Actual Number Of Cases Research Articles

The burden of visceral leishmaniasis in South Asia

This supplement presents a collection of studies that were undertaken in India and Nepal on the burden of visceral leishmaniasis (VL), investigating issues related to the epidemiology and economic impact of the disease. Since 2005, the governments of India, Nepal and Bangladesh are engaged in a collaborative effort to control and eliminate visceral leishmaniasis from the Indian subcontinent. With 60% of the global VL burden in South Asia, this disease remains an important public health problem in the region. VL not only leads to tremendous human suffering since untreated cases result in death, but also has a profound impact on the livelihood of affected households (Boelaert et al. 2009). Renewed interest given to VL over the past decade resulted in important innovations in diagnosis and treatment. However, many aspects of the VL burden of disease are still not clear. One of the major challenges for the elimination initiative is the absence of reliable epidemiological surveillance data on VL morbidity and mortality in the region. Without these data it is difficult to assess whether the initiative is achieving its stated goal – the reduction of the annual incidence of VL to <1/10 000 population at the district level in Nepal, and the sub-district and upazila level in India and Bangladesh respectively (World Health Organization 2005) – or whether the various control interventions have their intended effect. The current officially reported figures are obtained through passive case detection in government health services and usually do not include cases detected by the private for-profit sector, which constitutes a majority of the health providers in the Indian subcontinent. These figures therefore largely underestimate the actual number of cases. For example Singh et al. (2006) documented underreporting by a factor of eight in a community development block in Muzaffarpur district in Bihar, India in 2001–2003 and more recently (Singh et al. 2010c) estimated underreporting by a factor of four in Vaishali district, also in Bihar. This ‘decrease’ in underreporting is attributed by some to the effect of the VL elimination initiative and the recent contribution of several not-for-profit NGOs operating in the area with specific VL care programs. Population-based surveys such as those described above provide us with valuable information on local incidence rates, and repeating these surveys over time might allow us to not only monitor progress of the VL elimination initiative, but also to assess the effectiveness of VL control strategies. This supplement includes several populationbased surveys that can shed further light on the true frequency of infection and disease in the region. VL incidence rates (and underreporting) vary greatly between countries (Mondal et al. 2009) as well as between districts and within districts as shown by Das et al. (2010) in this supplement. Moreover, VL cases tend to cluster within certain sections of the village at hamlet level and further at household level (Ahluwalia et al. 2003). Incidence rates can be ten times greater at hamlet level (in the range of 1– 2% per year) than the aggregate figures recorded at district level (in the range of 1–2 per 1000 per year). Some of the work presented in this supplement by Singh et al. (2010b) and Rijal et al. (2010) has documented precisely what the burden is in such so-called ‘hot spots’ at hamlet level in endemic districts. The impact of VL in these affected communities tends therefore to be much stronger than would seem from aggregate figures, because those communities tend to be the most deprived ones, of lowest cast, and lowest economic status (Boelaert et al. 2009). Singh et al. also point to some gender-specific differences in burden of infection, a theme which is under-researched so far, apart from work in Bangladesh (Ahluwalia et al. 2003). Our understanding of the risk factors for VL in SouthAsia has greatly improved in recent years. Identified risk factors have been fairly similar across studies, with the presence of a previous case of kala-azar in the household as the strongest predictor of risk and living conditions as a recurrent theme. Killick-Kenrick coined the term ‘paradise for sandflies’ to describe the housing conditions in endemic villages. Damp earthen floors, mud-plastered walls with cracks, proximity to water bodies, soil littered with organic matter, sleeping on the ground etc. are all linked to poverty as well as to increased exposure to peri-domestic sandflies. Most of the published studies assessed the risk for VL Tropical Medicine and International Health doi:10.1111/j.1365-3156.2010.02564.x

