Enantiomeric fraction as an indicator of pharmaceutical biotransformation during wastewater treatment and in the environment--a review.

Enantioselective analysis of some pharmaceuticals during wastewater treatment has the potential to reveal significant insights regarding the effectiveness of biotransformation processes. Furthermore, enantioselective analysis of chiral pharmaceuticals in the aquatic environment may provide a useful historical record revealing the dominant source of (treated or untreated) wastewater contamination. This review of the recent scientific literature has identified only a handful of studies that have directly investigated these promising applications. However, a range of enantioselective analytical techniques are likely to be adaptable from those which have been developed within the pharmaceutical industry. These include direct enantioseparations of enantiomers on chiral stationary phases as well as indirect separations by achiral stationary phases after chiral derivatization to form pairs of physically distinguishable diastereomers. Further investigations of the patterns of enantiomeric fractionation of pharmaceuticals in wastewater and environmental samples will provide an increasingly solid understanding of the relationship between biotransformation processes and the often overlooked parameter of enantiomeric fraction.

Comparison of two multiple-locus variable-number tandem-repeat analysis methods for molecular strain typing of human Brucella melitensis isolates from the Middle East.

Brucella species are highly monomorphic, with minimal genetic variation among species, hindering the development of reliable subtyping tools for epidemiologic and phylogenetic analyses. Our objective was to compare two distinct multiple-locus variable-number tandem-repeat analysis (MLVA) subtyping methods on a collection of 101 Brucella melitensis isolates from sporadic human cases of brucellosis in Egypt (n = 83), Qatar (n = 17), and Libya (n = 1). A gel-based MLVA technique, MLVA-15(IGM), was compared to an automated capillary electrophoresis-based method, MLVA-15(NAU), with each MLVA scheme examining a unique set of variable-number tandem repeats. Both the MLVA(IGM) and MLVA(NAU) methods were highly discriminatory, resolving 99 and 101 distinct genotypes, respectively, and were able to largely separate genotypes from Egypt and Qatar. The MLVA-15(NAU) scheme presented higher strain-to-strain diversity in our test population than that observed with the MLVA-15(IGM) assay. Both schemes were able to genetically correlate some strains originating from the same hospital or region within a country. In addition to comparing the genotyping abilities of these two schemes, we also compared the usability, limitations, and advantages of the two MLVA systems and their applications in the epidemiological genotyping of human B. melitensis strains.

Activation of c-kit is necessary for mobilization of reparative bone marrow progenitor cells in response to cardiac injury.

Cardiovascular disease is the number-one cause of mortality in the developed world. The aim of this study is to define the mechanisms by which bone marrow progenitor cells are mobilized in response to cardiac ischemic injury. We used a closed-chest model of murine cardiac infarction/reperfusion, which segregated the surgical thoracotomy from the induction of cardiac infarction, so that we could study isolated fluctuations in cytokines without the confounding impact of surgery. We show here that bone marrow activation of the c-kit tyrosine kinase receptor in response to released soluble KitL is necessary for bone marrow progenitor cell mobilization after ischemic cardiac injury. We also show that release of KitL and c-kit activation require the activity of matrix metalloproteinase-9 within the bone marrow compartment. Finally, we demonstrate that mice with c-kit dysfunction develop cardiac failure after myocardial infarction and that bone marrow transplantation rescues the failing cardiac phenotype. In light of the ongoing trials of progenitor cell therapy for heart disease, our study outlines the endogenous repair mechanisms that are invoked after cardiac injury. Amplification of this pathway may aid in restoration of cardiac function after myocardial infarction.

Estrogen and the growth of breast cancer: new evidence suggests indirect action.

The growth of the MCF-7 human breast cancer cell line is unresponsive to the presence of estrogen in culture media. Paradoxically, in nude mice, growth of these cells and formation of solid tumors are dependent on estrogen. Tumors fail to develop in ovariectomized mice, but do develop in intact mice and in ovariectomized mice given estrogen. Primary cultures derived from MCF-7 tumors revert to unresponsiveness to estrogen. However, when these cultures are again transplanted into nude mice, estrogen is required for tumor formation. The continuous culture, the solid tumor, and the primary cultures therefrom have similar estrogen-binding capacities and affinities. These results indicate that mammary carcinoma cell growth in vivo is subject to inhibition that can be overcome by estrogen.

Tracking the mental health of a nation: prevalence and correlates of mental disorders in the second Singapore mental health study.

