2,279 research outputs found

    BCG vaccination and leprosy protection: review of current evidence and status of BCG in leprosy control.

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    The bacillus Calmette-Guérin (BCG) vaccine, initially developed to provide protection against TB, also protects against leprosy; and the magnitude of this effect varies. Previous meta-analyses did not provide a summary estimate of the efficacy due to the heterogeneity of the results. We conducted a meta-analysis of published data including recently published studies (up to June 2009) to determine the efficacy of BCG protection on leprosy and to investigate whether age at vaccination, clinical form, number of doses, type of study, the latitude of study area and year of publication influence the degree of efficacy and explain the variation. In the light of the results, we argue for more emphasis on the role of BCG vaccination in leprosy control and research

    Influenza, Campylobacter and Mycoplasma Infections, and Hospital Admissions for Guillain-Barré Syndrome, England

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    TOC Summary line: Campylobacter, Mycoplasma pneumoniae, and influenza (or influenza vaccination) act as infectious triggers for Guillain-Barré syndrome

    Zika, chikungunya and dengue: the causes and threats of new and re-emerging arboviral diseases.

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    The recent emergence and re-emergence of viral infections transmitted by vectors-Zika, chikungunya, dengue, Japanese encephalitis, West Nile, yellow fever and others-is a cause for international concern. Using as examples Zika, chikungunya and dengue, we summarise current knowledge on characteristics of the viruses and their transmission, clinical features, laboratory diagnosis, burden, history, possible causes of the spread and the expectation for future epidemics. Arboviruses are transmitted by mosquitoes, are of difficult diagnosis, can have surprising clinical complications and cause severe burden. The current situation is complex, because there is no vaccine for Zika and chikungunya and no specific treatment for the three arboviruses. Vector control is the only comprehensive solution available now and this remains a challenge because up to now this has not been very effective. Until we develop new technologies of control mosquito populations, the globalised and urbanised world we live in will remain vulnerable to the threat of successive arbovirus epidemics

    Ultraestructura externa de Manayunkia speciosa (Fabriciidae) del Río Uruguay, Argentina

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    The external ultrastructure of Manayunkia speciosa Leidy, 1858 from specimens collected at the lower Uruguay River, South America is described using scanning-electron-microscopy. The branchial crown has a pair of semicircular lateral lobes, a pair of mediodorsal radioles and a pair of medioventral ones. Radiolar surfaces are ciliated. The faecal groove is observed on peristomium middorsally. The anterior margin of the anterior peristomial ring formed a rectangular lobe, with a ciliated band. Chaetal shape exemplifies the basic type of tapering cylinder. Two types of thoracic notochaetae: one wider distally, with a smooth handle, and covered on the surface by denticles, and other are significantly finer at the base and covered by thin structures with a free distal end. These structures were not previously recorded in Fabriciidae. Rows of 3 aligned uncini anteriorly projected are found in the thorax. Each uncinus presents a long manubrium which connects with the crest, extending to a main fang. The teeth of the crest are equal in size. The abdomen present 4 types of neurochaetae: one of small size than the other 3. In the abdomen 10-14 uncini form dense dorsal-transverse-lines. Each uncinus presents a short manubrium. The crest is covered with teeth of similar size.Se describe la ultraestructura externa mediante el uso de SEM de especímenes de Manayunkia speciosa Leidy, 1858, colectados en el Río Uruguay, Sudamérica. La corona branquial presenta un par de lóbulos laterales semicirculares, un par de radiolos en posición mediodorsal y otro medioventral. La superficie de las pínulas es ciliada. Sobre el peristomio se observa un surco fecal mediodorsal. El margen anterior del anillo peristomial anterior está formado por un lóbulo rectangular con una banda ciliada. Las setas son de tipo cilíndrico ahusado. Existen 2 tipos de notosetas torácicas: unas anchas distalmente con mango liso, cubiertas por dentículos sobre su superficie; y otras significativamente más delgadas en la base, cubiertas por extensiones delgadas con extremo distal libre. Estas estructuras son registradas por primera vez en Fabriciidae. El tórax presenta grupos de 3 uncinos alineados, proyectados anteriormente, cada uno presenta un manubrio largo, cresta y diente principal. Los dientes de la cresta son similares en tamaño. En el abdomen se registraron 4 tipos de neurosetas: una pequeña y 3 de mayor tamaño. El abdomen presenta de 10 a 14 uncinos agrupados en una línea transversal dorsal. Cada uncino posee un manubrio corto. La cresta está cubierta por dientes de tamaño similar.Facultad de Ciencias Naturales y MuseoInstituto de Limnología "Dr. Raul A. Ringuelet

    Ultraestructura externa de Manayunkia speciosa (Fabriciidae) del Río Uruguay, Argentina

