Global distribution and environmental suitability for chikungunya virus, 1952 to 2015

Chikungunya fever is an acute febrile illness caused by the chikungunya virus (CHIKV), which is transmitted to humans by Aedes mosquitoes. Although chikungunya fever is rarely fatal, patients can experience debilitating symptoms that last from months to years. Here we comprehensively assess the global distribution of chikungunya and produce high-resolution maps, using an established modelling framework that combines a comprehensive occurrence database with bespoke environmental correlates, including up-to-date Aedes distribution maps. This enables estimation of the current total population-at-risk of CHIKV transmission and identification of areas where the virus may spread to in the future. We identified 94 countries with good evidence for current CHIKV presence and a set of countries in the New and Old World with potential for future CHIKV establishment, demonstrated by high environmental suitability for transmission and in some cases previous sporadic reports. Aedes aegypti presence was identified as one of the major contributing factors to CHIKV transmission but significant geographical heterogeneity exists. We estimated 1.3 billion people are living in areas at-risk of CHIKV transmission. These maps provide a baseline for identifying areas where prevention and control efforts should be prioritised and can be used to guide estimation of the global burden of CHIKV.

[Diving Accidents]

Decompression injuries occur on account of the special hyperbaric effects during the emerge phase and require superior therapeutic knowledge. Vitally important is emergency treatment with high concentrated oxygen at an early stage. Sever decompression injuries require oxygenation in a hyperbaric treatment chamber.

The relationship between previous trauma and alcohol and substance misuse in women

Introduction

The association between previous trauma and the development of alcohol and substance misuse is well established, however, much of the research is focused on the association of PTSD with alcohol and substance misuse. This research will be focussing on trauma in general and its influence on the development of alcohol and substance misuse in women.

Objectives

The main objective of this study was to investigate the relationship between previous traumatic events and the development of alcohol and substance misuse in women.

Methods

This was a retrospective case note study of 146 female patients from a UK based detoxification and rehabilitation centre. Trauma history from patient files were audited, with the trauma experienced being assigned a category.

Results

Out of 146 women with alcohol and/or substance misuse, 132 (90%) had experienced a previous trauma. The types of trauma experienced include; domestic (53%), traumatic grief (36%), sexual abuse (35%), physical (15%), bullying (4%) and neglect (4%). These results show that women who suffer from alcohol/substance misuse are highly likely to have suffered a previous trauma.

Conclusions

The results from this study suggest that women who have suffered previous trauma are high risk for alcohol and substance misuse problems, therefore early intervention and a robust psychological support system should be provided to women who have a history of trauma. Furthermore in addition to addiction treatment and behaviour focused therapy already in place trauma focussed therapy may prove beneficial.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Comparison of Short vs Long Anti-rotation in Treating Trochanteric Fractures

Introduction: A comparative evaluation of the surgical treatment and outcome of patients with pertrochanteric fractures treated with short versus long proximal femoral nail antirotation. Materials and methods: A retrospective review was conducted of patients with pertrochanteric fractures treated between January 2011 and June 2012. In all 80 patients were enrolled in the study, of which 40 were treated with short PFNA and the remaining with long PFNA. Comparative analyses of demographic data, peri-operative outcome and complications were carried out. Results: There was no significant difference noted in the two groups with regards to Arbeitsgemeinschaft fur Osteosynthesefragen (AO) fracture classification, time from injury to surgery, blood transfusion post surgery and hospital stay. The surgical duration for a short PFNA procedure was significantly less (58 minutes) when compared to that of a long PFNA (87 minutes). Similarly intra-operative blood loss was significantly higher in the long PFNA group as compared to the short PFNA. Conclusions: A relatively quicker surgical time of just under an hour , lesser blood loss and better learning curve with trainee surgeons make short PFNA a better implant choice in the treatment of pertrochanteric fractures.

The One-Stop Aortic Surveillance Clinic

Background

The principle of interval ultrasound surveillance of small abdominal aortic aneurysms (AAA) is well established. The fundamental principle of surveillance is that repair of AAA is a serious undertaking and the risk of the operation outweighs the risk of rupture in aneurysms less than 5.5 cm. Surveillance is well established but requires multiple visits to both the surgical clinic and the ultrasound department.

Report

This report presents a system whereby the vascular surgeon is trained in the process of aortic sonography with a view to one-stop clinic assessment. After training of the main investigators in aortic sonography, the surgeons performed scans on the aortas of 80 consecutive patients and compared the scan result with the subsequent formal scan.

Discussion

Surgical and radiographer scans correlate very closely. It is believed that the one-stop aortic surveillance model is safe, accurate, and improves both the patient journey and clinic throughput.

Biofouling control in a membrane filtration system by a newly isolated novel quorum quenching bacterium, Bacillus methylotrophicus sp. WY

A newly isolated QQ bacterium, Bacillus methylotrophicus strain WY substantially enhanced the membrane performance by reducing the rate of biofouling.

Spectacles in Stomach: A Case of Successful Endoscopic Removal

Ingestion of foreign bodies is a common reason for emergency visit. The ingested objects include batteries, needles, dentures, coins, sharps etc. Radiolucency and the length of the objects are important factors that affect their management. Long objects over 10 cm are less likely to pass through the duodenal curve. Sharp object that is not retrieved at the earliest may penetrate the wall and cause complications. We present here a challenging case of a middle aged psychiatric patient who swallowed long and sharp arms of her spectacles that were successfully retrieved endoscopically.

New digital technologies for the surveillance of infectious diseases at mass gathering events

Outbreaks of infectious diseases at mass gatherings can strain the health system of the host region and pose a threat to local and global health. In addition to strengthening existing surveillance systems, most host nations also use novel technologies to assess disease risk and augment traditional surveillance approaches. We review novel approaches to disease surveillance using the Internet, mobile phone applications, and wireless sensor networks. These novel approaches to disease surveillance can result in prompt detection.

Reliability of Carotid Doppler performed in a dedicated Stroke Prevention Clinic

Introduction:

Doppler ultrasound (DUS) is used as a screening tool to assess internal carotid artery (ICA) disease. Recent reports suggest that the DUS may be inaccurate in over 28% of patients. We sought to evaluate the accuracy of DUS, when performed in a dedicated stroke prevention clinic (SPC).

Methods:

We retrospectively reviewed the charts of patients who had a DUS performed in our SPC, followed by conventional cerebral angiography. Three groups of patients were defined. Group 1 had DUS measured ICA stenosis of >50%; Group II had a DUS measured ICA stenosis of <50%; Group III had complete ICA occlusion on DUS.

Results:

Sixty-seven patients (69 arteries) were included in the study. There were 45 patients in Group I and based on the findings of cerebral angiography, carotid endarterectomy was considered inappropriate in only one patient. - a misclassification rate of 2.2% (95%CI: 0 – 6.5%). Group II consisted of 19 patients and on cerebral angiography, none of these patients had a stenosis of >50% - a misclassification rate of 0%. Group III consisted of five patients in whom DUS showed complete ICA occlusion. The angiogram confirmed the occlusion in all five patients – a misclassification rate of 0%. Overall, misclassification rate was 1.45% (95% CI: 0 - 4.3%).

Conclusions:

Doppler ultrasound when performed in a stroke prevention clinic (SPC), has a high accuracy in measuring ICA stenosis of >50%. Doppler ultrasound is reliable in detecting complete ICA occlusion and finally DUS is a reliable screening tool to rule out clinically significant ICA stenosis.