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Objective: To investigate the demographic characteristics, seasonal variations, effects associated with air pollution, and geographic morbidity of asthma in Songkhla.Material and Methods: This research conducted a time series analysis of secondary data from 1 January, 2013 to 31 December, 2017. The distributed lag non-linear model was employed to analyze associations between air pollutants and daily asthma outpatient visits, and the Bayesian hierarchical modelling was used to map asthma morbidity spatiotemporally.Results: A total of 250,127 asthma diagnoses corresponding to 36,761 patients were found in the medical records. Most asthma outpatients were female (61.1%); males (1-5 years) constituted the majority of individuals during the first peak, while females (40-50 years) predominated the second peak. The trend analysis revealed a seasonal variation in the number of asthma outpatient visits; the highest rates were during the June-December period. The regression coefficient analysis revealed carbon monoxide (CO), nitrogen dioxide (NO2 ), relative humidity, and visibility to have the most significant positive effect on asthma, while the cos (wind direction) had the highest negative effect/impact. Significant associations were found between outpatient gender and age and CO, NO2 , sulfur dioxide, ozone, and particulate matter less than 10 micron. The Hat Yai and Central districts of Songkhla province were identified as morbidity hotspots.Conclusion: The number of asthma-related outpatient visits increased during the rainy season. Asthma affected primarily young boys and middle-aged women in this province, and they constitute the most sensitive group to air pollutants such as CO and NO2 and meteorological conditions like relative humidity and visibility. The highest morbidity rates were found in urbanized habitats.

Summary In addition to being a good food source, freshwater snails are considered one of the positively and negatively influencing invertebrates on the environment. Several biotic and abiotic factors are thought to affect the distribution and the dynamics of these snails. Freshwater snails are the most dominant and conspicuous individuals of the freshwater biota in Damietta Governorate. In this study, freshwater snails were collected monthly from 5 geographically and environmentally different sites at Damietta Governorate at the north of Egypt during June 2017-May 2018. Seven snail species; Lanistes carinatus, Lanistes varicus, Pila wernei, Segmentorbis angustus, Melanoides tuberculata, Biomphalaria alexandrina, and Gabbiella senoriansis, were identified. Lanistes carinatus was the most abundant species (56.4%) in the collection sites. Besides, Al-Inaniyyah village had the highest snail species abundance and variety. The abundance of the most recorded species varied seasonally; the highest abundance was recorded during summer while the lowest was during winter. The abundance of some snail species correlated positively or negatively with some physico-chemical parameters; water temperature, dissolved oxygen, conductivity, total dissolved salts, and electrical conductivity. Two types of trematode cercariae; gymnocephalus cercariae and xiphidiocercariae, were harvested from Lanistes carinatus. The highest prevalence of both cercarial types was detected during summer. The correlation between the prevalence of both cercarial types and the physico-chemical parameters were determined. Xiphidiocercariae were the most predominant cercarial type in Damietta Governorate. Our findings suggest that the invasion of some freshwater snails is likely to be the cause of the low prevalence or complete absence of some medically important intermediate snail hosts. We recommend further characterization of the distribution of freshwater snails and the interrelationships among them in Egypt, and suggest a controlled use of selected snail species to combat their medically important analogues.

Background Time spent in daily activities (sleep, sedentary behaviour and physical activity) has important consequences for health and wellbeing. The amount of time spent varies from day to day, yet little is known about the temporal nature of daily activity patterns in adults. The aim of this review is to identify the annual rhythms of daily activity behaviours in healthy adults and explore what temporal factors appear to influence these rhythms. Methods Six online databases were searched for cohort studies exploring within-year temporal patterns (e.g. season effects, vacation, cultural festivals) in sleep, sedentary behaviour or physical activity in healthy 18 to 65-year-old adults. Screening, data extraction, and risk of bias scoring were performed in duplicate. Extracted data was presented as mean daily minutes of each activity type, with transformations performed as needed. Where possible, meta-analyses were performed using random effect models to calculate standardised mean differences (SMD). Results Of the 7009 articles identified, 17 studies were included. Studies were published between 2003 and 2019, representing 14 countries and 1951 participants, addressing variation in daily activities across season (n = 11), Ramadan (n = 4), vacation (n = 1) and daylight savings time transitions (n = 1). Meta-analyses suggested evidence of seasonal variation in activity patterns, with sleep highest in autumn (+ 12 min); sedentary behaviour highest in winter (+ 19 min); light physical activity highest in summer (+ 19 min); and moderate-to-vigorous physical activity highest in summer (+ 2 min) when compared to the yearly mean. These trends were significant for light physical activity in winter (SMD = − 0.03, 95% CI − 0.58 to − 0.01, P = 0.04). Sleep appeared 64 min less during, compared to outside Ramadan (non-significant). Narrative analyses for the impact of vacation and daylight savings suggested that light physical activity is higher during vacation and that sleep increases after the spring daylight savings transition, and decreases after the autumn transition. Conclusions Research into temporal patterns in activity behaviours is scarce. Existing evidence suggests that seasonal changes and periodic changes to usual routine, such as observing religious events, may influence activity behaviours across the year. Further research measuring 24-h time use and exploring a wider variety of temporal factors is needed.

Background The oral sugar test (OST) is commonly used to diagnose insulin dysregulation (ID) and equine metabolic syndrome; however, possible seasonal changes in OST results have not been evaluated. Objective To determine the possible variation in insulin response to OST throughout the year and risk factors associated with maximum insulin concentration (InsMax) and ID. Study design Prospective, longitudinal cohort study. Methods The oral sugar test was performed on 29 Finnhorses every other month six times. Serum total adiponectin concentration and phenotypic variables related to obesity were also measured. Changes in InsMax, adiponectin, scale weight, body condition score, cresty neck score, and fasting glucose concentration were assessed. Risk factor analyses were performed on InsMax and ID status, and ID groups were compared with each other. Results Fourteen horses were categorised with non-ID each time and 15 as having ID at least once during the follow-up period. The ID status of 12 horses varied throughout the year, but neither the insulin variables measured during the OST nor adiponectin expressed significant seasonal variation. Increasing age and cresty neck score, and decreasing adiponectin were observed as risk factors for a high InsMax after OST. The risk of ID was higher in horses with no exercise compared to horses with exercise (OR 7.6, 95% CI 1.2-49.3, p = 0.03). Horses with ID had lower serum adiponectin concentrations, longer neck circumference and larger height than horses in the non-ID group. Main limitations The environmental conditions (feeding, exercise) were not constant for all horses throughout the study and only one breed was used. Conclusions Neither OST results nor adiponectin varies with season; however, there were a substantial number of horses with variable ID status throughout the year, in which repeated OSTs may be beneficial. Lack of exercise was a risk factor for ID.

Purpose: The purpose of the study is to evaluate the prevalence of preventable keratitis, seasonal variations, and microbiological etiology along with quack practices presented at a Tertiary Eye Care Center in Maharashtra (Central India), over a period of 1 year. Materials and Methods: A retrospective study of microbiology of corneal scraping reports in infectious keratitis cases from July 17, 2017 to June 17 2018. Incidence of bacterial and fungal keratitis and culture growth were analyzed for seasonal pattern. Type and frequency of quack practice in the patients were analyzed as well. Results: Among the 795 infectious keratitis cases, culture growth was positive in 322 (40.5%) samples; 258 (80.1%) and 64 (19.9%) were of fungal and bacterial etiology, respectively. The predominant fungal organism was Fusarium Spp. (61.2%) and the predominant bacteria organisms were Streptococcus spp. and Nocardia with (28.1/%) each. Seasonal statistics showed peak in infectious keratitis in rainy seasons with higher incidence of fungal keratitis. It was seen that in 50% of the participants, trauma was the predisposing factor. Six percent of the patients had a history of quack practice from which 53% removed the foreign body with the tip of the tongue. Conclusions: Infectious keratitis is a common problem in central India, with fungal being the most common etiology with surge in rainy season. A significant number of patients still prefer traditional ways of treatment hence awareness and basic knowledge can prevent blindness caused by preventable infectious keratitis.