AIMS: The second Singapore Mental Health Study (SMHS) - a nationwide, cross-sectional, epidemiological survey - was initiated in 2016 with the intent of tracking the state of mental health of the general population in Singapore. The study employed the same methodology as the first survey initiated in 2010. The SMHS 2016 aimed to (i) establish the 12-month and lifetime prevalence and correlates of major depressive disorder (MDD), dysthymia, bipolar disorder, generalised anxiety disorder (GAD), obsessive compulsive disorder (OCD) and alcohol use disorder (AUD) (which included alcohol abuse and dependence) and (ii) compare the prevalence of these disorders with reference to data from the SMHS 2010. METHODS: Door-to-door household surveys were conducted with adult Singapore residents aged 18 years and above from 2016 to 2018 (n = 6126) which yielded a response rate of 69.0%. The subjects were randomly selected using a disproportionate stratified sampling method and assessed using World Health Organization Composite International Diagnostic Interview version 3.0 (WHO-CIDI 3.0). The diagnoses of lifetime and 12-month selected mental disorders including MDD, dysthymia, bipolar disorder, GAD, OCD, and AUD (alcohol abuse and alcohol dependence), were based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. RESULTS: The lifetime prevalence of at least one mood, anxiety or alcohol use disorder was 13.9% in the adult population. MDD had the highest lifetime prevalence (6.3%) followed by alcohol abuse (4.1%). The 12-month prevalence of any DSM-IV mental disorders was 6.5%. OCD had the highest 12-month prevalence (2.9%) followed by MDD (2.3%). Lifetime and 12-month prevalence of mental disorders assessed in SMHS 2016 (13.8% and 6.4%) was significantly higher than that in SMHS 2010 (12.0% and 4.4%). A significant increase was observed in the prevalence of lifetime GAD (0.9% to 1.6%) and alcohol abuse (3.1% to 4.1%). The 12-month prevalence of GAD (0.8% vs. 0.4%) and OCD (2.9% vs. 1.1%) was significantly higher in SMHS 2016 as compared to SMHS 2010. CONCLUSIONS: The high prevalence of OCD and the increase across the two surveys needs to be tackled at a population level both in terms of creating awareness of the disorder and the need for early treatment. Youth emerge as a vulnerable group who are more likely to be associated with mental disorders and thus targeted interventions in this group with a focus on youth friendly and accessible care centres may lead to earlier detection and treatment of mental disorders.

Upgrading agricultural wastes using three different carbonization methods: Thermal, hydrothermal and vapothermal.

In this study, three different methods for high quality solid fuel production were tested and compared experimentally. Oil palm empty fruit bunches, mesocarp fibers, palm kernel shells and rubber seeds shells were treated using thermal (TC), hydrothermal (HTC) and vapothermal (VTC) carbonization. All thermochemical methods were accomplished by using a custom made batch-type reactor. Utilization of novel single reactor equipped with suspended internal container provided efficient operation since both steam generator and raw materials were placed inside the same reactor. Highest energy densification was achieved by VTC process followed by TC and HTC processes. The heating value enhancement in VTC and TC was achieved by the increase in fixed carbon content and reduction in volatile matter. The formation of the spherical components in HTC hydrochar which gave a sharp peak at 340 °C in the DTG curves was suggested as the reason that led to the increment in energy content.

Field data-based mathematical modeling by Bode equations and vector fitting algorithm for renewable energy applications.

The power system always has several variations in its profile due to random load changes or environmental effects such as device switching effects when generating further transients. Thus, an accurate mathematical model is important because most system parameters vary with time. Curve modeling of power generation is a significant tool for evaluating system performance, monitoring and forecasting. Several numerical techniques compete to fit the curves of empirical data such as wind, solar, and demand power rates. This paper proposes a new modified methodology presented as a parametric technique to determine the system's modeling equations based on the Bode plot equations and the vector fitting (VF) algorithm by fitting the experimental data points. The modification is derived from the familiar VF algorithm as a robust numerical method. This development increases the application range of the VF algorithm for modeling not only in the frequency domain but also for all power curves. Four case studies are addressed and compared with several common methods. From the minimal RMSE, the results show clear improvements in data fitting over other methods. The most powerful features of this method is the ability to model irregular or randomly shaped data and to be applied to any algorithms that estimating models using frequency-domain data to provide state-space or transfer function for the model.

