Health status of the elderly population among four primitive tribes of Orissa, India: a clinico-epidemiological study.

Primitive tribal groups (PTGs) are the most marginalised and vulnerable communities in India. Clinico-epidemiological studies on morbidity patterns among the elderly primitive tribe members are essential to recommend special intervention programmes to improve the health of the elderly in these communities. A community-based cross-sectional study was carried out among the elderly populations of four different PTGs, namely Langia Saora (LS), Paudi Bhuiyan (PB), Kutia Kondh (KK) and Dongria Kondh (DK) living in the forests of Orissa, India. Clinical and anthropometric data were collected using standard methods and haemoglobin was estimated by the cyanomethaemoglobin method. The average number of illnesses per person was 3.0. Common disabilities like vision and hearing impairment and mobility-related problems were found in considerable numbers. Gastrointestinal problems like acid peptic disease were found among 2.6% to 20% of cases. Non-specific fever was marked in 10.2% to 24.2% of individuals. The iodine deficiency disorder, namely goitre, was found among 4.2% to 6.0% of individuals. Diseases of the respiratory tract, like upper and lower respiratory tract infection, asthma, tuberculosis and leprosy, were found in small numbers. The prevalence of hypertension among males and females was 31.8% and 42.2%, respectively. The LS had the highest prevalence of hypertension (63% among men and 68% among women). With regard to anaemia status, severe anaemia was marked in 70% of males and 76.7% of females in the LS, while in other groups the prevalence of severe anaemia ranged from 15% to 33%. Although the prevalence of severe anaemia in other tribal communities is lower than in the LS, mild to moderate anaemia was found to range from 60% to 80%. The present study revealed a high prevalence of physical disabilities with both non-communicable as well as communicable diseases among the elderly primitive tribal members. This warrants the implementation of a special health care strategy to reduce suffering at this crucial age and improve quality of life.

Vitiligo: a part of a systemic autoimmune process.

BACKGROUND: Recent clinical and animal experimental studies postulate that the pathogenetic mechanisms of vitiligo could be of systemic origin as vitiligo is associated with ocular and auditory abnormalities as well as other autoimmune disorders.Hence, we studied genetic factors, systemic associations, ocular and auditory abnormalities of vitiligo. METHODS: The study group included 150 new cases of various types of vitiligo. One hundred age- and sex-matched nonvitiligo cases were included as controls in the study. A complete family history was taken for all patients. Examination was carried out taking note of the type of vitiligo and approximate percentage of body surface involved. All relevant laboratory investigations, a thorough audiological examination including pure tone audiometry and a complete ophthalmologic examination were carried out in all patients and controls. Statistical analysis was done using the Chi square test. RESULTS: Fifty-four vitiligo patients (36%) had a family history of vitiligo. Anemia was present in 30 (20%) vitiligo patients but only in five (5%) controls, a difference that was statistically significant (c2 = 15.8, P < 0.001). Diabetes mellitus was present in 24 (16%) vitiligo patients and only 2 (2%) of controls (Chi square, c2 = 12.4, P < 0.001). Hypothyroidism and alopecia areata were present in 18 (12%) and 11 (7.4%) vitiligo patients respectively and none of the controls. Hypoacusis was seen in 30 (20%) vitiligo patients and two (2%) controls (c2 = 8.19, P < 0.005). Twenty-four vitiligo patients (16%) and five controls (5%) had specific ocular abnormalities like uveitis, iris and retinal pigmentary abnormalities (c2 = 7.39, P < 0.001). CONCLUSION: This study demonstrates statistically significant clinical evidence confirming that vitiligo is a part of systemic autoimmune process.

Hepatic and haematological adverse reactions associated with the use of multidrug therapy in leprosy--a five year retrospective study.

This study analyses retrospectively some of the risks associated with the use of WHO-multidrug therapy (MDT) in Sri Lanka. Case records of 3,333 new cases of leprosy attending the Central Leprosy Clinic in Colombo during 1991-1995, were analysed for adverse drug reactions involving the liver and blood. There were 81 reports of suspected hepatic or haematological adverse reactions associated with the use of MDT, of which 39 were classified as haemolytic anaemia, 25 as toxic hepatitis, 2 as methaemoglobinaemia and 15 as anaemia. Dapsone, was incriminated in the majority of adverse reactions (72%). Adverse drug reactions were more common in female than male subjects (55% vs 45%; P < 0.5), but there was no significant differences between the age groups. Majority of adverse reactions was seen within the first three months of initiation of MDT. This study in no way undermines the benefits of MDT but highlights the risks and suggests measures to minimize these risks.

Hepatic and haematological adverse reactions associated with the use of multidrug therapy in leprosy - a five year retrospective study

This study analyses retrospectively some of the risks associated with the use of WHO-multidrug therapy (MDT) in Sri Lanka. Case records of 3,333 new cases of leprosy attending the Central Leprosy Clinic in Colombo during 1991-1995, were analysed for adverse drug reactions involving the liver and blood. There were 81 reports of suspected hepatic or haematological adverse reactions associated with the use of MDT, of which 39 were classified as haemolytic anaemia, 25 as toxic hepatitis, 2 as methaemoglobinaemia and 15 as anaemia. Dapsone, was incriminated in the majority of adverse reactions (72 per cent). Adverse drug reactions were more common in female than male subjects (55 per cent vs 45 per cent; P < 0.5), but there was no significant differences between the age groups. Majority of adverse reactions was seen within the first three months of initiation of MDT. This study in no way undermines the benefits of MDT but highlights the risks and suggests measures to minimize these risks.

