A comparison of clinical and radiological findings in adults and children with Japanese encephalitis

Background: Japanese encephalitis (JE) is the most common human endemic encephalitis, prevalent mainly in Southeast Asia. It affects both adults and children in different areas, but there is no comparative study of their clinical features and outcomes. Objective: To evaluate clinical and radiological features in adults and children with JE. Methods: Patients with serologically or virologically confirmed JE who were treated during the past 10 years were included in this study. All patients underwent a detailed neurological examination, computed tomography, or magnetic resonance imaging. The presence of movement disorders, anterior horn cell involvement, and electroencephalographic changes was noted. After 6 months, each patient's outcome was defined as poor, partial, or complete recovery. The clinical and radiological findings for both adults and children were compared using χ2 tests. Results: The results are based on 30 children and 37 adults. Seizure was present in 23 adults (62.2%) and in 17 children (56.7%). Three children had associated neurocysticercosis, and all of them had partial seizures. The occurrence of focal neurological deficit, anterior horn cell involvement, and parkinsonian features was not significantly different between adults and children. Dystonia was more common in children, occurring in 20 (66.7%) compared with 7 adults (18.9%). Six adults died, but none of the children did; however, the 6-month outcome was better for surviving adults compared with the children. Computed tomography and magnetic resonance imaging findings were not significantly different between the 2 groups. Conclusions: Children with JE are more likely to have dystonia and a poor outcome at 6 months compared with adults. The difference in clinical findings and outcome in children and adults with JE may be owing to immunological factors, maturation of the central nervous system, and neuronal plasticity

Design of electron beam bending magnet system for electron and photon therapy: A simulation approach

The doubly achromatic electron beam bending magnet system using two sector magnets has been designed for the medical applications to treat the cancer. The aim of electron beam bending magnet system is to focus an electron beam having a spot size less than 3 mm × 3 mm, energy spread within 3% and divergence angle ≤ 3mrad at the target position. To achieve these parameters, the simulation has been carried out using Lorentz-3EM software. The beam spot, divergence angle and energy spread have been observed with respect to the variation in angles of sector magnets and drift distance. Based on the simulated results, it has been optimized that the first and second magnet has an angle 206° and 35° and the drift distance 80 mm. It is also observed that at the 1125, 1762, 2570, 3265 and 4155 Amp-turn, the optimized design produces 3369, 4972, 6384, 7584 and 9568 Gauss of magnetic field at median plane which require to bend 6, 9, 12, 15 and 18 MeV energy of electron, respectively, for the electron therapy application. The output beam parameters of the optimized design are energy spread ±3%, divergence angle ~3 mrad and spot size 2.6 mm. Moreover, for 6 MV and 15 MV photon therapy applications, an electron beam of energy 6.5 MeV and 15.5 MeV extracted from magnet system and focused on the bremsstrahlung target. Various materials have been studied for photon generation using Monte Carlo based Fluka code and Tungsten material has been optimized as bremsstrahlung target which produces continuous energy bremsstrahlung spectrum. For the photon therapy, the 1233 and 3327 amp-turn, in an optimized design produces 3616 and 7785 Gauss of magnetic field at median plane require to bend 6.5 and 15.5 MeV energy of electron, respectively, which further produces bremsstrahlung radiation from Tungsten target

Thermoluminescence studies of CaSO4: Eu nanophosphor for electron dosimetry

Sample of CaSO4: Eu nanophosphor has been synthesized by chemical co-precipitation method and irradiated with 6.5 MeV electrons over the fluence range from 5×1014 to 4×1015 e/cm2. The as-synthesized sample has been characterized by the XRD and TEM. The TEM image reveals that the nanocrystallites are in the form of nanorods of length 75 to 125 nm, with varying diameter of 10 to 20 nm. The XRD yields an average grain size ~15 nm, with hexagonal structure. The electron irradiated samples exhibit the thermoluminescence glow curve with a single peak at 162 °C. Moreover, the TL peak intensity increases with the increase in electron fluence and saturates beyond 3×1015 e/cm2. Moreover, TL glow curves have been theoretically fitted using computerized glow curve deconvolution (CGCD) method to determine trapping parameters. The results indicate that CaSO4: Eu can be used as a dosimeter for 6.5 MeV electrons over dose range from 15-80 kGy

