Individuals In High-risk Groups Research Articles

BRUCELLOSIS IN HIGH RISK GROUP INDIVIDUALS

Purpose: The purpose of this study was to investigate the seroprevalence of brucellosis among high-risk group individuals, consisting of veterinarians and para-veterinarians, shepherds, butchers and animal owners. Methods: The present work was carried out at Project Directorate on Animal Disease Monitoring and Surveillance, Bangalore, by using the recently developed indirect enzyme-linked immunosorbent assay (ELISA) for antibodies to Brucella abortus. Results: The results were compared with the conventional serological tests, Rose Bengal plate test and standard tube agglutination test. The result showed that the indirect ELISA was more sensitive than the conventional tests. Of 618 tested, the disease of prevalence was at 41.23% in veterinary inspectors, 30.92% in veterinary assistants, 12.37% in veterinary officers, 6.18% in veterinary supervisors, 6.18% in Group D workers, 2.06% in shepherds and 1.03% in butchers. Conclusions: This study results highlight the immediate necessity to institute control measures to control Brucellosis.

<i>Brucellosis</i> in high risk group individuals

The purpose of this study was to investigate the seroprevalence of brucellosis among high-risk group individuals, consisting of veterinarians and para-veterinarians, shepherds, butchers and animal owners. The present work was carried out at Project Directorate on Animal Disease Monitoring and Surveillance, Bangalore, by using the recently developed indirect enzyme-linked immunosorbent assay (ELISA) for antibodies to Brucella abortus. The results were compared with the conventional serological tests, Rose Bengal plate test and standard tube agglutination test. The result showed that the indirect ELISA was more sensitive than the conventional tests. Of 618 tested, the disease of prevalence was at 41.23% in veterinary inspectors, 30.92% in veterinary assistants, 12.37% in veterinary officers, 6.18% in veterinary supervisors, 6.18% in Group D workers, 2.06% in shepherds and 1.03% in butchers. This study results highlight the immediate necessity to institute control measures to control Brucellosis.

CHERNOBYL BEYOND 20 YEARS: WHAT IS RADIATION-INDUCED THYROID CANCER?

Along with a summary of clinical data on Chernobyl thyroid cancer, presented will be the scope of current understanding of the molecular mechanisms of radiation-induced thyroid cancer in children and adolescents with a focus on the discussion of how to further assist the long-term follow-up of the operated patients with thyroid cancer and to outline the approaches to the identification of the groups at high risk of the disease. Special attention should be paid to a high risk group of individuals who had been exposed to radioactive iodines after the Chernobyl accident and whose age is from 20 to 30 year-old in 2006.

Impact of Melanoma Diagnosis on Sun-Awareness and Protection: Efficacy of Education Campaigns in a High-Risk Population

Malignant melanoma is a significant cause of morbidity and mortality worldwide. Sun-awareness campaigns increase public knowledge but may not translate into behavioral changes in practice, which is particularly alarming when reported for individuals in high-risk groups. In particular, patients diagnosed with melanoma are at increased risk of developing subsequent primary melanomas compared with the general population. The study was undertaken (1) to assess whether patients with known risk factors for developing melanoma had been exposed to preventative campaign messages prior to their diagnosis, (2) to quantify whether the diagnosis of melanoma changed sun-related attitudes and behavior, and (3) to assess the adequacy of sun-related advice given to patients with melanoma, as well as their compliance with the advice. Using an anonymous questionnaire, 217 patients previously diagnosed with melanoma were interviewed on the source and frequency of received sun-related advice, as well as on their knowledge, attitudes, and behavior toward sun protection before and after the diagnosis. The number of patients who reported receiving sun-related advice after being diagnosed with melanoma increased by 36% (52% pre-vs. 88% postDiagnosis), with advice being given more frequently and more often by a physician (19% pre- vs. 49% postdiagnosis). Furthermore, sun-related attitudes and behavioral practices were positively altered. Yet, patients with known risk factors were not preferentially targeted for advice before their diagnosis. The diagnosis of melanoma leads to increased sun-awareness and protection. While dermatologists should continue their efforts to promote and reinforce sun-awareness in patients with melanoma, additional emphasis on preventative targeting of high-risk individuals would be of marked benefit in decreasing the overall incidence of melanoma. Non-dermatologists, such as family physicians, can be key players in this preventative campaign, and can be educated to recognize and educate patients at risk, as well as direct them to be followed under dermatology care.