Annual influenza vaccination offers the best means to control and prevent influenza-associated illnesses. Vaccination of health care workers (HCWs) is crucial for reducing influenza-related morbidity and mortality, and health authorities recommend universal vaccination of this population. We evaluate the rates of influenza vaccination among HCWs and factors influencing uptake among health care professional groups in a children’s hospital in Ankara, Turkey. We surveyed 108 HCWs using a self-administered questionnaire. Influenza vaccination coverage rates (VCR) among HCWs for at least one dose in their lifetimes was 60.2%. In the 2016–2017 influenza season, VCR of HCWs was 14.8%. We found a significantly higher rate of vaccinated participants among physicians (83.3%), older HCWs (mean age ± SD, 36.2 ± 7.7 year), HCWs who believed in the necessity for vaccination (79.5%), and HCWs who have worked for a longer time (> 5 years) in the health care profession (71.2%) (p = 0.023, p = 0.002, p = 0.001, p = 0.003 respectively). For those who refused vaccination, the most common reason was doubts about its effectiveness. The most used source for information about the influenza vaccine among HCWs was the Ministry of Health (MoH). The MoH’s policies should prioritize HCWs to improve VCRs. Electronic supplementary material The online version of this article (10.1057/s41271-020-00250-1) contains supplementary material, which is available to authorized users.

Objectives To assess seasonal variations in the incidence of rhegmatogenous retinal detachment (RRD) in the Eastern Black Sea region of Turkey. Materials and methods Patients presenting due to primary RRD to a university hospital operating as a reference clinic in the region between 2011 and 2018 were evaluated retrospectively. Patients' ages, sex, affected eye, and presentation times were recorded. Years were divided into months, quarters, seasons, and half-year periods, and these periods were analyzed in terms of differences in patient numbers. Results Two hundred eighty-one eyes of 276 patients meeting the study criteria were included. The patients' mean age was 60.2 years, and the male:female ratio was 1.35:1. Right and left eye rates were similar. Detachments were most common (49.4%) in the upper temporal quadrant. Eighty-nine patients (31.6%) had undergone uncomplicated phacoemulsification surgery a mean 2.7 years previously. The mean annual case number was 35.13±5.43, and no statistically significant variation was determined in case numbers by year (p=0.558). Analysis of all years revealed a monthly mean case number of 23.42±4.4, with the highest number of cases, 29 (10.3%), being seen in September and the lowest number, 13 (4.7%), in December. No statistically significant monthly variation was determined (p=0.613). Similarly, no statistically significant variation was observed in case numbers analyzed by quarter, season, or half-year (p>0.05). Conclusion The incidence of cases of uncomplicated RRD does not exhibit seasonal variation in our region. We also think that since 31.6% had a history of cataract surgery, patients undergoing phacoemulsification surgery, even if uncomplicated, should be periodically assessed for detachment.

The review presents the main clinical forms of eye allergy. The modern classification of conjunctival allergic diseases (CAD) divides them into several types according to the presence or absence of proliferative changes complicated by atopic dermatitis or mechanical artifactual irritation. These include: 1) allergic conjunctivitis (AC) without proliferative changes, including seasonal allergic conjunctivitis and chronic allergic conjunctivitis, in which the symptoms persist the whole year; 2) atopic keratoconjunctivitis, a chronic allergic conjunctival disease affecting patients with atopic dermatitis, 3) spring keratoconjunctivitis with conjunctival and proliferative changes — papillary conjunctival hyperplasia with the involvement of the cornea (superficial punctate keratitis, erosion, persistent epithelial defect, sterile corneal ulceration), 4) giant papillary conjunctivitis (GPC) accompanied by proliferative changes in the upper lid and the arch of the conjunctiva of the eyeball, caused by mechanical irritation factors (contact lenses, eye prostheses, or surgical sutures). To treat these conditions, the following groups of medications are used: artificial tears; topical antihistamine drugs; mast cell membrane stabilizers; dualaction drugs, preferably without preservatives, nonsteroid anti-inflammatory medications and vasoconstrictors having side effects. Olopatadin 1 mg/1 ml, preservative free (Olofadin -ECO), has certain advantages due to the fact that it combines antihistamine and membrane stabilizing action. Due to the presence of an antihistamine component in the composition, an acute reaction is stopped, while the effect of the drug is accumulated due to the presence of a membrane-stabilizing component. It is safe for long-term therapy.

Objectives Deslorelin 4.7 mg and melatonin 18 mg subcutaneous implants were studied in purebred male and female cats, via questionnaires sent to French cat breeders, to assess breed, age, duration of the contraceptive effect, fertility after use, changes in behaviour and side effects. Methods Reproductive data were collected in 57 tom cats and 41 queens implanted with deslorelin 4.7 mg, and 42 queens implanted with melatonin 18 mg, for a total of 140 purebred cats, from 38 different catteries, representing 18 breeds. Results Using deslorelin (Suprelorin 4.7 mg; Virbac), sexual behaviour in males was inhibited for a mean ± SD of 13.4 ± 3.2 (range 8–21) months in 37/57 cats. Of these, 24/37 mated successfully and produced litters at a mean of 15.5 ± 3.6 (range 9–20) months. Inhibition lasted 11 ± 1.1 (range 9–12; n = 6), 13.2 ± 2.4 (range 12–18; n = 6) and 15 ± 3.5 (range 9–18; n = 6) months in Norwegian Forest Cat, Singapura and Ragdoll males, respectively. In 26/41 females implanted with deslorelin 4.7 mg, oestrus was inhibited for a mean of 16.0 ± 5.7 (8–38) months; 12/26 went on to produce a litter. Of the side effects specific to females: two presented persistent oestrus, leading to the removal of the implant; two developed lactation; one had fibroadenomatosis; and one was sterilised owing to cystic endometrial hyperplasia. Using melatonin (Melovine 18 mg; Ceva), 33/42 females had oestrus inhibited for a mean of 86 ± 50 (range 21–277) days after implantation with a peak return to oestrus in March, and 12/33 had a subsequent litter. No side effects were reported. Conclusions and relevance This study is the first to collect a large amount of field data, in 140 purebred male and female cats where a deslorelin 4.7 mg or a melatonin 18 mg implant was used. These field results may allow for more accurate clinical advice and open up new avenues of research.

Background: Sentinel influenza-like illness (ILI) surveillance is an essential component of a comprehensive influenza surveillance program. Community-based ILI surveillance systems that rely solely on sentinel healthcare practices omit important segments of the population, including those who do not seek medical care. Participatory surveillance, which relies on community participation in surveillance, may address some limitations of traditional ILI systems. Objective: We aimed to evaluate FluWatchers, a crowdsourced ILI application developed to complement and complete ILI surveillance in Canada. Methods: Using established frameworks for surveillance evaluations, we assessed the acceptability, reliability, accuracy and usefulness of the FluWatchers system 2015–2016, through 2018–2019. Evaluation indicators were compared against national surveillance indicators of ILI and of laboratory confirmed respiratory virus infections. Results: The acceptability of FluWatchers was demonstrated by growth of 50%–100% in season-over-season participation, and a consistent season-over-season retention of 80%. Reliability was greater for FluWatchers than for our traditional ILI system, although both systems had week-over-week fluctuations in the number of participants responding. FluWatchers’ ILI rates had moderate correlation with weekly influenza laboratory detection rates and other winter seasonal respiratory virus detections including respiratory syncytial virus and seasonal coronaviruses. Finally, FluWatchers has demonstrated its usefulness as a source of core FluWatch surveillance information and has the potential to fill data gaps in current programs for influenza surveillance and control. Conclusion: FluWatchers is an example of an innovative digital participatory surveillance program that was created to address limitations of traditional ILI surveillance in Canada. It fulfills the surveillance system evaluation criteria of acceptability, reliability, accuracy and usefulness.