Clinical Management of Pandemic 2009 Influenza A(H1N1) Infection

Antiviral therapy and vaccination are important strategies for controlling pandemic 2009 influenza A(H1N1) but efficacy depends on the timing of administration and is often limited by supply shortage. Patients with dyspnea, tachypnea, evidence of hypoxemia, and pulmonary infiltrates on chest radiograph should be hospitalized. Patients with severe illness or underlying medical conditions that increase the risk of more severe disease should be treated with oseltamivir or zanamivir as soon as possible, without waiting for the results of laboratory tests. Lung-protective ventilation strategy with a low tidal volume and adequate pressure, in addition to a conservative fluid management approach, is recommended when treating adult patients with ARDS. Extracorporeal membrane oxygenation has emerged as an important rescue therapy for critically ill patients. Use of systemic steroids was associated with delayed viral clearance in severe acute respiratory syndrome and H3N2 infection. Low-dose corticosteroids may be considered in the treatment of refractory septic shock. Passive immunotherapy in the form of convalescent plasma or hyperimmune globulin may be explored as rescue therapy. More data are needed to explore the potential role of IV gamma globulin and other drugs with immunomodulating properties, such as statins, gemfibrozil, and N-acetyl-cysteine. Health-care workers must apply strict standard and droplet precautions when dealing with suspected and confirmed case and upgrade to airborne precautions when performing aerosol-generating procedures. Nonpharmacologic measures, such as early case isolation, household quarantine, school/workplace closure, good community hygiene, and restrictions on travel are useful measures in controlling an influenza pandemic at its early phase.

The detrimental crime of abortion: A comparative study between Malaysian law and common law

Although procreation is considered as the most important function of marriage, millions of women use some means of contraception and even resort to abortion. Medical reasons constitute only a small proportion of the actual number of cases and the rest being for social and other reasons. Islam places great value on human life. Any attempt to take it away in any stages is a heinous crime. This research will discuss the different viewpoints of Islamic jurists regarding the legal position of abortion and its punishment under Islamic criminal law. Besides that, this research will also make a comparison with Malaysian and common laws. As a result, the writer found out that abortion should be prohibited as it is a crime against human being and it can only be allowed where the fully trained medical doctor view that the continuance of the pregnancy will endanger the life of the mother. Key words: Detrimental, crime of abortion, comparative law, Islamic law, common law.

Introduction of the standard prehospital stroke life support (PSLS) training of EMS paramedics for the prehospital management of cerebrovascular disease in Japan.

Although the introduction of t-PA (tissue plasminogen activator) was considered radical treatment for acute cerebral ischemic disease, the actual number of cases for such administration was limited in Japan for many reasons; one such reason was related to the ability of EMT (emergency medical technician) paramedics to transport patients to the proper hospital for treatment within 2 hours of onset. From this point of view, the Committee of the Prehospital Stroke Life Support (PSLS) of the Japanese Society for Emergency Medicine (JSEM) developed an original standard for prehospital treatment of stroke. In this paper, the author provides an overview of PSLS and the half-day practical course, which has been widely disseminated over a short period of time.

Estimate of Novel Influenza A/H1N1 cases in Mexico at the early stage of the pandemic with a spatially structured epidemic model.

Determining the number of cases in an epidemic is fundamental to properly evaluate several disease features of high relevance for public health policies such as mortality, morbidity or hospitalization rates. Surveillance efforts are however incomplete especially at the early stage of an outbreak due to the ongoing learning process about the disease characteristics. An example of this is represented by the number of H1N1 influenza cases in Mexico during the first months of the current pandemic. Several estimates using backtrack calculation based on imported cases from Mexico in other countries point out that the actual number of cases was likely orders of magnitude larger than the number of confirmed cases. Realistic computational models fed with the best available estimates of the basic disease parameters can provide an ab-initio calculation of the number of cases in Mexico as other countries. Here we use the Global Epidemic and Mobility (GLEaM) model to obtain estimates of the size of the epidemic in Mexico as well as of imported cases at the end of April and beginning of May. We find that the reference range for the number of cases in Mexico on April 30th is 121,000 to 1,394,000 in good agreement with the recent estimates by Lipsitch et al. [M. Lipsitch, PloS One 4:e6895 (2009)]. The number of imported cases from Mexico in several countries is found to be in good agreement with the surveillance data.

