Search

The mission of the Armed Forces Health Surveillance Center, Division of Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) is to support global public health and to counter infectious disease threats to the United States Armed Forces, including newly identified agents or those increasing in incidence. Enteric diseases are a growing threat to U.S. forces, which must be ready to deploy to austere environments where the risk of exposure to enteropathogens may be significant and where routine prevention efforts may be impractical. In this report, the authors review the recent activities of AFHSC-GEIS partner laboratories in regards to enteric disease surveillance, prevention and response. Each partner identified recent accomplishments, including support for regional networks. AFHSC/GEIS partners also completed a Strengths, Weaknesses, Opportunities and Threats (SWOT) survey as part of a landscape analysis of global enteric surveillance efforts. The current strengths of this network include excellent laboratory infrastructure, equipment and personnel that provide the opportunity for high-quality epidemiological studies and test platforms for point-of-care diagnostics. Weaknesses include inconsistent guidance and a splintered reporting system that hampers the comparison of data across regions or longitudinally. The newly chartered Enterics Surveillance Steering Committee (ESSC) is intended to provide clear mission guidance, a structured project review process, and central data management and analysis in support of rationally directed enteric disease surveillance efforts.

In Egypt, little is known about the genetic background of Escherichia coli isolates harboring extended-spectrum β-lactamase (ESBL). Five hundred twenty Enterobacteriaceae were prospectively collected (May 2007-August 2008) at the Theodor Bilharz Research Institute (Cairo). Among the collected Enterobacteriaceae, 56% (n=291) were E. coli and 32% (n=165) Klebsiella pneumoniae. A total of 16% (n=3) of all isolates were ESBL, 19% (n=55) of the E. coli and 14% (n=23) of the K. pneumoniae. The proportion of E. coli ESBL producers did not differ significantly between in and outpatients (20% vs. 17%) but was significantly different for non-E. coli ESBL producers (18.5% vs. 1.2%: p=0.0001). The majority of E. coli ESBL producers (75%) was isolated from urine. All the ESBL-producing Enterobacteriaceae available for molecular study (n=74) produced CTX-M-15. Among the CTX-M-15-producing E. coli isolates; 40% belonged to phylogenetic group A, 32% to D, and 26% to B2. ERIC-2 PCR profiles were obtained for all these E. coli isolates and multilocus sequence typing for those belonging to group B2. Genotyping analyses showed strain diversity; however, some clusters had profiles indistinguishable from that of previously published clones. Multilocus sequence typing showed that 75% of E. coli group B2 belonged to clone ST131. This indicates that a new country in Africa is adversely affected by clones of E. coli-producing CTX-M-15., (© Mary Ann Liebert, Inc.)

This study compared the effect of payment systems on recall visits and oral health outcomes for four patient payer groups. The authors reviewed recall audit data obtained over a 4-year period. Dental payer groups in the study population differed with respect to dental outcomes. Patients who had recall visits at 1 year or longer had worse outcomes than patients seen more frequently. A Medicaid subgroup with the greatest number of risk factors displayed improved oral health outcomes when seen on a more frequent recall schedule. Study findings suggest that, given the increased risks to maintaining oral health, patients being supported by public-funded programs would benefit from more frequent recalls. Such an emphasis would appear to provide the opportunity to improve outcomes in disadvantaged populations and increase the quality of care offered.

Objective: The objective of this study was to evaluate in vitro apical microleakage of root canal filling materials for primary teeth., Methods: Fifty extracted primary anterior teeth were distributed into 6 groups: 4 experimental groups; 1 negative control group; and 1 positive control group. Zinc oxide and eugenol (ZOE), Kri paste, calcium hydroxide (Ca(OH)(2)), and Vitapex were inserted into the canal using a lentulo spiral mounted in a slow-speed handpiece. All teeth were then subjected to a dye leakage test using 2% methylene blue as the tracer., Results: The highest dye penetration was recorded for teeth filled with ZOE, with mean values of 9.01+/-1.23 mm. Vitapex showed the lowest dye penetration, with mean values of 4.02+/-1.79 mm. Comparison between groups showed significant difference when the Vitapex and Kri paste groups were compared to the ZOE group (P<.0001). Also, a significant difference between the Vitapex and Ca(OH)2 group (P=.014) was detected. The result showed no difference between Vitapex and Kri paste (P=.658) nor between Kri paste and Ca(OH)(2) (P=.185)., Conclusions: All the resorbable root canal filling materials used in primary teeth showed apical leakage. The highest apical leakage was recorded for ZOE, while Vitapex showed minimum dye leakage.

