Epidemiology of febrile diseases in the emergency department of a Caribbean Island: The Curaçao experience

Objective: The aetiology of febrile diseases in tropical countries often remains poorly characterized. We aim to describe the aetiology and outcome of febrile illnesses at the Emergency Department (ED) in Curaçao. Methods: From April 2008 - April 2009, all adult febrile patients (T > 38.5 oC) at the ED of the St Elisabeth Hospital, Curaçao, Netherlands Antilles, were included. Clinical data were recorded, routine laboratory measurements and blood cultures were taken. Final diagnoses were made at discharge by an independent physician and in retrospect by the main investigator. Results: Four hundred and three patients were included: 223 patients (55.6%) were hospitalized, 32 patients (7.9%) died and 18 patients (4.5%) were admitted to the Intensive Care Unit. In 129 febrile patients (32.0%), infection was proven; 84.4% of patients had bacterial (29.0% urinary tract infection, 23.2% pneumonia infection), 5.6% viral and 10.0% parasitic or fungal infections. Twenty-one patients (5.2%) were discharged with a non-infectious diagnosis and 172 patients (42.7%) without a clear diagnosis. Conclusion: A high mortality rate of 7.9% was observed. We found a high prevalence of bacterial infections, with pneumonia and urinary tract infections as the most common causes of fever. One in 20 patients did not have an infectious disease

Sickle cell patients are characterized by a reduced glycocalyx volume

The glycocalyx is an important anti-inflammatory and anti-adhesive barrier at the luminal side of endothelial cells. Glycocalyx volume was significantly reduced in sickle cell patients (HbSS/HbSβ0-thalassemia median 0.47L, IQR 0.27-0.66, HbSC/HbSβ+-thalassemia 0.23L, 0.0-0.58) compared with controls (1×109L, 0.52-1.77) (p=0.03). Reduced glycocalyx may be a new factor in the pathophysiology of sickle cell disease

Non-AIDS defining cancers in the D:A:D Study-time trends and predictors of survival : a cohort study

BACKGROUND:Non-AIDS defining cancers (NADC) are an important cause of morbidity and mortality in HIV-positive individuals. Using data from a large international cohort of HIV-positive individuals, we described the incidence of NADC from 2004-2010, and described subsequent mortality and predictors of these.METHODS:Individuals were followed from 1st January 2004/enrolment in study, until the earliest of a new NADC, 1st February 2010, death or six months after the patient's last visit. Incidence rates were estimated for each year of follow-up, overall and stratified by gender, age and mode of HIV acquisition. Cumulative risk of mortality following NADC diagnosis was summarised using Kaplan-Meier methods, with follow-up for these analyses from the date of NADC diagnosis until the patient's death, 1st February 2010 or 6 months after the patient's last visit. Factors associated with mortality following NADC diagnosis were identified using multivariable Cox proportional hazards regression.RESULTS:Over 176,775 person-years (PY), 880 (2.1%) patients developed a new NADC (incidence: 4.98/1000PY [95% confidence interval 4.65, 5.31]). Over a third of these patients (327, 37.2%) had died by 1st February 2010. Time trends for lung cancer, anal cancer and Hodgkin's lymphoma were broadly consistent. Kaplan-Meier cumulative mortality estimates at 1, 3 and 5 years after NADC diagnosis were 28.2% [95% CI 25.1-31.2], 42.0% [38.2-45.8] and 47.3% [42.4-52.2], respectively. Significant predictors of poorer survival after diagnosis of NADC were lung cancer (compared to other cancer types), male gender, non-white ethnicity, and smoking status. Later year of diagnosis and higher CD4 count at NADC diagnosis were associated with improved survival. The incidence of NADC remained stable over the period 2004-2010 in this large observational cohort.CONCLUSIONS:The prognosis after diagnosis of NADC, in particular lung cancer and disseminated cancer, is poor but has improved somewhat over time. Modifiable risk factors, such as smoking and low CD4 counts, were associated with mortality following a diagnosis of NADC

Increased serum levels of anti-angiogenic factors soluble fms-like tyrosine kinase and soluble endoglin in sickle cell disease

The anti-angiogenic factors soluble fms-like tyrosine kinase (sFlt)-1 and soluble endoglin (sEng) have been shown to be of importance in angiogenesis by sequestering and inhibiting vascular endothelial growth factor, placenta-like growth factor and transforming growth factor-beta(1) signaling. Given the potential role of angiogenesis in the pathophysiology of sickle cell disease (SCD)-related complications, serum levels of sFlt-1 and sEng were determined in SCD patients and controls. Both sFlt-1 (p = 0.002) and sEng (p = 0.004) were elevated in patients during clinically asymptomatic SCD with no further increment during painful crisis. These data suggest that sFlt-1 and sEng may be important in the regulation of angiogenesis in SCD

Recent Geometric Flows in Multi-orientation Image Processing via a Cartan Connection

Applications of geometric flows to multi-orientation image processing require the choice of an (affine) connection on the Lie group G of roto-translations. Typical choices of such connections are called the (−), (0) and (+) connection. As the construction of these connections in standard references is quite involved, we provide an overview. We show that these connections are members of a larger, one-parameter class of connections, and we motivate that the (+) connection is most suited for our image analysis applications. The class ∇[ν], with ν∈R, is given by ∇[ν]XY=ν[X,Y] for all left-invariant vector fields X, Y  on G. Their auto-parallel curves are the exponential curves. Their torsion is T[X, Y ] = (2ν − 1)[X, Y ], and the (−), (0) and (+) connections arise for ν=0,12,1.We propose the case ν = 1, as then the Hamiltonian flows on T∗(G) for Riemannian distance minimizers on G (induced by left-invariant metric tensor field G) reduce to ∇[1]γ˙λ=0 and γ˙=G|−1γλ, where γ˙is velocity and λ is momentum. So now ‘shortest curves’ have parallel momentum, whereas ‘straight curves’ have auto-parallel velocity. We also extend this idea to sub-Riemannian geometry via a partial connection.The connection underlies PDE flows for crossing-preserving geodesic wavefront propagation and denoising in multi-orientation image processing, where we use: 1. The ‘shortest curves’ for tracking in multi-orientation image representations, 2. The ‘straight curve fits’ for locally adaptive frames in PDEs for crossing-preserving image denoising and enhancement