Epidemiological and morbidity assessment of Schistosoma japonicum infection in a migrant fisherman community, the Dongting Lake region, China

We assessed the epidemiology and morbidity related to Schistosoma japonicum infection by both parasitological (Kato-Katz method and miracidium hatching test) and ultrasound examination in a migrant fisherman community (n = 106) from the Dongting Lake region in China in 2001. A prevalence of 69.8% and a mean infection intensity of 66.5 eggs per gram (epg) were recorded for this group. Males had a higher level of infection (77%) and intensity (92.2 epg) compared with females (58% and 28.6 epg, respectively). Subjects aged 11-20 years had the highest prevalence of infection (91%) and the heaviest infection intensity (85.3 epg) among all age groups. Twenty-six percent of the subjects had not been treated previously for schistosomiasis. Parenchymal fibrosis (> or = stage II) detected by ultrasound and spleen enlargement (or splenectomy) occurred in 37% and 9% of subjects, respectively. Portal vein dilation was detected in 18% subjects, and 58% (11/19) of those patients with portal vein enlargement were shown to have parenchymal fibrosis (> or = stage II). These results indicate that S. japonicum infection and related morbidity in mobile fisherman is still unacceptably high despite the fact that China has implemented a Schistosomiasis Control Project financed by a World Bank Loan for a period of 8 years since 1992. Clearly, new approaches for schistosomiasis control, especially in communities like these mobile fishermen, should be explored.     

Treatment of septic arthritis

Surgery and needle aspiration have been evaluated as initial modes of drainage in 59 patients with acute septic arthritis. Full recovery was noted in 42% treated surgically at the outset. On the other hand, 67% of those treated by needle aspiration recovered without sequelae, despite the greater prevalence in this group of adverse host factors-eg, serious underlying illness, concommitant extraarticular infection, prior arthritis in the infected joint, and recent antibiotic or immunosuppressive therapy.     

Audit tool for external beam radiation therapy departments

PurposeDevelopment of a self-contained audit tool for external beam radiation therapy to assess compliance with the major recommendations from professional organizations and generally accepted standards of practice. Intensity modulated radiation therapy, stereotactic body radiation therapy, stereotactic radiosurgery, and volumetric modulated arc therapy were included in this review.Methods and MaterialsA physics quality working group developed a department vision, distinguished and summarized key references, and condensed important elements of good documentation practices. The results were then compiled in a checklist format and used to perform audits at 3 sites.ResultsThe final audit tool contains 65 items spanning a wide range of external beam radiation therapy practices. Several of the audit items address issues not commonly identified by other authoritative sources. A total of 48 process improvements were identified at the 3 sites audited.ConclusionsThe enclosed self-inspection list may be useful to a site as an annual review tool, as an aid in preparation for the American College of Radiology-American Society for Therapeutic Radiology and Oncology practice accreditation, or as a catalyst for general quality improvement. Sites can quickly identify opportunities for improvement by concentrating on high importance items and commonly identified areas of noncompliance.     

Alzheimer's Therapeutics: Translation of Preclinical Science to Clinical Drug Development

Over the past three decades, significant progress has been made in understanding the neurobiology of Alzheimer''s disease. In recent years, the first attempts to implement novel mechanism-based treatments brought rather disappointing results, with low, if any, drug efficacy and significant side effects. A discrepancy between our expectations based on preclinical models and the results of clinical trials calls for a revision of our theoretical views and questions every stage of translation—from how we model the disease to how we run clinical trials. In the following sections, we will use some specific examples of the therapeutics from acetylcholinesterase inhibitors to recent anti-Aβ immunization and γ-secretase inhibition to discuss whether preclinical studies could predict the limitations in efficacy and side effects that we were so disappointed to observe in recent clinical trials. We discuss ways to improve both the predictive validity of mouse models and the translation of knowledge between preclinical and clinical stages of drug development.     

Three‐Dimensional Contrast Echocardiography in Assessing Left Ventricular Diverticulum

Congenital left ventricular (LV) diverticulum is a rare malformation that can be alone or in association with other congenital abnormalities. Since the several complications have been reported in association with LV diverticulum, as cardiac rupture, heart failure, and endocarditis, patients with LV diverticulum who are managed with conservative treatment would require regular checkups to ascertain the absence of such complications. We report a case of LV diverticulum in a 47‐year‐old man. He took the serial three‐dimensional contrast echocardiography, which was reliable and readily available tool for defining LV diverticulum and monitoring the presence of complications.     

Pain Management in Current Combat Operations

Pain management in the U.S. Military, particularly in combat, shares many of the same principles found in civilian heath care organizations andinstitutions. Pain is one of the most common reasons for which soldiers seek medical attention in the combat environment, which mirrors the civilian experience. However, the combat environment exacerbates the typical challenges found in treating acute pain andhas the additional obstacles of a lack of supplies andequipment, delayed or prolonged evacuation times anddistances, devastating injuries, provider inexperience, anddangerous tactical situations. These factors contribute to the difficulty in controlling a soldier's pain in combat. Furthermore, civilian health care providers have also learned the importance of practicing pain management principles in austere andtactical environments because of recent natural andman-made domestic disasters. Pain management research, education, andtreatment strategies have been created to try to achieve adequate battlefield analgesia, andthese lessons learned may aid civilian health care providers if the circumstances arise. This article presents a brief history andcurrent overview of pain management for combat casualties on today's battlefield. Recent natural disasters andincreased threats for terrorist acts have proven the need for civilian health care providers to be properly trained in pain management principles in an austere or tactical environment     

A case Series Describing Thermal Injury Resulting From Zeolite Use for Hemorrhage Control in Combat Operations

Four cases are presented to illustrate cutaneous burns sustained with the use of zeolite in the treatment of major hemorrhage secondary to combat wounds. Zeolite, a microporous crystalline aluminosilicate granular hemostatic agent, can cause secondary thermal injuries through an exothermic reaction that is likely related to the absorption of free fluid at the hemorrhage site. Understanding of this process may help both military andcivilian EMS personnel avoid or minimize secondary thermal injury while still benefiting from zeolite's hemostatic capabilities.