Impact of Melanoma Diagnosis on Sun-Awareness and Protection: Efficacy of Education Campaigns in a High-Risk Population

Background: Malignant melanoma is a significant cause of morbidity and mortality worldwide. Sun-awareness campaigns increase public knowledge but may not translate into behavioral changes in practice, which is particularly alarming when reported for individuals in high-risk groups. In particular, patients diagnosed with melanoma are at increased risk of developing subsequent primary melanomas compared with the general population. Objectives: The study was undertaken (1) to assess whether patients with known risk factors for developing melanoma had been exposed to preventative campaign messages prior to their diagnosis, (2) to quantify whether the diagnosis of melanoma changed sun-related attitudes and behavior, and (3) to assess the adequacy of sun-related advice given to patients with melanoma, as well as their compliance with the advice. Methods: Using an anonymous questionnaire, 217 patients previously diagnosed with melanoma were interviewed on the source and frequency of received sun-related advice, as well as on their knowledge, attitudes, and behavior toward sun protection before and after the diagnosis. Results: The number of patients who reported receiving sun-related advice after being diagnosed with melanoma increased by 36% (52% pre-vs. 88% postDiagnosis), with advice being given more frequently and more often by a physician (19% pre- vs. 49% postdiagnosis). Furthermore, sun-related attitudes and behavioral practices were positively altered. Yet, patients with known risk factors were not preferentially targeted for advice before their diagnosis. Conclusions: The diagnosis of melanoma leads to increased sunwareness and protection. While dermatologists should continue their efforts to promote and reinforce sun-awareness in patients with melanoma, additional emphasis on preventative targeting of high-risk individuals would be of marked benefit in decreasing the overall incidence of melanoma. Non-dermatologists, such as family physicians, can be key players in this preventative campign, and can be educated to recognize and educate patients at risk, as well as direct them to be followed under dermatology care.

The use of stress echocardiography in the assessment of mitral valvular disease.

Stress echocardiography plays an important role in evaluating asymptomatic patients with significant mitral stenosis and symptomatic patients with only mild disease at rest, as it correlates the exercise-induced symptoms with changes in transmitral gradients, pulmonary pressures, and mitral valve area. In patients with mitral regurgitation (MR), exercise or dobutamine protocols assess for the change in the degree of regurgitation and the pulmonary artery pressure (PAP) in response to high flow states, and detect underlying left ventricular (LV) dysfunction prior to valvular surgery. Exercise echocardiography also helps in the prognostic assessment of patients with mitral valve prolapse as new MR, or latent LV dysfunction may be provoked to identify a group of high risk individuals with normal resting echocardiographic parameters. Finally, it evaluates the proper functioning of prosthetic mitral valves and helps on the monitoring of transmitral gradients and PAPs after mitral valve surgery.

Hormone Replacement Therapy Does Not Affect Plasma Homocysteine in Postmenopausal Women with Coronary Artery Disease

Objective: The objective was to evaluate the effect of hormone replacement therapy (HRT) on plasma homocysteine levels in postmenopausal women with coronary artery disease (CAD) and to investigate associations of homocysteine to other cardiovascular risk factors. Methods: The women in this single-center, controlled, and randomized study were examined at baseline, and after 3 and 12 months, after they had been recruited consecutively from patients referred for investigational coronary angiography. All analyses were performed examiner blind. They were randomized to HRT consisting of transdermal application of continuous 17β-estradiol with cyclic medroxyprogesterone acetate (MPA) tablets for 14 days every 3rd month, or to a control group. Results: After 3 months of unopposed 17β-estradiol, no significant effect on homocysteine was observed compared to the control group. The absolute decrease of 5% in median plasma homocysteine levels after 12-month HRT did not reach statistical significance. Plasma homocysteine seemed slightly higher in women with three- or four-vessel disease, but the difference was not significant. With increasing homocysteine levels, free tissue factor pathway inhibitor (TFPI) antigen increased, whereas E-selectin decreased. In women with diabetes or elevated blood glucose >6.0 mmol/l, plasma homocysteine was correlated to body mass index, C-peptide and insulin as well as age. Conclusion: Transdermal application of 17β-estradiol and sequential MPA do not affect plasma homocysteine in women with established CAD. Plasma homocysteine is stable in women with CAD over time, and unless special intervention is undertaken, repetitive measurements are not necessary in this particular group of high-risk individuals. The circulating anticoagulant TEPI is related to plasma homocysteine.

