3D Vector Reconstruction of the Muscles of the Ventral Region of the Neck from Anatomical Sections of Korean Visible Human at the Paris Descartes Anatomy Laboratory

Objective: To carry out a 3D vector reconstruction of the muscles of the ventral region of the neck from anatomical sections of the “Korean Visible Human” for educational purposes. Materials and Methods: The anatomical subject was a 33-year-old Korean man who died of leukemia. He was 164 cm tall and weighed 55 kgs. The anatomical sections were made in 2010 after an MRI and a CT scan. A special saw (cryomacrotome) made it possible to make cuts 0.2 mm thick on the frozen body, i.e. 5960 cuts. Sections numbered 1500 to 2000 (or 500 cuts covering the neck) were used for our study. A segmentation by manual contouring of each anatomical element of the anterior neck region was done using Winsurf version 3.5 software on a laptop PC running Windows 7 equipped with an 8 gigabyte RAM. Results: We modeled the sternocleidomastoid muscles, the supra-hyoid muscles, the infra-hyoid muscles and the muscle structures of the anterior neck region, the aero-digestive axis of the anterior neck region and the vasculo-nervous axis of the neck. This model is easily manipulated using the Acrobat 3Dpdf interface. Each item accessible in a menu can be displayed, hidden or made transparent, and 3D labels are available as well as educational menus for learning anatomy. This vector model has been integrated into the Diva3d virtual dissection table, a new educational tool used by universities and medical schools to learn anatomy. This model was also uploaded to the Sketchfab? website and 3D printed using an ENDER? pro 3 printer. Conclusion: This original work constitutes a remarkable educational tool for the anatomical study of the anterior neck region and can also be used as a 3D atlas for simulation purposes for training in therapeutic gestures.

Transperineal laser ablation of the prostate as a treatment for benign prostatic hyperplasia and prostate cancer: The results of a Delphi consensus project

Objective: To evaluate transperineal laser ablation (TPLA) with Echolaser® (Echolaser® TPLA, Elesta S.p.A., Calenzano, Italy) as a treatment for benign prostatic hyperplasia (BPH) and prostate cancer (PCa) using the Delphi consensus method.Methods: Italian and international experts on BPH and PCa participated in a collaborative consensus project. During two rounds, they expressed their opinions on Echolaser® TPLA for the treatment of BPH and PCa answering online questionnaires on indications, methodology, and potential complications of this technology. Level of agreement or disagreement to reach consensus was set at 75%. If the consensus was not achieved, questions were modified after each round. A final round was performed during an online meeting, in which results were discussed and finalized.Results: Thirty-two out of forty invited experts participated and consensus was reached on all topics. Agreement was achieved on recommending Echolaser® TPLA as a treatment of BPH in patients with ample range of prostate volume, from <40 mL (80%) to >80 mL (80%), comorbidities (100%), antiplatelet or anticoagulant treatment (96%), indwelling catheter (77%), and strong will of preserving ejaculatory function (100%). Majority of respondents agreed that Echolaser® TPLA is a potential option for the treatment of localized PCa (78%) and recommended it for low-risk PCa (90%). During the final round, experts concluded that it can be used for intermediate-risk PCa and it should be proposed as an effective alternative to radical prostatectomy for patients with strong will of avoiding urinary incontinence and sexual dysfunction. Almost all participants agreed that the transperineal approach of this organ-sparing technique is safer than transrectal and transurethral approaches typical of other techniques (97% of agreement among experts). Pre-procedural assessment, technical aspects, post-procedural catheterization, pharmacological therapy, and expected outcomes were discussed, leading to statements and recommendations.Conclusion: Echolaser® TPLA is a safe and effective procedure that treats BPH and localized PCa with satisfactory functional and sexual outcomes.

