Sexually transmitted diseases in men in Mogadishu, Somalia

The prevalence of viral and bacterial sexually transmitted diseases were studied in 101 men attending a dermatovenereal outpatient clinic in Mogadishu. A control group of 103 healthy adult men were included for the serological part of the study. Serological markers of hepatitis B virus (HBV), human immunodeficiency virus (HIV), cytomegalovirus (CMV) and herpes simplex virus (HSV) were studied. All sera were tested for syphilis markers. HBV serum markers were detected in 84% of the men in the study group and 66% of the healthy controls (P less than 0.005). Hepatitis B virus carriers were detected more frequently in the study group than among the controls. Also, 96% of the men in both groups had CMV antibodies and all of them had antibodies to HSV. No sera were found to contain HIV antibodies. The TPHA-positivity was 10% and 3% in the study and control groups respectively, and 5% of the patients had syphilis IgM antibodies. Sexual contact with prostitutes was recorded in 54% and 48% respectively of patients and controls, and such contact was correlated with TPHA-positivity in the study group. Chlamydia trachomatis antigen was detected in urogenital specimens of 14% of the men in the study group and gonococcal culture was positive in 53% of those with urethral discharge.     

Fosfomycin in the treatment of recurrent tract infections in type 2 diabetic patients

The aim of this study was to evaluate the efficacy of chronic therapy with fosfomycin trometamol (TF) in the treatment and prevention of recurrent, uncomplicated urinary tract infections (NIDDM) in type 2 diabetic women. INVESTIGATED GROUP: The study comprised 45 type 2 diabetes women aged 50-70 years. All patients enrolled into the study suffered from the NIDDM presented with clinical signs of uroinfection and positive urine culture with bacterial uropathogen sensitive to TF. Study period lasted 12 months and during the first 9 months patients were treated with TF. The patients remained under regular medical supervision in diabetic outpatient clinic every 3 months. Efficacy of treatment was proved when both clinical cure and uropathogen eradication were achieved in 3, 6, 9 or 12th month from the study beginning. RESULTS: The difference in efficiency of fosfomycin treatment after 3 months of the study duration in comparison with duration before study beginning was statistically different (p<0.001). The differences in efficiency of fosfomycin treatment after 6 months of study duration in comparison with time before 3 months were statistically different (p=0.03). There was not statistically differences in efficiency of fosfomycin treatment between the 6th and 9th month of study duration (NS). CONCLUSION: Fosfomycin is the safe and effective antimicrobial method to cure and prevent NIDDM.     

A Multicenter European Trial of Intravenous Immune Globulin in Immune Thrombocytopenic Purpura in Childhood

Since a pilot study of intravenous immune globulin showed it to induce a rapid rise of thrombocytes in immune thrombocytopenia purpura (ITP) in childhood, a randomized study was started for acute, untreated ITP and a prospective study for acute and chronic, pretreated ITP in children. The results of the pilot study and preliminary data of the ongoing studies are presented. Although little is known of the effects of intravenous immune globulin, possible mechanisms of action are discussed.     

Difficulties in bringing point-of-use water treatment to scale in rural Guatemala

In an earlier study in rural Guatemala, 257 households that received flocculant-disinfectant to treat their drinking water had 39% less diarrhea than 257 control households. Three weeks after completion of the study, national marketing of the flocculant-disinfectant was extended into the study communities. Six months later, we assessed frequency of and characteristics associated with purchase and use of the flocculant-disinfectant by revisiting the original study households and administering a questionnaire. Four hundred sixty-two households (90%) completed the follow-up survey; 22 households (5%) purchased the flocculant-disinfectant within the preceding 2 weeks and used it within the last week. Neither being randomized to the intervention group during the efficacy study nor combined spending on laundry soap, toothpaste, and hand soap in the preceding week was associated with active repeat use. Even after efficacy was demonstrated within their community and an aggressive sophisticated marketing approach, few households purchased flocculant-disinfectant for point-of-use water treatment.     

