Prevalence of incidental distal biceps signal changes on magnetic resonance imaging

Background@#Knowledge of the base rate of signal changes consistent with distal biceps tendinopathy on magnetic resonance imaging (MRI) has the potential to influence strategies for diagnosis and treatment of people that present with elbow pain. The aim of this study is to measure the prevalence of distal biceps tendon signal changes on MRIs of the elbow by indication for imaging. @*Methods@#MRI data for 1,306 elbows were retrospectively reviewed for mention of signal change in distal biceps tendon. The reports were sorted by indication. @*Results@#Signal changes consistent with distal biceps tendinopathy were noted in 197 of 1,306 (15%) patients, including 34% of patients with biceps pain, 14% of patients with unspecified pain, and 8% of patients with a specific non-biceps indication. Distal biceps tendon changes noted on radiology reports were associated with older age, male sex, and radiologists with musculoskeletal fellowship training. @*Conclusions@#The finding that distal biceps MRI signal changes consistent with tendinopathy are common even in asymptomatic elbows reduces the probability that symptoms correlate with pathology on imaging. The accumulation of signal changes with age, also independent of symptoms, suggests that tendon pathology persists after symptoms resolve, that some degree of distal biceps tendinopathy is common in a human lifetime, and that tendinopathy may often be accommodated without seeking care.Level of evidence: IV.

Management of laryngopharyngeal reflux in Brazil: a national surveys / Manejo do refluxo laringofaríngeo no Brasil: pesquisa nacional

Abstract Introduction: Studies assessing the management of laryngopharyngeal reflux by otolaryngologists have reported an important heterogeneity regarding the definition, diagnosis, and treatment, which leads to discrepancies in the management of the patient. Information about the current knowledge and practices of Brazilian otolaryngologists in laryngopharyngeal reflux is lacking. Objective: To investigate the trends in management of laryngopharyngeal reflux disease among Brazilian otolaryngologists. Methods: A survey was sent by email to the members of the Brazilian Association of Otolaryngology-Head Neck Surgery. This survey has initially been conducted by the laryngopharyngeal reflux study group of young otolaryngologists of the International Federation of Otolaryngological Societies. Results: According to the survey responders, the prevalence of laryngopharyngeal reflux was estimated to be 26.8% of patients consulting in otolaryngology and the most common symptoms were globus sensation, throat clearing, cough and stomach acid reflux. Nasal obstruction, Eustachian tube dysfunction, acute and chronic otitis media, vocal fold nodules and hemorrhage were considered not associated with laryngopharyngeal reflux by the majority of responders. About 2/3 of Brazilian otolaryngologists based the diagnosis of laryngopharyngeal reflux on the assessment of both symptoms and findings and a positive response to empiric therapeutic trials. Proton pump inhibitor utilized once or twice daily, was the most commonly used therapeutic scheme. Only 21.4% of Brazilian otolaryngologists have heard about nonacid and mixed laryngopharyngeal reflux and the awareness about the usefulness of multichannel intraluminal impedance pH monitoring (MII-pH) was minimal; 30.5% of responders did not consider themselves as well-informed about laryngopharyngeal reflux. Conclusion: Although the laryngopharyngeal reflux-related symptoms, main diagnostic and treatment approaches referred by Brazilian otolaryngologists are consistent with the literature, the survey identified some limitations, such as the insufficient awareness of the role of laryngopharyngeal reflux in many otolaryngological conditions and of the possibility of non-acid or mixed reflux in refractory cases. Future studies are needed to establish international recommendations for the management of laryngopharyngeal reflux disease.

