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Democracy in Nigeria and of course in Akwa Ibom State has created lopsided development and thereby widened the gap of inequality in the State. Democracy is a political and constitutional arrangement in which the values of economic development and social welfare of the citizens can grow and be sustained. Inspite of the great potentials in agricultural, mineral and human resources in the state, development has remained uneven. The coastal communities like other rural areas in the mainland, are grossly underdeveloped, despite harbouring the wealth of the state, particularly, petroleum oil and gas. The coastal areas of the state are replete with poor or absence of basic infrastructure, poverty, unemployment high-crime rate, and youth restiveness. The article concludes that democracy in the state rather than foster a sustained development, has created uneven and uncordinated development especially in the coastal areas. That only adequate provision of social infrastructures with sustainable development programme can secure the future of the people both in the hinterland as well as in the coastal communities.

The paper explores the impact of industrial fishing on the Obolo (Andoni) people. The Obolo people sometime called Andoni are among the various ethnic groups found in the Niger Delta region precisely, the Eastern Niger Delta. Presently the Obolo speaking people are found in two local government areas, namely; Andoni local government, administered by the Rivers State government, while the Eastern Obolo Local Government is in Akwa Ibom State. Traditionally, fishing is the main occupation of the people. Other occupations of the people include, commerce, farming and marine transportation. The Obolo people are artisanal fishermen and women who engaged in fishing in the creeks, rivers and later in the open sea (Atlantic Ocean). The emergent of industrial or mechanized fishing which probably began in Nigeria in the 1950s has led to an increase in both Nigerian and foreign fishing trawler vessels; which ultimately led to what is described in fishery as “by-catch” and “discard”. Ukpatu (2012:3) defines the “by-catch” as anything the fishermen does not intend to catch namely; sea turtle, fish, crabs, shrimps, sharks, weed and sea debris; while “discard referred to the sub-set of the by-catch or portion of the catch that is thrown over into the sea, Andoni Forum, USA (2004:1). The by-catch is a new trend in fishing among the Obolo in particular and the coastal communities in general. The new trend is described in Obolo language as “Kpokpoben” meaning “don’t select” or “just carry” or “trawler”. The Kpokpoben provides employment, food, boast economic activities of the people of the coastal communities. In spite of what seem to be the advantages, its adverse effects include, depletion in natural fish stock, damage to fishing gears, loss of lives and property. Other adverse effects are increase in sea piracy and water pollution. The study recommends among others, the review / overhaul of the fishery laws in Nigeria, equipping the Nigerian Navy with modern security gadgets and mounting an enlightenment campaign in English and Local languages to create an awareness on the adverse effects of the kpokpoben on the Andoni environment

Terrorism has become one of the most recurring decimals across the globe, creating tension in every quarter. This anomaly has necessitated both state and non-state actors to engage in concerted efforts to curtail it. Hence, this study seeks to evaluate the prevalent acts of terror perpetrated by the Islamic State group across their area of jurisdiction for about a decade now. The work traces its emergence, linking it with its spread and recent plethora of activities. The research makes use of secondary sourced materials. The chapter suggests a global cultural re-orientation, especially among young people, good governance in the Middle East, commitment over terror war by stakeholders, etc. The author believes that this essay would serve as an invaluable resource to enhance scholars of conflict in the war against terror as well as serve as a stimulating factor for further studies on the issue.

Unlike Cigarettes, waterpipe tobacco smoking devices have a water container that acts as a partial filter through which the tobacco smoke passes before reaching the smoker. In addition to variations in the design of the apparatus itself, the type of tobacco used in waterpipe smoking differs from cigarette tobacco in the addition of flavorings and molasses.1 Recent investigations suggest that levels of harm from waterpipe smoking are comparable to those of cigarette smoking,2–4 possibly due to cellular damage induced by carcinogens and other chemical constituents. Waterpipes also deliver nicotine, the primary addictive substance in tobacco. Nicotine has been measured in waterpipe tobacco,5 waterpipe tobacco smoke,6 and the blood plasma of waterpipe smokers.7 Some studies suggest that, compared to cigarettes, waterpipes can deliver the same or greater doses of nicotine,8–10 given the complex interplay between the length of the smoking session, smoking topography, and the chemical characteristics of waterpipe smoke.11 Furthermore, waterpipe use is associated with classic features of tobacco/nicotine dependence: abstinent waterpipe smokers report symptoms similar to those reported by abstinent cigarette smokers (e.g., urge to smoke, restlessness, and craving), and these symptoms are reduced by subsequent waterpipe tobacco smoking.12,13 Dependence on nicotine is attributed to its ability to stimulate the brain's reward pathway.14–17 Other behavioral, cognitive, and social components are also involved,18,19 including sensory cues accompanying the act of smoking, such as taste, aroma, handling, puffing, and inhaling.20 Waterpipe smoking has its own specific cues, including varied smells and tastes from sweetened and flavored waterpipe tobacco, the hand-to-mouth action, and the highly social setting of many waterpipe sessions in restaurants or cafes.2,11 To our knowledge, only a few studies have addressed the issue of nicotine dependence among waterpipe users.2,11,21 Unlike cigarette smoking, for which decades of research led to the development and validation of instruments to assess dependency, such as the Fagerstrom Tolerance Questionnaire (FTQ), the Fagerstrom test for nicotine dependence (FTND)22 and the Reasons for Smoking (RFS) scales, very little research has been carried out on these characteristics in waterpipe smokers. In the present study, we aimed to assess evidence for nicotine dependence in habitual waterpipe smokers, using adapted versions of the FTND and RFS scales.

