities in Human Papillomavirus Risk and Disease in the United States: Mixed-Methods Analysis.

BackgroundRacial and ethnic minorities are disproportionately affected by human papillomavirus (HPV)-related cancer, many of which could have been prevented with vaccination. Yet, the initiation and completion rates of HPV vaccination remain low among these populations. Given the importance of social media platforms for health communication, we examined US-based HPV images on Twitter. We explored inconsistencies between the demographics represented in HPV images and the populations that experience the greatest burden of HPV-related disease.ObjectiveThe objective of our study was to observe whether HPV images on Twitter reflect the actual burden of disease by select demographics and determine to what extent Twitter accounts utilized images that reflect the burden of disease in their health communication messages.MethodsWe identified 456 image tweets about HPV that contained faces posted by US users between November 11, 2014 and August 8, 2016. We identified images containing at least one human face and utilized Face++ software to automatically extract the gender, age, and race of each face. We manually annotated the source accounts of these tweets into 3 types as follows: government (38/298, 12.8%), organizations (161/298, 54.0%), and individual (99/298, 33.2%) and topics (news, health, and other) to examine how images varied by message source.ResultsFindings reflected the racial demographics of the US population but not the disease burden (795/1219, 65.22% white faces; 140/1219, 11.48% black faces; 71/1219, 5.82% Asian faces; and 213/1219, 17.47% racially ambiguous faces). Gender disparities were evident in the image faces; 71.70% (874/1219) represented female faces, whereas only 27.89% (340/1219) represented male faces. Among the 11-26 years age group recommended to receive HPV vaccine, HPV images contained more female-only faces (214/616, 34.3%) than males (37/616, 6.0%); the remainder of images included both male and female faces (365/616, 59.3%). Gender and racial disparities were present across different image sources. Faces from government sources were more likely to depict females (n=44) compared with males (n=16). Of male faces, 80% (12/15) of youth and 100% (1/1) of adults were white. News organization sources depicted high proportions of white faces (28/38, 97% of female youth and 12/12, 100% of adult males). Face++ identified fewer faces compared with manual annotation because of limitations with detecting multiple, small, or blurry faces. Nonetheless, Face++ achieved a high degree of accuracy with respect to gender, race, and age compared with manual annotation.ConclusionsThis study reveals critical differences between the demographics reflected in HPV images and the actual burden of disease. Racial minorities are less likely to appear in HPV images despite higher rates of HPV incidence. Health communication efforts need to represent populations at risk better if we seek to reduce disparities in HPV infection.

Adaptive metabolic pattern biomarker for disease monitoring and staging of lung cancer with liquid biopsy

In this manuscript, we demonstrate the applicability of a metabolic liquid biopsy for the monitoring and staging of patients with lung cancer. This method provides an unbiased detection strategy to establish a more precise correlation between CTC quantification and the actual burden of disease, therefore improving the accuracy of staging based on current imaging techniques. Also, by applying statistical analysis techniques and probabilistic models to the metabolic status and distribution of peripheral blood mononuclear cell (PBMC) populations “perturbed” by the presence of CTCs, a new category of adaptive metabolic pattern biomarker (AMPB) is described and unambiguously correlated to the different clinical stages of the patients. In fact, this strategy allows for classification of different categories of disease within a single stage (stage IV) before computed tomography (CT) and positron emission tomography (PET) scans and with lower uncertainty.

Imaging findings in Erdheim-Chester disease: what every radiologist needs to know.

Erdheim-Chester disease (ECD) is a rare sporadic non-Langerhans cell histiocytic (LCH) proliferative disorder with systemic predilection. It usually affects adults in the 5th-7th decades of life and has non-specific clinical manifestations. Its suspicion is often heralded by the presence of characteristic radiological findings and subsequently confirmed by demonstration of CD68-positive xanthogranulomatous infiltrates on histopathology. Despite being a non-malignant entity, it might be fatal due to organ dysfunction. Imaging plays a key role in the diagnosis, management, and follow-up. Imaging findings are essential to establish the diagnosis, assess actual disease burden, and explore the aetiopathogenesis and therapeutic options to halt disease progression and associated morbidity.

