Chronic critical leg ischaemia must include leg ulcers

Objectives:In a previous series on conservative treatment in patients with leg ulcers and severe arterial occlusive disease (systolic digital blood pressure (SDBP) < 30 mmHg) a 70% risk of leg amputation and a negligeable potential for ulcerhealing was found. This series assess the efficacy of arterial reconstruction in such patients.Design:Retrospective study of consecutive patients in a department of vascular surgery and of dermatology in cooperation with the wound healing center.Material and Methods:Thirty-nine patients with 42 ulcerated legs underwent arterial revascularisation. 88% of the procedures were distal to the inguinal ligament.Main results:One patient died postoperatively (3%). Seven (18%) had wound complications, but none had graft infections. After 1 year the cumulative secondary patency was 90%, ulcer healing 70% and the limb salvage 90%. Thus only four legs (10%) had been amputated.Conclusions:Arterial revascularisation for leg ulcers is indicated when conservative treatment fails. Legs with ulceration and SDBP < 30 mmHg should be included in the concept of chronic critical ischaemia

Invasive group A, B, C and G streptococcal infections in Denmark 1999–2002: epidemiological and clinical aspects

ABSTRACTGroup A streptococci (GAS) have been described frequently as an emerging cause of severe invasive infections in population-based surveillance studies, whereas the descriptions of group B, C and G streptococci (GBS, GCS and GGS) have been less frequent. Enhanced surveillance for invasive GAS, GBS, GCS and GGS was performed in Denmark in 1999–2002. A detailed questionnaire was completed for 1237 (98%) of 1260 invasive infections. GAS infections dominated (40%), followed by GGS (32%), GBS (23%) and GCS (6%). Most (74%) patients had predisposing factors, and there were no significant differences between the four serogroups when comparing the prevalence of cancer, diabetes mellitus, chronic heart or lung diseases, immunodeficiency or alcohol abuse. The overall case fatality rate at day 30 was 21%, increasing significantly to 59% for patients with streptococcal toxic shock syndrome (STSS). STSS was significantly more frequent in GAS patients (10%) than in GCS (4%), GBS (2%) and GGS (2%) patients. Regression analyses showed that, despite a younger median age among GAS patients, the probability of developing septic shock and mortality was significantly higher among GAS patients than among GBS and GGS patients. These analyses showed no significant differences between GAS and GCS infections. Invasive infections caused by GAS, GBS, GCS and GGS are still a major challenge for clinicians. Continued epidemiological and microbiological surveillance is important to assess the development of these infections and to improve preventative strategies

Alternate wet/dry irrigation in rice cultivation: a practical way to save water and control malaria and Japanese encephalitis?

Water management / Water scarcity / Water use efficiency / Water conservation / Irrigated farming / Waterborne diseases / Rice / Malaria / Disease vectors / Productivity / Flood irrigation / Environmental control / Climate / China / East Africa / India / Indonesia / Japan / Philippines / Portugal / USA

Small irrigation tanks as a source of malaria mosquito vectors: a study in north-central Sri Lanka

Watersheds / Tank irrigation / Rehabilitation / Malaria / Waterborne diseases / Disease vectors / Sri Lanka / Yan Oya

An investigation of the relationship between depth to groundwater and malaria prevalence, Punjab, Pakistan

GroundwaterMalariaDisease vectorsWaterborne diseasesLand usePublic healthFarmersInstitutionsInfrastructureMapsStatisticsRice

Pre-elimination stage of malaria in Sri Lanka: assessing the level of hidden parasites in the population

<p>Abstract</p> <p>Background</p> <p>With the dramatic drop in the transmission of malaria in Sri Lanka in recent years, the country entered the malaria pre-elimination stage in 2008. Assessing the community prevalence of hidden malaria parasites following several years of extremely low transmission is central to the process of complete elimination. The existence of a parasite reservoir in a population free from clinical manifestations, would influence the strategy for surveillance and control towards complete elimination.</p> <p>Methods</p> <p>The prevalence of hidden parasite reservoirs in two historically malaria endemic districts, Anuradhapura and Kurunegala, previously considered as high malaria transmission areas in Sri Lanka, where peaks of transmission follow the rainy seasons was assessed. Blood samples of non-febrile individuals aged five to 55 years were collected from randomly selected areas in the two districts at community level and a questionnaire was used to collect demographic information and movement of the participants. A simple, highly sensitive nested PCR was carried out to detect both <it>Plasmodium falciparum </it>and <it>Plasmodium vivax</it>, simultaneously.</p> <p>Results</p> <p>In total, 3,023 individuals from 101 villages participated from both districts comprising mostly adults between the ages 19-55 years. Out of these, only about 1.4% of them (n = 19) could recall having had malaria during the past five years. Analysis of a subset of samples (n = 1322) from the two districts using PCR showed that none of the participants had hidden parasites.</p> <p>Discussion</p> <p>A reservoir of hidden parasites is unlikely to be a major concern or a barrier to the ongoing malaria elimination efforts in Sri Lanka. However, as very low numbers of indigenous cases are still recorded, an island-wide assessment and in particular, continued alertness and follow up action are still needed. The findings of this study indicate that any future assessments should be based on an adaptive sampling approach, involving prompt sampling of all subjects within a specified radius, whenever a malaria case is identified in a given focus.</p