Waterborne Outbreak of Gastroenteritis: Effects on Sick Leaves and Cost of Lost Workdays

We examined the acute and cumulative effects of this incidence on sick leaves among public sector employees residing in the clean and contaminated areas, and the additional costs of lost workdays due to the incidence.Daily information on sick leaves of 1789 Finnish Public Sector Study participants was obtained from employers' registers. Global Positioning System-coordinates were used for linking participants to the clean and contaminated areas. Prevalence ratios (PR) for weekly sickness absences were calculated using binomial regression analysis. Calculations for the costs were based on prior studies.Among those living in the contaminated areas, the prevalence of participants on sick leave was 3.54 (95% confidence interval (CI) 2.97–4.22) times higher on the week following the incidence compared to the reference period. Those living and working in the clean area were basically not affected, the corresponding PR for sick leaves was 1.12, 95% CI 0.73–1.73. No cumulative effects on sick leaves were observed among the exposed. The estimated additional costs of lost workdays due to the incidence were 1.8–2.1 million euros.The prevalence of sickness absences among public sector employees residing in affected areas increased shortly after drinking water distribution system was contaminated, but no long-term effects were observed. The estimated costs of lost workdays were remarkable, thus, the cost-benefits of better monitoring systems for the water distribution systems should be evaluated

Demographic and microbial characteristics of extrapulmonary tuberculosis cases diagnosed in Malatya, Turkey, 2001-2007

<p>Abstract</p> <p>Background</p> <p>Extrapulmonary tuberculosis (EPTB) has an increasing rate in Turkey. The reason remains largely unknown. A better understanding of the demographic and microbial characteristics of EPTB in the Turkish population would extend the knowledgebase of EPTB and allow us to develop better strategies to control tuberculosis (TB).</p> <p><b>Methods</b></p> <p>We retrospectively evaluated clinical and laboratory data of 397 bacteriologically-confirmed TB cases diagnosed during an eight year-period using by chi-square analysis and multivariate logistic regression model.</p> <p>Results</p> <p>Of the 397 study patients, 103 (25.9%) had EPTB and 294 (74.1%) had pulmonary tuberculosis (PTB). The most commonly seen two types of EPTB were genitourinary TB (27.2%) and meningeal TB (19.4%). TB in bone/joints, pleural cavity, lymph nodes, skin, and peritoneal cavity occurred at a frequency ranging from 9.7% to 10.7%. The age distribution was significantly different (P < 0.01) between PTB and EPTB, with patients older than 45 years tending to have an increased risk of EPTB. Furthermore, the distribution of different types of EPTB differed significantly among age groups (P = 0.03). Meningeal and bone and/or joint TB were more commonly observed among the male patients, while lymphatic, genitourinary, and peritoneal TB cases were more frequently seen among females. Unique strain infection was statistically significantly associated with EPTB (OR: 2.82, 95% CI [1.59, 5.00])</p> <p>Conclusions</p> <p>EPTB accounted for a significant proportion of TB cases in Malatya, Turkey between 2001 and 2007. The current study has provided an insight into the dynamics of EPTB in Malatya, Turkey. However, the risk factors for having EPTB in Malatya, Turkey remain to be assessed in future studies using population-based or randomly selected sample.</p

Discordant identification of pediatric severe sepsis by research and clinical definitions in the SPROUT international point prevalence study

