Outbreak of Viral Hepatitis E in a Regimental Training Centre

Background

An outbreak of viral hepatitis occurred in a regimental centre with 265 cases occurring during a 3 months period.

Methods

190 serum samples were tested for IgM antibodies against viral hepatitis E by Enzyme Immuno Assay (EIA) and for antibodies against Hepatitis A and Hepatitis B viruses. Epidemiological investigation comprised review of surveillance data, filling up epidemiological case sheet, sanitary survey, inspection of water supplies and bacteriological examination of water for coliforms.

Result

97.4% of the serum samples were positive for IgM antibodies against Hepatitis E virus. Two leaks were detected in water pipelines, which were passing through contaminated areas around improperly functioning septic tanks and soak pits. The attack rate among recruits being supplied water through leaking pipelines was 11.1% whereas it was 2.89% in those not directly exposed. This difference was statistically significant (p<0.001). Bacteriological examination of water showed a high coliform count.

Conclusion

The outbreak of viral hepatitis E occurred due to sewage contamination of water pipelines.Key Words: Hepatitis E, Outbreak     

Cytokines : as useful Prognostic Markers in Lymphoma Cases

Cytokines are believed to be involved in the pathogenesis and enhanced expression in patients with Hodgkin''s and Non-Hodgkins lymphoma. Based on this phenomenon, a multicentric study was carried out in various lymphoma cases. The diagnosis of lymphoma was made on tissue biopsies and fine needle aspiration cytology (FNAC). Out of a total of 72 cases studied, 45 were of Hodgkin''s lymphoma (62.5%) and 27 cases were of Non-Hodgkin''s lymphoma (37.5%). Maximum cases of Hodgkin''s disease occurred in the age group of 30-40 years and males outnumbered females. Hodgkin''s lymphoma cases were predominantly of mixed cellularity histologic type (46.66%) whereas majority cases of Non-Hodgkin''s lymphoma were of high grade histologic type (48.14%) with predominance in the age group 51-60 years. In both these type of lymphomas, the IL-2R and IL-6 levels were found to be increased more than four fold (as compared to healthy controls) (p<0.05). The cytokine levels decreased after chemotherapy in patients showing response to therapy. However, there were few conflicting and unreliable trends in the IL-6 levels after chemotherapy where elevated IL-6 levels persisted in patients in clinical remission. Overall, it was seen that both IL-2R and IL-6 can be used as an indicator for assessing prognosis and drug therapy in lymphoma cases. IL-2R was found to be a better prognostic marker than IL-6 in assessing the response of lymphoma patient to chemotherapy, more so in Hodgkin''s disease.Key Words: Cytokines, IL-2R, IL-6, Lymphoma     

Physician attitudes about non-medical switching to biosimilars: results from an online physician survey in the United States

Objective: This study was designed to understand the level of familiarity of US rheumatologists, gastroenterologists and dermatologists with biosimilar therapies, their experience with non-medical switching (switching medications for reasons unrelated to patient health) of patients between biologics and their attitudes towards switching from a biologic to a biosimilar.

Methods: A total of 297?US physicians who currently prescribe biologics for their patients completed a 15-minute online survey. Rheumatologists, dermatologists and gastroenterologists were included.

Results: The majority of physicians (84%) did not want stable patients undergoing a non-medical switch to a biosimilar. While 60% of physicians believed non-medical switching to biosimilars may have a positive impact on healthcare system costs, multiple negative impacts were also expected. A majority of physicians anticipated a negative impact on patient mental health (59%), treatment efficacy (57%), patient safety (53%) and physician office management (60%).

Conclusions: The majority of physicians had concerns regarding non-medical switching to biosimilars and the impact such switching would have on patient care and physician practice.     

On planning of samples for linkage analysis: Two ways of a sample size reduction

The sample size required for a given type I and type II errors of linkage decision is determined by using the earlier proposed method of the linkage test power estimation [Ginsburg et al., 1996]. Dependence of the sample size on the heterozygotic genotype penetrance is investigated. Two approaches to sample size reduction are considered: the choice of marker gene and the special extension of analyzed pedigree structures. Their effects are quantitatively evaluated in some illustrative situations. It is shown that a practical reduction in sample size can be achieved only when the added part of a pedigree has a special set of phenotypic characteristics in its members. © 1996 Wiley-Liss, Inc.     

A search for natural bioactive compounds in Bolivia through a multidisciplinary approach. Part IV. Is a new haem polymerisation inhibition test pertinent for the detection of antimalarial natural products?

