254 research outputs found
Prospective surveillance of invasive group a streptococcal disease, Fiji, 2005-2007.
We undertook a prospective active surveillance study of invasive group A streptococcal (GAS) disease in Fiji over a 23-month period, 2005-2007. We identified 64 cases of invasive GAS disease, which represents an average annualized all-ages incidence of 9.9 cases/100,000 population per year (95% confidence interval [CI] 7.6-12.6). Rates were highest in those >65 years of age and in those <5 years, particularly in infants, for whom the incidence was 44.9/100,000 (95% CI 18.1-92.5). The case-fatality rate was 32% and was associated with increasing age and underlying coexisting disease, including diabetes and renal disease. Fifty-five of the GAS isolates underwent emm sequence typing; the types were highly diverse, with 38 different emm subtypes and no particular dominant type. Our data support the view that invasive GAS disease is common in developing countries and deserves increased public health attention
Prospective Surveillance of Invasive Group A Streptococcal Disease, Fiji, 2005–2007
These infections are more common and case-fatality rate is higher in Fiji than in industrialized countries
Focused cardiac ultrasound screening for rheumatic heart disease by briefl y trained health workers: a study of diagnostic accuracy
Background Echocardiographic screening for rheumatic heart disease (RHD) can identify individuals with subclinical
disease who could benefi t from antibiotic prophylaxis. However, most settings have inadequate resources to
implement conventional echocardiography and require a feasible, accurate screening method. We aimed to investigate
the accuracy of screening by non-expert operators using focused cardiac ultrasound (FoCUS).
Methods In this prospective study of diagnostic accuracy, we recruited schoolchildren aged 5 to 15 years in Fiji to
undergo two blinded tests. The index test was a FoCUS assessment of mitral and aortic regurgitation, performed by
nurses after an 8-week training programme. The reference standard was the diagnosis of RHD by a paediatric
cardiologist, based on a standard echocardiogram performed by a skilled echocardiographer. The primary outcome
was the accuracy of the index test with use of the most sensitive criteria (any regurgitation).
Findings We included 2004 children in the study. The index tests were done between September, 2012, and
September, 2013, by seven nurses in eight schools in Fiji. The diagnostic accuracy of the screening test (area under
receiver operator characteristic curve) was 0·89 (95% CI 0·83–0·94). When the primary cut-off point (any
regurgitation) was used for analysis, sensitivity was 84·2% (72·1–92·5) and specifi city was 85·6% (83·9–87·1). The
sensitivity of individual nurses ranged from 66·7% to 100% and specifi city 74·0% to 93·7%.
Interpretation Screening by briefl y trained nurses using FoCUS was accurate for the diagnosis of RHD. Refi nements
to training and screening test methods should be studied in a range of settings, and in parallel with investigations of
the long-term clinical and cost-eff ectiveness of screening for RHD
Molecular Tracers of the Central 12 pc of the Galactic Center
We have used the BIMA array to image the Galactic Center with a 19-pointing
mosaic in HCN(1-0), HCO+(1-0), and H 42-alpha emission with 5 km/s velocity
resolution and 13'' x 4'' angular resolution. The 5' field includes the
circumnuclear ring (CND) and parts of the 20 and 50 km/s clouds. HCN(1-0) and
HCO+ trace the CND and nearby giant molecular clouds while the H 42-alpha
emission traces the ionized gas in Sgr A West. We find that the CND has a
definite outer edge in HCN and HCO+ emission at ~45'' radius and appears to be
composed of two or three distinct streams of molecular gas rotating around the
nucleus. Outside the CND, HCN and HCO+ trace dense clumps of high-velocity gas
in addition to optically thick emission from the 20 and 50 km/s clouds. A
molecular ridge of compressed gas and dust, traced in NH3 emission and
self-absorbed HCN and HCO+, wraps around the eastern edge of Sgr A East. Just
inside this ridge are several arcs of gas which have been accelerated by the
impact of Sgr A East with the 50 km/s cloud. HCN and HCO+ emission trace the
extension of the northern arm of Sgr A West which appears to be an independent
stream of neutral and ionized gas and dust originating outside the CND. Broad
line widths and OH maser emission mark the intersection of the northern arm and
the CND. Comparison to previous NH3 and 1.2mm dust observations shows that HCN
and HCO+ preferentially trace the CND and are weaker tracers of the GMCs than
NH3 and dust. We discuss possible scenarios for the emission mechanisms and
environment at the Galactic center which could explain the differences in these
images.Comment: 24 pages, including 17 figures; to appear in The Astrophysical
Journa
Scabies prevalence after ivermectin-based mass drug administration for lymphatic filariasis, Samoa 2018–2019
Background: Scabies is a common skin infestation caused by the Sarcoptes scabei mite. Ivermectin, one of three drugs used in mass drug administration (MDA) for lymphatic filariasis, is also effec-tive for treating scabies. Ivermectin-based MDA was first conducted in Samoa in August 2018, with ivermectin being offered to those aged ≥5 years. Here, we report scabies prevalence in Samoa after MDA.
Methods: We conducted household surveys 1.5–3.5 months (Survey 1) and 6–8 months (Survey 2) after the 2018 MDA in 35 primary sampling units. We conducted clinical examination for sca-bies-like rash and used International Alliance for the Control of Scabies classification crite-ria. We estimated scabies prevalence by age, gender and region. Multivariable logistic regression was used to assess factors associated with prevalence.
Results: We surveyed 2868 people (499 households) and 2796 people (544 households) aged 0–75 years in Surveys 1 and 2, respectively. Scabies prevalence increased from 2.4% (95% CI 2.1–2.7%) to 4.4% (95% CI 4.0–4.9%) between surveys. Scabies was associated with younger age (0–4 years: aOR 3.5 [2.9–4.2]; 5–15 years: aOR 1.6 [1.4–1.8] compared to ≥16 years), female gender (aOR 1.2 [95% CI 1.1–1.4]; region (aOR range from 1.4 [1.1– 1.7] to 2.5 [2.1–3.1] between regions), large households (aOR 2.6 [2.0–3.4] households ≥13), and not taking MDA in 2018 (aOR 1.3 [95% CI 1.1–1.6]).
Conclusions: We found moderate prevalence of scabies in two population-representative surveys conducted within 8 months of the 2018 MDA for lymphatic filariasis. Prevalence appeared to increase between the surveys, and ongoing surveillance is recommended, particularly in young children
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