A Reliable Stochastic Numerical Analysis for Typhoid Fever Incorporating With Protection Against Infection

In this paper,a reliable stochastic numerical analysis for typhoid fever incorporating with protection against infection has been considered.We have compared the solutions of stochastic and deterministic typhoid fever model.It has been shown that the stochastic typhoid fever model is more realistic as compared to the deterministic typhoid fever model.The effect of threshold number T*hold in stochastic typhoid fever model.The proposed framework of the stochastic non-standard finite difference scheme(SNSFD)preserves all dynamical properties like positivity,bounded-ness and dynamical consistency defined by Mickens,R.E.The stochastic numerical simulation of the model showed that increase in protection leads to low disease prevalence in a population.

Outcome of surgical treatment of intestinal perforation in typhoid fever

AIM:To represent our clinical experience in the treatment of intestinal perforation arising from typhoid fever.METHODS:The records of 22 surgically-treated patients with typhoid intestinal perforation were evaluated retrospectively.RESULTS:There were 18 males and 4 females,mean age 37 years(range,8-64 years).Presenting symptoms were fever,abdominal pain,diarrhea or constipation.Sixteen cases were subjected to segmental resection and end-to-end anastomosis,while 3 cases received 2-layered primary repair following debridement,one case with multiple perforations received 2-layered primary repair and end ileostomy,one case received segmental resection and end-to-end anastomosis followed by an end ileostomy,and one case received segmental resection and end ileostomy with mucous fistula operation.Postoperative morbidity was seen in 5 cases and mortality was found in one case.CONCLUSION:Intestinal perforation resulting from Salmonella typhi is an important health problem in Eastern and Southeastern Turkey.In management of this illness,early and appropriate surgical intervention is vital.

Peritonitis secondary to ruptured splenic abscess:A grave complication of typhoid fever

Splenic abscesses are increasingly being identified,possibly due to widespread use of imaging modalities in clinical practice.The commonest clinical features are high grade fever and exclusively localised left upper quadrant abdominal pain.These symptoms are similar to most infectious diseases prevalent in the tropics,making imaging by ultrasonography or computer tomography a necessity in the diagnosis.There are reports from different geographic areas on splenic abscesses associated with typhoid fever.We reported ruptured splenic abscess presenting with peritonitis as a rare and grave complication of typhoid fever.

Refractory hypocalcemia precipitated by dual infection with typhoid fever and hepatitis A in a patient with congenital hypoparathyroidism

We present this rare occurrence of a 17 yr old boy,a known case of congenital hypoparathyroidism, who presented with fever and jaundice for 8 days and 2 episodes of generalised tonic-clonic seizures.Premorbidly patient was on regular oral calcium supplementations with normal serum calcium levels.Investigations revealed severe hypocalcaemia(3.2 mg/dL),low 25 hydroxyvitamin D levels and hypomagnesacmia.The marked elevation of serum bilirubin was accompanied by derangement of liver enzymes.Microbiological investigations were confirmatory for both hepatitis A and typhoid fever.In spite of the aggressive management with intravenous calcium gluconate infusion,refractory hypocalcaemia persisted with recovery only after gradual decline in the bilirubin levels.We inferred that the cholestatic process produced by both acute viral hepatitis A and typhoid fever precipitated this state of refractory hypocalcaemia in the previously well preserved patient.

Splenic abscess in typhoid fever - Surgical management

Splenic abscess is an uncommon clinical presentation in surgical practice,associated with high morbidity and mortality.Mortality may be 100%if left untreated.Splenic abscess is also rarely encountered as a complication of typhoid fever.We present here a case of multiple splenic abscesses with neuropsychiatric complications due to typhoid fever,which was managed successfully with splenectomy and other supportive therapies.Another case of single splenic abscess due to enteric fever was treated successfully with CT-guided aspiration and appropriate antibiotics.Being a rare entity in clinical practice,splenic abscess has been poorly studied.Haemalogenous seeding of the spleen due to typhoid is a common cause of splenic abscess in the tropical countries.In multiple or multiloeulated abscesses aspiration usually does not succeed,which happened in our case.Splenectomy remains the definitive choice of treatment.However,Ultra sonography(USG) or CT-guided aspiration may be tried in selective cases.

