济南市2016年报告本地和外地麻疹病例特征分析

目的分析济南市报告本地和外地麻疹病例分布和就诊特征,为本市麻疹防控提供相应措施和建议.方法数据来源于“麻疹监测信息报告管理系统”2016年1月1日-2016年12月31日济南市医疗机构报告的所有麻疹病例,对本地和外地麻疹病例特征进行描述和比较分析.结果2016年济南市报告本地麻疹病例960例,占64.78％;外地麻疹病例522例,占35.22％.报告外地病例主要来自齐河县、高唐县和夏津县.报告外地病例出现高峰的时间早于本地病例.外地病例中0～6岁儿童占74.14％,本地病例以≥15岁成人为主,占52.40％.本地和外地病例发病前7～21 d有医院就诊史的比例分别为52.60％和52.11％,其中有市儿童医院就诊史的比例分别为38.02％和23.16％.病例报告医院主要是市传染病医院和市儿童医院.34.14％的病例发病后去过2家或多家医院就诊.本地和外地病例发病报告时间间隔均为5d,报告外地病例出疹后1d、2d、3d内来我市就诊的比例分别为70.73％、86.64％和92.34％,均高于本地病例(57.95％、76.63％和88.68％).结论大量外地麻疹病例来济南市就诊、部分病例多次就诊、本地病例就诊不及时等增加了本市麻疹疫情扩散的风险,医院内感染是麻疹传播的重要因素,应加强传染源管理,强化重点医疗机构院感防控工作.     

北京市西城区健康人群麻疹抗体水平调查

目的调查北京市西城区健康人群麻疹抗体水平,为调整现有免疫策略、有效控制麻疹疫情,实现消除麻疹目标提供依据。方法按容量比例概率抽样法（probability proportion to size,pps）抽样的方法,2012年在北京市西城区随机选择10个居委会,每个居委会随机抽取在京连续居住6个月以上的人员22名作为调查对象,共220名。采用面对面问卷调查收集调查对象的人口学特征、含麻疹成分疫苗免疫史,并采集静脉血5ml。使用ELISA方法检测研究对象麻疹IgG抗体水平。结果调查对象麻疹抗体阳性率为85．91％,抗体水平中位数为976IU·l-1。不同年龄组人群中,麻疹抗体阳性率和抗体水平差异均具有统计学意义（χ2=42．39,P〈0．01;H=38．84,P〈0．01）,其中8月龄以下儿童抗体阳性率和抗体水平最低,分别为21．43％、120IU·l-1;1～4岁、5～9岁儿童及40岁以上成人较高,阳性率均达95．45％,抗体水平中位数分别为3059IU·l-1、2099Iu·l-1、2308IU·l-1;其余年龄组人群抗体阳性率在72．73％～95．45％之间,抗体水平在512～1679IU·l-1之间。未接种过麻疹疫苗的人群麻疹抗体阳性率和抗体水平明显低于接种过疫苗和接种情况不详的人群（χ2=28．73,P〈0．01;H=1．56,P〈0．01）,差异有统计学意义。结论北京市西城区常住人口中,1～9岁儿童麻疹抗体水平较高,发生大范围麻疹暴发和流行的风险较小,〈8月龄婴儿和15～40岁人群麻疹抗体水平有待进一步提高。     

麻疹疫苗反复注射对哮喘患儿IL-12、IL-13水平的影响

目的与方法:通过观察轻-中度发作期哮喘患儿麻疹疫苗反复注射前后IL-12,IL-13及血清总IgE水平的变化,探讨麻苗治疗对哮喘患儿的免疫影响及其治疗小儿哮喘的作用机制。采用生物素-亲合素双抗夹心酶联免疫(ABC-ELISA)法测定麻苗治疗前后13例哮喘患儿(麻苗治疗组)血浆及外周血单个核细胞(PBMC)培养上清中的IL-12、IL-13与血清总IgE水平,并与12例单纯对症治疗组哮喘患儿及17例正常对照组小儿比较。结果:麻苗治疗后,IL-12水平与对症治疗组无显著差异(P＞0.05),IL-13与血清总IgE水平显著降低(P＜0.05)。血浆IL-12水平与血清总IgE水平呈负相关(r=-0.437,P＜0.05),PBMC培养上清中的IL-12水平与血清总IgE水平无相关性;血浆及PBMC培养上清中的IL-13水平与血清总IgE水平呈正相关(r=0.657及r=0.485,P＜0.01);血浆及PBMC培养上清中的IL-12水平与IL-13水平呈负相关(r=-0.460及r=-0.383,P＜0.05)。结论:麻疹疫苗反复注射是通过下调哮喘患儿IL-13水平,进而降低血清总IgE水平,而对IL-12水平无显著影响。     

