Enhanced surveillance of hepatitis B infection in inner-western Sydney

Objectives: We developed an enhanced surveillance system for hepatitis B to improve the detection of newly acquired cases and to collect epidemiological data. Methods: The study was undertaken from February to June (inclusive) 2005 at the Sydney South West Area Health Service Eastern Zone Public Health Unit. A letter was sent to treating doctors on receipt of a notification, requesting additional information on cases. Cases identified by the treating doctors as newly acquired were followed up by telephone. Results: There were 295 notifications of hepatitis B in the period, of which three were newly acquired infections. Only one of these three cases was identified through enhanced surveillance. Information on ethnicity was obtained. Conclusions: This enhanced surveillance system is of limited value as an ongoing process. We recommend that it be undertaken periodically to monitor the epidemiology of the disease

A tuberculosis contact investigation involving two private nursing homes in inner western Sydney in 2004

Australia has one of the lowest incidence rates of tuberculosis (TB) in the world, approximately five per 100,000 per year 1, although in some parts of the country the incidence is considerably higher. In the former Central Sydney Area Health Service the incidence rate in 2003 was 14 per 100,000 per year.2 The incidence is also higher in those aged 65 years and over1, a population that has declining immunocompetence due to a variety of factors.3 Furthermore, the subpopulation of this group (and, indeed, of people of any age) living in residential institutions such as nursing homes and hostels are at even greater risk of TB infection and disease due to their chronic ill health and multiple medical problems.3 Despite this, there are no guidelines in NSW regarding TB screening of the elderly, either in response to potential exposure or with regard to screening at entry to a residential facility. There are also very few reports in the literature of TB contact investigations in residential facilities. Those that have been published come from the United States and are concerned with TB in hospitals or correctional facilities.3,4,5,6 There has been one report of TB transmission in a school setting in Sydney7, but there is a paucity of Australian literature that clarifies what is required for contact investigations in the local residential care setting. This paper describes a contact investigation resulting from a case of active TB in a health care worker employed by a number of nursing homes in inner-western Sydney and highlights the need for policies with regard to TB screening of the elderly residing in nursing homes

Formulation and In-vitro Characterization of floating microcapsules as gastroretentive drug delivery system containing Itopride hydrochloride by W/O/O multiple emulsion solvent diffusion technique

Itopride hydrochloride loaded floating microcapsules were prepared by W/O/O multiple emulsion solvent diffusion method using ethyl cellulose and eudragit RSPO 100 as drug release rate controlling polymers. Drug containing aqueous phase was emulsified in ACN: DCM primary organic phase. This W/O primary emulsion was further emulsified in continuous phase (light liquid paraffin) containing emulsifying agent (span 80).Formulated microcapsules were harvested by filtration and subsequent washing with petroleum ether. Further microcapsules were evaluated for flow properties, %product yield, particle size, %EE, buoyancy, in-vitro drug release, SEM, FTIR and DSC analysis.Floating microcapsules were prepared with varying proportions of EC and eudragit RSPO 100. Microcapsules containing drug: EC: Eudragit RSPO 100 (Formulation F5) in proportion of 1:2:1shows desired properties. All formulations show good to excellent flow properties. F5 formulation shows 91.41± 2.84% production yield, mean particle size was29.39± 5.45µm, %buoyancy 88.27±1.75%, EE 98.53±0.349%. Cumulative % drug release from microcapsules of F5 formulation was 98.99± 1.90% in 24hours and following Korsmeyer–Peppas kinetic model for drug release with R2 value 0.9805. SEM analysis revealed formation of spherical microcapsules with rough surface indicates encapsulation of drug within polymer coat. FTIR and DSC analysis shows no interaction between drug and polymers used in formulation.Formulated multiple unit floating gastroretentive microcapsules of Itopride hydrochloride have potential to delivered drug in upper part of GIT for extended period of time, thereby reducing dosing frequency, enhance bioavailability and improved patient compliance

