Chikungunya virus, Cameroon, 2006

We report the isolation of chikungunya virus from a patient during an outbreak of a denguelike syndrome in Cameroon in 2006. The virus was phylogenetically grouped in the Democratic Republic of the Congo cluster, indicating a continuous circulation of a genetically similar chikungunya virus population during 6 years in Central Africa.     

Thrombosis in one coronary artery causes generalized coronary vasoconstriction in a dog model of unstable angina

We investigated the effect of thrombosis in one coronary artery upon the vascular resistance of another coronary artery. In previous investigations, using an animal model of unstable angina, we have observed increased resistance downstream from thrombus within a left circumflex coronary artery (LCx) stenosis and vasoconstriction of collateral vessels from the left anterior descending artery (LAD) supplying the distal LCx vascular bed. In the present paper, we induced thrombosis within a stenosis of the LCx of 16 beagle dogs, and observed the changes in blood flow to the myocardium supplied by the LAD using the radioactive microsphere technique. This blood flow decreased with thrombosis (P = 0.005) in these animals, whereas it did not do so in three time-control experiments. The pressures across the coronary vascular bed, i.e. arterial pressure to coronary venous pressure (coronary sinus catheter), did not change. Thus the vascular resistance of the LAD bed increased significantly from 147 +/- ll.5 mmHg/ml/sec/g of tissue to 172 +/- 13.4 mmHg/ml/sec/g of tissue (P = 0.02). As the LAD territory is not perfused with blood from the artery containing thrombus, we conclude that the effect observed is caused either by release of vasoconstrictors from the thrombus into the general circulation, or by activation of a neural reflex vasoconstriction. The study suggests that unstable angina involving thrombosis in one coronary artery is a global coronary vascular disease.     

Colonoscopy screening rates among patients of colonoscopy-trained African American primary care physicians

BACKGROUND:

When performed competently, colonoscopy screening can reduce colorectal cancer rates, especially in high‐risk groups such as African Americans. Training primary care physicians (PCPs) to perform colonoscopy may improve screening rates among underserved high‐risk populations.

METHODS:

The authors compared colonoscopy screening rates and computed adjusted odds ratios for colonoscopy‐eligible patients of trained African American PCPs (study group) versus untrained PCPs (comparison group), before and after initiating colonoscopy training. All colonoscopies were performed at a licensed ambulatory surgery center with specialist standby support. Retrospective chart review was conducted on 200 consecutive, established outpatients aged ≥50 years at each of 12 PCP offices (7 trained African American PCPs and 5 untrained PCPs, practicing in the same geographic region). There were a total of 1244 study group and 923 comparison group patients.

RESULTS:

Post‐training colonoscopy rates in both groups were higher than pretraining rates: 48.3% versus 9.3% in the study group, 29.6% versus 9.8% in the comparison group (both P < .001). African American patients in the study group showed a >5‐fold increase (8.9% pretraining vs 52.8% post‐training), with no change among whites (18.2% vs 25.0%). Corresponding pretraining and post‐training rates among comparison patients were 10.4%% and 38.7%, respectively, among African Americans (P < .001), and 13.3% versus 13.2%, respectively, among whites. After adjusting for demographics, duration since becoming the PCP's patient, and health insurance, the study group had a 66% higher likelihood of colonoscopy in the post‐training period (odds ratio, 1.66; 95% confidence interval, 1.30‐2.13), and African Americans had a 5‐fold increased likelihood of colonoscopy relative to whites.

CONCLUSIONS:

Colonoscopy‐trained PCPs may help reduce colorectal cancer disparities. Cancer 2011;. © 2011 American Cancer Society.     

Severe Hypothyroidism From Iodine Deficiency Associated With Parenteral Nutrition

Parenteral nutrition is crucial for supply of nutrients in children who cannot tolerate a full enteral diet. In the United States, it is not standard of care to give iodine to children dependent on parenteral nutrition, hence iodine is not routinely included in the micronutrient package. Herein, we present a case of a boy with hypothyroidism secondary to iodine deficiency after prolonged exclusive use of parenteral nutrition. Our case highlights the importance of screening for iodine deficiency and administering timely iodine supplementation in these at‐risk children to prevent iatrogenic hypothyroidism.     

Chronic Catecholamine Depletion Switches Myocardium from Carbohydrate to Lipid Utilisation

Purpose: Chronic cardiac transplantation denervation (i.e., global sympathetic denervation with myocardial catecholamine depletion, plus parasympathetic denervation) is known to inhibit myocardial oxidation of glucose. It is not known whether this is due to increased utilization of lactate, lipid or ketone bodies. The purpose of the present study was to test the hypothesis that the extraction and contribution of blood-borne fatty acids (FA) to overall oxidative energy conversion is increased. Methods: In anaesthetised dogs (control n = 6, cardiac denervated n = 6), we investigated fatty acid (FA) utilization. The studies were made at least four weeks after surgical cardiac denervation. Measurements were made of total FAs and with a radio-labelled tracer (U-¹⁴C palmitate). Results: The contribution of FA utilisation to overall substrate oxidation rose from 31% (control) to 48% (cardiac denervated). The increase in the ratio (%) of CO₂ production from palmitate oxidation to total CO₂ production increased from 4.0 ± 1.8 (control) to 10.6 ± 5.8 (denervated, p = 0.04). The time from uptake of FA to release of CO₂ product was unaltered. Conclusion: We conclude that the contribution of FA oxidation to overall energy conversion is increased in chronically denervated hearts, which is postulated to result from a decline in the active form of pyruvate dehydrogenase. This would appear to be a result of chronic catecholamine depletion.     

