Comparison of Models Analyzing a Small Number of Observed Meningitis Cases in Navrongo, Ghana.

The "meningitis belt" is a region in sub-Saharan Africa where annual outbreaks of meningitis occur, with epidemics observed cyclically. While we know that meningitis is heavily dependent on seasonal trends, the exact pathways for contracting the disease are not fully understood and warrant further investigation. Most previous approaches have used large sample inference to assess impacts of weather on meningitis rates. However, in the case of rare events, the validity of such assumptions is uncertain. This work examines the meningitis trends in the context of rare events, with the specific objective of quantifying the underlying seasonal patterns in meningitis rates. We compare three main classes of models: the Poisson generalized linear model, the Poisson generalized additive model, and a Bayesian hazard model extended to accommodate count data and a changing at-risk population. We compare the accuracy and robustness of the models through the bias, RMSE, and standard deviation of the estimators, and also provide a detailed case study of meningitis patterns for data collected in Navrongo, Ghana.

Interaction of prenatal exposure to cigarettes and MAOA genotype in pathways to youth antisocial behavior.

Genetic susceptibility to antisocial behavior may increase fetal sensitivity to prenatal exposure to cigarette smoke. Testing putative gene x exposure mechanisms requires precise measurement of exposure and outcomes. We tested whether a functional polymorphism in the gene encoding the enzyme monoamine oxidase A (MAOA) interacts with exposure to predict pathways to adolescent antisocial behavior. We assessed both clinical and information-processing outcomes. One hundred seventy-six adolescents and their mothers participated in a follow-up of a pregnancy cohort with well-characterized exposure. A sex-specific pattern of gene x exposure interaction was detected. Exposed boys with the low-activity MAOA 5' uVNTR (untranslated region variable number of tandem repeats) genotype were at increased risk for conduct disorder (CD) symptoms. In contrast, exposed girls with the high-activity MAOA uVNTR genotype were at increased risk for both CD symptoms and hostile attribution bias on a face-processing task. There was no evidence of a gene-environment correlation (rGE). Findings suggest that the MAOA uVNTR genotype, prenatal exposure to cigarettes and sex interact to predict antisocial behavior and related information-processing patterns. Future research to replicate and extend these findings should focus on elucidating how gene x exposure interactions may shape behavior through associated changes in brain function.

Detection of gastrointestinal and abdominal infections by 99mTc-ciprofloxacin.

BACKGROUND/AIMS: The aim of the study is detection and evaluation of the abdominal and gastrointestinal infective foci using 99mTc-ciprofloxacin (Laboratory for radioactive isotopes, Vinca). METHODOLOGY: In total 21 patients with clinical suspicion on abdominal or gastrointestinal infection were investigated. In all the patients, planar liver/spleen scintigraphy was performed. Ciprofloxacin chloride (3.5 mg) was mixed with 555 MBq of 99mTc in 3 mL of physiological solution and incubated for 20 min. After slow i.v. injection in a cubital vein, dynamic acquisition (1 f/min) was performed during the first 60 min in the position of interest, followed by static acquisition (500,000 imp) anterior and posterior view, abdomen and pelvis after 1 h and 4 h in all patients. When necessary, additional scintigrams were acquired after 24 h. In all the patients with negative or equivocal findings of planar scintigraphy, emission computerized tomography (SPECT) was performed (60 positions, 6 degrees). Interpretation was made by three independent observers. Additional data were provided using clinical findings, ultrasonography, computed tomography and magnetic resonance imaging, laboratory analyses, and surgical or microbiological confirmation of infection. RESULTS: There were eleven true-positive findings, seven true negative, two were false negative while one was false positive due to intestinal obstruction. Sensitivity was 79%, specificity 91%, positive predictive value 92%, negative predictive value 77%, accuracy 84%. CONCLUSIONS: According to our results, scintigraphy with radiolabeled ciprofloxacin is a useful method for detection and assessment of exact localization of abdominal and gastrointestinal infections.

Research hurdles complicating the analysis of infertility treatment and child health.

Research aimed at the empirical evaluation of infertility treatment including assisted reproductive technologies (ART) on child health and development is hampered by investigators' inability to methodologically separate possible treatment effects from underlying fecundity impairments. While the literature continues to identify ART as a risk factor for many child health outcomes, less attention has been paid to the methodologic rigor needed to answer this question. We identify aspects of fecundity and the nuances of medical practice that need to be considered and captured when designing epidemiologic investigations aimed at assessing ART and child health. These include: (i) the use of prospective study designs in which the unit of analysis (cycle versus individual versus couple) is defined; (ii) data collection on relevant time-varying covariates at, before and during treatment; and (iii) the use of statistical techniques appropriate for hierarchical data and correlated exposures. While none of these issues in and by itself is unique to ART research, attention to these issues has been lacking in much of the published research limiting our ability to evaluate health consequences for children. Longitudinal studies of children conceived with ART will benefit from attention to these issues and, hopefully, produce answers to lingering questions about safety.

[Iatrogenic perforations of the esophagus and hypopharynx--5 year experience at the Center for Esophageal Surgery]. / Jatrogene perforacije jednjaka i hipofarinksa--petogodisnje iskustvo Centra za hirurgiju jednjaka.

