Showing papers in "Tropical and geographical medicine in 1988"

Effects of sheesha and cigarette smoking on pulmonary function of Saudi males and females.

Abstract: The effects of sheesha or cigarette smoking on pulmonary function values were examined in 441 and 154 male and female smokers respectively. Cigarette smokers showed a marked decline in pulmonary function values with increasing age that was more pronounced than in non-smokers. VC, FEV1 and FVC mean values of male sheesha smokers were significantly lower than those of corresponding non-smokers with all pulmonary function measurements demonstrating a decline with age in sheesha smokers, particularly in the age group 20-49. The extent of the decline in pulmonary function measurements in young and middle aged female sheesha smokers (20-45 years) was not as pronounced as that of older female smokers. It is concluded that sheesha smoking as well as cigarette smoking, will produce similar harmful effects on the function of ventilatory capacity of both male and female subjects and increase the risk of developing obstructive airway disease, with sheesha smokers being at a greater risk.

Human monkeypox: disease pattern, incidence and attack rates in a rural area of northern Zaire.

Abstract: Human monkeypox is a zoonosis that occurs sporadically in the tropical rainforest of western and central Africa. This article presents the results of epidemiological features of 91 monkeypox patients reported in Bumba zone in northern Zaire during the period 1981 to 1985. Their age ranged from 7 months to 29 years (93% below 15 years of age). 11% of patients had visible smallpox vaccination scars. Deaths occurred sporadically; the overall case-fatality rate was 9%. 91 patients arose in 61 separate outbreaks; 42 of them consisted of only a single case. The source of infection was suspected to be animal for 70 cases, and human for the remaining 21 cases. The illness occurred in all months of the year. There was a considerable clustering of cases in the northern part of the zone. The average annual incidence rate in the observed zone was 0.63 cases per 10,000 population with marked differences in age, time and place. The average annual primary attack rate among unvaccinated individuals (1.7/10,000) sharply contrasted with those vaccinated (0.04/10,000). The secondary attack rate for contacts without vaccination scar (4.3%) differed significantly from those who had been vaccinated in past (0.7%). Many unvaccinated contacts living under conditions of maximal exposure to index cases escaped not only the disease but also infection. The low incidence rate of human monkeypox indicates its limited public health importance even in a well-known enzootic area.

Podoconiosis in Aequatorial Guinea. Report of two cases from different geological environments.

Abstract: Two cases of podoconiosis (endemic non-filarial elephantiasis of the lower legs) are described. Microcrystals were demonstrated in lymph node biopsies by scanning electron microscopy and energy dispersive x-ray analysis techniques. The findings were compatible with the elements present in black lava soil and red clay soil, respectively.

Illicit sale of pharmaceuticals in Africa: sellers and clients in the suburbs of Dakar.

Abstract: Illicit drug sale seems to be increasing in developing countries, but it has received little scientific interest from research workers and health planners. A study was carried out in the underprivileged suburbs of Dakar. 10 sellers selected on two markets and a street corner were observed during one week day each: 144 buyers were thus seen on the spot. Age and sex distribution reveals differentiation in customers' patterns: women are more present on markets while men usually buy on street corners; young children are often sent by their parents when the location of the sale is near the house. The closer the seller is to his clients, the more regular they are. This suggests a differential integration in social life. Pharmaceuticals are bought for symptomatic treatment, especially pain or fatigue (77%). Aspirin is part of 58% of drugs sold; antidiarrhoeals (mainly tetracycline) and antimalarials (4-aminoquinolines) represent 12% and 7% of sales, respectively. Prices are low, as pharmaceuticals are sold as individual tablets. Total cost of drugs thus sold by 102 sellers on the 13 main markets of Pikine is 100,000 $ per year - 11 times the Ministry of Public Health expenditure for pharmaceuticals in this area. Better accessibility to drugs in primary health care structures would give an alternative choice to populations and be more effective than mere repression against illicit sellers.

Swellengrebel lecture. Hypnozoites and 'relapses' in Plasmodium vivax and in vivax-like malaria.

Abstract: Les hypnozoites: leur histoire, morphologie, activation, reponse a la primaquine. Suivies d'une critique de la theorie des hypnozoites

Cutaneous histoplasmosis in the acquired immune deficiency syndrome--a report of three cases from Trinidad.

