Soil transmitted helminth infection in primary school children varies with ecozone in the Ngorongoro Conservation Area, Tanzania.

BACKGROUND: Soil-transmitted helminthiasis is a neglected tropical disease, thriving in environments of poverty and disadvantage. Our objective was to determine the prevalence and intensity of four soil transmitted helminths (STH) among primary school children in the Ngorongoro Conservation Area (NCA), Tanzania. METHODS: A cross-sectional study was performed between May 15th and June 2nd, 2014. Six of 20 primary schools were chosen, based on elevation, designated low elevation ecozone (LEE) or high elevation ecozone (HEE). A total of 340 children from standards one to four were recruited. Height and weight of each child was determined and body mass index (BMI) was calculated. Stool samples were analyzed using the Kato-Katz, Wisconsin, and Baermann techniques to detect STH eggs and larvae. An interviewer-administered questionnaire on socio-demographic variables was used to capture information from the school's headmaster and a checklist was used to assess sanitation facilities. RESULTS: STHs identified included Ascaris (presumably lumbricoides), Trichuris (presumably trichiura), hookworms (presumably Ancylostoma duodenale and/or Necator americanus), and Strongyloides (presumably stercoralis). The overall prevalence of STH infection was 29.0% in LEE and 34.0% in HEE. Prevalence was 34.3% and 28.2% in males versus females, respectively. Ascaris sp. were only identified in HEE, prevalence of Trichuris sp. and hookworms were significantly higher in HEE compared to LEE, and Strongyloides spp. prevalence was lower in HEE. Intensity of Trichuris sp. was significantly higher in HEE and lower for hookworms. We did not detect a significant relationship between BMI and helminth intensity; however, BMI was lower in lower elevations and in males vs. females. Sanitation practices are taught at the schools, but challenges were identified when implementing. Latrine facilities were available and latrine-cleaning routines were practiced; however, hand washing practices were challenging due to restricted water availability. CONCLUSIONS: Significant differences in prevalence in HEE and LEE exist, and STH infections are still very common among school children suggesting that anthelminthic intervention and education may be necessary in this region. Based on this outcome, the study area in the NCA would be classified as a medium risk area, where periodic treatment recommendations should be based on prevalence estimations in the different ecozones. TRIAL REGISTRATION: Ethics approval was obtained from the Catholic University of Health and Allied Sciences (CUHAS; Lake Zone Institutional Review Board MR/53/100/307)); the Conjoint Health Research Ethics Board (CHREB) at the University of Calgary in Canada (Study ID REB14-0127); the National Institute of Medical Research (NIMR) of Tanzania; and the Tanzania Commission for Science and Technology (COSTEC).

The dynamics of travel avoidance: The case of Ebola in the U.S.

The study examined factors that influenced Americans' avoidance of domestic travel due to confirmed cases of Ebola in the United States in late 2014. The Health Belief Model served as a theoretical framework for the study. Data were generated from 1613 Americans from an online survey. Perceived susceptibility and self-efficacy were found to significantly influence domestic travel avoidance. The findings also supported the significant role of perceived risk, subjective knowledge, age, and gender. Given the possibility that an Ebola outbreak may reemerge in the future and the emergence of additional health-related crises (e.g., Zika virus), the findings may also aid the tourism industry in planning for and responding to other health pandemics.

Malignant Vagal Paraganglioma.

Paragangliomas are rare, typically benign neuroendocrine tumors that represent a small portion of head and neck tumors. A small percentage of these are known to have malignant potential. They arise from the carotid body, jugular bulb or vagus nerves. There is limited literature discussing the management of malignant vagal paragangliomas. We present a case of a 25 year old female with a left malignant vagal paraganglioma. The following case presentation will describe the presentation, classic radiologic findings, and management of a malignant vagal paraganglioma along with a review of the literature.

Ectopic cervical thymus: an uncommon diagnosis in the evaluation of pediatric neck masses.

Ectopic cervical thymic tissue is an uncommon cause of neck masses in children, with fewer than 100 cases reported in children who presented with primary neck masses. To illustrate the unique characteristics of these tumors, we report the case of a 13-month-old boy with ectopic thymic tissue presenting with asymptomatic, bilateral, and solid cervical masses. This case report highlights several unique findings: (1) the rare nature of solid thymic tumors compared with cystic lesions, (2) the utility of magnetic resonance imaging scanning with and without fat suppression for diagnosis, and (3) the risks of surgical removal of thymic tissue in children. Despite its infrequent occurrence and often asymptomatic presentation, ectopic cervical thymus masses should be included as a rare cause of cervical masses in the pediatric population. Awareness of this diagnosis will allow for appropriate preoperative diagnostic studies, which may preclude the need for biopsy.

Management of the draining ear in children.

There are a variety of causes of otorrhea in children. The most important factor in reaching the proper diagnosis and providing relief of the problem is aural toilet. Once adequate debridement has been performed, the diagnosis is usually clearer, and treatment with ototopicals is significantly more effective. Most cases of otorrhea are due to infection or granulation tissue and can be managed initially with appropriately selected ototopical medication, thereby avoiding the risks and side effects of systemic therapy and the need for referral to a specialist. However, otorrhea in children that is refractory to medical therapy may be due to retained tympanostomy tubes or insidious pathology such as cholesteatoma or malignancy. In such cases, prompt referral to the otolaryngologist can facilitate accurate diagnosis and successful management.

Postoperative pain after adult tonsillectomy with PlasmaKnife compared to monopolar electrocautery.

OBJECTIVES/HYPOTHESIS: Monopolar cautery is the most commonly used technique for tonsillectomy. The aim of the present study is to compare postoperative pain using a new technology, PlasmaKnife tonsillectomy (PKT), in comparison with monopolar cautery tonsillectomy (MCT). STUDY DESIGN: Prospective, randomized, single-blinded, self-controlled study using paired organs. METHODS: Thirty-two adult patients, aged 18 to 30 years, scheduled for tonsillectomy for recurrent tonsillitis were included. Patients were randomly assigned to undergo PKT on one side and MCT on the opposite side. The primary outcome was self-rated daily pain assessed by using a 10-point scale. Patients were provided 21-day pain diaries and were phoned twice weekly by a research assistant to assess pain and remind them to complete diaries. Secondary outcomes included comparisons of operative time, blood loss, and postoperative complications. RESULTS: Repeated measures analysis of variance comparing PKT to MCT during the 21-day postoperative period revealed no difference in postoperative pain between the two groups (P = .131). In addition, total operative time (P = .276) and blood loss (P = .418) did not differ significantly between PKT and MCT. CONCLUSIONS: Adult subjects undergoing PKT do not experience less postoperative pain in comparison to MCT.

Cavernous sinus syndrome secondary to pituitary adenoma: A case report.

In this case report we demonstrate the intimate association between the sella turcica and the cavernous sinus and review the neuroanatomy involved. The otolaryngologist should be aware of this association when collaborating with a neurosurgeon in pituitary surgery.