Dientamoeba fragilis prevalence coincides with gastrointestinal symptoms in children less than 11 years old in Sweden.

Dientamoeba fragilis is a protozoan with a debated role in gastrointestinal (GI) disease. Although correlated to GI symptoms, no virulence factors have been described. In this study, we evaluated the cause of GI symptoms in children at two schools, with children aged 1 to 10 years, in the county of Jönköping, Sweden. D. fragilis infection correlated to GI symptoms in children and Enterobius vermicularis correlated to D. fragilis infection.

Central autonomic regulation in congenital central hypoventilation syndrome.

Congenital central hypoventilation syndrome (CCHS) patients show significant autonomic dysfunction in addition to the well-described loss of breathing drive during sleep. Some characteristics, for example, syncope, may stem from delayed sympathetic outflow to the vasculature; other symptoms, including profuse sweating, may derive from overall enhanced sympathetic output. The dysregulation suggests significant alterations to autonomic regulatory brain areas. Murine models of the genetic mutations present in the human CCHS condition indicate brainstem autonomic nuclei are targeted; however, the broad range of symptoms suggests more widespread alterations. We used functional magnetic resonance imaging (fMRI) to assess neural response patterns to the Valsalva maneuver, an autonomic challenge eliciting a sequence of sympathetic and parasympathetic actions, in nine CCHS and 25 control subjects. CCHS patients showed diminished and time-lagged heart rate responses to the Valsalva maneuver, and muted fMRI signal responses across multiple brain areas. During the positive pressure phase of the Valsalva maneuver, CCHS responses were muted, but were less so in recovery phases. In rostral structures, including the amygdala and hippocampus, the normal declining patterns were replaced by increasing trends or more modest declines. Earlier onset responses appeared in the hypothalamus, midbrain, raphé pallidus, and left rostral ventrolateral medulla. Phase-lagged responses appeared in cerebellar pyramis and anterior cingulate cortex. The time-distorted and muted central responses to autonomic challenges likely underlie the exaggerated sympathetic action and autonomic dyscontrol in CCHS, impairing cerebral autoregulation, possibly exacerbating neural injury, and enhancing the potential for cardiac arrhythmia.

Unique cause of duodenal obstruction by an abdominal aortic aneurysm.

We report herein a unique cause of duodenal obstruction secondary to expansion of an abdominal aortic aneurysm in a 75-year-old man with congenital malrotation of the intestines. The duodenum was found to be compressed between the abdominal aortic aneurysm inferiorly and the peritoneal band superiorly. The patient underwent uncomplicated lysis of peritoneal bands relieving the duodenal obstruction, followed by repair of the abdominal aortic aneurysm.

Population-based study of rotavirus vaccination and intussusception.

BACKGROUND: During the first year that the rhesus rotavirus tetravalent vaccine (RRV-TV) was licensed, the Vaccine Adverse Event Reporting System received several reports of intussusception after vaccination. To evaluate the risk of intussusception, we conducted a retrospective cohort study in ten managed care organizations. METHODS: Cases of intussusception were identified by searching electronic databases for diagnoses of intussusception (ICD-9 Code 560.0) in infants 1 to 11 months of age and confirmed by medical chart review. Vaccination and enrollment data were obtained from administrative databases. Incidence rate ratios (RR) of intussusception were computed by dividing incidence rates in prespecified risk intervals after vaccination by the background rate of intussusception and adjusted for age by Poisson regression. Cox proportional hazard regression was used to evaluate risk by vaccine dose. RESULTS: Of 463,277 children 56,253 had been vaccinated with a total of 91 371 doses of RRV-TV. The incidence rate of intussusception was 25/100,000 person years among unexposed infants and 340/100,000 person years 3 to 7 days postvaccination. In the interval 3 to 7 days after vaccination, the age-adjusted RR was 16.0 (95% confidence interval, 5.5 to 46.7) for all doses combined and 30.4 (95% confidence interval, 8.8 to 104.9) after the first dose. RRs for the 8- to 14- and 15- to 21-day risk intervals were >1.0, but the confidence intervals substantially overlapped 1.0. The attributable risk was one case of intussusception per 11 073 children vaccinated. CONCLUSIONS: RRV-TV is associated with an increased risk of intussusception. The risk is greatest 3 to 7 days after the first vaccination dose.

[Cost-effectiveness analysis of cardiovascular disease prevention: a graded list as aid to the rational distribution of resources]. / Analys av kostnadseffektiviteten vid prevention av hjärt-kärlsjukdom: rankinglista ett hjälpmedel för att rätt fördela resurserna.

