Cerebral malaria admissions in Papua New Guinea may show inter-annual cyclicity: An example of about a 1.5-year cycle for malaria incidence in Burundi

Best available descriptions of malaria incidence and mortality dynamics are important to better plan and evaluate the implementation of programs to monitor (e.g., remote sensing) and control the disease, especially in endemic zones. This was stressed recently by Cibulskis et al (2007) in the view of completeness of monthly reporting for cerebral malaria admissions in Papua New Guinea (latitude 6 degree S, 1987-1996). Notably, regardless of the rate of its completeness, the temporal dynamics of admissions was preserved over the years, however, neither raw data nor results on further analyses about eventual inter-annual cyclic components (periods T>1 year) were provided despite obvious graphical patterns for such a specific time structure (chronome). Interestingly, in a recent analysis by Gomez-Elipe et al (2007) on monthly malaria notifications in Burundi, at almost the same latitude (province of Karuzi, >3 degree S, 1997-2001), the data have shown neither trend not periodic oscillations beyond a 6-month (0.5-year) period. Since the graphical representation of both data sets have indicated an eventual existence of inter-annual variations, and because both are located at the same latitude zone, we have further analyzed the data from Burundi for such periodic oscillations. By using a periodogram regression analysis, we discovered a multicomponent cyclic chronome with periods above 12 months (T=17.5-18.0, 27.5 and 65.0-65.5 months, all at p<0.05). Notably, the most strong cyclic pattern at p<0.002 in the periodogram of the detrended malaria rates in Burundi remained only that with a peak at about 1.5 years (period T=17.5-18.0 months, R=0.51, z=5.3). It is possible that likely inter-annual cyclic patterns might exist also in the time structure for cerebral malaria admissions in Papua New Guinea and, if confirmed, these may be found very useful in epidemic forecasting and programs implementation. We explored these cyclic variations and also discussed possible associations with environmental factors exhibiting alike cyclicity

Results from the National Strategy for improvement of iodine nutrition in Bulgaria: a study of children and pregnant women living in an iodine-deficient area

Background: A significant part of Bulgaria is considered an iodine-deficient area. The National Strategy for Prevention and Control of Iodine Deficiency Disorders (IDD) was developed in 1994, and regular surveys undertaken in 2000–2003 indicated a normalization of the iodine supply in the Bulgarian population, including some at-risk population groups (children, schoolchildren, pregnant women). Despite the results achieved, mandating periodic cohort surveys for tracking the elimination of iodine deficiency is necessary. Objective: The aim of this study was to evaluate the results of the the national strategy for improvement of iodine nutrition in children and pregnant women living in an iodine-deficient area in Bulgaria 15 years after its update. Subjects and methods: Study subjects were 73 children aged 9.21 ± 2.07 years (29 boys and 44 girls) and 16 pregnant women living in the town of Asenovgrad. Urinary iodine concentration was measured and used as an index of iodine intake. Results: The median urinary iodine of the inspected children was between 100–199 μg/l, which is an indicator of optimal iodine nutrition. Almost 1/3 of the children (31.5%) had iodine deficiency. The median urinary iodine concentration of the 16 pregnant women investigated was 127.0 μg/l, which is an indicator of insufficient iodine intake. Conclusion: Despite the normalization of the iodine supply in the past years in the at-risk population groups of children and pregnant women, a considerable portion of them still has iodine deficiency. Recommendations for improving health education and iodine nutrition in at-risk population groups were made

Cerebral Venous Sinus Thrombosis - Diagnostic Strategies and Prognostic Models: A Review

In 1825, Ribes described a case of a 45-year old man who died after a 6-month history of epilepsy, seizures and delirium. The autopsy examination revealed thrombosis of the superior sagittal sinus, the left lateral sinus and a cortical vein in the parietal region. This was probably the first detailed description of extensive cerebral venous sinus thrombosis (CVST). Since then, the literature describing this disease has comprised of case reports, series and some newer prospective studies, including recent reviews and guidelines (statement) on the diagnosis and management of CVST (Siddiqui \u26 Kamal, 2006; Stam, 2005; Saposnik et al, 2011; Brown \u26 Thore, 2011). The cerebral venous sinus thrombosis is a challenging condition and it is most common than previously thought. CVST accounts for 0.5% to 1.0% of all strokes and usually affects young individuals. Important advances have been made in the understanding of the pathophysiology of this vascular disorder. The diagnosis of CVST is still frequently overlooked or delayed as a result of the wide spectrum of clinical symptoms and the often sub-acute or lingering onset. Patients with CVST commonly present with headache, although some develop a focal neurological deficit, decreased level of consciousness, seizures, or intracranial hypertension without focal neurological signs. Uncommonly, an insidious onset may create a diagnostic challenge. The main problem of this disorder is that it is very often unrecognised at initial presentation. In particular, a prothrombotic factor or a direct cause is identified in approximately 66% of the CVST patients (a list of most important causal and risk factors are listed in Table 1). Cerebral venous thrombosis is more common in women than men, with a female to male ratio of 3:1 (cited in Ferro \u26 Canhao, 2011). The imbalance may be due to the increased risk of CVST associated with pregnancy and puerperium and with oral contraceptives. The female predominance in CVST is found in young adults, but not in children or older adults