Significance of continuous rotavirus and norovirus surveillance in Indonesia.

Diarrhea significantly contributes to the global burden of diseases, particularly in developing countries. Rotavirus and norovirus are the most dominant viral agents responsible for diarrheal disease globally. The aim of this review was to conduct a comprehensive assessment of rotavirus and norovirus study in Indonesia. Articles about rotavirus and norovirus surveillance in Indonesia were collected from databases, including PubMed and Google Scholar. Manual searching was performed to identify additional studies. Furthermore, relevant articles about norovirus diseases were included. A national surveillance of rotavirus-associated gastroenteritis has been conducted for years, resulting in substantial evidence about the high burden of the diseases in Indonesia. In contrast, norovirus infection received relatively lower attention and very limited data are available about the incidence and circulating genotypes. Norovirus causes sporadic and epidemic gastroenteritis globally. It is also emerging as a health problem in immunocompromised individuals. During post-rotavirus vaccination era, norovirus potentially emerges as the most frequent cause of diarrheal diseases. Our review identifies knowledge gaps in Indonesia about the burden of norovirus diseases and the circulating genotypes. Therefore, there is a pressing need to conduct national surveillance to raise awareness of the community and national health authority about the actual burden of norovirus disease in Indonesia. Continuing rotavirus surveillance is also important to assess vaccine effectiveness and to continue tracking any substantial changes of circulating rotavirus genotypes.

A cross-sectional study of malaria endemicity and health system readiness to deliver services in Kenya, Namibia and Senegal.

Despite good progress towards elimination, malaria continues to contribute substantially to the sub-Saharan African disease burden. Sustaining previous gains requires continued readiness to deliver malaria services in response to actual disease burden, which in turn contributes to health systems strengthening. This study investigates a health system innovation. We examined whether malaria prevalence, or endemicity, is a driver of health facility readiness to deliver malaria services. To estimate this association, we geo-linked cross-sectional facility survey data to endemicity data for Kenya, Namibia and Senegal. We tested the validity and reliability of the primary study outcome, the malaria service readiness index and mapped service readiness components in a geographic information system. We conducted a weighted multivariable linear regression analysis of the relationship between endemicity and malaria service readiness, stratified for urban or rural facility location. As endemicity increased in rural areas, there was a concurrent, modest increase in service readiness at the facility level [β: 0.028; (95% CI 0.008, 0.047)], whereas no relationship existed in urban settings. Private-for-profit facilities were generally less prepared than public [β: -0.102; (95% CI - 0.154, -0.050)]. Most facilities had the necessary supplies to diagnose malaria, yet availability of malaria guidelines and adequately trained staff as well as medicines and commodities varied. Findings require cautious interpretation outside the study sample, which was a more limited subset of the original surveys' sampling schemes. Our approach and findings may be used by national malaria programs to identify low performing facilities in malarious areas for targeted service delivery interventions. This study demonstrates use of existing data sources to evaluate health system performance and to identify within- and cross-country variations for targeted interventions.

Self-Reports of Constrictive Bronchiolitis Among Service Members Participating in the Veterans Administration and Department of Defense Airborne Hazards and Open Burn Pit Registry

