High mortality associated with an outbreak of hepatitis E among displaced persons in Darfur, Sudan

BACKGROUND: Hepatitis E virus (HEV) causes acute onset of jaundice and a high case-fatality ratio in pregnant women. We provide a clinical description of hospitalized case patients and assess the specific impact on pregnant women during a large epidemic of HEV infection in a displaced population in Mornay camp (78,800 inhabitants), western Darfur, Sudan. METHODS: We reviewed hospital records. A sample of 20 clinical cases underwent laboratory confirmation. These patients were tested for immunoglobulin G (IgG) and immunoglobulin M (IgM) antibody to HEV (serum) and for amplification of the HEV genome (serum and stool). We performed a cross-sectional survey in the community to determine the attack rate and case-fatality ratio in pregnant women. RESULTS: Over 6 months, 253 HEV cases were recorded at the hospital, of which 61 (24.1%) were in pregnant women. A total of 72 cases (39.1% of those for whom clinical records were available) had a diagnosis of hepatic encephalopathy. Of the 45 who died (case-fatality ratio, 17.8%), 19 were pregnant women (specific case-fatality ratio, 31.1%). Acute hepatitis E was confirmed in 95% (19/20) of cases sampled; 18 case-patients were positive for IgG (optical density ratio > or =3), for IgM (optical density ratio >2 ), or for both, whereas 1 was negative for IgG and IgM but positive for HEV RNA in serum. The survey identified 220 jaundiced women among the 1133 pregnant women recorded over 3 months (attack rate, 19.4%). A total of 18 deaths were recorded among these jaundiced pregnant women (specific case-fatality ratio, 8.2%). CONCLUSIONS: This large epidemic of HEV infection illustrates the dramatic impact of this disease on pregnant women. Timely interventions and a vaccine are urgently needed to prevent mortality in this special group

A Large Outbreak of Hepatitis E Among a Displaced Population in Darfur, Sudan, 2004: The Role of Water Treatment Methods.

BACKGROUND: The conflict in Darfur, Sudan, was responsible for the displacement of 1.8 million civilians. We investigated a large outbreak of hepatitis E virus (HEV) infection in Mornay camp (78,800 inhabitants) in western Darfur. METHODS: To describe the outbreak, we used clinical and demographic information from cases recorded at the camp between 26 July and 31 December 2004. We conducted a case-cohort study and a retrospective cohort study to identify risk factors for clinical and asymptomatic hepatitis E, respectively. We collected stool and serum samples from animals and performed a bacteriological analysis of water samples. Human samples were tested for immunoglobulin G and immunoglobulin M antibody to HEV (for serum samples) and for amplification of the HEV genome (for serum and stool samples). RESULTS: In 6 months, 2621 hepatitis E cases were recorded (attack rate, 3.3%), with a case-fatality rate of 1.7% (45 deaths, 19 of which involved were pregnant women). Risk factors for clinical HEV infection included age of 15-45 years (odds ratio, 2.13; 95% confidence interval, 1.02-4.46) and drinking chlorinated surface water (odds ratio, 2.49; 95% confidence interval, 1.22-5.08). Both factors were also suggestive of increased risk for asymptomatic HEV infection, although this was not found to be statistically significant. HEV RNA was positively identified in serum samples obtained from 2 donkeys. No bacteria were identified from any sample of chlorinated water tested. CONCLUSIONS: Current recommendations to ensure a safe water supply may have been insufficient to inactivate HEV and control this epidemic. This research highlights the need to evaluate current water treatment methods and to identify alternative solutions adapted to complex emergencies

