Onchocerciasis in Ecuador: infection in children in the Santiago Basin focus, province of Esmeraldas.

The prevalence of onchocerciasis infection in children aged 1-12 in the Santiago Basin focus, province of Esmeraldas, Ecuador, was determined to see if active transmission of the disease had occurred in the past 6 years. An infection rate of 45.0% was found. Compared to that found in 1980 (14.5%), the infection rate had increased by 210.1%. The increase was greater on the Rio Santiago (340.5%) than on the Rio Cayapas (195.5%). An increase of 286% was seen in the skin microfilarial density in the 1-4 year age group, with a 56.8% increase in the 5-12 year age group. The prevalence of infection in children aged 0-4 years (those born since the first enquiry in 1980) was 64.3%, with an average skin microfilarial density of 12.2 microfilariae (mf)/mg and with 20% presenting nodules, of which 92.1% occurred in the head region. Of the 34 children examined aged less than one year, 25 (73.5%) were positive for microfilariae with an average microfilarial skin density of 9.6 mf/mg. These data suggest that there is active transmission of the disease in the Santiago Basin onchocercal foci.

The effect of antimalarial chloroquine therapy and prophylaxis on concurrent infection with Onchocerca volvulus in Ecuador.

The effect of chloroquine phosphate on Onchocerca volvulus in vivo was studied in Ecuadorians undergoing treatment for malaria. All persons with a diagnosis of acute malaria and treated with 2500 mg of chloroquine over 3 d showed a 100% reduction of dermal O. volvulus microfilariae 7 d after treatment. However, 28 d after treatment the microfilarial densities returned to their pre-treatment levels and at 35 d they had increased to 121.6% of their pre-treatment values. Treatment did not appear to have any effect on the adult O. volvulus examined histologically in extirpated nodules. Patients treated for acute malaria and subsequently kept on a prophylactic regimen of 500 mg chloroquine weekly showed a reduction of 56.7% from pre-treatment microfilarial density after 27 weeks. Patients who underwent nodulectomy as well as treatment for acute malaria and were given 500 mg of chloroquine prophylactically for 27 weeks showed a reduction in dermal microfilarial density of 93.6%. Symptoms of onchocerciasis were reduced in the latter group of patients, with the elimination of all acute dermatological changes within 6 weeks. Ocular examination of these surgically and chemotherapeutically treated individuals revealed reductions of 94.9% of microfilariae in the anterior chamber, 95.9% of live microfilariae in the cornea, and 95.1% of dead microfilariae in the cornea. There was a reduction of 69.8% in corneal fluffy opacities. No alteration in the visual acuity or in visible lesions in the posterior segment was recorded. The results suggest that a complex interaction between chloroquine and O. volvulus takes place in vivo, which can be beneficial to the patient over a long period.(ABSTRACT TRUNCATED AT 250 WORDS)

Neuropsychiatric manifestations of diffuse Lewy body disease.

This article reviews the nature and prevalence of Lewy bodies (LBs) found during postmortem examination of demented individuals. Neuropathologic findings associated with diffuse Lewy body disease (DLBD) are contrasted with those of other causes of dementia (e.g., Pick's disease and Alzheimer's disease). A sufficiently specific clinical syndrome is suggested to enhance the antemortem diagnosis of DLBD. Current and speculative clinical management strategies of DLBD are discussed.

A Descriptive Study of Psychiatric Consultations in a Community Primary Care Center.

BACKGROUND: This retrospective chart review study describes on-site psychiatric consultations at a large, urban community primary care center. The referral population, diagnostic reliability of primary care providers (PCPs) and social workers, appropriateness of PCP-initiated treatment, impact of treatment recommendations, and outcomes are examined. METHOD: Charts of all patients who received psychiatric consultations (N = 78) during an 8-month period (August 1996 to April 1997) were reviewed. RESULTS: Prereferral diagnoses by PCPs matched the psychiatrist's diagnosis based on DSM-IV diagnostic criteria approximately half the time. PCPs initiated psychopharmacology in half the referrals (39/78) and used generally appropriate medications (30/39) based on diagnosis by a psychiatrist, but at subtherapeutic doses (21/39). PCPs tended to continue medications recommended by the psychiatrist. At 1 year, PCPs clearly documented improvement in nearly a third of the consults (24/78). CONCLUSION: Diagnostic disagreement of caregivers, inadequate PCP psychopharmacology practices, and patient nonadherence are 3 main problems that impede optimal care within the model of psychiatric consultation described in this study.