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    The external ultrastructure of Manayunkia speciosa Leidy, 1858 from specimens collected at the lower Uruguay River, South America is described using scanning-electron-microscopy. The branchial crown has a pair of semicircular lateral lobes, a pair of mediodorsal radioles and a pair of medioventral ones. Radiolar surfaces are ciliated. The faecal groove is observed on peristomium middorsally. The anterior margin of the anterior peristomial ring formed a rectangular lobe, with a ciliated band. Chaetal shape exemplifies the basic type of tapering cylinder. Two types of thoracic notochaetae: one wider distally, with a smooth handle, and covered on the surface by denticles, and other are significantly finer at the base and covered by thin structures with a free distal end. These structures were not previously recorded in Fabriciidae. Rows of 3 aligned uncini anteriorly projected are found in the thorax. Each uncinus presents a long manubrium which connects with the crest, extending to a main fang. The teeth of the crest are equal in size. The abdomen present 4 types of neurochaetae: one of small size than the other 3. In the abdomen 10-14 uncini form dense dorsal-transverse-lines. Each uncinus presents a short manubrium. The crest is covered with teeth of similar size.Se describe la ultraestructura externa mediante el uso de SEM de especímenes de Manayunkia speciosa Leidy, 1858, colectados en el Río Uruguay, Sudamérica. La corona branquial presenta un par de lóbulos laterales semicirculares, un par de radiolos en posición mediodorsal y otro medioventral. La superficie de las pínulas es ciliada. Sobre el peristomio se observa un surco fecal mediodorsal. El margen anterior del anillo peristomial anterior está formado por un lóbulo rectangular con una banda ciliada. Las setas son de tipo cilíndrico ahusado. Existen 2 tipos de notosetas torácicas: unas anchas distalmente con mango liso, cubiertas por dentículos sobre su superficie; y otras significativamente más delgadas en la base, cubiertas por extensiones delgadas con extremo distal libre. Estas estructuras son registradas por primera vez en Fabriciidae. El tórax presenta grupos de 3 uncinos alineados, proyectados anteriormente, cada uno presenta un manubrio largo, cresta y diente principal. Los dientes de la cresta son similares en tamaño. En el abdomen se registraron 4 tipos de neurosetas: una pequeña y 3 de mayor tamaño. El abdomen presenta de 10 a 14 uncinos agrupados en una línea transversal dorsal. Cada uncino posee un manubrio corto. La cresta está cubierta por dientes de tamaño similar.Facultad de Ciencias Naturales y MuseoInstituto de Limnología "Dr. Raul A. Ringuelet

    Small-area level socio-economic deprivation and tuberculosis rates in England: An ecological analysis of tuberculosis notifications between 2008 and 2012.

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    BACKGROUND: Tuberculosis (TB) rates in England are among the highest in high-income countries. Poverty and historic and current immigration from high TB incidence parts of the world are two major drivers of tuberculosis in England. However, little has been done in recent years to examine socio-economic trends in TB rates in England, and to disentangle the role of deprivation from that of place of birth in the current TB epidemiology. OBJECTIVES: To assess the association between England's 2008-2012 TB notification rates and small area-level deprivation, together and separately in the UK-born and foreign-born populations. METHODS: Ecological analysis of the association between quintiles of England's 2010 Index of Multiple Deprivation (IMD) and TB rates at the Lower-layer Super Output Area (LSOA; average population ~1500) level, using negative binomial and zero-inflated negative binomial regression models, adjusting for age, sex, urban/rural area classification, and area-level percentage of non-White residents. RESULTS: There was a log-linear gradient between area-deprivation levels and TB rates, with overall TB rates in the most deprived quintile areas three times higher than the least deprived quintile after adjustment for age and sex (IRR = 3.35; 95%CI: 3.16 to 3.55). The association and gradient were stronger in the UK-born than the foreign-born population, with UK-born TB rates in the most deprived quintiles about two-and-a-half times higher than the least deprived quintile (IRR = 2.39; 95%CI: 2.19 to 2.61) after controlling for age, sex, urban/rural classification and percentage of non-White residents; whereas the comparable figure for foreign-born persons was 80% higher (IRR = 1.78; 95%CI: 1.66 to 1.91). CONCLUSIONS: Socio-economic deprivation continues to play a substantial role in sustaining the TB epidemic in England, especially in the UK-born population. This supports the case for further investigations of the underlying social- determinants of TB

    Risk factors for tuberculosis in older children and adolescents: a matched case-control study in Recife, Brazil.

