3).Conclusions-Compliance is greater with nose mask CPAP than with face mask CPAP because the overall comfort is better and compensates for increased symptoms associated with mouth leakage. Improved face mask design is needed. (Thorax 1998;53:290-292) Keywords: continuous positive airway pressure; sleep apnoea/hypopnoea syndrome; face masks Continuous positive airway pressure (CPAP) therapy for sleep apnoea/hypopnoea syndrome (SAHS) is traditionally given via a nose mask. However, many patients with SAHS find this method of treatment unsatisfactory, often due to symptoms related to mouth air leakage. 1Patients who have had unsuccessful uvulopalatopharyngoplasties (U3P) for treatment of SAHS are particularly likely to experience increased mouth leakage on nasal CPAP which is associated with reduced nightly compliance. 2The CPAP pressure required is essentially the same for nose masks and face masks, 3 so face masks which cover both nose and mouth may be advantageous if they reduce the symptoms associated with mouth leakage.We have compared nose and face mask CPAP therapy with respect to side eVects from the mask and compliance in newly diagnosed patients with SAHS in a randomised double limb trial. We also compared nose and face mask CPAP in patients with unsuccessful uvulopalatopharyngoplasties for treatment of SAHS (SAHS/U3P patients). MethodsAll subjects gave informed consent to take part in the study. RANDOMISED TRIALTwenty consecutive newly diagnosed patients with SAHS (mean (SE) apnoea/hypopnoea index 34 (5.2)/hour, age 52 (3) years, body mass index 32 (1) kg/m 2 , CPAP pressure 9 (1) cm H 2 O) were enrolled into the study after their CPAP titration night. Initial CPAP titration was performed using a nose mask. Patients were randomised to face mask or nose mask CPAP for four weeks each. At the end of

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Abstract.Chikungunya virus (CHIKV) emerged in the Caribbean island of Saint-Martin in December 2013. We implemented a hospital-based surveillance system to detect and describe CHIKV cases including severe forms of the infection and deaths in the islands of Martinique and Guadeloupe. A case was defined as a patient with a CHIKV laboratory confirmation cared for in a public hospital for chikungunya for at least 24 hours, and a severe CHIKV case was defined as a CHIKV case presenting one or more organ failures. Sociodemographic, clinical, and laboratory data were collected and cases classified into severe or nonsevere based on medical records. From December 2013 to January 2015, a total of 1,836 hospitalized cases were identified. Rate of hospital admissions for CHIKV infection was 60 per 10,000 suspected clinical CHIKV cases and severity accounted for 12 per 10,000. A total of 74 deaths related to CHIKV infection occurred. Infants and elderly people were more frequently hospitalized compared with others and severity was more frequently reported in elderly subjects and subjects with underlying health condition. Fifteen neonatal infections consecutive to mother-to-child transmission were diagnosed, seven of which were severe. The most vulnerable groups of the population, such as the elderly, infants, individuals with comorbidities, and pregnant women, should remain the main targets of public health priorities.

We discovered a highly virulent variant of subtype-B HIV-1 in the Netherlands. One hundred nine individuals with this variant had a 0.54 to 0.74 log 10 increase (i.e., a ~3.5-fold to 5.5-fold increase) in viral load compared with, and exhibited CD4 cell decline twice as fast as, 6604 individuals with other subtype-B strains. Without treatment, advanced HIV—CD4 cell counts below 350 cells per cubic millimeter, with long-term clinical consequences—is expected to be reached, on average, 9 months after diagnosis for individuals in their thirties with this variant. Age, sex, suspected mode of transmission, and place of birth for the aforementioned 109 individuals were typical for HIV-positive people in the Netherlands, which suggests that the increased virulence is attributable to the viral strain. Genetic sequence analysis suggests that this variant arose in the 1990s from de novo mutation, not recombination, with increased transmissibility and an unfamiliar molecular mechanism of virulence.

ZIKV infection is usually benign, when symptomatic, but in countries at risk of ZIKV epidemics, adequate intensive care bed capacity is required for management of severe GBS cases. Arbovirus RNA detection by RT-PCR should be part of the management of GBS cases.