The document provides standards for Japanese encephalitis (JE) surveillance. JE is a mosquito-borne viral encephalitis prevalent in Asia that can cause fatal neurological damage. Surveillance is critical to characterize the disease epidemiology and burden, identify high-risk populations, and document the impact of control measures like vaccination. The standards recommend case definitions, types of surveillance including case-based reporting, minimum data elements, data analysis and uses to guide JE control policies and assess vaccination impact.
CNS Iinfection dengue, Teaching Slides, Dr M D Mohire, Kolhapur, Maharashtra,...Mahavir Mohire
1) A study of 210 patients with infectious acute encephalitis syndrome (AES) in India found that 62% had a specific etiological diagnosis. The most common causes were herpes virus (12 patients) and Japanese encephalitis virus (8 patients) for neurological AES, and scrub typhus (42 patients) and dengue virus (20 patients) for systemic AES.
2) Using a syndromic approach, neurological AES could be differentiated from systemic AES with 100% specificity based on the absence of myalgia or rash. Thalamic involvement on imaging predicted Japanese encephalitis with 100% specificity for neurological AES cases.
3) Targeted testing and treatment based on the syndromic approach substantially reduced
1. Introduction
Japanese encephalitis virus (JEV) is a mosquito borne encephalitis caused by group B arbovirus (flavivirus) and transmitted by Culex mosquitoes.
It is a zoonotic disease,i.e. infecting mainly animals and incidentally man.
JE is the leading cause of viral encephalitis in asia and occurs in almost all Asian countries. Largely as a result of immunization, its incidence has been declining in japan, the Korean peninsula and in some regions of china, but the disease is increasingly reported from Bangladesh, India, Nepal, Pakistan, northern Thailand and Viet Nam.
World Encephalitis Day is celebrated on 22nd February every year by raising awareness about encephalitis.
2. Magnitude of problem
JE is the leading cause of viral encephalitis in Asia and occurs in almost all Asian countries.
Increasing no of cases are reported from Bangladesh, India, Nepal, Pakistan ,Thailand and Vietnam.
Estimated 50,000 case occur globally each year, with 10,000 deaths and nearly 15,000 disabled.
About 85% cases are children of less than 15 years of age.
More than 3 billion people are at risk of developing the disease.
3. Global Scenario
Major epidemics were reported from Japan (1871 and 1924), northern Vietnam (1965), Thailand (1969, 1970), India (1973), Nepal (1978) and from Sri Lanka (1985-87).
At present, the geographic range of JEV infection extends from eastern to Southeast Asia and northern Australia, and to southern Asia.
However, it is likely to increase in Bangladesh, Cambodia, Indonesia, Laos, Myanmar, North Korea, Pakistan, Philippines and other countries because of population growth, intensified rice farming, pig rearing, and the lack of vaccination programs and surveillance.
4. Risk Factors
Common risk factors in the development of Japanese encephalitis are:
Residents or military in Southeast Asia and Western Pacific regions
Summer season
Outdoor recreational activities
Accommodations in endemic areas that lack air conditioning, bed nets, or window screens
Contact with: Mosquitos, Birds , Pigs
5. Agent Factor
JEV is transmitted to humans through bites from infected mosquitoes of the Culex species (mainly Culex tritaeniorhynchus).
The virus exists in a transmission cycle between mosquitoes, pigs and/or water birds (enzootic cycle).
6. Host factor
Pigs and aquatic birds (mainly herons and egrets of the Ardeidae family) are the natural hosts for the virus.
Pigs are considered amplifying hosts since they allow manifold virus multiplication without suffering from disease and maintain prolonged viraemia .
In endemic areas, most people are infected below the age of 15 years.
In hyper – endemic areas, half of all Japanese encephalitis cases occur before the age of four years, and almost all before 10 years of age.
7. Mode of Transmission
JE virus is transmitted to humans through the bite of infected Culex species mosquitoes, particularly Culex tritaeniorhynchus.
The virus is maintained in a cycle between mosquitoes and vertebrate hosts.
Japanese encephalitis virus (JEV) is a mosquito-borne flavivirus that is the leading cause of viral encephalitis in Asia. It is transmitted between mosquitoes and pigs or birds, with humans as incidental hosts. Most infections are asymptomatic, but approximately 1 in 250 results in severe clinical illness with neurological symptoms. There is no antivaccine, so treatment focuses on relieving symptoms. Safe and effective vaccines are available to prevent disease. Controlling mosquito populations and immunizing those at risk in endemic areas are key to prevention and control of JEV transmission.
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
1. Acute rheumatic fever (ARF) is an autoimmune response to strep throat infection that can lead to long-term heart damage known as rheumatic heart disease (RHD).
2. While penicillin remains the primary treatment, ARF and RHD continue to be a major problem in low-income countries.
3. Recent research has provided a better understanding of the true global burden of RHD and identified priorities like vaccine development, early detection of RHD, and improving quality of life for those affected.
The document summarizes current methods for diagnosing dengue virus infection. It discusses the limitations of clinical diagnosis due to non-specific symptoms in early infection. Laboratory diagnostic methods include virus isolation through mosquito inoculation or cell culture, which is sensitive but requires specialized facilities. Reverse-transcriptase PCR detection of viral RNA in blood is now more widely used, as it is rapid, sensitive and specific. Both virus isolation and PCR can detect infection early in the viremic phase. Serological tests detect antibody response and are more useful later in infection or for secondary dengue diagnosis. Improved early diagnosis remains a challenge, especially with development of a dengue vaccine.
This document provides an overview of herpes simplex encephalitis (HSE). It discusses the etiology, epidemiology, pathophysiology, clinical manifestations, diagnosis and treatment of HSE. Key points include: HSE is most commonly caused by HSV-1 and is a leading cause of viral encephalitis in children; presentation varies from non-specific symptoms to seizures, altered mental status and focal neurological deficits; diagnosis involves CSF analysis, neuroimaging and PCR testing; and treatment involves high-dose intravenous acyclovir administered for at least 21 days. Recurrence of HSE is possible due to viral reactivation or immune-mediated processes.
CNS Iinfection dengue, Teaching Slides, Dr M D Mohire, Kolhapur, Maharashtra,...Mahavir Mohire
1) A study of 210 patients with infectious acute encephalitis syndrome (AES) in India found that 62% had a specific etiological diagnosis. The most common causes were herpes virus (12 patients) and Japanese encephalitis virus (8 patients) for neurological AES, and scrub typhus (42 patients) and dengue virus (20 patients) for systemic AES.
2) Using a syndromic approach, neurological AES could be differentiated from systemic AES with 100% specificity based on the absence of myalgia or rash. Thalamic involvement on imaging predicted Japanese encephalitis with 100% specificity for neurological AES cases.
3) Targeted testing and treatment based on the syndromic approach substantially reduced
1. Introduction
Japanese encephalitis virus (JEV) is a mosquito borne encephalitis caused by group B arbovirus (flavivirus) and transmitted by Culex mosquitoes.
It is a zoonotic disease,i.e. infecting mainly animals and incidentally man.
JE is the leading cause of viral encephalitis in asia and occurs in almost all Asian countries. Largely as a result of immunization, its incidence has been declining in japan, the Korean peninsula and in some regions of china, but the disease is increasingly reported from Bangladesh, India, Nepal, Pakistan, northern Thailand and Viet Nam.
World Encephalitis Day is celebrated on 22nd February every year by raising awareness about encephalitis.
2. Magnitude of problem
JE is the leading cause of viral encephalitis in Asia and occurs in almost all Asian countries.
Increasing no of cases are reported from Bangladesh, India, Nepal, Pakistan ,Thailand and Vietnam.
Estimated 50,000 case occur globally each year, with 10,000 deaths and nearly 15,000 disabled.
About 85% cases are children of less than 15 years of age.
More than 3 billion people are at risk of developing the disease.