Conseils pratiques pour la vaccination généralisée contre l'hépatite B

• L'injection doit etre strictement intramusculaire et effectuee dans le muscle deltoide. • La vaccination comporte 3 injections aux temps 0, 1 mois et 6 mois, sans rapel. • L'intervalle entre la premiere et la deuxieme dose ne doit pas etre plus court que 1 mois mais peut etre plus long. • L'intervalle entre la deuxieme et la troisieme dose ne doit pas etre plus court que 2 mois mais peut etre plus long que 5 mois. • Les vaccins commercialement disponibles sont interchangeables: une immunisation commencee avec l'un peut etre poursuivie avec un autre. • Le controle du titre d'anticorps est inutile dans le contexte d'une vaccination generalisee.

Practical recommendations for general introduction of hepatitis B vaccination

The Swiss Federal Office of Public Health and the Swiss Advisory Board on Immunisation recommended that universal vaccination against hepatitis B be introduced in January 1998. The target population for immunisation are youngsters between 11 and 15 years of age. This recommendation does not preclude ongoing selective vaccination of individuals in high risk groups, nor the routine immunisation of individuals younger or older than the target age (if needed). Injections should be given in the deltoïd area and needle length is critical to ensure proper resorption of the antigen and adequate immune response. Three doses are recommended at times 0, 1 month and 6 months with no booster dose. The time interval between the second and third dose should not be shorter than 2 months but can be longer than 5 months. Vaccination initiated with one commercial brand can be completed with a different brand. The simultaneous administration of immune globulin with the initiation of vaccination and the measurement of serum antibodies after completion of vaccination are unnecessary.

Use of non-steroidal anti-inflammatory drugs in the prevention of Alzheimer’s disease in the high risk patient

Alzheimer's disease (AD) is a major neurological disorder causing dementia in the elderly. Because the causes of AD are not known, there is no real treatment for this disorder. However, a number of risk factors have been associated with AD. Among these factors, a family history of AD is most significant. An inverse association between non-steroidal anti-inflammatory drugs (NSAIDs) use and AD has been previously demonstrated in several epidemiological studies. Here the potential use of NSAIDs as a protective measure for individuals in high risk groups is suggested. Normal 0 false false false EN-CA X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin-top:0in; mso-para-margin-right:0in; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0in; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin;}

A follow-up study of progression from dysplasia to squamous cell carcinoma with immunohistochemical examination of p53 protein overexpression in the bronchi of ex-chromate workers.

Squamous cell carcinoma (SCC) of the bronchus is considered to develop from preneoplastic 'dysplasia', but reports of sequential observation of this dysplasia-carcinoma sequence in humans are very few. We followed four dysplastic lesions found in the bronchi of three ex-chromate workers by bronchoscopy and biopsy and found that all of them progressed to SCC. Of the four lesions, three were severe dysplasias at the first biopsy which progressed to SCCs in 7-13 months. The last one was a slight dysplasia at the first biopsy and showed progression of the atypia to carcinoma in 6 years and 10 months. An immunohistochemical analysis of the chronological change in p53 protein expression in these lesions and in normal ciliated epithelium taken from the surroundings was conducted in each case. Overexpression of p53 protein was observed in two of the severe dysplasias and the one slight dysplasia, as well as their eventual SCCs. However, no such change was apparent in one case of severe dysplasia or its eventual SCC. Normal epithelium was consistently negative. Our results provide direct proof of the dysplasia-carcinoma sequence and suggest that alteration in the expression of p53 protein might be an important early event which persists. Therefore, the immunohistochemical detection of p53 overexpression in biopsy specimens of bronchial epithelium might be useful for evaluation of preneoplastic lesions in high-risk group individuals and for early diagnosis of bronchial cancer.

