Ivermectin dosing based on physical appearance

Ivermectin is a safe and effective microfilaricide which has been shown to have a beneficial impact on some onchocercal eye lesions. Current requirements for the distribution of ivermectin are that patients be weighed, and that their dose be determined according to their weight. This requirement increases the cost of distributing the drug to communities in need of treatment and, when scales breakdown, may lead to the suspension of distribution. Data are presented on a simple, alternative method of dose assessment based on the physical appearance of the patient. Fifteen assessors achieved an overall level of agreement with the weight-based schedule of 86% on a sample of 6420 patients. The level of agreement varied between assessors, from 73% to 95%. About 6% of the population would have received doses outside the range of the current weight-based schedule. We believe that the current insistence that each individual's dose of ivermectin be determined by weighing will hamper efforts to distribute the drug to those most in need of it and that our data indicate that workers can be trained to distribute ivermectin safely without weighing every individual. We would welcome confirmation of our findings from other populations.     

Association of Japanese encephalitis virus infection with Guillain-Barré syndrome in endemic areas of South India*

This study is a report of 34 cases of Guillain-Barré syndrome (GBS) observed in Bangalore (South India), an endemic area for Japanese encephalitis virus (JEV) infection. Virological and immunological findings suggested an antecedent and recent JEV infection in 21/34 patients. Nineteen patients among them showed high levels of JEV-specific IgM antibodies in serum and/or CSF, while the viral antigen could be demonstrated in one case and virus isolation from the CSF was successful in one patient. EMG studies revealed features of predominantly demyelinating neuropathy in 18/25 cases. Comparison of clinical findings, duration of illness and outcome in GBS patients with evidence of JEV infection and those without did not reveal any differences. Pathological findings in one patient corroborated the association of JEV with GBS. We conclude that, JEV infection may predispose to Guillain-Barré syndrome in endemic areas.     

Effects of Ecological and Standardized Vocational Assessments on Office of Vocational Rehabilitation Counselors' Perceptions Regarding Individuals with Developmental Disabilities

The purpose of this study was to examine the effects of an ecological and a standardized vocational assessment on Office of Vocational Rehabilitation (OVR) counselors' perceptions of individuals with developmental disabilities. One hundred and forty-one OVR counselors with experience in making funding decisions were randomly assigned to read either an ecological or a standardized vocational assessment report on an individual with developmental disabilities. Each group (ecological or standardized) then responded to 3 items on a questionnaire regarding job coach funding approval, time required for training, and employment outcome for the individual with disabilities. No statistically significant differences were found between groups with respect to job coach funding decisions. In contrast, significant differences between the 2 groups indicated that OVR counselors in the ecological assessment group perceived the individual with disabilities to need less training time, and to be more likely to remain on the job after job coaching was terminated than those in the standardized assessment group. Implications in terms of OVR funding decisions and directions for research are presented.     

Colonic ischemic necrosis following therapeutic embolization

Transcatheter embolization of the middle colic artery for diverticular bleeding was followed by ischemic necrosis in the transverse colon at the site of previous anastomosis and stricture formation. This is a potential complication of intra-arterial embolization for colonic bleeding.