Changes in the incidence of juvenile rheumatoid arthritis in Finland

OBJECTIVE: To study trends in the incidence of juvenile rheumatoid arthritis (JRA). METHODS: The study covered subjects who were entitled under the nation-wide sickness insurance scheme to receive specially reimbursed medication for juvenile rheumatic diseases in 11 of 21 central hospital districts in Finland (the base population comprised about 445,000 children <16 yr of age) in 1995. Data from the years 1980, 1985 and 1990 were compared with data from 1995 concerning the central part of the area, which had been included in a previous study by us. RESULTS: A total of 87 incident cases (58 girls and 29 boys) satisfied criteria for JRA in 1995 in the study area. The incidence of JRA was 19.5 per 100 000 [95% confidence interval (CI) 15.6-24.1] of the population <16 yr of age for the whole area. It was 22.7 per 100,000 (95% CI 17.3-29.2) for the area that had been covered by the earlier study (five districts) and 14.9 per 100,000 (95% CI 9.8-21.7) for the new area (six additional districts). The incidence of JRA was significantly higher than in the earlier years (1980, 1985 and 1990) in the same district (trend, P=0.024). The highest incidence, 60.3 per 100,000 (95% CI 35.8-95.4), was noted in 1995 among girls in the age group 10-15 yr in the southernmost part of the study area. CONCLUSIONS: There was both temporal and regional variation in the incidence of JRA. Results of the present study suggest that environmental factors may influence the frequency of JRA.     

Prevalence of hypertension in Nepalese community triples in 25 years: a repeat cross-sectional study in rural Kathmandu

Aim/ObjectivesThe objective of the study was to examine if there has been any change in the prevalence of hypertension (HTN) in the Nepalese population in the last two and half decades.MethodsA population-based cross-sectional study was done in Bhadrabas village area of Kathmandu valley to estimate the prevalence of HTN and the findings were compared to the study done in the same location 25 years ago.FindingsThe study shows that there has been a three-fold increment in the prevalence of HTN in the same location. The major causes behind this increment appear to be increased salt intake and increased body mass index (BMI).ConclusionThis is the first repeat cross-sectional study on blood pressure (BP) in a Nepalese population. There is a very high prevalence as well as a sharp rise in HTN prevalence in this society largely because of changing lifestyle which is most likely because of socio-economic transition.     

Orthohantavirus Survey in Indigenous Lands in a Savannah-Like Biome,Brazil

In Brazil, the first confirmed cases of hantavirus cardiopulmonary syndrome in Indigenous populations occurred in 2001. The purpose of this study was to determine the seroprevalence of orthohantavirus infections in the Utiariti Indigenous land located in the southeastern region of the Brazilian Amazon. In December 2014 and 2015, a survey was conducted using an enzyme-linked immunosorbent assay in nine villages belonging to the Haliti–Paresí Indigenous communities. A total of 301 participants were enrolled in the study. Of the two study cohorts, the one from 2014 showed a prevalence of 12.4%, whereas the one from 2015 had a serum prevalence of 13.4%. Analysis of the paired samples of 110 Indigenous people who participated in both stages of the study enabled identification of four individuals who had seroconverted during the study period. Identifying the circulation of orthohantaviruses in the Utiariti Indigenous land highlights a serious public health problem in viral expansion and highlights the need to implement preventive measures appropriate to the sociocultural reality of these communities.     

Trends in waist circumferences in young British children: a comparative study

OBJECTIVE: To compare waist circumference (a measure of central fatness) and body mass index (BMI, a measure of general fatness) between a contemporary cohort and similar aged British children measured in 1987. DESIGN:: Comparative study of two cohorts. The first was a cross-sectional survey and the second an ongoing longitudinal survey. SETTING:: The cross-sectional study was conducted throughout Great Britain during 1987. The ongoing longitudinal study was conducted in the Avon region between 1995 and 1998. PARTICIPANTS: A total of 1821 children were measured in the cross-sectional study, and around 1000 children were measured in the longitudinal study. Ages ranged between 2 and 5 y. MAIN OUTCOME MEASURES: Waist circumference, height, weight and BMI. Values were expressed as mean+/-s.d. Age-related measures were compared. RESULTS: At equivalent ages, mean waist circumference values were greater in the contemporary children, compared with children measured in the earlier cross-sectional study in 1987 (P<0.05). Although boys from the contemporary cohort had the larger absolute waist circumference measurements, the absolute and percentage differences in waist circumference between the cohorts were greater for the girls. Mean BMI values were slightly but significantly higher in the contemporary children compared with children measured in the earlier cross-sectional study (P<0.05). The proportional increase in waist circumference for each age-sex group generally exceeded the proportional increase in BMI. CONCLUSION: These results suggest that central fatness in young British children has increased over the period of 1987-97 to a greater extent than general fatness. This should be of concern since evidence associates greater central adiposity with adverse levels of cardiovascular risk factors in children. Furthermore, the study highlights important shortcomings of the BMI measurement, in that it provides no information on body fat distribution and can mask true obesity-related risk in children.     

