Determining target populations for leprosy prophylactic interventions: a hotspot analysis in Indonesia.

BACKGROUND: Leprosy incidence remained at around 200,000 new cases globally for the last decade. Current strategies to reduce the number of new patients include early detection and providing post-exposure prophylaxis (PEP) to at-risk populations. Because leprosy is distributed unevenly, it is crucial to identify high-risk clusters of leprosy cases for targeting interventions. Geographic Information Systems (GIS) methodology can be used to optimize leprosy control activities by identifying clustering of leprosy cases and determining optimal target populations for PEP. METHODS: The geolocations of leprosy cases registered from 2014 to 2018 in Pasuruan and Pamekasan (Indonesia) were collected and tested for spatial autocorrelation with the Moran's I statistic. We did a hotspot analysis using the Heatmap tool of QGIS to identify clusters of leprosy cases in both areas. Fifteen cluster settings were compared, varying the heatmap radius (i.e., 500 m, 1000 m, 1500 m, 2000 m, or 2500 m) and the density of clustering (low, moderate, and high). For each cluster setting, we calculated the number of cases in clusters, the size of the cluster (km2), and the total population targeted for PEP under various strategies. RESULTS: The distribution of cases was more focused in Pasuruan (Moran's I = 0.44) than in Pamekasan (0.27). The proportion of total cases within identified clusters increased with heatmap radius and ranged from 3% to almost 100% in both areas. The proportion of the population in clusters targeted for PEP decreased with heatmap radius from > 100% to 5% in high and from 88 to 3% in moderate and low density clusters. We have developed an example of a practical guideline to determine optimal cluster settings based on a given PEP strategy, distribution of cases, resources available, and proportion of population targeted for PEP. CONCLUSION: Policy and operational decisions related to leprosy control programs can be guided by a hotspot analysis which aid in identifying high-risk clusters and estimating the number of people targeted for prophylactic interventions.

Anisakis (Nematoda: Ascaridoidea) from Indonesia.

Despite Indonesia's high marine biodiversity, there is a lack of information regarding fish parasites in Indonesian waters. During a sampling of 136 teleost species from Indonesian waters, 22 of them were infected with larvae of Anisakis Dujardin, 1845, a genus with zoonotic potential. We genetically identified 118 worms, provide a revision of all available sequences of the ITS-1-5.8S-ITS-2 marker from Indonesian Anisakis in GenBank (n = 125), and establish 16 new host records. So far, 53 Indonesian teleosts harbour Anisakis spp., 32 of them with known sequence data, increasing the worldwide teleosts with genetically identified Anisakis from 155 to 177. Sequence analyses of this marker in the 243 Anisakis specimens identified 3 Anisakis sp. HC-2005 and 39 (16%) A. typica (sensu stricto). A. berlandi and A. pegreffii are reported for the first time from teleosts in the equatorial region and A. physeteris from the Pacific Ocean. The latter 3 species were exclusively found in the migratory scombrid Auxis rochei. Most common infection sites were the body cavity, with 299 (of 848) worms in the mesenteries surrounding the liver, and 129 unattached. Musculature infection was very low, demonstrating minor risk of anisakiasis for human consumers. A total of 193 worms (~79%) had a distinct genotype distinguished from A. typica by 4 positions in the ITS-1 region. This genotype is reported since 2008 as 'A. typica', 'sibling', 'Anisakis sp./type 1', 'sp. I', 'sp. 2' or 'sp. II'. To avoid further misleading identification, we hereby apply the subspecific entity Anisakis typica var. indonesiensis until description of the adults becomes available.

THe "U" technique: a new method for Norplant implants removal.

The standard technique for Norplant implants removal was compared with a new technique called the "U" technique, which employs the use of a modified no-scalpel vas deferens holding forceps to grasp and remove the capsules. Seventy-six women requesting Norplant implants removal were randomly assigned to Group 1 (standard removal technique) or Group 2 ("U" removal technique). Variables measured included: (a) time required for complete removal, (b) number of capsules not broken or damaged during removal, and (c) number of incisions required for removal of all six capsules. In clients with visible or palpable capsules, the standard removal technique required significantly more time to remove all six capsules, on average, than the "U" technique (19 versus 7 minutes, p < 0.001); also more capsules were damaged during removal (5.6 undamaged versus 6.0, p < 0.01). In addition, with the standard technique, five clients required two incisions for removal of all six capsules while none of the clients required more than one incision with the "U" technique. Our conclusion is that the "U" technique is a quicker and easier method of removing Norplant capsules than the standard technique.

PIP: The standard technique for Norplant implants removal was compared with a new technique called the "U" technique, which employs the use of a modified no-scalpel vas deferens holding forceps to grasp and remove the capsules. 76 women requesting Norplant implants removal were randomly assigned to Group 1 (standard removal technique) or Group 2 ("U" removal technique). Variables measured included: time required for complete removal; number of capsules not broken or damaged during removal; and number of incisions required for removal of all six capsules. In clients with visibles or palpable capsules, the standard removal technique required significantly more time to remove all six capsules, on average, than the "U" technique (19 versus 7 minutes, p 0.001); also, more capsules were damaged during removal (5.6 undamaged vs. 6.0, p 0.01). In addition, with the standard technique, five clients required two incisions for removal of all six capsules, while none of the clients required more than one incision with the "U" technique. Our conclusion is that the "U" technique is a quicker and easier method of removing Norplant capsules than the standard technique.

[Periarticular ossification following severe brain injury]. / Periartikuläre Ossifikationen nach schwerem Schädel-Hirn-Trauma.

A particular ossification should be considered besides primary neurological causes, if there are functional restrictions of the joint movements after severe head trauma. New bone formation has been seen extending from the periarticular tissue. The problems of the new bone formation in both hip-joints are shown in a patient with traumatic apallic syndrome. After exact indication and with careful and atraumatic operative technique functional restitution of the joints can be achieved without danger of recurrence.