Risk factors for mortality from imported falciparum malaria in the United Kingdom over 20 years: an observational study

Objectives To determine which travellers with malaria are at greatest risk of dying, highlighting factors which can be used to target health messages to travellers. Design Observational study based on 20 years of UK national data. Setting National register of malaria cases. Participants 25 054 patients notified with Plasmodium falciparum malaria, of whom 184 died, between 1987 and 2006. Main outcome measures Comparison between those with falciparum malaria who died and non-fatal cases, including age, reason for travel, country of birth, time of year diagnosed, malaria prophylaxis used. Results Mortality increased steadily with age, with a case fatality of 25/548 (4.6%) in people aged >65 years, adjusted odds ratio 10.68 (95% confidence interval 6.4 to 17.8), P<0.001 compared with 18–35 year olds. There were no deaths in the ≤5 year age group. Case fatality was 3.0% (81/2740 cases) in tourists compared with 0.32% (26/8077) in travellers visiting friends and relatives (adjusted odds ratio 8.2 (5.1 to 13.3), P<0.001). Those born in African countries with endemic malaria had a case fatality of 0.4% (36/8937) compared with 2.4% (142/5849) in others (adjusted odds ratio 4.6 (3.1 to 9.9), P<0.001). Case fatality was particularly high from the Gambia. There was an inverse correlation in mortality between region of presentation and number of cases seen in the region (R2=0.72, P<0.001). Most delay in fatal cases was in seeking care. Conclusions Most travellers acquiring malaria are of African heritage visiting friends and relatives. In contrast the risks of dying from malaria once acquired are highest in the elderly, tourists, and those presenting in areas in which malaria is seldom seen. Doctors often do not think of these as high risk groups for malaria; for this reason they are important groups to target in pre-travel advice

Bone Health in Type 1 Diabetes: Where We Are Now and How We Should Proceed

Type 1 diabetes (T1D) is autoimmune disease with chronic hyperglycaemic state. Besides diabetic retinopathy, nephropathy, and neuropathy, T1D is characterized by poor bone health. The reduced bone mineralization and quality/strength, due to hyperglycemia, hypoinsulinemia, autoimmune inflammation, low levels of insulin growth factor-1 (IGF-1), and vitamin D, lead to vertebral/hip fractures. Young age of T1D manifestation, chronic poor glycemic control, high daily insulin dose, low BMI, reduced renal function, and the presence of complications can be helpful in identifying T1D patients at risk of reduced bone mineral density. Although risk factors for fracture risk are still unknown, chronic poor glycemic control and presence of diabetic complications might raise the suspicion of elevated fracture risk in T1D. In the presence of the risk factors, the assessment of bone mineral density by dual-energy X-ray absorptiometry and the search of asymptomatic vertebral fracture by lateral X-ray radiography of thorax-lumbar spine should be recommended. The improvement of glycemic control may have a beneficial effect on bone in T1D. Several experiments showed promising results on using anabolic pharmacological agents (recombinant IGF-1 and parathyroid hormone) in diabetic rodents with bone disorder. Randomized clinical trials are needed in order to test the possible use of bone anabolic therapies in humans with T1D

Bone Health in Type 1 Diabetes: Where We Are Now and How We Should Proceed

Type 1 diabetes (T1D) is autoimmune disease with chronic hyperglycaemic state. Besides diabetic retinopathy, nephropathy, and neuropathy, T1D is characterized by poor bone health. The reduced bone mineralization and quality/strength, due to hyperglycemia, hypoinsulinemia, autoimmune inflammation, low levels of insulin growth factor-1 (IGF-1), and vitamin D, lead to vertebral/hip fractures. Young age of T1D manifestation, chronic poor glycemic control, high daily insulin dose, low BMI, reduced renal function, and the presence of complications can be helpful in identifying T1D patients at risk of reduced bone mineral density. Although risk factors for fracture risk are still unknown, chronic poor glycemic control and presence of diabetic complications might raise the suspicion of elevated fracture risk in T1D. In the presence of the risk factors, the assessment of bone mineral density by dual-energy X-ray absorptiometry and the search of asymptomatic vertebral fracture by lateral X-ray radiography of thorax-lumbar spine should be recommended. The improvement of glycemic control may have a beneficial effect on bone in T1D. Several experiments showed promising results on using anabolic pharmacological agents (recombinant IGF-1 and parathyroid hormone) in diabetic rodents with bone disorder. Randomized clinical trials are needed in order to test the possible use of bone anabolic therapies in humans with T1D