In a study designed to compare the cost-effectiveness of three cardiovascular disease prevention programmes, subject to a defined budget, a population was subgrouped according to risk levels. Cost per year of life saved and annual budget expenditure were calculated for each subgroup. Budget expenditure was defined in terms of current direct costs. A ranked list was constructed, and the cut-off level of 'acceptable' cost-effectiveness elicited.

Cost-effectiveness analysis with defined budget: how to distribute resources for the prevention of cardiovascular disease?

The aim of the study was to undertake cost-effectiveness calculations subject to a defined budget. The setting chosen was the prevention of cardiovascular disease (CVD) by means of three intervention programmes in a Swedish county council. The population in the county was divided into subgroups according to risk level. For each subgroup the cost per years of life saved was calculated, as well as the annual budget claims. The budget available was defined as present direct cost in the programmes. The calculations resulted in a programming solution showing the optimal distribution of resources between the programmes. Also a league table was constructed and the cut-off value for a 'acceptable' cost-effectiveness was shown. The conclusion that can be drawn is that a combination of internationally published intervention results and local data regarding epidemiology and resource improves the accuracy and usefulness of cost-effectiveness ratios. However, the model presented is a first attempt containing only three interventions: the planned next phase is to integrate more interventions in the model.

Helicobacter pylori adhesin binding fucosylated histo-blood group antigens revealed by retagging.

The bacterium Helicobacter pylori is the causative agent for peptic ulcer disease. Bacterial adherence to the human gastric epithelial lining is mediated by the fucosylated Lewis b (Leb) histo-blood group antigen. The Leb-binding adhesin, BabA, was purified by receptor activity-directed affinity tagging. The bacterial Leb-binding phenotype was associated with the presence of the cag pathogenicity island among clinical isolates of H. pylori. A vaccine strategy based on the BabA adhesin might serve as a means to target the virulent type I strains of H. pylori.

The inaccuracy of axillary temperatures measured with an electronic thermometer.

Temperatures were measured using an electronic thermometer in an emergency department to determine the relationship between oral or rectal and axillary measurements. A total of 164 data pairs were obtained--95 in afebrile children, and 69 in febrile children. The correlation coefficient was .74 for oral-axillary pairs, and .70 for rectal-axillary pairs. The mean difference between oral and axillary temperatures was 1.17 degrees C +/- 0.72 degrees C, and between rectal and axillary temperatures was 1.81 degrees C +/- 0.97 degrees C. Using 37.4 degrees C (greater than or equal to 2 SDs) axillary as the upper limit of normal, the sensitivity, specificity, and positive and negative predictive values were calculated for detecting a fever. The sensitivity was 46%; specificity, 99%; positive predictive value, 97%; and negative predictive value, 72% for combined oral-axillary and rectal-axillary data. It was concluded that axillary temperatures are not sensitive enough to determine a fever when measured with an electronic thermometer. Electronic thermometers should be used to determine oral or rectal temperatures; axillary temperatures may be misleading and should be abandoned in the outpatient setting.

Management of digitalis therapy in a primary care area.

A retrospective study of 323 patients on digitalis therapy was performed in the primary care area of Skellefteå health district with the highest prescription of cardiac glycosides. The study comprised 90% of all patients on digitalis. Indications for treatment and the underlying heart disease were especially scrutinized. In one-third of all patients no underlying heart disease was defined and in about half of them the effectiveness of treatment was poorly documented. The study underlines the importance of defining the indication for treatment combined with a subsequent careful evaluation of the therapy in order to optimize treatment with cardiac glycosides.

What do patients know about their digitalis? A comparison between two different areas in Sweden.

Out of 1183 unselected out-patients in Skellefteå and 620 in Uppsala, 200 patients from each place were selected at random to be sent a questionnaire on their medication with digitalis. Answers to the questionnaires were obtained from 196 patients (98 per cent) in Skellefteå and from 163 patients in Uppsala (82 per cent). About 85 per cent stated that they took their digoxin as prescribed once a day. About 60 per cent knew correctly why digoxin treatment was given and 20 per cent were uncertain as to why they took digoxin. About 45 per cent stated that they felt improved thanks to the digoxin therapy. 55 per cent did not know about digitalis side-effects. About 50 per cent denied having received any information about digitalis and 50 per cent were unsatisfied with the information they had been given. Only 15 per cent were content with the information. Methods for improving the information to patients are proposed.

Absorption of visible radiation by aerosols in the volcanic plume of mount st. Helens.

Samples of particles from Mount St. Helens were collected in both the stratosphere and troposphere for measurement of the light absorption coefficient. Results indicate that the stratospheric dust had a small but finite absorption coefficient ranging up to 2 x 10(-7) per meter at a wavelength of 0.55 micrometer, which is estimated to yield an albedo for single scatter of 0.98 or greater. Tropospheric results showed similar high values of an albedo for single scatter.