Acute encephalitis syndrome surveillance, Kushinagar district, Uttar Pradesh, India, 2011-2012

In India, quality surveillance for acute encephalitis syndrome (AES), including laboratory testing, is necessary for understanding the epidemiology and etiology of AES, planning interventions, and developing policy. We reviewed AES surveillance data for January 2011-June 2012 from Kushinagar District, Uttar Pradesh, India. Data were cleaned, incidence was determined, and demographic characteristics of cases and data quality were analyzed. A total of 812 AES case records were identified, of which 23\% had illogical entries. AES incidence was highest among boys<6 years of age, and cases peaked during monsoon season. Records for laboratory results (available for Japanese encephalitis but not AES) and vaccination history were largely incomplete, so inferences about the epidemiology and etiology of AES could not be made. The low-quality AES/Japanese encephalitis surveillance data in this area provide little evidence to support development of prevention and control measures, estimate the effect of interventions, and avoid the waste of public health resources

Identifying sources, pathways and risk drivers in ecosystems of Japanese Encephalitis in an epidemic-prone north Indian district

Japanese Encephalitis (JE) has caused repeated outbreaks in endemic pockets of India. This study was conducted in Kushinagar, a highly endemic district, to understand the human-animal-ecosystem interactions, and the drivers that influence disease transmission. Utilizing the ecosystems approach, a cross-sectional, descriptive study, employing mixed methods design was employed. Four villages (two with pig-rearing and two without) were randomly selected from a high, a medium and a low burden (based on case counts) block of Kushinagar. Children, pigs and vectors were sampled from these villages. A qualitative arm was incorporated to explain the findings from the quantitative surveys. All human serum samples were screened for JE-specific IgM using MAC ELISA and negative samples for JE RNA by rRT-PCR in peripheral blood mononuclear cells. In pigs, IgG ELISA and rRT-PCR for viral RNA were used. Of the 242 children tested, 24 tested positive by either rRT-PCR or MAC ELISA; in pigs, 38 out of the 51 pigs were positive. Of the known vectors, Culex vishnui was most commonly isolated across all biotopes. Analysis of 15 blood meals revealed human blood in 10 samples. Univariable analysis showed that gender, religion, lack of indoor residual spraying of insecticides in the past year, indoor vector density (all species), and not being vaccinated against JE in children were significantly associated with JE positivity. In multivariate analysis, only male gender remained as a significant risk factor. Based on previous estimates of symptomatic: asymptomatic cases of JE, we estimate that there should have been 618 cases from Kushinagar, although only 139 were reported. Vaccination of children and vector control measures emerged as major control activities; they had very poor coverage in the studied villages. In addition, lack of awareness about the cause of JE, lack of faith in the conventional medical healthcare system and multiple referral levels causing delay in diagnosis and treatment emerged as factors likely to result in adverse clinical outcomes

Global respiratory syncytial virus–related infant community deaths

Background Respiratory syncytial virus (RSV) is a leading cause of pediatric death, with >99% of mortality occurring in low- and lower middle-income countries. At least half of RSV-related deaths are estimated to occur in the community, but clinical characteristics of this group of children remain poorly characterized. Methods The RSV Global Online Mortality Database (RSV GOLD), a global registry of under-5 children who have died with RSV-related illness, describes clinical characteristics of children dying of RSV through global data sharing. RSV GOLD acts as a collaborative platform for global deaths, including community mortality studies described in this supplement. We aimed to compare the age distribution of infant deaths <6 months occurring in the community with in-hospital. Results We studied 829 RSV-related deaths <1 year of age from 38 developing countries, including 166 community deaths from 12 countries. There were 629 deaths that occurred <6 months, of which 156 (25%) occurred in the community. Among infants who died before 6 months of age, median age at death in the community (1.5 months; IQR: 0.8−3.3) was lower than in-hospital (2.4 months; IQR: 1.5−4.0; P < .0001). The proportion of neonatal deaths was higher in the community (29%, 46/156) than in-hospital (12%, 57/473, P < 0.0001). Conclusions We observed that children in the community die at a younger age. We expect that maternal vaccination or immunoprophylaxis against RSV will have a larger impact on RSV-related mortality in the community than in-hospital. This case series of RSV-related community deaths, made possible through global data sharing, allowed us to assess the potential impact of future RSV vaccines