Introduction: Consensus criteria for pediatric severe sepsis have standardized enrollment for research studies. However, the extent to which critically ill children identified by consensus criteria reflect physician diagnosis of severe sepsis, which underlies external validity for pediatric sepsis research, is not known. We sought to determine the agreement between physician diagnosis and consensus criteria to identify pediatric patients with severe sepsis across a network of international pediatric intensive care units (PICUs). Methods: We conducted a point prevalence study involving 128 PICUs in 26 countries across 6 continents. Over the course of 5 study days, 6925 PICU patients &lt;18 years of age were screened, and 706 with severe sepsis defined either by physician diagnosis or on the basis of 2005 International Pediatric Sepsis Consensus Conference consensus criteria were enrolled. The primary endpoint was agreement of pediatric severe sepsis between physician diagnosis and consensus criteria as measured using Cohen's ?. Secondary endpoints included characteristics and clinical outcomes for patients identified using physician diagnosis versus consensus criteria. Results: Of the 706 patients, 301 (42.6 %) met both definitions. The inter-rater agreement (? ± SE) between physician diagnosis and consensus criteria was 0.57 ± 0.02. Of the 438 patients with a physician's diagnosis of severe sepsis, only 69 % (301 of 438) would have been eligible to participate in a clinical trial of pediatric severe sepsis that enrolled patients based on consensus criteria. Patients with physician-diagnosed severe sepsis who did not meet consensus criteria were younger and had lower severity of illness and lower PICU mortality than those meeting consensus criteria or both definitions. After controlling for age, severity of illness, number of comorbid conditions, and treatment in developed versus resource-limited regions, patients identified with severe sepsis by physician diagnosis alone or by consensus criteria alone did not have PICU mortality significantly different from that of patients identified by both physician diagnosis and consensus criteria. Conclusions: Physician diagnosis of pediatric severe sepsis achieved only moderate agreement with consensus criteria, with physicians diagnosing severe sepsis more broadly. Consequently, the results of a research study based on consensus criteria may have limited generalizability to nearly one-third of PICU patients diagnosed with severe sepsis

Abnormal 99mTc-MDP uptake in radiation nephritis: A Case Report

The radiation nephritis is a long-term degenerative injury involving nephron and mesangium after radiation exposure. 51 year-old male patient who underwent gastric surgery due to adenocarcinoma 18 months ago and had postoperative chemo-radiotherapy using FUFA Mayo Clinic regimen after surgical resection of gastric cancer. After one year from end of the radiation therapy, bone scan showed markedly increased 99mTc-MDP uptake in the upper pole of the left kidney. [Med-Science 2012; 1(2.000): 125-130

HBsAg, anti-HCV, anti-HIV 1/2, and syphilis seroprevalence in blood donors in Eastern Marmara Region, Turkey and an overview of transfusion transmitted infections in Turkey

Introduction: Blood transfusion and component therapies are life-saving medical practices. However these therapies, are not without risks and may lead to the transmission of infectious agents from donor to recipient. Screening of blood donations for infectious agents is necessary to achieve transfusion safety. The aim of the study was to determine the six-years seroprevalence of HBV (hepatitis B virus), HCV (hepatitis C virus), HIV (human immunodeficiency virus), and syphilis in blood donors and to present an overview of transfusion transmitted infections in Turkey. Material and methods: A total of 150,787 volunteer blood donors who admitted to blood centers located in Eastern Marmara Region, Turkey between January 2009 and October 2014 were included in this study. HBsAg (hepatitis B surface antigen), anti-HCV (hepatitis C virus antibody), and HIV-1/2 antibody were detected by using Chemiluminescent Microparticle Enzyme Immunoassay (CMIA) method. Syphilis screening was performed by using VDRL (Venereal Disease Research Laboratory) test in the first three years and by CMIA-based treponemal test in the last three years. Results: Among the blood donors, 140,536 (93.2%) were male and 10,251 (6.8%) female. Out of all donors, 2,019 (1.33%) donors were positive for at least one screening test. The seroprevalence of HBV, HCV, HIV, and syphilis were 0.8 % (n=1340), 0.38% (n=578), 0,0025% (n=38) and 0,004 % (n=63), respectively. A significant decrease was observed in HBV seroprevalence by years (p < 0.005) Conclusion: The risk of transfusion-transmitted infections can be decreased by effectively using questionnaires and screening tests in blood donation centers, HBV vaccination programs, and awareness-raising activities. It is necessary to use improved screening methods for detection of transfusion-transmitted infection agents