The global burden of injuries

The traditional view of injuries as "accidents", or random events, has resulted in the historical neglect of this area of public health. However, the most recent estimates show that injuries are among the leading causes of death and disability in the world. They affect all populations, regardless of age, sex, income, or geographic region. In 1998, about 5.8 million people (97.9 per 100,000 population) died of injuries worldwide, and injuries caused 16% of the global burden of disease. Road traffic injuries are the 10th leading cause of death and the 9th leading cause of the burden of disease; self-inflicted injuries, falls, and interpersonal violence follow closely. Injuries affect mostly young people, often causing long-term disability. Decreasing the burden of injuries is among the main challenges for public health in the next century--injuries are preventable, and many effective strategies are available. Public health officials must gain a better understanding of the magnitude and characteristics of the problem, contribute to the development and evaluation of injury prevention programs, and develop the best possible prehospital and hospital care and rehabilitation for injured persons.

Diaphragmatic fatigue and high-intensity exercise in patients with chronic obstructive pulmonary disease

Patients with chronic obstructive pulmonary disease (COPD) are at a mechanical disadvantage and should be predisposed to the development of diaphragmatic fatigue when the ventilatory system is stressed by exercise. The purpose of this study was to determine whether patients with moderately severe COPD develop contractile fatigue of the diaphragm after cycle exercise to the limits of tolerance. Twelve male patients with COPD, age 61.4 +/- 3.0 yr, participated. Their forced expiratory volume in 1 s (FEV(1)) was 1.79 +/- 0.14 L, 49.6 +/- 3.4% of predicted. Patients cycled at 60-70% of their predetermined maximal work capacity until they had to stop because of intolerable symptoms. Twitch transdiaphragmatic pressure (Pdi,tw) was measured during cervical magnetic stimulation before and 10, 30, and 60 min after exercise. A persistent fall in Pdi,tw postexercise of >/= 10% was considered potentially indicative of contractile fatigue of the diaphragm. Patients cycled for 10.2 +/- 2.0 min at a workload of 59.9 +/- 4.3 W. Patients exercised maximally relative to their capacity reaching a peak oxygen consumption (V O(2)) of 108.1 +/- 2.8% of the peak V O(2) obtained during a preliminary maximal incremental exercise test. Pdi,tw was not significantly different from baseline at any time postexercise. Pdi,tw was 19.9 +/- 1.6 cm H(2)O at baseline, 19.6 +/- 2.0 cm H(2)O at 10 min postexercise, 18. 6 +/- 2.0 cm H(2)O at 30 min postexercise, and 19.5 +/- 1.7 cm H(2)O at 60 min postexercise. In the individual patients, two of the patients had a persistent >/= 10% fall in Pdi,tw postexercise, potentially indicative of contractile fatigue of the diaphragm. In conclusion, the majority of patients with moderately severe COPD do not develop contractile fatigue of the diaphragm after high-intensity constant workload cycle exercise to the limits of tolerance.

Decapitation death

An unusual decapitation death of a young man from a road traffic accident involving a two-wheel scooter is reported.

Importance of clinical diagnosis of malaria in national malaria control programme

The study conducted at Kheda district, Gujarat, revealed that judgement of patient on the basis of symptoms and diagnosis of the doctor were correct in 50 and 27% of the suspected malaria cases respectively. In malaria control programme, emphasis on health education and passive case detection is indicated.

A study of antigenic variants of foot and mouth disease virus type A in India between 1977 and 1985

The structural polypeptides of thirty-three field isolates of foot and mouth disease virus (FMDV) collected in India between 1977 and 1985 were analysed by SDS-polyacrylamide gel electrophoresis. They were placed in eleven groups based on their patterns and compared with results of conventional serological (virus neutralisation and complement fixation) tests. Variation occurred in the structural proteins of the viruses isolated between 1977 and 1981; however, the polypeptide patterns of viruses isolated in 1984 and 1985 were identical.

Gel diffusion determinations on feeding behaviour patterns of anophelines in Orissa State, India

In 1981 Entomological Field Research Units were established in three districts of Orissa State, India, from which Anopheles bloodmeals were forwarded regularly for analysis to an Entomological Laboratory in Bhubaneswar. At the onset of 1982, the laboratory introduced a modified gel diffusion technique for determining the origin of mosquito bloodmeals and by the end of 1983, 22,300 smears had been processed and analyzed. The technique is relatively very simple, fast and inexpensive. The results are reproducible and the use of double controls (negative and positive) ensure a high degree of reliability.

Evaluation of serology as a tool for malaria surveillance in East Champaran District of Bihar, India

The indirect immunofluorescence test was evaluated as a tool for malaria surveillance. The population of 12 villages in the East Champaran District of Bihar with a low annual parasitic index and a low annual blood examination rate was surveyed in order to confirm the low endemicity of malaria in these villages. Two specimens of blood, one taken during the pre-transmission season and one taken during the post-transmission season, were collected for parasitological and serological studies. The paired samples showed no parasite positivity in the study population in both surveys. All the villages had very low serological titres. However, the presence of malaria antibodies in the zero to five years age group (the sentinel group) indicated that malaria transmission occurred in the study area at a very low level. The seropositivity and the geometric mean titre were lower in the pre-transmission season than in the post-transmission season, but the overall reduction in geometric mean titre, which was very low throughout the study, was not statistically significant. The study emphasizes the importance of serological tests in malaria surveillance.

Pulmonary megakaryocytes: "missing link" between cardiovascular and respiratory disease?

Pulmonary megakaryocytes were quantitated in a series of 30 consecutive hospital necropsies using a two stage immunoperoxidase stain for factor VIII related antigen. In all 30 cases they were found with a mean density of 14.65 megakaryocytes/cm2 in lung sections of 5 micron in thickness. The maximum concentration of intrapulmonary megakaryocytes was consistently found to be in the central zone of the right upper lobe. Less than 22% of the observed cells possessed abundant cytoplasm, the rest appearing as effete, naked, and seminaked nuclei. The mean megakaryocyte count was found to be increased in association with both respiratory pathology (positive smoking history and impaired lung function) and cardiovascular disease states--shock; thromboembolism; myocardial infarction; and severe atheroma in the abdominal aorta, the coronary circulation, and the circle of Willis. Pulmonary megakaryocytes probably embolise from bone marrow. This may reflect stimulated thrombopoiesis, caused by increased platelet consumption in association with atherosclerotic disease, but it cannot be taken to confirm that the lung is the principal site of platelet production.