In March 2020, a national elimination strategy for coronavirus disease was introduced in New Zealand. Since then, hospitalizations for lower respiratory tract infection among infants

Objective To investigate the effects of seasonal and climatic changes on postoperative in-hospital mortality and length of stay (LOS) in patients with type A acute aortic dissection (AAD). Methods Patients undergoing implantation of the modified triple-branched stent graft to replace the descending aorta in addition to aortic root reconstruction for type A AAD in our hospital from January 2016 to December 2019 were included. Relevant data were retrospectively collected and analyzed. Results A total of 404 patients were included in our analyses. The multivariate unconditional logistic regression analysis showed that patients admitted in autumn (OR 4.027, 95% CI 1.023–17.301, P = 0.039) or with coronary heart disease (OR 8.938, 95% CI 1.991–29.560, P = 0.049) were independently associated with an increased risk of postoperative in-hospital mortality. Furthermore, patients admitted in autumn (OR 5.956, 95% CI 2.719–7.921, P = 0.041) or with hypertension (OR 3.486, 95% CI 1.192–5.106, P = 0.035) were independently associated with an increased risk of longer LOS. Conclusion Patients admitted in autumn or with coronary heart disease are at higher risk of in-hospital mortality following surgery for type A AAD. Also, patients admitted in autumn or with hypertension have a longer hospital LOS. In the autumn of the temperature transition, we may need to strengthen the management of medical quality after surgery for type A AAD.

Sudden Sensorineural Hearing Loss (SSHL) is sensorineural hearing loss that occurs in 3 days or less, characterized by 30 dBHL or more, over at least 3 contiguous audiometric frequencies. In this study, we aimed to evaluate the SSHL incidence and its relationship with the seasons retrospectively by examining the patients diagnosed with SSHL in our clinic in the last 10 years. In our study, the files of 1920 patients diagnosed with SSHL in our hospital between January 2000 and December 2019 were analyzed retrospectively. The patients were evaluated separately according to age groups, gender, sudden hearing loss, months and seasons. SSHL was most common in January and October, but this difference was not statistically significant compared to other months (p>0.05). When the distribution according to the seasons was examined, it was observed that 28% of patients were in winter, 24% in spring, 26% in autumn and 22% in summer. The difference between seasons was not statistically significant (p>0.05). In October, the first month of the autumn season, and January, the first month of the winter season, we can attribute the high rate of SSHL to seasonal transitions. However, a more detailed study is required in this regard. A more precise result could be achieved with data on annual temperature transitions, humidity status and frequency of viral infections, which can only give us a preliminary information. [Med-Science 2020; 9(3.000): 560-2]

We would like to report our experience of 2 patients co‐infected with Streptococcus pneumoniae (S. pneumoniae) and coronavirus disease 2019 (Covid‐19) in the United Kingdom. This article is protected by copyright. All rights reserved.

Summary Purpose The clinical presentation, complications and mortality in molecularly confirmed influenza A and B infections were analyzed. Methods This retrospective observational single-centre study included all influenza positive patients older than 18 years who were hospitalized and treated at the flu isolation ward during 2017/2018. The diagnosis was based on point-of-care tests with the AlereTM. Results Of the 396 patients tested positive for influenza, 24.2% had influenza A and 75.8% influenza B. Influenza A patients were younger (median age 67.5 years vs. 77 years, p

Durchsucht man die deutschsprachige medizinische Literatur nach dem Begriff „Sommergrippe“, scheitert man klaglich. Jeder glaubt zu wissen, was damit gemeint ist, doch keiner schreibt daruber. Ist das uberhaupt ein serioses Thema?

Objectives Varicose vein operations are traditionally performed during the winter season because of supposed advantages during post-operative care. This prospective study aimed to investigate how, and on what grounds, patients and physicians time varicose vein surgery. Methods Unselected patients attending a consultation for varicose vein surgery at a Regional Hospital in Thun, Switzerland were asked to fill out an anonymous and standardised questionnaire to register the C of CEAP, age, and gender and to understand the drivers behind the timing of the actual intervention. The five main criteria were: job, workplace; symptoms, prevention; family, leisure, sports; season; and other. Results Between May 2015 and April 2017 (a 24 month period spanning two full seasonal cycles) 153 consecutive patients were included and returned 153 questionnaires for analysis. The actual timing of varicose vein surgery correlated inversely with the average temperatures measured in Thun. Among men (n = 65, 43% of the study population), job requirements were the most frequent determinant (41% of cases) of the operating day. Among women, by contrast, symptoms and prevention were named most often (32% of cases) as the leading motivation for surgical timing. Although for both men and women job and workplace was a leading factor over all CEAP classes (28.6%), the importance of symptoms and prevention increased with the CEAP class: from 26.3% in classes 2–4 to 51.8% in classes 5–6. Conclusions Although inversely correlated with outside temperature, the concentration of varicose vein surgery to the winter months seems to be coincidental. The patient's job situation represents overall the most important determinant of surgical planning. Symptoms and prevention are more important in certain subgroups than in others, that is among women and among patients with high CEAP classes., Highlights • Varicose vein surgery shows typical seasonal variability, with a peak in winter. • The patient's job represents the most important determinant for surgical planning. • Symptoms and prevention are more important in certain subgroups than in others.

Patients with end-stage renal disease (ESRD) experience unique patterns in their lifetime, such as the start of dialysis and renal transplantation. In addition, there is also an intricate link between ESRD and biological time patterns. In terms of cyclic patterns, the circadian blood pressure (BP) rhythm can be flattened, contributing to allostatic load, whereas the circadian temperature rhythm is related to the decline in BP during hemodialysis (HD). Seasonal variations in BP and interdialytic-weight gain have been observed in ESRD patients in addition to a profound relative increase in mortality during the winter period. Moreover, nonphysiological treatment patters are imposed in HD patients, leading to an excess mortality at the end of the long interdialytic interval. Recently, new evidence has emerged on the prognostic impact of trajectories of common clinical and laboratory parameters such as BP, body temperature, and serum albumin, in addition to single point in time measurements. Backward analysis of changes in cardiovascular, nutritional, and inflammatory parameters before the occurrence as hospitalization or death has shown that changes may already occur within months to even 1-2 years before the event, possibly providing a window of opportunity for earlier interventions. Disturbances in physiological variability, such as in heart rate, characterized by a loss of fractal patterns, are associated with increased mortality. In addition, an increase in random variability in different parameters such as BP and sodium is also associated with adverse outcomes. Novel techniques, based on time-dependent analysis of variability and trends and interactions of multiple physiological and laboratory parameters, for which machine-learning -approaches may be necessary, are likely of help to the clinician in the future. However, upcoming research should also evaluate whether dynamic patterns observed in large epidemiological studies have relevance for the individual risk profile of the patient. (c) 2018 S. Karger AG, Basel

