scholarly journals Melioidosis: A Neglected Infection in Bangladesh

2021 ◽  
Vol 22 (2) ◽  
pp. 139-145
Author(s):  
Fazle Rabbi Chowdhury ◽  
Chandan Kumar Roy ◽  
Lovely Barai ◽  
Shrebash Paul ◽  
Forhad Uddin Hasan Chowdhury ◽  
...  
Keyword(s):  
First Generation ◽  
Preventive Measures ◽  
Clinical Specimen ◽  
Risk Groups ◽  
Common Risk Factor ◽  
Phase 3 ◽  
Intensive Phase ◽  
Drug Of Choice ◽  
Amoxicillin Clavulanic Acid ◽  
Diagnostic Microbiology

Bangladesh is an example of a highly populous, agricultural country where melioidosis may be a significantly under diagnosed cause of infection and death. A recent regression model predicted 16,931 cases annually in Bangladesh with a mortality rate of 56%. However, we only manage to confirm (culture) around 80 cases in last 60 years. A lack of awareness among microbiologists and clinicians and a lack of diagnostic microbiology infrastructure are factors that are likely to lead to the underreporting of melioidosis. Melioidosis transmits through inoculation, inhalation and ingestion. Diabetes mellitus is the most common risk factor (12 times higher chance of getting the infection) predisposing individuals to melioidosis and is present in >50% of all patients. The clinical presentation is widely varied and can be mistaken for other diseases such as tuberculosis or more common forms of pneumonia giving rise to its nickname as the “great mimicker”. Disease manifestations vary from pneumonia or localized abscess to acute septicemias, or may present as a chronic infection. Culture is considered the current gold-standard for diagnosis and culture-confirmation should always be sought in patients where disease is suspected. It is strongly recommended that any non–Pseudomonas aeruginosa, oxidase-positive, Gram-negative bacillus isolated from any clinical specimen from a patient in an endemic area should be suspected to be Burkholderia pseudomallei (BP). In addition, based on antibiogram, any Gramnegative bacilli that are oxidase-positive, typically resistant to aminoglycosides (e.g., gentamicin), colistin, and polymyxin but sensitive to amoxicillin/clavulanic acid should be considered as BP. This bacteria is inherently resistant to penicillin, ampicillin, first generation and second-generation cephalosporins, gentamicin, tobramycin, streptomycin, and polymyxin. For intensive phase (10 to 14 days), ceftazidime or carbapenem is the drug of choice. For eradication phase (3 to 6 months), oral trimethoprim/ sulfamethoxazole is the drug of choice. Surgery (drainage of abscess) has an important role in the management of melioidosis. Preventive measures through protective gears could be useful particularly for the risk groups. J MEDICINE 2021; 22: 139-145

scholarly journals Resource allocation in the Covid-19 health crisis: are Covid-19 preventive measures consistent with the Rule of Rescue?

2021 ◽  
Author(s):  
Julian W. März ◽  
Søren Holm ◽  
Michael Schlander
Keyword(s):  
Resource Allocation ◽  
Large Scale ◽  
Preventive Measures ◽  
Risk Groups ◽  
Healthcare Resources ◽  
Health Crisis ◽  
Rule Of Rescue ◽  
Post War ◽  
Vaccination Campaigns ◽  
N95 Respirators

AbstractThe Covid-19 pandemic has led to a health crisis of a scale unprecedented in post-war Europe. In response, a large amount of healthcare resources have been redirected to Covid-19 preventive measures, for instance population-wide vaccination campaigns, large-scale SARS-CoV-2 testing, and the large-scale distribution of protective equipment (e.g., N95 respirators) to high-risk groups and hospitals and nursing homes. Despite the importance of these measures in epidemiological and economic terms, health economists and medical ethicists have been relatively silent about the ethical rationales underlying the large-scale allocation of healthcare resources to these measures. The present paper seeks to encourage this debate by demonstrating how the resource allocation to Covid-19 preventive measures can be understood through the paradigm of the Rule of Rescue, without claiming that the Rule of Rescue is the sole rationale of resource allocation in the Covid-19 pandemic.

