Background:

Despite remarkable progression toward polio eradication worldwide, wild poliovirus (WPV) importation has been a great challenge for China, as it shares borders with WPV-endemic countries. The objective of this study was to estimate poliovirus antibody seroprevalance among children < 15 years of age in 3 border provinces (Yunnan Province, Tibet Autonomous Region and Xinjiang Uygur Autonomous Region) in China.

Methods:

A cross-sectional, hospital-based study was undertaken in 3 border provinces in 2010. Subjects, aged <15 years old who visited hospitals at prefecture level or above to have their blood drawn for any reason, were invited to participate in our study. Neutralizing antibody titers to polio serotypes 1 (P1), 2 (P2) and 3 (P3) were assayed according to World Health Organization manual for the virological investigation of polio. Antibody titers ≥ 8 were considered positive.

Results:

Among the 1,360 subjects enrolled, 1,220 (89.7%), 1,259 (92.6%), and 1,112 (81.8%) were seropositive to P1, P2 and P3 respectively, and 1,051 (77.3%) subjects were seropositive to all the three serotypes. The highest seropositive rates were observed in Xinjiang Uygur Autonomous Region. By age, 3 - 5 year olds had the highest rate of seroposivity, and seropositivity decreased significantly with increasing age.

Conclusion:

The risk of WPV importation will continue until WPV transmission has been interrupted worldwide. Consistent with the Global Polio Eradication Initiative's polio endgame strategy, China must maintain its polio--free status by ensuring adequate population immunity against polio. Because immunity wanes with increasing age, a booster dose with bivalent types 1 and 2 oral poliovirus vaccine could be considered for teenagers in China.

Abstract Urban and rural areas have distinctive health problems, which require consideration. To examine sociocultural features of cholera and its community context, a semi-structured explanatory model interview based on vignettes depicting typical clinical features of cholera was used to interview 379 urban and rural respondents in Western Kenya. Findings included common and distinctive urban and rural ideas about cholera, and its prevention and treatment. The three most commonly perceived causes among urban and rural respondents collectively were drinking contaminated water, living in a dirty environment and lacking latrines. However, a dirty environment and flies were more prominently perceived causes among urban respondents. Rural respondents were less likely to identify additional symptoms and more likely to identify biomedically irrelevant perceived causes of cholera. Oral rehydration therapy was the most frequently reported home treatment. Health facilities were recommended unanimously at both sites. For prevention, rural respondents were more likely to suggest medicines, and urban respondents were more likely to suggest health education and clean food. Findings indicate community priority, demand for and potential effectiveness of enhanced efforts to control cholera in Western Kenya, and they suggest strategies that are particularly well suited for control of cholera in urban and rural areas.

Chepang communities are one of the most deprived ethnic communities in Nepal. According to the National Pathfinder Survey, dental caries is a highly prevalent childhood disease in Nepal. There is no data concerning the prevalence of caries along with knowledge, attitude and oral hygiene practices among Chepang schoolchildren. The objectives of this study were to 1) record the prevalence of dental caries 2) report experience of dental pain 3) evaluate knowledge, attitude and preventive practices on oral health of primary Chepang schoolchildren.A cross sectional epidemiological study was conducted in 5 government Primary schools of remote Chandibhanjyang Village Development Committee (VDC) in Chitwan district. Ethical approval was taken from the Institutional Review Board within the Research Department of the Institute of Medicine (IOM) Tribhuvan University. Consent was obtained from parents for conducting clinical examination and administrating questionnaire. Permission was taken from the school principal in all schools. Data was collected using a pretested questionnaire on 131 schoolchildren aged 8-16-year- olds attending Grade 3-5. Clinical examination was conducted on 361 school children aged 5-16 -year-olds attending grade 1-5. Criteria set by the World Health Organization (1997) was used for caries diagnosis. The questionnaires, originally constructed in English and translated into Nepali were administered to the schoolchildren by the researchers. SPSS 11software was used for data analysis.Caries prevalence for 5-6 -year-old was above the goals recommended by WHO and Federation of Dentistry international (FDI) of less than 50% caries free children. Caries prevalence in 5-6-year-olds was 52% and 12-13-year-olds was 41%. The mean dmft/DMFT score of 5-6 -year-olds and 12 -13-year -olds was 1.59, 0.31 and 0.52, 0.84 respectively. The DMFT scores increased with age and the d/D component constituted almost the entire dmft/DMFT index. About 31% of 8-16-year-olds school children who participated in the survey reported having suffered from oral pain. Further, the need for treatment of decayed teeth was reported at 100%. About 76% children perceived teeth as an important component of general health and 75% reported it was required to eat. A total 93% children never visited a dentist or a health care service. Out of 56% children reporting cleaning their teeth daily, only 24% reported brushing their teeth twice daily. About 86% of the children reported using toothbrush and toothpaste to clean their teeth. Although 61% children reported to have received oral health education, 82% children did not know about fluoride and its benefit on dental health. About 50% children reported bacteria as the main cause of tooth decay and 23% as not brushing teeth for gingivitis. Frequency of sugar exposure was low; 75% of children reported eating sugar rich food once daily.Caries prevalence of 5-6 -year- old Chepang school children is above the recommended target set by FDI/WHO. The study reported 31% schoolchildren aged 8-16-year old suffered oral pain and decayed component constituted almost the entire dmft/DMFT index. The brushing habit was reportedly low with only 24% of the children brushing twice daily. A nationwide scientifically proven, cost effective school based interventions is needed for prevention and control of caries in schoolchildren in Nepal.

