Reservoir-Driven Heterogeneous Distribution of Recorded Human Puumala virus Cases in South-West Germany.

Endemic regions for Puumala virus (PUUV) are located in the most affected federal state Baden-Wuerttemberg, South-West Germany, where high numbers of notified human hantavirus disease cases have been occurring for a long time. The distribution of human cases in Baden-Wuerttemberg is, however, heterogeneous, with a high number of cases recorded during 2012 in four districts (H districts) but a low number or even no cases recorded in four other districts (L districts). Bank vole monitoring during 2012, following a beech (Fagus sylvatica) mast year, resulted in the trapping of 499 bank voles, the host of PUUV. Analyses indicated PUUV prevalences of 7-50% (serological) and 1.8-27.5% (molecular) in seven of eight districts, but an absence of PUUV in one L district. The PUUV prevalence differed significantly between bank voles in H and L districts. In the following year 2013, 161 bank voles were trapped, with reduced bank vole abundance in almost all investigated districts except one. In 2013, no PUUV infections were detected in voles from seven of eight districts. In conclusion, the linear modelling approach indicated that the heterogeneous distribution of human PUUV cases in South-West Germany was caused by different factors including the abundance of PUUV RNA-positive bank voles, as well as by the interaction of beech mast and the proportional coverage of beech and oak (Quercus spec.) forest per district. These results can aid developing local public health risk management measures and early warning models.

The slow agonizing birth of primary health care services.

PIP: Although the need for a network of effective primary health care (PHC) services which are affordable, accessible, acceptable, and available to all was recognized by an international conference at Alma Ata in 1978, countries are far from realizing this goal. The necessary knowledge, experience, and other resources are, however, available in South Africa to provide wide-scale primary health care to the national population. The world leader of PHC in the 1940s, South Africa has models of successful PHC services, but it continues to struggle toward implementation. Resources continue to be wasted on meetings to draft PHC strategies and related seminars as a result of politics, vested interests, unwillingness to cooperate and share, bureaucracy, territorialism, ad hoc decisions, and uncoordinated planning and implementation. Moreover, approaches to PHC are fragmented and PHC continues to not be understood by many health workers, decision makers, and academics. A unified commitment and determination on all fronts, immediate decisions on funding, coordinated implementations, and the rapid deployment of the variety of mobile clinic services are called for to successfully implement PHC in South Africa.^ieng

The tuberculosis epidemic--why we are slipping up.

Bedletters of 100 diagnosed cases of tuberculosis from Kalafong Hospital, Pretoria, were reviewed retrospectively. All patients were followed up to evaluate treatment and notification. An overall treatment failure rate of 13% was recorded, mainly due to non-compliance by patients referred to clinics. There was an undernotification rate of at least 48%.

Follow-up tuberculosis prevalence survey of Transkei.

After 5 years a follow-up prevalence survey was conducted in Transkei on a randomly selected sample of the rural population. The parameters investigated were bacteriological prevalence of tubercle bacilli in sputum, radiological prevalence of chest abnormalities associated with tuberculosis in adults, and hypersensitivity to tuberculin in children. Bacteriological positivity was 2.1% on smear microscopy and 4.3% on culture. Radiological evidence of tuberculosis was demonstrable in 12.5% of subjects, of whom 8.7% were considered active and 3.8% inactive. The mean prevalence of tuberculin positivity according to the Mantoux test was 30.1%. An annual risk of infection of 4% was calculated, showing a continuous decrease of 5% per year on the 7% risk of infection encountered in 1972. Compared with the first survey, a general reduction in prevalence of tuberculosis is evident.

Comparison of isoniazid phenotyping of black and white patients with emphasis on South African blacks.

Black tuberculosis patients from South Africa (S. A.) as well as from Birmingham, Alabama, U.S.A., showed a higher percentage of fast inactivators of isoniazid (INH) than that found in the North American white population, simultaneously sampled. In S. A. blacks, the frequency of fast inactivation was 57.9--59.6%, while in American blacks of Birmingham it amounted to 60.3%; in comparison to the above groups the rate of fast acetylators in Canadian Caucasians was 41.9% and in the USA white population 41.0%. For phenotyping of isoniazid inactivators a urine test was used. In this method the concentrations of INH (including isoniazidhydrazones) as well as acetylisoniazid were determined in the specimens collected 6--8 hrs following a test dose of 10 mg/kg INH.

Phenotyping of South African black tuberculosis patients for inactivation of isoniazid.

Studies of isoniazid inactivation rates in black tuberculosis patients from South Africa and Birmingham, Alabama, showed a higher frequency of fast inactivation than those of North American Caucasian patients. After an oral test dose of 10 mg/kg isoniazid the percentage of fast inactivators in black patients of South Africa and Alabama was close to 60% while in North American white participants (Canadian and Birmingham Caucasians), the frequency of fast inactivation was approximately 40%.

