Neonatal posterior fossa haemorrhage associated with vacuum extractor.

We report one case of posterior fossa intracranial haemorrhage in a full-term Malay baby boy following vacuum assisted delivery. The patient, a term baby boy was delivered by a vacuum extraction and later developed signs of increased intracranial pressure 72 hours after birth. Computed tomography (CT) of the brain showed a posterior fossa intracranial haemorrhage with acute obstructive hydrocephalus.

A note on parameter estimation for variant Creutzfeldt-Jakob disease epidemic models.

A recent series of papers has raised issues regarding estimation of the key epidemiological parameters of variant Creutzfeldt-Jakob disease (vCJD) from fitting survival models to case data. In particular, it was stated that the scale of the epidemic cannot be estimated and must be fixed in any analysis. We show that this problem is an artefact of the approximate likelihood used in these papers to facilitate model-fitting, and is not a concern if estimation is based on the full likelihood.

Seroprevalence of IgG antibodies to SARS-coronavirus in asymptomatic or subclinical population groups.

We systematically reviewed the current understanding of human population immunity against SARS-CoV in different groups, settings and geography. Our meta-analysis, which included all identified studies except those on wild animal handlers, yielded an overall seroprevalence of 0.10% [95% confidence interval (CI) 0.

The effect on treatment comparisons of different measurement frequencies in human immunodeficiency virus observational databases.

Data collected in a routine clinical setting are frequently used to compare antiretroviral treatments for human immunodeficiency virus (HIV). Differences in the frequency of measurement of HIV RNA levels and CD4-positive T-lymphocyte cell counts introduce a possible source of bias into estimates of the difference in effectiveness between treatments. The authors investigated the size of this bias when survival analysis methods are used to compare the initial efficacy of antiretroviral regimens.

Preliminary report on spiegelberg pre and post-operative monitoring of severe head-injured patients who received decompressive craniectomy.

The monitoring of craniospinal compliance is uncommonly used clinically despite it's value. The Spiegelberg compliance monitor calculates intracranial compliance (C = deltaV/deltaP) from a moving average of small ICP perturbations (deltaP) resulting from a sequence of up to 200 pulses of added volume (deltaV = 0.1 ml, total V = 0.

Developing a realistic sexual network model of chlamydia transmission in Britain.

Background: A national chlamydia screening programme is currently being rolled out in the UK and other countries. However, much of the epidemiology remains poorly understood. In this paper we present a stochastic, individual based, dynamic sexual network model of chlamydia transmission and its parameterisation.

Aorto-bronchial fistula following aortic and bronchial stenting of a thoracic aneurysm.

A 66-year-old man underwent repair of an abdominal aortic aneurysm and synchronous stenting of a thoracic aneurysm compressing his left main bronchus. This resulted in further bronchial compression which was also stented. An aorto-bronchial fistula resulting in severe haemoptysis occurred a few weeks later.

Stimulated release of exogenous GABA and glutamate from cerebral cortical synaptosomes and brain slices by bis(acetato)tetrakis(imidazole) copper(II) complex.

In these experiments we have tested the effect of bis(acetato)tetrakis (imidazole) copper(II) on the release and uptake of 14C-GABA and 3H-glutamate from brain slices and brain cortical synaptosomes. Cu(OAc)2(Im)4 in concentrations ranging from 1 to 100 microM has increased the release of GABA and glutamate from brain slices and synaptosomal preparations in a dose-related manner when the effect on GABA release is two-fold greater than glutamate and 10-fold greater than alanine. Pretreatment with a GABA uptake inhibitor such as 1-2 mM nipecotic acid has no effect on 14C-GABA release, whereas hydroxy aspartate, the glutamate uptake inhibitor, has elevated the stimulated release of glutamate.

Mortality in patients with successful initial response to highly active antiretroviral therapy is still higher than in non-HIV-infected individuals.

Mortality in HIV-infected patients has decreased dramatically since the introduction of highly active antiretroviral therapy (HAART). We analyzed progression to death in a population of 3678 antiretroviral treatment-naive patients from the ATHENA national observational cohort from 24 weeks after the start of HAART. Mortality was compared with that in the general population in the Netherlands matched by age and gender.

Methods for estimating the case fatality ratio for a novel, emerging infectious disease.

During the course of an epidemic of a potentially fatal disease, it is important that the case fatality ratio be well estimated. The authors propose a novel method for doing so based on the Kaplan-Meier survival procedure, jointly considering two outcomes (death and recovery), and evaluate its performance by using data from the 2003 epidemic of severe acute respiratory syndrome in Hong Kong, People's Republic of China. They compare this estimate obtained at various points in the epidemic with the case fatality ratio eventually observed; with two commonly quoted, naïve estimates derived from cumulative incidence and mortality statistics at single time points; and with estimates in which a parametric mixture model is used.

Giant nerve sheath tumour: report of six cases.

Giant nerve sheath tumour is a rare tumour originating from the nerve sheath. It differs from the conventional nerve sheath tumour only by the size these tumours can reach. There are two main type of tumours that occur in the nerve sheath which include neurofibroma and schwannoma.

Gender difference in HIV-1 RNA viral loads.

Objectives: To test and characterize the dependence of viral load on gender in different countries and racial groups as a function of CD4 T-cell count.

Methods: Plasma viral load data were analysed for > 30,000 HIV-infected patients attending clinics in the USA [HIV Insight (Cerner Corporation, Vienna, VA, USA) and Plum Data Mining LLC (East Meadow, NY, USA) databases] and the Netherlands (Athena database; HIV Monitoring Foundation, Amsterdam, Netherlands). Log-normal regression models were used to test for an effect of gender on viral load while adjusting for covariates and allowing the effect to depend on CD4 T-cell count.

