RESUMO
An open-label, randomized, controlled trial was used to compare the safety and efficacy of intramuscular artemether (a loading dose of 3.2 mg/kg, followed by 1.6 mg/kg daily for 4 days) and intravenous quinine (a loading dose of 20 mg quinine dihydrochloride/kg, followed first by 10 mg/kg every 8 h, each injection taking 4 h, for at least 48 h, and then oral quinine for a total of 7 days) in the management of strictly defined severe/complicated malaria in Melanesian adults. Four (12%) of the 33 patients who enrolled and completed follow-up died (one of the 15 who received artemether and three of the 18 who received quinine). Overall, cerebral malaria was uncommon (6%) whilst jaundice was common (76%). The time taken to clear 50% of parasites was less in those treated with artemether (median = 8 h; range = 2-24 h) than in the patients given quinine (median = 14 h; range = 2-25 h; P = 0.05). Temperature defervescence was also quicker in those treated with artemether (median = 32 hours; range = 20-112 h) than in those in the quinine group (median = 48 h; range = 28-88 h; P = 0.034). Hypoglycaemia was not observed in any patient treated with artemether but complicated therapy in 11 (79%) of the 14 patients given quinine who had not had pre-treatment spontaneous hypoglycaemia. No serious adverse effects were attributable to artemether. The Plasmodium falciparum infections observed during the 1 month of follow-up, in three patients who had received artemether and two who had been given quinine, were probably due to recrudescence. Plasmodium vivax parasitaemias were also observed during follow-up, in one or two patients in each treatment group. Artemether appears safe in Melanesian adults and is probably as effective as intravenous quinine in the treatment of severe or complicated falciparum malaria.
Assuntos
Antimaláricos/administração & dosagem , Artemisininas , Malária Falciparum/tratamento farmacológico , Quinina/administração & dosagem , Sesquiterpenos/administração & dosagem , Adulto , Artemeter , Humanos , Injeções Intramusculares , Injeções Intravenosas , Malária Falciparum/complicações , Malária Falciparum/mortalidade , Papua Nova Guiné , Resultado do TratamentoRESUMO
PIP: By mid-1995, a total of 308 HIV cases had been reported in Papua New Guinea. The majority (74%) of these cases were diagnosed in Port Moresby. This article describes the clinical characteristics of HIV infection in 67 adults who presented to Port Moresby General Hospital in 1990-95. The median age at presentation was 27 years in men and 28 years in women, with an equal distribution of cases by sex. The major presenting symptoms were wasting and weight loss exceeding 10% of body weight (94%), chronic diarrhea (47%), prolonged fever (77%), and oropharyngeal candidiasis (66%). Pulmonary tuberculosis was diagnosed on the basis of chest X-ray and history in 37 patients (56%), but only 3 had sputum positive for acid-fast bacilli. Anemia was present in 75%. 65 patients (97%) fulfilled the World Health Organization criteria for AIDS. The inpatient mortality rate in this series was 43%, and 13 of these 29 patients died within a month of their first presentation.^ieng
Assuntos
Infecções por HIV/diagnóstico , Síndrome da Imunodeficiência Adquirida/diagnóstico , Síndrome da Imunodeficiência Adquirida/epidemiologia , Adolescente , Adulto , População Negra , Feminino , Infecções por HIV/epidemiologia , Humanos , Incidência , Masculino , Papua Nova Guiné/epidemiologia , Fatores de RiscoRESUMO
Severe falciparum malaria usually occurs in children, but also occurs in nonimmune migrants or partially immune adults in areas of unstable transmission. We have studied prospectively 70 adult patients with strictly defined severe malaria from the south coast of Papua New Guinea where malaria transmission is not intense. Only 19 (27.1%) were migrants from areas where malaria transmission does not occur; many other patients were periurban dwellers who had become infected after visits to their home villages. The most common clinical features were jaundice or hepatic dysfunction, impaired consciousness, renal failure, cerebral malaria, and anemia. Hypoglycemia was common following treatment with quinine. The overall case fatality rate was 18.6%; renal failure and cerebral malaria in particular were associated with a poor outcome. Reduction in mortality might be achieved by aggressive therapy of renal failure with earlier institution of dialysis; the use of preventive measures for immigrants or urban dwellers returning to high transmission areas might reduce the incidence of this dangerous disease.
