On 6 February 2015, Kampala city authorities alerted the Ugandan Ministry of Health of a “strange disease” that killed one person and sickened dozens. We conducted an epidemiologic investigation to identify the nature of the disease, mode of transmission, and risk factors to inform timely and effective control measures. We defined a suspected case as onset of fever (≥37.5 °C) for more than 3 days with abdominal pain, headache, negative malaria test or failed anti-malaria treatment, and at least 2 of the following: diarrhea, nausea or vomiting, constipation, fatigue. A probable case was defined as a suspected case with a positive TUBEX® TF test. A confirmed case had blood culture yielding Salmonella Typhi. We conducted a case-control study to compare exposures of 33 suspected case-patients and 78 controls, and tested water and juice samples. From 17 February–12 June, we identified 10,230 suspected, 1038 probable, and 51 confirmed cases. Approximately 22.58% (7/31) of case-patients and 2.56% (2/78) of controls drank water sold in small plastic bags (ORM-H = 8.90; 95%CI = 1.60–49.00); 54.54% (18/33) of case-patients and 19.23% (15/78) of controls consumed locally-made drinks (ORM-H = 4.60; 95%CI: 1.90–11.00). All isolates were susceptible to ciprofloxacin and ceftriaxone. Water and juice samples exhibited evidence of fecal contamination. Contaminated water and street-vended beverages were likely vehicles of this outbreak. At our recommendation authorities closed unsafe water sources and supplied safe water to affected areas.
<b><i>Introduction:</i></b> The association between total immunoglobulin E (IgE) levels and urinary albumin excretion has not been fully established. Current study aimed to evaluate the association between total IgE levels and urinary albumin-to-creatinine ratio (UACR) among adult Americans. <b><i>Methods:</i></b> Current cross-sectional study utilized data from the 2005 to 2006 National Health and Nutrition Examination Survey, including individuals aged 20 years and above. To assess the relationships between total IgE levels and UACR, both multivariable linear regression models and smooth curve fitting were employed. <b><i>Results:</i></b> The study included a total of 3,400 participants (weighted mean age: 46.6 ± 0.8 years), with 1,625 females (weighted percentage: 47.8%). After adjusting for potential confounders, we observed a positive association between higher total IgE levels on a log2 scale and increased UACR (<i>β</i> = 3.34; 95% CI: 1.40–5.28, <i>p</i> = 0.002). Furthermore, the association displayed a non-linear dose-response pattern. The interaction test revealed a significant distinction in the correlation between total IgE and UACR when stratified by hyperlipidemia (<i>p</i> for interaction <0.001). The results remained robust in sensitivity analyses. <b><i>Conclusion:</i></b> Our study revealed a significant and independent association between elevated total IgE levels and an increased UACR, which also exhibited a distinct non-linear pattern, highlighting the intricate nature of the connection between IgE levels and UACR.
OBJECTIVE To observe the promoting consciousness effect of electroacupuncture therapy on the patients with long-term coma caused by severe craniocerebral trauma. METHODS Twenty-nine cases with coma more than 3 weeks and Glasgow Coma Scales (GCS) of 8 or less were divided into an observation group (n=15) and a control group (n=14). They were treated with the same western medicine. In addition to ordinary treatment, the observation group was treated with electroacupuncture at Baihui (GV 20), Shuigou (GV 26), Yongquan (KI 1) etc. for 30 min and the needles were retained for 30 min, once each day. RESULTS The average awake time and awake rate were 40.1 days and 73.3% (11/15) respectively in the observation group, which were higher than 51.8 days and 28.6% (4/14) in the control group. CONCLUSION Electroacupuncture therapy combine with western medicine is more effective in improving consciousness of patients in coma caused by severe craniocerebral trauma.