Iatrogenic perforations of the esophagus and hypopharynx are important problem, due to diagnostic difficulties, controversies about adequate treatment, and high morbidity and mortality rate. Incidence of iatrogenic perforations is from 50 to 75% of all perforations. In the period from April 1999. to April 2004, 15 patients with iatrogenic perforation of the esophagus and hypopharynx were treated at the Department of esophageal surgery, First University Surgical Hospital in Belgrade. In majority of patients iatrogenic perforation occured during endoscopic interventional procedure (endoscopic removal of ingested foreign body--10 pts, endotracheal intubation--2 pts, intraoperative iatrogenic perforation--2 pts, pneumatic dilatation--1 pt). Surgical treatment was performed in 12 (80%) pts and 3 (20%) pts were treated conservatively. Surgical approach was cervicoabdominal, thoracoabdominal and cervicothoracoabdominal in 9.1 and 2 pts, respectively. Among 12 operated pts, primary repair of the esophagus was performed in 5 pts, and esophageal resection or exclusion in 7 pts. Overall mortality rate was 13.3% (2 pts), in surgical group 8.3% (1 pt) and in conservatively treated group 33.3% (1 pt). Iatrogenic perforations of the esophagus and hypopharynx are diagnostic and therapeutic problem. Awareness of the possibility of esophageal perforation during instrumental manipulations and early diagnosis is essential for successful, individually adapted, and in most cases surgical, treatment.

Meta-analysis of diagnostic test accuracy assessment studies with varying number of thresholds.

Current meta-analytic methods for diagnostic test accuracy are generally applicable to a selection of studies reporting only estimates of sensitivity and specificity, or at most, to studies whose results are reported using an equal number of ordered categories. In this article, we propose a new meta-analytic method to evaluate test accuracy and arrive at a summary receiver operating characteristic (ROC) curve for a collection of studies evaluating diagnostic tests, even when test results are reported in an unequal number of nonnested ordered categories. We discuss both non-Bayesian and Bayesian formulations of the approach. In the Bayesian setting, we propose several ways to construct summary ROC curves and their credible bands. We illustrate our approach with data from a recently published meta-analysis evaluating a single serum progesterone test for diagnosing pregnancy failure.

Doppler information pertaining to the intrapartum period.

The aim of the study was to evaluate the use of color-Doppler velocimetry during the labor. 325 intrapartal measurements of the umbilical artery, fetal aorta, middle cerebral artery and arcuate arteries were performed in a group of 105 patients. The resistance index (RI) and pulsatility index (PI) were measured. During the active labor the RI and PI of the umbilical artery remained unchanged. The impedance in arcuate arteries have increased (p < 0.05). The RI and PI of the middle cerebral artery showed non significantly increased mean values when compared with the corresponding values during pregnancy. But, a short term, transitory decreased impedance is registered during the decrement slope of contraction. Since fetal outcome was normal in all newborns, these changes are considered as physiologic.

[Experience of the surgical service and surgeons at the 1st Surgical Clinical Center in Belgrade in the primary care of abdominal war injuries 1991-1992]. / Iskustvo hirurskih ekipa i hirurga I Hirurske klinike Klinickog centra u Beogradu u primarnom zbrinjavanju ratnih povreda abdomena 1991-1992]

During the recent (1991/92) war on the territory of the former Yugoslavia, 12 of our surgeons participated in the treating of war abdominal injuries, on 8 localities with the various characteristics of combat. Treating all injuries, with adequate evidence and documentation, the general experience of all participants of our team was that abdominal injuries range from 0-12% depending on the the intensity of combat, with the mean percentage of 5.43% while combined injuries approximate 50% with the most common injuries of extremities (24%). The number of laparotomies was 65. The most common cause of abdominal injuries were bullets (75%) except in the localities with heavy combat where the explosive and bullet woundings were equally observed. The blast injuries were recorded in 3%. The most common injured organs were large (29.5%), small intestine (23.46%) liver, stomach and spleen subsequently. The severity of injury and mortality depends mostly of the number of injured organs, and multiorgan lesions were systematically observed (1.89 of injured organs SD 0.96). The total hospital mortality was 6.15% (4 cases: 2 "in tabula" and 2 later) due to multiorgan injuries with severe shock and bleeding. To achieve better results, early transportation to a place where operation could be made is necessary, with the effective first aid and good organisation of the initial management and triage. The diagnosis must be fast and effective, decision quick and the operation must deal with all the injuries primary, by the most safe surgical procedure, with the exposition of external wound.

[Recurrent varices after surgical treatment]. / Rekurentni variksi posle hirurskog lecenja.

Authors showed 240 patients with post-surgical, recidive varices. The cause of these varices were: perforators incompetentions, bad safeno-femoral deconnection, non extirpated collateral veins etc. Diagnosis of these complications is based upon Doppler and phlebographic examinations. Surgical treatment is based upon pathophysiological and pathoanatomic substrate (extirpation varices, subfascial ligature or discision perforators, etc).

[Subfascial discission--the method of choice in the treatment of insufficiency of the perforant veins and venous ulcer]. / Subfascijalna discizija--metoda izbora u lecenju insuficijentnih perforatora i venskih ulkusa.

Authors described operative method of subfascial discision of perforators by the use special phlebotomy for it. Intrahospital (517 legs) and long term (76 patients) was analyzed. The operation with subfascial discision of perforators has shown the best results compared with the ligature and resection these veins.

[Local tissue changes in venous ulcers of the leg]. / Lokalne tkivne promene u "ulcus venosum cruris-u".

Authors investigated anaerobic metabolites (lactate, pyruvate), gas analyzes, pathohistological changes (light and electron microsc.) and regulatory agents in the local blood of venous ulcers. The cause of anaerobic disturbance is hypoxia and hypercapnia (hypostatic ulcers) and pathologic vasodilatation and arteriolo-venules shunts (postthrombotic ulcers). Pericapillary fibrin deposition aggravate tissue necrosis and destructions.