DC-based smart PV-powered home energy management system based on voltage matching and RF module.

The main tool for measuring system efficiency in homes and offices is the energy monitoring of the household appliances' consumption. With the help of GUI through a PC or smart phone, there are various applications that can be developed for energy saving. This work describes the design and prototype implementation of a wireless PV-powered home energy management system under a DC-distribution environment, which allows remote monitoring of appliances' energy consumptions and power rate quality. The system can be managed by a central computer, which obtains the energy data based on XBee RF modules that access the sensor measurements of system components. The proposed integrated prototype framework is characterized by low power consumption due to the lack of components and consists of three layers: XBee-based circuit for processing and communication architecture, solar charge controller, and solar-battery-load matching layers. Six precise analogue channels for data monitoring are considered to cover the energy measurements. Voltage, current and temperature analogue signals were accessed directly from the remote XBee node to be sent in real time with a sampling frequency of 11-123 Hz to capture the possible surge power. The performance shows that the developed prototype proves the DC voltage matching concept and is able to provide accurate and precise results.

Stigma towards people with mental disorders and its components - a perspective from multi-ethnic Singapore.

AIMS: The current study aimed to: (i) describe the extent of overall stigma as well as the differences in stigma towards people with alcohol abuse, dementia, depression, schizophrenia and obsessive compulsive disorder, as well as (ii) establish the dimensions of stigma and examine its correlates, in the general population of Singapore, using a vignette approach. METHODS: Data for the current study came from a larger nation-wide cross-sectional study of mental health literacy conducted in Singapore. The study population comprised Singapore Residents (Singapore Citizens and Permanent Residents) aged 18-65 years who were living in Singapore at the time of the survey. All respondents were administered the Personal and Perceived scales of the Depression Stigma scale and the Social Distance scale to measure personal stigma and social distance, respectively. Weighted mean and standard error of the mean were calculated for continuous variables, and frequencies and percentages for categorical variables. Exploratory structural equation modelling and confirmatory factor analysis were used to establish the dimensions of stigma. Multivariable linear regressions were conducted to examine factors associated with each of the stigma scale scores. RESULTS: The mean age of the respondents was 40.9 years and gender was equally represented (50.9% were males). The findings from the factor analysis revealed that personal stigma formed two distinct dimensions comprising 'weak-not-sick' and 'dangerous/unpredictable' while social distance stigma items loaded strongly into a single factor. Those of Malay and Indian ethnicity, lower education, lower income status and those who were administered the depression and alcohol abuse vignette were significantly associated with higher weak-not-sick scores. Those of Indian ethnicity, 6 years of education and below, lower income status and those who were administered the alcohol abuse vignette were significantly associated with higher dangerous/unpredictable scores. Those administered the alcohol abuse vignette were associated with higher social distance scores. CONCLUSION: This population-wide study found significant stigma towards people with mental illness and identified specific groups who have more stigmatising attitudes. The study also found that having a friend or family member with similar problems was associated with having lower personal as well as social distance stigma. There is a need for well-planned and culturally relevant anti-stigma campaigns in this population that take into consideration the findings of this study.

Role of hormones in the growth and regression of human breast cancer cells (MCF-7) transplanted into athymic nude mice.

The hormonal environments require by human breast cancer cells MCF-7 to produce solid tumors in nude mice are described. A 100% take was obtained within 7 days following inoculation of 2X10(6) actively growing (log phase) MCF-7 cells into the mammary fat pads of intact, athymic BALB/c nude mice. Tumors failed to develop, even with an inoculum of 20X10(6) cells/mouse, in ovariectomized mice or in mice made diabetic with streptozotocin and observed for 90 days after cell inoculation. A 100% incidence of tumors was obtained in mice that were either hypophysectomized or made diabetic but received injections of 0.2 IU insulin/day/mouse. A 100% incidence of tumors was also obtained in ovariectomized mice that received 17 beta-estradiol in the form of a pellet placed subcutaneously in the interscapular region at the time of cell inoculation. Palpable tumors also developed in ovariectomized mice treated with prolactin, perphenazine, estrone, or estriol, but no takes were observed in ovariectomized mice treated with progesterone, 5 alpha-dihydrotestosterone, or hydrocortisone. Growth of the MCF-7 tumor was stimulated five- to sixfold in both intact and hypophysectomized mice that each received a 17 beta-estradiol pellet. Removal of the 17 beta-estradiol pellets form tumor-bearing ovariectomized mice failed to induce tumor regression. Tumors that continued to grow in ovariectomized mice deprived of 17 beta-estradiol regressed by 50% or more of their initial volume when tamoxifen was injected for 7 days at 5 micrograms/mouse/day) +/- theophyline (1 mg/mouse/day), tumor growth arrest was observed during the 2-to 3-week treatment period. Streptozotocin-induced diabetes in tumor-bearing mice always resulted in complete tumor regression following a 3-week treatment period.

