scholarly journals Risk factors for physical disability in patients with leprosy disease in Yunnan, China: Evidence from a retrospective observational study

2021 ◽  
Vol 15 (11) ◽  
pp. e0009923
Author(s):  
Xiaohua Chen ◽  
Hong-bing Liu ◽  
Tie-Jun Shui ◽  
Shun Zha
Keyword(s):  
Risk Factors ◽  
Physical Disability ◽  
Physical Disabilities ◽  
Delayed Diagnosis ◽  
Skin Lesions ◽  
Nerve Damage ◽  
Advanced Age ◽  
Han Ethnicity ◽  
Leprosy Patients ◽  
Male Sex

Background Leprosy is potentially debilitating. The risk factors related to physical disabilities associated with leprosy disease in Yunnan, China was not clear. Methodology/Principal findings We studied 10644 newly detected leprosy patients from Yunnan, China, from 1990 to 2019. Factors associated with Grade 1 (G1D) and Grade 2 (G2D) physical disabilities or overall physical disabilities (combined G1D and G2D) associated with leprosy were analyzed using multinomial and ordinal logistic regression analyses. The following factors were associated with the development of physical disability in these patients with leprosy: delayed diagnosis [odds ratio (OR): 5.652, 4.399, and 2.275; 95% confidence intervals (CIs): 4.516–7.073, 3.714–5.212, and 2.063–2.509; for ≥ 10, 5–10 y, and 2–5 years, respectively], nerve damage (OR: 3.474 and 2.428; 95% CI: 2.843–4.244, and 1.959–3.008; for 2 and 1 damaged nerves, respectively), WHO classification of PB (OR: 1.759; 95% CI: 1.341–2.307), Ridley-Jopling classification (OR: 1.479, 1.438, 1.522 and 1.239; 95% CI: 1.052–2.079, 1.075–1.923, 1.261–1.838, and 1.072–1.431; for TT, BT, BB, and BL when compared with LL, respectively), advanced age (OR: 1.472 and 2.053; 95% CI: 1.106–1.960 and 1.498–2.814; for 15–59 and over 60 years old, respectively), zero skin lesions (OR: 1.916; 95% CI: 1.522–2.413), leprosy reaction (OR: 1.528; 95% CI: 1.195–1.952), rural occupation (OR: 1.364; 95% CI: 1.128–1.650), Han ethnicity (OR: 1.268; 95% CI: 1.159–1.386), and male sex (OR: 1.128; 95% CI: 1.024–1.243). Conclusions Delayed diagnosis, nerve damage, no skin lesions, WHO and Ridley-Jopling classifications, leprosy reactions, advanced age, rural occupation, Han ethnicity, and male sex were associated with disability in leprosy patients. Identifying risk factors could help to prevent physical disability.

scholarly journals Survival Analysis of Risk Factors for Mortality in a Cohort of Patients with Tuberculosis

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Yi Xie ◽  
Jing Han ◽  
Weili Yu ◽  
Junping Wu ◽  
Xue Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mortality Rate ◽  
Pulmonary Tuberculosis ◽  
Treatment Effects ◽  
Cox Regression ◽  
Cohort Analysis ◽  
Advanced Age ◽  
Cox Regression Analysis ◽  
Antituberculosis Treatment ◽  
Male Sex

Identify the treatment effects and risk factors for mortality in patients with pulmonary tuberculosis receiving antituberculosis treatment under the Directly Observed Treatment Short-Course (DOTS) program to reduce the mortality rate of tuberculosis. A retrospective cohort analysis was conducted on the outcomes of antituberculosis treatment of 7,032 patients with tuberculosis in the DOTS program, in the Tuberculosis Management Information System from 2014 to 2017 in Tianjin, China. The Kaplan–Meier method and multifactor Cox proportional risk regression model were used to analyze the risk factors for mortality during antituberculosis treatment under DOTS. The success rate of antituberculosis treatment was 90.24% and the mortality rate was 4.56% among 7,032 cases of tuberculosis in Tianjin. Cox regression analysis showed that advanced age, male sex, human immunodeficiency virus (HIV) positivity, first sputum positivity, retreated tuberculosis, and a delayed visit (≥14 days) were risk factors for mortality in patients with pulmonary tuberculosis receiving antituberculosis treatment under DOTS. The treatment effects in patients with pulmonary tuberculosis during antituberculosis treatment under DOTS were positive in Tianjin. Advanced age, male sex, HIV positivity, first sputum positivity, retreated tuberculosis, and a delayed visit (≥14 days) increased the risk for mortality during antituberculosis treatment.