An approach to collaborative care and consultation: interviewing, cultural competence, and enhancing rapport and adherence.

Although changes in the US health care system promote a population-based approach, increases in population diversity emphasize the need for culturally competent, patient-centered, participatory care. Despite this perceived conflict, the global view has improved the recognition of mental health issues as a driver of overall health as well as health care spending. This recognition, along with the many forces that keep mental health care in the primary care sector, actually encourages the development of collaborative models that capitalize on the primary care provider's opportunity to leverage their rapport with the patient to improve access to, and comfort with, specialty mental health services. Engaging patients in their own path to recovery or well-being improves engagement in, and adherence to, the treatment plan and ultimately improves outcomes.

Electrogenic glutamine uptake by Peptostreptococcus anaerobius and generation of a transmembrane potential.

Peptostreptococcus anaerobius converted glutamine stoichiometrically to ammonia and pyroglutamic acid, and the Eadie-Hofstee plot of glutamine transport was biphasic. High-affinity, sodium-dependent glutamine transport (affinity constant [Kt] of 1.5 microM) could be driven by the chemical gradient of sodium, and more than 20 mM sodium was required for half-maximal velocity. High-affinity glutamine transport was not stimulated or inhibited by a membrane potential (delta psi). Low-affinity glutamine transport had a rate which was directly proportional to the external glutamine concentration, required less than 100 microM sodium, and was inhibited strongly by a delta psi. Cells which were treated with N,N-dicyclohexylcarbodiimide to inhibit the F1F0 ATPase still generated a delta psi but did so only if the external glutamine concentration was greater than 15 mM. Low-affinity glutamine uptake could not be saturated by as much as 200 mM glutamine, but glutamine-1 accounts for only a small fraction of the total glutamine at physiological pH values (pH 6 to 7). On the basis of these results, it appeared that the low-affinity glutamine transport was an electrogenic mechanism which was converting a chemical gradient of glutamine-1 into a delta psi. Other mechanisms of delta psi generation (electrogenic glutamine-pyroglutamate or -ammonium exchange) could not be demonstrated.

A periplasmic location is essential for the role of the ApbE lipoprotein in thiamine synthesis in Salmonella typhimurium.

ApbE is a lipoprotein in Salmonella typhimurium, and mutants unable to make this protein have a reduced ability to make thiamine (vitamin B(1)) and require it as a supplement for optimal growth in minimal glucose medium. Polyclonal antibodies specific to ApbE were used to determine that wild-type ApbE is located exclusively in the inner membrane. The periplasmic, monotopic topology of ApbE was determined by using computer-based hydrophobicity plots, LacZ and PhoA gene fusions, and proteinase protection experiments. This extracellular location of ApbE is required for its function, since a cytoplasmic form (ApbE(cyto)) did not allow an apbE mutant to grow in the absence of thiamine. A periplasmic form of ApbE (ApbE(peri)) lacking the lipoprotein modification allowed an apbE mutant to grow in the absence of thiamine, indicating that soluble ApbE could function in thiamine synthesis and that lipoation and membrane association were not required. Alteration of the amino acid implicated in membrane sorting for other lipoproteins did not result in a relocalization of ApbE to the outer membrane, suggesting that additional sorting determinants exist for ApbE.

The apbE gene encodes a lipoprotein involved in thiamine synthesis in Salmonella typhimurium.

Thiamine pyrophosphate is an essential cofactor that is synthesized de novo in Salmonella typhimurium. The biochemical steps and gene products involved in the conversion of aminoimidazole ribotide (AIR), a purine intermediate, to the 4-amino-5-hydroxymethyl-2-methyl pyrimidine (HMP) moiety of thiamine have yet to be elucidated. We have isolated mutations in a new locus (Escherichia coli open reading frame designation yojK) at 49 min on the S. typhimurium chromosome. Two significant phenotypes associated with lesions in this locus (apbE) were identified. First, apbE purF double mutants require thiamine, specifically the HMP moiety. Second, in the presence of adenine, apbE single mutants require thiamine, specifically both the HMP and the thiazole moieties. Together, the phenotypes associated with apbE mutants suggest that flux through the purine pathway has a role in regulating synthesis of the thiazole moiety of thiamine and are consistent with ApbE being involved in the conversion of AIR to HMP. The product of the apbE gene was found to be a 36-kDa membrane-associated lipoprotein, making it the second membrane protein implicated in thiamine synthesis.

Working with our communities: moving from service to scholarship in the health professions.