Effect of prolactin on growth and the estrogen receptor level of human breast cancer cells (MCF-7).

The intracellular specific 17beta-estradiol binding in the human breast cancer cell line, MCF-7, was shown to be modified by prolactin. Both ovine and human prolactin doubled the estradiol receptor (E2R) level, but the latter was at least 10 times more stimulatory on a concentration basis. Most of the E2R complex (approximately 80%) was transported to the nucleus, and the prolactin stimulation was reflected in an elevated nuclear uptake of the tritiated 17beta-estradiol. Neither ovine nor human prolactin altered the growth rate of the cells when E2R stimulation was maximal. Insulin (10 mug/ml) stimulated tritiated thymidine incorporation and total DNA content but had no apparent effect on E2R concentration. At 10(-4) M, N6,O2'-dibutyrylcyclicadenosine 3':5'-monophosphate increased insulin stimulation of tritiated thymidine incorporation and brought about a prolactin stimulation of apparent DNA synthesis. Theophylline (10(-3) M) blocked both of these effects of N6,O2'-dibutyrylcyclicadenosine 3':5'-monophosphate. The possible mechanism implicating prolactin as an effector of differentiation and growth of MCF-7 cells is discussed.

Relationship between insulin and estrogen binding to growth response in 7,12-dimethylbenz(a)anthracene-induced rat mammary tumors.

Insulin and estrogen binding have been determined in 7,12-dimethylbenz(a)anthracene-induced mammary tumors of rats in various endocrine states. Hormonal therapy, such as diabetes and ovariectomy, resulted in differential effects on growth patterns and hormone binding of tumors coexisting in the same host or in different hosts. It was observed that tumors that continued to grow after the host was made diabetic (insulin independent) or started to regress after ovariectomy (ovarian dependent) demonstrated decreased insulin binding. Tumors that regressed in diabetic hosts (insulin dependent) or continued to grow in ovariectomized animals (ovarian independent) showed an increased insulin-binding capacity. No significant change in insulin binding was observed in tumors that remained static after ovariectomy or induction of diabetes. Estrogen binding in tumor cells from diabetic rats paralleled the pattern of tumor growth response to diabetes; insulin-independent tumors demonstrated a significant increase in binding compared to tumors from intact hosts, and insulin-dependent tumors showed decreased estrogen receptor levels. From these results, we conclude that (a) insulin plays a positive role in regulating estrogen-binding capacity, (b) ovarian hormones may play a role in regulating insulin-binding capacity, and (c) a relationship between insulin and ovarian hormones and the growth of 7,12-dimethylbenz(a)anthracene-induced tumors is strongly suggested and may have therapeutic implications.

Cyclic adenosine 3':5'-monophosphate and protein kinase activity in insulin-dependent and -independent mammary tumors.

Approximately 70% of primary 7,12-dimethylbenz(alpha)-anthracene-induced mammary tumors regressed when (tumor-bearing) rats were made diabetic after treatment with streptozotocin. In the intact animal, cyclic adenosine 3':5"-monophosphate (cAMP) levels of tumors that regressed following the induction of diabetes were initially 4-fold lower than in unresponsive tumors but increased 4-fold during regression. The insulin-independent tumors showed no statistically significant changes. cAMP binding in cytosol of regressing tumors was about 80% above the initial values at 36 hr after therapy but decreased to about 45% 1 week later. On the contrary, the binding capacity of the nuclei showed a 56% increase at 36 hr and increased gradually to about 3-fold 1 week later. Within 36 hr after treatment, total histone kinase activity increased 127% in the cytosol and 153% in the nuclei of regressing tumors. The increment of histone kinase activity was almost totally in the cAMP-dependent component of the enzyme. These changes were not apparent in insulin-independent tumors. The results are interpreted to indicate that mammary tumor regression due to diabetes involves the cAMP system and occurs through a sequence of events similar to those observed during regression induced by either ovariectomy or dibutyryl cAMP (cyclic adenosine 3':5'-monophosphate) treatment.

