Tropical Medicine

Fasciolid flukes are among the largest and best known digenetic trematodes and have considerable historical and veterinary significance. Fasciola hepatica is commonly implicated in causing disease in humans. The origins, patterns of diversification, and biogeography of fasciolids are all ...

OBJECTIVE: To assess the extent and causes of microbiological contamination of household drinking water between source and point-of-use in developing countries. METHODS: A systematic meta-analysis of 57 studies measuring bacteria counts for source water and stored water in the home to assess how contamination varied between settings. RESULTS: The bacteriological quality of drinking water significantly declines after collection in many settings. The extent of contamination after water collection varies considerably between settings, but is proportionately greater where faecal and total coliform counts in source water are low. CONCLUSIONS: Policies that aim to improve water quality through source improvements may be compromised by post-collection contamination. Safer household water storage and treatment is recommended to prevent this, together with point-of-use water quality monitoring.

Although vaccination has almost eliminated measles in parts of the world, the disease remains a major killer in some high birth rate countries of the Sahel. On the basis of measles dynamics for industrialized countries, high birth rate regions should experience regular annual epidemics. Here, however, we show that measles epidemics in Niger are highly episodic, particularly in the capital Niamey. Models demonstrate that this variability arises from powerful seasonality in transmission-generating high amplitude epidemics-within the chaotic domain of deterministic dynamics. In practice, this leads to frequent stochastic fadeouts, interspersed with irregular, large epidemics. A metapopulation model illustrates how increased vaccine coverage, but still below the local elimination threshold, could lead to increasingly variable major outbreaks in highly seasonally forced contexts. Such erratic dynamics emphasize the importance both of control strategies that address build-up of susceptible individuals and efforts to mitigate the impact of large outbreaks when they occur.

Objective: To study the etiology and clinical profile of non-traumatic coma in children and to determine the clinical signs predictive of outcome. Methods: 100 consecutive cases of non-traumatic coma between 2 months to 12 years. Clinical signs studied were temperature, pulse, heart rate, blood pressure, coma severity by Glasgow coma scale (GCS), respiratory pattern, pupillary and corneal reflex, extra ocular movements, motor patterns, seizure types and fundus picture. These were recoded at admission and after 48 hours of hospital stay. Etiology of coma was determined on basis of clinical history, examination and relevant laboratory investigations by the treating physician. The outcome was recorded as survived or died, and among those who survived as normal, mild, moderate, or severe disability. Chi-square test and logistic regression analysis were done to determine predictors of outcome. Results: Etiology of coma in 60% cases was CNS infection (tubercular meningitis-19, encephalitis-18, bacterial meningitis-16, others-7); other causes were toxic-metabolic conditions (19%), status epilepticus (10%), intracranial bleed (7%), and miscellaneous (4%). 65 children survived, 11 were normal, 14 had mild disability, 21 had moderate disability and 14 were severely disabled and dependent. Survival was significantly better in patients with CNS infection (63%) as compared to those with toxic-metabolic causes (27%) and intracranial bleed (43%, P < 0.05). On bivariate analysis age ≤3 years, poor pulse volume, abnormal respiratory pattern and apnoea, abnormal pupillary size and reaction, abnormal extra ocular movements, absent corneal reflex, abnormal motor muscle tone at admission or 48 hours correlated significantly with mortality. Survival was better with increasing GCS (Spearman rho = .32, P < 0.001). On logistic regression age < 3 years, poor pulse volume, absent extraocular movements and papilloedema at admission and 48 hours after admission were independent significant predictors of death. Conclusion: CNS infections were the most common cause of non-traumatic coma in childhood. Simple clinical signs were good predictors of outcome. [Indian J Pediatr 2005; 72 (6) : 467-473]

