Clinical Factors Predictive of Pneumonia Caused by Pandemic 2009 H1N1 Influenza Virus

Pneumonia was the most common cause of death during the 2009 pandemic H1N1 influenza virus infection. Clinical risk factors for pneumonia caused by this virus are limited. We enrolled consecutive patients treated at the H1N1 Clinic in Thungsong Hospital in Nakhon Si Thammarat, Thailand, during June–December 2009 who had positive polymerase chain reaction results for H1N1 virus. Clinical features for patients given a diagnosis with and without pneumonia were studied. There were 441 patients with positive polymerase chain reaction results for H1N1 virus. Of these patients, 51 (11.56%) had pneumonia. Three independent clinical factors for H1N1 pneumonia were myalgia, dyspnea, and an absolute neutrophil count > 7,700 cells/μL. Adjusted odds ratios (95% confidence intervals) for these three variables were 0.413 (0.173–0.988), 2.625 (1.230–5.604), and 4.475 (1.882–10.644), respectively. Clinical features may be a useful tool for predicting risk for pneumonia caused by H1N1 virus.     

Randomized double-blind, placebo-controlled trial of oral atenolol in patients with unexplained syncope and positive upright tilt table test results

The objective of this investigation was the assessment of the response rate of oral atenolol in patients with vasovagal syncope after 1 month of treatment. We randomized into two groups all patients referred to our unit who had had at least one episode of syncope or two episodes of presyncope 1 month before presentation and had a positive isuprel Tilt Table Test (TTT). Group 1 (Gr 1) received oral atenolol, and group 2 (Gr 2) received placebo medication. After a 1-month period patients were reassessed for degree of their symptoms and underwent repeated TTT. Forty-two patients were enrolled in the study. Gr 1 and Gr 2 were comparable in age (38 ± 13 years vs 43 ± 14 years, p = 0.216 and sex (male/female = 6:15 vs 10:11, p = 0.204). The severity of attack was similar in both groups. Eight patients in Gr 1 and six patients in Gr 2 had mitral valve prolapse (p = 0.5). No significant differences were seen in systolic blood pressure (122 ± 17 vs 117 ± 16 mm Hg, p = 0.334), diastolic blood pressure (70 ± 11 vs 72 ± 11 mm Hg, p = 0.677), and heart rate (79 ± 12 vs 79 ± 13, p = 0.98) between the two groups. The response rates (negative TTT) after 1 month of treatment were 62% versus 5% (p = 0.0004) in the atenolol and control group, respectively. Moreover, patients who received atenolol reported feeling better compared with those who received placebo (71% vs 29%, p = 0.02). In conclusion, atenolol significantly improved symptoms of patients with vasovagal syncope. Patients who received atenolol were more likely to have negative isuprel TTT.     

A model for compound action potentials and currents in a nerve bundle II: A sensitivity analysis of model parameters for the forward and inverse calculations

The online version of the original article can be found at     

A vomiting phobia overcome by one session of flooding with hypnosis

A patient with a long-standing vomiting phobia was treated by flooding under a hypnotic trance. A follow-up 1 yr after treatment showed that she had remained free of her phobia.     

Breast self-examination: clinical results from a population-based prospective study

As part of the Department of Health's National Breast Screening Trial a seven year study is in progress in Huddersfield to assess the effect of an educational programme in Breast Self Examination (BSE) on the mortality due to breast cancer among women aged 45-64. The initial cohort of 22,484 women have completed 3 years in the study and show a higher than expected annual incidence rate of breast cancer. There is no significant difference in the incidence rates between those who attended meetings for BSE instruction and those who did not. Similarly there is no difference in stages of presentation of cancers between attenders and non-attenders at these meetings and also between cancers detected in the first, second and third years. Those who discovered abnormalities during self examination, however, presented with smaller lumps compared to other women. Assessment of prognostic factors do not at this time provide sufficient evidence to show that a community-base BSE campaign will result in a significant improvement in the stage of breast cancer presentation.     

An information value based analysis of physical and climatic factors affecting dengue fever and dengue haemorrhagic fever incidence

Background  

Vector-borne diseases are the most dreaded worldwide health problems. Although many campaigns against it have been conducted, Dengue Fever (DF) and Dengue Haemorrhagic Fever (DHF) are still the major health problems of Thailand. The reported number of dengue incidences in 1998 for the Thailand was 129,954, of which Sukhothai province alone reported alarming number of 682. It was the second largest epidemic outbreak of dengue after 1987. Government arranges the remedial facilities as and when dengue is reported. But, the best way to control is to prevent it from happening. This will be possible only when knowledge about the relationship of DF/DHF with climatic and physio-environmental agents is discovered. This paper explores empirical relationship of climatic factors rainfall, temperature and humidity with the DF/DHF incidences using multivariate regression analysis. Also, a GIS based methodology is proposed in this paper to explore the influence of physio-environmental factors on dengue incidences. Remotely sensed data provided important data about physical environment and have been used for many vector borne diseases. Information Values (IV) method was utilised to derive influence of various factors in the quantitative terms. Researchers have not applied this type of analysis for dengue earlier. Sukhothai province was selected for the case study as it had high number of dengue cases in 1998 and also due to its diverse physical setting with variety of land use/land cover types.