Falling Plasmodium knowlesi Malaria Death Rate among Adults despite Rising Incidence,Sabah, Malaysia, 2010–2014

Deaths from Plasmodium knowlesi malaria have been linked to delayed parenteral treatment. In Malaysia, early intravenous artesunate is now recommended for all severe malaria cases. We describe P. knowlesi fatalities in Sabah, Malaysia, during 2012–2014 and report species-specific fatality rates based on 2010–2014 case notifications. Sixteen malaria-associated deaths (caused by PCR-confirmed P. knowlesi [7], P. falciparum [7], and P. vivax [1] and microscopy-diagnosed “P. malariae” [1]) were reported during 2012–2014. Six patients with severe P. knowlesi malaria received intravenous artesunate at hospital admission. For persons >15 years of age, overall fatality rates during 2010–2014 were 3.4, 4.2, and 1.0 deaths/1,000 P. knowlesi, P. falciparum, and P. vivax notifications, respectively; P. knowlesi–associated fatality rates fell from 9.2 to1.6 deaths/1,000 notifications. No P. knowlesi–associated deaths occurred among children, despite 373 notified cases. Although P. knowlesi malaria incidence is rising, the notification-fatality rate has decreased, likely due to improved use of intravenous artesunate.     

A review on computer-aided recent developments for automatic detection of diabetic retinopathy

Diabetic retinopathy is a serious microvascular disorder that might result in loss of vision and blindness. It seriously damages the retinal blood vessels and reduces the light-sensitive inner layer of the eye. Due to the manual inspection of retinal fundus images on diabetic retinopathy to detect the morphological abnormalities in Microaneurysms (MAs), Exudates (EXs), Haemorrhages (HMs), and Inter retinal microvascular abnormalities (IRMA) is very difficult and time consuming process. In order to avoid this, the regular follow-up screening process, and early automatic Diabetic Retinopathy detection are necessary. This paper discusses various methods of analysing automatic retinopathy detection and classification of different grading based on the severity levels. In addition, retinal blood vessel detection techniques are also discussed for the ultimate detection and diagnostic procedure of proliferative diabetic retinopathy. Furthermore, the paper elaborately discussed the systematic review accessed by authors on various publicly available databases collected from different medical sources. In the survey, meta-analysis of several methods for diabetic feature extraction, segmentation and various types of classifiers have been used to evaluate the system performance metrics for the diagnosis of DR. This survey will be helpful for the technical persons and researchers who want to focus on enhancing the diagnosis of a system that would be more powerful in real life.     

Body mass index, height and cumulative menstrual cycles at the time of diagnosis are not risk factors for poor outcome in breast cancer

Obesity, height and age at menarche have been shown to be risk factors for the development of primary breast cancer. However, their prognostic influence on breast cancer once it has presented is uncertain. The present study analysed 448 patients with primary breast cancer to determine whether or not body mass index (BMI), height and cumulative menstrual cycles at diagnosis are independent prognostic variables. The effects of all three variables on survival time and disease free interval were estimated. Of the 448 patients after a median follow up of 6 years, 190 (42%) developed recurrence and 162 (36%) had died. Body Mass Index and height could be calculated from available data in 403 patients and cumulative menstrual cycles in 388 patients. There was no evidence of an effect of BMI on survival time (P=0.99; hazard ratio=1.000; 95% Confidence Interval 0.968-1.034) or disease free interval (P=0.92; hazard ratio=1.002; 95% Confidence Interval 0.973-1.031). Similarly, height and cumulative menstrual years did not influence outcome in patients with primary breast cancer. However, nodal status and tumour size were both significant prognostic factors (P<0.001). The present study found no association between Body Mass Index, height and cumulative menstrual years and outcome in patients with primary breast cancer.     