An Experimental Platform for Pulsed-Power Driven Magnetic Reconnection

We describe a versatile pulsed-power driven platform for magnetic reconnection experiments, based on exploding wire arrays driven in parallel [Suttle, L. G. et al. PRL, 116, 225001]. This platform produces inherently magnetised plasma flows for the duration of the generator current pulse (250 ns), resulting in a long-lasting reconnection layer. The layer exists for long enough to allow evolution of complex processes such as plasmoid formation and movement to be diagnosed by a suite of high spatial and temporal resolution laser-based diagnostics. We can access a wide range of magnetic reconnection regimes by changing the wire material or moving the electrodes inside the wire arrays. We present results with aluminium and carbon wires, in which the parameters of the inflows and the layer which forms are significantly different. By moving the electrodes inside the wire arrays, we change how strongly the inflows are driven. This enables us to study both symmetric reconnection in a range of different regimes, and asymmetric reconnection.Comment: 14 pages, 9 figures. Version revised to include referee's comments. Submitted to Physics of Plasma

Impact of Mechanical Unloading on Microvasculature and Associated Central Remodeling Features of the Failing Human Heart

ObjectivesThis study investigates alterations in myocardial microvasculature, fibrosis, and hypertrophy before and after mechanical unloading of the failing human heart.BackgroundRecent studies demonstrated the pathophysiologic importance and significant mechanistic links among microvasculature, fibrosis, and hypertrophy during the cardiac remodeling process. The effect of left ventricular assist device (LVAD) unloading on cardiac endothelium and microvasculature is unknown, and its influence on fibrosis and hypertrophy regression to the point of atrophy is controversial.MethodsHemodynamic data and left ventricular tissue were collected from patients with chronic heart failure at LVAD implant and explant (n = 15) and from normal donors (n = 8). New advances in digital microscopy provided a unique opportunity for comprehensive whole-field, endocardium-to-epicardium evaluation for microvascular density, fibrosis, cardiomyocyte size, and glycogen content. Ultrastructural assessment was done with electron microscopy.ResultsHemodynamic data revealed significant pressure unloading with LVAD. This was accompanied by a 33% increase in microvascular density (p = 0.001) and a 36% decrease in microvascular lumen area (p = 0.028). We also identified, in agreement with these findings, ultrastructural and immunohistochemical evidence of endothelial cell activation. In addition, LVAD unloading significantly increased interstitial and total collagen content without any associated structural, ultrastructural, or metabolic cardiomyocyte changes suggestive of hypertrophy regression to the point of atrophy and degeneration.ConclusionsThe LVAD unloading resulted in increased microvascular density accompanied by increased fibrosis and no evidence of cardiomyocyte atrophy. These new insights into the effects of LVAD unloading on microvasculature and associated key remodeling features might guide future studies of unloading-induced reverse remodeling of the failing human heart

Counter-propagating radiative shock experiments on the Orion laser and the formation of radiative precursors

We present results from new experiments to study the dynamics of radiative shocks, reverse shocks and radiative precursors. Laser ablation of a solid piston by the Orion high-power laser at AWE Aldermaston UK was used to drive radiative shocks into a gas cell initially pressurised between $0.1$ and $1.0 \ bar with different noble gases. Shocks propagated at {80 \pm 10 \ km/s} and experienced strong radiative cooling resulting in post-shock compressions of { \times 25 \pm 2}. A combination of X-ray backlighting, optical self-emission streak imaging and interferometry (multi-frame and streak imaging) were used to simultaneously study both the shock front and the radiative precursor. These experiments present a new configuration to produce counter-propagating radiative shocks, allowing for the study of reverse shocks and providing a unique platform for numerical validation. In addition, the radiative shocks were able to expand freely into a large gas volume without being confined by the walls of the gas cell. This allows for 3-D effects of the shocks to be studied which, in principle, could lead to a more direct comparison to astrophysical phenomena. By maintaining a constant mass density between different gas fills the shocks evolved with similar hydrodynamics but the radiative precursor was found to extend significantly further in higher atomic number gases (\sim$$4$ times further in xenon than neon). Finally, 1-D and 2-D radiative-hydrodynamic simulations are presented showing good agreement with the experimental data.Comment: HEDLA 2016 conference proceeding