Background Acute respiratory infections (ARI) cause considerable morbidity and mortality worldwide, especially in children. Unfortunately, there are limited multi-center data on common viral respiratory infections in south China. Methods A total of 4403 nasal swabs were collected from children in 10 cities in Guangdong, China in 2019. Seven respiratory viruses, influenza A virus (IFA), influenza B virus (IFB), respiratory syncytial virus (RSV), adenoviruses (ADV) and parainfluenza virus types 1–3 (PIV1, PIV2 and PIV3), were detected by direct immunofluorescence antibody assay. The personal information and clinical characteristics were recorded and analyzed. Results The results showed that at least one virus was detected in 1099 (24.96 %) samples. The detection rates of RSV, IFA, ADV, PIV3, PIV1 and PIV2 were 7.13 % (314/4403), 5.31 % (234/4403), 4.02 % (177/4403), 3.04 % (134/4403), 1.70 % (75/4403) and 1.16 % (51/4403), respectively. The detection rate of RSV was highest in 0–6-month-old children at 18.18 % (106/583), while the detection rate of IFA was highest in 12–18-year-old children at 20.48 % (17/83). The total detection rates in winter and spring were 35.67 % (219/614) and 34.56 % (403/1166), higher than those in summer, 17.41 % (284/1631), and autumn, 19.46 % (193/992). Conclusions RSV and IFA were the main respiratory viruses in children. With increasing age the detection rate of RSV decreased in children, but the trends for the detection rates of IFA and IFB were the opposite. This study provided the viral etiology and epidemiology of pediatric patients with ARI in Guangdong, China.

Background The paroxysmal nature of migraine is a hallmark of the disease. Some patients report increased attack frequency at certain seasons or towards the end of the week, while others experience diurnal variations of migraine attack onset. This systematic review investigates the chronobiology of migraine and its relation to the periodicity of attacks in existing literature to further understand the oscillating nature of migraine. Main body PubMed and Embase were systematically searched and screened for eligible articles with outcome measures relating to a circadian, weekly or seasonal distribution of migraine attacks. We found that the majority of studies reported morning hours (6 am–12 pm) as the peak time of onset for migraine attacks. More studies reported Saturday as weekly peak day of attack. There was no clear seasonal variation of migraine due to methodological differences (primarily related to location), however four out of five studies conducted in Norway reported the same yearly peak time indicating a possible seasonal periodicity phenomenon of migraine. Conclusions The findings of the current review suggest a possible role of chronobiologic rhythms to the periodicity of migraine attacks. Future studies are, however, still needed to provide more knowledge of the oscillating nature of migraine.

Patients exposed to pollutants are more likely to suffer from allergic rhinitis and may benefit from antioxidant treatment. Our study determined if patients diagnosed with grass-induced allergic rhinitis could benefit from broccoli sprout extract (BSE) supplementation. In total, 47 patients were confirmed with grass-induced allergic rhinitis and randomized to one of four groups: group 1 (nasal steroid spray + BSE), group 2 (nasal steroid spray + placebo tablet), group 3 (saline nasal spray + BSE) and group 4 (saline nasal spray + placebo tablet). Peak Nasal Inspiratory Flow (PNIF), Total Nasal Symptoms Scores (TNSS) and nasal mucus cytokine levels were analyzed in samples collected before and after the 3-week intervention. Comparing before and after the intervention, PNIF improved significantly when comparing Groups 1 and 2, vs. placebo, at various time points (p ≤ 0.05 at 5, 15, 60 and 240 min) following nasal challenge, while TNSS was only statistically significant at 5 (p = 0.03), 15 (p = 0.057) and 30 (p = 0.05) minutes. There were no statistically significant differences in various cytokine markers before and after the intervention. Combining nasal corticosteroid with BSE led to the most significant improvement in objective measures.

Newborn screening for congenital hypothyroidism (CH) is performed by measuring the concentration of thyroxine (T4) and/or thyroid-stimulating hormone (TSH) in dried blood spots. Unfortunately, the levels of T4 and TSH vary due to multiple factors, and therefore the false-positive rate for the test is a challenge. We analyzed screening data from 2008 to 2017 to determine the effect of seasonal changes and manufacturer kit lot changes on T4 and TSH values and on numbers of infants referred. Over a 10-year period, we screened 2.4 million infants using commercially available fluoroimmunoassays to measure T4 and TSH concentrations in dried blood spots. During colder months, daily mean T4 and TSH values were higher and referral rates and false-positive rates were higher. However, there was no significant difference between the number of confirmed CH cases. Furthermore, in rare instances, we observed differences in T4 daily mean values during the 10-year period when manufacturer kit lot changes were made. Seasonal temperature variations influence measured T4 and TSH values and consequently lower the positive predictive value for CH testing in colder months. Newborn screening (NBS) programs should be aware that manufacturer kit lot changes may also influence T4 values.

Livestock depredation by large carnivores is a conventional human&ndash, wildlife conflict, both at the local and regional level. Many species of wildlife have become endangered because of this conflict. In this study, an investigation of livestock depredation was conducted for the north China leopard in and around Tieqiaoshan Provincial Nature Reserve in Shanxi Province between 2015 and 2018. Data were obtained from League Cat Forest Department records. Additionally, standardized, structured, and semi-structured questionnaires were used to collect data with the help of reserve field staff. The results show that there was a significant difference (p = 0.015) in livestock depredation in various seasons of the year, the highest depredation was recorded in spring, followed by summer. A significant difference (p = 0.02) was observed between cattle and other livestock species, showing that more cattle were killed by the north China leopard. Most of the livestock depredation occurred during late morning and evening, likely because the leopards are crepuscular. Residents in and around the reserve suffered a high economic loss, ranging between RMB 5000 and 10,000 (USD 706.76&ndash, 1413.53) per year in terms of the estimated market price of the killed livestock. The attitudes of residents towards the north China leopard vary according to the economic activities of the locals, with about 76% of the livestock keepers reporting that the leopard is &ldquo, very dangerous&rdquo, and 8% of the arable farmers in and around the reserve indicating that leopard is &ldquo, very dangerous.&rdquo, We recommend that a system with local participants would ensure more effective management of human-north China leopard conflict, as it would allow local communities to take greater responsibility.

BackgroundRussia has one of the highest rates of mortality from cardiovascular disease (CVD). At age 35–69 years, they are eight times higher than in neighbouring Norway. Comparing profiles of blood-based CVD biomarkers between these two populations can help identify reasons for this substantial difference in risk.MethodsWe compared age-standardised mean levels of CVD biomarkers for men and women aged 40–69 years measured in two cross-sectional population-based studies: Know Your Heart (KYH) (Russia, 2015–2018; n=4046) and the seventh wave of the Tromsø Study (Tromsø 7) (Norway, 2015–2018; n=17 646). A laboratory calibration study was performed to account for inter-laboratory differences.ResultsLevels of total, low-density lipoprotein-, high-density lipoprotein-cholesterol and triglycerides were comparable in KYH and Tromsø 7 studies. N-terminal pro-b-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hs-cTnT) and high-sensitivity C-reactive protein (hsCRP) were higher in KYH compared with Tromsø 7 (NT-proBNP was higher by 54.1% (95% CI 41.5% to 67.8%) in men and by 30.8% (95% CI 22.9% to 39.2%) in women; hs-cTnT—by 42.4% (95% CI 36.1% to 49.0%) in men and by 68.1% (95% CI 62.4% to 73.9%) in women; hsCRP—by 33.3% (95% CI 26.1% to 40.8%) in men and by 35.6% (95% CI 29.0% to 42.6%) in women). Exclusion of participants with pre-existing coronary heart disease (279 men and 282 women) had no substantive effect.ConclusionsDifferences in cholesterol fractions cannot explain the difference in CVD mortality rate between Russia and Norway. A non-ischemic pathway to the cardiac damage reflected by raised NT-proBNP and hs-cTnT is likely to contribute to high CVD mortality in Russia.