Aim: The aim of this study was to assess the effect of repeated (twice) applications of two fluoride varnishes (Duraflor and CavityShield) on the surface micromorphology of a high-viscosity glass ionomer (Fuji IX GP), a compomer (F2000), and a flowable composite (Filtek Flow) using a profilometer and scanning electron microscope (SEM)., Methods and Materials: Fifteen specimens were prepared from each material, surface roughness (Ra) was measured with a profilometer, and an impression was made for epoxy replicas. The fluoride varnishes were applied to the experimental specimens of each material at repeated intervals of 48 hours. For all specimens, Ra was measured and SEM replicas were examined., Results: The final Ra of glass ionomer was 3.49 +/- 0.59 (mean +/- SD) for CavityShield, 4.69 +/- 1.33 for Duraflor, and 2.96 +/- 1.53 for the controls. The final Ra of flowable composite was 0.53 +/- 0.20 for CavityShield, 2.61 +/- 3.08 for Duraflor, and 0.15 +/- 0.09 for controls. For glass ionomer and flowable composite, Duraflor was associated with a significantly higher roughness at the final measurement compared to controls (P < 0.05). SEM micrographs showed differing surface topographies which in many specimens confirmed Ra analysis., Conclusion: Fuji IX GP and Filtek Flow showed significantly higher roughness after two applications of Duraflor compared to controls.

Purpose: This study evaluated in vivo 2 different obturation techniques (lentulo spiral mounted in a slow-speed handpiece and hand-held) in primary teeth., Methods: The study was carried out on 24 children (mean age = 6.71 years) who had received 50 single-visit zinc oxide and eugenol (ZOE) pulpectomies in primary molars. The root canal filling materials were deposited into the canals either by a lentulo spiral mounted in a slow-speed handpiece or by a hand-held lentulo spiral. Evaluation of pulpectomized molars was performed by both authors immediately and 6 months following treatment using specific clinical and radiographic criteria. In cases of disagreement, the lower rank was selected., Results: The study found 64% (16/25) optimal filling (if 1 or more of the canals having ZOE ended at the radiographic apex or up to 2 mm short of the apex) when the lentulo spiral mounted in the slow-speed handpiece was used. It also found a 96% (21/22) clinical success rate in the group obturated by the lentulo spiral mounted in a slow-speed handpiece vs 48% (12/25) optimal filling and a 92% (23/25) clinical success rate in the group obturated by a hand-held lentulo spiral. The radiographic success for over- and optimally filled canals, when combining both lentulo groups, was significantly greater than underfilled root canals (P = .009)., Conclusions: There was no statistically significant difference between the 2 techniques of obturation, according to the quality of the root canal filling or success rate.

This was a prospective pilot study of 11 polycystic ovary syndrome (PCOS) patients primed with limited ovarian stimulation. Oocytes were collected 60 hours after human chorionic gonadotropin (hCG) and resulted in pregnancies and the delivery of a healthy baby.