北京市朝阳区2010-2012年麻疹野毒株分子流行特征分析

目的 了解近三年北京市朝阳区流行的麻疹野病毒分子流行特征,为本地区消除麻疹提供科学依据.方法 采集北京市朝阳区2010-2012年麻疹疑似病例的咽拭子和（或）尿液标本接种vero/SLAM细胞,对分离的麻疹病毒用逆转录及聚合酶链反应扩增麻疹病毒核蛋白（N）基因羧基末端676个核苷酸片段,对扩增产物进行核苷酸序列测定和分析,并以羧基末端450个核苷酸片段构建基因亲缘关系树,进行遗传距离及核苷酸、氨基酸同源性分析.结果 分离出18株麻疹病毒,均为H1基因型,H1a亚型.这18株野毒株之间核苷酸同源性为98.2％～100.0％（核苷酸差异为0～8bp）,氨基酸变异范围为0～2.7％（氨基酸差异为0～4AA）.与H1a亚型参考毒株Chin9322相比,核苷酸变异范围为0.7％～1.6％（核苷酸差异为3 ～7 bp）.18株野毒株共有7种基因序列,其中2010年5种、2011年1种、2012年3种基因序列.V2基因序列出现在2010和2012年的病例中,V7序列出现在2010和2011年的病例中.其余5种序列只在单一年份的病例中检出.结论 北京近年来流行的本土麻疹病毒为H1a亚型,当年相同基因序列的一组病例提示有麻疹传播链的存在.北京市朝阳区存在基因序列完全相同的麻疹野毒株在2010、2012年循环出现.     

Influence of gender on the distribution of type 2 diabetic complications at the obafemi awolowo teaching hospital,Ile-Ife,Nigeria

BackgroundSex specific differences appear particularly relevant in the management of type 2 DM.ObjectiveWe determined gender specific differences in cardio-metabolic risk, microvascular and macrovascular complications in patients with type 2 diabetes.MethodsFour hundred type 2 diabetes patients, males and females, matched for age and disease duration were recruited from the diabetes clinic. Relevant clinical and laboratory information were obtained or performed.Results190(47.5%) were male and 210 (52.5%) were female respectively. The mean age of the study population was 60.6 + 9.93 years. Women had higher prevalence of hypertension (and obesity. Mean total cholesterol was significantly higher in women but men were more likely to achieve LDL treatment goals than women (69.5% vs 59.0%, p<0.05). More women (47.1% & 31.4%) reached glycaemic goals of <10mmol/l for 2HPP and HBA1c of <7.0%.There were no gender differences in the distribution of microvascular and macrovascular complications (p>0.05) but women were more likely to develop moderate and severe diabetic retinopathy (p= 0.027).ConclusionWomen with T2DM had worse cardiometabolic risk profile with regards to hypertension, obesity and lipid goals. Men achieved therapeutic goals less frequently than did women in terms of glycaemia. Microvascular and macrovascular complications occurred commonly in both sexes.     

Effect of the alterations in the fusion protein of measles virus isolated from brains of patients with subacute sclerosing panencephalitis on syncytium formation

Measles virus (MV) is the causative agent of subacute sclerosing panencephalitis (SSPE) and viruses isolated from brains of the patients contain numerous mutations. We have previously demonstrated that the hemagglutinin (H) protein of MV SSPE strains can interact with the signaling lymphocyte activation molecule (SLAM) and an unidentified molecule on Vero cells, but not with CD46, as a receptor. The mechanism by which MV SSPE strains can induce cell–cell fusion in SLAM-negative Vero cells is not understood. We report here on the effect of mutations in the fusion (F) proteins of three MV SSPE strains on syncytium formation. The F proteins of the three SSPE strains were functional and co-expression with H protein from the MV wild-type or SSPE strains in this study induced formation of large syncytia in Vero cells as well as in cell lines expressing SLAM or CD46. Expression of chimeric F proteins of SSPE strains showed that amino acid substitutions in the F protein extracellular as well as cytoplasmic domain contributed to enhanced cell–cell fusion in Vero cells. These findings suggest a common molecular mechanism and a key role of the F protein for syncytium formation in cells expressing an unidentified third receptor for MV.     

