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PubMedDate not supplied

Characteristics of dengue fever in a large public hospital, Jeddah, Saudi Arabia.

BACKGROUND: This study aims to determine demographic, clinical and laboratory profile along with disease outcome of all confirmed cases of dengue fever (DF) and dengue hemorrhagic fever (DHF) admitted in King Abdulaziz Hospital & Oncology Center, Jeddah, Saudi Arabia. We also want to highlight the significance of implementing a well targeted community based disease prevention program. METHODS: All patients admitted from May 2004 till April 2005 with a suspected diagnosis of DF and DHF were followed. All cases confirmed by a positive serology (IgM alone or IgM and IgG) to dengue fever were studied in detail to determine age, gender, ethnicity, monthly distribution, clinical and laboratory profile. RESULTS: A total of 80 patients were admitted with a suspected diagnosis of DF. Among these, 39 (48.75%) patients were confirmed by positive serology to have the disease. Male to female ratio was 3.3:1. Their ages ranged from 2 to 60 years with a mean of 27.6 +/- 11.2. Twelve patients were Saudis, while the rest were non-Saudis coming from different countries in Asia, Africa and Middle East. Maximum number of patients (48.72%) was seen in the summer months of June, July and August. Commonest presentation was fever (100%), headache (48.72%), myalgias (66.7%) and vomiting (25.64%). Rash, hemorrhagic manifestations and positive tourniquet test were relatively uncommon. Only two patients fulfilled WHO criteria of DHF. Main hematological abnormalities were thrombocytopenia (79.49%) and leucopenia (48.72%). Significant elevation of PTT was observed in 25.64% of patients. Abnormal liver function tests with high transaminases were seen in about 66.7% of patients, whereas 33.33% of patients had significantly elevated creatine kinase. All patients improved clinically with improvement of chemical and hematological parameters. None of the patients died in this series. CONCLUSION: DF continues to be a significant health problem in Western region of Saudi Arabia. Large number of pilgrims coming from disease endemic areas all over the world facilitates the continued introduction of dengue virus with different strains. Fortunately there has been no serious outbreak of dengue fever in recent years. A sharp vigilance is required by concerned authorities to prevent and minimize any future outbreak. It is extremely important to implement and maintain an effective, sustainable and community based disease prevention program.

Adolescent↗
PubMed2001

Partnerships in international applied epidemiology training and service, 1975-2001.

In 1951 the Centers for Disease Control and Prevention created the Epidemic Intelligence Service to provide training and epidemiologic service on the model of a clinical residency program. By January 2001, an additional 28 applied epidemiology and training programs (AETPs) had been implemented around the globe (with over 945 graduates and 420 persons currently in training). Field Epidemiology Training Programs and Public Health Schools Without Walls are the most common models. Applied epidemiologists, or field epidemiologists, use science as the basis for intervention programs designed to improve public health. AETPs train people by providing them with health competencies through providing service to public health intervention programs and strengthening health systems. AETPs are relatively expensive to create and maintain, but they are highly sustainable and can produce immediate benefits. Of the 19 programs that began before 1997, 18 (95%) continue to produce graduates. The Training Programs in Epidemiology for Public Health Interventions Network was organized in 1997 to provide support, peer review, and quality assurance for AETPs. In 2001, new programs are planned or in development in India, Argentina, China, and Russia.

Centers for Disease Control and Prevention, U.S.↗
PubMed2001

Uli'eo Koa Program: incorporating a traditional Hawaiian dietary component.