Lipid Profile in the First-Degree Relatives of Patients with Precocious Coronary Heart Disease in Rohtak Area (Northern India)

Twenty-five patients with precocious coronary heart disease (CHD) (aged forty years or less) and 82 first-degree relatives were studied for lipid profile. Eighty-eight age- and sex-matched controls were also studied. The mean serum cholesterol, triglycerides, low density lipoprotein cholesterol, very low density lipoprotein cholesterol, and total cholesterol/high density lipoprotein cholesterol of patients and their first-degree relatives were significantly higher as compared with normal controls. High density lipoprotein cholesterol values were found to be almost identical in the patient group, their first-degree relatives, and normal controls. Hyperlipidemia was found in 68% of patients with CAD, of their first-degree relatives, and 24% of controls. Almost all lipid fractions in relatives of hyperlipidemic patients paralleled those of the patients suffering from CHD. Of 25 families studied, 16 had hyperlipidemia. In conclusion, it can be stated that there is a statistically significant hyperlipidemia in young patients with CHD that has a significant familial clustering, thus delineating a group of high-risk individuals (first-degree relatives of young coronary patients) for possible primary prevention of CHD. This familial clustering could be due to genetic or environmental factors; however, the relative contribution of these two factors requires further investigation.

Incidence of HTLV‐I/II infection in seronegative high‐risk individuals

The frequency of human T-cell lymphotropic virus types I and II (HTLV-I/II) polymerase chain reaction (PCR) reactivity was studied in two groups of high-risk individuals in Amsterdam: hard drug users and heterosexual outpatients of the sexual transmitted diseases (STD) clinic. Both groups were seronegative as determined by enzyme-linked immunosorbent assay (ELISA), Western blot (WB), and radioimmuno-precipitation assay (RIPA). Detection of HTLV-I and HTLV-II in peripheral blood mononuclear cells (MNC) was performed by PCR, using primer sets indicative for the pol and tax genes. In the hard drug users group (n = 25) no evidence of HTLV-I/II infection was found whereas in the STD group (n = 21) one individual was identified with HTLV-II proviral DNA. Positive reactions in PCR were confirmed only for three seropositive controls after in vitro culture of MNC but not for the PCR-positive, seronegative individual. Virus production in vitro could not be detected by a sensitive HTLV-I antigen capture assay for viral p24gag proteins after in vitro T-cell stimulation of MNC, either from PCR-positive or PCR-seronegative individuals. This suggests again a low viral production rate. It is concluded that infection with HTLV-II can be detected among high-risk seronegative individuals.

Detection of human cytomegalovirus in peripheral mononuclear cells and urine samples using PCR.

Samples of peripheral blood lymphocytes from 105 different blood donors were investigated for the presence of human cytomegalovirus (HCMV) DNA using the polymerase chain reaction (PCR) with primers specific for the Pst I w fragment (IE region). Viral DNA sequences were detected in 53 samples, a fifth of which had been previously serotyped as HCMV negative. In the latter cases, Western blot analysis re-determined two out of three individuals that were resampled as seropositive. PCR could therefore be used to extend existing methods employed for the identification of HCMV infected blood samples prior to transfusion to individuals in high risk groups. In addition, the value of PCR as a diagnostic test was evaluated in a small pilot study by comparing the results obtained with urine samples from babies suffering congenital infection and from other high risk patients, with data obtained by isolation of infectious virus or through the detection of immediate early antigens in infected cultures. Data from this study indicated that PCR is at least as sensitive as the other methods used in HCMV diagnosis.

New Developments in AIDS

At the present time there is no effective therapy for the HIV infection itself, nor for the opportunistic infections, malignancies, immune perturbations, and other manifestations of AIDS. However, as a result of knowledge gained regarding the modes of transmission of HIV, public health officials have made recommendations which, if followed, would slow or even halt further spread of the virus. Thus it is hoped that educational efforts directed at individuals in high-risk groups will be effective in stopping transmission of this disease and that ongoing research efforts will soon provide therapeutic agents to cure it or slow its progression.