scholarly journals RISK ASSESSMENT OF HEALTH DISORDERS IN EMPLOYEES AT THE MACHINERY ENTERPRISE

2020 ◽  
Vol 99 (1) ◽  
pp. 76-79
Author(s):  
Lyubov A. Balabanova ◽  
S. K. Kamaev ◽  
A. A. Imamov ◽  
O. R. Radchenko
Keyword(s):  
High Risk ◽  
Working Conditions ◽  
Preventive Measures ◽  
Risk Groups ◽  
Machine Building ◽  
Occupational Factors ◽  
Building Enterprise ◽  
The Impact ◽  
Occupational Contact ◽  
Male Workers

Introduction. Adverse effects of environmental factors can cause dysfunction of organs and systems, hormonal dysfunction, genetic disorders, which can adversely affect the health of future generations. The aim is to study occupational risk factors and assess their impact on the health of male workers of machine-building enterprises, to develop preventive measures. Material and methods. The working conditions of 318 male workers of the main professions of the machine-building enterprise (miller, locksmith, electric and gas welder, turner, caster, etc.), having occupational contact with harmful occupational factors, were studied in comparison with 148 employees of the control group. Epidemiological, socio-hygienic, statistical and risk calculation methods were used. Results. 68.2% of respondents were found to have occupational contact with cutting fluid, 24.3% contact with chemicals, 14.4% - with heavy metals, 66.2% of respondents work in conditions of noise exposure, 40.1% - local vibration, 22.3% - in conditions of hypothermia, 14.4% - in conditions of overheating. Excess of maximum permissible concentrations of benzo(a)pyrene, aerosols of mineral oils, epichlorohydrin was detected in the air of the working zone. At workplaces, there were excess levels of noise, general vibration, thermal radiation. The impact of harmful occupational factors in the workplace was established to create a high risk to the health of workers. Conclusion. Working conditions of workers of the machine-building enterprise are mainly estimated as harmful. Critical organs and systems for the development of occupational pathology were identified, the high carcinogenic risk from exposure to benzo(a)pyrene was revealed. Employees of the machine-building enterprise were shown to have a high risk of oncology, respiratory diseases, central nervous system diseases, pathology in offspring. As a result, risk groups were formed and targeted preventive measures were proposed, including monitoring of the health status of high-risk groups, occupational selection, and medical examinations.

Peculiarities of the course of toxoplasmosis and toxocarosis in modern conditions of the сovid-19pandemic and their prevention

2021 ◽  
Vol 43 (3-4) ◽  
pp. 46-56
Author(s):  
O. V. Bobrova ◽  
◽  
N.G. Mikhanovska ◽  
K. A. Krivonos ◽  
S. M. Vorobyov ◽  
...  
Keyword(s):  
Preventive Measures ◽  
Congenital Toxoplasmosis ◽  
Risk Groups ◽  
Acute Stage ◽  
Epidemiological Surveillance ◽  
Government Agencies ◽  
National Program ◽  
Disease Treatment ◽  
Modern Methods ◽  
Near Future