SESSION TITLE: Environmental and Occupational Health SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: Constructive bronchiolitis (CB) is a bronchiolar airway disease of particular concern among military service members post deployment. The identification and proper diagnosis is important both in terms of treatment and understanding the actual disease burden in this population. We hypothesize that service members with self-reported diagnosis of CB will have unique identifiable risk factors when compared to those reporting no diagnosis of CB. METHODS: The Veterans Administration and Department of Defense (VA/DoD) established the Airborne Hazards and Open Burn Pit Registry (AHOBPR) in June 2014 as a voluntary, online survey for military personnel deployed to the Persian Gulf, Afghanistan, and Djibouti after July 1990. As of July 31, 2015, 42,558 individuals who were deployed to Iraq, Afghanistan or the surrounding regions after October 7, 2001, completed the online questionnaire and were included in this analysis. In this nested case control study, we assessed risk factors among service members with and without a self-reported diagnosis of CB, matching by age (+/- 1 year) and sex (male/female). There was a 1:2 match for controls by age and sex. A participant was deemed a case if they responded “yes” to the item, “Have you ever been told by a doctor or other health care professional that you had constrictive bronchiolitis (CB)?”. Controls responded “no” to that item. We characterized cases and controls by military service, exposure, and health condition variables from the survey and used logistic regression models to identify independent associations between these variables (p<0.10 in bivariate analysis) and case status. RESULTS: Overall there are 433 AHOBPR participants who self-reported CB on the registry survey. A majority of the participants reporting CB were male (393 (90.1%)), overweight (BMI 25.0-29.9 kg/m2) (197 (45.2%)), and never smoked (264 (60.6%)). Among cases there is a greater self-report of additional respiratory disease diagnoses than controls: Chronic Bronchitis (61.5% vs. 19.3%), COPD (24.1% vs. 0.2%), and Asthma (47.0% vs. 12.2%). Fewer cases reported current smoking (9.4%) or past smoking (25.5%) compared to controls (current smoking 11.6%, past smoking 29.7%). Quartile of cumulative hours of burn pit smoke exposure was higher among cases compared to controls (highest quartile in cases 25.1%, in controls 11.4%). Logistic regression showed associations between reporting diagnosis of CB and Burn Pit Smoke Exposure (Decile 1 [OR 0.4 (CI 0.2-0.7)] to Decile 4 [OR 1.8 (CI 0.9-3.3)]), dyspnea or decreased exercise tolerance (OR 2.9 (CI 1.9-4.5)), self-reported diagnosis of Asthma (OR 2.3 (CI1.5-3.6)), Chronic Bronchitis (OR 4.3 (CI 2.9-6.3), Emphysema (OR 17.0 (CI 3.2-89.2), and COPD (OR 57.8 (CI 12.7-262.9)). CONCLUSIONS: Registry participants who self-reported a diagnosis of CB had a greater prevalence of other self-reported respiratory conditions in comparison to controls, which may reflect uncertainty or confusion about diagnosed conditions. CLINICAL IMPLICATIONS: When evaulating a patient with a diagnosis of CB consider other diagnoses as well to ensure a complete and accurate assessment. DISCLOSURE: The following authors have nothing to disclose: Nisha Jani, Michael Falvo, Anays Sotolongo, Omowunmi Osinubi, Chin-Lin Tseng, Mazhgan Rowneki, Michael Montopoli, Sybil Morley, Vincent Mitchell, Drew Helmer No Product/Research Disclosure Information

Regional and Sex Differences in the Prevalence and Awareness of Hypertension: An H3Africa AWI-Gen Study Across 6 Sites in Sub-Saharan Africa.

There is a high prevalence of hypertension and related cardiovascular diseases in sub-Saharan Africa, yet few large studies exploring hypertension in Africa are available. The actual burden of disease is poorly understood and awareness and treatment to control it is often suboptimal. The study sought to report the prevalence of measured hypertension and to assess awareness and control of blood pressure among older adults in rural and urban settings in 6 sites located in West, East, and Southern Africa. In addition, we examined regional, sex, and age differences related to hypertension. A population-based cross-sectional study was performed at 6 sites in 4 African countries: Burkina Faso (Nanoro), Ghana (Navrongo), Kenya (Nairobi), and South Africa (Agincourt, Dikgale, Soweto). Blood pressure measurements were taken using standardized procedures on 10,696 adults 40 to 60 years of age. Hypertension was defined as systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg or taking antihypertensive medication. The mean prevalence of hypertension ranged from 15.1% in Nanoro to 54.1% in Soweto. All 3 of the South African sites had a mean prevalence of hypertension of over 40.0%, significantly higher than in Nairobi (25.6%) and Navrongo (24.5%). Prevalence increased with age in both sexes and at all sites. A significantly higher prevalence of hypertension was observed in women in Agincourt, Dikgale, and Nairobi, whereas in Nanoro this trend was reversed. Within the hypertensive group the average proportion of participants who were aware of their blood pressure status was only 39.4% for men and 53.8% for women, and varied widely across sites. Our study demonstrates that the prevalence of hypertension and the level of disease awareness differ not only between but also within sub-Saharan African countries. Each nation must tailor their regional hypertension awareness and screening programs to match the characteristics of their local populations.

