Ecological comparison of the risks of mother-to-child transmission and clinical manifestations of congenital toxoplasmosis according to prenatal treatment protocol

We compared the relative risks of mother-to-child transmission of Toxoplasma gondii and clinical manifestations due to congenital toxoplasmosis associated with intensive prenatal treatment in Lyon and Austria, short term treatment in 51% of Dutch women, and no treatment in Danish women. For each cohort, relative risks were standardized for gestation at seroconversion. In total, 856 mother–child pairs were studied: 549 in Lyon, 133 in Austria, 123 in Denmark and 51 in The Netherlands. The relative risk for mother-to-child transmission compared to Lyon was 1·24 (95% CI: 0·88, 1·59) in Austria; 0·59 (0·41, 0·81) in Denmark; and 0·65 (0·37, 1·01) in The Netherlands. Relative risks for clinical manifestations compared with Lyon (adjusted for follow-up to age 3 years) were: Austria 0·19 (0·04, 0·51); Denmark 0·60 (0·13, 1·08); and The Netherlands 1·46 (0·51, 2·72). There was no clear evidence that the risk of transmission or of clinical manifestations was lowest in centres with the most intensive prenatal treatment

Zoonotic Diseases Report 2014

De Staat van zoönosen geeft jaarlijks een overzicht van infectieziekten die overgaan van dier op mens, de zogenoemde zoönosen. Het gaat om de mate waarin meldingsplichtige zoönosen voorkomen en de ontwikkelingen daarvan op de lange termijn. Hierbij betreft het zowel het aantal ziektegevallen bij mensen als het voorkomen van deze ziekteverwekkers bij dieren. Ook worden elk jaar opmerkelijke voorvallen uitgelicht en wordt een thema behandeld. Voor de meeste zoönosen zijn in 2014 geen uitgesproken veranderingen waargenomen. Wel is het aantal mensen met leptospirose (waarvan de bekendste vorm de ziekte van Weil is) aanmerkelijk hoger dan het vorige jaar, van gemiddeld 30 gevallen in de afgelopen jaren naar 97 in 2014. Ook steeg het aantal Hantavirusinfecties (van gemiddeld 13 in de voorgaande jaren naar 36 in 2014). UItgelicht Een opmerkelijke gebeurtenis in 2014 is dat twee patiënten in een ziekenhuis zijn opgenomen met een ernstige longontsteking na een infectie met Chlamydia caviae. Beide patiënten bleken thuis cavia's te houden die een luchtweginfectie hadden doorgemaakt. Verder was er sinds 2003 weer een uitbraak van vogelgriep bij pluimveebedrijven veroorzaakt door een hoogpathogeen virus. Hierbij zijn vier van de vijf besmette bedrijven onafhankelijk van elkaar besmet geraakt. Het virus was vermoedelijk afkomstig van trekkende watervogels. Het is onbekend of dit virustype overdraagbaar is op de mens; wereldwijd zijn daar geen gevallen van bekend. Vogels Het thema van dit jaar is 'Onze gevleugelde vrienden' en gaat over zoönosen die via vogels kunnen worden overgebracht, zoals de papegaaienziekte. Hierbij wordt onder andere beschreven op welke vliegroutes van trekvogels gezamenlijke broed- en voederplaatsen liggen waar ze elkaar kunnen treffen en zoönoseverwekkers aan elkaar zouden kunnen overdragen.The Zoonotic Diseases Report provides an annual overview of infectious diseases transmitted from animals to humans, so-called zoonotic diseases or zoonoses. It focuses on the degree to which notifiable zoonoses occur and how they develop over the long term. Specifically, this concerns both the number of human cases and the occurrence of these pathogens in animals. Noteworthy incidents of zoonoses are also highlighted each year and a particular theme is discussed. For most zoonoses, no pronounced changes were observed in 2014. Nonetheless, the number of people with leptospirosis (of which the most well-known form is Weil's disease) was considerably higher than in the previous year, rising from an average of 30 cases in recent years to 97 cases in 2014. The number of Hantavirus infections also rose (from an average of 13 cases in the previous years to 36 cases in 2014). A closer look A notable event in 2014 is the admission of two patients to hospital with serious lung infections after being infected with Chlamydia caviae. Both patients kept guinea pigs at home that suffered from respiratory infections. There was also the first outbreak of highly pathogenic avian influenza since 2003 affecting five poultry farms. Four of the five farms became contaminated independently of each other. It is thought that the virus was transmitted from waterfowls. It is not known whether the particular virus strain can be transmitted to humans; worldwide no cases of such transmission have been reported. Birds This year's theme is 'Our winged friends'. It focuses on zoonoses that can be transmitted by birds, such as psittacosis (parrot fever). The migratory routes that coincide with shared breeding and feeding locations where migratory birds can come into contact with one another and thereby possibly transmit zoonotic pathogens to each other are also described.NVW

North Pacific Surgical Association A booming economy means a bursting trauma system: association between hospital admission for major injury and indicators of economic activity in a large Canadian health region

Abstract BACKGROUND: Injury epidemiology fluctuates with economic activity in many countries. These relationships remain unclear in Canada. METHODS: The annual risk of admission for major injury (Injury Severity Score R12) to a highvolume, level-1 Canadian trauma center was compared with indicators of economic activity over a 16-year period using linear regression

The management of patients with primary chronic anal fissure: a position paper

Anal fissure is one of the most common and painful proctologic diseases. Its treatment has long been discussed and several different therapeutic options have been proposed. In the last decades, the understanding of its pathophysiology has led to a progressive reduction of invasive and potentially invalidating treatments in favor of conservative treatment based on anal sphincter muscle relaxation. Despite some systematic reviews and an American position statement, there is ongoing debate about the best treatment for anal fissure. This review is aimed at identifying the best treatment option drawing on evidence-based medicine and on the expert advice of 6 colorectal surgeons with extensive experience in this field in order to produce an Italian position statement for anal fissures. While there is little chance of a cure with conservative behavioral therapy, medical treatment with calcium channel blockers, diltiazem and nifepidine or glyceryl trinitrate, had a considerable success rate ranging from 50 to 90%. Use of 0.4% glyceryl trinitrate in standardized fashion seems to have the best results despite a higher percentage of headache, while the use of botulinum toxin had inconsistent results. Nonresponding patients should undergo lateral internal sphincterotomy. The risk of incontinence after this procedure seems to have been overemphasized in the past. Only a carefully selected group of patients, without anal hypertonia, could benefit from anoplasty