Suchergebnisse

Objective: To determine the population incidence and clinical features of Escherichia coli bacteraemia in Canberra, Australia. Design, setting and participants: Canberra (including the nearby local government areas of Queanbeyan and Yarrowlumla) has a geographically isolated population of about 366 000 people. Its six hospitals also provide tertiary medical services for the surrounding region. Confining our analysis (by residential postcodes) to Canberra residents only, we used microbiology laboratory records and population statistics to calculate the population incidence of E. coli bacteraemia from January 2000 to December 2004. Clinical data were also collected prospectively on episodes occurring within three of the hospitals. Main outcome measures: Population incidence of E. coli bacteraemia; place of acquisition of infection; focus of infection within body; recovery, new morbidity or death at 7 days. Results: During the 5-year period, 515 episodes of E. coli bacteraemia occurred in Canberra residents, an incidence of 28 per 100 000 population per year. The highest rate was in men aged ≥ 80 years (463 per 100 000). Overall, E. coli bacteraemia occurred in equal numbers in males and females, but incidence was higher in males aged < 1 year and ≥ 60 years. Most episodes occurred in people aged ≥ 60 years (316/ 511 [62%]) and most were community-associated (347/511 [68%]). Hall the infections (257/511) had a genitourinary focus and 28% (141/511) a gastrointestinal focus. The 7-day case-fatality rate was 5%. Prostate biopsies and urinary catheters were notable preventable foci of health care-associated bacteraemia. Resistance of isolates to gentamicin (2.1%), ciprofloxacin (1.8%) and cefotaxime (0.4%) was low. Conclusions: E. coli is the most common cause of bacteraemia in Canberra, and incidence increases with age. Most cases have a community onset, but many episodes are related to health care procedures. Ongoing surveillance is important for identifying risk factors that may be modified to reduce disease.

Objective: To determine the population incidence and clinical features of Escherichia coli bacteraemia in Canberra, Australia. Design, setting and participants: Canberra (including the nearby local government areas of Queanbeyan and Yarrowlumla) has a geographically isolated population of about 366 000 people. Its six hospitals also provide tertiary medical services for the surrounding region. Confining our analysis (by residential postcodes) to Canberra residents only, we used microbiology laboratory records and population statistics to calculate the population incidence of E. coli bacteraemia from January 2000 to December 2004. Clinical data were also collected prospectively on episodes occurring within three of the hospitals. Main outcome measures: Population incidence of E. coli bacteraemia; place of acquisition of infection; focus of infection within body; recovery, new morbidity or death at 7 days. Results: During the 5-year period, 515 episodes of E. coli bacteraemia occurred in Canberra residents, an incidence of 28 per 100 000 population per year. The highest rate was in men aged ≥ 80 years (463 per 100 000). Overall, E. coli bacteraemia occurred in equal numbers in males and females, but incidence was higher in males aged < 1 year and ≥ 60 years. Most episodes occurred in people aged ≥ 60 years (316/ 511 [62%]) and most were community-associated (347/511 [68%]). Hall the infections (257/511) had a genitourinary focus and 28% (141/511) a gastrointestinal focus. The 7-day case-fatality rate was 5%. Prostate biopsies and urinary catheters were notable preventable foci of health care-associated bacteraemia. Resistance of isolates to gentamicin (2.1%), ciprofloxacin (1.8%) and cefotaxime (0.4%) was low. Conclusions: E. coli is the most common cause of bacteraemia in Canberra, and incidence increases with age. Most cases have a community onset, but many episodes are related to health care procedures. Ongoing surveillance is important for identifying risk factors that may be modified to reduce disease.

The aim of this paper was to analyze the data obtained from case reports of oral angiolipoma in terms of age and gender distribution, site of occurrence, nature (intraosseous/ extraosseus) and infiltration. an internet search using Google scholar and Pubmed engine was carried out using search terms 'angiolipoma' and 'oral'/'mouth'. English literature full text articles and abstracts of oral angiolipoma obtained from 1976-2016 were analyzed for clinical data and presented in this article.