Relapse typhoid fever in North-eastern state in Malaysia

Objective:To discuss the prevalence,clinical and laboratory presentations of relapse typhoid fever.Methods:All relapse cases were reviewed to identify the clinical and laboratory presentation of the relapse typhoid fever.Results:Two hundred and forty six patients were admitted to a teaching tertiary hospital in North-eastern state of Malaysia and fourteen(5.69%) relapse cases were identified.The duration of relapse after the patient was discharged was(25.0±9.9) d.The patients presented with fever,diarrhoea,headache,abdominal pain and constipation. The duration of fever before admission in the initial episode[(8.6±4.2) d]was significantly longer than the relapse episode[(5.0±2.5) d](P=0.019).Four patients have hepatomegaly in initial episode and ten in relapse episode(P=0.852).The defervescence days of initial episodes was (3.2±2.2) d,comparing to relapse episode[(2.0±1.8) d]which was statistically not significant (P=0.124).Conclusion:Assumption of the relapse typhoid fever is milder comparing to original episodes based on observation and is not supported by statistical analysis.

Survey of food handlers in bukas (a type of local restaurant) in Lagos, Nigeria about typhoid fever

Purpose: The study was conducted to survey the knowledge and behavioural practices of food handlers in bukas (a type of local restaurant) in Nigeria with the aim of assessing the hygiene practices of food handlers and whether they were knowledgeable about typhoid fever and its mode of transmission. Methods: One hundred and seventy four (174) Respondents were ad- ministered questionnaires on their sociode- mographic characteristics, behavioural practices and knowledge of typhoid fever. Results: Ma- jority of the food handlers drank pure water (32.1%), borehole water (32.6%) and public tap water (31.1%) at the about the same frequecy. More than half (62.2%) washed their hands with water only before eating while 27.7% did not wash their hands always before preparing food. After using toilets, 71.9% washed their hands with soap and water while 28.1% washed their hands with only water. When asked if they had heard about typhoid fever 90% said they had heard, out of which15.6% did not know how it was contracted while the others had partial knowledge. Conclusion: Food handlers play a prominent role in the transmission of typhoid fever and so it is important that the food handlers are well informed about their hygiene status and the causes of typhoid fever trans- mission and ways by which typhoid fever spread is prevented. This will go a long way to help reduce the incidence of typhoid fever in the country.

A Single Blind Comparative Randomized Non-Inferior Multicenter Study for Efficacy and Safety of Levofloxacin versus Ciprofloxacin in the Treatment of Uncomplicated Typhoid Fever

Ciprofloxacin is currently the drug of choice for typhoid fever, but Salmonella typhi resistance to ciprofloxacin is increasing, while levofloxacin has been shown to be very effective in a few open studies. This study aimed to compare the efficacy, and safety of levofloxacin and ciprofloxacin for typhoid fever. From 110 patients with confirmed typhoid fever, 54 patients received oral levofloxacin 500 mg once daily with one drop out, while 56 received ciprofloxacin 500 mg twice daily for 7 days with two drop outs. Defervescence of fever was achieved on an average of 3 days after initiating levofloxacin and 5 days after starting ciprofloxacin and one microbiologically non confirmed typhoid fever relapse occurred in the levofloxacin group while two relapses with positive Salmonella microorganism occurred in the ciprofloxacin group. No carrier of Salmonella typhi was found in both groups at day 30. Adverse reactions were more pronounced in the ciprofloxacin group compared to the levofloxacin group. In conclusion, oral levofloxacin 500 mg once daily for one week showed faster fever clearance compared to ciprofloxacin 500 mg twice daily in typhoid fever in Indonesia, and less adverse reactions occurred with levofloxacin compared to ciprofloxacin. This electronic document is a “live” template. The various components of your paper (title, text, heads, etc.) are already defined on the style sheet, as illustrated by the portions given in this document.

