Tropical and geographical medicine最新文献

The purpose of this study was: 1) to measure tumour necrosis factor alpha (TNF) in the plasma of Plasmodium falciparum infected subjects; and 2) to correlate the presence of TNF to symptomatology. Plasma from 77 malaria infected individuals (with malaria parasites) were assayed for TNF by ELISA. The mean age of the subjects under study was 16.36 +/- 0.80 (mean +/- SEM) years. Thirty-nine (51%) subjects had measurable plasma TNF. Taking symptomatology into account, 10 (59%) of the 17 asymptomatics and 29 (48%) of the 60 symptomatics had measurable plasma TNF. A risk ratio of 0.9 was obtained for the association between the detection of plasma TNF and the presence of symptoms. In plasma from 13 healthy controls no TNF was detected. The results suggest that if TNF plays a negative role in the pathogenesis of malaria, it must be in the presence of other predisposing factors.

The study aimed to examine the general contribution of motor traffic accidents (MTAs) to the total number of deaths in Dar es Salaam city from 1985 to 1991, and the number of people impaired by MTAs in 1991. Data of deaths from all causes, deaths caused by MTAs and of people impaired by MTAs was collected. In seven years the contribution of MTAs to the total number of deaths was more or less constant (24 to 21 people per 1,000 deaths), with the exception of 1985 (48 per 1,000 deaths). In 1991, a total of 1,829 MTAs were recorded in Muhimbili Medical Centre and these claimed 113 human lives on the spot and impaired 2,834 who had to attend medical services for injuries. The victims were in their prime years (11-40 years). The problem of MTAs in Dar es Salaam reflects those of other urban centres in Africa.

A qualitative anthropological study in Gondar region, northwestern Ethiopia, revealed a very striking difference in cultural patterns of defecation in the two sexes which coincided with a high male/female ratio (16.5:1) of sigmoid volvulus morbidity in the regional hospital. Adult males show very irregular bowel behaviour, with bowel motions varying from zero to four per day. Irregular bowel behaviour in males, combined with the population's consumption of high fibre diets producing flatus and bulky stools, appears to overload the sigmoid colon, which elongates and dilates gradually, and subsequently undergoes volvulus occasionally. In women, on the other hand, the custom of limiting defecation to dawn and dusk is strictly adhered to and this regularity of bowel movements seems to protect them from overloading of the sigmoid colon and its consequences, despite their consumption of similar diets. In conclusion, it is believed that the high male/female ratio in sigmoid volvulus morbidity in Gondar region appears to be connected to gender specific patterns of defecation.

A case of Angiostrongylus costaricensis in a captive C. penicillata in a German zoological garden is described. Clinical symptoms were lacking, the morphological lesions consisted of intestinal granulomas harbouring rhabdidiform larvae. The adult worms were present in the ileo-caecal branches of the mesenteric artery.

Serum hepatitis B surface antigen (HBsAg) status and ferritin levels were measured in 3 groups of subjects: Group A (n = 14) with chronic non-neoplastic liver disease (CNLD), Group B (n = 14) with primary hepatocellular carcinoma (PHC) and Group C (n = 14) comprising healthy matched controls without liver disease. Serum ferritin values were lowest in Group C, intermediate in Group A and highest in the Group B patients (all p < 0.05). About 79% of the patients with PHC, 43% of those with CNLD and none (0%) of the healthy controls, had hyperferritinaemia (serum ferritin > 400 ng/ml). Hyperferritinaemia and HBsAg positivity coexisted in 15% and 73% of the patients with CNLD and PHC, respectively. Hyperferritinaemia and HBsAg were significantly positively related in the patients with PHC (chi 2 5.09, p < 0.05). The predictive indices of hyperferritinaemia in chronic liver disease appeared superior for PHC than for CNLD, and became somewhat enhanced with coexisting HBsAg positivity. These results suggest that serum ferritin could be useful as a tumour marker for PHC in patients with established chronic liver disease.

Sixty negroid patients with liver cirrhosis were examined for their cutaneous features at the University College Hospital, Ibadan, Nigeria. When compared with age and sex matched controls, the cirrhotic patients had significantly lower body temperature, onycholysis and hyperpigmented palmo-plantar macular areas (p < 0.05). Until now, these features have not been previously associated with liver cirrhosis. Other cutaneous signs such as sparse silky hair, female public hair pattern, digital clubbing, leuconychia, ankle oedema and corneal jaundice are found more commonly in cirrhotic patients (p < 0.05) and have been previously documented. All these features in a middle-aged man with hepatomegaly may be of added distinctive value particularly in many rural centres in tropical countries where facilities for definitive histological diagnosis are frequently lacking. The relevance of some of these cutaneous features in the light of the pattern described in Caucasians is also discussed.

The main endemic area of kala-azar (visceral leishmaniasis) in the Sudan is in Eastern State and the Blue Nile area of Central State. In order to obtain more recent information about kala-azar in both States, the major hospitals and health centres were visited, the physicians and medical assistants interviewed and available records inspected. In Eastern State a cross-sectional survey of one village was carried out and a longitudinal population-based study of another village started. In this State, after a decline since 1985, a sharp increase in the number of cases was noted from 1991 onwards. This increase was seen in large areas, especially along the Rahad and Dinder Rivers. In contrast, in Central State, there was a decline in the frequency of the disease since the 1960s in the area around Sennar and Singa, which was regarded as a hyperendemic focus up to about 30 years ago. It was hypothesized that this decline may be related to the extensive agricultural development with regular insecticiding and the deforestation of the area. Several aspects with regard to transmission of kala-azar are discussed.

Venomous snake bite without envenoming ('dry-bite') has been recognized throughout the world, but neglected in the Brazilian literature. Forty cases of patients bitten by venomous snakes of the genera Bothrops (lance-headed vipers) and Crotalus (South American rattlesnakes), confirmed by identification of the captured or dead snake, were seen in a 34-month prospective study carried out in a teaching hospital in southeastern Brazil. Out of the 33 cases of lance-headed viper and 7 of rattlesnake bite, respectively 10 (30.3%) and 3 (42.9%) had no clinical or laboratory evidence of local or systemic envenoming. Both within the Bothrops and Crotalus groups, there was no significant difference in sex and age of the patients, and time between bite and medical assistance between the patients who had from those who did not have clinical envenoming. The high prevalence of 'dry-bite' in this study may have several possible explanations, and has implications on the indication of antivenom for the treatment of venomous snake bite. Antivenom administration may be postponed or even not indicated for victims of snake bite presenting no manifestations of local or systemic envenoming.

The final diagnosis of sickle cell disease (SCD) is established by haemoglobin (Hb) electrophoresis. The test, however, is expensive and absent in most hospitals in Kenya. We studied sensitivity, specificity and cost-effectiveness of the peripheral blood film (PBF) in diagnosing sickle cell anaemia (SCA), the most common type of sickle cell disease (SCD) in Kenya. The PBF can be done even in dispensaries. The study was performed in SCA endemic western Kenya in 767 subjects during 12 months. Hb level, WBC count, PBF, sickle cell test (SCT) and cellulose acetate paper electrophoresis (CAPE) were performed. In the PBF, presence of sickle cells was pathognomonic for SCA. SCA was found in 21, sickle cell trait in 120, and normal genotype in 616 subjects. Sensitivity of the PBF versus SCT and CAPE to detect SCA was 76% with a specificity of 99.7%. The PBF was cheaper than both methods by 31.1%.