BACKGROUND : In 2008 a nosocomial outbreak of five cases of viral hemorrhagic fever due to a novel arenavirus, Lujo virus, occurred in Johannesburg, South Africa. Lujo virus is only the second pathogenic arenavirus, after Lassa virus, to be recognized in Africa and the first in over 40 years. Because of the remote, resource-poor, and often politically unstable regions where Lassa fever and other viral hemorrhagic fevers typically occur, there have been few opportunities to undertake in-depth study of their clinical manifestations, transmission dynamics, pathogenesis, or response to treatment options typically available in industrialized countries. METHODS AND FINDINGS : We describe the clinical features of five cases of Lujo hemorrhagic fever and summarize their clinical management, as well as providing additional epidemiologic detail regarding the 2008 outbreak. Illness typically began with the abrupt onset of fever, malaise, headache, and myalgias followed successively by sore throat, chest pain, gastrointestinal symptoms, rash, minor hemorrhage, subconjunctival injection, and neck and facial swelling over the first week of illness. No major hemorrhage was noted. Neurological signs were sometimes seen in the late stages. Shock and multi-organ system failure, often with evidence of disseminated intravascular coagulopathy, ensued in the second week, with death in four of the five cases. Distinctive treatment components of the one surviving patient included rapid commencement of the antiviral drug ribavirin and administration of HMG-CoA reductase inhibitors (statins), N-acetylcysteine, and recombinant factor VIIa. CONCLUSIONS : Lujo virus causes a clinical syndrome remarkably similar to Lassa fever. Considering the high case-fatality and significant logistical impediments to controlled treatment efficacy trials for viral hemorrhagic fever, it is both logical and ethical to explore the use of the various compounds used in the treatment of the surviving case reported here in future outbreaks. Clinical observations ...

Abstract Gastrointestinal problems are common during wars, and they have exerted significant adverse effects on the health of service members involved in warfare. The spectrum of digestive diseases has varied during wars of different eras. At the end of the 20th century, new frontiers of military medical research emerged due to the occurrence of high-tech wars such as the Gulf War and the Kosovo War, in which ground combat was no longer the primary method of field operations. The risk to the military personnel who face trauma has been greatly reduced, but disease and non-battle injuries (DNBIs) such as neuropsychological disorders and digestive diseases seemed to be increased. Data revealed that gastrointestinal symptoms such as constipation, diarrhea, dyspepsia, and noncardiac chest pain are common among military personnel during modern wars. In addition, a large number of deployed soldiers and veterans who participated in recent wars presented with chronic gastrointestinal complaints, which fulfilled with the Rome III criteria for functional gastrointestinal disorders (FGIDs). It was also noted that many veterans who returned from the Gulf War suffered not only from chronic digestive symptoms but also from neuropsychological dysfunction; however, they also showed symptoms of other systems. Presently, this broad range of unexplained symptoms is known as "Gulf War syndrome". The mechanism that underlies Gulf War syndrome remains unclear, but many factors have been associated with this syndrome such as war trauma, stress, infections, immune dysfunction, radiological factors, anthrax vaccination and so on. Some have questioned if the diagnosis of FGIDs can be reached given the complexity of the military situation. As a result, further studies are needed to elucidate the pathogenesis of gastrointestinal disease among military personnel.

In the present review, the main objective was to describe the epidemiology and clinical features of ciguatera fish poisoning in Hong Kong. From 1989 to 2008, the annual incidence of ciguatera varied between 3.3 and 64.9 (median 10.2) per million people. The groupers have replaced the snappers as the most important cause of ciguatera. Pacific-ciguatoxins (CTX) are most commonly present in reef fish samples implicated in ciguatera outbreaks. In affected subjects, the gastrointestinal symptoms often subside within days, whereas the neurological symptoms can persist for weeks or even months. Bradycardia and hypotension, which can be life-threatening, are common. Treatment of ciguatera is primarily supportive and symptomatic. Intravenous mannitol (1 g/kg) has also been suggested. To prevent ciguatera outbreaks, the public should be educated to avoid eating large coral reef fishes, especially the CTX-rich parts. A Code of Practice on Import and Sale of Live Marine Fish for Human Consumption for Prevention and Control of Ciguatera Fish Poisoning was introduced from 2004 to 2013. The Food Safety Ordinance with a tracing mechanism came into full effect in February 2012. The Government would be able to trace the sources of the fishes more effectively and take prompt action when dealing with ciguatera incidents.