Metabolic syndrome severity score: range and associations with cardiovascular risk factors

Introduction: Metabolic Syndrome Severity Score (MSSS) is a new clinical prediction rule (CPR) for diagnostic and therapeutic decisions and employs available components (sex, age, race, systolic blood pressure, waistline circumference, high-density lipoprotein, triglycerides and fasting blood glucose). The aim of our work was to perform cross-sectional pilot trial on middle-aged healthy volunteers and patients with metabolic syndrome (MetS) with and without type 2 diabetes mellitus (T2DM) for studying feasibility and implementation of MSSS and its associations with cardiovascular risk factors.Material and methods: We approached 64 eligible participants from Bulgaria. The MSSS values, together with demographic, anthropometric, medical history, laboratory findings, CVD risk factors, QRISK2 score for 10-year cardiovascular risk and predicted heart age, were analysed. Descriptive statistics with tests for comparison (e.g., t-test, c2) between groups as well as ANOVA and logistic regression were applied. Results: We analysed data from 56 participants (aged 50.11 ±3.43 years). The MSSS was higher in MetS patients (including 6 T2DM patients) than in controls (n = 29; 51.8%) presented as percentiles (69.97% and 34.41%, respectively) and z-scores (0.60 and –0.45, respectively) (p < 0.05). The logistic regression model of MSSS indicated a positive association with MetS/T2DM cases (correctness > 85%, p < 0.01). For further validation purposes, positive correlations of MSSS with CVDrisk factor as diastolic blood pressure (Rho = 0.399; p < 0.003) and QRISK2 score (Rho = 0.524; p < 0.001) or predicted heart age (Rho = 0.368; p < 0.007) were also found.Conclusions: The pilot study of MSSS in Bulgaria indicated feasibility and consistency of its implementation among patients with metabolic syndrome and/or T2DM and healthy volunteers

Ultrazvučne značajke bulbouretralnih žlijezda kunića (Oryctolagus cuniculus).

The aim of the study was to describe some of the ultrasonographic features of domestic rabbit bulbourethral glands, with regard to their relevance to reproductive pathology. The glands of ten sexually mature, clinically healthy, white, male New Zealand rabbits, aged 18 months, with body masses ranging from 2.8-3.2 kg, were investigated following anaesthesia. A perineal sonographic approach was applied. The glands were observed in two planes. They were viewed sonographically as solid, hyperechoic, heterogeneous structures. A hyperechoic gland without a hypoechoic center was visualized in sagittal section. In transverse section, normal bulbourethral glands were visualized dorsolaterally to the bulbar urethra, and a hypoechoic urethra was located ventromedially. As part of the study, the sonographic features of the bulbourethral glands were compared in a liquid isotonic medium. The analogous results of both methods allowed us to propose the use of perineal ultrasonography as a sufficiently definitive, non-invasive method for visualizing rabbit bulbourethral glands.Cilj ovog istraživanja bio je opisati neke ultrazvučne značajke bulbouretralnih žlijezda kunića s obzirom na njihovu važnost u patologiji spolnih organa. Nakon anestezije bile su pretražene žlijezde 10 spolno zrelih, klinički zdravih kunića bijele novozelandske pasmine u dobi od 18 mjeseci, tjelesne mase 2,8 - 3,2 kg. Ultrazvučna pretraga obavljena je u perinealnom području. Žlijezde su bile pretražene u dvije ravnine. Ultrazvučno su se vidjele kao dvije hiperehogene solidne, heterogene tvorevine. Hiperehogena žlijezda bez hipoehogenog centra bila je uočljiva na sagitalnoj ravnini. U poprječnoj ravnini normalne bulbouretralne žlijezde uočavale su se dorzolateralno od bulbarne uretre, a hipoehonogena uretra bila je smještena ventromedijalno.Ultrazvučne značajke bulbouretralnih žlijezda bile su uspoređivane u odnosu na izotonični tekući medij. Na osnovi postignuća sličnih rezultata dvjema metodama može se predložiti perinealni ultrazvučni pristup kao primjerena neinvazivna metoda za vizualizaciju bulbouretralnih žlijezda kunića