From the Centers for Disease Control. Conference on new approaches for tuberculosis preventive therapy.

A conference on short-course preventive therapy for tuberculosis was held in Atlanta, Georgia on 8-10 September 1986. The objectives of the conference, sponsored by the Division of Tuberculosis Control, Centers for Disease Control (CDC), were to review the scientific basis for isoniazid (INH) preventive therapy, discuss the current status of preventive therapy in the United States, review the pharmacological and microbiologic aspects of all antimycobacterial drugs, and determine whether a study of short-course preventive therapy was necessary and feasible. Approximately 10 million individuals in the United States are infected by Mycobacterium tuberculosis, and the majority of new cases of tuberculosis occur in persons who were infected more than six months before the disease became manifest. The treatment of infected individuals with a six-to-12month course of INH reduced the risk of disease by 65%-90% [1]. The American Thoracic Society (ATS) and the CDC currently recommend INH preventive therapy for infected individuals in high-risk groups (e.g., close contacts; individuals who recently converted to positive skin tests; those with radiographic evidence of inactive, previously untreated pulmonary tuberculosis; and individuals with positive skin tests who have medical conditions that predispose to the development of tuberculosis) and other individuals with positive skin tests who are 15 years of age are given preventive chemotherapy [3]. Moreover, of those started on preventive therapy, only 75% complete the recommended course of therapy. Reasons for the failure to prescribe preventive therapy include the perceived risk of toxicity and low probability of developing tuberculosis. The difficulty experienced by

Familial hyperlipidemia in stroke in the young.

Serum cholesterol, low density lipoproteins (LDL), very low density lipoproteins (VLDL) and chylomicron levels were studied in 25 young patients (age 40 years or less) of non-embolic ischemic stroke of unknown aetiology. Fifteen patients were males and 10 were females. The prevalence of hyperlipidemia was found to be 60%. Frederickson's type IIb hyperlipoproteinemia was the commonest (32%) abnormal pattern observed, followed by type IIa (12%), type IV (12%) and type V (4%). Family studies were carried out in all the 25 index patients (15 hyperlipidemic and 10 normolipidemic). Familial hyperlipidemia (i.e. 2 or more hyperlipidemic members in the same family) was found in 9 of the 15 hyperlipidemic index patients and in none of the normolipidemic index patients. The common pattern was found to be that of familial combined hyperlipidemia. The study indicates that screening the family members of hyperlipidemic young patients of non-embolic ischemic stroke may delineate a group of high risk individuals for possible primary prevention before they develop the disease.

The value of lung cancer detection by six-monthly chest radiographs.

Results are reported of a prospective study, carried out by the Mass Radiography Service of the North-West Metropolitan Region for the purpose of evaluating early lung cancer detection by six-monthly chest radiographs. The lung cancer experience of a test group of 29,723 men aged 40 and over who were offered six-monthly chest radiographs over a period of three years is compared with a similarly constituted control group of 25,311 men who were radiographed only at the beginning and the end of the study. In the test group 29,416 men (98·9%) and in the control group 25,044 men (99%) were followed up. The methods employed to achieve this result are analysed. The six-monthly surveys of the test group yielded 65 cases of lung cancer, giving an annual incidence and detection rate of 0·9 per thousand examined. Of these cases 65% were resected. Of all cases of lung cancer in the test group, irrespective of their source of detection, 43·6% were operable, compared with 29% in the control group. The difference (P=0·03) is statistically significant. The annual mortality rate from lung cancer based on 62 deaths in the test group and 59 deaths in the control was 0·7 and 0·8 per thousand respectively. The conclusions are reached that since early detection by six-monthly chest radiographs has not significantly reduced the mortality from lung cancer in a population at risk, a policy of such large-scale surveys of men in the cancer age would not seem justified, but that the increased discovery of resectable lung cancer by this method forms a reasonable basis for encouraging individuals in high-risk groups to make regular use of existing mass radiography facilities.

Sudden and unexpected non-traumatic deaths in adults: A review of epidemiological and clinical studies

Sudden and unexpected non-traumatic deaths in adults: A review of epidemiological and clinical studies