Emma L Carson,1 L Kirsty Pourshahidi,1 Sharon M Madigan,2 Francina R Baldrick,1 Martin G Kelly,3 Eamon Laird,4 Martin Healy,5 JJ Strain,1 Maria S Mulhern1 1Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, University of Ulster, Coleraine, Co. Londonderry, UK; 2Respiratory Dietitian, Pulmonary Rehabilitation Team, Belfast Health and Social Care Trust, Belfast, UK; 3Respiratory Team, Altnagelvin Hospital, Western Health and Social Care Trust, Londonderry, UK; 4School of Medicine, Trinity College, Dublin, Ireland; 5Department of Biochemistry, Central Pathology Laboratory, St James Hospital, Dublin, Ireland Background: Owing to hospitalization, reduced functional capacity and consequently, less sunlight exposure, suboptimal vitamin D status (25-hydroxyvitamin D [25(OH)D]

Background Nontuberculous Mycobacteria (NTM) are environmental microorganisms that can affect human health. A 2009–2010 occurrence survey of NTM in potable tap water samples indicated an increased recovery rate for many clinically significant species such as M. avium (30%) and M. abscessus (12%). To determine if these trends by species were mirrored in human infections, isolation rates of NTM species identified in clinical laboratory reports from four states were evaluated. Method Clinical laboratory reports from the Mississippi, Missouri, Ohio, and Wisconsin Health Departments were used to investigate the species of NTM isolated from human specimens in 2014. The NTM positive specimen reports were tabulated for each species and complex/group. The number of reports by month were used to investigate seasonal trends. The 2014 isolation rates were compared to historic values to examine longitudinal trends. Results The positive rate of NTM specimens increased from 8.2 per 100,000 persons in 1994 to 16 per 100,000 persons in 2014 (or 13.3 per 100,000 after excluding Mycobacterium gordonae). Changes in NTM diversity were observed in complex/groups known to be clinically significant. Between 1994 and 2014 the rate implicating M. abscesses-chelonae group and M. avium complex increased by 322 and 149%, respectively. Conclusions Based on public health data supplied by the four State’s Health Departments and the 2014 U.S. population, 50,976 positive NTM specimen reports per year were projected for the nation; serving as an indicator for the national potential disease burden that year. Electronic supplementary material The online version of this article (10.1186/s12879-018-3043-7) contains supplementary material, which is available to authorized users.

Background Influenza has an important public health impact worldwide with its considerable annual morbidity among persons with or without risk factors and its serious complications among persons in high-risk groups. The seasonal influenza vaccine is essential for preventing the burden of influenza in a population. Since the vaccine is reformulated each season according to the virus serotypes in circulation, its effectiveness can vary from season to season. Vaccine effectiveness is defined as the relative risk reduction in vaccinated individuals in observational studies. Aims To calculate influenza vaccine effectiveness in preventing laboratory-confirmed influenza in the Turkish population for the first time using the national sentinel surveillance data in the 2014-2015 influenza season. Study design Test-negative case-control study. Methods We compared vaccination odds of influenza positive cases to influenza negative controls in the national influenza surveillance in Turkey to estimate influenza vaccine effectiveness. Results The influenza vaccine effectiveness against influenza A (H1N1) (68.4%, 95% CI: -2.9 to 90.3) and B (44.6%, 95% CI: -27.9 to 66.6) were moderate, and the influenza vaccine effectiveness against influenza A (H3N2) (75.0%, 95% CI: -86.1 to 96.7) was relatively high; all had low precision given the low vaccination coverage. Overall, the influenza vaccination coverage rate was 4.2% (95% CI: 3.5 to 5.0), which is not sufficient to control the burden of influenza. Conclusion In Turkey, national surveillance for influenza should be strengthened and utilised annually for the assessment of influenza vaccine effectiveness with more precision. Annual influenza vaccine effectiveness in Turkey should continue to be monitored as part of the national sentinel influenza surveillance.

Background: With a global rising trend in prevalence of allergic diseases, more attention has been paid to investigation of environmental risk factors. Many risk factors have so far been identified. However, novel risk factors specific to Taiwanese environment and lifestyle were still relatively unknown. Objective: To investigate the potential effects of a number of little-known indoor risk factors on the frequency of doctor's visit for respiratory problems in context of Taiwanese environment and lifestyle. Methods: A cross-sectional, population-based study was performed on a 861 participants around Kaohsiung area, Taiwan. Survey investigation was employed to assess the household environment and the frequency of doctor's visit for respiratory problems. Results: Participants who performed “daily cleaning” was shown to have a significantly (p=0.007) higher mean number of doctor's visits in comparison to those who did not. Similar observation was made for participants who periodically took out beddings (p=0.042). Age had a significant positive correlation (linear regression β 0.089) with frequency of respiratory problems. Conclusion: The habit of daily cleaning was implicated as a potential indoor risk factor due to the unique nature of Taiwanese cleaning habit and close contact with cleaning supplies, which could serve as chemical irritants. Bedding takeout was predicted to be an indicator of chronic allergies rather than an actual risk factor. However, both were controversial in their role as potential indoor risk factor, and required further examination.

The 880 million agricultural workers of the world are especially vulnerable to increasing heat stress due to climate change, affecting the health of individuals and reducing labour productivity. In this study, we focus on rice harvests across Asia and estimate the future impact on labour productivity by considering changes in climate at the time of the annual harvest. During these specific times of the year, heat stress is often high compared to the rest of the year. Examining climate simulations of the Coupled Model Intercomparison Project 6 (CMIP6), we identified that labour productivity metrics for the rice harvest, based on local wet-bulb globe temperature, are strongly correlated with global mean near-surface air temperature in the long term (p ≪ 0.01, R 2 > 0.98 in all models). Limiting global warming to 1.5 °C rather than 2.0 °C prevents a clear reduction in labour capacity of 1% across all Asia and 2% across Southeast Asia, affecting the livelihoods of around 100 million people. Due to differences in mechanization between and within countries, we find that rice labour is especially vulnerable in Indonesia, the Philippines, Bangladesh, and the Indian states of West Bengal and Kerala. Our results highlight the regional disparities and importance in considering seasonal differences in the estimation of the effect of climate change on labour productivity and occupational heat-stress.

Background Seasonal influenza‐associated mortality estimates help identify the burden of disease and assess the value of public health interventions such as annual influenza immunization. Vital registration is limited in Bangladesh making it difficult to estimate seasonal influenza mortality. Objectives Our study aimed to estimate seasonal influenza‐associated mortality rates for 2010‐2012 in Bangladesh. Methods We conducted surveillance among hospitalized patients with severe acute respiratory illness (SARI) for persons aged ≥5 years and severe pneumonia for children 60 years. During 2011‐2012, the estimated influenza‐associated mortality rate was 13 (95% CI 10‐16) per 100 000 among children 60 years. Conclusions We identified a substantial burden of influenza‐associated deaths in Bangladesh suggesting that the introduction of prevention and control measures including seasonal vaccination should be considered by local public health decision‐makers.