Underdiagnosis of acute rheumatic fever in primary care settings in a developing country

To determine the incidence rate, characterize the clinical features and assess the diagnostic evaluation of children presenting with features of acute rheumatic fever (ARF) at two clinics in a region of Fiji where rheumatic heart disease is known to be endemic. We reviewed 5 years (2003-2008) of primary care records from 15 841 patients aged 4-20 years using a pre-determined case definition for ARF; and we reviewed detailed clinical data from 944 cases with features of possible ARF. The crude incidence of first episodes of definite ARF in this setting among patients aged 4-20 years was 24.9 per 100 000 person-years. Joint involvement suggestive of a potential first presentation of ARF but not sufficient for a definite retrospective diagnosis was documented in a further 94 records. There were another 514 cases of joint involvement less suggestive of ARF and 316 cases of unexplained fever with no evidence of localized infection. Patients presenting with potential features of ARF seldom had a diagnostic evaluation sufficient to exclude its diagnosis. The incidence of ARF at these clinics is nearly twice that reported in a local hospital-based study, but it is likely to under-represent the actual number of cases presenting to primary care. There is a need for better surveillance for ARF and to develop simple and practical approaches to diagnosing ARF in primary care in low-resource settings.

Consultation activities of clinical ethics committees in the United Kingdom: an empirical study and wake-up call

Objective:To identify the consultation activities of clinical ethics committees (CECs) in the UK and the views of CEC chairpersons regarding such activities.Methods:An anonymous, password-protected online questionnaire was sent by e-mail...

Changes in the epidemiology of hepatitis B virus infection following the implementation of immunisation programmes in northeastern Greece

The objective of this study was to investigate changes in the epidemiology of hepatitis B virus infection in the general population and selected groups of immigrants in the region of northeastern Greece over the last decade in relation to the introduction of hepatitis B vaccination programmes. Two population-based seroprevalence surveys were carried out during the years 1992-1994 and 1998-2006. In total, 25,105 individuals were tested for the presence of hepatitis B virus markers: HBsAg, anti-HBs and anti-HBc. Childhood/adolescence immunisation programmes began early in 1994 in selected groups of immigrants and were complemented by the national vaccination programme in 1998. Between 1992-1994 and 1998-2006, the HBsAg carrier rate declined from 5.4% [95% CI: 4.5-5.9] in adults (20-60 years old) and 1.9% [95% CI: 1.6-2.4] in children/adolescents (5-19 years old) of indigenous residents to 3.4% [95% CI: 2.9-3.8] and 0.6% [95% CI: 0.2-1.4] respectively (p<0.05). In spite of a decrease compared with 1992-1994, the percentage of HBsAg carriers was still relatively high in 1998-2006 among the Muslim religious minority group (8.2% [95% CI: 8.0-8.7] in adults and 2% [95% CI: 1.7-2.4] in children/adolescents) and in immigrants from the former Soviet Union (4.3% [95% CI: 3.6-4.7] in adults and 1.1% [95% CI: 0.8-2.4] in children/adolescents) (p<0.05 for both selected groups versus general population). The decline of the prevalence of HBsAg in the general population and selected groups of immigrants in northeastern Greece over the last decade supports the effectiveness of the ongoing immunisation programme although the information on the actual number of cases of acute HBV infection is not available.

Malignant solitary fibrous tumour of the orbit

We aimed to report a case of orbital solitary fibrous tumour (SFT) in a child and to review the relevant literature. We describe an SFT in a 13-year-old boy with a 1-month history of painless proptosis in the left eye. Magnetic resonance imaging revealed a well circumscribed mass filling most of the left intraconal orbit. The lesion was excised and histopathological examination revealed a malignant SFT. Postoperative follow-up for 18 months was uneventful. Malignant SFT of the orbit should be included in the differential diagnosis of paediatric orbital tumours. Complete surgical excision remains the preferred method of management and the longterm prognosis is guarded.

Novedades etiopatogénicas en el carcinoma de células renales: carcinogénesis y vías de desarrollo tumoral

AbstractRenal cancer is the third leading urological tumor after prostate and bladder cancers. Annual incidence of renal cancer in all stages has markedly increased in recent years. This represents a true increase in the number of actual cases that is not fully accounted for by widespread use of diagnostic imaging tests.This article is intended to provide an update on the carcinogenesis and tumor development pathways involved in the genesis of this tumor. Renal cell carcinoma (RCC) arises in renal epithelium and accounts for more than 90% of all malignant kidney tumors. Approximately 2% of RCCs are associated to hereditary syndromes, specific oncogenes, or changes in tumor suppressor genes. Changes in the VHL gene exist in all hereditary cases. This gene (located in the short arm of chromosome 3:3p25-26) is also involved in more than 60% of sporadic cases. This paper systematically addresses the latest findings on implications of the VHL gene in angiogenesis and its potential relationship to new molecules involved in management of RCC.