Psychological quality of life and employability skills among newly registered first-year students: Opportunities for further university development

In accord with new European university reforms initiated by the Bologna Process, our objective was to evaluate influences on the relationship between psychological quality of life (QoL) and the acquisition of academic employability skills (AES) among first-year students at the University in Luxembourg. At the beginning (2 months in) and the end (9 months) of the academic year, 973 newly registered students participated in this study involving two cross-university surveys. Students who redoubled or who had studied at other universities were excluded. Data were collected with an online questionnaire comprising the psychological Whoqol-bref subscale, AES scale, and questions about other related factors. The AES score decreased from 74.2 to 65.6. At both time points, the psychological Whoqol-bref was positively correlated with environmental and social relations QoL and perceived general health. Multiple regression models including interaction terms showed that a higher psychological QoL was associated with better general health (difference satisfied-dissatisfied 9.44), AES (slope 0.099), social relationships QoL (0.321), and environmental QoL (0.298). No interaction with time effects was significant, which indicates that the effects remain stable with time. If the university could maintain the QoL indicators at appropriate levels or manage decreases as they occur, it would have implications for health promotion and the creation of new student support systems. The SQA- LES project provides valuable information for universities aiming to develop a European Higher Educational Area.

Toward Energy-Efficient and Trustworthy eHealth Monitoring System

The rapid technological convergence between Internet of Things(IoT),Wireless Body Area Networks(WBANs)and cloud computing has made e-healthcare emerge as a promising application domain,which has significant potential to improve the quality of medical care.In particular,patient-centric health monitoring plays a vital role in e-healthcare service,involving a set of important operations ranging from medical data collection and aggregation,data transmission and segregation,to data analytics.This survey paper firstly presents an architectural framework to describe the entire monitoring life cycle and highlight the essential service components.More detailed discussions are then devoted to {\em data collection} at patient side,which we argue that it serves as fundamental basis in achieving robust,efficient,and secure health monitoring.Subsequently,a profound discussion of the security threats targeting eHealth monitoring systems is presented,and the major limitations of the existing solutions are analyzed and extensively discussed.Finally,a set of design challenges is identified in order to achieve high quality and secure patient-centric monitoring schemes,along with some potential solutions.

Biomarkers of cetuximab resistance in patients with head and neck squamous cell carcinoma

Objective:In patients with head and neck squamous cell carcinoma(HNSCC),cetuximab[a monoclonal antibody targeting epidermal growth factor receptor(EGFR)]has been shown to improve overall survival when combined with radiotherapy in the locally advanced setting or with chemotherapy in first-line recurrent and/or metastatic(R/M)setting,respectively.While biomarkers of resistance to cetuximab have been identified in metastatic colorectal cancer,no biomarkers of efficacy have been identified in HNSCC.Here,we aimed to identify biomarkers of cetuximab sensitivity/resistance in HNSCC.Methods:HNSCC patients treated with cetuximab at the Curie Institute,for whom complete clinicopathological data and formalin-fixed paraffin-embedded(FFPE)tumor tissue collected before cetuximab treatment were available,were included.Immunohistochemistry analyses of PTEN and EGFR were performed to assess protein expression levels.PIK3 CA and H/N/KRAS mutations were analyzed using high-resolution melting(HRM)and Sanger sequencing.We evaluated the predictive value of these alterations in terms of progression-free survival(PFS).Results:Hot spot activating PIK3 CA and KRAS/HRAS mutations were associated with poor PFS among HNSCC patients treated with cetuximab in the first-line R/M setting,but not among HNSCC patients treated with cetuximab in combination with radiotherapy.Loss of PTEN protein expression had a negative predictive value among HNSCC patients treated with cetuximab and radiotherapy.High EGFR expression did not predict cetuximab sensitivity in our patient population.Conclusions:Hot spot activating PIK3 CA and RAS mutations predicted cetuximab resistance among HNSCC patients in the firstline R/M setting,whereas loss of PTEN protein expression predicted resistance to cetuximab when combined to radiotherapy.

Toward an easier indigocarmine chromoendoscopy

Indigocarmine chromoendoscopy has been proven to improve the detection of colonic lesions during screening colonoscopy, and is associated with increased adenoma detection rates. Furthermore, it is commonly used to help in the delineation and characterization of colorectal neoplasms. However, it usually requires the use of a spraying catheter that decreases the suction capacity of the endoscope, and is time- consuming. Herein, we report on the feasibility of indigo carmine chromoendoscopy during colonoscopy without using a spraying catheter, with the dye being administered through the air/water channel of the endoscope. Since the suction channel remains free, the air can be exsufflated and the staining then applies uniformly onto the colonic walls with the excess indigocarmine dye being immediately eliminated. In our experience with various types of colonoscopes and cap-assisted colonoscopy, this procedure makes indigocarmine chromoendoscopy much easier and quicker to perform, and might save the use of a spray catheter.