Hepatitis E infection in children: Study of an outbreak

BACKGROUND: Hepatitis E virus (HEV) is responsible for most of the hepatitis epidemics in the developing world and it frequently affects young adults. Therefore, common perception is that it does not affect children. METHODS: A group of 20 school children (13 years old) were possibly exposed to hepatitis E virus infection during a 2 day trekking trip. Epidemiological and clinical information was correlated to the presence of the hepatitis E virus genome and antibodies to HEV structural and non-structural proteins found in the blood of the children, using polymerase chain reaction and line immunoassay techniques. RESULTS: Ten children developed icteric hepatitis, seven prodrome-like illness without jaundice while three remained asymptomatic. Immunoglobulin M (IgM) antibodies to open reading frame (ORF)2 protein (pORF2) were detected in all 19 children tested, whereas 11 and 10 of the children were positive for IgM antibodies against ORF1 (pORF1) and ORF3 (pORF3) proteins, respectively. The rate of HEV infection was found to be 85%. Viraemia was observed in 11 children and was present in four of the seven anicteric patients (55%) compared with six of the nine (66%) icteric patients. One child without any symptom also had viraemia. CONCLUSIONS: The data obtained indicate a high susceptibility of children for HEV infection and a frequently prolonged viraemia in those infected.     

Antagonism of Azole Activity against Candida albicans following Induction of Multidrug Resistance Genes by Selected Antimicrobial Agents

Antifungal azoles (e.g., fluconazole) are widely used for prophylaxis or treatment of Candida albicans infections in immunocompromised individuals, such as those with AIDS. These individuals are frequently treated with a variety of additional antimicrobial agents. Potential interactions between three azoles and 16 unrelated drugs (antiviral, antibacterial, antifungal, and antiprotozoal agents) were examined in vitro. Two compounds, tested at concentrations achievable in serum, demonstrated an antagonistic effect on azole activity against C. albicans. At fluconazole concentrations two to four times the 50% inhibitory concentration, C. albicans growth (relative to treatment with fluconazole alone) increased 3- to 18-fold in the presence of albendazole (2 microg/ml) or sulfadiazine (50 microg/ml). Antagonism (3- to 78-fold) of ketoconazole and itraconazole activity by these compounds was also observed. Since azole resistance has been correlated with overexpression of genes encoding efflux proteins, we hypothesized that antagonism results from drug-induced overexpression of these same genes. Indeed, brief incubation of C. albicans with albendazole or sulfadiazine resulted in a 3-to->10-fold increase in RNAs encoding multidrug transporter Cdr1p or Cdr2p. Zidovudine, trimethoprim, and isoniazid, which were not antagonistic with azoles, did not induce these RNAs. Fluphenazine, a known substrate for Cdr1p and Cdr2p, strongly induced their RNAs and, consistent with our hypothesis, strongly antagonized azole activity. Finally, antagonism was shown to require a functional Cdr1p. The possibility that azole activity against C. albicans is antagonized in vivo as well as in vitro in the presence of albendazole and sulfadiazine warrants investigation. Drug-induced overexpression of efflux proteins represents a new and potentially general mechanism for drug antagonism.     

Failures of automatic and strategic processing in schizophrenia: comparisons of event-related brain potential and startle blink modification.

Noises elicit startle blinks that are inhibited when immediately (approximately 100 ms) preceded by non-startling prepulses, perhaps reflecting automatic sensory gating. Startle blinks are facilitated when preceded by prepulses at longer lead intervals, perhaps reflecting strategic processes. Event-related brain potentials (ERPs) and startle blinks were used to investigate the well-documented prepulse inhibition failure in schizophrenia. Blinks and ERPs were recorded from 15 schizophrenic men and 20 age-matched controls to noises alone and to noises preceded by prepulses at 120 (PP120), 500 (PP500) and 4000 ms (PP4000) lead intervals. Neither blinks nor any of the ERP components elicited by the noise alone differentiated schizophrenics from controls, although responses to noises were modified by prepulses differently in the two groups. With the N1 component of the ERP, patients showed normal inhibition but lacked facilitation, and with P2, patients lacked inhibition, but showed normal facilitation. With reflex blinks and P300, inhibition was seen in both groups, but no facilitation. These results suggest that different neural circuits are involved in blink and cortical reflections of startle modification in schizophrenics and controls, with both automatic and strategic processes being impaired in schizophrenia.