Occupational Hypersensitivity Pneumonitis Reported to the Czech National Registry of Occupational Diseases in the Period 1992-2005

Between 1992 and 2005, 72 cases of occupational hypersensitive pneumonitis were reported to the Czech National Registry of Occupational Diseases. This represented 0.24% of all occupational diseases reported in the Czech Republic during that period. The greatest number of cases occurred in 1997 (10 cases), of which men constituted 58.3% (42 cases) and women 41.7% (30 cases). The most prevalent cases were farmer's lung (50 cases), malt worker's lung (7 cases) and chemical worker's lung (6 cases). Agriculture was the most common economic activity (total 48 cases), with cattleman and dairyman (total 26 cases) the most frequent occupations; less common were tractor driver (8 cases) and maltster (7 cases). Typical case reports after different exposures are presented. A peak in frequency was observed in the age groups of 45-49 and 50-54 yr (20.8% and 19.4% of cases, respectively) and within the first four years of employment (22.2% of cases). Median age was 48 yr and median exposure 12.5 yr. Incidence was in the range of 0.00-0.20 per 100,000 workers, which appears rather low. Due to the difficult diagnostics of hypersensitive pneumonitis, the actual number of cases is undoubtedly higher, and this disease is probably under-reported.

Impact of indoor residual spray with synthetic pyrethroid in Gandhinagar district, Gujarat

Background:Indoor residual spray (IRS), with appropriate insecticide, is an effective weapon for the control of malaria. Two rounds of indoor residual spray, with synthetic pyrethroid, are given in highly malaria endemic areas. It aims to prevent transmission of malaria by adult vector mosquitoes.Aims:To assess the impact of indoor residual spray in the highly malaria-endemic villages of Kalol taluka in Gandhinagar district.Design:High risk population for malaria, based on last three-year malaria situation.Setting:Malaria endemic rural areas in Gandhinagar district where indoor residual spray was undertaken with synthetic pyrethroid in 2006 and 2007.Study Variables:Exploratory - Rural areas; Outcome - coverage, acceptance.Analysis:Percentage and proportions.Results:Prior to the introduction of synthetic pyrethroid, in 2005, the annual parasitic incidence of the sprayed villages was 33.4. It came down to 8.8 in 2006. Continuation of this strategy in the same villages further brought down the annual parasitic incidence to 1.5 in 2007. A similar trend of steady decline was observed in actual numbers of cases and other malariometric indices as well.Conclusion:IRS, it still has a major role in the control of malaria if implemented with proper supervision, better coverage and community participation.

THE ENVIRONMENTAL IMPACT ASSESSMENT CAUSED BY THE DYKES FAILURE

The paper presents a risk analysis and assessment of the defence linear systems failure (dykes) in case of accidental flood. Also, breach scenarios and hydrographs computation for the corresponding accidental high waters are provided. The impact assessment is highlighted through a global matrix model for costs quantification. It is also presented the flooding computation model for different versions of the linear defence systems and in a correspondent way the Inundation Accidental Dike (I.A.D.) computation in Java language. The results of the theoretical computations were verified and confirmed on a large number of actual cases of dykes failures in our country in the period 2005 2007. The model and the computation program, the real time simulation of the linear defence system failure allow for the possibility to make some favourable decisions in order to mitigate the negative effects during all phases of floods (before, during and after failure).

Alleged drug facilitated sexual assault (DFSA) in Northern Ireland from 1999 to 2005. A study of blood alcohol levels