This study aims at estimating the recent trends in HIV-1 prevalence and the factors associated with infection among pregnant women in the Gulu District of north Uganda, a rural area severely affected by civil strife. In 2000-2003, a total of 4459 antenatal clinic attendees of Lacor Hospital were anonymously tested for HIV-1 infection. The overall and age-specific prevalence did not show any significant trend over time. The age-standardized prevalence slightly declined, from 12.1% in 2000 to 11.3% in 2003. Increased age [20-24 years: adjusted odds ratio (AOR) 1.63; 95% CI 1.18-2.25; ≥25 years: AOR 2.56; 95% CI 1.91-3.44], residence in urban areas (AOR 1.76; 95% CI 1.41-2.18), being unmarried (AOR 1.60; 95% CI 1.27-2.01), increased age of partner (25-34 years: AOR 1.87; 95% CI 1.29-2.73; ≥35 years: AOR 2.68; 95% CI 1.72-4.16), modern occupation of partner (AOR 1.98; 95% CI 1.53-2.58), and short time of residence at the current address (AOR 1.36; 95% CI 1.05-1.76) were associated with infection. The HIV-1 prevalence in this rural district is high and similar to that observed in urban antenatal clinics, probably reflecting the effect of the last 18 years of civil strife.

To determine the prevalence and disease association of Helicobacter pylori (H. pylori) in dyspeptic patients in southwest Nigeria. Obafemi Awolowo University Teaching Hospitals Complex, Ile-lfe, Nigeria. Consecutive dyspeptic patients for upper gastrointestinal endoscopy from January 1996 to March 1997 were investigated for H. pylori in gastric biopsy by histopathology and culture. Patients without gastroduodenal ulcerations or neoplastic lesions constituted the nonulcer dyspeptic (NUD) group. 138 (92 males, 46 females) patients aged 4.5-85 years [mean (7) = 45+/-SD 17.8 years] who had upper gastrointestinal endoscopy were analyzed for presence of H. pylori. Eighty-three had histopathology alone, while 55 others had both histology and culture. Endoscopic diagnosis included duodenal ulcer (DU) (n=35, 23%); gastric ulcer (n=4, 3%); gastric cancer (n=14, 9%); NUD, including gastritis (n=49, 32%); duodenitis (n=47, 31%); and normal (n=16, 11%). Overall, H. pylori was positive in 107 of ...

The efficacies of specific Bothrops atrox-Lachesis and standard Bothrops-Lachesis antivenoms were compared in the north eastern Amazon region of Brazil. The main aim was to investigate whether a specific antivenom raised against the venom of B. atrox, the most important Amazon snake species from a medical point of view, was necessary for the treatment of patients in this region. Seventy-four patients with local and systemic effects of envenoming by Bothrops or Lachesis snakes were randomly allocated to receive either specific (n = 38) or standard (n = 36) antivenoms. In 46 cases (24 in the standard antivenom group, 22 in the other) the snake was identified either by enzyme immunoassay or by examination of the dead snake, as B. atrox in 45, L. muta in one. Patients were similar in all clinical and epidemiological respects before treatment. Results indicated that both antivenoms were equally effective in reversing all signs of envenoming detected both clinically and in the laboratory. Venom-induced haemostatic abnormalities were resolved within 24 h after the Clinical trial of two antivenoms for the treatment of Bothrops and Lachesis bites 29 start of antivenom therapy in most patients. The extent of local complications, such as local skin necrosis and secondary infection, was similar in both groups. There were no deaths. The incidence of early anaphylactic reactions was 18% and 19%, respectively for specific and standard antivenoms; none was life-threatening. Measurement of serum venom concentrations by enzyme immunoassay (EIA) confirmed that both antivenoms cleared venom antigenaemia effectively. EIA also revealed that one patient had been bitten by Lachesis muta, although the clinical features in this case were not distinctive.