A Comparative Study of the Typhidot (Dot-EIA) versus Widal Test in Diagnosis of Typhoid Fever among Egyptian Patients

Background and Study Aim: Typhoid (Enteric) fever is a systemic infection caused by Salmonella Typhi and Salmonella Paratyphi. It is endemic in the developing countries including Egypt. Different diagnostic tools can achieve diagnosis and include cultures from the blood, stool, bone marrow, rarely urine for isolation of the organism. Antibody detection by Widal test and relatively recent typhoid are also used. The current study aimed at comparing the most commonly used antibody detection Widal test with the rapid antibody detection typhidot for diagnosis of typhoid fever among Egyptian adults. Patients and Methods: The study included 140 patients who are presented with picture suggestive of typhoid fever. Confirmed cases after the blood culture were included in the final analysis. Widal and typhidot tests were performed in all patients and were compared for sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy. Results: 45 patients out of 140 were diagnosed as typhoid fever by blood culture. Out of them, Widal test was positive in 39 patients with sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of 86.7%, 89.5%, 79.5%, 93.4% and 88.5% respectively. Typhidot test was positive in 42 patients with sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of 93.3%, 90.6%, 82.3%, 96.6%, and 91.4% respectively (P = 0.00). Conclusions: Typhidot test is reliable, simple highly sensitive and specific test in diagnosing typhoid fever when compared with Widal test.

Acute Cerebellar Ataxia—Uncommon Manifestation of Typhoid Fever

Enteric fever is widely prevalent in the tropics. Central nervous system involvement is not rare and reported incidence varies from 5% to 35% [1]. Various well-known neuropsychiatric manifestations include confusional state, encephalopathy, meningism, convulsions and focal neurological deficits. Acute cerebellar ataxia as an isolated neurological complication of enteric fever is very rare and limited to only a few case reports [2]. Here we report a case of enteric fever who presents Acute Cerebellar Ataxia.

Association between the incidence of typhoid and paratyphoid fever and meteorological variables in Guizhou, China

Background Typhoid/paratyphoid fever （TPF） is endemic in Guizhou.We conducted wavelet analysis and Spearman＇s rank correlation analysis to explore the impact of meteorological variations on TPF infection in Guizhou,in an attempt to assess the risk factors associated with TPF epidemics.Methods We examined the association between TPF incidence in Guizhou and temperature,precipitation and relative humidity using 24 years of data from 1984 to 2007.Periodicities of TPF incidence and the impact of climate factors on the TPF were detected by Spearman＇s rank correlation and wavelet analysis,Results Temperature and precipitation with a 1-month lag were positively correlated with the monthly incidence of TPF.The multiyear incidence pattern of TPF in Guizhou was explicitly periodic.Moreover,the association and driving effect of precipitation on TPF were observed,and the results showed that the incidence of TPF in Guizhou had a closer correlation with precipitation than with temperature.Conclusions Safe water supply is the key issue for TPF control in Guizhou.Moreover,climate variation might impact the enteric infections,which may inform policy assessment for TPF control in Guizhou.

基于Logistic回归分析探讨中医厥阴寒厥患者红外热图特征

目的:运用Logistic回归分析探讨中医《伤寒论》中厥阴寒厥患者红外热图特征,确定该病的红外热成像模型。方法:回顾性选取2021年7月-8月期间就诊于柳州市中医医院治未病中心及体检中心的330人为研究对象,根据四诊合参将研究对象分为厥阴寒厥组和非寒厥组。基于西医结构学理论和中医学理论确定定位方法,将研究对象划定红外中医身体区域分界并命名,测量区域内温度值以定量分析。综合运用线性、非线性数据处理方法,构建厥阴寒厥证的医用红外诊断模型,分析厥阴寒厥证的主要影响因素,评价厥阴寒厥证的医用红外诊断模型的预测能力。结果:(1)采用斯皮尔曼相关系数法探究各身体表面温度变量与厥阴寒厥证的相关关系,发现厥阴寒厥证和“双手掌-督脉”“双手掌-大椎穴”“双手掌-双胁肋”“双脚面-督脉”“双脚面-大椎穴”“双脚面-双胁肋”“双腋窝-双手掌”“双腋窝-双脚面”“脸部-双手掌”“脸部-双脚面”的温度相关性较高;之后运用多因素间共线性分析,得出“双腋窝-双手掌”和“双腋窝-双脚面”这两组自变量是其中的关键因素;(2)以“双腋窝-双手掌”和“双腋窝-双脚面”为主要影响因素,建立的二元Logistic逐步回归模型,训练样本准确率为88.5%,预测样本诊断准确率为100%,准确率较高。结论:医用红外热成像技术能客观诊断厥阴寒厥证,丰富中医诊断的方式,同时也能为中医的诊断体系提供一些科研思路。

Typhoid intestinal perforation in developing countries: Still unavoidable deaths?