Waterpipe use is a highly prevalent form of tobacco use in the Eastern Mediterranean Region that is rooted in long-held cultural traditions that predate the use of cigarettes and present a particular challenge for tobacco control efforts. We did a stratified sampling of 4,994 Egyptian men from rural households of Egypt in order to conduct an interviewer-administered prevalence survey to identify differences in attitudes and beliefs toward smoking and smoking cessation between waterpipe users, cigarette smokers, mixed users (cigarette + waterpipe), and non-smokers. We found that cigarette smokers, mixed users, and/or non-smokers were (1) two- to ninefold more likely to believe that smoking decreased adult life expectancy and harmed a fetus than waterpipe users, (2) significantly more likely to believe that smoking is a sin (“haram”) than were waterpipe users. Among tobacco users, we found that cigarette smokers and/or mixed users were significantly more likely to indicate pre-contemplation, contemplation, or intention to quit tobacco than waterpipe users. Our findings from rural Egyptian men indicate that waterpipe users are distinct from cigarette smokers in their perception that their form of tobacco use is less harmful and/or less subject to religious proscription. These beliefs may explain why waterpipe users seem less inclined to quit their tobacco habit and need to be considered in the design of tobacco cessation and prevention methods in Egypt and the region.

Waterpipe smoking is popular in many parts of the world. Micronuclei (MN) evaluation in the exfoliated oral cells of smokers is a non-invasive technique for evaluation of possible tobacco harm. We aimed to assess whether MN levels are higher in waterpipe smokers than in never smokers. We examined oral smears of 128 adult male waterpipe smokers and 78 males who never smoked tobacco in rural Egypt. The total number of MN per 1000 cells per subject, and the number of MN-containing cells per individual were compared. We observed a higher level of total MN in waterpipe smokers (10 +/- 4) than in never smokers (4 +/- 2, p < 0.001). A similar difference was found for the mean number of affected cells per individual (8 +/- 3 vs. 4 +/- 1.62, p < 0.001). MN levels were not significantly dose related. This study is among the first to assess the association between waterpipe smoking and a cytogenetic measure of tobacco harm. The twofold increase in MN level is consistent with previous reports of MN in cigarette smokers. More research is needed to determine if such MN levels are predictive of future health consequences.

Background: Current and former smokers are at increased risk to develop oral cancer. This analysis was performed to determine whether current and former smokers are more likely to undergo an exam for oral cancer than non-smokers. Methods: The Maryland Cancer Survey performed in 2002 was a population-based random digit dial, statewide survey on cancer screening and risk behaviors, targeting adults aged 40 years and older. The dataset contains self-reported information on oral cancer examinations, current smoking status, and health care access information for 4840 Maryland residents. Results: 2062 (42.6%) of Marylanders aged 40 years and older reported ever having had an oral cancer examination. Dentists and dental hygienists performed 90.9% of the exams. Current and former smokers were no more likely than those who have never smoked to have ever had the examination (adjusted OR=1.02, 95% CI=0.85–1.23 and OR=1.09, 95% CI=0.94–1.25, respectively). Other predictors associated with having an oral cancer exam included having more than a high school of education, being female, non-black, being in good to excellent health, and having a recent physical exam. Having visited the dentist in the last year had the highest odds of having ever had an oral cancer exam. Conclusions: Current and former smokers are a high-risk group who need to be targeted for oral cancer exams by dental professionals and primary care physicians.