Background Invasive Mucorales infections (IMI) lead to significant morbidity and mortality in immunocompromised hosts. The role of season and climatic conditions in case clustering of IMI remain poorly understood. Methods Following detection of a cluster of sinopulmonary IMIs in patients with hematologic malignancies, we reviewed center-based medical records of all patients with IMIs and other invasive fungal infections (IFIs) between January of 2012 and August of 2015 to assess for case clustering in relation to seasonality. Results A cluster of 7 patients were identified with sinopulmonary IMIs (Rhizopus microsporus/azygosporus, 6; Rhizomucor pusillus, 1) during a 3 month period between June and August of 2014. All patients died or were discharged to hospice. The cluster was managed with institution of standardized posaconazole prophylaxis to high-risk patients and patient use of N-95 masks when outside of protected areas on the inpatient service. Review of an earlier study period identified 11 patients with IMIs of varying species over the preceding 29 months without evidence of clustering. There were 9 total IMIs in the later study period (12 month post-initial cluster) with 5 additional cases in the summer months, again suggesting seasonal clustering. Extensive environmental sampling did not reveal a source of mold. Using local climatological data abstracted from National Centers for Environmental Information the clusters appeared to be associated with high temperatures and low precipitation. Conclusions Sinopulmonary Mucorales clusters at our center had a seasonal variation which appeared to be related to temperature and precipitation. Given the significant mortality associated with IMIs, local climatic conditions may need to be considered when considering center specific fungal prevention and prophylaxis strategies for high-risk patients.

Hiroyuki Onodera,1 Takeru Urayama,2 Kazue Hirota,3 Kazuhiro Maeda,3 Ritsuko Kubota-Koketsu,3,4 Kazuo Takahashi,5 Katsuro Hagiwara,6 Yoshinobu Okuno,3 Kazuyoshi Ikuta,3,4 Mikihiro Yunoki,2,4,6 1Medical Information Department, 2Research and Development Division, Japan Blood Products Organization, Tokyo, 3Research and Development Division, The Research Foundation for Microbial Diseases of Osaka University, Kagawa, 4Former Department of Virology, Research Institute for Microbial Diseases, Osaka University, 5Virology Division, Department of Infectious Diseases, Osaka Prefectural Institute of Public Health, Osaka, 6Pathogenic Risk Evaluation, Graduate School of Veterinary Medicine, Rakuno Gakuen University, Hokkaido, Japan Abstract: Influenza viruses A/H1N1, A/H3N2, and B are known seasonal viruses that undergo annual mutation. Intravenous immunoglobulin (IVIG) contains anti-seasonal influenza virus globulins. Although the virus-neutralizing (VN) titer is an indicator of protective antibodies, changes in this titer over extended time periods have yet to be examined. In this study, variations in hemagglutination inhibition (HI) and VN titers against seasonal influenza viruses in IVIG lots over extended time periods were examined. In addition, the importance of monitoring the reactivity of IVIG against seasonal influenza viruses with varying antigenicity was evaluated. A/H1N1, A/H3N2, and B influenza virus strains and IVIG lots manufactured from 1999 to 2014 were examined. The HI titer was measured by standard methods. The VN titer was measured using a micro-focus method. IVIG exhibited significant HI and VN titers against all investigated strains. Our results suggest that the donor population maintains both specific and cross-reactive antibodies against seasonal influenza viruses, except in cases of pandemic viruses, despite major antigen changes. The titers against seasonal influenza vaccine strains, including past strains, were stable over short time periods but increased slowly over time. Keywords: IVIG, influenza, seasonal, neutralization, vaccine

Background: Saline nasal irrigation is labelled as an add-on treatment in patients with allergic rhinitis (AR). The primary aim of this study was to compare the efficacy of 21-day use of buffered hypertonic saline (BHS) versus normal saline solution (NSS) on reducing nasal symptoms in children with seasonal AR (SAR). Comparing their efficacy on nasal cytology counts (NCC), quality of life, and sleep quality was the secondary aim. Methods: In this 21-day, open-label, randomized controlled study, 36 SAR children (aged 6-13 years) with a Total 5 Symptom Score (T5SS) ≥5 received twice-daily BHS or NSS delivered through a nasal douche. Efficacy measures were least square mean changes (LSmc) in T5SS, NCC, Paediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ), and Pittsburgh Sleep Quality Index (PSQI) scores. Results: BHS improved the T5SS total score to a greater extent than NSS (LSmc -6.45 vs. -5.45, p < 0.001). Concerning NCC, BHS significantly reduced the scores of neutrophils (LSmc -0.76, p = 0.004) and eosinophils (LSmc -0.46, p = 0.018), while NSS did not. Similarly, only BHS yielded a significant improvement in the PRQLQ score (LSmc -0.57, p = 0.009), whereas the improvement in PSQI score was comparable between the BHS (LSmc -0.77, p = 0.025) and NSS (LSmc -1.39, p < 0.001) groups. Overall, BHS was well tolerated. Conclusions: In children with SAR, BHS is effective in improving nasal symptoms and NCC, with an associated beneficial effect on quality of life.

Background: Serum 25-hydroxyvitamin D (25(OH)D) assays have become readily available in India over the past decade. A large number of cross-sectional studies have been performed on the vitamin D status and the prevalence of vitamin D deficiency (VDD) in India. However, seasonal and long-term trends in serum 25(OH)D levels have been reported less frequently. Aim: To determine the seasonal and year-wise variation in vitamin D status at a tertiary care hospital in north India. Materials and Methods: Using hospital records, the data on serum 25(OH) D assays performed in its endocrinology laboratory between 2008 and 2016 were obtained. For analysis of seasonal trends, the months of a year were divided into following seasons: March to June (summer season), July to October (rainy season), and November to February (winter season). VDD was defined as serum 25(OH)D concentration 100 ng/mL) and vitamin D toxicity (serum 25(OH)D >150 ng/mL) were seen in 319 (1.2%) and 27 (0.1%) assays, respectively. Conclusions: This study provides data on seasonal and year-wise trends in vitamin D status over a long period of time at a tertiary care hospital in north India. A long-term trend toward improving vitamin D status, especially in females, was noted in the study. The prevalence of VDD was found to decrease in the analyzed samples during the study period.

Because of the inflammatory mechanisms of most chronic upper airway diseases such as rhinitis and chronic rhinosinusitis, systemic steroids have been used for their treatment for decades. However, it has been very well documented that-potentially severe-side-effects can occur with the accumulation of systemic steroid courses over the years. A consensus document summarizing the benefits of systemic steroids for each upper airway disease type, as well as highlighting the potential harms of this treatment is currently lacking. Therefore, a panel of international experts in the field of Rhinology reviewed the available literature with the aim of providing recommendations for the use of systemic steroids in treating upper airway disease. ispartof: CLINICAL AND TRANSLATIONAL ALLERGY vol:10 issue:1 ispartof: location:England status: published

Introduction Environmental triggers of acute myocardial infarction (AMI) have gained mounting evidence from various geographies of the world. However, due to geographic variations in seasonal temperature and other metrological parameters, it is difficult to generalize the findings in one population to another population with different climatic conditions. Therefore, the aim of this study was to assess the relationship between meteorological parameters and the number of primary percutaneous coronary intervention (PCI) procedures for AMI at a tertiary care cardiac hospital in Karachi, Pakistan. Methods For this cross-sectional study, data was obtained on the number of primary PCI procedures conducted at the National Institute of Cardiovascular Diseases (NICVD) Karachi, Pakistan during 1st June 2016 to 31st May 2018. Daily meteorological data of the Karachi region for the same period was obtained from the Pakistan Meteorological Department. It consists of temperature, atmospheric pressure, and relative humidity. Based on the weather conditions of Karachi, the data was divided into two seasons; summer (April to October) and winter (November to March). Multiple linear regression analysis was performed taken the number of primary PCI performed as regressand and time trend, average temperature, temperature variation, and relative humidity as regressors. Results A total of 115,494 hospital admissions were recorded during the study period out of which rate of primary PCI was 10.5% (12,107). A negative relationship between average temperature and number of primary PCI was observed with standardized regression coefficients of -0.13 (p < 0.001) on the overall regression model. A similar significant negative relationship of average temperature was observed on the regression model for the cold season with standardized regression coefficients of -0.17 (p < 0.001). While no such relationship was observed for the warm season. Conclusion The average daily temperature was found to be negatively related to the number of primary PCI. Subgroup analysis revealed that the average daily temperature had a significant negative relationship with the number of primary PCI in the cold season; however, no such impact was observed in the warm season.