3. Global Scenario
Major epidemics were reported from Japan (1871 and 1924), northern Vietnam (1965), Thailand (1969, 1970), India (1973), Nepal (1978) and from Sri Lanka (1985-87).
At present, the geographic range of JEV infection extends from eastern to Southeast Asia and northern Australia, and to southern Asia.
However, it is likely to increase in Bangladesh, Cambodia, Indonesia, Laos, Myanmar, North Korea, Pakistan, Philippines and other countries because of population growth, intensified rice farming, pig rearing, and the lack of vaccination programs and surveillance.
4. Risk Factors
Common risk factors in the development of Japanese encephalitis are:
Residents or military in Southeast Asia and Western Pacific regions
Summer season
Outdoor recreational activities
Accommodations in endemic areas that lack air conditioning, bed nets, or window screens
Contact with: Mosquitos, Birds , Pigs
5. Agent Factor
JEV is transmitted to humans through bites from infected mosquitoes of the Culex species (mainly Culex tritaeniorhynchus).
The virus exists in a transmission cycle between mosquitoes, pigs and/or water birds (enzootic cycle).
6. Host factor
Pigs and aquatic birds (mainly herons and egrets of the Ardeidae family) are the natural hosts for the virus.
Pigs are considered amplifying hosts since they allow manifold virus multiplication without suffering from disease and maintain prolonged viraemia .
In endemic areas, most people are infected below the age of 15 years.
In hyper – endemic areas, half of all Japanese encephalitis cases occur before the age of four years, and almost all before 10 years of age.
7. Mode of Transmission
JE virus is transmitted to humans through the bite of infected Culex species mosquitoes, particularly Culex tritaeniorhynchus.
The virus is maintained in a cycle between mosquitoes and vertebrate hosts.
Japanese encephalitis virus (JEV) is a mosquito-borne flavivirus that is the leading cause of viral encephalitis in Asia. It is transmitted between mosquitoes and pigs or birds, with humans as incidental hosts. Most infections are asymptomatic, but approximately 1 in 250 results in severe clinical illness with neurological symptoms. There is no antivaccine, so treatment focuses on relieving symptoms. Safe and effective vaccines are available to prevent disease. Controlling mosquito populations and immunizing those at risk in endemic areas are key to prevention and control of JEV transmission.
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
1. Acute rheumatic fever (ARF) is an autoimmune response to strep throat infection that can lead to long-term heart damage known as rheumatic heart disease (RHD).
2. While penicillin remains the primary treatment, ARF and RHD continue to be a major problem in low-income countries.
3. Recent research has provided a better understanding of the true global burden of RHD and identified priorities like vaccine development, early detection of RHD, and improving quality of life for those affected.
The document summarizes current methods for diagnosing dengue virus infection. It discusses the limitations of clinical diagnosis due to non-specific symptoms in early infection. Laboratory diagnostic methods include virus isolation through mosquito inoculation or cell culture, which is sensitive but requires specialized facilities. Reverse-transcriptase PCR detection of viral RNA in blood is now more widely used, as it is rapid, sensitive and specific. Both virus isolation and PCR can detect infection early in the viremic phase. Serological tests detect antibody response and are more useful later in infection or for secondary dengue diagnosis. Improved early diagnosis remains a challenge, especially with development of a dengue vaccine.
This document provides an overview of herpes simplex encephalitis (HSE). It discusses the etiology, epidemiology, pathophysiology, clinical manifestations, diagnosis and treatment of HSE. Key points include: HSE is most commonly caused by HSV-1 and is a leading cause of viral encephalitis in children; presentation varies from non-specific symptoms to seizures, altered mental status and focal neurological deficits; diagnosis involves CSF analysis, neuroimaging and PCR testing; and treatment involves high-dose intravenous acyclovir administered for at least 21 days. Recurrence of HSE is possible due to viral reactivation or immune-mediated processes.
The document discusses investigations into the relationship between the Borna Disease Virus (BDV) and schizophrenia. It summarizes findings from multiple studies that tested schizophrenic patients and controls for antibodies and RNA from BDV. Most investigations found higher percentages of BDV antibodies in schizophrenic patients compared to controls. However, one study from Korea found no evidence of BDV. Factors like geography and variations in testing procedures could account for differences in results. Overall, the evidence suggests BDV may play a role in the pathogenesis of schizophrenia for some infected individuals. More research is still needed to fully understand the virus and its relationship to mental illness.
This patient presented with fever, gait instability, and slurred speech. Investigations revealed cryptococcal meningitis. As a kidney transplant recipient on immunosuppressants, he was at risk for opportunistic infections. Examination found dysarthria and ataxia. Imaging and CSF analysis confirmed cryptococcal infection in the central nervous system. He received liposomal amphotericin B and was discharged on fluconazole to complete treatment for this fungal meningitis.
This document discusses the neuropsychiatric manifestations of HIV infection. It begins by describing the history and epidemiology of HIV, noting it was first isolated in 1983 in West Africa and North America. It then covers the etiological agent of HIV, the virus itself. The majority of the document discusses the neurological and psychiatric manifestations of HIV, including opportunistic infections of the central nervous system like toxoplasmosis and cryptococcal meningitis, direct effects on the brain, and psychiatric conditions like delirium. It provides clinical features and treatment approaches for many of the conditions presented.
Typical & atypical clinical presentations of COVID-19 in childrenMoosaAllawati1
A brief presentation about some typical symptoms in children diagnosed with COVID-19 in Oman along with atypical or unusual presentations of the disease in the same age group in the USA and Bahrain.
1. Kawasaki disease (KD) is a medium vessel vasculitis that primarily affects young children and can lead to coronary artery abnormalities if not treated promptly.
2. It was first described in 1967 by Japanese pediatrician Tomisaku Kawasaki as an acute febrile illness characterized by changes in extremities, rashes, conjunctival injections, lip and oral changes, and cervical lymphadenopathy.
3. KD is one of the most common causes of acquired heart disease in children in developed countries. While underdiagnosed in India, it affects children of all races worldwide.
- Middle East Respiratory Syndrome (MERS) is a novel coronavirus that was first detected in 2012. It causes severe respiratory illness, with a mortality rate of 35-50%.
- The virus likely originated in bats and may be transmitted via an animal or environmental reservoir. Person-to-person transmission has occurred, especially in healthcare settings.
- At risk groups include older adults and those with underlying medical conditions. Symptoms include fever, cough, shortness of breath. Diagnosis is made via PCR testing of respiratory samples. There is no vaccine and treatment is supportive.
The document discusses the novel coronavirus infections, including clinical and epidemiological evidence from 15 cases between April 2012 and February 2013. Most cases occurred in Saudi Arabia and involved adult males. Three clusters were identified, including a hospital outbreak in Jordan. While some limited human-to-human transmission was observed, the overall risk of infection and transmissibility were considered low. WHO recommends enhanced surveillance and case definitions but no special screening or travel restrictions.
This study examined the prevalence of cryptococcal meningitis (CM) among people living with HIV/AIDS (PLHAs) at a hospital in southern Odisha, India. Of 112 clinically diagnosed CM patients, 16 cases were confirmed via cerebrospinal fluid analysis, showing a prevalence of 14.3%. Males aged 21-40 were most commonly affected. The most common symptoms were fever, headache, altered sensorium, and neck stiffness. CD4 T-lymphocyte counts were below 100 cells/μl in 93.7% of confirmed cases. All patients responded initially to antifungal therapy but 2 died during hospitalization and 4 were lost to follow up. Early diagnosis and treatment of CM is
This study characterized dengue infections in Pakistan by analyzing hematological and serological markers in 154 suspected dengue cases and 146 control patients with other febrile illnesses. NS1 antigen was detected in 55% of dengue cases, IgM antibodies in 30%, and both in 15%. Control groups primarily had malaria (71%) and enteric fever (20%). Hematological markers (platelet count, hematocrit, WBC) measured before and after treatment showed significant differences for platelet count and hematocrit but not WBC count between the groups. Analysis of clinical symptoms and serological/hematological markers helps diagnose dengue, assess prognosis, and inform prevention efforts to reduce morbidity, mortality and spread of the disease.
