Kawasaki syndrome in Hawaii

OBJECTIVE: To describe the incidence and epidemiology of Kawasaki syndrome (KS) in Hawaii. METHODS: Retrospective analysis of the State Inpatient Database for Hawaii residents hospitalized with KS during 1996 through 2001. RESULTS: During 1996 through 2001, 267 persons younger than 18 years of age living in Hawaii were hospitalized with KS; 226 (84.6%) were younger than 5 years of age. The average annual incidence for KS was 45.2 per 100,000 children younger than 5 years of age. The incidence was higher for children younger than 1 year of age than for those 1-4 years of age (74.3 and 37.5 per 100,000). The KS incidence for Asian and Pacific Islander children and for White children was 70.9 and 35.3 per 100,000, respectively. Incidence was highest among Japanese American children living in Hawaii (197.7 per 100,000). Honolulu County had the most KS patients (85.0%) and the highest incidence (53.1 per 100,000) among Hawaii counties. For children younger than 5 years of age hospitalized with KS, the median length of stay was 2 days, and the median hospital charge was $9379. CONCLUSION: During 1996 through 2001, the annual incidence rate for KS among children younger than 5 years of age in Hawaii was the highest in the United States. The incidence among Japanese American children in Hawaii was higher than that among other racial groups in the state and when compared with children living in Japan.     

Coinfection and clinical manifestations of tuberculosis in human immunodeficiency virus-infected and -uninfected adults at a teaching hospital, northwest Ethiopia.

BACKGROUND AND PURPOSE: The pattern of clinical presentations of tuberculosis (TB) is reflected in the microbiological, radiological, and histological characteristics of the disease. However, coinfection with human immunodeficiency virus (HIV) poses special diagnostic and therapeutic challenges. This study was aimed at assessing the clinical manifestations of TB in patients with or without HIV coinfection in a hospital-based cross-sectional study in Gondar, Ethiopia. METHODS: TB was diagnosed following standard clinical, bacteriological, radiological, and histological procedures. HIV serostatus was checked by enzyme-linked immunosorbent assay. RESULTS: This study included 257 TB patients, of whom 52.1% were coinfected with HIV. Pulmonary TB and extrapulmonary TB were diagnosed in 64.2% and 35.8% of the patients, respectively. No significant association was found between sputum smear positivity and HIV serostatus. One-fifth of the patients reported hemoptysis. More than one-third had chest pain, and >90% reported fever and weight loss. Night sweats and cough were reported by 86% and 82.5%, respectively. Coarse crepitations were the most frequent auscultatory finding (33.9%). Sputum smear positivity rate was 26.8%. Cavitation was significantly associated with sputum smear positivity (odds ratio = 9.0, 95% confidence interval = 2.4-34.1). Wasting, cough of 相似文献   

Kawasaki Syndrome and Factors Associated With Coronary Artery Abnormalities in California

BACKGROUND:: Kawasaki syndrome (KS) occurs in children <18 years of age and is the leading cause of acquired heart disease among children in the United States. Understanding the epidemiology of KS and factors associated with coronary artery abnormalities (CAA) may lead to timely diagnosis and treatment of KS and could limit CAA. METHODS:: Epidemiologic characteristics, including risk factors for the development of CAA, among KS and incomplete KS patients <18 years of age with onset during 2000-2009 reported by the California Department of Public Health to the Centers for Disease Control and Prevention's national KS surveillance system were analyzed. RESULTS:: A total of 2056 KS and incomplete KS patients <18 years of age were reported during 2000-2009. The median age of patients was 2 years; 60% of patients were male. Of 1818 patients with race information reported, 56% were white and 28% were Asian/Pacific Islander. Ninety-eight percent of patients received intravenous immunoglobulin. Of 1843 patients with information on cardiac complications, 89 (5%) had coronary artery aneurysms and 341 (19%) had CAA. Characteristics associated with the occurrence of CAA in KS patients were male sex, Asian/Pacific Islander race, age <1 year or 9-17 years, and not receiving intravenous immunoglobulin treatment before the fifth day of illness. CONCLUSIONS:: This study suggests that intravenous immunoglobulin treatment before the fifth day of illness may reduce CAA among KS patients. Timely diagnosis and treatment of KS continue to be important in reducing the occurrence of cardiac complications.     

Researching accessible and affordable treatment for common dermatological problems in developing countries. An Ethiopian experience

Background Skin diseases are very common in rural and urban areas of Ethiopia, and traditional preparations of plant origin might represent the only alternative to synthetic drugs. Improving knowledge of traditional medicines and assessing their safety and effectiveness is necessary. Methods We conducted a two‐arm, randomized, double‐blind, placebo‐controlled trial assessing the efficacy of some cosmetic herbal preparations for common dermatologic problems: a 3% thyme essential oil antifungal cream and a 10% chamomile extract cream for eczema‐like lesions. Results Ten subjects (66.5%) treated with the 3% thyme active cream were completely healed vs. four subjects (28.5%) from the placebo group (P = 0.040). A large number of subjects treated with the chamomile cream were healed or improved, but no significant differences were found between active cream and placebo. A high rate of treatment acceptance was registered in both groups, no adverse effects were reported. Conclusions A 3% thyme essential oil cream could represent a cheap and easily available opportunity to treat and heal mild to moderate cases of fungal infections; a common emollient cream could be a very effective intervention when treating mild to moderate cases of pityriasis alba and eczema‐like lesions. Further research is needed.     