Intravascular catheter related infections in children admitted on the paediatric wards of Mulago hospital,Uganda

Introduction

Worldwide use of intravascular catheters (IVC) has been associated with both local and systemic infections. No studies have been done in the sub-Saharan region on IVC related infections.

Objective

To determine the prevalence, causative organisms and their antimicrobial susceptibility pattern and the factors associated with infections related to short term peripheral venous catheters in children admitted to the general paediatric wards in Mulago Hospital, Uganda.

Methods

A cross-sectional study of 391 children aged one day to 12 years, on Jelliffe ward in Mulago Hospital, who had short peripheral venous intravascular catheters uncoated with no antibiotic or antiseptic, was done. Social demographic characteristics, anthropometry, clinical examination including the catheter site were determined at enrollment. The children had their blood, catheter tip and hub samples taken off for culture and sensitivity as well as complete blood counts. The data collected was entered using EPI-INFO and analysed with SPSS packages.

Results

Out of the 391 short term peripheral venous catheters collected, 20.7% catheter tips and 11.3% catheter hubs were colonised. Phlebitis was observed in 17.4%. Bacteria isolated from colonised catheter tips were Staphylococcus aureus (60.5%), Staphylococcus epidermidis (23.5%). The most common organism isolated from the hub was Staphylococcus aureus (56.8%) followed by Staphylococcus epidermidis (18.1%). Gram positive and negative organisms were sensitive to ciprofloxacin, gentamycin for gram-negative organisms and augmentin, cefuroxime, ceftriaxone for the gram-positive organisms. After logistic regression, factors such oedema, modified Glasgow coma score of <10/15, 6 hourly benzyl penicillin were significantly associated with colonisation of the tip while use of 25% dextrose, chloramphenicol 6 hourly and blood transfusion were significantly associated with colonisation of the hub.

Conclusion

The study showed that infections related to short peripheral venous catheters in paediatric general wards in Mulago Hospital occurs and prevalence was 20.72% for tips and 11.3% for hubs.     

Epidemiology and microbiological investigations of community-acquired pneumonia in children admitted at the emergency department of a university hospital

BackgroundThe management of children with community-acquired pneumonia (CAP) is largely influenced by the development of new molecular diagnostic tests that allow the simultaneous detection of a wide range of pathogens.ObjectivesEvaluation of a diagnostic approach including multiplex PCR assays for revisiting the epidemiology and etiology of CAP in children at hospital.Study designChildren of all ages consulting at the Emergency Department of the University hospital of Saint-Etienne, France, during the 2012–2013 winter period were included. In addition to bacterial cultures, the following pathogens were detected using biplex commercially-available rt-PCR tests: adenovirus, respiratory syncytial virus, human metapneumovirus, bocavirus, rhinovirus/enterovirus, coronavirus, influenza viruses A and B, parainfluenza viruses, Mycoplasma pneumoniae and Chlamydophila pneumonia.ResultsFrom 85 patients with CAP, at least one pathogen was identified in 81 cases (95.3%), including 4 bacterial exclusive infections (4.7%), 53 viral exclusive infections (62.4%) and 24 mixed infections (28.2%). Coinfection by at least two viruses was observed in 37 cases (43.5%). Mean age was higher in the case of documented bacterial infection (P < 0.05). In the subgroup of viral exclusive infection, the mean age of severe cases was 2.0 years vs 3.8 years in mild and moderate cases (P < 0.05).ConclusionsThese findings highlight the huge proportion of CAP of viral origin, the high number of co-infection by multiple viruses and the low number of bacterial CAP, notably in children under 5 years, and address the need to re-evaluate the indications of empiric antimicrobial treatment in this age group.     