The search for new antimalarial agents in plant crude extracts using traditional screening tests is time-consuming and expensive. New in vitro alternative techniques, based on specific metabolic or enzymatic process, have recently been developed to circumvent testing of antimalarial activity in parasite culture. The haem polymerisation inhibition test (HPIA) was proposed as a possible routine in vitro assay for the detection of antimalarial activity in natural products. A total of 178 plant extracts from the Pharmacopeia of the Bolivian ethnia Tacana, were screened for their ability to inhibit the polymerisation of haematin. Five extracts from Aloysia virgata (Ruíz & Pavón) A.L. Jussieu (Verbenaceae), Bixa orellana L. (Bixaceae), Caesalpinia pluviosa D.C. (Caesalpiniaceae), Mascagnia stannea (Griseb) Nied. (Malpighiaceae) and Trichilia pleenea (Adr. Jussieu) (Meliaceae) demonstrated more than 70% inhibition of haematin polymerisation at 2.5 mg/ml. The extracts were also tested for antimalarial activity in culture against F32 strain (chloroquine-sensitive) and D2 strain (chloroquine-resistant) of Plasmodium falciparum and in vivo against P. berghei. The extract from Caesalpinia pluviosa was the only one that showed activity in HPIA and in the classical test in culture. The accuracy and pertinence of HPIA, applied to natural products is discussed.     

Reinforcement magnitude modulates the rate-dependent effects of fluvoxamine and desipramine on fixed-interval responding in the pigeon

Some doses of fluvoxamine can decrease ethanol-maintained behavior more than food-maintained behavior. This might be explained by differences in reinforcement magnitude. In a previous study, the effects of fluvoxamine on fixed-ratio responding did not depend upon reinforcement magnitude. Response rates, however, differed with reinforcement magnitude. These differences in response rates might explain the failure to observe differences in the potency of fluvoxamine with changes in reinforcement magnitude. In this study, we examined whether the effects of fluvoxamine and desipramine depended on the reinforcement magnitude and response rate, by administering these drugs to pigeons responding under a multiple fixed-interval schedule, in which responding in three components was maintained by differing durations of food presentation (2, 4, and 8 s). The effects of fluvoxamine and desipramine depended jointly on control rate, reinforcement magnitude, and dose. Low fluvoxamine doses had rate-dependent effects in all three components, increasing lower rates more than higher rates: as dose increased, these rate-dependent effects became greater in the components maintained by the 2-s or 4-s food presentation; whereas, in the component maintained by the 8-s presentations, they declined. Low desipramine doses had rate-dependent effects only in the component maintained by the 2-s presentations, whereas higher doses had rate-dependent effects in components maintained by 2-s or 4-s presentations. Still higher doses had rate-dependent effects in all the three components. Although the effects of fluvoxamine and desipramine might not depend on reinforcement magnitude when studied under fixed-ratio schedules, reinforcement magnitude can modulate their effects when they are studied over a wider range of control response rates.     

Optimizing strategies for laser angioplasty

The intrinsic optical properties of normal and diseased vascular tissues and their interaction with continuous wave (cw) and pulsed laser light were investigated to determine the optimal source for laser angioplasty. Both intima and atheromatous plaque demonstrated increasing spectral absorbance at shorter wavelengths (in the near ultraviolet). The relative differences in absorbance between diseased and nondiseased tissues were not sufficient to allow selective ablation of plaque. Atheromatous plaque appears more resistant than normal intima to damage by cw argon laser. The interaction of tissue with a high-power, pulsed ultraviolet laser showed a nonlinear response as pulse repetition rate and pulse energy were varied. From theoretical considerations and our experimental results, we propose that a pulsed ultraviolet laser with 50 millijoules of power per pulse and a repetition rate of 10 pps would be safer and more effective for recanalization than the cw argon laser.     

Concept Mapping with South Asian Immigrant Women: Barriers to Mammography and Solutions

Despite benefits of screening mammography, many South Asian (SA) immigrant women in Canada remain under screened. We aimed to elicit their experiences and beliefs about barriers to mammography and possible solutions. SA immigrant women aged 50 years or over were eligible if they never had a mammogram or had one more than 3 years ago. We employed the participatory mixed-method approach of Concept Mapping. Sixty women participated with a mean age of 58 years. Participants brainstormed 150 items which were consolidated into 67 items. After sorting and rating, cluster analysis revealed eight clusters of barriers on knowledge, fear, language and transportation, access to mammogram center, access to doctor, beliefs and practices, self-care, and family dependence. Participants discussed possible solutions, and emphasized out-reach models to address knowledge gaps and issues of language and transportation. One example was a community-based shuttle bus to screening centres, hosted by trained co-ethnic workers. The results are discussed to enhance the socio-cultural sensitivity of breast screening programs.