The incidence of Lyme disease (LD) reported to the Maryland Department of Health and Mental Hygiene during 1992 was 6.5100,000 population, ranging from 29.3 cases/100,000 on the Eastern Shore (74.4% of all cases) to no cases in the mountains of western Maryland. Among the 317 reported patients, 44.4% gave a history of tick exposure and 78.9% had positive serologic test results. For the 187 (59.0%) patients meeting the Centers for Disease Control and Prevention (CDC) surveillance case definition, erythema migrans (EM) occurred in 69.5%, with arthritic (26.7%), neurologic (13.4%), and cardiac (2.1%) manifestations being less frequent. Patients not meeting the surveillance case definition were significantly more likely to have influenza-like symptoms, a smaller rash, and arthralgia. Patients meeting the CDC criteria were more likely to have an onset during the major transmission season in the summer (odds ratio (OR): 2.1; confidence interval (CI): 1.2 to 3.6) since this was the time when most (115130) patients with EM were detected. Positive serologic results were more likely (OR: 2.2; CI: 1.2 to 4.2) in those not meeting the case definition. The treatment given to patients thought to have LD was almost always that recommended in the literature and there was no difference between treatment prescribed for patients meeting and those not meeting the case definition. These data show that physicians in Maryland are treating many patients for LD who are clinically diagnosed as having LD (e.g., febrile patients with flulike symptoms, patients with arthralgias or erythematous rashes < 5 cm in size) and who have positive serologic test results but who do not meet the CDC surveillance case definition. These patients and the large number of unreported patients being seen and treated for LD or tick bites must be added to the overall burden of LD in the state.

Background : The reported incidence of congenital syphilis in the United States rose dramatically during the 1980s. Although lack of prenatal care has been associated with congenital syphilis, little has been published regarding missed opportunities for prenatal intervention. Goal of this Study : To determine whether congenital syphilis increases in Maryland between 1989 and 1991 resulted from a true increase in congenital syphilis incidence or a change in the surveillance case definition, and to describe missed opportunities for prenatal intervention. Study Design : This was a retrospective cohort study. Results : When the revised case definition was used, a 473% increase in the number of cases was seen. Among infants who met the revised definition, 45% of mothers had received no prenatal care. Among those whose mothers had received prenatal care, opportunities to intervene were missed for 53%. Conclusions : Although a true increase in congenital syphilis incidence occurred before 1990, the increase reported in Maryland between 1989 and 1991 was primarily due to the change in case definition. Many cases of congenital syphilis could have been prevented with early and adequate prenatal care.

purpose: The purpose of this investigation was to observe and assess the actual disinfection or sterilization of endoscopes in health care facilities. materials and methods: A total of 22 hospitals and four ambulatory care centers in three states were studied. Facility protocols were reviewed, interviews conducted with relevant personnel, actual disinfection or sterilization procedures observed, and biologic tests performed to determine and assess disinfection/sterilization procedures. results: Fundamental errors observed during the course of the investigation included respective failures to time the period of disinfection, to clean all channels, to flush all channels with disinfectant, to fully immerse the endoscope in the disinfectant solution, and to use a disinfectant. At 78% of the facilities, failure to sterilize all biopsy forceps was observed. A total of 23.9% of the bacterial cultures from the internal channels of 71 gastrointestinal endoscopes grew 100,000 colonies or more of bacteria. These cultures were obtained after the completion of all disinfection/sterilization procedures and the device was deemed ready for use in the next patient. conclusions: These data indicate that actual disinfection/sterilization procedures for endoscopes are not always optimal, and high-level disinfection of gastrointestinal endoscopes is not always achieved.

Recent concerns regarding the safety of shellfish consumption have focused on the risk posed by naturally occurring marine bacteria such as Vibrio species and by viruses such as Norwalk and related agents. Despite the widespread environmental presence of Vibrio species in the Chesapeake Bay, the rate of reported infections remains low; there have also been no reports of major Norwalk outbreaks associated with shellfish in this area. As infections with these agents may not always be recognized because of difficulties in making the diagnosis and/or their mild or subclinical presentation, a serosurvey was conducted among healthy volunteers living in the Chesapeake Bay region. Serum and questionnaire data were collected during the fall of 1987 from 267 persons with varying levels of exposure to shellfish: shellfish industry workers, persons attending a local seafood festival, and Seventh-day Adventists (who traditionally abstain from eating shellfish). In comparisons among groups, a significant association could not be demonstrated between shellfish consumption or contact and antibody response to Vibrio cholerae O1 or Norwalk virus. Rates of seropositivity were high for both agents (up to 22% seropositive with a V. cholerae O1 Inaba vibriocidal assay, 14% with an enzyme-linked immunosorbent assay for cholera toxin, and up to 70% seropositive with an enzyme-linked immunosorbent assay for antibodies to Norwalk virus); the basis for these responses in population-based studies remains to be determined. Shellfish industry workers did have a significantly elevated antibody response to the unencapsulated phase variant of Vibrio vulnificus as compared with the other groups studied. Infection with V. vulnificus may be relatively common among persons with high levels of exposure to shellfish.

