The Diagnostic Interview Schedule (DIS) is a highly structured instrument that enables lay examiners to gather the clinical information necessary to generate psychiatric disorders according to the DSM-III, Feighner, and Research Diagnostic Criteria. It was developed originally as the diagnostic interview for the Epidemiologic Catchment Area (ECA) survey. Because it adheres to DSM-III and can be used by lay interviewers, thus making it practical for studies involving large samples, it has been used for other population surveys in North and South America, Europe, and Asia. This investigation compares the epidemiology of DSM-III-defined alcohol abuse and addiction in DIS-based population surveys cross-nationally (in St Louis, Mo; Edmonton, Canada; Puerto Rico; Taipei City, Taiwan; and South Korea). We found considerable variation in the lifetime prevalence of alcoholism but a similarity in the age of onset, the symptomatic expression, and the associated risk factors. We also found an inverse correlation between the prevalence of alcoholism and the strength of the association of the risk factors we examined. The work described herein demonstrates the utility of consistent definition and method in cross-cultural psychiatric research. The substantive findings have implications for the definition of alcoholism and for a better understanding of genetic and environmental interactions in its etiology.
Paragonimiasis is a parasitic infection of the lungs caused by zoonotic lung flukes of the genus Paragonimus. Most cases are reported from Asia and caused by P. westermani following consumption of raw crustaceans. With the exception of imported cases, human paragonimiasis was rarely described prior to 1984 in the United States (US), which has only one indigenous lung fluke species, P. kellicotti. Between 1984 and 2010, 15 cases of P. kellicotti paragonimiasis were reported in the United States. This study will analyze all US cases and compare an earlier series of six cases reported during the period 1984-2005 with a recently reported cluster of nine cases from Missouri during the period 2006-2010 in order to determine any significant behavioral and/ or recreational risk factors for paragonimiasis and to recommend early diagnostic, treatment and preventive strategies. Significant behavioral and recreational risk factors included eating raw crayfish while on canoeing trips on local rivers (p = 0.002), eating raw crayfish while on canoeing trips in Missouri (p = 0.002), and eating raw crayfish while intoxicated (p = 0.007). The male:female case ratio was 9.3:1.0 and more than 80% of cases presented with fever, cough, pleural effusions and peripheral eosinophilia. One patient developed cerebral paragonimiasis, and one patient died of pneumonic sepsis. Clinicians should inquire about consumption of raw or undercooked crayfish in all patients with unexplained fever, cough, eosinophilia and pleural effusions returning from camping or canoeing adventures in P. kellicotti-endemic areas of the Mississippi River Drainage Basin; institute diagnostic evaluation by specific parasitological and serological methods and treat all cases as soon as possible to avoid the pulmonary and cerebral complications of paragonimiasis.
Echinococcus granulosus was diagnosed by fine-needle aspiration cytology of a lung cyst in a 6-yr-old white female in central Missouri. No adverse reaction occurred following the aspiration. The cytologic sample yielded clear fluid containing numerous clearly identifiable protoscoleces diagnostic for echinococcosis using routine PAP staining. Since hydatid disease is extremely uncommon in the Midwest, it had not initially been considered in the differential diagnosis. The infection was probably not indigenous to Missouri, since the patient lived the first 3 1/2 yr of life in Alaska, where the organism is endemic. This can only be speculative, however, since echinococcal organisms are found in wildlife in the Midwest.
Person-to-person spread is the predominant mode of transmission of hepatitis A virus (HAV) infection. However, based on findings for national surveillance for viral hepatitis, since 1983, 3%-8% of reported hepatitis A cases have been associated with suspected or confirmed foodborne or waterborne outbreaks (1). This report summarizes three recent foodborne outbreaks of hepatitis A and addresses the prevention of this problem.
