Lead poisoning outbreak among opium users in the Islamic Republic of Iran, 2016-2017.

OBJECTIVE: To describe an outbreak of lead poisoning among opium users in the Islamic Republic of Iran and estimate the number of affected people in the country. METHODS: We used data from the country's largest poison treatment centre to illustrate the epidemiology of an outbreak of lead poisoning in oral opium users. We describe the government's referral and treatment guidelines in response to the outbreak. Based on the number of individuals treated and previous studies on the prevalence of oral opium use we estimated the total number of people at risk of lead-contaminated opium nationwide. FINDINGS: In February 2016, we noticed a steep increase in the numbers of oral opium users referred to our poison treatment centre with abdominal pain, anaemia and constipation. Numbers peaked in June 2016 but the outbreak was ongoing in August 2017. The mean blood lead level in a sample of 80 patients was 140.3 µg/dL (standard deviation: 122.6). Analysis of an illegal opium sample showed 3.55 mg lead in 1 g opium. Treatment was exposure reduction with opioid substitutes and laxatives, or chelation therapy if indicated. Over 7 months, 4294 poison cases were seen at main referral hospitals in Tehran out of an estimated 31 914 oral opium users in the city. We estimate more than 260 000 out of 773 800 users nationwide remain untreated and at risk of poisoning. CONCLUSION: Lead-contaminated opium and heroin that has transited through the Iranian markets is a global risk and highlights a need for better monitoring of illegal drug supplies.

Effectiveness of Eupatorium perfoliatum 30C in Prevention of Dengue Fever and Acute Febrile Illness during 2017 Dengue Outbreak in Urban Slums of Delhi: A Prospective, Open-Label, Community-Based, Parallel Cohort Study.

OBJECTIVE: This study was undertaken to assess the effectiveness of Eupatorium perfoliatum (EP) 30C on the incidence of dengue fever and acute febrile illness (AFI) during the 2017 dengue outbreak. METHODS: We conducted a prospective, open-label, community-based parallel cohort study involving apparently healthy individuals residing in 06 urban slums (JJ colony) of Delhi. The participants were enrolled in two cohorts - the medicine cohort (MC) and the control cohort (CC). Participants in MC were given weekly one dose of EP 30C for 10 weeks along with Information, Education and Communication (IEC) material regarding dengue. Participants in the CC were provided with the IEC material only. The primary outcome measure was the incidence of dengue fever as per case definitions notified in the national guidelines for clinical management of dengue fever by the Government of India during the 10 weeks follow-up period. The secondary outcome measures were the incidence of AFI and the hospitalization of confirmed dengue cases. RESULTS: The analysis included 40,769 participants residing in 06 slum clusters of Delhi out of which 28,321 participants were in MC and 12,448 participants were in CC. The incidence of laboratory-confirmed dengue in the MC was 2.57 per 10,000 person-weeks (95% confidence interval [CI], 2.02-3.22) in comparison with 7.55 per 10,000 person-weeks (95% CI, 6.12-9.21) in the CC. The incidence of AFI in the MC was 19.66 per 10,000 person-weeks (95% CI, 18.07-21.36) in comparison with 40.96 per 10,000 person-weeks (95% CI, 37.48-44.67) in the CC. The overall protective effect of EP against laboratory-confirmed dengue was 65.77% (95% CI, 53.37-74.87; p = 0.0001) and against AFI was 52.58% (95% CI, 46.37-58.07; p = 0.0001). Hospitalization reported in the MC was nil as against 4.35% in the CC. No dengue-related case fatalities were reported from either cohort. None of the participants from the MC reported any adverse events owing to the prophylactic intervention. CONCLUSION: The study concludes that EP 30C was able to prevent dengue significantly. Randomized controlled trials are needed to confirm or refute our findings.Das Ziel dieser Studie war die Beurteilung der Wirksamkeit von Eupatorium perfoliatum (EP) 30C auf die Inzidenz von Dengue-Fieber und akuter fiebriger Erkrankung (AFE) während des Dengue-Ausbruchs 2017.Wir führten eine prospektive, unverblindete, Bevölkerungs-Parallelgruppen-Kohortenstudie mit augenscheinlich gesunden Bewohnern von 6 städtischen Slums (JJ-Kolonie) in Delhi durch. Die Teilnehmer wurden in 2 Kohorten aufgenommen, einer Medizinkohorte (MK) und einer Kontrollkohorte (KK). Die Teilnehmer in der MK erhielten 10 Wochen lang wöchentlich eine Dosis EP 30C und dazu Aufklärungsmaterialien über Dengue. Die Teilnehmer in der KK erhielten nur die Aufklärungsmaterialien. Die primäre Zielgröße war die Dengue-Fieber-Inzidenz laut der in den nationalen Leitlinien für das klinische Management des Dengue-Fiebers von der indischen Regierung bekannt gegebenen Falldefinition in dem zehnwöchigen Beobachtungszeitraum. Die sekundären Zielgrößen waren die Inzidenz von AFE und die Anzahl hospitalisierter bestätigter Dengue-Fälle.In die Analyse wurden 40,769 Bewohner von 6 Slum-Clustern in Delhi einbezogen, davon wurden 28,321 Teilnehmer in die MK aufgenommen und 12,448 Teilnehmer in die KK. Die Inzidenz von im Labor bestätigter Dengue betrug in der MK 2,57 pro 10,000 Personen/Woche (95%-Konfidenzintervall [KI]: 2,02­3,22), verglichen mit 7,55 pro 10,000 Personen/Woche (95%-KI: 6,12­9,21) in der KK. Die Inzidenz von AFI betrug in der MK 19,66 pro 10,000 Personen/Woche (95%-Konfidenzintervall [KI]: 18,07­21,36), verglichen mit 40,96 pro 10,000 Personen/Woche (95%-KI: 37,48­44,67) in der KK. Der Schutzeffekt (SE) von EP betrug gegen im Labor bestätigte Dengue 65,77% (95%-KI: 53,37­74,87; p = 0,0001) und gegen AFI 52,58% (95%-KI: 46,37­58,07; p = 0,0001). Die Hospitalisierungsrate war in der MK gleich Null versus 4,35% in der KK. In keiner Kohorte waren Dengue-bedingte Todesfälle zu verzeichnen. Bei keinem der Teilnehmer in der MK traten jegliche unerwünschten Ereignisse infolge der prophylaktischen Maßnahme auf.Die Studie gelangt zu dem Schluss, dass Eupatorium perfoliatum 30C in signifikantem Maße Dengue vorbeugen konnte. Randomisierte kontrollierte Studien sind erforderlich, um unsere Ergebnisse zu bestätigen bzw. zu widerlegen.