Alleged sexual assault cases, identified from the forensic science Northern Ireland (FSNI) database, which had toxicology assays carried out on either blood or urine samples, were examined for the years 1999 up to and including 2005. In 1999 there were 30 toxicology requests while in 2005 there were 51, representing a 70% increase. The percentage of cases containing alcohol, drugs or both increased from 66% in 1999 to 78% in 2005. The estimated average blood alcohol concentration remained broadly similar throughout the spread of years. It was found to be 218 mg% (milligrams per 100 millilitres) in 1999 and 217 mg% in 2005. The actual number of cases studied within the 12 h cut-off time rose from 9 in 1999 to 22 in 2005. The relationship between negative toxicology results and time delay between the alleged assault and forensic sampling was examined. This showed that between 44% and 74% of cases were found to have a time delay of > 12 h. Some of these cases may therefore represent false negative results. The presence of drugs, either alone or in combination with other drugs, doubled between 1999 and 2005. Increased identification was found with antidepressants, recreational drugs, benzodiazepines and analgesics, some of which were also associated with alcohol consumption. The findings are sufficient to cause alarm for the health and safety of certain individuals and their increased vulnerability to sexual assault in some social settings. Additionally, the legal implications of what constitutes valid consent needs to be considered further in the light of these findings, if attrition rates are to improve.

Information Campaigns: 10 Years of Experience in the Early Treatment and Intervention in Psychosis (TIPS) Study

&lt;p&gt;This article presents an overview of the strategies developed and implemented from 1997 to 2007 in an early detection site in Norway as part of the early Treatment and Intervention in Psychosis (TIPS) study. These strategies include intensive Information Campaigns (ICs) about the signs and symptoms of psychosis and easy access to low-threshold detection teams for rapid case identification. Few, if any other studies of first-episode psychosis, have used such a system over so many years in a regular and repeated fashion. The TIPS early intervention program reduced the healthcare sector’s median duration of untreated psychosis (DUP) in first-episode schizophrenia from 15 weeks to 4.5 weeks using a combination of these easy-access detection teams and massive ICs that targeted diverse audiences. Data on 5,230 referrals are presented in this article, along with their sources of referral and the actual number of cases who were identified with a first episode of psychosis via the detection teams as the initial contact point with specialized mental health services. The TIPS study has shown that such strategies are a vital part of bringing persons with first-episode psychosis into adequate treatment earlier, thereby reducing DUP. &lt;/p&gt; &lt;h4&gt;ABOUT THE AUTHORS&lt;/h4&gt; &lt;p&gt;Inge Joa, RN; Jan Olav Johannessen, MD; and Tor K. Larsen, MD, are with the Stavanger University Hospital, Department of Psychiatry, Regional Centre for Clinical Research in Psychosis, Stavanger, Norway. Thomas H. McGlashan, MD, is with Yale University School of Medicine, Department of Psychiatry, New Haven, CT. &lt;/p&gt; &lt;p&gt;Ms. Joa, Dr. Johannessen, Dr. Larsen, and Dr. McGlashan have disclosed no relevant financial relationships. &lt;/p&gt; &lt;h4&gt;EDUCATIONAL OBJECTIVES&lt;/h4&gt; &lt;ol&gt;&lt;li&gt;Explain the goals of the Early Treatment and Intervention in Psychosis (TIPS) study. &lt;/li&gt; &lt;li&gt;Describe the strategies employed by the TIPS study to achieve its aims, especially through the utilization of information campaigns. &lt;/li&gt; &lt;li&gt;Discuss the results of the TIPS study in terms of community median duration of untreated psychosis (DUP). &lt;/li&gt;&lt;/ol&gt;

Evidence for an Environmental Influence Leading to the Development of JAK2V617F-Positive Polycythemia Vera: A Molecular Epidemiological Study.

