Podcasts about methods cases

Background: Malaria has been shown to change blood counts. Recently, a few studies have investigated the alteration of the peripheral blood monocyte-to-lymphocyte count ratio (MLCR) and the neutrophil-to-lymphocyte count ratio (NLCR) during infection with Plasmodium falciparum. Based on these findings this study investigates the predictive values of blood count alterations during malaria across different sub-populations. Methods: Cases and controls admitted to the Department of Infectious Diseases and Tropical Medicine from January 2000 through December 2010 were included in this comparative analysis. Blood count values and other variables at admission controlled for age, gender and immune status were statistically investigated. Results: The study population comprised 210 malaria patients, infected with P. falciparum (68%), Plasmodium vivax (21%), Plasmodium ovale (7%) and Plasmodium malariae (4%), and 210 controls. A positive correlation of parasite density with NLCR and neutrophil counts, and a negative correlation of parasite density with thrombocyte, leucocyte and lymphocyte counts were found. An interaction with semi-immunity was observed; ratios were significantly different in semi-immune compared to non-immune patients (P

Background: Artisanal small-scale gold mining (ASGM) is a poverty-driven activity practiced in over 70 countries worldwide. Zimbabwe is amongst the top ten countries using large quantities of mercury to extract gold from ore. This analysis was performed to check data availability and derive a preliminary estimate of disability-adjusted life years (DALYs) due to mercury use in ASGM in Zimbabwe. Methods: Cases of chronic mercury intoxication were identified following an algorithm using mercury-related health effects and mercury in human specimens. The sample prevalence amongst miners and controls (surveyed by the United Nations Industrial Development Organization in 2004 and the University of Munich in 2006) was determined and extrapolated to the entire population of Zimbabwe. Further epidemiological and demographic data were taken from the literature and missing data modeled with DisMod II to quantify DALYs using the methods from the Global Burden of Disease (GBD) 2004 update published by the World Health Organization (WHO). While there was no disability weight (DW) available indicating the relative disease severity of chronic mercury intoxication, the DW of a comparable disease was assigned by following the criteria 1) chronic condition, 2) triggered by a substance, and 3) causing similar health symptoms. Results: Miners showed a sample prevalence of 72% while controls showed no cases of chronic mercury intoxication. Data availability is very limited why it was necessary to model data and make assumptions about the number of exposed population, the definition of chronic mercury intoxication, DW, and epidemiology. If these assumptions hold, the extrapolation would result in around 95,400 DALYs in Zimbabwe's total population in 2004. Conclusions: This analysis provides a preliminary quantification of the mercury-related health burden from ASGM based on the limited data available. If the determined assumptions hold, chronic mercury intoxication is likely to have been one of the top 20 hazards for population health in Zimbabwe in 2004 when comparing with more than 130 categories of diseases and injuries quantified in the WHO's GBD 2004 update. Improving data quality would allow more accurate estimates. However, the results highlight the need to reduce a burden which could be entirely avoided.

Objective: Rotavirus (RV) gastroenteritis is a notifiable disease in Germany. The reports to the authorities contain few data concerning the severity of disease. The aims of this study were to determine incidence and outcome of very severe cases of RV disease. Methods: Cases of very severe RV disease were collected by the German Paediatric Surveillance Unit for rare diseases (Erhebungseinheit fur seltene padiatrische Erkrankungen in Deutschland) using anonymous questionnaires based on hospitalized patients between April 2009 and March 2011. Inclusion criteria were detection of RV antigen in feces, patient aged 0-16 years and 1 or more of the following criteria: intensive care treatment, hypernatremia or hyponatremia (> 155 mmol/ L or < 125 mmol/ L), clinical signs of encephalopathy (somnolence, seizures, apnea) and RV-associated death. Results: During 2 years, 130 cases of very severe RV disease were reported, 101 of 130 were verified. Seventeen patients had nosocomial infection, of whom 14 were neonates in intensive care. Among those, 12 infants had verified or suspected necrotizing enterocolitis. Eighty-four community-acquired cases were reported, median age was 10.5 months (0-108 months). The median hospital stay was 6 days, and 48 patients needed intensive care treatment. Among children less than 5 years of age, the yearly incidence of community-acquired very severe RV disease was 1.2 of 100,000 (95% confidence interval: 0.9-1.4/100,000). A total of 26 of 84 and 10 of 84 patients had severe hypernatremia or hyponatremia, respectively, and 58 of 84 patients had signs of encephalopathy. Three deaths were reported (1 nosocomial and 2 community acquired). Conclusions: RV infection in Germany can have a life-threatening course. A substantial number are nosocomial infections.