Trends in the incidence and prevalence of atrial fibrillation and estimated thromboembolic risk using the CHA2DS2-VASc score in the entire Korean population

BackgroundData on the epidemiology of atrial fibrillation (AF) and temporal trends are not well established in the Korean population. We aimed to estimate the incidence and prevalence of AF in Korea between 2008 and 2015. MethodsUsing the National Health Insurance Service database, we analyzed as a nationwide cohort the entire Korean adult population from 2008 to 2015 (n=41,505,679 in 2015). AF was identified by using diagnostic codes. ResultsDuring an 8-year period representing 314,311,360 person-years of follow-up, 496,341 individuals were newly diagnosed with AF. The incidence of AF increased to >1.12-fold as follows: from 15.34 to 17.14 per 10,000 person-years (p<0.001). We also found a 1.68-fold increase in the prevalence of AF, from 0.46% in 2008 to 0.67% in 2015 (p<0.001). The incidence and prevalence of AF increased with advancing age. The median age of the AF patients increased from 68 to 71years (p<0.001). The prevalence of diabetes and heart failure in AF subjects increased (p<0.001). The percentage of patients with a CHA2DS2-VASc score of ≥2, who were strongly recommended for anticoagulation treatment, increased from 80.2% to 86.8% (p<0.001). ConclusionThe incidence and prevalence of AF gradually increased from 2008 to 2015. The proportion of AF patients who were candidates for anticoagulation therapy also significantly increased owing to population aging and increasing comorbidities (i.e., heart failure and diabetes). These findings may provide a framework to understand the actual disease burden and establish the optimal management strategy for AF.

Accounting for multimorbidity can affect the estimation of the Burden of Disease: a comparison of approaches.

BackgroundVarious Burden of Disease (BoD) studies do not account for multimorbidity in their BoD estimates. Ignoring multimorbidity can lead to inaccuracies in BoD estimations, particularly in ageing populations that include large proportions of persons with two or more health conditions. The objective of this study is to improve BoD estimates for the Netherlands by accounting for multimorbidity. For this purpose, we analyzed different methods for 1) estimating the prevalence of multimorbidity and 2) deriving Disability Weights (DWs) for multimorbidity by using existing data on single health conditions.MethodsWe included 25 health conditions from the Dutch Burden of Disease study that have a high rate of prevalence and that make a large contribution to the total number of Years Lived with a Disability (YLD). First, we analyzed four methods for estimating the prevalence of multimorbid conditions (i.e. independent, independent age- and sex-specific, dependent, and dependent sex- and age-specific). Secondly, we analyzed three methods for calculating the Combined Disability Weights (CDWs) associated with multimorbid conditions (i.e. additive, multiplicative and maximum limit). A combination of these two approaches was used to recalculate the number of YLDs, which is a component of the Disability-Adjusted Life Years (DALY).ResultsThis study shows that the YLD estimates for 25 health conditions calculated using the multiplicative method for Combined Disability Weights are 5 % lower, and 14 % lower when using the maximum limit method, than when calculated using the additive method. Adjusting for sex- and age-specific dependent co-occurrence of health conditions reduces the number of YLDs by 10 % for the multiplicative method and by 26 % for the maximum limit method. The adjustment is higher for health conditions with a higher prevalence in old age, like heart failure (up to 43 %) and coronary heart diseases (up to 33 %). Health conditions with a high prevalence in middle age, such as anxiety disorders, have a moderate adjustment (up to 13 %).ConclusionsWe conclude that BoD calculations that do not account for multimorbidity can result in an overestimation of the actual BoD. This may affect public health policy strategies that focus on single health conditions if the underlying cost-effectiveness analysis overestimates the intended effects. The methodology used in this study could be further refined to provide greater insight into co-occurrence and the possible consequences of multimorbid conditions in terms of disability for particular combinations of health conditions.