CONTEXT: As faculty at health professionals schools have become increasingly engaged with their communities in partnerships to improve health, new questions have arisen about faculty rewards for such activities. To sustain the community work of their faculty, institutions need to reconceptualize faculty rewards, promotion, and tenure that are relevant to community activities. HISTORICAL PERSPECTIVE: Scholarship has evolved since the 17th century from a focus on character-building to the practical needs of the nation to an emphasis on research. In 1990, Boyer proposed four interrelated dimensions of scholarship: (1) discovery; (2) integration;(3) application; and (4) teaching. The challenge became the development of criteria and innovative and creative ways to assess community scholarship. CURRENT MODELS FOR COMMUNITY SCHOLARSHIP: This paper reviews four evidence-based models to document and evaluate scholarly activities that are applicable to community scholarship. PROPOSED MODEL FOR COMMUNITY SCHOLARSHIP: We propose a new model for community scholarship that focuses on both processes and outcomes, crosses the boundaries of teaching, research, and service, and reshapes and integrates them through community partnership. We hope this model will generate national discussion about community scholarship and provide thought-provoking information that will move the idea of community scholarship to its next stage of development.

Evidence that rseC, a gene in the rpoE cluster, has a role in thiamine synthesis in Salmonella typhimurium.

In Salmonella typhimurium, the genetic loci and biochemical reactions necessary for the conversion of aminoimidazole ribotide (AIR) to the 4-amino-5-hydroxymethyl-2-methyl pyrimidine (HMP) moiety of thiamine remain unknown. Preliminary genetic analysis indicates that there may be more than one pathway responsible for the synthesis of HMP from AIR and that the function of these pathways depends on the availability of AIR, synthesized by the purine pathway or by the purF-independent alternative pyrimidine biosynthetic (APB) pathway (L. Petersen and D. Downs, J. Bacteriol. 178:5676-5682, 1996). An insertion in rseB, the third gene in the rpoE rseABC gene cluster at 57 min, prevented HMP synthesis in a purF mutant. Complementation analysis demonstrated that the HMP requirement of the purF rseB strain was due to polarity of the insertion in rseB on the downstream rseC gene. The role of RseC in thiamine synthesis was independent of rpoE.

Onchocerciasis in Ecuador, 1980-1986: epidemiological evaluation of the disease in the Esmeraldas province.

An increase in both the prevalence (68.3%) and intensity of infection (106.2%) occurred in the Ecuadorian onchocercal focus during the 6 year period, 1980 to 1986. In 1986, a higher prevalence of infection was noted in males (53.6%) than females (33.1%), but a greater rate of increase of infection over the 6 years was seen in females than males (75.7% vs 61.9% respectively). In all endemic areas, the Chachi race had a higher prevalence of infection as well as higher increase rate of infection than the Black. In the hyperendemic and hypoendemic areas the highest increase of infection was seen in the Chachi female and Chachi male respectively. The prevalence of infection in 1986 was greater than that in 1980 for all ages, with the greatest increase of infection in the 1-4 year age groups. There was an average increase of 106.2% in the microfilarial skin density with an increase seen in all age groups. A higher microfilariae density increase was seen in the hypoendemic (100.0%) than the hyperendemic (66.5%) areas. The Blacks showed a greater microfilarial density increase than the Chachi (155.1% vs 70.7% respectively) with the Black female showing the highest increase (117.6%) in the hyperendemic area and the Black male showing the highest (155.6%) in the hypoendemic area. Along the Rio Cayapas, high microfilarial densities were found in 3 major areas on the river, a reflection of man-vector exposure.

Onchocerciasis in Ecuador: recent observations in the province of Esmeraldas.

To evaluate the transmission of onchocerciasis that had occurred in the past 6 years in the province of Esmeraldas, in 1986 the onchocercal focus was re-examined using the same methodology as in the original survey of 1980. An increased prevalence of infection of 73.9% was noted, with an increase of 73.0% found in the principal focus, the Santiago Basin, and a 76.7% increase in the satellite foci. In the principle focus, a higher increase was noted on the Rio Santiago (88.8%) than on the Rio Cayapas (68.6%), while an increase of only 39.7% was seen on the Rio Onzoles. Geographical extension of both the onchocercal focus and its respective hyperendemic areas were found on the Rio Cayapas and Rio Santiago. A higher increased prevalence of infection was found in the children (210.0%) than in the adults (29.5%). In the satellite foci, the Rio Canande showed the higher increase of infection (146.4%), with an increase of 61.3% seen in adults and 1409.1% in children. Active transmission of the disease exists in all onchocercal foci, each with its distinct and varying intensity.