RESUMEN
Aims. Predicting the risk of severity at an early stage in an individual patient will be invaluable in preventing morbidity and mortality caused by dengue. We hypothesized that such predictions are possible by analyzing multiple parameters using mathematical modeling. Methodology. Data from 11 adult patients with dengue fever (DF) and 25 patients with dengue hemorrhagic fever (DHF) were analyzed. Multivariate statistical analysis was performed to study the characteristics and interactions of parameters using dengue NS1 antigen levels, dengue IgG antibody levels, platelet counts, and lymphocyte counts. Fuzzy logic fundamentals were used to map the risk of developing severe forms of dengue. The cumulative effects of the parameters were incorporated using the Hamacher and the OWA operators. Results. The operator classified the patients according to the severity level during the time period of 96 hours to 120 hours after the onset of fever. The accuracy ranged from 53% to 89%. Conclusion. The results show a robust mathematical model that explains the evolution from dengue to its serious forms in individual patients. The model allows prediction of severe cases of dengue which could be useful for optimal management of patients during a dengue outbreak. Further analysis of the model may also deepen our understanding of the pathways towards severe illness.
Asunto(s)
Dengue/epidemiología , Dengue/inmunología , Modelos Teóricos , Dengue Grave/epidemiología , Dengue Grave/inmunología , Algoritmos , Bases de Datos Factuales , Dengue/sangre , Virus del Dengue , Brotes de Enfermedades , Lógica Difusa , Humanos , Inmunoglobulina G/química , Recuento de Linfocitos , Informática Médica , Análisis Multivariante , Recuento de Plaquetas , Reproducibilidad de los Resultados , Dengue Grave/sangre , Factores de Tiempo , Proteínas no Estructurales Virales/metabolismoRESUMEN
Many publications have highlighted a lack of practical competencies in recently qualified interns. Consultation between the University of Queensland and the Medical Education Unit at Redcliffe Hospital identified key areas where intervention could lead to greater work readiness, and the development of a complementary programme of practical workshops to remedy those deficiencies. A variety of content experts introduced the Graduate Medical Course 3 and 4 students to a range of practical skills during a dedicated lunch time one hour workshop each week over a period of 30 weeks. Several sessions were audited by the trainers though the majority of sessions used self-evaluation by the participants. There was an overall self-reported increase in the ability to perform the tasks from 25% before the session to 90% afterwards. Seven of the participants are returning to the hospital as interns, and a follow-up survey will be performed to judge the usefulness of the programme.
Asunto(s)
Competencia Clínica/normas , Curriculum/normas , Internado y Residencia/normas , Estudiantes de Medicina , Humanos , Internado y Residencia/métodos , Evaluación de Programas y Proyectos de Salud/métodos , Evaluación de Programas y Proyectos de Salud/normasRESUMEN
Leptospirosis poses a severe threat to the lives of farmers in Sri Lanka, thus, development of an effective chemoprophylaxis is deemed essential. We tested oral penicillin as chemoprophylaxis against leptospirosis in high transmission areas in central Sri Lanka in October 2005. Eight hundred active farmers were randomly assigned to take either oral penicillin (500 mg bid) or a similar looking placebo over a month during active farming season. The primary study point was the incidence of serologically confirmed leptospirosis. Data were available for 602 subjects of whom 319 (152 taking penicillin and 167 taking placebo) had good compliance, shown by tablet count. Of 5 subjects hospitalized with fever, 3 had serological evidence of leptospirosis, all of whom belonged to the placebo group. Therefore, oral penicillin may be effective chemoprophylaxis against leptospirosis.