Radiative cooling effects on reverse shocks formed by magnetised supersonic plasma flows

We study the structure of reverse shocks formed by the collision of supersonic, magnetised plasma flows driven by an inverse (or exploding) wire array with a planar conducting obstacle. We observe that the structure of these reverse shocks varies dramatically with wire material, despite the similar upstream flow velocities and mass densities. For aluminium wire arrays, the shock is sharp and well defined, consistent with magneto-hydrodynamic theory. In contrast, we do not observe a well-defined shock using tungsten wires, instead, we see a broad region dominated by density fluctuations on a wide range of spatial scales. We diagnose these two very different interactions using interferometry, Thomson scattering, shadowgraphy, and a newly developed imaging refractometer which is sensitive to small deflections of the probing laser corresponding to small-scale density perturbations. We conclude that the differences in shock structure are most likely due to radiative cooling instabilities which create small-scale density perturbations elongated along magnetic field lines in the tungsten plasma. These instabilities grow more slowly and are smoothed by thermal conduction in the aluminium plasma

Design and fabrication of gas cell targets for laboratory astrophysics experiments on the Orion high-power laser facility

This paper describes the design and fabrication of a range of ‘gas cell’ microtargets produced by the Target Fabrication Group in the Central Laser Facility (CLF) for academic access experiments on the Orion laser facility at the Atomic Weapons Establishment (AWE). The experiments were carried out by an academic consortium led by Imperial College London. The underlying target methodology was an evolution of a range of targets used for experiments on radiative shocks and involved the fabrication of a precision machined cell containing a number of apertures for interaction foils or diagnostic windows. The interior of the cell was gas-filled before laser irradiation. This paper details the assembly processes, thin film requirements and micro-machining processes needed to produce the targets. Also described is the implementation of a gas-fill system to produce targets that are filled to a pressure of 0.1–1 bar. The paper discusses the challenges that are posed by such a target

Determination of quality of life in adolescents with idiopathic scoliosis subjected to conservative treatment.

<p>Abstract</p> <p>Introduction and objectives</p> <p>Physical deformities caused by adolescent idiopathic scoliosis (AIS) coupled with conservative treatment of AIS with orthesis unavoidably impacts on patients' quality of life (QoL). The present study aimed at evaluating the QoL in patients affected by AIS treated with brace. The study also sought to determine the ability of different QoL questionnaires to monitor QoL over the course of treatment.</p> <p>Materials and methods</p> <p>Data were collected in 108 consecutive patients (96 females, 16 males) affected by AIS admitted to the outpatient orthopaedic clinic of the Catholic University of the Sacred Heart in Rome (Italy). Patients were subjected to full-time (i.e., 22 hrs per day) conservative treatment with the progressive action short brace (PASB), the Lyon brace or a combination of PASB + Lyon brace. Three instruments were used for QoL determination: the Scoliosis Research Society 22 (SRS-22), Bad Sobernheim Stress Questionnaire (BSSQ) and the Brace Questionnaire (BrQ).</p> <p>Results</p> <p>A significant correlation was detected among the 3 scores (p < 0.001). The BrQ possesses a higher capacity to detect changes in QoL in relation to the patient gender, type of brace, curve severity at baseline and at the completion of treatment, and curve type. Overall, boys displayed a higher QoL than girls. In all 3 questionnaires, higher QoL scores were determined in patients treated with the PASB compared with those using the Lyon brace. QoL scores were significantly correlated with the curve severity. Higher QoL scores were obtained by participants with thoraco-lumbar curves as compared with those with other curves.</p> <p>Conclusions</p> <p>The 3 questionnaires are effective in capturing changes in QoL in AIS patients subjected to conservative treatment. However, the BrQ possesses a higher discriminatory capacity compared with the other questionnaires tested. PASB-based treatment is associated with better QoL than the Lyon bracing.</p