Evaluation of Cholera and Other Diarrheal Disease Surveillance System,Niger State,Nigeria-2012

Objective

To determine how the cholera and other diarrheal disease surveillance system in Niger state is meeting its surveillance objectives, to evaluate its performance and attributes and to describe its operation to make recommendations for improvement.

Introduction

Cholera causes frequent outbreaks in Nigeria, resulting in mortality. In 2010 and 2011, 41,936 cases (case fatality rate [CFR]-4.1%) and 23,366 cases (CFR-3.2%) were reported (1). Reported cases in Nigeria by week 26, 2012 was 309 (CFR-1.29%) involving 20 Local Government Areas in 6 States. In Nigeria, there are currently eleven (11) States including Niger state at high risk for cholera/bloodless diarrhea outbreaks.In 2011, Niger state had 2472 cholera cases (CFR-2%) and 45,111 other diarrhea diseases cases, recorded in more than half of state Purpose of surveillance system is to ensure early detection of cholera and other diarrheal cases and to monitor trends towards evidence-based decision for management, prevention and control.

Methods

We conducted evaluation in July, 2012. We used CDC guideline on surveillance system evaluation (2001) as guide to assess operation, performance and attributes (2). We conducted key informant/in-depth interviews with stakeholders. We examined cholera action plans for preparedness and response, conducted laboratory assessment, extracted and analyzed cholera surveillance (2005–2012) for frequencies/proportions using Microsoft Excel. Thematic analysis was done for qualitative data. We shared findings with stakeholders at all levels.

Results

Surveillance system was setup for early detection and monitoring towards evidence-based decision. State government funds system. Case definition used is highly sensitive and is any patient aged 5 years or more who develops acute watery diarrhea, with/without vomiting. Though simple case definition, laboratory confirmation makes surveillance complex. A passive system, active during outbreaks; has formal and informal sources of information and part of Integrated Disease Surveillance and Response (IDSR) system and flow(fig.1). It takes 24–48 hours between outbreaks onset, confirmation and response.Line list showed undefined/poorly labeled outcomes. Of 2472 cases in 2011 1320 (49%) were found in line list. 2011 monthly data completeness was 75%. So far in 2012, 5(0.02%) of all diarrhea cases were cholera. System captures only age as sociodemographics.Of 11 suspected cholera cases tested during 2011 epidemic, 7 confirmed as cholera (PPV-63%). Of 3 rumours of cholera outbreaks (January 2011-July 2012), one (PPV-33%) was true. Acceptability of system is high among all stakeholders interviewed. Timeliness of monthly reporting was 68.7% (

Continuous infusion of local anesthetic at iliac crest bone-graft sites for postoperative pain relief. A randomized, double-blind study

BACKGROUND: Autologous bone graft is the so-called gold standard for reconstruction of bone defects and nonunions. The most frequent complication is donor site pain. The iliac crest is a common source for autologous bone graft. The purpose of this study was to determine whether a continuous infusion of 0.5% bupivacaine into the iliac crest harvest site provides pain relief that is superior to the relief provided by systemic narcotic pain medication alone in patients undergoing reconstructive orthopaedic trauma procedures. METHODS: A prospective, double-blind randomized study of patients over eighteen years of age who were undergoing harvesting of iliac crest bone graft was conducted. The patients were randomized to the treatment arm (bupivacaine infusion pump) or the placebo arm. Postoperatively, all study patients received morphine sulfate with use of a patient-controlled analgesia pump. The patients recorded the pain at the donor and recipient sites with use of a scale ranging from 0 to 10. The use of systemic narcotic medication was recorded. Independent-samples t tests were used to assess differences in perceived pain relief between the treatment and control groups at zero, eight, sixteen, twenty-four, thirty-two, forty, and forty-eight hours after surgery. Pain was also assessed at two and six weeks postoperatively. RESULTS: Sixty patients were enrolled. Across all data points, except pain at the recipient site at twenty-four hours, no significant differences in the perception of pain were found between the bupivacaine group and the placebo group. On the average, patients in the treatment group reported more pain than those in the control group. No significant difference was found between the two groups with regard to the amount of narcotic medication used. CONCLUSIONS: No difference in perceived pain was found between the groups. The results of this small, unstratified study indicate that continuous infusion of bupivacaine at iliac crest bone-graft sites during the postoperative period is not an effective pain-control measure in hospitalized patients receiving systemic narcotic medication.     