Reliability and validity of the French version of the Global Physical Activity Questionnaire

Background:The Global Physical Activity Questionnaire(GPAQ)has been used to measure physical activity(PA)and sedentary time in France,but no study has assessed its psychometric properties.This study aimed to compare the reliability as well as criterion and concurrent validity of the French version of the GPAQ with the French International Physical Activity Questionnaire long form(IPAQ-LF)and use of an accelerometer in a general adult population.Methods:We included 92 participants(students or staff)from the Medicine Campus at the University of Lorraine,Nancy(north-eastern France).The French GPAQ was completed twice,7 days apart,to study test-retest reliability.The IPAQ-LF was used to assess concurrent validity of the GPAQ,and participants wore an accelerometer(ActiGraph GT3X+)for 7 days to study criterion validity.Reliability as well as concurrent and criterion validity of the GPAQ were tested by the intraclass correlation coefficient(ICC),Spearman correlation coefficient for quantitative variables,and Kappa and Phi coefficients for qualitative variables.Both concurrent and criterion validity of GPAQ were assessed by Bland-Altman plots.Results:The GPAQ showed poor to good reliability(ICC=0.37-0.94;Kappa=0.50-0.62)and concurrent validity(Spearman r=0.41-0.86),but only poor criterion validity(Spearman r=-0.22-0.42).Limits of agreement for the GPAQ and accelerometer were wide,with differences between 286.5 min/week and 601.3 min/week.Conclusion:The French version of the GPAQ provides limited but acceptable reliability and validity for the measurement of PA and sedentary time.It may be used for assessing PA and sedentary time in a French adult population.

1例中国被收养女性罹患神经性贪食症的案例：跨文化研究

概述:一直以来,饮食障碍被认为是西方国家特有的与文化相关的综合症。因为神经性厌食症,这个理论似乎已被打破,但仍少有关于神经性贪食症的跨文化研究,故这方面文献有限。在本临床病例中,我们试图探讨文化因素对这一疾病的影响。我们研究了此病例中的非典型特征,特别关注到容易被忽略的患者的外表容貌和收养隐秘被揭晓所诱发的心理冲击。神经性贪食症触发了一种亲子关系和自我认同的重新寻找,以期日后再度恢复良好家庭关系并最终获得自我。同样我们也研究本病例中的中国收养状况。本病例提示文化因素影响的重要性,跨文化研究可以帮助我们更好的理解神经性贪食症,并提示了有效治疗手段。

Diagnostic errors of nasal fractures in the emergency department:A monocentric retrospective study

Nasal bone fracture is one of the most common face bone injuries and the third most frequent of all body fractures.[1]Clinical examination is considered to be the gold standard to confirm the diagnosis of a nasal fracture.However,diagnosis may be challenging in case of haematoma and oedema of adjacent tissues,this leading to the use of X-rays to confirm or infirm the hypothesis.[2]Radiographic explorations for midface traumas can also be indicated for forensic purposes.[3]

Potential Compressive Sites of the Anterior Interosseous Nerve in the Proximal Forearm: An Anatomic Study

Background: The etiology and treatment of spontaneous paralysis variants of anterior interosseous nerve (AIN) syndrome remains controversial. Variation and multiple sites of potential compression complicate the successful performance of neurolysis. This anatomic study of the AIN and sites of potential compression in the proximal forearm facilitates critical steps involved in neurolytic procedures and management. Methods: Upper extremities of twelve cadavers were examined to evaluate potential sites of AIN compression in the proximal forearm. Potential sites of musculoaponeurotic compression were evaluated, including: lacertus fibrosus;inferior fibrous arch of the humeral head of the pronator teres (PT) muscle;inferior fibrous arch of the ulnar head of the PT muscle;fibrous arch in the flexor digitorum superficialis (FDS) muscle;Gantzer’s muscle;and vascular structures near the AIN and median nerve. Results: The AIN arose at a mean distance of 54.5 mm distal to the elbow from the posterior (n = 9) or ulnar side (n = 3) of the median nerve. Relative positions of AIN branches were variable. A fibrous arch was found between the lacertus fibrosus and the PT in two cases. Nine cadavers had two fibrous arches in the PT and FDS, and three cadavers had one arch. An accessory head in the FDS was found to be a risk of AIN compression. Gantzer’s muscle was present in six cases, crossing the AIN superficially. Two potentially compressive vascular arches were identified. Conclusions: Our observations confirm that multiple musculoaponeurotic and/or vascular structures can contribute to AIN compression in the proximal forearm. Understanding the complex anatomic relationships of this nerve is crucial to improving outcomes of neurolysis in cases of non-regressive AIN paralysis.