To establish the anti-platelet or aspirin like effects of flavonoid rich food (chocolate). Methods: This was a non-randomized quasi experimental study in which, 65 healthy adult volunteers, 27 males and 38 females, participated. The subjects included were healthy, non-smoking adults. Health of subjects was evaluated by a questionnaire for which a written informed consent was taken prior to admission in the study. Research protocol was approved by the college's, "Research and Ethical committee". Division of subjects into two groups, a control group which consumed 100mgs of oral aspirin and an interventional group consuming 100mgs oral aspirin and 18.75gms of dark chocolate (flavonoid rich), was carried out. The Bleeding time estimation for both the groups was done by "Duke Method" of bleeding time estimation. Results: Data was analyzed by SPSS 15.0. First, a bivariate analysis was done by comparing both the pre-test groups i.e. before consumption of aspirin and also before consumption of chocolate and aspirin together through independent t-test Later, regression analysis was also done. Bivariate analysis compared both the control and interventional groups. After comparing pre-test groups a p-value of 0.798 was obtained and after comparing post test groups a p-value of 0.006 was determined. Regression analysis yeilded an R-square of 0.25. Conclusion: Chocolate has a significant role in augmenting the anti-platelet effects of aspirin.

objectives Lay health workers (LHWs) are used in many settings to increase immunisation uptake among children. However, little is known about the effectiveness of these interventions. The objective of this review was to assess the effects of LHW interventions on childhood immunisation uptake.

The pharmacology of anti-SARS-CoV-2 drugs, Molnupiravir (M) and repurposed Ivermectin (IV) were compared. The IC 50 for the inhibition of viral replication were 0.3µM for M and 2.8µM for IV. Both drugs have good oral absorption, with M achieving peak plasma concentrations by 2 hours and IV by 5 hours. The plasma half life were 7 hours for M and 81-91 hours for IV. M inhibits viral replication inducing viral mutagenesis in RdRp, causing viral error catastrophe and viral extinction. IV affects viral cell entry, nuclear transport and inhibits replication via RdRp. IV has additional effect to suppress cytokine production through STAT-3 inhibition. M is a more potent antiviral drug and IV has a longer residence in the body. Their effects on RdRp and cytokine inhibition are potentially complimentary for anti-COVID-19 activity. Both IV and M should be compared in randomized controlled clinical trials, and the possibility of their combination for anti-SARS-CoV-2 antiviral actions, explored further.

To detect by magnetic resonance imaging (MRI) the presence and type of knee injuries in non-professional runners after running an ultra-marathon, and to determine whether ultra-marathon running exacerbates pre-existing knee injuries or results in new permanent injuries. A prospective MRI study of one knee of 10 randomly selected participants who completed the Comrades Marathon between 1997 and 2002. Their knees were scanned 48 hours before the race, and 48 hours and 1 month after the race. All scans were performed at the Radiology Department, Wentworth Hospital, Durban, and the University of KwaZulu-Natal. Scores of all knee injuries detected on MRI scans immediately before the race, compared with the scores after the race. All scanned knees demonstrated an abnormal amount of joint fluid before the race; this increased immediately after the race in 5 runners and remained unchanged in another 5. At 1 month, 5 knees showed decreased joint fluid and 5 remained unchanged, but these were...

This article is a prospective study of the clinical, laboratory and radiological picture of children satisfying the case definition criteria of dengue by WHO admitted at Sri Ramachandra Medical College and Research Institute, a suburban tertiary referral centre, to determine the predictive factors for dengue shock syndrome (DSS). Data were analyzed by Chi-squared test and Student's t-test for significance after dividing the patients into two groups, those with and those without DSS for the same. Bleeding manifestations, presence of effusion on USG/X-ray, haematocrit`35%, WBC _4000/ cumm, Na •130 meq/l, bicarbonate level of _18 mmol/l, deranged coagulation profile and serum glutamic pyruvic transaminase (SGPT)¸40 IU were predictive of DSS.

