Assuntos
Raquianestesia/efeitos adversos , Cefaleia/etiologia , Adulto , Fatores Etários , Raquianestesia/instrumentação , Raquianestesia/métodos , Pressão do Líquido Cefalorraquidiano , Diagnóstico Diferencial , Dura-Máter , Desenho de Equipamento , Feminino , Cefaleia/diagnóstico , Cefaleia/fisiopatologia , Cefaleia/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Agulhas , Gravidez , Complicações na Gravidez , Punções/efeitos adversos , Fatores SexuaisRESUMO
This three-phase study was designed to compare high dose ivermectin with a standard diethylcarbamazine (DEC) regimen for patient tolerability, potential to kill adult filaria, and duration of microfilarial suppression in 30 Haitian subjects with Wuchereria bancrofti microfilaremia. All were first given a 1-mg oral dose of ivermectin (phase 1) to reduce microfilaria densities. Participants were randomized into three groups: Group 1 received DEC (6mg/kg per day for 12 days), Group 2 received 200 mcg/kg of ivermectin, and Group 3 received 400 mcg/kg of ivermectin (200 mcg/kg per day for 2 days). All drug regimens were well tolerated with few adverse reactions. Most reactions occurred during phase I and consisted primarily of headache, fever, and myalgia. At the end of phase 1, 27 of 30 (90%) patients were microfilaria negative. During phase 2, four of the six men receiving DEC developed scrotal reactions suggesting killing adult worms; no such reactions were noted in 10 men receiving ivermectin (p less than 0.05). At one-year follow up (phase 3), all treatment groups had less than 10% return to pretreatment microfilaria levels. The mean percent of baseline microfilaria counts were for Group 1, 0.9% (range 0-5%); Group 2, 8.2% (range 0-31%); and Group 3, 3.8% (range 0-25%). Seven individuals in Group 1 were microfilaria-negative, while only one and three individuals were microfilaria-negative in Groups 2 and 3, respectively. These results suggest that DEC causes more damage to the adult worms and greater reduction in microfilaria densities than ivermectin, but that high doses of ivermectin may suppress microfilaremia in lymphatic filariasis for periods much longer than previously reported.
Assuntos
Dietilcarbamazina/uso terapêutico , Filariose Linfática/tratamento farmacológico , Ivermectina/uso terapêutico , Wuchereria bancrofti , Adolescente , Adulto , Animais , Método Duplo-Cego , Tolerância a Medicamentos , Filariose Linfática/sangue , Feminino , Seguimentos , Haiti , Humanos , Masculino , Microfilárias/efeitos dos fármacos , Microfilárias/crescimento & desenvolvimento , Pessoa de Meia-Idade , Wuchereria bancrofti/efeitos dos fármacos , Wuchereria bancrofti/crescimento & desenvolvimentoRESUMO
Measurement of blood cholinesterase activity and of the urinary metabolites of fenitrothion (p-nitrocresol) and malathion (monocarboxylic acid) was used to assess the exposure to these insecticides of workers in the Haitian malaria control programme and of residents in the sprayed houses. Cholinesterase activity was significantly reduced at the end of the working week in 3 out of 28 fenitrothion workers. Urinary levels of p-nitrocresol (PNC) in the spraymen ranged from 2.2 to 25.2 mg/l. In fenitrothion workers who had no direct contact with spraying (weighers and supervisors), the cholinesterase activity remained >/= 75% of the normal control value, and the urinary PNC levels were relatively low. Urinary malathion monocarboxylic acid (MCA) levels at the end of the working week ranged between 1.1 and 5.3 mg/l in workers using malathion and their blood cholinesterase activity remained essentially normal. In both groups of workers the cholinesterase levels improved and the urinary excretion of metabolites decreased after 2 days of rest from the spraying operations. In the residents of the sprayed houses, low concentrations of PNC and MCA were detected in the urine 1 day after spraying and measurable but reduced levels were still present after 7 days. In all these cases the cholinesterase activity remained >/= 75% of the normal control value.