Pattern of congenital heart diseases in a tertiary care teachinghospital, Chinna Kakani, Guntur

Objective: To evaluate the spectrum and pattern of congenital heart diseases in NRI general hospital, a tertiary care teaching hospital, Chinna Kakani, Andhra Pradesh. Methods: A retrospective hospital based analysis of children attending pediatric department over a period of two years during January, 2014 to December, 2015 was performed. Patients suspected to have cardiac symptoms or cardiac murmurs were referred for 2D echo and colour Doppler to confirm the diagnosis. Prevalence rate per 1000 patients was calculated. Relative frequencies of individual CHD types as a proportion of total CHDs were also calculated. Results: A total of 174 Echo confirmed cases of CHDs were identified from a total of 60,000 patients attending the hospital over a two year period with a calculated prevalence of 2.9/1000 patients. Of total cases 96 were female and 78 were male children. A total of 149 Acyanotic CHD cases (86.5%) were identified of which, Isolated ASD were 52 (35%), Isolated VSD were 42(28%), AVCD were 2 (1.34%), PS were 12(8%),AS were 4(2.7%), COA were 2(1.34%), PDA were22(14.7%), combination of ASD + VSD were 10(6.7%) and Dextrocardia with situs inversus were 3(2%). A total of 25 cases of Cyanotic CHD were identified, of which TOF and its variants were 16(64%), DORV+VSD+PS were 2(8%), rare complex CHDs like DORV+HLHS, TAPVC, Ebstien Anomaly, Cortriatrium, were one case(4%) each and TGA were 3(12%) cases. Conclusion: The calculated prevalence of CHD at 2.9 /1000 among hospital attending patients could be an underestimation of actual disease burden in our community. The maximum numbers of children with CHD were identified by 5 years of age. The most commonly found Acyanotic CHDs were ASD, VSD and PDA. The most common cyanotic CHD was TOF.

Molecular serogrouping of serologically atypical shigella isolates from South India

Background: Shigellae are the causative agents of bacillary dysentery, represents a significant public health problem worldwide especially in developing countries. New serotypes or subserotypes in Shigella are not uncommon and are reported from different parts of the world. Notably, atypical Shigella exhibit greater antibiotic resistance than typical Shigella serotypes and also found to harbour integrons which has the ability to acquire resistance genes. The purpose of this work was to amplify rfb regions (contains the genes coding for the enzymes responsible for O-antigen synthesis) of non-agglutinating Shigella isolates to characterize these by endonuclease restriction and to study the presence of antimicrobial resistance genes (AMR). Methods & Materials: A total of 3647 faeces specimens were processed between January to December 2014, among these, 27.5% (n = 176) were identified as Shigella spp. Eight non-agglutinable Shigella isolates obtained were included in the study for molecular characterization. These strains were tested for their antimicrobial susceptibility against six antibiotics by Kirby Bauer disc diffusion method. All the isolates were screened for the AMR genes (dhfr1A, sulII, bla-OXA, bla-TEM, bla-CTX-M, AmpC and qnrA,B,S) by PCR. The isolates were also amplified for their O-antigen gene cluster using Expand long template PCR system and the amplicons were further restricted using MboII enzyme. Results: The prevalence of shigellosis during the study period was 4.8%. The antimicrobial resistance for the atypical Shigella were 50% for ampicillin, co-trimoxazole (87%), nalidixic acid (37%), cefixime (12.5%) and all were susceptible to norfloxacin and cefotaxime. The AMR gene PCR results showed 25% of dhfr1A (n = 2), 62.5% sulII (n = 5), 50% bla-TEM (n = 4), 50% qnrS (n = 4) and all the isolates were negative for bla-OXA, bla-CTX-M and AmpC genes. rfb-RFLP results showed clearly identifiable and reproducible pattern, six different patterns were obtained. Conclusion: This study revealed the description of O-specific patterns allowing serotype identification without the use of antisera. Although the number of atypical Shigella strains in this study was only eight, thorough and strict monitoring of isolation of such atypical strains would help to understand the actual disease burden caused by the new Shigella serovars and consequently to study the epidemiology of shigellosis.