Aspectos epidemiológicos, sociais e sanitários em áreas do médio Solimöes: I - Estudo das localidades de Säo Francisco do Laranjal, Aranaí e Säo Lázaro do Surubim, município de Coari, Amazonas / Epidemiological, social and sanitary aspects in area of Médio Solimöes: I - Study of localities of Säo Francisco do Laranjal, Aranaí and Säo Lázaro do Surubim, municipality of Coari, State of Amazonas

Um estudo seccional foi realizado em 1991 nas localidades de Säo Francisco do Laranjal, Aranaí e Säo Lázaro, no município de Coari, localizado no Médio Solimöes, no Estado do Amazonas, envolvendo 406 pessoas residentes, visando determinar as condiçöes sociais e sanitárias e indicaçöes epidemiológicos e laboratoriais específicos sobre a prevalência de anemia, parasitoses intestinais, malária, toxoplasmose, hepatite B e hanseníase. No inquérito foram aplicadas duas fichas padronizadas, uma domiciliar para avaliaçäo das condiçöes econômicas e sanitárias e outra individual para anamnese e exame físico. De cada pessoa foi solicitado amostra de fezes para exames pelos métodos de Lutz (sedimentaçäo) e de Baerman, e colhido sangue para dosagem de hemoglobina e micro-hematócrito, gota, gota expessa e esfregaço para a malária, sorologia para toxoplasmose e para hepatite por vírus B (HBsAg e Anti-HBs). A principal atividade econômica da populaçäo é a agricultura de subsistência e a pesca. Nas três localidades existe escola de 1§ grau mas em nenhuma existe posto de saúde. O índice de aglomeraçäo foi em média 5,3 pessoas por domicílio dos quais 84,2 por cento säo construídos de madeira e 77,5 por cento têm apenas um dormitório para toda a família. O abastecimento de água é feito diretamente do rio; em 89,4 por cento das casas näo existem instalaçöes sanitárias e em sua totalidade o lixo é abandonado ou jogado no próprio rio. A anemia esteve presente em 56,4 por cento dos examinados, 16,2 por cento com menos de 10g/Hg por cento. O exame de fezes revelou 81,9 por cento com um ou mais parasitos (72,6 por cento com mais de um parasito), com predomínio do Ascaris lumbricoides. Chama a atençäo a E. histolytica com 15,6 por cento, diagnósticada com métodos näo específicos. Surpeendentemente todas as lâminas foram negativas para malária; 65,8 por cento dos soros foram reagentes para toxoplasmose, 10,6 por cento com títulos iguais ou superiores a 1: 1024. No exame físico foram diagnósticados três casos de hanseníase (7,38 por 1.000). Apenas 1,9 por cento dos soros foram HBSAg positivos porém 34,3 por cento tinham anticorpos Anti-HBs

Public-health epidemiology in Vanuatu.

Vanuatu, which formerly was known as the New Hebrides, is an archipelago in the southwest Pacific Ocean with a tropical humid climate. The national health system and the state of health of the population generally are satisfactory. The main diseases of public-health importance are malaria and tuberculosis. Their epidemiology and control are discussed. An epidemic of Plasmodium falciparum malaria, which commenced in 1980, is described; this possibly can be explained by an increase in chloroquine-resistant P. falciparum over the same period. Other diseases also are reviewed. Many tropical diseases of great significance elsewhere are not of much significance in Vanuatu. Medical advice for visiting travellers is provided.

Public-health epidemiology in Vanuatu

Vanuatu, which formerly was known as the New Hebrides, is an archipelago in the southwest Pacific Ocean with a tropical humid climate. The national health system and the state of health of the population generally are satisfactory. The main diseases of public-health importance are malaria and tuberculosis. Their epidemiology and control are discussed. An epidemic of Plasmodium falciparum malaria, which commenced in 1980, is described; this possibly can be explained by an increase in chloroquine-resistant P. falciparum over the same period. Other diseases also are reviewed. Many tropical diseases of great significance elsewhere are not of much significance in Vanuatu. Medical advice for visiting travellers is provided.

Prevalence of disease in Southeast Asian teenagers. Results of screening medical examination at a residential vocational training facility.

Findings on health screening of immigrant Southeast Asian adolescents enrolled at a Federally funded vocational training facility were reviewed for the years 1979-1982. History of or positive skin test for tuberculosis was found in 55%. A heavy parasite burden was found in 46% of the recent Laotian immigrants, but was infrequent in Vietnamese who had been in the United States for several months before testing. Anemia was found in only 5.5%, though an additional 6.5% had findings suggestive of Thalasemia trait. Hepatitis B surface antigen positivity occurred in 16.8% but none had abnormal liver enzymes. One case of leprosy and three cases of idiopathic microscopic hematuria were detected.

Iron therapy in severe cutaneous leprosy

Abnormally low haemoglobin readings have been found in patients suffering from leprosy, particularly the lepromatous form, in the absence of intercurrent disease and secondary septic complications. This is particularly, marked in the L2 and L3 cases where patients fail to improve on routine treatment over a prolonged period. Response to Ferri et Ammon. Citrate is immediate and rapid up to a level of about 65-70 percent, and further gain follows the administration of Ferrous Sulphate. Clinical improvement follows the rise in haemoglobin. The haemoglobin curve appears to be an accurate clinical barometer, similar to the Blood Sedimentation Index. Haemoglobin estimations are simpler and take far less time. The possible influence of the diet is indicated. The investigation took place over 14 months, involving 195 persons and including 21 "controls" (Summary)