Facilitators and Barriers to Community Acceptance of Safe,Dignified Medical Burials in the Context of an Ebola Epidemic,Sierra Leone, 2014

Sierra Leone was heavily affected by the Ebola epidemic, with over 14,000 total cases. Given that corpses of people who have died from Ebola are highly infectious and given the extremely high risk of Ebola transmission associated with direct contact with bodies of people who have died of Ebola, community acceptance of safe, dignified medical burials was one of the important components of efforts to stop the Ebola epidemic in Sierra Leone. Information on barriers and facilitators for community acceptance of safe, dignified medical burials is limited. A rapid qualitative assessment using focus group discussions (FGDs) explored community knowledge, attitudes, and practices towards safe and dignified burials in seven chiefdoms in Bo District, Sierra Leone. In total, 63 FGDs were conducted among three groups: women >25 years of age, men >25 years of age, and young adults 19–25 years of age. In addition to concerns about breaking cultural traditions, barriers to safe burial acceptance included concerns by family members about being able to view the burial, perceptions that bodies were improperly handled, and fear that stigma may occur if a family member receives a safe, dignified medical burial. Participants suggested that providing opportunities for community members to participate in safe and dignified burials would improve community acceptance.     

Measurement of coronary collateral flow and resistance in the presence of an open critical stenosis, and the response to intra-arterial thrombosis

OBJECTIVE: (1) Can one measure coronary collateral flow around an open critical stenosis? (2) Does intracoronary platelet thrombosis affect native coronary collateral vessels? METHODS: We measured regional myocardial blood flow by the radioactive microsphere technique in seven anaesthetised dogs with an ultrasonic flowmeter on the circumflex branch of the left coronary artery (LCx). Measurements were made (a) in a control period, (b) after induction of a tight stenosis on the LCx, and (c) after additional arterial damage at the stenosis to induce intraluminal thrombosis. Collateral flow was calculated from LCx tissue flow(in ml/min/g tissue) minus LCx flowmeter flow which is in ml/min. Therefore, it was necessary to use scaling by reference back to the control measurements and conversion to ml/min/g tissue equivalent. RESULTS: LCx stenosis induced collateral flow from the other coronary arteries into the LCx area of supply, which decreased (mean+/-S.E.) from 0.23+/-0.03 to 0.15+/-0.05 ml/min/g tissue with thrombosis. Collateral resistance correspondingly increased with thrombosis from 187.6+/-18. 2 to 1069+/-544 mmHg/ml/min/g (P<0.02). CONCLUSION: Coronary collateral flow around an open stenosis can be measured by reference back to control conditions. The coronary collaterals vasoconstrict in the presence of thrombosis even though they are in the stream of blood coming from normal coronary arteries.     

Prevalence of War-Related Sexual Violence and Other Human Rights Abuses Among Internally Displaced Persons in Sierra Leone

Lynn L. Amowitz, MD,MSPH,MSc; Chen Reis, JD,MPH; Kristina Hare Lyons, MALD; Beth Vann, MSW; Binta Mansaray, MA; Adyinka M. Akinsulure-Smith, PhD; Louise Taylor, MBA,LLM; Vincent Iacopino, MD,PhD

JAMA. 2002;287:513-521.

Context  Sierra Leone's decade-long conflict has cost tens of thousands of lives and all parties to the conflict have committed abuses.

Objective  To assess the prevalence and impact of war-related sexual violence and other human rights abuses among internally displaced persons (IDPs) in Sierra Leone.

Design and Setting  A cross-sectional, randomized survey, using structured interviews and questionnaires, of internally displaced Sierra Leone women who were living in 3 IDP camps and 1 town, which were conducted over a 4-week period in 2001.

Participants  A total of 991 women provided information on 9166 household members. The mean (SE) age of the respondents was 34 (0.48) years (range, 14-80 years). The majority of the women sampled were poorly educated (mean [SE], 1.9 [0.11] years of formal education); 814 were Muslim (82%), and 622 were married (63%).

Main Outcome Measures  Accounts of war-related sexual assault and other human rights abuses.

Results  Overall, 13% (1157) of household members reported incidents of war-related human rights abuses in the last 10 years, including abductions, beatings, killings, sexual assaults and other abuses. Ninety-four (9%) of 991 respondents and 396 (8%) of 5001 female household members reported war-related sexual assaults. The lifetime prevalence of non–war-related sexual assault committed by family members, friends, or civilians among these respondents was also 9%, which increased to 17% with the addition of war-related sexual assaults (excluding 1% of participants who reported both war-related and non–war-related sexual assault). Eighty-seven percent of women believed that there should be legal protection for women's human rights. More than 60% of respondents believed a man has a right to beat his wife if she disobeys, and that it is a wife's duty/obligation to have sex with her husband even if she does not want to.

Conclusions  Sexual violence committed by combatants in Sierra Leone was widespread and was perpetrated in the context of a high level of human rights abuses against the civilian population.