Field evaluation of FD-DAT, rK39 dipstick and KATEX (urine latex agglutination) for diagnosis of visceral leishmaniasis in northwest Ethiopia

Three novel diagnostic tests for visceral leishmaniasis (VL), namely FD-DAT, rK39 dipstick and KATEX, were evaluated under field conditions using 101 clinical cases suspected of having VL enrolled in a trial either by active (63 patients) or passive (38 patients) surveillance. VL was confirmed in 49 patients: 35 by both aspirate smear microscopy and NNN culture, 10 by NNN culture alone and 4 by aspirate smear microscopy alone. Based on tests performed in the field, sensitivity for FD-DAT, rK39 dipstick and KATEX was determined to be 95.3% (95% CI 82.9-99.2%), 71.7% (95% CI 56.3-83.5%) and 57.4% (95% CI 42.3-71.4%), respectively. Similarly, the specificity was determined to be 62.7% (95% CI 48.1-75.5%), 82.4% (95% CI 68.6-91.1%) and 84.3% (95% CI 70.9-92.5%), respectively. A higher sensitivity of KATEX (73.9% vs. 41.7%) and higher specificity of FD-DAT (100.0% vs. 48.6%) were demonstrated under passive case detection compared with active case detection. FD-DAT is recommended for confirmation of VL diagnosis in hospital settings, whereas its use in the field will be limited to exclude VL in clinical suspects. The sensitivity of KATEX and rK39 dipstick tests needs to be improved to promote their use as first-line diagnostic tests in the field setting of northwestern Ethiopia.     

Kawasaki syndrome in Denmark

OBJECTIVE: To describe the epidemiologic characteristics of Kawasaki syndrome (KS) and to estimate national KS incidence rates among children in Denmark. METHODS: A retrospective population-based study using hospital discharge records with a KS diagnosis for children younger than 15 years selected from the Danish National Hospital Register for 1981-2004. Incidence rates were calculated using the number of KS patients and corresponding census data. RESULTS: During 1981-2004, 360 children younger than 15 years were hospitalized with KS in Denmark, with 73% younger than 5 years. In this age group, the average annual incidence of KS gradually increased from 1981 to 1999 and thereafter stabilized at 4.5 to 5.0 per 100,000 person-years. The incidence was greater for boys than for girls (RR = 1.6, 95% CI = 1.2-2.0) and was highest among infants younger than 1 year (4.5), declining with increasing age (P = 0.03). However, the age-specific decline in incidence was only observed for boys, whereas the incidence for girls remained unchanged by age. The median length of hospital stay was 12 days, and the incidence peaked in the winter months. CONCLUSIONS: Major epidemiologic characteristics identified among Danish childhood KS are consistent with those described in previous studies, such as highest incidence among young children and winter-seasonality. The KS incidence rate among children younger than 5 years in Denmark increased steadily during the early study period (coinciding with global recognition of KS) and seems to have stabilized from 1998-1999 onwards. Although the incidence among Danish children was lower than that reported for several other European countries, differences in methodology challenge definite comparisons.     

Making pregnancy safer initiative--program impact in selected pilot areas

OBJECTIVE: This paper highlights program evaluation carried out on Making Pregnancy Safer Program interventions implemented by FHD in partnership with WHO, UNICEF, UNFPA, SIDA Sweden, the World bank and European Commission to increase availability of Emergency Obstetric Care Services in four pilot regions. METHOD: A participatory evaluation design was employed that included FMoH, RHB and other key partners. The qualitative approach examined client and community perception, provider's perspectives and program manager's views at different levels with regard to service provision, quality of care, service utilization and the impact of the MPS strategy. The quantitative aspect assessed met and unmet needs, service utilization and quality of service. RESULTS: Evaluation shown positive trend in process indicators of maternal health service utilization. Staff who received training in Emergency Obstetric Care are better off in both skill and knowledge acquisition. Majority of facilities had basic resources and functions for Emergency Obstetrics care. However, infrastructure deficiencies such as absence of waiting area, lack of privacy for clients, lack of toilets and water, shortage of life saving drugs, lack of context specific IEC materials were observed. At the community level, the main reason for dissatisfaction with health facility services was poor service provider attitude. CONCLUSION: MPS established a strong foundation to build stronger, better quality of emergency obstetrics and neonatal care that are used by those who needed it. It is time to consolidate and sustain improvements and vigorously support Regional Health Bureaus to ensure quality emergency obstetrics and neonatal care can be made available for all pregnant women, and progress toward the Millennium Development Goals can be achieved.