Introduction Understanding tobacco use among nondaily and light daily cigarette smokers is needed because they are dissimilar from other smokers and may require specific prevention efforts. Method We compared three groups of adult male smokers in rural Egypt: light daily and nondaily smokers versus moderate-to-heavy daily smokers. Data were obtained from a household survey in 2003 in six randomly selected villages in the Nile Delta region of Egypt. There were 7,657 adult participants, of whom 48.6% were male and 51.4% were female. Among them, 1,401 males (37.6%) and 5 females (0.1%) were self-identified as current cigarette smokers; further analysis focused on males. We restricted data analysis to those who reported a stable pattern of 3+ years of smoking. There were 42 nondaily smokers. Daily smokers were subdivided into two groups: light daily smokers (who smoked no more than 10 cigarettes/day; n = 223) and moderate-to-heavy daily smokers (who smoked at least 11 cigarettes/day; n = 769). Results We found statistically significant differences between these groups on nearly every measure: nondaily smokers tended to be younger and unmarried, but they also had higher levels of education and professional occupations compared with the other smokers. Nondaily and the light daily smokers were more likely than moderate-to-heavy smokers to be planning to quit and to have self-efficacy for quitting, and they were less likely to be smoking in the presence of their wife and children at home. Discussion Further understanding of nondaily and light daily smokers may aid in tailoring specific interventions.

Little is known about the genetic contribution to cigarette smoking and nicotine addiction in Egypt. The dopamine D2 receptor gene contains a TaqI repeat fragment length polymorphism creating two alleles with functional significance, DRD2*A1 and DRD2*A2. We investigated the relationship between these alleles and tobacco use in a study of 389 Egyptian male current smokers (mean age = 40 years; SD = 12). Participants were interviewed in 2004 on their smoking behaviors and quit attempts, and were given the Fagerstrom Test for Nicotine Dependence (FTND). Blood samples were obtained and genotyped for DRD2 A1and A2 alleles. The frequencies of A1/A2, A1/A2, and A2/A2 genotypes were 6%, 29%, and 65%, respectively. We found no statistically significant association between genotype and age at onset of smoking, years of smoking, FTND score, or average number of cigarettes smoked per day. DRD2 genotype was associated with the number of cigarettes smoked in the past 48 hr (42.2 in A1 carriers vs. 37.6 in A2, p = .03), the previous quit duration (28% in A1 vs. 40% in A2 quit for more than 1 month, p = .05), and the depth of inhalation (82% in A1 vs. 72% in A2 inhaled the smoke deeply, p = .03). Logistic regression analysis including DRD2 genotype, FTND score, age at smoking initiation, marital status, and education as predictors showed that maximum duration of quit time was associated with FTND score (p = .003), DRD2 genotype (p = .01), marital status (p = .03), and age at smoking initiation (p = .04). These findings suggest a modest association between DRD2 genotype and quitting behavior in male cigarette smokers in Egypt.

This study investigated behavioral and sociodemographic factors associated with tobacco use among female university students patronizing water pipe cafes in Cairo, Egypt. We interviewed two groups of female university student smokers (100 and 96 students from a public and a private university, respectively). The interviews took place in nine water pipe cafes near the two universities. A logistic regression model was developed to analyze the relationship between tobacco-related knowledge and beliefs and the choice between smoking water pipe or cigarettes. Among these smokers, 27% smoked cigarettes only, 37.8% smoked water pipe only, and 35.2% smoked both types of tobacco. Most of the water pipe smokers (74.1%) preferred this method because they believe it to be less harmful than smoking cigarettes. More than half of the subjects were encouraged to start smoking by other females (56.6%). Curiosity was a significant factor for initiation (OR = 2.8, 95% CI = 1.3-6.2, p

Objective To compare Papanicolaou (Pap) and May-Grunwald Giemsa (MGG) stain as 2 techniques for staining for buccal mucosal cells to detect micronuclei (MN) infield studies. Study design Eighty cytologic smears (2 per individual) were taken from the buccal mucosa of 40 cigarette smokers recruited at a rural village in Egypt. Forty smears were stained with Pap stain and 40 with MGG stain. All were assessed for cellularity and scored for MN. Results Pap stain was faster and easier to process and transport in the field study than was MGG stain. Regarding MGG smears, bacteria and cell debris masked the MN as compared to Pap smears, in which the fixative destroyed the bacteria and made the cell boundaries clearly demarcated. Using Pap stain, MN were seen easily in transparent cytoplasm. Conclusion Pap stain is the preferred method infield studies for scoring and detecting MN in cells of buccal mucosa.