Resumo Introdução: Estudos que avaliaram o manejo do refluxo laringofaríngeo por otorrinolaringologistas mostraram uma importante heterogeneidade em relação à definição, diagnóstico e tratamento, o que leva a discrepâncias no tratamento do paciente. Faltam informações sobre o conhecimento e as práticas atuais dos otorrinolaringologistas brasileiros sobre o refluxo laringofaríngeo. Objetivo: Investigar as tendências no manejo da doença do refluxo laringofaríngeo entre os otorrinolaringologistas brasileiros. Método: O questionário foi enviado por e-mail aos membros da Associação Brasileira de Otorrinolaringologia-Cirurgia de Cabeça e Pescoço. Esta pesquisa foi inicialmente conduzida pelo LPR Study Group of Young Otolaryngologists da International Federation of Otolaryngological Societies. Resultados: De acordo com os respondentes da pesquisa, a prevalência de refluxo laringofaríngeo foi estimada em 26,8% dos pacientes consultados e os sintomas mais comuns foram sensação de globus, pigarro, tosse e refluxo de ácido estomacal. Obstrução nasal, disfunção da trompa de Eustáquio, otite média aguda e crônica, nódulos nas pregas vocais e hemorragia foram considerados como não associados ao refluxo laringofaríngeo pela maioria dos respondentes. Cerca de 2/3 dos otorrinolaringologistas brasileiros basearam o diagnóstico de refluxo laringofaríngeo na avaliação dos sintomas e achados e na resposta positiva a testes terapêuticos empíricos. Inibidores de bomba de prótons uma ou duas vezes ao dia foi o esquema terapêutico mais usado. Somente 21,4% dos otorrinolaringologistas brasileiros já ouviram falar sobre refluxo laringofaríngeo não ácido e misto e o conhecimento sobre a utilidade do monitoramento de pH por impedância intraluminal multicanal foi mínimo; 30,5% dos respondentes não se consideraram tão bem informados sobre o refluxo laringofaríngeo. Conclusão: Embora os sintomas relacionados ao refluxo laringofaríngeo e as principais abordagens diagnósticas e terapêuticas referidas pelos otorrinolaringologistas brasileiros sejam consistentes com a literatura, a pesquisa identificou algumas limitações, como o conhecimento insuficiente do papel do refluxo laringofaríngeo em diversas condições otorrinolaringológicas e da possibilidade de refluxo não ácido ou misto em casos refratários. Estudos futuros são necessários para estabelecer recomendações internacionais para o manejo de doença do refluxo laringofaríngeo.

Detection of enteroviruses during a 2018 hand, foot and mouth disease outbreak in Malaysia

@#Hand, foot, and mouth disease (HFMD) is a common childhood disease caused by enteroviruses. In 2018, a HFMD outbreak in Malaysia affected over 76,000 children. In this study, we used RT-qPCR and CODEHOP PCR to detect the causative agents in 89 clinically diagnosed HFMD patients in Kuala Lumpur and Selangor. Most (62.9%) of the children were below 3 years old. PCR with either assay detected enteroviruses in 84.2% (75/89) and CODEHOP PCR successfully typed 66.7% (50/75) of the enteroviruses. Sequencing of CODEHOP amplicons showed co-circulation of multiple enteroviruses with coxsackievirus A6 (CV-A6) and A16 as the predominant serotypes, but not the neurovirulent enterovirus A71. CV-A6 infection was more common in children less than 12 months old (p=0.01) and was more likely to cause vesicles in the gluteal area (p=0.01) compared to other enteroviruses. Establishing a robust identification method during HFMD outbreaks is important for patient management and public health responses.

In-vitro DNA and cell damage induced by 5-chloro-2-methyl-4-isothiazolin-3-one (CMIT) and suppressive effect of selected phytochemicals against CMIT toxicity

Aim: The aim of the present study was to measure in-vitro DNA and cell damage induced by 5-chloro-2-methyl-4-isothiazolin-3-one (CMIT), one of the humidifier disinfectants, and to investigate the suppressive effect of various phytochemicals against CMIT toxicity. Methodology: In-vitro comet assay was performed to determine the degree of CMIT-induced DNA damage at single cell level by measuring the olive tail moment. Upon treating CMIT on the rat lymphocytes, the inhibitory effects of Vitamin C and several phytochemicals such as berberine, curcumin and resveratrol were assessed. In addition, MTT assay was used to examine the protective effect of resveratrol on CMIT-induced cytotoxicity in cultured lung cells. Results: In in-vitro comet assay, the increased olive tail moment induced by CMIT was effectively inhibited by Vitamin C, berberine, curcumin and resveratrol treatment. Especially, resveratrol showed the best suppressive effect against DNA damage by CMIT. In MTT assay, resveratrol also showed significant suppressive effect against cytotoxicity induced by CMIT in cultured lung cells. Interpretation: Phytochemicals such as Vitamin C, berberine, curcumin and resveratrol can be utilized in the development of preventive or therapeutic compositions against the injury caused by CMIT toxicity.

