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Sample records for suspected epidemic keratoconjunctivitis

  1. Orbital Inflammation Developing from Epidemic Keratoconjunctivitis in an Adult

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    Sung In Kim

    2013-08-01

    Full Text Available Introduction: We report a rare case of epidemic keratoconjunctivitis (EKC that developed into an orbital inflammation in an adult. Case Presentation: A 67-year-old Korean man, who had been diagnosed with EKC and treated for conjunctival injection and chemosis in the right eye for 4 days, was referred to Oculoplastics as orbital cellulitis was suspected. At the point of referral, clinical features such as decreased visual acuity, severe eyelid swelling, chemosis, follicles, corneal edema, limitations in lateral eye movement, and diplopia were observed in the right eye. Orbital cellulitis was suspected according to orbital computed tomography scan images, but there was no response to systemic antibiotics. Systemic steroid was administered instead, and then his symptoms and signs started to improve. The final diagnosis of this patient was orbital inflammation related to EKC based on the facts that there was no response to antibiotics, that he presented with contralateral symptoms and signs, that pseudomembrane formation occurred in both eyes, and that the symptoms resolved completely after 2 weeks. Conclusion: Clinicians need to consider the possibility of orbital inflammation developing from EKC, even in an adult patient, and treat the patient properly if the EKC symptoms and signs, such as conjunctival injection and follicles, are accompanied with symptoms and signs similar to orbital cellulitis.

  2. An outbreak of epidemic keratoconjunctivitis at an outpatient ophthalmology clinic

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    Timothy J Doyle

    2010-12-01

    Full Text Available Epidemic keratoconjunctivitis (EKC is an acute eye infection caused by adenovirus. We investigated an outbreak of EKC at an outpatient ophthalmology practice in the context of a suspected community wide increase in EKC activity. A site visit was made to the facility reporting the outbreak. A line list was created of patients clinically diagnosed with EKC at the practice during the previous 5 months. A questionnaire was faxed to all other licensed ophthalmologists in the county regarding recent EKC activity in their facility. Descriptive data analyses were conducted. The outbreak facility reported 37 patients clinically diagnosed with EKC during the previous 5 months. In addition, the single ophthalmologist at the practice also had symptoms compatible with EKC during the outbreak period. Specimens were collected on 4 patients and all were positive for adenovirus serotype 8. Forty percent of ophthalmologists surveyed in the county saw at least one EKC patient in the previous 3 months, and 20% reported a perceived increase in EKC activity in recent months over normal seasonal patterns. The outbreak at the facility likely began as part of a widespread community increase in EKC that may have been amplified at the facility through nosocomial transmission. Medical providers experiencing increases in EKC activity above seasonally expected norms should contact their public health department for assistance with etiologic diagnoses and outbreak control.

  3. Adenovirus-related epidemic keratoconjunctivitis outbreak at a hospital-affiliated ophthalmology clinic.

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    Muller, Matthew P; Siddiqui, Naureen; Ivancic, Rose; Wong, David

    2018-01-02

    Adenovirus-associated epidemic keratoconjunctivitis (A-EKC) is a cause of large and prolonged outbreaks in ophthalmology clinics and can result in substantial morbidity. A-EKC outbreaks are often the result of contaminated ophthalmologic equipment, surfaces, or hands. Contaminated multidose eye drops are also a likely culprit, but few prior studies provide clear epidemiologic evidence that adenovirus transmission resulted from contamination of eye drops. We describe an A-EKC outbreak at a large, hospital-affiliated eye clinic that affected 44 patients. The unique epidemiology of the outbreak provides strong evidence that contaminated multidose dilating eye drops resulted in adenovirus transmission. Removal of multidose eye medication from the clinic, combined with case finding, enhanced infection control and enhanced environmental cleaning, led to rapid control of the outbreak. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  4. Epidemiological and virological features of epidemic keratoconjunctivitis due to new human adenovirus type 54 in Japan.

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    Kaneko, Hisatoshi; Suzutani, Tatsuo; Aoki, Koki; Kitaichi, Nobuyoshi; Ishida, Susumu; Ishiko, Hiroaki; Ohashi, Tsutomu; Okamoto, Shigeki; Nakagawa, Hisashi; Hinokuma, Rikutaro; Asato, Yoshimori; Oniki, Shinobu; Hashimoto, Teiko; Iida, Tomohiro; Ohno, Shigeaki

    2011-01-01

    New human adenovirus (HAdV)-54 causes epidemic keratoconjunctivitis (EKC) and is virologically close to and has occasionally been detected as HAdV-8. Taking HAdV-54 into account, we re-determined HAdV type in EKC samples to determine its epidemiology in Japan, and examined the virological features of HAdV-54. HAdV type was re-determined in 776 conjunctival swabs from Japan and 174 from six other countries, obtained between 2000 and 2009. Using 115 HAdV strains obtained before 1999, trends regarding HAdV-8 and HAdV-54 were also determined. In addition, immunochromatography (IC) kit features, DNA copy numbers and viral isolation of HAdV-54 in samples were evaluated. Recently, HAdV-37 and HAdV-54 have been the major causative types of EKC in Japan. HAdV-54 has been isolated each year since 1995, whereas HAdV-8 has become less common since 1997, although it remains the most common cause of EKC in the six other countries investigated where HAdV-54 is yet to be detected. HAdV-54 is comparable to other EKC-related HAdV types in terms of IC kit sensitivity and DNA copy numbers, although HAdV-54 grows more slowly on viral isolation. EKC due to HAdV-54 can result in epidemics; therefore, it should be accurately diagnosed and monitored as an emerging infection worldwide.

  5. Human adenovirus type 8 epidemic keratoconjunctivitis with large corneal epithelial full-layer detachment: an endemic outbreak with uncommon manifestations

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    Lee YC

    2015-05-01

    Full Text Available Yueh-Chang Lee,1 Nancy Chen,1 I-Tsong Huang,2–4 Hui-Hua Yang,2 Chin-Te Huang,1 Li-Kuang Chen,2–5 Min-Muh Sheu1,6,7 1Department of Ophthalmology, 2Taiwan CDC Collaborating Laboratories of Virology, 3Department of Laboratory Medicine, Buddhist Tzu-Chi General Hospital, Hualien, Taiwan; 4Graduate Institute of Medical Sciences, 5Department of Laboratory Diagnosis, 6Department of Ophthalmology and Visual Science, Tzu-Chi University, Hualien, Taiwan; 7Department of Ophthalmology, Mennonite Christian Hospital, Hualien, Taiwan Abstract: Epidemic viral conjunctivitis is a highly contagious disease that is encountered year-round. The causative agents are mainly adenoviruses and enteroviruses. It occurs most commonly upon infection with subgroup D adenoviruses of types 8, 19, or 37. For common corneal involvement of human adenovirus type 8 epidemic keratoconjunctivitis, full-layer epithelial detachment is rarely seen. Herein, we report three cases of epidemic keratoconjunctivitis during an outbreak which manifested as large corneal epithelial full-layer detachment within a few days. The lesions healed without severe sequelae under proper treatment. The unique manifestation of this outbreak may indicate the evolution of human adenovirus type 8. Keywords: EKC, HAdV-8, cornea, virology, epidemic viral conjunctivitis

  6. Human adenovirus type 8: the major agent of epidemic keratoconjunctivitis (EKC).

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    Adhikary, Arun Kumar; Banik, Urmila

    2014-12-01

    Human adenovirus type 8 (HAdV-8) is the most common causative agent of a highly contagious eye disease known as epidemic keratoconjunctivitis (EKC). HAdV-8 strains have been classified into genome types HAdV-8A to 8K and HAdV/D1 to D12 according to restriction endonuclease analysis. This review focuses on the significance of HAdV-8 as an agent of EKC. Molecular analysis of HAdV-8 genome types HAdV-53 and HAdV-54 was performed to reveal potential genetic variation in the hexon and fiber, which might affect the antigenicity and tropism of the virus, respectively. On the basis of the published data, three patterns of HAdV-8 genome type distribution were observed worldwide: (1) genome types restricted to a microenvironment, (2) genome types distributed within a country, and (3) globally dispersed genome types. Simplot and zPicture showed that the HAdV-8 genome types were nearly identical to each other. HAdV-54 is very close to the HAdV-8P, B and E genomes, except in the hexon. In a restriction map, HAdV-8P, B, and E share a very high percentage of restriction sites with each other. Hypervariable regions (HVRs) of the hexon were conserved and were 100% identical among the genome types. The fiber knob of HAdV-8P, A, E, J and HAdV-53 were 100% identical. In phylogeny, HVRs of the hexon and fiber knob of the HAdV-8 genome types segregated into monophyletic clusters. Neutralizing antibodies against one genome type will provide protection against other genome types, and the selection of future vaccine strains would be simple due to the stable HVRs. Molecular analysis of whole genomes, particularly of the capsid proteins of the remaining genome types, would be useful to substantiate our observations. Copyright © 2014 Elsevier B.V. All rights reserved.

  7. Vernal keratoconjunctivitis

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    Bernadetha Shilio

    2005-03-01

    Full Text Available Why is allergic eye disease a problem for eye workers?Why is allergic eye disease, and vernal keratoconjunctivitis (VKC in particular, a problem for eye workers and patients in hot climates?

  8. No sequence variation in part of the hexon and the fibre genes of adenovirus 8 isolated from patients with conjunctivitis or epidemic keratoconjunctivitis (EKC) in Norway during 1989 to 1996.

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    Vainio, K; Borch, E; Bruu, A L

    2001-07-01

    Several local epidemics of keratoconjunctivitis/conjunctivitis caused by adenovirus type 8 (Ad8) occurred in Norway from August 1995 to May 1996. A smaller epidemic occurred in 1992. The Ad8 hexon forms the surface of the virion and contains the hypervariable regions loop I(1) and loop I(2). The fibre mediates the primary contact with cells. Sequence variation in hexon and fibre genes might play an important role in the pathogenicity of adenoviruses. The aim of this study was to investigate the genetic variability at the hexon and fibre genes in 26 strains of Ad8 isolated from 1989 to 1996. The genetic variability of 26 strains of Ad8 isolated from 1989 to 1996 was studied by sequencing part of the hexon and fibre genes. The Ad8 sequences were compared with each other and with two Ad8 strains from the EMBL database. In addition, 14 of the 26 isolates were subjected to restriction endonuclease analysis. No significant sequence variation was seen during the six year period. The Ad8 strains causing epidemics of keratoconjunctivitis/conjunctivitis in Norway are genetically stable.

  9. Sensitivity and Specificity of Suspected Case Definition Used during West Africa Ebola Epidemic.

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    Hsu, Christopher H; Champaloux, Steven W; Keïta, Sakoba; Martel, Lise; Bilivogui, Pepe; Knust, Barbara; McCollum, Andrea M

    2018-01-01

    Rapid early detection and control of Ebola virus disease (EVD) is contingent on accurate case definitions. Using an epidemic surveillance dataset from Guinea, we analyzed an EVD case definition developed by the World Health Organization (WHO) and used in Guinea. We used the surveillance dataset (March-October 2014; n = 2,847 persons) to identify patients who satisfied or did not satisfy case definition criteria. Laboratory confirmation determined cases from noncases, and we calculated sensitivity, specificity and predictive values. The sensitivity of the defintion was 68.9%, and the specificity of the definition was 49.6%. The presence of epidemiologic risk factors (i.e., recent contact with a known or suspected EVD case-patient) had the highest sensitivity (74.7%), and unexplained deaths had the highest specificity (92.8%). Results for case definition analyses were statistically significant (pdefinition used in Guinea contributed to improved overall sensitivity and specificity.

  10. [Vernal keratoconjunctivitis].

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    Pleyer, U; Leonardi, A

    2015-02-01

    Vernal keratoconjunctivitis (VKC) is a bilateral, usually seasonally recurrent inflammation of the conjunctiva. Clinically characteristic findings are tarsal giant conjunctival papillae (> 1 mm) and/or limbal gelatinous changes (Trantas dots). The underlying etiology and pathophysiology of VKC remains unclear; however, clinical findings and immunohistochemical studies suggest a complex, both IgE-dependent and IgE-independent immune-mediated etiology. Several predisposing conditions include endocrine, genetic, neurogenic, environmental and socioeconomic risk factors. Mast cell stabilizers, antihistamines and topical corticosteroids are often used during acute flare-ups in VKC; however this approach is unsatisfactory for controlling severe cases and avoiding recurrences. Immunomodulatory agents, such as cyclosporin A and tacrolimus are promising alternative agents for long-term management. In most children the clinical course of VKC is self-limiting and may disappear following puberty; however, some VKC patients will face sight-threatening complications which are mainly due to corneal involvement and iatrogenic damage caused by prolonged corticosteroid treatment.

  11. Vernal keratoconjunctivitis.

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    Bonini, S; Coassin, M; Aronni, S; Lambiase, A

    2004-04-01

    Vernal keratoconjunctivitis (VKC) is an allergic eye disease that especially affects young boys. The most common symptoms are itching, photophobia, burning, and tearing. The most common signs are giant papillae, superficial keratitis, and conjunctival hyperaemia. Patients with VKC frequently have a family or medical history of atopic diseases, such as asthma, rhinitis, and eczema. However, VKC is not associated with a positive skin test or RAST in 42-47% of patients, confirming that it is not solely an IgE-mediated disease. On the basis of challenge studies as well as immunohistochemical and mediator studies, a Th2-driven mechanism with the involvement of mast cells, eosinophils, and lymphocytes has been suggested. Th2 lymphocytes are responsible for both hyperproduction of IgE (interleukin 4, IL-4) and for differentiation and activation of mast cells (IL-3) and eosinophils (IL-5). Other studies have demonstrated the involvement of neural factors such as substance P and NGF in the pathogenesis of VKC, and the overexpression of oestrogen and progesterone receptors in the conjunctiva of VKC patients has introduced the possible involvement of sex hormones. Thus, the pathogenesis of VKC is probably multifactorial, with the interaction of the immune, nervous, and endocrine systems. The clinical management of VKC requires a swift diagnosis, correct therapy, and evaluation of the prognosis. The diagnosis is generally based on the signs and symptoms of the disease, but in difficult cases can be aided by conjunctival scraping, demonstrating the presence of infiltrating eosinophils. Therapeutic options are many, in most cases topical, and should be chosen on the basis of the severity of the disease. The most effective drugs, steroids, should however be carefully administered, and only for brief periods, to avoid secondary development of glaucoma.A 2% solution of cyclosporine in olive oil or in castor oil should be considered as an alternative. The long-term prognosis of

  12. Clinical grading of vernal keratoconjunctivitis.

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    Bonini, Stefano; Sacchetti, Marta; Mantelli, Flavio; Lambiase, Alessandro

    2007-10-01

    The purpose of the present review is to provide an overview on the clinical features of vernal keratoconjunctivitis on the basis of cases series presented in the literature. Furthermore, a new grading system of vernal keratoconjunctivitis based on the severity of the disease is proposed. Different treatment options are discussed based on the clinical grade of vernal keratoconjunctivitis. Recent epidemiological studies on the demographic, clinical and immunologic features of vernal keratoconjunctivitis are presented. The efficacy and complications of treatments are described. Diagnosis and treatment of patients is a challenge for ophthalmologists as no precise diagnostic criteria have been established, the pathogenesis is unclear, and antiallergic treatments are often unsuccessful. This review describes old and new concepts of vernal keratoconjunctivitis diagnosis and treatment: the clinical features, the diagnostic criteria, the common features between this and other ocular allergies and the therapeutic strategies. On the basis of this knowledge, a new grading system is introduced based on clinical signs and symptoms of ocular surface inflammation. This new grading of vernal keratoconjunctivitis may help clinicians and researchers to classify disease activity and to establish a common agreement for treatments.

  13. [Vernal keratoconjunctivitis in children].

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    Oraszewska-Matuszewska, Bronisława; Pieczara, Ewa; Sameochowiec-Donocik, Elibieta; Filipek, Erita

    2005-01-01

    To evaluate the course of palpebral type of vernal keratoconjunctivitis (VKC) and relation of the number of recurrences per year, to patients age and to estimate the frequency of irreversible corneal transparency changes and visual acuity decrease. There were 34 eyes of 17 children, 13 boys (76.4%) included 2 brothers and 4 girls. The age of patients was from 5 to 14 years, mean 9.1. All patients were hospitalized because of pathological corneal changes. Follow up from 2 to 13 years (mean 8.4). The number of recurrences ranged from 2 to 5 per year and there was not correlation between age of children and frequency of episodes. We have observed punctate keratopathy (79.14% of cases) and corneal ulcers (26.5% of cases). In 25 eyes of 13 patients cryocoagulation and/or excision of giant palpebral papillae were done. Visual acuity ranged from 0.01 to 1.0 and mean value before treatment was 0.879 +/- 0.09 and after 0.884 +/- 0.10. The difference was not statistically significant (p = 0.878). (1) The course of VKC is recurrent, the number of recurrences per year does not depend on the age of patients, but is correlated with giant papillae of palpebral conjunctiva presence. (2) Large papillae should be excised, in order to make the healing of cornea quicker. (3) Permanent visual function decreasing is not frequent because partial leucoma is localized at the periphery of cornea.

  14. Management of vernal keratoconjunctivitis.

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    Leonardi, Andrea

    2013-12-01

    Vernal keratoconjunctivitis (VKC) is a relatively rare, chronic form of ocular allergy that can potentially cause severe visual complications. Affecting mainly children and young adults, it is an IgE- and T cell-mediated disease, leading to a chronic inflammation in which eosinophil, lymphocyte and structural cell activation are involved. Treatment of VKC requires a multiple approach that includes conservative measures and pharmacologic treatment. Patients and parents should be made aware of the long duration of disease, its chronic evolution and possible complications. Treatment should be based on the duration and frequency of symptoms and the severity of corneal involvement. Mast cell stabilizers and antihistamines have been proven to be effective for the treatment of mild to moderate forms of VKC. In the most severe cases, topical steroids can be used as rescue medication to reduce conjunctival and corneal inflammation. Immunomodulators that have been investigated for VKC treatment include topical ocular preparations of cyclosporine A and tacrolimus. Topical cyclosporine A has been proven to be effective in the long-term treatment of VKC, significantly improving signs and symptoms without significant side effects.

  15. Vernal keratoconjunctivitis: an update.

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    De Smedt, Stefan; Wildner, Gerhild; Kestelyn, Philippe

    2013-01-01

    Vernal keratoconjunctivitis (VKC) is a bilateral, usually seasonally recurrent, allergic inflammation of the conjunctiva, characterised by limbal gelatinous hypertrophy and/or upper tarsal giant conjunctival papillae. Although rare in temperate regions, it represents an important cause of hospital referral in many parts of Africa and Asia. Clinical and immunohistochemical studies suggest that IgE-dependent (type I allergic) and IgE-independent (type IV allergic) mechanisms are involved in the immunopathogenesis of VKC, in which various inflammatory cells, including different T cell subpopulations play an active role via a cascade of chemical mediators. Endocrine, genetic, neurogenic, environmental and socioeconomic risk factors have been identified. However, its aetiology and pathophysiology remain unclear. The clinical course of this disease is usually benign and self-limiting, but a minority of patients will face very debilitating and sight threatening complications. Topical corticosteroids are often used during flare-ups in combination with mast cell stabilizers as maintenance treatment for VKC. However this management is unsatisfactory in controlling severe cases and avoiding recurrences. Non-steroidal immune modulators such as ciclosporin A and tacrolimus are promising alternatives, but tolerance to these agents needs to be improved and production costs reduced. The purpose of this review is to give an update on its epidemiology, immunopathogenesis and management.

  16. Listeria monocytogenes endophthalmitis following keratoconjunctivitis

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    Shoughy SS

    2014-01-01

    Full Text Available Samir S Shoughy,1 Khalid F Tabbara1–31The Eye Center and The Eye Foundation for Research in Ophthalmology, Riyadh, Saudi Arabia; 2Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 3The Wilmer Ophthalmological Institute of The Johns Hopkins University School of Medicine, Baltimore, MD, USAAbstract: Endophthalmitis due to endogenous or exogenous bacteria is a rare infection of the eye. We report a case of endophthalmitis following Listeria monocytogenes keratoconjunctivitis in a 27-year-old healthy white male presenting with hand motion visual acuity, right eye mucopurulent conjunctivitis, elevated intraocular pressure, and pigmented hypopyon 6 months post-keratectomy. The conjunctivitis was unresponsive to a 5-day course of topical tobramycin eye drops, and the patient developed keratitis with pain that progressed to endophthalmitis after 21 days. Diagnostic B-scan revealed vitreous exudates. Intraocular fluid specimen showed Gram-positive organisms and the aqueous culture grew penicillin-/aminoglycoside-sensitive L. monocytogenes. The patient was given intravitreal and systemic vancomycin and ceftazidime. The eye was unresponsive to intravenous penicillin and gentamicin; the anterior chamber progressively flattened and developed phthisis bulbi. L. monocytogenes keratoconjunctivitis may lead to bacterial endophthalmitis. Prompt culture and early antibiotic therapy are recommended.Keywords: conjunctivitis, L. monocytogenes, endophthalmitis

  17. Corneal complications of vernal keratoconjunctivitis.

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    Solomon, Abraham

    2015-10-01

    Vernal keratoconjunctivitis (VKC) is a severe bilateral chronic allergic inflammatory disease of the ocular surface. In most of the cases, the disease is limited to the tarsal conjunctiva and to the limbus. However, in the more severe cases, the cornea may be involved, leading to potentially sight threatening complications. Prompt recognition of these complications is crucial in the management of VKC, which is one of the most severe ocular allergic diseases. A vicious cycle of inflammation occurs as a result of a set of reciprocal interactions between the conjunctiva and the cornea, which results in damage to the corneal epithelium and corneal stoma, and to the formation of shield ulcers and plaques, infectious keratitis, keratoconus, scarring, and limbal stem cell deficiency. These corneal complications can cause permanent decrease or loss of vision in children suffering from VKC. Corneal complications in VKC are the result of an on-going process of uncontrolled inflammation. Proper recognition of the corneal complications in VKC is crucial, as most of these can be managed or prevented by a combination of medical and surgical measures.

  18. Dry Eye in Vernal Keratoconjunctivitis

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    Villani, Edoardo; Strologo, Marika Dello; Pichi, Francesco; Luccarelli, Saverio V.; De Cillà, Stefano; Serafino, Massimiliano; Nucci, Paolo

    2015-01-01

    Abstract The purpose of this comparative cross-sectional study was to investigate the use of standardized clinical tests for dry eye in pediatric patients with active and quiet vernal keratoconjunctivitis (VKC) and to compare them with healthy children. We recruited 35 active VKC, 35 inactive VKC, and 70 age-matched control healthy subjects. Each child underwent a complete eye examination, including visual analog scale symptoms assessment, biomicroscopy, fluorescein break-up time (BUT), corneal fluorescein and conjunctival lissamine green staining, corneal esthesiometry, Schirmer test with anesthetic, and meibomian glands inspection and expression. Active VKC patients showed significantly increased symptoms and signs of ocular surface disease, compared with the other 2 groups. Inactive VKC patients, compared with control subjects, showed increased photophobia (P < 0.05; Mann-Whitney U test), conjunctival lissamine green staining and Schirmer test values, and reduced BUT and corneal sensitivity [P < 0.05 by analysis of variance (ANOVA) least significant difference posthoc test for BUT and Schirmer; P < 0.001 by Mann-Whitney U test for lissamine green staining and corneal sensitivity]. Our results confirm the association between VKC and short-BUT dry eye. This syndrome seems to affect the ocular surface in quiescent phases too, determining abnormalities in tear film stability, epithelial cells integrity, and corneal nerves function. The very long-term consequences of this perennial mechanism of ocular surface damage have not been fully understood yet. PMID:26496269

  19. Vernal keratoconjunctivitis: atopy and autoimmunity.

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    Zicari, A M; Nebbioso, M; Lollobrigida, V; Bardanzellu, F; Celani, C; Occasi, F; Cesoni Marcelli, A; Duse, M

    2013-05-01

    Vernal Keratoconjunctivitis (VKC) is a rare chronic ocular inflammatory disease and it mainly affects boys in the first decade of life. Although it is a self-limiting disease, patients may present many phases characterized by an exacerbation of inflammatory symptoms with a consequent decline of the quality of life. define the clinical and immunological profile of patients affected by VKC and investigate their familiar history of autoimmune disorders and their autoimmunity pattern. 28 children were enrolled (20 males, 71%) aged between 4 and 14 years of life affected by VKC. Family history of allergic and immunological diseases was collected for each patient. In particular, it was asked whether some components of their families were affected by Hashimoto's thyroiditis, type I diabetes, psoriasis or rheumatoid arthritis and Systemic Lupus Erythematosus (SLE). All VKC children underwent a serological evaluation of anti-nuclear antibodies (ANA). A family history of immunological disorders was found in 46% of patients, 28% of Hashimoto's thyroiditis, 14% of type I diabetes, 14% of psoriasis, and 1 of Systemic Lupus Erythematosus. Furthermore, 35% of patients was ANA positive and they corresponded to patients with a higher ocular score and with the most important clinical symptoms. the detection of ANA positivity and of a familiar history of autoimmune disorders in a high percentage of children with VKC may help us to better understand the association of this ocular inflammatory disease with systemic autoimmune disorders and atopic condition.

  20. uv keratoconjunctivitis vs. established dose effect relationships

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    Gulvady, N.U.

    1976-08-01

    A patient who received a uv dose to his eyes 11 times greater than the photokeratitic threshold of Pitts and 4/sup 1///sub 2/ times the photokeratitic threshold as found by Leach. The patient had severe keratoconjunctivitis for 3 days and did not develop any keratitis.

  1. Vernal Keratoconjunctivitis in Kashmir: A temperate zone.

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    Sofi, Rayees Ahmad; Mufti, Asmat

    2016-12-01

    The objective of this study was to observe the clinical features of patients with vernal keratoconjunctivitis attending the Outpatient Department of a mobile eye unit, Directorate of Health Services, Jammu and Kashmir over a period of 1 year. The greater prevalence of VKC is seen in the regions with hot, humid climate, and higher load of airborne allergens. The clinical profile of this disease seems to have geographical variation. The study was conducted in the mobile eye unit, Directorate of Health Services, Kashmir, a comparatively cooler area. All the patients with vernal keratoconjunctivitis who presented to the OPD during this period were examined. The diagnosis of vernal keratoconjunctivitis was based on typical history, clinical features, and examination. All the patients with the complaints of itching, watering, and photophobia were examined. After proper history, clinical features, and ocular examination under slit lamp, the data were recorded for patients who were diagnosed with vernal keratoconjunctivitis. Of all the patients who had allergic ocular disorders, a total of 212 patients were diagnosed as cases with vernal keratoconjunctivitis. This is a non-interventional study, and the ethical clearance was obtained from the regulatory board of the hospital. The study abides by the tenets laid down in the declaration of Helsinki. During this 1-year period, 212 vernal keratoconjunctivitis patients were examined, of whom 155 (73 %) were males and 57 (27 %) were females. As per the age group, 40 % (85) of patients were in the age group of 11-15 years. 93 % (197) of patients had bilateral disease, and 7 % (15) had unilateral. It was seen that 75 % (159) had seasonal attack. Different types of disease were observed: 77 % (163) had bulbar disease, 7 % (15) had palpebral, and 16 % (34) had mixed disease. During this period, we noticed that VKC led to complications also. It was seen that 3 % (6) of patients had steroid induced glaucoma, 5 % (11) had

  2. Topical cyclosporine for atopic keratoconjunctivitis.

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    González-López, Julio J; López-Alcalde, Jesús; Morcillo Laiz, Rafael; Fernández Buenaga, Roberto; Rebolleda Fernández, Gema

    2012-09-12

    Atopic keratoconjunctivitis (AKC) is a chronic ocular surface non-infectious inflammatory condition that atopic dermatitis patients may suffer at any time point in the course of their dermatologic disease and is independent of its degree of severity. AKC is usually not self resolving and it poses a higher risk of corneal injuries and severe sequelae. Management of AKC should prevent or treat corneal damage. Although topical corticosteroids remain the standard treatment for patients with AKC, prolonged use may lead to complications. Topical cyclosporine A (CsA) may improve AKC signs and symptoms, and be used as a corticosteroid sparing agent. To determine the efficacy and gather evidence on safety from randomised controlled trials (RCTs) of topical CsA in patients with AKC. We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 6), MEDLINE (January 1946 to July 2012), EMBASE (January 1980 to July 2012), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to July 2012), Cumulative Index to Nursing and Allied Health Literature (CINAHL) (January 1937 to July 2012), OpenGrey (System for Information on Grey Literature in Europe) (www.opengrey.eu/), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov), the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en), the IFPMA Clinical Trials Portal (http://clinicaltrials.ifpma.org/no_cache/en/myportal/index.htm) and Web of Science Conference Proceedings Citation Index- Science (CPCI-S). We did not use any date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 9 July 2012. We also handsearched the following conference proceedings: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, International Council of Opthalmology and Societas

  3. A comprehensive review on vernal keratoconjunctivitis with emphasis on proteomics.

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    Pattnaik, Lolly; Acharya, Laxmikanta

    2015-05-01

    Allergic conjunctivitis presents as a spectrum of different clinical entities, such as perennial allergic conjunctivitis, seasonal allergic conjunctivitis, atopic keratoconjunctivitis and vernal keratoconjunctivitis. Vernal keratoconjunctivitis (VKC) is a disorder that is often associated with allergens and is seen during the spring season. Herein, we focused on vernal keratoconjunctivitis (VKC) and reviewed its epidemiology, clinical presentations, ocular associations, available treatment options, and the progressive understanding of its histopathological features; we have also systematically elaborated on the various studies on proteomics. Initial theories of a solely IgE-mediated mechanism have been replaced by those considering IgE and non-IgE mechanisms. Developments in basic and clinical research will open novel diagnostic approaches for the early detection and cure of the disease. Copyright © 2015. Published by Elsevier Inc.

  4. Bacteriological Investigation of Infectious Keratoconjunctivitis in Norwegian Sheep

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    Hofshagen M

    2004-03-01

    Full Text Available Contagious keratoconjunctivitis is a rather common disease in Norwegian sheep. Since the knowledge of its aetiology is limited, the present study was performed to determine the microorganisms involved. Local veterinarians throughout the country collected conjunctival swabs from both sick (n = 43 and healthy (n = 42 sheep on 15 farms with outbreaks of ovine keratoconjunctivitis, and further from healthy sheep (n = 50 on 17 farms not showing any signs of conjunctival disease. All samples were cultivated for bacteria and mycoplasma. Listeria monocytogenes was isolated from 3 cases (1% in one single herd. Staphylococcus aureus (5%, Corynebacterium spp. (2% and Escherichia coli (4% were isolated only in herds with keratoconjunctivitis, but from both sick and healthy animals. Moraxella (Branhamella ovis was isolated from 28% of sampled animals in affected herds and from 10% of sampled animals in healthy herds. The corresponding numbers for Moraxella spp. were 9%/12%, for Pseudomonas spp. 7%/8%, for Staphylococcus spp. 22%/22%, for Bacillus spp. 12%/14%, for Micrococcus spp. 6%/2% and for Streptococcus/Enterococcus spp. 2%/2%. Mycoplasma conjunctivae was isolated from 16 animals with keratoconjunctivitis (37% and from 3 animals without clinical signs (7% in farms with keratoconjunctivitis. In farms without clinical signs of keratoconjunctivitis, M. conjunctivae was isolated in 4 animals (8%. To our knowledge, this is the first time M. conjunctivae has been isolated in Norway. Other predisposing agents found were Moraxella (Branhamella ovis and Listeria monocytogenes. The etiological importance of different microorganisms in ovine keratoconjunctivitis seems to vary; some are probably only present as secondary invaders. Other possible causes of ovine keratoconjunctivitis in Norway, such as Chlamydia psittaci, remain to be investigated.

  5. Severe vernal keratoconjunctivitis successfully treated with subcutaneous omalizumab.

    Science.gov (United States)

    de Klerk, Timothy A; Sharma, Vibha; Arkwright, Peter D; Biswas, Susmito

    2013-06-01

    A 12-year-old boy with severe mixed limbal and palpebral vernal keratoconjunctivitis experienced persistent ocular symptoms despite treatment with topical corticosteroids or cyclosporine. Signs and symptoms resolved completely with monthly subcutaneous omalizumab, an immunomodulating biologic agent. To our knowledge, this is the first report of its use as a monotherapy agent to treat vernal keratoconjunctivitis. Copyright © 2013 American Association for Pediatric Ophthalmology and Strabismus. Published by Mosby, Inc. All rights reserved.

  6. BILATERAL STEROID INDUCED GLAUCOMA IN VERNAL KERATOCONJUNCTIVITIS

    Directory of Open Access Journals (Sweden)

    Bangal Surekha V, Bankar Mahima S, Bhandari Akshay J, Kalkote Prasad R

    2015-01-01

    Full Text Available Vernal Keratoconjunctivits (VKC is a bilateral recurrent allergic interstitial conjunctival inflammation with a periodic seasonal incidence and of self limiting nature, mainly affecting the younger population. Patients of VKC on steroid therapy are at higher risk of developing steroid induced glaucoma. Raised intraocular pressure due to steroids typically occurs within few weeks of starting steroid therapy and comes back to normal on immediate stoppage of steroids. A case of steroid induced glaucoma in a 30 years old female with vernal keratoconjunctivitis. She was on topical steroids for 3-4 years. She was incompliant with the instructions to stop steroids. She eventually developed steroid induced glaucoma and glaucomatous optic neuropathy with tunnel vision.

  7. Vitiligo in association with vernal keratoconjunctivitis.

    Science.gov (United States)

    Kumar, Sunil; Al Khars, Wajeeha

    2016-01-01

    Vernal keratoconjunctivitis (VKC) is a chronic allergic inflammation of ocular surface involving the tarsal and/or bulbar conjunctiva. Signs of VKC are confined to the conjunctiva and cornea. The skin of the lid remains uninvolved. Here we report a case of 17 year-old male suffering from VKC who develops vitiligo of lid skin and lash poliosis. All ocular and systemic causes of localized skin and lash depigmentation were excluded in our patient by thorough clinical examination and investigations. During regular follow-up for two-year patient did not develop any ocular and systemic illness presenting as vitiligo and poliosis. We believe that VKC was the most possible etiology of Vitiligo of lid and lash poliosis in this patient.

  8. Pathogenesis of Vernal Keratoconjunctivitis and Associated Factors.

    Science.gov (United States)

    Nebbioso, Marcella; Zicari, Anna Maria; Celani, Camilla; Lollobrigida, Valeria; Grenga, Roberto; Duse, Marzia

    2015-01-01

    To investigate the role of some variables, including allergy and autoimmunity, in the pathogenesis of vernal keratoconjunctivitis (VKC). The VKC is a chronic and often severe form of bilateral keratoconjunctivitis. Usually, it begins during the first decade and disappears during the end of the second decade of life. 26 patients with VKC were selected. The diagnosis was performed by the ophthalmologist through a score based on ocular signs and subjective symptoms before and after administration of 1% cyclosporine A (Cy) eyedrops. Each variable was graded: 0 = absent; 1 = mild; 2 = moderate; 3 = severe. Patients with a total score ≥7 were included in the study. Blood samples were collected at the initial time for the determination of autoimmunity by total IgE and antinuclear antibodies (ANA). A Skin Prick Test (SPT) was performed on each patient to common inhalants and food allergens. 53.8% of the children resulted atopic. The most important allergens were house dust mites and grasses. 46.1% of the patients showed total IgE >100 UI/ml and 30.8% had ANA positivity at the first determination. The photophobia occurred in 42.3% of children, most frequently with respect to other symptoms like secretion or tearing (30.8%), foreign body sensation (15.4%), itching and conjunctival hyperemia (11.5%). Fortunately all children improved their symptoms after Cy eyedrop therapy. Moreover, there was an elevated percentage (30.8%) of children with ANA positivity compared with the values in the general pediatric population. Despite the fact that it is a non-specific autoantibody, its high presence in a population of children with VKC may have an important role in clarifying etiopathogenesis and chronic inflammation.

  9. Tear levels of IL-16 in vernal keratoconjunctivitis

    Directory of Open Access Journals (Sweden)

    Onur Çatak

    2013-09-01

    Full Text Available Objective: Vernal keratoconjunctivitis is more common inchildren and young adults having an atopic background.The aim of the present study was to determine the interleukin-16 (IL-16 levels in tear fluids of patients withvernal keratoconjunctivitis (VKC.Methods: Tear fluid samples were collected from 20patients with VKC and 10 healthy subjects. Tear fluidsamples were collected with microcapillary tubes for hematocritat the lateral canthus of patients in the supineposition without any anesthesia. Tear levels of IL-16 weremeasured by ELISA kit.Results: The mean levels of IL-16 among the patients(514±135 pg/ml was significantly higher than amongcontrols (358±139 pg/ml (p=0.04.Conclusions: These results considered that IL-16 havesignificant effect on the pathogenetic process of vernalkeratoconjunctivitis.Key words: Interleukin-16, vernal keratoconjunctivitis,enzyme-linked immunosorbent assay

  10. Tacrolimus Ointment for Treatment of Vernal Keratoconjunctivitis.

    Science.gov (United States)

    Al-Amri, Abdulrahman M; Mirza, Aleem Gulzar; Al-Hakami, Ahmed Mossa

    2016-01-01

    To evaluate the safety and efficacy of tacrolimus 0.1% ointment for the treatment of refractory vernal keratoconjunctivitis (VKC). This prospective, nonrandomized case series enrolled 20 patients (40 eyes) with severe VKC, who were treated with tacrolimus 0.1% ointment. The mean age of the patients was 18.25 ± 4.2 years (range, 9-31 years). Each patient completed a follow-up period of at least 24 months. The main outcome measure was the clinical response to treatment. Significant improvements in clinical signs and symptoms were achieved in all patients 6 weeks after starting treatment with topical tacrolimus. Treatment was gradually reduced, with increasing intervals between applications. VKC recurred in all patients who attempted to discontinue treatment. No additional medications were required and no significant changes in visual acuity or refraction were documented. Five patients discontinued treatment due to a severe burning sensation and were excluded from the study. Tacrolimus, 0.1% ointment, is a safe and effective treatment for VKC refractory to standard treatment and may be used as a substitute for steroid treatments used to controlled disease activity. However, adverse effects could cause poor patient compliance.

  11. Spooky Suspects

    Science.gov (United States)

    Pacifici, Lara

    2011-01-01

    This activity presents an option for covering biology content while engaging students in an investigation that highlights the spirit of Halloween. Students are engaged in the story line and have fun trying to solve the mystery kidnapping by using science skills to examine the evidence and eliminate some ghoulish suspects. (Contains 1 figure.)

  12. Tacrolimus in Corticosteroid-Refractory Vernal Keratoconjunctivitis.

    Science.gov (United States)

    Chatterjee, Samrat; Agrawal, Deepshikha

    2016-11-01

    To evaluate the efficacy of 0.03% tacrolimus in the treatment of corticosteroid-refractory vernal keratoconjunctivitis (VKC). This open-label study enrolled 30 patients with VKC who were not responding to topical corticosteroid treatment for at least 4 weeks. All patients were treated with 0.03% tacrolimus eye ointment 3 times daily, 0.05% ketotifen eye drops twice daily, and preservative-free artificial tears. Symptoms (itching, redness, watering, discharge, burning, and photophobia) and signs (conjunctival injection, papillae, cobblestone papillae, limbal inflammation, or hypertrophy and corneal epithelial staining) were graded on a 4-point scale at enrolment, after 4 weeks, and at the end of treatment period, which was at 12 weeks. Composite scores for symptoms and signs were computed by summing individual scores. Treatment failure was denoted if additional treatment with corticosteroids were required. The composite scores for symptoms (10.8, 3.8, 3.4) and signs (8.7, 4.7, 4.0) in 23 patients showed a statistically significant (P < 0.05) improvement from baseline to the 4- and 12-week visits. Among the signs, upper tarsal papilla showed improvement only at 12 weeks, but the scores for giant cobblestone papillae did not reach statistically significant reduction even at 12 weeks. There was improvement in visual acuity at 12 weeks, although it was not statistically significant (P = 0.05). Treatment failure was recorded in 17% patients. The only adverse effect reported was transient stinging sensation lasting for a few days. Tacrolimus 0.03% was apparently safe and effective in treating patients with steroid-refractory VKC. A small subset of patients may still require supplemental topical corticosteroids for resolution of their symptoms.

  13. Vernal keratoconjunctivitis-like disease in adults.

    Science.gov (United States)

    Leonardi, Andrea; Lazzarini, Daniela; Motterle, Laura; Bortolotti, Massimo; Deligianni, Velika; Curnow, S John; Bonini, Stefano; Fregona, Iva A

    2013-05-01

    To identify clinical, demographic, immunologic, and health-related quality-of-life data from a cohort of vernal keratoconjunctivitis (VKC) patients with the onset of the disease after puberty (VKC-like disease). Retrospective, observational case series. Forty-nine patients with late-onset VKC-like disease from among 600 consecutive VKC patients. History of disease, test results for allergen sensitivity, signs and symptoms, impact of disease on work productivity, health-related quality of life, and treatment satisfaction were assessed. In addition, multiplex bead analysis for Th1/Th2 cytokines were carried out in tear samples from 20 VKC patients (10 adults and 10 children) and from 10 normal subjects. A family history of allergy was positive in only 28% and positive prick test results were present in 55% of the 49 VKC-like adult patients. Based on typical signs and symptoms, 48% were affected by the limbal form, 33% were affected by the tarsal form, and 19% were affected by the mixed form. Corneal ulcer complicated the disease in only 2 adult patients. Although the disease was not considered a limiting factor for work, productivity was reduced by 26% and social activities were reduced by 31% during active flare-ups. No significant differences were found in tear cytokine pattern production between VKC in children and VKC in adults. A late onset VKC-like disease can appear in young adults with signs and symptoms similar to those in pediatric disease, but with less corneal involvement. Copyright © 2013 Elsevier Inc. All rights reserved.

  14. Tear ferning in normal dogs and dogs with keratoconjunctivitis sicca ...

    African Journals Online (AJOL)

    This study evaluates tear ferning as an ancillary technique for the evaluation of the canine tear film in normal eyes and eyes affected by keratoconjunctivitis sicca (KCS). Thirty dogs with KCS and 50 control dogs with normal tear film were evaluated with a full ophthalmoscopic examination and a Schirmer tear test type 1 ...

  15. Topographic corneal changes in patients with vernal keratoconjunctivitis.

    Science.gov (United States)

    Dantas, Paulo Elias Correa; Alves, Milton Ruiz; Nishiwaki-Dantas, Maria Cristina

    2005-01-01

    To carry out a case-control clinical study in patients with vernal keratoconjunctivitis, aiming at information about the anterior corneal curvature and visual performance using a quantitative corneal descriptor analyzer (Holladay Diagnostic Summary). We examined 342 eyes of 171 patients divided into 2 groups. Group 1 with 142 eyes of 71 patients with a clinical diagnosis of vernal keratoconjunctivitis (cases) and Group 2 with 200 eyes of 100 patients (controls) from the Department of Ophthalmology/"Santa Casa" of São Paulo. Patients were submitted to a complete examination and corneal topography with a quantitative corneal surface contour descriptor (Holladay Diagnostic Summary). Clinical and topographic criteria were established to diagnose keratoconus in both groups. The frequency of patients with a clinical diagnosis of keratoconus associated with vernal keratoconjunctivitis in Group 1 was 9.85% (7 patients). According to topographic criteria, the frequency in Group 1 was 22.53% (16 patients). In Group 2, no patient presented biomicroscopic, refratometric or topographic characteristics of keratoconus. All studied topographic variables, including corneal asphericity, presented statistical significance (pvernal keratoconjunctivitis. Visual performance is compromised by aberrations and changes in corneal asphericity and other topographic variables.

  16. Hyposensitization in the treatment of resistant cases of vernal keratoconjunctivitis.

    Science.gov (United States)

    Mahdy, Reda A; Nada, Waled M; Shahien, Ezzat A; Boghdadi, Ghada A; Marei, Ayman A

    2010-09-01

    The study evaluated the treatment of resistant cases of vernal keratoconjunctivitis by hyposensitization resulting from intradermal skin reactions of different allergens. This prospective study was carried out in the Department of Ophthalmology and the Department of Microbiology and Immunology, Zagazig University, and included 36 patients with bilateral vernal keratoconjunctivitis that was resistant to topical corticosteroids and antihistaminic drugs. Patients were subjected to intradermal skin reactions to different allergens after stoppage of the medication. Subcutaneous injections of different allergens were administered in addition to topical vasoconstrictor and antihistaminic eye drops for different durations of 12, 18, and 24 months. The study revealed that most of the patients were sensitive to pollens (65%), house dust (55%), and tobacco smoke (40%). Among 36 total patients who received different doses of allergens, 10 of 20 patients showed marked improvement following a 24-month treatment period, with a 50% success rate. Another 3 of 9 patients showed marked improvement following an 18-month treatment period, with a 33.3% success rate. The use of intradermal skin reactions to determine the sensitivity for different stimulating allergens in resistant cases of vernal keratoconjunctivitis was conclusive. Treatment by hyposensitization using prepared vaccines had an acceptable success rate especially in patients treated for 24 months. Future studies will be needed to determine how effective this treatment is with other allergens and for longer durations of hyposensitization. Additional immunologic studies will be essential for developing a strategy of management of resistance in such cases of resistant vernal keratoconjunctivitis.

  17. Lacrimomimetic effect of lopieal cyclosporins A in canine keratoconjunctivitis

    Directory of Open Access Journals (Sweden)

    Carlos Horário Lightowler

    1993-12-01

    Full Text Available The authors make a description of the results attained with the topical use of keratoconjunctivitis sicca. In all treated cases they observed an increase in the values of the Schirmer tear test marked improvement of the eyes and furthermore an attenuation of the melanic pigment deposited on the cornea.

  18. Prevalence of Keratoconjunctivitis Sicca among adults in Abia State ...

    African Journals Online (AJOL)

    Keratoconjunctivitis Sicca (KSC) is autoimmune inflammation process that occurs mostly in middle age and in older population. It has been shown to occur due ... in the elderly and middle aged. Eye care practitioners are thus encouraged to take proper case history in order to diagnose KCS whenever the case is presented.

  19. Brimonidine allergy presenting as vernal-like keratoconjunctivitis.

    Science.gov (United States)

    Shah, Aparna A; Modi, Yasha; Thomas, Benjamin; Wellik, Sarah R; Galor, Anat

    2015-01-01

    To report a brimonidone-induced allergic reaction that mimicked a limbal form of vernal keratoconjunctivitis in the setting of background ocular surface toxicity. A 78-year-old male with a history of primary open angle glaucoma presented with symptoms of unilateral blurry vision, irritation, and redness shortly after starting brimonidine exclusively in the right eye. Examination revealed injected palpebral and bulbar conjunctiva, diffuse punctate epithelial erosion and discrete, non-staining corneal limbal infiltrates superiorly. Given the unilateral presentation, the patient was diagnosed with an allergic limbal keratoconjunctivitis secondary to bromonidine. Shortly after discontinuing the brimonidine, there was full resolution of the corneal limbal infiltrates. The punctate epithelial erosions and tear film abnormalities remained. Direct medication allergy and ocular surface disease are two distinct entities that often co-exist. Distinguishing between the two entities, sometimes by trial and error, is critical in the management of these patients.

  20. Clinical presentation of vernal keratoconjunctivitis in Bharatpur Medical College

    Directory of Open Access Journals (Sweden)

    Polina Dahal

    2015-11-01

    Full Text Available Background & Objectives: To evaluate the different clinical presentation of Vernal Keratoconjunctivitis (VKC in our context.Materials & Methods: Ninety diagnosed VKC patients attending the outpatient department of College of Medical Sciences from 1st March 2014 to 1st June 2015 were enrolled in the study.Results: The study revealed male predominance (83.33%. Commonly occurring symptoms were itching (100% and redness (80%. Commonest sign was tarsal papillae (100%. Conjunctival hyperemia was seen in 94.1% cases and 180 eyes of 90 cases showed Vernal Keratoconjunctivitis.Conclusion: The clinical presentation of VKC patients in our context are very much similar to the findings of the other study done in Nepal and other parts of the world. Commonly occurring symptoms are itching, redness and commonly occurring signs are tarsal papillae and conjunctival hyperemia.JCMS Nepal. 2015; 11(2:17-19

  1. Oral cyclosporine therapy for refractory severe vernal keratoconjunctivitis

    Directory of Open Access Journals (Sweden)

    Nikhil S Gokhale

    2012-01-01

    Full Text Available We report the success of oral cyclosporine therapy in a patient with severe vision-threatening vernal keratoconjunctivitis. A child presented with severe allergy which was not controlled with topical steroids, cyclosporine and mast cell stabilizers. Oral steroids were required repeatedly to suppress inflammation. Child showed a dramatic improvement and stabilization with oral cyclosporine therapy. Oral cyclosporine therapy can be tried in severe vision-threatening allergy refractory to conventional therapy.

  2. Kingella kingae Keratitis in a Child with Underlying Vernal Keratoconjunctivitis

    Directory of Open Access Journals (Sweden)

    Salim Nurul-Laila

    2017-01-01

    Full Text Available Kingella kingae had rarely been reported as a causative organism for corneal ulcer and had not been described before in vernal keratoconjunctivitis (VKC. Generally regarded as commensals of respiratory tract particularly in young children, it had however been isolated from the corneal ulcer scraping of both adult and children. We report a case of bacterial ulcer with isolation of Kingella kingae from the corneal scraping in a young child with underlying VKC.

  3. Kingella kingae Keratitis in a Child with Underlying Vernal Keratoconjunctivitis

    OpenAIRE

    Salim Nurul-Laila; Khai-Siang Chai; Ahmad Tajudin Liza-Sharmini; Ismail Shatriah

    2017-01-01

    Kingella kingae had rarely been reported as a causative organism for corneal ulcer and had not been described before in vernal keratoconjunctivitis (VKC). Generally regarded as commensals of respiratory tract particularly in young children, it had however been isolated from the corneal ulcer scraping of both adult and children. We report a case of bacterial ulcer with isolation of Kingella kingae from the corneal scraping in a young child with underlying VKC.

  4. Kingella kingae Keratitis in a Child with Underlying Vernal Keratoconjunctivitis.

    Science.gov (United States)

    Nurul-Laila, Salim; Chai, Khai-Siang; Liza-Sharmini, Ahmad Tajudin; Shatriah, Ismail

    2017-01-01

    Kingella kingae had rarely been reported as a causative organism for corneal ulcer and had not been described before in vernal keratoconjunctivitis (VKC). Generally regarded as commensals of respiratory tract particularly in young children, it had however been isolated from the corneal ulcer scraping of both adult and children. We report a case of bacterial ulcer with isolation of Kingella kingae from the corneal scraping in a young child with underlying VKC.

  5. Oral cyclosporine therapy for refractory severe vernal keratoconjunctivitis

    Science.gov (United States)

    Gokhale, Nikhil S; Samant, Rohini; Sharma, Vishnu

    2012-01-01

    We report the success of oral cyclosporine therapy in a patient with severe vision-threatening vernal keratoconjunctivitis. A child presented with severe allergy which was not controlled with topical steroids, cyclosporine and mast cell stabilizers. Oral steroids were required repeatedly to suppress inflammation. Child showed a dramatic improvement and stabilization with oral cyclosporine therapy. Oral cyclosporine therapy can be tried in severe vision-threatening allergy refractory to conventional therapy. PMID:22569387

  6. Very Low Prevalence of Keratoconus in a Large Series of Vernal Keratoconjunctivitis Patients.

    Science.gov (United States)

    Caputo, Roberto; Versaci, Francesco; Pucci, Neri; de Libero, Cinzia; Danti, Gioia; De Masi, Salvatore; Mencucci, Rita; Novembre, Elio; Jeng, Bennie H

    2016-12-01

    To evaluate the prevalence of keratoconus (KC) and other corneal abnormalities by means of videokeratography and tomography in a large series of patients affected by vernal keratoconjunctivitis (VKC). Cross-sectional study. Setting: Single-center children's hospital. A total of 651 consecutive patients with VKC and a control group of 500 were prospectively recruited between May 1, 2012 and September 30, 2013, with a minimum follow-up of 12 months. All patients were evaluated by means of a Scheimpflug camera combined with a Placido corneal topographer. Keratoconus, suspected keratoconus, or its absence were determined in each patient. The corneal symmetry index of front (SIf) and back curvature (SIb), shape indices, and thicknesses were compared between the 2 groups. Prevalence of keratoconus and corneal indices modifications. Five out of 651 patients (0.77%) demonstrated topographic signs of KC. Two of them were bilateral. All patients were older than 7 years of age, and the mean age was 11.54 years. Four other patients (0.61%) were classified as KC suspects by the screening program. Of 304 patients older than 11 years (mean age 14.4 years), 4 (1.32%) were found to have KCN, and 4 (1.32%) were KC suspects. The corneal indices of patients in the VKC group were extremely similar to those in the control group. (P > .05). The prevalence of KC in our patient population, compared with previous reports in the literature, is much lower. The similar corneal indices in both groups suggest the absence of permanent corneal deformation due to VKC. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Primary Sjögren's syndrome and keratoconjunctivitis sicca: Diagnostic methods, frequency and social disease aspects

    DEFF Research Database (Denmark)

    Bjerrum, Kirsten Birgitte

    ophthalmology, Sjögren's syndrome, keratoconjunctivitis sicca, conjunctiva, dry eye, Schirmer-1 test, Rose Bengal score, break-up time, tear film, Copenhagen criteria......ophthalmology, Sjögren's syndrome, keratoconjunctivitis sicca, conjunctiva, dry eye, Schirmer-1 test, Rose Bengal score, break-up time, tear film, Copenhagen criteria...

  8. VERNAL KERATOCONJUNCTIVITIS IN SCHOOL CHILDREN IN NORTH BANGALORE: AN EPIDEMIOLOGICAL AND CLINICAL EVALUATION

    OpenAIRE

    Ashwini; Dhatri; Rajeev

    2015-01-01

    OBJECTIVE: To describe the demographic profile, clinical presentation and health seeking behaviour in children with vernal keratoconjunctivitis in north Bangalore. MATERIALS AND METHODS: Cross sectional survey of school children conducted between Feb 2014 to May 2014. Children were interviewed using a questionnaire on Vernal keratoconjunctivitis related symptoms. Children received a full eye examination including vision using snellen chart, slit lamp examination and fundus...

  9. New Finding in Vernal Keratoconjunctivitis: Splendore-Hoeppli Phenomenon.

    Science.gov (United States)

    Soleimani, Mohammad; Tabatabaei, Seyed Ali; Mirshahi, Reza; Nozarian, Zohreh; Jabbarvand Behrbouz, Mahmoud

    2016-06-01

    To report 2 cases of Splendore-Hoeppli phenomenon, a rare histopathologic observation, as a late clinical finding in vernal keratoconjunctivitis (VKC). We report the cases of 2 young women with subconjunctival nodules as a manifestation of Splendore-Hoeppli phenomenon with a history of severe VKC. After eliminating other conditions causing such a reaction, both patients were treated using frequent topical corticosteroid, plus topical cyclosporine 2% in one of patient. Complete resolution was observed in both patients. The Splendore-Hoeppli phenomenon could be a part of VKC manifestations.

  10. Clinical trial with 2% sodium cromoglycate (Opticrom) in vernal keratoconjunctivitis.

    Science.gov (United States)

    El Hennawi, M

    1980-01-01

    An open assessment study was carried out during the summer of 1972 in which 2% sodium cromoglycate eyedrops were evaluated in the treatment of patients with vernal keratoconjunctivitis. A highly significant number of patients found the eyedrops effective, while a marked improvement was recorded in mild and moderate cases; in severe cases or in acute exacerbations additional steroid therapy was recommended. Sodium cromoglycate eyedrops were found to be as effective as Decadron and superior to Antistin-Privine. Furthermore SCG eyedrops could replace or reduce local steroid therapy in vernal keratoconjuntivitis and so avert the possible rise in ocular tension caused by steroids. PMID:6775687

  11. Extrinsic and idiopathic vernal keratoconjunctivitis? Two cases with dissimilar immunopathology.

    Science.gov (United States)

    Zavaro, A; Baryishak, Y R; Samra, Z; Sompolinsky, D

    1983-01-01

    Two clinically similar cases of vernal keratoconjunctivitis with dissimilar immunological data are reported. One patient had strikingly elevated IgE levels in both serum and tears, and his tear fluid contained specific IgE antibodies to a number of allergens. Conjunctival scrapings and peripheral blood samples showed marked eosinophilic reactions. The other patient showed normal values for tear and serum IgE; no IgE type antibodies to allergens were detected; and no local or systemic eosinophilic reactions were observed. The immunopathogenesis of these cases is discussed. PMID:6639909

  12. Supratarsal injection of triamcinolone for severe vernal keratoconjunctivitis in children

    Directory of Open Access Journals (Sweden)

    Alexandre Xavier da Costa

    Full Text Available ABSTRACT Purpose: To evaluate the use of supratarsal injection of triamcinolone acetonide in severe vernal keratoconjunctivitis (VKC in children. Methods: Patients included in this open clinical trial were those with severe VKC-associated with keratitis, gelatinous limbal infiltrates, and/or giant papillae, with a history of recurrence and resistance to conventional topical antiallergic agents. Patients were treated with a supratarsal injection of 20 mg triamcinolone acetonide. Results: Analysis included 27 injections in 23 eyes of 17 patients with severe allergic keratoconjunctivitis. Mean age was 12.3 (range: 7-19 years. Mean follow-up time was 39.3 months (SD=19.21. In the 17 patients, the disease was successfully controlled for an average of 3.6 months (range: 1-16, during which allergy symptoms and signs were significantly improved, with complete resolution of lid edema and conjunctival chemosis, significant decline of pannus and keratitis, and reduction of giant papillae size. Conclusion: Treatment of severe, acute VKC in children with supratarsal injection of 20 mg triamcinolone acetonide showed satisfactory results and was well tolerated by patients; it may therefore constitute a safe option for severe and challenging cases. While full disease remission was not achieved, a significant improvement was found in ocular allergy symptoms and signs, with a reduction in the frequency of acute recurrences.

  13. Supratarsal injection of triamcinolone for severe vernal keratoconjunctivitis in children.

    Science.gov (United States)

    Costa, Alexandre Xavier da; Gomes, José Álvaro Pereira; Marculino, Leonardo Guedes Candido; Liendo, Vera Lucia; Barreiro, Telma Pereira; Santos, Myrna Serapião Dos

    2017-06-01

    To evaluate the use of supratarsal injection of triamcinolone acetonide in severe vernal keratoconjunctivitis (VKC) in children. Patients included in this open clinical trial were those with severe VKC-associated with keratitis, gelatinous limbal infiltrates, and/or giant papillae, with a history of recurrence and resistance to conventional topical antiallergic agents. Patients were treated with a supratarsal injection of 20 mg triamcinolone acetonide. Analysis included 27 injections in 23 eyes of 17 patients with severe allergic keratoconjunctivitis. Mean age was 12.3 (range: 7-19) years. Mean follow-up time was 39.3 months (SD=19.21). In the 17 patients, the disease was successfully controlled for an average of 3.6 months (range: 1-16), during which allergy symptoms and signs were significantly improved, with complete resolution of lid edema and conjunctival chemosis, significant decline of pannus and keratitis, and reduction of giant papillae size. Treatment of severe, acute VKC in children with supratarsal injection of 20 mg triamcinolone acetonide showed satisfactory results and was well tolerated by patients; it may therefore constitute a safe option for severe and challenging cases. While full disease remission was not achieved, a significant improvement was found in ocular allergy symptoms and signs, with a reduction in the frequency of acute recurrences.

  14. Corneal Complications And Visual Impairment In Vernal Keratoconjunctivitis Patients.

    Science.gov (United States)

    Arif, Abdus Salam; Aaqil, Bushra; Siddiqui, Afsheen; Nazneen, Zainab; Farooq, Umer

    2017-01-01

    Vernal kerato-conjunctivitis (VKC) is an infrequent but serious form of allergic conjunctivitis common in warm and humid areas where air is rich in allergens. It affects both eyes asymmetrically. Although VKC is a self-limiting disease but visions affecting corneal complications influence the quality of life in school children. The aim of this study was to list the corneal complications due to this condition and to find out the extent of visual impairment among VKC patients. This cross-sectional study was conducted in the department of Ophthalmology, Benazir Bhutto Shaheed Hospital on 290 eyes of diagnosed cases of VKC. The diagnosis of VKC was made on the basis of history and examination. Visual acuity was recorded using Snellen's notation and visual impairment was classified according to World Health Organization classification for visual disabilities. The mean age of presentation was 10.83±6.13 years. There were 207 (71.4%) males and 83 (28.6%) females. Corneal scarring was observed in 59 (20.3%) eyes. Keratoconus was found to be in 17 (5.9%) eyes. Shield ulcer was detected in 09 (3.1%) eyes while 07 (2.4%) eyes had corneal neovascularization. Majority of the patients with visual loss had corneal scarring and the complication that led to severe visual loss in most of the eyes was Keratoconus. Vernal kerato-conjunctivitis in the presence of corneal complications is a sight threatening disease and can lead to severe visual impairment.

  15. Safety and efficacy of lodoxamide in vernal keratoconjunctivitis.

    Science.gov (United States)

    Das, Dial; Khan, Moosa; Gul, Ali; Alam, Raffique

    2011-03-01

    To observe the safety and efficacy of topical Lodoxamide eye drops in patients with diagnosed vernal keratoconjunctivitis (VKC). This study was conducted at Department of Pharmacology and Therapeutics, BMSI, JPMC, Karachi in collaboration with Department of Ophthalmology, JPMC, Karachi, from April to October, 2009. A total of forty patients with diagnosed vernal keratoconjunctivitis were selected and enrolled consecutively from the out patient department (OPD) of Ophthalmology. Each patient received two drops of Lodoxamide eye drops topically in each eye four times daily. Patients were examined with a torch and slit lamp at baseline and follow-up visits. Out of 40 patients included, 39 completed the study and there was a significant effect of the drug on symptoms and signs of the disease. At the end of the study, 38 (97.4%) were cured, with few side effects. The cure criteria was based on patient's history of becoming symptom-free and resolution of ocular signs. Topical lodoxamide eye drops, when used for treatment of VKC, are effective with fewer adverse effects.

  16. Conjunctival Inclusion Cysts in Long-standing Chronic Vernal Keratoconjunctivitis

    Science.gov (United States)

    Lee, Seung-Won; Lee, Seung-Chan

    2007-01-01

    Purpose To report a case of conjunctival inclusion cysts on the corneal limbus of a patient with chronic vernal keratoconjunctivitis during 16 months' follow up Methods The patient was a 26 year old male without any specific history of surgery or trauma. Giant papillae, shield ulcers, and Horner-Trantas dots were detected. During the 16 month follow-up, Sodium cromoglycate eye drops and Prednisolone acetate 1% eye drops were given 3 times a day. During this period, conjunctival cysts were detected on the corneal limbus in both eyes. In spite of improvement of the corneal and conjunctival conditions, the conjunctival cysts did not seem to show any specific changes. For relief of foreign body sensation, excision of the conjunctival cysts and giant papillae of the left eye and histopathologic examination of the specimen was performed. Results On histopathological examination, the conjunctival cysts consisted of nonkeratinizing stratified epithelial cells filled with PAS-positive mucous substance. Inflammatory cells were not found in the vicinity. Conclusions Conjunctival inclusion cysts can be seen as an atypical finding of long-standing vernal keratoconjunctivitis. Mechanical friction between the giant papillae and conjunctiva may be a factor in inducing the formation of the conjunctival cysts. PMID:18063892

  17. Cyclosporine a 0.05% eye drops for the treatment of subepithelial infiltrates after epidemic keratoconjunctivitis

    Directory of Open Access Journals (Sweden)

    Okumus Seydi

    2012-08-01

    Full Text Available Abstract Background To evaluate the treatment with topical 0.05% cyclosporine A (CsA in patients with subepithelial corneal infiltrates (SEI. Methods We reviewed 16 patients (22 eyes before and after the treatment with 0.05% CsA eye drops. All patients had been treated previously with topical corticosteroids without any improvement and also they had to stop the medication secondary to intraocular pressure elevation. The objective data recorded included best-corrected visual acuity (BCVA, evaluation of corneal subepithelial infiltrate scores (CSIS, intraocular pressure (IOP prior to treatment and the last follow-up visit. Results Six males (37.5% and 10 females (62.5%, mean age of 35.2 ± 16.6 years, were included. The patients’ average topical CsA use duration was 5.1 ± 3.5 months (1 – 13 months. The average follow up time of the patients was 9.2 ± 4.7 months (4 – 22 months. One patient, although he didn’t have a 0 scale of SCIS, did not show up for follow up examinations after six months. The mean BCVA (logarithm of the minimum angle of resolution before and after the treatment were 0.15 ± 0.15 and 0.07 ± 0.07 respectively, CSIS 1.68 ± 0.89 and 0.23 ± 0.53 respectively, IOP 18.50 ± 3.82 and 16.86 ± 2.76 mmHg respectively. There were statistically significant improvements in BCVA (p = 0.002, reduction of CSIS (p = 0.002 and reduction of IOP (p  Conclusions Topical 0.05% CsA is a safe and effective alternative treatment in patients with SEI who do not respond to other treatment modalities or have undesired side effects from topical steroids.

  18. Dry Eye in Vernal Keratoconjunctivitis: A Cross-Sectional Comparative Study

    National Research Council Canada - National Science Library

    Villani, Edoardo; Strologo, Marika Dello; Pichi, Francesco; Luccarelli, Saverio V; De Cillà, Stefano; Serafino, Massimiliano; Nucci, Paolo

    2015-01-01

    The purpose of this comparative cross-sectional study was to investigate the use of standardized clinical tests for dry eye in pediatric patients with active and quiet vernal keratoconjunctivitis (VKC...

  19. Prevalence and associated factors of vernal keratoconjunctivitis among children in Gondar city, Northwest Ethiopia

    OpenAIRE

    Hayilu, Dereje; Legesse,Kbrom; Lakachew, Natinael; Asferaw, Mulusew

    2016-01-01

    Background Vernal keratoconjunctivitis (VKC) is a common cause of ocular morbidity in children in warm dry climates such as Sub?Saharan Africa and accounts for about 3?% of serious ophthalmic cases in tropical countries. The purpose of this study was to assess the prevalence and associated factors of vernal keratoconjunctivitis among children living in Gondar City, Ethiopia. Methods A Cross Sectional Design study was carried out in 737 children under the age of 18?years in Gondar City from Ap...

  20. The Use of Bandage Contact Lenses in Adenoviral Keratoconjunctivitis.

    Science.gov (United States)

    Uçakhan, Ömür; Yanik, Özge

    2016-11-01

    To evaluate the safety and efficacy of the use of the bandage contact lenses (BCLs) in adenoviral keratoconjunctivitis-related ocular surface problems. Fifteen eyes of 15 consecutive patients presenting at the Ankara University Medical Center, Cornea and Contact Lens Service, and requiring BCL use for adenoviral keratoconjunctivitis-related ocular surface problems were enrolled. Visual acuity, slitlamp examination findings, indication and duration of the BCL use, the total follow-up, and any adjuvant medication were recorded. All patients were followed regarding the success of treatment and adverse effects associated with BCL use. The average age at the time of presentation was 26.8±15.5 years. The major reasons for BCL use included epithelial defect (7 eyes), filamentous keratopathy (5 eyes), epithelial edema (1 eyes), and filamentous keratopathy together with epithelial defect (2 eyes). After the first appearance of conjunctivitis symptoms, the mean time to BCL application was 9.0±3.9 days. The mean duration of contact lens wear was 9.9±6.5 days, and the mean follow-up was 26.4±15.8 days. Preservative-free artificial tears and topical antibiotics were used in all cases. Besides, topical ganciclovir 0.15% gel (8 eyes), topical 0.4% povidone-iodine solution (9 eyes), and topical steroids (11 eyes) were used in various combinations. At the end of the follow-up period, the mean visual acuity improved from 0.23±0.32 logMAR units (∼0.6 Snellen line) to 0.0l±0.04 logMAR units (∼1.0 Snellen line) (P=0.042). No sight-threatening complication related to contact lens wear was encountered. Adjuvant use of BCLs seems to be safe and effective in the treatment of adenoviral keratoconjunctivitis-related ocular surface problems. Close follow-up and prophylactic use of topical antibiotics are rationalistic for prevention of secondary infections.

  1. Tear levels of macrophage migration inhibitory factor in vernal keratoconjunctivitis

    Directory of Open Access Journals (Sweden)

    Onur Çatak

    2013-06-01

    Full Text Available Objective: The pathogenesis of vernal keratoconjunctivitis(VKC is not fully understood and cannot be explainedonly with type I hypersensitivity reaction. The aim of thisstudy was to determine the Macrophage migration inhibitoryfactor (MIF levels in tear fluids of patients with VKC.Methods: Tear fluid samples were collected with microcapillarytubes for hematocrit at the lateral canthus ofpatients in the supine position without any anesthesia.Tear levels of MIF were measured by ELISA kit. Tear fluidsamples were collected from 10 healthy subjects and 20patients with VKC.Results: Tear levels of MIF in patients with VKC weresignificantly higher than those in controls (p<0,001.Conclusion: These results suggested that MIF may havesignificant effect on the pathogenetic process of VKC. JClin Exp Invest 2013; 4 (2: 195-198Key words: Macrophage migration inhibitory factor, vernalkeratoconjunctivitis, ELISA

  2. Impact of Vernal Keratoconjunctivitis on School Children in Egypt.

    Science.gov (United States)

    Marey, Hatem M; Mandour, Sameh S; El Morsy, Osama A; Farahat, Hassan G; Shokry, Shaimaa M

    2017-01-01

    To evaluate the prevalence of vernal keratoconjunctivitis (VKC) and its impact on school children in Egypt. A total of 3,706 students from six randomly selected schools of Menoufia were included where 126 had symptoms according to the VKC related symptoms questionnaire. Selected children were referred to a hospital for further assessment. The mean age of included children was 8.79±31.87 years, with a VKC prevalence of 3.3%, and male-to-female ratio of 2.3:1. The most frequently reported symptoms were ocular itching, followed by burning sensation, tearing, red eye, discharge, and photophobia. Signs vary between mild and severe cases; however, all cases had a negative impact on school attendance and performance. The prevalence of VKC differs according to the age group of included cases and the local temperature of the study area. School attendance, performance, lifestyle, and social activities were negatively affected by VKC.

  3. Treatment of asymmetrical vernal keratoconjunctivitis with supratarsal corticosteroid injection.

    Science.gov (United States)

    Thanathanee, Onsiri; Bhoomibunchoo, Chavakij; Suwan-apichon, Olan

    2014-11-19

    A 6-year-old Thai girl presented with itching, redness and copious discharge in both eyes. Slit-lamp biomicroscopy of the left eye revealed cobblestone papillae with marked ptosis while in the right eye only small papillae were observed. Punctuate epithelial keratitis was noted only in the left eye. There were no associated factors for giant papillary conjunctivitis (ie, suture or contact lens). The cobblestone papillae in the left eye persisted after maximal topical and oral antiallergic medications. Two doses of supratarsal corticosteroid (20 mg of triamcinolone acetonide) injection without any topical or oral antiallergic medications were undertaken in the left eye 1 month apart. Cobblestone papillae and punctate epithelial erosion (including allergic symptoms) were completely recovered. There was no recurrence after 18 months of follow-up. This case report indicates that using supratarsal corticosteroid injection by itself in recalcitrant vernal keratoconjunctivitis provides promising results. 2014 BMJ Publishing Group Ltd.