Typhoid fever is a public health challenge mostly concentrated in impoverished, overcrowded areas of the developing world, with lack of safe drinking and sanitation. The most serious complication is typhoid intestinal perforation(TIP), observed in 0.8% to 39%, with a striking rate difference between high-income and low-middle-income countries. Although the mortality rate consequent to TIP in resource-poor countries is improved in the last decades, it is still fluctuating from 5% to 80%, due to surgical-and not surgical-related constraints. Huge economic costs and long timelines are required to provide a short-to middle-term solution to the lack of safe water and sanitation. Inherent limitations of the currently available diagnostic tools may lead to under-evaluation as well as over-evaluation of the disease, with consequent delayed treatment or inappropriate, excessive antibiotic use, hence increasing the likelihood of bacterial resistance. There is a need for immunization programs in populations at greatest risk, especially in sub-Saharan Africa. Uniform surgical strategies and guidelines, on the basis of sound or prospective surgical studies and adapted to the local realities, are still lacking. Major drawbacks of the surgical treatment are the frequent delays to surgery, either for late diagnosis or for difficult transports, and the unavailable appropriate intensive care units in most peripheral facilities. As a consequence, poor patient's conditions at presentation, severe peritoneal contamination and unsuitable postoperative care are the foremost determinant of surgical morbidity and mortality.

The Relative Prevalence of Typhoid and Malaria in Febrile Patients in Freetown, Sierra Leone

Malaria and typhoid fever are debilitating diseases responsible for the deaths of thousands of lives annually. Over the last decade both diseases have received increasing attention with particular focus on malaria. However, recent reports indicate an increasing co-infection rate between mala- ria and typhoid fever. Familiar signs and symptoms of both diseases have led to the belief in some communities that it’s a new disease. In this study, we investigated the relationship between mala- ria and typhi O and H antigens among patients reporting with fever. Patients reporting with fever from April 2013-March 2014 were recruited for the study. Our results showed that there was no association between having malaria and typhoid fever infection. However, having fever was asso- ciated with having both diseases. Also, fever among patients was more likely to be caused by Sal- monella typhi O and H antigens than plasmodium parasites. Infections of both diseases were higher in wet season than in dry season. The study recommends that malaria and typhoid fever intervention programs are increased in endemic areas. Also attention should be paid to typhoid fever infection rates in the country.

《圣济总录》治疗伤寒头痛特色探析

《圣济总录》是国内现存最早的官方修订的大型医书,代表着北宋医学发展的水平。《圣济总录》首次对伤寒头痛的学术思想进行系统整理,认为伤寒、伤风、温病、热病、风温等病因皆可导致此病的发生。治疗上首宗张仲景的六经辨证,将伤寒头痛分为太阳头痛、阳明头痛、少阳头痛、厥阴头痛;其次针对时气因素导致寒郁化热的伤寒头痛,多采用辛开凉散之法;善用药引,其中茶是使用次数最多的药引,用以引导主方药物直达病所、提高疗效。

混合式教学模式下《伤寒琢》在中医实习生中的教学及考核实践

目的阐明基于慕课(massive open online courses,MOOC)及线下教学为主的混合式教学模式在《伤寒琢》中医实习生课程中的教学效果。方法2022年7—9月,选择南京中医药大学附属医院大五中医实习生60名,运用分层随机法分成线下组及混合组,各30名,每组总课时皆为36学时。线下组为《伤寒琢》线下教学,而混合组选择《伤寒琢》线上线下联合教学。课程后两组分别进行考核,分为临床标准化病人(standardized patients,SP)考核及统一试卷考试,同时课程结束后对教师及学生分别进行反馈调查。结果混合组学生中医临床诊疗操作、医德考核、SP打分、试卷考试及总成绩皆优于线下组,差异有统计学意义(P<0.05)。此外两组教师及学生对课程的反馈评分差异无统计学意义(P>0.05)。结论慕课对《伤寒琢》课程的线下教学具有促进作用,且不同教学方法并不影响教师及学生的教、学体验。