Protective effect of phytochemicals on the triclosan-induced DNA damag

Aim: Triclosan, an antibacterial and antifungal agent, is widely used in several consumer products, including soaps, toothpaste and surgical cleaning treatments. The present study aimed to examine oxidative DNA damage in rat lymphocytes and its protection by phytochemicals via comet assay. Methodology: DNA damage of rat lymphocytes induced by triclosan was measured by the olive tail moment in the comet assay. Following the addition of N-acetylcysteine, curcumin, berberine and resveratrol, the reduction of DNA damage was observed by using comet assay. Results: The increased olive tail moment induced by triclosan was significantly reduced upon treating N-acetylcysteine and three phytochemicals, such as curcumin, berberine and resveratrol. Notably, the oxidative DNA damage by triclosan was dramatically suppressed by curcumin close to the control value, which means almost complete protection in vitro. Interpretation: These results suggest that in vitro suppressive effect of curcumin, berberine and resveratrol against DNA damage by triclosan might be due to their antioxidative properties, and could be utilized for developing a reducing agent for triclosan toxicity. Key words: These results suggest that in vitro suppressive effect of curcumin, berberine and resveratrol against DNA damage by triclosan might be due to their antioxidative properties, and could be utilized for developing a reducing agent for triclosan toxicity.

Male and female runners demonstrate different sagittal plane mechanics as a function of static hamstring flexibility

ABSTRACTBackground:Injuries to runners are common. However, there are many potential contributing factors to injury. While lack of flexibility alone is commonly related to injury, there are clear differences in hamstring flexibility between males and females.Objective: To compare the effect of static hamstring length on sagittal plane mechanics between male and female runners.Method: Forty subjects (30.0±6.4 years) participated and were placed in one of 4 groups: flexible males (n=10), inflexible males (n=10), flexible females (n=10), and inflexible females (n=10). All subjects were free of injury at the time of data collection. Three-dimensional kinematics and kinetics were collected while subjects ran over ground across 2 force platforms. Sagittal plane joint angles and moments were calculated at the knee and hip and compared with a 2-way (sex X flexibility) ANOVA (α=0.05).Results: Males exhibited greater peak knee extension moment than females (M=2.80±0.47, F=2.48±0.52 Nm/kg*m, p=0.05) and inflexible runners exhibited greater peak knee extension moment than flexible runners (In=2.83±0.56, Fl=2.44±0.51 Nm/kg*m, p=0.01). For hip flexion at initial contact, a significant interaction existed (p<0.05). Flexible females (36.7±7.4º) exhibited more hip flexion than inflexible females (27.9±4.6º, p<0.01) and flexible males (30.1±9.5º, p<0.05). No differences existed for knee angle at initial contact, peak knee angle, peak hip angle, or peak hip moment.Conclusion: Hamstring flexibility results in different mechanical profiles in males and females. Flexibility in the hamstrings may result in decreased moments via active or passive tension. These differences may have implications for performance and injury in flexible female runners.

Evaluation of salivary function by sialoscintigraphy in locally advanced nasopharyngeal cancer patients after intensity modulated radiotherapy.

PURPOSE: This study aimed to evaluate the salivary gland function changes by sialoscintigraphy in locally advanced nasopharyngeal cancer (NPC) after intensity modulated radiotherapy (IMRT). MATERIALS AND METHODS: Salivary function was assessed by sialoscintigraphy. Quantitative sialoscintigraphy was performed in 24 NPC patients prior to and after IMRT. Results were categorized in four groups according to the duration of treatment. The sialoscintigraphy parameters were examined. RESULTS: Sialoscintigraphy showed a significant difference in the secretion of each interval groups. The parameters of scintigraphy, except maximum accumulation (MA) of submandibular glands, decreased first after radiotherapy, and then recovered. However, the MA of submandibular glands was continuously downhill after radiation. CONCLUSIONS: The sialoscintigraphy parameters of each gland changed with the different radiation dose and follow‑up intervals. The salivary function was influenced after radiotherapy in locally advanced NPC, especially, in the submandibular gland. Strategies to improve the salivary function should be assessed.

