新加坡医院

INTRODUCTION:Small intestinal atresia (SIA) consists of a congenital obstruction of the lumen of the duodenum, jejunum, or ileum with varying severity. The aim of the investigation was to analyze the prevalence and mortality of SIA, using data from the International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR). METHODS:Data on SIA cases were collected from 25 ICBDSR members' surveillance programs in 17 countries over 1974-2015. All pregnancy outcomes were included, but terminations of pregnancy were not available for 11 programs. Statistical analysis is descriptive, and the prevalence is established by the total of SIA cases divided by the total of births. The survival time was calculated, and mortality was analyzed individually using the Kaplan-Meier method for comparison. RESULTS:The total prevalence of SIA was 2.1 per 10,000 births. Iran had the highest prevalence with 11.5 per 10,000 total births (95% CI: 9-14.1); on the other hand, the lowest prevalence of SIA was in Mexico-Nuevo Leon with 0.5 per 10,000 births (95% CI: 0.3-0.8), and Cali-Colombia had zero cases. In South America, a higher prevalence of SIA was estimated compared to what was reported in 2000. Most deaths occurred between Day 2 and 6, except in Bogotá-Colombia, Spain, UK-Wales, and Mexico, where the deaths occurred on Day 1. The mortality in the first year was 4.3%, but the specific causes of death were not determined in this study. CONCLUSION:The prevalence of SIA was about 2.1 per 10,000 births during a 41-year period in 25 centers, with variations in prevalence according to geographical locations. Future research is suggested to analyze changes in trends and the impact of early diagnosis and treatment in mortality.

Cryptosporidiosis, the disease caused by infection with Cryptosporidium spp., is an important threat to both human and veterinary health; some Cryptosporidium species, particularly Cryptosporidium parvum, being zoonotic. The most usual manifestation of cryptosporidiosis is acute diarrhoeal disease, but respiratory disease due to Cryptosporidium baileyi infection can also occur in poultry. In other livestock, particularly young ruminants in which C. parvum is the most clinically relevant species, this can have an important impact. Although the mortality rate is generally low, morbidity can be considerable and can result in significant economic losses due to veterinary costs and reduced productivity. Considerable efforts have therefore been directed towards developing tools for combating cryptosporidiosis in livestock. Although diagnostic tools have improved in the past decades, treatments and prevention have not advanced at a commensurate pace. The two mainly available pharmaceutical treatments for livestock are shown to have some effect on reducing diarrhoea and oocyst shedding, but have limited therapeutic windows and restrictions on use. A recently introduced vaccine provides protection to calves by raising antibodies against C. parvum in pregnant cows, which are transferred to their calves via colostrum. It is only for use in cattle and not available globally. With both the available pharmaceutical treatments and the vaccine, oocyst shedding is not eliminated, thus environmental contamination remains a source of infection for animals and people. This means that on-farm operations, including biosecurity measures and management of slurry and manure, should be used in combination with pharmaceutical treatment and vaccination. However, the efficacy of such measures needs further investigation. This review is based on the recently updated DISCONTOOLS analysis, which identifies knowledge gaps and advances the development and implementation of new tools for controlling cryptosporidiosis in livestock. While vaccination and treatment have important roles, appropriate farm management, especially good farm hygiene, as well as handling and treatment of manure, remains a vital component for reducing the risk of cryptosporidiosis.