Risikofaktoren für die Diagnoseverzögerung bei idiopathischer Lungenfibrose vermeiden

2019 ◽  
pp. III-IV
Author(s):  
Fotios Drakopanagiotakis ◽  
Andreas Günther
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Negative Binomial ◽  
Diagnostic Delay ◽  
Delayed Diagnosis ◽  
Final Diagnosis ◽  
Inhalation Therapy ◽  
Total Delay ◽  
Specific Patient ◽  
Male Sex

Background: Surveys and retrospective studies of patients with idiopathic pulmonary fibrosis (IPF) have shown a significant diagnostic delay. However, the causes and risk factors for this delay are not known. Methods: Dates at six time points before the IPF diagnosis (onset of symptoms, first contact to a general practitioner, first hospital contact, referral to an interstitial lung disease (ILD) centre, first visit at an ILD centre, and final diagnosis) were recorded in a multicentre cohort of 204 incident IPF patients. Based on these dates, the delay was divided into specific patient-related and healthcare-related delays. Demographic and clinical data were used to determine risk factors for a prolonged delay, using multivariate negative binomial regression analysis. Results: The median diagnostic delay was 2.1 years (IQR: 0.9-5.0), mainly attributable to the patients, general practitioners and community hospitals. Male sex was a risk factor for patient delay (IRR: 3.84, 95% CI: 1.17-11.36, p = 0.006) and old age was a risk factor for healthcare delay (IRR: 1.03, 95% CI: 1.01-1.06, p = 0.004). The total delay was prolonged in previous users of inhalation therapy (IRR: 1.99, 95% CI: 1.40-2.88, p < 0.0001) but not in patients with airway obstruction. Misdiagnosis of respiratory symptoms was reported by 41% of all patients. Conclusion: Despite increased awareness of IPF, the diagnostic delay is still 2.1 years. Male sex, older age and treatment attempts for alternative diagnoses are risk factors for a delayed diagnosis of IPF. Efforts to reduce the diagnostic delay should focus on these risk factors.

scholarly journals Iatrogenic outbreak of M. chelonae skin abscesses

1996 ◽  
Vol 117 (1) ◽  
pp. 113-119 ◽  
Author(s):  
D. Camargo ◽  
C. Saad ◽  
F. Ruiz ◽  
M. E. Ramirez ◽  
M. Lineros ◽  
...  
Keyword(s):  
Risk Factors ◽  
Incubation Period ◽  
Subcutaneous Injection ◽  
Control Design ◽  
Skin Lesions ◽  
Case Control ◽  
Mycobacterium Chelonae ◽  
Biochemical Characteristics ◽  
Male Sex ◽  
Number Of Injections

SummaryWe describe an outbreak of skin lesions due to Mycobacterium chelonae subsp. abscessus associated with injections of lidocaine (lignocaine) given by a ‘bioenergetic’ (a practitioner of alternative medicine) in Colombia. The lidocaine carpules and the lesions of the patients yielded mycobacteria with identical biochemical characteristics.Using the methodology of Sartwell and a case control design we examined the incubation period and assessed risk factors. Of 667 potentially exposed individuals, a total of 298 patients were interviewed, of whom 232 had skin lesions. The median incubation period was 30·5 days (range 15–59 days). Male sex (OR 2·85, 95% CI 1·26–6·51), increasing age (OR 1·25, 95% CI 1·03–1·53), subcutaneous injection route (OR 3·72, 95% CI 1·09–12·7) and number of injections (OR 1·01, 95% CI 1·00–1·03) were risk factors for disease.To our knowledge, this is the largest reported outbreak of M. chelonae infection, the first in which the organism has been isolated from the putative vehicle of infection, and the first in which the incubation period could be determined.