Traditional Hawaiian Diet (THD) programs were developed over the past 15 years as a culturally appropriate community intervention for improving the health status of Native Hawaiians. THD programs are generally three weeks in length and incorporate a diet regimen of foods traditional to the Hawaiian culture, coupled with an education component that emphasizes cultural beliefs and practices that support health and wellness. In accordance with traditional practice, THD meals consist mainly of vegetable foods, with controlled amounts of protein. THD programs have demonstrated high success in weight reduction of severely overweight individuals, as well as reductions of serum cholesterol, triglycerides, glucose, and blood pressure. THD programs, to date, have focused on the reduction of these risk factors. The Uli'eo Koa Program, Warrior Preparedness Program, is a pilot study that incorporated a traditional Hawaiian diet component to ascertain its effects on a group of moderately active, non-obese Native Hawaiian adults--specifically the diet's contribution to wellness and physical fitness. Other components of the Uli'eo Koa Program were a physical exercise regimen and a traditional healing component. The purpose of the dietary component of the Uli'eo Koa Program was to provide the nutritional support needed to sustain nutritional requirements for increased physical activity within this group. The year-long Uli'eo Koa Program consisted of three phases. In Phase I, exercise was conducted twice a day and three meals, including snacks, were provided for participants over a three-week period. During Phase II, structured exercise time and meals were decreased to three times a week and two times a week, respectively, for eight weeks. Participants were responsible for maintaining these regimens on their own outside of the structured activities. In Phase III (in progress at the time of this manuscript preparation), the remainder of the program year, participants were solely responsible for structuring their own physical and dietary behaviors. The nutrient composition of the meals followed a traditional Hawaiian diet, which was typically high in complex carbohydrates, low (< 10%) in total dietary fat and limited in protein (as compared to a standard American diet). Dietary assessments were conducted at the onset (baseline) of the program, using a 24-hour dietary recall methodology. When the post-dietary assessments, conducted at the end of Phase II, were compared to the baseline assessments, positive results were indicated by the reported increases in intakes of all major nutrients, including key vitamins and minerals required for exercise. A final dietary assessment will be conducted at the end of the program year (Phase III) to determine maintenance of positive dietary habits. Implications and future research are discussed.

Adult↗
PubMed1999

Reducing coronary heart disease in the Australian Coalfields: evaluation of a 10-year community intervention.

Coronary heart disease is a leading cause of death in Australia with the Coalfields district of New South Wales having one of the country's highest rates. Identification of the Coalfields epidemic in the 1970's led to the formation of a community awareness program in the late 1980's (the healthy heart support group) followed by a more intense community action program in 1990, the Coalfields Healthy Heartbeat (CHHB). CHHB is a coalition of community members, local government officers, health workers and University researchers. We evaluate the CHHB program, examining both the nature and sustainability of heart health activities undertaken, as well as trends in risk factor levels and rates of coronary events in the Coalfields in comparison with nearby local government areas. Process data reveal difficulties mobilising the community as a whole; activities had to be selected for interested subgroups such as families of heart disease patients, school children, retired people and women concerned with family nutrition and body maintenance. Outcome data show a significantly larger reduction in case fatality for Coalfields men (although nonfatal heart attacks did not decline) while changes in risk factors levels were comparable with surrounding areas. We explain positive responses to the CHHB by schools, heart attack survivors and women interested in body maintenance in terms of the meaning these subgroups find in health promotion discourses based on their embodied experiences. When faced with a threat to one's identity, health discourse suddenly becomes meaningful along with the regimens for health improvement. General public disinterest in heart health promotion is examined in the context of historical patterns of outsiders criticising the lifestyle of miners, an orientation toward communal rather than individual responsibility for health (i.e. community 'owned' emergency services and hospitals) and anger about risks from environmental hazards imposed by industrialists.

Adult↗
PubMed2000

Institutionalization of community action projects to reduce alcohol-use related problems: systematic facilitators.

This article reviews papers from a recent conference on community action research in order to identify factors that contribute to long-term maintenance, sustainability, or institutionalization of community project interventions. The descriptions of long-term outcomes and aftereffects of projects that emerged in the conference are valuable because relatively few instances of institutionalization have been documented in the scientific literature. After a general theoretical discussion of institutionalization in communities, the article identifies characteristics of successful community action programs that outlived their original funding. These characteristics include honoring community values and cultural relevance, cultivating key leader support, and utilizing indigenous staff. They also include developing local resources, maintaining flexibility, and leveraging prior success. The paper concludes by noting that aiming for policy and structural changes is a goal for an institutionalization of measures positively affecting desired health outcomes, even if the programs which created them are not themselves sustained.

Alcoholism↗
PubMed2002

Complexities in ETS-domain transcription factor function and regulation: lessons from the TCF (ternary complex factor) subfamily. The Colworth Medal Lecture.