On 28 March, 2016, the Ministry of Health received a report on three deaths from an unknown disease characterized by fever, jaundice, and hemorrhage which occurred within a one-month period in the same family in central Uganda. We started an investigation to determine its nature and scope, identify risk factors, and to recommend eventually control measures for future prevention.We defined a probable case as onset of unexplained fever plus ≥1 of the following unexplained symptoms: jaundice, unexplained bleeding, or liver function abnormalities. A confirmed case was a probable case with IgM or PCR positivity for yellow fever. We reviewed medical records and conducted active community case-finding. In a case-control study, we compared risk factors between case-patients and asymptomatic control-persons, frequency-matched by age, sex, and village. We used multivariate conditional logistic regression to evaluate risk factors. We also conducted entomological studies and environmental assessments.From February to May, we identified 42 case-persons (35 probable and seven confirmed), of whom 14 (33%) died. The attack rate (AR) was 2.6/100,000 for all affected districts, and highest in Masaka District (AR = 6.0/100,000). Men (AR = 4.0/100,000) were more affected than women (AR = 1.1/100,000) (p = 0.00016). Persons aged 30-39 years (AR = 14/100,000) were the most affected. Only 32 case-patients and 128 controls were used in the case control study. Twenty three case-persons (72%) and 32 control-persons (25%) farmed in swampy areas (ORadj = 7.5; 95%CI = 2.3-24); 20 case-patients (63%) and 32 control-persons (25%) who farmed reported presence of monkeys in agriculture fields (ORadj = 3.1, 95%CI = 1.1-8.6); and 20 case-patients (63%) and 35 control-persons (27%) farmed in forest areas (ORadj = 3.2; 95%CI = 0.93-11). No study participants reported yellow fever vaccination. Sylvatic monkeys and Aedes mosquitoes were identified in the nearby forest areas.This yellow fever outbreak was likely sylvatic and transmitted to a susceptible population probably by mosquito bites during farming in forest and swampy areas. A reactive vaccination campaign was conducted in the affected districts after the outbreak. We recommended introduction of yellow fever vaccine into the routine Uganda National Expanded Program on Immunization and enhanced yellow fever surveillance.
During March 2008, a college in Urumqi, capital of Xinjiang Uygur Autonomous Region in China, reported a measles outbreak, amid a city-wide outbreak involving >2700 cases.Suspected case patients were defined as patients with onset of fever (≥38°) and rash between 7 March and 30 April 2008. Probable case patients were defined as suspected case patients with >3 days of rash or known exposure to someone with laboratory-confirmed measles. Confirmed case patients were defined as suspected or probable case patients with Koplik spots or positive titer for immunoglobulin M antibody. We conducted a case-control investigation to identify risk factors for transmission.We identified 162 suspected (attack rate, 1.9%), 99 probable, and 62 confirmed case patients. The epidemic curve indicated a point source initially, followed by person-to-person transmission. Approximately 63% of 90 probable case patients and 27% of 150 asymptomatic student controls randomly selected among classmates of student case patients visited internet cafés during the exposure period (odds ratio [OR], 4.5; 95% confidence interval [CI], 2.6-8.0); 66% of case patients and 45% of student controls reported close contact with a measles case patient (OR, 2.3; 95% CI, 1.3-3.9). In stratified analysis, visiting internet cafés (OR, 4.0; 95% CI, 1.5-11) remained significantly associated with disease, but contact with case patients (OR, 1.9; 95% CI, .79-4.4) became nonsignificant.This measles outbreak was transmitted in internet cafés, followed by secondary transmission. Chinese universities should require proof of immunity or 2 doses of measles vaccine at college entry.
Globalization has opened many fronts for disease outbreaks because of the quick movement of people and porous borders around the world. The emergence of zoonotic diseases and other communicable diseases highlights the need for implementation of the Global Health Security Agenda packages if countries are to achieve compliance with International Health Regulations (IHR 2005). Health workforce development is one of the critical components that must be addressed with utmost urgency if gaps in early disease detection and response are to be addressed. In this regard, this case study is based on a measles outbreak investigation in Uganda simulating a real-life outbreak investigation by field epidemiologists and seeks to demonstrate the principles of applied epidemiology outlining the critical steps in outbreak investigations and generation of evidence for decision making. It aims to shore up the health workforce capacity by providing practical training for field epidemiology students and professionals that builds their skills in outbreak investigation. This case study can be completed in less than three hours.
A methodology for studying the deagglomeration performance and emptying behavior of micronized mannitol powder from two commercial capsule-based dry powder inhalers (DPIs), the low- and high-resistance RS01®, is presented. Mathematical modeling played a key role in the interpretation of the powder release behavior from these two DPI systems. Non-linear regression models, which were characterized from the aerosol obscuration versus time profiles obtained from laser diffraction particle sizing data, were used to estimate rate constants for emptying of mannitol powder. The effects of device resistance and associated pressure drops, sampling flow rate, rates of powder emptying, and the presence of capsule on the dispersion characteristics were studied. The presence of a capsule significantly improved the aerosolization performance of mannitol powder from both inhalers, which may be due to the extended powder–air–device interactions within the device. It is important to consider the stochastic nature of movement and physical state of the capsule when assessing the aerosolization mechanisms and dispersion performance from these complex delivery systems. The methodology set out in this study has the capacity to provide a greater level of detail in the study of aerosol plume characteristics from capsule-based DPIs.Copyright 2015 American Association for Aerosol Research
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