Fibroid originated from rudimentary horn in mullerian agenesis

Mullerian agenesis or Mayer Rokitansky- Kuster- Hauser syndrome is defined by congenital absence of both the uterus and vagina. It affects 1 in 4000-5000 females. Leiomyoma arising from the uterine remanent in case of MRKH is very rare. Very few cases have been reported in literature. The exact etiopathogenesis of leiomyoma from the rudimentary uterus in MRKH syndrome is not known. We are reporting a rare case of 35-year-old married, nulliparous female who presented with primary amenorrhea and lump in lower abdomen since, 1 year. On physical examination, a mass of 18-week size of uterus, firm in consistency, irregular, nontender, mobile from side to side, occupying right iliac and hypogastric region was detected. Provisional diagnosis of multiple leiomyoma with mullerian anomaly was made on USG and MRI for which laparotomy was performed. Per-operatively, there was a mass of approx. 15 x 8 x 8 cm consisting of multiple fibroids present, uterus not visualized separately. Right ovary and tube absent. Left fallopian tube and ovary were normal arising from left rudimentary horn with no endometrial tissue. Blind end with no cervix. Partial agenesis of vagina. No communication possible between rudimentary horn and vagina. Patient underwent hysterectomy in view of non-functioning uterus. Histopathology report confirmed the diagnosis. Finally, it was diagnosed as a case of multiple leiomyoma originating from uterine remanent. Post-operative period was uneventful

The natural history of primary sclerosing cholangitis in 781 children. A multicenter, international collaboration

There are limited data on the natural history of primary sclerosing cholangitis (PSC) in children. We aimed to describe the disease characteristics and long-term outcomes of pediatric PSC. We retrospectively collected all pediatric PSC cases from 36 participating institutions and conducted a survival analysis from the date of PSC diagnosis to dates of diagnosis of portal hypertensive or biliary complications, cholangiocarcinoma, liver transplantation, or death. We analyzed patients grouped by disease phenotype and laboratory studies at diagnosis to identify objective predictors of long-term outcome. We identified 781 patients, median age 12 years, with 4,277 person-years of follow-up; 33% with autoimmune hepatitis, 76% with inflammatory bowel disease, and 13% with small duct PSC. Portal hypertensive and biliary complications developed in 38% and 25%, respectively, after 10 years of disease. Once these complications developed, median survival with native liver was 2.8 and 3.5 years, respectively. Cholangiocarcinoma occurred in 1%. Overall event-free survival was 70% at 5 years and 53% at 10 years. Patient groups with the most elevated total bilirubin, gamma-glutamyltransferase, and aspartate aminotransferase-to-platelet ratio index at diagnosis had the worst outcomes. In multivariate analysis PSC-inflammatory bowel disease and small duct phenotypes were associated with favorable prognosis (hazard ratios 0.6, 95% confidence interval 0.5-0.9, and 0.7, 95% confidence interval 0.5-0.96, respectively). Age, gender, and autoimmune hepatitis overlap did not impact long-term outcome. CONCLUSION: PSC has a chronic, progressive course in children, and nearly half of patients develop an adverse liver outcome after 10 years of disease; elevations in bilirubin, gamma-glutamyltransferase, and aspartate aminotransferase-to-platelet ratio index at diagnosis can identify patients at highest risk; small duct PSC and PSC-inflammatory bowel disease are more favorable disease phenotypes

Trade Credit Policies for Supplier, Manufacturer, and Retailer: An Imperfect Production-Inventory System with Rework

In this study, we developed a trade credit policy for a three-layer supply chain consisting of a supplier, a manufacturer and a retailer. We propose an optimal production rate and selling price for the manufacturer and the retailer under an imperfect production system. The suggested coordination policy optimizes the profit of each supply chain member. Two models were formulated for two real-life strategies respectively. The first one is a collaborative (integrated) system and the second one is a Stackelberg leadership system. Both strategies were analyzed for various credit periods, respectively offered by the supplier to the manufacturer, by the manufacturer to the retailer, and by the retailer to the customers, by considering price-sensitive demand and a certain replenishment rate. Finally, we concluded which strategy will be better for inventory management under the given restrictions in the form of propositions. The concavity property for the net profit function was established with respect to the selling price and the production rate, which was also described graphically and analyzed by numerical examples