PPARγ induces growth inhibition and apoptosis through upregulation of insulin-like growth factor-binding protein-3 in gastric cancer cells

Peroxisome proliferator activator receptor-gamma (PPARγ) is a ligand-activated transcriptional factor involved in the carcinogenesis of various cancers. Insulin-like growth factor-binding protein-3 (IGFBP-3) is a tumor suppressor gene that has anti-apoptotic activity. The purpose of this study was to investigate the anticancer mechanism of PPARγ with respect to IGFBP-3. PPARγ was overexpressed in SNU-668 gastric cancer cells using an adenovirus gene transfer system. The cells in which PPARγ was overexpressed exhibited growth inhibition, induction of apoptosis, and a significant increase in IGFBP-3 expression. We investigated the underlying molecular mechanisms of PPARγ in SNU-668 cells using an IGFBP-3 promoter/luciferase reporter system. Luciferase activity was increased up to 15-fold in PPARγ transfected cells, suggesting that PPARγ may directly interact with IGFBP-3 promoter to induce its expression. Deletion analysis of the IGFBP-3 promoter showed that luciferase activity was markedly reduced in cells without putative p53-binding sites (-Δ1755, -Δ1795). This suggests that the critical PPARγ-response region is located within the p53-binding region of the IGFBP-3 promoter. We further demonstrated an increase in PPARγ-induced luciferase activity even in cells treated with siRNA to silence p53 expression. Taken together, these data suggest that PPARγ exhibits its anticancer effect by increasing IGFBP-3 expression, and that IGFBP-3 is a significant tumor suppressor.

Efecto del aumento de la dimensión vertical oclusal en la posición natural de cabeza en pacientes portadores de prótesis removible / Effect of occlusal vertical dimension increase on natural head position in patients with removable prostheses

OBJETIVO Estudiar la variación de la posición natural de la cabeza al aumentar la dimensión vertical oclusal (DVO) en pacientes portadores de prótesis removible. PACIENTES Y MÉTODOS El estudio analítico, cuasi experimental, incluyó un total de 56 adultos mayores portadores de prótesis removibles totales y parciales (solo con grupo V remanente) atendidos en la Facultad de Odontología de la Universidad de Chile el año 2011, en los cuales se analizó la posición de la cabeza en sentido sagital al modificar la DVO aumentando progresivamente la altura oclusal en 5, 10 y 15 mm, mediante el uso de fotografías de perfil estandarizadas en posición natural de la cabeza. Hipótesis: el aumento de la DVO se asocia con una rotación posterior de la cabeza. RESULTADOS Todos los voluntarios mostraron cambio de la posición natural de cabeza, rotando posteriormente al modificar la DVO. El test ANOVA no mostró que esta diferencia fuera estadística. Hubo asociación positiva entre el cambio gradual de la DVO y el grado de rotación de la cabeza. El test de Pearson mostró asociación estadística. CONCLUSIÓN Los resultados permiten concluir que mientras mayor sea el aumento de altura oclusal mayor es la rotación posterior de la cabeza. Los hallazgos de este estudio apoyan el concepto de que existe una integración anatómica y funcional entre los distintos elementos que componen la unidad cráneo cérvico mandibular, actuando como un todo frente a la variación de uno de sus componentes.

