Keratoconus associated with Williams-Beuren syndrome:a new case report

Dear Editor,I am Dr.Soraya Mediero,from Department of Ophthalmology of La Paz University Hospital,Madrid,Spain.I write to present a case report of keratoconus associated with Williams-Beuren syndrome（WBS）.

NEW INQUIRY INTO THE APPLICATION OF CASE TOOLS TO CIM PROCESS

There is an urgent necessity to introduce the life cycle development method and a Computer-Aided Software Engineering (CASE) environment to support the development of a Computer Integrated Manufacturing (CIM) system. In this paper, we present several ideas while inquiring how to apply CASE tools to CIM process effectively, and propose five proper applicable paradigms to enhance the possibility of applications that the CIM process may make better use of CASE tools.

Temporal Dynamics in COVID-19 Transmission: Case of Some African Countries

Coronavirus disease 2019 (COVID-19) has become a global threat to public health and economy. The potential burden of this pandemic in developing world, particularly the African countries, is much concerning. With the aim of providing supporting evidence for decision making, this paper studies the dynamics of COVID-19 transmission through time in selected African countries. Time-dependent reproduction number (Rt) is one of the tools employed to quantify temporal dynamics of the disease. Pattern of the estimated reproduction numbers showed that transmissibility of the disease has been fluctuating through time in most of the countries included in this study. In few countries such as South Africa and Democratic Republic of Congo (DRC), these estimates dropped quickly and stayed stable, but greater than 1, for months. Regardless of their variability through time, the estimated reproduction numbers remain greater than or nearly equal to 1 in all countries. Another Statistical model used in this study, namely Autoregressive Conditional Poisson (ACP) model, showed that expected (mean) number of new cases is significantly dependent on short range change in new cases in all countries. In countries where there is no persistent trend in new cases, current mean number of new cases (on day t) depend on both previous observation and previous mean (day t - 1). In countries where there is continued trend in new cases, current mean is more affected by number of new cases on preceding day.

THE PROSPECTIVE STUDY OF RELATIONSHIP BETWEEN LOW SELENIUM AND KASHIN-BECK DISEASE

The relationship of causeresult between low selenium (Se) and KashinBeck disease (KBD) was probed by the prospective study of epidemiological method with regarding lowSe as an exposure factor in this paper. 597 healthy children lived in KBD areas with low, middle and high prevalence were divided into the lowSe exposed group and the nonlowSe exposed group according to their Se content in hair. The lowSe exposed group was divided into three subgroups, such as Se content in hair110 ng/g, 110 ng/g<Se content in hair150 ng/g and 150 ng/g<Se content in hair200 ng/g, respectively. Six new cases of the total with KBD (incidence was 0574% personyear) were found in the lowSe exposed group during three years period of the investigation. No new case was found in the non lowSe exposed group . KBD incidence was not significantly different between those two groups. Two new cases were found in children with Se content in hair kept below 110 ng/g during three years (incidence: 121% personyear). SMR in each group indicated that the new cases observed in the lowSe exposed group was remarkable lower than the new cases expected. It was not observed that the doseresponse relationship between lowSe and KBD, and was not supported that the lowSe was a predominant factor to cause KBD.