Experience of Management of Anorexia Nervosa Patients with Extremely Severe Malnutrition in a Transdisciplinary Clinical Nutrition-Eating Disorders Inpatient Unit

Background: The question of where to hospitalize extremely malnourished patients with anorexia nervosa (AN) is a real dilemma. On one hand, psychiatrists have to deal with severe medical complications that are not within their competences and that justify hospitalization in an internal medicine ward. On the other hand, medical doctors have to face psychic decompensations that would justify admission to a psychiatric ward. In this context, we share our experience of management of severely malnourished AN adult patients in a transdisciplinary specialized eating disorders (ED) unit, referral center for AN associated with somatic severity. Method: First, we described the modalities of care proposed to patients with AN hospitalized in the medical unit. Intensive medical care, both somatic and psychiatric, are provided thanks to a transdisciplinary therapeutic program, where objectives are to: medically stabilize the patient, initiate progressive refeeding and start supportive psychotherapy before being transferred to a psychiatric ED unit. Secondly, we conducted a retrospective descriptive study that included all adult patients with AN admitted for the first time to the unit, between November 1997 and January 2014, for severe malnutrition and/or complications of the ED. Objective was to specify patients’ characteristics: demographic, nutritional status, history of ED, care pathway. Results: Among a cohort of 386 adult patients with AN (21 males and 365 females) admitted for the first time in the unit, mean age was 29.4 (±11.5) years, mean BMI was 12.7 (±2.2) kg/m2. Before being supported in the unit, 78.2% of patients had already been hospitalized in other hospitals. Mean length of stay was 35.2 days. Patients were clinically serious and unstable because of life-threatening somatic complications due to a low BMI. During hospital stay, a temporary transfer to medical intensive care unit was necessary for 25.6% of patients. Average patient weight gain was 0.777 kg per week and 81.9% of patients benefited from enteral nutrition. Conclusion: This specialized transdisciplinary unit where physician nutritionists and psychiatrists coordinate medical care together, allow a better understanding and management of extreme malnutrition associated with AN. Thanks to their expertise, care teams are less critical and less rejecting towards patients. Thus, therapeutic alliance could be optimized.

Hierarchy of Rural Localities in the Niakhar Area (Fatick, Senegal)

Although the study of the hierarchy of localities presents an important social and economic stake, studies focused on the hierarchy of rural localities are relatively weak, especially in Africa. It is important to highlight the hierarchy of rural areas in order to reveal poles that can support sustainable growth. Our main objective is to study the hierarchy of rural localities in the Niakhar area, using a geographic approach. The data come from the Niakhar demographic, epidemiological and environmental observatory database and the Niakhar Atlas project of the French Research Institute for Development (IRD). The net flow method, the primacy index, the median population threshold method and the measurement of the correlation between level of centrality and population size are used to analyze the data. Our study allowed us to determine the main types of centrality and to establish the hierarchy of rural localities in the Niakhar zone. It also highlighted the strong correlation between the rank of localities and the size of the population of the latter. The main contribution of our work is to have highlighted, in order, the structuring localities of the rural space of the Niakhar area, by combining several indicators of centrality.

Characteristics of Prostate Cancers Missed by Biopsies: Evaluation of Cumulative Tumor Volume Missed According to Cancer True Prevalence