Age wise seroprevalence of hepatitis viral markers in acute infectious hepatitis patients at a tertiary care centre in India

Introduction: Age wise seroprevalence of acute viral hepatitis still remains debatable. The burden of the disease could be reduced to a considerable extent, if seroprevalence of different viruses are known for various age groups. Objectives: To determine the age wise seroprevalence of hepatitis viral markers in clinically suspected infectious hepatitis at a tertiary care hospital in urban India Methodology: This prospective study was conducted over a period of 1 year from January -December 2008. The study arm had 600 patients with clinically suspected acute infectious hepatitis while control arm had 200 age and sex matched subjects. Both groups were divided into 0-10,11-20, 21-30, 31-40 and >40 years age groups .Serum samples were tested for IgM anti HAV, IgM anti HEV, IgM anti HCV and HBsAg using commercially available enzyme linked immunosorbent assay kits. Results: Highest seropositivity of anti-HAV IgM was in 0-10 years of age for the study arm. HAV seroprevalence decreased with increasing age. Highest seropositivity of HBsAg was in 20-30 years of age group for the study group (7.6%) followed by 11-20 years (4.5%), 0-10 years (2.8%) and >40 years (2.5%). Highest seropositivity to IgM anti HCV was seen in 11-20 years(9%) in the study arm followed by 21-30 years (6.1%), 0-10 years (5.1%) and >40 years (3.7%) of age. Highest seropositivity of anti-HEV IgM was in the 21-30 years (10.7%) in the study arm followed by 31-40 years (2.9%), 11-20 years (2.7%) and 0-10 years (0.9%). Conclusion: Both HAV and HEV are significant causes of enterically transmitted acute viral hepatitis. HAV is the major cause of acute viral hepatitis in childhood. Hepatitis B virus is the major cause of acute viral hepatitis in adults. HCV is a common cause of acute hepatitis in young adults. HCV infections remain under reported while the actual disease burden is much higher. Keywords: Seroprevalence, Age wise, HBsAg, HCV, HAV, HEV

Meningococcal Disease in Korea: an Epidemiologic Study of the Underestimated Infectious Disease.

Meningococcal Disease in Korea: an Epidemiologic Study of the Underestimated Infectious Disease.

Parkinsonian Symptoms with Fever

Introduction: West Nile virus (WNV) is the most common arthropod borne virus and is the leading cause of domestically acquired disease in the United States. Case Description: A 75-year-old man presented in August 2015 with sepsis and one day of confusion, fever of 104°F, a white blood cell count (WBC) of 19.80, and blood pressure of 204/91, in the setting of a recent admission for small bowel obstruction. On exam, he was only oriented to self with slurred speech, tongue and bilateral quadriceps fasciculations, cogwheel rigidity and tremor of bilateral upper arms, and dysmetria. He did not have skin changes, no meningeal signs, or visual problems. Initially, he was treated empirically for meningitis. Head computed tomography (CT), magnetic resonance imaging (MRI), abdominal CT, chest X-ray (CXR) were negative. He remained febrile and hypertensive for four days, with worsening Parkinson’s features. Blood and urine cultures were negative and antibiotics were stopped. Neurology started a Sinemet trial. Lumbar puncture (LP) revealed mild pleocytosis and no detectable WNV. On day six, his white blood cell count (WBC) resolved, blood pressures were under control, and defervesced-only with supportive care. All of his Parkinson’s symptoms resolved. On day seven, serum WNV IgM was positively elevated >5.00. One week later, he had seroconverted. Discussion: The first case of WNV was isolated in 1937 in Uganda. This case report reminds us of the necessity to heighten public health awareness for WNV. It also portends the need for WNV surveillance in order to control disease spread. Our priorities need to shift toward early disease identification and implementation of control measures. Reporting databases like ArboNET are effective, however, as it currently stands, the onus of reporting lies in the hands of health care professionals. This leads to an underestimate of the actual disease prevalence and burden. Frequently, WNV cannot be detected in serum because the viremia is short lived and peaks before clinical symptoms are present. Case reports have documented that WNV can present as Parkinsonian symptoms including hypomimia, bradykinesia and postural instability. Persistent fever without a known source should initiate a search for the cause, and merits a thorough review of the patient’s social history. Treatment should be focused on supportive care while pending laboratory confirmation of WNV, and irrespective of imaging studies. Consistent with the literature, our patient did not have significant imaging findings. WNV can be a preventable disease if preventative measures are taken. Thus, the long-term sequelae of WNV, which include depression, fatigue, headaches, cognitive and muscular deficits, can be potentially avoided.