Evaluating active leprosy case identifcation methods in six districts of Nepal

Background Nepal has achieved and sustained the elimination of leprosy as a public health problem since 2009,but 17 districts and 3 provinces with 41%(10,907,128)of Nepal’s population have yet to eliminate the disease.Pediatric cases and grade-2 disabilities(G2D)indicate recent transmission and late diagnosis,respectively,which necessitate active and early case detection.This operational research was performed to identify approaches best suited for early case detection,determine community-based leprosy epidemiology,and identify hidden leprosy cases early and respond with prompt treatment.Methods Active case detection was undertaken in two Nepali provinces with the greatest burden of leprosy,Madhesh Province(40%national cases)and Lumbini Province(18%)and at-risk prison populations in Madhesh,Lumbini and Bagmati provinces.Case detection was performed by(1)house-to-house visits among vulnerable populations(n=26,469);(2)contact examination and tracing(n=7608);in Madhesh and Lumbini Provinces and,(3)screening prison populations(n=4428)in Madhesh,Lumbini and Bagmati Provinces of Nepal.Per case direct medical and nonmedical costs for each approach were calculated.Results New case detection rates were highest for contact tracing(250),followed by house-to-house visits(102)and prison screening(45)per 100,000 population screened.However,the cost per case identifed was cheapest for house-to-house visits[Nepalese rupee(NPR)76,500/case],followed by contact tracing(NPR 90,286/case)and prison screening(NPR 298,300/case).House-to-house and contact tracing case paucibacillary/multibacillary(PB:MB)ratios were 59:41 and 68:32;female/male ratios 63:37 and 57:43;pediatric cases 11%in both approaches;and grade-2 disabilities(G2D)11%and 5%,respectively.Developing leprosy was not signifcantly diferent among household and neighbor contacts[odds ratios(OR)=1.4,95%confdence interval(CI):0.24-5.85]and for contacts of MB versus PB cases(OR=0.7,95%CI 0.26-2.0).Attack rates were not signifcantly diferent among household contacts of MB cases(0.32%,95%CI 0.07-0.94%)and PB cases(0.13%,95%CI 0.03-0.73)(χ^(2)=0.07,df=1,P=0.9)and neighbor contacts of MB cases(0.23%,0.1-0.46)and PB cases(0.48%,0.19-0.98)(χ^(2)=0.8,df=1,P=0.7).BCG vaccination with scar presence had a signifcant protective efect against leprosy(OR=0.42,0.22-0.81).Conclusions The most efective case identifcation approach here is contact tracing,followed by house-to-house visits in vulnerable populations and screening in prisons,although house-to-house visits are cheaper.The fndings suggest that hidden cases,recent transmission,and late diagnosis in the community exist and highlight the importance of early case detection.

Dynamic variations in COVID-19 with the SARS-CoV-2 Omicron variant in Kazakhstan and Pakistan

Background The ongoing coronavirus disease 2019(COVID-19)pandemic caused by the severe acute respiratory syndrome-coronavirus 2(SARS-CoV-2)and the Omicron variant presents a formidable challenge for control and prevention worldwide,especially for low-and middle-income countries(LMICs).Hence,taking Kazakhstan and Pakistan as examples,this study aims to explore COVID-19 transmission with the Omicron variant at different contact,quarantine and test rates.Methods A disease dynamic model was applied,the population was segmented,and three time stages for Omicron transmission were established:the initial outbreak,a period of stabilization,and a second outbreak.The impact of population contact,quarantine and testing on the disease are analyzed in five scenarios to analysis their impacts on the disease.Four statistical metrics are employed to quantify the model’s performance,including the correlation coefficient(CC),normalized absolute error,normalized root mean square error and distance between indices of simulation and observation(DISO).Results Our model has high performance in simulating COVID-19 transmission in Kazakhstan and Pakistan with high CC values greater than 0.9 and DISO values less than 0.5.Compared with the present measures(baseline),decreasing(increasing)the contact rates or increasing(decreasing)the quarantined rates can reduce(increase)the peak values of daily new cases and forward(delay)the peak value times(decreasing 842 and forward 2 days for Kazakhstan).The impact of the test rates on the disease are weak.When the start time of stage Ⅱ is 6 days,the daily new cases are more than 8 and 5 times the rate for Kazakhstan and Pakistan,respectively(29,573 vs.3259;7398 vs.1108).The impact of the start times of stageⅢon the disease are contradictory to those of stageⅡ.Conclusions For the two LMICs,Kazakhstan and Pakistan,stronger control and prevention measures can be more effective in combating COVID-19.Therefore,to reduce Omicron transmission,strict management of population movement should be employed.Moreover,the timely application of these strategies also plays a key role in disease control.