Assuntos
Malária Falciparum/complicações , Adolescente , Adulto , Anemia/epidemiologia , Anemia/etiologia , Criança , Feminino , Humanos , Hipoglicemia/epidemiologia , Hipoglicemia/etiologia , Icterícia/epidemiologia , Icterícia/etiologia , Hepatopatias Parasitárias/epidemiologia , Hepatopatias Parasitárias/etiologia , Malária Cerebral/epidemiologia , Malária Falciparum/epidemiologia , Masculino , Pessoa de Meia-Idade , Papua Nova Guiné/epidemiologia , Parasitemia/complicações , Parasitemia/epidemiologia , Gravidez , Complicações Parasitárias na Gravidez/epidemiologia , Insuficiência Renal/epidemiologia , Insuficiência Renal/etiologiaRESUMO
Eleven cases of cryptococcal meningitis were diagnosed and biotyped from September 1991 to August 1992 in Papua New Guinea (PNG). Seven isolates were Cryptococcus neoformans var. gattii from paediatric and adult patients, one with diabetes mellitus and 4 were C. neoformans var. neoformans from adults, of whom 2 had human immunodeficiency virus type 1 (HIV-1) infection, and one each had tuberculosis and Plasmodium vivax malaria. Significant clinical findings were headache, fever, meningism, vomiting, photophobia, papilloedema and cranial nerve lesions. Five patients (45.5%) died; 3 of these were adults with var. gattii and 2 were men with both var. neoformans and HIV-1 infections. This prospective tropical study documents the emergence of C. neoformans var. neoformans in patients with HIV-1 infection in a country where previously var. gattii had predominated in the immunocompetent. There has been no earlier report of cryptococcosis in an HIV-1 seropositive patient in PNG. Despite presumed exposure to both varieties of C. neoformans, var. gattii infections had been most frequent. As HIV-1 spreads, the proportion of hosts infected with var. neoformans may rise. The course of meningitis caused by the 2 varieties of C. neoformans may differ, with mortality in the tropics remaining particularly high. In PNG the environmental source of C. neoformans remains elusive.
Assuntos
Criptococose/complicações , Meningite/microbiologia , Adolescente , Adulto , Anfotericina B/efeitos adversos , Anfotericina B/uso terapêutico , Antifúngicos/efeitos adversos , Antifúngicos/uso terapêutico , Criança , Criptococose/tratamento farmacológico , Feminino , Flucitosina/efeitos adversos , Flucitosina/uso terapêutico , Humanos , Masculino , Meningite/complicações , Meningite/tratamento farmacológico , Papua Nova Guiné , Resultado do TratamentoRESUMO
Thirty-two patients with enzyme-immunoassay-proven death adder (Acanthophis sp.) bites were studied in Port Moresby, Papua New Guinea. Eighteen were envenomed; local signs were rare and none had incoagulable blood, but all except one had signs of neurotoxicity. Five (27.7%) envenomed patients required intubation and ventilation. One patient developed renal failure, previously undescribed following death adder bites. Laboratory investigations showed mild prolongation of prothrombin and partial thromboplastin times in some patients. In vitro studies showed that the venom contains anticoagulant activity, but does not cause fibrinogenolysis. In contrast to taipan envenoming, neurotoxicity did not progress after antivenom administration, and there was reversal of neurotoxicity, evident within 6 h, in three severely envenomed patients treated less than 12 h after the bite. One patient treated with antivenom and anticholinesterases had the most dramatic response to treatment; the optimum management of bites by this species may include prompt treatment with both antivenom and anticholinesterases in addition to effective first aid.