The prevalence of systemic lupus erythematosus in Lithuania: the lowest rate in Northern Europe

The aim of this study was to explore the prevalence of systemic lupus erythematosus (SLE) in Lithuania (Vilnius). Two different studies were designed for SLE cases identification: registry-based SLE study and population-based SLE study. For the registry-based study patients were enrolled during the period of 1999-2004 and from two sources, including out-patient clinics of Vilnius and tertiary rheumatology center with interview during the year 2004. Only Vilnius residents who fulfilled the ACR 1982 revised criteria for the classification of SLE were counted in this study. Seventy-six living adult patients with SLE were interviewed and accounted for the prevalence of 16.2/100000 (0.016%) using the Vilnius adult population in January 2004 (a population of 470451). The population study of randomly selected 10,000 Vilnius inhabitants with beforehand validation of the survey was performed in the same year. The population-based study revealed two cases for 4017 respondents, but the low response rate may be important. Extrapolating the results to population of 10000 inhabitants, the point prevalence of SLE in the entire sample was at least 0.02%. Therefore, the prevalence of SLE in Lithuania is the lowest if compared to Northern European countries.     

Changes in bronchial reactivity in asthmatic children after treatment with beclomethasone alone or in association with salbutamol

Airway inflammation is consistently present in patients with severe asthma. The combination of inhaled steroids and bronchodilators may be useful both for treating symptoms and improving the underlying inflammatory condition. We have compared the effect of beclomethasone dipropionate (BDP) combined with salbutamol (S), BDP alone, and placebo, on the severity of bronchial responsiveness in 30 children with allergic asthma during the period of specific allergen exposure. In children treated with BDP alone, PC20-FEV1 methacholine was 0.66 +/- 0.54 at the beginning and 1.91 +/- 2.11 at the end of the study period (p greater than 0.05). In children treated with BDP + S PC20, methacholine was 1.21 +/- 1.43 at the beginning and 4.22 +/- 3.88 at the end of the study (p less than 0.05). The group of children treated with placebo had a PC20-FEV1 methacholine of 0.79 +/- 0.61 at the beginning of the study and 0.80 +/- 0.46 at the end of the study. The results of the present study show that maintenance treatment with inhaled beclomethasone combined with salbutamol may lead to greater improvement in bronchial hyperreactivity than treatment with inhaled beclomethasone dipropionate alone.     

Evaluation of prevalence and risk factors of gestational diabetes in a tertiary care hospital in Kerala

AimsThe prospective study was conducted with the aim to evaluate the prevalence and risk factors of gestational diabetes mellitus in a tertiary care referral hospital in Kerala.Materials and MethodsA prospective observational study was conducted with the aim to study the prevalence, risk factors, complications, treatment pattern and cost analysis of GDM. The study was carried out in the Obstetrics & Gynecology dDepartment of Al Shifa hHospital located in northern Kerala.ResultsOver an eight-month period, 201 patients who met the inclusion criteria were enrolled for study from which prevalence of GDM was estimated at 15.9%. The study revealed higher prevalence of risk factors and complications such as age >25 years, BMI >26 kg/m², family history of DM, past history GDM, history of big baby, gestational hypertension, vaginal candidiasis, premature rupture of membranes and hyperbilirubinemia in GDM group as compared to non-GDM group. The study also demonstrated that modern life-style was a major influencing factor for development of diabetes in the study population.ConclusionThe study reveals the necessity of proper screening diagnosis and management of GDM in pregnant women by the clinicians so as to prevent the future burden of type 2 diabetes.     

葡萄糖调节受损干预治疗进展

葡萄糖调节受损（IGR）干预治疗的是当今糖尿病预防的循证医学研究热点。目前,证实干预IGR能降低2型糖尿病发病危险的研究有中国大庆研究、多国STOP—NIDDM研究、美国DPP研究、瑞典Malmo研究、芬兰DPS研究、TRIPOD研究、ORIGIN研究、DREAM研究、NAVIGATOR研究等。主要的干预方法是饮食控制、运动锻炼等强化生活方式改变;药物干预,主要药物：阿卡波糖、二甲双胍、罗格列酮、雷米普利等;中医中药干预。本文就葡萄糖调节受损干预治疗现状作一综述。     

Positive serology for dengue viral infection in pediatric patients with kawasaki disease in southern Thailand