scholarly journals Clinical characteristics and risk factors associated with severe COVID-19: prospective analysis of 1,045 hospitalised cases in North-Eastern France, March 2020

2020 ◽  
Vol 25 (48) ◽  
Author(s):  
Charlotte Kaeuffer ◽  
Coralie Le Hyaric ◽  
Thibaut Fabacher ◽  
Joy Mootien ◽  
Benjamin Dervieux ◽  
...  
Keyword(s):  
Risk Factors ◽  
Severe Disease ◽  
Credible Interval ◽  
Advanced Age ◽  
World Health ◽  
Factors Associated ◽  
Inflammatory Parameters ◽  
Hospitalised Patients ◽  
Male Sex ◽  
Health Organization

Background In March 2020, the COVID-19 outbreak was declared a pandemic by the World Health Organization. Aim Our objective was to identify risk factors predictive of severe disease and death in France. Methods In this prospective cohort study, we included patients ≥ 18 years old with confirmed COVID-19, hospitalised in Strasbourg and Mulhouse hospitals (France), in March 2020. We respectively compared patients who developed severe disease (admission to an intensive care unit (ICU) or death) and patients who died, to those who did not, by day 7 after hospitalisation. Results Among 1,045 patients, 424 (41%) had severe disease, including 335 (32%) who were admitted to ICU, and 115 (11%) who died. Mean age was 66 years (range: 20–100), and 612 (59%) were men. Almost 75% of patients with body mass index (BMI) data (n = 897) had a BMI ≥ 25 kg/m2 (n = 661). Independent risk factors associated with severe disease were advanced age (odds ratio (OR): 1.1 per 10-year increase; 95% CrI (credible interval): 1.0–1.2), male sex (OR: 2.1; 95% CrI: 1.5–2.8), BMI of 25–29.9 kg/m2 (OR: 1.8; 95% CrI: 1.2–2.7) or ≥ 30 (OR: 2.2; 95% CrI: 1.5–3.3), dyspnoea (OR: 2.5; 95% CrI: 1.8–3.4) and inflammatory parameters (elevated C-reactive protein and neutrophil count, low lymphocyte count). Risk factors associated with death were advanced age (OR: 2.7 per 10-year increase; 95% CrI: 2.1–3.4), male sex (OR: 1.7; 95% CrI: 1.1–2.7), immunosuppression (OR: 3.8; 95% CrI: 1.6–7.7), diabetes (OR: 1.7; 95% CrI: 1.0–2.7), chronic kidney disease (OR: 2.3; 95% CrI: 1.3–3.9), dyspnoea (OR: 2.1; 95% CrI: 1.2–3.4) and inflammatory parameters. Conclusions Overweightedness, obesity, advanced age, male sex, comorbidities, dyspnoea and inflammation are risk factors for severe COVID-19 or death in hospitalised patients. Identifying these features among patients in routine clinical practice might improve COVID-19 management.

scholarly journals Epidemiological characteristics of patients with severe COVID-19 infection in Wuhan, China: evidence from a retrospective observational study

2020 ◽  
Author(s):  
Fang Wang ◽  
Jinhong Cao ◽  
Yong Yu ◽  
Jianbo Ding ◽  
Ehab S Eshak ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Chronic Disease ◽  
Critical Illness ◽  
Critically Ill ◽  
Cox Regression ◽  
Advanced Age ◽  
Male Sex ◽  
Susceptible Populations ◽  
Epidemiological Characteristics

