Epidemiology of soil-transmitted helminth infections in Semarang,Central Java,Indonesia

Soil-transmitted helminth (STH) infections are endemic in Indonesia. However, prevalence data for many parts of the country are incomplete. The aim of this study was to determine human STH prevalence and knowledge and practices relating to STH risk behaviour, to provide a current view of the status of STH infection in rural communities in Central Java. A cross-sectional survey of 16 villages was conducted in Semarang, Central Java in 2015. Demographic and household data together with information about knowledge and practices relating to STH and hygiene were elicited through face-to-face interviews. Stool samples were collected and examined using the flotation method. Children (aged 2–12 years) also had their haemoglobin (Hb) levels, height and weight data collected, and BMI estimated. Data were analysed using univariate logistic regression analysis. A total of 6,466 individuals with a mean age of 33.5 years (range: 2–93) from 2,195 households were interviewed. The overall prevalence of STH was 33.8% with Ascaris lumbricoides (roundworm) the predominant nematode identified (prevalence = 26.0%). Hookworm and Trichuris trichiura (whipworm) were found in 7.9% and 1.8% of participants, respectively. Females were at increased odds of infection with A. lumbricoides (adjusted OR 1.14, 95% CI [1.02–1.29], p = 0.02). Adults in age groups 51–60 and over 60 years had the highest odds of being infected with hookworm (adjusted OR 3.01, 95% CI [1.84–4.91], p<0.001 and adjusted OR 3.79, 95% CI [2.30–6.26], p<0.001, respectively) compared to 6–12 year olds. Farmers also had higher odds of being infected with hookworm (adjusted OR 2.36, 95% CI [1.17–4.76], p = 0.02) compared to other occupation categories. Poverty (OR 2.14, 95% CI [1.77–2.58], p<0.001), overcrowding (OR 1.35, 95% CI [1.27–1.44], p<0.001), goat ownership (OR 1.61, 95% CI [1.10–2.41], p = 0.02) and the presence of dry floor space in the home (OR 0.73, 95% CI [0.58–0.91], p = 0.01) were all household factors significantly associated with an increased odds of infection. Infection with STH was not significantly associated with the gastrointestinal illness (p>0.05), BMI or Hb levels; however, one third of all 2–12 year olds surveyed were found to be anaemic (i.e. Hb concentrations below 110g/l or 115g/l for children under 5 and 5 years or older, respectively), with a greater proportion of school-age children at risk. Knowledge and behaviour related to hygiene and gastrointestinal diseases varied widely and were generally not associated with STH infection. The study revealed that STH infection remains endemic in Central Java despite ongoing deworming programs. Current control efforts would benefit from being re-evaluated to determine a more effective way forward.     

Observations on a Medical Teacher Training Program

An increasing interest in educational science as applied to medical education is apparent in the past decade. Recently, a six-week teacher training program was held at the Center for the Study of Medical Education at the University of Illinois. Fifteen medical faculty members, including five Canadians, participated. During this period there was an opportunity to engage in discussions and independent study of several aspects of medical education, using the personnel from the Center''s four major divisions as resource people. Training in educational science is important for all teachers, and a centre to provide this type of instruction should be available in Canada.     

A mathematical assessment of suture line stress in the end-to-side anastomosis—I. Steady flow

The tensile force acting on the suture line connecting a synthetic graft to a host artery in an end-to-side anastomosis is shown to increase from 23,000 to 55,000 dyn as the ratio of the graft-artery area increased from 0.5 to 1.2. The angle of the end-to-side anastomosis is shown to have negligible effect on the suture line stress. The stresses calculated for 3-0. Tevdek suture subjected to the above forces are shown to be one-fiftieth of the yield strength of that suture material. However, it is suggested that such suture forces could cause the suture to tear through the host arterial wall unless sufficient sutures per cm, and maximum suture-host artery contact area are established.     