Patterns of sex worker-client contacts and their implications for the persistence of sexually transmitted infections.

Sex workers (SWs) and their clients are often identified as being central in transmission of sexually transmitted infections (STIs). Little is known about how patterns of contact between SWs and their clients influence the persistence of STIs. We developed an individual-based simulation model to explore how variation in number of client contacts per SW, whether clients repeatedly visited the same SW, and the relative sizes of the SW and client populations influence the endemic prevalence of gonorrhea and herpes simplex virus type 2 infection.

[Establishment and analysis of a log to record scorpion stings in Morocco].

Within the framework of a strategy against scorpion stings, an information system was established to track the indicators of morbidity and mortality caused by scorpion stings. The study of these indicators was carried out based upon a national record of scorpion stings. During the year 2001, 15,571 cases of scorpion stings were reported, that translates into an incidence rate of 1.

A comparison of foetal and labour outcomes in Caucasian and Afro-Caribbean women with diabetes in pregnancy.

Materno-foetal complications have an increased prevalence in pregnancies complicated by diabetes. Ethnicity and cultural background may further affect these outcomes. In this study, we compared labour and foetal outcomes in Afro-Caribbean and Caucasian women with diabetes in pregnancy, using the Birmingham computerised database of diabetes in pregnancy.

Real-time epidemiology: Understanding the spread of SARS.

Fitting transmission models to outbreak data allows key epidemiological parameters to be estimated and the impact of control measures to be evaluated. and describe the use of such models in the 2003 SARS epidemic in Hong Kong.

Epidemiological and genetic analysis of severe acute respiratory syndrome.

The severe acute respiratory syndrome (SARS) epidemics in 2002-2003 showed how quickly a novel infectious disease can spread both within communities and internationally. We have reviewed the epidemiological and genetic analyses that have been published both during and since these epidemics, and show how quickly data were collected and analyses undertaken. Key factors that determine the speed and scale of transmission of an infectious disease were estimated using statistical and mathematical modelling approaches, and phylogenetic analyses provided insights into the origin and evolution of the SARS-associated coronavirus.

The epidemiology of severe acute respiratory syndrome in the 2003 Hong Kong epidemic: an analysis of all 1755 patients.

Background: As yet, no one has written a comprehensive epidemiologic account of a severe acute respiratory syndrome (SARS) outbreak from an affected country.

Objective: To provide a comprehensive epidemiologic account of a SARS outbreak from an affected territory.

Design: Epidemiologic analysis.

Effect of bis(acetato)tetrakis(imidazole) copper(II) in delaying the onset and reducing the mortality rate of strychnine- and thiosemicarbazide- induced convulsions.

The anticonvulsant activity of bis(acetato)tetrakis(imidazole) copper(II), Cu(OAc)2(Im)4, was studied in normal mice using chemical convulsions induced by strychnine, thiosemicarbazide, picrotoxin, and pentelenetetrazol. Intraperitoneal administration of Cu(OAc)2(Im)4, 50 mg/kg body mass, has delayed the onset of strychnine (3 mg/kg)-induced convulsion by 204% (p < or = 0.005) and thiosemicarbazide (20 mg/kg)-induced convulsant by 61% (p < or = 0.

SARS-CoV antibody prevalence in all Hong Kong patient contacts.

A total of 1,068 asymptomatic close contacts of patients with severe acute respiratory (SARS) from the 2003 epidemic in Hong Kong were serologically tested, and 2 (0.19%) were positive for SARS coronavirus immunoglobulin G antibody. SARS rarely manifests as a subclinical infection, and at present, wild animal species are the only important natural reservoirs of the virus.

Use of observational data in evaluating treatments: antiretroviral therapy and HIV.

Observational data are increasingly used in various therapeutic areas to evaluate the use, effectiveness and side effects of new treatments. Whilst randomized clinical trials remain the gold standard for evaluating the efficacy of new agents, they have a number of limitations for HIV, including the limited number of combinations that are compared and the costs of long-term follow-up. Observational data from seroconverter and clinical cohorts have been used to compare the short- and longer-term effectiveness of different therapy combinations and to evaluate the longer-term risks associated with antiretroviral therapy.

Investigating ethnic inequalities in the incidence of sexually transmitted infections: mathematical modelling study.

Objectives: To investigate ethnic differences in rates of gonorrhoea using empirical sexual behaviour data in a simple mathematical model. To explore the impact of different intervention strategies in this simulated population.

Methods: The findings from cross sectional studies of gonorrhoea rates and sexual behaviour in three ethnic groups in south east London were used to determine the parameters for a deterministic, mathematical model of gonorrhoea transmission dynamics, in a population stratified by sex, sexual activity (rate of partner change), and ethnic group (white, black African, and black Caribbean).

Epidemiology, transmission dynamics and control of SARS: the 2002-2003 epidemic.

This paper reviews current understanding of the epidemiology, transmission dynamics and control of the aetiological agent of severe acute respiratory syndrome (SARS). We present analyses of data on key parameters and distributions and discuss the processes of data capture, analysis and public health policy formulation during the SARS epidemic are discussed. The low transmissibility of the virus, combined with the onset of peak infectiousness following the onset of clinical symptoms of disease, transpired to make simple public health measures, such as isolating patients and quarantining their contacts, very effective in the control of the SARS epidemic.

Outcome of severe traumatic brain injury: comparison of three monitoring approaches.

The determination of cerebral perfusion pressure (CPP) is regarded as vital in monitoring patients with severe traumatic brain injury. Besides indicating the status of cerebral blood flow (CBF), it also reveals the status of intracranial pressure (ICP). The abnormal or suboptimal level of CPP is commonly correlated with high values of ICP and therefore with poor patient outcomes.