  4. Clinical Usefulness of Monitoring Expression Levels of CCL24 (Eotaxin-2) mRNA on the Ocular Surface in Patients with Vernal Keratoconjunctivitis and Atopic Keratoconjunctivitis

    OpenAIRE

    Yukiko Shiraki; Jun Shoji; Noriko Inada

    2016-01-01

    Purpose. This study aimed to evaluate the clinical efficacy of using expression levels of CCL24 (eotaxin-2) mRNA on the ocular surface as a biomarker in patients with vernal keratoconjunctivitis (VKC) and atopic keratoconjunctivitis (AKC). Methods. Eighteen patients with VKC or AKC (VKC/AKC group) and 12 control subjects (control group) were enrolled in this study. The VKC/AKC clinical score was determined by objective findings in patients by using the 5-5-5 exacerbation grading scale. All su...

  5. Vernal keratoconjunctivitis: a severe allergic eye disease with remodeling changes.

    Science.gov (United States)

    Vichyanond, Pakit; Pacharn, Punchama; Pleyer, Uwe; Leonardi, Andrea

    2014-06-01

    Vernal keratoconjunctivitis (VKC) is an unusually severe sight-threatening allergic eye disease, occurring mainly in children. Conventional therapy for allergic conjunctivitis is generally not adequate for VKC. Pediatricians and allergists are often not familiar with the severe clinical symptoms and signs of VKC. As untreated VKC can lead to permanent visual loss, pediatric allergists should be aware of the management and therapeutic options for this disease to allow patients to enter clinical remission with the least side effects and sequelae. Children with VKC present with severe ocular symptoms, that is, severe eye itching and irritation, constant tearing, red eye, eye discharge, and photophobia. On examination, giant papillae are frequently observed on the upper tarsal conjunctiva (cobblestoning appearance), with some developing gelatinous infiltrations around the limbus surrounding the cornea (Horner-Trantas dot). Conjunctival injections are mostly severe with thick mucus ropy discharge. Eosinophils are the predominant cells found in the tears and eye discharge. Common therapies include topical antihistamines and dual-acting agents, such as lodoxamide and olopatadine. These are infrequently sufficient and topical corticosteroids are often required for the treatment of flare ups. Ocular surface remodeling leads to severe suffering and complications, such as corneal ulcers/scars. Other complications include side effects from chronic topical steroids use, such as increased intraocular pressure, glaucoma, cataract and infections. Alternative therapies for VKC include immunomodulators, such as cyclosporine A and tacrolimus. Surgery is reserved for those with complications and should be handled by ophthalmologists with special expertise. Newer research on the pathogenesis of VKC is reviewed in this article. Vernal keratoconjunctivitis is a very important allergic eye disease in children. Complications and remodeling changes are unique and can lead to blindness

  6. The differences of tear function and ocular surface findings in patients with atopic keratoconjunctivitis and vernal keratoconjunctivitis.

    Science.gov (United States)

    Hu, Y; Matsumoto, Y; Dogru, M; Okada, N; Igarashi, A; Fukagawa, K; Tsubota, K; Fujishima, H

    2007-08-01

    The pathogenesis of the ocular surface disease in atopic keratoconjunctivitis (AKC) and vernal keratoconjunctivitis (VKC) has not been fully understood. We tried to clarify the differences in the ocular surface status in patients with AKC, VKC, and healthy control subjects. Twenty-four eyes of 12 AKC patients, 12 eyes of six VKC patients, and 20 eyes of 10 normal control subjects were studied. The subjects underwent corneal sensitivity measurements, Schirmer test, tear film break-up time (BUT), vital staining of the ocular surface, conjunctival impression and brush cytology. Impression cytology samples underwent periodic acid Schiff staining for goblet cell density, squamous metaplasia grading, and immunohistochemical staining for MUC1, 2, 4, and 5AC. Brush cytology specimens underwent staining for inflammatory cell counting and Real Time PCR for MUC1, 2, 4, and 5AC mRNA expression. The mean BUT, corneal sensitivity, and conjunctival goblet cell density values in AKC patients were significantly lower compared with VKC patients and control subjects. The squamous metaplasia grades in eyes with AKC were significantly higher compared to eyes with VKC and controls. The inflammatory cell response in brush cytology specimens was different between patients with AKC and VKC. Eyes with AKC showed significantly higher MUC1, 2 and 4 and lower MUC5AC mRNA expression compared to eyes with VKC. Differences of the infiltrates, higher level of tear instability, lower corneal sensitivity, up-regulation of MUC1, 2, and 4, and down regulation of MUC5AC were important differential features of the ocular surface disease in AKC compared with VKC.

  7. Detection of equine herpesvirus in horses with idiopathic keratoconjunctivitis and comparison of three sampling techniques.

    Science.gov (United States)

    Hollingsworth, Steven R; Pusterla, Nicola; Kass, Philip H; Good, Kathryn L; Brault, Stephanie A; Maggs, David J

    2015-09-01

    To determine the role of equine herpesvirus (EHV) in idiopathic keratoconjunctivitis in horses and to determine whether sample collection method affects detection of EHV DNA by quantitative polymerase chain reaction (qPCR). Twelve horses with idiopathic keratoconjunctivitis and six horses without signs of ophthalmic disease. Conjunctival swabs, corneal scrapings, and conjunctival biopsies were collected from 18 horses: 12 clinical cases with idiopathic keratoconjunctivitis and six euthanized controls. In horses with both eyes involved, the samples were taken from the eye judged to be more severely affected. Samples were tested with qPCR for EHV-1, EHV-2, EHV-4, and EHV-5 DNA. Quantity of EHV DNA and viral replicative activity were compared between the two populations and among the different sampling techniques; relative sensitivities of the sampling techniques were determined. Prevalence of EHV DNA as assessed by qPCR did not differ significantly between control horses and those with idiopathic keratoconjunctivitis. Sampling by conjunctival swab was more likely to yield viral DNA as assessed by qPCR than was conjunctival biopsy. EHV-1 and EHV-4 DNA were not detected in either normal or IKC-affected horses; EHV-2 DNA was detected in two of 12 affected horses but not in normal horses. EHV-5 DNA was commonly found in ophthalmically normal horses and horses with idiopathic keratoconjunctivitis. Because EHV-5 DNA was commonly found in control horses and in horses with idiopathic keratoconjunctivitis, qPCR was not useful for the etiological diagnosis of equine keratoconjunctivitis. Conjunctival swabs were significantly better at obtaining viral DNA samples than conjunctival biopsy in horses in which EHV-5 DNA was found. © 2015 American College of Veterinary Ophthalmologists.

  8. Prevalence and associated factors of vernal keratoconjunctivitis among children in Gondar city, Northwest Ethiopia.

    Science.gov (United States)

    Hayilu, Dereje; Legesse, Kbrom; Lakachew, Natinael; Asferaw, Mulusew

    2016-09-29

    Vernal keratoconjunctivitis (VKC) is a common cause of ocular morbidity in children in warm dry climates such as Sub-Saharan Africa and accounts for about 3 % of serious ophthalmic cases in tropical countries. The purpose of this study was to assess the prevalence and associated factors of vernal keratoconjunctivitis among children living in Gondar City, Ethiopia. A Cross Sectional Design study was carried out in 737 children under the age of 18 years in Gondar City from April to May 2015. Basic ophthalmic examination was performed using a 3x magnifying loop and torch light and a pretested and structured questionnaire was completed. The association between vernal keratoconjunctivitis and factors such as socio-economic, demographic, and environmental status, and history of allergic disease in affected children and their family members was examined using logistic regression multivariate analysis. The prevalence of vernal keratoconjunctivitis was 5.8 % (95 % CI: 4.14, 7.53) (43/737) and mixed type VKC was the most frequent form which was found in 35 out of 43 cases (81.4 %). The following were positively associated with vernal keratoconjunctivitis: use of kerosene/firewood for cooking (AOR = 6.25 (95 % CI: 1.61, 25)), child dust exposure (AOR = 10.0 (95 % CI: 4.16, 20.0)), child history of non-ocular allergic diseases (AOR = 4.0 (95 % CI: 1.92, 8.33)), family history of non-ocular allergic diseases (AOR = 3.57(95 % CI: 1.39, 9.09). There is a high prevalence of vernal keratoconjunctivitis in this region. The use of kerosene/firewood for cooking, child dust exposure, and non-ocular allergic disease in the child or their family were statistically significant risk factors for vernal keratoconjunctivitis.

  9. A simplified quantitative method for assessing keratoconjunctivitis sicca from the Sjögren's Syndrome International Registry

    DEFF Research Database (Denmark)

    Whitcher, John P; Shiboski, Caroline H; Shiboski, Stephen C

    2010-01-01

    To describe, apply, and test a new ocular grading system for assessing keratoconjunctivitis sicca (KCS) using lissamine green and fluorescein.......To describe, apply, and test a new ocular grading system for assessing keratoconjunctivitis sicca (KCS) using lissamine green and fluorescein....

  10. Inclusion keratoconjunctivitis ('pink eye') in sheep. A proposal for a new name for chlamydial keratoconjunctivitis in sheep and comment on recent clinical trials.

    Science.gov (United States)

    Bogaard, A E

    1984-09-01

    The cytoplasmatic inclusion bodies, which, in 1931, Coles discovered in the corneal cells of sheep suffering from contagious keratoconjunctivitis are now considered to be the reticulate bodies of a chlamydia, Colesiota conjunctivae (synonym: Chlamydia psittaci ovis). According to the postulates of Koch Colesiota conjunctivae is a primary cause of contagious keratoconjunctivitis in sheep, but the clinical picture is complex and is a result of the interaction between the infecting chlamydiae, host resistance factors, and secondary infections caused by opportunistic bacterial ocular pathogens. The clinical syndrome might also be caused by other micro-organisms, such as Mycoplasma conjunctivae or environmental factors, such as dust. However, in these cases, cytoplasmatic inclusion bodies cannot be found in the corneal cells of diseased eyes. To differentiate chlamydial keratoconjunctivitis from keratoconjunctivitis due to other causes, it is proposed to include in the name the laboratory findings typical for this disease: Sheep Inclusion Keratoconjunctivitis. Chlamydia are Gram-negative bacteria, which are obligate intracellular parasites. Prolonged treatment seems to be required to eradicate chlamydiae from a host and antibiotics must reach intracellular levels that are higher than their minimum inhibitory concentration for chlamydiae. Tetracyclines are the drugs of choice. This means that for a microbiological cure, diseased sheep must be injected several times a day for a week or more. Because the disease is usually self-limiting and economic losses are considered low, this seems unnecessary and control of the disease by local treatment of secondary infections seems sufficient. However, this will not prevent spreading of the disease in a herd and relapses may occur.

  11. The efficacy of topical interferon alpha 2b treatment in refractory vernal keratoconjunctivitis.

    Science.gov (United States)

    Turan-Vural, Ece; Acar, Banu Torun; Acar, Suphi

    2012-04-01

    This study aimed to investigate the efficacy and safety of a 2-month topical interferon alpha 2b treatment in patients with refractory vernal keratoconjunctivitis. Twelve (10 male, 2 female) patients with refractory vernal keratoconjunctivitis received topical treatment with one million IU/mL interferon alpha 2b 4 times a day for 2 months. Symptom and ophthalmological examination scores were assessed at baseline and during follow-up. No significant complications or side effects associated with the use of topical interferon alpha 2b were observed. Symptom scores for itching, tearing, photophobia, and total symptom score, and objective scores for corneal lesion, hyperemia, chemosis, papillary hypertrophy, secretion, and total examination score significantly improved during the 2-month treatment. Improvements were maintained after discontinuation of the treatment for most parameters. Topical interferon alpha 2b treatment seems to offer a safe and effective alternative for the treatment of refractory vernal keratoconjunctivitis for a brief period.

  12. An Update on the Therapeutic Approach to Vernal Keratoconjunctivitis.

    Science.gov (United States)

    Esposito, Susanna; Fior, Giulia; Mori, Alessandro; Osnaghi, Silvia; Ghiglioni, Daniele

    2016-10-01

    Vernal keratoconjunctivitis (VKC) is an inflammatory disease of the ocular surface. It commonly occurs in the first decade of life, has a wide geographical distribution, and usually occurs in warm, dry areas. The pathogenesis of VKC seems to have an immune, nervous, and endocrine basis. The most common eye symptoms are itching, discharge, tearing, eye irritation, redness of the eyes, and photophobia. Although VKC generally has a good prognosis, the lack of clarity regarding the origin of the disease makes treatment a challenge for pediatricians and ophthalmologists. The purpose of this review is to discuss the pathogenesis, clinical features, and diagnostic criteria in VKC, with a focus on its therapeutic management. The selection of a therapeutic scheme from the many available options is based on clinical features and the personal preferences of both physicians and patients. Due to the lack of uniform grading of disease severity, there is no worldwide consensus on first-line and second-line therapeutic approaches. The choice of treatment for long-term moderate to severe VKC includes topical cyclosporine or tacrolimus. Further data are needed to define the minimal effective concentration and the safety of these drugs in eye drops and to clarify the diagnosis of VKC in patients who require these drugs. Finally, while promising newly discovered drugs are expected to enter into clinical practice, further studies on their efficacy and safety are required.

  13. Serum Vitamin D Levels in Children with Vernal Keratoconjunctivitis.

    Science.gov (United States)

    Bozkurt, Banu; Artac, Hasibe; Ozdemir, Hulya; Ünlü, Ali; Bozkurt, Mete Kaan; Irkec, Murat

    2016-10-24

    To evaluate serum 25-hydroxyvitamin D [25(OH)D3] levels of vernal keratoconjunctivitis (VKC) children. A total of 62 non-atopic healthy children (64.5% male, mean age 10.79 ± 3.3 years) and 29 VKC children (75.9%, mean age 12.17 ± 2.7 years) were included in the study. Serum 25(OH)D3 levels measured by HPLC were compared between the two groups and a p value of <0.05 was considered as statistically significant. The mean serum 25(OH)D3 level of VKC group was significantly lower than in the control group (11.02 ± 5.16 ng/mL and 15.99 ± 7.36 ng/mL, respectively) (p = 0.002). Severe vitamin D deficiency (<10 ng/mL) was detected in 48.3% of VKC children and 22.6% of the controls (p = 0.017). Time spent outdoors during daylight was higher in the control group (229.5 ± 101.2 min) compared with the VKC group (160.7 ± 65.9 min) (p = 0.008), and showed a significant correlation with serum 25(OH)D3 levels (Spearman rho = 0.812) (p<0.001). Children with VKC should be evaluated for vitamin D deficiency, which might occur secondary to sun avoidance.

  14. Vernal keratoconjunctivitis with giant papillae on the inferior tarsal conjunctiva.

    Science.gov (United States)

    Asada, Yosuke; Ebihara, Nobuyuki; Funaki, Toshinari; Yokoi, Norihiko; Murakami, Akira; Matsuda, Akira

    2014-01-01

    In vernal keratoconjunctivitis (VKC), giant papillae are commonly observed on the superior tarsal conjunctiva. We found 3 cases of giant papillae on the inferior tarsal conjunctiva, and diagnosed them as being VKC based on their clinical and histopathological features. Three patients with inferior tarsal giant papillae were studied. In 2 patients, the giant papillae were resected for therapeutic purposes. Immunohistochemical analysis was carried out by indirect immunofluorescent staining using anti-CD3, anti-CD20, anti-CD35 antibodies. In all 3 patients, giant papilla formation was observed on the inferior lid margin. Clusters of CD20 B lymphocytes with CD35 follicular dendritic cells, and CD3 marginal zone T lymphocytes, common features of lymphoid neogenesis, were observed. In 2 patients, typical giant papillary formation was also observed on the superior tarsal conjunctiva. In all the patients, topical dexamethasone and tacrolimus treatments were found to be effective. The giant papillae of VKC can occur not only on the superior tarsal conjunctiva but also on the inferior tarsal conjunctiva. The possibility of the presence of giant papillae on the inferior tarsal conjunctiva should be considered in the clinical examination of patients with VKC.

  15. Assessment of corneal alterations by confocal microscopy in vernal keratoconjunctivitis.

    Science.gov (United States)

    Nebbioso, Marcella; Zicari, Anna Maria; Lollobrigida, Valeria; Marenco, Marco; Duse, Marzia

    2015-01-01

    Vernal keratoconjunctivitis (VKC) is a bilateral chronic, seasonally exacerbated inflammation of the ocular surface that especially affects male children and young boys. To evaluate the corneal microscopic features of patients affected by VKC and to assess whether some corneal changes were associated with specific ocular symptoms and/or signs. 20 children aged between 4 and 14 years were enrolled. All patients underwent corneal confocal microscopy by Confoscan CS3 (Nidek). 350 images of the central cornea of each eye were obtained with a ×40 noncontact lens 3,5 micron gap in automode. Some alterations of the sub-basal and stromal corneal nerves were detected. These alterations were more evident in patients with higher severity of photophobia. On the other hand, there were scarce other signs of the anterior segment of the eye. Our preliminary findings show that there is another group of patients affected by VKC, characterized by an intense photophobia caused by corneal damage and without other significant ocular alterations. Therefore confocal microscopy may be useful for an early identification of corneal alterations before the onset of severe ocular symptoms and to set an appropriate therapeutic management.

  16. Effect of Topical Cyclosporine in grading of Vernal keratoconjunctivitis.

    Directory of Open Access Journals (Sweden)

    Dr Krupali Raol

    2017-06-01

    Full Text Available Background & Objective: To evaluate efficacy of topical aqueous solution of 0.05% cyclosporine in first time diagnosed vernal keratoconjunctivitis (VKC including palpebral, bulbar and mixed form. Methods: 25 patients of VKC received CsA 0.05% aqueous ophthalmic solution in a dosage of one drop every 12 hours in both eyes for 6 months. Follow up visits (day 1, 2 weeks, 1 month, 2 months, 3 months and 6 months. Five symptoms were evaluated and six clinical signs were charted. Total objective score of 13 or more over atleast 3 variables was included (CART – scoring system. Results: Comparison of 1st Day with 2 weeks score showed no significant effect in the score value (t=0.90, df = 24, p<0.1. 1st Day with 3rd month score showed maximum effect in the score value (t = 35.76, df = 24, p<0.0001. 3rd month with 6th month score showed sustained effect of cyclosporine showing no major change in the score line (t test, t = 1.80, df = 24, p <0.05. Conclusion: Topical application of a 0.05% CsA aqueous solution has been shown to be effective in the treatment of patients with VKC. CsA could be an important alternative to steroid treatment.

  17. Ocular complications of severe vernal keratoconjunctivitis (VKC) in Yemen.

    Science.gov (United States)

    Al-Akily, Saleh A; Bamashmus, Mahfouth A

    2011-07-01

    The objective of this study was to assess the ocular complications and visual loss among patients with severe vernal keratoconjunctivitis (VKC). Four hundred and thirty-one patients with VKC seen at Ibn Al-Haitham Eye Center were the study group. This is a retrospective non-comparative observational study between 01 January 2002 and 31 December 2002. Visual acuity was measured with the standard Snellen visual acuity chart and for children under 5 years of age Kay pictures were used. Visual impairment was assessed by means of the World Health Organization criteria for visual disabilities. Cases with severe VKC that developed ocular complications leading to blindness and severe visual impairment were analyzed. The majority of VKC patients were males (75.9%) with a male:female ratio of 3.1:1. A total of 68 (15.7%) patients (54 boys and 14 girls) had severe VKC. The ocular findings among 20 patients with severe VKC that led to blindness and severe visual impairment included keratoconus (7); steroid-induced cataract (5), central corneal scars (5) and steroid-induced glaucoma (3). Two of the keratoconus cases developed acute hydrops. Severe VKC in developing countries including Yemen is a potentially blinding disease. Visual loss may be due to keratoconus and corneal scars, as well as complications of the unsupervised use of topically administered corticosteroids.

  18. Ocular complications of severe vernal keratoconjunctivitis (VKC) in Yemen☆

    Science.gov (United States)

    Al-Akily, Saleh A.; Bamashmus, Mahfouth A.

    2011-01-01

    Objectives The objective of this study was to assess the ocular complications and visual loss among patients with severe vernal keratoconjunctivitis (VKC). Methods Four hundred and thirty-one patients with VKC seen at Ibn Al-Haitham Eye Center were the study group. This is a retrospective non-comparative observational study between 01 January 2002 and 31 December 2002. Visual acuity was measured with the standard Snellen visual acuity chart and for children under 5 years of age Kay pictures were used. Visual impairment was assessed by means of the World Health Organization criteria for visual disabilities. Cases with severe VKC that developed ocular complications leading to blindness and severe visual impairment were analyzed. Results The majority of VKC patients were males (75.9%) with a male:female ratio of 3.1:1. A total of 68 (15.7%) patients (54 boys and 14 girls) had severe VKC. The ocular findings among 20 patients with severe VKC that led to blindness and severe visual impairment included keratoconus (7); steroid-induced cataract (5), central corneal scars (5) and steroid-induced glaucoma (3). Two of the keratoconus cases developed acute hydrops. Conclusion Severe VKC in developing countries including Yemen is a potentially blinding disease. Visual loss may be due to keratoconus and corneal scars, as well as complications of the unsupervised use of topically administered corticosteroids. PMID:23960939

  19. Infrared ocular thermography in dogs with and without keratoconjunctivitis sicca.

    Science.gov (United States)

    Biondi, Flávia; Dornbusch, Peterson T; Sampaio, Manuella; Montiani-Ferreira, Fabiano

    2015-01-01

    Infrared thermography was used to measure temperature differences of the corneal surface between nasal and temporal limbus regions and central cornea of normal dogs and dogs with keratoconjunctivitis sicca (KCS), in order to establish temperature values in normal canine eyes and in patients with decreased Schirmer tear tests (STT) values. Dogs investigated were all either patients seen at the Veterinary Teaching Hospital of Federal University of Paraná or normal dogs that belonged to the same institution. STT were performed in all eyes. A total of 40 control eyes (STT ≥15 mm/min) and 20 eyes with low STT values (STT ≤14 mm/min) were examined. The mean STT value for eyes with normal STT values was 22.9 ± 3.9 mm/min (mean ± standard deviation), and the mean STT value for eyes with low STT value was 7.2 ± 4.8 mm/min. The mean corneal temperature was significantly lower in eyes with low STT values than in control eyes (P popular ancillary test for the diagnoses of ocular surface disorders. © 2013 American College of Veterinary Ophthalmologists.

  20. Vitamin D levels in children affected by vernal keratoconjunctivitis.

    Science.gov (United States)

    Zicari, Anna Maria; Cafarotti, Arianna; Occasi, Francesca; Lollobrigida, Valeria; Nebbioso, Marcella; Pecorella, Irene; De Castro, Giovanna; Spalice, Alberto; Loffredo, Lorenzo; Villa, Maria Pia; Duse, Marzia

    2017-02-01

    Vernal keratoconjunctivitis (VKC) is a chronic and often severe bilateral conjunctivitis. VKC etiology still remains unclear although endocrine, genetic, neurogenic and environmental factors have been implicated. Vitamin D is a fat-soluble prohormone whose main function is the regulation of calcium and phosphate metabolism. The aim of this study was to evaluate serum vitamin D in children affected by VKC compared to the healthy children and investigate the relationship between its levels and disease severity. A total of 110 children, 47 affected by VKC, aged between 5 and 12 years were enrolled at the Department of Pediatrics, Division of Allergy and Immunology, "Sapienza" University of Rome. Used as controls were 63 healthy children with negative skin prick test (SPT), without allergic, ocular and systemic disease. Serum samples were obtained in April from all the children included in the study. Vitamin D dosage was repeated in October in 20 patients after therapy and in 20 controls. A conjunctival scraping was performed in all children affected by VKC. Children affected by VKC had lower vitamin D levels compared to healthy controls and we found an increase in vitamin D levels after therapy with cyclosporine eye drops 1% although this increase was lower than that of healthy controls. Moreover we found significant correlations between vitamin D level and the severity of the disease. The study shows that children affected by VKC have lower vitamin D levels when compared to healthy controls and highlights a significant correlation between its levels and disease severity.

  1. [Mycoplasma pneumoniae epidemic as zoonosis].

    Science.gov (United States)

    Mikola, I; Balogh, G; Nagy, A; Mátyás, M; Glávits, R; Stipkovits, L

    1997-11-16

    At a secondary school in Budapest, in the first class, 30 students became sick with fever and upper respiratory catarrhal symptoms between September 19 and October 31, 1995. Two children were hospitalized with a diagnosis of pneumonia, in case of the two children treated at the Szent László Hospital, suspect of Mycoplasma infection raised which was also confirmed by cold agglutination test. During the epizootiological examination on the spot they found a terrarium in the classroom where the students raised a Syrian gold hamster family. Mycoplasmas were isolated from the lung samples of the hamsters during the pathological examination which proved to be Mycoplasma pneumoniae. Owing to the close etiologic relationships between epidemiological anamnesis, characteristics of the epidemic, as well as findings of patients and pathological or histological findings in the hamsters together with the results of bacteriological examinations, the epidemic should be considered as a zoonosis.

  2. Analysis on tacrolimus efficacy in the treatment of vernal keratoconjunctivitis

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    Xin Zhang

    2014-04-01

    Full Text Available AIM: To evaluate the curative effects of tacrolimus on vernal keratoconjunctivitis(VKC. METHODS: A double-blind, randomized, placebo-controlled trial.Sixteen ambulatory patients from department of ophthalmology in West China Hospital of Sichuan University were randomly divided into drug treatment group and control group. Patients in treatment group were treated with tacrolimus eye drops, and control group with the basic placebo eye drops. Observation period of the trial was 28 days after taking the drops. The signs and symptoms were recorded and marked respectively. Total variation of ocular signs before or after therapy was main therapeutic index but subjective symptoms were the secondary index. RESULTS: Comparison in groups: there were significant differences on the scores of signs and symptoms before and after medication. After the drug treatment group, consciousness of each period symptom score was lower than before the medication, and over time, symptom score gradually reduced, the difference was statistically significant, but the control group after the medication had no statistically significant differences between different periods. Compared between the groups: There were no significant differences of subjective symptoms and signs before and after medication at the first review, but there were statistically significant differences during the other two reviews. Score variation(scores before or after medicationhad no significant differences in the first review but had it in the following two times.CONCLUSION:Tacrolimus can be used to improve the signs and symptoms of VKC, especially for the severe patients who are nonresponse to the anti-anaphylaxis drops. Tacrolimus can be quick and excellent to improve the effects, so it can be applied into clinic.

  3. Corneal biochemical features of patients with vernal keratoconjunctivitis.

    Science.gov (United States)

    Emre, Sinan; Başer, Esin; Oztürk, Bilge; Zorlu, Sibel; Uzun, Ozgür; Gülhan, Ceren

    2013-02-01

    Vernal keratoconjunctivitis (VKC) is a chronic, bilateral, seasonally exacerbated, allergic inflammation of the ocular surface, involving bulbar and ⁄ or tarsal conjunctiva and cornea. The ocular response analyzer (ORA) measures corneal biomechanical properties in vivo by monitoring and analyzing the corneal behavior when its structure is submitted to a force induced by an air jet. This study was designed to examine corneal biomechanical properties and intraocular pressure in patients with VKC, and to compare with control eyes. ORA measurements were performed on the both eyes of 26 patients with VKC (group I) and 14 healthy children who served as the control group (group II). Corneal hysteresis (CH), corneal resistance factor (CRF) and intraocular pressure [Goldmann correlated (IOPg) and corneal compensated (IOPcc)] were recorded with ORA. Mean age of patients with VKC and control groups were 11.3 ± 5.8 and 10.6 ± 1.9 years for groups I and II respectively. Mean (± SD) of the CH and CRF readings were 10.1 ± 1.6 versus 10.5 ± 1.6 (p > 0.05) and 9.5 ± 1.7 versus 10.8 ± 1.7 mmHg (p 0.05) in groups I and II respectively. Statistical analysis revealed significant differences for CRF and IOPg between the study groups. The mean CRF and IOPg values of patients with VKC were lower than those of controls. According to the results of our study, one can conclude that corneal biomechanical property, CRF, could be different in VKC patients compared to normals.

  4. Epidemic hypochlorhydria.

    Science.gov (United States)

    Gledhill, T; Leicester, R J; Addis, B; Lightfoot, N; Barnard, J; Viney, N; Darkin, D; Hunt, R H

    1985-01-01

    During a study of gastric secretion four out of six previously healthy subjects developed hypochlorhydria after a transient illness with nausea, vomiting, and abdominal pain. Mean basal and peak acid outputs were 0 and 2.3 mmol (84 mg)/h one month after the onset of illness and 1.5 and 27.0 mmol/h (55 and 984 mg/h) at eight months' follow up. Two of the subjects were followed up at 18 months, when mean basal and peak acid outputs were 3.9 and 33.5 mmol/h (142 and 1221 mg/h). No endoscopic abnormality was seen at one and eight months, but biopsies showed active superficial gastritis, which resolved in one subject and became chronic in two. Schilling tests performed in three subjects at eight months showed diminished retention of vitamin B12. During hypochlorhydria a 24 hour intragastric analysis was performed for total and nitrate reducing bacteria, pH, and concentrations of nitrite and total and stable N-nitroso compounds. Of the 48 samples of gastric juice examined, 47 had bacterial growth of more than 10(6) organisms/ml and 46 had growth of nitrate reducing bacteria of more than 10(5) organisms/ml. Mean intragastric nitrite concentrations were 10 times higher than in a group of eight healthy controls. Both mean total and mean stable N-nitroso compound concentrations, however, were not appreciably different from those in controls. Although community transmission was a possibility, serological screening and electron microscopy of gastric biopsy specimens failed to show an infective cause. Transmission of an unidentified enteric pathogen via a contaminated pH electrode was therefore suspected. Thus gastric juice should not be returned to the stomach after contact with a contaminated glass electrode as this is a possible cause of atrophic gastritis. Images FIG 1 FIG 2 PMID:3922503

  5. Genomic identification of human vaccinia virus keratoconjunctivitis and its importance as a laboratory-acquired infection

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    Zahra Movahedi Motlagh

    2016-01-01

    Full Text Available Context: Vaccinia virus (VACV is a member of orthopoxvirus genus of the family Poxviridae. VACVs are enveloped, double-stranded DNA viruses. Several species of this family, for example, molluscum contagiosum, smallpox, deerpox, horsepox, rabbitpox, and VACVs may cause conjunctivitis. Aims: Given the high incidence of keratoconjunctivitis in Iran (approximately 3.6%-53.9% and insufficient clinical diagnostic measures, laboratory tests for detection of its causes and determination of accurate keratoconjunctivitis/conjunctivitis prevalence due to different pathogens are essential. Settings and Design: In this research, conjunctival samples collected from 100 patients with keratoconjunctivitis signs were referred to an eye hospital of Iran. Subjects and Methods: After DNA extraction, polymerase chain reaction (PCR was carried out for detection of VACV. PCR-positive products were further subjected to DNA sequencing. Statistical Analysis Used: The results were analyzed using Chi-square test. Results: In this study, 28% of the samples were positive and a statistically significant relationship obtained between working in medical or research laboratories and VACV prevalence (P < 0.05. Conclusions: This study showed a high rate of VACV keratoconjunctivitis, and therefore, further studies for its prevention and control are necessary.

  6. Alpha-1 Antitrypsin, a Diagnostic and Prognostic Marker of Vernal Keratoconjunctivitis

    OpenAIRE

    Ahsan, Akif; Salman, Khushtar A; Alam, Sana; Siddiqui, Anwar H.; Naeem, Syed Shariq; Ahmad, Aquil; Khan, Iqbal M

    2014-01-01

    Introduction: A major chunk of ocular allergies in humans involve the conjunctiva, of which Vernal Keratoconjunctivitis (VKC) appears to be more common. VKC, a chronic allergic conjunctivitis, frequently affects young males and is characterized by intense inflammation of the limbal and/or tarsal conjunctiva. The etiology and immuno-pathogenesis of VKC still remain unclear.

  7. Limbal Pseudoepitheliomatous Hyperplasia Mimicking Ocular Surface Squamous Neoplasia in Palpebral Vernal Keratoconjunctivitis

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    Chintan Malhotra

    2013-01-01

    Full Text Available Purpose. Pseudoepitheliomatous hyperplasia at the limbus can mimic an ocular surface squamous neoplasia. It is an uncommon manifestation of vernal keratoconjunctivitis and has been reported previously in limbal VKC. It, however, has not been reported as a manifestation in the palpebral form of the disease and needs to be kept in the differential diagnosis of a limbal mass lesion in vernal keratoconjunctivitis. Case Report. We report the case of a 24 year old male patient having palpebral VKC and presenting with a papillomatous limbal mass with focal areas of keratinization mimicking an ocular surface squamous neoplasia. An excision biopsy was performed, and the specimen sent for histopathologywhich revealed features of pseudoepitheliomatous hyperplasia with no evidence of dysplasia or malignant transformation. The subepithelium revealed a dense plasma-rich inflammation. Discussion. We report this relatively uncommon presentation of limbal pseudoepitheliomatous hyperplasia mimicking an ocular surface squamous neoplasia in palpebral vernal keratoconjunctivitis. Wide excision as is required for an ocular surface neoplasia may thus be avoided if this entity is recognized in vernal keratoconjunctivitis.

  8. A Severe Aspect of Pediatric Ocular Allergy to Recognize: Vernal Keratoconjunctivitis

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    Hande Taylan Þekeroðlu

    2012-09-01

    Full Text Available Aim: To determine the clinical features of vernal keratoconjunctivitis and to evaluate the safety and the efficacy of the medical treatment on clinical grades. Material and Method: All patients with vernal keratoconjunctivitis who had been treated with mast-cell stabilizers, antihistamines and artificial tear drops previously were enrolled in the study. Topical steroids were added during recurrences, were tapered and discontinued according to the clinical improvement. Topical cyclosporin 0.05% four times daily was used additionally in cases of inadequate response to treatment or evident steroid dependance. Main outcome measures were the clinical features, change of clinical grades, response to treatment, rate of recurrences and side effects of the eyedrops. Results: Twenty patients ( 13 males, 7 females with vernal keratoconjunctivitis in different severity scales were included. The median age of the patients was 10 (9-11 years. The median follow-up time was 35 (15-56 months. Ten patients received topical cyclosporine. The rate of recurrences was similar in patients who received topical cyclosporine compared to those who were followed with topical steroids. (p=0.17 No severe adverse reaction to any of the formulations was seen. Discussion: Topical 0.05% cyclosporin is safe and effective for the treatment of vernal keratoconjunctivitis as a steroid sparing agent. It helps to obtain good clinical response without serious adverse effects and provides improvement on the clinical grades.

  9. Limbal pseudoepitheliomatous hyperplasia mimicking ocular surface squamous neoplasia in palpebral vernal keratoconjunctivitis.

    Science.gov (United States)

    Malhotra, Chintan; Jain, Arun K; Thapa, Bikram

    2013-01-01

    Purpose. Pseudoepitheliomatous hyperplasia at the limbus can mimic an ocular surface squamous neoplasia. It is an uncommon manifestation of vernal keratoconjunctivitis and has been reported previously in limbal VKC. It, however, has not been reported as a manifestation in the palpebral form of the disease and needs to be kept in the differential diagnosis of a limbal mass lesion in vernal keratoconjunctivitis. Case Report. We report the case of a 24 year old male patient having palpebral VKC and presenting with a papillomatous limbal mass with focal areas of keratinization mimicking an ocular surface squamous neoplasia. An excision biopsy was performed, and the specimen sent for histopathologywhich revealed features of pseudoepitheliomatous hyperplasia with no evidence of dysplasia or malignant transformation. The subepithelium revealed a dense plasma-rich inflammation. Discussion. We report this relatively uncommon presentation of limbal pseudoepitheliomatous hyperplasia mimicking an ocular surface squamous neoplasia in palpebral vernal keratoconjunctivitis. Wide excision as is required for an ocular surface neoplasia may thus be avoided if this entity is recognized in vernal keratoconjunctivitis.

  10. Vernal keratoconjunctivitis: culmination of management using immunosuppression, surgical and prosthetic therapy over quarter century.

    Science.gov (United States)

    Das, Shilpa; Pasari, Anand S; Sangwan, Virender S

    2016-11-23

    A 22-year-old male patient presented in 1988 with active vernal keratoconjunctivitis. He was treated with topical mast cell stabilisers and corticosteroids. Chronic inflammation despite topical treatment necessitated oral immunosuppressants. Active disease came under control with this; however, the patient gradually developed limbal stem cell deficiency. He underwent bilateral pannus resection with amniotic membrane transplantation that resulted in improved ocular surface. In 2007, patient was found to have significant bilateral posterior subcapsular cataracts and underwent bilateral cataract surgery with intraocular lens implantation with good visual outcome. In 2016, he was provided with scleral lens prosthetic device, which further improved vision. At last follow-up, more than 25 years after his initial visit, his visual acuity was 20/25 in both eyes with a stable surface. With a comprehensive approach using immunosuppression, surgical therapy and scleral lens prosthetic device, chronic vernal keratoconjunctivitis can be well managed as illustrated in this case. 2016 BMJ Publishing Group Ltd.

  11. Efficacy of topical 0.05% cyclosporine treatment in children with severe vernal keratoconjunctivitis.

    Science.gov (United States)

    Çoban-Karataş, Müge; Özkale, Yasemin; Altan-Yaycıoğlu, Rana; Sızmaz, Selçuk; Pelit, Aysel; Metindoğan, Sevda; Cantürk-Uğurbaş, Sılay; Aydın-Akova, Yonca

    2014-01-01

    We aimed to determine the efficacy of topical cyclosporine in children with vernal keratoconjunctivitis refractory to topical mast cell stabilizer and antihistamine therapy. Thirty-one patients, 24 boys and 7 girls younger than 16 years of age, were included in the study. All patients were scored on a four-point scale from 0 to 3 for symptoms and signs. Each patient received topical cyclosporine 0.05% emulsion (Restasis, Allergan Inc., Irvine, CA, USA) four times daily in addition to preservative-free artificial tears and was followed for 6 months. The data was recorded before the initiation of treatment (day 0) and at the 1st, 3rd, and 6th months following treatment. After six months of treatment, severity of all symptoms and signs showed a statistically significant decrease (pvernal keratoconjunctivitis in children.

  12. Measure of keratoconus progression in patients with vernal keratoconjunctivitis using scanning slit topography.

    Science.gov (United States)

    Taneja, Mukesh; Ashar, Jatin N; Mathur, Anurag; Vaddavalli, Pravin K; Rathi, Varsha; Sangwan, Virender; Murthy, Somashiela

    2013-02-01

    To document topographic changes using Orbscan in patients with keratoconus and vernal keratoconjunctivitis over 1 year. Retrospective analysis of clinical and Orbscan data of 22 eyes of 11 patients with keratoconus and VKC with follow up over 1 year period was done. The parameters studied included patients demographics, clinical features, visual acuity, refraction and Orbscan IIz. The changes in various Orbscan parameters were studied over the 1-year period. Mean age was 14±4.1 years. 20 eyes had clinical keratoconus, while 2 had forme fruste keratoconus. 8 eyes of 22 showed evident progression (>1 diopter change in mean simulated (sim) K over 12 months). There was no significant difference in the visual acuity or clinical features over follow up. In patients with progression, statistically significant change (pvernal keratoconjunctivitis and keratoconus. Copyright © 2012 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

  13. Chronic keratoconjunctivitis with dermatitis as a presenting sign of child abuse.

    Science.gov (United States)

    Moore, Daniel B; Herlihy, Erin P; Weiss, Avery H

    2012-04-01

    A 13-month-old girl presented with chronic keratoconjunctivitis with dermatitis. She was initially diagnosed with corneal abrasion and mild preseptal cellulitis and was treated with topical and oral antibiotics. After failing to respond to standard therapy, she was eventually identified as a victim of abuse. We discuss key findings that could have provoked earlier recognition. Copyright © 2012 American Association for Pediatric Ophthalmology and Strabismus. Published by Mosby, Inc. All rights reserved.

  14. Systematic approach to managing vernal keratoconjunctivitis in clinical practice: Severity grading system and a treatment algorithm

    OpenAIRE

    Gokhale, Nikhil S

    2016-01-01

    Vernal keratoconjunctivitis is an ocular allergy that is common in the pediatric age group. It is often chronic, severe, and nonresponsive to the available treatment options. Management of these children is difficult and often a dilemma for the practitioner. There is a need to simplify and standardize its management. To achieve this goal, we require a grading system to judge the severity of inflammation and an algorithm to select the appropriate medications. This article provides a simple and...

  15. Topical tacrolimus for the treatment of severe allergic keratoconjunctivitis in children.

    Science.gov (United States)

    Liendo, Vera Lucia; Vola, Maria Eugenia; Barreiro, Telma Pereira; Wakamatsu, Tais Hitomi; Gomes, José Álvaro Pereira; Santos, Myrna Serapião Dos

    2017-01-01

    Administration of eye drops containing antihistamines or sodium cromoglycate and its derivatives for the treatment of allergic keratoconjunctivitis is often insufficient and usually requires the addition of corticosteroids. However, the risk of complications, such as glaucoma and cataract, limits the use of corticosteroids to short courses, resulting in inadequate long-term treatment response. Immunosuppressive drugs have been considered as a valid alternative to steroids for atopic keratoconjunctivitis and vernal keratoconjunctivitis. This study aimed to evaluate the use of topical tacrolimus (TCL) in improving the clinical signs of severe allergic keratoconjuctivitis in children. Patients with severe allergic keratoconjunctivitis associated with corneal epitheliopathy, gelatinous limbal infiltrates, and/or papillary reaction, along with a history of recurrences and resistance to conventional topical anti-allergy agents, were included in this open clinical trial. Patients were treated with 0.03% TCL ointment for ocular use. A severity score ranging from 0 to 9, with 9 being the highest and 0 being the lowest, was assigned based on signs observed on biomicroscopy prior to and following TCL treatment. Analyses included 66 eyes of 33 patients. After a mean follow-up period of 13 months (range, 12-29 months), TCL treatment significantly decreased the mean symptom score severity for the right (from 5.56 ± 1.18 to 2.76 ± 1.5; p<0.001) and left (from 5.94 ± 1.16 to 2.86 ± 1.64; p<0.001). Topical TCL was effective and significantly improved the clinical signs of allergic keratoconjuctivitis in children. Thus, it is a potential new option for severe and challenging cases of ocular allergy.

  16. Topical tacrolimus for the treatment of severe allergic keratoconjunctivitis in children

    Directory of Open Access Journals (Sweden)

    Vera Lucia Liendo

    Full Text Available ABSTRACT Purpose: Administration of eye drops containing antihistamines or sodium cromoglycate and its derivatives for the treatment of allergic keratoconjunctivitis is often insufficient and usually requires the addition of corticosteroids. However, the risk of complications, such as glaucoma and cataract, limits the use of corticosteroids to short courses, resulting in inadequate long-term treatment response. Immunosuppressive drugs have been considered as a valid alternative to steroids for atopic keratoconjunctivitis and vernal keratoconjunctivitis. This study aimed to evaluate the use of topical tacrolimus (TCL in improving the clinical signs of severe allergic keratoconjuctivitis in children. Methods: Patients with severe allergic keratoconjunctivitis associated with corneal epitheliopathy, gelatinous limbal infiltrates, and/or papillary reaction, along with a history of recurrences and resistance to conventional topical anti-allergy agents, were included in this open clinical trial. Patients were treated with 0.03% TCL ointment for ocular use. A severity score ranging from 0 to 9, with 9 being the highest and 0 being the lowest, was assigned based on signs observed on biomicroscopy prior to and following TCL treatment. Results: Analyses included 66 eyes of 33 patients. After a mean follow-up period of 13 months (range, 12-29 months, TCL treatment significantly decreased the mean symptom score severity for the right (from 5.56 ± 1.18 to 2.76 ± 1.5; p<0.001 and left (from 5.94 ± 1.16 to 2.86 ± 1.64; p<0.001. Conclusion: Topical TCL was effective and significantly improved the clinical signs of allergic keratoconjuctivitis in children. Thus, it is a potential new option for severe and challenging cases of ocular allergy.

  17. Direct fluorescent antibody assay and polymerase chain reaction for the detection of Chlamydia trachomatis in patients with vernal keratoconjunctivitis

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    Maria Cristina Nishiwaki-Dantas

    2011-01-01

    Full Text Available OBJECTIVES: To identify Chlamydia trachomatis via polymerase chain reaction and a direct fluorescent antibodyassay in patients with vernal keratoconjunctivitis while comparing the efficacies of both tests for detectingChlamydia trachomatis in these conditions. METHODS: Conjunctival scraping samples were obtained from 177 patients who were divided into two groups: avernal keratoconjunctivitis group (group A and a control group (group B. The polymerase chain reaction and adirect fluorescent antibody assay were performed. Sensitivity, specificity, receiver operating characteristic curves,and areas under the curve were calculated for both tests in groups A and B. Receiver operating characteristic curveswere plotted using a categorical variable with only two possible outcomes (positive and negative. RESULTS: Statistical analysis revealed a significant association between vernal keratoconjunctivitis and Chlamydia trachomatis infection detected by a direct fluorescent antibody assay with high sensitivity and specificity. Allpatients in group A with positive polymerase chain reactions also presented with positive direct fluorescentantibody assays. CONCLUSION: The association between vernal keratoconjunctivitis and Chlamydia trachomatis infection wasconfirmed by positive direct fluorescent antibody assays in 49.4% of vernal keratoconjunctivitis patients and bypositive polymerase chain reactions in 20% of these patients. The direct fluorescent antibody assay detectedChlamydia trachomatis in a higher number of patients than did the polymerase chain reaction. Although thediagnosis of trachoma is essentially clinical, the disease may not be detected in vernal keratoconjunctivitis patients.Due to the high frequency of chlamydial infection detected in patients with vernal keratoconjunctivitis, we suggestconsidering routine laboratory tests to detect Chlamydia trachomatis in patients with severe and refractory allergicdisease.

  18. Direct fluorescent antibody assay and polymerase chain reaction for the detection of Chlamydia trachomatis in patients with vernal keratoconjunctivitis.

    Science.gov (United States)

    Nishiwaki-Dantas, Maria Cristina; de Abreu, Mariza Toledo; de Melo, Cynthia Mendonça; Romero, Ivana Lopes; Neto, Rubens Belfort Matos; Dantas, Paulo Elias Correa

    2011-01-01

    To identify Chlamydia trachomatis via polymerase chain reaction and a direct fluorescent antibody assay in patients with vernal keratoconjunctivitis while comparing the efficacies of both tests for detecting Chlamydia trachomatis in these conditions. Conjunctival scraping samples were obtained from 177 patients who were divided into two groups: a vernal keratoconjunctivitis group (group A) and a control group (group B). The polymerase chain reaction and a direct fluorescent antibody assay were performed. Sensitivity, specificity, receiver operating characteristic curves, and areas under the curve were calculated for both tests in groups A and B. Receiver operating characteristic curves were plotted using a categorical variable with only two possible outcomes (positive and negative). Statistical analysis revealed a significant association between vernal keratoconjunctivitis and Chlamydia trachomatis infection detected by a direct fluorescent antibody assay with high sensitivity and specificity. All patients in group A with positive polymerase chain reactions also presented with positive direct fluorescent antibody assays. The association between vernal keratoconjunctivitis and Chlamydia trachomatis infection was confirmed by positive direct fluorescent antibody assays in 49.4% of vernal keratoconjunctivitis patients and by positive polymerase chain reactions in 20% of these patients. The direct fluorescent antibody assay detected Chlamydia trachomatis in a higher number of patients than did the polymerase chain reaction. Although the diagnosis of trachoma is essentially clinical, the disease may not be detected in vernal keratoconjunctivitis patients. Due to the high frequency of chlamydial infection detected in patients with vernal keratoconjunctivitis, we suggest considering routine laboratory tests to detect Chlamydia trachomatis in patients with severe and refractory allergic disease.

  19. Prospective, multicenter demographic and epidemiological study on vernal keratoconjunctivitis: a glimpse of ocular surface in Italian population.

    Science.gov (United States)

    Lambiase, Alessandro; Minchiotti, Simona; Leonardi, Andrea; Secchi, A G; Rolando, Maurizio; Calabria, Giovanni; Orsoni, Jelka; Zola, Enrica; Ferreri, Giuseppe; Aragona, Pasquale; Reibaldi, Alfredo; Chisari, Giorgio; Bonini, Stefano

    2009-01-01

    To evaluate the frequency and epidemiological features of vernal keratoconjunctivitis (VKC) in Italy. a specific electronic clinical chart for vernal keratoconjunctivitis was created to standardize: 1) medical history; 2) diagnostic criteria; 3) signs and symptoms; and 4) treatments. This study involved 6 Italian referral centers for ocular surface diseases: between March 2005 and March 2006, all referred patients were included, clinical data collected and statistically examined. The mean age of the vernal keratoconjunctivitis population (n = 156) was 13.8 +/- 8.8 with 64.1% of subjects under 14 years of age and a male/female ratio of 3.5:1. Among VKC patients, 48.7% showed associated systemic allergic diseases. Only 32.1% of patients were positive for RAST and/or prick test. The limbal form (53.8%) was the most frequent subtype of vernal keratoconjunctivitis. Approximately 9% of patients showed a severe form of vernal keratoconjunctivitis. At the first visit patients were treated with: multiple action or mast cell stabilizer eye drops (58.1% and 41.3% of cases, respectively), topical corticosteroids alone (0.6%) or in association (26.8% of cases). All patients used topical steroids at least once in the studied year. Systemic antihistamine therapy was used by 25.6% of patients. In this cohort, 32.7% of patients required two or more examinations per year for exacerbations of their symptoms. Vernal keratoconjunctivitis is a severe ocular condition that mainly affects young males. Vernal keratoconjunctivitis is characterized by different clinical features and therapeutic responses, suggesting the need for a standardized therapeutic approach on the basis of a grading of disease severity.

  20. Subcutaneous allergen-specific immunotherapy versus topical treatment in vernal keratoconjunctivitis.

    Science.gov (United States)

    Mahdy, Reda Abdel Rahman; Nada, Waled M; Marei, Ayman A

    2012-05-01

    The study evaluated the treatment of cases with vernal keratoconjunctivitis by subcutaneous allergen-specific immunotherapy (SCIT) versus topical treatment according to clinical improvement and total serum immunoglobulin (Ig) E. Prospective randomized study. The study included 64 patients with bilateral vernal keratoconjunctivitis. Cases were divided into 2 groups: group 1, 32 patients who were subjected to topical treatment; and group 2, 32 patients who were subjected to intradermal skin reactions to different allergens. Prepared subcutaneous injections of different allergens were administered. Follow-up was performed to detect criteria of improvement according to clinical data and total serum IgE. The study revealed that the treatment by SCIT was more effective in improving the clinical symptoms and reducing the serum IgE than topical treatment because there was a greater reduction in symptoms in group 1 of immunotherapy (72%) than in group 2 of medical treatment (59%) (P vernal keratoconjunctivitis by SCIT was more effective than topical treatment in improving the clinical symptoms and reducing the total serum IgE.

  1. Clinical Usefulness of Monitoring Expression Levels of CCL24 (Eotaxin-2) mRNA on the Ocular Surface in Patients with Vernal Keratoconjunctivitis and Atopic Keratoconjunctivitis.

    Science.gov (United States)

    Shiraki, Yukiko; Shoji, Jun; Inada, Noriko

    2016-01-01

    Purpose. This study aimed to evaluate the clinical efficacy of using expression levels of CCL24 (eotaxin-2) mRNA on the ocular surface as a biomarker in patients with vernal keratoconjunctivitis (VKC) and atopic keratoconjunctivitis (AKC). Methods. Eighteen patients with VKC or AKC (VKC/AKC group) and 12 control subjects (control group) were enrolled in this study. The VKC/AKC clinical score was determined by objective findings in patients by using the 5-5-5 exacerbation grading scale. All subjects underwent modified impression cytology and specimens were obtained from the upper tarsal conjunctiva. Expression levels of CCL24 (eotaxin-2) mRNA on the ocular surface were determined using real-time reverse transcription polymerase chain reaction. Results. The VKC group was divided into two subgroups, depending on the clinical score: the active stage subgroup with 100 points or more of clinical scores and the stable stage subgroup with 100 points or less. CCL24 (eotaxin-2) mRNA expression levels in the active VKC/AKC stage subgroup were significantly higher than those in the stable VKC/AKC subgroup and the control group. Clinical scores correlated significantly with CCL24 (eotaxin-2) mRNA expression levels in the VKC group. Conclusions. CCL24 (eotaxin-2) mRNA expression levels on the ocular surface are a useful biomarker for clinical severity of VKC/AKC.

  2. Pediatric glaucoma suspects

    Directory of Open Access Journals (Sweden)

    Kooner K

    2014-06-01

    Full Text Available Karanjit Kooner,1 Matthew Harrison,1 Zohra Prasla,1 Mohannad Albdour,1 Beverley Adams-Huet21Department of Ophthalmology, 2Department of Clinical Sciences, Division of Biostatistics, University of Texas Southwestern Medical Center, Dallas, TX, USAPurpose: To report demographic and ocular features of pediatric glaucoma suspects in an ethnically diverse population of North Central Texas.Design: Retrospective cross-sectional chart review.Participants: Subjects included 75 (136 eyes pediatric glaucoma suspects. Patients with one or more of the following risk factors were included: cup-to disc (C/D ratio of ≥0.6; intraocular pressure (IOP ≥21 mmHg; family history of glaucoma; congenital glaucoma in the opposite eye; history of blunt trauma to either eye; and presence of either Sturge–Weber or Axenfeld–Rieger syndrome, or oculodermal melanocytosis.Methods: Data were extracted from electronic patient medical records. Patient records with incomplete data were excluded. The main outcome measures were race, sex, age, IOP, C/D, family history of glaucoma; and glaucoma treatment.Results: Subjects included 28 (37.3% Hispanics, 20 (26.6% African Americans, 20 (26.6% Caucasians, and seven (9.3% Asians. Forty (53.3% of the patients were male. Suspicious optic disc was seen in 57 (76%; elevated IOP in 25 (33.3%; presence of family history in 13 (17.3%, and Sturge–Weber syndrome in nine (12% patients. The average C/D ratio was 0.58±0.2. The C/D ratios of African American (0.65±0.2, Hispanic (0.63±0.2, and Asian (0.62±0.15 patients were significantly greater than those of Caucasians (0.43±0.18; P=0.0004, 0.0003, and 0.0139, respectively. Caucasian patients were the youngest (7.9±4.8 years. Eleven cases (14.7% required medication.Conclusion: Thirty-three point seven percent of patients seen in the glaucoma clinic were glaucoma suspects. The most common risk factors for suspected glaucoma were suspicious optic discs, elevated IOP, and family history

  3. Blocking Self-avoiding Walks Stops Cyber-epidemics: A Scalable GPU-based Approach

    OpenAIRE

    Nguyen, Hung T.; Cano, Alberto; Vu, Tam; Dinh, Thang N.

    2017-01-01

    Cyber-epidemics, the widespread of fake news or propaganda through social media, can cause devastating economic and political consequences. A common countermeasure against cyber-epidemics is to disable a small subset of suspected social connections or accounts to effectively contain the epidemics. An example is the recent shutdown of 125,000 ISIS-related Twitter accounts. Despite many proposed methods to identify such subset, none are scalable enough to provide high-quality solutions in nowad...

  4. Multidrug-resistant bacteria induce recurrent keratoconjunctivitis in a patient with common variable immunodeficiency: case report and literature review.

    Science.gov (United States)

    Chao, Jiang; Yumei, Zhou; Zhiqun, Wang; Yang, Zhang; Xuguang, Sun

    2013-11-01

    We present a case study regarding a patient with recurrent keratoconjunctivitis that presented as an initial manifestation of common variable immunodeficiency (CVID). We describe a case and review the recent relevant medical literature. A 33-year-old male had recurrent keratoconjunctivitis induced by multidrug-resistant bacteria. Topical vancomycin treatment was effective, but infection recurred when the vancomycin treatment was stopped. The patient was transferred to the Department of Medicine to rule out potential systemic immune diseases and was finally diagnosed with CVID. Intravenous immunoglobulin (IVIG) was administered, and the patient was followed up monthly without any recurrence of infection to date. IVIG will be administered monthly for the patient's lifetime. Keratoconjunctivitis is a CVID-associated manifestation, sometimes appearing as the first presentation. CVID should be considered when unexplained recurrent conjunctival and/or corneal bacterial infections are observed. Topical therapy is not sufficient to treat this infection and IVIG is necessary.

  5. Modeling Epidemic Network Failures

    DEFF Research Database (Denmark)

    Ruepp, Sarah Renée; Fagertun, Anna Manolova

    2013-01-01

    This paper presents the implementation of a failure propagation model for transport networks when multiple failures occur resulting in an epidemic. We model the Susceptible Infected Disabled (SID) epidemic model and validate it by comparing it to analytical solutions. Furthermore, we evaluate...

  6. Severe vernal keratoconjunctivitis requiring trabeculectomy with mitomycin C for corticosteroid-induced glaucoma.

    Science.gov (United States)

    Ang, Marcus; Ho, Ching-Lin; Tan, Donald; Chan, Cordelia

    2012-01-01

    To describe clinical features of severe vernal keratoconjunctivitis with steroid response in Asian children and risk factors for glaucoma filtration surgery. Retrospective non-controlled, comparative case series. Patients with severe vernal keratoconjunctivitis seen at a single centre over 6 years. Clinical features, symptoms and treatment modalities were recorded for patients (i) diagnosed with severe VKC (clinical grade ≥ 3); (ii) had >2 recordings of increased intraocular pressures of >21 mmHg; (iii) and a minimum follow-up period of 1 year post-presentation. Corticosteroid-induced glaucoma requiring trabeculectomy with mitomycin-C. Six patients (eight eyes) of 36 patients required trabeculectomy/mitomycin-C. All were male. Mean age of disease onset was 9.3 ± 4.5 years for a mean duration of 6.08 ± 3.5 years. Mean intraocular pressures increase from baseline was 29.0 ± 8.2 mmHg and all required >2 anti-glaucoma medications. The main risk factor for trabeculectomy was a greater increase in intraocular pressures from baseline (odds ratio 1.3; 95% confidence interval, 1.0-1.5; P = 0.011), which was independent of potential confounders such as type and duration of corticosteroid use. Comparing eyes pre- and post-trabeculectomy, all improved in clinical severity of vernal keratoconjunctivitis (mean clinical grade improvement 2.1; 95% confidence interval, 1.3-3.0; P < 0.001) and reduced dependence on topical corticosteroids for mean duration of 22.5 ± 15.3 months. In our study, patients with a 'greater steroid response', that is, higher increase in intraocular pressures from baseline are associated with a 30% higher risk toftrabeculectomy. © 2011 The Authors. Clinical and Experimental Ophthalmology © 2011 Royal Australian and New Zealand College of Ophthalmologists.

  7. Childhood chronic anterior uveitis associated with vernal keratoconjunctivitis (VKC: successful treatment with topical tacrolimus. Case series

    Directory of Open Access Journals (Sweden)

    Taddio Andrea

    2011-11-01

    Full Text Available Abstract Uveitis treatment involves topical corticosteroids along with cycloplegic-mydriatics. Particularly severe cases may require systemic corticosteroids and immunosuppressive drugs. Vernal keratoconjunctivitis (VKC treatment consists of a brief period of topical corticosteroids and/or cyclosporine. In patients refractory to traditional treatment, the use of 0.1% topical ophtalmic FK- 506 (tacrolimus ointment has been occasionally reported. This is the first report of the coexistence of uveitis and VKC. The documented response to topical tacrolimus eyedrop of uveitis and VKC is also of interest, in particular since to our knowledge there are no published reports on its clinical use in uveitis.

  8. Surgical management and immunohistochemical study of corneal plaques in vernal keratoconjunctivitis

    Directory of Open Access Journals (Sweden)

    Hsiu-Yi Lin

    2013-09-01

    Full Text Available Two children with shield ulcer in vernal keratoconjunctivitis unresponsive to steroid therapy received plaque removal by superficial keratectomy, followed by amniotic membrane transplantation (AMT. Hematoxylin and eosin staining of the excised corneal specimen revealed a thick layer of eosinophilic material attached to the Bowman's layer. These deposits were positive for eosinophil granule major basic protein, as confirmed by an immunohistochemical study. The shield ulcer healed after the amniotic membrane was removed. No recurrent corneal plaque developed, although corneal opacity complicated in both cases. Lamellar keratectomy with AMT offers an effective management by removing the cytotoxic plaques and protecting the denuded stroma from deposition of inflammatory debris.

  9. Systematic approach to managing vernal keratoconjunctivitis in clinical practice: Severity grading system and a treatment algorithm.

    Science.gov (United States)

    Gokhale, Nikhil S

    2016-02-01

    Vernal keratoconjunctivitis is an ocular allergy that is common in the pediatric age group. It is often chronic, severe, and nonresponsive to the available treatment options. Management of these children is difficult and often a dilemma for the practitioner. There is a need to simplify and standardize its management. To achieve this goal, we require a grading system to judge the severity of inflammation and an algorithm to select the appropriate medications. This article provides a simple and practically useful grading system and a stepladder algorithm for systematic treatment of these patients. Use of appropriate treatment modalities can reduce treatment and disease-related complications.

  10. Systematic approach to managing vernal keratoconjunctivitis in clinical practice: Severity grading system and a treatment algorithm

    Directory of Open Access Journals (Sweden)

    Nikhil S Gokhale

    2016-01-01

    Full Text Available Vernal keratoconjunctivitis is an ocular allergy that is common in the pediatric age group. It is often chronic, severe, and nonresponsive to the available treatment options. Management of these children is difficult and often a dilemma for the practitioner. There is a need to simplify and standardize its management. To achieve this goal, we require a grading system to judge the severity of inflammation and an algorithm to select the appropriate medications. This article provides a simple and practically useful grading system and a stepladder algorithm for systematic treatment of these patients. Use of appropriate treatment modalities can reduce treatment and disease-related complications.

  11. Childhood chronic anterior uveitis associated with vernal keratoconjunctivitis (VKC): successful treatment with topical tacrolimus. Case series

    Science.gov (United States)

    2011-01-01

    Uveitis treatment involves topical corticosteroids along with cycloplegic-mydriatics. Particularly severe cases may require systemic corticosteroids and immunosuppressive drugs. Vernal keratoconjunctivitis (VKC) treatment consists of a brief period of topical corticosteroids and/or cyclosporine. In patients refractory to traditional treatment, the use of 0.1% topical ophtalmic FK- 506 (tacrolimus) ointment has been occasionally reported. This is the first report of the coexistence of uveitis and VKC. The documented response to topical tacrolimus eyedrop of uveitis and VKC is also of interest, in particular since to our knowledge there are no published reports on its clinical use in uveitis. PMID:22047067

  12. Vernal keratoconjunctivitis in the black child and its response to therapy.

    Science.gov (United States)

    Dahan, E; Appel, R

    1983-01-01

    A clinical study of vernal keratoconjunctivitis in black children in Southern Africa was conducted to report on the peculiar, predominantly limbal form of the disease, and to test its response to therapy. Pigmented and thickened limbal conjunctiva gave the disease its typical appearance. In severe cases these lesions were encroaching on to the cornea and threatened sight. Placebo had no effect on the course of the disease. Topical steroids and sodium cromoglycate were equally effective. A combination of steroids and SCG proved particularly effective in treating severe cases, indicating a possible synergistic effect of the 2 drugs. Images PMID:6412738

  13. Technology and the Glaucoma Suspect

    National Research Council Canada - National Science Library

    Blumberg, Dana M; De Moraes, Carlos Gustavo; Liebmann, Jeffrey M; Garg, Reena; Chen, Cynthia; Theventhiran, Alex; Hood, Donald C

    2016-01-01

    ...), stereoscopic disc photographs, and automated perimetry as assessed by a group of glaucoma specialists in differentiating individuals with early glaucoma from suspects. Forty-six eyes (46 patients...

  14. Understanding the Opioid Epidemic

    Science.gov (United States)

    ... Search Form Controls Cancel Submit Search The CDC Opioid Overdose Note: Javascript is disabled or is not ... message, please visit this page: About CDC.gov . Opioid Overdose Opioid Basics Understanding the Epidemic Commonly Used ...

  15. Dynamics of beneficial epidemics

    CERN Document Server

    Berdahl, Andrew; De Bacco, Caterina; Dumas, Marion; Ferdinand, Vanessa; Grochow, Joshua A; Hébert-Dufresne, Laurent; Kallus, Yoav; Kempes, Christopher P; Kolchinsky, Artemy; Larremore, Daniel B; Libby, Eric; Power, Eleanor A; Stern, Caitlin A; Tracey, Brendan

    2016-01-01

    Pathogens can spread epidemically through populations. Beneficial contagions, such as viruses that enhance host survival or technological innovations that improve quality of life, also have the potential to spread epidemically. How do the dynamics of beneficial biological and social epidemics differ from those of detrimental epidemics? We investigate this question using three theoretical approaches as well as an empirical analysis of concept propagation. First, in evolutionary models, we show that a beneficial horizontally-transmissible element, such as viral DNA, spreads super-exponentially through a population, substantially more quickly than a beneficial mutation. Second, in an epidemiological social network approach, we show that infections that cause increased connectivity lead to faster-than-exponential fixation in the population. Third, in a sociological model with strategic rewiring, we find that preferences for increased global infection accelerate spread and produce super-exponential fixation rates,...

  16. Modularity promotes epidemic recurrence

    CERN Document Server

    Jesan, T; Sinha, Sitabhra

    2016-01-01

    The long-term evolution of epidemic processes depends crucially on the structure of contact networks. As empirical evidence indicates that human populations exhibit strong community organization, we investigate here how such mesoscopic configurations affect the likelihood of epidemic recurrence. Through numerical simulations on real social networks and theoretical arguments using spectral methods, we demonstrate that highly contagious diseases that would have otherwise died out rapidly can persist indefinitely for an optimal range of modularity in contact networks.

  17. Congenital keratoconjunctivitis sicca and ichthyosiform dermatosis in the cavalier King Charles spaniel.

    Science.gov (United States)

    Barnett, K C

    2006-09-01

    To record a previously unreported congenital and hereditary condition affecting the eyes and skin in the cavalier King Charles spaniel. Nineteen cases (13 litters) were investigated, with particular reference to eye and skin clinical signs. In addition, five generation pedigrees were obtained and studied from all cases with the exception of one. The eye signs were due to keratoconjunctivitis sicca, a common ocular disease in the dog, but rarely of congenital origin. The skin signs were of an ichthyosiform dermatosis; ichthyosis being a rare skin disease in the dog. In human beings, ichthyosis is a similar disease, mainly inherited and with a neonatal onset, and sometimes accompanied by other developmental defects. In the cavalier King Charles spaniel, the coat abnormality was noted at birth by the breeders as a 'curly coat', with deterioration of the skin signs as the animal became adult. These two conditions occurring together in this breed is well recognised by some breeders but rarely by the veterinary profession. Successful treatment is not possible, although some improvement, particularly of the keratoconjunctivitis sicca, can be obtained. The probable hereditary nature of the condition is an important factor for control.

  18. ORAL DIETHYLCARBAMAZINE AS ADJUVANT THERAPY IN REFRACTORY VERNAL KERATOCONJUNCTIVITIS - A PROSPECTIVE STUDY

    Directory of Open Access Journals (Sweden)

    Roopashree

    2015-10-01

    Full Text Available PURPOSE: To evaluate the role of oral diethylcarbamazine as an adjuvant therapy in refractory vernal keratoconjunctivitis associated with eosinophilia. MATERIALS AND METHODS: Twenty four patients with bilateral refractory severe vernal keratoconjunctivitis (VKC and eosinophilia were included in the prospective study. The average age of patients was 8.25 years (range 3 to 14 years including 18 males (75% and 6 females (25%. The absolute eosinophil count (AEC in these pa tients was on an average 1065.79 cells/μL (range 530 to 3120 cells/μL. All the patients were given oral diethylcarbamazine (DEC as an adjuvant therapy for refractory VKC. RESULTS: At an average follow up of 7.2 months (range 6 to 11 months, only 2 cases (8.3% had recurrent exacerbation of VKC. Signs and symptoms of VKC improved significantly with remission in all the patients within 3 months. Absolute eosinophil count repeated after 3 months of starting DEC was on an average 376.25 cells/μL (range 200 t o 950 cells/μL. There was a statistically significant reduction in eosinophilia following oral DEC at p<0.0001. CONCLUSION: Oral DEC effectively reduces eosinophilia seen in refractory VKC. It is a cost effective and safe alternative as an adjuvant in ref ractory VKC with good clinical response

  19. [Follow-up study on patients with vernal keratoconjunctivitis undergoing topical 0.1% tacrolimus treatment].

    Science.gov (United States)

    Harada, Natsuko; Inada, Noriko; Ishimori, Akiko; Shoji, Jun; Sawa, Mitsuru

    2014-04-01

    A retrospective study for evaluating the clinical course of patients with vernal keratoconjunctivitis (VKC) treated with topical tacrolimus ophthalmic suspension 0.1% (Tacrolimus). Subjects were 30 patients (24 men and 6 women) with VKC who were treated with a combined therapy of Tacrolimus and antiallergic ophthalmic solution, and could be followed up for six months. The subjects were divided into two groups: 1. A conversion treatment group in which Tacrolimus was substituted for a steroid ophthalmic solution [21 patients; average age 14.7 +/- 9.44 years (mean +/- SD)] and 2. An additional treatment group receiving Tacrolimus and anti-allergic ophthalmic solution [9 patients; average age 28.2 +/- 7.31 years (mean +/- SD)]. The therapeutic effects of the patients were evaluated chronologically using the ocular clinical score according to the papillae-limbus-cornea grading score and eosinophil cationic protein (ECP) levels in tears. Papillae-limbus-cornea grading scores were significantly decreased from 8 (median) points at instillation initiation to 5 points at the first month after initiation of Tacrolimus treatment (p vernal keratoconjunctivitis was remarkable at one month after instillation initiation. For evaluating the effect of treatment and diagnosing exacerbation in VKC treated with Tacrolimus, a follow-up examination using clinical indexes such as the papillae-limbus-cornea grading score and ECP levels in tears is beneficial.

  20. Research progress of the epidemic situation and the prevention and control of trachoma

    Directory of Open Access Journals (Sweden)

    Ya-Dong Wang

    2014-10-01

    Full Text Available Trachoma, a contagious keratoconjunctivitis(KC, caused by Chlamydia trachomatis infection, is rife in 57 countries in the world at present. The World Health Organization(WHOlisted the global alliance to eliminate blinding trachoma by 2020 as one of top priorities of its blindness prevention in 1998. A simplified classification system for identifying and naming trachoma, designated by WHO, and the SAFE strategy based on community intervention were extended continuously in the world in 10 years since then. The trachoma prevalence trend has showed a change compared with that in the past. China has launched the blindness prevention action, aimed to eliminate blinding trachoma by 2016. In this paper,we reviews progress in diagnosis, treatment and epidemic of trachoma since the extension of the SAFE strategy.