线上慕课联合线下教学在研究生伤寒琢课程中的实践效果

目的明晰线上慕课(massive online open course,MOOC)联合线下教学在研究生伤寒琢课程中的实践效果。方法选择南京中医药大学2021级中医学相关专业120名硕士研究生(以下简称研究生)为研究对象。根据学位类型、性别、年龄等因素,采用分层随机方法将120名研究生分为试验组和对照组,每组60名研究生。两组研究生教学时间均为36学时。试验组研究生采用线上慕课联合线下课堂教学,其中线上慕课教学12学时,线下课堂教学24学时;对照组研究生采用线下课堂教学。教学结束后,两组研究生分别进行2种考核:标准化病人(SP)参与的情景模拟考核和统一试卷考试。情景模拟考核SP由临床SP扮演,考核内容分为中医临床诊疗操作水平、医德表现和SP主观感受3个部分,皆以百分制评分,3部分考试评分占总成绩的60%,各部分成绩在总成绩中的占比均为20%;统一试卷考试评分占总成绩的40%。然后,将2种考核方式、4个项目的考核成绩按照既定比例计算总成绩。同时,教学结束后对教师和两组研究生进行教学效果问卷调查。结果试验组研究生中医临床诊疗操作水平、医德表现和SP主观感受评分,试卷考试成绩和总成绩均优于对照组研究生,其差异均具有统计学意义(均P<0.01)。教师和两组研究生对教学效果的评分比较,其差异均无统计学意义(均P>0.05)。结论线上慕课联合线下教学在研究生伤寒琢课程中的实践效果优于单一线下教学,且这种混合式教学方式不影响师生的教学体验,值得进一步应用推广。

秦伯未经方医案用药理法探微

目前学界对近代名医秦伯未的关注仍多集中于其在《黄帝内经》研究与辨证论治体系建构方面所取得的成就,对于其在仲景学说上所倾注之心力则了解不足。秦伯未对仲景医学的推崇主要因于其“以切实之经验,贡献于世人”,注重其实用性的特点。故在充分结合秦伯未对仲景病脉证治体系理论阐释的基础上,探求其经方医案中所蕴藏的学术思想与经验,挖掘其活用经方药对配伍、善以经方异病同治、擅用经方时方合方、融通伤寒温病而兼治外感内伤等经方运用理法,并附秦伯未于北京中医药大学东直门医院查房实录一则,以期有助于名家学术经验传承与弘扬,也供现代中医临床与研究工作参鉴。

伤寒黄疸方“麻黄连轺赤小豆汤”证候分析、方中连轺考证及对连翘药用价值和研究的启示

麻黄连轺赤小豆汤是伤寒黄疸三方之一,但未受重视,方中连轺来源不明,地位作用难辨。本文首先对方中麻黄功用和全方证候进行剖析,确定了本方主要用来“清利湿热”以退黄;在此基础上考证“连轺”为“连翘之根”,而非“翘根”,今人以连翘代连轺使用效果相当;接着分析了方中“连翘”的重要地位,并根据连翘作用广泛但缺乏主治病证的特点对连翘药用、研究开发指出了一些有价值的方向,为深入开展连翘理论和实践研究提供了借鉴启示。

伤寒、温病、温疫、寒湿疫传变规律的比较

对伤寒、温病、温疫、寒湿疫传变规律进行比较和总结。伤寒为寒邪从皮毛而入机体,以伤阳为主线,经六经传变;温病为温热之邪从口鼻入侵人体,以伤阴为主线,经卫气营血传变和三焦传变;温疫为湿热戾气从口鼻而入膜原,经表里九传。寒湿疫为寒湿戾气从口鼻而入伏膜原,以伤阳为主线,表里分传,走表入里,或出于三阳肺卫之表,或入肺脾太阴之里,阻滞四焦。寒湿疫分为郁闭脱虚四个阶段,如伏邪不尽,常波及四焦,变证繁多,且后遗症多。