In the fall of 2001, approximately 15,000 U.S. military personnel participated in a military exercise in the northwestern Egyptian desert. To assess the prevalence and impact of diarrhea and enteropathogen distribution, we conducted a post-deployment survey and a case series study. A departure convenience sampling (n = 3725) was used in the post-deployment survey. Overall, 9.3% reported diarrhea, 2.6% sought medical care, and 2.8% stopped or decreased their work for at least a day. Among those reporting diarrhea, 41.7% had symptoms for less than 2 days, 43.5% had symptoms from 2-5 days, and 14.8% had symptoms for more than 5 days. In the case series study, pathogens were identified in 53.6% of the 129 cases enrolled. Pathogens identified included enterotoxigenic E. coli (n = 53), enteroaggregative E. coli (n = 13), Cryptosporidium (n = 9), Campylobacter jejuni (n = 7), noroviruses (n = 7), Shigella flexneri (n = 2), rotavirus (n = 2), and Entamoeba histolytica (n = 2). Among those seeking care for diarrhea, two thirds reported a decreased ability or inability to perform their jobs for at least one day, but overall, diarrhea was much less prevalent than in past surveys in this region, with minimal impact on the mission.

Objectives: We aimed to test the possibility that LOS could be used to avoid the risk of occurrence of severe OHSS in PCOD patients with past history of severe OHSS in their previous IVF treatment., Study Design: A prospective study, with patients stood as their own controls. Twenty patients with history of severe OHSS in their previous IVF treatment were included in the study. The patients received LOS cycles during the six months period commencing January 1998, a full dose of human chorionic gonadotropin (10,000 IU) was administered when the leading follicle reached a mean diameter of 12 mm, and oocytes retrieval 36 h later was followed by intracytoplasmic sperm injection (ICSI) and embryo transfer. Signs and symptoms of severe OHSS were recorded., Results: All patients produced mature oocytes, achieved fertilisation and eight clinical pregnancies were diagnosed. None of the patients re-experienced the symptoms of severe OHSS, and none required hospitalisation., Conclusion: We confirm that, in the studied group of patients, LOS helped in the prevention of the severe forms of OHSS in PCOD patients with past history of severe OHSS.

This pilot study including five patients, examined the feasibility of obtaining oocytes from partially stimulated ovarian follicles in patients with polycystic ovarian disease (PCOD). We evaluated oocyte maturity, and fertilization potentials. The diagnosis of PCOD was based on ultrasound findings and endocrine criteria. The long protocol of pituitary ovarian axis down-regulation was used and follicles were stimulated with daily injections of human menopausal gonadotropin (HMG), until the mean diameter of the leading follicle reached 12 mm. A full dose of HCG (10000 I.U.) was administered and oocytes were collected 36 h later. The mean number of oocytes collected per patient was 12.6+/-4.9, the mean number of MII oocytes was 8.8+/-4.4, with fertilization rate of 70.5% following intracytoplasmic sperm injection (ICSI). To our knowledge this is the first report in the literature documenting the recovery of mature oocytes following limited stimulation of the ovaries. The potentials of this novel approach open a new dimension in the management of patients with PCOD.

The cellular and humoral immune responses of patients with S. mansoni infection were evaluated before and one month after each of two intramuscular doses of diphtheria/tetanus toxoid vaccine. Patients were divided into "responder" and "non-responder" groups based on anti-tetanus toxoid (anti-TT) IgG levels after vaccination. The specific anti-TT IgG1 response of the responder group was predominantly in the IgG, subclass. The lymphoproliferative response to PHA was also significantly higher in the responder group; this elevation was detectable before and after each vaccination. The responses to PWM and SPL were comparable in the two groups before vaccination, although the responder group had a higher response to SPL after vaccination. IgG antibodies for schistosome adult worm and egg antigens were significantly lower in the responder group prior to vaccination but not thereafter. Anti-diphtheria IgG antibodies were comparable in the two groups after vaccination at all times. Clinically, the non-responder patients had a higher incidence of splenomegaly (84.6% vs 44.8%) and were significantly older than the responder patients (mean 34.1 yrs vs 18.7 yrs). The cause for the reduced anti-tetanus IgG response in schistosomiasis patients is believed to be multifactorial. T cell or antigen presenting cell dysfunction, high levels of IgG antibodies specific for schistosome antigens, splenomegaly and age are factors that might lead to reduced anti-TT IgG response.