Assuntos
Coagulação Sanguínea/efeitos dos fármacos , Rabdomiólise/etiologia , Mordeduras de Serpentes/sangue , Mordeduras de Serpentes/complicações , Venenos de Víboras/intoxicação , Viperidae , Adolescente , Adulto , Idoso , Animais , Antivenenos/uso terapêutico , Criança , Inibidores da Colinesterase/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sistema Nervoso/efeitos dos fármacos , Papua Nova Guiné , Mordeduras de Serpentes/terapiaRESUMO
One hundred sixty-six patients with enzyme immunoassay-proven bites by taipans (Oxyuranus scutellatus canni) were studied in Port Moresby, Papua New Guinea. One hundred thirty-nine (84%) showed clinical evidence of envenoming: local signs were trivial, but most developed hemostatic disorders and neurotoxicity. The blood of 77% of the patients was incoagulable and 35% bled spontaneously, usually from the gums. Fifty-one per cent had microscopic hematuria. Neurotoxic signs (ptosis, ophthalmoplegia, bulbar paralysis, and peripheral muscular weakness) developed in 85%. Endotracheal intubation was required in 42% and mechanical ventilation in 37%. Electrocardiographic abnormalities (sinus bradycardia and septal T wave inversion) were found in 52% of a group of 69 unselected patients. Specific antivenom raised against Australian taipan venom was effective in stopping spontaneous systemic bleeding and restoring blood coagulability but, in most cases, it neither reversed nor prevented the evolution of paralysis even when given within a few hours of the bite. However, early antivenom treatment was associated statistically with decreased incidence and severity of neurotoxic signs. The low case fatality rate of 4.3% is attributable mainly to the use of mechanical ventilation, a technique rarely available in Papua New Guinea. Earlier use of increased doses of antivenoms of improved specificity might prove more effective.
Assuntos
Antivenenos/uso terapêutico , Venenos Elapídicos/intoxicação , Elapidae , Paralisia/etiologia , Mordeduras de Serpentes/fisiopatologia , Adolescente , Adulto , Animais , Transtornos da Coagulação Sanguínea/etiologia , Transtornos da Coagulação Sanguínea/terapia , Criança , Pré-Escolar , Eletrocardiografia/efeitos dos fármacos , Feminino , Coração/efeitos dos fármacos , Coração/fisiopatologia , Hemostasia/efeitos dos fármacos , Humanos , Técnicas Imunoenzimáticas , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/etiologia , Doenças do Sistema Nervoso/terapia , Papua Nova Guiné , Paralisia/terapia , Estudos Prospectivos , Mordeduras de Serpentes/complicações , Mordeduras de Serpentes/terapia , Fatores de TempoRESUMO
Snake bite is an important medical problem in some areas of Papua New Guinea and appears to be most common in the Central Province and National Capital District. The overall incidence for Central Province is 215.5 per 100,000 population, but Kairuku subprovince has an incidence of 526 per 100,000, which is amongst the highest in the world. The clinical pattern of envenoming also varies within the Province, suggesting that different species of snake may be responsible for bites in different areas. Most envenomed patients are bitten during daylight on the lower limb and are rarely able to describe the snake. The mortality rate in Central Province is 7.9 per 100,000; most patients die from ventilatory failure due to severe neurotoxicity. Mortality might be reduced by increased use of compression bandaging as a first aid measure, earlier treatment with antivenom and earlier referral to hospital.
Assuntos
Mordeduras de Serpentes/epidemiologia , Adolescente , Adulto , Bandagens , Causas de Morte , Criança , Pré-Escolar , Feminino , Primeiros Socorros , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Papua Nova Guiné/epidemiologia , Insuficiência Respiratória/mortalidade , Estações do Ano , Mordeduras de Serpentes/mortalidadeRESUMO
The mechanisms of haemostatic failure were studied in 87 patients bitten by the Papuan taipan (Oxyuranus scutellatus canni). Eighty (92%) had evidence of a coagulopathy on laboratory testing; 36 (41.4%) developed spontaneous systemic bleeding, although this was rarely of clinical significance. Coagulation assays in 48 completely defibrinated patients showed marked reductions in factors V and VIII and reductions in factors II, IX, XI, XII and XIIIA. There was a reduction in plasminogen and alpha 2-antiplasmin levels and both total and cross-linked fibrin(ogen) degradation products (FDP) levels were elevated. The mean platelet count was initially decreased and fell further during admission. Similar but less severe changes were seen in patients who were mildly defibrinated. Following treatment with antivenom, fibrinogen levels rose rapidly and coagulability was restored within 6-12 h in 93% of patients. These abnormalities may be primarily attributable to the prothrombin activator present in taipan venom, but it is likely that other uncharacterized venom components contributed.