A review of the management of perforated duodenal ulcers at a tertiary hospital in south western Nigeria

Background

Gastro-duodenal perforations are common and may complicate peptic ulcer disease. Management is often by surgical closure.

Objective

To determine the patterns of presentation and mode of management of duodenal ulcer perforations.

Methods

Retrospective review of patients with duodenal ulcer perforations seen at the Obafemi Awolowo University Teaching Hospital between June 2001 and July 2011. Patients'' records were reviewed for demography, duration of disease, probable risk factors, type of surgery and complications. Data obtained was analyzed using SPSS 15.0.

Result

Forty- five patients were reviewed. There were 37 males (82.2%). Mean age was 39.7years (range 15–78years). There were 10 (22.6%) students and 8(17.8%) farmers. NSAIDs abuse (11), previous peptic ulcer disease (2), and no prior dyspeptic symptoms (20) constituted 24.4%, 4.4% and 44.4% respectively of cases. Seven (16%) patients presented less than 24 hours of onset of illness. Forty one perforations (91.1%) involved the first part of duodenum. Twenty two (49%) patients had Graham''s omental patch. We had one (2.2%) failed repair and six (13.3%) mortalities.

Conclusion

Late presentation of duodenal ulcer perforation is common with high mortality. Pragmatic surgical intervention with Graham''s omentopexy with broad spectrum antibiotics is still commonly practiced.     

Effects of call reminders,short message services (SMS) reminders,and SMS immunization facts on childhood routine vaccination timing and completion in Ilorin,Nigeria

BackgroundReminders via mobile devices deployed as short message services (SMS) or calls have been identified to be a useful strategy in improving routine immunization uptake in several countries.ObjectiveTo identify the timeliness of appointments with reminders (calls or SMS), SMS health education and the routine care, and the vaccination completion rates in Ilorin, Nigeria.MethodMother-infant pairs presenting for the first vaccination appointment were randomized into four (three interventions, one control) groups, each consisting of 140 participants. Intervention groups were reminders via calls (A), SMS reminders (B), immunization fact SMS messages (C) and controls on usual care (D). Reminders were made a day before the appointment while SMS immunization facts were sent at five weeks, nine weeks and eight months. Appropriate timing was defined as the scheduled visit ±3 days.ResultsThe immunization completion rates after the nine months'' visit were 99.2%, 99.3%, 97% and 90.4% for Groups A, B, C and D respectively. Compared with controls, Group A had the highest odds [AOR 8.78 (6.10, 12.63)] of presenting at an appropriate time, followed by Group B [AOR 2.56 (1.96, 3.35)], then Group C [AOR 2.44 (1.87, 3.18)].ConclusionReminders/SMS immunization facts improve vaccination completion rates.     

Prevalence of venous thromboembolism risk factors in hospitalized patients at the University of Nigeria Teaching Hospital,Enugu Nigeria

BackgroundVenous thromboembolism (VTE) is a common and lethal disease. Assessing the risk factors will help to modify exposures.AimThis study, assessed VTE risk factors in hospitalized patients at the University of Nigeria Teaching Hospital, Enugu.Patients and MethodsThis was an observational, case-control study. Three hundred and fifty (350) patients were recruited for the study: This comprised 150 medical patients, 140 surgical patients and a population of 60 healthy control group. Subjects were evaluated once using the Caprini risk assessment model (RAM).ResultsOver 50% of all hospitalized patients, were at risk for VTE. Surgical patients were at a higher risk than medical patients. Hemoglobin concentration was associated with the risk of VTE in surgical patients, while d-dimer was associated with VTE risk in medical patients.ConclusionThis study shows a high prevalence of VTE risk factors among hospitalized patients at the University of Nigeria Teaching Hospital.     