The article is devoted (dedicated) to topical problems of socially significant parasitosis, peculiarities of toxoplasmosis and toxocariasis in the conditions of the COVID-19 pandemic, measures of prevention of these parasitic invasions. Ways of infection, clinical features of chronic toxoplasmosis in the acute stage, and toxocariasis are described. An overview of modern methods of diagnosis of toxoplasmosis and toxocariasis is presented, the necessity of line-blot analysis in our country is described, first of all, to clarify the stage of the disease in congenital toxoplasmosis, as well as for differential diagnosis of stages of this disease. treatment of patients with toxoplasmosis invasion. Indications for examination of patients with toxoplasmosis are presented. The main measures for the prevention of congenital toxoplasmosis, which is dangerous for newborns, are outlined. Preventive measures to prevent toxocariasis infection are described, which is a necessary basis for improving the system of epidemiological surveillance for the spread of toxoplasmosis and toxocariasis in all regions of our country. Emphasis was placed on the need to strengthen control by government agencies to prevent parasitological pollution, the urgency of establishing a National Program for surveillance of parasitic infestations in the near future to control their spread and prevent serious consequences for the health of infected, the need and feasibility of specialized treatment centers. and rehabilitation of patients with parasitic infestations, primarily toxoplasmosis and toxocariasis. The necessity of dispensary observation for persons from risk groups for severe toxoplasmosis – pregnant women, immunocompromised persons, persons with immunodeficiency of different genesis, the main solutions for the prevention of these parasites.

Prediction of placental insufficiency in pregnant women with different somatotypes

2020 ◽  
Vol 69 (4) ◽  
pp. 23-28
Author(s):  
Kristina G. Tomayeva
Keyword(s):  
Pregnant Women ◽  
Preventive Measures ◽  
Risk Groups ◽  
Serum Levels ◽  
Placental Insufficiency ◽  
Fetal Growth Retardation ◽  
Fetal Hypoxia ◽  
Body Type ◽  
Effective Implementation ◽  
Placental Dysfunction

Hypothesis/aims of study. Poor placental vascularization can lead to placental insufficiency, due to which the metabolism of nutrients and microelements between the maternal and fetal blood circulations subsequently decreases. Due to poor perfusion of placental vessels, placental dysfunction occurs. Chronic fetal hypoxia causes fetal growth retardation. The aim of this study was to assess the frequency of placental insufficiency in women with different somatotypes and to develop a model for predicting the risk of this pathology. Study design, materials and methods. A total of 390 women were examined, of whom 110 were macrosomatic, 173 mesosomatic, and 107 microsomatic. Somatometry was performed according to R.N. Dorokhov for women in the early stages of pregnancy (up to 9-10 weeks). Placental insufficiency markers (VEGF, PlGF, IL-6, and endocan-1) were determined spectrophotometrically in blood serum at the gestational age of 1213 and 2223 weeks using ELISA methods. Results. Placental insufficiency was significantly more prevalent among the women of the macro- and microsomatic body type compared with those of mesosomatotypes (p 0.05). In pregnant women with subsequent placental insufficiency, VEGF and PlGF serum levels at 1213 weeks were lower, when compared to those in patients who did not develop pathology (p 0.05), and the levels of serum endocan-1 and IL-6 were higher in comparison with those in individuals who did not develop pathology (p 0.05). Using multiple regression analysis, we obtained the regression equation (formula), which predicts the development of placental insufficiency in women of different somatotypes. Conclusion. The resulting formula allows us to accurately predict the development of placental insufficiency and to form high-risk groups among women for the development of this disease. This will contribute to the effective implementation of therapeutic and preventive measures to avert the development of this pathology.

Development and validation of a prognostic model for overall survival in chemotherapy-naive men with metastatic castration-resistant prostate cancer (mCRPC) from the phase 3 prevail clinical trial.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 5022-5022
Author(s):  
Andrew J. Armstrong ◽  
Ping Lin ◽  
Celestia S. Higano ◽  
Cora N. Sternberg ◽  
Guru Sonpavde ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Overall Survival ◽  
Prognostic Factors ◽  
High Risk ◽  
Prognostic Model ◽  
Risk Groups ◽  
Multivariable Model ◽  
Training Set ◽  
Phase 3 ◽  
Testing Set