Introduction Overweight and obese individuals are at increased risk for developing and dying from colorectal cancer. Studies suggest that overweight and obese women are more likely to avoid or delay cancer screening. Our objective was to determine whether overweight or obese adults aged 50 years and older living in Maryland in 2002 were less likely to be up-to-date with colorectal cancer screening than normal and underweight adults. Methods The relationship between body mass index and colorectal cancer screening was evaluated based on responses from 3436 participants aged 50 years and older to the Maryland Cancer Survey 2002, a population-based random-digit–dial telephone survey. The survey contains self-reported information on colorectal cancer screening, height, weight, and potential confounders. Logistic regression was performed to calculate odds ratios (ORs) and 95% confidence intervals (CIs), adjusted for age, sex, race, employment, marital status, education, area of residence, and health-care–related variables. Results Overall, 64.9% of Marylanders aged 50 and older were up-to-date with colorectal cancer screening. Compared with normal and underweight individuals, overweight individuals had similar odds of being up-to-date with colorectal cancer screening (OR, 1.05; 95% CI, 0.83–1.33). Obese individuals had slightly lower odds, but this difference was not statistically significant (OR, 0.84; 95% CI, 0.65–1.09). Recommendation by a health care provider for colorectal cancer screening was strongly associated with up-to-date colorectal cancer screening (OR, 36.7; 95% CI, 28.7–47.0). Conclusion Our study shows no statistically significant association between body mass index levels and up-to-date colorectal cancer screening. We recommend that physicians and other health care providers increase up-to-date colorectal cancer screening rates in the population by referring their patients for appropriate screening.

A cross sectional study was carried out in two rural secondary schools in Qualyobia governorate in the academic year 2002-2003 in order to assess the students' knowledge, attitudes and practice toward smoking. An anonymous self-administered questionnaire was used. A total of 635 students, 416 males and 219 females were interviewed. The response rate was 100%. The prevalence of ever tried cigarette was 29% (40% among males and 7% among females) with a median age of initiation at 11 years of age. The prevalence of current cigarette smoking among all students was 7.7 (11.5% among males and 0% among females). Waterpipe (Shisha) smoking was reported by 19% (26% among males and 5% among females) with median age of initiation at 12 yearsof age. The risk of smoking is higher among sons of highly educated mothers (OR=3.7, 95% CI=1-12), Boy only school students have almost half the risk of smoking than mixed school male students (OR=0.4, 95% CI=0.2-0.8). On studying the effect of having a smoker family member or friends on students smoking, having a smoker friend increases the risk of male students three time (OR=3, 95%CI=2-5) while others smoking was not statistically significant. More than 90% of the students (both males and females) thought that active and passive smoking are harmful. More females than males thought smoking is addictive (89% of the females and 81% of the males) while more males than females agreed that smokers have more friends (34% of males, 26% of the females) and that smoking makes boys look handsome (8% of males, 3% of females).

The overall goal of the ESPRI is to reduce tobacco use in Egypt by carrying out interlocking observational, intervention and policy research, and through capacity building for research, prevention, communications and policy on smoking prevention. Having the ability to rely on ESPRI for the best scientific knowledge will add momentum to the current efforts underway to curb smoking in Egypt.

The basic ingredients for a successful prevention program for Egypt are all present but to be successful, these efforts need to be maintained year round with additional resources for prevention and treatment made available to reach out to all regions and neighborhoods in Egypt. We need to expand our treatment capabilities by training primary care physicians to be more active in the area of smoking prevention and treatment.