Purpose: To characterize missed prostate tumors and their cumulative volume with various biopsy regimens to determine optimal biopsy schemes. Methods: We performed 6, 12 and 18-core needle biopsies on 165 and 36-core biopsies on 47 autopsy prostates, respectively. The 6-core biopsy included 6 cores from the mid peripheral zone (MPZ), the 12-core biopsy included 6 cores from the MPZ and lateral PZ (LPZ), and the 18-core biopsies included 6 cores from the MPZ, LPZ and central zone (CZ). The 36-core biopsies included 12 cores in each of these 3 areas. We analyzed the sensitivity of biopsies at each site and evaluated the cumulative volume of cancers and tumor foci missed. Results: Whole-mount analysis identified 59 cancers, 110 tumor foci, and a total cumulative tumor volume of 43 cm3. The percentage of tumor foci and corresponding cumulative volume missed with 6, 12, 18 and 36-core biopsies were of 79% and 58%, 64% and 48%, 57% and 26%, and 42% and 17%, respectively (p 0.05). 12-core biopsies from the MPZ and LPZ performed best for clinically significant cancers detection. However, increasing the number of cores over the 6-core biopsy cutoff increased solely the detection of tumor foci 0.5 cm3. Conclusion: Twelve biopsies from the MPZ and LPZ detected most of the clinically significant cancers while missing most of the tumor foci. These missed tumors represented only a small amount of the overall cancer volume.

Acute anemia after dental extraction:A case report

A patient treated with a vitamin K antagonist (VKA) since the implantation of two mechanical heart valves developed acute anemia after the extraction of a tooth. This case report and data in the literature indicate a need for specific measures before, during, and after oral surgery in patients taking anticoagulant therapy: 1) the bleeding risk should be evaluated before the procedure. The INR should be measured routinely, 2) the procedure should be scheduled early in the week to allow an evaluation at the fibrinolysis peak, i.e., 48 to 72 hours after surgery, which is the time of greatest risk of delayed bleeding, 3) the surgical procedure should be appropriate for the elevated bleeding risk, 4) postoperative monitoring is of the most importance, as bleeding is usually delayed in patients on VKA therapy, 5) when poor treatment adherence is expected, day-hospital admission is useful to ensure that the postoperative protocol is implemented properly and to detect early bleeding. The treatment of post-extraction acute anemia includes local hemostasis protocol with the revision of the socket followed by red-blood-cell pack transfusion. A daily fluindione dosage control, and a normal hemoglobin level will allow the patient to leave the hospital.

Oral Manifestations of Neurofibromatosis Type 1

Neurofibromatosis type 1 (NF-1) is a common genetic disorder with a highly variable phenotype. The disease affects both proliferation and differentiation of cells of neurectodermal origin. The presence of tumors is very common like benign nodular neurofibromas. Tumors with unclear prognosis may be present like plexiform neurofibromas whose prognosis is more uncertain. While many organs exhibit pathologies, most commonly affected are the nervous system, skin, gastrointestinal tract and heart. Oral abnormalities are also very common: 72% of NF-1 patients exhibit pathologies in oral mucosa, gums, maxillary and temporomandibular joints, and teeth. The incidence of NF-1 and its relationship to the prevalence of caries have been discussed in other researches. It is known that poor oral hygiene plays a key role in the development of periodontal disease and caries. Here we review the oral manifestations of neurofibromatosis type 1 that we illustrate by a patient followed in the center of rare diseases of the hospital Henri Mondor, clinical service in which we work.

Distinct profiles of systemic biomarkers of oxidative stress in chronic human pathologies:Cardiovascular,psychiatric,neurodegenerative,rheumatic,infectious,neoplasmic and endocrinological diseases

Oxidative stress is involved in chronic and acute pathologies: cardiovascular, neurodegenerative, neoplastic, inflammatory and infectious diseases. Clinical trials focused on prevention of cardiovascular and neoplastic diseases involving antioxidant supplementation have however provided predominantly negative obserations in large-scale studies. Screening of patient cohorts to assess baseline oxidative stress on the basis of a biomarker profile is decisive but lacking. For the first time, we evaluated the level of oxidative stress, testing more than 10 established biomarkers, in a comprehensive initial survey of 617 patients displaying chronic human pathologies. Multiple diseasespecific abnormalities were identified in plasma, whole blood and/or urine. This is the case for vitamins and oligo elements, vitamin C, vitamin E, β-carotene, selenium, zinc and copper;endogenous antioxidants such as reduced and oxidised glutathione, thiols, urate, and glutathione peroxidase activity, and a biomarker of oxidative DNA damage (8-hydroxy-2’-deoxy guanosine). The distinct biomarker profiles suggest the involvment of multiple forms of oxidative insults which arein some way partially specific to each pathological condition. This finding is in favor of the determination of an integrated score to combine contributions of distinct biomarkers, in order to screen patients presenting elevated levels of oxidative stress.

