Ann Trop Med Parasit
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Ann Trop Med Parasit · Sep 1997
ReviewPrevalences of Loa loa microfilaraemia throughout the area endemic for the infection.
Several cases of encephalopathy recorded in Cameroon since 1991 were in patients with very high, coincident, Loa loa microfilaraemias who had been treated with ivermectin for onchocerciasis. There was thus an urgent need to identify those areas where loiasis is hyperendemic, and where specific monitoring procedures should be developed if large-scale ivermectin treatment of onchocerciasis is to be implemented. ⋯ By superimposing these maps on those which show where onchocerciasis is meso- or hyper-endemic, it is now possible to identify several areas, in south-eastern Nigeria, southern and central Cameroon, the south of the Central African Republic, Equatorial Guinea, Gabon, and the north and west of the Democratic Republic of the Congo (ex-Zaire), where ivermectin treatment, although indicated, is most likely to lead to adverse reactions because of L. loa infections. Additional surveys, to delineate the areas highly infected with L. loa more accurately, are required.
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Ann Trop Med Parasit · Apr 1997
ReviewIs there a place for traditional midwives in the provision of community-health services?
Traditional midwives (TM) have been involved in delivering babies, and providing a broad range of other services to women, for hundreds of years. They are usually local women with little formal education. As they are well known in their communities they are often called to assist women at the time of delivery. ⋯ Rather, the studies have shown that the success of the programmes depends on the resources available, the people involved in the training and how the training is carried out. Some of the lessons learnt from working with TM apply to any two groups of people working together. If TM are going to be offered training, and this must be a local decision made after consultation and an evaluation of prevailing resources and conditions, the training should be a two-way process, with both parties learning from each other.
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The pathogenesis of severe, Plasmodium falciparum malaria in African children is considered in the context of its two major clinical syndromes: malaria with respiratory distress; and malaria with neurological disturbance. Respiratory distress is an important prognostic marker in children with P. falciparum infections. In the majority of cases it reflects an underlying metabolic acidosis, usually associated with lactic acidaemia. ⋯ Four distinct groups of children fulfilling the WHO definition of cerebral malaria may be distinguished: (1) prolonged post-ictal state; (2) covert status epilepticus; (3) severe metabolic derangement (particularly hypoglycaemia and metabolic acidosis); and (4) children with a primary neurological syndrome. These distinctions are important from a therapeutic point of view, as well as for their implications for studies on underlying pathogenic factors. A simple framework is presented to summarize how three major processes, anaemia, the acute phase response and sequestration of infected cells, may interact to lead to reduced tissue oxygenation as a unifying process in the pathogenesis of both major clinical syndromes of severe malaria.
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The 15th known case of systemic Strongyloidiasis in an AIDS patient is recorded, with emphasis on the fulminant clinical cause and diffuse organ involvement.
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A 1-year prospective study in Gaza of diarrhoeal disease in children aged < 5 years demonstrated that Salmonella spp. (18.5% of cases), Cryptosporidium (14.6%), Campylobacter spp. (8.3%) and rotavirus (6.8%) were the major pathogens. However, when compared with non-diarrhoeic controls, only Cryptosporidium and rotavirus were significantly associated with diarrhoea. Cryptosporidiosis was found only in children aged < 2 years and significantly more children with cryptosporidiosis were malnourished. ⋯ However, more children with rotavirus infection vomited and cryptosporidial diarrhoea lasted significantly longer (14.9 days) than rotavirus diarrhoea (5.9 days). Overcrowding was linked with an increased risk of cryptosporidiosis and breast feeding was associated with some protection. Twenty-one of the 29 children who died during the study died with diarrhoea and Cryptosporidium was detected in eight (38%) of these 21 children.