Tropical and geographical medicine最新文献

Pathways patients take to psychiatric care will reflect the nature of the services available and the popular beliefs about mental illness. Studying the pathways may help in the identification of sources of delay in the receipt of care and suggest possible improvements. By studying the pathways of 159 patients to a tertiary psychiatric service in Nigeria, we show that traditional and religious healers are consulted at some stage by many patients with mental illness. Such healers are the first carers to a large proportion of the patients. These patients are not different from those who consult orthodox medical practitioners either in demographic features, presenting complaints, or nearness to service. Patients who consult traditional healers first tended to arrive at a tertiary psychiatric service much later than those who consult other carers. Our observations suggest that attempts to incorporate traditional medical care into the health care system must seek to improve their referral skill.

Sera from patients with visceral leishmaniasis (VL) (n = 26), healthy residents of Mogadishu (n = 157), inhabitants of a village in an endemic area (n = 276) and healthy Swedes (n = 60) were examined using the direct agglutination test (DAT), immunofluorescence (IF) and ELISA for antibodies against Leishmania donovani. The study was carried out in order to provide baseline data for antibody responses in visceral leishmaniasis as existing in Somalia and to explore which one of these methods would be most suitable for diagnosis of clinical cases as well as for epidemiological population studies in Somalia. All patients had high levels of circulating antibodies, however, lower values were recorded in the early stages of the disease. High reactivity in ELISA was seen first after one year. All three tests distinguished well between sera from VL patients and healthy controls. Approximately 10% of the sera from villagers were reactive above the cut-off levels in the three tests. DAT is the simplest to perform and does not require much equipment. ELISA can be made simple and economic if performed in one serum dilution and read visually. IF requires more expensive and specialized equipment and is not suitable for large scale examination of sera. A complete evaluation of the three tests should also include the analysis of sera from various stages and manifestations of the disease.

Caring for persons with HIV infection is particularly difficult in resource-poor countries. In order to improve the quality of care we first have to evaluate how such care is presently organized. We need a better assessment of the needs and demands of persons with HIV infection as well as their families. Care for persons with HIV/AIDS should be decentralized and home-based care in a non-stigmatizing way should be promoted. The fight against discrimination of persons with HIV should be intensified. A lot can be achieved by reorganizing and strengthening existing health care systems, by better listening to patients and families and by promoting solidarity among communities.

Clinical observations on toxicity after ingestion of gall bladder of Labeo rohita, a freshwater fish found commonly in India, were recorded from 22 patients between 1985 to 1990. The gall bladder in raw, cooked or desiccated form was swallowed as a traditional method of treatment for various chronic diseases. Patients generally presented with gastrointestinal symptoms such as cramping pain, nausea and vomiting within 12 hours (mean 4.6 +/- 3.7 hours) after ingestion. Subsequently renal failure was observed in all and hepatic dysfunction in some (36.3%) patients. The outcome in general is good. From the clinical course the role of toxic substance(s) is presumed as the causative factor(s), which needs further evaluation.

The distribution of physicians in the different States of Nigeria is unknown. Recently, data about physicians and their practice location in Oyo State became available. The overall physician:population ratio was 1:7,858, with a ratio of 1:3,877 in Ibadan local government areas and 1:27,439 in other local government areas in the state (z = 9.32, p < 0.001). Similarly, specialists are more likely to locate in Ibadan local government areas. With increasing supply of physicians, this pattern of distribution may possibly persist and widen the differences in the availability of physicians between the Ibadan and other local government areas in the state. Our findings have important implications for policy review by the government to plan the future supply of physician manpower and alleviate physician maldistribution.

The prevalence and microfilarial density of Loa loa and Mansonella perstans filariasis have been determined in three successive surveys in one village in the dense rainforest of Southern Cameroon. The prevalence of L. loa microfilaraemia was 30.9% with a geometric mean density of 81.4 microfilariae/30 microliter blood. There was no difference between men and women. The prevalence increased with age from 14.5% at 0-9 years to 52.9% at 40-49 years, whereafter it stablized. The microfilarial density increased until the age of 30-39 years. The highest densities have been found around noon, although the difference was not significant. The prevalence of M. perstans microfilaraemia was 26.6% with a median density of 2.0 microfilariae/30 microliter blood. Both prevalence and density were increasing with age and were higher for men than for women. The time of day that the blood sample was taken had no influence on the microfilarial density of M. perstans.

A self-limiting psychosis characterized by acute onset of visual and auditory hallucinations and poor sleep developed in six adults between 8 and 24 hours after oral administration of 750-1500 mg of the antimalarial mefloquine. All patients had no personal or family history of psychosis and were neurologically and mentally normal before mefloquine ingestion. These cases illustrate that acute psychotic symptoms may occur in patients treated with mefloquine.

This article provides an overview of the spectrum of infectious and toxic illnesses that may occur following the consumption of contaminated shellfish in Hong Kong. These include hepatitis A, hepatitis E, infections due to vibrio species, paralytic shellfish poisoning, neurotoxic shellfish poisoning and heavy metal poisoning. Possible preventive measures are discussed.

A case of primary cervical choriocarcinoma in a 40-year-old Indian woman is reported. Though malignant transformation of a cervical pregnancy is a possibility, we believe that a D & C performed three years ago could also be the source of trophoblasts implantation in the cervix followed by subsequent malignant transformation. Primary cervical choriocarcinoma should be considered a differential diagnosis in a woman of child-bearing age presenting with postcoital bleeding and having a negative cervical cytology. A timely beta hCG assay may confirm the diagnosis and prompt early treatment.