The epidemiology of tuberculosis in Phuentsholing General Hospital: a six-year retrospective study

ABSTRACT: BACKGROUND: This study was carried out to describe the epidemiology and treatment outcomes of TB infection in Bhutan at Phuentsholing General Hospital (PGH). Retrospective analysis of TB data was carried out using data from the TB registry of PGH from 2004-2009. Comparisons were made between TB, clinical presentation, diagnosis, and outcomes amongst male and female. RESULTS: A total of 735 patients were analyzed, 12.4% (91) of whom were children ([less than or equal to]14 years). The highest cases was reported in 2009 (148), lowest in 2004 (93). Males and females were equally infected with TB. The median age was 25 years, (range 11 months - 98 years; IQR=20-35). Extra-pulmonary Tuberculosis (EPT) 62.6% (57) was the commonest form of TB in children. Pleural effusion was more common in males 62.8% (27) (p=0.013). Smear positive pulmonary tuberculosis (SPPT) 54.3% (207) (p=0.02) and treatment defaulted 84.2% (16) (p=0.004) was higher in males. However, transfer-in cases 57.0% (90) (p=0.036) and treatment outcome-failure 92.3% (12) (p=0.002) were more in females than males. The cure rate for SPPT was 69.0% (293) and unknown treatment outcome for all forms of TB was 11.2% (82). CONCLUSION: TB infection has increase over the study period; SPPT increased more than other two forms of TB. The majority of the TB patients were in the age group of 15-34 years. Males and females were equally infected with TB and children made up 12.4% of TB patients. The cure rate amongst SPPT was 69%, which is much lower that the national target of 85% set by National Tuberculosis Control Programme (NTCP). Further studies need to be undertaken to identify the risk factor for TB in the economically productive age group. There is a need for improvement in the services, recording and reporting so as to meet the target of cure rate of 85% in SPPT patients.     

Acoustic detection and acoustic habitat characterisation of the critically endangered white-bellied heron (Ardea insignis) in Bhutan

1. Growing developmental activities, such as hydropower construction, farm roads, and other human activities, are affecting the critically endangered white-bellied heron (WBH). Out of a known global population of 60, 28 individuals inhabit the river basin area and freshwater lakes and ponds of Bhutan. Several constraints impede continuous monitoring of endangered species, such as the isolated and cryptic nature of the species and the remoteness of its habitat; to date, there are no long-term reference data or techniques implemented for continuous monitoring of this species.
2. In this study, we designed acoustic detection and habitat characterisation methods using long-duration recordings from three habitat areas in Bhutan. Acoustic indices were extracted and used to implement a species-specific call detector and to generate habitat soundscape representations. Using WBH calls annotated in month-long recordings from a known site, a novel indices-based detector was implemented and tested. A total of 960 hr of continuous audio recordings from three habitats in Bhutan were analysed.
3. We found that a species call detector implemented using a combination of acoustic indices (that includes measures of spectral and temporal entropy and different angles of spectral ridges) has a correct detection rate of 81%. Additionally, visual inspection of the species’ acoustic habitat using long-duration false-colour spectrograms enabled qualitative assessment of acoustic habitat structure and other dominant acoustic events.
4. This study proposes a combined approach of species acoustic detection and habitat soundscape analysis for holistic acoustic monitoring of endangered species. As a direct outcome of this work, we documented acoustic reference data on the critically endangered WBH from multiple habitat areas and have analysed its temporal vocalisation patterns across sites.

     

The measurement of afterload, vascular input impedance, and power distribution in aorto-femoral bypass

The effects of aorto-femoral bypass grafts on the vascular input impedance, and the ratio of pulsatile to total power were studied in eight dogs. Unilateral ileo-femoral stenosis was simulated and comparisons were made between the input impedance and power distribution in healthy and simulated disease situations. Input impedance magnitude spectra and phase were displayed graphically and it was shown that the presence of the simulated disease increases the ratio of pulsatile to total power as measured in the abdominal aorta from 7.5 to 14.8% (p less than 0.05). This suggests that the presence of the stenosis creates an impedance mismatch thus causing reflected waves to propagate proximally towards the heart. It was concluded that the way in which the heart transfers fluid power into the arterial bed was compromised by the presence of the ileo-femoral partial stenoses. It is further suggested that the system described in the paper makes it possible to quantitatively assess afterload, vascular input impedance and cardiovascular power distribution as a quasi-real time diagnostic procedure.