Prevalence of hypertension and its associated risk factors in a sub-urban area of central Nepal

Background: Burgeoning burden of non-communicable diseases (especially hypertension) along with communicable diseases has made the situation more worrying in an economically constraint countries like Nepal. Studies are therefore necessary to assess the actual burden of disease; however nominal studies have focused this situation especially in semi urban areas of Nepal. This study was therefore conducted with the main aim of assessing the prevalence of hypertension in suburban area of central Nepal and to find the associated risk factors. Methods: A cross sectional study was conducted in a sub urban area of Changunarayan municipality of Nepal utilizing consecutive convenience sampling method. A total of 240 consenting participants aged ≥18 were enrolled in the study. Data was collected using questionnaire and measurements of blood pressure, waist/hip circumference, height and weight were taken. Chi square test was used to assess the strength of relationship between the categorical variables with p value taken significant at ≤0.05. Only values with significant association were used to obtain the Odds Ratios (OR) via binary logistic regression. Results: The prevalence of hypertension and pre-hypertension was found to be 20.4% and 35.4% respectively. Further, study illustrates the significant association (p≤0.05) of age, gender, family type, presence of co-morbidities, smoking, alcohol intake habits, habit of adding salt, BMI and waist/hip ratio with hypertension. Conclusions: Results of high prevalence of hypertension and its association with several factors indicates the necessity for timely detection, treatment and control of hypertension using various strategies.

PKDL--A Silent Parasite Pool for Transmission of Leishmaniasis in Kala-azar Endemic Areas of Malda District, West Bengal, India.

Post Kala-azar Dermal Leishmaniasis (PKDL) is a chronic but not life-threatening disease; patients generally do not demand treatment, deserve much more attention because PKDL is highly relevant in the context of Visceral Leishmaniasis (VL) elimination. There is no standard guideline for diagnosis and treatment for PKDL. A species-specific PCR on slit skin smear demonstrated a sensitivity of 93.8%, but it has not been applied for routine diagnostic purpose. The study was conducted to determine the actual disease burden in an endemic area of Malda district, West Bengal, comparison of the three diagnostic tools for PKDL case detection and pattern of lesion regression after treatment. The prevalence of PKDL was determined by active surveillance and confirmed by PCR based diagnosis. Patients were treated with either sodium stibogluconate (SSG) or oral miltefosine and followed up for two years to observe lesion regression period. Twenty six PKDL cases were detected with a prevalence rate of 27.5% among the antileishmanial antibody positive cases. Among three diagnostic methods used, PCR is highly sensitive (88.46%) for case confirmation. In majority of the cases skin lesions persisted after treatment completion which gradually disappeared during 6–12 months post treatment period. Reappearance of lesions noted in two cases after 1.5 years of miltefosine treatment. A significant number of PKDL patients would remain undiagnosed without active mass surveys. Such surveys are required in other endemic areas to attain the ultimate goal of eliminating Kala-azar. PCR-based method is helpful in confirming diagnosis of PKDL, referral laboratory at district or state level can achieve it. So a well-designed study with higher number of samples is essential to establish when/whether PKDL patients are free from parasite after treatment and to determine which PKDL patients need treatment for longer period.

Granulomatosis with polyangiitis: Indian experience

Granulomatosis with polyangiitis (GPA) is now a well-recognised clinical entity in India. The earliest description of GPA in India (then called Wegener's granulomatosis) appeared as a single case in a series of 108 cases of systemic vasculitis published in 1985. Later, several short case-series (mostly from northern India) and a number of case reports were published. The number of published cases of GPA from India till date is about 130 (actual burden of disease is certainly much larger as only a few cases get published). The overall clinical profile, response to treatment and long-term outcome of GPA do not differ significantly from what is described in western literature. A female preponderance has been noted in the Indian series, whereas no gender predilection was seen in western series. Although many cases used to masquerade as pulmonary tuberculosis in the past, the situation has improved considerably, with better awareness about the disease and availability of ANCA as a diagnostic test. High relapse rate and significant organ damage continue to pose a challenge. Cyclophosphamide combined with prednisolone is the standard induction regimen. Rituximab and its two biosimilars are being increasingly used in the management of refractory cases as well as for induction of remission in certain situations.