Japanese encephalitis is a virus spread by the bite of infected mosquitoes. It's more common in rural and agricultural areas.
Most cases are mild. Rarely, it causes serious brain swelling with a sudden headache, high fever and disorientation.
Treatment involves supportive care. A vaccine is available.
This article reviews past and potential future clinical trials for treating Creutzfeldt-Jakob disease (CJD). Four randomized controlled trials of potential treatments showed no efficacy. Analyses revealed the importance of recruiting patients early and at a national/international level due to disease rarity. Preclinical studies often overstated treatment potential. The only proven treatment is intraventricular pentosan polysulfate for variant CJD. Future trials require validated preclinical studies using multiple disease models and consensus diagnostic criteria for early patient enrollment. Developing treatments remains challenging but learning from past studies could improve future efforts.
Case presentation, meningitis and treatment, Moh'd SharshirMoh'd sharshir
Meningitis is an inflammation of the meninges, the membranes surrounding the brain and spinal cord. It is caused by bacterial, viral, or fungal infections. The classic symptoms are fever, headache, and neck stiffness. Diagnosis involves examination of cerebrospinal fluid which shows increased white blood cells and decreased glucose levels in bacterial meningitis. Treatment depends on the identified pathogen but generally involves antibiotics. Adjunctive steroids may reduce complications for some types of bacterial meningitis. Outcomes vary depending on the cause, but bacterial meningitis can have mortality rates around 20% even with treatment.
This document summarizes a presentation on bacterial meningitis. It discusses the clinical presentation, mortality and risks, diagnostic workup including CSF results, treatment including antibiotics and vaccination, and scripts for bacterial versus viral meningitis. Key points include that untreated bacterial meningitis has nearly 100% mortality, but with treatment mortality is around 25%. Presentation often includes fever, nuchal rigidity, and altered mental status. Diagnostic tests include lumbar puncture and analysis of CSF findings. Treatment involves antibiotics and dexamethasone to improve outcomes.
Abstract—Chikunguniya can be associated with encephalitis which is a rare complication of chikunguniya. Such a rare case was attended at National University Hospital (Hondura) in August 2015, which was studied in detail. A 64 years, Honduran patient was admitted during the convalescent period of an acute febrile illness with arthralgias one month prior. Two weeks later, he developed a severe inability to form new memories disorientation to date and time; forgetting family member´s names and daily routines. The patient exhibited spontaneous crying and sadness. Premorbid cognitive, behavioral and functional abilities were normal. Patient was evaluated and investigated. On investigation Chikungunya IgM antibodies were positive and on Brain MRI revealed predominantly right medial temporal lobe hyperintensities in Diffusion weighed images; also seen in FLAIR sequences. Patient was confirmed as Chikunguniya case associated with medial temporal lobe encephalitis. So it is suggested that patients presenting with a rapidly evolving amnestic syndrome after an acute febrile illness with polyarthralgias in an endemic region should be tested for the Chikungunya virus. More cases must be described and studied, however, to better characterize this condition.
Multisystem inflammatory syndrome in children and adolescents with COVID-19Chaitanya Nukala
Multisystem Inflammatory Syndrome in children (MIS-C) OR
Pediatric Multisystem Inflammatory Syndrome [PMIS] OR
pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 [PIMS-TS], OR
pediatric hyper inflammatory syndrome, or pediatric hyper inflammatory shock) OR
KAWA-COVID
This document provides information about the definition, epidemiology, pathophysiology, clinical manifestation, diagnostic evaluation, treatment, and prognosis of specific antibody deficiency (SAD). It defines SAD as having normal immunoglobulin levels but an impaired antibody response to pneumococcal polysaccharides. The prevalence of SAD is estimated to be 3.5-48.6% in different populations. Diagnosis involves testing for a normal response to protein antigens and conjugate vaccines but an impaired response to the 23-valent pneumococcal polysaccharide vaccine. Clinical manifestations include recurrent sinusitis, otitis media, and pneumonia.
Japanese encephalitis (JE) is a mosquito-borne viral disease that is the leading cause of viral encephalitis in Asia. It is caused by the JE virus and transmitted via Culex mosquitoes, primarily Culex tritaeniorhynchus. The virus cycles between pigs and birds as amplifying hosts and mosquitoes. Most human cases occur in rural agricultural areas where vectors breed. Clinical presentation ranges from asymptomatic infection to encephalitis. Acute encephalitis syndrome (AES) surveillance and case classification are important for monitoring JE disease burden and outbreaks. Laboratory confirmation requires detection of JE virus, antigens, RNA or IgM antibodies in serum or cerebrospinal fluid.
Herpes Simples viral encephalitis by aminu arzetAminuArzet
This document provides an overview of herpes simplex encephalitis (HSE), including its epidemiology, transmission, pathogenesis, clinical presentation, diagnosis, treatment, prognosis, and prevention. HSE is caused by the herpes simplex virus entering the brain via neuronal pathways from a primary infection. It is characterized by rapid onset of fever, headache, and altered mental status. Diagnosis involves PCR or antibody testing of CSF. Treatment is with intravenous acyclovir, which reduces mortality from 70% to 10-20% if administered early. Survivors often have neurological deficits, seizures, or cognitive impairments. Prompt diagnosis and treatment improve prognosis.
The document discusses investigations into the relationship between the Borna Disease Virus (BDV) and schizophrenia. It summarizes findings from multiple studies that tested schizophrenic patients and controls for antibodies and RNA from BDV. Most investigations found higher percentages of BDV antibodies in schizophrenic patients compared to controls. However, one study from Korea found no evidence of BDV. Factors like geography and variations in testing procedures could account for differences in results. Overall, the evidence suggests BDV may play a role in the pathogenesis of schizophrenia for some infected individuals. More research is still needed to fully understand the virus and its relationship to mental illness.
This patient presented with fever, gait instability, and slurred speech. Investigations revealed cryptococcal meningitis. As a kidney transplant recipient on immunosuppressants, he was at risk for opportunistic infections. Examination found dysarthria and ataxia. Imaging and CSF analysis confirmed cryptococcal infection in the central nervous system. He received liposomal amphotericin B and was discharged on fluconazole to complete treatment for this fungal meningitis.
This document discusses the neuropsychiatric manifestations of HIV infection. It begins by describing the history and epidemiology of HIV, noting it was first isolated in 1983 in West Africa and North America. It then covers the etiological agent of HIV, the virus itself. The majority of the document discusses the neurological and psychiatric manifestations of HIV, including opportunistic infections of the central nervous system like toxoplasmosis and cryptococcal meningitis, direct effects on the brain, and psychiatric conditions like delirium. It provides clinical features and treatment approaches for many of the conditions presented.
Typical & atypical clinical presentations of COVID-19 in childrenMoosaAllawati1
A brief presentation about some typical symptoms in children diagnosed with COVID-19 in Oman along with atypical or unusual presentations of the disease in the same age group in the USA and Bahrain.
1. Kawasaki disease (KD) is a medium vessel vasculitis that primarily affects young children and can lead to coronary artery abnormalities if not treated promptly.
2. It was first described in 1967 by Japanese pediatrician Tomisaku Kawasaki as an acute febrile illness characterized by changes in extremities, rashes, conjunctival injections, lip and oral changes, and cervical lymphadenopathy.
3. KD is one of the most common causes of acquired heart disease in children in developed countries. While underdiagnosed in India, it affects children of all races worldwide.
- Middle East Respiratory Syndrome (MERS) is a novel coronavirus that was first detected in 2012. It causes severe respiratory illness, with a mortality rate of 35-50%.
- The virus likely originated in bats and may be transmitted via an animal or environmental reservoir. Person-to-person transmission has occurred, especially in healthcare settings.