Abstract: Three cases are reported of patients with the Acquired Immune Deficiency Syndrome (AIDS) and cutaneous histoplasmosis. Their initial presentation was that of a generalised maculopapular rash. Two patients were bisexual males and the third was an unmarried female. The range of opportunistic infections seen in AIDS patients in Trinidad is mentioned and clinicians are alerted to the fact that in areas endemic for Histoplasma capsulatum maculopapular rash in patients with AIDS may suggest disseminated histoplasmosis. The value of skin biopsy is mentioned.

Nutrition and immunity.

Abstract: Nutrition is a critical determinant of immunocompetence and risk of illness The critical role of nutrition in modulation of immune responses is based on physiological considerations In humans, isolated vitamin A deficiency seldom occurs, and it is usually associated with protein energy malnutrition Excessive intake of nutrients and vitamins impairs immune response and may be considered a type of malnutrition The extent of immunological impairment depends not only on the severity of nutritional deficiency but also on the presence of infection The immune system is an important link in the chain of host defense mechanisms and protects the host from the microbial invasion An incompetent immune system is one of the factors that add to the vulnerability of the deficient individual to infection Most research concerning the role of iron in immunity has been concentrated in the area of cell-mediated immune response, and several approaches have been used to study cell-mediated immunity in iron deficiency

Sensorineural hearing loss in Ghanaians with sickle cell anaemia.

Abstract: The prevalence of haemoglobin S in Ghana is well documented. A study seeking to determine the prevalence of sensorineural deafness in Ghanaian sickle cell anaemia patients was conducted. About 29% of the SS-patients studied showed hearing losses ranging from 30 to 60 dB in the high frequency range of 4 to 8 kHz. This observation was favourable compared to those made by different workers among geographically different populations.

A model for Plasmodium falciparum sporozoite challenge and very early therapy of parasitaemia for efficacy studies of sporozoite vaccines

Abstract: Plasmodium falciparum parasitaemias were induced in four non-immune volunteers by the bites of mosquitoes infected from cultured gametocytes. Radical cure was accomplished before three of the four volunteers developed clinical malaria. Despite very low peak levels of parasitaemia, the plasmodium was recultured from the blood of all volunteers. This volunteer model of early detection of parasitaemia and prompt treatment will contribute to the safe and practical efficacy testing of sporozoite vaccines, thus facilitating the selection of candidate vaccines for large scale definitive field trials.

Probable transmission of brucellosis from breast milk to a newborn.

Abstract: The 1st reported case of neonatal brucellosis is described. Brucellosis is rare in children under 2 years of age. In this case a 1-month-old Kuwaiti female was admitted to the hospital with high fever of 1 weeks duration. The child weighed 2650 grams at birth and had been exclusively breastfed. At the infants admission to the hospital the mother complained of a fever of over 2 weeks duration right hip arthralgia weakness and malaise. The mothers Brucella melitensis agglutination was 1:1280 in blood and 1:2560 in her breast milk. Cultures from the breast milk revealed mixed growth of Staphylococcus epidermidis and Bacteroides spp. In the infant the brucella agglutination titer was 1:640 and Brucella melitensis was isolated in repeated blood cultures. Both mother and infant were treated with streptomycin and made complete recoveries. Transmission of brucella in this case appears to have been via the mothers breast milk. In areas where brucella is endemic brucellosis should be considered as a possible cause of nonspecific symptoms and failure to thrive in infants and young children.

Cerebral infarct precipitated by praziquantel in neurocysticercosis--a cautionary note.

Abstract: A patient who developed a cerebral infarct during the course of praziquantel therapy for neurocysticercosis is described. Destruction of a large number of cysts by praziquantel followed by a massive inflammatory response was likely to have precipitated the event. Caution on the use of this drug in patients with heavy parasite loads is emphasized.

Seasonal variation in respiratory syncytial virus infections in children in Benin-City, Nigeria.

