Bacterial Shedding in Household Contacts of Cholera Patients in Dhaka,Bangladesh

Multiple Vibrio cholerae infections within the same household are common. Household contacts of patients with cholera were observed with daily clinical assessments and collection of rectal swab cultures for nine days after presentation of the index case. During the follow-up period, 71 (24%) of 294 household contacts developed a positive V. cholerae rectal swab, signifying bacterial shedding. The average length of bacterial shedding was 2.0 days (95% confidence interval 1.7–2.4). However, 16 (5%) of 294 contacts shed V. cholerae for ≥ 4 days. In a multivariate analysis, malnutrition was predictive of long-term shedding (odds ratio = 1.4, 95% confidence interval = 1.3–13, P = 0.02). High rates of V. cholerae infection and bacterial shedding among household contacts of cholera patients represent an opportunity for intervention to reduce V. cholerae transmission.     

Risk Factors Associated with Clinical Malaria Episodes in Bangladesh: A Longitudinal Study

Malaria is endemic to Bangladesh. In this longitudinal study, we used hydrologic, topographic, and socioeconomic risk factors to explain single and multiple malaria infections at individual and household levels. Malaria incidence was determined for 1,634 households in 54 villages in 2009 and 2010. During the entire study period 21.8% of households accounted for all (n = 497) malaria cases detected; 15.4% of households had 1 case and 6.4% had ≥ 2 cases. The greatest risk factors for malaria infection were low bed net ratio per household, house construction materials (wall), and high density of houses. Hydrologic and topographic factors were not significantly associated with malaria risk. This study identifies stable malaria hotspots and risk factors that should be considered for cost-effective targeting of malaria interventions that may contribute to potential elimination of malaria in Bangladesh.     

ICU发生呼吸机相关性肺炎的危险因素分析

目的分析ICU发生呼吸机相关性肺炎(VAP)的危险因素,以期为VAP的预防提供参考。方法回顾性分析2008年1月—2011年6月我院ICU行人工机械通气患者300例的相关临床资料,采用多因素Logistic回归分析分析患者发生VAP的危险因素。结果 80例患者发生VAP,发生率为26.67%。Logistic回归分析结果显示,误吸、机械通气时间3 d、抗生素联用是发生VAP的危险因素(P值分别为0.032、0.033、0.015)。结论 ICU发生VAP的危险因素为误吸、机械通气时间3 d及抗生素联用。     

早发性卒中相关性肺炎的危险因素分析

卒中相关性肺炎（stroke associated pneumonia,SAP）是临床确诊的急性卒中患者出现发热、咳嗽、咳痰、呼吸困难等症状,根据特定诊断程序（有微生物学检查依据和／或胸部X线表现）而确诊的肺炎。2003年Hilker等提出这个概念,推测SAP可能有自身独立的临床规律,并进一步将急性卒中发病后72h内发生的SAP称为早发性SAP。     

Zymodemes of Entamoeba histolytica in Dhaka, Bangladesh

Stool samples containing Entamoeba histolytica were obtained from two sources: an urban hospital and an urban slum. Using the enzyme patterns of three enzymes (E.C.2.7.1.1 hexokinase, E.C.5.3.1.9 glucose phosphate isomerase and E.C.2.7.5.1 phosphoglucomutase) stained after cellulose acetate electrophoresis, four zymodemes (I, II, XIV and XVI) were identified in 71 isolates. Zymodemes considered to be pathogenic (II and XIV) were identified from 31 of 34 isolates from the urban hospital, and these zymodemes were strongly associated with dysentery and trophozoites containing ingested red blood corpuscles. Blood visible to the naked eye was more commonly seen in stools from which zymodeme XIV was isolated than in those containing zymodeme II (P less than 0.001). Zymodemes considered to be non-pathogenic (I and XVI) were identified in 34 of 37 isolates from slum dwellers and were not associated with blood in the stools.     

Alcohol-related Death and Associated Risk Factors in Urban Middle-aged Males

ABSTRACT Alcohol-related disorders belong to the spectrum of major non-infectious diseases in Western societies which can be prevented by means that have not yet been fully implemented. Total consecutive mortality in a population of 10 353 middle-age males invited to take a part in a preventive medical population program in Malmö was followed up for 3.5–8.5 years (mean 4.5) after the time of invitation and analysed in relation to participation or non-participation and forensic or in-hospital autopsy. Entry characteristics in the 7935 males who attended the screening were compared in order to evaluate risk factor patterns for the major categories of premature death during the follow-up period. Even in the males participating in the screening, alcohol-related deaths (ARD) constituted a major mortality category, comprising 55 of 218 cases, whereas cancer comprised 61 and coronary heart disease (CHD) 50 of the premature deaths in this group. Both in the ARD and CHD categories of male premature mortality, significant and distinctly differential risk factor patterns were found; in CHD for smoking, cholesterol, serum triglycerides and systolic blood pressure, and in ARD for γ-glutamyltransferase, questionnaire alcoholism screening test and, inversely, serum cholesterol and serum creatinine. In both groups of diseases, these risk factors could be combined into highly predictive multiple logistic risk factor functions. The discriminative power of this instrument was even higher in ARD than in CHD deaths. In consequence, these factors may be applied both as indicators of the ARD risk and as signals and instrument for directed preventive measures in analogy with previously well established and tested methods for the regulation of blood pressure, serum lipids, etc. in the conquest of the cardiovascular diseases.     