Abstract Background The new coronavirus (COVID-19) rapidly resulted in a pandemic. We report the characteristics of patients with severe or critical severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Wuhan city, China, and the risk factors related to infection severity and death. Methods We extracted the demographic and clinical data of 7283 patients with severe COVID-19 infection from designated Wuhan hospitals as of 25 February 2020. Factors associated with COVID-19 critical illness and mortality were analysed using logistic- and Cox-regression analyses. Results We studied 6269 patients with severe COVID-19 illness and 1014 critically ill patients. The median (IQR) age was 64 (53–71) years; 51.2% were male, 38.9% were retirees and 7.4% had self-reported histories of chronic disease. Up to the end of the study, 1180 patients (16.2%) recovered and were discharged, 649 (8.9%) died and the remainder were still receiving treatment. The number of daily confirmed critical cases peaked between 23 January and 1 February 2020. Patients with advanced age [odds ratio (OR), 1.03; 95% confidence intervals (CIs), 1.03–1.04], male sex (OR, 1.57; 95% CI, 1.33–1.86) and pre-existing diabetes (OR, 2.11), hypertension (OR, 2.72), cardiovascular disease (OR, 2.15) or respiratory disease (OR, 3.50) were more likely to be critically ill. Compared with those who recovered and were discharged, patients who died were older [hazard ratio (HR), 1.04; 95% CI, 1.03–1.05], more likely to be male (HR, 1.74; 95% CI, 1.44–2.11) and more likely to have hypertension (HR, 5.58), cardiovascular disease (HR, 1.83) or diabetes (HR, 1.67). Conclusion Advanced age, male sex and a history of chronic disease were associated with COVID-19 critical illness and death. Identifying these risk factors could help in the clinical monitoring of susceptible populations.

scholarly journals Presenting symptoms of leprosy at diagnosis: Clinical evidence from a cross-sectional, population-based study

2021 ◽  
Vol 15 (11) ◽  
pp. e0009913
Author(s):  
Xiaohua Chen ◽  
Shun Zha ◽  
Tie-Jun Shui
Keyword(s):  
Physical Disability ◽  
Delayed Diagnosis ◽  
Skin Lesions ◽  
Motor Dysfunction ◽  
Clinical Feature ◽  
Diagnostic Challenge ◽  
Cross Sectional ◽  
Presenting Symptoms ◽  
Awareness Campaigns ◽  
Initial Symptoms

Background Leprosy is associated with different dermatologic and neurologic manifestations within a wide clinical spectrum, causing a great diagnostic challenge. Therefore, we aimed to examine associations between common presenting symptoms of leprosy and stage at diagnosis. Methodology/Principal findings In this cross-sectional study, we analyzed population-level data from the Leprosy Management Information System (LEPMIS) in Yunnan, China, from 2010–2020 and enrolled patients with newly detected leprosy. The data of 2125 newly detected leprosy patients, with 5000 symptoms, were analyzed. Numbness (828/5000, 16.56%), erythema (802/5000, 16.04%), Painless nor pruritic skin lesions (651/5000, 13.02%), eyebrow hair loss (467/5000, 9.34%), and tubercles (442/5000, 8.84%) were common symptoms of leprosy. The symptoms related to skin (1935/2533, 76.39%) and leprosy reaction (279/297, 93.94%) were mainly existed in MB group. While the symptoms related to disability (263/316, 83.49%), clinical feature (38/56, 69.09%), and facial features (19/23, 82.61%) were predominantly presented in delayed diagnostic group. Despite low proportions, formic sensation (99/5000, 1.98%), pain (92/5000, 1.84%), pruritus (56/5000, 1.12%), finger contracture (109/5000, 2.18%), muscle atrophy (71/5000, 1.42%), and motor dysfunction (18/5000, 0.36%) were reported during the diagnosis of leprosy. The proportions of skin, skin and nerve, and nerve symptoms as initial symptoms were 33.25%, 44.95%, and 21.80% and as only symptoms were 28.66%, 57.81%, and 13.91%, respectively. In those with physical disability, nerve symptoms were the most frequent symptoms (57.65% and 65.36% for the initial and only symptoms, respectively) compared with skin and skin and nerve symptoms. In the delayed diagnosis group, nerve symptoms were the most frequent symptoms (15.73% and 17.25%) and were associated with the longest diagnostic intervals (mean±SD: 38.88±46.02 and 40.35±49.36 months for initial and only symptoms, respectively) when compared with skin and skin and nerve symptoms. Conclusions Understanding the nature of presenting symptoms and developing symptom awareness campaigns would improve the level of leprosy awareness in the community. As nerve symptoms were related to a higher proportion of physical disability and longer diagnosis interval, we should increase awareness about nerve symptoms. Individuals with nerve symptoms should be considered the target group. Neurology outpatient visits may provide potential screening opportunities, and holding focused training for specialized neurology medical staff would enhance the capacity of the health system to recognize leprosy early.