OBJECTIVE To determine the variation in the natural head positionon increasing the Occlusal Vertical Dimension (OVD) in patients who use removable dentures. PATIENTS AND METHODS An analytical, quasi-experimental study was conducted on 56 elderly patients volunteers, carriers of removal full and partial (only with group V remaining) dentures seen in the Odontology Faculty of the University of Chile in 2011. An analysis was made of the head position in a sagittal direction to change the OVD, gradually increasing the occlusal height by 5, 10 and 15 millimeters, using standardized profile photographs of the natural head position. Hypothesis: The increase in the OVD is associated with a posterior rotation of the head. RESULTS All the volunteers showed a change in the natural head position, posteriorly rotated to change the OVD. The ANOVA test showed that this change was not statistically different. There was a positive association between a gradual change in OVD and the degree of head rotation. The Pearson test showed a statistical association. CONCLUSION It could be concluded from the results that, the greater the increase in occlusal height, the greater is the posterior rotation of the head. The findings of this study support the concept that there is an anatomical integration between the different elements that make up the cranio-cervico-mandibular unit, acting together against the variation of one of its components.

Asociación entre Presencia de Levaduras del Género Candida y Factores del Paciente Adulto Mayor con y sin Estomatitis Protésica / Association between Presence of Candida Yeasts and Elderly Patient Factors with and without Denture Stomatitis

La estomatitis protésica (ESP) es una alteración de la mucosa de soporte de diverso grado de severidad, que puede complicarse clínicamente con la presencia de levaduras del género Candida (LGC). Factores del individuo, del ambiente oral y del microorganismo favorecen la infección, que de no tratarse oportunamente puede evolucionar hacia lesiones hiperplásicas. Los objetivos fueron establecer relación clínico ­ microbiológica entre especies de LGC y ESP, asociar condiciones sistémicas (CS) prevalentes de pacientes portadores de prótesis con presencia y cantidad de LGC y efecto en la severidad de ESP; y asociar factores locales: uso continuo de prótesis y antigüedad protésica, con prevalencia de LGC y severidad de ESP. Un estudio observacional analítico fue realizado en 93 pacientes, edad promedio 67 años, 26% hombres y 74% mujeres, atendidos en el área de Prótesis Removible (Facultad de Odontología, Universidad de Chile), seleccionados de acuerdo a criterios de inclusión y firma del consentimiento informado. La recolección muestral de saliva no estimulada y mucosa oral se realizó considerando las variables del estudio. Estas muestras fueron procesadas de acuerdo a protocolos preestablecidos. El análisis microscópico permitió verificar desarrollo de colonias macromorfológicamente compatibles con LGC. Para el análisis estadístico se utilizaron test ANOVA y Kruskall Wallis. Existe relación clínica microbiológica entre presencia de LGC y ESP. El aumento de LGC se relaciona con severidad de ESP. La especie dominante es Candida albicans sobre no albicans. La presencia de ambas se asocia con aumento de la severidad de ESP. Al asociar las CS se observa asociación con depresión, no así con hipertensión arterial y diabetes mellitus. En relación a los factores locales protésico continuo y antigüedad protésica, existe relación entre antigüedad y presencia de LGC en pacientes con ESP, sin diferencias estadísticas entre presencia de LGC y uso protésico continuo en pacientes con ESP.

Denture stomatitis (DS) is a change of the support mucous of diverse severity that can get clinically complex with the presence of yeasts of the Candida genus (YCG). Individual's factors of the oral and microorganism environment favor the infection, which can evolve to hyperplasic lesions if not treated early. The aims were to establish clinical-microbiological relationship between YCG and DS species, associate systematic conditions (SC) prevalent of patients using prosthesis with presence and quantity of YCG and effect on DS severity; and associate local factors: continuous use of prosthesis and age of the prosthesis (AP), with YCG prevalence and DS severity. An analytical observational study was performed in 93 patients, average age 67 years old, 26% male and 74% female, treated at the Removable Prosthesis Area (Facultad de Odontología, Universidad de Chile), selected according to inclusion criteria and signature of informed consent. The unstimulated saliva and oral mucous sample recollection was performed considering the study's variables. The microscopic analysis allowed to check macro morphologically YCG compatible colonies development. For the statistical analysis, ANOVA and Kruskall Wallis tests were used. There is a microbiological clinical relationship between the presence of YCG and DS. The increase of YCG is related to the severity of DS. The dominant species is Candida albicans over not albicans. The presence of both is associated with the increase of DS severity. By associating the SC, a relation with depression is observed, but not with arterial hypertension and mellitus diabetes. As for the continuous local prosthetic factors and AP, a relationship exists between AP and presence of YCG in patients with DS, without statistical differences between YCG and continuous prosthetic use in patients with DS.