The ETS-domain transcription factor family can be divided into a series of subfamilies. Elk-1 represents the founding member of the ternary complex factor (TCF) subfamily. By focusing on the TCF subfamily, we can demonstrate the complexities that exist in the function and regulation of ETS-domain transcription factors. This article focuses on Elk-1 in detail and summarizes the functions of other TCFs. The key themes covered include the domain structure of the TCFs, the mechanisms of complex formation with serum response factor, regulation of TCFs by mitogen-activated protein kinase cascades, and transcriptional regulatory properties of the TCFs. Finally, the emerging role of the TCFs in vivo is discussed. A picture is developing indicating that, while these proteins exhibit significant sequence and functional conservation, key differences in their structure and regulation are being identified which may relate to unique functions of these proteins in vivo.

Amino Acid Sequence↗
PubMed1997

Effectiveness and cost of the inpatient treatment of posttraumatic stress disorder: comparison of three models of treatment.

OBJECTIVE: This study compared the outcomes and costs of three models of Department of Veterans Affairs (VA) inpatient treatment for posttraumatic stress disorder (PTSD): 1) long-stay specialized inpatient PTSD units, 2) short-stay specialized evaluation and brief-treatment PTSD units, and 3) nonspecialized general psychiatric units. METHOD: Data were drawn from 785 Vietnam veterans undergoing treatment at 10 programs across the country. The veterans were followed up at 4-month intervals for 1 year after discharge. Successful data collection averaged 66.1% across the three follow-up intervals. RESULTS: All models demonstrated improvement at the time of discharge, but during follow-up symptoms and social functioning rebounded toward admission levels, especially among participants who had been treated in long-stay PTSD units. Veterans in the short-stay PTSD units and in the general psychiatric units showed significantly more improvement during follow-up than veterans in the long-stay PTSD units. Greatest satisfaction with their programs was reported by veterans in the short-stay PTSD units. Finally, the long-stay PTSD units proved to be 82.4% and 53.5% more expensive over 1 year than the short-stay PTSD units and general psychiatric units, respectively. CONCLUSIONS: The paucity of evidence of sustained improvement from costly long-stay specialized inpatient PTSD programs and the indication of high satisfaction and sustained improvement in the far less costly short-stay specialized evaluation and brief-treatment PTSD programs suggest that systematic restructuring of VA inpatient PTSD treatment could result in delivery of effective services to larger numbers of veterans.

Attitude to Health↗
PubMedDate not supplied

Beneficial effects of bradykinin on porcine ischemic myocardium.

Exogenous bradykinin was administered to pigs in which an experimental infarction was evoked by ischemia and reperfusion. Ischemia (45 min) was induced in a closed-chest model with a balloon catheter in the left anterior descending artery, reperfusion by deflating and removing the balloon. The pigs were treated with saline (n = 11) or bradykinin (0.1 mg/kg in 30 min) infusion (n = 10) during the last 15 min of the ischemic period and the first 15 min of reperfusion. During ischemia, heart rate increased in the saline group to 120 +/- 9% of the initial value (p less than 0.05) and in the bradykinin group to 155 +/- 13% (p less than 0.05). After reperfusion, the rate-pressure product was increased in both groups. The increase of arterial creatine kinase levels was significantly less in the bradykinin-treated group. However, the catecholamine and purine levels were increased, as was the plasma renin activity when compared with the saline group. Two weeks after the infarction, six pigs had died in each group. In three out of five surviving saline-treated pigs and one out of four surviving bradykinin-treated pigs, a sustained ventricular tachyarrhythmia was inducible after programmed electrical stimulation. In conclusion, although systemically administered bradykinin caused a temporary increase in myocardial ischemia, it did reduce the (enzymatic indices of) infarct size. Therefore, the beneficial effects, previously found for ACE-inhibitors might at least partially be related to the potentiation of endogenous bradykinin.

Animals↗
PubMed2004

Control of Japanese encephalitis in India: a reality.

