A Case of Cutaneous Myiasis Caused by Cordylobia anthropophaga Larvae in a Korean Traveler Returning from Central Africa

The cutaneous myiasis has been rarely reported in the Republic of Korea. We intended to describe here a case of furuncular cutaneous myiasis caused by Cordylobia anthropophaga larvae in a Korean traveler returned from Central Africa. A patient, 55-year-old man, had traveled to Equatorial Guinea, in Central Africa for a month and just returned to Korea. Physical examinations showed 2 tender erythematous nodules with small central ulceration on the left buttock and thigh. During skin biopsy, 2 larvae came out from the lesion. C. anthropophaga was identified by paired mouth hooks (toothed, spade-like, oral hooklets) and 2 posterior spiracles, which lack a distinct chitinous rim. Although rarely described in Korea until now, cutaneous myiasis may be encountered more frequently with increasing international travel and exchange workers to tropical areas.

Delayed double reading of whole blood clotting test (WBCT) results at 20 and 30 minutes enhances diagnosis and treatment of viper evenomation

The whole blood clotting test (WBCT) is a simple test of coagulation that is often used in the assessment, diagnosis, and therapeutic monitoring of snakebite patients in sub-Saharan Africa. WBCT requires only a clean glass tube and several milliliters of venous blood and is ideal for use in poorly equipped health centers throughout the rural areas where 95% of snakebites occur. However, questions surrounding the accuracy and reliability of the test remain unanswered due to variations in testing conditions and a lack of comparative research with which to validate them. This is the first study to evaluate WBCT results at both 20-min (WBCT20) and 30-min (WBCT30) reading times in the same group of snakebite patients. Methods In order to define the best reading time, the authors compared the results of serial WBCT evaluation at both 20 and 30 min after collection in 23 patients treated for snake envenomation in Bembèrèkè, northern Benin. Results WBCT results were identical at both reading times in patients without coagulopathy or when coagulation was restored permanently following a single dose of antivenom. Out of 17 patients with coagulopathy, 14 showed discrepancies between WBCT20 and WBCT30 results in at least one pair of serial evaluations. These could be completely contradictory results (e.g. normal clot at WBCT20 and no clot at WBCT30) or a marked difference in the quality of the clot (e.g. no clotting activity at WBCT20 and an unstable partial clot at WBCT30)...

A Case of Pregnant Woman with beta-Thalassemia in Korean

Thalassemia is hereditary disease characterized by impaired production of the normal globin peptide. Beta-thalassemia, a common disorder in Central Africa, the Middle East, and Southeast Asia, has been rarely reported in Korea. It should be considered in the differential diagnosis of hypochromic, microcytic anemia. The genetic subtypes among the different ethnic groups vary; this may pose challenges in prenatal diagnosis or genetic counselling. During pregnancy, women with thalassemia will often show more significant anemia. Recently we have experienced Korean pregnant woman with beta-thalassemia associated with anemia. We describe this case with a brief review of the literature.

The impact and cost-effectiveness of the Amref Health Africa-Smile Train Cleft Lip and Palate Surgical Repair Programme in Eastern and Central Africa

Introduction: cleft lip with or without cleft palate (CLP) is a congenital malformation that causes significant morbidity in low and middle income countries. Amref Health Africa has partnered with Smile Train to provide CLP surgeries since 2006.Methods: we analyzed anonymised data of 37,274 CLP patients from the Smile Train database operated on in eastern and central Africa between 2006 and 2014. Cases were analyzed by age, gender, country and surgery type. The impact of cleft surgery was determined by measuring averted Disability-Adjusted Life Years (DALYs) and delayed averted DALYs. We used mean Smile Train costs to calculate cost-effectiveness. We calculated economic benefit using the human capital approach and Value of Statistical Life (VSL) methods.Results: the median age at time of primary surgery was 5.4 years. A total of 207,879 DALYs were averted at a total estimated cost of US$13 million. Mean averted DALYs per patient were 5.6, and mean cost per averted DALY was $62.8. Total delayed burden of disease from late age at surgery was 36,352 DALYs. Surgical correction resulted in $292 million in economic gain using the human capital approach and $2.4 billion using VSL methods.Conclusion: cleft surgery is a cost-effective intervention to reduce disability and increase economic productivity in eastern and central Africa. Dedicated programs that provide essential CLP surgery can produce substantial clinical and economic benefits

Outbreaks of Ebola virus disease in Africa: the beginnings of a tragic saga

The tremendous outbreak of Ebola virus disease occurring in West Africa since the end of 2013 surprises by its remoteness from previous epidemics and dramatic extent. This review aims to describe the 27 manifestations of Ebola virus that arose after its discovery in 1976. It provides an update on research on the ecology of Ebola viruses, modes of contamination and human transmission of the disease that are mainly linked to close contact with an infected animal or a patient suffering from the disease. The recommendations to contain the epidemic and challenges to achieve it are reminded.

Molecular characterization of chikungunya virus from Andhra Pradesh, India & phylogenetic relationship with Central African isolates.

BACKGROUND & OBJECTIVE: Chikungunya virus has caused numerous large outbreaks in India. Suspected blood samples from the epidemic were collected and characterized for the identification of the responsible causative from Rayalaseema region of Andhra Pradesh. METHODS: RT-PCR was used for screening of suspected blood samples. Primers were designed to amplify partial E1 gene and the amplified fragment was cloned and sequenced. The sequence was analyzed and compared with other geographical isolates to find the phylogenetic relationship. RESULTS: The sequence was submitted to the Gen bank DNA database (accession DQ888620). Comparative nucleotide homology analysis of the AP Ra-CTR isolate with the other isolates revealed 94.7+/-3.6 per cent of homology of CHIKAPRa-CTR with other isolates of Chikungunya virus at nucleotide level and 96.8+/-3.2 per cent of homology at amino acid level. INTERPRETATION & CONCLUSION: The current epidemic was caused by the Central African genotype of CHIKV, grouped in Central Africa cluster in phylogenetic trees generated based on nucleotide and amino acid sequences.