Objective: To evaluate the comparative efficacy of 400 mg albendazole (Smith Kline Beecham) as a single dose and three brands of mebendazole (Janssen, Unibios and East African Pharmaceuticals) at doses of 100 mg twice a day for three consecutive days in the treatment of single or mixed infections with Ascaris lumbricoides and or Trichuris trichiura in four treatment groups of school children. Design: Randomized trial. Setting: Wondo-Genet, southern Ethiopia. Subjects: School children, aged six to nineteen years. Results: The percentage cure rate and egg reduction rate obtained with albendazole and mebendazole from the three brands were not significantly different in the treatment of ascariasis. However, significant differences were found among the percentage cure rates and egg reduction rates of the four treatment groups in the treatment of trichuriasis. Comparatively, high cure rate (89.8%) and egg reduction rate (99.1%) were observed in vermox (Janssen) treated group followed by Unibios (India) treated group (53.3% and 96.53% cure and egg reduction rates, respectively), whereas low cure rate (17.1%) and egg reduction rate (69.8%) were seen in the albendazole treated group. Conclusion: The results of this study suggest that in areas of single or mixed infections with Trichuris trichiura and/or Ascaris lumbricoides are common public health problems and where laboratory facilities are not available to make parasite identification, mebendazole (particularly vermox, a product of Janssen laboratory) would be the drug of choice to treat trichuriasis and ascariasis. However, either mebendazole from the different brands or albendazole is effective in the treatment of ascariasis in areas where trichuriasis is not prevalent.

To assess the impact of health education on the knowledge and attitudes of paramedical students in Saudi Arabia toward HIV/AIDS. We carried out an interventional study on a sample selected from students of health institutes and health colleges in Saudi Arabia during the calendar year 2002-2003. The intervention shows a positive effect on students&#39; knowledge regarding means of transmission of HIV and means of protection from HIV/AIDS. Furthermore, it has a positive impact on students&#39; attitudes toward accepting discussion of AIDS topics with others, acceptance of home care for HIV infected family member and acceptance of HIV-infected individual&#39;s right at work. Preference of confidentiality was also significantly increased after intervention. Health education intervention has a positive impact on students&#39; knowledge and attitudes towards HIV/AIDS and we recommend a nationwide health education program on HIV/AIDS.

To better understand the potential environmental health risk presented by West Nile virus (WNV)-contaminated feces, we quantified the amount of WNV present in the feces of experimentally infected American crows (Corvus brachyrhynchos) and fish crows (Corvus ossifragus). Peak fecal titers ranged from 10(3.5) to 10(8.8) plaque-forming units (PFU)/g for 10 American crows and from 10(2.3) to 10(6.4) PFU/g for 10 fish crows. The presence of infectious WNV in bird feces indicates a potential for direct transmission of WNV. Thus, handlers of sick or dead birds should take appropriate precautions to avoid exposure to fecal material.

Psychologists as part of a team, make important contributions for the treatment of psychiatric disorders. New Mexico and Louisiana in United States have recently granted prescribing privileges to psychologists who have successfully completed additional training. This study determined the opinions of conveniently selected university students in Islamabad on clinical psychologists being granted similar prescribing privileges after additional training and certification by the Pakistan Medical and Dental Council (PMDC). Four hundred and five students completed the questionnaires; with 51 students enrolled in Psychology departments who were excluded from the reported analysis. One hundred and sixty-five respondents were male (46.6%), and 189 (53.4%) were female. Two hundred and seventy-six (78%) students were enrolled in masters, while the rest in higher degree programme. Cumulatively, 272 (76.8%) students believed that after additional training, clinical psychologists may be allowed to ...

The Special Programme for Research and Training in Tropical Diseases (TDR) co-sponsored by UNICEF, UNDP, World Bank and WHO has been supporting research capacity strengthening in low- and middle-income countries for over 40 years. In order to assess and continuously optimize its capacity strengthening approaches, an evaluation of the influence of TDR training grants on research career development was undertaken. The assessment was part of a larger evaluation conducted by the European Science Foundation. A comprehensive survey questionnaire was developed and sent to a group of 117 trainees supported by TDR who had completed their degree (masters or PhD) between 2000 and 2012; of these, seventy seven (77) responded. Most of the respondents (80%) rated TDR support as a very important factor that influenced their professional career achievements. The “brain drain” phenomenon towards high-income countries was particularly low amongst TDR grantees: the rate of return to their region of or...