In the present review, the main objective was to describe the epidemiology and clinical features of ciguatera fish poisoning in Hong Kong. From 1989 to 2008, the annual incidence of ciguatera varied between 3.3 and 64.9 (median 10.2) per million people. The groupers have replaced the snappers as the most important cause of ciguatera. Pacific-ciguatoxins (CTX) are most commonly present in reef fish samples implicated in ciguatera outbreaks. In affected subjects, the gastrointestinal symptoms often subside within days, whereas the neurological symptoms can persist for weeks or even months. Bradycardia and hypotension, which can be life-threatening, are common. Treatment of ciguatera is primarily supportive and symptomatic. Intravenous mannitol (1 g/kg) has also been suggested. To prevent ciguatera outbreaks, the public should be educated to avoid eating large coral reef fishes, especially the CTX-rich parts. A Code of Practice on Import and Sale of Live Marine Fish for Human Consumption for Prevention and Control of Ciguatera Fish Poisoning was introduced from 2004 to 2013. The Food Safety Ordinance with a tracing mechanism came into full effect in February 2012. The Government would be able to trace the sources of the fishes more effectively and take prompt action when dealing with ciguatera incidents.

Children with chronic diseases Chronic viral hepatitis Among human hepatitis viruses, hepatitis B (HBV) and C (HCV) viruses are able to persist in the host for years and thereby causing chronic hepatitis. Three hundred and seventy and 130 million people is estimated to be infected with HBV and HCV, respectively, worldwide (1). In endemic areas, HBV infection is often acquired perinatally or early in childhood and becomes chronic in a high proportion of cases. Universal vaccination of newborns has been effective in reducing the spread of infection. However, hepatitis B is still a social and health problem in underdeveloped areas where immunisation policies are unavailable, and even in developed countries, where the reservoir of infection is maintained by immigration and adoption. In some endemic areas children with chronic hepatitis B are also at risk for superinfection with the hepatitis delta virus (HDV), which worsens the prognosis of liver disease. HCV is not a less important problem. The prevalence of circulating anti-HCV antibodies in the pediatric population averaged 0.3% in Italy in the early 1990s (2), but a national observational study suggest that the number of "new" pediatric infections dropped by approximately 40% in 2000-2004 compared with the previous 5 years (3). The lower prevalence of HCV in children reflects the disappearance of transfusion-related hepatitis and the reduced efficiency of mother-to-child (vertical or perinatal) transmission, although the latter form of transmission is currently responsible for most "new" infections in the developed world and contributes to maintaining the reservoir of infection worldwide (4-7). This favourable epidemiologic trend is balanced, however, by the strong tendency of HCV infection acquired early in life (either perinatally or following blood transfusions) to become chronic (8-14). In the absence of a specific vaccination, HCV infection remains a major global health problem and HCV-related end-stage liver disease is still the most frequent indication for liver transplantation in adult patients. Chronic viral hepatitis acquired in childhood is a long-lasting process based on host-virus interaction, which may change over the years. A number of factors related to the virus (genotype, therapy), to the host (hormonal status, immunocompetence, therapy) and to the environment (alcohol, drugs, co-infections) affects the natural history of the disease, especially during adolescence and early adulthood. Strategies to improve the prevention and treatment of HBV and HCV infection, and the related liver disease in children, before the possible development of irreversible complications, should be investigated and implemented. HIV infection Countries most heavily affected, HIV has reduced life expectancy by more than 20 years, hampered economic growth, and deepened household poverty (UNAIDS. Data from: www.unaids.org/en/KnowledgeCentre/HIVData/GlobalReport/2008/2008_Global_report.asp). Mother-to-child transmission (MTCT) is the main source of pediatric HIV-1 infection. MTCT of HIV-1 mainly occurs around the time of delivery, but breastfeeding is an additional route of viral transmission and accounts for about one-third of pediatric infections in resource-poor Countries (15). In the absence of antiretroviral therapy, about 30% of women transmit the virus to their infants. The estimated number of perinatally acquired AIDS cases in the United States peaked at 945 in 1992 and declined rapidly with expanding prenatal testing and implementation of appropriate preventive interventions (16). At the end of 2007, there were 2 million children living with HIV around the world, an estimated 370,000 children became newly infected with HIV in 2007, and, of the 2 millions people who died of AIDS during 2007, more than one in seven were children. Every hour, around 31 children die as a result of AIDS. HIV can affects a child's life through its effects directly on the child, on that child's family, and on the community within the child is growing up: - Many children are themselves infected with HIV - Children live with family members who are infected with HIV - Children act as carers for sick parents who have AIDS - Many children have lost one or both parents to AIDS, and are orphaned - An increasing number of households are headed by children, as