- At risk groups include older adults and those with underlying medical conditions. Symptoms include fever, cough, shortness of breath. Diagnosis is made via PCR testing of respiratory samples. There is no vaccine and treatment is supportive.
The document discusses the novel coronavirus infections, including clinical and epidemiological evidence from 15 cases between April 2012 and February 2013. Most cases occurred in Saudi Arabia and involved adult males. Three clusters were identified, including a hospital outbreak in Jordan. While some limited human-to-human transmission was observed, the overall risk of infection and transmissibility were considered low. WHO recommends enhanced surveillance and case definitions but no special screening or travel restrictions.
This study examined the prevalence of cryptococcal meningitis (CM) among people living with HIV/AIDS (PLHAs) at a hospital in southern Odisha, India. Of 112 clinically diagnosed CM patients, 16 cases were confirmed via cerebrospinal fluid analysis, showing a prevalence of 14.3%. Males aged 21-40 were most commonly affected. The most common symptoms were fever, headache, altered sensorium, and neck stiffness. CD4 T-lymphocyte counts were below 100 cells/μl in 93.7% of confirmed cases. All patients responded initially to antifungal therapy but 2 died during hospitalization and 4 were lost to follow up. Early diagnosis and treatment of CM is
This study characterized dengue infections in Pakistan by analyzing hematological and serological markers in 154 suspected dengue cases and 146 control patients with other febrile illnesses. NS1 antigen was detected in 55% of dengue cases, IgM antibodies in 30%, and both in 15%. Control groups primarily had malaria (71%) and enteric fever (20%). Hematological markers (platelet count, hematocrit, WBC) measured before and after treatment showed significant differences for platelet count and hematocrit but not WBC count between the groups. Analysis of clinical symptoms and serological/hematological markers helps diagnose dengue, assess prognosis, and inform prevention efforts to reduce morbidity, mortality and spread of the disease.
Japanese encephalitis is a virus spread by the bite of infected mosquitoes. It's more common in rural and agricultural areas.
Most cases are mild. Rarely, it causes serious brain swelling with a sudden headache, high fever and disorientation.
Treatment involves supportive care. A vaccine is available.
This article reviews past and potential future clinical trials for treating Creutzfeldt-Jakob disease (CJD). Four randomized controlled trials of potential treatments showed no efficacy. Analyses revealed the importance of recruiting patients early and at a national/international level due to disease rarity. Preclinical studies often overstated treatment potential. The only proven treatment is intraventricular pentosan polysulfate for variant CJD. Future trials require validated preclinical studies using multiple disease models and consensus diagnostic criteria for early patient enrollment. Developing treatments remains challenging but learning from past studies could improve future efforts.
Case presentation, meningitis and treatment, Moh'd SharshirMoh'd sharshir
Meningitis is an inflammation of the meninges, the membranes surrounding the brain and spinal cord. It is caused by bacterial, viral, or fungal infections. The classic symptoms are fever, headache, and neck stiffness. Diagnosis involves examination of cerebrospinal fluid which shows increased white blood cells and decreased glucose levels in bacterial meningitis. Treatment depends on the identified pathogen but generally involves antibiotics. Adjunctive steroids may reduce complications for some types of bacterial meningitis. Outcomes vary depending on the cause, but bacterial meningitis can have mortality rates around 20% even with treatment.
This document summarizes a presentation on bacterial meningitis. It discusses the clinical presentation, mortality and risks, diagnostic workup including CSF results, treatment including antibiotics and vaccination, and scripts for bacterial versus viral meningitis. Key points include that untreated bacterial meningitis has nearly 100% mortality, but with treatment mortality is around 25%. Presentation often includes fever, nuchal rigidity, and altered mental status. Diagnostic tests include lumbar puncture and analysis of CSF findings. Treatment involves antibiotics and dexamethasone to improve outcomes.
Abstract—Chikunguniya can be associated with encephalitis which is a rare complication of chikunguniya. Such a rare case was attended at National University Hospital (Hondura) in August 2015, which was studied in detail. A 64 years, Honduran patient was admitted during the convalescent period of an acute febrile illness with arthralgias one month prior. Two weeks later, he developed a severe inability to form new memories disorientation to date and time; forgetting family member´s names and daily routines. The patient exhibited spontaneous crying and sadness. Premorbid cognitive, behavioral and functional abilities were normal. Patient was evaluated and investigated. On investigation Chikungunya IgM antibodies were positive and on Brain MRI revealed predominantly right medial temporal lobe hyperintensities in Diffusion weighed images; also seen in FLAIR sequences. Patient was confirmed as Chikunguniya case associated with medial temporal lobe encephalitis. So it is suggested that patients presenting with a rapidly evolving amnestic syndrome after an acute febrile illness with polyarthralgias in an endemic region should be tested for the Chikungunya virus. More cases must be described and studied, however, to better characterize this condition.
Multisystem inflammatory syndrome in children and adolescents with COVID-19Chaitanya Nukala
Multisystem Inflammatory Syndrome in children (MIS-C) OR
Pediatric Multisystem Inflammatory Syndrome [PMIS] OR
pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 [PIMS-TS], OR
pediatric hyper inflammatory syndrome, or pediatric hyper inflammatory shock) OR
KAWA-COVID
This document provides information about the definition, epidemiology, pathophysiology, clinical manifestation, diagnostic evaluation, treatment, and prognosis of specific antibody deficiency (SAD). It defines SAD as having normal immunoglobulin levels but an impaired antibody response to pneumococcal polysaccharides. The prevalence of SAD is estimated to be 3.5-48.6% in different populations. Diagnosis involves testing for a normal response to protein antigens and conjugate vaccines but an impaired response to the 23-valent pneumococcal polysaccharide vaccine. Clinical manifestations include recurrent sinusitis, otitis media, and pneumonia.
Japanese encephalitis (JE) is a mosquito-borne viral disease that is the leading cause of viral encephalitis in Asia. It is caused by the JE virus and transmitted via Culex mosquitoes, primarily Culex tritaeniorhynchus. The virus cycles between pigs and birds as amplifying hosts and mosquitoes. Most human cases occur in rural agricultural areas where vectors breed. Clinical presentation ranges from asymptomatic infection to encephalitis. Acute encephalitis syndrome (AES) surveillance and case classification are important for monitoring JE disease burden and outbreaks. Laboratory confirmation requires detection of JE virus, antigens, RNA or IgM antibodies in serum or cerebrospinal fluid.
Herpes Simples viral encephalitis by aminu arzetAminuArzet
This document provides an overview of herpes simplex encephalitis (HSE), including its epidemiology, transmission, pathogenesis, clinical presentation, diagnosis, treatment, prognosis, and prevention. HSE is caused by the herpes simplex virus entering the brain via neuronal pathways from a primary infection. It is characterized by rapid onset of fever, headache, and altered mental status. Diagnosis involves PCR or antibody testing of CSF. Treatment is with intravenous acyclovir, which reduces mortality from 70% to 10-20% if administered early. Survivors often have neurological deficits, seizures, or cognitive impairments. Prompt diagnosis and treatment improve prognosis.
1. Japanese encephalitis is a viral disease transmitted through mosquito bites that causes brain swelling and inflammation.
2. The virus has a zoonotic transmission cycle between mosquitoes, pigs, and water birds, though humans are accidental hosts.
3. Symptoms range from fever and headache to meningitis or encephalitis. There is no specific treatment, so care is supportive.
1) Viral encephalitis is caused by neurotropic viruses and has varied clinical presentations depending on the causative virus and host factors.
2) Diagnosis involves PCR and RT-PCR testing of CSF for common viruses. Next-generation sequencing may help identify unknown causes.
3) Treatment of HSV encephalitis involves acyclovir, while other viral encephalitides receive supportive care. Vaccines have been effective in preventing certain causes. Outcomes remain generally poor depending on factors like age and delay of treatment.