KOH is known to penetrate deeply and destroy the skin because it dissolves keratin. [5] Ten percent potassium hydroxide (KOH) solution has been prescribed for mollusca to be applied at home and has the added advantage of being relatively painless. Recently, imiquimod, a topical immune response modifier, has been successfully used in the treatment of external anogenital warts. [6-8] Mechanism of action is the induction of cell-mediated immunity, which helps in the regression of mollusca-similar to that observed in viral warts. [9,10] The principal antiviral cytokine, interferon-γ (in addition to other inflammatory cytokines), is induced by imiquimod cream. The aim of this study was to evaluate and compare How to cite this article: Metkar A, Pande S, Khopkar U. An open, nonrandomized, comparative study of imiquimod 5% cream versus 10% potassium hydroxide solution in the treatment of molluscum contagiosum.

The relationship between the percent phagocytosis of platelets by differentiated THP-1 cells was examined using flowcytometry and the peripheral platelet counts as well as platelet-associated IgG (PAIgG) in 36 patients with secondary dengue virus (DV) infections. The percent phagocytosis and the levels of PAIgG were significantly increased in these patients during the acute phase compared with the healthy volunteers. The increased percent phagocytosis and PAIgG found during the acute phase significantly decreased during the convalescent phase. An inverse correlation between platelet count and the percent phagocytosis (P = 0.011) and the levels of PAIgG (P = 0.041) was found among these patients during the acute phase. No correlation was found, however, between the percent phagocytosis and the levels of PAIgG. Our present data suggest that accelerated platelet phagocytosis occurs during the acute phase of secondary DV infections, and it is one of the mechanisms of thrombocytopenia in...

The prevalence of antibiotic-resistant Escherichia coli isolates from faecal samples from 117 poultry industry workers, 100 patients and119 healthy chicken were compared. Resistance of E. coli chicken isolates to ampicillin, chloramphenicol, gentamicin, spectinomycin, tetracycline and trimethoprim ϩ sulphamethoxazole (TMP ϩ SMX) (range 57% -99.1%) were significantly higher than those isolated from patients (range 21.9% -71.4%) and workers (range 35% -71.8%). However, for drugs not used in poultry, such as amoxicillin ϩ cluvalanate (AMX ϩ CLV), ceftazidime and nitrofurantoin, resistance rates of chicken isolates (range 0% -2.6%) were significantly lower than those of patient isolates (range 8.7% -30%). Resistance to spectinomycin reached 96% in E. coli chicken isolates and 71% in organisms isolated from humans. Use of this drug in Saudi Arabia is mostly limited to veterinary purposes. Multidrug resistance is alarmingly high in all groups but was highest in chicken isolates (77.4%). Serotyping of E. coli isolates showed that 27% of the organisms isolated from patients were overlapping with 10.9% of the chicken isolates, indicating the possibility of chicken being a source of the resistance pool for humans. We therefore call for the banning of antibiotics in the poultry industry as growth promoters and recommend that their use be restricted to treating infections.

A cross-sectional study was conducted among 285 school children aged 5-18 years in Nyanza Province, Western Kenya, to determine the prevalence of geophagy and the types and amounts of soil eaten. Stool samples were taken from a subsample of 53 (19%) and their silica content determined to compare the results with the reported geophagy. Geophagy was practised by 73% of the children. The prevalence decreased with age for both sexes up to age 15, then remained stable for girls between 15 and 18 years but continued to decrease for boys in that age range.

Objective: Vivax malaria is common in Pakistan. We carried out this study to determine the effects of this infection on blood counts and the impact of splenomegaly on these results.
Methods: This was a retrospective observational study carried out at 1 Mountain Medical Battalion, Bagh, Azad Kashmir. Old medical records of all patients admitted with vivax malaria from Jan 2010 to Oct 2012 were scrutinized. The presence or absence of a palpable spleen and the results of complete blood counts and platelet counts measured at the time of admission were noted down. Anaemia was defined as Hb<13g/dl in men, leukopenia as total leukocyte count (TLC)<4000/µl and thrombocytopenia as platelets count <150000/µl. Data was analysed with STATA version 12.1. The results of haematology parameters were compared amongst patients with splenomegaly and the rest.
Results: Anaemia was seen in 22.15%, neutropenia in 23.49% and thrombocytopenia in 90.60% of the 149 male patients having a mean age of 27.54±5.11 years. The differences in mean blood counts and the number of patients with haematological abnormalities in the two groups were statistically insignificant.
Conclusion: Since the blood counts are not affected by presence or absence of splenomegaly, mechanisms other than hypersplenism are important.

