Paul J. Fields

Pediatric Head and Neck Tumors: An Intra-Demographic Analysis Using the SEER* Database

Background The aim of this study was to determine the most frequently presenting tumors exclusive to the head and neck within the pediatric population, and to identify racial disparities within the existing incidence rates. Material/Methods The population-based Surveillance, Epidemiology, and End Results (SEER) registry was utilized to identify the frequency and incidence rates of various tumors found exclusively in the head and neck, diagnosed between 1973 and 2008 in pediatric patients. The tumor categories were based on those defined by the US Department of Health and Human Services National Cancer Institute (NCI). Proportional comparisons were applied to evaluate the intra-demographic incidence rate differences. Results Among the 11 categories defined, the 5 most prevalent head and neck cancers within the pediatric population were salivary gland tumors (n=319); followed by nasopharyngeal neoplasms (n=311); tumors of the nose, nasal cavity and middle ear (n=208); gum and other mouth tumors (n=134); and glossal tumors (n=61). Proportional comparisons between racial frequency rates indicated that salivary gland tumors were greatest among white pediatric patients (n=246, CI=0.8 to 14.1%, p<.05). Nasopharyngeal cancers were highest among blacks (CI=−26.8 to −12.1%) and other races (CI=−23.6 to −3.4%) relative to the white population. Conclusions Salivary gland tumors were the most commonly seen head and neck tumors overall among pediatric patients between 1973 and 2008. Incidence rate differences between white, black, and other racial background pediatric patients revealed that overall, head and neck tumors are most prevalent among pediatric patients within the white ethnic population, while nasopharyngeal tumors showed a strong prevalence in blacks and other ethnic populations.

Cystic Echinococcosis in Turkana, Kenya: The Role of Cross-Sectional Screening Surveys in Assessing the Prevalence of Human Infection.

Cystic echinococcosis (CE) is a neglected zoonotic disease caused by Echinococcus granulosus. Infection leads to formation of cysts within the viscera of the human host. In the 1980s, the transhumant population of northwest Turkana, Kenya, was found to have the highest prevalence of CE in the world. In 1983, AMREF Health Africa and the Kenya Medical and Research Institute launched a CE Control Program in northwest Turkana, screening and treating the local people. This epidemiological study of CE in Turkana analyses approximately 30 years of surveillance and surgical data. Cyst data were categorized using the World Health Organization CE ultrasound classification system before being analyzed for cyst, patient, and population characteristics, and surveillance data from 1985 are compared with more recent surveillance data to assess changes in prevalence in the control region since the commencement of control activities. In 1985, the prevalence of CE among the Turkana was 5.6%. In 2010-2011 and 2011-2012, calculated CE prevalence rates were 1.9% and 3.8%, respectively. Since the 1980s, the age distribution of people with CE in Turkana has shifted: initially, cases of CE appeared predominantly within younger age groups, but recent data reveal a higher prevalence within older age groups. The frequency of infection in females also significantly decreased. The reduction in CE prevalence from 5.6% in the 1980s to 1.9-3.8% in 2010-2012 and the shift in age distribution of CE-infected individuals over time indicate that the prevalence of CE in Turkana has decreased since the control program began.

Clinical, Serological, and Molecular Observations from a Case Series Study during the Asian Lineage Zika Virus Outbreak in Grenada during 2016

This paper describes the spatial and temporal distribution of cases, demographic characteristics of patients, and clinical manifestations of Zika virus (ZIKV) during the 2016 outbreak in Grenada. The first reported case was recorded in St. Andrew Parish in April, and the last reported case was seen in November, with peak transmission occurring in the last week of June, based on test results. Data were collected from a total of 514 patients, of whom 207 (40%) tested positive for ZIKV. No evidence was found that testing positive for ZIKV infection was related to age, gender, or pregnancy status. Clinical presentation with rash (OR = 2.4, 95% CI = 1.5 to 3.7) or with lymphadenopathy (OR = 1.7, 95% CI = 1.0 to 2.9) were the only reported symptoms consistent with testing positive for ZIKV infection. During the Zika outbreak, the infection rate was 20 clinical cases per 10,000 in the population compared to 41 cases per 10,000 during the chikungunya outbreak in Grenada in 2014 and 17 cases per 10,000 during the dengue outbreak in 2001-2002. Even though the country has employed vector control programs, with no apparent decrease in infection rates, it appears that new abatement approaches are needed to minimize morbidity in future arbovirus outbreaks.

Cystic echinococcosis in Turkana, Kenya: 30 years of imaging in an endemic region

Cystic echinococcosis (CE), a widespread, complex zoonosis, causes chronic disease associated with high morbidity. The pastoral Turkana people of Kenya have one of the highest prevalence rates of CE in the world. Between 1983 and 2015, a CE control program in the Turkana region used ultrasound (US) screening surveys and surgical outreach visits to evaluate CE prevalence and treat those with the disease. As the gold standard modality for diagnosing CE, US reveals a great deal of information about the disease in affected populations. The aim of this study is to discuss the characteristics of untreated CE in the Turkana people as revealed by US data collected during the CE control program and evaluate disease presentation, factors influencing the risk of transmission, and the timeline of disease progression. Data were obtained from written patient notes from US screenings and images; cysts were classified using the World Health Organization (WHO) standardized US classification of CE. Findings include greater prevalence of cysts, later stages of cysts, and multiple cysts in older age groups, with no multiple cysts occurring in patients under six years of age, which are consistent with the assertion that rates of exposure, transmission, and infection increase with age in endemic regions. Findings also raise questions regarding the timeline of disease progression, and factors potentially influencing disease transmission within this and other endemic populations. A comprehensive survey focusing on cultural and community observations (e.g., changing behaviors, hygienic practices, etc.) may provide more detailed information regarding factors that facilitate transmission.

Meta-Analysis of the Prevalence of Dirofilaria Immitis In Dogs from Grenada, West Indies

A comparison of several individual studies was made in order to determine the statistical significance for the prevalence of Dirofilaria immitis in dogs (n=1245) in Grenada, using necropsy and different ELISA test kits. The overall prevalence was estimated to be 17% in a study of live dogs, 12% in a study of necropsied dogs, and 14% when combining the studies using meta-analysis. There was no evidence of infection in dogs less than 6 months of age and no statistical difference (P>0.50) between male and female dogs. The prevalence reported is the cause for concern particularly since Dirofilaria immitis in dogs were found in all parishes in Grenada, favorable climatic conditions exist for vector-borne transmission, there is only sporadic use of preventatives, and there is an almost complete lack of public knowledge of the zoonotic potential of this filarial parasite in Grenada.