scholarly journals Survival of direct composite restorations placed under general anesthesia in adult patients with intellectual and/or physical disabilities

2021 ◽  
Author(s):  
Mona Shaghayegh Maes ◽  
Philipp Kanzow ◽  
Valentina Hrasky ◽  
Annette Wiegand
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
General Anesthesia ◽  
Physical Disability ◽  
Median Survival Time ◽  
Cox Regression ◽  
Physical Disabilities ◽  
Adult Patients ◽  
Cox Regression Analysis ◽  
Composite Restorations

Abstract Objectives This study aimed to assess the survival of direct composite restorations placed under general anesthesia in adult patients with intellectual and/or physical disabilities. Materials and methods Survival of composite restorations placed under general anesthesia in adult patients with intellectual and/or physical disabilities was retrospectively analyzed. Failure was defined as the need for replacement of at least one surface of the original restoration or extraction of the tooth. Individual-, tooth-, and restoration-related factors were obtained from dental records. Five-year mean annual failure rate (mAFR) and median survival time were calculated (Kaplan-Meier statistics). The effect of potential risk factors on failure was tested using univariate log-rank tests and multivariate Cox-regression analysis (α = 5%). Results A total of 728 restorations in 101 patients were included in the analysis. The survival after 5 years amounted to 67.7% (5-year mAFR: 7.5%) and median survival time to 7.9 years. Results of the multivariate Cox-regression analysis revealed physical disability (HR: 50.932, p = 0.001) and combined intellectual/physical disability (HR: 3.145, p = 0.016) compared with intellectual disability only, presence of a removable partial denture (HR: 3.013, p < 0.001), and restorations in incisors (HR: 2.281, p = 0.013) or molars (HR: 1.693, p = 0.017) compared with premolars to increase the risk for failure. Conclusion Composite restorations placed under general anesthesia in adult patients with intellectual and/or physical disabilities showed a reasonable longevity as 67.7% survived at least 5 years. Clinical relevance Survival of composite restorations depends on risk factors that need to be considered when planning restorative treatment in patients with intellectual and/or physical disabilities. NCT04407520

Clinical characteristics, risk factors, and outcomes of POEMS syndrome

Neurology ◽  
2020 ◽  
Vol 95 (3) ◽  
pp. e268-e279 ◽  
Author(s):  
Stephen Keddie ◽  
David Foldes ◽  
Francisca Caimari ◽  
Stephanie E. Baldeweg ◽  
Joshua Bomsztyk ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Laboratory ◽  
Chronic Inflammatory Demyelinating Polyneuropathy ◽  
Delayed Diagnosis ◽  
Significant Risk ◽  
Skin Lesions ◽  
Poems Syndrome ◽  
Active Monitoring ◽  
Risk Of Death

ObjectivePOEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin lesions) is a paraneoplastic disorder resulting in severe neurologic disability. Understanding the clinical, laboratory, neurophysiologic, and histopathologic features as well as treatment responses of POEMS will assist in more accurate and timely diagnosis, risk stratification, and effective management.MethodsThis was a retrospective longitudinal cohort study from 1998 to March 2019, with 7,184 person-months of follow-up time. Hospital databases were used to collate presenting features, investigations, therapies, and response.ResultsOne hundred patients were included with a median follow-up time of 59 months (range, 1–252). Mean symptom onset to diagnosis was 15 months (range, 1–77), with 54% of patients initially misdiagnosed with chronic inflammatory demyelinating polyneuropathy. Median number of multisystem features at diagnosis was 7. Ninety-six (96%) presented with neuropathy, which was length-dependent in 93 (93%) and painful in 75 (75%). At diagnosis, 35% of patients were wheelchair or bedbound, with median Overall Neuropathy Limitation Score of 6, improving to 3 following treatment (p < 0.05). Five-year survival was 90% and 82% at 10 years, with 5- and 10-year progression-free survival of 65% and 53%. Nontreatment with autologous stem cell transplantation, nonhematologic response, and non–vascular endothelial growth factor response are significant risk factors in multivariate analysis to predict progression or death. Risk factors are incorporated to develop a risk score enabling stratification of high- and low-risk cases.ConclusionsPOEMS syndrome is a rare multisystem condition with delayed diagnosis and poor neurologic function at presentation. Therapy has favorable outcomes. Patients at high risk of death or progression can be identified, which may allow for more active monitoring and influence management.