  1. Configuring the autism epidemic

    DEFF Research Database (Denmark)

    Seeberg, Jens; Christensen, Fie Lund Lindegaard

    2017-01-01

    Autism has been described as an epidemic, but this claim is contested and may point to an awareness epidemic, i.e. changes in the definition of what autism is and more attention being invested in diagnosis leading to a rise in registered cases. The sex ratio of children diagnosed with autism...... is skewed in favour of boys, and girls with autism tend to be diagnosed much later than boys. Building and further developing the notion of ‘configuration’ of epidemics, this article explores the configuration of autism in Denmark, with a particular focus on the health system and social support to families...... with children diagnosed with autism, seen from a parental perspective. The article points to diagnostic dynamics that contribute to explaining why girls with autism are not diagnosed as easily as boys. We unfold these dynamics through the analysis of a case of a Danish family with autism....

  2. Configuring the autism epidemic

    DEFF Research Database (Denmark)

    Christensen, Fie Lund Lindegaard; Seeberg, Jens

    2017-01-01

    is skewed in favour of boys, and girls with autism tend to be diagnosed much later than boys. Building and further developing the notion of ‘configuration’ of epidemics, this article explores the configuration of autism in Denmark, with a particular focus on the health system and social support to families...... with children diagnosed with autism, seen from a parental perspective. The article points to diagnostic dynamics that contribute to explaining why girls with autism are not diagnosed as easily as boys. We unfold these dynamics through the analysis of a case of a Danish family with autism.......Autism has been described as an epidemic, but this claim is contested and may point to an awareness epidemic, i.e. changes in the definition of what autism is and more attention being invested in diagnosis leading to a rise in registered cases. The sex ratio of children diagnosed with autism...

  3. Discrete epidemic models.

    Science.gov (United States)

    Brauer, Fred; Feng, Zhilan; Castillo-Chavez, Carlos

    2010-01-01

    The mathematical theory of single outbreak epidemic models really began with the work of Kermack and Mackendrick about decades ago. This gave a simple answer to the long-standing question of why epidemics woould appear suddenly and then disappear just as suddenly without having infected an entire population. Therefore it seemed natural to expect that theoreticians would immediately proceed to expand this mathematical framework both because the need to handle recurrent single infectious disease outbreaks has always been a priority for public health officials and because theoreticians often try to push the limits of exiting theories. However, the expansion of the theory via the inclusion of refined epidemiological classifications or through the incorporation of categories that are essential for the evaluation of intervention strategies, in the context of ongoing epidemic outbreaks, did not materialize. It was the global threat posed by SARS in that caused theoreticians to expand the Kermack-McKendrick single-outbreak framework. Most recently, efforts to connect theoretical work to data have exploded as attempts to deal with the threat of emergent and re-emergent diseases including the most recent H1N1 influenza pandemic, have marched to the forefront of our global priorities. Since data are collected and/or reported over discrete units of time, developing single outbreak models that fit collected data naturally is relevant. In this note, we introduce a discrete-epidemic framework and highlight, through our analyses, the similarities between single-outbreak comparable classical continuous-time epidemic models and the discrete-time models introduced in this note. The emphasis is on comparisons driven by expressions for the final epidemic size.

  4. Boston type 1 keratoprosthesis for severe blinding vernal keratoconjunctivitis and Mooren's ulcer.

    Science.gov (United States)

    Basu, Sayan; Taneja, Mukesh; Sangwan, Virender S

    2011-06-01

    Indications for the Boston keratoprosthesis differ throughout the world depending on the prevailing regional causes of end-stage corneal disease. We report the short term anatomical and functional outcomes of the Boston type 1 keratoprosthesis for severe bilaterally blinding vernal keratoconjunctivitis and Mooren's ulcer. A retrospective chart review was conducted of 2 patients who underwent several unsuccessful ocular surface reconstruction procedures before Boston type 1 keratoprosthesis implantation. The anatomical and visual outcomes of the Boston type 1 keratoprosthesis at 1 year of follow-up were assessed clinically and by anterior segment optical coherence tomography imaging. The keratoprosthesis was retained in both the eyes at 1 year postoperatively with a best-corrected visual acuity of 20/30 in both patients. To our knowledge this is the first report of successful Boston keratoprosthesis implantation for these two unusual indications.

  5. Outcomes and Rationale of Excision and Mucous Membrane Grafting in Palpebral Vernal Keratoconjunctivitis.

    Science.gov (United States)

    Iyer, Geetha; Agarwal, Shweta; Srinivasan, Bhaskar

    2017-10-13

    To report outcomes of mucous membrane grafting (MMG) for refractory giant papillae in vernal keratoconjunctivitis. Eleven eyes of 6 patients having giant papillae and recurrent shield ulcers refractory to topical medications, cryotherapy, and supratarsal steroid injections and shave excision of papillae underwent surgical resection of the giant papillae with MMG. Average occurrence of shield ulcers was twice per eye per year before the procedure with 50% of eyes having steroid-induced cataract and glaucoma. No recurrence of the shield ulcer in any eye was observed over a mean follow-up period of 38.2 (range 9-106) months. The papillae recurred beyond the graft junction in one eye. Surgical excision of refractory giant papillae followed by MMG does have its advantages in reducing their corneal complications, and it should be considered early in the management of exuberant refractory giant papillae.

  6. Surgical management and immunohistochemical study of corneal plaques in vernal keratoconjunctivitis.

    Science.gov (United States)

    Lin, Hsiu-Yi; Yeh, Po-Ting; Shiao, Cheng-Shiang; Hu, Fung-Rong

    2013-09-01

    Two children with shield ulcer in vernal keratoconjunctivitis unresponsive to steroid therapy received plaque removal by superficial keratectomy, followed by amniotic membrane transplantation (AMT). Hematoxylin and eosin staining of the excised corneal specimen revealed a thick layer of eosinophilic material attached to the Bowman's layer. These deposits were positive for eosinophil granule major basic protein, as confirmed by an immunohistochemical study. The shield ulcer healed after the amniotic membrane was removed. No recurrent corneal plaque developed, although corneal opacity complicated in both cases. Lamellar keratectomy with AMT offers an effective management by removing the cytotoxic plaques and protecting the denuded stroma from deposition of inflammatory debris. Copyright © 2012. Published by Elsevier B.V.

  7. Vernal keratoconjunctivitis in an Israeli group of patients and its treatment with sodium cromoglycate.

    Science.gov (United States)

    Baryishak, Y R; Zavaro, A; Monselise, M; Samra, Z; Sompolinsky, D

    1982-01-01

    Vernal keratoconjunctivitis (VKC) is usually considered as an allergic eye disorder of type I, and in most therapeutic trials it has been shown to yield to topical treatment with sodium cromoglycate. This has been confirmed in the present study of VKC patients from Israel. However, some of the cases seemed not to benefit from this treatment. In a survey of IgE levels in VKC patients in Israel tear IgE levels were significantly increased in 63.5%, but in 29% of the patients both tear and blood IgE levels were normal to low. The possibility that some of the cases diagnosed as VKC might have another cause than IgE-mediated atopy is discussed. Images PMID:6800400

  8. The role of Chlamydia pneumoniae in the etiology of keratoconjunctivitis sicca (KCS).

    Science.gov (United States)

    Krásny, Jan; Hrubá, Dana; Netuková, Magdalena

    2014-01-01

    The authors aimed to show the possible relationship between keratoconjunctivitis sicca (KCS) and Chlamydia pneumonia from the point of view of clinical and microbiological diagnostics. 94 adult patients were treated for follicular conjunctivitis with symptoms of KCS with possible Chlamydia pneumoniae etiology. The diagnosis of a chlamydial infection is based on the serological positivity of chlamydia antibodies and is further based on the antigen positivity in conjunctival imprint preparations. Patients were treated with azithromycin for a period of 12 days. The reciprocal relationship between chlamydial infection and ocular symptoms was proved at 21 patients (22%). Ninety% of patients showed positive anti-Chlamydia pneumoniae IgA and/or IgM with positivity in 80%, including anti-LSP IgA and/or IgM antibodies. This finding was in correlation with the medium to strongly positive finding of anti-cHSP60 IgG. In two patients, this infection was confirmed by the positivity of Chlamydia pneumoniae DNA in peripheral leucocytes. The test group (100 healthy persons) showed 69% negative finding of anti-Chlamydia pneumoniae antibodies or only positive anamnestic antibodies (IgG) and 31% positive antibodies IgA or IgM without clinical sings. This study indicated the possible relationship between KCS and Chlamydia pneumoniae in the course of simultaneous clinical signs of follicular conjunctivitis. KCS is a consequence of the action of local infection at the surface of the conjunctiva. It also indicated the necessity of simultaneous evaluation of microbiological findings and the clinical picture in consideration of overall antibiotic treatment in view of the high antibody background of Chlamydia pneumoniae in the adult population in the Czech Republic. The authors aimed to show the possible relationship between the keratoconjunctivitis sicca and Chlamydia pneumoniae based on results of the two studies. Some patents on conjunctivitis are also briefly described in this article.

  9. Kanpur epidemic: Time course

    Indian Academy of Sciences (India)

    The first peak was related to water contamination which began in December 1990. The second peak was related to failure of municipal authorities to chlorinate water during the 2nd week of February 1991. The epidemic came under control quickly after water contamination was controlled, providing confirmation for role of ...

  10. The Obesity Epidemic

    Centers for Disease Control (CDC) Podcasts

    2011-07-18

    Learn about obesity and the community initiatives taking place to prevent and reduce this epidemic.  Created: 7/18/2011 by National Center for Chronic Disease Prevention and Health Promotion, Division of Nutrition, Physical Activity and Obesity.   Date Released: 7/18/2011.

  11. Global HIV/AIDS Epidemic

    Science.gov (United States)

    ... Policy The Global HIV/AIDS Epidemic The Global HIV/AIDS Epidemic Published: Nov 29, 2017 Facebook Twitter ... 2001-FY 2018 Request The Global Response to HIV/AIDS International efforts to combat HIV began in ...

  12. Epidemics on interconnected networks

    Science.gov (United States)

    Dickison, Mark; Havlin, S.; Stanley, H. E.

    2012-06-01

    Populations are seldom completely isolated from their environment. Individuals in a particular geographic or social region may be considered a distinct network due to strong local ties but will also interact with individuals in other networks. We study the susceptible-infected-recovered process on interconnected network systems and find two distinct regimes. In strongly coupled network systems, epidemics occur simultaneously across the entire system at a critical infection strength βc, below which the disease does not spread. In contrast, in weakly coupled network systems, a mixed phase exists below βc of the coupled network system, where an epidemic occurs in one network but does not spread to the coupled network. We derive an expression for the network and disease parameters that allow this mixed phase and verify it numerically. Public health implications of communities comprising these two classes of network systems are also mentioned.

  13. Resilience of epidemics on networks

    CERN Document Server

    Lu, Dan; Zhang, Jiaquan; Wang, Huijuan; Li, Daqing

    2016-01-01

    Epidemic propagation on complex networks has been widely investigated, mostly with invariant parameters. However, the process of epidemic propagation is not always constant. Epidemics can be affected by various perturbations, and may bounce back to its original state, which is considered resilient. Here, we study the resilience of epidemics on networks, by introducing a different infection rate ${\\lambda_{2}}$ during SIS (susceptible-infected-susceptible) epidemic propagation to model perturbations (control state), whereas the infection rate is ${\\lambda_{1}}$ in the rest of time. Through simulations and theoretical analysis, we find that even for ${\\lambda_{2}<\\lambda_{c}}$, epidemics eventually could bounce back if control duration is below a threshold. This critical control time for epidemic resilience, i.e., ${cd_{max}}$ can be predicted by the diameter (${d}$) of the underlying network, with the quantitative relation ${cd_{max}\\sim d^{\\alpha}}$. Our findings can help to design a better mitigation stra...

  14. Steroid-induced ocular hypertension in Asian children with severe vernal keratoconjunctivitis

    Directory of Open Access Journals (Sweden)

    Ang M

    2012-08-01

    Full Text Available Marcus Ang,1 Seng-Ei Ti,1 Raymond Loh,1 Sonal Farzavandi,1 Rongli Zhang,2 Donald Tan,1 Cordelia Chan11Singapore National Eye Centre, Singapore; 2Singapore Eye Research Institute, SingaporeBackground: We describe clinical characteristics and risk factors for corticosteroid response in children with severe vernal keratoconjunctivitis (VKC.Design: Retrospective, noncontrolled, comparative case series.Participants: Patients from three tertiary centers in Singapore.Methods: We reviewed patients with severe VKC (clinical grade > 2 who were on topical steroid therapy, with a minimum follow-up period of 1 year post-presentation. Logistic regression was used to determine risk factors for corticosteroid response.Main outcome measure: Corticosteroid response was defined as intraocular pressure (IOP>21 mmHg (three consecutive readings, or a rise of more than 16 mmHg from baseline, after commencement of steroid therapy in the absence of other possible causes of raised IOP.Results: Forty-one of 145 (28.3% patients developed a corticosteroid response, of which eight (5.5% progressed to glaucoma. The overall mean age of onset of VKC was 9.9 ± 4.4 years. Longer duration of corticosteroid use (OR, 5.06; 95% CI: 1.04–25.56; P = 0.45 and topical dexamethasone 0.01% (OR, 2.25; 95% CI: 1.99–5.08; P = 0.40 were associated with corticosteroid response. Mixed type of VKC (OR, 9.76; 95% CI: 3.55–26.77; P < 0.001, the presence of limbal neovascularization of ≥ three quadrants (OR, 6.33; 95% CI: 2.36–16.97; P < 0.001, and corneal involvement (OR, 3.51; 95% CI: 1.31–9.41; P = 0.012 were significant clinical risk factors after adjusting for potential confounders such as age, sex, ethnicity, duration, and type of corticosteroid used.Conclusion: Children on long-term oral corticosteroids with severe, mixed-type VKC and corneal involvement are more likely to develop corticosteroid response, and may require early treatment to prevent progression to glaucoma

  15. Efficacy and safety of low-dose topical tacrolimus in vernal keratoconjunctivitis

    Directory of Open Access Journals (Sweden)

    Shoughy SS

    2016-04-01

    Full Text Available Samir S Shoughy,1 Mahmoud O Jaroudi,1 Khalid F Tabbara1–3 1The Eye Center and The Eye Foundation for Research in Ophthalmology, 2Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 3Wilmer Ophthalmological Institute of the Johns Hopkins University School of Medicine, Baltimore, MD, USA Objective: The objective of this study was to evaluate the efficacy and safety of topical low-dose tacrolimus (0.01% solution in patients with vernal keratoconjunctivitis (VKC. Patients and methods: A total of 62 consecutive patients with VKC refractory to conventional treatment were included retrospectively. Tacrolimus 0.01% ophthalmic solution was administered to patients twice daily after discontinuation of all previous topical medications. The duration of treatment ranged from 1 month to 29 months. The clinical symptoms of itching, redness, foreign body sensation, and discharge and the clinical signs of conjunctival hyperemia, conjunctival papillary hypertrophy, limbal infiltration, Trantas dots, and superficial punctate keratopathy were graded as 0 (normal, 1+ (mild, 2+ (moderate, or 3+ (severe. Assessment was carried out before initiation of therapy and on the last visit after treatment. Results: There were 62 patients with VKC comprising 49 male and 13 female patients. The median age was 12 years (range: 5–47 years. The mean visual acuity improved from 20/30 to 20/25 following treatment. There was statistically significant improvement in symptoms of itching (P<0.001, redness (P<0.001, foreign body sensation (P<0.001, and discharge (P<0.001. Statistically significant improvement was also observed in clinical signs of conjunctival hyperemia (P<0.001, limbal infiltration (P<0.001, Trantas dots (P<0.001, superficial punctate keratopathy (P<0.001, and conjunctival papillary hypertrophy (P<0.001. The solution form of tacrolimus was well tolerated. None of the patients developed elevation of intraocular pressure

  16. The epidemic of methylisothiazolinone

    DEFF Research Database (Denmark)

    Schwensen, Jakob F; Uter, Wolfgang; Bruze, Magnus

    2017-01-01

    BACKGROUND: The use of methylisothiazolinone (MI) in cosmetic products has caused an unprecedented epidemic of MI contact allergy. Current data concerning exposures at a European level are required. OBJECTIVES: To describe demographics and MI exposures for European patients with MI contact allerg....... Fifteen patients (7.3%) had previously experienced allergic reactions when they were in newly painted rooms. CONCLUSION: Clinically relevant MI contact allergy remains prevalent across European countries, mainly because of exposure to rinse-off and leave-on cosmetic products....

  17. Increased Incidence of Thyroid Dysfunction and Autoimmunity in Patients with Vernal Keratoconjunctivitis

    Directory of Open Access Journals (Sweden)

    Stefano Stagi

    2014-01-01

    Full Text Available Hormones may play a role in the pathophysiology of vernal keratoconjunctivitis (VKC. An increased incidence of thyroid autoantibodies was recently observed in VKC, although there were no data on thyroid function. Two hundred and eighty-eight patients (202 males, 86 females; range 5.5 to 16.9 years with VKC were evaluated and compared with 188 normal age- and sex-matched subjects. In all subjects, serum concentrations of free T4, TSH, thyroperoxidase, thyroglobulin, and TSHr autoantibodies were evaluated. In VKC, the family history of thyroid diseases showed no significant differences compared to the controls (9.4 versus 8.6%, whereas the family history of autoimmune diseases was significantly higher (13.2% versus 6.3%; P<0.05. Subclinical hypothyroidism was diagnosed in 6.6% (versus 1.6% of the controls; P<0.05 and overt hypothyroidism in 0.7% (versus 0.0% of the controls; P=NS. Finally, 5.2% of patients were positive for thyroid autoantibodies, which were significantly higher with respect to the controls (0.5%, P<0.05. In the patients positive for thyroid autoantibodies, 80% showed a sonography pattern that suggested autoimmune thyroiditis. Thyroid function and autoimmunity abnormalities are frequently present in children with VKC. Children with VKC should be screened for thyroid function and evaluated for thyroid autoimmunity.

  18. Increased incidence of thyroid dysfunction and autoimmunity in patients with vernal keratoconjunctivitis.

    Science.gov (United States)

    Stagi, Stefano; Pucci, Neri; Di Grande, Laura; de Libero, Cinzia; Caputo, Roberto; Pantano, Stefano; Mattei, Ivan; Mori, Francesca; de Martino, Maurizio; Novembre, Elio

    2014-01-01

    Hormones may play a role in the pathophysiology of vernal keratoconjunctivitis (VKC). An increased incidence of thyroid autoantibodies was recently observed in VKC, although there were no data on thyroid function. Two hundred and eighty-eight patients (202 males, 86 females; range 5.5 to 16.9 years) with VKC were evaluated and compared with 188 normal age- and sex-matched subjects. In all subjects, serum concentrations of free T4, TSH, thyroperoxidase, thyroglobulin, and TSHr autoantibodies were evaluated. In VKC, the family history of thyroid diseases showed no significant differences compared to the controls (9.4 versus 8.6%), whereas the family history of autoimmune diseases was significantly higher (13.2% versus 6.3%; P<0.05). Subclinical hypothyroidism was diagnosed in 6.6% (versus 1.6% of the controls; P<0.05) and overt hypothyroidism in 0.7% (versus 0.0% of the controls; P = NS). Finally, 5.2% of patients were positive for thyroid autoantibodies, which were significantly higher with respect to the controls (0.5%, P<0.05). In the patients positive for thyroid autoantibodies, 80% showed a sonography pattern that suggested autoimmune thyroiditis. Thyroid function and autoimmunity abnormalities are frequently present in children with VKC. Children with VKC should be screened for thyroid function and evaluated for thyroid autoimmunity.

  19. Low dose Mitomycin-C in severe vernal keratoconjunctivitis: A randomized prospective double blind study

    Directory of Open Access Journals (Sweden)

    Jain Arun

    2006-01-01

    Full Text Available Purpose: To study the efficacy and safety of low dose topical Mitomycin C (MMC in severe Vernal keratoconjunctivitis (VKC. Design: Placebo controlled double masked randomized clinical trial. Materials and Methods: Twenty-eight patients with severe VKC were randomly assigned to receive either topical MMC (0.01% (n=17 or distilled water (n=11 three times daily for a period of two weeks. Signs and symptoms were recorded on day of presentation and at the end of treatment period (2 weeks. Mann Whitney test was used to analyze the signs and symptoms in the two groups. Results: No statistically significant difference was observed in terms of severity of symptoms at presentation. At two weeks patients in the MMC group showed significant decrease in tearing, foreign body sensation, discharge, hyperemia, punctate keratitis, limbal edema and trantas spots. No adverse effect of MMC was observed. Conclusion: Short term low dose topical MMC is an effective and safe drug to control acute exacerbations in patients of severe VKC refractory to conventional treatment.

  20. Dry Eye in Vernal Keratoconjunctivitis: A Cross-Sectional Comparative Study.

    Science.gov (United States)

    Villani, Edoardo; Strologo, Marika Dello; Pichi, Francesco; Luccarelli, Saverio V; De Cillà, Stefano; Serafino, Massimiliano; Nucci, Paolo

    2015-10-01

    The purpose of this comparative cross-sectional study was to investigate the use of standardized clinical tests for dry eye in pediatric patients with active and quiet vernal keratoconjunctivitis (VKC) and to compare them with healthy children.We recruited 35 active VKC, 35 inactive VKC, and 70 age-matched control healthy subjects. Each child underwent a complete eye examination, including visual analog scale symptoms assessment, biomicroscopy, fluorescein break-up time (BUT), corneal fluorescein and conjunctival lissamine green staining, corneal esthesiometry, Schirmer test with anesthetic, and meibomian glands inspection and expression.Active VKC patients showed significantly increased symptoms and signs of ocular surface disease, compared with the other 2 groups. Inactive VKC patients, compared with control subjects, showed increased photophobia (P < 0.05; Mann-Whitney U test), conjunctival lissamine green staining and Schirmer test values, and reduced BUT and corneal sensitivity [P < 0.05 by analysis of variance (ANOVA) least significant difference posthoc test for BUT and Schirmer; P < 0.001 by Mann-Whitney U test for lissamine green staining and corneal sensitivity].Our results confirm the association between VKC and short-BUT dry eye. This syndrome seems to affect the ocular surface in quiescent phases too, determining abnormalities in tear film stability, epithelial cells integrity, and corneal nerves function. The very long-term consequences of this perennial mechanism of ocular surface damage have not been fully understood yet.

  1. Tacrolimus eye drops as monotherapy for vernal keratoconjunctivitis: a randomized controlled trial.

    Science.gov (United States)

    Müller, Eduardo Gayger; Santos, Myrna Serapião Dos; Freitas, Denise; Gomes, José Álvaro Pereira; Belfort, Rubens

    2017-06-01

    To assess the efficacy of monotherapy using tacrolimus eye drops versus sodium cromoglycate for the treatment of vernal keratoconjunctivitis (VKC). Randomized double-masked controlled trial comparing the efficacy of tacrolimus 0.03% eye drops t.i.d. (Group 1) with sodium cromoglycate 4% eye drops t.i.d. (Group 2) for the symptomatic control of VKC at days 0, 15, 30, 45, and 90 of follow-up. Visual acuity, intraocular pressure, and other complications were evaluated to assess safety and side effects. In total, 16 patients were included, with 8 enrolled in each group. Two patients from Group 2 were excluded from the analysis at days 45 and 90 because of corticosteroid use. Most patients were male (81.8%) and presented with limbal VKC (56.3%). There were statistically significant differences in favor of tacrolimus in the following severity scores: itching at day 90 (p=0.001); foreign body sensation at day 15 (p=0.042); photophobia at day 30 (p=0.041); keratitis at day 30 (p=0.048); and limbal activity at days 15 (p=0.011), 30 (p=0.007), and 45 (p=0.015). No relevant adverse effects were reported, except for a burning sensation with tacrolimus, though this did not compromise treatment compliance. Treatment with tacrolimus was superior to sodium cromoglycate when comparing severity scores for symptoms of itching, foreign body sensation, and photophobia, as well as for signs of limbal inflammatory activity and keratitis.

  2. In vivo confocal microscopy of meibomian glands and palpebral conjunctiva in vernal keratoconjunctivitis

    Directory of Open Access Journals (Sweden)

    Qiaoling Wei

    2015-01-01

    Full Text Available Purpose: To investigate the correlations between conjunctival inflammatory status and meibomian gland (MG morphology in vernal keratoconjunctivitis (VKC patients by using in vivo confocal microscopy (CM. Materials and Methods: Nineteen VKC patients (7 limbal, 7 tarsal, and 5 mixed forms and 16 normal volunteers (controls were enrolled. All subjects underwent CM scanning to obtain the images of upper palpebral conjunctiva and MGs. Inflammatory cell (IC density in palpebral conjunctival epithelial and stromal layers, Langerhans cell (LC density at lid margins and the stroma adjacent to the MG, and MG acinar unit density (MGAUD were recorded. The longest and shortest diameters of MG acinar were measured. The Kruskal-Wallis test was used to compare the parameter differences whereas the Spearman′s rank correlation analysis was applied to determine their correlations. Results: Among all groups, no significant statistical differences were found in epithelial and stromal IC densities, mean values of MG acinar unit densities, or longest and shortest diameters. Both LC parameters in the tarsal-mixed groups were significantly higher than those in the limbal and control groups. All LC densities of VKC patients showed a positive correlation with MGAUD and shortest diameter. Conclusions: In VKC patients, the conjunctival inflammatory status could be associated with the MG status. In vivo CM is a noninvasive, efficient tool in the assessment of MG status and ocular surface.

  3. Mean platelet volume and neutrophil to lymphocyte ratio in patients with vernal keratoconjunctivitis

    Directory of Open Access Journals (Sweden)

    Bilal Elbey

    2015-03-01

    Full Text Available Objective: It was aimed to investigate the neutrophil, eosinophil, lymphocyte, platelet count, neutrophil to lymphocyte ratio (NLR and mean platelet volume (MPV in patients with vernal keratoconjunctivitis (VKC. Methods: The medical records of the VKC patients who admitted to ophthalmology polyclinic were evaluated. Age and sex matched control group was consisted with patients without any systemic or ocular disease except strabismus. Age and gender of all participants were recorded. Hemogram parameters such as mean platelet volume (MPV, neutrophil, eosinophil, lymphocyte, platelet count, NLR were measured by automatized analyzer. Data were compared between the groups. Results: Thirty patients and 30 control subjects were studied. There were no significant differences with respect to age and gender between groups. The mean MPV and NLR values were higher but not statistically significant in VKC group compared to control group (p=0.19, p=0.16, respectively. Conclusion:The results of the current study demonstrated that MPV and NLR values were not associated with VKC. Higher MPV and NLR results in patients with VKC although the differences were not reach statistically significances may suggest that MPV and NLR may be auxiliary parameter.J Clin Exp Invest 2015; 6 (1: 40-43

  4. Supratarsal injection of corticosteroids in the treatment of refractory vernal keratoconjunctivitis.

    Directory of Open Access Journals (Sweden)

    Singh S

    2001-01-01

    Full Text Available PURPOSE: To study and compare the efficacy of supratarsal injection of dexamethasone sodium phosphate, triamcinolone acetonide and hydrocortisone sodium succinate in treating refractory vernal keratoconjunctivitis (VKC. METHODS: Prospective randomized, double-masked, case control trial, including 90 eyes of 45 patients with refractory VKC. Both eyes of each patient were randomly assigned to receive supratarsal injection of one of three compounds under study: dexamethasone sodium phosphate (2 mg, triamcinolone acetonide (10.5 mg, and hydrocortisone sodium succinate (50 mg. RESULTS: All the three drugs were equally effective with no statistically significant difference in the time of resolution of cobblestone papillae, lid oedema, conjunctival discharge and chemosis, Tranta′s dots and shield ulcers. There was no statistically significant difference in the severity and rate of recurrence of disease following supratarsal injection of all the three drugs. But recurrence of disease to same severity was seen within 6 months of injection in all cases irrespective of compounds used. CONCLUSION: Supratarsal injection of corticosteroids is very effective for temporary suppression of severe inflammation associated with VKC.

  5. Quiescent and Active Tear Protein Profiles to Predict Vernal Keratoconjunctivitis Reactivation.

    Science.gov (United States)

    Micera, Alessandra; Di Zazzo, Antonio; Esposito, Graziana; Sgrulletta, Roberto; Calder, Virginia L; Bonini, Stefano

    2016-01-01

    Vernal keratoconjunctivitis (VKC) is a chronic recurrent bilateral inflammation of the conjunctiva associated with atopy. Several inflammatory and tissue remodeling factors contribute to VKC disease. The aim is to provide a chip-based protein analysis in tears from patients suffering from quiescent or active VKC. This study cohort included 16 consecutive patients with VKC and 10 controls. Participants were subjected to clinical assessment of ocular surface and tear sampling. Total protein quantification, total protein sketch, and protein array (sixty protein candidates) were evaluated. An overall increased Fluorescent Intensity expression was observed in VKC arrays. Particularly, IL1β, IL15, IL21, Eotaxin2, TACE, MIP1α, MIP3α, NCAM1, ICAM2, βNGF, NT4, BDNF, βFGF, SCF, MMP1, and MMP2 were increased in quiescent VKC. Of those candidates, only IL1β, IL15, IL21, βNGF, SCF, MMP2, Eotaxin2, TACE, MIP1α, MIP3α, NCAM1, and ICAM2 were increased in both active and quiescent VKC. Finally, NT4, βFGF, and MMP1 were highly increased in active VKC. A distinct "protein tear-print" characterizes VKC activity, confirming some previously reported factors and highlighting some new candidates common to quiescent and active states. Those candidates expressed in quiescent VKC might be considered as predictive indicators of VKC reactivation and/or exacerbation out-of-season.

  6. Long-term use of 0.003% tacrolimus suspension for treatment of vernal keratoconjunctivitis.

    Science.gov (United States)

    Al-Amri, Abdulrahman Mohammed; Fiorentini, Sandra Flavia; Albarry, Maan A; Bamahfouz, Ashjan Yousef

    2017-01-01

    To evaluate the safety and efficacy of 0.003% tacrolimus suspension for the treatment of refractory vernal keratoconjunctivitis (VKC). This prospective study included 40 eyes of 20 patients with severe VKC. After discontinuing all other medications, patients were treated with varying doses of 0.003% tacrolimus suspension. All were followed for at least 24 months. Changes in signs and symptoms after treatment were evaluated; adverse events were assessed. The clinical response to the treatment was the most important measurement to achieve the conclusion. The mean age of the patients was 15.7 ± 1.4 years. Two patients discontinued treatment due to severe burning sensation and were excluded from the study. Significant improvements in all signs and symptoms, including itching, foreign body sensation, papillae, and Trantas dots, were seen in all patients 6 weeks after starting topical tacrolimus. Itching was the first symptom to improve. Treatment was gradually reduced, and intervals were increasing between applications. Recurrence occurred in all patients who attempted to discontinue treatment. No additional medications were required to provide relief, and no significant changes in visual acuity or refraction were seen. The safety and efficacy of 0.003% Tacrolimus suspension treatment for refractory VKC were achieved and it can be considered a useful option instead of steroids, despite the poor compliance in few patients due its adverse effects.

  7. Effect of vernal keratoconjunctivitis on vitreous depth in patients with keratoconus.

    Science.gov (United States)

    Cingü, Abdullah Kürşat; Kaya, Savaş; Çınar, Yasin; Şahin, Muhammed; Türkçü, Fatih Mehmet; Yüksel, Harun; Murat, Mehmet; Çaça, İhsan

    2015-05-01

    The aim of this study was to comparatively evaluate the vitreous depth (VD) of keratoconic eyes in patients with or without vernal keratoconjunctivitis (VKC). Eighty eyes of 80 consecutive keratoconus (KC) patients and 40 emmetropic control subjects were enrolled. KC patients were divided into two groups according to accompanying VKC (VKC-KC group and KC group). Mean outcome measures were best-corrected visual acuity (BCVA), spherical equivalent (SE), mean keratometry (Km), intraocular pressure (IOP), and axial length (AL) and its components. The eyes with the highest Km were selected for statistical analysis for each participant. There were 50, 30, and 40 patients in the VKC-KC group, KC group, and control group respectively. The KC group and VKC-KC group were similar in BCVA, SE, Km, CCT, ACD, LT, and IOP (p>0.05). The mean ACD was significantly lower in the control group when compared with the KC group and VKC-KC group. The mean AL and VD were significantly higher in VKC-KC group than those of KC group and the control group, whereas similar in KC and control groups (p>0.05). In the current study we showed that VKC-associated KC patients have significantly longer AL and VD when compared with KC patients without VKC. Posterior segment elongation in VKC-KC group may be associated with the type IV collagen destruction due to chronic longstanding inflammation in VKC patients.

  8. Topographic corneal changes in children with vernal keratoconjunctivitis: A report from Kathmandu, Nepal.

    Science.gov (United States)

    Gautam, Vijay; Chaudhary, Meenu; Sharma, Ananda Kumar; Shrestha, Gauri Shankar; Rai, Pooja Gautam

    2015-12-01

    The present study was conducted to determine corneal topographic characteristics of children with vernal keratoconjunctivitis (VKC) and compare the corneal topographic indices in VKC subjects with normal subjects In the hospital based comparative study, 115 consecutive subjects with VKC and 102 age and sex matched normal subjects were selected for the videokeratography with NIDEK ophthalmic operating system. Keratoconus-like topography was determined based on the expert classifier system. Other assessments included visual acuity testing with LogMAR chart, slit lamp biomicroscopy, dilated fundus examination, measurement of central corneal thickness and intraocular pressure. Topographic indices were analyzed and compared using unpaired t-test among different groups. Sensitivity and specificity was estimated by the ROC curve. Among 115 subjects with VKC, males comprised of 86 subjects (66.1%) and mean age of presentation was 10.9 (SD 4.9) years with mixed VKC in 56.5%. Keratoconus-like topography was present in 13 subjects (11.3%). The keratoconus predictiv index (sensitivity 92.3%, specificity 98.5%), the opposite sectoral index (sensitivity 84.6%; specificity 93.2%), the differential sectoral index (sensitivity 92.3%; specificity 90.8%) were found to be signficantly associated with VKC subjects having keratoconus-like topography. A high prevalence of keratoconus-like topography was observed in patients with VKC. Copyright © 2015 Elsevier Ltd. All rights reserved.

  9. In vivo confocal microscopy of meibomian glands and palpebral conjunctiva in vernal keratoconjunctivitis.

    Science.gov (United States)

    Wei, Qiaoling; Le, Qihua; Hong, Jiaxu; Xiang, Jun; Wei, Anji; Xu, Jianjiang

    2015-04-01

    To investigate the correlations between conjunctival inflammatory status and meibomian gland (MG) morphology in vernal keratoconjunctivitis (VKC) patients by using in vivo confocal microscopy (CM). Nineteen VKC patients (7 limbal, 7 tarsal, and 5 mixed forms) and 16 normal volunteers (controls) were enrolled. All subjects underwent CM scanning to obtain the images of upper palpebral conjunctiva and MGs. Inflammatory cell (IC) density in palpebral conjunctival epithelial and stromal layers, Langerhans cell (LC) density at lid margins and the stroma adjacent to the MG, and MG acinar unit density (MGAUD) were recorded. The longest and shortest diameters of MG acinar were measured. The Kruskal-Wallis test was used to compare the parameter differences whereas the Spearman's rank correlation analysis was applied to determine their correlations. Among all groups, no significant statistical differences were found in epithelial and stromal IC densities, mean values of MG acinar unit densities, or longest and shortest diameters. Both LC parameters in the tarsal-mixed groups were significantly higher than those in the limbal and control groups. All LC densities of VKC patients showed a positive correlation with MGAUD and shortest diameter. In VKC patients, the conjunctival inflammatory status could be associated with the MG status. In vivo CM is a noninvasive, efficient tool in the assessment of MG status and ocular surface.

  10. Is there is an association between the presence of Staphylococcus species and occurrence of vernal keratoconjunctivitis?

    Science.gov (United States)

    Al-Hakami, Ahmed M; Al-Amri, Abdulrahaman; Abdulrahim, Ihab; Hamid, Mohamed E

    2015-01-01

    The aim of this study was to identify the association of normal bacterial flora with vernal keratoconjunctivitis (VKC) occurrence in VKC and non-VKC groups. Conjunctival specimens were collected from 18 VKC patients and 22 healthy controls, cultured and identified following standard methods. The association between the presence of bacteria and occurrence of VKC was analyzed using Chi square statistic. Comparable bacterial growth was observed in VKC (77.8%) as well as control group (77.2%) (p = 0.970). Analysis of individual bacterial revealed that Staphylococcus aureus was detected more frequently in VKC (27.78% vs. 4.55% in control, p = 0.041) and Staphylococcus epidermidis was found much more commonly in the control eyes (45.45% in control vs. 5.56% in VKC, p = 0.005). An aggravating role of S. aureus colonization in the occurrence of VKC, and a possible role of S. epidermidis against the occurrence of VKC were concluded.

  11. Effect of lodoxamide and disodium cromoglycate on tear eosinophil cationic protein in vernal keratoconjunctivitis

    Science.gov (United States)

    Leonardi, A.; Borghesan, F.; Avarello, A.; Plebani, M.; Secchi, A.

    1997-01-01

    AIM—To validate the use of tear eosinophil cationic protein (ECP) as a marker for eosinophil activation, and its pharmacological modulation, in addition to evaluating the efficacy of lodoxamide and sodium cromoglycate in the treatment of vernal keratoconjunctivitis (VKC).
METHODS—Tears were collected from 30 patients affected by active mild to moderate VKC before and after therapy with disodium cromoglycate 4% (DSCG) (n=15) or lodoxamide 0.1% (n=15) for 10 days. Tear cytology and ECP measurement were performed, and ocular signs and symptoms evaluated.
RESULTS—While statistically significant changes did not occur after DSCG therapy, mean tear ECP increased from 343 (SD 363) µg/l to 571 (777) µg/l due to marked elevation in six eyes. The clinical score in DSCG eyes did not improve. After lodoxamide therapy, both clinical signs and symptoms, and tear ECP levels (560 (756) µg/l to 241 (376) µg/l) decreased significantly (p<0.0001 and p<0.01, respectively). Compared with DSCG treatment, lodoxamide was more effective in reducing signs and symptoms (p<0.005). ECP levels were significantly correlated with signs, symptoms, corneal involvement, and number of eosinophils in tears (p<0.0001).
CONCLUSIONS—In patients with VKC, lodoxamide significantly reduced ECP tear levels, and thus, eosinophil activation, and was more effective than DSCG in reducing clinical signs and symptoms.

 PMID:9135403

  12. Serum levels of IL-17 in patients with vernal keratoconjunctivitis: a preliminary report.

    Science.gov (United States)

    Zicari, A M; Nebbioso, M; Zicari, A; Mari, E; Celani, C; Occasi, F; Tubili, F; Duse, M

    2013-05-01

    Vernal Keratoconjunctivitis (VKC) is a chronic and often severe form of bilateral tarsal and/or bulbar conjunctivitis. The purpose of the present study is to measure the Interleukin-17 (IL-17) serum levels in children with VKC evaluating the role of the systemic inflammation in patients affected by VKC. Fifteen patients were enrolled with VKC aged between 6 and 10 years of life. Serum were obtained from the peripheral blood samples collected from all the children included in the study to evaluate serum level of IL-17. Serum levels of IL-17 were significantly higher in patients with VKC than in healthy controls (10.3 ± 9.36 pg/ml vs. 3.3 ± 6.20 pg/ml respectively; p < 0.04). The presence of a significantly higher level of IL-17 in patients with VKC suggests a possible role of this cytokine in the pathogenesis of VKC. Further studies on larger samples of patients are warranted to confirm These findings in order to identify new possible therapeutic targets.

  13. Surgical resection and amniotic membrane transplantation for treatment of refractory giant papillae in vernal keratoconjunctivitis.

    Science.gov (United States)

    Guo, Ping; Kheirkhah, Ahmad; Zhou, Wei-wei; Qin, Lei; Shen, Xiao-li

    2013-06-01

    The aim of this study was to evaluate the outcome of surgical resection and amniotic membrane transplantation (AMT) for treatment of refractory symptomatic giant papillae in vernal keratoconjunctivitis (VKC). This is a retrospective study of 13 eyes of 9 patients with refractory giant papillae associated with corneal shield ulcer and/or punctate epithelial erosions who underwent surgical resection of the papillae combined with AMT to cover the tarsal conjunctival defect. During 14.2 ± 4.2 months of postoperative follow-up, smooth tarsal conjunctival surface was achieved in all cases, with no recurrence of the giant papillae in any eye. Corneal shield ulcers and punctate epithelial erosions healed within 2 weeks after surgery and did not recur during the follow-up. Best-corrected visual acuity improved from 0.26 ± 0.21 logarithm of the minimum angle of resolution preoperatively to 0.02 ± 0.04 logarithm of the minimum angle of resolution postoperatively (P = 0.01). Three patients experienced recurrence of VKC symptoms, but without giant papillae, which could be well controlled by topical medications. Surgical resection combined with AMT is an effective procedure for treatment of refractory giant papillae in patients with VKC.

  14. Demographic and clinical profile of vernal keratoconjunctivitis at a tertiary eye care center in India.

    Science.gov (United States)

    Saboo, Ujwala S; Jain, Manish; Reddy, Jagadesh C; Sangwan, Virender S

    2013-09-01

    To study the demographic and clinical profile of patients with vernal keratoconjunctivitis (VKC) at a tertiary eye care center in India. Retrospective chart analysis of 468 patients of VKC seen from January 2006 to December 2006. Mean age at presentation was 12 years. Majority of the patients had mixed pattern disease (72%). Chronic perennial disease was seen in 36% patients. Personal or family history of allergies was noted in 5% patients. Severe disease based on clinical grading was present in 37% patients. Moderate to severe vision loss was seen in 12% of total population. Persistent disease beyond 20 years of age was found in 12% patients. VKC-related complications such as corneal scarring (11%), shield ulcer (3%), keratoconus (6%), and limbal stem cell deficiency (1.2%) were seen. Treatment-related complications like corticosteroid-induced cataract and glaucoma were seen in 6% and 4% of patients, respectively. Clinical pattern of VKC seen in the tropical climate of India is essentially similar to that seen in other tropical countries. Few distinct features that we noted represent chronic perennial disease, low association with atopy, and higher propensity for disease and treatment-related complications.

  15. Cytological and immunohistochemical study of the limbal form of vernal keratoconjunctivitis by the replica technique.

    Science.gov (United States)

    el Asrar, A M; Geboes, K; Missotten, L; Emarah, M H; Maudgal, P C; Desmet, V

    1987-01-01

    The cellular composition of the inflammatory infiltrate present in 13 patients with the limbal form of vernal keratoconjunctivitis was examined in the conjunctival scrapings and the limbic replicas by means of Giemsa stain and immunohistochemistry. Conjunctival scrapings showed the presence of mast cells, lymphocytes, plasma cells, polymorphonuclear leucocytes, and very few basophils in all the specimens. Eosinophils were present in only four scrapings. The superficial epithelium of the limbic lesion and the adjacent cornea and conjunctiva was studied by the replica technique. The limbic lesion area showed the presence of necrotic epithelial cells mixed with inflammatory cells, including eosinophils, mast cells, lymphocytes, plasma cells, and polymorphonuclear leucocytes and very few basophils. Most of the inflammatory cells were HLA-DR+. Many OKT6+ cells were present, indicating the presence of Langerhans cells. T-lymphocytes including a few helper/inducer cells and many suppressor/cytotoxic cells, were detected in the infiltrate. In addition many B-lymphocytes were observed. These findings suggest that other immune mechanisms in addition to type 1 reaction are involved in the pathogenesis of the disease. Images PMID:3318919

  16. Ongoing dengue epidemic - Angola, June 2013.

    Science.gov (United States)

    2013-06-21

    On April 1, 2013, the Public Health Directorate of Angola announced that six cases of dengue had been reported to the Ministry of Health of Angola (MHA). As of May 31, a total of 517 suspected dengue cases had been reported and tested for dengue with a rapid diagnostic test (RDT). A total of 313 (60.5%) specimens tested positive for dengue, including one from a patient who died. All suspected cases were reported from Luanda Province, except for two from Malanje Province. Confirmatory diagnostic testing of 49 specimens (43 RDT-positive and six RDT-negative) at the CDC Dengue Branch confirmed dengue virus (DENV) infection in 100% of the RDT-positive specimens and 50% of the RDT-negative specimens. Only DENV-1 was detected by molecular diagnostic testing. Phylogenetic analysis indicated this virus has been circulating in the region since at least 1968, strongly suggesting that dengue is endemic in Angola. Health-care professionals throughout Angola should be aware of the ongoing epidemic, the recommended practices for clinical management of dengue patients, and the need to report cases to MHA. Persons in Angola should seek medical care for acute febrile illness to reduce the risk for developing complications. Laboratory-confirmed dengue also has been reported from seven countries on four continents among persons who had recently traveled to Luanda, including 79 persons from Portugal. Angola is the third of four African countries to report a dengue outbreak in 2013. Persons returning from Africa with acute febrile illness should seek medical care, including testing for DENV infection, and suspected cases should be reported to public health authorities.

  17. Hepatitis E epidemics in India

    Indian Academy of Sciences (India)

    We compiled this slide in 1992. It shows dates, locations and number of cases for various epidemics reported from different parts of India till that time. The first well recorded epidemic was in 1955-56 here in Delhi with nearly 30000 cases. Large outbreaks occurred in 1978 in Kashmir. My interest in this disease began in ...

  18. Ocular effects of long term use of topical steroids among children and adolescents with vernal keratoconjunctivitis: a prospective observational study.

    Science.gov (United States)

    Mandal, Radhakrishna; Maiti, Prasenjit; Sasmal, Nirmal Kumar; Sinha, Nirmalya; Gupta, Aninda; Das, Kali Sankar; Biswas, Mukul Chandra

    2011-10-01

    Topical steroids were often irrationally used on long term basis for quick relief from ocular discomfort of inflammatory eye conditions like vernal keratoconjunctivitis in spite of their well known deleterious ocular effects. The present study was undertaken to determine the ocular effects of long term use of topical steroids among the patients with vernal keratoconjunctivitis and also to evaluate the ocular responses after withdrawal of steroids. The prospective observational study was carried out in a tertiary eye care centre of West Bengal. A total 150 referred patients of vernal keratoconjunctivitis, those used topical steroids for more than a month were included in the study. A complete set of ophthalmic examinations including measurement of intra-ocular pressure and visual acuity was carried out during registration. After withdrawal of steroids, the patients were followed-up periodically and finally evaluated after 8 weeks for any Improvement of Intra-ocular pressure and best corrected visual acuity. The data was analysed by SPSS 12.0.1 software package. Proportions were used for Interpretation. Paired t-test was used for comparison between two proportions (before and after withdrawal of steroids) and p-value <0.05 was considered as the level of significance. Though ropy mucus discharge with minimal conjunctival involvement was found the most common (74.7%) ocular manifestation, grave consequences like glaucoma was also evident among 8.7% of the study participants. Significant improvements (p<0.05) were observed for both reduction of intra-ocular pressure and visual acuity after 8 weeks of withdrawal of topical steroids. Topical steroids should be used cautiously with periodic ophthalmic examinations including intra-ocular pressure.

  19. Epidemics after Natural Disasters

    Science.gov (United States)

    Gayer, Michelle; Connolly, Maire A.

    2007-01-01

    The relationship between natural disasters and communicable diseases is frequently misconstrued. The risk for outbreaks is often presumed to be very high in the chaos that follows natural disasters, a fear likely derived from a perceived association between dead bodies and epidemics. However, the risk factors for outbreaks after disasters are associated primarily with population displacement. The availability of safe water and sanitation facilities, the degree of crowding, the underlying health status of the population, and the availability of healthcare services all interact within the context of the local disease ecology to influence the risk for communicable diseases and death in the affected population. We outline the risk factors for outbreaks after a disaster, review the communicable diseases likely to be important, and establish priorities to address communicable diseases in disaster settings. PMID:17370508

  20. A clinical study to assess the efficacy of Triyushnadi Anjana in Kaphaja Abhishyanda with special reference to vernal keratoconjunctivitis.

    Science.gov (United States)

    Dhiman, K S; Sharma, Gunjana; Singh, Shailender

    2010-10-01

    Vernal keratoconjunctivitis / spring catarrh is a variety of exogenous allergic conjunctivitis, which is a very troublesome ocular disease of childhood and in the adolescent age group. The child suffers from intense itching, grittiness, discharge, redness, lacrimation, photophobia, and so on, thereby, decreasing his learning hours. The troublesome features are aggravated in the spring season / hot climate that lasts for years together and rarely persists after adolescence. Mast cell stabilizers, topical Nonsteroidal anti-inflammatory drugs (NSAIDs), and steroids are the available treatment options that too with symptomatic relief and potential side effects, which limits the long-term use of these medicines. The clinical picture of vernal keratoconjunctivitis / spring catarrh is very similar to Kaphaja Abhishyanda, and Triyushnadi Anjana Bhaishajya Ratnavali (B.R.), and its treatment was clinically tried on the patients attending the Netra Roga OPD of the R.G. Government P.G. Ayurveda College Hospital at Paprola (H.P.). A proper protocol and performa was adopted with strict inclusion and exclusion criteria. In the first phase, a pilot study was conducted on 38 clinically diagnosed patients with vernal keratoconjunctivitis, and it gave 100% relief in photophobia, foreign body (FB) sensation, and lacrimation, with marked relief in other features. Encouraged by this pilot work, Triyushnadi Anjana (TA) and 2% sodium cromoglycate (mast cell stabilizer) eye drops in the second-phase clinical trial on 32 patients were tried clinically to evaluate the comparative efficacy. In the second clinical trial, the patients were randomly divided into two groups and Group I was given sodium cromoglycate 2% eye drops and Group II was given TA. The outcome of this study verified the results of the first phase pilot study, and on comparison of the results of the two groups in the second clinical study it was observed that the TA-treated group showed better results. Transient irritation

  1. Treatment of superior limbic keratoconjunctivitis with a large-diameter contact lens and Botulium Toxin A.

    Science.gov (United States)

    Chun, Yeoun Sook; Kim, Jae Chan

    2009-08-01

    To evaluate the effect of a large-diameter (16-20 mm) hydrogel contact lens (CL) or an injection of Botulinum Toxin A to Riolan muscle for the treatment of superior limbic keratoconjunctivitis (SLK). Eight eyes from 8 patients were fitted with large-diameter CL for 7 days. The clinical improvement and changes of fluorescein and rose bengal staining were examined on the day of diagnosis and 3, 7, 14, and 30 days after the CL was fitted. Three eyes showing symptoms of recurrence of SLK within 1 month after removal of the CL and 2 eyes with complications related to CL were treated with an injection of Botulinum Toxin A to pretarsal orbicularis muscle, Riolan. The changes of symptoms and vital stains were also evaluated on day 7 and 1, 2, 3, and 6 months after the injection. The mean age was 48 +/- 13.5 years, and the group consisted of 6 females and 2 males. Dry eye syndrome and horizontal conjunctival corrugation were found in all 8 patients, superior conjunctivochalasis in 5 patients, and floppy eyelid syndrome in 2 patients. Complete resolution after more than 1 month with CL only was seen in 3 eyes (37.5%). Clinical symptoms improved in 4.62 days and vital staining in 10.75 days after fitting of the CL. Superficial punctuate keratopathy related to CL occurred in 3 eyes (37.5%). Five eyes (62.5%) that were treated with botulinum showed distinct improvement within 7 days after the injection, and the effect was maintained for 2-7 months. The fitting of large-diameter CL can be considered for the treatment of acute severe symptoms of SLK for a short time. An injection of Botulinum toxin to the Riolan muscle can effectively and rapidly resolve the symptoms associated with SLK, and its effect of maintenance was a mean of 4 months.

  2. Efficacy and safety of low-dose topical tacrolimus in vernal keratoconjunctivitis.

    Science.gov (United States)

    Shoughy, Samir S; Jaroudi, Mahmoud O; Tabbara, Khalid F

    2016-01-01

    The objective of this study was to evaluate the efficacy and safety of topical low-dose tacrolimus (0.01%) solution in patients with vernal keratoconjunctivitis (VKC). A total of 62 consecutive patients with VKC refractory to conventional treatment were included retrospectively. Tacrolimus 0.01% ophthalmic solution was administered to patients twice daily after discontinuation of all previous topical medications. The duration of treatment ranged from 1 month to 29 months. The clinical symptoms of itching, redness, foreign body sensation, and discharge and the clinical signs of conjunctival hyperemia, conjunctival papillary hypertrophy, limbal infiltration, Trantas dots, and superficial punctate keratopathy were graded as 0 (normal), 1+ (mild), 2+ (moderate), or 3+ (severe). Assessment was carried out before initiation of therapy and on the last visit after treatment. There were 62 patients with VKC comprising 49 male and 13 female patients. The median age was 12 years (range: 5-47 years). The mean visual acuity improved from 20/30 to 20/25 following treatment. There was statistically significant improvement in symptoms of itching (P<0.001), redness (P<0.001), foreign body sensation (P<0.001), and discharge (P<0.001). Statistically significant improvement was also observed in clinical signs of conjunctival hyperemia (P<0.001), limbal infiltration (P<0.001), Trantas dots (P<0.001), superficial punctate keratopathy (P<0.001), and conjunctival papillary hypertrophy (P<0.001). The solution form of tacrolimus was well tolerated. None of the patients developed elevation of intraocular pressure, cataract, or infectious keratitis. Low-dose topical tacrolimus 0.01% solution is effective and safe in the management of patients with refractory VKC.

  3. Evaluation of keratoconus by videokeratography in subjects with vernal keratoconjunctivitis (VKC

    Directory of Open Access Journals (Sweden)

    MR Shoja

    2006-07-01

    Full Text Available BACKGROUND: To assess demographic variables and the incidence of keratoconus in patients with VKC and to evaluate the characteristics of Vernal Keratoconjunctivitis (VKC associated with keratoconus. METHODS: One hundred and fifty patients with VKC were studied at Ophthalmology Department of Shaheed Sadoughi medical center between October 2004 and June 2005. Both eyes of VKC patients were evaluated by Orbscan topography for the diagnosis of keratoconus. Corneal topography maps were examined with modified Robinowitz-McDonnell test. The characteristics of VKC were recorded in keratoconus patients. RESULTS: The study included 93 male and 57 female subjects. The patients mean age was 13.07 ± 4.71 (range 8-24 years. The clinical forms of VKC were as follows: 45.2% mixed, 38% palpebral and 16.7% limbal types. Fifty four (36% of 150 subjects with VKC had complications of pseudogerontoxon, punctate keratitis and shield ulcer. Eighty-four eyes (42 subjects of 150 patients with VKC were detected as having keratoconus by videokeratography maps (28%. There were 27 males and 15 females in keratoconus group. 16.7% of the eyes had mild, 33.3% had moderate and 50% had severe keratoconus. Eyes with severe keratoconus presented at younger age (12.7 ± 3.35 years than moderate keratoconus (18.3 ± 2.15 years. Keratoconus was more common in male gender, long-standing disease, mixed and palpebral VKC. CONCLUSION: Screening of keratoconus subjects with corneal topography allows early detection and management of keratoconus. The higher incidence of keratoconus in our study is due to videokeratography study of early keratoconus. KEYWORDS: VKC, videokeratography, keratoconus.

  4. Alpha-1 antitrypsin, a diagnostic and prognostic marker of vernal keratoconjunctivitis.

    Science.gov (United States)

    Ahsan, Akif; Salman, Khushtar A; Alam, Sana; Siddiqui, Anwar H; Naeem, Syed Shariq; Ahmad, Aquil; Khan, Iqbal M

    2014-05-01

    A major chunk of ocular allergies in humans involve the conjunctiva, of which Vernal Keratoconjunctivitis (VKC) appears to be more common. VKC, a chronic allergic conjunctivitis, frequently affects young males and is characterized by intense inflammation of the limbal and/or tarsal conjunctiva. The etiology and immuno-pathogenesis of VKC still remain unclear. Alpha-1 antitrypsin (AAT), a member of serine proteinase inhibitor (SERPIN) superfamily, is an acute phase protein whose concentration in blood increases in response to inflammation. AAT deficiency is one of the many factors that may be involved in several abnormalities such as liver disease, emphysema, inflammatory joint diseases and inflammatory eye diseases. In the present study, the role played by this protein in VKC was analyzed in a selective case/control study to assess its diagnostic and prognostic value. The case control study included 50 patients of VKC reporting to Ophthalmology out patient department (OPD). Age and sex matched 40 healthy subjects served as control. Serum AAT level of both the cases and controls were evaluated and compared. Moreover the serum AAT levels of the patients at presentation were compared with their serum AAT level after three weeks post treatment. Levels of AAT in the serum of VKC patients at presentation (2.80 ± 0.42 mg/ml) were significantly higher as compared to controls (2.31 ± 0.21 mg/ml) whereas no significant difference was observed between the serum level of post treatment VKC patients (2.48 ± 0.26 mg/ml) and controls. AAT is a potent acute phase protein whose concentration rises significantly in VKC, irrespective of the age and sex of the patient. Moreover, the serum level of AAT declined significantly post treatment; therefore it might be used as a prognostic marker.

  5. Corneal backward scattering and higher-order aberrations in children with vernal keratoconjunctivitis and normal topography.

    Science.gov (United States)

    Chan, Tommy C Y; Wong, Emily S; Chan, Jason C K; Wang, Yumeng; Yu, Marco; Maeda, Naoyuki; Jhanji, Vishal

    2017-11-01

    To investigate the corneal backward scattering and higher-order aberrations (HOAs) in children with vernal keratoconjunctivitis (VKC) and normal topography. Thirty-six eyes of 22 patients with VKC and 54 eyes of 34 normal subjects were included. All participants had clear cornea, absence of dry eyes and a normal corneal tomography. Scheimpflug imaging was used to measure corneal backward scattering in zones centred on the corneal apex (central 2-mm zone and paracentral 2- to 6-mm zone), and HOAs were compared between VKC and normal control. The mean age of participants was 12.0 ± 4.1 years in VKC group and 11.2 ± 4.1 years in control group (p = 0.339). There was no significant intergroup difference in mean keratometry, astigmatism and apex pachymetry (p ≥ 0.076). Total corneal backscatter was higher in the VKC group compared to the control group (p ≤ 0.012). Anterior and posterior cornea displayed a higher level of backward scattering in the VKC group (p < 0.001 for anterior; p ≤ 0.048 for posterior). Patients with VKC exhibited higher total HOAs and coma (p ≤ 0.036). There were significant correlations between total anterior HOAs and backward scattering measured at the central (r = 0.500; p = 0.032) and paracentral zones (r = 0.470; p = 0.024) for VKC. The current study showed optical quality changes in patients with clear corneas and quiescent VKC. An increase in corneal backward scattering and HOAs was noted in patients with VKC as compared to normal patients. © 2017 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  6. Deep Anterior Lamellar Keratoplasty in Keratoconic Patients with versus without Vernal Keratoconjunctivitis.

    Science.gov (United States)

    Feizi, Sepehr; Javadi, Mohammad Ali; Javadi, Fatemeh; Jafarinasab, Mohammad Reza

    2015-01-01

    To compare the clinical outcomes of deep anterior lamellar keratoplasty (DALK) for keratoconus in patients with vernal keratoconjunctivitis (VKC) versus those without VKC. In this retrospective comparative study, records of 262 eyes with keratoconus (Group 1) and 28 keratoconic eyes with VKC (Group 2) that had undergone DALK were compiled. Reviewed parameters included length of follow-up, best-corrected visual acuity (BCVA), refractive error, complications and cumulative graft survival. Mean duration of follow-up was 38.6 ± 20.2 and 34.4 ± 20.9 months in groups 1 and 2, respectively (P = 0.21). Mean post-operative BCVA was 0.19 ± 0.11 and 0.20 ± 0.15 logMAR, in groups 1 and 2 (P = 0.79). BCVA≥20/40 was achieved in 91.6 and 88.5% of eyes in groups 1 and 2, respectively (P = 0.48). Epithelial problems were encountered in 31.3 and 42.9% of operated eyes, respectively (P = 0.16). Vascularization of suture tracts and stitch abscesses were encountered more frequently in the eyes with VKC (P = 0.01 and <0.001, respectively). At the 33-month follow-up examination, rejection-free graft survival rates were 56.0% in group 1 and 33.3% in group 2, with mean durations of 41.0 and 32.1 months, respectively (P = 0.15). Graft survival rates were 98.1% in group 1 and 95.0% in group 2, with mean durations of 88.6 and 88.4 months, respectively (P = 0.74). Clinical outcomes of DALK in keratoconic eyes with VKC were comparable to those in eyes with keratoconus alone. However, complications such as suture tract vascularization and stitch abscesses were more common when VKC coexisted, necessitating closer monitoring.

  7. Identification of human tear fluid biomarkers in vernal keratoconjunctivitis using iTRAQ quantitative proteomics.

    Science.gov (United States)

    Leonardi, A; Palmigiano, A; Mazzola, E A; Messina, A; Milazzo, E M S; Bortolotti, M; Garozzo, D

    2014-02-01

    Understanding and treating vernal keratoconjunctivitis (VKC) has been a challenge because the pathogenesis is unclear and antiallergic therapy often unsuccessful. The aim of the study was to analyze peptide profiles in human tears using mass spectrometry to elucidate compositional differences between healthy subjects and patients affected by VKC. Tears were collected from healthy subjects and VKC patients. Digested samples were treated with iTRAQ (isobaric tag for relative and absolute quantitation). Separation of tryptic peptides was realized using a MicroHPLC interfaced with a microfraction collector. MS and MS/MS mass spectra were performed using a MALDI TOF/TOF 4800 Applied Biosystem spectrometer. Protein Pilot™ software with Paragon™ algorithm v4.1.46 or GPS™ with Mascot engine was used as search engines with SwissProt or IPI human as the databases. A significant number of peptides were examined, and 78 proteins were successfully identified. In all VKC samples, levels of serum albumin, transferrin, and hemopexin were found up to 100 times higher than control tear levels and correlated to the severity of disease. Hemopexin, transferrin, mammaglobin B, and secretoglobin 1D were found significantly over-expressed in VKC samples compared with the control samples. Tear samples from patients treated with topical cyclosporine or corticosteroids showed a dramatic reduction in these protein levels. LC MALDI MS and isobaric tag for relative and absolute quantitation technique may be useful in the quantitative and qualitative characterization of the peptidoma of human tears. These techniques may identify target proteins to be used in the diagnosis and management of VKC and other inflammatory ocular surface conditions. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  8. Efficacy and safety of topical cyclosporine A 0.05% in vernal keratoconjunctivitis.

    Science.gov (United States)

    Yücel, Ozlem Eski; Ulus, Nihal Demir

    2016-09-01

    While corticosteroids are an effective choice of treatment for severe vernal keratoconjunctivitis (VKC), their long-term use is restricted due to side effects. This study was conducted to evaluate the efficacy and safety of topical cyclosporine A (CsA) 0.05% in the treatment of VKC. A total of 30 patients with VKC that was resistant to topical corticosteroids, antihistamines and mast cell stabilisers were treated with topical CsA 0.05%. Patients were evaluated at Weeks 4, 8 and 12 after the initiation of therapy. Symptoms and signs observed before and after treatment were recorded and scores were assigned. Scores for symptoms and signs, the need for topical corticosteroids and ocular side effects were evaluated. At baseline, the median values of the symptom and sign scores were 10.0 (range 5.0-18.0) and 6.0 (range 2.0-13.0), respectively. At Week 4 of treatment with topical CsA 0.05%, the median values of the symptom and sign scores were 3.0 (range 0-14.0) and 3.0 (range 0-8.0), respectively. The reductions in the symptom and sign scores were statistically significant. The reduction in the need for corticosteroid was statistically significant by Week 12 of therapy. No significant side effects were reported. Topical CsA 0.05%, which can help to reduce corticosteroid usage, is an effective and safe alternative for the treatment of resistant VKC. Further studies are needed to determine the optimal duration of therapy and possibility of recurrence.

  9. Microarray-based IgE detection in tears of patients with vernal keratoconjunctivitis.

    Science.gov (United States)

    Leonardi, Andrea; Borghesan, Franco; Faggian, Diego; Plebani, Mario

    2015-11-01

    A specific allergen sensitization can be demonstrated in approximately half of the vernal keratoconjunctivitis (VKC) patients by conventional allergic tests. The measurement of specific IgE in tears using a multiplex allergen microarray may offer advantages to identify local sensitization to a specific allergen. In spring-summer 2011, serum and tears samples were collected from 10 active VKC patients (three females, seven males) and 10 age-matched normal subjects. Skin prick test, symptoms score and full ophthalmological examination were performed. Specific serum and tear IgE were assayed using ImmunoCAP ISAC, a microarray containing 103 components derived from 47 allergens. Normal subjects resulted negative for the presence of specific IgE both in serum and in tears. Of the 10 VKC patients, six resulted positive to specific IgE in serum and/or tears. In three of these six patients, specific IgE was found positive only in tears. Cross-reactivity between specific markers was found in three patients. Grass, tree, mites, animal but also food allergen-specific IgE were found in tears. Conjunctival provocation test performed out of season confirmed the specific local conjunctival reactivity. Multiple specific IgE measurements with single protein allergens using a microarray technique in tear samples are a useful, simple and non-invasive diagnostic tool. ImmunoCAP ISAC detects allergen sensitization at component level and adds important information by defining both cross- and co-sensitization to a large variety of allergen molecules. The presence of specific IgE only in tears of VKC patients reinforces the concept of possible local sensitization. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  10. Tear cytokine levels in vernal keratoconjunctivitis: the effect of topical 0.05% cyclosporine a therapy.

    Science.gov (United States)

    Oray, Merih; Toker, Ebru

    2013-08-01

    The aims of this study were to evaluate the efficacy of topical 0.05% cyclosporine A on clinical signs and symptoms of vernal keratoconjunctivitis (VKC) and to examine its effect on tear cytokine levels. Twenty-one patients with active VKC and 15 healthy volunteers were included. Patients were treated with topical 0.05% cyclosporine A. Symptoms and signs were scored on the day of enrollment and at the end of month 1 and month 3. Tear and serum samples were collected before and on the third month of treatment. Interleukin (IL)-2, soluble IL-2 receptor (sIL-2R), IL-3, IL-4, IL-5, IL-6, IL-9, IL-13, IL-17, eotaxin, tumor necrosis factor alpha (TNF-α), and interferon gamma (IFN-γ) in cell-free tear and serum supernatants were measured by multiplex bead analysis. At the end of month 1 and month 3 with topical 0.05% cyclosporine A treatment, statistically a significant decrease was observed in sign and symptom scores of the patients (P < 0.0001). Tear IL-2, sIL-2R, IL-9, IL-17, IFN-γ, and eotaxin levels in VKC patients were significantly higher than those in controls (P < 0.05). IL-3, IL-4, IL-5, and TNFα levels tended to be higher in VKC patients. There was also statistically significant reduction from before 0.05% cyclosporine A treatment to after treatment in tear levels of IL-4, IL-5, IL-17A, TNFα, IFN-γ, and eotaxin (P < 0.05). IL-2 and sIL-2R levels tended to be lower than pretreatment levels. Topical 0.05% cyclosporine A is effective in alleviating signs and symptoms of VKC patients and shows its effect probably by decreasing the local production of some inflammatory mediators in tears.

  11. Systematic review and meta‐analysis of randomised clinical trials on topical treatments for vernal keratoconjunctivitis

    Science.gov (United States)

    Mantelli, F; Santos, M S; Petitti, T; Sgrulletta, R; Cortes, M; Lambiase, A; Bonini, S

    2007-01-01

    Aims The aim of this study was to assess the efficacy of currently available topical drugs for vernal keratoconjunctivitis (VKC) through a meta‐analysis of randomised clinical trials (RCTs). Methods Twenty‐seven RCTs (n = 2184 eyes) that had evaluated the efficacy of topical drugs for the treatment of VKC were selected according to the set criteria; 10 of these trials were suitable for statistical analysis and were enrolled in the meta‐analysis. Articles published up to December 2005 were identified from the following data sources: Medline, Embase, Lilacs, the Cochrane Controlled Trials Register, and references from relevant articles. Articles in any language published with an English abstract, were screened, and those selected for inclusion were written in English, French, German, Italian, Portuguese or Spanish. The quality of the trials was assessed by the Delphi list. Statistical analysis was performed using STATA® software. Results A significant improvement in all signs and symptoms, except photophobia, was observed after topical treatment for active VKC, independent of the type of treatment. Comparison of the efficacy of different drugs was not possible due to a lack of standardised criteria among studies. Conclusion The currently available topical drugs are effective in treating acute phases of VKC. However, there is a lack of evidence to support the recommendation of one specific type of medication for treating this disorder. There is a need for standard criteria to assess diagnosis and therapy based on severity. There is also a need for RCTs assessing long‐term effects of single drugs to control the disease and to prevent complications. PMID:17588996

  12. Steroid-induced ocular hypertension in Asian children with severe vernal keratoconjunctivitis.

    Science.gov (United States)

    Ang, Marcus; Ti, Seng-Ei; Loh, Raymond; Farzavandi, Sonal; Zhang, Rongli; Tan, Donald; Chan, Cordelia

    2012-01-01

    We describe clinical characteristics and risk factors for corticosteroid response in children with severe vernal keratoconjunctivitis (VKC). Retrospective, noncontrolled, comparative case series. Patients from three tertiary centers in Singapore. We reviewed patients with severe VKC (clinical grade > 2) who were on topical steroid therapy, with a minimum follow-up period of 1 year post-presentation. Logistic regression was used to determine risk factors for corticosteroid response. Corticosteroid response was defined as intraocular pressure (IOP) >21 mmHg (three consecutive readings), or a rise of more than 16 mmHg from baseline, after commencement of steroid therapy in the absence of other possible causes of raised IOP. Forty-one of 145 (28.3%) patients developed a corticosteroid response, of which eight (5.5%) progressed to glaucoma. The overall mean age of onset of VKC was 9.9 ± 4.4 years. Longer duration of corticosteroid use (OR, 5.06; 95% CI: 1.04-25.56; P = 0.45) and topical dexamethasone 0.01% (OR, 2.25; 95% CI: 1.99-5.08; P = 0.40) were associated with corticosteroid response. Mixed type of VKC (OR, 9.76; 95% CI: 3.55-26.77; P < 0.001), the presence of limbal neovascularization of ≥ three quadrants (OR, 6.33; 95% CI: 2.36-16.97; P < 0.001), and corneal involvement (OR, 3.51; 95% CI: 1.31-9.41; P = 0.012) were significant clinical risk factors after adjusting for potential confounders such as age, sex, ethnicity, duration, and type of corticosteroid used. Children on long-term oral corticosteroids with severe, mixed-type VKC and corneal involvement are more likely to develop corticosteroid response, and may require early treatment to prevent progression to glaucoma.