Prognosticators and the relationship of depression and quality of life in head and neck cancer.

Background and Purpose: To evaluate the relationship of emotional status and health-related quality of life (HRQOL) in disease-free head and neck cancer (HNC) patients post treatment and to explore their predictive factors. Materials and Methods: Seventy-three HNC patients, post treatment at least 1 year, were recruited to complete three questionnaires, EORTC QLQ-C30, EORTC-H&N35 cancer module, and the Beck Depression Inventory-II (BDI-II). Results: Patients with depression demonstrated significantly poor global health status/QoL (score 41.7 vs. 71.9, P<0.001) and almost all functioning, except for role functioning. Besides, depressive patients presented statistically significant worse symptoms in all QLQ-C30 items, except constipation and financial problems, and in all QLQ-H&N35 symptoms except for teeth and coughing problems. Depression was significantly negative correlated with all functional scales and global health status/QoL (r = -0.341 to -0.750, all P<0.05), and was significantly positive correlated with symptom scales (r = 0.348 to 0.793, all P<0.05), except for constipation. Stepwise multiple linear regression analyses showed that physical functioning and physical distressful symptoms play an important role in the perception of HRQOL (total 46% explained). Global health status and impaired social functioning could explain depression in addition to emotional functioning (total 64% explained). Conclusions: HNC patients with depression were noted to have poorer HRQOL in almost every functioning symptom. HNC patients may get benefit from early interventions to improve HRQOL, emotional status, or both by a more rapid and friendly questionnaire to earlier identify patients with poor HRQOL or depressive status.

A trial design that generates only ''positive'' results.

In this article, we test the hypothesis that randomized clinical trials of acupuncture for pain with certain design features (A + B versus B) are likely to generate false positive results. Based on electronic searches in six databases, 13 studies were found that met our inclusion criteria. They all suggested that acupuncture is effected (one only showing a positive trend, all others had significant results). We conclude that the 'A + B versus B' design is prone to false positive results and discuss the design features that might prevent or exacerbate this problem.

Acute mushroom poisoning : a report of 41 cases.

A retrospective analysis of all mushroom poisoning cases admitted in Tansen Mission Hospital in the period of two months of the year 2005 was done. Forty-one cases were admitted during that period, among which only 34 case records could be found for analysis. Female (58.82%) outnumbered the male and 15 (44.11%) of the cases were from pediatric age group. The poisoning was secondary to consumption of different species of Amanita variety including the most poisonous Amanita phalloides. The commonest symptoms at the time of presentation in both adults and children was gastrointestinal (diarrhea, vomiting and abdominal pain). There were 12 mortalities and they died at the median interval of 3.5 days after admission. The main cause of death was acute liver failure and acute renal failure. Relative risk of having a bad outcome was found to be higher when the mushroom was consumed with alcohol when compared with non-alcoholics. High mortality was probably due to late presentation and only the conservative management in all the cases. Increased community and medical awareness is needed to reduce the frequency, morbidity and mortality of mushroom poisoning.

Dynamic causal models of neural system dynamics:current state and future extensions.

Complex processes resulting from interaction of multiple elements can rarely be understood by analytical scientific approaches alone; additional, mathematical models of system dynamics are required. This insight, which disciplines like physics have embraced for a long time already, is gradually gaining importance in the study of cognitive processes by functional neuroimaging. In this field, causal mechanisms in neural systems are described in terms of effective connectivity. Recently, dynamic causal modelling (DCM) was introduced as a generic method to estimate effective connectivity from neuroimaging data in a Bayesian fashion. One of the key advantages of DCM over previous methods is that it distinguishes between neural state equations and modality-specific forward models that translate neural activity into a measured signal. Another strength is its natural relation to Bayesian model selection (BMS) procedures. In this article, we review the conceptual and mathematical basis of DCM and its implementation for functional magnetic resonance imaging data and event-related potentials. After introducing the application of BMS in the context of DCM, we conclude with an outlook to future extensions of DCM. These extensions are guided by the long-term goal of using dynamic system models for pharmacological and clinical applications, particularly with regard to synaptic plasticity.