Effects of Ocimum gratissimum L essential oil at subinhibitory concentrations on virulent and multidrug-resistant Shigella strains from Lagos,Nigeria

Ocimum gratissimum leaf extracts have been extensively demonstrated to be effective against the various aetiologic agents of diarrhoea, including Shigellae. However, the mechanism of the shigellocidal action of this plant remains to be understood. This study investigated the effects of O. gratissimum essential oil (EO) at subinhibitory concentrations of 0.75 and 1.0 microg/ml on virulence and multidrug-resistant strains of 22 Shigella isolates from Nigeria. Compared with untreated Shigella strains, O. gratissimum EO caused significant decreases (p<0.01) in extracellular protease activity, o-lipopolysaccharide rhamnose content and incidence of invasiveness mediated as keratoconjunctivitis in guinea pig. The disparity in extracellular protease activity and o-lipopolysacharide rhamnose between the two treatment groups was also found to be significant (p<0.05), suggesting greater anti-virulent effects of O. gratissimum oil at 1.0 microg/ml. Antibiotic susceptibility testing revealed that the EO of O. gratissimum reduced the MICs of antibiotics to which Shigellae showed resistance by 9.8-53.1% and fluoroquinolones by 18.2-45.5%. The results of this study strongly suggest inhibition of extracellular protease and expression of O-LPS rhamnose in Shigellae by O. gratissimum EO. The future use of O. gratissimum- antibiotic combinations as a therapeutic measure against shigellosis is discussed.     

Skin diseases among children attending the out patient clinic of the University of Nigeria teaching hospital, Enug

Background

The prevalence of skin diseases varies worldwide and information regarding local prevalence of its various causes may help the development of policies towards better management.

Objective

To document the types of skin disorders seen among children attending the University of Nigeria Teaching Hospital, Enugu( UNTH).

Methods

The medical register from the children out patient clinic was used to obtain information on pattern and outcome of skin diseases seen from January 1996 to December 2005.

Results

Of the 16,337 children seen in children.s out patient clinic (CHOP), 1506 (1.3%) had a skin disease. Age range was one week to 16 years with a mean ± SD of 3.89 ± 3.8 years. Children aged 0 – 5 years constituted 70.24% of patients with skin diseases. The commonest skin condition was pyoderma (29.81%) seen mainly in those below 5 years, followed by scabies (13.55%). Approximately 1/3 (33.3%) of the patients were referred to the dermatology clinic.

Conclusion

Infectious skin diseases constitute a high percentage of skin disorders encountered in paediatrics. Almost half (48.4%) of the skin problems were diagnosed as non-specific dermatitis suggesting the need of better dermatological training of the paediatric residents.     

CD4 T cell control primary measles virus infection of the CNS: regulation is dependent on combined activity with either CD8 T cells or with B cells: CD4, CD8 or B cells alone are ineffective

Measles virus (MV), one of the most infectious of human pathogens, still infects over 30 million humans and causes over 500,000 deaths each year [Griffin, D., 2001. Measles virus. In: Fields, B., Knipe, D., Howley, P. (Eds.), Fields Virology. Lippincott-Raven, Philadelphia, pp. 1401-1442; ]. Death is primarily due to secondary microbial infections associated with the immunosuppression caused by MV. Studies of humans with genetic or acquired deficiencies of either the humoral or cellular arm of the immune system, and rodent models have implicated T cells in the control of the ongoing MV infection but the precise role and activities of the specific T cell subset or the molecules they produce is not clear. Using a transgenic mouse model in conjunction with depletion and reconstitution of individual B and T cell subsets alone or in combination, we show that neither CD4, CD8 nor B cells per se control acute MV infection. However, combinations of either CD4 T cells and B cells, or of CD4 and CD8 T cells are essential but CD8 T with B cells are ineffective. Interferon-gamma and neutralizing antibodies, but neither perforin nor TNF-alpha alone are associated with clearance of MV infection. TNF-alpha combined with interferon-gamma is more effective in protection than interferon alone. Further, the lack of an interferon-gamma response leads to persistence of MV.     

Evaluation of cases with a preliminary diagnosis of Crimean- Congo hemorrhagic fever and comparison of characteristics in patients admitted to a secondary care hospital in Kastamonu,Turkey

Background

Crimean-Congo hemorrhagic fever (CCHF) is an endemic disease in Turkey. The clinical presentation and laboratory findings are not specific especially in cases without hemorrhagic findings.

Objective

We aimed to evaluate CCHF cases and compare them with non-CCHF cases in terms of their characteristics during admission.