  13. Management, clinical outcomes, and complications of shield ulcers in vernal keratoconjunctivitis.

    Science.gov (United States)

    Reddy, Jagadesh C; Basu, Sayan; Saboo, Ujwala S; Murthy, Somasheila I; Vaddavalli, Pravin K; Sangwan, Virender S

    2013-03-01

    To assess the clinical outcomes and complications of shield ulcers by various treatment methods. Retrospective, interventional case series. setting: Cornea and anterior segment service of L.V. Prasad Eye Institute, India. study population: One hundred ninety-three eyes of 163 patients clinically diagnosed with vernal keratoconjunctivitis and shield ulcers. intervention: The treatment algorithm was based on the Cameron clinical grading of shield ulcers. Grade 1 ulcers received medical therapy alone. Grade 2 and grade 3 ulcers received either medical therapy alone or medical therapy combined with debridement, amniotic membrane transplantation (AMT), or both. main outcome measures: Re-epithelialization time and best-corrected visual acuity. Grade 1 ulcers were seen in 71 (37%) eyes, grade 2 ulcers were seen in 79 (41%) eyes, and grade 3 ulcers were seen in 43 (22%) eyes. In the grade 1 group, re-epithelialization was seen in 67 (94%) eyes. In the grade 2 group, re-epithelialization was seen in 36 (88%) eyes that received medical treatment, in 20 (95%) eyes that underwent debridement, and in 17 (100%) eyes that underwent AMT. In the grade 3 group, re-epithelialization was seen in only 1 (1.7%) eye that received medical treatment, whereas it was seen in all eyes that underwent debridement and AMT. The mean best-corrected visual acuity after re-epithelialization of the shield ulcer was 20/30, 20/30, and 20/40 in the grade 1, grade 2, and grade 3 groups, respectively. Recurrence and secondary bacterial keratitis were seen in 28 (14.5%) and 20 (10%) eyes, respectively. Grade 1 shield ulcers respond well to medical therapy alone, whereas grade 2 ulcers occasionally may require additional debridement or AMT. Grade 3 ulcers, however, largely are refractory to medical therapy and require debridement and AMT for rapid re-epithelialization. Copyright © 2013 Elsevier Inc. All rights reserved.

  14. Use of cyclosporine A and tacrolimus in treatment of vernal keratoconjunctivitis.

    Science.gov (United States)

    Vichyanond, Pakit; Kosrirukvongs, Panida

    2013-06-01

    Vernal keratoconjunctivitis is a sight-threatening inflammatory disease of conjunctiva and cornea. It is frequently observed in young children with the onset usually occurring in the first decade of life. Mild cases of VKC tend to remit with nonspecific and supportive therapy. In contrast, severe cases are usually more protracted with remission/relapse occurring for a prolonged period of time. Although VKC is classified as an allergic eye condition, the role of allergens as an inciting factor is not clear. Pathogenesis of VKC involves roles for IgE, cytokines, chemokines, and inflammatory cells (T and B lymphocytes, mast cells, basophils, neutrophils, and eosinophils) with the release of their granular proteins, proliferation of fibroblasts, and laying down exuberant amounts of collagen fibers in the conjunctival tissue. In severe VKC cases-often of tarsal VKC-diagnostic giant papilla are classically observed on the upper tarsal plate, giving the classic 'cobble-stone' appearance. Corneal ulcer can occur from the effect of eosinophilic granular proteins on corneal epithelium and by physical trauma by intense eye rubbing. Topical corticosteroids, often required for controlling symptoms and signs in severe VKC, can lead to serious ocular complications. Immunomodulators that have been investigated for VKC treatment include topical ocular preparations of cyclosporine A and tacrolimus. Severe VKC responds promptly to topical cyclosporine A and tacrolimus, mostly within 1 month of therapy. Prolonged use of cyclosporine A and tacrolimus in VKC is safe and is tolerated by most patients without significant side effects. Recent investigations on the use of these two agents in VKC are the main purpose of this review. The use of cyclosporine A and tacrolimus are a major breakthrough in treatment for severe VKC, a debilitating allergic eye disease in children.

  15. Histamine H4 receptors in normal conjunctiva and in vernal keratoconjunctivitis.

    Science.gov (United States)

    Leonardi, A; Di Stefano, A; Vicari, C; Motterle, L; Brun, P

    2011-10-01

    While it is known that histamine is the primary mediator of ocular allergy, the presence and distribution of histamine receptors are not well documented in the human eye. Our aim was to evaluate histamine receptor expression in normal and vernal keratoconjunctivitis conjunctiva. Mucosal biopsies were obtained from conjunctiva of healthy donors and from tarsal conjunctiva of vernal patients. Immunostaining and semi-quantitative reverse-transcriptase polymerase chain reaction for H(1), H(2), H(3), and H(4) receptors were performed. Histamine receptor expression was also evaluated in conjunctival cell cultures exposed to histamine, interleukin-4, interleukin-5, interferon-γ and tumor necrosis factor-α. Immunostaining for H(1) and H(2) receptors was slightly positive in normal and over-expressed in vernal tissues. H(3) receptors were rarely present in normal and inflamed conjunctiva. In striking contrast to control tissues, H(4) receptors were highly expressed in all inflamed tissues, particularly by stromal inflammatory cells. Semi-quantitative reverse-transcriptase polymerase chain reaction demonstrated an over-expression of H(1), H(2), and H(4) receptors in vernal vs control tissues. Notably, H(4) receptors were five times more expressed in vernal vs control tissues. In cell cultures, H(2) receptor expression was stimulated eight times the normal levels by interleukin-4 and three times by histamine, but the H(4) receptor was only slightly affected by stimulation with these mediators. Increased expression of H1, and particularly of H(2) and H(4) receptors in vernal keratoconjunctival tissues indicate their important role in the pathogenesis of this disease. H(4) receptors may be a target in the treatment of allergic inflammation. © 2011 John Wiley & Sons A/S.

  16. Genome-wide association study of infectious bovine keratoconjunctivitis in Angus cattle.

    Science.gov (United States)

    Kizilkaya, Kadir; Tait, Richard G; Garrick, Dorian J; Fernando, Rohan L; Reecy, James M

    2013-03-26

    Infectious Bovine Keratoconjunctivitis (IBK) in beef cattle, commonly known as pinkeye, is a bacterial disease caused by Moraxellabovis. IBK is characterized by excessive tearing and ulceration of the cornea. Perforation of the cornea may also occur in severe cases. IBK is considered the most important ocular disease in cattle production, due to the decreased growth performance of infected individuals and its subsequent economic effects. IBK is an economically important, lowly heritable categorical disease trait. Mass selection of unaffected animals has not been successful at reducing disease incidence. Genome-wide studies can determine chromosomal regions associated with IBK susceptibility. The objective of the study was to detect single-nucleotide polymorphism (SNP) markers in linkage disequilibrium (LD) with genetic variants associated with IBK in American Angus cattle. The proportion of phenotypic variance explained by markers was 0.06 in the whole genome analysis of IBK incidence classified as two, three or nine categories. Whole-genome analysis using any categorisation of (two, three or nine) IBK scores showed that locations on chromosomes 2, 12, 13 and 21 were associated with IBK disease. The genomic locations on chromosomes 13 and 21 overlap with QTLs associated with Bovine spongiform encephalopathy, clinical mastitis or somatic cell count. Results of these genome-wide analyses indicated that if the underlying genetic factors confer not only IBK susceptibility but also IBK severity, treating IBK phenotypes as a two-categorical trait can cause information loss in the genome-wide analysis. These results help our overall understanding of the genetics of IBK and have the potential to provide information for future use in breeding schemes.

  17. Efficacy of nedocromil 2% versus fluorometholone 0.1%: a randomised, double masked trial comparing the effects on severe vernal keratoconjunctivitis

    Science.gov (United States)

    Tabbara, K.; Al-Kharashi, S.

    1999-01-01

    AIMS—To compare the efficacy of topical nedocromil 2% with fluorometholone 0.1% in vernal keratoconjunctivitis (VKC).
METHODS—In a double masked random design, 24 patients with severe vernal keratoconjunctivitis were placed at random on nedocromil 2% eye drops in one eye and fluorometholone 0.1% in the fellow eye. At the end of the 2 week treatment period, the patient crossed over the eye drops (if asymptomatic in one eye), or continued with nedocromil sodium in both eyes (if asymptomatic in both eyes). All patients were examined weekly and ocular surface temperature recorded for a period of 6 weeks. 
RESULTS—Improvement in the watering, discharge, conjunctival hyperaemia, papillary hypertrophy, and Trantas' dots was noted in both groups, but overall fluorometholone was significantly more effective than nedocromil. Eyes treated with fluorometholone showed a significant decrease in ocular surface temperature compared with nedocromil treated eyes (p = 0.03).
CONCLUSIONS—Both nedocromil and fluorometholone were effective in ameliorating the signs and symptoms of vernal keratoconjunctivitis. No adverse effects were noted in the nedocromil group.

 Keywords: vernal keratoconjunctivitis; nedocromil; fluorometholone; ocular allergy PMID:10396195

  18. The epidemic of distraction.

    Science.gov (United States)

    Weksler, Marc E; Weksler, Babette B

    2012-01-01

    Multitasking is a rapidly growing phenomenon affecting all segments of the population but is rarely as successful as its proponents believe. The use of mobile electronic devices contributes importantly to multitasking and cognitive overload. Although personal electronic devices provide many benefits, their adverse effects are frequently overlooked. Personal observation and a review of the scientific literature supports the view that overuse or misuse of personal electronic devices promotes cognitive overload, impairs multitasking and lowers performance at all ages but particularly in the elderly. This phenomenon appears to be rapidly increasing and threatens to become a tsunami as spreading electronic waves cause an 'epidemic of distraction'. Mobile electronic devices often bring benefits to their users in terms of rapid access to information. However, there is a dark side to the increasing addiction to these devices that challenges the health and well-being of the entire population, targeting, in particular, the aged and infirm. New approaches to information gathering can foster creativity if cognitive overload is avoided. Copyright © 2012 S. Karger AG, Basel.

  19. Epidemic of neurolathyrism in Ethiopia.

    Science.gov (United States)

    Getahun, H; Mekonnen, A; TekleHaimanot, R; Lambein, F

    1999-07-24

    After a drought and famine, overconsumption of the drought-tolerant grasspea triggered an epidemic of neurodegenerative neurolathyrism in Northeast Ethiopia. Environmental, nutritional, and medical factors seem to affect the susceptibility.

  20. Epidemic cholera spreads like wildfire

    Science.gov (United States)

    Roy, Manojit; Zinck, Richard D.; Bouma, Menno J.; Pascual, Mercedes

    2014-01-01

    Cholera is on the rise globally, especially epidemic cholera which is characterized by intermittent and unpredictable outbreaks that punctuate periods of regional disease fade-out. These epidemic dynamics remain however poorly understood. Here we examine records for epidemic cholera over both contemporary and historical timelines, from Africa (1990-2006) and former British India (1882-1939). We find that the frequency distribution of outbreak size is fat-tailed, scaling approximately as a power-law. This pattern which shows strong parallels with wildfires is incompatible with existing cholera models developed for endemic regions, as it implies a fundamental role for stochastic transmission and local depletion of susceptible hosts. Application of a recently developed forest-fire model indicates that epidemic cholera dynamics are located above a critical phase transition and propagate in similar ways to aggressive wildfires. These findings have implications for the effectiveness of control measures and the mechanisms that ultimately limit the size of outbreaks.

  1. Virus-Specific Differences in Rates of Disease during the 2010 Dengue Epidemic in Puerto Rico

    Science.gov (United States)

    Sharp, Tyler M.; Hunsperger, Elizabeth; Santiago, Gilberto A.; Muñoz-Jordan, Jorge L.; Santiago, Luis M.; Rivera, Aidsa; Rodríguez-Acosta, Rosa L.; Gonzalez Feliciano, Lorenzo; Margolis, Harold S.; Tomashek, Kay M.

    2013-01-01

    Background Dengue is a potentially fatal acute febrile illness (AFI) caused by four mosquito-transmitted dengue viruses (DENV-1–4) that are endemic in Puerto Rico. In January 2010, the number of suspected dengue cases reported to the passive dengue surveillance system exceeded the epidemic threshold and an epidemic was declared soon after. Methodology/Principal Findings To characterize the epidemic, surveillance and laboratory diagnostic data were compiled. A suspected case was a dengue-like AFI in a person reported by a health care provider with or without a specimen submitted for diagnostic testing. Laboratory-positive cases had: (i) DENV nucleic acid detected by reverse transcriptase-polymerase chain reaction (RT-PCR) in an acute serum specimen; (ii) anti-DENV IgM antibody detected by ELISA in any serum specimen; or (iii) DENV antigen or nucleic acid detected in an autopsy-tissue specimen. In 2010, a total of 26,766 suspected dengue cases (7.2 per 1,000 residents) were identified, of which 46.6% were laboratory-positive. Of 7,426 RT-PCR-positive specimens, DENV-1 (69.0%) and DENV-4 (23.6%) were detected more frequently than DENV-2 (7.3%) and DENV-3 (Puerto Rico in the late 1960's. This epidemic re-emphasizes the need for more effective primary prevention interventions to reduce the morbidity and mortality of dengue. PMID:23593526

  2. Therapeutic Effect of 0.1% Tacrolimus Eye Drops in the Tarsal Form of Vernal Keratoconjunctivitis.

    Science.gov (United States)

    Wan, Qi; Tang, Jing; Han, Yu; Wang, Dan; Ye, Hongquan

    2017-08-12

    The purpose of this study was to evaluate the efficacy and safety of 0.1% tacrolimus eye drops in the tarsal form of vernal keratoconjunctivitis (VKC) and to survey the changes of dendritic cells at the palpebral conjunctiva in patients with VKC by in vivo confocal microscopy. A total of 17 patients (34 eyes) with the tarsal form of VKC were enrolled in this prospective, nonrandomized case series. They were treated with 0.1% tacrolimus eye drops twice daily after discontinuation of all other topical medications. Subjective ocular symptoms and objective ocular signs were scored on a 4-point scale by one ophthalmologist and the characteristics of the dendritic cells in each right eye at the palpebral conjunctiva were evaluated by in vivo confocal microscopy before treatment and at the 1st, 2th, 4th, and 8th weeks after treatment. After 1 week of treatment with 0.1% tacrolimus eye drops, the score for each symptom in all patients showed a significant (p < 0.001) improvement, and 13 patients (76%) experienced dramatic relief of symptoms. In addition, there was a significantly (p < 0.001) decreased clinical sign score (except for giant papillae) after 4 weeks, and a significant (p < 0.001) improvement in the score of giant papillae after 8 weeks of treatment. The characteristics of dendritic cells (including cell count, total area, average size, perimeter, and diameter) showed a significant (p < 0.05) decrease after 2 weeks of treatment. During the follow-up, no other topical medications were required and no significant changes in visual acuity were documented. No cataracts or elevation of intraocular pressures were detected. Only 5 patients (29%) had a tingling or burning sensation or discomfort. Tacrolimus 0.1% eye drops are an effective and safe treatment for the tarsal form of VKC, and can rapidly inhibit the activity of dendritic cells, improve symptoms, reduce papillary hyperplasia, and reverse damage at the palpebral conjunctiva. The side effects could affect the

  3. An essential role for dendritic cells in vernal keratoconjunctivitis: analysis by laser scanning confocal microscopy.

    Science.gov (United States)

    Liu, M; Gao, H; Wang, T; Wang, S; Li, S; Shi, W

    2014-03-01

    CD4+ T helper type 2 cells play a central role in the pathogenesis of vernal keratoconjunctivitis (VKC), and antigen-presenting cells are required for the cell activation. In this study, we aimed to survey the density, distribution, and morphology of dendritic cells (DCs) in patients with VKC by in vivo confocal microscopy. Thirty-five patients (mean, 12.4 ± 5.3 years) affected by VKC were included. All patients were treated with 0.1% fluorometholone eye drops and 0.5% cyclosporine A eye drops. The density and morphological and distributional characteristics of DCs in each right eye were evaluated by in vivo confocal microscopy before treatment and at 1, 3, and 6 months after treatment. Thirty-five age-matched normal subjects (mean, 16.5 ± 1.8 years) were studied as controls. There was significant difference in age between the VKC group and the control group (F = 18.17, P < 0.05). Compared with normal eyes, increased numbers of DCs were found in patients with VKC, with mean cell densities of 244.09 ± 59.76 cells/mm(2) at the bulbar conjunctiva, 574.53 ± 87.34 cells/mm(2) at the limbus, and 403.32 ± 106.59 cells/mm(2) at the peripheral cornea before treatment. These DCs exhibited a typical dendritic shape. At 3 months after treatment, the DC density at the conjunctiva decreased significantly (P < 0.05), approximating that in the controls. At 3 and 6 months, the DC densities at the limbus and peripheral cornea also decreased significantly (P < 0.05), but were still statistically higher than those in the controls. These DCs, with small dendritic processes or irregular shapes, were observed to gradually locate at the epithelial basal membrane and subbasal nerve plexus. In vivo confocal microscopy appears to be a valuable tool in evaluating the dynamic change of DCs at the conjunctiva and cornea. DCs play an essential role in VKC and therefore may constitute a target for therapeutic intervention for VKC. © 2013 John Wiley & Sons Ltd.

  4. Puntoplastia en el tratamiento de la queratoconjuntivitis seca Punctum surgery for the treatment of keratoconjunctivitis sicca

    Directory of Open Access Journals (Sweden)

    Nereyda G. Martínez Suárez

    2008-12-01

    autologous conjunctiva did not improve their condition. No patient got worse and complications did not occur. CONCLUSIONS: Quantitative and qualitative improvement was observed in 83,87 % of patients with 2nd degree keratoconjunctivitis sicca, who were performed punctum surgery with the punctual plug technique regardless of the used material.

  5. Iatrogenic keratoconjunctivitis sicca in a dog Ceratoconjuntivite seca iatrogênica em cão

    Directory of Open Access Journals (Sweden)

    Denise Eliza de Almeida

    2004-06-01

    Full Text Available Qualitative and quantitative abnormalities in primary components of the tear can alter the dynamics of the lacrimal film, compromising its function. Lipids, an aqueous fraction and mucoproteins constitute the lacrimal film. Keratoconjunctivitis sicca (KCS is a disease commonly diagnosed in dogs. It is characterized by the deficiency of the aqueous fraction in the lacrimal film that results in dryness, inflammation of the conjunctive and cornea with progressive corneal illness and reduction of vision and pain. Due to the significant contribution of the third eyelid lacrimal gland to the production of the aqueous fraction of the lacrimal film, the removal of this gland when prolapsed is an important cause of iatrogenic keratoconjuctivitis sicca. This paper describes a clinical case of iatrogenic keratoconjuctivitis sicca in a 10 month-old Boston Terrier which was caused by the removal of the third eyelid lacrimal gland due to its prolapse.Anormalidades quali-quantitativas em componentes primários da lágrima podem alterar a dinâmica do filme lacrimal, comprometendo sua função. O filme lacrimal é composto por lipídios, uma fração aquosa e por mucoproteínas. A ceratoconjuntivite seca (CCS é uma enfermidade freqüentemente diagnosticada em cães, caracterizada pela deficiência da fração aquosa do filme lacrimal, resultando em dessecação e inflamação da conjuntiva e córnea, dor, doença corneana progressiva e redução da visão. Devido à contribuição significativa da glândula da terceira pálpebra na produção da porção aquosa do filme lacrimal, a remoção desta glândula, quando prolapsada, constitui-se em importante causa de CCS iatrogênica. Este trabalho relata um caso clínico de ceratoconjuntivite seca iatrogênica, em um cão da raça Boston Terrier de 10 meses de idade, causada pela remoção cirúrgica da glândula lacrimal da terceira pálpebra, quando esta encontrava-se prolapsada.

  6. A Study to Evaluate and Compare the Efficacy and Safety of Topical Cyclosporine A 0.5% with Topical Placebo (Artificial Tears) in Alleviating the Principal Signs Associated with Vernal Keratoconjunctivitis

    OpenAIRE

    Abha Gahlot; Rupali Maheshgauri; Bhargav Kotadia; Kanisha Jethwa; Gira Raninga

    2016-01-01

    Introduction Vernal keratoconjunctivitis is a severe, typically seasonal recurrent ocular inflammatory disorder .Topical cyclosporine-A is inhibitory to many T-cell dependent inflammatory mechanisms which are likely to play role in treatment of vernal keratoconjunctivitis. Methodology The study was conducted on 100 patients of vernal keratoconjunctivits selected from Ophthalmology out patients Department of Dr. D.Y Patil Hospital, Pune. Patients were divided in two groups of 50 each...

  7. Suspected levamisole intoxication in calves.

    Science.gov (United States)

    Müller, K R; Dwyer, C

    2016-07-01

    A group of 32 Friesian and four Hereford calves, 3-4 months old with body weights between 100-120 kg, were purchased from a weaner sale. On arrival at the property the Hereford calves were treated with a combination anthelmintic containing 2 g/L abamectin and 80 g/L levamisole hydrochloride. Shortly afterwards they developed tremors and frothing from the mouth, and two died overnight. The Friesian calves were treated with the same anthelmintic on the following day, when some showed hypersalivation and frothing from the mouth. Examination of the three most severely affected Friesian calves revealed severe nicotinic-type symptoms including hypersalivation, frothing from the mouth, muscle tremors, recumbency, rapid respiration, hyperaesthesia, and central nervous system depression. Other calves showed mild to moderate signs of intoxication including restlessness, tail switching, salivation, tremors, frequent defaecation, mild colic and jaw chomping. Two calves died shortly afterwards. An adverse drug event investigation revealed that the formulation and quality of the anthelmintic was within the correct specification, and that the drench gun was functioning correctly. Suspected levamisole intoxication due to a combination of possible overdosing, dehydration, and stress caused by transportation and prolonged yarding. Susceptibility to levamisole toxicity in New Zealand calves can be increased if factors like dehydration or stress are present. Levamisole has a narrow margin of safety, and overdosing in calves can easily occur if the dose rate is not based on their actual weight or health status.

  8. Networked SIS Epidemics With Awareness

    KAUST Repository

    Paarporn, Keith

    2017-07-20

    We study a susceptible-infected-susceptible epidemic process over a static contact network where the nodes have partial information about the epidemic state. They react by limiting their interactions with their neighbors when they believe the epidemic is currently prevalent. A node\\'s awareness is weighted by the fraction of infected neighbors in their social network, and a global broadcast of the fraction of infected nodes in the entire network. The dynamics of the benchmark (no awareness) and awareness models are described by discrete-time Markov chains, from which mean-field approximations (MFAs) are derived. The states of the MFA are interpreted as the nodes\\' probabilities of being infected. We show a sufficient condition for the existence of a

  9. Environmental Factors Influencing Epidemic Cholera

    Science.gov (United States)

    Jutla, Antarpreet; Whitcombe, Elizabeth; Hasan, Nur; Haley, Bradd; Akanda, Ali; Huq, Anwar; Alam, Munir; Sack, R. Bradley; Colwell, Rita

    2013-01-01

    Cholera outbreak following the earthquake of 2010 in Haiti has reaffirmed that the disease is a major public health threat. Vibrio cholerae is autochthonous to aquatic environment, hence, it cannot be eradicated but hydroclimatology-based prediction and prevention is an achievable goal. Using data from the 1800s, we describe uniqueness in seasonality and mechanism of occurrence of cholera in the epidemic regions of Asia and Latin America. Epidemic regions are located near regional rivers and are characterized by sporadic outbreaks, which are likely to be initiated during episodes of prevailing warm air temperature with low river flows, creating favorable environmental conditions for growth of cholera bacteria. Heavy rainfall, through inundation or breakdown of sanitary infrastructure, accelerates interaction between contaminated water and human activities, resulting in an epidemic. This causal mechanism is markedly different from endemic cholera where tidal intrusion of seawater carrying bacteria from estuary to inland regions, results in outbreaks. PMID:23897993

  10. A study of the 2006 Chikungunya epidemic outbreak in Mauritius

    Directory of Open Access Journals (Sweden)

    Mr. V. Pydiah

    2008-01-01

    Full Text Available Chikungunya epidemic outbreaks have affected more than 1 million people in 2005-2006 in many Indian Ocean islands and in India. Mauritius experienced a major outbreak in February/March 2006 following a minor outbreak in April/May 2005. No cases have been registered on the island since August 2006. The objectives of this study were to understand the timing and development of the 2006-outbreak in Mauritius, to investigate the possibility of a future outbreak, and to propose measures to prevent the recurrence of an epidemic in Mauritius. Mauritius rainfall, temperature and humidity data were analyzed. A door-to-door household census-type survey was carried out in a study locality on the island. A compartmental human-mosquito interaction model was integrated to understand outbreak evolutions in the surveyed locality and in a theoretical locality. It was observed that the onset of the 2006-outbreak in February followed an abnormally high rainfall in the third week of January 2006. 51% of the surveyed population was found to be suspected Chikungunya cases. Computer simulations indicated that a small number of infected humans and mosquitoes existed in the surveyed locality at the outbreak onset. From simulations in the theoretical locality, it was deduced that the level of infectivity in some localities may be below a herd immunity threshold and that the additional percentage of infected inhabitants in a follow-up epidemic would be significantly reduced with the case-reactive control of infected adult mosquitoes.

  11. Treatment of patients with keratoconjunctivitis sicca with Optive™: results of a multicenter, open-label observational study in Germany

    Directory of Open Access Journals (Sweden)

    Thomas Kaercher

    2008-11-01

    Full Text Available Thomas Kaercher1, Patricia Buchholz2, Friedemann Kimmich31Augenarztpraxis, Heidelberg, Germany; 2Allergan Europe, Ettlingen, Germany; 3Eyecons, Pfinztal, GermanyObjective: To evaluate the efficacy and tolerability of OptiveTM, a new dry eye product containing sodium carboxymethylcellulose (0.5% and glycerol (0.9%, in patients with keratoconjunctivitis sicca (KCS.Methods: This was a non-interventional and observational study including patients with dry eye who required a change of medication or were naïve to dry eye treatment (N = 5,277. Disease severity, tear break-up time (TBUT, tolerability, and change in clinical symptoms were recorded at baseline and at final visit (2 to 4 weeks after first treatment.Results: The severity of KCS was mild in 18.6%, moderate in 59.9%, and severe in 21.5% of patients based on physicians’ assessment. TBUT was measured in 4,338 patients before switching to or initiating therapy with Optive and at final visit. Baseline measurement of mean TBUT was 7.7 ± 3.9 seconds. This value increased to 10.0 ± 4.7 seconds at final visit. Most patients (85.4% reported improvement in local comfort. The majority (75.1% of patients felt an improvement in symptoms after changing their treatment. Two percent of patients reported adverse events, and 0.4% were treatment-related.Conclusions: Optive was well tolerated and improved the symptoms of dry eye after 2 to 4 weeks.Keywords: keratoconjunctivitis sicca, dry eye, sodium carboxymethylcellulose, glycerol, OptiveTM

  12. Epidemic Network Failures in Optical Transport Networks

    DEFF Research Database (Denmark)

    Ruepp, Sarah Renée; Katsikas, Dimitrios; Fagertun, Anna Manolova

    2013-01-01

    This paper presents a failure propagation model for transport networks which are affected by epidemic failures. The network is controlled using the GMPLS protocol suite. The Susceptible Infected Disabled (SID) epidemic model is investigated and new signaling functionality of GMPLS to support epid...... epidemic failure resolution is proposed. The results provide important input to service recovery mechanisms under epidemic failures.......This paper presents a failure propagation model for transport networks which are affected by epidemic failures. The network is controlled using the GMPLS protocol suite. The Susceptible Infected Disabled (SID) epidemic model is investigated and new signaling functionality of GMPLS to support...

  13. HIV epidemic in South Africa: A comparison of HIV epidemic ...

    African Journals Online (AJOL)

    2014-08-26

    Aug 26, 2014 ... 2Department of Statistics,. University of South Africa,. Pretoria, South ... antenatal care surveillance (ANC) surveys, we explored trends and patterns in HIV prevalence in KwaZulu-Natal and Western ... HIV infection in this age group is associated with recent infection, thus indicating an increasing epidemic in ...

  14. HIV epidemic in South Africa: A comparison of HIV epidemic ...

    African Journals Online (AJOL)

    2014-08-26

    Aug 26, 2014 ... and population-based surveys conducted in different years show a decline in HIV prevalence amongst youth in KwaZulu-Natal compared with an increase in the same age group in the Western Cape. HIV infection in this age group is associated with recent infection, thus indicating an increasing epidemic in ...

  15. The narcissism epidemic is dead : Long live the narcissism epidemic

    NARCIS (Netherlands)

    Wetzel, Eunike; Brown, Anna; Hill, Patrick; Chung, J.M.H.; Robins, R.W.; Roberts, B.W.

    2017-01-01

    Are recent cohorts of college students more narcissistic than their predecessors? To address debates about the so-called “narcissism epidemic,” we used data from three cohorts of students (N1990s = 1,166; N2000s = 33,647; N2010s = 25,412) to test whether narcissism levels (overall and specific

  16. Epidemic Synchronization in Robotic Swarms

    DEFF Research Database (Denmark)

    Schiøler, Henrik; Nielsen, Jens Frederik Dalsgaard; Ngo, Trung Dung

    2009-01-01

    Clock synchronization in swarms of networked mobile robots is studied in a probabilistic, epidemic framework. In this setting communication and synchonization is considered to be a randomized process, taking place at unplanned instants of geographical rendezvous between robots. In combination wit...

  17. A Framework for Epidemic Models

    NARCIS (Netherlands)

    Gielen, J.L.W.

    2003-01-01

    A framework is developed that enables the modeling of the various mechanisms of epidemic processes. A model within the framework is completely characterized by a set of transmission functions. These functions support the modeling of the infectivity of a new infective as a function of its

  18. Visual Mining of Epidemic Networks

    CERN Document Server

    Clémençon, Stéphan; Rossi, Fabrice; Tran, Viet Chi; 10.1007/978-3-642-21498-1_35

    2012-01-01

    We show how an interactive graph visualization method based on maximal modularity clustering can be used to explore a large epidemic network. The visual representation is used to display statistical tests results that expose the relations between the propagation of HIV in a sexual contact network and the sexual orientation of the patients.

  19. Stochastic Processes in Epidemic Theory

    CERN Document Server

    Lefèvre, Claude; Picard, Philippe

    1990-01-01

    This collection of papers gives a representative cross-selectional view of recent developments in the field. After a survey paper by C. Lefèvre, 17 other research papers look at stochastic modeling of epidemics, both from a theoretical and a statistical point of view. Some look more specifically at a particular disease such as AIDS, malaria, schistosomiasis and diabetes.

  20. Opioids: The Prescription Drug & Heroin Overdose Epidemic

    Science.gov (United States)

    ... About the Epidemic Help, Resources and Information National Opioids Crisis Search Search National Helpline SAMHSA’s National Helpline ... 1-800-622-4357 Visit Helpline Website THE OPIOID EPIDEMIC IN NUMBERS 80% Nearly 80% of heroin ...

  1. Investigation of a suspected outbreak of lipoatrophia semicircularis in children.

    Science.gov (United States)

    Rius, Cristina; Baselga, Eulalia; Tizón, Jorge; Fuentes, Paulina; Muñoz-Garza, Fania Zamantta; Roigé, Glòria; Llebaria, Xavier; Caylà, Joan A

    2017-08-10

    Recent reports of outbreaks of lipoatrophia semicircularis (LS) in various countries have generated discussion regarding the potential role of the environmental characteristics of office workplaces in new buildings. The objective of this study was to investigate a suspected outbreak of LS among children in a public school in Barcelona, which generated tremendous alarm. We performed an epidemiological assessment including descriptive and prevalence analyses, and an environmental investigation followed by a psychiatric assessment according to Small's criteria. We compared the prevalence of LS and its 95% confidence interval between children and staff attending the day-care centre under study and other centres. Among 86 children attending a day-care centre we detected 11 confirmed and 2 possible cases of LS (15.1%) while among 41 children attending other day-care centres we identified 8 cases and 4 possible cases (29.3%) (P=.10). Among 12 day-care staff, we detected 8 cases of LS (66.7%) while among 19 women working different jobs we identified 14 with the same condition as the staff (73.7%) (P=.98). All lesions were finally classified as indentations with different locations. The environmental evaluation didn't identify any exposure factors with a significant role in the onset of the outbreak. The outbreak shared 13 of Small's 16 criteria regarding epidemic somatoform disorder ("mass hysteria"). The presence of indentations can be considered a normal variant in the lower extremities of children. The characteristic development of the process leads us to the conclusion that this outbreak was an epidemic somatoform disorder. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  2. Definition and characterization of localised meningitis epidemics in Burkina Faso: a longitudinal retrospective study

    Directory of Open Access Journals (Sweden)

    Tall Haoua

    2012-01-01

    Full Text Available Abstract Background The epidemiology of meningococcal meningitis in the African meningitis belt is characterised by seasonality, localised epidemics and epidemic waves. To facilitate research and surveillance, we aimed to develop a definition for localised epidemics to be used in real-time surveillance based on weekly case reports at the health centre level. Methods We used national routine surveillance data on suspected meningitis from January 2004 to December 2008 in six health districts in western and central Burkina Faso. We evaluated eight thresholds composed of weekly incidence rates at health centre level for their performance in predicting annual incidences of 0.4%and 0.8% in health centre areas. The eventually chosen definition was used to describe the spatiotemporal epidemiology and size of localised meningitis epidemics during the included district years. Results Among eight weekly thresholds evaluated, a weekly incidence rate of 75 cases per 100,000 inhabitants during at least two consecutive weeks with at least 5 cases per week had 100% sensitivity and 98% specificity for predicting an annual incidence of at least 0.8% in health centres. Using this definition, localised epidemics were identified in all but one years during 2004-2008, concerned less than 10% of the districts' population and often were geographically dispersed. Where sufficient laboratory data were available, localised epidemics were exclusively due to meningococci. Conclusions This definition of localised epidemics a the health centre level will be useful for risk factor and modelling studies to understand the meningitis belt phenomenon and help documenting vaccine impact against epidemic meningitis where no widespread laboratory surveillance exists for quantifying disease reduction after vaccination.

  3. A case of suspect “cyanosis”

    OpenAIRE

    Elisabetta Antonucci; Matteo Conte; Michele Di Pumpo; Giuseppe Antonucci

    2013-01-01

    CLINICAL CASE A 70-year old woman was admitted to our hospital because of fever, asthenia and a suspected stroke. Her medical history showed a congenital cardiopathy (Patent Foramen Ovale, PFO). Skin and oral mucosa pigmentation, orthostatic hypotension, hypoglycemia and hyponatriemia arose the suspect of Addison’s disease. The diagnosis was confirmed by the evaluation of basal levels of plasma ACTH and serum cortisol, and serum cortisol levels after ACTH stimulation. Abdominal CT scan showed...

  4. Epidemic thresholds for bipartite networks

    Science.gov (United States)

    Hernández, D. G.; Risau-Gusman, S.

    2013-11-01

    It is well known that sexually transmitted diseases (STD) spread across a network of human sexual contacts. This network is most often bipartite, as most STD are transmitted between men and women. Even though network models in epidemiology have quite a long history now, there are few general results about bipartite networks. One of them is the simple dependence, predicted using the mean field approximation, between the epidemic threshold and the average and variance of the degree distribution of the network. Here we show that going beyond this approximation can lead to qualitatively different results that are supported by numerical simulations. One of the new features, that can be relevant for applications, is the existence of a critical value for the infectivity of each population, below which no epidemics can arise, regardless of the value of the infectivity of the other population.

  5. Multiple routes transmitted epidemics on multiplex networks

    Energy Technology Data Exchange (ETDEWEB)

    Zhao, Dawei [Information Security Center, State Key Laboratory of Networking and Switching Technology, Beijing University of Posts and Telecommunications, P.O. Box 145, Beijing 100876 (China); National Engineering Laboratory for Disaster Backup and Recovery, Beijing University of Posts and Telecommunications, Beijing 100876 (China); Shandong Provincial Key Laboratory of Computer Network, Shandong Computer Science Center, Jinan 250014 (China); Li, Lixiang [Information Security Center, State Key Laboratory of Networking and Switching Technology, Beijing University of Posts and Telecommunications, P.O. Box 145, Beijing 100876 (China); National Engineering Laboratory for Disaster Backup and Recovery, Beijing University of Posts and Telecommunications, Beijing 100876 (China); Peng, Haipeng, E-mail: penghaipeng@bupt.edu.cn [Information Security Center, State Key Laboratory of Networking and Switching Technology, Beijing University of Posts and Telecommunications, P.O. Box 145, Beijing 100876 (China); National Engineering Laboratory for Disaster Backup and Recovery, Beijing University of Posts and Telecommunications, Beijing 100876 (China); Luo, Qun; Yang, Yixian [Information Security Center, State Key Laboratory of Networking and Switching Technology, Beijing University of Posts and Telecommunications, P.O. Box 145, Beijing 100876 (China); National Engineering Laboratory for Disaster Backup and Recovery, Beijing University of Posts and Telecommunications, Beijing 100876 (China)

    2014-02-01

    This letter investigates the multiple routes transmitted epidemic process on multiplex networks. We propose detailed theoretical analysis that allows us to accurately calculate the epidemic threshold and outbreak size. It is found that the epidemic can spread across the multiplex network even if all the network layers are well below their respective epidemic thresholds. Strong positive degree–degree correlation of nodes in multiplex network could lead to a much lower epidemic threshold and a relatively smaller outbreak size. However, the average similarity of neighbors from different layers of nodes has no obvious effect on the epidemic threshold and outbreak size. -- Highlights: •We studies multiple routes transmitted epidemic process on multiplex networks. •SIR model and bond percolation theory are used to analyze the epidemic processes. •We derive equations to accurately calculate the epidemic threshold and outbreak size. •ASN has no effect on the epidemic threshold and outbreak size. •Strong positive DDC leads to a lower epidemic threshold and a smaller outbreak size.

  6. Leptospirosis: A Silent Epidemic Disease

    Directory of Open Access Journals (Sweden)

    Maria Cristina Schneider

    2013-12-01

    Full Text Available This special issue of International Journal of Environmental Research and Public Health is dedicated to leptospirosis, an endemic zoonotic disease that is a cause of many acute undifferentiated fevers, especially in tropical countries [1,2]. While it can be debated whether leptospirosis is an emerging disease, it is evident that it is becoming an emerging public health problem. It is recognized as a disease of epidemic potential that has a significant health impact in many parts of the world.

  7. Spectral clustering with epidemic diffusion

    Science.gov (United States)

    Smith, Laura M.; Lerman, Kristina; Garcia-Cardona, Cristina; Percus, Allon G.; Ghosh, Rumi

    2013-10-01

    Spectral clustering is widely used to partition graphs into distinct modules or communities. Existing methods for spectral clustering use the eigenvalues and eigenvectors of the graph Laplacian, an operator that is closely associated with random walks on graphs. We propose a spectral partitioning method that exploits the properties of epidemic diffusion. An epidemic is a dynamic process that, unlike the random walk, simultaneously transitions to all the neighbors of a given node. We show that the replicator, an operator describing epidemic diffusion, is equivalent to the symmetric normalized Laplacian of a reweighted graph with edges reweighted by the eigenvector centralities of their incident nodes. Thus, more weight is given to edges connecting more central nodes. We describe a method that partitions the nodes based on the componentwise ratio of the replicator's second eigenvector to the first and compare its performance to traditional spectral clustering techniques on synthetic graphs with known community structure. We demonstrate that the replicator gives preference to dense, clique-like structures, enabling it to more effectively discover communities that may be obscured by dense intercommunity linking.

  8. Epidemic spread on weighted networks.

    Directory of Open Access Journals (Sweden)

    Christel Kamp

    Full Text Available The contact structure between hosts shapes disease spread. Most network-based models used in epidemiology tend to ignore heterogeneity in the weighting of contacts between two individuals. However, this assumption is known to be at odds with the data for many networks (e.g. sexual contact networks and to have a critical influence on epidemics' behavior. One of the reasons why models usually ignore heterogeneity in transmission is that we currently lack tools to analyze weighted networks, such that most studies rely on numerical simulations. Here, we present a novel framework to estimate key epidemiological variables, such as the rate of early epidemic expansion (r0 and the basic reproductive ratio (R0, from joint probability distributions of number of partners (contacts and number of interaction events through which contacts are weighted. These distributions are much easier to infer than the exact shape of the network, which makes the approach widely applicable. The framework also allows for a derivation of the full time course of epidemic prevalence and contact behaviour, which we validate with numerical simulations on networks. Overall, incorporating more realistic contact networks into epidemiological models can improve our understanding of the emergence and spread of infectious diseases.

  9. Understanding the Cholera Epidemic, Haiti

    Science.gov (United States)

    Barrais, Robert; Faucher, Benoît; Haus, Rachel; Piarroux, Martine; Gaudart, Jean; Magloire, Roc; Raoult, Didier

    2011-01-01

    After onset of a cholera epidemic in Haiti in mid-October 2010, a team of researchers from France and Haiti implemented field investigations and built a database of daily cases to facilitate identification of communes most affected. Several models were used to identify spatiotemporal clusters, assess relative risk associated with the epidemic’s spread, and investigate causes of its rapid expansion in Artibonite Department. Spatiotemporal analyses highlighted 5 significant clusters (p<0.001): 1 near Mirebalais (October 16–19) next to a United Nations camp with deficient sanitation, 1 along the Artibonite River (October 20–28), and 3 caused by the centrifugal epidemic spread during November. The regression model indicated that cholera more severely affected communes in the coastal plain (risk ratio 4.91) along the Artibonite River downstream of Mirebalais (risk ratio 4.60). Our findings strongly suggest that contamination of the Artibonite and 1 of its tributaries downstream from a military camp triggered the epidemic. PMID:21762567

  10. Urban epidemic of bubonic plague in Majunga, Madagascar: epidemiological aspects.

    Science.gov (United States)

    Boisier, P; Rasolomaharo, M; Ranaivoson, G; Rasoamanana, B; Rakoto, L; Andrianirina, Z; Andriamahefazafy, B; Chanteau, S

    1997-05-01

    After an absence of 62 years, an epidemic of plague occurred in the harbour city of Majunga (Madagascar) from July 1995 to March 1996, following sporadic cases in March and May 1995. By 15 March 1996, 617 clinically suspected cases of bubonic plague had been notified. Laboratory testing was carried out for 394 individuals: 60 (15.2%) were confirmed to have bubonic plague and 48 (12.2%) were considered as presumptive cases. The incidence was significantly higher in males in all age groups and in both sexes in the 5-19 age group. Twenty-four deaths were related to plague, but early treatment with streptomycin has confirmed its effectiveness insofar as the case-farality ratio was only 8.7% among confirmed and presumptive cases admitted to hospital. The difficulty of clinically diagnosing bubonic plague was affirmed. The disease met favourable conditions through the poverty and low level of hygiene prevalent in most parts of Majunga.

  11. The phenomenology of specialization of criminal suspects.

    Directory of Open Access Journals (Sweden)

    Michele Tumminello

    Full Text Available A criminal career can be either general, with the criminal committing different types of crimes, or specialized, with the criminal committing a specific type of crime. A central problem in the study of crime specialization is to determine, from the perspective of the criminal, which crimes should be considered similar and which crimes should be considered distinct. We study a large set of Swedish suspects to empirically investigate generalist and specialist behavior in crime. We show that there is a large group of suspects who can be described as generalists. At the same time, we observe a non-trivial pattern of specialization across age and gender of suspects. Women are less prone to commit crimes of certain types, and, for instance, are more prone to specialize in crimes related to fraud. We also find evidence of temporal specialization of suspects. Older persons are more specialized than younger ones, and some crime types are preferentially committed by suspects of different ages.

  12. Congenital keratoconjunctivitis sicca and ichthyosiform dermatosis in 25 Cavalier King Charles spaniel dogs. Part I: clinical signs, histopathology, and inheritance.

    Science.gov (United States)

    Hartley, Claudia; Donaldson, David; Smith, Ken C; Henley, William; Lewis, Tom W; Blott, Sarah; Mellersh, Cathryn; Barnett, Keith C

    2012-09-01

    The clinical presentation and progression (over 9 months to 13 years) of congenital keratoconjunctivitis sicca and ichthyosiform dermatosis (CKCSID) in the Cavalier King Charles spaniel dog are described for six new cases and six previously described cases. Cases presented with a congenitally abnormal (rough/curly) coat and signs of KCS from eyelid opening. Persistent scale along the dorsal spine and flanks with a harsh frizzy and alopecic coat was evident in the first few months of life. Ventral abdominal skin was hyperpigmented and hyperkeratinized in adulthood. Footpads were hyperkeratinized from young adulthood with nail growth abnormalities and intermittent sloughing. Long-term follow-up of cases (13/25) is described. Immunomodulatory/lacrimostimulant treatment had no statistically significant effect on Schirmer tear test results, although subjectively, this treatment reduced progression of the keratitis. Histopathological analysis of samples (skin/footpads/lacrimal glands/salivary glands) for three new cases was consistent with an ichthyosiform dermatosis, with no pathology of the salivary or lacrimal glands identified histologically. Pedigree analysis suggests the syndrome is inherited by an autosomal recessive mode. © 2011 American College of Veterinary Ophthalmologists.

  13. Congenital keratoconjunctivitis sicca and ichthyosiform dermatosis in Cavalier King Charles spaniel dogs. Part II: candidate gene study.

    Science.gov (United States)

    Hartley, Claudia; Barnett, Keith C; Pettitt, Louise; Forman, Oliver P; Blott, Sarah; Mellersh, Cathryn S

    2012-09-01

    To identify causative mutation(s) for congenital keratoconjunctivitis sicca and ichthyosiform dermatosis (CKCSID) in Cavalier King Charles spaniel (CKCS) dogs using a candidate gene approach. DNA samples from 21 cases/parents were collected. Canine candidate genes (CCGs) for similar inherited human diseases were chosen. Twenty-eight candidate genes were identified by searching the Pubmed OMIM database (http://www.ncbi.nlm.nih.gov/omim). Canine orthologues of human candidate genes were identified using the Ensembl orthologue prediction facility (http://www.ensembl.org/index.html). Two microsatellites flanking each candidate gene were selected, and primers to amplify each microsatellite were designed using the Whitehead Institute primer design website (http://frodo.wi.mit.edu/primer3/). The microsatellites associated with all 28 CCGs were genotyped on a panel of 21 DNA samples from CKCS dogs (13 affected and eight carriers). Genotyping data was analyzed to identify markers homozygous in affected dogs and heterozygous in carriers (homozygosity mapping). None of the microsatellites associated with 25 of the CCGs displayed an association with CKCSID in the 21 DNA samples tested. Three CCGs associated microsatellites were monomorphic across all samples tested. Twenty-five CCGs were excluded as cause of CKCSID. Three CCGs could not be excluded from involvement in the inheritance of CKCSID. © 2012 American College of Veterinary Ophthalmologists.

  14. Sex Hormones in Allergic Conjunctivitis: Altered Levels of Circulating Androgens and Estrogens in Children and Adolescents with Vernal Keratoconjunctivitis

    Directory of Open Access Journals (Sweden)

    Marta Sacchetti

    2015-01-01

    Full Text Available Purpose. Vernal keratoconjunctivitis (VKC is a chronic allergic disease mainly affecting boys in prepubertal age and usually recovering after puberty. To evaluate a possible role of sex hormones in VKC, serum levels of sex hormones in children and adolescents with VKC were assessed. Methods. 12 prepubertal and 7 early pubertal boys with active VKC and 6 male patients with VKC in remission phase at late pubertal age and 48 healthy age and sex-matched subjects were included. Serum concentration of estrone, 17 beta-estradiol, dehydroepiandrosterone-sulfate, total testosterone and free testosterone, dihydrotestosterone (DHT, cortisol, delta-4-androstenedione, follicle-stimulating hormone, luteinizing hormone, and sex-hormones binding globuline (SHBG were evaluated. Results. Serum levels of Estrone were significantly increased in all groups of patients with VKC when compared to healthy controls (P<0.001. Prepubertal and early pubertal VKC showed a significant decrease in DHT (P=0.007 and P=0.028, resp. and SHBG (P=0.01 and P=0.002, resp. when compared to controls and serum levels of SHBG were increased in late pubertal VKC in remission phase (P=0.007. Conclusions and Relevance. VKC patients have different circulating sex hormone levels in different phases of the disease and when compared to nonallergic subjects. These findings suggest a role played by sex hormones in the pathogenesis and/or activity of VKC.

  15. 'Pink eye' or 'zere oogjes' or keratoconjunctivitis infectiosa ovis (KIO). Clinical efficacy of a number of antimicrobial therapies.

    Science.gov (United States)

    König, C D

    1983-07-01

    In a comparative study the clinical efficacy of five different treatments of keratoconjunctivitis infectiosa ovis (KIO) were tested, namely an intramuscular injection of chloramphenicol base (dosage 15 mg/kg), spiramycin base (Suanovil dosages 10 to 25 mg/kg), oxytetracycline (Engemycine Forte, Terramycin LA, dosages respectively 5 and 10 mg/kg), tiamulin (Dynamutulin, dosage 10 mg/kg) and subcutaneous injection of procaine penicillin G, benzathine penicillin G. and dihydrostreptomycin in the lower eyelid. It appeared from these field trials that spiramycin base, oxytetracycline and tiamulin had a clearly positive effect on the clinical course of 'pink eye', although with tiamulin there was only a temporary effect (high percentage of relapses). In view of the field data the following dosage schemes are, for the time being, advised: spiramycin base (Suanovil), and oxytetracycline (formulation with a good biological availability) both 20 to 30 mg/kg and, if necessary, to be repeated on days 5 and 10 after the first intramuscular injection. The dosage scheme advised for tiamulin is 20-30 mg/kg to be repeated on day 3 and if necessary on days 6 and 9 after the intramuscular injection. In mild cases it is sufficient to rub the eyes with for example oxytetracycline eye-ointment, a few times a day.

  16. Treatment of patients with keratoconjunctivitis sicca with Optive: results of a multicenter, open-label observational study in Germany.

    Science.gov (United States)

    Kaercher, Thomas; Buchholz, Patricia; Kimmich, Friedemann

    2009-01-01

    To evaluate the efficacy and tolerability of Optive, a new dry eye product containing sodium carboxymethylcellulose (0.5%) and glycerol (0.9%), in patients with keratoconjunctivitis sicca (KCS). This was a non-interventional and observational study including patients with dry eye who required a change of medication or were naïve to dry eye treatment (N = 5,277). Disease severity, tear break-up time (TBUT), tolerability, and change in clinical symptoms were recorded at baseline and at final visit (2 to 4 weeks after first treatment). The severity of KCS was mild in 18.6%, moderate in 59.9%, and severe in 21.5% of patients based on physicians' assessment. TBUT was measured in 4,338 patients before switching to or initiating therapy with Optive and at final visit. Baseline measurement of mean TBUT was 7.7 +/- 3.9 seconds. This value increased to 10.0 +/- 4.7 seconds at final visit. Most patients (85.4%) reported improvement in local comfort. The majority (75.1%) of patients felt an improvement in symptoms after changing their treatment. Two percent of patients reported adverse events, and 0.4% were treatment-related. Optive was well tolerated and improved the symptoms of dry eye after 2 to 4 weeks.

  17. Treatment of patients with keratoconjunctivitis sicca with Optive™: results of a multicenter, open-label observational study in Germany

    Science.gov (United States)

    Kaercher, Thomas; Buchholz, Patricia; Kimmich, Friedemann

    2009-01-01

    Objective: To evaluate the efficacy and tolerability of Optive™, a new dry eye product containing sodium carboxymethylcellulose (0.5%) and glycerol (0.9%), in patients with keratoconjunctivitis sicca (KCS). Methods: This was a non-interventional and observational study including patients with dry eye who required a change of medication or were naïve to dry eye treatment (N = 5,277). Disease severity, tear break-up time (TBUT), tolerability, and change in clinical symptoms were recorded at baseline and at final visit (2 to 4 weeks after first treatment). Results: The severity of KCS was mild in 18.6%, moderate in 59.9%, and severe in 21.5% of patients based on physicians’ assessment. TBUT was measured in 4,338 patients before switching to or initiating therapy with Optive and at final visit. Baseline measurement of mean TBUT was 7.7 ± 3.9 seconds. This value increased to 10.0 ± 4.7 seconds at final visit. Most patients (85.4%) reported improvement in local comfort. The majority (75.1%) of patients felt an improvement in symptoms after changing their treatment. Two percent of patients reported adverse events, and 0.4% were treatment-related. Conclusions: Optive was well tolerated and improved the symptoms of dry eye after 2 to 4 weeks. PMID:19668542

  18. Sequential Keraring implantation and corneal cross-linking for the treatment of keratoconus in children with vernal keratoconjunctivitis.

    Science.gov (United States)

    Abozaid, Mortada A

    2017-01-01

    The purpose of this study was to assess the safety and efficacy of femtosecond laser-assisted Keraring implantation followed by transepithelial accelerated corneal collagen cross-linking (CXL) for the treatment of keratoconus in children with vernal keratoconjunctivitis (VKC). This is a prospective interventional non-comparative case series. Eighteen eyes of 11 children with keratoconus and VKC were included in this study. All the cases were treated with femtosecond laser-assisted Keraring implantation followed after 2 weeks by transepithelial accelerated CXL, and the patients were followed up for 1 year. The preoperative mean uncorrected visual acuity (UCVA) was 1.01±0.2 (logMAR), whereas the postoperative mean UCVA was 0.6±0.2. The preoperative mean best-corrected visual acuity (BCVA) was 0.6±0.1, whereas the postoperative mean BCVA was 0.40±0.2. The preoperative average keratometry was 50.3±2.7 D, whereas the postoperative average keratometry was 45.8±3.1 D. The results of this study suggest that femtosecond laser-assisted Keraring implantation followed by CXL is safe and effective in the management of keratoconus in children with VKC. However, studies with a longer follow-up period are needed.

  19. Clinical study of conjunctival papilla grinding technique in the treatment of severe vernal keratoconjunctivitis with huge conjunctival nipple

    Directory of Open Access Journals (Sweden)

    Bing-Bing Chen

    2013-11-01

    Full Text Available AIM: To observe and assess the efficacy and safety of conjunctival papilla grinding technique in the treatment of severe vernal keratoconjunctivitis(VKCwith giant conjunctival papilla. METHODS: The prospective and controlled study was performed in 17 patients(24 eyeswith VKC. Eight patients(12 eyeswith giant conjunctival papillae were treated with grinding technique and 9 patients(12 eyeswere performed with conjunctival papillectomy, respectively. A comparison was made on the changes of symptoms including itching, tearing, light sensitivity and grittiness and physical signs of conjunctival papilla and the corneal epithelium before and after surgery.RESULTS:The symptoms and signs in the first week, the second week and the forth week after the operation were obviously improved in the two groups, and differences in these aspects before and after surgery were of statistical significance(P0.01. However, by grading of the signs of huge conjunctival nipple in the first week, the second week and the forth week after the operation, and conditions of repair of corneal damage in the second postoperative week, the result showed that efficacy of the grinding group was better than that of the surgical removal group(PCONCLUSION:Conjunctival nipples grinding operation can make the rough conjunctival wound flat quickly, relieve symptoms, and promote the repair of keratoconjunctival epithelium. And it is an effective, safe, and simple method to treat the severe VKC with huge conjunctival nipples.

  20. Comparison of efficacy and safety of topical Ketotifen (Zaditen with Cromolyn sodium in the treatment of Vernal keratoconjunctivitis

    Directory of Open Access Journals (Sweden)

    MR Shoja

    2005-03-01

    Full Text Available Background: This study compared the efficacy of Ketotifen fumarate .025% (Zaditen with Cromolyn sodium 4% (Opticrom eye drops in prevention of itching, tearing, and redness in Vernal Keratoconjunctivitis (VKC. Methods: This double blind randomized single center clinical trial conducted between April and August 2004 in Yazd. One hundred eligible patients with clinical diagnosis of moderate VKC were randomly prescribed Zaditen (group A: n=50 and Cromolyn sodium (group B: n=50 eye drops for a 4 weeks period. Itching, lacrimation, redness, and photophobia were scored on a 4-points severity scale. Results: After 7 days of treatment, the response rates based on subjects assessment of global efficacy was significantly greater in Ketotifen group (61.5% than in Cromolyn group(53%.A clear response to treatment occurred in 94.4 of Zaditen and 81.2% of Sodium Cromoglycate treated patients. The investigator,s assessment of response rates also showed that Ketotifen was superior to Cromolyn sodium (P=0.001. Ketotifen produced a significantly better outcome than Cromolyn for relief of signs and symptoms of VKC (P<0.05. Ketotifen fumarate treatment significantly reduced the total signs and symptoms score for each patients, in compare with day 0. Conclusion: Ketotifen had a faster onset of action and provided better symptom relief than Cromolyn. The rapid onset of action and symptom control, make Zaditen a valuable treatment for VKC. Keywords : VKC , allergic conjuctivitis , zaditen

  1. Topical cyclosporine a 0.05% eyedrops in the treatment of vernal keratoconjunctivitis - randomized placebo-controlled trial.

    Science.gov (United States)

    Keklikci, Ugur; Dursun, Birgul; Cingu, Abdullah Kursat

    2014-01-01

    Vernal keratoconjunctivitis (VKC) is a chronic, bilateral inflammation of the conjunctiva that mostly affects children and young adult males. Management of VKC is primarily aimed at reducing symptoms and preventing serious vision threatening sequelae. To assess the efficacy of topical cyclosporine A (CsA) 0.05% on the signs and symtomps in the management of VKC. This is a placebo-controlled, randomized prospective study. Sixty-two patients with VKC were included in this study. Patients were randomly assigned (1 : 1) to treatment with topical 0.05% CsA eyedrops or a placebo (artificial tears) for a period of 4 weeks, 4 times daily. Ocular signs and symptoms were in all patients scored at entry and at the end of 4 weeks. When pre-treatment mean signs and symptoms scores were compared in both groups, there was no significant difference (p > 0.05). However, mean post-treatment scores as regards signs and symptoms were found to be lower in cyclosporine group than those in placebo group (p < 0.001). No side effects of the treatment with CsA 0.05% eyedrops were observed. It was found that topical CsA 0.05% eyedrops were safe and effective in the treatment of patients with VKC.

  2. The Study of Interleukin-17 Level in Vernal Keratoconjunctivitis Disease and its Relationship between Symptom and Sign Severity.

    Science.gov (United States)

    Validad, Mohammad Hosein; Khazaei, Hossein Ali; Pishjoo, Masoud; Safdari, Zohre

    2016-07-15

    Vernal keratoconjunctivitis (VKC) is a bilateral multi-factorial disease. The pathogenesis of this disease is not obviously determined, but the role of various inflammatory cytokines has been specified. This study has provided a comparison between the level of interleukin-17 (IL17) in the serum and tears of case and control groups, and also the relationship between the level of this interleukin with severity of signs and symptoms of the disease. This case-control study has been accomplished on 40 individuals (20 healthy people and 20 patients who suffer from VKC) in Al-Zahra Eye Center in 2014. The level of interleukin was isolated in an individual's tear by Schirmer strips; moreover, serum interleukin has been measured. The average of interleukin 17 in serum in the case group was 25.5±4.1 pg/dl and in the control group was 12.5±5.7 pg/dl. The average of interleukin 17 in the case group was 259.6±91.4 pg/dl in the tear and was 50.6±20.8 pg/dl for the control group; the signs and symptoms of the IL-17 disease were associated with the severity of Trantas dots. Interleukin-17 has a role in the pathogenesis of VKC and also has been proven in the former studies.

  3. Sex hormones in allergic conjunctivitis: altered levels of circulating androgens and estrogens in children and adolescents with vernal keratoconjunctivitis.

    Science.gov (United States)

    Sacchetti, Marta; Lambiase, Alessandro; Moretti, Costanzo; Mantelli, Flavio; Bonini, Stefano

    2015-01-01

    Vernal keratoconjunctivitis (VKC) is a chronic allergic disease mainly affecting boys in prepubertal age and usually recovering after puberty. To evaluate a possible role of sex hormones in VKC, serum levels of sex hormones in children and adolescents with VKC were assessed. 12 prepubertal and 7 early pubertal boys with active VKC and 6 male patients with VKC in remission phase at late pubertal age and 48 healthy age and sex-matched subjects were included. Serum concentration of estrone, 17 beta-estradiol, dehydroepiandrosterone-sulfate, total testosterone and free testosterone, dihydrotestosterone (DHT), cortisol, delta-4-androstenedione, follicle-stimulating hormone, luteinizing hormone, and sex-hormones binding globuline (SHBG) were evaluated. Serum levels of Estrone were significantly increased in all groups of patients with VKC when compared to healthy controls (P < 0.001). Prepubertal and early pubertal VKC showed a significant decrease in DHT (P = 0.007 and P = 0.028, resp.) and SHBG (P = 0.01 and P = 0.002, resp.) when compared to controls and serum levels of SHBG were increased in late pubertal VKC in remission phase (P = 0.007). VKC patients have different circulating sex hormone levels in different phases of the disease and when compared to nonallergic subjects. These findings suggest a role played by sex hormones in the pathogenesis and/or activity of VKC.

  4. Atualização no tratamento das ceratoconjuntivites cicatriciais Update of the treatment of cicatricial keratoconjunctivitis

    Directory of Open Access Journals (Sweden)

    José Alvaro Pereira Gomes

    2000-02-01

    Full Text Available As ceratoconjuntivites cicatriciais (CCC representam um grupo de doenças que induz seis tipos principais de alterações oculares: olho seco; alterações palpebrais; destruição do limbo e células germinativas corneais; destruição da membrana basal; processo inflamatório; alteração na integração neuroanatômica da superfície ocular. Essas alterações acabam causando instabilidade epitelial corneal, vascularização e inflamação crônica. O resultado final é a perda de transparência da córnea e diminuição da acuidade visual. O autor descreve os seis tipos de alterações e faz uma revisão atualizada do tratamento de cada um deles.Cicatricial keratoconjunctivitis is a group of diseases that induces six different types of ocular disorders: dry eye; eyelid blinking disturbances; destruction of limbal stem cells; destruction of basement membrane; inflammation; and neuroanatomic disintegration. These disorders cause corneal epithelial instability, neovascularization and chronic inflammation which result in loss of corneal transparency and decreased visual acuity. The author describes the six types of disorders and reviews the latest therapeutic approaches for each of them.

  5. Vernal Keratoconjunctivitis in School Children in Rwanda and Its Association with Socio-Economic Status: A Population-Based Survey

    Science.gov (United States)

    Smedt, Stefan De; Nkurikiye, John; Fonteyne, Yannick; Hogewoning, Arjan; Esbroeck, Marjan Van; Bacquer, Dirk De; Tuft, Stephen; Gilbert, Clare; Delanghe, Joris; Kestelyn, Philippe

    2011-01-01

    Vernal keratoconjunctivitis (VKC) is an allergic eye disease and an important cause of hospital referral among children in Africa and Asia. Hospital-based studies have suggested a role for parasites in its pathogenesis. To determine the prevalence and risk factors for VKC in Central Africa, we conducted a nested population-based case control study in Rwanda, involving randomly selected primary schools from different environments (rural/urban) and climate. A prevalence of VKC of 4.0% (95% confidence interval 3.3–4.7%) was found among 3,041 children studied (participation rate 94.7%). The intestinal parasitic burden was not related to VKC. Besides hot dry climate (odds ratio [OR] = 1.5, P = 0.05) and male gender (OR = 1.7, P = 0.005), multivariate analysis identified higher economic status as a risk for VKC (OR = 1.4, P = 0.005). The effect on VKC of higher economic status appears not to act through differences in parasitic intestinal load. PMID:21976577

  6. Therapeutic Effect of 0.03% Tacrolimus Ointment for Ocular Graft versus Host Disease and Vernal Keratoconjunctivitis

    Science.gov (United States)

    Ryu, Eun Hye; Kim, Joung Mok; Laddha, Pradnya M; Chung, Eui-Sang

    2012-01-01

    Purpose To determine whether topical tacrolimus might prove effective in the treatment of refractory anterior segment inflammatory diseases, and to evaluate its efficacy in eyes with ocular graft versus host disease (GVHD), and vernal keratoconjunctivitis (VKC). Methods Twenty-eight eyes of 14 patients with anterior segment inflammation refractory to steroid treatment were treated with 0.03% tacrolimus ointment at the Samsung Medical Center, Seoul, Korea from March 2008 through August 2009. Seven patients had ocular GVHD and seven had VKC. We evaluated the conjunctival and corneal inflammatory change at one, two, four, and eight weeks after treatment with a scoring system. Time to initial response of treatment and therapeutic effect between GVHD and VKC was also analyzed. After the eight-week treatment period, patients were divided into two groups (maintenance group and discontinuance group). Eight patients maintained the treatment for an additional four months, and six patients discontinued the treatments. Therapeutic effect was also compared between the groups at eight weeks and six months after treatment. Results The mean conjunctival and corneal inflammation score was reduced significantly at eight weeks after treatment (p 0.05). Six months after treatment, we noted no therapeutic differences between the maintenance group and discontinuance group (p > 0.05). Conclusions 0.03% tacrolimus ointment was safe and effective for use in anterior segment inflammatory disease refractory to steroid. PMID:22870021

  7. Efficacy of 1.25% and 1% topical cyclosporine in the treatment of severe vernal keratoconjunctivitis in childhood.

    Science.gov (United States)

    Spadavecchia, Laura; Fanelli, Pietro; Tesse, Riccardina; Brunetti, Luigia; Cardinale, Fabio; Bellizzi, Mario; Rizzo, Giovanna; Procoli, Ugo; Bellizzi, Gianfranco; Armenio, Lucio

    2006-11-01

    Cyclosporine eyedrops 2% have been used for treatment of corticosteroid-resistant vernal keratoconjunctivitis (VKC) cases. The purpose of our study was to verify the efficacy of 1.25% vs. 1% topical cyclosporine in improving severe form of VKC in childhood. Twenty children with severe VKC, were enrolled in a double-blind, placebo-controlled study and received cyclosporine 1.25% in one eye for 2 wk. Then an open trial was conducted during the next 3 months and 2 wk. Thirty-two more patients were recruited the next year into a new open trial and they received cyclosporine 1% for 4 months. Ocular subjective symptoms and objective signs were scored in all children at entry, 2 wk and 4 months. Skin prick tests and conjunctival scraping tests were also performed; serum immunological and biochemical markers were assessed. The mean score values for severity of subjective symptoms and objective signs were significantly decreased after 2 wk, and 4 months, compared with those at entry (p < 0.001), in both groups of children who received cyclosporine eyedrops 1.25% and 1%, respectively. Serum markers did not differ from the beginning to the end of treatment. Conjunctival eosinophils and cyclosporine serum levels were not detectable at the end of therapy, nor were endothelial corneal cells damaged. Our findings suggest that 1% cyclosporine concentration might be the minimal effective treatment regimen to control symptoms and local inflammation in severe forms of VKC.

  8. Clinical and Cytologic Evidence of Limbal Stem Cell Deficiency in Eyes With Long-Standing Vernal Keratoconjunctivitis.

    Science.gov (United States)

    Saboo, Ujwala S; Basu, Sayan; Tiwari, Shubha; Mohamed, Ashik; Vemuganti, Geeta K; Sangwan, Virender S

    2013-01-01

    We aimed to study the impression cytology (IC) of the ocular surface in eyes with vernal keratoconjunctivitis (VKC) and clinical evidence of limbal stem cell deficiency (LSCD). This is a prospective comparative study. This study included 78 eyes of 40 patients with VKC. Limbal stem cell deficiency was diagnosed clinically based on the presence of corneal findings such as dull irregular epithelial reflex, superficial neovascularization, conjunctivalization, and loss of limbal palisades of Vogt. The study group consisted of 28 eyes of 15 patients with clinically diagnosed LSCD and control group of 50 eyes of 25 patients without LSCD. Conjunctival and corneal IC was done in all eyes. Presence of goblet cells in the corneal samples on IC was considered confirmatory of LSCD. Compared with controls, patients with LSCD were older and had longer duration of disease. On IC, goblet cells were present on the cornea in 53.6% of eyes with clinically diagnosed LSCD and in none of the control eyes (P < 0.0001). Clinically diagnosed LSCD in study eyes correlated with cytologic findings of greater conjunctival squamous metaplasia, decreased conjunctival goblet cells, greater corneal cell metaplasia, and increased inflammation as compared with control eyes. Most of the eyes with VKC and clinical evidence of LSCD have cytologic evidence of LSCD with goblet cells on the cornea.

  9. A case of suspect “cyanosis”

    Directory of Open Access Journals (Sweden)

    Elisabetta Antonucci

    2013-05-01

    Full Text Available CLINICAL CASE A 70-year old woman was admitted to our hospital because of fever, asthenia and a suspected stroke. Her medical history showed a congenital cardiopathy (Patent Foramen Ovale, PFO. Skin and oral mucosa pigmentation, orthostatic hypotension, hypoglycemia and hyponatriemia arose the suspect of Addison’s disease. The diagnosis was confirmed by the evaluation of basal levels of plasma ACTH and serum cortisol, and serum cortisol levels after ACTH stimulation. Abdominal CT scan showed atrophy and calcification of adrenal glands. CONCLUSIONS In most cases, Addison’s disease is provoked by autoimmune destruction of the adrenal cortex; however, in our reported patient, tuberculosis could be a possible cause.

  10. An epidemic outbreak of cryptosporidiosis

    DEFF Research Database (Denmark)

    Mølbak, Kåre; Højlyng, Niels; Ingholt, Liselotte

    1990-01-01

    In the first year of a prospective community study of childhood diarrhea conducted in a semiurban area in the capital of Guinea Bissau, Cryptosporidium sp. was found in 73 (6.0%) of 1216 episodes of diarrhea. The parasite was the second most prevalent intestinal parasite, and the only one...... significantly associated with diarrhea (OR = 2.79, P = 0.0006). The seasonal distribution was striking, with a peak prevalence in the beginning of the rainy season (May 17.6%) when an epidemic outbreak of diarrhea started. The prevalence was highest in children younger than 18 months, an age at which...

  11. The cancer, a silent epidemic.

    Directory of Open Access Journals (Sweden)

    Edith María Beltrán Molina

    2014-03-01

    Full Text Available This article deals with some very interesting aspects related to cancer the first cause of death in many countries with a high prevalence in Cuba so it is necessary to increase prevention and education to reduce risk factors and prevalence of malignancy. Taking into account the importance of cancer awareness as well as the social therapeutic and technological resources available to Cuba for its treatment it is propose with this work to exemplify the Cuban scientific treatment of cancer as a silent epidemic of the XXI century.

  12. Contact allergy epidemics and their controls

    DEFF Research Database (Denmark)

    Thyssen, Jacob Pontoppidan; Johansen, Jeanne Duus; Menné, Torkil

    2007-01-01

    Contact dermatitis can be severe and lead to sick leave as well as significant healthcare expenses. The aim of this review is to present the published knowledge on 6 historical epidemics of contact allergy to apply this knowledge on the prevention and control of future contact allergy epidemics. ...... to prevent contact allergy epidemics. It is essential that dermatologist, scientists, administrators, and consumers organize and structure known methods to accelerate the control of emerging contact allergens....

  13. Epidemic Survivability: Characterizing Networks Under Epidemic-like Failure Propagation Scenarios

    DEFF Research Database (Denmark)

    Manzano, Marc; Calle, Eusebi; Ripoll, Jordi

    2013-01-01

    in telecommunication networks has not been extensively considered, nowadays, with the increasing computation capacity and complexity of operating systems of modern network devices (routers, switches, etc.), the study of possible epidemic-like failure scenarios must be taken into account. When epidemics occur......, such as in other multiple failure scenarios, identifying the level of vulnerability offered by a network is one of the main challenges. In this paper, we present epidemic survivability, a new network measure that describes the vulnerability of each node of a network under a specific epidemic intensity. Moreover......, this metric is able to identify the set of nodes which are more vulnerable under an epidemic attack. In addition, two applications of epidemic survivability are provided. First, we introduce epidemic criticality, a novel robustness metric for epidemic failure scenarios. A case study shows the utility...