Responses of Patients with Disorders of Consciousness to Habit Stimulation:A Quantitative EEG Study

Whether habit stimulation is effective in DOC patient arousal has not been reported. In this paper, we analyzed the responses of DOC patients to habit stimulation. Nineteen DOC patients with alcohol consumption or smoking habits were recruited and 64-channel EEG signals were acquired both at the resting state and at three stimulation states. Wavelet transformation and nonlinear dynamics were used to extract the features of EEG signals and four brain lobes were selected to investigate the degree of EEG response to habit stimulation. Results showed that the highest degree of EEG response was from the callname stimulation, followed by habit and music stimulations. Significant differences in EEG wavelet energy and response coefficient were found both between habit and music stimulation, and between habit and call-name stimulation. These findings prove that habit stimulation induces relatively more intense EEG responses in DOC patients than music stimulation, suggesting that it may be a relevant additional method for eliciting patient arousal.

Approach to identifying research gaps on vector-borne and other infectious diseases of poverty in urban settings:scoping review protocol from the VERDAS consortium and reflections on the project’s implementation

Background:This paper presents the overall approach undertaken by the“VEctor boRne DiseAses Scoping reviews”(VERDAS)consortium in response to a call issued by the Vectors,Environment and Society unit of the Special Programme for Research and Training in Tropical Diseases hosted by the World Health Organization.The aim of the project was to undertake a broad knowledge synthesis and identify knowledge gaps regarding the control and prevention of vector-borne diseases in urban settings.Methods:The consortium consists of 14 researchers,13 research assistants,and one research coordinator from seven different institutions in Canada,Colombia,Brazil,France,Spain,and Burkina Faso.A six-step protocol was developed for the scoping reviews undertaken by the consortium,based on the framework developed by Arksey and O’Malley and improved by Levac et al.In the first step,six topics were identified through an international eDelphi consultation.In the next four steps,the scoping reviews were conducted.The sixth step was the VERDAS workshop held in Colombia in March 2017.Discussion:In this article,we discuss several methodological issues encountered and share our reflections on this work.We believe this protocol provides a strong example of an exhaustive and rigorous process for performing broad knowledge synthesis for any given topic and should be considered for future research initiatives and donor agendas in multiple fields to highlight research needs scientifically.

A scoping review on the field validation and implementation of rapid diagnostic tests for vector-borne and other infectious diseases of poverty in urban areas

Background:Health personnel face challenges in diagnosing vector-borne and other diseases of poverty in urban settings.There is a need to know what rapid diagnostic technologies are available,have been properly assessed,and are being implemented to improve control of these diseases in the urban context.This paper characterizes evidence on the field validation and implementation in urban areas of rapid diagnostics for vector-borne diseases and other diseases of poverty.Main body:A scoping review was conducted.Peer-reviewed and grey literature were searched using terms describing the targeted infectious diseases,diagnostics evaluations,rapid tests,and urban setting.The review was limited to studies published between 2000 and 2016 in English,Spanish,French,and Portuguese.Inclusion and exclusion criteria were refined post hoc to identify relevant literature regardless of study design and geography.A total of 179 documents of the 7806 initially screened were included in the analysis.Malaria(n=100)and tuberculosis(n=47)accounted for the majority of studies that reported diagnostics performance,impact,and implementation outcomes.Fewer studies,assessing mainly performance,were identified for visceral leishmaniasis(n=9),filariasis and leptospirosis(each n=5),enteric fever and schistosomiasis(each n=3),dengue and leprosy(each n=2),and Chagas disease,human African trypanosomiasis,and cholera(each n=1).Reported sensitivity of rapid tests was variable depending on several factors.Overall,specificities were high(>80%),except for schistosomiasis and cholera.Impact and implementation outcomes,mainly acceptability and cost,followed by adoption,feasibility,and sustainability of rapid tests are being evaluated in the field.Challenges to implementing rapid tests range from cultural to technical and administrative issues.Conclusions:Rapid diagnostic tests for vector-borne and other diseases of poverty are being used in the urban context with demonstrated impact on case detection.However,most evidence comes from malaria rapid diagnostics,with variable results.While rapid tests for tuberculosis and visceral leishmaniasis require further implementation studies,more evidence on performance of current tests or development of new alternatives is needed for dengue,Chagas disease,filariasis,leptospirosis,enteric fever,human African trypanosomiasis,schistosomiasis and cholera.