Epidemiology of pertussis in a country with high vaccination coverage

Introduction

Pertussis has been a preventable disease in Catalonia since 1965, but the annual number of cases remains high. The aim of this study was to analyze the epidemiology of pertussis in Catalonia and its implications for control purposes.

Methods

An epidemiological study was carried out in Catalonia between 2004 and 2008. Pertussis cases reported to the Department of Health were collected and disease reports were filled out with the case information. Incidence rates, rate ratios (RR) and their 95% confidence intervals (CI) were calculated.

Results

963 cases were reported: 555 (57.6%) were confirmed and 408 (42.4%) were suspected cases. The reported incidence rate was 2.01 × 10⁻⁵ person years in 2004 and 4.34 in 2008. The biggest increase in cases between 2004 and 2008 was observed in the ≥35 years age group (RR: 6.98; 95%CI: 2.11-36.36). 303 (31.5%) patients were hospitalized, of whom 93.7% were aged <1 year. Clinical differences were observed in paroxysmal cough (83.8% in suspected and 76.4% in confirmed cases, p = 0.005), posttussive vomiting (47.1% and 36.1%, respectively, p = 0.001), apnoea (13.7% and 21.3%, respectively, p = 0.003) and fever (20.1% and 12.4%, respectively, p = 0.001).

Conclusion

Pertussis incidence rates increased during the study period, with the greatest increase occurring in the ≥35 years age group. A booster dose of vaccine in young people could reduce the circulation of B. pertussis in adolescents and adults and indirectly reduce the incidence in children.     

Immune disease expressed in liver and platelets in an adolescent: a case report

We report a case of a 15-year-old boy with autoimmune hepatitis lacking common serologic markers and normal gammaglobulinemia associated with immune thrombocytopenia and family history of psoriasis. He presented to our department with a 4-year history of a cervical posterior lymphadenopathy and recent petechiae. Previous laboratory results 6 months before already showed hepatocellular injury. After exclusion of other causes, the diagnosis of autoimmune hepatitis was made based on clinical grounds, associated immune disorder and histological features of liver biopsy.The authors alert for this atypical presentation of autoimmune hepatitis and associated immune thrombocytopenia.     

Diabetes Risk Perception and Intention to Adopt Healthy Lifest yles Among Primary Care Patients

OBJECTIVE

To examine perceived risk of developing diabetes in primary care patients.

RESEARCH DESIGN AND METHODS

We recruited 150 nondiabetic primary care patients. We made standard clinical measurements, collected fasting blood samples, and used the validated Risk Perception Survey for Developing Diabetes questionnaire.

RESULTS

Patients with high perceived risk were more likely than those with low perceived risk to have a family history of diabetes (68 vs. 18%; P < 0.0001) and to have metabolic syndrome (53 vs. 35%; P = 0.04). However, patients with high perceived risk were not more likely to have intentions to adopt healthier lifestyle in the coming year (high 26.0% vs. low 29.2%; P = 0.69).

CONCLUSIONS

Primary care patients with higher perceived risk of diabetes were at higher actual risk but did not express greater intention to adopt healthier lifestyles. Aspects of health behavior theory other than perceived risk need to be explored to help target efforts in the primary prevention of diabetes.Many clinical trials have shown that healthier lifestyles leading to modest weight loss can prevent diabetes in populations at risk (1,2), but changing behavior in real-life patients remains a challenge. Risk perception is a major component of most health behavior theories (3). Perceived risk to develop diabetes can be measured using a validated questionnaire such as the Risk Perception Survey for Developing Diabetes (RPS-DD) (4). There are no reports of diabetes risk perception estimated by the RPS-DD in primary care settings. We tested the hypotheses that primary care patients who perceive themselves at higher risk are 1) actually at higher risk for future diabetes and 2) more likely to intend to adopt healthier lifestyle behaviors.     

Inhibition of fms-like tyrosine kinase 3 alleviates experimental arthritis by reducing formation of dendritic cells and antigen presentation

TKs are intracellular signaling molecules essential for cell homeostasis. Inhibition of TKs is used in treatment of malignancies and diabetes mellitus. The present study evaluated the role of Flt3 in antigen-induced arthritis. Mice were immunized with mBSA, and arthritis was induced by an i.a. injection of mBSA. Treatment with the Flt3 inhibitor sunitinib was started together with mBSA immunization or together with the induction of arthritis. The mBSA-injected joints were evaluated morphologically for signs of synovitis and bone/cartilage destruction. Markers of bone metabolism and antibody responses were measured by ELISA. Maturation of DCs in the bone marrow and spleen was evaluated by flow cytometry. Sunitinib treatment reduced the intensity of synovitis and the incidence of bone destruction. The reduction in bone destruction was seen when the treatment was started at the time of immunization or at the time of arthritis induction. The antiarthritic effect was achieved by inhibition of DCs, reduction of antibody production, and bone metabolism. Inhibition of Flt3 is a potent antiarthritic mechanism reducing antigen presentation, synovial inflammation, and bone resorption. Down-regulation of TKs may be a useful tool in the treatment of human RA.     

A meta-analysis of the use of 4 % icodextrin solution to prevent adhesion formation after gynaecological surgery

Post-surgical adhesions are common and can cause substantial co-morbidity. The aim of this review was to investigate the efficacy of 4 % icodextrin solution, a widely used adhesion prevention agent, in gynaecological surgery. Randomised-controlled trials comparing the use of 4 % icodextrin solution vs. Ringer’s-lactated saline (control) in women of any age undergoing fertility-conserving surgery either by laparoscopy or laparotomy were searched and meta-analysis performed. Compared to Ringer’s-lactated saline, there was no significant difference in the number of patients free from de novo adhesions at second-look laparoscopy (SLL) (odds ratio, 1.21 [0.76, 1.93]), the adhesion score reduction at SLL (mean difference (MD), 0.71 [?0.66, 2.08]), the percentage reduction in adhesion extent (MD, 5.47 [?4.18, 15.12]) or severity (MD, 13.49 [?23.78, 50.75]). The included studies reported the effect of 4 % icodextrin in different ways thus limiting meta-analysis. This is the first meta-analysis of icodextrin and the lack of evidence found to support the use of icodextrin suggests further research is required which should be presented in a uniform manner.