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Cognitive dysfunction in depression is associated with poorer clinical outcomes and impaired psychosocial functioning. However, most treatments for depression do not specifically target cognition. Neurocognitive deficits such as memory and concentration problems tend to persist after mood symptoms recover. Improving cognition in depression requires a better understanding of brain systems implicated in depression. A comprehensive approach is warranted for refined methods of assessing and treating cognitive dysfunction in depression.
Acute mastoiditis is a significant cause of morbidity in the paediatric population. This paper reviews our experience with this condition over the last 10 years and compares it with historical data from Alder Hey Children's Hospital, Liverpool, UK.
A retrospective case note review of patients who presented between 2003 and 2012 was performed.
Forty-six patients with acute mastoiditis were identified. Imaging with computed tomography and magnetic resonance imaging was carried out in 14 cases (30.4 per cent). Intracranial complications were identified in six patients (13.0 per cent), one of whom required neurosurgical intervention. In 27 cases (58.7 per cent), a surgical procedure was performed. Data from 1995 to 2000 revealed similar rates of imaging (30.0 per cent), but significantly lower rates of surgical intervention (23 per cent). A lower rate of intracranial complications (4.8 per cent) in the historical cohort did not prove to be statistically significant (p = 0.419).
The numbers of paediatric patients presenting with acute mastoiditis appears essentially unchanged. Improvement in imaging technology and aids to interpretation may explain the apparent increase of intracranial complications.
Cholera is an important public health problem in Bangladesh. Interventions to prevent cholera depend on their cost-effectiveness which in turn depends on cholera incidence. Hospital-based diarrhoeal disease surveillance has been ongoing in six Bangladeshi hospitals where a systematic proportion of patients admitted with diarrhoea were enrolled and tested for Vibrio cholerae. However, incidence calculation using only hospital data underestimates the real disease burden because many ill persons seek treatment elsewhere. We conducted a healthcare utilization survey in the catchment areas of surveillance hospitals to estimate the proportion of severe diarrhoeal cases that were admitted to surveillance hospitals and estimated the population-based incidence of severe diarrhoea due to V. cholerae by combining both hospital surveillance and catchment area survey data. The estimated incidence of severe diarrhoea due to cholera ranged from 0·3 to 4·9/1000 population in the catchment area of surveillance hospitals. In children aged <5 years, incidence ranged from 1·0 to 11·0/1000 children. Diarrhoeal deaths were most common in the Chhatak Hospital's catchment area (18·5/100 000 population). This study provides a credible estimate of the incidence of severe diarrhoea due to cholera in Bangladesh, which can be used to assess the cost-effectiveness of cholera prevention activities.
This study aimed to determine the prevalence of hearing impairment in Bangladeshi people of all ages.
A nationally representative cross-sectional survey was carried out in 2013. A total of 4260 subjects (1774 males and 2486 females), with a mean age of 32 years, participated. Hearing impairment was determined by pure tone audiometry and otoacoustic emissions testing.
Disabling hearing loss (greater than 40 dB loss in adults, and greater than 30 dB loss in children younger than 15 years, in their better hearing ears) was present in 9.6 per cent (95 per cent confidence interval, 8.5–10.8 per cent) of the respondents. Hearing loss was more prevalent in socio-economically deprived people and in those older than 60 years. Multiple logistic regression analysis identified age, socio-economic deprivation, family history, impacted ear wax, chronic suppurative otitis media, otitis media with effusion, and otitis externa as the significant predictors of disabling hearing loss.
Deafness prevention should focus mainly on chronic suppurative otitis media, otitis media with effusion, and impacted ear wax prevention, integrated within the primary healthcare system and addressing the equity issue.
Presence of Vibrio cholerae serogroups O1 and O139 in the waters of the rural area of Matlab, Bangladesh, was investigated with quantitative measurements performed with a portable flow cytometer. The relevance of this work relates to the testing of a field-adapted measurement protocol that might prove useful for cholera epidemic surveillance and for validation of mathematical models. Water samples were collected from different water bodies that constitute the hydrological system of the region, a well-known endemic area for cholera. Water was retrieved from ponds, river waters, and irrigation canals during an inter-epidemic time period. Each sample was filtered and analysed with a flow cytometer for a fast determination of V. cholerae cells contained in those environments. More specifically, samples were treated with O1- and O139-specific antibodies, which allowed precise flow-cytometry-based concentration measurements. Both serogroups were present in the environmental waters with a consistent dominance of V. cholerae O1. These results extend earlier studies where V. cholerae O1 and O139 were mostly detected during times of cholera epidemics using standard culturing techniques. Furthermore, our results confirm that an important fraction of the ponds’ host populations of V. cholerae are able to self-sustain even when cholera cases are scarce. Those contaminated ponds may constitute a natural reservoir for cholera endemicity in the Matlab region. Correlations of V. cholerae concentrations with environmental factors and the spatial distribution of V. cholerae populations are also discussed.