  14. Congenital Malaria Among Newborns Admitted for Suspected ...

    African Journals Online (AJOL)

    Background: Signs and symptoms of congenital malaria do not differ much from those of neonatal sepsis: both can co-exist, and most times very difficult to differentiate clinically. Objective: To document the prevalence, risk factors for congeni tal malar ia among neonates admitted for suspected neonatal sepsis, and ...

  15. Congenital Malaria Among Newborns Admitted for Suspected ...

    African Journals Online (AJOL)

    None of the clinical feature had good sensitivity, specificity or predictive value for congenital malaria, and only 1.6% death was recorded in a baby with high parasite density. Conclusion: Congenital malaria is common in newborns with suspected neonatal sepsis. History of peripartum pyrexia, prematurity and intrauterine ...

  16. MRI for clinically suspected appendicitis during pregnancy.

    NARCIS (Netherlands)

    Cobben, L.P.; Groot, I.; Haans, L.; Blickman, J.G.; Puylaert, J.

    2004-01-01

    OBJECTIVE: The purpose of this study was to evaluate whether MRI can be used to accurately diagnose or exclude appendicitis in pregnant patients with clinically suspected appendicitis. CONCLUSION: Our results suggest that MRI is helpful in the examination and diagnosis of acute appendicitis in

  17. Biomechanical properties of keratoconus suspect eyes.

    Science.gov (United States)

    Saad, Alain; Lteif, Yara; Azan, Elodie; Gatinel, Damien

    2010-06-01

    Measuring corneal biomechanical properties may help detect keratoconus suspect corneas and eliminate the risk of ectasia after LASIK. Data of 504 eyes separated into three groups were retrospectively reviewed: normal (n = 252), keratoconus suspect (n = 80), and keratoconus (n = 172). Corneal hysteresis (CH) and corneal resistance factor (CRF) were measured with an ocular biomechanics analyzer. Mean corneal hysteresis was 10.6 +/- 1.4 (SD) mm Hg in the normal group, compared with 10.0 +/- 1.6 mm Hg in the keratoconus suspect group and 8.1 +/- 1.4 mm Hg in the keratoconus group. The mean CRF was 10.6 +/- 1.6 mm Hg in the normal group compared with 9.7 +/- 1.7 in the keratoconus suspect group and 7.1 +/- 1.6 mm Hg in the keratoconus group. Mean CH and CRF were significantly different between the three groups (P corneas. Analyzing signal curves obtained with the biomechanics analyzer may provide additional valuable information for selecting qualified patients for refractive surgery.

  18. Characterization of suspected illegal skin whitening cosmetics.

    Science.gov (United States)

    Desmedt, B; Van Hoeck, E; Rogiers, V; Courselle, P; De Beer, J O; De Paepe, K; Deconinck, E

    2014-03-01

    An important group of suspected illegal cosmetics consists of skin bleaching products, which are usually applied to the skin of the face, hands and décolleté for local depigmentation of hyper pigmented regions or more importantly, for a generalized reduction of the skin tone. These cosmetic products are suspected to contain illegal active substances that may provoke as well local as systemic toxic effects, being the reason for their banning from the EU market. In that respect, illegal and restricted substances in cosmetics, known to have bleaching properties, are in particular hydroquinone, tretinoin and corticosteroids. From a legislative point of view, all cosmetic products containing a prohibited whitening agent are illegal and must be taken off the EU market. A newly developed screening method using ultra high performance liquid chromatography-time off flight-mass spectrometry allows routine analysis of suspected products. 163 suspected skin whitening cosmetics, collected by Belgian inspectors at high risk sites such as airports and so-called ethnic cosmetic shops, were analyzed and 59% were classified as illegal. The whitening agents mostly detected were clobetasol propionate and hydroquinone, which represent a serious health risk when repeatedly and abundantly applied to the skin. Copyright © 2013 Elsevier B.V. All rights reserved.

  19. Suspecting Neurological Dysfunction From E Mail Messages ...

    African Journals Online (AJOL)

    A non medical person suspected and confirmed neurological dysfunction in an individual, based only on e mail messages sent by the individual. With email communication becoming rampant “peculiar” email messages may raise the suspicion of neurological dysfunction. Organic pathology explaining the abnormal email ...

  20. Suspected poisoning of domestic animals by pesticides.

    Science.gov (United States)

    Caloni, Francesca; Cortinovis, Cristina; Rivolta, Marina; Davanzo, Franca

    2016-01-01

    A retrospective study was carried out by reviewing all suspected cases of domestic animal poisoning attributed to pesticides, reported to the Milan Poison Control Centre (MPCC) between January 2011 and December 2013. During this period, pesticides were found to be responsible for 37.3% of all suspected poisoning enquiries received (815). The most commonly species involved was the dog (71.1% of calls) followed by the cat (15.8%), while a limited number of cases involved horses, goats and sheep. Most cases of exposure (47.1%) resulted in mild to moderate clinical signs. The outcome was reported in 59.9% of these cases, with death occurring in 10.4% of them. Insecticides (40.8%) proved to be the most common group of pesticides involved and exposure to pyrethrins-pyrethroids accounted for the majority of calls. According to the MPCC data, there has been a decrease in the number of suspected poisonings cases attributed to pesticides that have been banned by the EU, including aldicarb, carbofuran, endosulfan and paraquat. In contrast, there has been an increase of suspected poisoning cases attributed to the neonicotinoids, imidacloprid and acetamiprid, probably due to their widespread use in recent years. Cases of suspected poisoning that involved exposure to rodenticides accounted for 27.6% of calls received by the MPCC and anticoagulant rodenticides were the primary cause of calls, with many cases involving brodifacoum and bromadiolone. Herbicides were involved in 14.2% of calls related to pesticides and glyphosate was the main culprit in cases involving dogs, cats, horses, goats and sheep. As far as exposure to molluscicides (11.5%) and fungicides (5.9%), most of the cases involved dogs and the suspected poisoning agents were metaldehyde and copper compounds respectively. The data collected are useful in determining trends in poisoning episodes and identifying newly emerging toxicants, thus demonstrating the prevalence of pesticides as causative agents in animal

  1. The epidemic of Athens, 430 - 426 BC

    African Journals Online (AJOL)

    1998-01-01

    Jan 1, 1998 ... mus, the generally accepted word for 'mouse')." The epidemic of Constantinople in 542 AD probably represents the first recorded plague epidemic - a disease which later created havoc as the 'Black Death' in medieval Europe".22. Plague classically manifests itself in either bubonic or septicaemic forms, but ...

  2. Reemerging threat of epidemic typhus in Algeria.

    Science.gov (United States)

    Mokrani, K; Fournier, P E; Dalichaouche, M; Tebbal, S; Aouati, A; Raoult, D

    2004-08-01

    We report a case of epidemic typhus in a patient from the Batna region of Algeria, who presented with generalized febrile exanthema. The clinical diagnosis was confirmed by serological cross-adsorption followed by Western blotting. Our report emphasizes the threat of epidemic typhus in the highlands of Algeria.

  3. Tacrolimus vs. cyclosporine eyedrops in severe cyclosporine-resistant vernal keratoconjunctivitis: A randomized, comparative, double-blind, crossover study.

    Science.gov (United States)

    Pucci, Neri; Caputo, Roberto; di Grande, Laura; de Libero, Cinzia; Mori, Francesca; Barni, Simona; di Simone, Lorena; Calvani, Annamaria; Rusconi, Franca; Novembre, Elio

    2015-05-01

    Vernal keratoconjunctivitis (VKC) is a chronic sight-threatening ocular disease. Topical cyclosporine A (Cyc) has been widely administered as a steroid-sparing drug, although in about 7-10% of cases, it has been ineffective. The purpose of this study was to evaluate the efficacy of 0.1% topical tacrolimus (Tcr) in patients with severe VKC who failed to respond to 1% Cyc eyedrops. Consecutive patients with severe, Cyc-resistant VKC were enrolled in a double-blind, comparative, crossover (DBCO) trial; all patients were treated with 1% Cyc in one eye and 0.1% Tcr in the other eye for 3 wk. After a washout period of 7 days, patients were instructed to cross over the medications for three additional weeks. Objective ocular score, subjective score, and quality-of-life questionnaires (QoLQ) were collected during the trial. Blood samples were drawn to assess several safety parameters. Thirty patients have been enrolled (mean age 9.05 ± 2.12 yr). In each of the two phases of the DBCO trial, a significant improvement in objective and subjective scores was observed in the eyes treated with 0.1% Tcr (p < 0.001). Likewise, the quality of life significantly improved despite only half the eyes being successfully treated. Serum creatinine and blood parameters were constantly within the normal range, and both blood Cyc and Tcr concentrations remained below the lowest detectable levels. Topical Tcr is very effective and safe in the short term for patients suffering from severe VKC resistant to topical Cyc. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  4. Chaperone patterns in vernal keratoconjunctivitis are distinctive of cell and Hsp type and are modified by inflammatory stimuli.

    Science.gov (United States)

    Leonardi, A; Tarricone, E; Corrao, S; Alaibac, M; Corso, A J; Zavan, B; Venier, P; Conway de Macario, E; Macario, A J L; Di Stefano, A; Cappello, F; Brun, P

    2016-03-01

    Vernal keratoconjunctivitis (VKC) is a severe ocular allergy with pathogenic mechanism poorly understood and no efficacious treatment. The aims of the study were to determine quantities and distribution of Hsp chaperones in the conjunctiva of VKC patients and assess their levels in conjunctival epithelial and fibroblast cultures exposed to inflammatory stimuli. Hsp10, Hsp27, Hsp40, Hsp60, Hsp70, Hsp90, Hsp105, and Hsp110 were determined in conjunctiva biopsies from nine patients and nine healthy age-matched normal subjects, using immunomorphology and qPCR. Conjunctival epithelial cells and fibroblasts were cultured and stimulated with IL-1β, histamine, IL-4, TNF-α, or UV-B irradiation, and changes in Hsp levels were determined by Western blotting. Hsp27, Hsp40, Hsp70, and Hsp90 levels increased in the patients' conjunctiva, whereas Hsp10, Hsp60, Hsp100, and Hsp105 did not. Double immunofluorescence demonstrated colocalization of Hsp27, Hsp40, Hsp70, and Hsp90 with CD68 and tryptase. Testing of cultured conjunctival cells revealed an increase in the levels of Hsp27 in fibroblasts stimulated with IL-4; Hsp40 in epithelial cells stimulated with IL-4 and TNF-α and in fibroblasts stimulated with IL-4, TNF-α, and IL-1β; Hsp70 in epithelial cells stimulated with histamine and IL-4; and Hsp90 in fibroblasts stimulated with IL-1β, TNF-α, and IL-4. UV-B did not induce changes. VKC conjunctiva displays distinctive quantitative patterns of Hsps as compared with healthy controls. Cultured conjunctival cells respond to cytokines and inflammatory stimuli with changes in the Hsps quantitative patterns. The data suggest that interaction between the chaperoning and the immune systems drives disease progression. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  5. Topical tacrolimus 0.03% as sole therapy in vernal keratoconjunctivitis: a randomized double-masked study.

    Science.gov (United States)

    Müller, Guilherme Gubert; José, Newton Kara; de Castro, Rosane Silvestre

    2014-03-01

    This study sought to evaluate the efficacy of the isolated use of tacrolimus compared with the combined use of tacrolimus and olopatadine for the treatment of severe vernal keratoconjunctivitis (VKC). Twenty-one patients with severe VKC were randomized into two groups: one treated with 0.03% tacrolimus ointment combined with 1% olopatadine ophthalmic solution and the other with 0.03% tacrolimus ointment combined with placebo eye drops. The clinical signs and symptoms were graded from 0 to 3, and the efficacy of treatment was determined by the difference between the score at the beginning of treatment and after 30 days. The clinical impression of improvement as perceived by the evaluator and the self-assessment provided by the patient were scored at day 30 of treatment and compared between the groups. The scores for symptoms decreased between the assessments in both groups (-1.7±3.9 in the experimental group; -0.6±1.6 in the control group), with no significant difference between groups (P=0.205). The scores for clinical signs decreased between the assessments in the experimental group (-1.1±2.7) and increased in the control group (0.3±0.9) but with no significant differences (P=0.205). There was no significant difference between the groups regarding the self-assessment (P=0.659) and the clinical impression of the evaluator (P=0.387). The isolated use of tacrolimus and the combined use of tacrolimus and olopatadine seems to have the same efficacy, although controlled studies with larger samples are required to confirm this hypothesis.

  6. Sequential Keraring implantation and corneal cross-linking for the treatment of keratoconus in children with vernal keratoconjunctivitis

    Directory of Open Access Journals (Sweden)

    Abozaid MA

    2017-10-01

    Full Text Available Mortada A Abozaid Ophthalmology Department, Faculty of Medicine, Sohag University, Sohag, Egypt Purpose: The purpose of this study was to assess the safety and efficacy of femtosecond laser-assisted Keraring implantation followed by transepithelial accelerated corneal collagen cross-linking (CXL for the treatment of keratoconus in children with vernal keratoconjunctivitis (VKC.Study design: This is a prospective interventional non-comparative case series.Patients and methods: Eighteen eyes of 11 children with keratoconus and VKC were included in this study. All the cases were treated with femtosecond laser-assisted Keraring implantation followed after 2 weeks by transepithelial accelerated CXL, and the patients were followed up for 1 year.Results: The preoperative mean uncorrected visual acuity (UCVA was 1.01±0.2 (logMAR, whereas the postoperative mean UCVA was 0.6±0.2. The preoperative mean best-corrected visual acuity (BCVA was 0.6±0.1, whereas the postoperative mean BCVA was 0.40±0.2. The preoperative average keratometry was 50.3±2.7 D, whereas the postoperative average keratometry was 45.8±3.1 D. Conclusion: The results of this study suggest that femtosecond laser-assisted Keraring implantation followed by CXL is safe and effective in the management of keratoconus in children with VKC. However, studies with a longer follow-up period are needed. Keywords: cross-linking plus, intrastromal corneal ring segments, pediatric keratoconus, spring catarrh

  7. Evaluation of retinal nerve fiber layer thickness in vernal keratoconjunctivitis patients under long-term topical corticosteroid therapy.

    Science.gov (United States)

    Cingu, Abdullah Kursat; Cinar, Yasin; Turkcu, Fatih Mehmet; Sahinoglu-Keskek, Nedime; Sahin, Alparslan; Sahin, Muhammed; Yuksel, Harun; Caca, Ihsan

    2014-09-01

    The aim of this study was to evaluate the retinal nerve fiber layer (RNFL) thickness in vernal keratoconjunctivitis (VKC) patients who were under long-term topical corticosteroid therapy. Thirty-six eyes of 36 VKC patients with clear cornea and normal videokeratography and 40 eyes of 40 age- and gender-matched normal children were included in the study. Clinical and demographic characteristics of the patients were noted and detailed ophthalmological examination was performed. Visual acuity (VA), spherical equivalent (SE), axial length (AL) and RNFL thickness measurements were compared between the groups. To correct ocular magnification effect on RNFL, we used Littmann's formula. All VKC patients had history of topical corticosteroid use and the mean duration of the topical corticosteroid use was 23.8 ± 9.09 months. There was no significant difference between the groups in terms of intraocular pressure (IOP). VKC group had significantly worse VA, greater SE and AL and thinner mean global, superior and inferior RNFL thickness. There were significant negative correlations between the duration of topical corticosteroid use and the mean global, superior and temporal RNFL thickness in VKC group. After correction of magnification effect, VKC group still had thinner mean global, superior and inferior RNFL thickness, and significant difference between the groups in inferior RNFL thickness did not disappear. Significant RNFL thickness difference between the groups suggests a possible effect of long-term corticosteroid use in VKC patients. Because visual field (VF) analysis in pediatric patients is difficult to perform and IOP may be illusive, RNFL thickness measurements in addition to routine examinations in VKC patients may help clinicians in their practice.

  8. Comparison between fish and linseed oils administered orally for the treatment of experimentally induced keratoconjunctivitis sicca in rabbits

    Directory of Open Access Journals (Sweden)

    Danielle Alves Silva

    2017-09-01

    Full Text Available The objective of this study was to compare the efficacy of two sources of omega 3 and 6, fish oil (FO and linseed oil (LO, orally administered, alone or in combination, for treating experimentally induced keratoconjunctivitis sicca (KCS in rabbits. Twenty-eight New Zealand rabbits were used in this study. Seven animals were allocated to the C group (negative control, and KCS was induced in 21 animals by topically applying 1% atropine sulfate drops for 7 days. Treatment with atropine was maintained throughout the study period (12 weeks. The rabbits were divided into 3 treatment groups containing 7 animals each: FO group, LO group and FLO group (FO and LO. The animals were evaluated using the Schirmer Tear Test I (STT I, Rose Bengal Test (RBT, fluorescein test (FT, tear film break-up time (TBUT, and conjunctival and histopathological analysis. There was a significant increase in STT I and TBUT values in treatment groups, but the increase occurred earlier in the FO group. The results of the RBT and FT were similar among treatment groups, except FT, in the FLO group, negative staining was only in 12 weeks. There was a significant decrease in the number of goblet cells in the FLO group compared with the other groups. The results demonstrated that orally administered of FO and LO improved the clinical signs of KCS. However, improvement occurred earlier in the FO group. Using oils in combination did not provide additional benefits. These results contribute to the future development of new oral formulations as adjuvant therapies for KCS.

  9. Corneal topographic response to intraocular pressure reduction in patients with vernal keratoconjunctivitis and steroid-induced glaucoma.

    Science.gov (United States)

    Dada, T; Konkal, V; Tandon, R; Singh, R; Sihota, R

    2007-02-01

    To study the corneal topographic response to IOP reduction in vernal keratoconjunctivitis (VKC) with steroid-induced glaucoma. A total of 42 eyes of 21 patients with VKC and steroid-induced glaucoma (Group I) and 66 eyes of 33 patients with VKC without glaucoma (Group II) underwent an evaluation by Orbscan topography. In eyes with glaucoma, the IOP was controlled medically and the corneal topography was repeated at 3 months to evaluate effect on corneal parameters. The mean baseline IOP was 36.40+/-13.08 mmHg in Group I, 14.67+/-4.62 mmHg in Group II (P<0.0001). The IOP after treatment at 3 months follow-up was 15.00+/-5.41 mmHg in Group I (P<0.0001). In Group I, the mean maximum Sim K decreased from 44.86+/-3.21 D to 43.87+/-2.62 D (P=0.031) and mean posterior corneal elevation decreased from 64.9+/-22.36 microm to 35.7+/-28.91 microm at 3 months after reduction of IOP (P=0.001). There was a significant positive correlation between the reduction in the IOP and the decrease in the posterior corneal elevation (r=0.664, P=0.001). Eyes with VKC with and without glaucoma have similar corneal topography. Increased IOP associated with steroid-induced glaucoma and VKC may contribute to an increase in the corneal curvature and posterior corneal elevation. These changes may be reversed by a reduction in the IOP with medical therapy.

  10. Nerve growth factor has a modulatory role on human primary fibroblast cultures derived from vernal keratoconjunctivitis-affected conjunctiva

    Science.gov (United States)

    Micera, Alessandra; Lambiase, Alessandro; Stampachiacchiere, Barbara; Sgrulletta, Roberto; Normando, Eduardo Maria; Bonini, Sergio

    2007-01-01

    Purpose To evaluate the role of nerve growth factor (NGF) in remodeling processes of vernal keratoconjunctivitis (VKC). VKC is a chronic inflammatory disorder of the conjunctiva and is characterized by marked tissue remodeling. NGF, a pleiotrophic factor with documented profibrogenic activities, is produced by inflammatory and structural cells populating the VKC conjunctiva and is increased in the serum and tears of VKC patients. Methods Primary cultures of VKC-derived fibroblasts (VKC-FBs) were exposed to increasing NGF concentrations (1-500 ng/ml) to evaluate and compare the expression of α-smooth muscle actin (αSMA, a defining myofibroblast marker), collagens (types I and IV), and metalloproteinases and tissue inhibitors (MMP9/TIMP1, MMP2/TIMP2) at the biochemical as well as molecular levels. Results Endogenous NGF was increased in the VKC-FB supernatant, as compared to healthy-FB supernatant. VKC-FBs expressed αSMA and increased types I and IV collagens. VKC-FBs, and in particular all αSMA positive cells, expressed both trkANGFR and p75NTR, while healthy-FBs only expressed trkANGFR. Exogenous NGF did not change αSMA expression, while αSMA expression was enhanced by specific neutralization of p75NTR. NGF (10 ng/ml) exposure significantly decreased type I collagen expression, without affecting type IV collagen, and increased MMP9mRNA and protein. Conclusions The autocrine modulation of differentiation and response of VKC-FBs to NGF exposure with downregulation of type I collagen and upregulation of MMP9 expression supports a relevant role for NGF in tissue remodeling of VKC. PMID:17653039

  11. A break in the obesity epidemic?

    DEFF Research Database (Denmark)

    Visscher, T L S; Heitmann, B L; Rissanen, A

    2015-01-01

    epidemic. However, follow-ups of short duration may, in part, explain the apparent break or decrease in the obesity epidemic. On the other hand, a single focus on body mass index (BMI) ⩾25 or ⩾30 kg m(-)(2) is likely to mask a real increase in the obesity epidemic. And, in both children and adults, trends......Recent epidemiologic papers are presenting prevalence data suggesting breaks and decreases in obesity rates. However, before concluding that the obesity epidemic is not increasing anymore, the validity of the presented data should be discussed more thoroughly. We had a closer look...... into the literature presented in recent reviews to address the major potential biases and distortions, and to develop insights about how to interpret the presented suggestions for a potential break in the obesity epidemic. Decreasing participation rates, the use of reported rather than measured data and small sample...

  12. Inferring epidemic contact structure from phylogenetic trees.

    Directory of Open Access Journals (Sweden)

    Gabriel E Leventhal

    Full Text Available Contact structure is believed to have a large impact on epidemic spreading and consequently using networks to model such contact structure continues to gain interest in epidemiology. However, detailed knowledge of the exact contact structure underlying real epidemics is limited. Here we address the question whether the structure of the contact network leaves a detectable genetic fingerprint in the pathogen population. To this end we compare phylogenies generated by disease outbreaks in simulated populations with different types of contact networks. We find that the shape of these phylogenies strongly depends on contact structure. In particular, measures of tree imbalance allow us to quantify to what extent the contact structure underlying an epidemic deviates from a null model contact network and illustrate this in the case of random mixing. Using a phylogeny from the Swiss HIV epidemic, we show that this epidemic has a significantly more unbalanced tree than would be expected from random mixing.

  13. The evaluation of suspected child physical abuse.

    Science.gov (United States)

    Christian, Cindy W

    2015-05-01

    Child physical abuse is an important cause of pediatric morbidity and mortality and is associated with major physical and mental health problems that can extend into adulthood. Pediatricians are in a unique position to identify and prevent child abuse, and this clinical report provides guidance to the practitioner regarding indicators and evaluation of suspected physical abuse of children. The role of the physician may include identifying abused children with suspicious injuries who present for care, reporting suspected abuse to the child protection agency for investigation, supporting families who are affected by child abuse, coordinating with other professionals and community agencies to provide immediate and long-term treatment to victimized children, providing court testimony when necessary, providing preventive care and anticipatory guidance in the office, and advocating for policies and programs that support families and protect vulnerable children. Copyright © 2015 by the American Academy of Pediatrics.

  14. Suspects in criminal investigations of rape

    Directory of Open Access Journals (Sweden)

    Marinković Darko

    2014-01-01

    Full Text Available Investigations of sexual assaults mostly focus on victims and their credibility, which may cause lack of firm evidence in relation to suspects. Given the fact that the criminal offence of rape is characterised by a high incidence of false reports and accusations, frequently indicating specific persons as the perpetrators, certain caution is necessary in the investigation in order to avoid false accusations and/or convictions. As regards the personality of the rapist and motives for committing a forcible sexual act, certain types or rather certain categories of perpetrators can be distinguished, although it should be noted that a large number of rapists do not belong to one category only, but rather combine characteristics of several different types. During a criminal investigation it is of vital importance to differentiate between a rape as a surprise attack and a rape as abuse of trust, as they are compatible with the nature of the suspect's defence. The suspect shall be subjected to a forensic examination in the course of the investigation in order to find traces which prove vaginal, anal or oral penetration, coerced sexual intercourse and identity of the rapist. While conducting an interrogation of a suspected rapist, a crime investigating officer shall use either factual or emotional approach to his interviewee, depending on his psychological and motivational characteristics. In this regard, the factual approach is believed to be more efficient with anger rapists and sadistic rapists, whereas the compassionate approach gives good results with the gentlemen-rapists and partly with the power asserting rapists.

  15. Glaucoma suspect & Humphrey Field Analyzer a correlation

    Directory of Open Access Journals (Sweden)

    P Dahal

    2012-09-01

    Full Text Available Glaucoma originally meant "clouded", in Greek.The term glaucoma refers to a group of diseases that have in common characteristic optic neuropathy with associated visual field loss for which elevated intraocular pressure is one of the primary risk factor. The purpose of the study is to correlate the clinically diagnosed cases of glaucoma suspect with the Humphrey Field Analyzer (HFA. Fifty cases of glaucoma suspect who attended the glaucoma clinic of Nepal Eye Hospital Tripureswor, Kathmandu, Nepal and who meets at least two criteria, among the four types of glaucoma suspects were advised for the HFA for the study. In this study out of 50 patient, 36 (72% patients had normal visual field. 14 (28% patients had thinning of the neural retinal rim (NRR in both eyes. The significant relation with thinning of neural retina rim and glaucomatous hemifield test was found in the study. Journal of College of Medical Sciences-Nepal,2012,Vol-8,No-1, 23-28 DOI: http://dx.doi.org/10.3126/jcmsn.v8i1.6822

  16. Tocolytics for suspected intrapartum fetal distress.

    Science.gov (United States)

    Kulier, R; Hofmeyr, G J

    2000-01-01

    Prophylactic tocolysis with betamimetics and other agents has become widespread as a treatment for fetal distress. Uterine relaxation may improve placental blood flow and therefore fetal oxygenation. However there may also be adverse maternal cardiovascular effects. The objective of this review was to assess the effects of tocolytic therapy for suspected fetal distress on fetal, maternal and perinatal outcomes. We searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register. Date of last search: February 1999. Randomised trials comparing tocolytic therapy with no treatment or treatment with another tocolytic agent for suspected fetal distress. Two reviewers assessed trial quality and extracted data. Three studies were included. Compared with no treatment, there were fewer failed improvements in fetal heart rate abnormalities with tocolytic therapy (relative risk 0.26, 95% 0.13 to 0.53). Betamimetic therapy compared with magnesium sulphate showed a non-significant trend towards reduced uterine activity (relative risk 0.07, 95% confidence interval 0.00 to 1.10). Betamimetic therapy appears to be able to reduce the number of fetal heart rate abnormalities and perhaps reduce uterine activity. However there is not enough evidence based on clinically important outcomes to evaluate the use of betamimetics for suspected fetal distress.

  17. Intracellular IL-4, IL-5, and IFN-γ as the main characteristic of CD4+CD30+ T cells after allergen stimulation in patients with vernal keratoconjunctivitis.

    Science.gov (United States)

    Magaña, Diana; Aguilar, Gustavo; Linares, Marisela; Ayala-Balboa, Julio; Santacruz, Concepción; Chávez, Raúl; Estrada-Parra, Sergio; Garfias, Yonathan; Lascurain, Ricardo; Jiménez-Martínez, Maria C

    2015-01-01

    Vernal keratoconjunctivitis (VKC) is a severe form of allergic conjunctivitis, in which inflammatory infiltrates of the conjunctiva are characterized by CD3+ and CD30+ cells. Until today, the functional involvement of CD30+ T cells in VKC was unclear. Our aim was to evaluate the functional characteristics of CD30+ T cells after allergen stimulation in peripheral blood mononuclear cells obtained from patients with VKC. Seventeen consecutive patients at the Institute of Ophthalmology with active forms of VKC were included. After allergen stimulation, we observed the frequency of CD30+ T cells increased compared with non-stimulated cells (pkeratoconjunctivitis, compared with healthy controls (p=0.03). Blockage with IL-4 significantly diminished CD30 frequency in the allergen-stimulated cells. Our results suggest that after allergenic stimulation, CD4+CD30+ cells are the most important source of IL-4, IL-5, and IFN-γ. IL-4 acts as an activation loop that increases CD30 expression on T cells after specific stimulation. These findings suggest that CD4+CD30+ T cells are effector cells and play a significant role in the immune pathogenic response in patients with vernal keratoconjunctivitis.

  18. Response Strategies against Meningitis Epidemics after Elimination of Serogroup A Meningococci, Niger.

    Science.gov (United States)

    Maïnassara, Halima Boubacar; Paireau, Juliette; Idi, Issa; Pelat, Jean-Paul Moulia; Oukem-Boyer, Odile Ouwe Missi; Fontanet, Arnaud; Mueller, Judith E

    2015-08-01

    To inform epidemic response strategies for the African meningitis belt after a meningococcal serogroup A conjugate vaccine was introduced in 2010, we compared the effectiveness and efficiency of meningitis surveillance and vaccine response strategies at district and health area levels using various thresholds of weekly incidence rates. We analyzed reports of suspected cases from 3 regions in Niger during 2002-2012 (154,392 health area weeks), simulating elimination of serogroup A meningitis by excluding health area years with identification of such cases. Effectiveness was highest for health area surveillance and district vaccination (58-366 cases; thresholds 7-20 cases/100,000 doses), whereas efficiency was optimized with health area vaccination (5.6-7.7 cases/100,000 doses). District-level intervention prevented meningitis epidemic response after elimination of serogroup A meningitis.

  19. The Narcissism Epidemic Is Dead; Long Live the Narcissism Epidemic.

    Science.gov (United States)

    Wetzel, Eunike; Brown, Anna; Hill, Patrick L; Chung, Joanne M; Robins, Richard W; Roberts, Brent W

    2017-12-01

    Are recent cohorts of college students more narcissistic than their predecessors? To address debates about the so-called "narcissism epidemic," we used data from three cohorts of students (1990s: N = 1,166; 2000s: N = 33,647; 2010s: N = 25,412) to test whether narcissism levels (overall and specific facets) have increased across generations. We also tested whether our measure, the Narcissistic Personality Inventory (NPI), showed measurement equivalence across the three cohorts, a critical analysis that had been overlooked in prior research. We found that several NPI items were not equivalent across cohorts. Models accounting for nonequivalence of these items indicated a small decline in overall narcissism levels from the 1990s to the 2010s ( d = -0.27). At the facet level, leadership ( d = -0.20), vanity ( d = -0.16), and entitlement ( d = -0.28) all showed decreases. Our results contradict the claim that recent cohorts of college students are more narcissistic than earlier generations of college students.

  20. Pre-admission antibiotics for suspected cases of meningococcal disease.

    Science.gov (United States)

    Sudarsanam, Thambu D; Rupali, Priscilla; Tharyan, Prathap; Abraham, Ooriapadickal Cherian; Thomas, Kurien

    2013-08-02

    Meningococcal disease can lead to death or disability within hours after onset. Pre-admission antibiotics aim to reduce the risk of serious disease and death by preventing delays in starting therapy before confirmation of the diagnosis. To study the effectiveness and safety of pre-admission antibiotics versus no pre-admission antibiotics or placebo, and different pre-admission antibiotic regimens in decreasing mortality, clinical failure and morbidity in people suspected of meningococcal disease. We updated searches of CENTRAL (2013, Issue 4), MEDLINE (1966 to April week 4, 2013), EMBASE (1980 to May 2013), Web of Science (1985 to May 2013), CAB Abstracts (1985 to May 2013), LILACS (1982 to May 2013) and prospective trials registries to May 2013. Randomised controlled trials (RCTs) or quasi-RCTs comparing antibiotics versus placebo or no intervention, in people with suspected meningococcal infection, or different antibiotics administered before admission to hospital or confirmation of the diagnosis. Two review authors independently assessed trial quality and extracted data from the search results. We calculated the risk ratio (RR) and 95% confidence interval (CI) for dichotomous data. We included only one trial so data synthesis was not performed. We assessed the overall quality of the evidence using the GRADE approach. We found no RCTs that compared pre-admission antibiotics versus no pre-admission antibiotics or placebo. One open-label, non-inferiority RCT, conducted during an epidemic in Niger, evaluated a single dose of intramuscular ceftriaxone versus a single dose of intramuscular long-acting (oily) chloramphenicol. Ceftriaxone was not inferior to chloramphenicol in reducing mortality (RR 1.2, 95% CI 0.6 to 2.6; N = 503; 308 confirmed meningococcal meningitis; 26 deaths; moderate-quality evidence), clinical failures (RR 0.8, 95% CI 0.3 to 2.2; N = 477, 18 clinical failures; moderate-quality evidence) or neurological sequelae (RR 1.3, 95% CI 0.6 to 2.6; N

  1. Predicting extinction rates in stochastic epidemic models

    Science.gov (United States)

    Schwartz, Ira B.; Billings, Lora; Dykman, Mark; Landsman, Alexandra

    2009-01-01

    We investigate the stochastic extinction processes in a class of epidemic models. Motivated by the process of natural disease extinction in epidemics, we examine the rate of extinction as a function of disease spread. We show that the effective entropic barrier for extinction in a susceptible-infected-susceptible epidemic model displays scaling with the distance to the bifurcation point, with an unusual critical exponent. We make a direct comparison between predictions and numerical simulations. We also consider the effect of non-Gaussian vaccine schedules, and show numerically how the extinction process may be enhanced when the vaccine schedules are Poisson distributed.

  2. Using Phenomenological Models to Characterize Transmissibility and Forecast Patterns and Final Burden of Zika Epidemics

    DEFF Research Database (Denmark)

    Chowell, Gerardo; Hincapie-Palacio, Doracelly; Ospina, Juan

    2016-01-01

    BACKGROUND: The World Health Organization declared the ongoing Zika virus (ZIKV) epidemic in the Americas a Public Health Emergency of International Concern on February 1, 2016. ZIKV disease in humans is characterized by a "dengue-like" syndrome including febrile illness and rash. However, ZIKV...... impact. METHODS: We obtained daily counts of suspected Zika cases by date of symptoms onset from the Secretary of Health of Antioquia, Colombia during January-April 2016. We calibrated the generalized Richards model, a phenomenological model that accommodates a variety of early exponential and sub...

  3. Prevalence of glaucoma suspects and pattern of intra-ocular ...

    African Journals Online (AJOL)

    Background: Glaucoma is the commonest cause of irreversible blindness in the world. Some glaucoma patients start out as glaucoma suspects for years. Aim: To determine the prevalence of glaucoma suspects and pattern of intra-ocular pressure distribution in glaucoma suspects. Methods: This survey was carried out in ...

  4. Nuclear Pedigree Criteria of Suspected HNPCC

    Directory of Open Access Journals (Sweden)

    Kładny Józef

    2003-01-01

    Full Text Available Abstract The criteria for the diagnosis of HNPCC established by the ICG-HNPCC are very restrictive as they do not allow for the diagnosis of a large number of "suspected HNPCC" cases - these are families which do no fulfill the strict diagnostic "Amsterdam criteria", but do present with several pedigree and clinical features characteristic for HNPCC. Several series of families suspected of harboring germline mutations in DNA mismatch repair genes have been studied for germline changes in DNA mismatch repair genes and a mutation rate of somewhere between 8-60% was found. Therefore a subgroup of members of the ICG-HNPCC has been working on pedigree/clinical diagnostic criteria for suspected HNPCC. Materials and methods Part I The study was based on two series of colorectal cancer (CRC cases: 1 HNPCC - this group comprised 190 patients affected by CRC from randomly selected families which fulfilled the Amsterdam II criteria registered in Düsseldorf, Germany (102 cases of CRC, Denmark (18 CRCs, Leiden, Holland (23 CRCs and Szczecin, Poland (47 CRCs. 2 Consecutive CRCs - this group comprised 629 (78.0% of 806 individuals with CRC diagnosed in 1991-1997 in the city of Szczecin (ca. 400,000 of inhabitants, Poland. Nuclear pedigrees in both groups were compared for frequency of occurrence of clinical features, that have been shown to be associated with HNPCC. Part II 52 consecutive CRC cases from Szczecin, matching the criteria recognized in part I as appropriate for diagnosis of cases "suspected of HNPCC" were studied for the occurrence of germline hMSH2/hMLH1 constitutional mutations using "exon by exon" sequencing. Results The combination of features - i.e. the occurrence of an HNPCC associated cancer (CRC or cancer of the endometrium, small bowel or urinary tract in a 1st degree relative of a CRC patient; at least one of the patients being diagnosed under age of 50 - appeared to be strongly associated to HNPCC with an OR - 161. Constitutional

  5. Spatiotemporal Dynamics of Dengue Epidemics, Southern Vietnam

    Science.gov (United States)

    Cuong, Hoang Quoc; Vu, Nguyen Thanh; Cazelles, Bernard; Boni, Maciej F.; Thai, Khoa T.D.; Rabaa, Maia A.; Quang, Luong Chan; Simmons, Cameron P.; Huu, Tran Ngoc

    2013-01-01

    An improved understanding of heterogeneities in dengue virus transmission might provide insights into biological and ecologic drivers and facilitate predictions of the magnitude, timing, and location of future dengue epidemics. To investigate dengue dynamics in urban Ho Chi Minh City and neighboring rural provinces in Vietnam, we analyzed a 10-year monthly time series of dengue surveillance data from southern Vietnam. The per capita incidence of dengue was lower in Ho Chi Minh City than in most rural provinces; annual epidemics occurred 1–3 months later in Ho Chi Minh City than elsewhere. The timing and the magnitude of annual epidemics were significantly more correlated in nearby districts than in remote districts, suggesting that local biological and ecologic drivers operate at a scale of 50–100 km. Dengue incidence during the dry season accounted for 63% of variability in epidemic magnitude. These findings can aid the targeting of vector-control interventions and the planning for dengue vaccine implementation. PMID:23735713

  6. Competing activation mechanisms in epidemics on networks

    Science.gov (United States)

    Castellano, Claudio; Pastor-Satorras, Romualdo

    2012-04-01

    In contrast to previous common wisdom that epidemic activity in heterogeneous networks is dominated by the hubs with the largest number of connections, recent research has pointed out the role that the innermost, dense core of the network plays in sustaining epidemic processes. Here we show that the mechanism responsible of spreading depends on the nature of the process. Epidemics with a transient state are boosted by the innermost core. Contrarily, epidemics allowing a steady state present a dual scenario, where either the hub independently sustains activity and propagates it to the rest of the system, or, alternatively, the innermost network core collectively turns into the active state, maintaining it globally. In uncorrelated networks the former mechanism dominates if the degree distribution decays with an exponent larger than 5/2, and the latter otherwise. Topological correlations, rife in real networks, may perturb this picture, mixing the role of both mechanisms.

  7. The system of the epidemic process.

    Science.gov (United States)

    Cherkasskii, B L

    1988-01-01

    An original social-ecological concept of the epidemic process has been constructed on the basis of using social ecology, systemic approach and the basic principles of cybernetics. According to this concept, the epidemic process is regarded as a biosocial, hierarchic, integral system providing for the reproduction of the species of human parasites. At a higher level of organization, the epidemic process is an epidemiological social-ecological system consisting of two interacting subsystems: the biological (epidemiological ecosystem) and the social (social and economic conditions of life of the society) subsystems where the biological subsystem plays the role of the governed object and the social acts as the internal regulator of these interactions. On the basis of this concept a rational structure of the system of epidemiological surveillance over infectious diseases has been proposed according to which each level of the structure of the epidemic process should be subject to adequate monitoring.

  8. Modeling Epidemics Spreading on Social Contact Networks.

    Science.gov (United States)

    Zhang, Zhaoyang; Wang, Honggang; Wang, Chonggang; Fang, Hua

    2015-09-01

    Social contact networks and the way people interact with each other are the key factors that impact on epidemics spreading. However, it is challenging to model the behavior of epidemics based on social contact networks due to their high dynamics. Traditional models such as susceptible-infected-recovered (SIR) model ignore the crowding or protection effect and thus has some unrealistic assumption. In this paper, we consider the crowding or protection effect and develop a novel model called improved SIR model. Then, we use both deterministic and stochastic models to characterize the dynamics of epidemics on social contact networks. The results from both simulations and real data set conclude that the epidemics are more likely to outbreak on social contact networks with higher average degree. We also present some potential immunization strategies, such as random set immunization, dominating set immunization, and high degree set immunization to further prove the conclusion.

  9. Epidemic spreading on weighted complex networks

    Energy Technology Data Exchange (ETDEWEB)

    Sun, Ye [Institute of Information Economy, Hangzhou Normal University, Hangzhou 311121 (China); Alibaba Research Center of Complexity Science, Hangzhou Normal University, Hangzhou 311121 (China); Liu, Chuang, E-mail: liuchuang@hznu.edu.cn [Institute of Information Economy, Hangzhou Normal University, Hangzhou 311121 (China); Alibaba Research Center of Complexity Science, Hangzhou Normal University, Hangzhou 311121 (China); Zhang, Chu-Xu [Institute of Information Economy, Hangzhou Normal University, Hangzhou 311121 (China); Alibaba Research Center of Complexity Science, Hangzhou Normal University, Hangzhou 311121 (China); Zhang, Zi-Ke, E-mail: zhangzike@gmail.com [Institute of Information Economy, Hangzhou Normal University, Hangzhou 311121 (China); Alibaba Research Center of Complexity Science, Hangzhou Normal University, Hangzhou 311121 (China)

    2014-01-31

    Nowadays, the emergence of online services provides various multi-relation information to support the comprehensive understanding of the epidemic spreading process. In this Letter, we consider the edge weights to represent such multi-role relations. In addition, we perform detailed analysis of two representative metrics, outbreak threshold and epidemic prevalence, on SIS and SIR models. Both theoretical and simulation results find good agreements with each other. Furthermore, experiments show that, on fully mixed networks, the weight distribution on edges would not affect the epidemic results once the average weight of whole network is fixed. This work may shed some light on the in-depth understanding of epidemic spreading on multi-relation and weighted networks.

  10. Clinical evaluation of a nutraceutical diet as an adjuvant to pharmacological treatment in dogs affected by Keratoconjunctivitis sicca.

    Science.gov (United States)

    Destefanis, Simona; Giretto, Daniela; Muscolo, Maria Cristina; Di Cerbo, Alessandro; Guidetti, Gianandrea; Canello, Sergio; Giovazzino, Angela; Centenaro, Sara; Terrazzano, Giuseppe

    2016-09-22

    Canine keratoconjunctivitis sicca (cKCS) is an inflammatory eye condition related to a deficiency in the tear aqueous fraction. Etiopathogenesis of such disease is substantially multifactorial, combining the individual genetic background with environmental factors that contribute to the process of immunological tolerance disruption and, as a consequence, to the emergence of autoimmunity disease. In this occurrence, it is of relevance the role of the physiological immune-dysregulation that results in immune-mediated processes at the basis of cKCS. Current therapies for this ocular disease rely on immunosuppressive treatments. Clinical response to treatment frequently varies from poor to good, depending on the clinical-pathological status of eyes at diagnosis and on individual response to therapy. In the light of the variability of clinical response to therapies, we evaluated the use of an anti-inflammatory/antioxidant nutraceutical diet with potential immune-modulating activity as a therapeutical adjuvant in cKCS pharmacological treatment. Such combination was administered to a cohort of dogs affected by cKCS in which the only immunosuppressive treatment resulted poorly responsive or ineffective in controlling the ocular symptoms. Fifty dogs of different breeds affected by immune-mediated cKCS were equally distributed and randomly assigned to receive either a standard diet (control, n = 25) or the nutraceutical diet (treatment group, n = 25) both combined with standard immunosuppressive therapy over a 60 days period. An overall significant improvement of all clinical parameters (tear production, conjunctival inflammation, corneal keratinization, corneal pigment density and mucus discharge) and the lack of food-related adverse reactions were observed in the treatment group (p < 0.0001). Our results showed that the association of traditional immune-suppressive therapy with the antioxidant/anti-inflammatory properties of the nutraceutical diet resulted in

  11. Genetic parameters of infectious bovine keratoconjunctivitis and its relationship with weight and parasite infestations in Australian tropical Bos taurus cattle.

    Science.gov (United States)

    Ali, Abdirahman A; O'Neill, Christopher J; Thomson, Peter C; Kadarmideen, Haja N

    2012-07-27

    Infectious bovine keratoconjunctivitis (IBK) or 'pinkeye' is an economically important ocular disease that significantly impacts animal performance. Genetic parameters for IBK infection and its genetic and phenotypic correlations with cattle tick counts, number of helminth (unspecified species) eggs per gram of faeces and growth traits in Australian tropically adapted Bos taurus cattle were estimated. Animals were clinically examined for the presence of IBK infection before and after weaning when the calves were 3 to 6 months and 15 to 18 months old, respectively and were also recorded for tick counts, helminth eggs counts as an indicator of intestinal parasites and live weights at several ages including 18 months. Negative genetic correlations were estimated between IBK incidence and weight traits for animals in pre-weaning and post-weaning datasets. Genetic correlations among weight measurements were positive, with moderate to high values. Genetic correlations of IBK incidence with tick counts were positive for the pre-weaning and negative for the post-weaning datasets but negative with helminth eggs counts for the pre-weaning dataset and slightly positive for the post-weaning dataset. Genetic correlations between tick and helminth eggs counts were moderate and positive for both datasets. Phenotypic correlations of IBK incidence with helminth eggs per gram of faeces were moderate and positive for both datasets, but were close to zero for both datasets with tick counts. Our results suggest that genetic selection against IBK incidence in tropical cattle is feasible and that calves genetically prone to acquire IBK infection could also be genetically prone to have a slower growth. The positive genetic correlations among weight traits and between tick and helminth eggs counts suggest that they are controlled by common genes (with pleiotropic effects). Genetic correlations between IBK incidence and tick and helminth egg counts were moderate and opposite between pre

  12. Genetic parameters of infectious bovine keratoconjunctivitis and its relationship with weight and parasite infestations in Australian tropical Bos taurus cattle

    Directory of Open Access Journals (Sweden)

    Ali Abdirahman A

    2012-07-01

    Full Text Available Abstract Background Infectious bovine keratoconjunctivitis (IBK or ‘pinkeye’ is an economically important ocular disease that significantly impacts animal performance. Genetic parameters for IBK infection and its genetic and phenotypic correlations with cattle tick counts, number of helminth (unspecified species eggs per gram of faeces and growth traits in Australian tropically adapted Bos taurus cattle were estimated. Methods Animals were clinically examined for the presence of IBK infection before and after weaning when the calves were 3 to 6 months and 15 to 18 months old, respectively and were also recorded for tick counts, helminth eggs counts as an indicator of intestinal parasites and live weights at several ages including 18 months. Results Negative genetic correlations were estimated between IBK incidence and weight traits for animals in pre-weaning and post-weaning datasets. Genetic correlations among weight measurements were positive, with moderate to high values. Genetic correlations of IBK incidence with tick counts were positive for the pre-weaning and negative for the post-weaning datasets but negative with helminth eggs counts for the pre-weaning dataset and slightly positive for the post-weaning dataset. Genetic correlations between tick and helminth eggs counts were moderate and positive for both datasets. Phenotypic correlations of IBK incidence with helminth eggs per gram of faeces were moderate and positive for both datasets, but were close to zero for both datasets with tick counts. Conclusions Our results suggest that genetic selection against IBK incidence in tropical cattle is feasible and that calves genetically prone to acquire IBK infection could also be genetically prone to have a slower growth. The positive genetic correlations among weight traits and between tick and helminth eggs counts suggest that they are controlled by common genes (with pleiotropic effects. Genetic correlations between IBK incidence

  13. Detecting nonlinearity and chaos in epidemic data

    Energy Technology Data Exchange (ETDEWEB)

    Ellner, S.; Gallant, A.R. [North Carolina State Univ., Raleigh, NC (United States). Dept. of Statistics; Theiler, J. [Santa Fe Inst., NM (United States)]|[Los Alamos National Lab., NM (United States)

    1993-08-01

    Historical data on recurrent epidemics have been central to the debate about the prevalence of chaos in biological population dynamics. Schaffer and Kot who first recognized that the abundance and accuracy of disease incidence data opened the door to applying a range of methods for detecting chaos that had been devised in the early 1980`s. Using attractor reconstruction, estimates of dynamical invariants, and comparisons between data and simulation of SEIR models, the ``case for chaos in childhood epidemics`` was made through a series of influential papers beginning in the mid 1980`s. The proposition that the precise timing and magnitude of epidemic outbreaks are deterministic but chaotic is appealing, since it raises the hope of finding determinism and simplicity beneath the apparently stochastic and complicated surface of the data. The initial enthusiasm for methods of detecting chaos in data has been followed by critical re-evaluations of their limitations. Early hopes of a ``one size fits all`` algorithm to diagnose chaos vs. noise in any data set have given way to a recognition that a variety of methods must be used, and interpretation of results must take into account the limitations of each method and the imperfections of the data. Our goals here are to outline some newer methods for detecting nonlinearity and chaos that have a solid statistical basis and are suited to epidemic data, and to begin a re-evaluation of the claims for nonlinear dynamics and chaos in epidemics using these newer methods. We also identify features of epidemic data that create problems for the older, better known methods of detecting chaos. When we ask ``are epidemics nonlinear?``, we are not questioning the existence of global nonlinearities in epidemic dynamics, such as nonlinear transmission rates. Our question is whether the data`s deviations from an annual cyclic trend (which would reflect global nonlinearities) are described by a linear, noise-driven stochastic process.

  14. Epidemics and rumours in complex networks

    CERN Document Server

    Draief, Moez

    2009-01-01

    Information propagation through peer-to-peer systems, online social systems, wireless mobile ad hoc networks and other modern structures can be modelled as an epidemic on a network of contacts. Understanding how epidemic processes interact with network topology allows us to predict ultimate course, understand phase transitions and develop strategies to control and optimise dissemination. This book is a concise introduction for applied mathematicians and computer scientists to basic models, analytical tools and mathematical and algorithmic results. Mathematical tools introduced include coupling

  15. [The history of cholera epidemics in Israel].

    Science.gov (United States)

    Schwartz, Eli; Bar-El, Dan; Schur, Natan

    2005-05-01

    During the years 1831-1918 Israel (Palestine at that time) suffered from repeated cholera epidemics. The cholera epidemics were the major cause of severe health crisis among the population. The epidemics were transmitted by returening pilgrims returning from Mecca and, during the first world War, by the Turkish soldiers crossing the country. The disease caused panic amongst the population due to its high mortality rate. Quarantine which was the major measure taken by the government at that time was repeatedly broken by people trying to escape from the affected area. During the epidemic of 1902, patients were even reluctant to be treated by physicians as they were blamed for causing death. On the other hand, cholera was a major trigger for maintaining a better sanitation and establishing social relief systems within the communities. Most of the epidemics occurred in the old cities such as Jerusalem, Tiberia and Jaffa where infrastructure was inadequate. Cholera outbreaks were the trigger to build outside the old cities as in case of Jerusalem in which after the 1865 outbreak the city was expanded outside the walls. Since the end of the Ottoman period in Israel, cholera epidemics ceased, and except for very small occeasional small outbreaks, cholera is not seen here more.

  16. Phylodynamic analysis of HIV sub-epidemics in Mochudi, Botswana

    Directory of Open Access Journals (Sweden)

    Vlad Novitsky

    2015-12-01

    Real-time HIV genotyping and breaking down local HIV epidemics into phylogenetically distinct sub-epidemics may help to reveal the structure and dynamics of HIV transmission networks in communities, and aid in the design of targeted interventions for members of the acute sub-epidemics that likely fuel local HIV/AIDS epidemics.

  17. Ceratoconjuntivite cicatricial bilateral associada a líquen plano: relato de caso Lichen planus leading to bilateral cicatrizing keratoconjunctivitis: case report

    Directory of Open Access Journals (Sweden)

    Camila Melo Gadelha Pereira Diniz

    2008-12-01

    Full Text Available Descrevemos um caso de ceratoconjuntivite cicatricial bilateral em uma paciente portadora de líquen plano e apresentamos revisão da literatura mundial sobre esse assunto. Cicatrização conjuntival, com formação de simbléfaro, olho seco, infiltração corneana, neovascularização e afinamento foram os sinais observados. Diagnóstico foi baseado nos achados clínicos e biópsia, após exclusão das causas típicas de ceratoconjuntivite cicatricial.To describe a case of bilateral cicatrizing keratoconjunctivitis in a patient with lichen planus and review the literature. Conjunctiva cicatrization with symblepharon formation, dry eye, corneal infiltration and neovascularization and thinning were the most observed prominent signs. Diagnosis was based on clinical findings and biopsy, after exclusion of typical causes of cicatricial keratoconjuntivitis.

  18. Uso da medicação homeopática no tratamento da ceratoconjuntivite primaveril: resultados iniciais Treatment of vernal keratoconjunctivitis with homeopathic medicine: a preliminary report

    Directory of Open Access Journals (Sweden)

    Cláudio Maciel de Sena

    2003-01-01

    Full Text Available OBJETIVO: Apresentar os primeiros resultados do uso da Homeopatia entre os pacientes com conjuntivite primaveril, avaliados no Serviço de Córnea e Doenças Externas do Hospital São Geraldo. MÉTODOS: Foram incluídos no presente estudo 13 pacientes apresentando ceratoconjuntivite primaveril, examinados no período de janeiro de 1998 a dezembro de 1999. A idade média dos pacientes foi de 9,5 anos, sendo nove do sexo masculino e quatro do sexo feminino. Todos os pacientes já haviam feito uso de corticóide tópico antes da sua inclusão no estudo. Antes de iniciar o tratamento homeopático, todos os pacientes foram examinados por um dos autores, sendo acompanhados pelo mesmo médico, mensalmente até os seis meses e depois trimestralmente até completar um ano do tratamento homeopático. O tratamento homeopático foi realizado por meio de uma dose única, via oral, baseando-se na totalidade sintomática do paciente. RESULTADOS: A porcentagem de melhora dos sinais e sintomas, entre os pacientes, foi de: lacrimejamento e dor ocular 100%; secreção ocular 92%; sensação de corpo estranho 86%; prurido e fotofobia 84%; relatavam diminuição ou ausência do desconforto que a ceratoconjuntivite primaveril provocava nas suas atividades diárias 84%; nódulos de Trantas 62,5%; hiperemia conjuntival 61%; erosões epiteliais 58% e hipertrofia da papila tarsal 8%. CONCLUSÃO: Este estudo sugere efeito benéfico da medicação homeopática no tratamento da ceratoconjuntivite primaveril, com melhora dos sinais e sintomas da doença. Sugere-se a realização de estudo duplo-cego, com maior número de casos, para a confirmação desses resultados.PURPOSE: To present a preliminary report of homeopathic medicine in the treatment of vernal keratoconjunctivitis, at the Cornea service, of the São Geraldo Hospital. METHODS: Thirteen patients with vernal keratoconjunctivitis, examined from January 1998 to December 1999, were included in the present study

  19. Epidemics in networks with nodal self-infection and the epidemic threshold

    NARCIS (Netherlands)

    Van Mieghem, P.F.A.; Cator, E.

    2012-01-01

    Since the Susceptible-Infected-Susceptible (SIS) epidemic threshold is not precisely defined in spite of its practical importance, the classical SIS epidemic process has been generalized to the ??SIS model, where a node possesses a self-infection rate ?, in addition to a link infection rate ? and a

  20. Epidemic cycling in a multi-strain SIRS epidemic network model.

    Science.gov (United States)

    Zhang, Xu-Sheng

    2016-04-18

    One common observation in infectious diseases caused by multi-strain pathogens is that both the incidence of all infections and the relative fraction of infection with each strain oscillate with time (i.e., so-called Epidemic cycling). Many different mechanisms have been proposed for the pervasive nature of epidemic cycling. Nevertheless, the two facts that people contact each other through a network rather than following a simple mass-action law and most infectious diseases involve multiple strains have not been considered together for their influence on the epidemic cycling. To demonstrate how the structural contacts among people influences the dynamical patterns of multi-strain pathogens, we investigate a two strain epidemic model in a network where every individual randomly contacts with a fixed number of other individuals. The standard pair approximation is applied to describe the changing numbers of individuals in different infection states and contact pairs. We show that spatial correlation due to contact network and interactions between strains through both ecological interference and immune response interact to generate epidemic cycling. Compared to one strain epidemic model, the two strain model presented here can generate epidemic cycling within a much wider parameter range that covers many infectious diseases. Our results suggest that co-circulation of multiple strains within a contact network provides an explanation for epidemic cycling.

  1. Contact Tracing Activities during the Ebola Virus Disease Epidemic in Kindia and Faranah, Guinea, 2014.

    Science.gov (United States)

    Dixon, Meredith G; Taylor, Melanie M; Dee, Jacob; Hakim, Avi; Cantey, Paul; Lim, Travis; Bah, Hawa; Camara, Sékou Mohamed; Ndongmo, Clement B; Togba, Mory; Touré, Leonie Yvonne; Bilivogui, Pepe; Sylla, Mohammed; Kinzer, Michael; Coronado, Fátima; Tongren, Jon Eric; Swaminathan, Mahesh; Mandigny, Lise; Diallo, Boubacar; Seyler, Thomas; Rondy, Marc; Rodier, Guénaël; Perea, William A; Dahl, Benjamin

    2015-11-01

    The largest recorded Ebola virus disease epidemic began in March 2014; as of July 2015, it continued in 3 principally affected countries: Guinea, Liberia, and Sierra Leone. Control efforts include contact tracing to expedite identification of the virus in suspect case-patients. We examined contact tracing activities during September 20-December 31, 2014, in 2 prefectures of Guinea using national and local data about case-patients and their contacts. Results show less than one third of case-patients (28.3% and 31.1%) were registered as contacts before case identification; approximately two thirds (61.1% and 67.7%) had no registered contacts. Time to isolation of suspected case-patients was not immediate (median 5 and 3 days for Kindia and Faranah, respectively), and secondary attack rates varied by relationships of persons who had contact with the source case-patient and the type of case-patient to which a contact was exposed. More complete contact tracing efforts are needed to augment control of this epidemic.

  2. Epidemic polyarthritis (Ross River) virus infection in the Cook Islands.

    Science.gov (United States)

    Rosen, L; Gubler, D J; Bennett, P H

    1981-11-01

    An epidemic of Ross River virus infection occurred in the Cook Islands early in 1980 and affected the majority of the inhabitants of Rarotonga, the most populated island in the group. This represents the easternmost extension of the virus which, until 1979, was believed limited to Australia, New Guinea, and the Solomon Islands. The clinical manifestations of Ross River disease, predominantly polyarthritis, did not differ significantly from those observed previously in Australia. However, unlike the experience in Australia, where Ross River virus has never been isolated from a patient with polyarthritis, the agent was recovered from the serum of one-half of approximately 100 such patients with serologically proven infections. It is not known if this latter observation is the result of a change in the virus, the different virus isolation technique employed, or other factors. It was found that the incubation period of the disease could be as short as 3 days--much less than previously suspected. Ross River virus was isolated from six pools of Aedes polynesiensis mosquitoes collected in nature and it appeared that this species was the most probable vector on Rarotonga. In view of the widespread distribution of Ae. polynesiensis on islands, in the eastern Pacific it would not be surprising if Ross River virus occurs in other previously unaffected areas in the future.

  3. Epidemic Spreading in Random Rectangular Networks

    CERN Document Server

    Estrada, Ernesto; Moreno, Yamir

    2015-01-01

    Recently, Estrada and Sheerin (Phys. Rev. E 91, 042805 (2015)) developed the random rectangular graph (RRG) model to account for the spatial distribution of nodes in a network allowing the variation of the shape of the unit square commonly used in random geometric graphs (RGGs). Here, we consider an epidemics dynamics taking place on the nodes and edges of an RRG and we derive analytically a lower bound for the epidemic threshold for a Susceptible-Infected-Susceptible (SIS) or Susceptible-Infected-Recovered (SIR) model on these networks. Using extensive numerical simulations of the SIS dynamics we show that the lower bound found is very tight. We conclude that the elongation of the area in which the nodes are distributed makes the network more resilient to the propagation of an epidemics due to the fact that the epidemic threshold increases with the elongation of the rectangle. On the other hand, using the "classical" RGG for modeling epidemics on non-squared cities generates a larger error due to the effects...

  4. Epidemic spreading with information-driven vaccination

    Science.gov (United States)

    Ruan, Zhongyuan; Tang, Ming; Liu, Zonghua

    2012-09-01

    Epidemic spreading has been well studied in the past decade, where the main concentration is focused on the influence of network topology but little attention is paid to the individual's crisis awareness. We here study how the crisis awareness, i.e., personal self-protection, influences the epidemic spreading by presenting a susceptible-infected-recovered model with information-driven vaccination. We introduce two parameters to quantitatively characterize the crisis awareness. One is the information creation rate λ and the other is the information sensitivity η. We find that the epidemic spreading can be significantly suppressed in both the homogeneous and heterogeneous networks when both λ and η are relatively large. More interesting is that the needed vaccine will be significantly reduced when the information is well spread, which is a good news for the poor countries and regions with limited resources.

  5. The epidemic of Tuberculosis on vaccinated population

    Science.gov (United States)

    Syahrini, Intan; Sriwahyuni; Halfiani, Vera; Meurah Yuni, Syarifah; Iskandar, Taufiq; Rasudin; Ramli, Marwan

    2017-09-01

    Tuberculosis is an infectious disease which has caused a large number of mortality in Indonesia. This disease is caused by Mycrobacterium tuberculosis. Besides affecting lung, this disease also affects other organs such as lymph gland, intestine, kidneys, uterus, bone, and brain. This article discusses the epidemic of tuberculosis through employing the SEIR model. Here, the population is divided into four compartments which are susceptible, exposed, infected and recovered. The susceptible population is further grouped into two which are vaccinated group and unvaccinated group. The behavior of the epidemic is investigated through analysing the equilibrium of the model. The result shows that administering vaccine to the susceptible population contributes to the reduction of the tuberculosis epidemic rate.

  6. Epidemic and Cascading Survivability of Complex Networks

    DEFF Research Database (Denmark)

    Manzano, Marc; Calle, Eusebi; Ripoll, Jordi

    2014-01-01

    Our society nowadays is governed by complex networks, examples being the power grids, telecommunication networks, biological networks, and social networks. It has become of paramount importance to understand and characterize the dynamic events (e.g. failures) that might happen in these complex...... networks. For this reason, in this paper, we propose two measures to evaluate the vulnerability of complex networks in two different dynamic multiple failure scenarios: epidemic-like and cascading failures. Firstly, we present epidemic survivability ( ES ), a new network measure that describes...... the vulnerability of each node of a network under a specific epidemic intensity. Secondly, we propose cascading survivability ( CS ), which characterizes how potentially injurious a node is according to a cascading failure scenario. Then, we show that by using the distribution of values obtained from ES and CS...

  7. Urgent epidemic control mechanism for aviation networks

    KAUST Repository

    Peng, Chengbin

    2011-01-01

    In the current century, the highly developed transportation system can not only boost the economy, but also greatly accelerate the spreading of epidemics. While some epidemic diseases may infect quite a number of people ahead of our awareness, the health care resources such as vaccines and the medical staff are usually locally or even globally insufficient. In this research, with the network of major aviation routes as an example, we present a method to determine the optimal locations to allocate the medical service in order to minimize the impact of the infectious disease with limited resources. Specifically, we demonstrate that when the medical resources are insufficient, we should concentrate our efforts on the travelers with the objective of effectively controlling the spreading rate of the epidemic diseases. © 2011 Springer-Verlag Berlin Heidelberg.

  8. Epidemic and Cascading Survivability of Complex Networks

    CERN Document Server

    Manzano, Marc; Ripoll, Jordi; Fagertun, Anna Manolova; Torres-Padrosa, Victor; Pahwa, Sakshi; Scoglio, Caterina

    2014-01-01

    Our society nowadays is governed by complex networks, examples being the power grids, telecommunication networks, biological networks, and social networks. It has become of paramount importance to understand and characterize the dynamic events (e.g. failures) that might happen in these complex networks. For this reason, in this paper, we propose two measures to evaluate the vulnerability of complex networks in two different dynamic multiple failure scenarios: epidemic-like and cascading failures. Firstly, we present \\emph{epidemic survivability} ($ES$), a new network measure that describes the vulnerability of each node of a network under a specific epidemic intensity. Secondly, we propose \\emph{cascading survivability} ($CS$), which characterizes how potentially injurious a node is according to a cascading failure scenario. Then, we show that by using the distribution of values obtained from $ES$ and $CS$ it is possible to describe the vulnerability of a given network. We consider a set of 17 different compl...

  9. Seasonal Influenza Epidemics and El Ninos

    Directory of Open Access Journals (Sweden)

    Olusegun Steven Ayodele Oluwole

    2015-11-01

    Full Text Available Seasonal influenza epidemics occur annually during the winter in the north and south hemispheres, but timing of peaks and severity vary seasonally. Low humidity, which enhances survival and transmission of influenza virus, is the major risk factor. Both El Nino and La Nina phases of El Nino-southern oscillation (ENSO, which determine inter-annual variation of precipitation, are putative risk factors. This study was done to determine if seasonality, timing of peak, and severity of influenza epidemics are coupled to phases of ENSO. Monthly time series of positive specimens for influenza viruses and of multivariate El Nino-Southern Oscillation Index from January 2000 to August 2015 were analyzed. Seasonality, wavelet spectra, and cross wavelet spectra analyses were performed. Of 31 countries in the dataset, 21 were in north hemisphere and 10 in south hemisphere. Highest number of influenza occurred in January in the north hemisphere, but in July in the south hemisphere, p < 0.0001. Seasonal influenza epidemic was coupled to El Nino, while low occurrence was coupled to La Nina. The moderate La Nina of 2010–2011 was followed by weak seasonal influenza epidemic. The influenza pandemic of 2009–2010 followed the moderate El Nino of 2009–2010, which had three peaks. Spectrograms showed time varying periodicities of 6–48 months for ENSO, 6–24 months for north hemisphere influenza, and 6–12 months for south hemisphere influenza. Cross spectrograms showed time varying periodicities at 6–36 months for ENSO and influenza in both hemispheres, p < 0.0001. Phase plots showed that influenza time series lagged ENSO in both hemispheres. Severity of seasonal influenza increases during El Nino, but decreases during La Nina. Coupling of seasonality, timing, and severity of influenza epidemics to the strength and waveform of ENSO indicate that forecast models of El Nino should be integrated into surveillance programmes for influenza epidemics.

  10. Epidemic spreading with immunization on bipartite networks

    CERN Document Server

    Tanimoto, Shinji

    2011-01-01

    Bipartite networks are composed of two types of nodes and there are no links between nodes of the same type. Thus the study of epidemic spread and control on such networks is relevant to sexually transmitted diseases (STDs). When entire populations of two types cannot be immunized and the effect of immunization is not perfect, we have to consider the targeted immunization with immunization rates. We derive the epidemic thresholds of SIR and SIS models with immunization and illustrate the results with STDs on heterosexual contact networks.

  11. Magnetic resonance imaging of suspected atrial tumors.

    Science.gov (United States)

    Menegus, M A; Greenberg, M A; Spindola-Franco, H; Fayemi, A

    1992-05-01

    Two-dimensional echocardiography has become the standard technique for evaluation of cardiac and paracardiac mass lesions. We have used magnetic resonance imaging (MRI) as an independent assessment of cardiac-associated masses in patients with echocardiograms demonstrating sessile atrial tumors. MRI was performed in seven patients, ages 33 to 84, whose echocardiographic diagnoses included left atrial mass (five), right atrial mass (one), and interatrial mass (one). In four of the patients with a diagnosis of left atrial mass, MRI showed extracardiac compression of the atrium, simulating a tumor (hiatal hernia, tortuous descending aorta, bronchogenic cyst). MRI was entirely normal in one patient with an apparent left atrial mass. MRI elucidated extension of an extracavitary mass into the interatrial septum in two patients. One of these patients with an echocardiographic right atrial mass had extension of a lipoma into the interatrial septum without atrial tumor. MRI confirmed the echocardiographic diagnosis of an interatrial mass in the other patient. We conclude that MRI, because of its ability to define anatomic relationships and tissue characteristics, is a powerful noninvasive tool for evaluating suspected cardiac mass lesions. Although echocardiography remains the primary screening test for the detection of cardiac masses, MRI is a more specific modality for precise diagnosis. Correct MRI interpretation may obviate the need for invasive studies or surgery.

  12. Fighting the Epidemic of Nuclear Plant Leaks.

    Science.gov (United States)

    Udell, Richard A.

    1983-01-01

    The current epidemic of steam generator tube leaks alone should put to rest the rosy future once envisioned for nuclear power. It is impossible to regulate quality into a nuclear plant; it must be built and designed that way. The economic impact of the leaks is discussed. (RM)

  13. Can epidemics be non-communicable?

    DEFF Research Database (Denmark)

    Seeberg, Jens; Meinert, Lotte

    2015-01-01

    This article argues that the concept of communicability that is central to the distinction between communicable diseases (CDs) and noncommunicable diseases (NCDs) is poorly conceptualized. The epidemic spread of NCDs such as diabetes, depression, and eating disorders demonstrates that they are co...

  14. Respiratory Protection against Pandemic and Epidemic Diseases.

    Science.gov (United States)

    Rubino, Ilaria; Choi, Hyo-Jick

    2017-10-01

    Respiratory protection against airborne pathogens is crucial for pandemic/epidemic preparedness in the context of personal protection, healthcare systems, and governance. We expect that the development of technologies that overcome the existing challenges in current respiratory protective devices will lead to a timely and effective response to the next outbreak. Copyright © 2017 Elsevier Ltd. All rights reserved.

  15. The epidemic of Athens, 430 - 426 BC

    African Journals Online (AJOL)

    1998-01-01

    Jan 1, 1998 ... It began with violent sensations of heat in the head, and redness and ... sufferer with a violence greater than human nature can bear, in the following point ... dwelling with men, gave a better opportunity of observing the effect on animals. Thucydides gives further information relevant to the epidemic:,,15. 1.

  16. A Simple Model for a SARS Epidemic

    Science.gov (United States)

    Ang, Keng Cheng

    2004-01-01

    In this paper, we examine the use of an ordinary differential equation in modelling the SARS outbreak in Singapore. The model provides an excellent example of using mathematics in a real life situation. The mathematical concepts involved are accessible to students with A level Mathematics backgrounds. Data for the SARS epidemic in Singapore are…

  17. Epidemic Models for SARS and Measles

    Science.gov (United States)

    Rozema, Edward

    2007-01-01

    Recent events have led to an increased interest in emerging infectious diseases. This article applies various deterministic models to the SARS epidemic of 2003 and a measles outbreak in the Netherlands in 1999-2000. We take a historical approach beginning with the well-known logistic curve and a lesser-known extension popularized by Pearl and Reed…

  18. School Violence, the Media's Phanton Epidemic.

    Science.gov (United States)

    Best, Joel

    2002-01-01

    Argues that public perceptions of an epidemic of school violence are media-induced; asserts that violence in schools declined during the 1990s; supports assertion with evidence from the National School Safety Center; states the estimates of bullying in school are exaggerated. (PKP)

  19. Cholera Epidemic Control | Zachariah | Malawi Medical Journal

    African Journals Online (AJOL)

    Journal Home > Vol 13, No 1 (2001) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. Cholera Epidemic Control. R Zachariah. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · AJOL African Journals ...