Polycythema vera (PV) is a chronic myeloproliferative disorder (MPD) associated with an acquired mutation (JAK2V617F) in over 90% of patients. The incidence of PV in the US, based on national cancer registry data from 2001–03, is 0.9 persons/105population/year. In Oct. 2006, the PA Dept. of Health requested the assistance of the Agency for Toxic Substances and Disease Registry (ATSDR) in confirming a suspected cluster of PV in the 3 counties (Carbon, Luzerne, & Schuylkill) surrounding the borough of Tamaqua, home to multiple Superfund and National Priorities Listing sites. These counties have a total population of ∼527,000 individuals. The ATSDR investigation identified a total of 131 possible PV cases, including 97 state cancer registry and 34 self-reported cases, of which 72 agreed to be interviewed and 63 were tested for JAK2V617F. The PV diagnosis was confirmed in 38 of the interviewed participants (53%) based on a JAK2V617F+ assay with granulocytes (37 cases) or a JAK2V617F− assay but satisfying WHO criteria for the diagnosis of PV (1 case). Of the 37 cases who met both clinical and molecular criteria (JAK2V617F+) for a diagnosis of PV, 18 (49%) had resided within a 13 mile radius of the McAdoo Associates Superfund Site (MASS) for >5 years during the period 1970–95. The MASS was the home of a hazardous waste recycling business from 1975–79 where large quantities of toxic chemicals were dumped directly into old mine shafts.The Environmental Protection Agency completed surface remediation in the early 90's, but was unable to determine the extent and fate of the chemicals poured into the mine. A spatial scan statistical analysis identified this area as a significant cluster and individuals living within this area had a 4.5 times greater risk of developing PV compared to individuals residing in the remainder of the 3 counties (p<0.001). 4 cases of JAK2V617F+ PV were identified within the described area along a 2-mile stretch of a single street containing 70 homes, including 2 individuals who lived in the same dwelling. No familial inheritance patterns of PV were documented, nor were any correlations noted with regards to type of employment or recreational/leisure activities. The lack of traditional epidemiological explanations and the high degree of statistical certainty for the geographical association of the cases strongly suggests that an external influence led to the development of PV. Since the PV rates are based on both self-identified and cancer registry cases, direct comparisons to state and national rates can't be made. However, it is likely that at least as many confirmed cases would have been found in the 61 “missing” registry cases as were found in the 20 “self-reporting” cases. Thus, the number of confirmed cases identified in this investigation should represent a conservative estimate of the total number of actual cases in the registry.The diagnosis of PV was confirmed in less than half of the registry participants, which highlights the utility of JAK2V617F analysis in epidemiological studies evaluating the incidence of MPD. Finally, the results of this investigation provide, for the first time, significant evidence for an association between an as yet uncharacterized external stimulus and the development of JAK2V617F+ PV.

PROXY CONSENT AND COUNTERFACTUALS

When patients are in vegetative states and their lives are maintained by medical devices, their surrogates might offer proxy consents on their behalf in order to terminate the use of the devices. The so-called 'substituted judgment thesis' has been adopted by the courts regularly in order to determine the validity of such proxy consents. The thesis purports to evaluate proxy consents by appealing to putative counterfactual truths about what the patients would choose, were they to be competent. The aim of this paper is to reveal a significant limitation of the thesis, which has hitherto been recognised only vaguely and intuitively. By appealing to the metaphysics of counterfactuals I explain how the thesis fails to determine the validity of proxy consents in a number of actual cases.

Seeking an International Dialogue on Research Integrity

Scientific misconduct is a global problem, yet protocols for addressing it remain highly fragmented and uneven. A conference held last month in Lisbon aimed to encourage international efforts to promote research integrity and to prevent misconduct.

Primary Malignant Melanoma of the Lung: Review of Literature and Report of a Case

Less than 25 cases of primary malignant melanoma of the lung have been reported in the literature, with limited mention in the surgical literature. When published criteria are strictly applied, the actual number of cases is even fewer. We report the case of a 74-year-old man who underwent a left lower pulmonary lobectomy for a large left lower lobe mass consistent with malignancy. Clinical and pathological review confirmed primary malignant melanoma of the lung. Relevant clinical and histopathological features and the criteria for diagnosis are reviewed.

Price quotation methodology for stereolithography parts based on STL model

Rapid prototyping (RP) service bureaus or providers are always facing the urgent price quotation requirements for RP parts from customers in today's competition market. This paper presents two effective methodologies of the price quotation for stereolithography (SL) parts based on STL model. A model of price quotation for the RP part was presented. Furthermore, the calculation of manufacturing cost for the SL system was also discussed in detail. Two quoting approaches which include the rough quotation based on weight and precise quotation based on build-time were proposed to determine the price quotation for SL parts. A new algorithm of predicting build-time of SL parts was put forward to implement the precise quotation. The algorithm incorporates the geometrical features drawn from the part's STL model and the value of support structures determined by a statistical method. The proposed quotation methods have been employed to develop a web-based automated quotation system that can provide instant and accurate price quotation for SL parts to support effectively the RP&M service. The application results of a number of actual cases show that the methods can satisfy the engineering requirements of price quotation at the early stage of product development.