Assuntos
Elapidae , Transtornos Hemorrágicos/etiologia , Mordeduras de Serpentes/complicações , Animais , Antivenenos/uso terapêutico , Fatores de Coagulação Sanguínea/análise , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Transtornos Hemorrágicos/sangue , Papua Nova Guiné , Plasminogênio/deficiência , Estudos Prospectivos , Protrombina/metabolismo , Mordeduras de Serpentes/sangue , Mordeduras de Serpentes/terapia , alfa 2-Antiplasmina/deficiênciaRESUMO
Cryptococcal meningitis is a common cause of chronic meningitis in Papua New Guinea, affecting apparently immunocompetent people. The majority of infections are believed to be due to Cryptococcus neoformans var. gattii. We have reviewed the records of 49 Melanesian adults who presented with proven cryptococcal meningitis to the University teaching hospital in Port Moresby, and compare our findings with other published studies of cryptococcal meningitis in the tropics and sub-tropics. None of the patients had an obvious cause of immunosuppression. Visual disturbances and fundoscopic changes of papilloedema or papillitis were particularly common. The in-hospital case fatality rate for patients treated with amphotericin B and flucytosine was 22.4%. Of the fully treated patients, 31% became completely blind before being discharged from hospital. Therapy directly aimed at reducing intracranial pressure may improve outcome.
Assuntos
Cegueira/microbiologia , Cryptococcus neoformans/classificação , Meningite Criptocócica/complicações , Adolescente , Adulto , Anfotericina B/uso terapêutico , Criança , Cryptococcus neoformans/isolamento & purificação , Feminino , Flucitosina/uso terapêutico , Humanos , Contagem de Leucócitos , Masculino , Meningite Criptocócica/líquido cefalorraquidiano , Meningite Criptocócica/tratamento farmacológico , Pessoa de Meia-Idade , Papua Nova Guiné , Recidiva , Resultado do TratamentoRESUMO
A previous questionnaire interview had revealed that betelnut chewing may aggravate asthma in 61% of asthma patients attending an outpatient clinic at Port Moresby General Hospital; the rest said it had no effect. The aim of the present study was to verify patients' subjective feelings through objective measurements. 7 asthma patients (Group C) who said betelnut aggravated their asthma, 8 asthma patients (Group B) who denied any effect and 8 nonasthmatic, healthy subjects (Group A) were given betelnut with accompanying ingredients and asked to chew as they would usually chew it. Their spirometric forced expiratory volume in the first second (FEV1) readings, heart rate and blood pressure were monitored before and after this challenge. Group A nonasthmatic subjects experienced only minor rises and falls in their FEV1 in response to betelnut chewing. 3 patients in Group B experienced overall rises (mean maximal % rise 25 +/- 19) while 5 patients had overall falls (mean maximal % fall 11 +/- 6). In Group C 1 patient had an overall rise in her FEV1 (maximal rise 10%) while 6 patients had falls (mean maximal % fall 22 +/- 7). In all groups the heart rate increased in response to betelnut. Betelnut chewing caused bronchoconstriction as demonstrated by decreases in FEV1 in a majority of the asthmatic patients studied; hence betelnut may act as a trigger factor for their asthma. In a few others increases in FEV1 were noted, while the rest experienced only minor changes.
Assuntos
Areca/fisiologia , Asma/fisiopatologia , Plantas Medicinais , Adulto , Idoso , Estudos de Casos e Controles , Constrição Patológica/induzido quimicamente , Constrição Patológica/fisiopatologia , Feminino , Volume Expiratório Forçado/efeitos dos fármacos , Humanos , Masculino , Mastigação , Pessoa de Meia-Idade , Fatores de TempoRESUMO
Multiple sclerosis is rare in equatorial countries and has not been diagnosed in the indigenous population of Papua New Guinea. We describe the clinical features of a young Papua New Guinean with optic neuritis and a myelopathy which we believe to be due to multiple sclerosis.