Campi Flegrei volcanic surveillance by thermal IR continuous monitoring

Solfatara and Pisciarelli areas are the most impressive example of hydrothermal activity at Campi Flegrei caldera (Southern Italy). In these areas INGV-Osservatorio Vesuviano has been handling since 2004 a surveillance network for continuous, long-term volcanological monitoring of fumaroles fields by using thermal IR acquisition stations. In this paper different methodologies of analysis applied to time series of IR scenes are introduced and discussed. In spite of substantially different approaches to data analysis, the results of these methodologies agree with ground deformation data of the same area and likely are a useful tool for volcano monitoring and long-term risk definition

Campi Flegrei volcanic surveillance by thermal IR continuous monitoring

Solfatara and Pisciarelli areas are the most impressive example of hydrothermal activity at Campi Flegrei caldera (Southern Italy). In these areas INGV-Osservatorio Vesuviano has been handling since 2004 a surveillance network for continuous, long-term volcanological monitoring of fumaroles fields by using thermal IR acquisition stations. In this paper different methodologies of analysis applied to time series of IR scenes are introduced and discussed. In spite of substantially different approaches to data analysis, the results of these methodologies agree with ground deformation data of the same area and likely are a useful tool for volcano monitoring and long-term risk definition

Thermal monitoring of hydrothermal activity by permanent infrared automatic stations: Results obtained at Solfatara di Pozzuoli, Campi Flegrei (Italy)

A permanent automatic infrared (IR) station was installed at Solfatara crater, the most active zone of Campi Flegrei caldera. After a positive in situ calibration of the IR camera, we analyze 2175 thermal IR images of the same scene from 2004 to 2007. The scene includes a portion of the steam heated hot soils of Solfatara. The experiment was initiated to detect and quantify temperature changes of the shallow thermal structure of a quiescent volcano such as Solfatara over long periods. Ambient temperature results as the main parameter affecting IR temperatures while air humidity and rain control image quality. A geometric correction of the images was necessary to remove the effects of slow movement of the camera. After a suitable correction the images give a reliable and detailed picture of the temperature changes, over the period October 2004 – January 2007, which suggests origin of the changes were linked to anthropogenic activity, vegetation growth and to the increase of the flux of hydrothermal fluids in the area of the hottest fumaroles. Two positive temperature anomalies were registered after the occurrence of two seismic swarms which affected the hydrothermal system of Solfatara in October 2005 and October 2006. It is worth noting that these signs were detected in a system characterized by a low level of activity with respect to systems affected by real volcanic crisis where more spectacular results will be expected. Results of the experiment show that this kind of monitoring system can be a suitable tool for volcanic surveillance

Defining non-functioning adrenal adenomas on the basis of the occurrence of hypocortisolism after adrenalectomy

Background In patients with adrenal incidentalomas (AI), there is uncertainty on how to rule out hypercortisolism. The occurrence of post-surgical (unilateral adrenalectomy) hypocortisolism (PSH) has been proposed as a proof of the presence of a pre-surgical hypercortisolism in AI patients. The aim of this study was to define the thresholds of cortisol level after 1 mg overnight dexamethasone suppression test (F-1mgDST), urinary free cortisol (UFC), midnight serum cortisol (MSC) and adrenocorticotroph hormone (ACTH) able to predict the absence of PSH in AI patients undergoing surgery. Methods In 60 patients who underwent AI excision, cortisol secretion was assessed by low-dose corticotropin stimulation test or insulin tolerance test, when needed. We searched for the lowest pre-surgical value of F-1mgDST, UFC and MSC and the highest value for ACTH in AI patients with PSH as indexes of normal cortisol secretion. Results the lowest values of F-1mgDST, UFC and MSC and the highest value for ACTH in PSH patients were 1.2 \ub5g/dL (33 nmol/L), 10.4 \ub5g/24h (29 nmol/24h), 1.2 \ub5g/dL (33 nmol/L) and 26.9 pg/ml (6 pmol/L), respectively, but only F-1mgDST &lt;1.2 \ub5g/dL (33 nmol/L) was able to predict the absence of PSH. Among AI patients with F-1mgDST &lt;1.2 \ub5g/dL (33 nmol/L) no subjects had diabetes mellitus and/or metabolic syndrome and these subjects tended to have a better metabolic profile than those with F-1mgDST 651.2 \ub5g/dL (33nmol/L) Conclusion in AI patients a F-1mgDST &lt;1.2 \u3bcg/dL (33 nmol/L) rules out PSH and could be used to exclude hypercortisolism in AI patients