An interview survey was carried out in a rural village and two nearby schools in Qalyubia Governorate to assess the pattern of smoking and knowledge about religious ruling (Fatwa) and its impact on the quit attempts. Also, a similar survey was conducted in 6 Shisha cafés in Cairo. The results showed that the majority of respondents (81% among rural adults, 83.2% among Shisha café patrons, 73.3% among rural youth and 81.4% among rural students) knew about the Fatwa on smoking. Higher proportions of all participants thought that smoking is a sin (97.3% among rural adults, 80.8% among Shisha café patrons, 94.4% among rural youth and 98.4% among rural students). There was a significantly higher knowledge about Fatwa on smoking among men than women. This indicates a successful outreach program targeted mainly to men through mosques. Knowledge about Fatwa on smoking increased significantly with increased exposure to antismoking messages from religious leader. Knowledge about the Fatwa on smoking or belief that smoking is a sin had no significant effect on quit attempts. Our results point to the need for intensive efforts on the part of religious leaders to translate the current belief that smoking is a sin into quitting among smokers. Better results may be achieved through personal interactions in small groups rather than in mosque settings.

Water-pipe smoking may lead to cancers, genetic damage, diseases of the lungs and other disease conditions. Many of the studies on these subjects are merely anecdotal or lack the necessary rigorous study design or the power needed to be certain of the results. Given the large number of people who smoke waterpipe and the fact that waterpipe smoking has become a fashionable trend in the Middle East and the Western world among the youth, it is essential to study the health effects of waterpipe smoking with renewed emphasis.

Nicotine dependence is a significant public health problem. This study describes the nicotine dependence status among male adults in rural communities in Egypt. A survey was carried out in five rural villages in Egypt to study the smoking prevalence. A total of 938 current smokers were identified and their nicotine dependence status was studied. About 9% of all smokers in the studied villages were found to have heavy dependence to nicotine. Heavy dependence was associated with younger age of smoking initiation (p0.05) and more smoking in the first hours of the day (p0.001). Heavy dependent smokers are less likely to quit smoking (p0.001), lack the confidence to quit by themselves (p0.001) and less likely to have tried to quit earlier (p0.001). Dependent smokers are more likely to smoke in the presence of their children (p0.001). Reasons for smoking included the habit of smoking helping them to keep them going when tired, to make them alert and not knowing what to do with their hands without a cigarette. The main reasons they identified for restarting smoking after quitting were the signs of withdrawal namely headaches, irritability and difficulty in concentration. Nicotine dependence status and attributes were comparable to studies reported in other countries around the world. Enhanced behavioral and medical intervention strategies are needed to motivate helping both low and heavy nicotine dependent smokers to increase the number and effectiveness of quit attempts.

Shisha café patrons in Cairo, Egypt were interviewed to assess their knowledge, attitudes and practices regarding smoking and health. The median age of initiation of Shisha smoking is 20 years. Shisha smokers know about the hazards of smoking and believe that Shisha smoking is less dangerous than cigarette smoking. Over half the Shisha smokers have tried to quit in the past year. The younger adults who smoke Shisha also tend to smoke more often with friends, smoke cigarettes in addition to Shisha and prefer fruit flavored tobacco as compared to tobacco mixed with molasses favored by Shisha smokers who are older. Heavy Shisha smoking was not related to age.

We examined isolates from 203 sporadic and outbreak-associated Salmonella enteritidis cases occurring in Maryland between 1985 and 1990. Plasmid profiles were determined for all isolates; 52 isolates were phage typed. Ten plasmid profiles were identified. A single profile (consisting of a single ca. 55-kb plasmid) emerged as the predominant profile in Maryland during the study period. This profile (which was closely associated with phage type 8) accounted for 86% of a group of isolates from sporadic cases in 1988 and 1989, compared with 43% of the 1985 isolates. Strains with this profile were identified in four of nine outbreaks, including one of three outbreaks in which eggs were implicated as a vehicle. While plasmid profiles and phage typing appear to provide complementary means of identifying specific strains of S. enteritidis, the emergence of what appears to be a single predominant clone has reduced the discriminant ability of both typing systems. The factors be a single predominant clone has reduced the discriminant ability of both typing systems. The factors contributing to the emergence of this one clone are still not well understood.

outbreak investigation: An outbreak of diarrhea, bloody diarrhea, and abdominal cramps occurred among persons undergoing flexable sigmoidoscopy at a branch clinic of a local health center. Illness was associated with use of sigmoidoscopes cleaned by one clinic assistant and appeared to be caused by 2% glutaraldehyde disinfectant solution left in the instruments after cleaning. animal studies: In subsequent animal studies, colonic instillation of 2 % glutaraldehyde solutions caused bloody diarrhea and a distinctive pattern of mucosal damage; similar changes were seen in a review of pathologic samples from other human cases of glutaraldehyde disinfectant-associated diarrhea. conclusion: Our data indicate that improper endoscopic reprocessing can result in serious illness and underscore the importance of adequate training and quality control in this area.