Highly polymorphic segments of the human genome containing variable numbers of tandem repeats (VNTRs) have been widely used to establish DNA profiles of individuals for use in forensics. Methods of estimating the probability of occurrence of matching DNA profiles between two randomly selected individuals have been subject to extensive debate regarding the possibility of significant substructure occurring within the major races. We have sampled two Caucasian subpopulations, Finns and Italians, at four commonly used VNTR loci to determine the extent to which the subgroups differ from each other and from a mixed Caucasian database. The data were also analyzed for the occurrence of linkage disequilibrium among the loci. The allele frequency distributions of some loci were found to differ significantly among the subpopulations in a manner consistent with population substructure. Major differences were also found in the probability of occurrence of matching DNA profiles between two individuals chosen at random from the same subpopulation. With respect to the Finnish and Italian subpopulations, the conventional product rule for estimating the probability of a multilocus VNTR match using a mixed Caucasian database consistently yields estimates that are artificially small. Systematic errors of this type were not found using the interim ceiling principle recently advocated in the National Research Council's report [National Research Council (1992) DNA Technology in Forensic Science (Natl. Acad. Sci., Washington)]. The interim ceiling principle is based on currently available racial or ethnic databases and sets an arbitrary lower limit on each VNTR allele frequency. In the future the ceiling frequencies are expected to be established from more adequate data acquired for relevant VNTR loci from multiple subpopulations.
Cites: Genomics. 1991 Sep;11(1):83-921765387
Cites: Science. 1992 Feb 28;255(5048):1053-417817770
Hematopoietic stem cell transplantation (HSCT) with a conditioning regimen of busulfan, cyclophosphamide, and etoposide for children with acute myelogenous leukemia (AML): a phase I study of the Pediatric Blood and Marrow Transplant Consortium.
Hematopoietic stem cell transplantation (HSCT) is an important treatment modality for children with AML. The optimal conditioning regimen is unknown. The aim of this study was to determine the appropriate dosing of etoposide in combination with busulfan and cyclophosphamide in this setting.
Twenty patients with a diagnosis of AML in first or second remission, or myelodysplasia scheduled for bone marrow transplantation, were included in this study. Patients received busulfan 640 mg/m(2) in 16 doses, cyclophosphamide 120 to 150 mg/kg in two doses, and etoposide from 40-60 mg/kg as a single dose. Extensive toxicity data was collected.
Nineteen patients were evaluable for toxicity. Mucositis was seen in all patients. Four patients developed bacteremia and one patient died from overwhelming sepsis on day +3. Four patients developed moderate to severe skin toxicity. The major dose-limiting +3 toxicity was hepatic toxicity, which occurred in 14 of 19 patients. Eight patients developed clinical veno-occlusive disease, including three patients at dose level 4, two of whom had life-threatening disease. This hepatic toxicity defined the MTD of 640 mg/m(2) busulfan, 120 mg/kg of cyclophosphamide, and 60 mg/kg of etoposide. Overall, 9 of 20 patients enrolled in the study survive in remission, 8/14 allogeneic (median follow-up 44 months), and one of six autologous patients (follow-up, 54 months).
We conclude that the combination of busulfan, cyclophosphamide, and etoposide at the doses defined above has activity in the treatment of children with high-risk AML/MDS undergoing allogeneic HSCT. Whether it offers an advantage over other conditioning regimens will require a randomized trial with a larger cohort of patients.
Precipitin tests and ELISA were used to investigate host-feeding patterns of 172 blood-fed Aedes albopictus (Skuse) collected at Potosi, MO, during the summers of 1989 and 1990. One hundred ten (64.0%) mosquitoes had fed on mammals, 29 (16.9%) on birds, and none on turtles or snakes. Thirty-three (19.2%) mosquitoes failed to react in all tests. Eighty-six (78.2%) of the 110 mammalian feeds were positive for lower taxa as follows: rabbit, 24.5%; deer, 14.5%; dog, 13.6%; human, 8.2%; squirrel, 7.3%; opossum, 4.5%; myomorph rodents other than Rattus, 3.6%; raccoon, 0.9%; and bovine, 0.9%. Positive feeds were not detected for the following mammals: cat (n = 99); horse (n = 95); Rattus (n = 84); and swine (n = 84). Fourteen (48.3%) of the 29 avian feeds were positive for lower taxa as follows: Passeriformes, 24.1%; Columbiformes, 17.2%; Ciconiiformes, 3.4%; and quail, 3.4%. These data, the first on host-feeding patterns for Ae. albopictus populations in the New World, indicate that Ae. albopictus is an opportunistic feeder that utilizes a wide variety of hosts and, therefore, has the potential to become involved in the transmission cycles of indigenous arboviruses.