Infectious mononucleosis (im) and epstein barr virusRashad Idrees
This document discusses infectious mononucleosis (IM) and Epstein-Barr virus (EBV). EBV is a herpes virus that causes IM. IM presents as fever, pharyngitis, lymphadenopathy, and lymphocytosis. While most cases resolve in 2 weeks, complications can occasionally occur. Diagnosis involves detecting heterophile antibodies or EBV serology. Treatment is symptomatic and management focuses on rest. Shingles is also discussed, caused by reactivation of varicella zoster virus. It presents as a rash in dermatomal distributions, and postherpetic neuralgia can occur. Antiviral treatment can reduce symptoms and the vaccine prevents shingles.
Japanese encephalitis is a viral disease transmitted through mosquito bites that causes neurological symptoms. It is primarily spread between water birds and pigs, with humans as accidental hosts. The document outlines the signs, transmission, diagnosis, treatment and prevention of Japanese encephalitis, including vaccination and vector control programs. The goal of prevention and control measures is to reduce mosquito populations and encourage personal protection against bites.
The document describes a case of a 23-year-old male presenting with tender bilateral tonsillar and cervical lymphadenopathy for 5 days, along with a low-grade fever of 100.2°F and sore throat with trouble swallowing for 1 day. On exam, the patient has enlarged tonsils with whitish exudate. The best next step in management is to obtain a rapid strep test to determine if the patient has streptococcal pharyngitis.
1) The study evaluated a rapid immunochromatographic assay for detecting anti-HEV IgM antibodies and found it to have 93% sensitivity and 100% specificity for diagnosing acute hepatitis E virus infection.
2) Japanese Encephalitis is a mosquito-borne viral infection that is a major cause of encephalitis in Asia. Pigs and birds help amplify and spread the virus, which is transmitted by Culex mosquitoes.
3) A study in southern Thailand found that between 1989-1990, Japanese Encephalitis virus was the primary cause of pediatric non-bacterial central nervous system infections in the region and was associated with significant morbidity and mortality. However, official reporting of cases by
Clinical Profile and Outcome of Children Admitted with Acute Encephalitis Syn...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Japanese Encephalitis NVBDCP- Dr Subhasish PaulSubhasish Paul
Japanese encephalitis is a leading cause of viral encephalitis in Asia. It is caused by a flavivirus transmitted by Culex mosquitoes, with pigs and wading birds acting as amplifying hosts. The disease predominantly affects children under 15 and causes neurological sequelae or death. Integrated prevention strategies include surveillance, case management, vector control through larviciding and indoor residual spraying, vaccination, and behavior change communication. Two types of vaccines are used - mouse brain-derived inactivated vaccines requiring multiple doses, and cell culture-derived live attenuated vaccines providing longer-term protection with fewer doses.
The document provides information on Dengue Fever, including that it is caused by a mosquito-borne flavivirus transmitted by Aedes aegypti and Aedes albopictus mosquitoes. It has four serotypes that provide varying levels of immunity. Symptoms include fever, headache, rash and bleeding. Diagnosis involves antibody and viral testing. Severe dengue is classified as dengue hemorrhagic fever or dengue shock syndrome, characterized by bleeding, low platelets and plasma leakage. Monitoring of patients involves serial complete blood counts and hematocrit levels to detect signs of plasma leakage. Proper fluid management and monitoring for bleeding and organ dysfunction is important throughout the illness.
Relapse of Herpes Simplex Encephalomyelitis Presenting As Guillain Barre Synd...iosrjce
This document describes a case study of a 70-year-old man who presented with symptoms of herpes simplex encephalomyelitis (HSE) including headache, vomiting, fever, confusion and weakness. He was treated with acyclovir and showed improvement, but later developed Guillain-Barré syndrome (GBS) with progressive weakness. Testing found positive antibodies for herpes simplex virus type 1, indicating either a current or past infection. Despite treatment, his condition deteriorated and he ultimately died. The authors conclude this is a rare case of HSE relapse presenting as GBS, likely due to viral reactivation rather than a new infection.
This document summarizes a study on Japanese encephalitis (JE). It begins with an introduction to JE, describing its discovery in 1871 in Japan and transmission via Culex mosquitoes. Symptoms and prevalence data from India and the locality are discussed. The causal virus is described along with its life cycle. Diagnosis methods like ELISA, PRNT and RT-PCR are covered. Preventive measures like vaccination campaigns and vector control are summarized. Conclusions note the role of environmental factors and need for improved immunization programs to control the disease.
Introduction: malignant syphilis is an uncommon form of secondary syphilis.This presentation usually occurs in immunocompromised patients, especially in those ones infected by human immunodeficiency virus (HIV). However, it is known that it might exceptionally affect individuals with normal immune response.
This case report describes an immunocompetent 30-year-old male patient who presented with widespread painful skin lesions and uveitis of the right eye. Laboratory tests initially were negative for syphilis but later tested positive, confirming the diagnosis of early malignant syphilis. Malignant syphilis is an uncommon form of secondary syphilis typically seen in immunocompromised individuals. However, this report describes the second known case of an immunocompetent patient presenting with both skin and ocular involvement. The patient was treated with intravenous ceftriaxone for 14 days and experienced an excellent clinical response.
This document discusses the clinical presentation and diagnosis of viral encephalitis. It notes that encephalitis involves inflammation of the brain parenchyma in addition to meningeal involvement seen in meningitis. Common symptoms include altered mental status, seizures, and focal neurological deficits. Diagnostic testing includes CSF analysis, which typically shows a lymphocytic pleocytosis, normal glucose, and mildly elevated proteins. CSF PCR and serology can help identify specific viral causes like herpes simplex virus or West Nile virus. Culture has limited utility while imaging is usually normal. Making a definitive diagnosis can be challenging and often the cause remains unknown.
This document discusses Japanese encephalitis (JE), a mosquito-borne viral disease. It provides background on JE, noting it is a leading cause of viral encephalitis in Asia. The purpose is to review potential new treatment approaches, as vaccines are available but the disease persists and outbreaks are challenging to predict. The virus life cycle and transmission between mosquitoes and pigs/birds is described. While some treatment trials have occurred, none have proven effective due to small sample sizes. The document discusses the virus pathogenesis and potential immunological targets for treatment, such as reducing inflammation. It reviews existing compounds with anti-JE activity in animal models that could be tested in humans.
This document discusses the management of neonatal sepsis and identifies areas of potential malpractice. It presents two case studies of neonates with sepsis that were potentially mismanaged. The document then outlines key topics to be covered, including features of neonatal sepsis, the role of CRP and procalcitonin in diagnosis, treatment planning considerations, controversies around certain drug uses, the role of blood exchange transfusions, and potential adjuvant therapies. Overall, the document aims to improve management of neonatal sepsis by revising basic knowledge around appropriate diagnosis and treatment.
This document discusses laboratory diagnosis of toxoplasmosis. It begins by outlining the high prevalence of toxoplasmosis in India, ranging from 15-57% depending on the region. It then describes the main diagnostic tests available, including antibody detection methods like dye test, ELISA, and western blot. It also covers detection of the parasite via microscopy, animal inoculation, and PCR. The document concludes by explaining applications of these tests for screening pregnant women, diagnosing congenital or neonatal infections, and identifying cerebral toxoplasmosis in immunocompromised patients.
This document discusses acute flaccid paralysis (AFP), including Guillain-Barré syndrome (GBS) and poliomyelitis. It provides information on the clinical assessment and investigations of different diseases that can cause AFP based on factors like onset of paralysis, progression, topography, and clinical features. Specific details are given on GBS and poliomyelitis like etiology, signs and symptoms, treatment, and immunization strategies for prevention. The importance of AFP surveillance is also highlighted as the standard for detecting polio cases and importation of wild poliovirus.