OBJECTIVES: Describe an outbreak of influenza A (H3N2); provide an analysis of vaccine efficacy; measure the sensitivity, specificity, and positive predictive value of 3 clinical case definitions of influenza. SETTING: A nursing home in Washington County, Maryland. The outbreak involved 52 residents (attack rate = 47.7%) and at least 10 of 140 employees (minimum attack rate = 7.1%). RESULTS: Twenty-five residents exhibited a 4-fold or greater increase in titer to influenza A/Sichuan/2/87. Vaccine efficacy was measured at -7.1%, suggesting that the influenza vaccine in 1988/1989 did not offer optimal protection against influenza A infection for the institutionalized elderly. CONCLUSIONS: The outbreak was a clear indicator of the need for rapid diagnosis. With the use of rapid diagnostic tests, influenza A could have been detected in time to use amantadine.

Records from the Maryland Public Health Department were screened for confirmed rodent and lagomorph rabies between 1981 and 1986. Questionnaires were designed for collection of information about events that led to the exposure of human and/or domestic animals to rabid rodent or lagomorphs. These species comprised 1.2% of all the reported rabies in the state. Woodchucks (Marmota monax) constituted 80.0% of all the reported rodent/lagomorph rabies cases in Maryland. The majority showed aggressive behavior (55.0%). Woodchucks exposed 15 persons (75.0% of all the exposures by rodents/lagomorphs). Domestic animal and human rabies exposure due to rodents and lagomorphs represents a small but significant number of the total exposure to rabid animals.

The clinical and epidemiologic features of vibrio infections occurring over 15 y in a hospital adjacent to the Chesapeake Bay were examined. Microbiologic techniques included the use of thiosulfate citrate bile salts sucrose (TCBS) medium on all stool specimens. Among 40 vibrio isolates from 32 patients, eight species were identified: V. parahaemolyticus (16), V. vulnificus (10), non-O1 V. cholerae (7), V. mimicus (3), V. hollisae (1), V. fluvialis (1), V. alginolyticus (1), and an unnamed halophilic vibrio. Sources included stool (13), wound (11), sputum (3), ear (3), bone (1), and gallbladder (1). While illnesses were diverse, they were relatively mild and self-limited with no mortality. The mild clinical spectrum and especially lack of mortality are in sharp contrast to the findings of previous reports. Even with the proximity to the bay and use of optimal isolation techniques, the demonstrated incidence of vibrio infections was low (1.6/100,000/y). The routine use of TCBS medium, which has been advocated for high-risk areas, was not cost-effective.

Six cases of neonatal meningitis due to Citrobacter diversus were diagnosed in three Baltimore (Maryland) hospitals between 1983 and 1985. Using plasmid profiles, biotypes, serotypes, and chromosomal restriction endonuclease digests as epidemiological markers, we studied 63 isolates of C. diversus (including four isolates from cerebrospinal fluid) from these and seven other hospitals in Maryland. Within two of the three hospitals with meningitis cases, the same strain of C. diversus was isolated from case infant(s), healthy neonates, and nursery personnel. In all three hospitals, C. diversus strains different from those implicated as a cause of meningitis were also isolated. Other than the meningitis-associated strains, 15 different strains of C. diversus were isolated from infants in the hospitals studied, with several distinct clusters of asymptomatic, colonized infants identified.

Between February and June, 1983, four cases of Citrobacter diversus neonatal meningitis were identified at a suburban Baltimore hospital. One of the 4 infants died at age 13 months, 2 (both of whom had brain abscesses) have evidence of developmental delay and 1 appears to be normal after 33 months of follow-up. A review of microbiology records revealed that C. diversus had been present in the hospital nursery prior to identification of the first infant with meningitis, with isolation from infants born 7 months, 4 months and 4 days, respectively, before the first meningitis case. C. diversus was isolated from 21 infants born during the outbreak period and from hand or rectal cultures of 5 nursing personnel. All isolates were biotype E, with two distinct clusters of cases identified on the basis of plasmid profile and serotype. In a case-control study isolation of C. diversus was significantly associated with male sex, low birth weight and care by house pediatricians. The outbreak was controlled by stringent infection control measures and exclusion of personnel carriers. During the 24 months following the outbreak 3431 babies discharged from the nursery were cultured for C. diversus; 3 were colonized with the organism.