An outbreak of cutaneous infection due to Mycobacterium abscessus associated to mesotherapy.

INTRODUCTION: In February 2009 an outbreak of subcutaneous abscesses due to Mycobacterium abscessus was detected in Spain which affected healthy women who had undergone mesotherapy procedures in an aesthetic clinic. METHODS: Epidemiological research, health inspection and microbiological studies were conducted. The patients were given antibiotic treatment (according to susceptibility testing) with clarithromycin, and in some cases, combined with amikacin. RESULTS: Seventeen out of 77 patients treated in the clinic were affected. The products used for the injections were homeopathic drugs in multi-dose vials. The environmental samples were negative. The sterile injection equipment and the clinical procedures were evaluated as correct. The storage conditions for the drugs were also correct, and all the samples tested negative for Mycobacteria. However Paenibacillus provencensis was isolated from samples of unused multi-dose vials and the withdrawal of the product from distribution was ordered. Deficiencies were detected in the sterile products process of at the homeopathic drug factory, so the production line was suspended. CONCLUSIONS: The results of environmental investigation suggest the most likely cause of the outbreak could have been the contamination of the products in the factory, although there was no laboratory confirmation. The widespread use of homeopathic products in invasive procedures requires extreme control during the manufacturing, handling and packaging process. It is important to consider mesotherapy and parenteral use of homeopathic medicines as potential sources of infection and therefore the same precautions in the procedures and quality assurance of products should be applied as with any other drug or medical activity.

Large-scale application of highly-diluted bacteria for Leptospirosis epidemic control.