Oral anticoagulants block the coagulation cascade either by an indirect mechanism (eg. vitamin K antagonists, VKAs) or by a direct one (eg. the novel oral anticoagulants, NOACs). VKAs are widely used as treatment of venous thromboembolism (VTE) and for stroke prevention in atrial fibrillation (AF) patients. Although low molecular weight heparin remains the first-line in VTE prophylaxis, more recently the novel oral anticoagulants such as dabigatran (initial dose of 110mg within 1-4 hours after surgery, followed by the full dose of 220mg once daily), rivaroxaban (dose of 10mg once daily, with the first dose administered 6-10 hours after the surgery) and apixaban (dose of 2.5mg twice daily, starting 12-24 hours after surgery, but available only in Europe) are approved for prophylaxis in patients undergoing major orthopaedic surgery. The period on which thromboembolic risk abates remains uncertain and trials on extended therapy are still ongoing. After showing at least non-inferiority to warfarin in RE-LY, ROCKET-AF and ARISTOTLE trials, dabigatran (110 or 150mg twice daily), rivaroxaban (20 or 15mg once daily) and apixaban (5mg twice daily) respectively were approved also for stroke prevention in AF patients. Whilst awaiting long-term safety data, the choice between all these available therapies should be based on patient preferences, compliance and ease of administration, as well as on local factors affecting cost-effectiveness.

PURPOSETo provide recommendations about prophylaxis and treatment of venous thromboembolism (VTE) in patients with cancer. Prophylaxis in the outpatient, inpatient, and perioperative settings was considered, as were treatment and use of anticoagulation as a cancer-directed therapy.

METHODS

A systematic review of the literature published from December 2007 to December 2012 was completed in MEDLINE and the Cochrane Collaboration Library. An Update Committee reviewed evidence to determine which recommendations required revision.ResultsForty-two publications met eligibility criteria, including 16 systematic reviews and 24 randomized controlled trials.RecommendationsMost hospitalized patients with cancer require thromboprophylaxis throughout hospitalization. Thromboprophylaxis is not routinely recommended for outpatients with cancer. It may be considered for selected high-risk patients. Patients with multiple myeloma receiving antiangiogenesis agents with chemotherapy and/or dexamethasone should receive prophylaxis with either low-molecular weight heparin (LMWH) or low-dose aspirin. Patients undergoing major cancer surgery should receive prophylaxis, starting before surgery and continuing for at least 7 to 10 days. Extending prophylaxis up to 4 weeks should be considered in those with high-risk features. LMWH is recommended for the initial 5 to 10 days of treatment for deep vein thrombosis and pulmonary embolism as well as for long-term (6 months) secondary prophylaxis. Use of novel oral anticoagulants is not currently recommended for patients with malignancy and VTE. Anticoagulation should not be used for cancer treatment in the absence of other indications. Patients with cancer should be periodically assessed for VTE risk. Oncology professionals should provide patient education about the signs and symptoms of VTE.

Abstract

Background:

Inhaled cyclosporine (CsA) is being investigated as a prophylaxis for lung transplant rejection. Lung deposition and systemic exposure of nebulized CsA in lung transplant patients was evaluated as part of the Phase 3 cyclosporine inhalation solution (CIS) trial (CYCLIST).

Methods:

Ten patients received 300 mg of CIS (62.5 mg/mL CsA in propylene glycol) admixed with 148 MBq of Tc-DTPA (technetium-99m bound to diethylenetriaminepentaacetic acid) administered using a Sidestream(®) disposable jet nebulizer. Deposition was assessed using a dual-headed gamma camera. Blood samples were collected over a 24-hr time period after aerosol dosing and analyzed for CsA levels. A pharmacokinetic analysis of the resulting blood concentration versus time profiles was performed.

Results:

The average total deposited dose was 53.7±12.7 mg. Average pulmonary dose was 31.8±16.3 mg, and stomach dose averaged 15.5±11.1 mg. Device performance was consistent, with breathing maneuvers influencing dose variation. Predose coaching with five of 10 patients reduced stomach deposition (22.6±11.2 vs. 8.3±5.2 mg; p=0.03). Blood concentrations declined quickly from a maximum of 372±140 ng/mL to 15.3±9.7 ng/mL at 24 hr post dose. Levels of AUC(0-24) [area under the concentration vs. time curve from 0 to 24 hr] averaged 1,493±746 ng hr/mL. On a three times per week dose regimen, this represents <5% of the weekly systemic exposure of twice per day oral administration.

Conclusions:

Substantial doses of CsA can be delivered to the lungs of lung transplant patients by inhaled aerosol. Systemic levels are small relative to typical oral CsA administration.