Background The etiologic agent of Kawasaki disease (KD) is unknown, but may be dengue infection because of reported cases of concomitant KD and dengue. Methods and Results Prospective study was conducted to ascertain the relationship of positive serology for dengue infection in pediatric patients presenting with KD. A total of 65 cases were diagnosed with KD during the period of 4 years and of the 48 who had a complete dengue serologic study, 9 had a positive dengue titer. Conclusion In the present study 18.7% of patients had proven dengue infection from a positive serologic study. Further case-control study with other pediatric patients presenting with acute febrile illness needs to be done to support this significant finding. (Circ J 2008; 72: 1492 - 1494).     

Bias in retrospective studies of trends in asthma incidence.

There is evidence for an increase in adult asthma prevalence. Several retrospective studies have shown an increase in asthma incidence by year of birth, consistent with an increasing trend in asthma incidence. The validity of this retrospective approach is unknown. Retrospective and prospective asthma incidence by year of birth were compared in the same community, during the same time period, from two independent studies; a cohort study and a cross-sectional study in Western Norway. In the prospective study, subjects without asthma were followed from 1985-1996/1997. In the retrospective study in 1998, subjects reported the age at which the disease started. Analyses of incident asthma in the period 1985-1996 were compared between the studies. The retrospective analysis showed a large increase in asthma incidence by year of birth, with an odds ratio (OR) of 2.9 comparing those born in 1969 with those born in 1927. The prospective study showed the opposite, with an OR of 0.2 comparing those born in 1969 with those born in 1927. There was only a 20% difference in the cumulative incidence of asthma. To conclude, retrospective estimates of trends in asthma incidence are likely to be severely biased by differential recall.     

Usefulness of a non-invasive scoring system in predicting the outcome of electrophysiologic studies in non-invasively unexplained syncope

BACKGROUND: An electrophysiologic study is a useful method to clarify the cause of non-invasively unexplained syncope in 18-60% of patients. However, it is invasive with possible procedure-related complications. Therefore, it would be helpful to identify patients in whom an electrophysiologic study is useful for diagnosis of syncope. METHODS: Patients with unexplained syncope were prospectively enrolled in a registry, if an electrophysiologic study was performed. The study group comprised of 643 consecutive patients. RESULTS: The electrophysiologic study revealed conduction abnormalities and tachyarrhythmias accounting for syncope in 35% of patients. Using a logistic regression model, history of injury during syncope (p<0.001), ejection fraction < or =40% (p=0.03), and PR interval >0.2 s (p=0.001) were independent predictors of an abnormal electrophysiologic study. These three clinical and easily measurable variables were entered into a scoring system. The maximal score consisted of 3 points. A score of >1 predicts a positive electrophysiologic study result in more than 70% of patients with non-invasively unexplained syncope. CONCLUSION: Electrophysiologic abnormalities were detected in 35% of patients with unexplained syncope. A history of injury, ejection fraction < or =40% and a PR interval >200 ms were independent predictors for a positive electrophysiologic study.     

Evaluation of risk factors for development of complications in Type II diabetes in Europe

AIMS/HYPOTHESIS: The Cost of Diabetes in Europe - Type II study is the first large coordinated attempt to measure the current standard of care and determine the costs of managing patients with Type II (non-insulin-dependent) diabetes mellitus. METHODS: The study evaluated glycaemic control, blood lipid levels and blood pressure, all of which are risk factors for complications. Records of these clinical characteristics were collected from over 7000 patients during the 6-month study period. RESULTS: The mean HbA(1c) value for the entire study population was 7.5%, ranging from 7.0% in Sweden to 7.8% in the United Kingdom. Only 31% of individuals achieved good glycaemic control (HbA(1c)< or = 6.5%) according to current European guidelines. Only 64% of the total study population were tested for HbA(1c) values at least once within the 6-month study period (ranging from 49% in Spain to 71% in the UK), although HbA(1c) testing every 3 months is recommended for all patients, by European Diabetes Policy Group guidelines. The majority of patients had borderline total cholesterol values, with a mean value of 5.7 mmol/l. Overall, 21% of patients were classified as having low risk cholesterol levels (<4.8 mmol/l). Good triglyceride levels (<1.7 mmol/l) were achieved by 47% of the total study population. During the study period, 81% of patients had their blood pressure measured, with 35% and 53.3% of the patients reaching the recommended targets for systolic and diastolic blood pressure, respectively. CONCLUSION/INTERPRETATION: This study showed that a high proportion of patients with risk factors for diabetes-related complications are not adequately controlled. Improvements in disease management and monitoring are therefore required to ensure that guideline targets are met, thus reducing the long-term complications of Type II diabetes.     