Concurrent Pneumonia in Children under 5 Years of Age Presenting to a Diarrheal Hospital in Dhaka,Bangladesh

Respiratory and gastrointestinal infections are the top killers of children worldwide, and their co-occurrence is reported but not well understood. Our aim was to determine the risk factors for concurrent presentation of diarrhea and pneumonia (DP) in a resource-limited setting in Bangladesh. We used data from the Diarrheal Disease Surveillance System of the icddr,b Dhaka Hospital to identify children < 60 months of age with diarrhea and concurrent pneumonia, defined as a history of cough, an abnormal lung examination, and tachypnea. For the years 1996–2007, out of total 14,628 diarrheal patients surveyed, there were 607 (4%) patients who satisfied criteria for pneumonia. Those with DP had a higher mortality rate (4% versus 0.05%, odds ratio [OR] = 86, 95% confidence interval [CI] = 26–286) and a longer hospital stay (mean 84 versus 26 hours, difference 58 hours, 95% CI = 52–64 hours) than those with diarrhea (D) only. In multivariable logistic regression comparing cases (N = 607) with controls matched for month and year of admission at a ratio of 1:3 (N = 1,808), we found that DP was associated with younger age, male gender, severe acute malnutrition (SAM), less maternal education, lower family income, and lack of current breast-feeding history.     

Household Environmental Conditions Are Associated with Enteropathy and Impaired Growth in Rural Bangladesh

We assessed the relationship of fecal environmental contamination and environmental enteropathy. We compared markers of environmental enteropathy, parasite burden, and growth in 119 Bangladeshi children (≤ 48 months of age) across rural Bangladesh living in different levels of household environmental cleanliness defined by objective indicators of water quality and sanitary and hand-washing infrastructure. Adjusted for potential confounding characteristics, children from clean households had 0.54 SDs (95% confidence interval [CI] = 0.06, 1.01) higher height-for-age z scores (HAZs), 0.32 SDs (95% CI = −0.72, 0.08) lower lactulose:mannitol (L:M) ratios in urine, and 0.24 SDs (95% CI = −0.63, 0.16) lower immunoglobulin G endotoxin core antibody (IgG EndoCAb) titers than children from contaminated households. After adjusting for age and sex, a 1-unit increase in the ln L:M was associated with a 0.33 SDs decrease in HAZ (95% CI = −0.62, −0.05). These results are consistent with the hypothesis that environmental contamination causes growth faltering mediated through environmental enteropathy.     

Factors associated with encephalopathy in patients with Salmonella enterica serotype Typhi bacteremia presenting to a diarrheal hospital in Dhaka, Bangladesh

To characterize clinical correlates of typhoid fever-associated encephalopathy, we performed a retrospective chart review of patients with Salmonella enterica serotype Typhi bacteremia who were hospitalized at the International Centre for Diarrhoeal Disease Research, Bangladesh, from February of 2009 to June of 2011. Of 207 patients bacteremic with Salmonella Typhi who were ≥ 5 years of age, we identified 43 (21%) patients with encephalopathy. Univariate analysis revealed that patients with encephalopathy more often presented at ages of 10-24 years and had severe dehydration, low oxygen saturation, high respiratory rate, low leukocyte count, low platelet count, and Widal flagellar H agglutinin (TH) titer ≥ 1:640 compared with typhoid patients without encephalopathy. Multivariate analysis using logistic regression showed that age, dehydration, leukocyte count, and Widal TH titer were independently associated with encephalopathy. Our findings suggest that age, severity of disease, and immune responses are associated with encephalopathy during Salmonella Typhi bacteremia, perhaps reflecting the impact of prominent inflammatory responses.     

Transmission of diarrhoea in two crowded areas with different sanitary facilities in Dhaka, Bangladesh

To determine the importance of water-borne and water-washed transmission of diarrhoea we compared the degree of contamination of children's hands and drinking water with their diarrhoeal morbidity. Diarrhoeal incidence in 137 children aged 1-6 years was obtained through fortnightly home visits during the calendar year 1985. Bacterial contamination of hands and drinking water was assessed semi-quantitatively by direct contact using agar-coated slides incorporating a selective medium permitting growth of Enterobacteriaceae (Hygicult, Orion Diagnostica, Finland). Results were expressed as 2-day mean log of colony forming units per gram (cfu/g). Children were studied in two densely populated urban areas: 56 children in one area with latrines and tubewells and 81 children in the other without such facilities. Mean diarrhoea attack rates were lower in the better sanitary area (2.5 vs 3.2, P less than 0.05) as were mean log levels of water contamination (3.1 cfu/g vs 4.3 cfu/g, P less than 0.001). There was no significant correlation between water contamination and diarrhoeal incidence on an individual basis. However, in both areas diarrhoea incidence was significantly correlated with the degree of contamination of hands. After adjusting for age the risk of diarrhoea increased significantly for children with more contaminated hands in the unimproved area. This relationship strongly supports the promotion of handwashing as a method of controlling diarrhoeal diseases and, by implication, the greater importance of water quantity compared to quality.     