This study examines the asymmetries among the different interests of officials and medical doctors who worked for the Rockefeller Foundation and their Colombian counterparts in the development and consolidation of the concept of “jungle yellow fever,” as distinguished from the known urban form of yellow fever. We explore the research responses to a variety of disease out-breaks in Colombia in the context of the Rockefeller campaigns against yellow fever, from the time of Roberto Franco&#39;s initial description of “yellow fever of the forests” in 1907 until the consolidation of the concept of “jungle yellow fever” by Fred Soper in 1938.

objective The Brazilian National Hansen's Disease Control Program recently identified clusters with high disease transmission. Herein, we present different spatial analytical approaches to define highly vulnerable areas in one of these clusters.

A pesar de que las nuevas terapias inmunosupresoras han mejorado notablemente la evolucion clinica de los trasplantes renales, los rechazos agudo y cronico siguen limitando la sobrevida a largo plazo del injerto. En base a lo anterior, el objetivo de este estudio fue determinar la presencia de anticuerpos sericos contra antigenos de histocompatibilidad (HLA) clase I y clase II en ninos con rechazo agudo del injerto renal. Metodos. Se realizo un estudio clinico prospectivo en pacientes con trasplante renal que presentaron rechazo agudo del injerto. Se les tomo muestra de suero al momento de la biopsia renal, misma que fue utilizada para la deteccion de anticuerpos contra antigenos HLA de clase I y II por ensayo basado en equipo fuoroanalizador (Luminex) y microperlas cubiertas con antigenos clase I y clase II de One Lambda. Resultados. De 21 pacientes estudiados, 17 pacientes (81%), fueron diagnosticados con rechazo celular y cuatro (19%) con rechazo agudo mediado por anticuerpos. El...

Hepatitis B is one of the most common infectious diseases in the world with high prevalence in most of sub-Saharan Africa countries. The complexity in its diagnosis and treatment poses a significant management challenge in the resource-limited settings including Tanzania, where most of the tests and drugs are either unavailable or unaffordable. This mini review aims at demonstrating the current status of the disease in the country and discussing the concomitant challenges in diagnosis, treatment, and prevention.

CONTEXT: Ready-to-use therapeutic foods (RUTFs) are an important component of effective outpatient treatment of severe wasting. However, their effectiveness in the population-based prevention of moderate and severe wasting has not been evaluated. OBJECTIVE: To evaluate the effect of a 3-month distribution of RUTF on the nutritional status, mortality, and morbidity of children aged 6 to 60 months in Niger. DESIGN, SETTING, AND PARTICIPANTS: A cluster randomized trial of 12 villages in Maradi, Niger. Six villages were randomized to intervention and 6 to no intervention. All children in the study villages aged 6 to 60 months were eligible for recruitment. INTERVENTION: Children with weight-for-height 80% or more of the National Center for Health Statistics reference median in the 6 intervention villages received a monthly distribution of 1 packet per day of RUTF (92 g [500 kcal/d]) from August to October 2006. Children in the 6 nonintervention villages received no preventive supplementation. Active surveillance for conditions requiring medical or nutritional treatment was conducted monthly in all 12 study villages from August 2006 to March 2007. MAIN OUTCOME MEASURES: Changes in weight-for-height z score (WHZ) according to the World Health Organization Child Growth Standards and incidence of wasting (WHZ <-2) over 8 months of follow-up. RESULTS: The number of children with height and weight measurements in August, October, December, and February was 3166, 3110, 2936, and 3026, respectively. The WHZ difference between the intervention and nonintervention groups was -0.10 z (95% confidence interval [CI], -0.23 to 0.03) at baseline and 0.12 z (95% CI, 0.02 to 0.21) after 8 months of follow-up. The adjusted effect of the intervention on WHZ from baseline to the end of follow-up was thus 0.22 z (95% CI, 0.13 to 0.30). The absolute rate of wasting and severe wasting, respectively, was 0.17 events per child-year (140 events/841 child-years) and 0.03 events per child-year (29 events/943 child-years) in the intervention villages, compared with 0.26 events per child-year (233 events/895 child-years) and 0.07 events per child-year (71 events/1029 child-years) in the nonintervention villages. The intervention thus resulted in a 36% (95% CI, 17% to 50%; P < .001) reduction in the incidence of wasting and a 58% (95% CI, 43% to 68%; P < .001) reduction in the incidence of severe wasting. There was no reduction in mortality, with a mortality rate of 0.007 deaths per child-year (7 deaths/986 child-years) in the intervention villages and 0.016 deaths per child-year (18 deaths/1099 child-years) in the nonintervention villages (adjusted hazard ratio, 0.51; 95% CI, 0.25 to 1.05). CONCLUSION: Short-term supplementation of nonmalnourished children with RUTF reduced the decline in WHZ and the incidence of wasting and severe wasting over 8 months. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00682708.