Abstract: The seasonal variation in respiratory syncytial virus (RSV) infections in children was examined in Benin City. Nasopharyngeal washes were obtained from children under 3 years hospitalised for acute lower respiratory infections during two seasons - rainy season (June-August) and dry season (December-February). RSV surface antigen was identified by ELISA. 54% of patients in the rainy season were ELISA positive for RSV compared to 8.8% during the dry season. Clinical features in the RSV infected patients were not different between the two seasons and were similar to that reported from temperate climates. It is concluded that RSV infections occur all year round with a peak during the rainy season.

Evaluation of iron status in Chadian pregnant women: consequences of maternal iron deficiency on the haematopoietic status of newborns.

Abstract: An assessment of iron status was performed on 112 pregnant women at delivery (and on their newborns in 70 cases) and on 114 menstruating women in N'Djamena, Chad. Anaemia (according to the haematocrit value) was observed in 25.0% of pregnant women and in 23.7% of menstruating women. Iron deficiency was defined as the combination of a low serum ferritin level (less than or equal to 12 micrograms/l), a low transferrin saturation (less than 16%) and/or a high erythrocyte protoporphyrin (greater than 3 micrograms/g Hb). A moderate increase in the serum ferritin level (between 13 and 50 micrograms/l) associated with a low transferrin saturation and/or a high erythrocyte protoporphyrin concentration indicated iron-deficiency in an inflammatory context. Iron deficiency was present in 66.9% of pregnant women and in 30.7% of menstruating women. Anaemia was associated with iron deficiency in 78.6% of cases in anaemic pregnant women and in 44.4% of cases in anaemic menstruating women. A correlation between maternal and newborn haematopoiesis was found, and some iron parameters in newborns were related to the iron status of mothers.

Concurrent sickle cell disease and diabetes mellitus.

Abstract: In an attempt to test our hypothesis that a child with sickle cell disease who developed diabetes mellitus early enough, could pass through the various stages of life undetected due to the protection offered by the glycosylation of sickle Hb, we have searched for evidence of the co-existence of the two diseases in Nigerians. We were, however, unable to find any HbSS-diabetic. This study, therefore, shows the extremely low prevalence rate of diabetes mellitus in sickle-cell anaemia subjects, which makes it difficult for us to test our hypothesis.

Diverticula of the colon in three Nigerian siblings.

Abstract: This is a report of diverticular disease of the colon in three Nigerian adult siblings Diverticular disease of the colon is known to be rare in Nigerians Presence of this disease in a large number of a particular family raises the possibility of a familial tendency or some other undefined underlying abnormality The three siblings have spent some years in the industrialized world Our anecdotal experience however shows that the prevalence of diverticular disease of the colon may be on the increase in Nigeria

Prevalence of blindness and visual impairment in the Luapula Valley, Zambia.

Abstract: A community based cross-sectional study on the prevalence and causes of blindness and visual impairment was carried out between August and December 1985 in the Luapula Valley. The study population consisted of 2503 villagers aged 6 years and above. Visual acuity was done on every participant whereas slit-lamp examination and ophthalmoscopy were done on selected individuals when indicated. The overall prevalence of monocular and bilateral blindness was 6.9% and 3.6% respectively. Cataracts and corneal opacities were the most common causes of visual loss in those aged 50 years and above. We conclude that blindness is an important public health problem in this valley and that this data provides a background that can be used to evaluate blindness prevention programmes that will be implemented in the future.

Effects of antimalarial agents on plasma levels of chlorpromazine and its metabolites in schizophrenic patients.

Abstract: The plasma content of chlorpromazine (CPZ) and its two metabolites 7-OH-chlorpromazine (CPZ-OH) and chlorpromazine sulphoxide (CPZ-SO) were measured in the blood of schizophrenic patients established on chlorpromazine therapy. Administration of the commonly used antimalarial agents chloroquine sulphate, amodiaquine hydrochloride and Fansidar one hour before the first dose of chlorpromazine for the day led to marked increases in CPZ and CPZ-OH over control levels. There were no consistent changes in CPZ-SO levels. The implications of these findings are discussed, first with regard to possible therapeutic relevance for the management of schizophrenia and more particularly, with regard to the possible toxic effects of concurrent administration of antimalarial agents and chlorpromazine.

Miang chewing in northern Thai villagers.