Antibiotic sensitivity of Helicobacter pylori in Jamaica

Helicobacter pylori infection is one of the commonest chronic infections worldwide. Eradication regimes usually contain two antibiotics, however resistance is increasing and this decreases treatment success. This study reports on the sensitivity and resistance of H pylori to several antibiotics in patients undergoing upper gastrointestinal endoscopy in Jamaica. The rapid urease test (CLO) was positive in 128 (38) of 336 patients. Fifty patients (39; 50/128) with positive CLO tests had positive cultures for H pylori. Two-thirds (32/48) of islolates were sensitive to metronidazole and one-third (16/48) were resistant. Ninety-seven per cent of isolates (31/32) were sensitive to erythromycin. The sensitivity for clarithromycin was 92 (11/12) with one isolate (8) resistant. All strains of H pylori (48/48) were sensitive to ampicillin and amoxicillin - clavulanate. Metronidazole resistance is present in one-third of H pylori isolates and resistance to macrolides is relatively low in Jamaican patients. It is important to monitor antibiotic resistance in order to provide clinicians with data on the most appropriate and cost effective eradication regimes for H pylori

Economic burden of varicella in Singapore--a cost benefit estimate of implementation of a routine varicella vaccination.

Varicella is a common childhood illness that can result in significant morbidity and mortality. As early as 1995, recommendations for routine varicella vaccination have been published, but have not been universally implemented, with cost of vaccination as a major reason. Though available from 1996, the vaccine has yet to be routinely implemented in Singapore. We set out to assess the economic burden of varicella and the cost-benefit of adding a varicella vaccine to the existing immunization schedule in Singapore. In this study, using data from 1994--1995 the direct cost estimates were based on all levels of medical care; inpatient care, emergency room visits, primary health care and medication. Indirect costs were estimated from the cost of time lost by patients and their families attending to medical needs, as well as loss of productivity due to absenteeism. The cost of a vaccination program targeted at 15-month old infants receiving concomitant measles-mumps-rubella immunization was also assessed. The cost-benefit ratio was then estimated. The total cost of varicella in Singapore was estimated to be US$11.8 million per annum. The loss of productivity accounted for a large proportion of the total cost as a lot of parents took leave when their children were ill. The estimates of total cost represent approximately US$188 per varicella case per year. In comparison, the cost of a vaccination program was found to be US$3.3 million per annum. The cost per case averted was US$104. From a societal point of view, for every dollar invested in a vaccination program, we would save about US$2 dollars.

Dyspepsia: review of management options

Dyspepsia is a common clinical problem which is associated with significant healthcare cost. The management of patients presenting with dyspepsia remains controversial. It has been shown to be cost effective and associated with long-term improvement to test and treat young patients positive for H. pylori, who present to the primary care setting. Patients negative for H. pylori may be treated with an antisecretory medication. Prompt endoscopy is recommended in patients over age 50 years, those with alarm symptoms and those who have failed previous therapy. In the Caribbean, the management of patients should be individualized in view of the relatively high prevalence of H pylori infection and gastric carcinoma

Helicobacter pylori infection in the Caribbean: update in management

Helicobacter pylori infection of the stomach is one of the commonest chronic infections worldwide and in the Caribbean, over 50 of the population are affected. H pylori is probably transmitted from person to person by oro-faecal and oro-oral means. H pylori is directly associated with peptic ulcer disease, chronic antral gastritis, gastric carcinoma and B-cell lymphoma of the stomach. In patients with peptic ulcers and H pylori infection, eradication of infection with antibiotics significantly decreases recurrence of ulcers. All patients with H pylori related disease should be tested and treated if positive. The treatment of H pylori infection has evolved over the years but at present triple therapy which includes two antibiotics is recommended.