Prevalence and antimicrobial resistance of Shigella flexneri serotype 2 variant in China.

Shigella flexneri serotype 2 variant (II:3,4,7,8) was isolated in 2008 and first reported in China in 2013. In the present study, epidemiological surveillance from 2003 to 2013 in China suggested that this serotype first appeared in Guangxi in 2003; it then emerged in Shanghai and Xinjiang in 2004 and in Henan in 2008. Of the 1813 S. flexneri isolates, 58 S. flexneri serotype 2 variant strains were identified. Serotype 2 variant has emerged as a prominent serotype in recent years, with 2a (32.6%), X variant (25.2%), 1a (9.4%), X (6.3%), 2b (5.4%), and 1b (3.6%). According to phenotypic and genotypic analysis, the serotype 2 variant originated from 2a to 2b. A higher antibiotic resistance rate was observed between 2009 and 2013 than that between 2003 and 2008. Among 22 cephalosporin-resistant isolates, blaTEM-1, blaOXA-1, blaCTX-3, blaCTX-14, and blaCTX-79 were detected. Among 22 fluoroquinolone-resistant isolates, a Ser80Ile mutation in parC was present in all of the isolates. Moreover, 21 isolates had three gyrA point mutations (Ser83Leu, His211Tyr, Asp87Asn, or Gly) and one isolate had two gyrA point mutations (Ser83Leu and His211Tyr). The prevalence of His211Tyr in the fluoroquinolone-resistant isolates is concerning, and the mutation was first reported in China. Besides, 22 isolates harbored the aac(6′)-Ib-cr gene, and two isolates harbored qnrS1. In view of the increased epidemic frequency and multidrug-resistant strain emergence, continuous surveillance will be needed to understand the actual disease burden and provide guidance for shigellosis.

Physician practices in requesting stool samples for patients with acute gastroenteritis, France, August 2013-July 2014.

A better understanding of physician practices in requesting stool samples for patients with acute gastroenteritis (AG) is needed to more accurately interpret laboratory-based surveillance data. A survey was conducted in General Practitioners (GPs) between August 2013 and July 2014 to estimate the proportion of stool samples requested for patients with AG and to identify factors associated with GP requests for a stool sample. National health insurance (NHI) data together with surveillance data from a French Sentinel GP network were also used to estimate the proportion of stool samples requested. This proportion was estimated at 4·3% in the GP survey and 9·1% (95% confidence interval 8·7-9·6) using NHI data. Multivariate analysis indicated that the ratio of stool samples requested was almost five times higher in patients with bloody diarrhoea and 10-20 times higher in patients with a long duration of illness before consultation. Laboratory-based surveillance data underestimates the actual burden of disease as fewer than one in 10 AG cases consulting their GP will be requested to submit a stool sample for laboratory testing. This underestimation varies by pathogen as stool samples are more frequently requested for severe illness.

SF-36 healty survey on psoriasis quality-of-life: a study of 414 Taiwanese patients.

Psoriasis is a chronic debilitating disease that impairs patients' physical and social functioning. The assessment of health-related quality of life (HRQoL) provides a comprehensive insight into the actual disease burden that are not captured by the traditional clinical parameters. The objective of this study is to identify factors that may impact patients' HRQoL. We conducted a cross-sectional study, recruiting a total of 414 psoriasis vulgaris patients between January 2008 and December 2011. Our study found no significant correlation between disease severity or duration of psoriasis with HRQoL. Female patients have poorer HRQoL. Psoriatic arthritis, nail involvement, burning and itching sensation have a detrimental effect on HRQoL. This study highlighted that specific disease-associated symptoms such as itching and burning sensation, nail involvement and/or concomitant arthritis were important factors that may impact patients' HRQoL devoid of clinical severity. Physicians should carefully consider these factors when treating psoriasis patients.