Background Hypernatremia is one of the most commonly encountered electrolyte disorders in the emergency department (ED). Few studies have reported the seasonal fluctuations of the prevalence of hypernatremia with conflicting results. We investigated the seasonal prevalence of hypernatremia in an emergency department in Japan. Methods A total of 12,598 patients presented to the ED between January 2015 and December 2017 were reviewed. The adult group aged between 18 and 64 years old consisted of 5427 patients and the elderly group aged over 65 years consisted of 7171 patients. Information collected included age, sex, serum sodium, and serum creatinine. Hypernatremia was defined as a serum sodium leve1 > 145 mEq/L, and moderate to severe hypernatremia was defined as a serum sodium level ≥ 150 mEq/L. Results The prevalence of hypernatremia was significantly higher in the elderly group than in the adult group (2.6% vs. 0.7%; p p r = − 0.34, p = 0.04). Conclusions Hypernatremia is prevalent in the elderly and the prevalence is highest during the winter. Special attention should be paid in the elderly patients to prevent hypernatremia especially in the winter.

ObjectiveTo identify whether renal transplant activity varies in a reproducible manner across the year.DesignRetrospective cohort study using NHS Blood and Transplant data.SettingAll renal transplant centres in the UK.ParticipantsA total of 24 270 patients who underwent renal transplantation between 2005 and 2014.Primary outcomeMonthly transplant activity was analysed to see if transplant activity showed variation during the year.Secondary outcomeThe number of organs rejected due to healthcare capacity was analysed to see if this affected transplantation rates.ResultsAnalysis of national transplant data revealed a reproducible yearly variance in transplant activity. This activity increased in late autumn and early winter (p=0.05) and could be attributed to increased rates of living (October and November) and deceased organ donation (November and December). An increase in deceased donation was attributed to a rise in donors following cerebrovascular accidents and hypoxic brain injury. Other causes of death (infections and road traffic accidents) were more seasonal in nature peaking in the winter or summer, respectively. Only 1.4% of transplants to intended recipients were redirected due to a lack of healthcare capacity, suggesting that capacity pressures in the National Health Service did not significantly affect transplant activity.ConclusionUK renal transplant activity peaks in late autumn/winter in contrast to other countries. Currently, healthcare capacity, though under strain, does not affect transplant activity; however, this may change if transplantation activity increases in line with national strategies as the spike in transplant activity coincides with peak activity in the national healthcare system.

The occurrence of the invasive nonindigenous copepod Oithona davisae Ferrari and Orsi, 1984, is reported for the first time in the Aegean Sea. The data we collected in August 2017 from 14 stations along the Turkish coast of the Aegean Sea reveal the spatial distribution of O. davisae between the openning of the Dardanelles Strait in the north and the Izmir Bay in the south. The O. davisae individuals, in seven mesozooplankton samples collected from a single station, were consistently found in the inner part of the Izmir Bay from April 2015-October 2016. The abundance of female O. davisae ranged from 4 ind./m3 in April 2015 to 31,524 ind./m3 in July 2016 and contributed to the total oithonid female population by 10.8% in April 2015 and 92.8% in September 2016. Our results show that this species is well established in the inner part of Izmir Bay and that it has become a permanent component of the copepod community in the area. © 2019 Blackwell Verlag GmbH Energy Information Administration DBTE-199 Gökhan KAMAN for helping to sampling and to the crew of R/V K. Piri Reis and R/V TÜBİTAK MAM Marmara Research Vessel for technical assistance during cruises. This work has been funded by “Integrated Marine Pollution Monitoring 2017-2019 Programme” carried out by Ministry of Environment and Urbanization/ General Directorate of EIA, Permit and Inspection/Department of Laboratory, Measurement and coordinated by TUBITAK-MRC ECPI, and Izmir Metropolitan Municipality General Directorate of Water and Sewage Administration through DBTE-199, 2015 project.

Herd-level risk factors related to the cow&rsquo, s environment have been associated with lameness. Uncomfortable stall surface and inadequate depth of bedding as well as abrasive alley way surface are contributing factors to increased levels of lameness. Access to pasture has been found as having a beneficial effect on cows&rsquo, locomotion. However, dairy cattle managed under grazing conditions are exposed to a different set of risk factors for lameness, mainly associated with cow tracks. Cow-based risk factors for lameness are not as clearly defined as the herd level risk factors. The objective of the present study was to use routine herd health monitoring data to identify cow-based risk factors for lameness and utilise this information to indicate cows at risk of developing lameness in the first 150 days of lactation. Lameness data were gathered from 10 pasture-based dairy herds. A total of 1715 cows were monitored, of which 1675 cows were available for analysis. Associations between lameness status and potential cow-level risk factors were determined using multivariable logistic regression. Parity 3 and 4 + cows showed odd ratios (OR&rsquo, s) for lameness of 3.92 and 8.60 respectively (95% confidence interval (CI) 2.46&ndash, 6.24, 5.68&ndash, 13.0). Maximum loss of Body condition score (BCS) after calving exhibits OR&rsquo, s for lameness of 1.49 (95% CI 1.08&ndash, 2.04) if cows lost 0.5 in BCS after calving and 2.26 (95% CI 1.30&ndash, 3.95) for cows losing more than 0.5 BCS. Animals calving in BCS 3.25 and &ge, 3.5 had correlating OR&rsquo, s of 0.54 (95% CI 0.34&ndash, 0.87) and 0.33 (95% CI 0.16&ndash, 0.65) for being lame compared to cows calving with BCS &le, 2.75. Data gathered as part of herd health monitoring can be used in conjunction with lameness records to identify shortcomings in lameness management. Findings and recommendations on lameness management can be formulated from readily available information on cow-based risk factors for lameness.