Effects of variations in physiological cortisol levels on thyrotropin secretion in subjects with adrenal insufficiency: a clinical research center study

Although pharmacological doses of glucocorticoids suppress TSH secretion, less is known regarding the effects of physiological variations in cortisol levels on TSH. To study this issue, seven subjects with primary adrenal insufficiency each underwent four studies. In the first study subjects received infusions of saline for 48 h (baseline study). In the second study subjects received infusions of hydrocortisone for 48 h in a pulsatile and diurnal pattern that replicated serum cortisol levels in healthy subjects (physiological study). In most cases, the dose of hydrocortisone was 19 mg/24 h, but this was adjusted as necessary until the resulting serum cortisol levels reproduced those seen in healthy, nonstressed control subjects. In the third study subjects received the same total dose of hydrocortisone as in the physiological study, but with pulses of equal magnitude spaced evenly throughout the time period (constant study). In the fourth study subjects received the same total dose of hydrocortisone, but with the diurnal pattern shifted 12 h from the physiological infusion (reversed study). TSH levels were measured every 15 min during the final 24 h of each study. During the baseline study, the 24-h mean TSH level was 2.87 +/- 0.56 mU/L and did not exhibit any diurnal variation. During the physiological study, daytime TSH levels decreased 39% compared to those during the baseline study due to decreased TSH pulse amplitude, and the normal TSH diurnal rhythm was reestablished. The constant and reversed studies did not lead to significant changes in serum TSH levels compared to baseline. These results suggest that the normal circadian variation in endogenous cortisol levels may control TSH secretion, with maximal TSH suppression seen during the time when cortisol levels are highest. However, changing the diurnal pattern of hydrocortisone infusion did not lead to reciprocal changes in TSH levels, and the specific nature of the interactions between cortisol and TSH within the physiological range remains to be fully elucidated.     

Policy-oriented cross-cultural study in Japan

Cross-cultural research in the field of social gerontology is very useful for the development of aging policies and programs especially in the beginning stage of population aging. This is because the aging of population brings about the decline of family care and other social changes that society has not experienced so far. There are three types of cross-cultural research in this field. The simplest type of cross-cultural policy-oriented study is the observation tour to advanced countries. The comparatively fast development of health and social services for the elderly in Japan between 1950 and the mid-1970s owes greatly to this type of study. As the level of services is improved, the comparison of numerical data on the levels of basic health and social services for the elderly is gradually taken up. This type of study was once frequently used in Japan by policy-makers and academicians. The third type of policy-oriented cross-cultural study is the one for the improvement of quality of services. It is to be noted that the methods to be used in this type of study is very different from those used in the comparative study of numerical data. It is a new challenge worthy of being defied, with their full strength, by contemporary and future Japanese social gerontologists.     

Variability of albumin excretion in diabetes

The variability of urinary albumin excretion was determined in 3 consecutive overnight urine collections from 152 adult type I diabetic patients (study A) and in two 1-h urine collections from 57 adult type I and type II diabetic patients, obtained at a 10-wk interval (= median, range = 2-30 wk) (study B). In both studies the coefficient of variation (CV) of urinary albumin excretion recorded as urinary albumin concentration (mg/l) was highest (study A: CV 51.1%; study B: CV 61.8%), whereas the CV of the urinary albumin/urinary creatinine ratio (mg/mmol) was lowest (study A: CV 41.9%; study B: CV 50.8%). In study A the CV of urinary albumin excretion rate (microgram/min) (CV 43.5%) did not differ from that of urinary albumin/urinary creatinine ratio. In study B, however, the CV of urinary albumin excretion rate (CV 57.2%) was higher than that of the urinary albumin/urinary creatinine ratio and of fractional albumin clearance (CV 51.0%). The variability of urinary albumin excretion was not related to its magnitude and could not be attributed to variations in plasma glucose, glycosylated haemoglobin or renal tubular glucose reabsorption. This high variability stresses the need to obtain several urine samples before the amount of albumin excreted can be reliably estimated. It is recommended that one does not use urinary albumin concentration but urinary albumin/urinary creatinine ratio or fractional albumin clearance in the assessment of urinary albumin excretion in diabetes management.