Tropical and geographical medicine最新文献

Decentralization of finances and responsibilities has been one of the most interesting developments in the health systems in developing countries during the last decades. In 1992, Senanga District (Zambia) was involved in a Pilot Project for Financial Decentralization. In order to evaluate the experiences of the health staff, focus group discussions were organized. Although several constraints were faced during the implementation of the project, decentralization was regarded as a valuable and workable concept. Continuation was advocated by all health workers.

Susceptibility to rubella in 428 Mexican females of childbearing age from four sanitary areas confined to a Mexican State (Queretaro) was determined. Members of the group were residents of urban and rural communities and selected by random sampling. Anti-viral antibodies were determined by inhibition of haemagglutination. Concentration was expressed as International Units of IgG anti-rubella haemagglutinin (IU/ml). Antibody concentrations lower than 15.6 (IU/ml) were regarded as non-protective. The percentage of women immune-protected to rubella in the areas varied from 28.8 to 75.6 with an average of 61.9. The difference in percentages of immune-protected females within the areas was statistically significant (chi 2 = 48.26 and p < 0.001). Immune protection was associated to population density, with less protection in less populated areas. Our results differ from the reported values of a serosurvey performed in the same state one year before: immune protection 61.9% versus 79.96%, respectively.

The manufacturing of quinine in The Netherlands began shortly after 1820; large scale production started with the foundation of the Amsterdam Chinine Factory in 1881. The quantity of sold quinine in the Province of North-Holland leads retrospectively to the conclusion that an epidemic of malaria had occurred around 1880. At the start of a new epidemic in 1899, it was demonstrated that quinine killed the bloodforms of tertian malaria immediately. However, 50% of the patients experienced a relapse, particularly after interruption of treatment. The length--f the course did not change the chance of relapse. With the beginning of another epidemic in 1919, scientific work and education of the people started in an organized fashion and patients were urged to use quinine only at the prescription of physicians. Because of the inability to prevent relapses, an alternative to quinine was badly needed. In 1930 plasmochin became available, which proved to be useful in combination with quinine. It was not until 1934 that the asymptomatic carriers were recognized as a problem for control because their unobserved parasitic relapses were considered a major source of infection for mosquitoes. In 1939 it was proposed to apply autumnal quininization, which meant a scrupulous screening of the population. The early forties brought yet another major epidemic. Both quinine and Quiniplex were used until the fifties, when endemic malaria disappeared. The new schizonticidal drugs came too late to challenge the primate of quinine in the era of temperate zone Plasmodium vivax in The Netherlands.

We compared the tumor necrosis factor (TNF-alpha), interferon gamma (IFN-gamma) and granulocyte-macrophage colony stimulating factor (GM-CSF) serum levels in 87 patients with malaria from the Brazilian Amazon. They included asymptomatic infected individuals and symptomatic patients with mild disease or severe malaria with or without cerebral involvement. As controls we examined individuals living in endemic areas without past history of malaria. The TNF-alpha serum levels were increased in patients with malaria and progressively decreased in those with severe disease 7 days after specific treatment. We found correlation between parasitaemia, TNF-alpha levels and severity of the disease. The correlation between high TNF-alpha levels and severe malaria was independent of cerebral involvement. The increase in both IFN-gamma and GM-CSF levels among malarious patients was not related to the degree of severity or mortality. IFN-gamma concentration, however, was associated with high parasitaemia at admission.

A retrospective study on the thyroid status of 832 infants, born in Panaga Hospital in Brunei, was conducted. Despite a high degree of ethnic variability, screening for congenital hypothyroidism (CHT) included a fixed T4 and a TSH reference interval, based on a population of Malay infants. We tested their reliability for this heterologous group of infants. New T4 and TSH intervals were determined for each ethnic group and compared, revealing false positive and false negative judgements made during the period of study. Caucasian infants showed significantly higher T4 and TSH serum levels than all other ethnic groups. Regarding T4, most false positive judgements were found among the Malay infants. False negative judgements were detected among the Caucasian female infants. A new reference scheme was recommended, consisting of reference values that are applicable in neonatal thyroid screening of all infants in Panaga Hospital, regardless of their ethnic origin.