Effect of growth on the estrogen receptor levels in MCF-7 cells.

MCF-7 cells have been shown to contain estrogen receptor in several cell fractions following homogenization: nuclei, microsomes, and cytosol. The amount of 17 beta-estradiol-binding capacity found in each cellular compartment depended on the inclusion of detergent in homogenization buffers and on the use of 0.25 M sucrose in the nuclear washes. 17 beta-Estradiol receptor (E2R) associated with nuclei (whole nuclei exchange assay, 0.6 M KCl soluble, and that found on membranes sheared from crude nuclear pellets by centrifugation in 0.25 M sucrose buffer) displayed a dissociation constant (Kd) of 0.77 +/- 0.01 (S.D.) nM (n = 7). KdS of the cytoplasmic (microsomes and soluble) receptors were determined to be 0.33 +/- 0.10 nM (n = 9). Exchangeable ligand on partially purified nuclei assumed its highest level in MCF-7 cells during logarithmic growth in serum-containing media (0.8 pmol/micrograms DNA) but declined after the culture reached confluence (0.2 pmol/micrograms DNA). Seventy-five % of the nuclear E2R declined linearly after feeding MCF-7 cells in logarithmic growth phase an estrogen- and serum-free medium (t1/2 3.5 days). Another class of salt-extractable nuclear receptor (0.2 pmol/micrograms DNA) persisted in postconfluent cultures whether fed estrogen (serum-containing media) or not (serum-free media). This residual binding capacity remained in nuclei of MCF-7 cells for an extended period of time. MCF-7 cells demonstrated functionality of E2R throughout their growth phases as evidenced by the replenishment of cytosolic E2R and the induction of progesterone receptor when given 17 beta-estradiol.

Transient electro-magneto-hydrodynamic two-phase blood flow and thermal transport through a capillary vessel.

Therapies with magnetic/electromagnetic field are employed to relieve pains or, to accelerate flow of blood-particles, particularly during the surgery. In this paper, a theoretical study of the blood flow along with particles suspension through capillary was made by the electro-magneto-hydrodynamic approach. Analytical solutions to the non-dimensional blood velocity and non-dimensional particles velocity are obtained by means of the Laplace transform with respect to the time variable and the finite Hankel transform with respect to the radial coordinate. The study of thermally transfer characteristics is based on the energy equation for two-phase thermal transport of blood and particles suspension with viscous dissipation, the volumetric heat generation due to Joule heating effect and electromagnetic couple effect. The solution of the nonlinear heat transfer problem is derived by using the velocity field and the integral transform method. The influence of dimensionless system parameters like the electrokinetic width, the Hartman number, Prandtl number, the coefficient of heat generation due to Joule heating and Eckert number on the velocity and temperature fields was studied using the Mathcad software. Results are presented by graphical illustrations.

Association of Grip Strength, Upper Arm Circumference, and Waist Circumference with Dementia in Older Adults of the WiSE Study: A Cross-Sectional Analysis.

OBJECTIVE: We examined the associations of handgrip strength, upper arm circumference, and waist circumference with dementia among Singapore older adults. DESIGN: Cross-sectional epidemiological study. SETTING: Residential homes, day care centres, nursing homes and institutions. PARTICIPANTS: 2,565 men and women aged 60 years and above who participated in the Well-being of the Singapore Elderly (WiSE) study in 2013. MEASUREMENTS: Socio-demographic correlates, dietary habits, health behaviours, grip strength, upper arm circumference, and waist circumference were collected. Grip strength was measured using a hand dynamometer with the dominant hand. Upper arm circumference was measured using a measuring tape around the thickest part of the upper arm while waist circumference measured in centimetres was measured at the narrowest part of the body between the chest and hips for women, and measured at the level of the umbilicus for men. Dementia was diagnosed using the 10/66 dementia diagnostic criteria. RESULTS: Mean grip strength was 13.07 kg (SE=0.60) for people with dementia and 21.98 kg (SE=0.26) for people without dementia. After adjusting for all factors, grip strength remained significantly associated with dementia (p <0.0001). Upper arm circumference was associated with dementia (p <0.0001) but this association was only significant in the univariate analysis. Waist circumference was not significantly associated with dementia. CONCLUSIONS: Lower grip strength was independently associated with dementia in the older adult population in Singapore. Further research needs to be done to ascertain whether this association exists for specific types of dementia and look into the relationship of other anthropometric measurements with dementia in Singapore.