Ligament and tendon injury to the elbow: clinical, surgical, and imaging features

Significant advances in the understanding of elbow anatomy, biomechanics, imaging, and surgical technique have been made over the last decade. Tendon injuries are often seen in athletes and physical laborers from repetitive eccentric overload. Ligament injuries are commonly seen in throwing athletes or after elbow dislocation. Magnetic resonance imaging has proven valuable for diagnosing and monitoring most of these soft tissue injuries, and effective surgical techniques have evolved to address them. This article describes typical clinical findings associated with ligament and tendon injuries in the elbow as well as common surgical therapies. The use of magnetic resonance imaging is highlighted throughout because this modality has revolutionized noninvasive evaluation of the elbow.     

Pulmonary function in the morbidly obese

BACKGROUND: Only limited data exist on the relationship of lung function to patients with extreme obesity. To assess the relationship between lung function tests and clinical characteristics in a cohort of morbidly obese patients undergoing evaluation for bariatric procedures in a university hospital in the United States. METHODS: Consecutive patients undergoing clinical evaluation were reviewed. The variables included demographic, anthropometric, clinical, and pulmonary function data. RESULTS: A total of 229 patients underwent a standardized preoperative evaluation. Of these 229 patients, 136 (59%) had evaluable data and 102 (75%) were women. The mean +/- standard deviation age was 45 +/- 10 years, the mean weight was 164 +/- 42 kg, and the mean body mass index was 57 +/- 13 kg/m(2). Smoking or asthma was reported in 38% and 24% of patients, respectively. The mean forced vital capacity and forced expiratory volume in 1 s was 80% +/- 17% of predicted and 76% +/- 19% of predicted, respectively. Of the 136 patients, 29% had a measured forced expiratory volume in 1 s/forced vital capacity of >/=.08 below the predicted ratio. The mean total lung capacity was 86% +/- 14% of predicted; 26% of subjects had a total lung capacity <80% of predicted. Multivariate logistic regression analysis demonstrated an association of obstructive ventilatory defects with male gender (odds ratio [OR] 2.35, 95% confidence interval [CI] 1.00-5.50) and current or previous smoking (OR 2.41, 95% CI 1.10-5.30), but not body mass index. Restrictive defects were associated with body mass index (OR 1.06, 95% CI 1.01-1.10), in particular, obesity hypoventilation syndrome (OR 3.7, 95% CI 1.2-11.1). CONCLUSION: The mean preoperative spirometry, lung volumes, and gas exchange values were within the established reference ranges. Restrictive ventilatory defects were less common than obstructive ventilatory patterns and were most prominently associated with obesity hypoventilation syndrome.     

Culture Duration Modulates Collagen Hydrolysate-Induced Tissue Remodeling in Chondrocyte-Seeded Agarose Hydrogels

Media supplementation with collagen hydrolysate was hypothesized to increase the collagen content in engineered cartilage. By d28, hydrolysate at 0.5 mg/mL increased type II collagen content and 1 mg/mL increased mechanical properties, total collagen content, and type II collagen content over controls. By d42, however, controls possessed the highest GAG content and compressive Young’s modulus. Real-time PCR found that 1 mg/mL increased type II collagen gene expression in d0 constructs, but increased MMP expression with no effect on type II collagen on d28. A 10 mg/mL concentration produced the lowest tissue properties, the lowest type II collagen gene expression on d0, and the highest MMP gene expression on d28. These results indicate that the duration of culture modulates the response of chondrocytes to collagen hydrolysate in 3D culture, transforming the response from positive to negative. Therefore, collagen hydrolysate as a media supplement is not a viable long-term method to improve the collagen content of engineered cartilage tissue.