scholarly journals Z-score is a possible predictor of the risk of coronary artery lesion development in patients with Kawasaki disease in Japan

2021 ◽  
Author(s):  
Takayuki Suzuki ◽  
Nobuyuki Kakimoto ◽  
Tomoya Tsuchihashi ◽  
Tomohiro Suenaga ◽  
Takashi Takeuchi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery ◽  
Kawasaki Disease ◽  
Characteristic Curve ◽  
Laboratory Data ◽  
Delayed Diagnosis ◽  
Area Under The Curve ◽  
Coronary Artery Lesion ◽  
Z Score ◽  
Male Sex

Abstract ABSTRACT Risk factors for coronary artery lesion (CAL) development in patients with Kawasaki disease (KD) include male sex, age <12 months, intravenous immunoglobulin (IVIG) resistance, and delayed diagnosis. We aimed to explore the relationship between CAL development and Z-score. We enrolled 281 patients with KD who were treated with our protocol. Echocardiography was performed in three phases: pre-treatment (P1), post-treatment (P2), and 4 weeks after onset (P3). The highest Z-score of the right, left main, left anterior descending, and left circumflex coronary arteries was expressed as Zmax at each phase. P3-Zmax ≥2.5 represented CAL development. Clinical parameters, such as laboratory data and Z-scores, were retrospectively compared between patients with and without CAL development. Sixty-seven patients (23.8%) showed a P1-Zmax ≥2.0, and CAL development occurred in 21 patients (7.5%). Independent risk factors associated with CAL development were P1-Zmax, a ΔZmax (P2-Zmax − P1-Zmax) ≥1, male sex, <12 months of age, and resistant to the first IVIG administration (adjusted odds ratio [95% confidence interval]: 1.98 [1.01–3.92], 4.04 [1.11-14.7], 6.62 [1.33–33.04], 4.71 [1.51–14.68], 5.26 [1.62–17.13], respectively). Using receiver operating characteristic curve analysis, a P1-Zmax ≥1.43 detected CAL development with an area under the curve of 0.64 (sensitivity = 81.0%; specificity = 48.1%). Conclusions : Our results suggest that P1-Zmax and a ΔZmax (P2-Zmax − P1-Zmax) ≥1 may predict CAL development.

scholarly journals Risk factors for physical disability due to leprosy: a case-control study

2021 ◽  
Author(s):  
Gerlane Cristinne Bertino Véras ◽  
José Ferreira Lima Júnior ◽  
Estelita Lima Cândido ◽  
Evanira Rodrigues Maia
Keyword(s):  
Risk Factors ◽  
Physical Disability ◽  
Case Control Study ◽  
Physical Disabilities ◽  
Case Control ◽  
Education Level ◽  
Regional Health ◽  
Software Packages ◽  
Low Education ◽  
Control Study

ABSTRACT Background The main consequence of leprosy is physical disability. Objective To identify risk factors of physical disabilities due to leprosy. Method Case-control study carried out at the Notifiable Diseases Information System – Leprosy in the 9th Regional Health District of the state of Paraíba, Brazil, between 2001 and 2014. Cases were individuals who presented degree of physical disability 1 or 2 at diagnosis or discharge; and controls included individuals with degree of physical disability 0 also at diagnosis and discharge. A 1:1 (case:control) proportion was used. Data were analyzed using the Epi Info and BioEstat software packages. Results The following cases and controls (428 each) at risk for physical disability were analyzed: aged ≥15 years (96.5%, OR=0.33, p<0.01), males (59.3%, OR=1.82, p<0.01), low education level (70.4%, OR=2.66, p<0.01), multibacillary classification (72.9%, OR=9.29; p< 0.01), number of lesions ≥5 (34.3%, OR=0.18, p<0.01), and number of nerves affected ≥1 (12.6%, OR=0.05; p<0.01). Late diagnosis, missing/inadequately filled data, absence/non-registration of dermato-neurological evaluation, and low control of contacts were observed. Conclusion The need for active surveillance and early detection of leprosy cases and contacts is highlighted.

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