Epidemic of Japanese Encephalitis has occurred in Andhra Pradesh during October-November, 1999 affecting 15 out of 23 districts. In total, 873 cases with 178 deaths have been recorded up to the day 29.11.99. The epidemiological investigation has been done in Anantapur district in western Andhra Pradesh, where the outbreak has started in the third week of October. In the district 47 PHC have been affected. On an average 4.5 per cent of 3175 villages have been affected. Average number of cases per affected village have been 1.5. Rural population has been primarily affected. Age groups 1-14 years including infants have been affected but nearly 86.8% of cases have been among 1-9 year age group. The overall case fatality rate has been 18.4 per cent. Clinical features have been high fever, headache, altered sensorium, convulsions and coma. A marked seasonal onset of a few cases per village and 93.75 per cent of human serum samples collected from hospitalised cases showed the evidence of J.E. virus infection indicating that the present outbreak was due to JE virus. High density of Culex vishnui complex mosquitoes has been observed in the area. All the environmental and ecological conditions, temperature, rainfall and relative humidity have been in favour of JE transmission. Analysis of the data for the last 10 years showed that the human JE cases occurred in Anantapur in September-October months, which shifted to October-November, 99. Prolonged draught conditions were observed till October. Possibly the delayed monsoon and congenial atmospheric conditions after monsoon were favourable to the vector species for extra-human cycle of transmission in 1999. Low level transmission leading to small number of cases continued during the succeeding years every September-October till the present epidemic. In all 24 PHCs and urban towns were identified with 212 cases and 39 deaths till 29.11.99.
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N Engl J Med
August 2019
From the Department of Pediatrics, Yale University, New Haven, CT (W.V.T.); Pediatric Endocrinology, Angeles Hospital of Puebla, Puebla City, Mexico (M.B.-P.); Novo Nordisk, Søborg, Denmark (U.F., H.F.-L.); the Diabetes and Endocrinology Unit, Department of Paediatrics, Cairo University, Cairo (M.H.); Novo Nordisk, Plainsboro, NJ (P.M.H.); the Department of Paediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (M.Y.J.); Novosibirsk Medical University, Novosibirsk, Russia (M.K.); the Division of Pediatric Endocrinology and Diabetes, UPMC Children's Hospital of Pittsburgh, Pittsburgh (I.L.); University of Texas Health Science Center at San Antonio, San Antonio (J.L.L.); the Diabetes Research Society, Hyderabad, India (P.R.); the Endocrinology, Diabetes and Metabolism Institute, Rambam Health Care Campus, Haifa, Israel (N.S.); the Department of Pediatrics, Subdivision of Endocrinology and Diabetes, Marmara University School of Medicine, Istanbul, Turkey (S.T.); the Department of Pediatrics, Paracelsus Medical University, Salzburg, Austria (D.W.); and the Institute of Cancer and Genomic Sciences, University of Birmingham, and Birmingham Women's and Children's Hospital, Birmingham, United Kingdom (T.B.).
Background: Metformin is the regulatory-approved treatment of choice for most youth with type 2 diabetes early in the disease. However, early loss of glycemic control has been observed with metformin monotherapy. Whether liraglutide added to metformin (with or without basal insulin treatment) is safe and effective in youth with type 2 diabetes is unknown.
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Department of Family Medicine, Department of Health, Mpumalanga, Middelburg, 1050, South Africa.
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