Poster on Psychosocial risk factors and musculoskeletal symptoms among nursesSiti Mastura
Nurses are at high risk of developing musculoskeletal symptoms due to the physical demands of their work including lifting, awkward postures, and transferring patients. This study examined the prevalence of musculoskeletal symptoms and relationship to psychosocial risk factors among nurses at Sultanah Bahiyah Hospital in Kedah, Malaysia. The results showed the highest prevalence of symptoms was in the upper back (70.6%), lower back (58%), and shoulders (55.9%). Most nurses reported high decision latitude, high job demands, good social support, high job insecurity, and job dissatisfaction. Social support and job insecurity were significantly associated with musculoskeletal symptoms. The findings suggest improving social support through team building and addressing job insecurity to help minimize
PSYCHOSOCIAL RISK FACTORS AND MUSCULOSKELETAL SYMPTOMS AMONG NURSESSiti Mastura
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
valuation of toxicological implications of inhalationexposure to kerosene fum...Siti Mastura
This document summarizes a study that evaluated the toxic effects of inhaling kerosene and petrol fumes in rats. The rats were exposed to the fumes for 4 hours per day over 2 weeks. Blood tests and liver tissue analysis were then used to assess liver damage. The study found that rats exposed to the fumes had significantly higher levels of liver enzymes (ALT, AST, ALP) and lipids (cholesterol, triglycerides) compared to unexposed rats, indicating liver dysfunction. Examination of liver tissues also revealed degenerative changes, supporting the biochemical results. The findings suggest that frequent exposure to kerosene and petrol fumes may be highly damaging to liver cells.
This guide provides an introduction to using SPSS 14. It includes instructions on starting SPSS, defining variables, entering data, computing new variables, selecting data subsets, and running basic statistical procedures such as frequencies, descriptives, and exploring normality. Key steps covered are creating variables in the Variable View window, entering data in the Data View window, using the Compute function to calculate a new "age" variable, selecting cases where age is less than 30, and analyzing the normality of a variable distribution through histograms, normal Q-Q plots, and Kolmogorov-Smirnov and Shapiro-Wilk tests of normality.
This document outlines the key elements of a model emergency preparedness plan for mining operations. It discusses the responsibilities of the mining company and the importance of engaging local communities, emergency response teams, and governments. The 10 steps of the UNEP APELL process for emergency planning are described. Case studies are referenced that illustrate how to effectively apply these principles of community involvement, hazard identification, emergency response training, and continuous improvement of emergency plans.
This document discusses principles of hazard tree risk management for wildland firefighters. It notes that falling trees remain a persistent threat and one of the leading causes of firefighter fatalities. The risk is determined by both the likelihood of a hazard occurring and the severity of potential consequences. Strategies are outlined for conducting strategic and tactical risk assessments to rate risk levels and implement appropriate mitigation measures to reduce risk to moderate or low levels where possible. Emergency response plans should also be in place to effectively respond if injuries do occur from hazard trees.
This document provides a report on firefighter training trends and hazards from the U.S. Fire Administration. It details several training incidents that resulted in injuries or near misses. It also summarizes training casualty data and discusses common hazards in training such as live fire exercises, physical stress, and unsafe practices. The report emphasizes the importance of following standards from the National Fire Protection Association and having proper safety protocols, qualified instructors, appropriate facilities, and medical support to reduce risks during firefighter training activities.
This document provides an overview of fault tree analysis (FTA):
1. FTA is a graphic method to identify the causes of failures or negative events in a system. It uses deductive reasoning to break down a negative event into its potential causes.
2. An FTA diagram uses symbols like rectangles, circles, and gates to represent events and their relationships. The analysis involves defining the negative event, understanding the system, constructing the tree, validating it, and evaluating alternatives.
3. The primary benefits of FTA are the meaningful data it produces to evaluate and improve system reliability. A limitation is that all significant failure contributors must be anticipated.
Guidelines for Incident Commanders- Final ReportFFPE Use in Chemical Agent VaporSiti Mastura
This document provides 3 levels of guidelines for incident commanders on the use of firefighter protective equipment during chemical agent rescue operations:
1. General guidelines provide maximum rescue time of 30 minutes for known living victims using standard turnout gear and SCBA, and 3 minutes for reconnaissance in unknown environments.
2. Representative exposure scenarios and test results in tables/graphs show protective performance of equipment in chemical environments.
3. Recommendations to reduce exposure time and agent concentrations, improve equipment, conduct pre-incident planning, and train responders to mitigate risks during rescue operations.
jurnal of occupational safety and healthSiti Mastura
The document summarizes an ergonomic study to optimize the design of a printing workstation. 4 factors were considered: the horizontal distance between the machine and worker (A), the vertical height of the work table (B), the vertical attitude of the material box (C), and the angle of the material box slope (D). The study used factorial experiments and response surface methodology to evaluate configurations based on 4 performance measures: cycle time, metabolic energy expenditure, worker posture, and lifting limitations. The results showed an optimized configuration (1121) reduced cycle time by 17.5% compared to the initial design, demonstrating how ergonomic optimization can improve productivity and working conditions.
The document describes several key microbiology techniques: 1) Aseptic technique for preventing contamination when transferring bacteria or collecting specimens. 2) Using inoculating loops to transfer bacterial colonies while flaming the loop to sterilize it. 3) Creating bacterial smears on slides by spreading suspensions to make thin films for staining. 4) Heat fixation to adhere bacteria to slides before staining. 5) Streaking loops of bacteria on agar plates to isolate single colonies.
Requirement and Technical Standard for Non Convention Cargo Siti Mastura
This document outlines technical requirements and standards for non-conventional cargo ships pertaining to safety, construction, radio, life saving appliances, and navigational aids. It includes 10 chapters that cover general provisions, inspections and surveys, construction and equipment, stability requirements, machinery installation, electrical installations, fire protection and extinction, life saving appliances, radio installations, and navigational equipment. The document provides definitions for key terms and sets minimum requirements for ships to obtain necessary certificates.
This document provides an overview of fault tree analysis, including its origins in 1962 for the US Air Force, how it is a graphical model of pathways leading to an undesirable loss event using logic symbols, and some key steps and rules in developing a fault tree analysis. It defines important terms like fault, failure, primary and secondary failures. It also illustrates some common logic symbols used and provides examples of potential top events to analyze.
Japanese Encephalitis is a mosquito-borne viral disease that affects the central nervous system. It is caused by the Japanese Encephalitis virus and transmitted via Culex mosquitoes. The virus is maintained in birds and pigs, which serve as amplifying hosts. While humans are incidental hosts, the disease can cause serious neurological illness. The document provides guidelines on the epidemiology, diagnosis, management, and prevention of Japanese Encephalitis in India.
This document presents a mathematical model of the spread of Japanese Encephalitis (JE) that couples SIRS models for the disease in both the reservoir population and human population. The model classifies populations into susceptible, infected, and removed classes. It derives equations to describe the dynamics and calculates the basic reproductive rate R0. The model shows that unlike other models, loss of immunity in this system is independent of exposure rate. It suggests passive immunization at recurrent intervals as the best control strategy to eradicate the disease.
Communication for behavioral impact(COMBI)Siti Mastura
The document describes a COMBI program in Malaysia to control dengue through community behavior change. The program was piloted in Hulu Langat, Selangor where most Aedes breeding occurred in semi-permanent water containers. 172 volunteers educated residents to check containers twice weekly and eliminate larvae. This reduced the Aedes Index from 5 to 0.96 over 16 weeks and dropped reported dengue cases in the area to 1. The COMBI approach successfully identified local breeding factors and engaged the community to potentially reduce disease transmission.
This document provides an overview of vector control in humanitarian emergencies. It describes the public health importance of vector-borne diseases among displaced populations, characterizes common disease vectors such as mosquitoes and flies, and defines approaches for developing context-appropriate vector control strategies. The document focuses on controlling vectors through methods like indoor residual spraying and larviciding, as well as safely monitoring vector control programs.