Surgical Treatment of Primary Small Bowel Volvulus Using Laparoscopy

Small bowel volvulus is a condition that usually occurs secondary to malrotation, congenital bands, postoperative adhesions and internal hernias. However, primary small bowel volvulus in adults is very rare, and this is defined as torsion of all or a large segment of the small intestine and its mesentery in the absence of preexisting etiologic factors. This is relatively prevalent in the adult populations of Central Africa, India and the Middle East, but it rarely occurs in Western European and North American populations and in Far-East Asians, including Koreans. The preoperative diagnosis is difficult because clinical examinations and plain films are of limited diagnostic value. Abdominal CT plays a major role in the preoperative diagnosis of this entity. Proper management of patients with a strangulated obstruction depends on an early and accurate diagnosis, and treatment must be timely to prevent gangrene. Prompt preoperative management and early surgical treatment is essential for a better outcome. We report here on a case of a 49-year-old man who was admitted with severe abdominal pain, and he had no history of previous abdominal operations. He was diagnosed as primary small volvulus by diagnostic laparoscopy, and he was managed using this modality.

Estratégias de controle da malária em São Tomé e Príncipe: 1946-2002 / Strategies of control of the malaria in São Tomé and Príncipe: 1946-2002

O presente trabalho analisa as estratégias de controle da malária em São Tomé e Príncipe, de 1946 aos dias atuais buscando identificar os limites e potencialidades para viabilizar e manter uma situação de controle sustentado ou erradicação. Características geográficas sócio- econômicas e conjunturais fazem de São Tomé e Príncipe um espaço endêmico, propício à produção e transmissão da malária.De acordo com este estudo, no período colonial recente, a redução dos níveis de endemicidade esteve sempre vinculada ao grau de eficácia das estratégias e a sustentabilidade das ações desenvolvidas. Estratégias baseadas na dedetização e na cloroquinazação produziram resultados mais relevantes reduzindo a mortalidade e o nível de endemicidade de hiper-holoendêmico para mesoendêmico.O mesmo estudo revela que após a independência, a implementação de estratégias de erradicação baseadas na pulverização intradomiciliar de DDT e na busca ativa e tratamento de casos tiveram resultados encorajadores. Porém, ambientes institucionais vulneráveis, ações não sustentadas no tempo, mudança no comportamento epidemiológico do vetor, resistência ao inseticida empregue, diminuição da sensibilidade do parasita à cloroquina, não foram capazes de propiciar um controle efetivo nem uma atuação sobre as condições ambientais, impedindo a circulação de parasitos e consequentemente a transmissão da doença. A transmissão da malária colocada em equilíbrio instável antes de se conseguir a interrupção da transmissão, influenciou, de forma negativa a receptividade levando a morbidade e a mortalidade a se instalarem em patamares mais altos.O recrudescimento revelou-se desastroso abrindo caminhos à novas vulnerabilidades. A malária continua sendo a primeira causa de morte e de morbidade em São Tomé e Príncipe. Mobiliza custos enormes com o tratamento e proteção e constitui um sério bloqueio ao progresso econômico do país. Considerando as forças e as fraquezas identificadas no decorrer deste estudo, as particularidades geográfico-ambientais, a complexidade dos fatores epidemiológicos e sócio-econômicos assim como os elementos técnicos em que se baseiam a estratégia mundial, o trabalho discute as estratégias que poderiam viabilizar um controle com sucesso.

A Familial Case of beta-Thalassemia Minor due to a Point Mutation (G-->A) at Position 1 in the Second Intervening Sequence / 대한혈액학회지

The thalassemias are congenital disorders in which globin chains are present in decreased amount or absent. Beta-thalassemia, a quite common disorder in Central Africa, the Middle East, and Southeast Asia, has been reported sporadically in Korea since 1988, and some mutations have been identified. We recently analyzed the beta-gene complexes of a family diagnosed with beta-thalassemia minor. The patient was a 20-year-old female who visited our hospital because of anemia and jaundice since her childhood. Through blood tests and hemoglobin electrophoresis, she was diagnosed as having beta-thalassemia minor. Subsequently, DNAs from the patient and her parents were analyzed in search of mutations in beta-gene complex. It was revealed that the patient and her father, a 50-year-old male, have G to A substitutions at position 1 in the second intervening sequence (IVS II-1, G-->A). The mutation was associated with silent mutation of C to T substitution at the codon 91 (CTG-->TTG). To our knowledge, this mutation has not been previously reported in Korea.

Unusual Eosinophilic Infiltration of the Skin in a Patient with Precedent Kimura's Disease

A 25 year old man presinted with erythematous and inderated plaques on the upper and lower extermities that were preceded by insect bites while traveling in central Africa. The patient had a past histrory of Kimura's disease, asthma, and allergic rhinitis, Histologic examination revealed panniculitls showing massive eosinophilic infiltration. The dermis showed eosinopbilic infilreatiom without flame figyres. The patient responded well to oral conrticosteroids. This patient did not fit the diagnosis of eosinoplilic pannicylitis, eosinophilic cellylitis, hypereosinophilic syndrome or eosinophilic vascylitis.