Japanese encephalitis is considered as a serious disease due to the complexity of the disease and lack of specific treatment. A secular trend towards declining of JE has been brought in China, Korea, and Japan with widespread use of JE vaccine. In India, the actual JE burden could be estimated only by strengthening diagnostic facilities for JE confirmation in hospitals. However, the available records at present indicate a rising trend in JE- occurrence and expansion of the disease into JE non-endemic areas, which cannot be ignored. JE control through vector control methods has limitations owing to sustainability and cost effectiveness of the programs. Under these circumstances, feasibility of JE vaccination in India has to be considered as a preventive measure, for which identification of risk areas, target populations to be immunized, cost-evaluation of immunization is emphasized. Since, JE vaccine is produced in India, extension of the availability of this vaccine into routine JE-immunization programs is not remote. China has proved that countries with limited sources can produce safe and effective JE vaccines.

Animals↗
PubMed1987

The interplay between endogenous catecholamines and induced ventricular tachycardia during electrophysiologic testing.

Plasma epinephrine and norepinephrine concentrations were measured before, during, and shortly after induced ventricular tachycardia (VT) in 22 selected patients. Sustained, unimorphic VT was induced by programmed ventricular stimulation and terminated after 45 to 384 seconds by overdrive pacing in all patients. In no patient did VT result in loss of consciousness. The baseline plasma catecholamine concentrations did not correlate with the baseline right ventricular effective refractory period, the cycle length of induced VT, or the number of extrastimuli required to induce VT. Induced VT was not associated with a significant increase in the mean plasma epinephrine concentration. In contrast, the plasma norepinephrine concentration increased from a mean baseline level of 317 +/- 136 pg/ml (mean +/- standard deviation) to 418 +/- 220 pg/ml during VT (p less than 0.01) and increased further to 569 +/- 387 pg/ml shortly after VT (p less than 0.01). The plasma norepinephrine concentration shortly after VT correlated with the rate and duration of VT and with the magnitude of decrease in mean blood pressure during VT (p less than 0.05 for each). In eight patients the same configuration of VT was induced on two sequential attempts; in five patients the same number of extrastimuli were required for the second induction of VT as for the first, whereas in three patients fewer extrastimuli were required. Plasma catecholamine concentrations were not higher in patients requiring fewer extrastimuli to induce the second episode of VT, either shortly after the first episode of VT or shortly after the second episode of VT.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1987

Prognostic value of the changes in the mode of ventricular tachycardia induction during therapy with amiodarone or amiodarone and a class 1A antiarrhythmic agent.

The prognostic value of 3 previously reported programmed stimulation efficacy criteria was studied in 70 patients taking amiodarone for sustained ventricular tachycardia (VT). At baseline all patients had VT inducible by programmed stimulation. After amiodarone loading (935 +/- 271 mg/day for 16 +/- 7 days), efficacy of amiodarone was determined by 3 programmed stimulation criteria (criterion I = VT not inducible or 15 beats or less; criterion II = VT not inducible or harder to induce; criterion III = VT not easier to induce). Amiodarone was effective in 12, 25 and 49 of 70 patients by criteria I, II and III, respectively. There were 16 recurrences or cardiac arrest during the follow-up period (19 +/- 19 months). Actuarial arrhythmia-free survival rates at 1 and 2 years were: 90% and 90% in patients with efficacy by criterion I and 78% and 78% in patients with inefficacy, respectively; 84% and 84% in patients with efficacy by criterion II and 78% and 78% in patients with inefficacy, respectively; and 80% and 80% in patients with efficacy by criterion III and 79% and 79% in patients with inefficacy, respectively (difference not significant for all). From the results of follow-up at 2 years, sensitivities of criteria I, II and III were 92%, 75% and 33%, respectively. Specificities were 17%, 26% and 70%, respectively, and predictive accuracies were 43%, 43% and 67%, respectively. Thus, patients with efficacy by criterion I appear to have a better prognosis when compared with patients with inefficacy. However, many patients with inefficacy by criterion I had a good outcome (nonspecificity).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1988

A case of left ventricular aneurysm of uncertain etiology presenting as ventricular tachycardia.