  20. Epidemic and power in imperial Recife

    Directory of Open Access Journals (Sweden)

    Rosilene Gomes Farias

    2016-06-01

    Full Text Available In 1856, during the cholera epidemic that hit Recife, actions were implemented to prevent the disease, which presupposed the social control of the poorest sections of the population. The article discusses how these actions demonstrate the power relations involving public and medical authorities in Recife of the Nineteenth Century.

  1. A Simulation Optimization Approach to Epidemic Forecasting.

    Science.gov (United States)

    Nsoesie, Elaine O; Beckman, Richard J; Shashaani, Sara; Nagaraj, Kalyani S; Marathe, Madhav V

    2013-01-01

    Reliable forecasts of influenza can aid in the control of both seasonal and pandemic outbreaks. We introduce a simulation optimization (SIMOP) approach for forecasting the influenza epidemic curve. This study represents the final step of a project aimed at using a combination of simulation, classification, statistical and optimization techniques to forecast the epidemic curve and infer underlying model parameters during an influenza outbreak. The SIMOP procedure combines an individual-based model and the Nelder-Mead simplex optimization method. The method is used to forecast epidemics simulated over synthetic social networks representing Montgomery County in Virginia, Miami, Seattle and surrounding metropolitan regions. The results are presented for the first four weeks. Depending on the synthetic network, the peak time could be predicted within a 95% CI as early as seven weeks before the actual peak. The peak infected and total infected were also accurately forecasted for Montgomery County in Virginia within the forecasting period. Forecasting of the epidemic curve for both seasonal and pandemic influenza outbreaks is a complex problem, however this is a preliminary step and the results suggest that more can be achieved in this area.

  2. The Prescription Opioid Pain Medication Overdose Epidemic

    Centers for Disease Control (CDC) Podcasts

    2016-04-19

    Overdose related to prescription opioids has become an epidemic. This podcast discusses the risks of this type of drug sometimes used to treat pain, and how to protect yourself. .  Created: 4/19/2016 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 4/19/2016.

  3. Cholera Epidemic Control | Zachariah | Malawi Medical Journal

    African Journals Online (AJOL)

    Malawi Medical Journal. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 13, No 1 (2001) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. Cholera Epidemic Control. R Zachariah. Full Text: EMAIL FREE ...

  4. Phylogenetics of the Danish HIV epidemic

    DEFF Research Database (Denmark)

    Audelin, Anne Margrethe; Cowan, Susan A; Obel, Niels

    2013-01-01

    BACKGROUND:: In Denmark 300 new individuals are diagnosed with HIV every year, despite decades of public health campaigns aimed to raise awareness of potential risk behaviour for HIV transmission. It is important to identify the driving forces of the epidemic, to enable more targeted campaigns...

  5. Social epidemics in the aftermath of disasters.

    NARCIS (Netherlands)

    IJzermans, C.J.

    2002-01-01

    Issue/problem: After disasters, terrorist attacks and wars social epidemics of medically unexplained physical symptoms/syndromes (ups) are often seen. In modern times people feel more vulnerable and especially under pressure of those incidents, everyday symptoms are interpreted as disease and

  6. Zika virus epidemic: the newest international emergency

    Directory of Open Access Journals (Sweden)

    Ruth Minamisava

    2016-03-01

    production, accurate diagnosis and treatment, training for caring for neurological syndromes and congenital malformations. (iii          Measures for travelers: counseling, disinfestation of aircrafts and airports. (iv          Sharing of information. Some inquiries have been made about the magnitude of this epidemic and its association with microcephaly and neurological disorders(4-5. It is reasonable to consider that there is an underreporting of microcephaly in the records of the Live Births Information System in Brazil. It is also to be expected that, after the national alert, the number of suspected cases would rise. When there is an increase or the implementation of surveillance, this always results in higher sensitivity of detection of suspected/reported cases with an increase in false positives. For these reasons, it is possible to say that part of the increase in reported cases of microcephaly may be attributable to the current intense surveillance. What is inconceivable, however, is that the prevalence of microcephaly in northeastern Brazil is 10 to 20 times higher than in other countries(6. At present, there are hypotheses that the Zika virus may have an etiologic and/or pathophysiological role for these events, which is usually rare. What seems indisputable is the gravity of the situation. Health managers cannot wait for high-level scientific evidence. Care and prudence when assessing is advisable, and the same goes for avoiding premature conclusions. However, given the potential threat, we have a duty to at least protect pregnant women and their fetuses. The current situation poses many challenges that we need to face and it seems logical that Brazil take the lead in beginning the actions. We recognize in our history both the success in the fight against yellow fever early in the last century and also our recent inefficiency in the fight against the Aedes aegypti mosquito to control dengue and chikungunya. It is necessary to create, renew, and

  7. Detection of Rabies antigen in brains of suspected Rabid dogs ...

    African Journals Online (AJOL)

    Objective: To detect the presence of rabies antigen in brains of suspected rabid dogs. Materials and Methods: Ninety six (96) brain specimens from suspected rabid dogs were examined for the presence of rabies antigen using Seller's staining technique and enzyme immunoassay. Results: The two techniques were both ...

  8. 48 CFR 803.806 - Processing suspected violations.

    Science.gov (United States)

    2010-10-01

    ... GENERAL IMPROPER BUSINESS PRACTICES AND PERSONAL CONFLICTS OF INTEREST Limitation on the Payment of Funds to Influence Federal Transactions 803.806 Processing suspected violations. A VA employee must report suspected violations of 31 U.S.C. 1352, Limitation on Use of Appropriated Funds to Influence Certain Federal...

  9. The clinical course of patients with suspected pulmonary embolism

    NARCIS (Netherlands)

    van Beek, E. J.; Kuijer, P. M.; Büller, H. R.; Brandjes, D. P.; Bossuyt, P. M.; ten Cate, J. W.

    1997-01-01

    BACKGROUND: The outcome of patients with suspected pulmonary embolism is known to a limited extent only. OBJECTIVE: To address this limited knowledge in a cohort in whom pulmonary embolism was proved or ruled out. METHODS: Consecutive patients with clinically suspected pulmonary embolism underwent

  10. Epidemic mechanisms of type A influenza.

    Science.gov (United States)

    Hope-Simpson, R E

    1979-08-01

    The antigenic varieties of influenza A virus isolated from 1968 to 1976 in a surveillance of a small, rather remote population were similar to those from England and Wales as a whole, despite frequent antigenic changes during the period. Household studies in the first two H3N2 influenza A epidemics found low attack rates within households, a high proportion (70%) of affected households with only one case of influenza, similar distributions of affected households in the two epidemics by the number of cases of influenza and similar distributions of the influenza cases by the day of their onset in the household outbreak. No serial interval could be demonstrated by cumulating household outbreaks. More than one minor variant was causing influenza contemporaneously in the same villages in several seasons, and different variants were on one occasion found on successive days in bedfellows. The regular occurrence of epidemics in winter was often accompanied by the disappearance of the epidemic variants and their replacement, after a virus-free interval, by new variants. These epidemiological findings seem best interpreted on the following tentative hypothesis. Influenza A sufferers do not transmit the virus during their illness; instead it rapidly becomes latent in their tissues so that they become symptomless carrier-hosts and develop specific immunity. Next season an extraneous seasonally mediated stimulus reactivates the latent virus residues so that the carrier-host becomes briefly infectious, though symptomless. Antigenic drift occurs because particles reconstituted to be identical with the progenitor virus cannot escape the specific immunity it has provoked in the carrier host. He can shed only mutants also determined by the progenitor virus. From the assortment of mutants shed by the carrier-host, his non-immune companions select that (those) which is best fitted to survive, and it rapidly causes influenzal illness. Epidemics consist largely or entirely of such

  11. Seasonal variation among tuberculosis suspects in four countries

    DEFF Research Database (Denmark)

    Mabaera, Biggie; Naranbat, Nymadawa; Katamba, Achilles

    2009-01-01

    The objective of the study was to analyze monthly trends across a calendar year in tuberculosis suspects and sputum smear-positive cases based on nationally representative samples of tuberculosis laboratory registers from Moldova, Mongolia, Uganda and Zimbabwe. Out of the 47 140 suspects registered...... in the tuberculosis laboratory registers, 13.4% (6312) were cases. The proportion varied from country to country, Moldova having the lowest (9%) and Uganda the highest (21%). From the monthly proportion of suspects and cases among total suspects and cases, seasonal variations were most marked in Mongolia which, among...... attendance to diagnostic laboratory services, evidenced by the contrasting findings of Mongolia (extreme continental northern climate) compared to Uganda (equatorial climate). A combination of external and possibly endogenous factors seems to determine whether tuberculosis suspects and cases present...

  12. Parameter Scaling for Epidemic Size in a Spatial Epidemic Model with Mobile Individuals.

    Directory of Open Access Journals (Sweden)

    Chiyori T Urabe

    Full Text Available In recent years, serious infectious diseases tend to transcend national borders and widely spread in a global scale. The incidence and prevalence of epidemics are highly influenced not only by pathogen-dependent disease characteristics such as the force of infection, the latent period, and the infectious period, but also by human mobility and contact patterns. However, the effect of heterogeneous mobility of individuals on epidemic outcomes is not fully understood. Here, we aim to elucidate how spatial mobility of individuals contributes to the final epidemic size in a spatial susceptible-exposed-infectious-recovered (SEIR model with mobile individuals in a square lattice. After illustrating the interplay between the mobility parameters and the other parameters on the spatial epidemic spreading, we propose an index as a function of system parameters, which largely governs the final epidemic size. The main contribution of this study is to show that the proposed index is useful for estimating how parameter scaling affects the final epidemic size. To demonstrate the effectiveness of the proposed index, we show that there is a positive correlation between the proposed index computed with the real data of human airline travels and the actual number of positive incident cases of influenza B in the entire world, implying that the growing incidence of influenza B is attributed to increased human mobility.

  13. Transferring the Malaria Epidemic Prediction Model to Users in East ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Download PDF. Journal articles. Development and validation of climate and ecosystem-based early malaria epidemic prediction models in East Africa. Download PDF. Journal articles. Identification of malaria transmission and epidemic hotspots in the western Kenya highlands : its application to malaria epidemic prediction.

  14. Prediction of Suspect Location Based on Spatiotemporal Semantics

    Directory of Open Access Journals (Sweden)

    Lian Duan

    2017-06-01

    Full Text Available The prediction of suspect location enables proactive experiences for crime investigations and offers essential intelligence for crime prevention. However, existing studies have failed to capture the complex social location transition patterns of suspects and lack the capacity to address the issue of data sparsity. This paper proposes a novel location prediction model called CMoB (Crime Multi-order Bayes model based on the spatiotemporal semantics to enhance the prediction performance. In particular, the model groups suspects with similar spatiotemporal semantics as one target suspect. Then, their mobility data are applied to estimate Markov transition probabilities of unobserved locations based on a KDE (kernel density estimating smoothing method. Finally, by integrating the total transition probabilities, which are derived from the multi-order property of the Markov transition matrix, into a Bayesian-based formula, it is able to realize multi-step location prediction for the individual suspect. Experiments with the mobility dataset covering 210 suspects and their 18,754 location records from January to June 2012 in Wuhan City show that the proposed CMoB model significantly outperforms state-of-the-art algorithms for suspect location prediction in the context of data sparsity.

  15. Toward a generalized theory of epidemic awareness in social networks

    Science.gov (United States)

    Wu, Qingchu; Zhu, Wenfang

    We discuss the dynamics of a susceptible-infected-susceptible (SIS) model with local awareness in networks. Individual awareness to the infectious disease is characterized by a general function of epidemic information in its neighborhood. We build a high-accuracy approximate equation governing the spreading dynamics and derive an approximate epidemic threshold above which the epidemic spreads over the whole network. Our results extend the previous work and show that the epidemic threshold is dependent on the awareness function in terms of one infectious neighbor. Interestingly, when a pow-law awareness function is chosen, the epidemic threshold can emerge in infinite networks.

  16. Epidemic extinction paths in complex networks

    Science.gov (United States)

    Hindes, Jason; Schwartz, Ira B.

    2017-05-01

    We study the extinction of long-lived epidemics on finite complex networks induced by intrinsic noise. Applying analytical techniques to the stochastic susceptible-infected-susceptible model, we predict the distribution of large fluctuations, the most probable or optimal path through a network that leads to a disease-free state from an endemic state, and the average extinction time in general configurations. Our predictions agree with Monte Carlo simulations on several networks, including synthetic weighted and degree-distributed networks with degree correlations, and an empirical high school contact network. In addition, our approach quantifies characteristic scaling patterns for the optimal path and distribution of large fluctuations, both near and away from the epidemic threshold, in networks with heterogeneous eigenvector centrality and degree distributions.

  17. Spread of epidemic disease on networks

    Science.gov (United States)

    Newman, M. E.

    2002-07-01

    The study of social networks, and in particular the spread of disease on networks, has attracted considerable recent attention in the physics community. In this paper, we show that a large class of standard epidemiological models, the so-called susceptible/infective/removed (SIR) models can be solved exactly on a wide variety of networks. In addition to the standard but unrealistic case of fixed infectiveness time and fixed and uncorrelated probability of transmission between all pairs of individuals, we solve cases in which times and probabilities are nonuniform and correlated. We also consider one simple case of an epidemic in a structured population, that of a sexually transmitted disease in a population divided into men and women. We confirm the correctness of our exact solutions with numerical simulations of SIR epidemics on networks.

  18. Extinction times of epidemic outbreaks in networks.

    Directory of Open Access Journals (Sweden)

    Petter Holme

    Full Text Available In the Susceptible-Infectious-Recovered (SIR model of disease spreading, the time to extinction of the epidemics happens at an intermediate value of the per-contact transmission probability. Too contagious infections burn out fast in the population. Infections that are not contagious enough die out before they spread to a large fraction of people. We characterize how the maximal extinction time in SIR simulations on networks depend on the network structure. For example we find that the average distances in isolated components, weighted by the component size, is a good predictor of the maximal time to extinction. Furthermore, the transmission probability giving the longest outbreaks is larger than, but otherwise seemingly independent of, the epidemic threshold.

  19. [The depression epidemic does not exist].

    Science.gov (United States)

    van der Feltz-Cornelis, Christina M

    2009-01-01

    There has been much discussion in the media about the question of the existence of a depression epidemic. This leads on to the questions of whether the social and economic approaches are adequate, and what the alternatives are. The concept of the disease 'depression' can be defined using a medical model, or from a patient's or a societal perspective. From a medical perspective, indeed a depression epidemic has ensued from the increased prosperity and the associated decompression of the mortality rate. Society responded with preventative measures and policies aimed at improving functioning in the workplace. However, patients with a major depressive disorder (MDD) who are eligible for treatment are often not motivated to take it up, or are undertreated. Research is necessary in order to explore what patients think about the identification and treatment of depression. The confusion regarding the concept of depression found in the media, needs to be cleared.

  20. B Plant/WESF suspect/counterfeit parts identification program

    Energy Technology Data Exchange (ETDEWEB)

    Mertz, D.W.

    1996-01-12

    This document describes a suspect/counterfeit parts inspection program required by DOE conducted in accordance with Internal Memo 16710-94-DWM-048, J.A. O`Brien to J. N. Nansen, B Plant Suspect/ Counterfeit Parts Action Plan, dated May 24, 1994. The program included: physical inspection of all spare parts inventories within the plant; screening of installed B Plant/WESF (Waste Encapsulation and Storage Facility) systems for applications where the use and subsequent potential failure of suspect/counterfeit parts could have critical consequences; and a physical inspection based upon this screening.

  1. New Approaches to the Methamphetamine Epidemic

    OpenAIRE

    Zusman, Mara B.

    2004-01-01

    Methamphetamine abuse has become an epidemic in the United States. As methamphetamine becomes increasingly available, more and more people are trying – and becoming addicted to – this potent drug. But although methamphetamine is made using over-the-counter (OTC) drugs containing pseudoephedrine, shifting OTC drugs containing pseudoephedrine to prescription status is not the solution to the methamphetamine crisis. Rather, society must adopt a comprehensive...

  2. Travelling waves in the lattice epidemic model

    Directory of Open Access Journals (Sweden)

    Zhixian Yu

    2010-07-01

    Full Text Available In this article, we establish the existence and nonexistence of travelling waves for a lattice non-monotone integral equation which is an epidemic model. Moreover, the wave is either convergent to the positive equilibrium or oscillating on the positive equilibrium at positive infinity, and has the exponential asymptotic behavior at negative infinity. For the non-monotone case, the asymptotic speed of propagation also coincides with the minimal wave speed.

  3. The glue ear 'epidemic': a historical perspective.

    Science.gov (United States)

    Alderson, David

    2011-12-01

    This paper explores the historical context of the dramatic rise in surgery for glue ear in the mid-20th century, and questions the published assertion that this represented a manufactured 'epidemic'. In examining historical sources, the reader's theoretical viewpoint greatly influences their conclusions: the sustained rise in treatment for glue ear may be seen as the advance of science in a golden age or the resistance of insular professionals to reason in the light of new scientific study methods. Current views on the practice of medicine, consumerism, science and standardisation, rationing and the nature of 'truth' all affect the way that we see this period. Technological advances clearly allowed better diagnosis and more effective treatment, but these did not appear to drive an 'epidemic', rather they were developed to meet the pre-existing challenges of otological practice. The proposition that an 'epidemic' was created does not appear to have any solid grounding. Society's perception of what constitutes disease and what needs treatment may have evolved, but the prevalence of other important diseases changed dramatically over this time period, and a real change in the epidemiology of glue ear cannot be dismissed. In defining the case for and against surgical treatment, a solely positivist, quantitative worldview cannot give us a complete picture of benefit and risk to individuals, families and society at large.

  4. Cyanobacteria facilitate parasite epidemics in Daphnia.

    Science.gov (United States)

    Tellenbach, C; Tardent, N; Pomati, F; Keller, B; Hairston, N G; Wolinska, J; Spaak, P

    2016-12-01

    The seasonal dominance of cyanobacteria in the phytoplankton community of lake ecosystems can have severe implications for higher trophic levels. For herbivorous zooplankton such as Daphnia, cyanobacteria have poor nutritional value and some species can produce toxins affecting zooplankton survival and reproduction. Here we present another, hitherto largely unexplored aspect of cyanobacteria, namely that they can increase Daphnia susceptibility to parasites. In a 12-yr monthly time-series analysis of the Daphnia community in Greifensee (Switzerland), we observed that cyanobacteria density correlated significantly with the epidemics of a common gut parasite of Daphnia, Caullerya mesnili, regardless of what cyanobacteria species was present or whether it was colonial or filamentous. The temperature from the previous month also affected the occurrence of Caullerya epidemics, either directly or indirectly by the promotion of cyanobacterial growth. A laboratory experiment confirmed that cyanobacteria increase the susceptibility of Daphnia to Caullerya, and suggested a possible involvement of cyanotoxins or other chemical traits of cyanobacteria in this process. These findings expand our understanding of the consequences of toxic cyanobacterial blooms for lake ecosystems and might be relevant for epidemics experienced by other aquatic species. © 2016 by the Ecological Society of America.

  5. Connecting the obesity and the narcissism epidemics.

    Science.gov (United States)

    Lemaitre, Bruno

    2016-10-01

    Obesity and metabolic syndromes are major threats to health in both developed and developing countries. This opinion article is a holistic attempt to understand the obesity epidemic, by connecting it to the widespread narcissism in society. The narcissism epidemic refers to an increased prevalence of status-striving individualism and a decreased sense of community, observed in Westerns populations and spreading worldwide. Based on social personality and evolutionary psychology approaches, I speculate that this rise of narcissism underlies a steep social hierarchy resulting in increase of social stress. This social stress markedly affects individuals who are sensitive to social hierarchy dominance due to their personality, yet are relegated at a lower social position. I speculate that over-eating is one major mechanism for coping with this stress, and discuss the possibility that visceral fat may constitute an adaptive behaviour to the lower social hierarchy position, which is perceived as unjust. Connecting the prevalence of obesity to the narcissism epidemic allows for a more thorough examination of factors, which contribute to obesity, which includes early difficult childhood experience, lower rank, and the overall competitive framework of the society. Copyright © 2016 The Author. Published by Elsevier Ltd.. All rights reserved.

  6. Memory effects on epidemic evolution: The susceptible-infected-recovered epidemic model

    Science.gov (United States)

    Saeedian, M.; Khalighi, M.; Azimi-Tafreshi, N.; Jafari, G. R.; Ausloos, M.

    2017-02-01

    Memory has a great impact on the evolution of every process related to human societies. Among them, the evolution of an epidemic is directly related to the individuals' experiences. Indeed, any real epidemic process is clearly sustained by a non-Markovian dynamics: memory effects play an essential role in the spreading of diseases. Including memory effects in the susceptible-infected-recovered (SIR) epidemic model seems very appropriate for such an investigation. Thus, the memory prone SIR model dynamics is investigated using fractional derivatives. The decay of long-range memory, taken as a power-law function, is directly controlled by the order of the fractional derivatives in the corresponding nonlinear fractional differential evolution equations. Here we assume "fully mixed" approximation and show that the epidemic threshold is shifted to higher values than those for the memoryless system, depending on this memory "length" decay exponent. We also consider the SIR model on structured networks and study the effect of topology on threshold points in a non-Markovian dynamics. Furthermore, the lack of access to the precise information about the initial conditions or the past events plays a very relevant role in the correct estimation or prediction of the epidemic evolution. Such a "constraint" is analyzed and discussed.

  7. CCL20/MIP-3 alpha mRNA expression in the conjunctival epithelium of normal individuals and patients with vernal keratoconjunctivitis.

    Science.gov (United States)

    Inada, Noriko; Ishimori, Akiko; Shoji, Jun

    2014-12-01

    CCL20, the single chemokine ligand for CCR6, contributes to recruiting CCR6-expressing memory B cells, memory T cells, Th17 cells and dendritic cells, and is involved in regulating immune responses, homeostasis, and inflammation in mucosal tissues. CCL20 messenger RNA (mRNA) expression was analyzed in the conjunctival epithelium in an in vivo study of patients with vernal keratoconjunctivitis (VKC group) and healthy volunteers (control group) using impression cytology. In vitro analysis of CCL20 mRNA was performed using cultured conjunctival epithelial cells (CECs). Real-time polymerase chain reaction was used to assess IL-8 and eotaxin-2 mRNA expression for comparison with CCL20 mRNA expression. In the control group, CCL20 mRNA expression was present in all conjunctival locations. However, CCL20 mRNA expression was significantly higher in the upper palpebral conjunctiva in the severe VKC group than in the mild VKC and control groups (p < 0.05, Steel test). In vitro stimulation of CECs with lipopolysaccharide (LPS) significantly increased CCL20 expression in a concentration-dependent manner that was significantly correlated with expression of IL-8 (p < 0.001, Spearman's rank correlation coefficient), but not eotaxin-2. We conclude that CCL 20 mRNA expression in the conjunctival epithelium plays a crucial role in regulating homeostasis at the ocular surface and in exacerbation of VKC.

  8. Comparative Evaluation of Tacrolimus Versus Interferon Alpha-2b Eye Drops in the Treatment of Vernal Keratoconjunctivitis: A Randomized, Double-Masked Study.

    Science.gov (United States)

    Zanjani, Habibollah; Aminifard, Mohammad Naim; Ghafourian, Abdolhossein; Pourazizi, Mohsen; Maleki, Alireza; Arish, Mohammed; Shahrakipoor, Mahnaz; Rohani, Mohammad Reza; Abrishami, Mojtaba; Khafri Zare, Ehsan; Barzegar Jalali, Farhad

    2017-06-01

    Vernal keratoconjunctivitis (VKC) is a bilateral, chronic, external ocular inflammatory disorder that mainly affects patients in their first or second decade. This study was designed to compare tacrolimus and interferon alpha-2b (IFN alpha-2b) eye drops in the treatment of VKC. In this randomized, double-masked clinical trial, 40 consecutive patients with VKC were sent to a referral eye hospital in a tropical region southeast of Iran. Patients were randomly assigned to receive either 0.005% tacrolimus or IFN alpha-2b (1,000,000 units/cc). Chi-square and t tests were used for comparison of outcomes between both groups. Mean ± SD age was 11.1 ± 5.2 years. Thirty-one patients (77.5%) were male. The mean duration of disease was 3.4 ± 2.9 years. In this study, the signs and symptoms were significantly reduced in patients after treatment in both groups (P = 0.0001). In the tacrolimus group, all patients responded to treatment whereas only one subject in the IFN group failed to respond (P = 0.99). Side effects in both groups were mild and tolerable. This study indicated that both 0.005% tacrolimus and IFN alpha-2b are effective and appear to be safe in treatment of recalcitrant VKC.

  9. Stopping and Questioning Suspected Shoplifters Without Creating Civil Liability

    Science.gov (United States)

    Reed, Jack R., Jr.

    1977-01-01

    Legal problems concerned with shoplifting suspects are addressed, including common law, criminal penalties, and the merchant's liability. Tangential questions and answers are presented along with discussion of pertinent court cases. (LBH)

  10. ALGORITHM OF MANAGEMENT OF PATIENTS WITH SUSPECTED BLUNT CARDIAC TRAUMA

    Directory of Open Access Journals (Sweden)

    S. R. Gilarevsky

    2013-01-01

    Full Text Available Abstract. Contemporary algorithm of diagnostic examination of patients with suspected blunt cardiac trauma is presented. General aspects of monitoring and treatment of such patients are also discussed. 

  11. Suspect confession of child sexual abuse to investigators.

    Science.gov (United States)

    Lippert, Tonya; Cross, Theodore P; Jones, Lisa; Walsh, Wendy

    2010-05-01

    Increasing the number of suspects who give true confessions of sexual abuse serves justice and reduces the burden of the criminal justice process on child victims. With data from four communities, this study examined confession rates and predictors of confession of child sexual abuse over the course of criminal investigations (final N = 282). Overall, 30% of suspects confessed partially or fully to the crime. This rate was consistent across the communities and is very similar to the rates of suspect confession of child sexual abuse found by previous research, although lower than that from a study focused on a community with a vigorous practice of polygraph testing. In a multivariate analysis, confession was more likely when suspects were younger and when more evidence of abuse was available, particularly child disclosure and corroborative evidence. These results suggest the difficulty of obtaining confession but also the value of methods that facilitate child disclosure and seek corroborative evidence, for increasing the odds of confession.

  12. Suspect aggression and victim resistance in multiple perpetrator rapes.

    Science.gov (United States)

    Woodhams, Jessica; Cooke, Claire

    2013-11-01

    Several research studies have reported an elevated level of aggression in rapes committed by multiple perpetrators compared to rapes committed by lone suspects. Several factors that have been linked to elevated aggression in generic samples of rape were examined for the first time with a sample of multiple perpetrator rapes. Factors that might be associated with victim resistance were also investigated. Victim and offender characteristics, as well as the behaviors displayed by victims and offenders, were extracted from the police files of 89 multiple perpetrator stranger rapes perpetrated against female victims in the United Kingdom. These behaviors were rated for their level of suspect (non-sexual) aggression and victim resistance, respectively. Degree of victim resistance was significantly and positively associated with suspect aggression. Older victims were the recipients of significantly higher levels of suspect aggression. Victims who were incapacitated from drugs and/or alcohol were less likely to be the recipients of suspect aggression. Group leaders displayed more aggression towards the victim than the followers in the groups. The number of perpetrators was significantly related to the degree of resistance displayed by the victim with offences perpetrated by fewer suspects being characterized by more victim resistance. Research regarding cognitive appraisal during criminal interactions and the respective roles of offenders is referred to in considering these relationships.

  13. Interviewing strategically to elicit admissions from guilty suspects.

    Science.gov (United States)

    Tekin, Serra; Granhag, Pär Anders; Strömwall, Leif; Giolla, Erik Mac; Vrij, Aldert; Hartwig, Maria

    2015-06-01

    In this article we introduce a novel interviewing tactic to elicit admissions from guilty suspects. By influencing the suspects' perception of the amount of evidence the interviewer holds against them, we aimed to shift the suspects' counterinterrogation strategies from less to more forthcoming. The proposed tactic (SUE-Confrontation) is a development of the Strategic Use of Evidence (SUE) framework and aims to affect the suspects' perception by confronting them with statement-evidence inconsistencies. Participants (N = 90) were asked to perform several mock criminal tasks before being interviewed using 1 of 3 interview techniques: (a) SUE-Confrontation, (b) Early Disclosure of Evidence, or (c) No Disclosure of Evidence. As predicted, the SUE-Confrontation interview generated more statement-evidence inconsistencies from suspects than the Early Disclosure interview. Importantly, suspects in the SUE-Confrontation condition (vs. Early and No disclosure conditions) admitted more self-incriminating information and also perceived the interviewer to have had more information about the critical phase of the crime (the phase where the interviewer lacked evidence). The findings show the adaptability of the SUE-technique and how it may be used as a tool for eliciting admissions. (c) 2015 APA, all rights reserved).

  14. Influence of Media on Seasonal Influenza Epidemic Curves.

    Science.gov (United States)

    Saito, Satoshi; Saito, Norihiro; Itoga, Masamichi; Ozaki, Hiromi; Kimura, Toshiyuki; Okamura, Yuji; Murakami, Hiroshi; Kayaba, Hiroyuki

    2016-09-01

    Theoretical investigations predicting the epidemic curves of seasonal influenza have been demonstrated so far; however, there is little empirical research using ever accumulated epidemic curves. The effects of vaccine coverage and information distribution on influenza epidemics were evaluated. Four indices for epidemics (i.e., onset-peak duration, onset-end duration, ratio of the onset-peak duration to onset-end duration and steepness of epidemic curves) were defined, and the correlations between these indices and anti-flu drug prescription dose, vaccine coverage, the volume of media and search trend on influenza through internet were analyzed. Epidemiological data on seasonal influenza epidemics from 2002/2003 to 2013/2014 excluding 2009/2010 season were collected from National Institute of Infectious Diseases of Japan. The onset-peak duration and its ratio to onset-end duration correlated inversely with the volume of anti-flu drug prescription. Onset-peak duration correlated positively with media information volume on influenza. The steepness of the epidemic curve, and anti-flu drug prescription dose inversely correlated with the volume of media information. Pre-epidemic search trend and media volume on influenza correlated with the vaccine coverage in the season. Vaccine coverage had no strong effect on epidemic curve. Education through media has an effect on the epidemic curve of seasonal influenza. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  15. The risk of blood transfusion-associated Chikungunya fever during the 2009 epidemic in Songkhla Province, Thailand.

    Science.gov (United States)

    Appassakij, Hatsadee; Promwong, Charuporn; Rujirojindakul, Pairaya; Wutthanarungsan, Rochana; Silpapojakul, Khachornsakdi

    2014-08-01

    Asymptomatic Chikungunya fever (CHIKF)-viremic blood donors could be a potential threat of spreading the disease unwittingly through contaminated blood transfusions. The relatively low prevalence of Chikungunya virus antibodies in the population and the records of more than 9000 suspected CHIKF cases raised concern about the potential transfusion-associated CHIKF during the 2009 epidemic. This study assessed the potential transfusion risk for CHIKF and the implementation of blood safety measures to mitigate this risk. A probabilistic model using key variables obtained from local information was used to estimate the weekly risk of transfusion-associated CHIKF during the 2009 epidemic. In addition, other blood safety measure-based strategies involving screening for donors at risk, donor tracing, and a 7-day quarantine of blood components at risk were implemented at the time of the epidemic. The risk of viremic donations per 100,000 ranged from 38.2 (95% confidence interval [CI], 36.5-39.8) to 52.3 (95% CI, 50.4-54.2). The potential risk of transfusion-associated CHIKF per 100,000 was estimated to be 1 in 2429 (0.04%; 95% CI, 1 in 6681 [0.02%]-1 in 1572 [0.06%]) to 1 in 1781 (0.06%; 95% CI, 1 in 3817 [0.03%]-1 in 1214 (0.08%]) donations. Among 26,722 donations, 11 (95% CI, 4-17) to 15 (95% CI, 7-22) donations were predicted to associate with transfusion risk. The implementation of blood safety measure-based strategies for this epidemic period suggested to deter 11 blood donations of transfusion risk. The interventions for blood safety measures applied in this study had mitigated the potential transfusion-associated CHIKF during the 2009 epidemic. © 2014 AABB.

  16. [The epidemic process as a system. I. The structure of the epidemic process].

    Science.gov (United States)

    Cherkasskiĭ, B L

    1985-03-01

    A new epidemiological concept (socio-ecological) has been formulated on the basis of the principles of the theory of systems and the theory of information. In accordance with this concept, the epidemic process is organized on the same principle as living matter, and the stability of this process at all levels of its organization is ensured by the processes of self-regulation. The conditions of the life of human society have been shown to be organically incorporated into the structure of the epidemic process as a regulating subsystem on the socio-ecological level.

  17. Presumed prevalence analysis on suspected and highly suspected breast cancer lesions in São Paulo using BIRADS® criteria

    Directory of Open Access Journals (Sweden)

    Vivian Milani

    Full Text Available CONTEXT AND OBJECTIVE: Breast cancer screening programs are critical for early detection of breast cancer. Early detection is essential for diagnosing, treating and possibly curing breast cancer. Since there are no data on the incidence of breast cancer, nationally or regionally in Brazil, our aim was to assess women by means of mammography, to determine the prevalence of this disease. DESIGN AND SETTING: The study protocol was designed in collaboration between the Department of Diagnostic Imaging (DDI, Institute of Diagnostic Imaging (IDI and São Paulo Municipal Health Program. METHODS: A total of 139,945 Brazilian women were assessed by means of mammography between April 2002 and September 2004. Using the American College of Radiology (ACR criteria (Breast Imaging Reporting and Data System, BIRADS®, the prevalence of suspected and highly suspected breast lesions were determined. RESULTS: The prevalence of suspected (BIRADS® 4 and highly suspected (BIRADS® 5 lesions increased with age, especially after the fourth decade. Accordingly, BIRADS® 4 and BIRADS® 5 lesions were more prevalent in the fourth, fifth, sixth and seventh decades. CONCLUSION: The presumed prevalence of suspected and highly suspected breast cancer lesions in the population of São Paulo was 0.6% and it is similar to the prevalence of breast cancer observed in other populations.

  18. Event history analysis of dengue fever epidemic and inter-epidemic spells in Barbados, Brazil, and Thailand.

    Science.gov (United States)

    Parker, Daniel; Holman, Darryl

    2012-11-01

    This study investigated meteorological and demographic factors affecting the length of dengue fever epidemics and the length of time between epidemics in Barbados, Brazil, and Thailand. Region-specific meteorological and demographic data were collected for 104 sites from public sources. Fixed effects piecewise logistic event history analysis was used to quantify the effects of time-varying covariates on the duration of inter-epidemic spells and for the duration of epidemics. Mean monthly temperature was the most important factor affecting the duration of both inter-epidemic spells (β=0.543; confidence interval (CI) 0.4954, 0.5906) and epidemic spells (β=-0.648; CI -0.7553, -0.5405). Drought conditions increased the time between epidemics. Increased temperature hastened the onset of an epidemic, and during an epidemic, higher mean temperature increased the duration of the epidemic. By using a duration analysis, this study offers a novel approach for investigating the dynamics of dengue fever epidemiology. Furthermore, these results offer new insights into prior findings of a correlation between temperature and the geographic range and vector efficiency of dengue fever. Copyright © 2012 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  19. Bronchiolitis: Analysis of 10 consecutive epidemic seasons.

    Science.gov (United States)

    Cangiano, Giulia; Nenna, Raffaella; Frassanito, Antonella; Evangelisti, Melania; Nicolai, Ambra; Scagnolari, Carolina; Pierangeli, Alessandra; Antonelli, Guido; Papoff, Paola; Petrarca, Laura; Capocaccia, Paolo; Moretti, Corrado; Midulla, Fabio

    2016-12-01

    Bronchiolitis is the leading cause of hospitalization in infants under 12 months. Our aims were to analyze epidemiological characteristics of infants with bronchiolitis over 10 consecutive seasons and to evaluate whether there are any clinical differences between infants hospitalized for bronchiolitis during epidemic peak months and infants in non-peak months. We enrolled consecutive enrolled 723 previously healthy term infants hospitalized at the Paediatric Emergency Department, "Sapienza" University of Rome over the period 2004-2014. Fourteen respiratory viruses were detected from nasopharyngeal aspirates by molecular methods. Clinical and demographic data were extracted from clinical charts. Viruses were detected in 351 infants (48.5%): RSV in 234 (32.4%), RV in 44 (6.1%), hBoV in 11 (1.5%), hMPV in 12 (1.6%), co-infections in 39 (5.4%), and other viruses in 11 (1.5%). Analyzing the 10 epidemic seasons, we found higher incidence for bronchiolitis every 4 years with a peak during the months December-January. Infants hospitalized during peak months had lower family history for asthma (P = 0.003), more smoking mothers during pregnancy (P = 0.036), were slightly higher breastfed (0.056), had lower number of blood eosinophils (P = 0.015) and had a higher clinical severity score (P = 0.017). RSV was detected mostly during peak months, while RV was equally distributed during the seasons. We found some variations in bronchiolitis incidence during epidemics, and discriminative characteristics in infants hospitalized for bronchiolitis during peak months and in non-peak months, that might reflect two different populations of children. Pediatr Pulmonol. 2016;51:1330-1335. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  20. [Current status of HIV epidemic and prevention and control program in Cambodia].

    Science.gov (United States)

    Kihara, M; Tajima, K; Tomizawa, I; Ozaki, S; Soda, K

    1995-01-01

    The authors of this paper visited Cambodia in March 1994, as part of the Ministry of Education program of international cooperation in AIDS research, to investigate the current status of the AIDS epidemic and develop plans for prevention and control. Cambodia is faced with an HIV crisis; examples are the dramatic increase in HIV-positive blood donors (0.08% in 1990, 3.6% in 1994) and the high rate of infection among high-risk behavior groups. The route of infection in all cases in which it was traceable was heterosexual. While the heterosexual route is considered to be the major route of transmission, unclean needles used in medical services are also suspected. Since 1991, aided by the World Health Organization, HIV infection surveillance and a comprehensive national plan for AIDS prevention and control have been established. In cooperation with nongovernmental organizations, policies have been put into effect. With the decline of the country's socioeconomic structure, however, the level of public hygiene has been drastically reduced and HIV/AIDS prevention and control plans have been facing great difficulties. Now, at the onset of the epidemic, which is a crucial time, there is urgent need for international assistance.

  1. Two approaches to forecast Ebola synthetic epidemics.

    Science.gov (United States)

    Champredon, David; Li, Michael; Bolker, Benjamin M; Dushoff, Jonathan

    2017-02-24

    We use two modelling approaches to forecast synthetic Ebola epidemics in the context of the RAPIDD Ebola Forecasting Challenge. The first approach is a standard stochastic compartmental model that aims to forecast incidence, hospitalization and deaths among both the general population and health care workers. The second is a model based on the renewal equation with latent variables that forecasts incidence in the whole population only. We describe fitting and forecasting procedures for each model and discuss their advantages and drawbacks. We did not find that one model was consistently better in forecasting than the other. Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.

  2. Cholera epidemics, war and disasters around Goma and Lake Kivu: an eight-year survey.

    Science.gov (United States)

    Bompangue, Didier; Giraudoux, Patrick; Piarroux, Martine; Mutombo, Guy; Shamavu, Rick; Sudre, Bertrand; Mutombo, Annie; Mondonge, Vital; Piarroux, Renaud

    2009-01-01

    During the last eight years, North and South Kivu, located in a lake area in Eastern Democratic Republic of Congo, have been the site of a major volcano eruption and of numerous complex emergencies with population displacements. These conditions have been suspected to favour emergence and spread of cholera epidemics. In order to assess the influence of these conditions on outbreaks, reports of cholera cases were collected weekly from each health district of North Kivu (4,667,699 inhabitants) and South Kivu (4,670,121 inhabitants) from 2000 through 2007. A geographic information system was established, and in each health district, the relationships between environmental variables and the number of cholera cases were assessed using regression techniques and time series analysis. We further checked for a link between complex emergencies and cholera outbreaks. Finally, we analysed data collected during an epidemiological survey that was implemented in Goma after Nyiragongo eruption. A total of 73,605 cases and 1,612 deaths of cholera were reported. Time series decomposition showed a greater number of cases during the rainy season in South Kivu but not in North Kivu. Spatial distribution of cholera cases exhibited a higher number of cases in health districts bordering lakes (Odds Ratio 7.0, Confidence Interval range 3.8-12.9). Four epidemic reactivations were observed in the 12-week periods following war events, but simulations indicate that the number of reactivations was not larger than that expected during any random selection of period with no war. Nyiragongo volcanic eruption was followed by a marked decrease of cholera incidence. Our study points out the crucial role of some towns located in lakeside areas in the persistence of cholera in Kivu. Even if complex emergencies were not systematically followed by cholera epidemics, some of them enabled cholera spreading.

  3. Cholera epidemics, war and disasters around Goma and Lake Kivu: an eight-year survey.

    Directory of Open Access Journals (Sweden)

    Didier Bompangue

    Full Text Available BACKGROUND: During the last eight years, North and South Kivu, located in a lake area in Eastern Democratic Republic of Congo, have been the site of a major volcano eruption and of numerous complex emergencies with population displacements. These conditions have been suspected to favour emergence and spread of cholera epidemics. METHODOLOGY/PRINCIPAL FINDINGS: In order to assess the influence of these conditions on outbreaks, reports of cholera cases were collected weekly from each health district of North Kivu (4,667,699 inhabitants and South Kivu (4,670,121 inhabitants from 2000 through 2007. A geographic information system was established, and in each health district, the relationships between environmental variables and the number of cholera cases were assessed using regression techniques and time series analysis. We further checked for a link between complex emergencies and cholera outbreaks. Finally, we analysed data collected during an epidemiological survey that was implemented in Goma after Nyiragongo eruption. A total of 73,605 cases and 1,612 deaths of cholera were reported. Time series decomposition showed a greater number of cases during the rainy season in South Kivu but not in North Kivu. Spatial distribution of cholera cases exhibited a higher number of cases in health districts bordering lakes (Odds Ratio 7.0, Confidence Interval range 3.8-12.9. Four epidemic reactivations were observed in the 12-week periods following war events, but simulations indicate that the number of reactivations was not larger than that expected during any random selection of period with no war. Nyiragongo volcanic eruption was followed by a marked decrease of cholera incidence. CONCLUSION/SIGNIFICANCE: Our study points out the crucial role of some towns located in lakeside areas in the persistence of cholera in Kivu. Even if complex emergencies were not systematically followed by cholera epidemics, some of them enabled cholera spreading.

  4. Heterogeneous Epidemic Model for Assessing Data Dissemination in Opportunistic Networks

    DEFF Research Database (Denmark)

    Rozanova, Liudmila; Alekseev, Vadim; Temerev, Alexander

    2014-01-01

    that amount of data transferred between network nodes possesses a Pareto distribution, implying scale-free properties. In this context, more heterogeneity in susceptibility means the less severe epidemic progression, and, on the contrary, more heterogeneity in infectivity leads to more severe epidemics...... — assuming that the other parameter (either heterogeneity or susceptibility) stays fixed. The results are general enough to be useful for estimating the epidemic progression with no significant acquired immunity — in the cases where Pareto distribution holds....

  5. Monitoring and prediction of an epidemic outbreak using syndromic observations

    OpenAIRE

    Skvortsov, Alex; Ristic, Branko

    2011-01-01

    The paper presents an algorithm for syndromic surveillance of an epidemic outbreak formulated in the context of stochastic nonlinear filtering. The dynamics of the epidemic is modeled using a generalized compartmental epidemiological model with inhomogeneous mixing. The syndromic (typically non-medical) observations of the number of infected people (e.g. visits to pharmacies, sale of certain products, absenteeism from work/study etc.) are used for estimation. The state of the epidemic, includ...

  6. Large epidemic thresholds emerge in heterogeneous networks of heterogeneous nodes

    OpenAIRE

    Hui Yang; Ming Tang; Thilo Gross

    2015-01-01

    One of the famous results of network science states that networks with heterogeneous connectivity are more susceptible to epidemic spreading than their more homogeneous counterparts. In particular, in networks of identical nodes it has been shown that network heterogeneity, i.e. a broad degree distribution, can lower the epidemic threshold at which epidemics can invade the system. Network heterogeneity can thus allow diseases with lower transmission probabilities to persist and spread. Howeve...

  7. A generalized cholera model and epidemic-endemic analysis

    National Research Council Canada - National Science Library

    Wang, Jin; Liao, Shu

    2012-01-01

    .... Particularly, this work unifies many existing cholera models proposed by different authors. We conduct equilibrium analysis to carefully study the complex epidemic and endemic behaviour of the disease...

  8. Behavioral synchronization induced by epidemic spread in complex networks

    Science.gov (United States)

    Sun, Mengfeng; Lou, Yijun; Duan, Jinqiao; Fu, Xinchu

    2017-06-01

    During the spread of an epidemic, individuals in realistic networks may exhibit collective behaviors. In order to characterize this kind of phenomenon and explore the correlation between collective behaviors and epidemic spread, in this paper, we construct several mathematical models (including without delay, with a coupling delay, and with double delays) of epidemic synchronization by applying the adaptive feedback motivated by real observations. By using Lyapunov function methods, we obtain the conditions for local and global stability of these epidemic synchronization models. Then, we illustrate that quenched mean-field theory is more accurate than heterogeneous mean-field theory in the prediction of epidemic synchronization. Finally, some numerical simulations are performed to complement our theoretical results, which also reveal some unexpected phenomena, for example, the coupling delay and epidemic delay influence the speed of epidemic synchronization. This work makes further exploration on the relationship between epidemic dynamics and synchronization dynamics, in the hope of being helpful to the study of other dynamical phenomena in the process of epidemic spread.

  9. Kuru: the old epidemic in a new mirror.

    Science.gov (United States)

    Goldfarb, Lev G

    2002-07-01

    The kuru epidemic lasted almost a century; it started in 1901-1902, reached epidemic proportions in the mid-1950s, and disappeared in the 1990s. Kuru is the prototype member of a group of disorders known as transmissible spongiform encephalopathies (TSEs) or prion diseases. Recent data on the genetics and pathogenesis of TSEs contribute to a better understanding of the documented kuru phenomena, and vice versa, observations made during the kuru epidemic are immensely helpful in understanding the epidemic of variant Creutzfeldt-Jakob disease that is currently developing in Europe. The major goal of this review is to identify and illustrate these points.

  10. Epidemics: Lessons from the past and current patterns of response

    Science.gov (United States)

    Martin, Paul

    2008-09-01

    Hippocrates gave the term 'epidemic' its medical meaning. From antiquity to modern times, the meaning of the word epidemic has continued to evolve. Over the centuries, researchers have reached an understanding of the varying aspects of epidemics and have tried to combat them. The role played by travel, trade, and human exchanges in the propagation of epidemic infectious diseases has been understood. In 1948, the World Health Organization was created and given the task of advancing ways of combating epidemics. An early warning system to combat epidemics has been implemented by the WHO. The Global Outbreak Alert and Response Network (GOARN) is collaboration between existing institutions and networks that pool their human and technical resources to fight outbreaks. Avian influenza constitutes currently the most deadly epidemic threat, with fears that it could rapidly reach pandemic proportions and put several thousands of lives in jeopardy. Thanks to the WHO's support, most of the world's countries have mobilised and implemented an 'Action Plan for Pandemic Influenza'. As a result, most outbreaks of the H5N1 avian flu virus have so far been speedily contained. Cases of dengue virus introduction in countries possessing every circumstance required for its epidemic spread provide another example pertinent to the prevention of epidemics caused by vector-borne pathogens.

  11. Dengue Deaths in Puerto Rico: Lessons Learned from the 2007 Epidemic

    Science.gov (United States)

    Tomashek, Kay M.; Gregory, Christopher J.; Rivera Sánchez, Aidsa; Bartek, Matthew A.; Garcia Rivera, Enid J.; Hunsperger, Elizabeth; Muñoz-Jordán, Jorge L.; Sun, Wellington

    2012-01-01

    Background The incidence and severity of dengue in Latin America has increased substantially in recent decades and data from Puerto Rico suggests an increase in severe cases. Successful clinical management of severe dengue requires early recognition and supportive care. Methods Fatal cases were identified among suspected dengue cases reported to two disease surveillance systems and from death certificates. To be included, fatal cases had to have specimen submitted for dengue diagnostic testing including nucleic acid amplification for dengue virus (DENV) in serum or tissue, immunohistochemical testing of tissue, and immunoassay detection of anti-DENV IgM from serum. Medical records from laboratory-positive dengue fatal case-patients were reviewed to identify possible determinants for death. Results Among 10,576 reported dengue cases, 40 suspect fatal cases were identified, of which 11 were laboratory-positive, 14 were laboratory-negative, and 15 laboratory-indeterminate. The median age of laboratory-positive case-patients was 26 years (range 5 months to 78 years), including five children aged Dengue was listed on the death certificate in only 5 instances. Conclusions During a dengue epidemic in an endemic area, none of the 11 laboratory-positive case-patients who died were managed according to current WHO Guidelines. Management issues identified in this case-series included failure to recognize warning signs for severe dengue and shock, prolonged ED stays, and infrequent patient monitoring. PMID:22530072

  12. Genetic Characterization of Northwestern Colombian Chikungunya Virus Strains from the 2014-2015 Epidemic.

    Science.gov (United States)

    Rodas, Juan D; Kautz, Tiffany; Camacho, Erwin; Paternina, Luis; Guzmán, Hilda; Díaz, Francisco J; Blanco, Pedro; Tesh, Robert; Weaver, Scott C

    2016-09-07

    Chikungunya fever, an acute and often chronic arthralgic disease caused by the mosquito-borne alphavirus, chikungunya virus (CHIKV), spread into the Americas in late 2013. Since then it has caused epidemics in nearly all New World countries, the second largest being Colombia with over 450,000 suspected cases beginning in September, 2014, and focused in Bolivar Department in the north. We examined 32 human sera from suspected cases, including diverse age groups and both genders, and sequenced the CHIKV envelope glycoprotein genes, known determinants of vector host range. As expected for Asian lineage CHIKV strains, these isolates lacked known Aedes albopictus-adaptive mutations. All the Colombian strains were closely related to those from the Virgin Islands, Saint Lucia, Mexico, Puerto Rico, and Brazil, consistent with a single, point-source introduction from the southeast Asia/Pacific region. Two substitutions in the E2 and E1 envelope glycoprotein genes were found in the Colombian strains, especially E1-K211E involving a residue shown previously to affect epistatically the penetrance of the E1-A226V A. albopictus-adaptive substitution. We also identified two amino acid substitutions unique to all American CHIKV sequences: E2-V368A and 6K-L20M. Only one codon, 6K-47, had a high nonsynonymous substitution rate suggesting positive selection. © The American Society of Tropical Medicine and Hygiene.

  13. Vector control in a malaria epidemic occurring within a complex emergency situation in Burundi: a case study

    Directory of Open Access Journals (Sweden)

    D'Alessandro Umberto

    2007-07-01

    Full Text Available Abstract Background African highlands often suffer of devastating malaria epidemics, sometimes in conjunction with complex emergencies, making their control even more difficult. In 2000, Burundian highlands experienced a large malaria outbreak at a time of civil unrest, constant insecurity and nutritional emergency. Because of suspected high resistance to the first and second line treatments, the provincial health authority and Médecins Sans Frontières (Belgium decided to implement vector control activities in an attempt to curtail the epidemic. There are few reported interventions of this type to control malaria epidemics in complex emergency contexts. Here, decisions and actions taken to control this epidemic, their impact and the lessons learned from this experience are reported. Case description Twenty nine hills (administrative areas were selected in collaboration with the provincial health authorities for the vector control interventions combining indoor residual spraying with deltamethrin and insecticide-treated nets. Impact was evaluated by entomological and parasitological surveys. Almost all houses (99% were sprayed and nets use varied between 48% and 63%. Anopheles indoor resting density was significantly lower in treated as compared to untreated hills, the latter taken as controls. Despite this impact on the vector, malaria prevalence was not significantly lower in treated hills except for people sleeping under a net. Discussion Indoor spraying was feasible and resulted in high coverage despite being a logistically complex intervention in the Burundian context (scattered houses and emergency situation. However, it had little impact on the prevalence of malaria infection, possibly because it was implemented after the epidemic's peak. Nevertheless, after this outbreak the Ministry of Health improved the surveillance system, changed its policy with introduction of effective drugs and implementation of vector control to prevent new

  14. Colliding Epidemics and the Rise of Cryptococcosis

    Directory of Open Access Journals (Sweden)

    Christina C. Chang

    2015-12-01

    Full Text Available Discovered more than 100 years ago as a human pathogen, the Cryptococcus neoformans–Cryptococcus gattii (C. neoformans–C. gattii complex has seen a large global resurgence in its association with clinical disease in the last 30 years. First isolated in fermenting peach juice, and identified as a human pathogen in 1894 in a patient with bone lesions, this environmental pathogen has now found niches in soil, trees, birds, and domestic pets. Cryptococcosis is well recognized as an opportunistic infection and was first noted to be associated with reticuloendothelial cancers in the 1950s. Since then, advances in transplant immunology, medical science and surgical techniques have led to increasing numbers of solid organ transplantations (SOT and hematological stem cell transplantations being performed, and the use of biological immunotherapeutics in increasingly high-risk and older individuals, have contributed to the further rise in cryptococcosis. Globally, however, the major driver for revivification of cryptococcosis is undoubtedly the HIV epidemic, particularly in Sub-Saharan Africa where access to care and antiretroviral therapy remains limited and advanced immunodeficiency, poverty and malnutrition remains the norm. As a zoonotic disease, environmental outbreaks of both human and animal cryptococcosis have been reported, possibly driven by climate change. This is best exemplified by the resurgence of C. gattii infection in Vancouver Island, Canada, and the Pacific Northwest of the United States since 1999. Here we describe how the colliding epidemics of HIV, transplantation and immunologics, climate change and migration have contributed to the rise of cryptococcosis.

  15. The opioid overdose epidemic: opportunities for pharmacists

    Directory of Open Access Journals (Sweden)

    Wu LT

    2017-07-01

    Full Text Available Li-Tzy Wu,1–4 Udi E Ghitza,5 Anne L Burns,6 Paolo Mannelli,1 1Department of Psychiatry and Behavioral Sciences, 2Department of Medicine, 3Duke Clinical Research Institute, Duke University School of Medicine, 4Center for Child and Family Policy, Sanford School of Public Policy, Duke University, Durham, NC, 5Center for Clinical Trials Network, National Institute on Drug Abuse, Bethesda, MD, 6American Pharmacists Association, Washington, DC, USA The USA is experiencing an opioid overdose epidemic. It has been driven largely by prescription opioids and intensified by a surge of illicit opioids (e.g., heroin and fentanyl.1,2 Drug-involved overdose, mainly opioids (e.g., prescription opioids and heroin, is a leading cause of accidental death in the USA. The opioid overdose epidemic has been escalating consistently for over a decade.2 Every day, an estimated 91 Americans die from opioid-related overdose.3 Opioid overdose appears to have disproportionally affected men, adults aged 25–64 years, and non-Hispanic whites.2

  16. [Epidemic process of gonorrhea in modern world].

    Science.gov (United States)

    Kostiukova, N N; Bekhalo, V A

    2009-01-01

    Gonorrhea in spite of its fully elucidated etiopathogenesis and available drugs for etiotropic therapy belongs to infections which are not controlled by vaccination due to absence of immunity formation. Analysis of scientific publication, statistical materials and WHO's data showed that epidemic process of gonorrhea infection depends mainly from people's behaviour, first of all, sexual. Modern epidemic process of gonorrhea infection consists from irregular increases and decreases of incidence due to various reasons. Reasons for increases of incidence appear to be simultaneous action of a range of biologic and anthropogenic factors. First reason--rapid increase of resistance of gonococci to widely used antibacterial preparations as well as synergy of pathogenic effects between HIV and gonococci; anthropogenic--wars, increase of high-risk groups due to urbanization, use of oral contraceptives, rise of prostitution, migration, inadequate access to medical care, poverty, intensification of intercourses (including hetero- and homosexual) between people, as well as demographic changes--increase of proportion of young people in population structure. Same but reciprocal factors lead to decrease of morbidity. Of them, the following were considered as most important: mass implementation of new effective antimicrobial drug as well as intensification of sanitary education, availability of early diagnostics and treatment, increase of material and cultural standards of life, decrease in number of persons belonging to high risk groups. Yet, capabilities of modern science expressed only in continuous development of new antibacterial drugs active against circulating population of gonococci, which is resistant to previously used drug.

  17. Epidemic contact tracing via communication traces.

    Directory of Open Access Journals (Sweden)

    Katayoun Farrahi

    Full Text Available Traditional contact tracing relies on knowledge of the interpersonal network of physical interactions, where contagious outbreaks propagate. However, due to privacy constraints and noisy data assimilation, this network is generally difficult to reconstruct accurately. Communication traces obtained by mobile phones are known to be good proxies for the physical interaction network, and they may provide a valuable tool for contact tracing. Motivated by this assumption, we propose a model for contact tracing, where an infection is spreading in the physical interpersonal network, which can never be fully recovered; and contact tracing is occurring in a communication network which acts as a proxy for the first. We apply this dual model to a dataset covering 72 students over a 9 month period, for which both the physical interactions as well as the mobile communication traces are known. Our results suggest that a wide range of contact tracing strategies may significantly reduce the final size of the epidemic, by mainly affecting its peak of incidence. However, we find that for low overlap between the face-to-face and communication interaction network, contact tracing is only efficient at the beginning of the outbreak, due to rapidly increasing costs as the epidemic evolves. Overall, contact tracing via mobile phone communication traces may be a viable option to arrest contagious outbreaks.

  18. Nepalese origin of cholera epidemic in Haiti.

    Science.gov (United States)

    Frerichs, R R; Keim, P S; Barrais, R; Piarroux, R

    2012-06-01

    Cholera appeared in Haiti in October 2010 for the first time in recorded history. The causative agent was quickly identified by the Haitian National Public Health Laboratory and the United States Centers for Disease Control and Prevention as Vibrio cholerae serogroup O1, serotype Ogawa, biotype El Tor. Since then, >500 000 government-acknowledged cholera cases and >7000 deaths have occurred, the largest cholera epidemic in the world, with the real death toll probably much higher. Questions of origin have been widely debated with some attributing the onset of the epidemic to climatic factors and others to human transmission. None of the evidence on origin supports climatic factors. Instead, recent epidemiological and molecular-genetic evidence point to the United Nations peacekeeping troops from Nepal as the source of cholera to Haiti, following their troop rotation in early October 2010. Such findings have important policy implications for shaping future international relief efforts. © 2012 The Authors. Clinical Microbiology and Infection © 2012 European Society of Clinical Microbiology and Infectious Diseases.

  19. Absolute Humidity and Pandemic Versus Epidemic Influenza

    Science.gov (United States)

    Shaman, Jeffrey; Goldstein, Edward; Lipsitch, Marc

    2011-01-01

    Experimental and epidemiologic evidence indicates that variations of absolute humidity account for the onset and seasonal cycle of epidemic influenza in temperate regions. A role for absolute humidity in the transmission of pandemic influenza, such as 2009 A/H1N1, has yet to be demonstrated and, indeed, outbreaks of pandemic influenza during more humid spring, summer, and autumn months might appear to constitute evidence against an effect of humidity. However, here the authors show that variations of the basic and effective reproductive numbers for influenza, caused by seasonal changes in absolute humidity, are consistent with the general timing of pandemic influenza outbreaks observed for 2009 A/H1N1 in temperate regions, as well as wintertime transmission of epidemic influenza. Indeed, absolute humidity conditions correctly identify the region of the United States vulnerable to a third, wintertime wave of pandemic influenza. These findings suggest that the timing of pandemic influenza outbreaks is controlled by a combination of absolute humidity conditions, levels of susceptibility, and changes in population-mixing and contact rates. PMID:21081646

  20. Resource allocation for epidemic control in metapopulations.

    Directory of Open Access Journals (Sweden)

    Martial L Ndeffo Mbah

    Full Text Available Deployment of limited resources is an issue of major importance for decision-making in crisis events. This is especially true for large-scale outbreaks of infectious diseases. Little is known when it comes to identifying the most efficient way of deploying scarce resources for control when disease outbreaks occur in different but interconnected regions. The policy maker is frequently faced with the challenge of optimizing efficiency (e.g. minimizing the burden of infection while accounting for social equity (e.g. equal opportunity for infected individuals to access treatment. For a large range of diseases described by a simple SIRS model, we consider strategies that should be used to minimize the discounted number of infected individuals during the course of an epidemic. We show that when faced with the dilemma of choosing between socially equitable and purely efficient strategies, the choice of the control strategy should be informed by key measurable epidemiological factors such as the basic reproductive number and the efficiency of the treatment measure. Our model provides new insights for policy makers in the optimal deployment of limited resources for control in the event of epidemic outbreaks at the landscape scale.

  1. High-mobility group box-1 (HMGB-1) and serum soluble receptor for advanced glycation end products (sRAGE) in children affected by vernal keratoconjunctivitis.

    Science.gov (United States)

    Zicari, Anna Maria; Zicari, Alessandra; Nebbioso, Marcella; Mari, Emanuela; Celani, Camilla; Lollobrigida, Valeria; Cesoni Marcelli, Azzurra; Occasi, Francesca; Duse, Marzia

    2014-02-01

    Vernal keratoconjunctivitis (VKC) is a chronic disease affecting conjunctiva even though the immunopathogenetic mechanisms underlying this inflammation are unclear. The aim of our study is to investigate serum levels of HMGB1 and circulating sRAGE in children affected by VKC before and after treatment with cyclosporine A (CsA) eye drops and in a group of healthy children. Twenty-four children affected by VKC aged between 5 and 12 yrs of life were enrolled at the Department of Pediatrics, Division of Allergy and Immunology, 'Sapienza' University of Rome. Twenty-four healthy children without atopy, ocular, and systemic disease, cross-matched for sex and age to patients affected by VKC, represented the controls. All children affected by VKC were treated with CsA 1% eye drops for 4 wks, and blood samples were collected before and 2 wks after the end of treatment while the controls underwent to a single blood sample at the time of enrollment. Serum basal levels of HMGB1 and sRAGE were higher in children with VKC when compared with controls while, in patients affected by VKC, no difference was detected between atopic and non-atopic, and between ANA-positive and ANA-negative children. A significant reduction in serum HMGB1 and sRAGE levels was detected after the therapy while CsA serum levels were negative. Our study gives a support to the definition of VKC as a systemic inflammation in which HMGB1 and its soluble receptors could play a role. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  2. Comparison of 1% cyclosporine eye drops in olive oil and in linseed oil to treat experimentally-induced keratoconjunctivitis sicca in rabbits

    Directory of Open Access Journals (Sweden)

    Leticia Rodrigues Parrilha

    2015-10-01

    Full Text Available ABSTRACTPurpose:To evaluate the effectiveness of topical 1% cyclosporine eye drops diluted in either of the two vehicles-olive and linseed oil-and that of the oils themselves in treating experimentally-induced keratoconjunctivitis sicca (KCS in rabbits.Methods:KCS was induced in 25 New Zealand rabbits using 1% atropine sulfate eye drops for 7 days before treatment and throughout the treatment period (12 weeks. The rabbits were divided into five groups: one control (C group without KCS induction and four treatment groups in which KCS was induced and treated topically with olive oil (O, linseed oil (L, cyclosporine in olive oil (CO, and cyclosporine in linseed oil (CL. The animals were evaluated using Schirmer tear test 1 (STT, the fluorescein test (FT, tear-film break-up time (TBUT, the rose bengal test (RBT, and histopathological analysis.Results:Values of STT and TBUT significantly decreased 1 week post-induction (p<0.05 and were similar to initial values after the 4th week of treatment, in all groups. After KCS induction, there was significantly less corneal damage in group L than in group CL, as assessed FT and RBT. Histopathology demonstrated that Groups L and CL presented less edema and corneal congestion. There was no significant difference in the goblet cell density (cells/mm2 between the groups (p=0.147.Conclusion:Cyclosporine diluted in olive oil or linseed oil was effective in the treatment of KCS, although it had better efficacy when diluted in linseed oil. Linseed oil presented better effectiveness, whether associated or not, than olive oil. These results may contribute to the creation of novel topical ophthalmic formulations for KCS treatment in future.

  3. Accuracy of Zika virus disease case definition during simultaneous Dengue and Chikungunya epidemics.

    Science.gov (United States)

    Braga, José Ueleres; Bressan, Clarisse; Dalvi, Ana Paula Razal; Calvet, Guilherme Amaral; Daumas, Regina Paiva; Rodrigues, Nadia; Wakimoto, Mayumi; Nogueira, Rita Maria Ribeiro; Nielsen-Saines, Karin; Brito, Carlos; Bispo de Filippis, Ana Maria; Brasil, Patrícia

    2017-01-01

    Zika is a new disease in the American continent and its surveillance is of utmost importance, especially because of its ability to cause neurological manifestations as Guillain-Barré syndrome and serious congenital malformations through vertical transmission. The detection of suspected cases by the surveillance system depends on the case definition adopted. As the laboratory diagnosis of Zika infection still relies on the use of expensive and complex molecular techniques with low sensitivity due to a narrow window of detection, most suspected cases are not confirmed by laboratory tests, mainly reserved for pregnant women and newborns. In this context, an accurate definition of a suspected Zika case is crucial in order for the surveillance system to gauge the magnitude of an epidemic. We evaluated the accuracy of various Zika case definitions in a scenario where Dengue and Chikungunya viruses co-circulate. Signs and symptoms that best discriminated PCR confirmed Zika from other laboratory confirmed febrile or exanthematic diseases were identified to propose and test predictive models for Zika infection based on these clinical features. Our derived score prediction model had the best performance because it demonstrated the highest sensitivity and specificity, 86·6% and 78·3%, respectively. This Zika case definition also had the highest values for auROC (0·903) and R2 (0·417), and the lowest Brier score 0·096. In areas where multiple arboviruses circulate, the presence of rash with pruritus or conjunctival hyperemia, without any other general clinical manifestations such as fever, petechia or anorexia is the best Zika case definition.

  4. Accuracy of Zika virus disease case definition during simultaneous Dengue and Chikungunya epidemics

    Science.gov (United States)

    Bressan, Clarisse; Dalvi, Ana Paula Razal; Calvet, Guilherme Amaral; Daumas, Regina Paiva; Rodrigues, Nadia; Wakimoto, Mayumi; Nogueira, Rita Maria Ribeiro; Nielsen-Saines, Karin; Brito, Carlos

    2017-01-01

    Background Zika is a new disease in the American continent and its surveillance is of utmost importance, especially because of its ability to cause neurological manifestations as Guillain-Barré syndrome and serious congenital malformations through vertical transmission. The detection of suspected cases by the surveillance system depends on the case definition adopted. As the laboratory diagnosis of Zika infection still relies on the use of expensive and complex molecular techniques with low sensitivity due to a narrow window of detection, most suspected cases are not confirmed by laboratory tests, mainly reserved for pregnant women and newborns. In this context, an accurate definition of a suspected Zika case is crucial in order for the surveillance system to gauge the magnitude of an epidemic. Methodology We evaluated the accuracy of various Zika case definitions in a scenario where Dengue and Chikungunya viruses co-circulate. Signs and symptoms that best discriminated PCR confirmed Zika from other laboratory confirmed febrile or exanthematic diseases were identified to propose and test predictive models for Zika infection based on these clinical features. Results and discussion Our derived score prediction model had the best performance because it demonstrated the highest sensitivity and specificity, 86·6% and 78·3%, respectively. This Zika case definition also had the highest values for auROC (0·903) and R2 (0·417), and the lowest Brier score 0·096. Conclusions In areas where multiple arboviruses circulate, the presence of rash with pruritus or conjunctival hyperemia, without any other general clinical manifestations such as fever, petechia or anorexia is the best Zika case definition. PMID:28650987

  5. The use of psychoactive prescription drugs among DUI suspects.

    Science.gov (United States)

    Karjalainen, Karoliina; Haukka, Jari; Lintonen, Tomi; Joukamaa, Matti; Lillsunde, Pirjo

    2015-10-01

    The study seeks to increase understanding of the use of psychoactive prescription drugs among persons suspected of driving under the influence (DUI). We studied whether the use of prescribed psychoactive medication was associated with DUI, and examined the difference in the use of prescription drugs between DUI recidivists and those arrested only once. In this register-based study, persons suspected of DUI (n=29470) were drawn from the Register of DUI suspects, and an age- and gender-matched reference population (n=30043) was drawn from the Finnish general population. Data on prescription drug use was obtained by linkage to the National Prescription Register. The associations of DUI arrest and use of psychoactive prescription drugs in different DUI groups (findings for alcohol only, prescription drugs, prescription drugs and alcohol, illicit drugs) were estimated by using mixed-effect logistic regression. The use of psychoactive prescription drugs and DUI appeared to be strongly associated, with DUI suspects significantly more likely to use psychoactive prescription drugs compared to the reference population. Gender differences existed, with the use of benzodiazepines being more common among female DUI suspects. Moreover, DUI recidivists were more likely to use psychoactive prescription drugs compared to those arrested only once. In addition to alcohol and/or illicit drug use, a significant proportion of DUI suspects were using psychoactive prescription drugs. When prescribing psychoactive medication, especially benzodiazepines, physicians are challenged to screen for possible substance use problems and also to monitor for patients' alcohol or illicit drug use while being medicated. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  6. Book Review: Placing the Suspect behind the Keyboard: Using Digital Forensics and Investigative Techniques to Identify Cybercrime Suspects

    Directory of Open Access Journals (Sweden)

    Thomas Nash

    2013-06-01

    Full Text Available Shavers, B. (2013. Placing the Suspect behind the Keyboard: Using Digital Forensics and Investigative Techniques to Identify Cybercrime Suspects. Waltham, MA: Elsevier, 290 pages, ISBN-978-1-59749-985-9, US$51.56. Includes bibliographical references and index.Reviewed by Detective Corporal Thomas Nash (tnash@bpdvt.org, Burlington Vermont Police Department, Internet Crime against Children Task Force. Adjunct Instructor, Champlain College, Burlington VT.In this must read for any aspiring novice cybercrime investigator as well as the seasoned professional computer guru alike, Brett Shaver takes the reader into the ever changing and dynamic world of Cybercrime investigation.  Shaver, an experienced criminal investigator, lays out the details and intricacies of a computer related crime investigation in a clear and concise manner in his new easy to read publication, Placing the Suspect behind the Keyboard. Using Digital Forensics and Investigative techniques to Identify Cybercrime Suspects. Shaver takes the reader from start to finish through each step of the investigative process in well organized and easy to follow sections, with real case file examples to reach the ultimate goal of any investigation: identifying the suspect and proving their guilt in the crime. Do not be fooled by the title. This excellent, easily accessible reference is beneficial to both criminal as well as civil investigations and should be in every investigator’s library regardless of their respective criminal or civil investigative responsibilities.(see PDF for full review

  7. Suspected Rhinolithiasis Associated With Endodontic Disease in a Cat.

    Science.gov (United States)

    Ng, Kevin; Fiani, Nadine; Peralta, Santiago

    2017-12-01

    Rhinoliths are rare, intranasal, mineralized masses formed via the precipitation of mineral salts around an intranasal nidus. Clinical signs are typically consistent with inflammatory rhinitis and nasal obstruction, but asymptomatic cases are possible. Rhinoliths may be classified as exogenous or endogenous depending on the origin of the nidus, with endogenous rhinoliths reportedly being less common. This case report describes a suspected case of endogenous rhinolithiasis in a cat which was detected as an incidental finding during radiographic assessment of a maxillary canine tooth with endodontic disease. Treatment consisted of removal of the suspected rhinolith via a transalveolar approach after surgical extraction of the maxillary canine tooth.

