A two-year study of bacterial, viral, and parasitic agents associated with diarrhea in rural Bangladesh

Enteric pathogens associated with diarrhea were studied for two years at a diarrhea treatment center in rural Bangladesh. Enterotoxigenic Escherichia coli (ETEC) was the most frequently identified pathogen for patients of all ages. Rotavirus and ETEC were isolated from approximately 50% and approximately 25%, respectively, of patients less than two years of age. A bacterial or viral pathogen was identified for 70% of these young children and for 56% of all patients with diarrhea. Most ETEC isolates were obtained in the hot dry months of March and April and the hot wet months of August and September. Rotavirus identification peaked in the cool dry months of December and January, but infected patients were found year-round. The low case-fatality rates for patients with watery diarrhea and substantial dehydration further document the usefulness of treating patients with diarrhea with either a glucose- or sucrose-base electrolyte solution such as those used in this treatment center.     

Genomic profiles of clinical and environmental isolates of Vibrio cholerae O1 in cholera-endemic areas of Bangladesh

Diversity, relatedness, and ecological interactions of toxigenic Vibrio cholerae O1 populations in two distinctive habitats, the human intestine and the aquatic environment, were analyzed. Twenty environmental isolates and 42 clinical isolates were selected for study by matching serotype, geographic location of isolation in Bangladesh, and season of isolation. Genetic profiling was done by enterobacterial repetitive intergenic consensus sequence-PCR, optimized for profiling by using the fully sequenced V. cholerae El Tor N16961 genome. Five significant clonal clusters of haplotypes were found from 57 electrophoretic types. Isolates from different areas or habitats intermingled in two of the five significant clusters. Frequencies of haplotypes differed significantly only between the environmental populations (exact test; P < 0.05). Analysis of molecular variance yielded a population genetic structure reflecting the differentiating effects of geographic area, habitat, and sampling time. Although a parameter confounding the latter differences explained 9% of the total molecular variance in the entire population (P < 0.01), the net effect of habitat and time could not be separated because of the small number of environmental isolates included in the study. Five subpopulations from a single area were determined, and from these we were able to estimate a relative differentiating effect of habitat, which was small compared with the effect of temporal change. In conclusion, the resulting population structure supports the hypothesis that spatial and temporal fluctuations in the composition of toxigenic V. cholerae populations in the aquatic environment can cause shifts in the dynamics of the disease.     

Clinical and histopathologic findings of basal cell carcinomas on completely covered anatomical sites of the body

Basal cell carcinoma (BCC) is the most common cancer type seen among the Caucasian population. Sun exposure may play a less important role in the causation of BCC in completely covered body sites than in sun-exposed skin. The aim of this study was to analyze in detail the BCCs that occur on completely covered anatomical sites. A total of 322 primary BCC cases was diagnosed. Of these, 44 were located on completely covered anatomical sites. Completely covered anatomical sites were classified as follows: trunk (including mammillae, excluding the neck), arms (excluding forearms and hands), legs (excluding feet), the perianal area and genitalia, and the buttocks and groin areas. Twenty-four lesions were of the superficial type, 14 lesions were of the nodular type, four lesions were of the infiltrative type, one lesion was of the morpheiform type, and one lesion was of the adenoid type. The most frequently reported symptom was itching. Forty-two percent of patients had no related symptoms. A close clinical check revealed 13 lesions which seemed to contain pigment. The preoperative diagnosis was based on clinical grounds and punch biopsies. Punch biopsies were performed on 10 cases which had been treated for a different diagnosis. The findings of our retrospective study showed that BCCs which occur on completely covered anatomical sites differ from those on sun-exposed skin. The clinical appearance of these sites with BCC may be similar to that which has other skin lesions. All physicians should bear in mind that BCC may occur not only in sun-exposed areas, but also in regions which are normally protected from ultraviolet radiation.     

Results of using Ilizarov distraction osteogenesis technique for the treatment of cubitus varus deformities in adults

Introduction  

Five adult patients, with posttraumatic cubitus varus deformity underwent corrective surgery by the Ilizarov method of distraction osteogenesis.     

Placebo-controlled evaluation of direct electrical current administration for palmoplantar hyperhidrosis

BACKGROUND: Direct electrical current (d.c.) administration based on tap water iontophoresis has been used as a therapeutic option for palmoplantar hyperhidrosis. The placebo effect of this technique has not been investigated adequately. AIM: To investigate whether d.c. administration has a possible placebo effect in the treatment of palmoplantar hyperhidrosis. METHODS: As a placebo, low alternating electrical current (a.c.; 9-12 mA, 10-15 V, and 8-10 Hz) was applied to the palms of 15 patients with idiopathic palmoplantar hyperhidrosis. The placebo effect was evaluated by inspection and sweat intensity measurements performed before and after placebo application. Patients then received d.c. treatment (18-22 mA, 40-60 V) according to the same procedure as applied for placebo. The final sweat intensity measurements of the patients were performed 1 week after the last session of d.c. treatment. Sweat intensities measured before and after placebo and at the end of d.c. treatment were analyzed statistically by paired t-test. RESULTS: The initial sweat intensity measurements of the palms, before placebo application, were 3.12 +/- 0.39 g/h on the right side and 3.17 +/- 0.28 g/h on the left side. The second sweat intensity measurements, 1 week after the last session of placebo, were 3.08 +/- 0.46 g/h on the right side and 3.16 +/- 0.21 g/h on the left side. There were no significant differences between the initial and second sets of sweat intensity measurements of the hands (P > 0.05 for both sides). The final sweat intensity measurements, 1 week after the last session of d.c. treatment, were 0.38 +/- 0.06 g/h on the right side and 0.39 +/- 0.07 g/h on the left side. CONCLUSIONS: Statistical evaluation of sweat intensity measurements and inspections revealed that d.c. administration had no placebo effect in the treatment of palmoplantar hyperhidrosis.     