A 12-month survey on the incidence of campylobacter infection in 1217 patients with diarrhoea was carried out in Jeddah, Saudi Arabia. Campylobacters were isolated from 55 (4·5%) patients, second in prevalence to salmonellas (6·2%). Shigellas were isolated from 4·2% of patients. Campylobacter isolation rates were high in children of all ages, as well as in young adults (36·5% of all isolates were from adults aged 20–39 years). Isolation rates peaked in September and November. Analysis of the results showed that 69% were Campylobacter jejuni (mostly biotype IV) and 31% C. coli. Serogroups 5 and 23 (Penner scheme) and phage type 125 (Preston scheme) were most frequently isolated. Resistance to erythromycin and tetracycline was observed in 7·3 and 32·7% of the isolates. Campylobacters are an important cause of bacterial enteritis in Saudi Arabia, both in adults and in children, and should be sought routinely.
The objective of the study was to determine the prevalence of smear-positive tuberculosis (TB) in a rural area in Bangladesh at Matlab. A TB surveillance system was established among 106000 people in rural Bangladesh at Matlab. Trained field workers interviewed all persons aged [ges ]15 years to detect suspected cases of TB (cough>21 days) and sputum specimens of suspected cases were examined for acid-fast bacilli (AFB). Of 59395 persons interviewed, 4235 (7·1%) had a cough for >21 days. Sputum specimens were examined for AFB from 3834 persons, 52 (1·4%) of them were positive for AFB. The prevalence of chronic cough and sputum positivity were significantly higher among males compared to females (P<0·001). The population-based prevalence rate of smear-positive TB cases was 95/100000 among persons aged [ges ]15 years. Cases of TB clustered geographically (relative risk 5·53, 95% CI 3·19–9·59). The high burden of TB among rural population warrants appropriate measures to control TB in Bangladesh. The higher prevalence of persistent cough and AFB-positive sputum among males need further exploration. Factors responsible for higher prevalence of TB in clusters should be investigated.
A study was undertaken on duck farming in a North-eastern part of India (Assam), representing almost all the agro-climatic zones. Five districts were selected, one from each agro-climatic zone except for the hill area. Twenty-five duck farmers from each district, a total of 125 in all, were selected on the basis of flock size. Results of the study in respect of socio-economic status of the farmer, demographic distribution, husbandry and feeding practice, production performance, incidence of diseases, mortality pattern and health protection programmes, marketing, finance and costs and returns from the flocks are highlighted.
Invasive group A streptococcal (GAS) infections have been of increasing concern worldwide during the past 15 years. Spread of group A streptococci to contacts with resulting invasive infection has been reported in families, in residential nursing homes, and even from patients to health care workers. We report an instance of temporally related life-threatening group A streptococcal infection in a husband and 2 weeks later in his wife. This example further emphasizes the need for careful observation among family members and other close contacts of patients with invasive group A streptococcal infection. Although at present there are no universal recommendations for monitoring or for antibiotic prophylaxis of close contacts of persons with invasive GAS infection, when added to existing literature, this report suggests additional consideration is required.
Silastic® (Dow-Corning) implants are used for augmentation rhinoplasty. Complications following their use usually occur within the first 24 months. We report a case in which the dorsal splint became displaced spontaneously five years after surgery.
In this study, the stress-deformation response of coal in the laboratory under threedimensional (3-D) loading conditions similar to those existing in an actual coal mine is investigated, and a constitutive model, including the effects of anisotropy, is developed. The coal samples were obtained from a mine in LeFlore County, Oklahoma, at a depth of approximately 25–30 ft below the ground surface. A High Capacity Cubical Device with servo-controlled independent loading along three axes of a cubical specimen and a computerized data acquisition and monitoring system were used to conduct the tests. A total of 21 tests under 4 different confining pressures and 5 different stress paths were conducted. The influence of the degree of anisotropy was investigated by comparing the transversely isotropic and isotropic idealizations for different stress paths (Triaxial Compression, Triaxial Extension and Simple Shear) at different confining pressures (1,600, 3,200 and 5,600 psi). The experimental results demonstrated that the coal exhibits inherent anisotropy and that it can be treated approximately as a transversely isotropic material. Also, the Young's moduli were found to be dependent on the confining pressure. The experimental data were used to evaluate the material constants associated with the elasto-plastic constitutive model developed in the study.
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