We obtained data from all cities with full coverage by the NIMSS, 2001-2003. These cities, among the largest in the country, represent 12.9 million people, or 50% of the country's total urban population. 11 Children aged 0-14 years, who number 3.4 million, comprise 26% of their population. With the names of their historical urban centres and total population size in 2001, these cities are: City of Cape Town Metropolitan Municipality (Cape Town; 2.9 million); City of Johannesburg Metropolitan Municipality (Johannesburg; 3.2 million); City of Tshwane Metropolitan Municipality (Pretoria; 2.0 million); eThekwini Metropolitan Municipality (Durban; 3.1 million); Nelson Man-Une traduction en français de ce résumé figure à la fin de l'article. Al final del artículo se facilita una traducción al español. ‫املقالة.‬ ‫لهذه‬ ‫الكامل‬ ‫النص‬ ‫نهاية‬ ‫يف‬ ‫الخالصة‬ ‫لهذه‬ ‫العربية‬ ‫الرتجمة‬ Objective To determine the leading causes of fatal injury for urban South African children aged 0-14 years, the distribution of those causes and the current potential for safety improvements. Methods We obtained injury surveillance data from the National Injury Mortality Surveillance System 2001-2003 for six major South African cities varying in size, development and sociodemographic composition. We calculated age-adjusted rates, by sex, population group and city, for death from the five leading causes of fatal injury as well as population attributable risks (PARs). Findings The leading causes of fatal injury in childhood included road traffic injuries-among vehicle passengers and especially among pedestrians-drowning, burns and, in some cities, firearm injuries. Large differences in PARs were observed, particularly for population groups and cities. Disparities between cities and between population groups were largest for deaths from pedestrian injuries, while differences between boys and girls were greatest for drowning deaths. Conclusion In the face of the high variability observed between cities and population groups in the rates of the most common types of fatal injuries, a safety agenda should combine safety-for-all countermeasures-i.e. lowering injury rates for all-and targeted countermeasures that help reduce the burden for those at greatest risk.

To assess the diagnostic accuracy of triphasic spiral CT in differentiating benign from malignant focal tumoral liver lesions. The study was conducted in Department of Radiology of Aga Khan University Hospital and Sind Institute of Urology and Transplantation, Karachi from Feb 2006 to Feb 2007. By convenient sampling, 45 patients found to have focal tumoral liver lesions were recruited for one year period and their triphasic CT scans findings were evaluated and later correlated with histopathology. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of triphasic CT scan were calculated. Among 45 patients, 136 liver lesions (11 benign and 125 malignant) were detected with the help of different enhancement patterns. Out of these, 37(82.2%) patients had malignant while 8 (17.8%) had benign lesions. On later histopathological examination, 35 (77.8%) of the total 45 cases had malignant lesions while 10 (22.2%) were diagnosed as benign le...

