Médecine tropicale : revue du Corps de santé colonial
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This article beckons readers to reflect on the extreme acts of violence inflicted on populations when civil warfare degenerates into war against civilians. The authors raise the issue of political, media, and humanitarian choices determining the response of industrial countries to crisis situations in economically challenged countries. They advocate an approach based on the "assist and testify" principle of Médecins Sans Frontières.
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Sensitivity, specificity, and predictive value are the standard parameters used to evaluate the efficacy of diagnostic tests. However all three parameters assume the existence of a gold standard test. ⋯ The solution involves assessment of agreement between two raters. This article based on an example drawn from an African setting describes the value and computation of the most widely used tool for assessing agreement and reproducibility of measures, i.e., the kappa coefficient.
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Review Randomized Controlled Trial Comparative Study Clinical Trial
Malaria prophylaxis/radical cure: recent experiences of the Australian Defence Force.
Since the eighties, the Australian Defence Force has deployed soldiers in malaria-endemic areas: Cambodia, Somalia, Rwanda, Bougainville, and East Timor. Currently, doxycycline is used as first line prophylactic drug and mefloquine is recommended for those who cannot tolerate the antibiotic. In 1998, the Australian Defence Force participated in the evaluation of tafenoquine for prophylaxis of both falciparum and vivax malaria in Thai soldiers. ⋯ Seven soldiers in each arm developed vivax malaria after returning to Australia. These results indicate that tafenoquine is not superior to primaquine in preventing vivax malaria. However study participants preferred the shorter course using tafenoquine and operationally it was found to be more suitable than primaquine.
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Soldiers on duty in tropical areas are at high risk of malaria and need chemoprophylactic regimens which may ensure the best efficacy, tolerability and compliance. Current Italian Army guidelines are based on recent military experiences in tropical areas, where mefloquine prophylaxis was as well tolerated as combination treatment with chloroquine and proguanil but more effective and easier to comply with, at least among soldiers. ⋯ Doxycycline is the first choice regimen for mefloquine-resistant areas and an alternative to mefloquine when this medication is contraindicated or not tolerated. The combination chloroquine-proguanil represents the alternative chemoprophylactic regimen when mefloquine and doxycycline are contraindicated or not tolerated.
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A number of cases of Loa-encephalopathy have been reported following ivermectin (Mectizan) treatment for onchocerciasis in patients with high Loa microfilaraemia. A possible explanation for these severe reactions is the formation of micro-emboli in small brain vessels as a result of massive paralysis of Loa microfilariae in the blood. This suggests that encephalopathy might be prevented by giving an initial low dose of ivermectin to induce a more gradual action on the Loa microfilariae. ⋯ Blood smears were made daily from day 1 to 7 after treatment and then on days 15 and 30. Results showed no difference in the effect of the dosage level on Loa microfilaraemia. This finding suggests that an initial low dose of 3 mg Mectizan will not prevent encephalopathy following treatment for onchocerciasis.