  8. Cholescintigraphy and ultrasonography in patients suspected of having acute cholecystitis

    DEFF Research Database (Denmark)

    Lauritsen, K B; Sommer, W; Hahn, L

    1988-01-01

    The diagnostic power of combined cholescintigraphy and ultrasonography was tested in 67 patients suspected of having acute cholecystitis; of these, 42 (63%) had acute cholecystitis. The predictive value of a positive scintigraphy (PVpos) was 95% and that of a negative (PVneg) was 91% (n = 67...... that in patients suspected of having acute cholecystitis cholescintigraphy should be the first diagnostic procedure performed. If the scintigraphy is positive, additional ultrasonographic detection of gallstones makes the diagnosis almost certain. If one diagnostic modality is inconclusive, the other makes a fair...

  9. Symptomatic Patency Capsule Retention in Suspected Crohn's Disease

    DEFF Research Database (Denmark)

    Rasmussen, Bjørn; Nathan, Torben; Jensen, Michael Dam

    2016-01-01

    The main limitation of capsule endoscopy is the risk of capsule retention. In patients with suspected Crohn's disease, however, this complication is rare, and if a small bowel stenosis is not reliably excluded, small bowel patency can be confirmed with the Pillcam patency capsule. We present two...... patients examined for suspected Crohn's disease who experienced significant symptoms from a retained patency capsule. Both patients had Crohn's disease located in the terminal ileum. In one patient, the patency capsule caused abdominal pain and vomiting and was visualized at magnetic resonance enterography...

  10. Obesity and diabetes epidemics: cancer repercussions.

    Science.gov (United States)

    Hjartåker, Anette; Langseth, Hilde; Weiderpass, Elisabete

    2008-01-01

    The prevalence of overweight (body mass index, BMI, between 25 and 30 kg/m2) and obesity (BMI of 30 kg/m2 or higher) is increasing rapidly worldwide, especially in developing countries and countries undergoing economic transition to a market economy. One consequence of obesity is an increased risk of developing type II diabetes. Overall, there is considerable evidence that overweight and obesity are associated with risk for some of the most common cancers. There is convincing evidence of a positive association between overweight/obesity and risk for adenocarcinoma of the oesophagus and the gastric cardia, colorectal cancer, postmenopausal breast cancer, endometrial cancer and kidney cancer (renal-cell). Premenopausal breast cancer seems to be inversely related to obesity. For all other cancer sites the evidence of an association between overweight/obesity and cancer is inadequate, although there are studies suggesting an increased risk of cancers of the liver, gallbladder, pancreas, thyroid gland and in lymphoid and haematopoietic tissue. Far less is known about the association between diabetes mellitus type I (also called insulin dependent diabetes mellitus or juvenile diabetes), type II diabetes (called non-insulin dependent diabetes mellitus or adult onset diabetes mellitus) and cancer risk. The most common type of diabetes mellitus, type II, seems to be associated with liver and pancreas cancer and probably with colorectal cancer. Some studies suggest an association with endometrial and postmenopausal breast cancer. Studies reporting on the association between type I diabetes mellitus, which is relatively rare in most populations and cancer risk are scanty, but suggest a possible association with endometrial cancer. Overweight and obesity, as well as type II diabetes mellitus are largely preventable through changes in lifestyle. The fundamental causes of the obesity epidemic-and consequently the diabetes type II epidemic-are societal, resulting from an

  11. Smoking epidemic eradication in a eco-epidemiological dynamical model

    NARCIS (Netherlands)

    Voorn, van G.A.K.; Kooi, B.W.

    2013-01-01

    Smoking is perceived as a major epidemic with regard to mortality. Modelling is a major tool used to obtain insight in the dynamics and possible solutions to decrease or even eradicate this epidemic. Most models on smoking consider the epidemiological context explicitly, in which smoking is regarded

  12. Gendered Epidemics and Systems of Power in Africa: A Feminist ...

    African Journals Online (AJOL)

    The article uses case studies, extracted from published epidemic stories and interprets these cases from a feminist and power analytical framework. The results suggest that while a disease or an epidemic affect a group of individuals, systemic factors regarding responsible governance and the role of national politics and ...

  13. Forests in transition: Post-epidemic vegetation conditions [Chapter 4

    Science.gov (United States)

    Rob Hubbard; Michael Battaglia; Chuck Rhoades; Jim Thinnes; Tom Martin; Jeff Underhill; Mark Westfahl

    2014-01-01

    More than 23 million acres of lodgepole pine forests across the western U.S. have experienced overstory mortality following the recent mountain pine beetle (MPB) epidemic (USDA Forest Service 2013). Unknowns regarding the immediate and long-term consequences of the epidemic challenge the ability of managers to make informed decisions aimed at sustaining forest health...

  14. The origin and emergence of an HIV-1 epidemic:

    DEFF Research Database (Denmark)

    Bruhn, Christian Anders Wathne; Audelin, Anne M.; Helleberg, Marie

    2014-01-01

    To describe, at patient-level detail, the determining events and factors involved in the development of a country's HIV-1 epidemic.......To describe, at patient-level detail, the determining events and factors involved in the development of a country's HIV-1 epidemic....

  15. Monitoring epidemic alert levels by analyzing Internet search volume.

    Science.gov (United States)

    Zhou, Xichuan; Li, Qin; Zhu, Zhenglin; Zhao, Han; Tang, Hao; Feng, Yujie

    2013-02-01

    The prevention of infectious diseases is a global health priority area. The early detection of possible epidemics is the first and important defense line against infectious diseases. However, conventional surveillance systems, e.g., the Centers for Disease Control and Prevention (CDC), rely on clinical data. The CDC publishes the surveillance results weeks after epidemic outbreaks. To improve the early detection of epidemic outbreaks, we designed a syndromic surveillance system to predict the epidemic trends based on disease-related Google search volume. Specifically, we first represented the epidemic trend with multiple alert levels to reduce the noise level. Then, we predicted the epidemic alert levels using a continuous density HMM, which incorporated the intrinsic characteristic of the disease transmission for alert level estimation. Respective models are built to monitor both national and regional epidemic alert levels of the U.S. The proposed system can provide real-time surveillance results, which are weeks before the CDC's reports. This paper focusses on monitoring the infectious disease in the U.S., however, we believe similar approach may be used to monitor epidemics for the developing countries as well.

  16. An information strategy for the epidemic control chain

    NARCIS (Netherlands)

    Visser, T.; Dijkman, J.J.; Grijpink, J.H.A.M.|info:eu-repo/dai/nl/095130861; Plomp, M.G.A.|info:eu-repo/dai/nl/313946809; Seignette, P.

    2011-01-01

    This article presents the results of the chain analysis of the epidemic control chain according to the method of chain-computerisation. The goal of the epidemic control chain is to prevent the disruption of society that is caused by disease or excess of preventive measures. The current

  17. The South African HIV epidemic, reflected by nine provincial ...

    African Journals Online (AJOL)

    A major deflection from the exponential growth patterns seen hitherto can be anticipated only once all or most of the highly populated provinces have traversed their respective points of inflection. The exponential model significantly explains the HIV epidemics in the provinces. The combination of these provincial epidemics ...

  18. Epidemic cerebrospinal meningitis in children at Federal Medical ...

    African Journals Online (AJOL)

    Epidemic meningococcal meningitis is a major public health problem still affecting tropical countries, particularly in Sub-Saharan Africa, which lies within African meningitis belt. Repeated large scale epidemics of CSM have been reported in northern Nigeria for the past four decades. It is one of the important causes of ...

  19. The cholera epidemic in South Africa, 1980 - 1987 Epidemiological ...

    African Journals Online (AJOL)

    During the cholera epidemic in South Africa, 1980-1987, 25251 cases of cholera were bacteriologically proven. The case-fatality rate was 1,4%. Outbreaks occurred in the summer rainfall season. Age-specific aUack rates followed the pattern typically found during the 'epidemic phase' of the disease in most years. The vast ...

  20. The cholera epidemic in South Africa, 1980 - 1987

    African Journals Online (AJOL)

    1991-05-04

    May 4, 1991 ... During the cholera epidemic in South Africa, 1980-1987,. 25251 cases of cholera were bacteriologically proven. The case-fatality rate was 1,4%. Outbreaks occurred in the summer rainfall season. Age-specific aUack rates followed the pattern typically found during the 'epidemic phase' of the disease in.

  1. The chemical bases of the various AIDS epidemics: recreational ...

    Indian Academy of Sciences (India)

    Why is there no vaccine against AIDS? Why is AIDS in the US and Europe not random like other viral epidemics? Why did AIDS not rise and then decline exponentially owing to antiviral immunity like all other viral epidemics? Why is AIDS not contagious? Why would only HIV carriers get AIDS who use either recreational or ...

  2. Florida's tuberculosis epidemic. Public health response.

    Science.gov (United States)

    Witte, J J; Bigler, W J

    1994-03-01

    Florida ranked fourth in the nation with 1,707 tuberculosis cases reported in 1992 for a rate of 12.7 per 100,000 population. Thirteen percent of these patients had AIDS. Recent cases in prisons, shelters, hospitals and schools have stimulated interest and media coverage. Resurgence of strains of multiple-drug resistant tuberculosis is a serious concern. The Florida Department of Health and Rehabilitative Services, in collaboration with allied agencies, has utilized several initiatives in response. The most significant, Tuberculosis Epidemic Containment Plan, details intervention strategies needed to eliminate TB in the state by the year 2010. Successful implementation depends upon local TB prevention and control coalitions that include private and public sector providers.

  3. Epidemics of Liquidity Shortages in Interbank Markets

    CERN Document Server

    Brandi, Giuseppe; Cimini, Giulio

    2016-01-01

    Financial contagion from liquidity shocks has being recently ascribed as a prominent driver of systemic risk in interbank lending markets. Building on standard compartment models used in epidemics, here we develop an EDB (Exposed-Distressed-Bankrupted) model for the dynamics of liquidity shocks reverberation between banks, and validate it on electronic market for interbank deposits data. We show that the interbank network was highly susceptible to liquidity contagion at the beginning of the 2007/2008 global financial crisis, and that the subsequent micro-prudential and liquidity hoarding policies adopted by banks increased the network resilience to systemic risk, yet with the undesired side effect of drying out liquidity from the market. We finally show that the individual riskiness of a bank is better captured by its network centrality than by its participation to the market, along with the currently debated concept of "too interconnected to fail".

  4. A new epidemic model of computer viruses

    Science.gov (United States)

    Yang, Lu-Xing; Yang, Xiaofan

    2014-06-01

    This paper addresses the epidemiological modeling of computer viruses. By incorporating the effect of removable storage media, considering the possibility of connecting infected computers to the Internet, and removing the conservative restriction on the total number of computers connected to the Internet, a new epidemic model is proposed. Unlike most previous models, the proposed model has no virus-free equilibrium and has a unique endemic equilibrium. With the aid of the theory of asymptotically autonomous systems as well as the generalized Poincare-Bendixson theorem, the endemic equilibrium is shown to be globally asymptotically stable. By analyzing the influence of different system parameters on the steady number of infected computers, a collection of policies is recommended to prohibit the virus prevalence.

  5. Epidemics scenarios in the "Romantic network"

    CERN Document Server

    Carvalho, Alexsandro M

    2012-01-01

    The structure of sexual contacts, its contacts network and its temporal interactions, play an important role in the spread of sexually transmitted infections. Unfortunately, that kind of data is very hard to obtain. One of the few exceptions is the "Romantic network" which is a complete structure of a real sexual network of a high school. In terms of topology, unlike other sexual networks classified as scale-free network. Regarding the temporal structure, several studies indicate that relationship timing can have effects on diffusion through networks, as relationship order determines transmission routes.With the aim to check if the particular structure, static and dynamic, of the Romantic network is determinant for the propagation of an STI in it, we perform simulations in two scenarios: the static network where all contacts are available and the dynamic case where contacts evolve in time. In the static case, we compare the epidemic results in the Romantic network with some paradigmatic topologies. We further...

  6. Quasi-neutral theory of epidemic outbreaks.

    Directory of Open Access Journals (Sweden)

    Oscar A Pinto

    Full Text Available Some epidemics have been empirically observed to exhibit outbreaks of all possible sizes, i.e., to be scale-free or scale-invariant. Different explanations for this finding have been put forward; among them there is a model for "accidental pathogens" which leads to power-law distributed outbreaks without apparent need of parameter fine tuning. This model has been claimed to be related to self-organized criticality, and its critical properties have been conjectured to be related to directed percolation. Instead, we show that this is a (quasi neutral model, analogous to those used in Population Genetics and Ecology, with the same critical behavior as the voter-model, i.e. the theory of accidental pathogens is a (quasi-neutral theory. This analogy allows us to explain all the system phenomenology, including generic scale invariance and the associated scaling exponents, in a parsimonious and simple way.

  7. Epidemic Dynamics in Open Quantum Spin Systems

    Science.gov (United States)

    Pérez-Espigares, Carlos; Marcuzzi, Matteo; Gutiérrez, Ricardo; Lesanovsky, Igor

    2017-10-01

    We explore the nonequilibrium evolution and stationary states of an open many-body system that displays epidemic spreading dynamics in a classical and a quantum regime. Our study is motivated by recent experiments conducted in strongly interacting gases of highly excited Rydberg atoms where the facilitated excitation of Rydberg states competes with radiative decay. These systems approximately implement open quantum versions of models for population dynamics or disease spreading where species can be in a healthy, infected or immune state. We show that in a two-dimensional lattice, depending on the dominance of either classical or quantum effects, the system may display a different kind of nonequilibrium phase transition. We moreover discuss the observability of our findings in laser driven Rydberg gases with particular focus on the role of long-range interactions.

  8. Epidemic spreading on evolving signed networks

    CERN Document Server

    Saeedian, M; Jafari, G R; Kertesz, J

    2016-01-01

    Most studies of disease spreading consider the underlying social network as obtained without the contagion, though epidemic influences peoples willingness to contact others: A friendly contact may be turned to unfriendly to avoid infection. We study the susceptible-infected (SI) disease spreading model on signed networks, in which each edge is associated with a positive or negative sign representing the friendly or unfriendly relation between its end nodes. In a signed network, according to Heiders theory, edge signs evolve such that finally a state of structural balance is achieved, corresponding to no frustration in physics terms. However, the danger of infection affects the evolution of its edge signs. To describe the coupled problem of the sign evolution and disease spreading, we generalize the notion of structural balance by taking into account the state of the nodes. We introduce an energy function and carry out Monte-Carlo simulations on complete networks to test the energy landscape, where we find loc...

  9. Mutual Feedback Between Epidemic Spreading and Information Diffusion

    CERN Document Server

    Zhan, Xiu-Xiu; Zhou, Ge; Zhang, Zi-Ke; Sun, Gui-Quan; Zhu, Jonathan J H

    2015-01-01

    The impact that information diffusion has on epidemic spreading has recently attracted much attention. As a disease begins to spread in the population, information about the disease is transmitted to others, which in turn has an effect on the spread of disease. In this paper, using empirical results of the propagation of H7N9 and information about the disease, we clearly show that the spreading dynamics of the two-types of processes influence each other. We build a mathematical model in which both types of spreading dynamics are described using the SIS process in order to illustrate the influence of information diffusion on epidemic spreading. Both the simulation results and the pairwise analysis reveal that information diffusion can increase the threshold of an epidemic outbreak, decrease the final fraction of infected individuals and significantly decrease the rate at which the epidemic propagates. Additionally, we find that the multi-outbreak phenomena of epidemic spreading, along with the impact of inform...

  10. Estimating the epidemic threshold on networks by deterministic connections

    Energy Technology Data Exchange (ETDEWEB)

    Li, Kezan, E-mail: lkzzr@sohu.com; Zhu, Guanghu [School of Mathematics and Computing Science, Guilin University of Electronic Technology, Guilin 541004 (China); Fu, Xinchu [Department of Mathematics, Shanghai University, Shanghai 200444 (China); Small, Michael [School of Mathematics and Statistics, The University of Western Australia, Crawley, Western Australia 6009 (Australia)

    2014-12-15

    For many epidemic networks some connections between nodes are treated as deterministic, while the remainder are random and have different connection probabilities. By applying spectral analysis to several constructed models, we find that one can estimate the epidemic thresholds of these networks by investigating information from only the deterministic connections. Nonetheless, in these models, generic nonuniform stochastic connections and heterogeneous community structure are also considered. The estimation of epidemic thresholds is achieved via inequalities with upper and lower bounds, which are found to be in very good agreement with numerical simulations. Since these deterministic connections are easier to detect than those stochastic connections, this work provides a feasible and effective method to estimate the epidemic thresholds in real epidemic networks.

  11. Concurrency-Induced Transitions in Epidemic Dynamics on Temporal Networks

    Science.gov (United States)

    Onaga, Tomokatsu; Gleeson, James P.; Masuda, Naoki

    2017-09-01

    Social contact networks underlying epidemic processes in humans and animals are highly dynamic. The spreading of infections on such temporal networks can differ dramatically from spreading on static networks. We theoretically investigate the effects of concurrency, the number of neighbors that a node has at a given time point, on the epidemic threshold in the stochastic susceptible-infected-susceptible dynamics on temporal network models. We show that network dynamics can suppress epidemics (i.e., yield a higher epidemic threshold) when the node's concurrency is low, but can also enhance epidemics when the concurrency is high. We analytically determine different phases of this concurrency-induced transition, and confirm our results with numerical simulations.

  12. Front dynamics in fractional-order epidemic models.

    Science.gov (United States)

    Hanert, Emmanuel; Schumacher, Eva; Deleersnijder, Eric

    2011-06-21

    A number of recent studies suggest that human and animal mobility patterns exhibit scale-free, Lévy-flight dynamics. However, current reaction-diffusion epidemics models do not account for the superdiffusive spread of modern epidemics due to Lévy flights. We have developed a SIR model to simulate the spatial spread of a hypothetical epidemic driven by long-range displacements in the infective and susceptible populations. The model has been obtained by replacing the second-order diffusion operator by a fractional-order operator. Theoretical developments and numerical simulations show that fractional-order diffusion leads to an exponential acceleration of the epidemic's front and a power-law decay of the front's leading tail. Our results indicate the potential of fractional-order reaction-diffusion models to represent modern epidemics. Copyright © 2011 Elsevier Ltd. All rights reserved.

  13. [Effect of major epidemics on cultural awareness].

    Science.gov (United States)

    Spitzy, K H

    1995-01-01

    Mankind has been stricken with "major" epidemic diseases throughout its history. The most serious among them immediately threaten man's life e.g. plague, cholera, smallpox, typhus, and dysentery, besides, there are others which take a slower course e.g. lues, leprosy, leishmaniasis, tuberculosis, and malaria. Yet, the "lesser" epidemic diseases like diphtheria, scarlet fever, mumps, pneumococcosis, influenza, and most recently AIDS may also turn into "major" ones. Originally, man exclusively depended on his genetic makeup for protection, and being particularly prone to attacks of disease he was subject to natural selection. Thus, only one human species survived, the homo sapiens. Interbreeding achieved biologic adaptation and created a balanced genetic polymorphism. Advancing in his degree of civilization, man formed groups, developed clothing, fire, houses, and tools, and his increasing cultural awareness allowed him to migrate from the tropical climates to more temperate, and less disease-infested zones. Immigration and wars, and the accompanying infections jeopardized and diminished entire populations and eradicated highly developed cultures like that of the American Indians. The plague, coming from Asia, and lues, from America, as well as cholera, influenza, and smallpox spread around the whole globe. Fear and terror led to irrational conclusions and triggered persecutions. The attitude of accepting disease as a God-sent fate (Hiob), or a God-sent punishment suppressed reasonable measures against disease. The necessary official measures have increasingly restricted liberty, and this patronizing treatment needs to be opposed with a higher sense of responsibility. Medical art has developed from more healing towards prophylactic and predictive medicine, which prognosticates the individual susceptibility to particular infections, and other risk factors.

  14. Diabesity: an overview of a rising epidemic.

    Science.gov (United States)

    Farag, Youssef M K; Gaballa, Mahmoud R

    2011-01-01

    'Diabesity' is the term for diabetes occurring in the context of obesity. In this review, we will overview the latest epidemiological data available describing the rising prevalence, health impact and economic impact of diabesity. We will also outline the measures required to slowdown this newly evolving epidemic. The global prevalence of diabetes in 2010 was 284 million people worldwide constituting around 6.4% of the world population, which is higher than was projected in earlier studies. Furthermore, the projections for 2030 show the prevalence to reach 439 million individuals comprising ~7.7% of the world population. The burden of diabetes on the world economy has been rising steadily in the last decade to reach $376 billion in 2010 and is expected to reach $490 billion in 2030. Diabesity represents a substantial economic burden as reflected by diabetes and obesity consuming 14 and 5.7% of the USA's total health expenditure, respectively, representing the highest known expenditure on diabesity worldwide. When costs associated with being overweight were also included, the upper limit of obesity expenditure rises to 9.1% of the USA's total healthcare expenditure. The highest recorded expenditure on diabetes alone was in Saudi Arabia consuming 21% of the country's total health expenditure, with no data available about the health expenditure on obesity. The health impact of diabesity is substantial to include long-term diabetic complications, reduction in health-related functioning, reduction of quality of life and reduced overall life expectancy. Long-term complications include myocardial infarction, cerebrovascular stroke and end-stage renal disease. Also recent advances have found that there is an association between chronic stress, depression and sleeping troubles to both diabetes and obesity. This century is the unprecedented diabetogenic era in human history. It is thus urgent to take steps including screening, prevention and early management in an attempt to

  15. Genetic susceptibility, evolution and the kuru epidemic.

    Science.gov (United States)

    Mead, Simon; Whitfield, Jerome; Poulter, Mark; Shah, Paresh; Uphill, James; Beck, Jonathan; Campbell, Tracy; Al-Dujaily, Huda; Hummerich, Holger; Alpers, Michael P; Collinge, John

    2008-11-27

    The acquired prion disease kuru was restricted to the Fore and neighbouring linguistic groups of the Papua New Guinea highlands and largely affected children and adult women. Oral history documents the onset of the epidemic in the early twentieth century, followed by a peak in the mid-twentieth century and subsequently a well-documented decline in frequency. In the context of these strong associations (gender, region and time), we have considered the genetic factors associated with susceptibility and resistance to kuru. Heterozygosity at codon 129 of the human prion protein gene (PRNP) is known to confer relative resistance to both sporadic and acquired prion diseases. In kuru, heterozygosity is associated with older patients and longer incubation times. Elderly survivors of the kuru epidemic, who had multiple exposures at mortuary feasts, are predominantly PRNP codon 129 heterozygotes and this group show marked Hardy-Weinberg disequilibrium. The deviation from Hardy-Weinberg equilibrium is most marked in elderly women, but is also significant in a slightly younger cohort of men, consistent with their exposure to kuru as boys. Young Fore and the elderly from populations with no history of kuru show Hardy-Weinberg equilibrium. An increasing cline in 129V allele frequency centres on the kuru region, consistent with the effect of selection in elevating the frequency of resistant genotypes in the exposed population. The genetic data are thus strikingly correlated with exposure. Considering the strong coding sequence conservation of primate prion protein genes, the number of global coding polymorphisms in man is surprising. By intronic resequencing in a European population, we have shown that haplotype diversity at PRNP comprises two major and divergent clades associated with 129M and 129V. Kuru may have imposed the strongest episode of recent human balancing selection, which may not have been an isolated episode in human history.

  16. Establishing the spread of bluetongue virus at the end of the 2006 epidemic in Belgium.

    Science.gov (United States)

    Méroc, E; Faes, C; Herr, C; Staubach, C; Verheyden, B; Vanbinst, T; Vandenbussche, F; Hooyberghs, J; Aerts, M; De Clercq, K; Mintiens, K

    2008-09-18

    Bluetongue (BT) was notified for the first time in several Northern European countries in August 2006. The first reported outbreaks of BT were confirmed in herds located near the place where Belgium, The Netherlands and Germany share borders. The disease was rapidly and widely disseminated throughout Belgium in both sheep and cattle herds. During the epidemic, case reporting by the Veterinary Authorities relied almost exclusively on the identification of herds with confirmed clinical infected ruminants. A cross-sectional serological survey targeting all Belgian ruminants was then undertaken during the vector-free season. The first objective of this study was to provide unbiased estimates of BT-seroprevalence for different regions of Belgium. Since under-reporting was suspected during the epidemic, a second goal was to compare the final dispersion of the virus based on the seroprevalence estimates to the dispersion of the confirmed clinical cases which were notified in Belgium, in order to estimate the accuracy of the case detection based on clinical suspicion. True within-herd seroprevalence was estimated based on a logistic-normal regression model with prior specification on the diagnostic test's sensitivity and specificity. The model was fitted in a Bayesian framework. Herd seroprevalence was estimated using a logistic regression model. To study the linear correlation between the BT winter screening data and the case-herds data, the linear predicted values for the herd prevalence were compared and the Pearson correlation coefficient was estimated. The overall herd and true within-herd seroprevalences were estimated at 83.3 (79.2-87.0) and 23.8 (20.1-28.1)%, respectively. BT seropositivity was shown to be widely but unevenly distributed throughout Belgium, with a gradient decreasing towards the south and the west of the country. The analysis has shown there was a strong correlation between the outbreak data and the data from the survey (r=0.73, p<0.0001). The case

  17. PMS2 Involvement in Patients Suspected of Lynch Syndrome

    NARCIS (Netherlands)

    Niessen, Renee C.; Kleibeuker, Jan H.; Westers, Helga; Jager, Paul O. J.; Rozeveld, Dennie; Bos, Krista K.; Boersma-van Ek, Wytske; Hollema, Harry; Sijmons, Rolf H.; Hofstra, Robert M. W.

    It is well-established that germline mutations in the mismatch repair genes MLH1, MSH2, and MSH6 cause Lynch syndrome. However, mutations in these three genes do not account for all Lynch syndrome (suspected) families. Recently, it was shown that germline mutations in another mismatch repair gene,

  18. Faecal Calprotectin in Suspected Paediatric Inflammatory Bowel Disease

    NARCIS (Netherlands)

    Degraeuwe, Pieter L. J.; Beld, Monique P. A.; Ashorn, Merja; Canani, Roberto Berni; Day, Andrew S.; Diamanti, Antonella; Fagerberg, Ulrika L.; Henderson, Paul; Kolho, Kaija-Leena; Van de Vijver, Els; van Rheenen, Patrick F.; Wilson, David C.; Kessels, Alfons G. H.

    Objectives: The diagnostic accuracy of faecal calprotectin (FC) concentration for paediatric inflammatory bowel disease (IBD) is well described at the population level, but not at the individual level. We reassessed the diagnostic accuracy of FC in children with suspected IBD and developed an

  19. Stabilization of the spine in patients with suspected cervical spine ...

    African Journals Online (AJOL)

    Stabilization of the spine in patients with suspected cervical spine injury in Mulago Hospital. BM Ndeleva, T Beyeza. Abstract. No Abstract. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · http://dx.doi.org/10.4314/eaoj.v5i1.67487 · AJOL African Journals ...

  20. Talking heads : interviewing suspects from a cultural perspective

    NARCIS (Netherlands)

    Beune, K.

    2009-01-01

    Although the literature on the interviewing of suspects has increased over the past decade, research on the use and effectiveness of police strategies and their boundary conditions is very rare. The present dissertation aims to fill this void by identifying behaviors that appeal to and persuade

  1. Nonreferral of Nursing Home Patients With Suspected Breast Cancer

    NARCIS (Netherlands)

    Hamaker, Marije E.; Hamelinck, Victoria C.; van Munster, Barbara C.; Bastiaannet, Esther; Smorenburg, Carolien H.; Achterberg, Wilco P.; Liefers, Gerrit-Jan; de Rooij, Sophia E.

    2012-01-01

    Introduction: People with suspected breast cancer who are not referred for diagnostic testing remain unregistered and are not included in cancer statistics. Little is known about the extent of and motivation for nonreferral of these patients. Methods: A Web-based survey was sent to all elderly care

  2. DNA typing from vaginal smear slides in suspected rape cases

    Directory of Open Access Journals (Sweden)

    Dayse Aparecida da Silva

    Full Text Available In an investigation of suspected rape, proof of sexual assault with penetration is required. In view of this, detailed descriptions of the genitalia, the thighs and pubic region are made within the forensic medical service. In addition, vaginal swabs are taken from the rape victim and some of the biological material collected is then transferred to glass slides. In this report, we describe two rape cases solved using DNA typing from cells recovered from vaginal smear slides. In 1999, two young women informed the Rio de Janeiro Police Department that they had been victims of sexual assaults. A suspect was arrested and the victims identified him as the offender. The suspect maintained that he was innocent. In order to elucidate these crimes, vaginal smear slides were sent to the DNA Diagnostic Laboratory for DNA analysis three months after the crimes, as unique forensic evidence. To get enough epithelial and sperm cells to perform DNA analysis, we used protocols modified from the previously standard protocols used for DNA extraction from biological material fixed on glass slides. The quantity of cells was sufficient to perform human DNA typing using nine short tandem repeat (STR loci. It was 3.3 billion times more probable that it was the examined suspect who had left sperm cells in the victims, rather than any other individual in the population of Rio de Janeiro.

  3. Cognitive Linguistic Performances of Multilingual University Students Suspected of Dyslexia

    Science.gov (United States)

    Lindgren, Signe-Anita; Laine, Matti

    2011-01-01

    High-performing adults with compensated dyslexia pose particular challenges to dyslexia diagnostics. We compared the performance of 20 multilingual Finnish university students with suspected dyslexia with 20 age-matched and education-matched controls on an extensive test battery. The battery tapped various aspects of reading, writing, word…

  4. Differential Diagnosis of Children with Suspected Childhood Apraxia of Speech

    Science.gov (United States)

    Murray, Elizabeth; McCabe, Patricia; Heard, Robert; Ballard, Kirrie J.

    2015-01-01

    Purpose: The gold standard for diagnosing childhood apraxia of speech (CAS) is expert judgment of perceptual features. The aim of this study was to identify a set of objective measures that differentiate CAS from other speech disorders. Method: Seventy-two children (4-12 years of age) diagnosed with suspected CAS by community speech-language…

  5. A suspected case of Addison’s disease in cattle

    OpenAIRE

    Lambacher, Bianca; Wittek, Thomas

    2015-01-01

    A 4.75-year old Simmental cow was presented with symptoms of colic and ileus. The clinical signs and blood analysis resulted in the diagnosis of suspected primary hypoadrenocorticism (Addison’s disease). Although Addison’s disease has been frequently described in other domestic mammals, to our knowledge, this disease has not previously been reported in cattle.

  6. Is extended biopsy protocol justified in all patients with suspected ...

    African Journals Online (AJOL)

    Objective: To determine the significance of an extended 10-core transrectal biopsy protocol in different categories of patients with suspected prostate cancer using digital guidance. Materials and Methods: We studied 125 men who were being evaluated for prostate cancer. They all had an extended 10-core digitally guided ...

  7. Correlates and Suspected Causes of Obesity in Children

    Science.gov (United States)

    Crothers, Laura M.; Kehle, Thomas J.; Bray, Melissa A.; Theodore, Lea A.

    2009-01-01

    The correlates and suspected causes of the intractable condition obesity are complex and involve environmental and heritable, psychological and physical variables. Overall, the factors associated with and possible causes of it are not clearly understood. Although there exists some ambiguity in the research regarding the degree of happiness in…

  8. Medical Evaluation of Suspected Child Sexual Abuse: 2011 Update

    Science.gov (United States)

    Adams, Joyce A.

    2011-01-01

    The medical evaluation of children with suspected sexual abuse includes more than just the physical examination of the child. The importance of taking a detailed medical history from the parents and a history from the child about physical sensations following sexual contact has been emphasized in other articles in the medical literature. The…

  9. Selective screening in neonates suspected to have inborn errors of ...

    African Journals Online (AJOL)

    Background: Inborn errors of metabolism (IEM) have a high morbidity and mortality in neonates. Unfortunately, there is no nationwide neonatal screen in Egypt, so several cases may be missed. Objective: The aim of this work was to detect the prevalence of IEM among neonates with suspected IEM, and to diagnose IEM as ...

  10. Sexual Health Before Treatment in Women with Suspected Gynecologic Malignancy.

    Science.gov (United States)

    Bretschneider, C Emi; Doll, Kemi M; Bensen, Jeannette T; Gehrig, Paola A; Wu, Jennifer M; Geller, Elizabeth J

    2017-08-22

    Sexual health in survivors of gynecologic cancer has been studied; however, sexual health in these women before treatment has not been thoroughly evaluated. The objective of our study was to describe the pretreatment characteristics of sexual health of women with suspected gynecologic cancer before cancer treatment. We performed a cross-sectional analysis of women with a suspected gynecologic cancer, who were prospectively enrolled in a hospital-based cancer survivorship cohort from August 2012 to June 2013. Subjects completed the validated Patient-Reported Outcomes Measurement Information System Sexual Function and Satisfaction Questionnaire. Pretreatment sexual health was assessed in terms of sexual interest, desire, lubrication, discomfort, orgasm, enjoyment, and satisfaction. Of 186 eligible women with suspected gynecologic cancer, 154 (82%) completed the questionnaire pretreatment. Mean age was 58.1 ± 13.3 years. Sexual health was poor: 68.3% reported no sexual activity, and 54.7% had no interest in sexual activity. When comparing our study population to the general U.S. population, the mean pretreatment scores for the subdomains of lubrication and vaginal discomfort were similar, while sexual interest was significantly lower and global satisfaction was higher. In a linear regression model, controlling for cancer site, age remained significantly associated with sexual function while cancer site did not. Problems with sexual health are prevalent in women with suspected gynecologic malignancies before cancer treatment. Increasing awareness of the importance of sexual health in this population will improve quality of life for these women.

  11. Use of budesonide Turbuhaler in young children suspected of asthma

    DEFF Research Database (Denmark)

    Bisgaard, H; Pedersen, S; Nikander, K

    1994-01-01

    The question addressed in this study was the ability of young children to use a dry-powder inhaler, Turbuhaler. One hundred and sixty five children suspected of asthma, equally distributed in one year age-groups from 6 months to 8 yrs, inhaled from a Pulmicort Turbuhaler, 200 micrograms budesonid...

  12. Doppler ultrasound in the assessment of suspected intra-uterine ...

    African Journals Online (AJOL)

    Ramakantb

    obesity with hypertension and non-insulin-dependent diabetes mellitus.[3] In this review, a brief discussion about the ultrasound diagnosis of suspected IUGR, and thereafter about the use of Doppler ultrasound in the diagnosis of IUGR, will be ... before that, all fetuses have relatively larger heads, which will mask the brain-.

  13. Candida meningitis in a suspected immunosuppressive patient - A ...

    African Journals Online (AJOL)

    Candida meningitis in a suspected immunosuppressive patient - A case report. EO Sanya, NB Ameen, BA Onile. Abstract. No Abstract. West African Journal of Medicine Vol. 25 (1) 2006: pp.79-81. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT.

  14. Ajmaline challenge in young individuals with suspected Brugada syndrome

    NARCIS (Netherlands)

    Sorgente, A.; Sarkozy, A.; Asmundis, C. de; Chierchia, G.B.; Capulzini, L.; Paparella, G.; Henkens, S.; Brugada, P.

    2011-01-01

    BACKGROUND: The clinical characteristics and the results of ajmaline challenge in young individuals with suspected Brugada syndrome (BS) have not been systematically investigated. METHODS: Among a larger series of patients included in the BS database of our Department, 179 patients undergoing

  15. A Diagnostic Program for Patients Suspected of Having Lung Cancer

    NARCIS (Netherlands)

    Stigt, Jos A.; Uil, Steven M.; Oostdijk, Ad H.; Boers, James E.; van den Berg, Jan-Willem K.; Groen, Harry J. M.

    2012-01-01

    In 297 patients suspected of having lung cancer, invasive diagnostic procedures followed positron emission tomography/computed tomography (PET-CT) on the same day. For patients with a diagnosis of malignancy (215/297), investigations were finalized on 1 day in 85%, and bronchoscopy was performed in

  16. Use of Chest Radiography In Patients Suspected of Pulmonary ...

    African Journals Online (AJOL)

    may be rushed into treatfng all cases of cough, fever and weight loss with negative sputums as PTB, and other diagnoses may be overlooked. A cheaper, quicker way of screening TB suspects would help con- siderably in this common problem. In Febuary 1991, the Norwegian Government do- nated two Odelka camer;l,s to ...

  17. The control of vector-borne disease epidemics.

    Science.gov (United States)

    Hosack, Geoffrey R; Rossignol, Philippe A; van den Driessche, P

    2008-11-07

    The theoretical underpinning of our struggle with vector-borne disease, and still our strongest tool, remains the basic reproduction number, R(0), the measure of long term endemicity. Despite its widespread application, R(0) does not address the dynamics of epidemics in a model that has an endemic equilibrium. We use the concept of reactivity to derive a threshold index for epidemicity, E(0), which gives the maximum number of new infections produced by an infective individual at a disease free equilibrium. This index describes the transitory behavior of disease following a temporary perturbation in prevalence. We demonstrate that if the threshold for epidemicity is surpassed, then an epidemic peak can occur, that is, prevalence can increase further, even when the disease is not endemic and so dies out. The relative influence of parameters on E(0) and R(0) may differ and lead to different strategies for control. We apply this new threshold index for epidemicity to models of vector-borne disease because these models have a long history of mathematical analysis and application. We find that both the transmission efficiency from hosts to vectors and the vector-host ratio may have a stronger effect on epidemicity than endemicity. The duration of the extrinsic incubation period required by the pathogen to transform an infected vector to an infectious vector, however, may have a stronger effect on endemicity than epidemicity. We use the index E(0) to examine how vector behavior affects epidemicity. We find that parasite modified behavior, feeding bias by vectors for infected hosts, and heterogeneous host attractiveness contribute significantly to transitory epidemics. We anticipate that the epidemicity index will lead to a reevaluation of control strategies for vector-borne disease and be applicable to other disease transmission models.

  18. Opioid analgesic administration in patients with suspected drug use.

    Science.gov (United States)

    Kreling, Maria Clara Giorio Dutra; Mattos-Pimenta, Cibele Andrucioli de

    2017-01-01

    To identify the prevalence of patients suspected of drug use according to the nursing professionals' judgement, and compare the behavior of these professionals in opioid administration when there is or there is no suspicion that patient is a drug user. A cross-sectional study with 507 patients and 199 nursing professionals responsible for administering drugs to these patients. The Chi-Square test, Fisher's Exact and a significance level of 5% were used for the analyzes. The prevalence of suspected patients was 6.7%. The prevalence ratio of administration of opioid analgesics 'if necessary' is twice higher among patients suspected of drug use compared to patients not suspected of drug use (p = 0.037). The prevalence of patients suspected of drug use was similar to that of studies performed in emergency departments. Patients suspected of drug use receive more opioids than patients not suspected of drug use. Identificar a prevalência de pacientes com suspeita de uso de drogas conforme opinião de profissionais de enfermagem e comparar a conduta desses profissionais na administração de opioides quando há ou não suspeita de que o paciente seja usuário de drogas. Estudo transversal com 507 pacientes e 199 profissionais de enfermagem responsáveis pela administração de medicamentos a esses pacientes. Para as análises foram utilizados os testes de Qui-Quadrado, Exato de Fisher e um nível de significância de 5%. A prevalência de pacientes suspeitos foi 6,7%. A razão de prevalência de administração de analgésicos opioides "se necessário" é duas vezes maior entre os pacientes suspeitos em relação aos não suspeitos (p=0,037). A prevalência de suspeitos foi semelhante à de estudos realizados em departamentos de emergência. Os suspeitos de serem usuários de drogas recebem mais opioides do que os não suspeitos.

  19. Magnetic resonance imaging versus bone scintigraphy in suspected scaphoid fracture

    Energy Technology Data Exchange (ETDEWEB)

    Tiel-van Buul, M.M.C. [Dept. of Nuclear Medicine, Academic Medical Center, Univ. of Amsterdam (Netherlands); Roolker, W. [Dept. of Nuclear Medicine, Academic Medical Center, Univ. of Amsterdam (Netherlands); Verbeeten, B.W.B. Jr. [Dept. of Radiology, Academic Medical Center, Univ. of Amsterdam (Netherlands); Broekhuizen, A.H. [Dept. of Traumatology, Academic Medical Center, Univ. of Amsredam (Netherlands)

    1996-08-01

    Magnetic resonance imaging (MRI) has become increasingly useful in the evaluation of musculoskeletal problems, including those of the wrist. In patients with a wrist injury, MRI is used mainly to assess vascularity of scaphoid non-union. However, the use of MRI in patients in the acute phase following carpal injury is not common. Three-phase bone scintigraphy is routinely performed from at least 72 h after injury in patients with suspected scaphoid fracture and negative initial radiographs. We evaluated MRI in this patient group. The bone scan was used as the reference method. Nineteen patients were included. Bone scintigraphy was performed in all 19 patients, but MRI could be obtained in only 16 (in three patients, MRI was stopped owing to claustrophobia). In five patients, MRI confirmed a scintigraphically suspected scaphoid fracture. In one patient, a perilunar luxation, without a fracture, was seen on MRI, while bone scintigraphy showed a hot spot in the region of the lunate bone, suspected for fracture. This was confirmed by surgery. In two patients, a hot spot in the scaphoid region was suspected for scaphoid fracture, and immobilization and employed for a period of 12 weeks. MRI was negative in both cases; in one of them a scaphoid fracture was retrospectively proven on the initial X-ray series. In another two patients, a hot spot in the region of MCP I was found with a negative MRI. In both, the therapy was adjusted. In the remaining six patients, both modalities were negative. We conclude that in the diagnostic management of patients with suspected scaphoid fracture and negative initial radiographs, the use of MRI may be promising, but is not superior to three-phase bone scintigraphy. (orig.)

  20. Clinical Profile of Suspected and Confirmed H1N1 Influenza Infection in Patients admitted at a Tertiary Care Teaching Hospital

    Directory of Open Access Journals (Sweden)

    Basavaraju Jayadeva

    2015-11-01

    Full Text Available Introduction: This study aimed to evaluate the clinical profile and outcomes of adult patients screened and diagnosed with H1N1 influenza infection at a tertiary care hospital in India. Materials and Methods: This retrospective  study was conducted on all adult patients suspected of H1N1 influenza admitted at a teaching hospital during the epidemic period of January-March 2015. Patients were screened and classified into three categories of A, B, and C based on international guidelines. Home confinement was recommended for patients in category A, and subjects in category B received treatment with Oseltamivir capsules. In addition, patients in category C received inpatient treatment with oseltamivir capsules. Results: In total, 695 patients were screened for H1N1 influenza infection during the epidemic, out of whom 380 patients (54.6% were in category A, 264 (37.9% were in category B, and 51 (7.3% were in category C. Throat swabs were collected and examined for 192 ( 27.6% patients, and 59 ( 8.4% cases were positive for H1N1 infection. Conclusion: According to the results of this study, close vigilance over the symptoms of patients infected with H1N1 influenza is more important than treatment and screening of suspicious cases during the epidemics of this infection. This is a retrospective cross sectional study. Hence, there were no comparative controls. The limitation of this study is,  thus the lack of control.

  1. An intervention to stop smoking among patients suspected of TB - evaluation of an integrated approach

    Directory of Open Access Journals (Sweden)

    Ahmad Maqsood

    2010-03-01

    Full Text Available Abstract Background In many low- and middle-income countries, where tobacco use is common, tuberculosis is also a major problem. Tobacco use increases the risk of developing tuberculosis, secondary mortality, poor treatment compliance and relapses. In countries with TB epidemic, even a modest relative risk leads to a significant attributable risk. Treating tobacco dependence, therefore, is likely to have benefits for controlling tuberculosis in addition to reducing the non-communicable disease burden associated with smoking. In poorly resourced health systems which face a dual burden of disease secondary to tuberculosis and tobacco, an integrated approach to tackle tobacco dependence in TB control could be economically desirable. During TB screening, health professionals come across large numbers of patients with respiratory symptoms, a significant proportion of which are likely to be tobacco users. These clinical encounters, considered to be "teachable moments", provide a window of opportunity to offer treatment for tobacco dependence. Methods/Design We aim to develop and trial a complex intervention to reduce tobacco dependence among TB suspects based on the WHO 'five steps to quit' model. This model relies on assessing personal motivation to quit tobacco use and uses it as the basis for assessing suitability for the different therapeutic options for tobacco dependence. We will use the Medical Research Council framework approach for evaluating complex interventions to: (a design an evidence-based treatment package (likely to consist of training materials for health professionals and education tools for patients; (b pilot the package to determine the delivery modalities in TB programme (c assess the incremental cost-effectiveness of the package compared to usual care using a cluster RCT design; (d to determine barriers and drivers to the provision of treatment of tobacco dependence within TB programmes; and (e support long term implementation

  2. An intervention to stop smoking among patients suspected of TB--evaluation of an integrated approach.

    Science.gov (United States)

    Siddiqi, Kamran; Khan, Amir; Ahmad, Maqsood; Shafiq-ur-Rehman

    2010-03-25

    In many low- and middle-income countries, where tobacco use is common, tuberculosis is also a major problem. Tobacco use increases the risk of developing tuberculosis, secondary mortality, poor treatment compliance and relapses. In countries with TB epidemic, even a modest relative risk leads to a significant attributable risk. Treating tobacco dependence, therefore, is likely to have benefits for controlling tuberculosis in addition to reducing the non-communicable disease burden associated with smoking. In poorly resourced health systems which face a dual burden of disease secondary to tuberculosis and tobacco, an integrated approach to tackle tobacco dependence in TB control could be economically desirable. During TB screening, health professionals come across large numbers of patients with respiratory symptoms, a significant proportion of which are likely to be tobacco users. These clinical encounters, considered to be "teachable moments", provide a window of opportunity to offer treatment for tobacco dependence. We aim to develop and trial a complex intervention to reduce tobacco dependence among TB suspects based on the WHO 'five steps to quit' model. This model relies on assessing personal motivation to quit tobacco use and uses it as the basis for assessing suitability for the different therapeutic options for tobacco dependence.We will use the Medical Research Council framework approach for evaluating complex interventions to: (a) design an evidence-based treatment package (likely to consist of training materials for health professionals and education tools for patients); (b) pilot the package to determine the delivery modalities in TB programme (c) assess the incremental cost-effectiveness of the package compared to usual care using a cluster RCT design; (d) to determine barriers and drivers to the provision of treatment of tobacco dependence within TB programmes; and (e) support long term implementation. The main outcomes to assess the effectiveness

  3. EMS runs for suspected opioid overdose: implications for surveillance and prevention.

    Science.gov (United States)

    Knowlton, Amy; Weir, Brian W; Hazzard, Frank; Olsen, Yngvild; McWilliams, Junette; Fields, Julie; Gaasch, Wade

    2013-01-01

    Opioid (including prescription opiate) abuse and overdose rates in the United States have surged in the past decade. The dearth and limitations of opioid abuse and overdose surveillance systems impede the development of interventions to address this epidemic. Objective. We explored evidence to support the validity of emergency medical services (EMS) data on naloxone administration as a possible proxy for estimating incidence of opioid overdose. We reviewed data from Baltimore City Fire Department EMS patient records matched with dispatch records over a 13-month time period (2008-2009) based on 2008 Census data. We calculated incidence rates and patient demographic and temporal patterns of naloxone administration, and examined patient evaluation data associated with naloxone administration. Results were compared with the demographic distributions of the EMS patient and city populations and with prior study findings. Of 116,910 EMS incidents during the study period for patients aged 15 years and older, EMS providers administered naloxone 1,297 times (1.1% of incidents), an average of 100 administrations per month. The overall incidence was 1.87 administrations per 1,000 residents per year. Findings indicated that naloxone administration peaked in the summer months (31% of administrations), on weekends (32%), and in the late afternoon (4:00-5:00 pm [8%]); and there was a trend toward peaking in the first week of the month. The incidence of suspected opioid overdose was highest among male patients, white patients, and those in the 45-54-year age group. Findings on temporal patterns were comparable with findings from prior studies. Demographic patterns of suspected opioid overdose were similar to medical examiner reports of demographic patterns of fatal drug- or alcohol-related overdoses in Baltimore in 2008-2009 (88% of which involved opioids). The findings on patient evaluation data suggest some inconsistencies with previously recommended clinical indications of

  4. Can influenza epidemics be prevented by voluntary vaccination?

    Directory of Open Access Journals (Sweden)

    Raffaele Vardavas

    2007-05-01

    Full Text Available Previous modeling studies have identified the vaccination coverage level necessary for preventing influenza epidemics, but have not shown whether this critical coverage can be reached. Here we use computational modeling to determine, for the first time, whether the critical coverage for influenza can be achieved by voluntary vaccination. We construct a novel individual-level model of human cognition and behavior; individuals are characterized by two biological attributes (memory and adaptability that they use when making vaccination decisions. We couple this model with a population-level model of influenza that includes vaccination dynamics. The coupled models allow individual-level decisions to influence influenza epidemiology and, conversely, influenza epidemiology to influence individual-level decisions. By including the effects of adaptive decision-making within an epidemic model, we can reproduce two essential characteristics of influenza epidemiology: annual variation in epidemic severity and sporadic occurrence of severe epidemics. We suggest that individual-level adaptive decision-making may be an important (previously overlooked causal factor in driving influenza epidemiology. We find that severe epidemics cannot be prevented unless vaccination programs offer incentives. Frequency of severe epidemics could be reduced if programs provide, as an incentive to be vaccinated, several years of free vaccines to individuals who pay for one year of vaccination. Magnitude of epidemic amelioration will be determined by the number of years of free vaccination, an individuals' adaptability in decision-making, and their memory. This type of incentive program could control epidemics if individuals are very adaptable and have long-term memories. However, incentive-based programs that provide free vaccination for families could increase the frequency of severe epidemics. We conclude that incentive-based vaccination programs are necessary to control

  5. The gin epidemic: much ado about what?

    Science.gov (United States)

    Abel, E L

    2001-01-01

    While there is no doubt that the era of the 'gin epidemic' was associated with poverty and social unrest, the surge in gin drinking was localized to London and was a concomitant, not the cause, of these problems. The two main underlying social problems were widespread overcrowding and poverty. The former was related to an unprecedented migration of people from the country to London. The latter stemmed from an economic ideology called 'poverty theory', whose basic premise was that, by keeping the 'inferior order' in poverty, English goods would be competitive and would remain that way since workers would be completely dependent on their employers. Widespread overcrowding and poverty led to societal unrest which manifested itself in increased drunkenness when cheap gin became available after Parliament did away with former distilling monopolies that had kept prices high. Reformers ignored the social causes of this unrest and, instead, focused on gin drinking by the poor which they feared was endangering England's wealth and security by enfeebling its labour force, and reducing its manpower by decreasing its population. Part of this hostility was also related to gin itself. While drunkenness was often spoken of affectionately when it was induced by beer, England's national drink, gin was considered a foreign drink, and therefore less acceptable. These concerns were voiced less often after the passage of the Tippling Act of 1751, which resulted in an increase in gin prices and decreased consumption. However, the second half of the century was also a period in which England's military victory over the French gave it new wealth and power, which dispelled upper-class fears about an enfeebled and dissolute working class. It was also an era when new public health measures, such as mass inoculation against smallpox, and a decrease in the marrying age, led to a population increase that dispelled reformist fears about manpower shortages. The conclusion is that, while the lower

  6. Control of African swine fever epidemics in industrialized swine populations

    DEFF Research Database (Denmark)

    Hisham Beshara Halasa, Tariq; Bøtner, Anette; Mortensen, Sten

    2016-01-01

    and national strategy (Basic), the basic strategy plus pre-emptive depopulation of neighboring swine herds, and intensive surveillance of herds in the control zones, including testing live or dead animals. Virus spread via wild boar was not modelled. Under the basic control strategy, the median epidemic...... resulted in marginal improvements to the control of the epidemics. However, adding testing of dead animals in the protection and surveillance zones was predicted to be the optimal control scenario for an ASF epidemic in industrialized swine populations without contact to wild boar. This optimal scenario...

  7. A rational clinical approach to suspected insulin allergy

    DEFF Research Database (Denmark)

    Bødtger, Uffe; Wittrup, M

    2005-01-01

    AIMS: Allergy to recombinant human (rDNA) insulin preparations is a rare complication of insulin therapy. However, insulin preparations contain several allergens, and several disorders can resemble insulin allergy. Studies evaluating the diagnostic procedures on suspected insulin allergy...... technique (n = 5), skin disease (n = 3) and other systemic allergy (n = 1). Nine other patients were found to be allergic to protamine (n = 3) or rDNA insulin (n = 6), and specific treatment was associated with relief in 8 patients (89%). Four patients had local reactions of unknown causes but symptom...... relief was obtained in three cases by unspecific therapy. Overall, 20 (91%) reported relief of symptoms. CONCLUSION: Our standardized investigative procedure of suspected insulin preparation (IP) allergy was associated with relief of symptoms in > 90% of patients. IP allergy was diagnosed in 41...

  8. Interdisciplinary action of nurses to children with suspected sexual abuse

    Directory of Open Access Journals (Sweden)

    Lia Leão Ciuffo

    2014-04-01

    Full Text Available Objective. Understanding the role of nurses as members of interdisciplinary teams in the care of children with suspected sexual abuse. Methodology. This is a qualitative research based on the sociological phenomenology of Alfred Schutz. In 2008 were interviewed eleven nurses who worked in reference institutions for the care of child victims of sexual abuse in Rio de Janeiro. Results. The category called 'Interacting with other professionals in child care' emerged from the analysis of performance of professionals. The intersubjective relations between the nurses and the interdisciplinary team will enable to understand the intent of care from the perspective of social, emotional and psychological needs of children and their families. Conclusion. Interdisciplinarity favored the development of actions based on acceptance, listening and agreements on possible solutions in the care of children with suspected sexual abuse.

  9. Atlantoaxial subluxation and nasopharyngeal necrosis complicating suspected granulomatosis with polyangiitis.

    Science.gov (United States)

    Mohapatra, Anand; Holekamp, Terrence F; Diaz, Jason A; Zebala, Lukas; Brasington, Richard

    2015-04-01

    Granulomatosis polyangiitis (GPA, formerly Wegener granulomatosis) is a vasculitis that typically involves the upper respiratory tract, lungs, and kidneys. The 2 established methods to confirm a suspicion of GPA are the antineutrophil cytoplasmic antibody (ANCA) test and biopsy. However, ANCA-negative cases have been known to occur, and it can be difficult to find biopsy evidence of granulomatous disease.We report a case of suspected granulomatosis with polyangiitis limited to the nasopharynx. With a negative ANCA and no histological evidence, our diagnosis was founded on the exclusion of other diagnoses and the response to cyclophosphamide therapy. This case is unique because the patient's lesion resulted in atlantoaxial instability, which required a posterior spinal fusion at C1-C2. This is the first reported case of suspected GPA producing damage to the cervical spine and threatening the spinal cord.

  10. Suspected side effects to the quadrivalent human papilloma vaccine

    DEFF Research Database (Denmark)

    Brinth, Louise; Theibel, Ann Cathrine; Pors, Kirsten

    2015-01-01

    INTRODUCTION: The quadrivalent vaccine that protects against human papilloma virus types 6, 11, 16 and 18 (Q-HPV vaccine, Gardasil) was included into the Danish childhood vaccination programme in 2009. During the past years, a collection of symptoms primarily consistent with sympathetic nervous...... system dysfunction have been described as suspected side effects to the Q-HPV vaccine. METHODS: We present a description of suspected side effects to the Q-HPV vaccine in 53 patients referred to our Syncope Unit for tilt table test and evaluation of autonomic nervous system function. RESULTS: All...... consistency in the reported symptoms as well as between our findings and those described by others. Our findings neither confirm nor dismiss a causal link to the Q-HPV vaccine, but they suggest that further research is urgently warranted to clarify the pathophysiology behind the symptoms experienced...

  11. Radiological (scintigraphic) evaluation of patients with suspected pulmonar thromboembolism

    Energy Technology Data Exchange (ETDEWEB)

    Biello, D.R.

    1987-06-19

    The optimal strategy for diagnostic evaluation of patients with suspected pulmonary thromboembolism (PE) is subject of controversial and often conflicting opinions. If untreated, as many as 30% of patients with PE may die. Conversely, anticoagulant therapy significantly decreases mortality from PE, but bleeding complications occur. Underdiagnosis may result in a preventable death, and overdiagnosis may lead to significant hemorrhage from unnecessary anticoagulant therapy. This article outlines a practical guide for the use of pulmonary ventilation-perfusion (V-P) scintigraphy in patients with suspected PE. Perfusion imaging involves the intravenous injection of radiolabeled particles ranging from 10 to 60 ..mu..m in diameter (technetium Tc 99m macroaggregated albumin or technetium Tc 99m serum albumin microspheres); these particles are trapped in the capillaries and precapillary arterioles of the lung. The radiolabeled particles are distributed to the lungs in proportion to regional pulmonary blood flow. The correspondence of perfusion defects to bronchopulmonary segments is best appreciated in the posterior oblique views.

  12. Impact of the obesity epidemic on cancer.

    Science.gov (United States)

    Goodwin, Pamela J; Stambolic, Vuk

    2015-01-01

    There is growing appreciation that the current obesity epidemic is associated with increases in cancer incidence at a population level and may lead to poor cancer outcomes; concurrent decreases in cancer mortality at a population level may represent a paradox, i.e., they may also reflect improvements in the diagnosis and treatment of cancer that mask obesity effects. An association of obesity with cancer is biologically plausible because adipose tissue is biologically active, secreting estrogens, adipokines, and cytokines. In obesity, adipose tissue reprogramming may lead to insulin resistance, with or without diabetes, and it may contribute to cancer growth and progression locally or through systemic effects. Obesity-associated changes impact cancer in a complex fashion, potentially acting directly on cells through pathways, such as the phosphoinositide 3-kinase (PI3K) and Janus kinase-signal transducer and activator of transcription (JAK-STAT) pathways, or indirectly via changes in the tumor microenvironment. Approaches to obesity management are discussed, and the potential for pharmacologic interventions that target the obesity-cancer link is addressed.

  13. Environmental signatures associated with cholera epidemics.

    Science.gov (United States)

    Constantin de Magny, Guillaume; Murtugudde, Raghu; Sapiano, Mathew R P; Nizam, Azhar; Brown, Christopher W; Busalacchi, Antonio J; Yunus, Mohammad; Nair, G Balakrish; Gil, Ana I; Lanata, Claudio F; Calkins, John; Manna, Byomkesh; Rajendran, Krishnan; Bhattacharya, Mihir Kumar; Huq, Anwar; Sack, R Bradley; Colwell, Rita R

    2008-11-18

    The causative agent of cholera, Vibrio cholerae, has been shown to be autochthonous to riverine, estuarine, and coastal waters along with its host, the copepod, a significant member of the zooplankton community. Temperature, salinity, rainfall and plankton have proven to be important factors in the ecology of V. cholerae, influencing the transmission of the disease in those regions of the world where the human population relies on untreated water as a source of drinking water. In this study, the pattern of cholera outbreaks during 1998-2006 in Kolkata, India, and Matlab, Bangladesh, and the earth observation data were analyzed with the objective of developing a prediction model for cholera. Satellite sensors were used to measure chlorophyll a concentration (CHL) and sea surface temperature (SST). In addition, rainfall data were obtained from both satellite and in situ gauge measurements. From the analyses, a statistically significant relationship between the time series for cholera in Kolkata, India, and CHL and rainfall anomalies was determined. A statistically significant one month lag was observed between CHL anomaly and number of cholera cases in Matlab, Bangladesh. From the results of the study, it is concluded that ocean and climate patterns are useful predictors of cholera epidemics, with the dynamics of endemic cholera being related to climate and/or changes in the aquatic ecosystem. When the ecology of V. cholerae is considered in predictive models, a robust early warning system for cholera in endemic regions of the world can be developed for public health planning and decision making.

  14. Systemic calicivirus epidemic in captive exotic felids.

    Science.gov (United States)

    Harrison, Tara M; Sikarskie, James; Kruger, John; Wise, Annabel; Mullaney, Thomas P; Kiupel, Matti; Maes, Roger K

    2007-06-01

    A 5-day-old, mother-raised, Amur tiger cub (Panthera tigris altaica) presented with tongue ulcerations. Identical lesions appeared and progressed to sloughing of the tongue in the three littermates of this cub the following day. The lesions progressed in all cubs to include sloughing of the carpal, tarsal, metacarpal, and metatarsal foot pad epithelium. Oral ulcerations were also noted in adult African lions (Panthera leo) and Amur tigers (Panthera tigris altaica), but not in two adult snow leopards (Panthera uncia) housed in the same building. All adult cats had been previously vaccinated for common feline diseases including feline calicivirus (FCV). Detection of FCV RNA in oral secretions by a real-time reverse transcription polymerase chain reaction assay (RRT-PCR) confirmed FCV infection in the tiger cubs and one lion. A male lion and a male tiger cub died during the disease outbreak. RRT-PCR confirmed FCV in multiple tissues in both of these animals. A stray cat live-trapped outside the feline building during the epidemic was found to be positive for FCV by virus isolation and was thought to be the source of infection.

  15. Chronic kidney disease epidemic: myth and reality.

    Science.gov (United States)

    Mangione, Filippo; Dal Canton, Antonio

    2011-10-01

    In recent years, an epidemic of chronic kidney disease (CKD) has emerged as one of the major public health problem. The prevalence of CKD is largely sustained by the inclusion of a substantial proportion of the elderly population within stage 3 CKD, according to the Kidney Disease Outcomes Quality Initiative staging system. However, some clarifications are necessary when interpreting these data. In fact, renal function "normally" declines with age, without bearing any unfavourable outcome; in addition, the Modification of Diet in Renal Disease formula used to calculate glomerular filtration rate (GFR) underestimates kidney function in the elderly and in women. Considerable interest in CKD has been generated by the evidence that predialysis CKD is associated with the increased risk of cardiovascular disease (CVD). Again, potential confounding factors must be ruled out. Age is thought to play a major role in this context. The most common causes of CKD, hypertension and diabetes mellitus, are also known to affect cardiovascular outcomes directly, thus preventing the recognition of an independent effect of kidney dysfunction on mortality by CVD. Taken together, these considerations point for a better definition of CKD. Early identification of patients at risk for accelerated decline in renal function is mandatory to plan strategies for screening and preventing CKD and its complications. At present, detection of CKD in the general population requires a multi-dimensional approach that should include the evaluation of clinical risk conditions, evaluation of albuminuria and sequential monitoring of GFR.

  16. SIS Epidemic Spreading with Heterogeneous Infection Rates

    CERN Document Server

    Qu, Bo

    2015-01-01

    In this work, we aim to understand the influence of the heterogeneity of infection rates on the Susceptible-Infected-Susceptible (SIS) epidemic spreading. Specifically, we keep the recovery rates the same for all nodes and study the influence of the moments of the independently identically distributed (i.i.d.) infection rates on the average fraction $y_\\infty$ of infected nodes in the meta-stable state, which indicates the severity of the overall infection. Motivated by real-world datasets, we consider the log-normal and gamma distributions for the infection rates and we design as well a symmetric distribution so that we have a systematic view of the influence of various distributions. By continuous-time simulations on several types of networks, theoretical proofs and physical interpretations, we conclude that: 1) the heterogeneity of infection rates on average retards the virus spread, and 2) a larger even-order moment of the infection rates leads to a smaller average fraction of infected nodes, but the odd-...

  17. Spatially explicit modelling of cholera epidemics

    Science.gov (United States)

    Finger, F.; Bertuzzo, E.; Mari, L.; Knox, A. C.; Gatto, M.; Rinaldo, A.

    2013-12-01

    Epidemiological models can provide crucial understanding about the dynamics of infectious diseases. Possible applications range from real-time forecasting and allocation of health care resources to testing alternative intervention mechanisms such as vaccines, antibiotics or the improvement of sanitary conditions. We apply a spatially explicit model to the cholera epidemic that struck Haiti in October 2010 and is still ongoing. The dynamics of susceptibles as well as symptomatic and asymptomatic infectives are modelled at the scale of local human communities. Dissemination of Vibrio cholerae through hydrological transport and human mobility along the road network is explicitly taken into account, as well as the effect of rainfall as a driver of increasing disease incidence. The model is calibrated using a dataset of reported cholera cases. We further model the long term impact of several types of interventions on the disease dynamics by varying parameters appropriately. Key epidemiological mechanisms and parameters which affect the efficiency of treatments such as antibiotics are identified. Our results lead to conclusions about the influence of different intervention strategies on the overall epidemiological dynamics.

  18. The heart failure epidemic: a UK perspective

    Directory of Open Access Journals (Sweden)

    Martin R Cowie

    2017-03-01

    Full Text Available Heart failure is appropriately described as an epidemic, with 1–2% of health care expenditure being directed at its management. In England, the National Institute for Health and Care Excellence (NICE has issued guidance on the best practice for the diagnosis and treatment of acute and chronic heart failure. Echocardiography is key to the diagnosis of the underlying cardiac abnormalities, and access to this (with our without biochemical testing using natriuretic peptides is key to high-quality and speedy diagnosis. New models of care aim to speed up access to echocardiography, but a shortage of technically trained staff remains a limiting factor in improving standards of care. The NHS audits the quality of care and outcome for patients admitted to hospital with heart failure, and this continues to show wide variation in practice, particularly, where patients are not reviewed by the local heart failure multidisciplinary team. Recently, the All Party Parliamentary Group on Cardiac Disease issued 10 suggestions for improvement in care for patients with heart failure – access to echocardiography being one of the key suggestions. Time will tell as to whether this support from law makers will assist in the implementation of NICE-recommended standards of care consistently across the country.

  19. Diabetes mellitus: The epidemic of the century

    Science.gov (United States)

    Kharroubi, Akram T; Darwish, Hisham M

    2015-01-01

    The epidemic nature of diabetes mellitus in different regions is reviewed. The Middle East and North Africa region has the highest prevalence of diabetes in adults (10.9%) whereas, the Western Pacific region has the highest number of adults diagnosed with diabetes and has countries with the highest prevalence of diabetes (37.5%). Different classes of diabetes mellitus, type 1, type 2, gestational diabetes and other types of diabetes mellitus are compared in terms of diagnostic criteria, etiology and genetics. The molecular genetics of diabetes received extensive attention in recent years by many prominent investigators and research groups in the biomedical field. A large array of mutations and single nucleotide polymorphisms in genes that play a role in the various steps and pathways involved in glucose metabolism and the development, control and function of pancreatic cells at various levels are reviewed. The major advances in the molecular understanding of diabetes in relation to the different types of diabetes in comparison to the previous understanding in this field are briefly reviewed here. Despite the accumulation of extensive data at the molecular and cellular levels, the mechanism of diabetes development and complications are still not fully understood. Definitely, more extensive research is needed in this field that will eventually reflect on the ultimate objective to improve diagnoses, therapy and minimize the chance of chronic complications development. PMID:26131326

  20. Epidemic spreading on evolving signed networks

    Science.gov (United States)

    Saeedian, M.; Azimi-Tafreshi, N.; Jafari, G. R.; Kertesz, J.

    2017-02-01

    Most studies of disease spreading consider the underlying social network as obtained without the contagion, though epidemic influences people's willingness to contact others: A "friendly" contact may be turned to "unfriendly" to avoid infection. We study the susceptible-infected disease-spreading model on signed networks, in which each edge is associated with a positive or negative sign representing the friendly or unfriendly relation between its end nodes. In a signed network, according to Heider's theory, edge signs evolve such that finally a state of structural balance is achieved, corresponding to no frustration in physics terms. However, the danger of infection affects the evolution of its edge signs. To describe the coupled problem of the sign evolution and disease spreading, we generalize the notion of structural balance by taking into account the state of the nodes. We introduce an energy function and carry out Monte Carlo simulations on complete networks to test the energy landscape, where we find local minima corresponding to the so-called jammed states. We study the effect of the ratio of initial friendly to unfriendly connections on the propagation of disease. The steady state can be balanced or a jammed state such that a coexistence occurs between susceptible and infected nodes in the system.

  1. The obesity epidemic and its cardiovascular consequences.

    Science.gov (United States)

    Behn, Agnieszka; Ur, Ehud

    2006-07-01

    Obesity has reached global epidemic proportions because of an increasingly obesogenic environment. This review examines the association between obesity, and in particular visceral fat, as a risk factor for cardiovascular disease and mortality. The World Health Organization defines obesity based on the body mass index. Recently the waist-to-hip ratio has been shown to be a significantly stronger predictor of cardiovascular events than body mass index. The metabolic syndrome and its evolving definition represent a cluster of metabolic risk factors which help predict cardiovascular disease and mortality. Although insulin resistance plays a central role in the pathophysiology of the metabolic syndrome, there is limited support for therapy with insulin sensitizers, thiazolidinediones, in patients with coronary artery disease. The current anti-obesity drugs, orlistat and sibutramine, have only a modest effect on weight loss. The blockade of the endocannabinoid system with rimonabant, however, may be a promising new strategy. Obesity is associated with significant increase in cardiovascular risk. Lifestyle modification remains the cornerstone of management although anti-obesity medications may be indicated in high risk individuals with comorbid disease.

  2. Radiotherapy in three suspect cases of feline thymoma.

    Science.gov (United States)

    Kaser-Hotz, B; Rohrer, C R; Fidel, J L; Nett, C S; Hörauf, A; Hauser, B

    2001-01-01

    Radiation therapy for three cases of suspect feline thymoma is described. The thymoma was controlled for 4 years in case no. 1. Case no. 2 responded well to radiation therapy but was euthanized after 2 months because of a nasal adenocarcinoma. Case no. 3 continues to do well more than 8 months after radiotherapy. Difficulties in diagnosing feline thymomas are discussed, and biological behavior as well as different treatment modalities of feline and human thymomas are compared.

  3. Percutaneous cholecystocentesis in cats with suspected hepatobiliary disease.

    Science.gov (United States)

    Byfield, Victoria L; Callahan Clark, Julie E; Turek, Bradley J; Bradley, Charles W; Rondeau, Mark P

    2017-12-01

    Objectives The objective was to evaluate the safety and diagnostic utility of percutaneous ultrasound-guided cholecystocentesis (PUC) in cats with suspected hepatobiliary disease. Methods Medical records of 83 cats with suspected hepatobiliary disease that underwent PUC were retrospectively reviewed. Results At the time of PUC, at least one additional procedure was performed in 79/83 cats, including hepatic aspiration and/or biopsy (n = 75) and splenic aspiration (n = 18). Complications were noted in 14/83 cases, including increased abdominal fluid (n = 11), needle-tip occlusion (n = 1), failed first attempt to penetrate the gall bladder wall (n = 1) and pneumoperitoneum (n = 1). There were no reports of gall bladder rupture, bile peritonitis or hypotension necessitating treatment with vasopressor medication. Blood products were administered to 7/83 (8%) cats. Seventy-two cats (87%) survived to discharge. Of the cats that were euthanized (9/83) or died (2/83), none were reported as a definitive consequence of PUC. Bacteria were identified cytologically in 10/71 samples (14%); all 10 had a positive aerobic bacterial culture. Bile culture was positive in 11/80 samples (14%). Of the cases with a positive bile culture, cytological description of bacteria corresponded to the organism cultured in fewer than 50% of cases. The most common cytologic diagnosis was hepatic lipidosis (49/66). The most common histopathologic diagnosis was cholangitis (10/21). Conclusions and relevance PUC was safe in this group of cats with suspected hepatobiliary disease. Complications were likely associated with ancillary procedures performed at the time of PUC. Bile analysis yielded an abnormal result in nearly one-third of cats with suspected hepatobiliary disease. Complete agreement between bile cytology and culture was lacking. Further evaluation of the correlation between bile cytology and bile culture is warranted.

