Cholera epidemiology in developed and developing countries: new thoughts on transmission, seasonality, and control.
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Biomedical subjects
Publications and source records attributed to C J Miller.
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During a six-year period we have evolved a method of teaching organ system radiology to sophomore medical students. This involves didactic and clinical sessions with small group discussions and activities central to the program. The course is designed to present a bridging course between the basic medical sciences and the clinical sciences and to better prepare students for their patient care responsibilities.
The survival and growth of toxigenic Vibrio cholerae 01 in water under various conditions of salinity, pH, temperature and cation composition and concentration were studied in an extensive series of laboratory experiments. Inter- and intra-strain variation in stress response (of 01 and non-01 strains) and the ability of V. cholerae to adapt to stressful environments were also studied. Toxigenic V. cholerae 01 were able to survive for at least 70 days at 25 degrees C in solutions of sea salt. The optimal salt concentration was 2.0% though all solutions in the range 0.25-3.0% gave good support. Substrains with enhanced capacity to persist at sub-optimal salinity (0.1%) were demonstrated. A great degree of inter-strain variation in stress response at low salinity (0.05%) was found among 59 strains, and this variation was unrelated to serogroup (01 or non-01), source (clinical or environmental) or country of origin (Tanzania or Bangladesh). At optimal salinity, inter-strain variation was less and 18 out of 20 strains remained viable at high concentrations for at least 40 months at 25 degrees C. V. cholerae 01 could not survive beyond 45 days at 4 degrees C and optimal salinity, either with or without nutrients. The optimal pH range for survival at 25 degrees C was 7.0-8.5 at optimal salinity, and 7.5-9.0 at low salinity. V. cholerae 01 require Na+ for survival in the absence of nutrients, and for enhanced growth in their presence. The presence of Ca2+ or Mg2+, in addition to Na+, further enhanced survival. These, and other results reported in this paper, suggest that toxigenic V. cholerae 01 are able to survive for extended periods in warm water containing no nutrients but having a salinity of 0.25-3.0% and a pH of around 8.0. With added nutrients and under the same conditions, rapid growth is possible. The implications of these findings for the identification of putative aquatic reservoirs of V. cholerae 01, and for the epidemiology of cholera, are considerable.
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A rare case of midline upper-lip sinus, without associated congenital anomalies, is presented. Etiopathogenesis between cleft central upper lip and central philtral sinus differ. Therefore, several theories for etiology are discussed, and a more plausible theory of epidermal burrowing and invagination is presented.
A case of metastatic minimal-deviation melanoma that appeared twelve months after radical surgery is presented. It is suggested that newly described varieties of melanoma be treated as standard varieties (on the basis of depth of invasion) until statistically significant numbers of such lesions are reported.
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We describe our management of two patients who had massive breast enlargement with necrosis in the first trimester. First, a therapeutic abortion was done to stop the breast growth, then we skin grafted the large ulcerated areas on the breasts, and finally we did a simple mastectomy with silicone gel implants for reconstruction. The latter procedure was to prevent almost certain recurrence of the problem during any succeeding pregnancy.
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Tiodonium chloride (4-chlorophenyl-2-thienyliodonium chloride), when used in a twice daily mouthrinse at a concentration of 0.3% for either one or four weeks, inhibited dental plaque formation in rats that had been inoculated with Streptococcus mutans 6715-15 and Actinomyces viscosus T-6. Mouthrinses containing 0.1 and 0.2% tiodonium chloride were also effective in inhibiting plaque, but not as consistently as the 0.3% level.
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The rhythm of syllables in repetitions of a phrase was measured with a finger-tapping task. These rhythm measurements were shown to vary with phrase level stress patterning. However, this relationship was not invariant. Acoustic measurements of the time between syllables showed stress pattern relationships similar to those observed in the rhythm-tapping task. The temporal differences between stress patterns appear to be (1) evident even when acoustic measurements exclude syllable duration, (2) significant even at a fast speaking rate, and (3) variable between speakers.