BACKGROUND The aim of this study was to determine the efficacy of sublingual administration of Dermatophagoides farinae drops for the treatment of allergic rhinitis (AR) accompanied by adenoid hypertrophy and the effect on immune function in children. MATERIAL AND METHODS Eosinophil counts in peripheral blood before and after treatment were determined; serum levels of immunoglobulin E (IgE), total IgE (T-IgE), immunoglobulin G4 (IgG4), interleukin-2 (IL-2), and interleukin-6 (IL-6) before and after treatment were detected by enzyme-linked immunosorbent assay. RESULTS The total effective rate in the study group was significantly higher than that in the control group (P

Introduction:Although circadian variation of (motor) symptoms in Parkinson disease (PD) patients has been described, it remains unclear what effect seasonal variation may have on non-motor symptoms (NMS).Methods:Cross-sectional retrospective study on 372 consecutive PD patients taking part in the Non-motor Longitudinal International Study at King's College Hospital London between November 2011 and July 2018. Patients were divided into three groups based on their date of assessment, using a simplified seasonal model: group 1: November–February (n = 107); group 2: March-15 June (n = 107); and group 3: 16 June–October (n = 158). Primary outcome was a seasonal difference in NMS scale (NMSS) total scores (higher scores reflecting greater disability). We hypothesized that PD patients exhibit circannual NMS burden patterns.Results:All groups were identical concerning disease onset and duration, HY stage, Levodopa equivalent dose, and gender. There was a seasonal difference in NMSS total scores (p = 0.040), with the highest scores (57.1 ± 42.5) in season 1 (winter months) and the lowest (45.1 ± 34.4) in season 3 (summer months) (p = 0.037). Seasonal differences were observed in NMSS domain 1 (cardiovascular symptoms) (p = 0.011), domain 4 (perceptual problems) (p = 0.017) and domain 9 (miscellaneous symptoms) (p = 0.009). A trend was observed for domain 2 (sleep) (p = 0.057).Conclusion:NMS in PD fluctuate throughout the year, with worsening of symptoms in the winter months compared to the summer months suggestive of dysfunction of the body's master clock, the suprachiasmatic nuclei. Such variations must be accommodated in daily care to ascertain appropriate changes in medication regimes and in clinical trials for the interpretation of outcomes.

OTO, ARZU/0000-0003-0229-2759; Sevketoglu, Esra/0000-0002-8330-2877, WOS: 000496521400006, PubMed: 31435144, Objectives:To analyze the course of seasonal viral infections of respiratory tract in patients hospitalized in pediatric intensive care units (PICU) of 16 centers in Turkey. Materials and methods: It is a retrospective, observational, and multicenter study conducted in 16 tertiary PICUs in Turkey includes a total of 302 children with viral cause in the nasal swab which required PICU admission with no interventions. Results: Median age of patients was 12 months. Respiratory syncytial virus (RSV) was more common in patients over one year of age whereas influenza, human Bocavirus in patients above a year of age was more common (p = 60 mm Hg. Conclusion: Our findings demonstrate that patients with neurological symptoms, tachycardia, hypoxia, hypotension, acidosis, impaired liver, and renal function at the time of admission exhibit more severe mortal progressions. Presence of acidosis and multiorgan failure was found to be predictor for mortality. Knowledge of clinical presentation and age-related variations among seasonal viruses may give a clue about severe course and prognosis. By presenting the analyzed data of 302 PICU admissions, current study reveals severity of viral respiratory tract infections and release tips for handling them.

Highlights • Significant growth reported in influenza vaccine production capacity since 2006. • Seasonal influenza vaccine production capacity has reduced since 2013. • Pandemic influenza vaccine production capacity is at its highest recorded level. • Challenges remain regarding maintenance of capacity and equitable distribution., A global shortage and inequitable access to influenza vaccines has been cause for concern for developing countries who face dire consequences in the event of a pandemic. The Global Action Plan for Influenza Vaccines (GAP) was launched in 2006 to increase global capacity for influenza vaccine production to address these concerns. It is widely recognized that well-developed infrastructure to produce seasonal influenza vaccines leads to increased capacity to produce pandemic influenza vaccines. This article summarizes the results of a survey administered to 44 manufacturers to assess their production capacity for seasonal influenza and pandemic influenza vaccine production. When the GAP was launched in 2006, global production capacity for seasonal and pandemic vaccines was estimated to be 500 million and 1.5 billion doses respectively. Since 2006 there has been a significant increase in capacity, with the 2013 survey estimating global capacity at 1.5 billion seasonal and 6.2 billion pandemic doses. Results of the current survey showed that global seasonal influenza vaccine production capacity has decreased since 2013 from 1.504 billion doses to 1.467 billion doses. However, notwithstanding the overall global decrease in seasonal vaccine capacity there were notable positive changes in the distribution of production capacity with increases noted in South East Asia (SEAR) and the Western Pacific (WPR) regions, albeit on a small scale. Despite a decrease in seasonal capacity, there has been a global increase of pandemic influenza vaccine production capacity from 6.2 billion doses in 2013 to 6.4 billion doses in 2015. This growth can be attributed to a shift towards more quadrivalent vaccine production and also to increased use of adjuvants. Pandemic influenza vaccine production capacity is at its highest recorded levels however challenges remain in maintaining this capacity and in ensuring access in the event of a pandemic to underserved regions.

ObjectivesDuring recent decades, there has been limited attention on the seasonal pattern of pertussis within a high vaccine coverage population. This study aimed to compare the seasonal patterns of clinical suspected pertussis cases with those of laboratory confirmed cases in Iran.MethodsThe current study was conducted using time series methods. Time variables included months and seasons during 2011–2013. The effects of seasons and months on the incidence of pertussis were estimated using analysis of variance or Kruskal–Wallis.ResultsThe maximum average incidence of clinically confirmed pertussis was 23.3 in July (p = 0.04), but the maximum incidence of clinical suspected pertussis was 115.7 in May (p = 0.6). The maximum seasonal incidences of confirmed and clinical pertussis cases were reported in summer (average: 12, p = 0.004), and winter (average: 108.1; p = 0.4), respectively.ConclusionThe present study showed that the seasonal pattern of laboratory confirmed pertussis cases is highly definite and different from the pattern of clinical suspected cases.

Acute eosinophilic pneumonia (AEP) is an uncommon inflammatory lung disease, and limited data exist concerning the clinical characteristics and factors that influence its occurrence. We retrospectively reviewed the records of AEP patients treated at Korean military hospitals between January 2007 and December 2013. In total, 333 patients were identified; their median age was 22 years, and all were men. All patients presented with acute respiratory symptoms (cough, sputum, dyspnea, or fever) and had elevated levels of inflammatory markers including median values of 13,185/µL for white blood cell count and 9.51 mg/dL for C-reactive protein. All patients showed diffuse ground glass opacity/consolidation, and most had pleural effusion (n = 265; 80%) or interlobular septal thickening (n = 265; 85%) on chest computed tomography. Most patients had normal body mass index (n = 255; 77%), and only 30 (9%) patients had underlying diseases including rhinitis, asthma, or atopic dermatitis. Most patients had recently changed smoking habits (n = 288; 87%) and were Army personnel (n = 297; 89%).The AEP incidence was higher in the Army group compared to the Navy or Air Force group for every year (P = 0.002). Both the number of patients and patients with high illness severity (oxygen requirement, intensive care unit admission, and pneumonia severity score class ≥ III) tended to increase as seasonal temperatures rose. We describe the clinical characteristics of AEP and demonstrate that AEP patients have recently changed smoking habits and work for the Army. There is an increasing tendency in the numbers of patients and those with higher AEP severity with rising seasonal temperatures., Graphical Abstract

Background Seasonal influenza is a respiratory illness caused by the influenza virus. During the 2017–2018 flu season, the Centers for Disease Control and Prevention noted approximately 959,000 hospitalizations and 79,400 deaths from influenza. We sought to evaluate the educational quality of informational videos pertaining to seasonal influenza on the popular social media forum, YouTube. Methods Using the keywords “seasonal influenza,” all videos from 28 January to 5 February 2017 were included and analyzed for characteristics, source, and content. The source was further classified as healthcare provider, alternative-medicine provider, the patient and/or their parents, company, media, or professional society. Videos about other categories of influenza (e.g. swine or Spanish) or in foreign languages were excluded. A total of 10 blinded reviewers scored each video independently. Results Overall, 300 videos were analyzed, with a median of 341.50 views, 1.00 likes, 0 dislikes, and 0 comments. Based on the average scores of videos by source, there was statistically significant difference in the average score among videos by video source ( p