Assuntos
Ácidos Carboxílicos/urina , Cresóis/urina , Inseticidas/metabolismo , Controle de Mosquitos , Exposição Ambiental , Fenitrotion/efeitos adversos , Fenitrotion/metabolismo , Haiti , Humanos , Inseticidas/efeitos adversos , Malation/efeitos adversos , Malation/metabolismo , Masculino , Monitorização FisiológicaRESUMO
Serologic and parasitologic studies were done in El Salvador, C.A., from 1974-1978 to examine the reliability of the diagnosis of Entamoeba histolytica infection in an endemic area and to confirm the estimates of morbidity and mortality due to amebiasis. The results suggest that infection with E. histolytica is common, but the estimated prevalence is too high. Misdiagnosis occurring in hospital and public health laboratories was documented. Data collected from examining family members of persons with E. histolytica infection and disease indicate that most infections are asymptomatic, and support the hypothesis that estimates of morbidity and mortality rates are excessive.
Assuntos
Amebíase/epidemiologia , Entamebíase/epidemiologia , Adolescente , Criança , Pré-Escolar , El Salvador , Entamoeba histolytica/isolamento & purificação , Entamebíase/diagnóstico , Fezes/parasitologia , Feminino , Inquéritos Epidemiológicos , Testes de Hemaglutinação , Humanos , Lactente , Masculino , Testes Sorológicos , Fatores de TempoRESUMO
To determine the role of rotavirus, enterotoxigenic Escherichia coli and enteropathogenic E. coli in diarrheal disease of non-hospitalized children and adults living in rural El Salvador, stool specimens were collected from 156 persons with diarrhea and 134 age- and sex-matched controls over a 1-year period. Enterotoxigenic Escherichia coli (ETEC) were isolated as frequently from controls (13.4%) as from diarrhea cases (12.2%). Enteropathogenic E. coli were isolated from 13 cases (8.3%) and 10 (7.7%) controls. Rotavirus was demonstrated in only five of the 129 specimens from cases examined; the five persons infected were less than or equal to 3 years of age. No invasive E. coli were found. Serotyping of ETEC revealed serogroups of ETEC previously associated with enterotoxigenicity but was not helpful in separating infection from disease. The etiology of diarrhea in this rural, non-hospitalized population was complex. Isolation of a known pathogen did not prove etiology. The rotaviruses, which have been isolated frequently from hospitalized persons, were rare. Further laboratory and epidemiologic studies in such populations are needed to identify those factors that determine pathogenicity.
Assuntos
Diarreia/microbiologia , Enterotoxinas/análise , Infecções por Escherichia coli/microbiologia , Viroses/microbiologia , Adolescente , Criança , Pré-Escolar , Diarreia Infantil/microbiologia , El Salvador , Escherichia coli/patogenicidade , Humanos , Lactente , Rotavirus/patogenicidade , População Rural , VirulênciaRESUMO
To test the hypothesis that the Duffy blood group negative genotype is a factor in resistance to Plasmodium vivax, we determined the Duffy blood group, the malaria antibodies, and the slide-demonstrated infection rates with P. vivax and P. falciparum of 420 persons living in Nueva Armenia, Honduras. In all, 247 persons were Duffy negative. Demonstrated infections with P. falciparum were almost equally distributed between Duffy-positive (5,8%) and Duffy-negative (4.9%) persons. Similarly, Duffy-positive (25.6%) and Duffy-negative (28.2%) persons had equal proportions of indirect fluorescent antibody test titers suggestive of past or present P. falciparum infection. In contrast, all 14 P. vivax infections were found in Duffy-negative persons. There was no evidence suggesting that Duffy-positive and Duffy-negative persons had different exposures to malaria. The Duffy negative genotype FyFy appears to be a factor in resistance to P. vivax.
Assuntos
Antígenos de Grupos Sanguíneos , Sistema do Grupo Sanguíneo Duffy , Imunidade Inata , Malária/imunologia , Anticorpos/análise , Sistema do Grupo Sanguíneo Duffy/genética , Honduras , Humanos , Malária/genética , Plasmodium falciparum/imunologia , Plasmodium vivax/imunologiaRESUMO
In the first 3 weeks after the 1976 earthquake in Guatemala a system for collecting, analysing, and disseminating information of medical importance was instituted in the disaster area. Data on cases of selected diseases, number of available hospital beds, and medical supplies were collected, and reported epidemics were investigated. The system functioned well despite the limited numbers of trained personnel. Collection and analysis were quick enough for data to be used immediately in decision-making. No epidemics of communicable diseases were observed in the affected area. The number of dog bites in Guatemala City increased but no cases of rabies were reported. The success of the surveillance system in Guatemala suggests that immediate use of epidemiological methods should be an integral part of disaster relief.