5022 Background: Prognostic models require updating to reflect contemporary medical practice. In a post hoc analysis of the phase 3 PREVAIL trial (enzalutamide vs placebo), we identified prognostic factors for overall survival (OS) in chemotherapy-naive men with mCRPC. Methods: Patients were randomly divided 2:1 into training (n = 1159) and testing (n = 550) sets. Using the training set, 23 predefined candidate prognostic factors (including treatment) were analyzed in a multivariable Cox model with stepwise procedures and in a penalized Cox proportional hazards model using the adaptive least absolute shrinkage and selection operator (LASSO) penalty (data cutoff June 1, 2014). A multivariable model predicting OS was developed using the training set; the predictive accuracy was assessed in the testing set using time-dependent area under the curve (tAUC). The testing set was stratified based on risk score tertiles (low, intermediate, high), and OS was analyzed using Kaplan-Meier methodology. Results: Demographics, disease characteristics, and OS were balanced between the training and testing sets; median OS was 32.7 months for both datasets. There were no enzalutamide treatment-prognostic factor interactions (predictors). The final multivariable model included 11 prognostic factors: prostate-specific antigen, treatment, hemoglobin, neutrophil-lymphocyte ratio, liver metastases, time from diagnosis to randomization, lactate dehydrogenase, ≥ 10 bone metastases, pain, albumin, and alkaline phosphatase. The tAUC was 0.74 in the testing set. Median (95% confidence interval [CI]) OS for the low-, intermediate-, and high-risk groups (testing set) were not yet reached (NYR) (NYR–NYR), 34.2 months (31.5–NYR), and 21.1 months (17.5–25.0). The hazard ratios (95% CI) for OS in the low- and intermediate-risk groups vs the high-risk group were 0.20 (0.14–0.29) and 0.40 (0.30–0.53), respectively. Conclusions: Our validated prognostic model incorporates factors routinely collected in chemotherapy-naive men with mCRPC treated with enzalutamide and identifies subsets of men with widely differing survival times. Clinical trial information: NCT01212991.

scholarly journals Vascular aging phenotypes based on VaSerа-screening results in young people with hypertension: Place of connective tissue dysplasia

2021 ◽  
Vol 27 (2) ◽  
pp. 188-205
Author(s):  
M. E. Evsevyeva ◽  
M. V. Eremin ◽  
M. V. Rostovtseva ◽  
E. N. Fursova ◽  
A. V. Rusydi ◽  
...  
Keyword(s):  
Young People ◽  
Connective Tissue ◽  
Preventive Measures ◽  
Risk Groups ◽  
Vascular Aging ◽  
Group Data ◽  
Connective Tissue Dysplasia ◽  
The University ◽  
Design And Methods ◽  
Expert Recommendations

Objective. To assess the occurrence of various vascular aging phenotypes among young people, depending on the level of blood pressure (BP) and in relation to risk factors (RF) and the presence of connective tissue dysplasia (CTD).Design and methods. In total, 250 young people (88 boys and 162 girls) aged from 18 to 25 years old were examined at the University Health Center. All the subjects were divided into tercile groups based on cardio-ankle vascular index (CAVI), determined by the VaSera-1500 (Fucuda Denshia, Japan). According to the latest expert recommendations the third tercile group corresponds to early vascular aging or EVA syndrome. The first tercile group corresponds to favorable vascular aging. We have analyzed the representation of various vascular phenotypes in individuals with elevated and normal BP, as well as the main RF and external signs of CTD in each of CAVI-tercile group. Data processing was performed using the software package “Statistica 10.0” (StatSoft Inc., USA).Results. Among young people with office hypertension and high normal BP, the EVA phenotype and phenotypes of normal and favorable vascular aging are equally distributed. In persons with office normal and elevated BP, vascular stiffness correlates with weight, body mass index and waist circumference (with the increase in arterial rigidity these indicators decrease). CTD is registered among subjects with severe vascular remodeling both in boys and girls.Conclusions. Our data indicate the feasibility of angiology screening for identification of vascular aging phenotypes as a part of preventive measures among young people, regardless of the level of initial office BP. This strategy strategy will contribute to a more differentiated identification of risk groups and more individualized preventive interventions based on vascular aging phenotypes.

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