Occurrence of malignant neoplasia in patients with primary hyperparathyroidism

Introduction The association between primary hyperparathyroidism (1HPT) and cancer is debated. The present study was aimed to investigate the occurrence of neoplasia in 1HPT. Patients and methods All consecutive patients (n = 1750) referred to our \u201cOsteoporosis and Metabolic Disease\u201d outpatients clinic for osteoporosis or hypercalcemia were eligible for the study. The exclusion criteria were: the finding of osteoporosis and/or altered calcium-phosphorous metabolism in the context of investigations for malignancy, the presence of diseases known to influence the cancer risk and the heavy smoking habit. Eventually, 1606 patients (1407 females, 199 males) were enrolled. In all patients calcium-phosphorous metabolism, PTH and vitamin D levels were measured and the occurrence of cancer during the 10 years prior the study inclusion was recorded. Results One-hundred-sixty-three patients had 1HPT while 1443 had not. Patients with and without 1HPT were comparable for age and gender. In 1HPT patients the occurrence of all, breast, kidney and skin cancer was significantly higher (21.5%, 12.2%, 2.5%, 1.8%, respectively) than in patients without 1HPT (12.4%, 6.9%, 0.3%, 0.3%, p < 0.05 for all comparisons). The 1HPT presence was significantly associated with the occurrence of all neoplasia and of breast, skin and kidney neoplasia (odds ratio, 95% confidence interval, p value: 1.93, 1.27\u20132.92, 0.002; 1.93, 1.11\u20133.35, 0.002; 9.18, 2.16\u201338.8, 0.003; 8.23, 1.71\u201339.5, 0.008, respectively), after adjusting for age, gender (as appropriate), smoking habit and vitamin D levels. Conclusion During the 10 years prior the diagnosis of 1HPT, the occurrence of all, breast, skin and kidney neoplasia is increased

Agro-environmental aspects of conservation agriculture compared to conventional systems : A 3-year experience on 20 farms in the Po valley (Northern Italy)

An evaluation of the effect of the conservation agriculture (CA) on agro-environmental aspects is needed at the farm scale in intensive production systems, which are likely prone to reduce soil fertility. Here, as part of the HelpSoil LIFE+ Project and involving 20 farms in the Po valley (Northern Italy), we have estimated the soil organic carbon (SOC) content, SOC stock, crop yield, biological fertility, soil biodiversity, and economic efficiency under different agricultural systems (CA and conventional, CvtA) at the beginning (March 2014) and end (October 2016) of the experimental period. CA was mostly represented by no-till practice (NT) coupled with the cultivation of winter cover crops. Minimum tillage (MT) was considered as CA or CvtA practice according to the farm design. The CA practices have been implemented on the monitored farms at different times (Long-term = before 2006, Medium-term = between 2006 and 2013, Short-term = after 2013). A direct comparison between CA and CvtA of soil-related variables, yields, and costs was performed on 14 out of the 20 farms; data were statistically treated with a linear mixed model. Overall, CA resulted in significantly higher SOC content, SOC stock, biological fertility, QBS-ar, and earthworms for the Medium-term group. Considering the effect of tillage practices observed on the 20 farms, SOC content was the highest in NT for the Long-term group. The biological fertility index was higher in NT and MT compared to CvtA within the Long-term and Medium-term groups in 2016. QBS-ar was the higher in MT and NT than CvtA for the Long-term and Medium-Term groups. The number of earthworms was the highest under NT for the Long-term group. Maize, winter wheat, and soybeans yields were generally 1 t ha 121 higher in CvtA than in CA, but this did not reach statistical significance. The cost for herbicides was 18% more expensive in NT, whereas the fuel consumption and total costs for weeding operations did not differ between NT and CvtA. The overall outcome of the analysis was that CA is a viable solution for intensive farms in the monitored area, but further skills need still to be acquired in to enhance its economic feasibility

Economic Burden Of Stroke: Analysis From An Administrative Database

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