Biomedical subjects

I Bergeri

Publications and source records attributed to I Bergeri.

4 recordsLinked to original sources

PubMed2004

Strengthening early warning function of surveillance in the Republic of Serbia: lessons learned after a year of implementation.

The Republic of Serbia, with WHO support, has implemented an early warning system (ALERT) for priority communicable diseases, to complement the routine surveillance system which notifies individual confirmed cases. The results of its evaluation, conducted one year after implementation is presented here. ALERT relies on notification of 11 syndromes by primary care facilities. Data is analysed weekly at district level and transmitted to national epidemiologists. ALERT is perceived to be a simple and flexible tool. Acceptability is higher at national level than at district level. Some districts perceive ALERT as a parallel system poorly connected to control measures. Sensitivity of ALERT in detecting cases of meningitis is 93%, and 37% for cases of hepatitis. Retrospective analysis of ALERT data identified 9 outbreaks, 5 of which had been recognized by epidemiologists. ALERT was the timeliest system for detecting 4 outbreaks identified by both systems. ALERT was useful for triggering timely investigation and control of outbreaks of hantavirus and salmonellosis and for detecting the start of the influenza season. However, ALERT did not detect clusters of brucellosis and tularaemia targeted by the unexplained fever syndrome. This evaluation underlined the need for a global review of surveillance activities when implementing new components such as ALERT. While control measures based on notification of individual confirmed cases are well understood and implemented, the investigation and verification process that should result from an increase in ALERT syndromes is not fully understood. Field epidemiology training programmes, such as the EPIET programme, are best suited to bring about this change of perspective.

Communicable Disease Control↗

PubMed2003

[Precipitating factors associated with diastolic heart failure in the elderly].

BACKGROUND: Beside basal myocardial dysfunction, acute heart failure involves associated factors, which increase pulmonary capillary pressure or decrease colloid osmotic pressure. The aim of this study was to evaluate the prevalence of these precipitating factors in a population presenting with acute heart failure with preserved left ventricular systolic function. METHODS: Forty-eight patients (25 men, 78 +/- 10 years) presenting pulmonary edema with a left ventricular ejection fraction > 45% were included. All had a Doppler echocardiography at the time of intravenous loop diuretics initiation. Patients with severe valve disease or symptomatic coronary disease were excluded. RESULTS: A history of heart failure, coronary disease, hypertension and diabetes was present in 62%, 42%, 64% and 33% of patients, respectively. On admission, mean left ventricular ejection fraction was 61 +/- 9% and 79% of patients had critical elevation in Doppler filling pressures. Associated factors were renal failure (creatinine clearance < 30 ml/min) in 33% patients, silent myocardial ischemia (troponin I > 0.5 ng/ml) in 31%, atrial fibrillation in 29%, high systolic blood pressure (> or = 160 mmHg) in 27%, major sepsis in 25%, severe hypoalbuminemia (< or = 2.5 g/dl) in 23%, and severe anemia (< 10 g/dl) in 17%, respectively. Four patients had no aggravating factor, whereas 34 and 10 patients had 1-2 and 3-4 associated factors, respectively. CONCLUSION: Besides diastolic dysfunction, factors leading to a critical decrease in the oncotic pressure such as pulmonary capillary pressure gradient are found in most of the elderly patients presenting acute diastolic heart failure and must be checked systematically.

Aged↗

PubMed2003

[In vivo evaluation of chloroquine therapeutic efficacy in uncomplicated Plasmodium falciparum malaria in Central African Republic ine 1997 and 1998].

The efficacy of oral chloroquine was assessed in 268 children aged from 6 to 59 months attending pediatric services in regional hospitals between September 1997 and December 1998, located in the five county towns of the sanitary regions of the Central African Republic. Chloroquine was prescribed at 25 mg per kg body weight, and administered over 3 days to patients suffering from uncomplicated malaria. Body temperature and blood smears including parasitaemia were recorded on days 0, 3, 7 and 14. The main objective of the present study was to evaluate the therapeutic efficacy of chloroquine in the treatment of uncomplicated malaria using in vivo tests according to the WHO protocol (1996). The secondary objective was to identify the predictive factors of chloroquine relapses. Early relapses rates were under 15% except in Bangui (40%). A recurrence of parasitaemia with fever, sign of late relapse, was noted in 9% of children in Bambari, 9% in Bangassou, 8% in Bangui, 5% in Bossangoa and 4% in Berberati. The rate of successfully treated patients was between 66% and 75% except in Bangui (36%). Only the places of study and anaemia in days 0 were significant predictive factors of therapeutic relapses. Since the emergence of chloroquine resistance cases to P. falciparum in 1983 in Central African Republic, the phenomenon has increased. According to our results, a strong chloroquine resistance appears in the capital Bangui. Therefore, chloroquine should be replaced there for the first line treatment of uncomplicated P. falciparum malaria. In the provinces, it doesn't seem necessary to change the current chloroquine-based first line treatment.

Administration, Oral↗

PubMed2002

[Everything (or almost everything) about the Kappa coefficient].

Sensitivity, specificity, and predictive value are the standard parameters used to evaluate the efficacy of diagnostic tests. However all three parameters assume the existence of a gold standard test. Thus the problem arises as to what method to use in the absence of a benchmark. The solution involves assessment of agreement between two raters. This article based on an example drawn from an African setting describes the value and computation of the most widely used tool for assessing agreement and reproducibility of measures, i.e., the kappa coefficient.

Statistics, Nonparametric↗