The nominal group technique (NGT) is a structured consensus-building process involving 4 steps: 1) individuals privately generate ideas in writing, 2) ideas are shared aloud and listed, 3) ideas are discussed one-by-one for clarity, and 4) ideas are ranked through anonymous voting to determine priorities. NGT encourages participation, prevents domination by any one person, and results in prioritized group recommendations. It is best used when gaining consensus from multiple stakeholders on priorities.
Debunking Nutrition Myths: Separating Fact from Fiction"AlexandraDiaz101
In a world overflowing with diet trends and conflicting nutrition advice, it’s easy to get lost in misinformation. This article cuts through the noise to debunk common nutrition myths that may be sabotaging your health goals. From the truth about carbohydrates and fats to the real effects of sugar and artificial sweeteners, we break down what science actually says. Equip yourself with knowledge to make informed decisions about your diet, and learn how to navigate the complexities of modern nutrition with confidence. Say goodbye to food confusion and hello to a healthier you!
The Children are very vulnerable to get affected with respiratory disease.
In our country, the respiratory Disease conditions are consider as major cause for mortality and Morbidity in Child.
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
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Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...Université de Montréal
“Psychiatry and the Humanities”: An Innovative Course at the University of Montreal Expanding the medical model to embrace the humanities. Link: https://www.psychiatrictimes.com/view/-psychiatry-and-the-humanities-an-innovative-course-at-the-university-of-montreal
PGx Analysis in VarSeq: A User’s PerspectiveGolden Helix
Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
Spontaneous Bacterial Peritonitis - Pathogenesis , Clinical Features & Manage...Jim Jacob Roy
In this presentation , SBP ( spontaneous bacterial peritonitis ) , which is a common complication in patients with cirrhosis and ascites is described in detail.
The reference for this presentation is Sleisenger and Fordtran's Gastrointestinal and Liver Disease Textbook ( 11th edition ).
1. Japanese encephalitis
surveillance standards*
January 2006
*From WHO-recommended standards for surveillance of
selected vaccine-preventable diseases
WHO/V&B/03.01
Complete document available online:
http://www.who.int/vaccines-documents/DocsPDF06/843.pdf
2. *From WHO-recommended standards for surveillance of selected vaccine-preventable diseases
Japanese encephalitis
FIELD TEST VERSION
Rationale for surveillance
Japanese encephalitis (JE) is a mosquito-borne viral encephalitis that occurs in
temperate and tropical regions of Asia and is maintained in a cycle of virus transmission
between vertebrate amplifying hosts (e.g. pigs, herons, egrets) and several Culex
mosquito species. The greatest transmission to humans occurs in rural settings,
particularly those in which agricultural practices increase the potential for breeding of
vectors or infection of vertebrate hosts. In urban settings, the potential for an outbreak of
JE is low, although transmission can occur. In recent decades, JE outbreaks have
occurred in areas previously non-endemic for the disease. The high case fatality rate
(20%–30%) and frequent residual neuropsychiatric damage in survivors (50%–70%) make
JE a major public health problem.
JE is the leading form of viral encephalitis in Asia, where about 50 000 cases and 10 000
deaths are reported each year, mostly among children. However, officially reported cases
of JE greatly under-represent the true impact, due to incomplete surveillance in many
affected areas. Among the control strategies, human vaccination has proven to be the
single most effective control measure.
Infection with Japanese encephalitis virus may be asymptomatic, or may cause febrile
illness, meningitis, myelitis or encephalitis. Encephalitis is the most commonly
recognized presentation, and is clinically indistinguishable from other causes of an acute
encephalitis syndrome (AES). Syndromic surveillance therefore aims to identify patients
with AES, and among these confirm JEV infection using standardized laboratory
techniques.
In most Asian countries, the epidemiology and public health burden of JE is poorly
understood. The primary goal of disease surveillance in these countries is to
characterize the epidemiology and burden of JE so as to advocate for and guide
programmatic interventions.
Where JE immunization is already ongoing, the primary purpose of surveillance is to
identify high-risk populations or geographic areas in need of improved vaccination
coverage and areas with new disease transmission, and to document the impact of
control measures.
In summary, JE surveillance is critical to characterize the epidemiology and burden of the
disease, identify high risk areas for appropriate public health response and document the
impact of control measures.
WHO/V&B/03.01 45
3. Japanese encephalitis (continued)
Recommended case definition
Clinical case definition
Clinically, a case of acute encephalitis syndrome is defined as a person of any age,
at any time of year with the acute onset of fever and a change in mental status
(including symptoms such as confusion, disorientation, coma, or inability to talk)
AND/OR new onset of seizures (excluding simple febrile seizures1 ). Other early clinical
findings may include an increase in irritability, somnolence or abnormal behaviour greater
than that seen with usual febrile illness.
Case classification
Suspected case: A case that meets the clinical case definition for AES.
Suspected cases should be classified in one of the following four ways (see Figure 1).
Laboratory-confirmed JE: A suspected case that has been laboratory-confirmed
as JE.
Probable JE: A suspected case that occurs in close geographic and temporal
relationship to a laboratory-confirmed case of JE, in the context of an outbreak.
“Acute encephalitis syndrome” – other agent: A suspected case in which diagnostic
testing is performed and an etiological agent other than JE virus is identified.
“Acute encephalitis syndrome” – unknown: A suspected case in which no
diagnostic testing is performed or in which testing was performed but no etiological agent
was identified or in which the test results were indeterminate.
Laboratory criteria for confirmation
Clinical signs of JE are indistinguishable from other causes of AES. Laboratory
confirmation is therefore essential for accurate diagnosis of JE.
Laboratory confirmation of a JE virus infection includes:
1. presence of JE virus-specific IgM antibody in a single sample of cerebrospinal fluid
(CSF) or serum,2 as detected by an IgM-capture ELISA specifically for JE virus;3
or any of the following:
2. detection of JE virus antigens in tissue by immunohistochemistry; OR
1
A simple febrile seizure is defined as a seizure that occurs in a child aged 6 months to less than 6 years old,
whose only finding is fever and a single generalized convulsion lasting less than 15 minutes, and who recovers
consciousness within 60 minutes of the seizure.
2
A serum sample should be obtained at admission. Because it may not yet be positive in a JE-infected person, a
second serum sample should be collected at discharge or on the 10th day of illness onset or at the time of death
and tested for presence of JE virus specific IgM.
3
Further confirmatory tests (e.g. looking for cross-reactivity with other flaviviruses circulating in the geographical
area) should be carried out: (a) when there is an ongoing dengue or other flavivirus outbreak; (b) when
vaccination coverage is very high; or (c) in cases in areas where there are no epidemiological and entomological
data supportive of JE transmission.
46 WHO-recommended standards for surveillance
4. Japanese encephalitis (continued)
Recommended case definition (continued)
3. detection of JE virus genome in serum, plasma, blood, CSF,4 or tissue by reverse
transcriptase polymerase chain reaction (PCR) or an equally sensitive and specific
nucleic acid amplification test; OR
4. isolation of JE virus in serum, plasma, blood, CSF,4 or tissue; OR
5. detection of a four-fold or greater rise in JE virus-specific antibody as measured by
haemagglutination inhibition (HI) or plaque reduction neutralization assay (PRNT) in
serum collected during the acute and convalescent phase of illness. The two
specimens for IgG should be collected at least 14 days apart. The IgG test should
be performed in parallel with other confirmatory tests to eliminate the possibility of
cross-reactivity, as indicated in footnote 3.
Note:
• The large majority of JE infections are asymptomatic. Therefore, in areas that are
highly endemic for JE, it is possible to have AES due to a cause other than JE
virus and have JE virus-specific IgM antibody present in serum. To avoid
implicating asymptomatic JE as the cause of other AES illnesses, sterile
collection and testing of a CSF sample from all persons with AES are
recommended when feasible.
• Only the first 5–10 JE cases of an outbreak need be confirmed through laboratory
testing. During periods of epidemic transmission of JE virus, laboratory
confirmation of every case may not be necessary.