Salmonella enteritidis ser. enteritidis was isolated from patrons and employees of three restaurants in a restaurant chain in Maryland during August and September 1985. Isolates from all three restaurants had identical plasmid profiles; this profile was present in 13 of 40 randomly selected S. enteritidis isolates received by the Maryland state health department laboratory during a comparable time period. The outbreak in one restaurant resulted in at least 71 illnesses, with 17 persons known to have been hospitalized. Scrambled eggs served on a "breakfast bar" were implicated as the vehicle of transmission in this restaurant, with eggs a possible vehicle in another of the three restaurants. The data point out the risks associated with improper handling of eggs in food service establishments, provide further evidence for the observed association between S. enteritidis and eggs in the northeastern United States, and demonstrate the utility of plasmid analysis in investigation of outbreaks involving common Salmonella serotypes.

In the literature to date, there have been 44 confirmed cases of infection with the Dysgonic Fermenter-2 (DF-2) bacterium. DF-2 infections appear to demonstrate a strong association with dog bites (or recent exposure to dogs) and have a predilection for patients with defective host defenses although immunocompetent individuals are also susceptible. Recently, the first two cases of documented DF-2 infection following cat bite have been reported. Of the cases reported, 42 of the 44 blood cultures grew DF-2. In one of the two cases where blood culture failed to grow DF-2, the bacterium was isolated at the time of operation from an infected myxoma of the tricuspid valve. In the other case, the organism was isolated from the eyelid margin of a case of angular blepharitis. Peripheral blood smears also afford an effective and practical clinical tool for early diagnosis; 9 of 10 patients for whom smears were done tested positive. This paper reviews the epidemiologic, microbiological, and clinical features of this relatively new illness and also offers general guidelines to physicians for clinical management. Health professionals, especially those providing care for high risk groups, should be alerted to this potentially fatal infection.

A case of cholera was identified in Baltimore County, Md., in October 1984. The Vibrio cholerae O1 isolate from the patient was hemolytic, biotype El Tor, serotype Inaba, and was toxigenic by the Y-1 adrenal cell assay; on Southern blot analysis, the strain had a unique HindIII restriction site in the cholera toxin gene identical to that of other U.S. V. cholerae O1 isolates. Two days before he became ill, the patient had eaten meat from crabs harvested along the Texas coast.

Background: In 1992 and 1993, the Maryland Hospital Association and the Maryland Department of Health and Mental Hygiene conducted 2 surveys of tuberculosis prevention practices in Maryland hospitals that showed poor compliance with the 1990 Centers for Disease Control and Prevention's guidelines for preventing transmission of tuberculosis in health care facilities. Objective: The objective of this study was to assess compliance in 1997 with the Centers for Disease Control and Prevention's guidelines in Maryland acute care hospitals. Methods: A written questionnaire with 3 components—Infection Control, Employee Health, and Microbiology Laboratory—was mailed to 56 Maryland acute care hospitals. Results: Seventy-three percent of the surveys were returned. One hundred percent of responding hospitals with tuberculosis isolation rooms reported negative pressure ventilation, 6 air exchanges per hour, and air exhausted to the outside or through high-efficiency particulate air filters. One hundred percent of the responding hospitals reported providing National Institute for Occupational Safety and Health–approved respiratory protection for health care workers; this compared with 24% in 1992 ( P P Conclusions: The survey results demonstrate excellent compliance with the 1994 Centers for Disease Control and Prevention recommendations for tuberculosis control in Maryland acute care hospitals, even in those facilities determined to be at minimal to low risk for tuberculosis exposure. The proposed Occupational Safety and Health Administration regulations are unlikely to further reduce the risk of tuberculosis exposure to health care workers in Maryland acute care hospitals. (AJIC Am J Infect Control 2000;28:133-7)

• An outbreak of 30 cases of Kawasaki syndrome (KS) occurred in Maryland from January through May 1983. The mean age of patients was 27 months; 60% were male. Rug shampoo exposure within one month and within six months of illness was not significantly greater in the 30 epidemic and seven sporadic cases than in their neighborhood and pediatric controls. These findings suggest that rug shampoo exposure may not be an important risk factor in the outbreak of KS in Maryland. (AJDC1985;139:277-279)

• An acute gastrointestinal tract illness affected 213 (52%) of 407 campers and 64 (53%) of 121 staff members attending a boys' camp in the Catoctin Mountains of Maryland during the summer of 1981. Nausea was the predominant symptom for ill campers and staff members (73%), but more staff members experienced diarrhea (49%) than did campers (9%). Twenty-three individuals had more than one episode of illness compatible with the case definition. Eight of nine paired blood specimens from ill staff members showed a fourfold increase in antibody titer to Norwalk virus by radioimmunoassay. Environmental inspections and laboratory tests failed to implicate a common source of exposure. ( AJDC 1985;139:787-789)