Trade Credit Policies for Supplier, Manufacturer, and Retailer: An Imperfect Production-Inventory System with Rework

In this study, we developed a trade credit policy for a three-layer supply chain consisting of a supplier, a manufacturer and a retailer. We propose an optimal production rate and selling price for the manufacturer and the retailer under an imperfect production system. The suggested coordination policy optimizes the profit of each supply chain member. Two models were formulated for two real-life strategies respectively. The first one is a collaborative (integrated) system and the second one is a Stackelberg leadership system. Both strategies were analyzed for various credit periods, respectively offered by the supplier to the manufacturer, by the manufacturer to the retailer, and by the retailer to the customers, by considering price-sensitive demand and a certain replenishment rate. Finally, we concluded which strategy will be better for inventory management under the given restrictions in the form of propositions. The concavity property for the net profit function was established with respect to the selling price and the production rate, which was also described graphically and analyzed by numerical examples

Knowledge of Physical Education Teachers of Chandigarh with Regard to Emergency Management of Avulsed Teeth at School

Objective: To assess the knowledge of Chandigarh physical education teachers regarding emergency management of avulsed teeth at school. Methods: A cross-sectional survey was conducted on 100 physical education teachers of Chandigarh using a questionnaire surveying demographic data and knowledge to manage tooth avulsion. A stratified random sampling technique was used to select the required sample. Data obtained was statistically analyzed using Chi-square test, descriptive statistics, and t-test. Results: Out of 100 school physical education teachers surveyed, 61% of the physical education trainers (PET) were having first aid training and 39% were not having any training. 44% of PET said tap water is the best storage medium followed by 19% fresh milk and 11% child's saliva. There was a statistically significant difference in knowledge to manage avulsed teeth between trained and untrained dentists regarding the extra-alveolar duration method (p = 0.0001), an extra-alveolar storage medium (p = 0.008). Conclusion: This study suggested that the knowledge about the concept of management of avulsed teeth was lacking in Chandigarh physical education teachers. Educational programs should be introduced to them to modify the approach of teachers to manage tooth avulsion at school

Ursodeoxycholic Acid Therapy in Pediatric Primary Sclerosing Cholangitis : Predictors of Gamma Glutamyltransferase Normalization and Favorable Clinical Course

Objective To investigate patient factors predictive of gamma glutamyltransferase (GGT) normalization following ursodeoxycholic acid (UDCA) therapy in children with primary sclerosing cholangitis. Study design We retrospectively reviewed patient records at 46 centers. We included patients with a baseline serum GGT level >= 50 IU/L at diagnosis of primary sclerosing cholangitis who initiated UDCA therapy within 1 month and continued therapy for at least 1 year. We defined "normalization" as a GGT level Results We identified 263 patients, median age 12.1 years at diagnosis, treated with UDCA at a median dose of 15 mg/kg/d. Normalization occurred in 46%. Patients with normalization had a lower prevalence of Crohn's disease, lower total bilirubin level, lower aspartate aminotransferase to platelet ratio index, greater platelet count, and greater serum albumin level at diagnosis. The 5-year survival with native liver was 99% in those patients who achieved normalization vs 77% in those who did not. Conclusions Less than one-half of the patients treated with UDCA have a complete GGT normalization in the first year after diagnosis, but this subset of patients has a favorable 5-year outcome. Normalization is less likely in patients with a Crohn's disease phenotype or a laboratory profile suggestive of more advanced hepatobiliary fibrosis. Patients who do not achieve normalization could reasonably stop UDCA, as they are likely not receiving clinical benefit. Alternative treatments with improved efficacy are needed, particularly for patients with already-advanced disease.Peer reviewe