[The forensic value of the length and weight of newborns, the placental weight and the correlation between placental and newborn weight in the evaluation of paternity (author's transl)]. / Zur Frage der forensischen Verwertbarkeit von Neugeborenenlänge, Neugeborenengewicht, Plazentargewicht und Quotient Plazentargewicht/Neugeborenengewicht bei Vaterschaftsgutachten.

The length of the infant, the weight of the infant, the weight of the placenta, and the correlation between the weight of the placenta and the weight of the infant are coarse parameters for the estimation of the maturity of an infant. We plotted these parameters of 20,000 deliveries in relationship to the stated length of gestation from 23--46 weeks. Our results correspond to those quoted in the literature. The values of the parameters show a marked variation which is accentuated by the small number of cases with very short or very prolonged gestation. These parameters are only of limited value in the determination of the paternity. The mean values including the first standard deviations are of some importance.

[Primary dysmenorrhoea and hyperprolactinemia (author's transl)]. / Primäre Dysmenorrhö und Hyperprolaktinämie.

Between 5 and 10% of all young girls and women suffer of severe primary dysmenorrhoea which interfers monthly with their activities. In this type of primary dysmenorrhoea we found hyperprolactinemia in 13 of 15 women who were examined. All 15 patients had a pituitary tumour ruled out and were treated with Bromo-ergocryptine (parlodel). Eight patients became free of symptoms and five were well improved. The possible correlation of hyperprolactinemia to premenstrual tension and severe primary dysmenorrhoea is discussed.

The significance of the tuberculosis infection risk and its application in Pretoria.

The value of the infection risk index for the determination of the TB situation and for the planning and evaluation of specific control measures is discussed. From tuberculin studies performed on schoolchildren in Pretoria since 1972, the annual risk of contracting a TB infection or of reinfection has been determined for all races in Pretoria; it is 0,05% for Whites, 0,53% for Coloureds, 0,68% for Asians, and 0,64% and 1,05% for Blacks in Atteridgeville and Mamelodi respectively. A downward trend of the risk could be shown for all population groups.

Evaluation of BCG vaccines and a new method of multipuncture administration.

In comparative investigations the Japanese vaccinating tool was found to be more satisfactory for BCG administration than the Heaf multipuncture apparatus. Not only were the immune responses achieved by 27 punctures made by the Japanese applicator equal to those produced by 40 punctures made by the Heaf apparatus, but the results were similar to those obtained with the intradermal method of vaccination. The Japanese applicator can be sterilized effectively, it is simple to use, durable, usable up to 100 times and cheap. All pre- and post-vaccination tuberculin testing was done intradermally with 2 tuberculin units of human PPD RT23. The studies also confirmed the high quality of the Japanese intradermal and percutaneous BCG vaccines. Administration of the potent percutaneous Japanese BCG vaccine with the Japanese applicator is an ideal, effective and safe method of BCG vaccination.

[A casuistic contribution to therapy with gestagen in metastasizing corpus carcinoma (author's transl)]. / Kasuistischer Beitrag zur Gestagen-Therapie beim metastasierenden Korpuskarzinom.

Casuistic contribution of a sucessfully with Gestagen treated stage IV corpus carcinoma which previously had been operated and undergone radiotherapy. Ten years after the primary treatment the patient presented herself asymptomatic and clinically free of a tumor. The possible mechanism of the effect of the Gestagen-therapy is discussed as well as the indication for the administration of Gestagen in a corpus carcinoma.

[The surgical treatment of pelvic thrombosis during pregnancy (author's transl)]. / Beitrag zur chirurgischen Behandlung der Beckenvenenthrombose in der Schwangerschaft.

Pelvic venous thrombosis during pregnancy is a rare event. The treatment discussed in the literature consists mostly of recommendations for therapeutic fibrinolysis. The surgical alternative is the retrograde operative thrombectomy with concommitant Caesarean Section. Two cases were successfully treated by this method at 33 and 39 weeks gestation. The cases are reported. The operative technique is described. The advantages and disadvantages of this treatment are discussed.

[Contribution to the diagnosis of gonorrhea (author's transl)]. / Beitrag zur Gonorrhödiagnostik

The culture is the optimal procedure for the diagnosis of gonorrhea in the female and should be used in every suspicious case. The percentage of loss through use of a transport medium (Stuart) and by submitting the specimen to a central laboratory for examination affects the results. For this reason a simple procedure was tested based on Chapin's candle-flame method and using Martin and Thayer's selective culture medium. This method can be used in every laboratory. The described procedure requires little more work than Gram's method. In our test series, a higher percentage of positive results were obtained with this method than with the microscopic diagnosis and the transport medium.