A 4-year study of the epidemiology of Vibrio cholerae in four rural areas of Bangladesh

How Vibrio cholerae spreads around the world and what determines its seasonal peaks in endemic areas are not known. These features of cholera have been hypothesized to be primarily the result of environmental factors associated with aquatic habitats that can now be identified. Since 1997, fortnightly surveillance in 4 widely separated geographic locations in Bangladesh has been performed to identify patients with cholera and to collect environmental data. A total of 5670 patients (53% <5 years of age) have been studied; 14.3% had cholera (10.4% due to V. cholerae O1 El Tor, 3.8% due to O139). Both serogroups were found in all locations; outbreaks were seasonal and often occurred simultaneously. Water-use patterns showed that bathing and washing clothes in tube-well water was significantly protective in two of the sites. These data will be correlated with environmental factors, to develop a model for prediction of cholera outbreaks.     

Correlation between the tissue Doppler, strain rate, strain imaging during the dobutamine infusion and coronary fractional flow reserve during catheterization: a comparative study

Coronary fractional flow reserve (FFR) as an invasive, and dobutamine stress echocardiography (DSE) as a noninvasive technique were used to detect critical coronary stenosis. This study was undertaken to assess correlation between these two techniques by using tissue Doppler, strain rate (SR), and strain imaging (S). METHODS: In 17 patients (aged 54.9+/-12.6, 4 F), a total of 22 vessels were studied. On dobutamine stress echocardiography, baseline and peak systolic (Sm), early (Em) and late (Am) diastolic myocardial velocities, SR and S were recorded from parasternal view (mid-posterior segment) for radial and apical view (mid-septum) for longitudinal deformation. Then coronary FFR was performed by using intracoronary adenosine infusion, and the value of < or = 0.75 was accepted as critical coronary stenosis. RESULTS: FFR was found to be significant in 10 vessels (FFR critical). Baseline Sm, Em/Am, SR, S values, and peak Em/Am, SR, S values were similar between critical or noncritical FFR groups. Baseline Sm and Em, and change between baseline and peak Sm and S were significantly higher in noncritical FFR group (p < 0.01, < 0.05, < 0.001, < 0.001, respectively). In all vessels, FFR after adenosine infusion showed a poor correlation with WMSI, Em, Am, Em/Am values, and the change in SR values (r = -0.22, 0.16, -0.14, 0.21, 18, respectively) showed a good correlation with the change in S (r = 0.51; p = 0.014), and a very good correlation with the change in Sm values (r = 0.77; p < 0.001) during DSE. When FFR values at left coronary system were analyzed for longitudinal SR and S values, it had a mild correlation with SR (r = 0.47, p = 0.044) and a good correlation with S (r = 0.66, p = 0.002). CONCLUSION: The quantification of regional myocardial deformation by using DSE rather than the motion would be more appropriate in detecting the ischemic dysfunctional segment supplied by the critical coronary stenosis. Strain measurement during the dobutamine infusion may provide an information on the FFR results of the culprit vessel.     

The effect of neuromuscular electrical stimulation on functional status and quality of life after knee arthroplasty: a randomized controlled study

[Purpose] The aim of this study was to investigate the effect of the addition of NMES to the post-TKA rehabilitation protocol on the functional status and quality of life of the patients. [Subjects and Methods] Patients were randomized into an exercise (control) and electrical stimulation (NMES) group. A home exercise program was prescribed for the control group. For the neuromuscular stimulation group 30 minute electrical stimulation applied to the vastus medialis muscle 5 days a week for 4 to 6 weeks. VAS, the timed up and go test, WOMAC and SF-36 scores were evaluated preoperatively and postoperatively at the first month and the third month of the follow-up period. [Results] Both the NMES group had 30 patients each, with 2 and 1 male patients respectively. The comparisons of WOMAC results at month 1 revealed that pain, stiffness, and total scores of the NMES group was significantly better than those of control group at the first and third months. Significantly better physical function and SF-36 subscales, except mental health, were found for the NMES group at the first month of follow-up. [Conclusion] The inclusion of the neuromuscular electrical stimulation program after knee arthroplasty was more effective at providing rapid improvements in knee pain, walking distance and quality of life.Key words: Quadriceps muscle, Knee joint, Arthroplasty