Sexually transmitted infections prevalence rates in slum communities of Dhaka, Bangladesh

The study objective was to estimate the prevalence of selected sexually transmitted infections (STIs) and associated factors among Dhaka slum dwellers. Blood and urine specimens were collected from 1534 men and women. Participants in this cross-sectional study responded to a questionnaire, providing socioeconomic data, symptomatology and treatment-seeking behaviour. Specimens were tested for syphilis, hepatitis B (HBsAg), Neisseria gonorrhoeae, Chlamydia trachomatis, and HIV. Serologic evidence of syphilis infection was found in 6.0% of respondents, HBsAg in 3.8%. Prevalence rates of gonorrhoea and chlamydia were 1.7% and <1%, respectively. No HIV infections were found. Men were more than twice as likely as women to be infected with syphilis or HBsAg carriers. Behaviours facilitating STI transmission were common among men. Syphilis infection is prevalent enough to warrant the initiation of screening programmes in this population. The prevalence rate of hepatitis B carriage suggests that this population would benefit from universal vaccination against hepatitis B.     

Risk Factors Associated with Alcohol Abuse in College Students

Abstract

A survey of 989 college students was conducted to investigate risk factors—gender, family history of alcohol abuse, family history of depression and mental illness, childhood hyperac-tivity, and antisocial personality—associated with alcohol abuse. Two hundred ninety-four subjects (29%) completing the alcohol subscale of the Diagnostic Interview Schedule met lifetime DSM-III criteria for alcohol abuse. Utilizing a loglinear model, expression of childhood and early adolescent deviant behavior, family history of depression, and gender were shown to be significantly associated with alcohol abuse among students.     

肥厚型心肌病猝死相关危险因素的研究进展

肥厚型心肌病是一种相对常见的心脏疾病,在普通人群的发病率为0.2%。其临床特征异质性大,但大部分患者的寿命不受影响。尽管如此,心脏性猝死仍然是一部分患者尤其是年轻患者的首发症状。因而,目前迫切需要寻找合理的危险分层方法,将肥厚型心肌病中心脏性猝死高风险的患者鉴别出来。现重点对肥厚型心肌病的相关危险因素做一总结。     

Investigation of Genetic Risk Factors Associated with Alcoholism

Alcoholism is a multifactorial disease influenced by genetic-environmental interaction. Genetic variation of the receptor may be associated with alcohol dependence due to its modified function in behavioral and physiological responses. In the present study, polymorphic alleles of cholecystokinin B receptor (CCKBR), serotonin 1A receptor (HT1AR) genes, and mitochondrial DNA were analyzed. DNAs were isolated from the blood samples of 112 healthy controls and 106 alcoholics. Genetic variation was detected by SSCP analysis, followed by direct sequencing of polymerase chain reaction product as well as restriction fragment-length polymorphism. Three different mutations were found in the exon 3 sequence of CCKBR: His (CAT) at aa207 → His (CAC) (5.4%), Arg (CGC) at aa215 → His (CAC) (4.5%), and Val (GTG) at aa138 → Met (ATG) (0.9%) in controls. Genotypic distribution of alcoholics was not significantly different with that in controls. A proline (CCG) to leucine (CTG) substitution at amino acid 16 of HT1AR was found in alcoholics (4.5%) and in controls (4.7%). This mutation site of HT1AR was different in comparison with the variants reported by Nakhai et al. ( Biochem Biophys. Res.Commun. 210:530 -536,1995). Analysis of the mitochondrial DNA showed that a 491 bp deletion in the sequence of ATPase exists as heteroplasmy in 58% of alcoholics, but not in controls. Heteroplasmic deletion of mitochondrial DNA may be a useful marker for alcohol abuse. Further study is undergoing to elucidate the cause and significance of this deletion in alcoholics.     

老年患者院内获得性肺炎危险因素分析

目的探讨老年患者院内获得性肺炎的危险因素及预防对策。方法分析68例老年院内获得性肺炎患者和60例非感染患者的临床资料。结果长期住院、全身应用激素、侵入性医疗操作、糖尿病、低体重、恶性肿瘤等是院内获得性肺炎的危险因素。结论加强对院内获得性肺炎危险因素的控制,是降低感染率的有效方法。