Abstract: The habit of chewing miang, composed of fermented tea leaves was studied among 100 farmers of Northern Thai origin. It was disclosed that the majority of miang chewers were 'multi-habituees' in that this habit was combined with other oral habits such as betel quid chewing, banana cigar and Thai cigarette smoking and alcohol consumption. Among women the most prevalent habit combination was miang chewing and khi yo cigar smoking whereas men showed a more differentiated habit pattern. A total of 37 men and 21 women showed oral lesions that could be related to the practice of one or several habits. Oral precancerous lesions such as leukoplakia were, however, only found among miang chewers who in addition indulged in other oral habits (betel quid chewing, smoking, alcohol usage). Language: en

Pneumococcal infections in eastern Saudi Arabia: serotypes and antibiotic sensitivity patterns.

Abstract: The serotypes and antibiotic sensitivity patterns of Streptococcus pneumoniae infections were studied in 208 patients. Male to female ratio was 3 to 1. The main underlying diseases were cardiopulmonary disease (53%), sickle cell disease (13%), diabetes mellitus (11%) and malignancies (11%). The commonest infections were conjunctivitis, bronchopulmonary infections and otitis media. Serotypes 6 and 19 were the most common, especially in children, constituting 66% of the isolates. All the isolates were sensitive to penicillin, ampicillin and vancomycin, but 65% were resistant to cotrimoxazole. Penicillin, therefore, remains the best antimicrobial agent for treatment. All the serotypes are represented in the polyvalent pneumococcal vaccine available in the country; therefore some benefit can be expected from vaccination especially in the high risk patients.

The geographical variation in the molluscicidal potency of Phytolacca dodecandra (Endod) berries in Zimbabwe.

Abstract: Searches for Phytolacca dodecandra were conducted throughout the country in order to determine the natural distribution of the plant molluscicide and to identify the plants that produce the most toxic berries. Berries were collected from a total of 74 plants and bioassays performed against Bulinus globosus. The berries collected from eight plants were found to be lethal to 50% or more of the snails and the most toxic berries were those collected from plants found growing in the drier and hotter parts of the country. The results suggest that the toxicity of the berries depend on the geographical features of the place from which these are collected.

Clinical aspects of typhoid fever in two rural Nigerian hospitals. A prospective study.

Abstract: During a prospective study among 234 patients admitted with fever in two rural hospitals in West and Central Nigeria 38 cases of typhoid fever were found. The diagnosis was based on extensive serological testing in the Netherlands. The diazotest was introduced but appeared not helpful. The ordinary Widal test was not fully reliable. Eighty five percent of the patients responded to chloramphenicol. The course of typhoid fever in West Nigeria was more severe than in Central Nigeria. The findings are compared with those of similar studies of typhoid fever.

Self-medication with chloroquine for malaria prophylaxis in urban and rural Zimbabweans.

Abstract: Representatives of 200 urban and 200 rural households were interviewed to determine the extent and appropriateness of the use of chloroquine obtained over-the-counter for malaria prophylaxis. Malaria prophylaxis was taken by 38 urban and 65 rural respondents. Chloroquine was the only drug used and was found in 7 urban and 40 rural households. The presence of chloroquine was detected in 4/130 urban and 11/136 rural urine samples tested. Knowledge about chloroquine was unsatisfactory with 6 urban and 10 rural respondents aware that chloroquine could have harmful adverse effects. The doses of chloroquine taken for prophylaxis varied widely, and of the 103 respondents who took prophylaxis only 16% (urban) and 31% (rural) were taking the correct dose. Self-medication accounts for a substantial, little acknowledged, portion of chloroquine use. To limit appropriate use of a powerful, potentially dangerous antimalarial drug and perhaps extend the useful therapeutic life of chloroquine clear recommendations and population education are needed.

Occurrence of some blood and intestinal parasites in dogs in Curaçao, Netherlands Antilles.