Methods

Cases with a preliminary diagnosis of CCHF at a secondary care hospital in Kastamonu in 2013 were evaluated, retrospectively. Cases testing RNA/IgM positive were considered as CCHF. Cases testing both RNA and IgM negative were considered as non-CCHF. The two groups were then compared in terms of their clinical, laboratory and epidemiological characteristics during admission.

Results

A total of 41 cases were tested and CCHF was found in 46.3% of cases. Fatality was 5.3% in CCHF cases. The frequency of tick bites and CK elevation in CCHF cases was significantly higher than non-CCHF cases (p<0.05). There were no significant differences between the two groups regarding other characteristics (p>0.05).

Conclusions

In cases with a preliminary diagnosis of CCHF, especially in cases without a history of tick bite and with normal CK levels during admission, performing tests for the differential diagnosis may be advisable without waiting for the results of tests for CCHF.     

Covid-19 pandemic: chronicle of responses and experiences of the infection prevention and control committee at a tertiary hospital in southwest Nigeria

Since the advent of 2019-Corona virus Disease (COVID-19) in Nigeria in February 2020, the number of confirmed cases has risen astronomically to over 61,307 cases within 8 months with more than 812 healthcare workers infected and some recorded deaths within their ranks.Infection prevention and control is a key component in ensuring safety of healthcare workers in the hospital as healthcare-associated infection is one of the most common complications of healthcare management. Unbridled transmission of infection can lead to shortage of healthcare personnel, reduced system efficiency, increased morbidity and mortality among patients and in some instances, total collapse of healthcare delivery services. The Infection Prevention and Control Committee is a recognised group by the Centre for Disease Control and Prevention with their core programmes including drawing up activities, procedures and policies designed to achieve above-stated objectives before, during and after any disease outbreak, especially emerging and re-emerging ones such as the 2019 Coronavirus Disease. In this report, we highlight the roles played by the Infection Prevention and Control Committee of the University of Medical Sciences Teaching Hospital to prevent the spread of COVID-19 within and outside the hospital community and the lessons learned to date.     

ECG abnormalities among HIV infected children placed on ART at Enugu,South East of Nigeria

BackgroundCardiovascular abnormalities are not much reported among human immunodeficiency virus (HIV) infected children especially in Africa where there is high HIV disease. In addition, the use of highly active antiretroviral therapy (HAART) in such children may have a protective effect on the cardiovascular system.MethodsCross-sectional study of randomly selected eighty HIV infected and 80 aged matched non- HIV-infected children were used. HIV-infected children were on HAART for more than 5years and had steadily received the treatment for 6 months prior to the time of the tests. Heights and weights were measured and body mass index calculated. Cardiac indices evaluated were heart rate (HR), PR interval, QRS duration, QT/QTC Interval, P/QRS/T Axis, RV5/SV1 voltage and RV5+SV1 voltage.ResultsThe average heart rate was significantly higher among HIV infected children on HAART than their non-infected counterparts (P= 0.019). At 0.05 significance level, their PR interval was significantly higher than those in the control group (P=0.050). The average QRS duration result also showed a significant difference between that of test and control subjects (P = 0.022)ConclusionThe HAART usage possibly improved the cardiovascular functioning in the infected children but the protective effects diminish with increase age and longer exposure     

SRBC致敏对大鼠脾脏淋巴细胞β—受体的影响

用受体结合实验测定大鼠脾脏淋巴细胞β-受体Bmax和Kd。5×10~9个SRBC ip大鼠后,d1 Bmax比对照组明显升高,d2达峰值,以后逐渐下降,d6降至对照水平。 d1- d3 β-受体Bmax与72h后血清IgM量高度正相关(r=0.86),ipl.8 mg/kg普萘洛尔后, d2 Bmax和 d5血清IgM量平行降低。在体外诱生抗体中,10μmol/LNE显著提高诱生的IgM量。可被1μmoI/L普萘洛尔阻断。上述结果表明:(1)SRBC致敏上行调节大鼠脾脏淋巴细胞β-受体密度;(2)脾脏淋巴细胞β-受体Bmax的上行调节可能促进其IgM的合成;(3)NE促进脾淋巴细胞IgM合成通过β-受体介导。