In order to define characteristics that would help differentiate a centipede bite from a viper bite, we designed a prospective study using the data collection system of a Poison Control Center. The clinical goal is to rapidly distinguish envenomations for which antitoxin may be indicated (viper) from those for which palliative care only is appropriate (centipede). During a year period, 31 cases, including two cases receiving double bites in each event, were reported. Centipede lengths were estimated to range from 3 to 20 cm. Ninety-two per cent of the bite marks were pointed in shape. A local reaction developed at the bitten site, but usually remaining localized to a 10 x 10 cm area of involvement. The length of the biting animal, the bite mark characteristics, the presence of haemorrhagic vesicles, the wound size and the progression of local reactions are useful in the rapid clinical differentiation between centipede bites and viper bites.

We studied the yield of blood and bone marrow (BM) cultures in 145 patients clinically suspected of typhoid fever (TF) in Indonesia. The objectives were to compare the positivity of blood culture using 3 ml versus 10 ml of blood and to examine in how far specific antibiotic treatment for TF interfered with the positivity of BM culture. Blood for culture was collected before antibiotic treatment was initiated in hospital and BM 1 to 10 days after the start of treatment. Cultures were performed with Oxgall subcultured on SS agar. Seventy-nine per cent of patients was treated for 14 days or more with oral chloramphenicol, 18% with chloramphenicol followed by ampicillin or cotrimoxazol and 3% with other antibiotics. Cultures were positive for Salmonella typhi or S-paratyphi A in 57 of the 145 patients (39.3%) when 3 ml of blood was cultured and in 58 (40%) when 10 ml of blood was cultured. BM culture was positive despite antibiotic treatment in 70 patients (48.2%); this positivity was significantly greater than that of blood cultures (p < 0.05). When we considered the positivity of BM culture in relation to the number of days on antibiotics in hospital, the yield of BM culture remained apparently unchanged during the first 5 days of treatment. This may be the consequence of slow elimination of S.typhi or S.paratyphi by the antibiotics used and could be responsible for relapses.

A study to determine the gender factor in the effect of socio-cultural beliefs on patients' perceptions of leprosy was conducted with the participation of 293 leprosy patients in Kaduna State, Nigeria. Results indicate that, contrary to popular belief, the male model is not the single interpretative model for leprosy as far as socio-cultural aspects are concerned. These differences are analysed and appropriate suggestions made.

From 1979-1988, 427 patients with falciparum malaria were prospectively investigated for chloroquine resistance. About 90% were infected in sub-Saharan Africa. Of the 361 non-immune patients 235 were evaluable; in 158 (67%) chloroquine resistance of Plasmodium falciparum could be confirmed. Chloroquine sensitivity was found in 77 (32%) patients. Sulfadoxine-pyrimethamine resistance was found in 33 patients. The history of use of chemoprophylaxis was recorded in 357 patients: 168 (49%) took adequate, 103 inadequate and 86 no chemoprophylaxis. In 65 of the 168 patients with a history of good compliance, prophylactic serum concentrations could be measured; in 56 (86%) patients the history was confirmed by the chloroquine level. All but one of them were infected with a resistant P. falciparum strain. Of the 66 semi-immune patients, 60 were infected in their homeland; in 5 (8%) chloroquine resistance was found. Only 1 of the 60 patients had used adequate chemoprophylaxis and proved to be infected with a resistant P. falciparum strain. During the study the spread of drug resistance from East Africa to other parts of Africa could be observed. Monitoring for drug-resistant falciparum malaria in travellers returning from malaria-endemic areas is a helpful tool in predicting the evolution of drug resistance in that area. In the non-endemic area such monitoring is essential for optimal advice on treatment of patients and of chemoprophylaxis in travellers.