Abstract: In August 1986, 133 dogs at the Veterinary Service of the Netherlands Antilles and the SPCA of Curacao were examined for microfilaremia and for evidence of gastrointestinal parasitism. Microfilariae of Dipetalonema reconditum were present in 27.8% of the dogs examined with no significant difference in the infection rate between domestic and feral dogs. Microfilariae of the canine heartworm Dirofilaria immitis were found in 9% of the dogs with a significantly higher rate of infection in domestic (pet) dogs (13.5%) than in feral dogs (3.4%). Of the intestinal parasites observed Ancylostoma sp. was present in the highest percentage of dogs (68.4%) followed by Toxocara sp. (7.5%). Other parasites were present in less than 5% of the dogs examined and included, in decreasing order of prevalence, Spirocerca sp., Giardia sp., coccidia, Taenia sp. and Trichuris sp. The present paper presents the first evidence of Di. reconditum on Curacao and suggests the introduction of D. immitis to the island within the 10 years preceeding this report. The persistently high rate of infection with Ancylostoma underscores the continuing risk of cutaneous larva migrans to human beings in the region.

Tumoral calcinosis: case reports from Saudi Arabia with a review of the literature.

Abstract: Tumoral calcinosis is a rare disease mainly reported among blacks, especially from the tropical and sub-tropical regions of Africa. Hitherto, no reports of this disease entity have been reported from North Africa and the Arab Peninsula. This paper is therefore the first documentation of tumoral calcinosis in nine patients from the Arabian Peninsula; seven of whom are Saudis and two Yemenis. Peculiar osseous and joint changes co-existed in one of the cases. Moreover, there was a high incidence in the feet, in 75% of cases. One of the lesions was quite extensive. Reason for these changes are suggested.

Breast cancer in pregnancy and lactation

Abstract: Thirty-six Nigerian women admitted with breast cancer during pregnancy and/or lactation (SGP) are the basis of this study of breast cancer in pregnancy and lactation. Thirty-six non pregnant but age and c TNM stage matched breast cancer patients and another thirty-six non pregnant, age matched women with benign breast neoplasms served as control group A (CGA) and control group B (CGB) respectively. Even though of similar c TNM state, the mean duration of tumor presence in the SGP (6 months) was shorter than in CGA (12 months). Also the SGP presented with tumor of higher histological grade (grade III, 55.6%) than those of CGA (grade III, 19.4%). These lead to the conclusion that breast cancer in the study group patients was more rapidly progressing and was therefore of worse prognosis. This conclusion is confirmed by a finding of survival in CGA patients that was 1.4 times that of the study group patients. We therefore conclude that breast cancer associated with pregnancy or lactation in Nigerian women progresses more rapidly and has a worse prognosis than cancer in their non pregnant counterparts.

A house-to-house survey of neonatal tetanus in urban and rural areas in the Gondar region, Ethiopia.

Abstract: A house-to-house survey of neonatal tetanus was performed in 30 population clusters in Gondar, Northwestern Ethiopia. At the end of the survey 37,219 households were visited and 2010 live births were recalled. Out of the 2010 live-born children 127 had died. Eighty died during the neonatal period. Nine of the neonatal deaths were due to tetanus, giving a neonatal tetanus mortality rate of 4.5/1000 live births. The problem of neonatal tetanus in developing countries, particularly that of Ethiopia, is discussed.

An observation of the dynamics of intestinal helminth infections in two isolated communities in south-western Nigeria.

Abstract: School pupils aged 8-12 years with triple infections of Ascaris lumbricoides, Trichuris trichiura and hookworms at Iwaya, a large urban slum in Lagos State and Iworoko/Igbemo, a rural farming community in Ondo State, Nigeria, were given single dose treatment of levamisole (40 mg.). Subsequent worm accumulation was studied by egg counts per gram of faeces on the 2nd week, 3rd, 5th, 9th and 12th months after treatment. Worm infection rates and load were heavier at Iwaya. The rates of worm recruitment were also higher at Iwaya. The differences observed between Iwaya and Iworoko/Igbemo communities were due to the huge population concentration in the former, low level of hygiene, poor drainage and complete absence of municipal facilities.

Amegakaryocytic thrombocytopenia of nutritional vitamin B12 deficiency.

Abstract: Description of a case of amegakaryocytic thrombocytopenia due to nutritional vitamin B12 deficiency. Megakaryocytes reappeared in the bone marrow after specific treatment and other haematological responses were prompt.