  4. Interviewing strategically to elicit admissions from guilty suspects

    OpenAIRE

    Tekin, Serra; Granhag, Pär Anders; Strömwall, Leif; Giolla, Erik Mac; Vrij, Aldert; Hartwig, Maria

    2015-01-01

    In this article we introduce a novel interviewing tactic to elicit admissions from guilty suspects. By influencing the suspects’ perception of the amount of evidence the interviewer holds against them, we aimed to shift the suspects’ counterinterrogation strategies from less to more forthcoming. The proposed tactic (SUE-Confrontation) is a development of the Strategic Use of Evidence (SUE) framework and aims to affect the suspects’ perception by confronting them with statement-evidence incons...

  5. MRI for clinically suspected pediatric appendicitis: case interpretation

    Energy Technology Data Exchange (ETDEWEB)

    Moore, Michael M.; Brian, James M.; Methratta, Sosamma T.; Hulse, Michael A.; Choudhary, Arabinda K.; Eggli, Kathleen D.; Boal, Danielle K.B. [Penn State Milton S. Hershey Medical Center, Division of Pediatric Radiology, Department of Radiology, Hershey, PA (United States)

    2014-05-15

    As utilization of MRI for clinically suspected pediatric appendicitis becomes more common, there will be increased focus on case interpretation. The purpose of this pictorial essay is to share our institution's case interpretation experience. MRI findings of appendicitis include appendicoliths, tip appendicitis, intraluminal fluid-debris level, pitfalls of size measurements, and complications including abscesses. The normal appendix and inguinal appendix are also discussed. (orig.)

  6. MRI for clinically suspected pediatric appendicitis: an implemented program

    Energy Technology Data Exchange (ETDEWEB)

    Moore, Michael M.; Gustas, Cristy N.; Choudhary, Arabinda K.; Methratta, Sosamma T.; Hulse, Michael A.; Eggli, Kathleen D.; Boal, Danielle K.B. [Penn State Milton S. Hershey Medical Center, Department of Radiology, Mail Code H066, 500 University Drive, P.O. Box 850, Hershey, PA (United States); Geeting, Glenn [Penn State Milton S. Hershey Medical Center, Department of Emergency Medicine, Hershey, PA (United States)

    2012-09-15

    Emergent MRI is now a viable alternative to CT for evaluating appendicitis while avoiding the detrimental effects of ionizing radiation. However, primary employment of MRI in the setting of clinically suspected pediatric appendicitis has remained significantly underutilized. To describe our institution's development and the results of a fully implemented clinical program using MRI as the primary imaging evaluation for children with suspected appendicitis. A four-sequence MRI protocol consisting of coronal and axial single-shot turbo spin-echo (SS-TSE) T2, coronal spectral adiabatic inversion recovery (SPAIR), and axial SS-TSE T2 with fat saturation was performed on 208 children, ages 3 to 17 years, with clinically suspected appendicitis. No intravenous or oral contrast material was administered. No sedation was administered. Data collection includes two separate areas: time parameter analysis and MRI diagnostic results. Diagnostic accuracy of MRI for pediatric appendicitis indicated a sensitivity of 97.6% (CI: 87.1-99.9%), specificity 97.0% (CI: 93.2-99.0%), positive predictive value 88.9% (CI: 76.0-96.3%), and negative predictive value 99.4% (CI: 96.6-99.9%). Time parameter analysis indicated clinical feasibility, with time requested to first sequence obtained mean of 78.7 +/- 52.5 min, median 65 min; first-to-last sequence time stamp mean 14.2 +/- 8.8 min, median 12 min; last sequence to report mean 57.4 +/- 35.2 min, median 46 min. Mean age was 11.2 +/- 3.6 years old. Girls represented 57% of patients. MRI is an effective and efficient method of imaging children with clinically suspected appendicitis. Using an expedited four-sequence protocol, sensitivity and specificity are comparable to CT while avoiding the detrimental effects of ionizing radiation. (orig.)

  7. Epidemiology of suspected wrist joint infection versus inflammation.

    Science.gov (United States)

    Skeete, Kshamata; Hess, Erik P; Clark, Tod; Moran, Steven; Kakar, Sanjeev; Rizzo, Marco

    2011-03-01

    To determine the cumulative prevalence of septic arthritis presenting to the emergency department of an academic medical center and evaluate the use of clinical data to diagnose infection versus inflammation. We conducted a records review of a single institution with 80,000 annual emergency room visits. We included a consecutive series of patients with suspected wrist infection from January 1, 2007, to December 31, 2008. Adults complaining of atraumatic wrist pain with either erythema or swelling on physical examination or a final diagnosis of septic arthritis, gout, pseudogout, cellulitis, wrist hematoma/edema, or wrist arthritic flare were suspected to have infection. We collected data using a standardized data abstraction form. We reviewed 804 patient records. A total of 104 patients meeting inclusion criteria for suspected wrist joint infection during the 2-year study period were included. Mean age was 62.5 years (SD, 20.2 y); 63 were men. There were 12 patients with a history of gout, 4 with a history of pseudogout, and 19 with a history of diabetes. Wrist arthrocentesis was performed in 31 patients, and 11 underwent surgical treatment. There were 16 patients with a final diagnosis of gout, 11 with pseudogout, 43 with cellulitis, 13 with upper extremity hematoma/edema, and 15 with wrist arthritic flare. The cumulative prevalence of septic arthritis was 5%. In this series of emergency department patients with suspected wrist joint infection, gout, pseudogout, and cellulitis were the most common etiologies. The cumulative incidence of septic wrist arthritis was low. Copyright © 2011 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  8. Suspected spinocellular carcinoma of the inferior eyelid resulted multiple chalazion.

    Science.gov (United States)

    Onesti, Maria Giuseppina; Troccola, Antonietta; Maruccia, Michele; Conversi, Andrea; Scuderi, Gianluca

    2013-01-01

    Chalazion is a subacute granulomatous inflammation of the eyelid caused by retention of tarsal gland secretions and it's the most common inflammatory lesion of the eyelid. In cases of doubtful clinical presentation the diagnosis with a biopsy and a histopathological examination is important because it can orientate an appropriate surgical treatment. We report a case of a 64-years-old diabetic man, suspected for a spinocellular lesion of the inferior eyelid of the left eye, it resulted unexpectedly a chalazion.

  9. CT-guided biopsy of suspected malignancy: A potential pitfall

    Directory of Open Access Journals (Sweden)

    Steven Henderson

    2013-11-01

    Full Text Available Paragangliomas are rare catecholamine-secreting neuro-endocrine tumours that can arise from sympathetic or parasympathetic tissue. Any manipulation of these tumours, without appropriate medical therapy, can result in excess catecholamine release leading to a catecholamine crisis. Neuro-endocrine tumours must be considered prior to interventional biopsy of an unknown soft-tissue mass, and appropriate biochemical investigations should be performed in suspected cases to prevent catastrophic complications.

  10. [Three cases of suspected re-infection of mumps virus].

    Science.gov (United States)

    Hatanaka, Akio; Kamada, Tomoko; Honda, Keiji; Tazaki, Akihisa; Kishine, Naomi; Kawashima, Yoshiyuki

    2012-08-01

    A 32-year-old woman, 5-year-old girl, and 33-year-old man visited our otorhinolaryngology outpatient clinic with tumentia of the unilateral parotid gland. A high titer of serum IgG antibodies against the mumps virus was detected. Around the same time, other members of their families had the same parotid tumentia, and they were diagnosed as having their first mumps infection. Therefore, the diagnosis of the three cases was strongly suspected to be re-infection with mumps. In Japan, it was classically believed that the mumps virus infection occurs only once in patients and reinfection doesn't occur. However, some pediatricians in Japan have reported that re-infection with mumps is strongly suspected when high titers of serum IgG antibodies against the mumps virus are found at the initial visit. It is now believed many more examples of mumps re-infection cases have existed than we previously believed. When high titers of serum IgG antibodies against the mumps virus are detected at an initial visit in patients who have had mumps previously, re-infection should be strongly suspected. And to make it certain, we suggest that the mumps IgG antibodies should be checked twice to confirm the diagnosis. If elevation of the IgG antibodies persist, the diagnosis will be much more certain.

  11. Ten-day observation of live rabies suspected dogs.

    Science.gov (United States)

    Tepsumethanon, V; Wilde, H; Sitprija, V

    2008-01-01

    This study aimed at analyzing a ten-day observation period of rabies suspected dogs and cats according to six criteria. Dogs and cats suspected of being rabid were brought for observation when they had either bitten a person or another animal or when abnormal behaviour or unusual illness was observed. Between 1985 and 2005, retrospective and prospective data from 1,222 dogs and 303 cats was collected during the ten-day observation period. If an animal had died, brain examination using fluorescent antibody testing was routinely performed. If an animal had survived for > or =10 days, it was released to its owner or transferred to the municipal dog shelter. A total of 644 dogs and 58 cats found rabid died within 10 days of observation. In addition, for 208 dogs confirmed rabid with laboratory tests between 1997 and 2005, six criteria were analysed from the day of submission. This experience with the implemented 10-day observation period confirms the WHO recommendation on identifying suspected rabid dogs or cats under veterinary supervision following a human exposure.

  12. MR delayed enhancement imaging findings in suspected acute myocarditis

    Energy Technology Data Exchange (ETDEWEB)

    Gahide, Gerald [CHU de Montpellier, Radiologie centrale - Pole Cardiovasculaire et Thoracique, Montpellier (France); Centre Hospitalo-Universitaire de Montpellier, Hopital A de Villeneuve, Montpellier (France); Bertrand, D.; Dacher, J.N. [CHU de Rouen, Radiologie centrale - Hopital Charles Nicolle, Rouen (France); Roubille, F.; Skaik, S.; Piot, C.; Leclerq, F. [CHU de Montpellier, Departement de Cardiologie - Pole Cardiovasculaire et Thoracique, Montpellier (France); Tron, C.; Cribier, A. [CHU de Rouen, Departement de Cardiologie - Hopital Charles Nicolle, Rouen (France); Vernhet, H. [CHU de Montpellier, Radiologie centrale - Pole Cardiovasculaire et Thoracique, Montpellier (France)

    2010-01-15

    The purpose of the study was to prospectively assess the clinical impact of routinely performed delayed enhancement imaging in suspected acute myocarditis. A two-centre prospective study was performed in patients with suspected acute myocarditis. The protocol included horizontal long axis, vertical long axis and short axis cine MR and delayed enhancement imaging after Gd-DTPA infusion (0.2 mmol/kg). Sixty consecutive patients were enrolled (aged 49.4{+-}17.8 years). MRI demonstrated delayed enhancement sparing the subendocardicardial layer in 51.6% of patients, concordant with the diagnosis of acute myocarditis; 16.7% of patients exhibited delayed enhancement involving the subendocardial layer with irregular margins, concordant with the diagnosis of acute myocardial infarction; 31.7% of patients had delayed enhancement imaging that was considered normal. Routine imaging to identify delayed enhancement provided crucial information in suspected acute myocarditis by reinforcing the diagnosis in 51.6% of patients and correcting a misdiagnosed acute myocardial infarction in 16.7% of patients. (orig.)

  13. Low dose computed tomography in suspected acute renal colic.

    Science.gov (United States)

    Meagher, T; Sukumar, V P; Collingwood, J; Crawley, T; Schofield, D; Henson, J; Lakin, K; Connolly, D; Giles, J

    2001-11-01

    To evaluate whether computed tomography (CT) of the renal tract in suspected renal colic using reduced exposure factors maintains diagnostic accuracy. Prospective multi-centre cohort study. Patients with suspected renal colic were examined using computed tomography (CT) of the renal tract followed by intravenous urography (IVU) in four different centres with five different CT systems. Sixty-nine patients with suspected renal colic had CT of the renal tract followed by IVU. CT was performed with reduced exposure factors, giving a mean CT effective dose of 3.5 (range 2.8-4.5) mSv compared with 1.5 mSv for IVU. Ureteric calculi were detected in 43 patients: CT and IVU detected 40 (93%) ureteric calculi. CT identified other lesions causing symptoms in five patients and identified renal calculi in 24 patients. IVU identified renal calculi in six patients and made false positive diagnosis of renal calculi in seven patients. Mean examination time for CT was 5 minutes and for IVU was 80 minutes. CT examination at reduced exposure factors maintains the diagnostic accuracy recorded in other series. Copyright 2001 The Royal College of Radiologists.

  14. The economics of cardiac biomarker testing in suspected myocardial infarction.

    Science.gov (United States)

    Goodacre, Steve; Thokala, Praveen

    2015-03-01

    Suspected myocardial infarction (MI) is a common reason for emergency hospital attendance and admission. Cardiac biomarker measurement is an essential element of diagnostic assessment of suspected MI. Although the cost of a routinely available biomarker may be small, the large patient population and consequences in terms of hospital admission and investigation mean that the economic impact of cardiac biomarker testing is substantial. Economic evaluation involves comparing the estimated costs and effectiveness (outcomes) of two or more interventions or care alternatives. This process creates some difficulties with respect to cardiac biomarkers. Estimating the effectiveness of cardiac biomarkers involves identifying how they help to improve health and how we can measure this improvement. Comparison to an appropriate alternative is also problematic. New biomarkers may be promoted on the basis of reducing hospital admission or length of stay, but hospital admission for low risk patients may incur significant costs while providing very little benefit, making it an inappropriate comparator. Finally, economic evaluation may conclude that a more sensitive biomarker strategy is more effective but, by detecting and treating more cases, is also more expensive. In these circumstances it is unclear whether we should use the more effective or the cheaper option. This article provides an introduction to health economics and addresses the specific issues relevant to cardiac biomarkers. It describes the key concepts relevant to economic evaluation of cardiac biomarkers in suspected MI and highlights key areas of uncertainty and controversy. Copyright © 2014 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

  15. Limitation of personal freedom by detention of suspect

    Directory of Open Access Journals (Sweden)

    Knežević Saša

    2011-01-01

    Full Text Available The right of personal freedom is one of the most important right from the set of basic human rights and freedoms, contained in the most important acts of international legal character, and the constitutions of states based on the rule of law. This right is directly related to the very human existence, and, therefore, it is necessary to make its legal articulation. Personal freedom means the right to security of the citizen, that he will not be arrested and detained in prison by the state authorities, as well as the right to be free to move and inhabit. However, from the very nature of Criminal Law protection of social values, arises the need to limit the right to personal freedom in exceptional circumstances, including the detention of the suspect. Keeping the suspect is a measure of procedural compulsion, by which, through the police decision, detained prison is temporarily imprisoned, for gathering information and hearing. The basic principles of humanity require that the detained suspect retains all the rights, derived from the principle of personal liberty.

  16. MIBG in the evaluation of suspected pheochromocytoma: Mayo Clinic experience

    Energy Technology Data Exchange (ETDEWEB)

    Brown, M.L.; Sheps, S.G.; Sizemore, G.; Swensen, S.J.; Gharib, H.; Grant, C.S.; van Heerden, J.A.

    1984-01-01

    Work done at the University of Michigan has shown that I-131 metaiodobenzylguanidine (MIBG) is an effective agent for the diagnosis and localization of pheochromocytoma. A recent report questioned the sensitivity of this test. In 1983, 40 patients at Mayo Clinic had 42 scans during the workup of suspected spontaneous pheochromocytoma or metastatic pheochromocytoma. All patients were given 500 ..mu..Ci I-131 MIBG supplied by the University of Michigan. The final diagnosis of pheochromocytoma (true positive (TP) and false negative (FN) and false positive (FP)) was made by surgery and pathology. True negative (TN) diagnosis was made by normal plasma and urinary catecholamines, and in many patients CT. There were 15 TP studies (six spontaneous pheochrocytoma, nine metastatic or recurrent pheochromoctyoma), and 22 TN studies. There was one FP study of recurrent paraganglioma near the bladder (CT was also FP) and four FN studies (two spontaneous and two metastatic) where one CT was also FN. This results in a sensitivity of 79%, specificity of 96%, and accuracy of 88%. MIBG is very useful in the workup of patients with known or suspected recurrent or metastatic pheochromocytoma and is helpful in the evaluation of the patient suspected of having a spontaneous pheochromocytoma when CT is normal.

  17. Stochastic population and epidemic models persistence and extinction

    CERN Document Server

    Allen, Linda J S

    2015-01-01

    This monograph provides a summary of the basic theory of branching processes for single-type and multi-type processes. Classic examples of population and epidemic models illustrate the probability of population or epidemic extinction obtained from the theory of branching processes. The first chapter develops the branching process theory, while in the second chapter two applications to population and epidemic processes of single-type branching process theory are explored. The last two chapters present multi-type branching process applications to epidemic models, and then continuous-time and continuous-state branching processes with applications. In addition, several MATLAB programs for simulating stochastic sample paths  are provided in an Appendix. These notes originated as part of a lecture series on Stochastics in Biological Systems at the Mathematical Biosciences Institute in Ohio, USA. Professor Linda Allen is a Paul Whitfield Horn Professor of Mathematics in the Department of Mathematics and Statistics ...

  18. Ending U.S. Opioid Abuse Epidemic Will Take Years

    Science.gov (United States)

    ... fullstory_167176.html Ending U.S. Opioid Abuse Epidemic Will Take Years: Report Expert panel calls for tighter ... this page, please enable JavaScript. (*this news item will not be available after 10/11/2017) By ...

  19. Epidemic cholera in Latin America: spread and routes of transmission.

    Science.gov (United States)

    Guthmann, J P

    1995-12-01

    In the most recent epidemic of cholera in Latin America, nearly a million cases were reported and almost 9000 people died between January 1991 and December 1993. The epidemic spread rapidly from country to country, affecting in three years all the countries of Latin America except Uruguay and the Caribbean. Case-control studies carried out in Peru showed a significant association between drinking water and risk of disease. Cholera was associated with the consumption of unwashed fruit and vegetables, with eating food from street vendors and with contaminated crabmeat transported in travellers' luggage. This article documents the spread of the epidemic and its routes of transmission and discusses whether the introduction of the epidemic to Peru and its subsequent spread throughout the continent could have been prevented.

  20. Unification of theoretical approaches for epidemic spreading on complex networks.

    Science.gov (United States)

    Wang, Wei; Tang, Ming; Eugene Stanley, H; Braunstein, Lidia A

    2017-03-01

    Models of epidemic spreading on complex networks have attracted great attention among researchers in physics, mathematics, and epidemiology due to their success in predicting and controlling scenarios of epidemic spreading in real-world scenarios. To understand the interplay between epidemic spreading and the topology of a contact network, several outstanding theoretical approaches have been developed. An accurate theoretical approach describing the spreading dynamics must take both the network topology and dynamical correlations into consideration at the expense of increasing the complexity of the equations. In this short survey we unify the most widely used theoretical approaches for epidemic spreading on complex networks in terms of increasing complexity, including the mean-field, the heterogeneous mean-field, the quench mean-field, dynamical message-passing, link percolation, and pairwise approximation. We build connections among these approaches to provide new insights into developing an accurate theoretical approach to spreading dynamics on complex networks.

  1. Epidemic spread in bipartite network by considering risk awareness

    Science.gov (United States)

    Han, She; Sun, Mei; Ampimah, Benjamin Chris; Han, Dun

    2018-02-01

    Human awareness plays an important role in the spread of infectious diseases and the control of propagation patterns. Exploring the interplay between human awareness and epidemic spreading is a topic that has been receiving increasing attention. Considering the fact, some well-known diseases only spread between different species we propose a theoretical analysis of the Susceptible-Infected-Susceptible (SIS) epidemic spread from the perspective of bipartite network and risk aversion. Using mean field theory, the epidemic threshold is calculated theoretically. Simulation results are consistent with the proposed analytic model. The results show that, the final infection density is negative linear with the value of individuals' risk awareness. Therefore, the epidemic spread could be effectively suppressed by improving individuals' risk awareness.

  2. [Epidemics and disease during the Revolution Period in Mexico].

    Science.gov (United States)

    Sanfilippo-Borrás, José

    2010-01-01

    The health condition in Mexico was bad around de beginning of the revolutionary period. The movement of troops led the development of epidemics like yellow fever, typhus, smallpox, and influenza that were enhance with natural disasters and hunger in whole country, from cost to cost and in the north big cities like Monterrey, Guadalajara and Saltillo. Doctor Liceaga conducted a well planned campaign against yellow fever eradicating water stagnant deposits in order to combat the vector transmission, the Aedes aegypti, mosquito with satisfactory results. The first smallpox epidemic in the XX Century in Mexico was in 1916. The Mexican physicians used the smallpox vaccine against this epidemic. An American physician named Howard Taylor Ricketts arrived to Mexico for studying the typhus transmission. Accidentally he had been infected and finally, he died from typhus. Definitively, the epidemics predominate along de revolutionary period in Mexico.

  3. 'Loneliness Epidemic' Called a Major Public Health Threat

    Science.gov (United States)

    ... page: https://medlineplus.gov/news/fullstory_167643.html 'Loneliness Epidemic' Called a Major Public Health Threat Social ... 7, 2017 MONDAY, Aug. 7, 2017 (HealthDay News) -- Loneliness may be more hazardous to your health than ...

  4. Epidemic spreading in time-varying community networks

    Energy Technology Data Exchange (ETDEWEB)

    Ren, Guangming, E-mail: wangxy@dlut.edu.cn, E-mail: ren-guang-ming@163.com [School of Electronic and Information, Guangdong Polytechnic Normal University, Guangzhou 510665 (China); Faculty of Electronic Information and Electrical Engineering, Dalian University of Technology, Dalian 116024 (China); Wang, Xingyuan, E-mail: wangxy@dlut.edu.cn, E-mail: ren-guang-ming@163.com [Faculty of Electronic Information and Electrical Engineering, Dalian University of Technology, Dalian 116024 (China)

    2014-06-15

    The spreading processes of many infectious diseases have comparable time scale as the network evolution. Here, we present a simple networks model with time-varying community structure, and investigate susceptible-infected-susceptible epidemic spreading processes in this model. By both theoretic analysis and numerical simulations, we show that the efficiency of epidemic spreading in this model depends intensively on the mobility rate q of the individuals among communities. We also find that there exists a mobility rate threshold q{sub c}. The epidemic will survive when q > q{sub c} and die when q < q{sub c}. These results can help understanding the impacts of human travel on the epidemic spreading in complex networks with community structure.

  5. Hybrid epidemics--a case study on computer worm conficker.

    Science.gov (United States)

    Zhang, Changwang; Zhou, Shi; Chain, Benjamin M

    2015-01-01

    Conficker is a computer worm that erupted on the Internet in 2008. It is unique in combining three different spreading strategies: local probing, neighbourhood probing, and global probing. We propose a mathematical model that combines three modes of spreading: local, neighbourhood, and global, to capture the worm's spreading behaviour. The parameters of the model are inferred directly from network data obtained during the first day of the Conficker epidemic. The model is then used to explore the tradeoff between spreading modes in determining the worm's effectiveness. Our results show that the Conficker epidemic is an example of a critically hybrid epidemic, in which the different modes of spreading in isolation do not lead to successful epidemics. Such hybrid spreading strategies may be used beneficially to provide the most effective strategies for promulgating information across a large population. When used maliciously, however, they can present a dangerous challenge to current internet security protocols.

  6. Hybrid epidemics--a case study on computer worm conficker.

    Directory of Open Access Journals (Sweden)

    Changwang Zhang

    Full Text Available Conficker is a computer worm that erupted on the Internet in 2008. It is unique in combining three different spreading strategies: local probing, neighbourhood probing, and global probing. We propose a mathematical model that combines three modes of spreading: local, neighbourhood, and global, to capture the worm's spreading behaviour. The parameters of the model are inferred directly from network data obtained during the first day of the Conficker epidemic. The model is then used to explore the tradeoff between spreading modes in determining the worm's effectiveness. Our results show that the Conficker epidemic is an example of a critically hybrid epidemic, in which the different modes of spreading in isolation do not lead to successful epidemics. Such hybrid spreading strategies may be used beneficially to provide the most effective strategies for promulgating information across a large population. When used maliciously, however, they can present a dangerous challenge to current internet security protocols.

  7. Underrecognition of Dengue during 2013 Epidemic in Luanda, Angola.

    Science.gov (United States)

    Sharp, Tyler M; Moreira, Rosa; Soares, Maria José; Miguel da Costa, Lúis; Mann, Jennifer; DeLorey, Mark; Hunsperger, Elizabeth; Muñoz-Jordán, Jorge L; Colón, Candimar; Margolis, Harold S; de Caravalho, Adelaide; Tomashek, Kay M

    2015-08-01

    During the 2013 dengue epidemic in Luanda, Angola, 811 dengue rapid diagnostic test-positive cases were reported to the Ministry of Health. To better understand the magnitude of the epidemic and identify risk factors for dengue virus (DENV) infection, we conducted cluster surveys around households of case-patients and randomly selected households 6 weeks after the peak of the epidemic. Of 173 case cluster participants, 16 (9%) exhibited evidence of recent DENV infection. Of 247 random cluster participants, 25 (10%) had evidence of recent DENV infection. Of 13 recently infected participants who had a recent febrile illness, 7 (54%) had sought medical care, and 1 (14%) was hospitalized with symptoms consistent with severe dengue; however, none received a diagnosis of dengue. Behavior associated with protection from DENV infection included recent use of mosquito repellent or a bed net. These findings suggest that the 2013 dengue epidemic was larger than indicated by passive surveillance data.

  8. Interplay between epidemic spread and information propagation on metapopulation networks.

    Science.gov (United States)

    Wang, Bing; Han, Yuexing; Tanaka, Gouhei

    2017-05-07

    The spread of an infectious disease has been widely found to evolve with the propagation of information. Many seminal works have demonstrated the impact of information propagation on the epidemic spreading, assuming that individuals are static and no mobility is involved. Inspired by the recent observation of diverse mobility patterns, we incorporate the information propagation into a metapopulation model based on the mobility patterns and contagion process, which significantly alters the epidemic threshold. In more details, we find that both the information efficiency and the mobility patterns have essential impacts on the epidemic spread. We obtain different scenarios leading to the mitigation of the outbreak by appropriately integrating the mobility patterns and the information efficiency as well. The inclusion of the impacts of the information propagation into the epidemiological model is expected to provide an support to public health implications for the suppression of epidemics. Copyright © 2017. Published by Elsevier Ltd.

  9. Effects of active links on epidemic transmission over social networks

    Science.gov (United States)

    Zhu, Guanghu; Chen, Guanrong; Fu, Xinchu

    2017-02-01

    A new epidemic model with two infection periods is developed to account for the human behavior in social network, where newly infected individuals gradually restrict most of future contacts or are quarantined, causing infectivity change from a degree-dependent form to a constant. The corresponding dynamics are formulated by a set of ordinary differential equations (ODEs) via mean-field approximation. The effects of diverse infectivity on the epidemic dynamics ​are examined, with a behavioral interpretation of the basic reproduction number. Results show that such simple adaptive reactions largely determine the impact of network structure on epidemics. Particularly, a theorem proposed by Lajmanovich and Yorke in 1976 is generalized, so that it can be applied for the analysis of the epidemic models with multi-compartments especially network-coupled ODE systems.

  10. The changing epidemiology of the bronchiolitis epidemic in Tallaght Hospital

    National Research Council Canada - National Science Library

    O'Connor, G; Tariq, M; Greally, P; Elnazir, B

    2013-01-01

    Bronchiolitis affects one third of babies in their first year of life. We investigated all bronchiolitis admissions to Tallaght Hospital in the last five years, with the hope of providing an insight into the epidemic in an Irish population...

  11. Spatial spread of the West Africa Ebola epidemic.

    Science.gov (United States)

    Kramer, Andrew M; Pulliam, J Tomlin; Alexander, Laura W; Park, Andrew W; Rohani, Pejman; Drake, John M

    2016-08-01

    Controlling Ebola outbreaks and planning an effective response to future emerging diseases are enhanced by understanding the role of geography in transmission. Here we show how epidemic expansion may be predicted by evaluating the relative probability of alternative epidemic paths. We compared multiple candidate models to characterize the spatial network over which the 2013-2015 West Africa epidemic of Ebola virus spread and estimate the effects of geographical covariates on transmission during peak spread. The best model was a generalized gravity model where the probability of transmission between locations depended on distance, population density and international border closures between Guinea, Liberia and Sierra Leone and neighbouring countries. This model out-performed alternative models based on diffusive spread, the force of infection, mobility estimated from cell phone records and other hypothesized patterns of spread. These findings highlight the importance of integrated geography to epidemic expansion and may contribute to identifying both the most vulnerable unaffected areas and locations of maximum intervention value.

  12. Type 2 diabetes: the emerging epidemic | Rheeder | South African ...

    African Journals Online (AJOL)

    Abstract. This article reports on the prevalence of diabetes in South Africa and gives projections for the epidemic proportions that this disease may take by the year 2030. South African Family Practice Vol. 48 (10) 2006: pp. 20 ...

  13. The Topological Weighted Centroid (TWC): A topological approach to the time-space structure of epidemic and pseudo-epidemic processes

    Science.gov (United States)

    Buscema, Massimo; Massini, Giulia; Sacco, Pier Luigi

    2018-02-01

    This paper offers the first systematic presentation of the topological approach to the analysis of epidemic and pseudo-epidemic spatial processes. We introduce the basic concepts and proofs, at test the approach on a diverse collection of case studies of historically documented epidemic and pseudo-epidemic processes. The approach is found to consistently provide reliable estimates of the structural features of epidemic processes, and to provide useful analytical insights and interpretations of fragmentary pseudo-epidemic processes. Although this analysis has to be regarded as preliminary, we find that the approach's basic tenets are strongly corroborated by this first test and warrant future research in this vein.

  14. [An etiological survey on a foodborne disease epidemic outbreak caused by Salmonella enteritidis].

    Science.gov (United States)

    Yang, Jin-chuan; Xia, Yang; Guo, Hui; Xu, Jing-jing; Wang, Lu-mei; Tong, Jing; Zhang, Lei; Liang, Jun-rong; Jing, Huai-qi; Li, Zhen-jun

    2013-02-01

    To conduct an etiological molecular epidemiological survey and laboratory test on a foodborne disease epidemic outbreak to make clear of the cause and implement effective prevention and control on it. On May 12th 2012, 135 kindergarten children were sent to Xuzhou City People's Hospital and Children's Hospital with gastrointestinal infection disease. A total of 34 anus swab samples and 4 vomit samples were collected from the patients. Real-time PCR rapid detection, strains separation and cultivation, phage lysis experiments, ATB automated identification system were used to make etiological detection and identification. The genomic DNA of salmonella enteritidis were typed with the pulsed-field gel electrophoresis (PFGE), cluster analysis were carried out together with the patterns of local Salmonella infections. Children in 20 classes were suffered from the gastrointestinal infection among the 21 classes. There were no significant aggregation of class distribution. Among the 135 patients, 76 were boys (56.3%) and 59 were girls (43.7%). The main symptoms were fever (above 38°C), diarrhea and bellyache. Through real-time PCR detection and strains separation, 19 salmonella enteritidis were isolated from 34 anus swab samples of suspected cases and the detection rate was 56%. There were no strains detected from vomit samples. All of the 19 salmonella enteritidis showed the same serological subtype, biochemical reaction, drug sensitivity and phage lysis pattern. The salmonella enteritidis had the identical PFGE pattern (100% similarity), and were different from the pattern of local sporadic infection cases. It was confirmed that this was an epidemic outbreak of foodborne disease caused by homologous salmonella enteritidis by epidemiological survey, clinical information, lab etiological test and molecular typing.

  15. Three Epidemics of Invasive Multidrug-Resistant Salmonella Bloodstream Infection in Blantyre, Malawi, 1998–2014

    Science.gov (United States)

    Feasey, Nicholas A.; Masesa, Clemens; Jassi, Chikondi; Faragher, E. Brian; Mallewa, Jane; Mallewa, Macpherson; MacLennan, Calman A.; Msefula, Chisomo; Heyderman, Robert S.; Gordon, Melita A.

    2015-01-01

    Background. The Malawi Liverpool Wellcome Trust Clinical Research Programme (MLW) has routinely collected specimens for blood culture from febrile patients, and cerebrospinal fluid from patients with suspected meningitis, presenting to Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi, since 1998. Methods. We present bloodstream infection (BSI) and meningitis surveillance data from 1998 to 2014. Automated blood culture, manual speciation, serotyping, and antimicrobial susceptibility testing were performed at MLW. Population data for minimum-incidence estimates in urban Blantyre were drawn from published estimates. Results. Between 1998 and 2014, 167 028 blood cultures were taken from adult and pediatric medical patients presenting to QECH; Salmonella Typhi was isolated on 2054 occasions (1.2%) and nontyphoidal Salmonella (NTS) serovars were isolated 10 139 times (6.1%), of which 8017 (79.1%) were Salmonella Typhimurium and 1608 (15.8%) were Salmonella Enteritidis. There were 392 cases of NTS meningitis and 9 cases of Salmonella Typhi meningitis. There have been 3 epidemics of Salmonella BSI in Blantyre; Salmonella Enteritidis from 1999 to 2002, Salmonella Typhimurium from 2002 to 2008, and Salmonella Typhi, which began in 2011 and was ongoing in 2014. Multidrug resistance has emerged in all 3 serovars and is seen in the overwhelming majority of isolates, while resistance to third-generation cephalosporins and fluoroquinolones is currently uncommon but has been identified. Conclusions. Invasive Salmonella disease in Malawi is dynamic and not clearly attributable to a single risk factor, although all 3 epidemics were associated with multidrug resistance. To inform nonvaccine and vaccine interventions, reservoirs of disease and modes of transmission require further investigation. PMID:26449953

  16. Three Epidemics of Invasive Multidrug-Resistant Salmonella Bloodstream Infection in Blantyre, Malawi, 1998-2014.

    Science.gov (United States)

    Feasey, Nicholas A; Masesa, Clemens; Jassi, Chikondi; Faragher, E Brian; Mallewa, Jane; Mallewa, Macpherson; MacLennan, Calman A; Msefula, Chisomo; Heyderman, Robert S; Gordon, Melita A

    2015-11-01

    The Malawi Liverpool Wellcome Trust Clinical Research Programme (MLW) has routinely collected specimens for blood culture from febrile patients, and cerebrospinal fluid from patients with suspected meningitis, presenting to Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi, since 1998. We present bloodstream infection (BSI) and meningitis surveillance data from 1998 to 2014. Automated blood culture, manual speciation, serotyping, and antimicrobial susceptibility testing were performed at MLW. Population data for minimum-incidence estimates in urban Blantyre were drawn from published estimates. Between 1998 and 2014, 167,028 blood cultures were taken from adult and pediatric medical patients presenting to QECH; Salmonella Typhi was isolated on 2054 occasions (1.2%) and nontyphoidal Salmonella (NTS) serovars were isolated 10,139 times (6.1%), of which 8017 (79.1%) were Salmonella Typhimurium and 1608 (15.8%) were Salmonella Enteritidis. There were 392 cases of NTS meningitis and 9 cases of Salmonella Typhi meningitis. There have been 3 epidemics of Salmonella BSI in Blantyre; Salmonella Enteritidis from 1999 to 2002, Salmonella Typhimurium from 2002 to 2008, and Salmonella Typhi, which began in 2011 and was ongoing in 2014. Multidrug resistance has emerged in all 3 serovars and is seen in the overwhelming majority of isolates, while resistance to third-generation cephalosporins and fluoroquinolones is currently uncommon but has been identified. Invasive Salmonella disease in Malawi is dynamic and not clearly attributable to a single risk factor, although all 3 epidemics were associated with multidrug resistance. To inform nonvaccine and vaccine interventions, reservoirs of disease and modes of transmission require further investigation. © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America.

  17. Imaging trends in suspected appendicitis-a Canadian perspective.

    Science.gov (United States)

    Tan, Victoria F; Patlas, Michael N; Katz, Douglas S

    2017-06-01

    The purpose of our study was to assess trends in the imaging of suspected appendicitis in adult patients in emergency departments of academic centers in Canada. A questionnaire was sent to all 17 academic centers in Canada to be completed by a radiologist who works in emergency radiology. The questionnaires were sent and collected over a period of 4 months from October 2015 to February 2016. Sixteen centers (94%) responded to the questionnaire. Eleven respondents (73%) use IV contrast-enhanced computed tomography (CT) as the imaging modality of choice for all patients with suspected appendicitis. Thirteen respondents (81%) use ultrasound as the first modality of choice in imaging pregnant patients with suspected appendicitis. Eleven respondents (69%) use ultrasound (US) as the first modality of choice in patients younger than 40 years of age. Ten respondents (67%) use ultrasound as the first imaging modality in female patients younger than 40 years of age. When CT is used, 81% use non-focused CT of the abdomen and pelvis, and 44% of centers use oral contrast. Thirteen centers (81%) have ultrasound available 24 h a day/7 days a week. At 12 centers (75%), ultrasound is performed by ultrasound technologists. Four centers (40%) perform magnetic resonance imaging (MRI) in suspected appendicitis in adult patients at the discretion of the attending radiologist. Eleven centers (69%) have MRI available 24/7. All 16 centers (100%) use unenhanced MRI. Various imaging modalities are available for the work-up of suspected appendicitis. Although there are North American societal guidelines and recommendations regarding the appropriateness of the multiple imaging modalities, significant heterogeneity in the first-line modalities exist, which vary depending on the patient demographics and resource availability. Imaging trends in the use of the first-line modalities should be considered in order to plan for the availability of the imaging examinations and to consider plans for

  18. Predictors of bacteremia in emergency department patients with suspected infection.

    Science.gov (United States)

    Chase, Maureen; Klasco, Richard S; Joyce, Nina R; Donnino, Michael W; Wolfe, Richard E; Shapiro, Nathan I

    2012-11-01

    The goal of this study is to identify clinical variables associated with bacteremia. Such data could provide a rational basis for blood culture testing in emergency department (ED) patients with suspected infection. This is a secondary analysis of a prospective cohort of ED patients with suspected infection. Data collected included demographics, vital signs, medical history, suspected source of infection, laboratory and blood culture results and outcomes. Bacteremia was defined as a positive blood culture by Centers for Disease Control criteria. Clinical variables associated with bacteremia on univariate logistic regression were entered into a multivariable model. There were 5630 patients enrolled with an average age of 59.9 ± 19.9 years, and 54% were female. Blood cultures were obtained on 3310 (58.8%). There were 409 (12.4%) positive blood cultures, of which 68 (16.6%) were methicillin-resistant Staphylococcus aureus (MRSA) and 161 (39.4%) were Gram negatives. Ten covariates (respiratory failure, vasopressor use, neutrophilia, bandemia, thrombocytopenia, indwelling venous catheter, abnormal temperature, suspected line or urinary infection, or endocarditis) were associated with all-cause bacteremia in the final model (c-statistic area under the curve [AUC], 0.71). Additional factors associated with MRSA bacteremia included end-stage renal disease (odds ratio [OR], 3.9; 95% confidence interval [CI], 1.9-7.8) and diabetes (OR, 2.0; 95% CI, 1.1-3.6) (AUC, 0.73). Factors strongly associated with Gram-negative bacteremia included vasopressor use in the ED (OR, 2.8; 95% CI, 1.7-4.6), bandemia (OR, 3.5; 95% CI, 2.3-5.3), and suspected urinary infection (OR, 4.0; 95% CI, 2.8-5.8) (AUC, 0.75). This study identified several clinical factors associated with bacteremia as well as MRSA and Gram-negative subtypes, but the magnitude of their associations is limited. Combining these covariates into a multivariable model moderately increases their predictive value. Copyright

  19. Evaluation of the World Health Organization 2009 classification of dengue severity in autopsied individuals, during the epidemics of 2011 and 2012 in Brazil.

    Science.gov (United States)

    Cavalcanti, Luciano Pamplona de Góes; Braga, Deborah Nunes de Melo; Pompeu, Margarida Maria de Lima; Lima, Antônio Afonso Bezerra; Silva, Lívia Maria Alexandre da; Aguiar, Marina Gondim; Castiglioni, Mariana; Araújo, Fernanda Montenegro de Carvalho; Malta, Daniele Lima; Queiroz, Anastácio

    2015-01-01

    The dengue classification proposed by the World Health Organization (WHO) in 2009 is considered more sensitive than the classification proposed by the WHO in 1997. However, no study has assessed the ability of the WHO 2009 classification to identify dengue deaths among autopsied individuals suspected of having dengue. In the present study, we evaluated the ability of the WHO 2009 classification to identify dengue deaths among autopsied individuals suspected of having dengue in Northeast Brazil, where the disease is endemic. This retrospective study included 121 autopsied individuals suspected of having dengue in Northeast Brazil during the epidemics of 2011 and 2012. All the autopsied individuals included in this study were confirmed to have dengue based on the findings of laboratory examinations. The median age of the autopsied individuals was 34 years (range, 1 month to 93 years), and 54.5% of the individuals were males. According to the WHO 1997 classification, 9.1% (11/121) of the cases were classified as dengue hemorrhagic fever (DHF) and 3.3% (4/121) as dengue shock syndrome. The remaining 87.6% (106/121) of the cases were classified as dengue with complications. According to the 2009 classification, 100% (121/121) of the cases were classified as severe dengue. The absence of plasma leakage (58.5%) and platelet counts classification is more sensitive than the WHO 1997 classification for identifying dengue deaths among autopsied individuals suspected of having dengue.

  20. A simple model for behaviour change in epidemics

    Directory of Open Access Journals (Sweden)

    Brauer Fred

    2011-02-01

    Full Text Available Abstract Background People change their behaviour during an epidemic. Infectious members of a population may reduce the number of contacts they make with other people because of the physical effects of their illness and possibly because of public health announcements asking them to do so in order to decrease the number of new infections, while susceptible members of the population may reduce the number of contacts they make in order to try to avoid becoming infected. Methods We consider a simple epidemic model in which susceptible and infectious members respond to a disease outbreak by reducing contacts by different fractions and analyze the effect of such contact reductions on the size of the epidemic. We assume constant fractional reductions, without attempting to consider the way in which susceptible members might respond to information about the epidemic. Results We are able to derive upper and lower bounds for the final size of an epidemic, both for simple and staged progression models. Conclusions The responses of uninfected and infected individuals in a disease outbreak are different, and this difference affects estimates of epidemic size.

  1. Predictive analysis effectiveness in determining the epidemic disease infected area

    Science.gov (United States)

    Ibrahim, Najihah; Akhir, Nur Shazwani Md.; Hassan, Fadratul Hafinaz

    2017-10-01

    Epidemic disease outbreak had caused nowadays community to raise their great concern over the infectious disease controlling, preventing and handling methods to diminish the disease dissemination percentage and infected area. Backpropagation method was used for the counter measure and prediction analysis of the epidemic disease. The predictive analysis based on the backpropagation method can be determine via machine learning process that promotes the artificial intelligent in pattern recognition, statistics and features selection. This computational learning process will be integrated with data mining by measuring the score output as the classifier to the given set of input features through classification technique. The classification technique is the features selection of the disease dissemination factors that likely have strong interconnection between each other in causing infectious disease outbreaks. The predictive analysis of epidemic disease in determining the infected area was introduced in this preliminary study by using the backpropagation method in observation of other's findings. This study will classify the epidemic disease dissemination factors as the features for weight adjustment on the prediction of epidemic disease outbreaks. Through this preliminary study, the predictive analysis is proven to be effective method in determining the epidemic disease infected area by minimizing the error value through the features classification.

  2. The impact of vaccine success and awareness on epidemic dynamics

    Science.gov (United States)

    Juang, Jonq; Liang, Yu-Hao

    2016-11-01

    The role of vaccine success is introduced into an epidemic spreading model consisting of three states: susceptible, infectious, and vaccinated. Moreover, the effect of three types, namely, contact, local, and global, of infection awareness and immunization awareness is also taken into consideration. The model generalizes those considered in Pastor-Satorras and Vespignani [Phys. Rev. E 63, 066117 (2001)], Pastor-Satorras and Vespignani [Phys. Rev. E 65, 036104 (2002)], Moreno et al. [Eur. Phys. J. B 26, 521-529 (2002)], Wu et al. [Chaos 22, 013101 (2012)], and Wu et al. [Chaos 24, 023108 (2014)]. Our main results contain the following. First, the epidemic threshold is explicitly obtained. In particular, we show that, for any initial conditions, the epidemic eventually dies out regardless of what other factors are whenever some type of immunization awareness is considered, and vaccination has a perfect success. Moreover, the threshold is independent of the global type of awareness. Second, we compare the effect of contact and local types of awareness on the epidemic thresholds between heterogeneous networks and homogeneous networks. Specifically, we find that the epidemic threshold for the homogeneous network can be lower than that of the heterogeneous network in an intermediate regime for intensity of contact infection awareness while it is higher otherwise. In summary, our results highlight the important and crucial roles of both vaccine success and contact infection awareness on epidemic dynamics.

  3. Parasite transmission in social interacting hosts: Monogenean epidemics in guppies

    Science.gov (United States)

    Johnson, Mirelle B.; Lafferty, Kevin D.; van Oosterhout, Cock; Cable, Joanne

    2011-01-01

    Background Infection incidence increases with the average number of contacts between susceptible and infected individuals. Contact rates are normally assumed to increase linearly with host density. However, social species seek out each other at low density and saturate their contact rates at high densities. Although predicting epidemic behaviour requires knowing how contact rates scale with host density, few empirical studies have investigated the effect of host density. Also, most theory assumes each host has an equal probability of transmitting parasites, even though individual parasite load and infection duration can vary. To our knowledge, the relative importance of characteristics of the primary infected host vs. the susceptible population has never been tested experimentally. Methodology/Principal Findings Here, we examine epidemics using a common ectoparasite, Gyrodactylus turnbulli infecting its guppy host (Poecilia reticulata). Hosts were maintained at different densities (3, 6, 12 and 24 fish in 40 L aquaria), and we monitored gyrodactylids both at a population and individual host level. Although parasite population size increased with host density, the probability of an epidemic did not. Epidemics were more likely when the primary infected fish had a high mean intensity and duration of infection. Epidemics only occurred if the primary infected host experienced more than 23 worm days. Female guppies contracted infections sooner than males, probably because females have a higher propensity for shoaling. Conclusions/Significance These findings suggest that in social hosts like guppies, the frequency of social contact largely governs disease epidemics independent of host density.

  4. Parasite transmission in social interacting hosts: monogenean epidemics in guppies.

    Directory of Open Access Journals (Sweden)

    Mirelle B Johnson

    Full Text Available BACKGROUND: Infection incidence increases with the average number of contacts between susceptible and infected individuals. Contact rates are normally assumed to increase linearly with host density. However, social species seek out each other at low density and saturate their contact rates at high densities. Although predicting epidemic behaviour requires knowing how contact rates scale with host density, few empirical studies have investigated the effect of host density. Also, most theory assumes each host has an equal probability of transmitting parasites, even though individual parasite load and infection duration can vary. To our knowledge, the relative importance of characteristics of the primary infected host vs. the susceptible population has never been tested experimentally. METHODOLOGY/PRINCIPAL FINDINGS: Here, we examine epidemics using a common ectoparasite, Gyrodactylus turnbulli infecting its guppy host (Poecilia reticulata. Hosts were maintained at different densities (3, 6, 12 and 24 fish in 40 L aquaria, and we monitored gyrodactylids both at a population and individual host level. Although parasite population size increased with host density, the probability of an epidemic did not. Epidemics were more likely when the primary infected fish had a high mean intensity and duration of infection. Epidemics only occurred if the primary infected host experienced more than 23 worm days. Female guppies contracted infections sooner than males, probably because females have a higher propensity for shoaling. CONCLUSIONS/SIGNIFICANCE: These findings suggest that in social hosts like guppies, the frequency of social contact largely governs disease epidemics independent of host density.

  5. Association of Drought with Typhus Epidemics in Central Mexico

    Science.gov (United States)

    Acuna-Soto, R.; Stahle, D.; Villanueva Diaz, J.; Therrell, M.

    2007-05-01

    Typhus is an acute infectious disease caused by the bacteria Rickettsia prowazekii, which is transmitted among humans by the body lice (Pediculus humanus corporis). The disease is highly contagious and transmission is favored in populations living in crowded conditions. Under these circumstances, typhus transmission is facilitated by factors that favor the colonization and proliferation of body lice such as absence of personal hygiene and wearing the same clothes for long periods of time. Historically, periods of war and famine were associated with devastating epidemics with high mortality rates in many parts of the world. Central Mexico has a long record of typhus epidemics. In this region, at > 2000 meters above sea level, the disease was endemic and occurred with a seasonal pattern in winter, with occasional large epidemics. Recently, we completed a chronology of epidemics in Mexico. A total of 22 well-defined major typhus epidemics were identified between 1650 and 1920. All of them caused periods of increased mortality that lasted 2 - 4 years (more than one standard deviation from the previous ten year period). The record of typhus epidemics was evaluated against the tree-ring record of Cuauhtmoc La Fragua, Puebla. This chronology, based on Douglas fir, has demonstrated to be a faithful record of precipitation in central Mexico. The results indicate that a statistically significant drought (t test, p war. This indicates that drought alone was capable of inducing the social conditions for increased transmission of typhus in pre-industrial central Mexico.

  6. Mathematical models to characterize early epidemic growth: A review

    Science.gov (United States)

    Chowell, Gerardo; Sattenspiel, Lisa; Bansal, Shweta; Viboud, Cécile

    2016-09-01

    There is a long tradition of using mathematical models to generate insights into the transmission dynamics of infectious diseases and assess the potential impact of different intervention strategies. The increasing use of mathematical models for epidemic forecasting has highlighted the importance of designing reliable models that capture the baseline transmission characteristics of specific pathogens and social contexts. More refined models are needed however, in particular to account for variation in the early growth dynamics of real epidemics and to gain a better understanding of the mechanisms at play. Here, we review recent progress on modeling and characterizing early epidemic growth patterns from infectious disease outbreak data, and survey the types of mathematical formulations that are most useful for capturing a diversity of early epidemic growth profiles, ranging from sub-exponential to exponential growth dynamics. Specifically, we review mathematical models that incorporate spatial details or realistic population mixing structures, including meta-population models, individual-based network models, and simple SIR-type models that incorporate the effects of reactive behavior changes or inhomogeneous mixing. In this process, we also analyze simulation data stemming from detailed large-scale agent-based models previously designed and calibrated to study how realistic social networks and disease transmission characteristics shape early epidemic growth patterns, general transmission dynamics, and control of international disease emergencies such as the 2009 A/H1N1 influenza pandemic and the 2014-2015 Ebola epidemic in West Africa.

  7. Paediatric HIV treatment failure: a silent epidemic

    Directory of Open Access Journals (Sweden)

    Jonathan M Bernheimer

    2015-07-01

    Full Text Available Paediatric antiretroviral treatment (ART failure is an under-recognized issue that receives inadequate attention in the field of paediatrics and within HIV treatment programmes. With paediatric ART failure rates ranging from 19.3% to over 32% in resource limited settings, a comprehensive evaluation of the causes of failure along with approaches to address barriers to treatment adherence are urgently needed.In partnership with the local Department of Health, a pilot programme has been established by Medecins Sans Frontieres (MSF in Khayelitsha, South Africa, to identify and support paediatric HIV patients with high viral loads and potential treatment failure. Through detailed clinical and psychosocial evaluations and adherence support with an innovative counselling model, treatment barriers are identified and addressed.Demographic and clinical characteristics from the cohort show a delayed median start date for ART, prolonged viraemia including a large number of patients who have never achieved viral load (VL suppression, a low rate of regimen changes despite failure, and a high percentage of pre-adolescent and adolescent patients who have not gone through the disclosure process.Stemming this epidemic of paediatric treatment failure requires programmatic responses to high viral loads in children, starting with improved “case finding” of previously undiagnosed HIV-infected children and adolescents. Viral load testing needs to be prioritized over CD4 count monitoring, and flagging systems to identify high VL results should be developed in clinics. Clinicians must understand that successful treatment begins with good adherence, and that simple adherence support strategies can often dramatically improve adherence. Moreover, appropriate adherence counselling should begin not when the child fails to respond to treatment. Establishing good adherence from the beginning of treatment, and supporting ongoing adherence during the milestones in these

  8. The asthma epidemic and our artificial habitats

    Directory of Open Access Journals (Sweden)

    Maziak Wasim

    2005-03-01

    Full Text Available Abstract Background The recent increase in childhood asthma has been a puzzling one. Recent views focus on the role of infection in the education of the immune system of young children. However, this so called hygiene hypothesis fails to answer some important questions about the current trends in asthma or to account for environmental influences that bear little relation to infection. Discussion The multi-factorial nature of asthma, reflecting the different ways we tend to interact with our environment, mandates that we look at the asthma epidemic from a broader perspective. Seemingly modern affluent lifestyles are placing us increasingly in static, artificial, microenvironments very different from the conditions prevailed for most part of our evolution and shaped our organisms. Changes that occurred during the second half of the 20th century in industrialized nations with the spread of central heating/conditioning, building insulation, hygiene, TV/PC/games, manufactured food, indoor entertainment, cars, medical care, and sedentary lifestyles all seem to be depriving our children from the essential inputs needed to develop normal airway function (resistance. Asthma according to this view is a manifestation of our respiratory maladaptation to modern lifestyles, or in other words to our increasingly artificial habitats. The basis of the artificial habitat notion may lie in reduced exposure of innate immunity to a variety of environmental stimuli, infectious and non-infectious, leading to reduced formulation of regulatory cells/cytokines as well as inscribed regulatory pathways. This could contribute to a faulty checking mechanism of non-functional Th2 (and likely Th1 responses, resulting in asthma and other immuno-dysregulation disorders. Summary In this piece I discuss the artificial habitat concept, its correspondence with epidemiological data of asthma and allergy, and provide possible immunological underpinning for it from an evolutionary

  9. Development of EKC after eximer laser photorefractive surgery and subsequent recurrence of EKC-like keratitis.

    Science.gov (United States)

    Park, Sung Joon; Jang, Yoon Soo; Koh, Tae Hyuk; Kwon, Young A; Song, Sang Wroul

    2011-12-01

    This research focuses on four cases of patients having undergone eximer laser photorefractive surgery who were diagnosed with adenoviral keratoconjunctivitis during the postoperative period and who later developed epidemic keratoconjunctivitis (EKC)-like keratitis. Two of the patients had undergone laser-assisted subepithelial keratectomy (LASEK), one had undergone laser in situ keratomileusis and one had photorefractive keratectomy. After the surgery adenoviral keratoconjunctivitis and recurrent late-developing EKC-like keratitis were observed in the patients. Recurrent late-developing EKC-like keratitis occurred in one of the patients, who had received LASEK as many as three times. The others had only one or two episodes.The corneal infiltrates of keratitis mainly occurred in the central cornea. Successful resolution of recurrent late-developing EKC-like keratitis was achieved through the use of topical steroids without sequelae and the final best-corrected visual acuity was as good as the base line. These keratitis infiltrates have been presumed to represent an immune response to the suspected adenoviral antigens deposited in corneal stroma during the primary adenoviral infection. Previous reports argued that patients with a history of adenoviral ketatoconjunctivitis were succeptible to adenoviral keratoconjunctivitis becoming reactivated; however, in our research, our patients had their first adenoviral infections after the eximer laser photorefractive surgery and reactivation was confirmed. We recommend that attention be paid to adenoviral infection after laser refractive operations, because these patients seem to have more frequent recurrences.

  10. Investigating the introduction of porcine epidemic diarrhea virus into an Ohio swine operation.

    Science.gov (United States)

    Bowman, Andrew S; Krogwold, Roger A; Price, Todd; Davis, Matt; Moeller, Steven J

    2015-02-15

    Porcine Epidemic Diarrhea virus (PEDV) is a highly transmissible coronavirus that causes a severe enteric disease that is particularly deadly for neonatal piglets. Since its introduction to the United States in 2013, PEDV has spread quickly across the country and has caused significant financial losses to pork producers. With no fully licensed vaccines currently available in the United States, prevention and control of PEDV disease is heavily reliant on biosecurity measures. Despite proven, effective biosecurity practices, multiple sites and production stages, within and across designated production flows in an Ohio swine operation broke with confirmed PEDV in January 2014, leading the producer and attending veterinarian to investigate the route of introduction. On January 12, 2014, several sows within a production flow were noted with signs of enteric illness. Within a few days, illness had spread to most of the sows in the facility and was confirmed by RT-PCR to be PEDV. Within a short time period, confirmed disease was present on multiple sites within and across breeding and post weaning production flows of the operation and mortality approached 100% in neonatal piglets. After an epidemiologic investigation, an outsourced, pelleted piglet diet was identified for assessment, and a bioassay, where naïve piglets were fed the suspected feed pellets, was initiated to test the pellets for infectious PEDV. The epidemiological investigation provided strong evidence for contaminated feed as the source of the outbreak. In addition, feed pellets collected from unopened bags at the affected sites tested positive for PEDV using RT-PCR. However, the bioassay study was not able to show infectivity when feeding the suspected feed pellets to a small number of naïve piglets. The results highlight the critical need for surveillance of feed and feed components to further define transmission avenues in an effort to limit the spread of PEDV throughout the U.S. swine industry.

  11. Early Indicators of Fatal Leptospirosis during the 2010 Epidemic in Puerto Rico.

    Science.gov (United States)

    Sharp, Tyler M; Rivera García, Brenda; Pérez-Padilla, Janice; Galloway, Renee L; Guerra, Marta; Ryff, Kyle R; Haberling, Dana; Ramakrishnan, Sharada; Shadomy, Sean; Blau, Dianna; Tomashek, Kay M; Bower, William A

    2016-02-01

    Leptospirosis is a potentially fatal bacterial zoonosis that is endemic throughout the tropics and may be misdiagnosed as dengue. Delayed hospital admission of leptospirosis patients is associated with increased mortality. During a concurrent dengue/leptospirosis epidemic in Puerto Rico in 2010, suspected dengue patients that tested dengue-negative were tested for leptospirosis. Fatal and non-fatal hospitalized leptospirosis patients were matched 1:1-3 by age. Records from all medical visits were evaluated for factors associated with fatal outcome. Among 175 leptospirosis patients identified (4.7 per 100,000 residents), 26 (15%) were fatal. Most patients were older males and had illness onset during the rainy season. Fatal case patients first sought medical care earlier than non-fatal control patients (2.5 vs. 5 days post-illness onset [DPO], p leptospirosis at first medical visit (43.9% vs. 9.6%, p = 0.01), they were admitted to the hospital no earlier than non-fatal controls (4.5 vs. 6 DPO, p = 0.31). Cases less often developed fever (p = 0.03), but more often developed jaundice, edema, leg pain, hemoptysis, and had a seizure (p ≤ 0.03). Multivariable analysis of laboratory values from first medical visit associated with fatal outcome included increased white blood cell (WBC) count with increased creatinine (p = 0.001), and decreased bicarbonate with either increased WBC count, increased creatinine, or decreased platelet count (p leptospirosis sought care earlier, but were not admitted for care any earlier than non-fatal patients. Combinations of routine laboratory values predictive of fatal outcome should be considered in admission decision-making for patients with suspected leptospirosis.

  12. Prognostic importance of quantitative echocardiographic evaluation in patients suspected of first non-massive pulmonary embolism

    DEFF Research Database (Denmark)

    Kjaergaard, Jesper; Schaadt, Bente Krogsgaard; Lund, Jens Otto

    2008-01-01

    AIMS: Patients suspected of acute pulmonary embolism (PE) frequently undergo echocardiography as a part of the initial work-up. Prognostic implication of routine echocardiography in patients suspected of PE remain to be established. METHODS AND RESULTS: Transthoracic echocardiography, including...

  13. Icare rebound tonometry in children with known and suspected glaucoma.

    Science.gov (United States)

    Flemmons, Meghan S; Hsiao, Ya-Chuan; Dzau, Jacqueline; Asrani, Sanjay; Jones, Sarah; Freedman, Sharon F

    2011-04-01

    Accurate intraocular pressure (IOP) measurement, important in managing pediatric glaucoma, often presents challenges. The Icare rebound tonometer shows promise for screening healthy children and has been reported comparable with Goldmann applanation in adults with glaucoma. The purpose of this study was to evaluate the Icare tonometer against Goldmann applanation for clinic IOP measurement in pediatric glaucoma. This was a prospective study comparing Icare versus Goldmann tonometry in pediatric glaucoma. Children with known or suspected glaucoma were recruited from scheduled clinic visits. IOP was measured with the Icare tonometer by a clinician and subsequently measured with Goldmann applanation tonometry (GAT) by a different single masked clinician. A total of 71 eyes of 71 children with known or suspected glaucoma were included. IOP by GAT ranged from 9 to 36 mm Hg. Icare readings ranged from 11 to 44 mm Hg. Mean difference between Icare and GAT was 2.3 ± SD 3.7 mm Hg, p IOPs were within ± 3 mm Hg of GAT in 63%. Icare IOPs were ≥GAT IOPs in 75%. The following factors were not associated with Icare IOPs greater than GAT: child's age, glaucoma diagnosis, strabismus, nystagmus, central corneal thickness, Icare instrument-reported reliability, number of glaucoma surgeries or medications, corneal abnormalities, and visual acuity. IOP by Icare tonometry was within 3 mm Hg of IOP by GAT in 63% and greater than GAT in 75%. This device may be reasonable to estimate IOP in selected children with known or suspected glaucoma whose IOP cannot otherwise be obtained in clinic; however, correlation of Icare IOPs with clinical findings must continue to be considered in each case. Copyright © 2011 American Association for Pediatric Ophthalmology and Strabismus. Published by Mosby, Inc. All rights reserved.

  14. Herbal hepatotoxicity: suspected cases assessed for alternative causes.

    Science.gov (United States)

    Teschke, Rolf; Schulze, Johannes; Schwarzenboeck, Alexander; Eickhoff, Axel; Frenzel, Christian

    2013-09-01

    Alternative explanations are common in suspected drug-induced liver injury (DILI) and account for up to 47.1% of analyzed cases. This raised the question of whether a similar frequency may prevail in cases of assumed herb-induced liver injury (HILI). We searched the Medline database for the following terms: herbs, herbal drugs, herbal dietary supplements, hepatotoxic herbs, herbal hepatotoxicity, and herb-induced liver injury. Additional terms specifically addressed single herbs and herbal products: black cohosh, Greater Celandine, green tea, Herbalife products, Hydroxycut, kava, and Pelargonium sidoides. We retrieved 23 published case series and regulatory assessments related to hepatotoxicity by herbs and herbal dietary supplements with alternative causes. The 23 publications comprised 573 cases of initially suspected HILI; alternative causes were evident in 278/573 cases (48.5%). Among them were hepatitis by various viruses (9.7%), autoimmune diseases (10.4%), nonalcoholic and alcoholic liver diseases (5.4%), liver injury by comedication (DILI and other HILI) (43.9%), and liver involvement in infectious diseases (4.7%). Biliary and pancreatic diseases were frequent alternative diagnoses (11.5%), raising therapeutic problems if specific treatment is withheld; pre-existing liver diseases including cirrhosis (9.7%) were additional confounding variables. Other diagnoses were rare, but possibly relevant for the individual patient. In 573 cases of initially assumed HILI, 48.5% showed alternative causes unrelated to the initially incriminated herb, herbal drug, or herbal dietary supplement, calling for thorough clinical evaluations and appropriate causality assessments in future cases of suspected HILI.

  15. Benefits of sonography in diagnosing suspected uncomplicated acute diverticulitis.

    Science.gov (United States)

    King, Welfur C; Shuaib, Waqas; Vijayasarathi, Arvind; Fajardo, Carlos G; Cabrera, Waldo E; Costa, Juan L

    2015-01-01

    Despite evidence demonstrating equivalent accuracy of sonography and computed tomography (CT) in the workup of mild/uncomplicated acute diverticulitis, CT is overwhelmingly performed as the initial diagnostic test, particularly in the acute setting. Our study evaluated potential radiation and turnaround time savings associated with performing sonography instead of CT as the initial diagnostic examination in the workup of suspected uncomplicated acute diverticulitis. We retrospectively reviewed medical records from January 2010 to December 2012 for patients presenting with clinical symptoms of acute diverticulitis. Patients were categorized as a whole and subgrouped by age (>40 and 40 years and 121 diverticulitis. © 2015 by the American Institute of Ultrasound in Medicine.

  16. A Suspected Pelvic Aneurysmal Bone Cyst in Pregnancy

    Directory of Open Access Journals (Sweden)

    Rayan Elkattah

    2013-01-01

    Full Text Available Albeit rare, the majority of identified bone lesions in pregnancy spare the pelvis. Once encountered with a pelvic bone lesion in pregnancy, the obstetrician may face a challenging situation as it is difficult to determine and predict the effects that labor and parturition impart on the pelvic bones. Bone changes and pelvic bone fractures have been well documented during childbirth. The data regarding clinical outcomes and management of pregnancies complicated by pelvic ABCs is scant. Highly suspected to represent an aneurysmal bone cyst, the clinical evaluation of a pelvic lesion in the ilium of a pregnant individual is presented, and modes of delivery in such a scenario are discussed.

  17. Patch Testing in Suspected Allergic Contact Dermatitis to Cosmetics

    OpenAIRE

    Pramod Kumar; Rekha Paulose

    2014-01-01

    Background. Increasing use of cosmetics has contributed to a rise in the incidence of allergic contact dermatitis (ACD) to cosmetics. It is estimated that 1–5.4% of the population is sensitized to a cosmetic ingredient. Patch testing helps to confirm the presence of an allergy and to identify the actual allergens which are chemical mixtures of various ingredients. Objectives. The aims of this study are to perform patch testing in suspected ACD to cosmetics and to identify the most common alle...

  18. Comparative analysis of protein evolution in the genome of pre-epidemic and epidemic Zika virus.

    Science.gov (United States)

    Ramaiah, Arunachalam; Dai, Lei; Contreras, Deisy; Sinha, Sanjeev; Sun, Ren; Arumugaswami, Vaithilingaraja

    2017-07-01

    Zika virus (ZIKV) causes microcephaly in congenital infection, neurological disorders, and poor pregnancy outcome and no vaccine is available for use in humans or approved. Although ZIKV was first discovered in 1947, the exact mechanism of virus replication and pathogenesis remains unknown. Recent outbreaks of Zika virus in the Americas clearly suggest a human-mosquito cycle or urban cycle of transmission. Understanding the conserved and adaptive features in the evolution of ZIKV genome will provide a hint on the mechanism of ZIKV adaptation to a new cycle of transmission. Here, we show comprehensive analysis of protein evolution of ZIKV strains including the current 2015-16 outbreak. To identify the constraints on ZIKV evolution, selection pressure at individual codons, immune epitopes and co-evolving sites were analyzed. Phylogenetic trees show that the ZIKV strains of the Asian genotype form distinct cluster and share a common ancestor with African genotype. The TMRCA (Time to the Most Recent Common Ancestor) for the Asian lineage and the subsequently evolved Asian human strains was calculated at 88 and 34years ago, respectively. The proteome of current 2015/16 epidemic ZIKV strains of Asian genotype was found to be genetically conserved due to genome-wide negative selection, with limited positive selection. We identified a total of 16 amino acid substitutions in the epidemic and pre-epidemic strains from human, mosquito, and monkey hosts. Negatively selected amino acid sites of Envelope protein (E-protein) (positions 69, 166, and 174) and NS5 (292, 345, and 587) were located in central dimerization domains and C-terminal RNA-directed RNA polymerase regions, respectively. The predicted 137 (92 CD4 TCEs; 45 CD8 TCEs) immunogenic peptide chains comprising negatively selected amino acid sites can be considered as suitable target for sub-unit vaccine development, as these sites are less likely to generate immune-escape variants due to strong functional constrains

  19. On the use of human mobility proxies for modeling epidemics.

    Directory of Open Access Journals (Sweden)

    Michele Tizzoni

    2014-07-01

    Full Text Available Human mobility is a key component of large-scale spatial-transmission models of infectious diseases. Correctly modeling and quantifying human mobility is critical for improving epidemic control, but may be hindered by data incompleteness or unavailability. Here we explore the opportunity of using proxies for individual mobility to describe commuting flows and predict the diffusion of an influenza-like-illness epidemic. We consider three European countries and the corresponding commuting networks at different resolution scales, obtained from (i official census surveys, (ii proxy mobility data extracted from mobile phone call records, and (iii the radiation model calibrated with census data. Metapopulation models defined on these countries and integrating the different mobility layers are compared in terms of epidemic observables. We show that commuting networks from mobile phone data capture the empirical commuting patterns well, accounting for more than 87% of the total fluxes. The distributions of commuting fluxes per link from mobile phones and census sources are similar and highly correlated, however a systematic overestimation of commuting traffic in the mobile phone data is observed. This leads to epidemics that spread faster than on census commuting networks, once the mobile phone commuting network is considered in the epidemic model, however preserving to a high degree the order of infection of newly affected locations. Proxies' calibration affects the arrival times' agreement across different models, and the observed topological and traffic discrepancies among mobility sources alter the resulting epidemic invasion patterns. Results also suggest that proxies perform differently in approximating commuting patterns for disease spread at different resolution scales, with the radiation model showing higher accuracy than mobile phone data when the seed is central in the network, the opposite being observed for peripheral locations. Proxies

  20. Could the Recent Zika Epidemic Have Been Predicted?

    Directory of Open Access Journals (Sweden)

    Ángel G. Muñoz

    2017-07-01

    Full Text Available Given knowledge at the time, the recent 2015–2016 zika virus (ZIKV epidemic probably could not have been predicted. Without the prior knowledge of ZIKV being already present in South America, and given the lack of understanding of key epidemiologic processes and long-term records of ZIKV cases in the continent, the best related prediction could be carried out for the potential risk of a generic Aedes-borne disease epidemic. Here we use a recently published two-vector basic reproduction number model to assess the predictability of the conditions conducive to epidemics of diseases like zika, chikungunya, or dengue, transmitted by the independent or concurrent presence of Aedes aegypti and Aedes albopictus. We compare the potential risk of transmission forcing the model with the observed climate and with state-of-the-art operational forecasts from the North American Multi Model Ensemble (NMME, finding that the predictive skill of this new seasonal forecast system is highest for multiple countries in Latin America and the Caribbean during the December-February and March-May seasons, and slightly lower—but still of potential use to decision-makers—for the rest of the year. In particular, we find that above-normal suitable conditions for the occurrence of the zika epidemic at the beginning of 2015 could have been successfully predicted at least 1 month in advance for several zika hotspots, and in particular for Northeast Brazil: the heart of the epidemic. Nonetheless, the initiation and spread of an epidemic depends on the effect of multiple factors beyond climate conditions, and thus this type of approach must be considered as a guide and not as a formal predictive tool of vector-borne epidemics.