OBJECTIVE To evaluate the efficacy comparison of Pueraria mirifica (PM), name in Thai is Kwao Kruea Khao, against conjugated equine estrogen (CEE) with/without medroxyprogesterone acetate (MPA) in the treatment of perimenopuasal women with climacteric symptoms. MATERIAL AND METHOD Perimenopausal women attending the Menopausal clinic of Hat Yai Regional Hospital were voluntarily recruited. The vasomotor symptoms such as hot flushes and night sweats, as well as other unpleasant symptoms, urogenital and psychological symptoms, were also assessed. Patients were voluntarily enrolled and randomly received daily 50 mg raw material of PM, Group A, or daily 0.625 mg of conjugated equine estrogen (CEE) with/without 2.5 mg of medroxyprogesterone acetate (MPA), Group B, depend on non-hysterectomized/hysterectomized condition. RESULTS Seventy-one patients were enrolled. Eleven of those were excluded for failing to complete the initial work-up and follow-up. Sixty cases were evaluated, 30 cases i...

Resumen La deforestación en Loreto está concentrada en dos focos principales: la carretera Iquitos – Nauta y los alrededores de Yurimaguas; y de los 53 distritos de Loreto más de la mitad están expuestos con muy alto riesgo a enfermarse de malaria. Se explora la relación de malaria con la deforestación abordándolo desde el punto de vista espacial para lo cual se usa técnicas de análisis de imágenes de satélite, análisis geoestadísticos e interpolaciones espaciales en los sistemas de información geográfica. Se encontró una fuerte correlación positiva con más del 80% de ajuste entre el incremento de la deforestación y la presencia de casos de malaria, esto refleja fuerte relación de la deforestación sobre la distribución espacial de la malaria en los lugares poblados rurales alrededor de Iquitos. Abstract Deforestation in Loreto is concentrated in two main foci: the Iquitos-Nauta highway and the surroundings of Yurimaguas; and of the 53 districts of Loreto more than half are exposed with very high risk to get sick from malaria. The relationship between malaria and deforestation is explored by addressing it from a spatial point of view, using satellite image analysis techniques, geostatistical analysis and spatial interpolations in geographic information systems. A strong positive correlation was found with more than 80% adjustment between the increase in deforestation and the presence of malaria cases, this would reflect a strong relationship between deforestation and the spatial distribution of malaria in rural towns around Iquitos. Resumo O desmatamento em Loreto está concentrado em dois focos principais: a rodovia Iquitos-Nauta e os arredores de Yurimaguas; e dos 53 distritos de Loreto mais da metade estão expostos com muito alto risco de ficar doente da malária. A relação entre a malária e o desmatamento é explorada abordando-a desde um ponto de vista espacial, utilizando técnicas de análise de imagens por satélite, análise geoestatística e interpolações espaciais em sistemas de informação geográfica. Uma forte correlação positiva foi encontrada com mais de 80% de ajuste entre o aumento do desmatamento e a presença de casos de malária, o que refletiria uma forte relação entre desmatamento e distribuição espacial da malária em cidades rurais em torno de Iquitos.

Objective: To validate the Thai Short-Form McGill Pain Questionnaire (Th-SFMPQ). Material and Method: A postal survey to find the most corresponding terms to those used in the original English short-form McGill Pain Questionnaire had been performed. The Thai version was created and validated. Sixty patients who had either musculoskeletal or neuropathic pain were assessed by two interviewers with this Th-SFMPQ. Results: Forty four women and sixteen men participated in this study. Average age was 44.3 + 12.8 years and 80% of them had musculoskeletal pain. Means of sensory score was 8.98, affective score was 5.73, total score was 14.71, total count was 7.33, Present Pain Intensity (PPI) was 3.21 and Visual Analog Scale (VAS) was 53.61. Cronbach's α value was 0.7881 and inter-rater validity value of PPI was more than 0.7. The correlation coefficient was quite high (r > 0.8) for all scales. Regarding content validity, three pain descriptors (i.e. stabbing, gnawing, and splitting) did not meet 33% in Melzack's criteria. Conclusion: The Th-SFMPQ has good internal consistency and inter-rater validity. Three uncommon descriptors should be substituted by other words or discarded in later version.

objective Information on Leishmania species diversity in western Brazilian Amazon and the clinical picture of human cutaneous leishmaniasis it causes is scarce. We describe clinical findings, diagnostic procedures and identification of Leishmania species in patients from that region.