Formation of metastasis by human breast carcinoma cells (MCF-7) in nude mice.

MCF-7 cells, a human breast carcinoma line, forms tumors when injected into athymic nude mice. These tumors are able to metastasize to lungs, liver and spleen. 17 beta-estradiol treatment increases both the growth rate and frequency of metastases. Castration or diabetes prevents metastasis formation, but treatment with estrogen or insulin restores the metastasizing capacity. MCF-7 cells secrete into the culture media collagenases able to lyse types I and IV collagens. Estrogen or insulin addition to the culture enhances collagenase production. Attention is called to the coexistence of enhancement in collagenase production and metastasis formation.

Coronary events in Khartoum, Sudan.

The aim of the study was to determine coronary events in a defined Sudanese population. All coronary events occurring in Khartoum, the capital of Sudan, were registered during the calendar year 1989. The cold pursuit method of identifying coronary events by surveillance of routinely collected data was adopted. A total of 517 cases representing coronary events in 1989 was recorded and submitted to the WHO MONICA diagnostic and classification protocol. The annual (1989) coronary event rate for men and women was 112/100,000, with a total mortality rate of 36/100,000 (men, 52/100,000; women, 18/100,000). Event rates for men and women were 162/100,000 and 64/100,000 and fatality rates were 33 and 30%, respectively. The highest event rate 364/100,000, occurring in men 45-64 years of age compared to 120/100,000 in women of the same age group. The study establishes a baseline for coronary event rates, mortality, and case fatality rates. It also defines coronary heart disease in Khartoum and provides means for comparison with other countries. We recommend that the disease receive more health attention, and efforts to define the precipitating risk factors should be undertaken. Health education and preventive measures to curb the disease are needed.

Investigation of an outbreak of multidrug-resistant Acinetobacter baumannii in trauma intensive care unit.

Between January and June 2002, an outbreak of multidrug-resistant Acinetobacter baumannii occurred in a trauma intensive care unit (TICU) at the Hamad Medical Corporation, Qatar. The outbreak involved 21 patients whose infection/colonization was hospital acquired. All the strains were resistant to all tested antibiotics except amikacin. An A. baumannii strain with a similar antibiogram was isolated from the environment, equipment and hands of healthcare workers (HCWs). The technique of open suctioning probably resulted in aerosilization and contamination of the immediate patient environment. This allowed the hands of HCWs to be contaminated with the outbreak strain, with subsequent transmission to other patients and their environment. Lack of proper hand hygiene between patients and equipment contact facilitated this transmission. A review of hand hygiene practices, extensive environmental cleaning, a closed suctioning system, education and review of other infection-control practices, contributed to the termination of the outbreak.

An epidemiological survey of rheumatic fever and rheumatic heart disease in Sahafa Town, Sudan.

STUDY OBJECTIVE: The aim was to determine the prevalence of rheumatic fever and rheumatic heart disease and to initiate a programme of secondary prophylaxis in Sahafa Town, Sudan. DESIGN: The study was a prospective case finding survey, carried out by a specially trained team headed by a cardiologist. SETTING: The study involved high risk school children (5-15 years of age) from Sahafa Town in the period 1986-1989. SUBJECTS: A total of 13,332 children on the school registers (7892 boys and 5430 girls) were examined generally and specifically for evidence of rheumatic fever or rheumatic heart disease. MAIN RESULTS: Out of the 13,322 children screened 351 were suspected cases and 146 were confirmed cases of rheumatic fever or rheumatic heart disease. The prevalence rates for all ages were 10/1000 for boys and 14/1000 for girls. The overall prevalence rate of the whole programme area was 11/1000, prevalence of rheumatic fever was 8/1000, and prevalence of rheumatic heart disease was 3/1000. The prevalence rate was significantly increased among the inner town inhabitants (15/1000) compared to the outer town inhabitants 4/1000 (p < 0.001). Monthly prophylactic benzathine penicillin in a dose of 1,200,000 IU was given to both suspected and confirmed cases. Penicillin coverage rate was 72%. CONCLUSIONS: Rheumatic fever continues to be a serious health problem. With economic pressures causing impending change in socioeconomic conditions in most Third World countries in the immediate future, rheumatic fever will continue to have a high prevalence rate and rheumatic fever and rheumatic heart disease prevention programmes will remain a central goal.