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    BACKGROUND: Tuberculosis is a major disease worldwide and most research focus on risk factors for adults, although there is a marked adolescent peak in incidence. The objective of this study was to identify risk factors for tuberculosis in children aged 7 to 19. METHODS: A case control study matched by age with 169 cases and 477 controls. The study population consisted of adolescents and older children from Recife, Brazil. Cases were individuals diagnosed with tuberculosis in the control programme and controls were selected in the neighborhood of cases. Conditional logistic regression was used to identify risk factors. RESULTS: Cigarette smoking increased by 50% the risk of tuberculosis but that this was not statistically significant (OR = 1.6). Other risk factors were sleeping in the same house as a case of tuberculosis (OR = 31.6), living in a house with no piped water (OR = 7.7) (probably as a proxy for bad living conditions), illiteracy (OR = 3.7) and male sex (OR = 1.8). The increase in risk with living in houses with no piped water was much more marked in males. The proportion of cases of tuberculosis attributed to contact with someone with TB was 38% and to illiteracy, lack of piped water and smoking, 20%. CONCLUSION: Household contact with tuberculosis, social factors and male sex play the biggest role in determining risk of TB disease among children and adolescents in the study. We recommend further research on the relationship of cigarette smoking on tuberculosis in adolescents, and on whether the sex differentials are more marked in bad living conditions. Separate studies should be conducted in older children and in adolescents

    Resposta brasileira à tuberculose: contexto, desafios e perspectivas

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    Risk factors for falls with severe fracture in elderly people living in a middle-income country: a case control study

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    BACKGROUND: Fracture after falling has been identified as an important problem in public health. Most studies of risk factors for fractures due to falls have been carried out in developed countries, although the size of the elderly population is increasing fast in middle income countries. The objective of this paper is to identify risk factors for fall related to severe fractures in those aged 60 or more in a middle-income country. METHODS: A case-control study was carried out in Rio de Janeiro-Brazil based general hospitals between 2002-2003. Two hundred-fifty hospitalised cases of fracture were matched with 250 community controls by sex, age group and living area. Data were collected for socio-demographic variables, health status and drugs used before the fall. A conditional logistic regression model was fitted to identify variables associated with the risk of fall related severe fracture. RESULTS: Low body mass index, cognitive impairment, stroke and lack of urine control were associated with increased risk of severe fall related fractures. Benzodiazepines and muscle relaxants were also related to an increased risk of severe fractures while moderate use of alcohol was associated with reduced risk. CONCLUSION: Although the association between benzodiazepines and fractures due to fall has been consistently demonstrated for old people, this has not been the case for muscle relaxant drugs. The decision to prescribe muscle relaxants for elderly people should take into account the risk of severe fracture associated with these drugs

    Estimating the impact of tuberculosis anatomical classification on treatment outcomes: A patient and surveillance perspective analysis.

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    INTRODUCTION: Tuberculosis anatomical classification is inconsistent in the literature, which limits current tuberculosis knowledge and control. We aimed to evaluate whether tuberculosis classification impacts on treatment outcomes at patient and aggregate level. METHODS: We analyzed adults from São Paulo State, Brazil with newly diagnosed tuberculosis from 2010-2013. We used an extended clinical classification of tuberculosis, categorizing cases as pulmonary, pulmonary and extrapulmonary, extrapulmonary and miliary/disseminated. Our primary outcome was unsuccessful outcome of treatment. To investigate the reported treatment outcome at the aggregate level, we sampled 500 different "countries" from the dataset and compared the impact of pulmonary and extrapulmonary classifications on the reported treatment success. RESULTS: Of 62,178 patients, 49,999 (80.4%) were pulmonary, 9,026 (14.5%) extrapulmonary, 1,651 (2.7%) pulmonary-extrapulmonary and 1,502 (2.4%) miliary/disseminated. Pulmonary-extrapulmonary cases had similar unsuccessful outcome of treatment compared with pulmonary (adjusted-OR 1.00, 95%CI, 0.88-1.13, p = 0.941), while extrapulmonary were associated with better (adjusted-OR 0.65, 95%CI, 0.60-0.71, p<0.001) and miliary/disseminated with worse outcomes (adjusted-OR 1.51, 95%CI, 1.33-1.71, p<0.001). We found that 60 (12%) countries would report a difference ≥10% in treatment success depending on whether they reported all clinical forms together (current WHO recommendation) or pulmonary forms alone, overestimating the treatment success of pulmonary forms. CONCLUSIONS: The expanded anatomical classification of tuberculosis was strongly associated with treatment outcomes at the patient level. Remarkably, pulmonary with concomitant extrapulmonary forms had similar treatment outcomes compared with pulmonary forms after adjustment for potential confounders. At the aggregate level, reporting treatment success for all clinical forms together might hide differences in progress between pulmonary and extrapulmonary tuberculosis control
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