AIDS erodes traditional community support systems - Children end up being their family's principal wage earners, as AIDS prevents adults from working, and creates expensive medical bills - As AIDS ravages a community, schools lose teachers and children are unable to access education - Doctors and nurses die, and children find it difficult to gain care for childhood diseases - Children may lose their friends to AIDS - Children who have HIV in their family may be stigmatized and affected by discrimination In the last 10 years, dramatic advances in medical management of HIV infection have followed the results of clinical trials of antiretroviral combination therapies in children. The use of antiretroviral therapy during pregnancy in HIV-infected women has resulted in a dramatic decrease in the transmission rate to infants, which is currently less than 2% in most high-income Countries (17). In parallel, the introduction of highly active antiretroviral therapy (HAART) has changed the natural history of HIV-1 infection and the life expectancy of HIV-1-infected adults (18,19) and children (20-26). Although in developed Countries children living with HIV infection are expected to live a long life, they still need to face major emotional burden, social stigma and global exclusion from the social contest (27). Being a child or an adolescent with HIV implies major problems in terms of management of multiple drugs, adherence to antiretroviral therapy, drug resistance, quality of life, frequency at school and social interactions with peers (28). Immunization in at risk children Vaccinations programs are one of the greatest public health interventions of the last century and have dramatically improved quality of life (29). Benefits of vaccination to the individual include partial or complete protection against infections and symptoms of illness, improved quality of life, and prevention of up to 3 million pediatric deaths per year worldwide (29,30). Benefits of a universal vaccination program to society include creation and maintenance of herd immunity, prevention of disease outbreaks, and reduced health care costs (30). Despite the availability of safe and effective vaccines and substantial progresses in reducing vaccine-preventable diseases, delivery to and acceptance of vaccinations by targeted populations are essential to further reducing and eliminating vaccine-preventable causes of morbidity and mortality (31). Children who are not vaccinated endanger public health representing a risk for other nonimmunized individuals, including subjects who cannot be immunized due to underlying health problems, and the small percentage of individuals in whom vaccination does not confer protection (29). They also contribute to increase health care costs (29). Access to immunizations, prevalence of vaccine-preventable diseases, and vaccination rates varies by geographic area or country. Throughout the United States and European Countries, immunization rates of children and adults are rising, but coverage levels have not reached established goals (32). As a result of low immunization rates, vaccine-preventable diseases still occur as evidenced by the measles epidemic, the large number of annual cases of varicella, pertussis, and hepatitis B, and the more than 50,000 annual deaths in adults from influenza or pneumococcal infections (33-36). In an attempt to eliminate the risk of outbreaks of some diseases, governments and other institutions have instituted policies requiring vaccination for all people (compulsory vaccinations). For example, actual vaccination policies in most developed Counties require that children receive common vaccinations before entering school. In addition to compulsory vaccines, certain populations should receive additional vaccinations. Subjects with chronic medical conditions are at increased risk for severe complications related to vaccine-preventable infections, such as influenza and pneumococcal infections (34,37). In Italy, compulsory vaccines are generally administered in vaccination centers and complementary vaccinations are actively offered to children with chronic conditions and are included in the Essential Levels of Care (38). Despite long-standing recommendations to provide recommended vaccinations to children with chronic medical conditions, immunisation rates in these vulnerable populations remain poor (39). Several conditions hamper implementation of these vaccinations, including problems in identifying at risk children, ineffective organizational strategies and lack of awareness of disease severity or poor confidence by parents in specific recommendations (40,41). Often, the presence of a chronic condition is erroneously considered a contraindication rather than an indication to vaccination. It is important to ensure that patients comply with the vaccination schedule to the extent possible, and to provide education to parents who may have concerns about pediatric vaccinations. Goals of the thesis In this PhD thesis, the organization and management of pediatric infectious diseases, with a perspective of public health, are investigated. Specific chronic diseases, as chronic viral hepatitis and HIV infection, have been selected as models to investigate the main aspects of prevention, management and treatment. The goal is to investigate the efficiency of organization and propose interventions with specific reference to treatment of infectious diseases, their direct and indirect results and how these conditions affect quality of life of at risk children and their families. The final goal of this research is to provide strategies to optimize public health system.