Background/Aims: Since detection of the prion protein gene (PRNP) morethan 30 mutations have been discovered. Some have only been found insingle case reports without known intrafamilial accumulation orneuropathological proof so that the causal connection between mutationand disease could not be proved. Those patients often present atypicalclinical phenotypes, and it is not unusual that they are classified asdiseases other than Creutzfeldt-Jakob disease (CJD). Methods: Cases ofsuspected CJD have been reported to the national reference center forprion diseases. Clinical and diagnostic data were collected, and aclassification of definite, possible or probable prion disease was made.Molecular analysis of PRNP was performed by capillary sequencing.Results: We have described 4 cases with atypical clinical and diagnosticfindings and unknown mutations in PRNP so far. Conclusion: Threepatients fulfilled the criteria of probable CJD, and 1 patient fulfilledthe criteria of possible CJD but the clinical picture in none of thepatients was typical CJD; hence, it remained questionable whether themutations were causal of the disease.

Background: The introduction of new invasive therapies for acute myocardial infarction and new medication schemes for secondary prevention is thought to increase life expectancy in 28-day survivors of a first myocardial infarction. The present study examined mortality and re-infarction rate of those patients in the light of changed therapeutic guidelines. Methods: Cases of 25 to 74 year old 28-day survivors of a first definite AMI based on MONICA criteria were identified in the Coronary Event Registry in Augsburg, Southern Germany, who had their index event between the 1st of January 1995 and the 31st of December 2003. Mortality and re-infarction rates were calculated for 1 year, 3 years and total follow-up. Cox models were built to compare the rates of persons, who suffered the index event between 1995 and 1999 (Study period 1) with those who had their first AMI between 2000 and 2003 (Study period 2). Results: Crude mortality was higher in Study period 1 than in Study period 2 and higher for women than for men. Re-infarction rates remained stable for men during both study periods, but women from Study period 1 had a much higher re-infarction rate than women in Study period 2. The hazard ratios showed no significant differences for mortality and re-infarction in men. Hazard ratios of re-infarction in women were significantly reduced, but have to be treated with caution as the number of re-infarctions during Study period 2 was very small. Mortality hazard ratios in women were also not significant. Conclusions: When comparing the time periods before and after the introduction of new therapeutic guidelines, an effect on mortality or re-infarction rate cannot be established. Several reasons are probably responsible for this finding. The population of patients has changed with respect to their risk factors and new diagnostic criteria may have also contributed. Further studies are needed to illuminate these questions.

Background: Haemophilus influenzae type b (Hib) vaccination led to a significant decrease in invasive bacterial infections in children. The aim of this study was to assess a potential shift to more non-type b invasive infections in a population with high Hib vaccination coverage and to compare the burden of suffering between children with Hib, capsulated non-b and non-capsulated Hi infections. Methods: Cases with confirmed invasive Hi infections were ascertained through two independent nationwide active surveillance systems in 1998-2005. Information on possible predisposing conditions and clinical information was available from 2001 onwards. Results: The total number of reported non-type b Hi cases varied between 10 cases in 1998, 27 in 2000 and 14 in 2005. In each year, non-capsulated serotypes outnumbered capsulated non-type b ones. 192 cases were detected in 2001-2005, more than one half was non-type b and 88% of the non-type b cases were non-capsulated. For cases with Hib/capsulated non-type b infections the most common clinical presentation was meningitis (67% each); 89%/78% had no potential predisposing condition, 75%/72% completely recovered from disease and 6% (each) died. In contrast, meningitis was diagnosed in 34% of the non-capsulated Hi infections, septicaemia in 28% and pneumonia 21%; 62% had no potential predisposing condition, 83% completely recovered and 3% died. Conclusion: There was no increase in non-type b Hi invasive infections during 8 years of active surveillance in Germany. Invasive disease due to non-type b Hi is not confined to children with risk factors. In patients with capsulated non-type b Hi infections the proportion of meningitis cases is similar to Hib, but double as high as in non-capsulated Hi.