A case of a 59-year-old Asian male with several episodes of syncope and palpitation is reported. Electrophysiologic study disclosed that sustained ventricular tachycardia was induced by programmed electrical stimulation at the right ventricular apex. The electrogram in the left ventricular aneurysm showed delayed activities and the fastest depolarization. Entrainment was observed by faster pacing. Left ventriculography showed a large aneurysm and normal coronary arteries. Congenital left ventricular aneurysm is the most likely clinical diagnosis given the lack of past history of chest pain, myocarditis, cardiomyopathy, etc. Congenital aneurysm which presents as ventricular tachycardia is very rare, and has never been reported in an Asian. Medical management has thus far been successful.

Bundle-Branch Block↗
PubMed2005

Thirty-five years of follow-up of anterior cruciate ligament-deficient knees in high-level athletes.

PURPOSE: The incidence and progression of osteoarthritis over a time period of 35 years following anterior cruciate ligament (ACL) disruption in high-level athletes has not been clearly determined. Our study examined this. TYPE OF STUDY: Retrospective cohort clinical study. METHODS: Following a central guideline, between March 1963 and December 1965, all 19 athletes in the Olympic program of former East Germany who sustained an ACL injury were treated without reconstruction. In a retrospective cohort study, the clinical results were evaluated for all patients from 1975 and 1985 and for 17 of the 19 patients in 2000; 18 of the 19 patients were examined arthroscopically in 1985. RESULTS: All patients were able to return to sports after a period of 6 to 14 weeks. Ten years after the injury, meniscectomy had to be performed in 15 of the 19 patients (79%). The medial meniscus was affected in 13 patients (68%) and the lateral in 7 (37%); 20 years after the injury, meniscectomy was necessary in 18 of the 19 patients (95%). In 1985, in 18 of the 19 knees, arthroscopy was performed and 13 patients (68%) had a grade 4 chondral lesion. Ten total knee replacements had to be performed until the end of the year 2000. CONCLUSIONS: We conclude that, despite the possibility of return to high-level activity with a definitive unstable knee, this will lead in 95% of cases to meniscal and cartilage damage over the next 20 years. In addition, cartilage damage and progressive osteoarthritis will occur and patients will have a high risk of becoming a candidate for further total joint replacement. LEVEL OF EVIDENCE: Level IV.

Anterior Cruciate Ligament↗
PubMed2004

Weight management in women.

With 61% of the American population overweight or obese, the need for treatment far exceeds the capacity of the health care system to provide care on an individual basis. Moreover, the most effective method for the delivery of treatment, and the best ways to induce and sustain client adherence to such a program, remain elusive. Obesity stands in the ignominious position of being the only epidemic in the latter decades of the twentieth century and into the new millennium that nurses--clinicians, academicians, and investigators alike seem to have virtually ignored. There are few past or present clinical descriptions, curriculum examples, or research results that have been presented or published by nurses that demonstrate the discipline's recognition of and commitment to this pervasive health problem. With the ever-increasing prevalence of obesity and obesity-related diseases, the burgeoning expansion of health care delivery in outpatient care, and the growing emphasis on health promotion, it is imperative that nurses in all roles give their long overdue and concerted attention to grappling with this unrelenting epidemic.

Attitude to Health↗
PubMed2004

Monitoring drug efficacy and early detection of drug resistance in human soil-transmitted nematodes: a pressing public health agenda for helminth control.

Control of soil-transmitted helminth infection and elimination of lymphatic filariasis by periodic chemotherapy increase drug pressure for possible occurrence of resistance against single dose anthelminthics. In veterinary practice, frequent treatment of closed populations has led to a serious problem of anthelminthic drug resistance which is now largely irreversible. Reduced efficacy of single dose drugs against nematodes of humans should be taken as early warnings to tackle the issue in due time. Research and development of sensitive tools for monitoring and early detection of drug resistance is urgently needed to sustain the benefits of helminth control programs gained so far. A concerted action with international partners and the creation of a network of scientists to address this issue is the next pressing public health issue for helminth control.

Animal Diseases↗
PubMed2004

Structural and functional characteristics of lung macro- and microvascular endothelial cell phenotypes.