Recommended types of surveillance
JE surveillance should be conducted year round. Where feasible, surveillance for and
reporting of JE should be performed within the context of integrated disease surveillance,
and linked synergistically with similar surveillance activities, such as those for acute
flaccid paralysis (AFP) or meningitis.
In all Asian countries
Comprehensive syndromic surveillance for acute encephalitis syndrome with aggregate
reporting is recommended. In sentinel hospitals, surveillance should be case-based with
specimens collected for laboratory confirmation.5 The number of sentinel hospitals can
be gradually increased if feasible logistically.
4
Detection of virus genome or virus isolation in serum, plasma or blood is very specific for JE diagnosis; however,
it is not sensitive as virus levels are usually undetectable in a clinically ill JE case. Therefore a negative result
by these methods should not be used to rule out JE in a suspected case. Similarly detection of virus genome or
virus isolation in CSF is usually only found in fatal cases and therefore not very sensitive and should not be used
for ruling out a diagnosis of JE.
5
During epidemics, laboratory testing can be limited to confirmation of the first 5–10 cases per geographic area per
epidemic.
WHO/V&B/03.01 47
5. Japanese encephalitis (continued)
Recommended types of surveillance (continued)
In Asian countries where a high level of JE control has been achieved
Surveillance should be case-based throughout the country and include laboratory
confirmation of all suspect cases.
Regardless of the type of surveillance, reporting should be weekly or monthly and include
“zero-reporting” (i.e. no blanks should be left in the reporting forms, a zero should be
indicated when there are no cases detected). Outbreak investigations should be initiated
if there is a sudden increase in cases or if cases reported are different from historical
information, in terms of season, geographical area, age group, or case fatality.
Recommended minimum data elements
Aggregated data
The recommended elements for aggregated data are:
• number of cases and deaths by week/month
• number of cases by age group, sex and immunization status
• number of cases by state/province.
Case-based data
The recommended elements for case-based data are:
• unique identifier
• age
• sex
• geographical area
• travel history over the past two weeks
• whether ever immunized against JE; 1 = yes; 2 = no; 9 = unknown
• If yes, number of doses administered
• if yes, type of JE vaccine (most recently received)
• date of last JE immunization
• date of onset of first symptoms
• fever: 1 = yes; 2 = no; 9 = unknown
• change in mental status; 1 = yes; 2 = no; 9 = unknown
• seizure: 1 = yes; 2 = no; 9 = unknown
• date CSF sample taken
• date serum sample 1 taken
• date serum sample 2 taken
• autopsy specimen taken: 1 = yes; 2 = no; 9 = unknown
• clinical diagnosis: ___________________
48 WHO-recommended standards for surveillance
6. Japanese encephalitis (continued)
Recommended minimum data elements (continued)
Depending on which laboratory tests used for serum or CSF:
• IgM serum 1 results: 1 = positive; 2 = negative; 3 = not tested; 9 = unknown
• IgM serum 2 results: 1 = positive; 2 = negative; 3 = not tested; 9 = unknown
• IgM CSF results: 1 = positive; 2 = negative; 3 = not tested; 9 = unknown
• virus detection (PCR, virus isolation, immunohistochemistry) results:
1 = positive; 2 = negative; 3 = not tested; 9 = unknown
• HI or PRNT results on acute and convalescent sera: 1 = positive (4 fold rise or
greater); 2 = negative (<4 fold rise); 3 = not tested; 9 = unknown
• date serum 1 results reported
• date serum 2 results reported
• date CSF results reported
• date virus detection results reported
• final classification: 1= laboratory confirmed JE; 2= probable JE; 3 = AES unknown;
4 = AES other agent
• status at discharge: 1 = alive; 2 = dead; 9 = unknown
• date of death or discharge.
Recommended data analyses, presentations, reports
Aggregated data
The recommended elements for aggregated data are:
• number and incidence of suspected cases by week, month, year, age group, and
geographic area;
• number and incidence of confirmed cases by week, month, year, age group, and
geographic area;
• JE vaccine coverage by year and geographical area;
• percentage of cases vaccinated and unvaccinated; and
completeness/timeliness of monthly reporting by geographical area.
Case-based data
The recommended elements for case-based data are the same as those for aggregated
data plus the following:
• suspected and confirmed cases – age-specific, gender-specific, geographic area-
specific, and immunization status-specific incidence;
• percentage of suspected cases with CSF and/or serum specimens;
• percentage of cases with serum 10 or more days after onset of illness (when testing
methodology is IgM-capture ELISA);
• case fatality ratio;
• final classification of all suspect cases; and
• proportion of AES attributed to JE.
WHO/V&B/03.01 49
7. Japanese encephalitis (continued)
Recommended data analyses, presentations, reports (continued)
Performance indicators of surveillance quality
The following targets are for countries with a well established AES surveillance system
(Table 1 and Table 2). Countries commencing with JE surveillance may set intermediate
targets.
Table 1: Targets for countries with established surveillance systems
Indicator Target
Completeness of monthly reporting > 90%
Timeliness of monthly reporting > 80%
Percentage of serum samples taken > 80%
a minimum of 10 days after onset
(When the testing methodology is
IgM-capture ELISA)
In countries where a high level of JE control has been achieved, the following indicators
can be helpful as managerial tools to identify areas where corrective action is needed
(Table 2).
Table 2: Indicators to assist corrective action
Indicator Target
Percentage of all suspect cases for > 80% a
which specimens were collected
Percentage of CSF/serum samples > 80%
reaching laboratory in adequateb condition
For all tests, laboratory results reported > 80%
< 1 month after receipt specimen
a
Only applicable for countries doing nationwide case-based surveillance.
b
“Adequate condition” means the specimen is transported using reverse cold chain.
50 WHO-recommended standards for surveillance
8. Japanese encephalitis (continued)
Principal uses of data for decision-making
The principal uses for decision-making are to:
• guide policy and strategies on JE control;
• assess the impact of vaccination;
• identify geographic areas or populations at high risk to further guide where
immunization coverage should be improved;
• monitor the performance of surveillance;
• monitor the performance of the laboratory; and
• monitor vaccine efficacy.
Special aspects
For persons vaccinated with Japanese encephalitis vaccine within six months of illness
onset, testing a single serum sample for Japanese encephalitis IgM may not be
diagnostic because it may give a false positive result. In such cases, a diagnosis can
only be confirmed by demonstrating JE IgM in the CSF, JE virus isolation, a positive
nucleic acid amplification test, immunohistochemistry, or a four-fold or greater rise in
antibody titre in acute and convalescent phase serum samples.
Efforts should be made to identify other causes of AES. As a general rule, persons with
acute encephalitis should undergo a lumbar puncture to obtain CSF to identify other
treatable agents that may result in an illness that manifests as acute encephalitis
syndrome. CSF with WBC = 1000/mm3 is unlikely to be due to Japanese encephalitis or
any other arbovirus; in these cases, bacterial causes of purulent meningitis such as
Haemophilus influenzae, Neisseria meningitidis, or Streptococcus pneumoniae should be
considered. In malaria-transmission areas, malaria testing should be carried out to rule
out cerebral malaria. Health care providers should also rule out herpes encephalitis, if
possible, as it is a treatable cause of AES.
Figure 1: Final classification scheme for AES cases a
Other
diagnostic tests AES other agent
IgM -ve AES unknown
Adequate blood/
CSF specimen
IgM +ve Lab-confirmed JE
Suspected JE (AES)
Geographic / temporal
Probable JE
No adequate blood/ link to lab-confirmed JE
CSF specimen during an outbreak
No geographic / temporal
link to lab-confirmed JE AES unknown
a
A suspected case of JE can also be a suspected case of bacterial meningitis (see bacterial meningitis section for
definitions). In this event, a CSF/blood sample should be sent to both bacteriology and virology laboratories to
allow rapid and appropriate case management and classification.
WHO/V&B/03.01 51