To study the status quo of oral professional and technical personnel of Guyuan city, Ningxia.In consultation with Administrative Department of Public Health, all oral health institutions by age, gender, education, professional, and department in four counties (Longde, Jingyuan, Pengyang and Xiji) and Yuanzhou district in Guyuan City were investigated. The distribution, basic information, professional branch, ratio with the amount of health system medical staff and population were analyzed.All comprehensive hospital at the county level and above set up department of stomatology. Center for Disease Control and Prevention, health inspection bureau, maternity and child health care bureau and 78.46% town health center didn't set up department of stomatology. Oral professional and technical personnel of Guyuan city in number was 115 and mainly young doctors, men were more than women. On education, the tertiary education was mostly received. On professional title, number of middle and senior professional title was relatively small. On profession, multi-disciplinary was common. The ratio of oral professional to general medical staff were 1:30, to local population was 1:13 thousands.The education and professional title of oral professional and technical personnel should be improved. It is recommended that comprehensive hospitals above the county level should branch in Stomatology, Center for Disease Control and Prevention, health inspection bureau, maternity and child health care bureau and town health center should offer services of stomatology, at least provide one dental professional and technical personnel in each place.

Background:

Fungal peritonitis (FP) is rare, but it is associated with high morbidity and mortality.
Patients and

Methods:

A prospective study was conducted based on the peritonitis episodes registry to evaluate FP rate, possible risk factors, and outcomes. The impact of prophylactic intervention with oral fluconazole was evaluated.


Results:

Over 24 years of experience, 417 patients underwent peritoneal dialysis (PD), followed for 956 patient-years. By the end of the study, the peritonitis rate reached 0.47 episodes per patient-year of treatment (ep/pt-y). FP was detected in 24 patients. The global rate of FP was 0.03 ep/pt-y (4.8%). Candida species accounted for 92% of the FP. Risk factors identified: recent use of antibiotics in 63% (13 episodes of bacterial peritonitis and 2 exit-site infections (ESI)) and immunosuppressive therapy in 8%. While rare, the FP proportion was still observed to increase from the beginning of the program, reaching 7.8% (0.05 ep/pt-y). A strategy of antifungal prophylaxis with oral fluconazole during peritonitis or ESI antibiotic therapy was adopted, which allowed thereafter a 4.0% falling FP proportion (by study end, rate of 0.01 ep/pt-y). Catheter removal occurred in all patients. The mortality rate was 12.5%. Reinsertion of dialysis catheter was attempted in 4 patients and PD was successfully resumed in 3 patients.


Conclusions:

FP was associated with high mortality and required early removal of the catheter in all patients. Recent use of antibiotics was a predisposing factor to PF. The quality control process determined a prophylactic strategy and reduction of PF after introduction of oral fluconazole was implemented.

Background Solanum nigrum fruit is traditionally used in Asia to manage, control, and treat diabetes but there is no scientific evidence of the efficacy of Solanum nigrum fruit in treatment of diabetes. We designed this study to investigate the effect of the administration of oral doses of aqueous extract from Solanum nigrum fruit on plasma glucose, lipid profiles, and the sensitivity of the vascular mesenteric bed to Phenylephrine in diabetic and non-diabetic rats. Material and Methods Animals were divided into 5 groups (n=10): 2 groups served as non-diabetic controls (NDC), and the other groups had diabetes induced with a single injection of streptozotocin (STZ). Solanum nigrum-treated chronic diabetic (CD-SNE) and Solanum nigrum-treated controls (ND-SNE) received 1g/l of Solanum nigrum added to drinking water for 8 weeks. The mesenteric vascular beds were prepared using the McGregor method. Results Administration of Solanum nigrum caused Ca/Mg ratio, plasma glucose, high-density lipoprotein (HDL), low-density lipoprotein (LDL), very low-density lipoprotein (VLDL), total cholesterol, and triglyceride concentrations to return to normal levels, and was shown to decrease alteration in vascular reactivity to vasoconstrictor agents. Conclusions Our results support the hypothesis that Solanum nigrum could play a role in the management of diabetes and the prevention of vascular complications in STZ-induced diabetic rats.

Inhalation exposure of outbred female white rats (initial age about 4 months) to formaldehyde vapours (12.8±0.69mg/m(3)) 4hrs per day, 5 days per week during 10 weeks induced statistically significant changes in some indices characterizing differential WBC count, functional status of the central nervous system and liver, redox and porphyrin metabolisms, bone marrow micronuclei count as well as free amino acid spectrum of the blood serum. The development of intoxication was accompanied by increased urinary excretion of formaldehyde, formic acid and methanol. Daily oral administration of glutamate (150-180mg), glycine (12mg) and methionine (50mg) in combination rendered all of the formaldehyde's toxic effects reduced. This administration also caused a significant increase in the ratio between the rates of excretion of formic acid and non-metabolized formaldehyde. This shift supposedly reflects activation of oxidative detoxifying biotransformation of formaldehyde. Taking into consideration that the combination of amino acids used in this study proved innocuous in protectively effective doses, the administration in this combination may be recommended to humans exposed to high levels of formaldehyde in workplace or ambient air.