Lung macro- and microvascular endothelial cells exhibit unique functional attributes, including signal transduction and barrier properties. We therefore sought to identify structural and functional features of endothelial cells that discriminate their phenotypes in the fully differentiated lung. Rat lung macro- (PAEC) and microvascular (PMVEC) endothelial cells each exhibited expression of typical markers. Screening for reactivity with nine different lectins revealed that Glycine max and Griffonia (Bandeiraea) simplicifolia preferentially bound microvascular endothelia whereas Helix pomatia preferentially bound macrovascular endothelia. Apposition between the apical plasmalemma and endoplasmic reticulum was closer in PAECs (8 nm) than in PMVECs (87 nm), implicating this coupling distance in the larger store operated calcium entry responses observed in macrovascular cells. PMVECs exhibited a faster growth rate than did PAECs and, once a growth program was initiated by serum, PMVECs sustained growth in the absence of serum. Thus, PAECs and PMVECs differ in their structure and function, even under similar environmental conditions.

Animals↗
PubMedDate not supplied

Building transformational partnerships in nursing.

Over the past decade, the nursing education and delivery system has moved to respond to the crisis in nursing workforce and to prepare itself for what promises to be a long and, at times, challenging struggle. Although much progress has been made, it is increasingly apparent that there are limits to what might be gained from primarily unilateral efforts. Already, issues such as scope of vision, resource constraints, and sustainability are beginning to crop up from even the best of the institutionally based efforts. What is becoming apparent to many leaders in organizations attempting to address these issues is that they cannot go it alone. They must develop partnerships with others in the education-care continuum to have any real hope of mounting and sustaining an effort to build the programs needed to address the long-term challenges of a nursing workforce that is adequate in number and skill. As this realization comes to consciousness, these leaders are becoming more aware of the need for partnerships as the foundation for a different type of strategic response. In taking the early steps toward a partnership, leaders are becoming sensitive to the different demands that a true partnership places on them and their colleagues. These demands may be periodically daunting, but they point to a set of outcomes that may actually have greater consequences for the public and patients. This article is about the creation, care, and feeding of these partnerships.

Clinical Competence↗
PubMed1995

Electrophysiologic profile and efficacy of intravenous dofetilide (UK-68,798), a new class III antiarrhythmic drug, in patients with sustained monomorphic ventricular tachycardia. Dofetilide Arrhythmia Study Group.

There is increasing evidence that class III antiarrhythmic agents may be superior to class I agents for the long-term treatment of life-threatening ventricular tachyarrhythmias. This open study evaluated the acute electrophysiologic effects, antiarrhythmic efficacy, and safety of different doses of intravenous dofetilide, a new class III drug, in 50 patients with sustained monomorphic ventricular tachycardia inducible by programmed electrical stimulation who had previously been unsuccessfully treated with 0 to 7 (median 3) other drugs. Intravenous dofetilide was administered over 60 minutes at the following dose levels: 1.5, 3.0, 6.0, 9.0, and 15.0 micrograms/kg. Significant class III activity was apparent at doses of 3.0 to 15.0 micrograms/kg, as evidenced by dose-related prolongation of the QTc interval by 13.4% to 14.2%, ventricular effective refractory period by 7.9% to 20.6%, and ventricular functional refractory period by 7.3% to 25.0%. The corresponding mean +/- SD plasma dofetilide concentrations ranged from 1.45 +/- 0.52 to 6.48 +/- 1.31 ng/ml. There was no evidence of reverse use-dependence. At these electrophysiologically active dose levels, intravenous dofetilide suppressed (complete response) or slowed (partial response) inducible ventricular tachycardia in 17 of 41 patients (41%) compared with 0 of 9 patients receiving only 1.5 micrograms/kg. The response rate was fairly uniform among the groups receiving 3.0, 6.0, 9.0, and 15.0 micrograms/kg. Intravenous dofetilide was hemodynamically well tolerated. Torsades de pointes (which was self-limiting) developed in only 1 patient, who was allocated to receive 15.0 micrograms/kg. There were no other proarrhythmic episodes or serious adverse effects. Further evaluation of the therapeutic potential of dofetilide in the management of life-threatening ventricular arrhythmias is justified.

Aged↗