BACKGROUND: Leptospirosis is a zoonotic disease of major importance in the tropics where the incidence peaks in rainy seasons. Natural disasters represent a big challenge to Leptospirosis prevention strategies especially in endemic regions. Vaccination is an effective option but of reduced effectiveness in emergency situations. Homeoprophylactic interventions might help to control epidemics by using highly-diluted pathogens to induce protection in a short time scale. We report the results of a very large-scale homeoprophylaxis (HP) intervention against Leptospirosis in a dangerous epidemic situation in three provinces of Cuba in 2007. METHODS: Forecast models were used to estimate possible trends of disease incidence. A homeoprophylactic formulation was prepared from dilutions of four circulating strains of Leptospirosis. This formulation was administered orally to 2.3 million persons at high risk in an epidemic in a region affected by natural disasters. The data from surveillance were used to measure the impact of the intervention by comparing with historical trends and non-intervention regions. RESULTS: After the homeoprophylactic intervention a significant decrease of the disease incidence was observed in the intervention regions. No such modifications were observed in non-intervention regions. In the intervention region the incidence of Leptospirosis fell below the historic median. This observation was independent of rainfall. CONCLUSIONS: The homeoprophylactic approach was associated with a large reduction of disease incidence and control of the epidemic. The results suggest the use of HP as a feasible tool for epidemic control, further research is warranted.

[Risk factors for delayed or missed measles vaccination in young children]. / Risikofaktoren für eine verspätete oder nicht erfolgte Masernimpfung bei Kleinkindern.

Because of low measles vaccine coverage rates, measles outbreaks have been observed several times during recent years in Germany. The aim of this study is to identify parents' attitudes and beliefs towards immunisations and socio-economic factors which are associated with delayed or missed first measles vaccination in young children. We used data from a representative German-wide immunisation survey on 2116 children born between 1 January 2002 and December 2004 by collecting precise vaccination information from vaccination cards. The influence of socio-economic determinants and parental attitudes towards immunisations on the timing of the first measles dose was analysed by using multivariable Cox regression. Of these children 46.8% (95% CI: 44.5-49.1) received their first measles dose according to the recommendations of the standing committee on vaccination (STIKO) by month 15. In multivariable analysis, fathers aged 28-33 years and birth order as well as parents' belief in homeopathy and other parental attitudes indicating lack of knowledge about the importance of vaccinations significantly influenced an early immunisation. Not general opposition, but insufficient parental knowledge about the harmfulness of measles infection seemed to be responsible for the low measles vaccination rates.

[Childhood vaccinations anno 2004. I. Effectiveness and acceptance of the Dutch National Vaccination Programme]. / Vaccinaties op de kinderleeftijd anno 2004. I. Effectiviteit en acceptatie van het Rijksvaccinatieprogramma.

Vaccinations are the most effective measures in public health. In the Netherlands after the second world war the morbidity and mortality of infectious diseases were a great problem. Nowadays these diseases are gone or reduced at a minimal level and for the greater part under control. The Dutch National Vaccination Programme aims at 10 infectious diseases. In the Netherlands there has always been a relatively small group of religious people who live together and reject vaccinations. Since the start of the vaccination programme in this group several small epidemics of poliomyelitis and measles have been observed. The other dispersed living non-vaccinated people are protected by herd-immunity, as long as the vaccination coverage is above 90%. During recent years an increasing number of people have doubts over the use and safety of vaccinations. There is a worldwide anti-vaccination movement, in the Netherlands represented by the 'Nederlandse Vereniging Kritisch Prikken'. The finding that there is now a greater spread of areas with a low or insufficient vaccination coverage, is cause for concern because experiences in several countries have shown that infectious diseases with all complications will recur when the vaccination percentage decreases. There is no scientific support for the hypothesis that vaccinations overwhelm or weaken the immune system of infants and there is no objection to start with vaccination at the age of two months. Anthroposofic and homeopathic arguments are neither scientifically, nor practically supported. Good promotion and education about the vaccination programme is of great importance and can be improved. Parents should make decisions based on good, objective information. Possible risks and side effects of vaccination should not be concealed.

Opium trade, insurgency, and HIV/AIDS in Afghanistan: relationships and regional consequences.

Global health and conflict studies share key linkages that have important research and policy implications but for which data are currently lacking. This analytical review examines the ongoing conflict in Afghanistan, using it as a basis to develop a conceptual framework that integrates security and public health concepts. The analysis draws on recent peer-reviewed and gray literature to assess the interrelationship among 3 variable clusters and their impact on the emergence of the HIV epidemic in Afghanistan. The evidence suggests that there is a complex indirect relationship linking illicit opium trade, the ongoing insurgency, and forced and spontaneous migration to the emergence of an injection drug use-driven HIV epidemic in Afghanistan. These findings demonstrate a clear need for an integrated cross-disciplinary and regional approach to the emerging threat of HIV/AIDS in Afghanistan, to inform more balanced and effective policy making in this and other regions of strategic global import.

Drug abuse in China: past, present and future.

Following British importation of opium to China in 1760s, the use and production of the drug in China increased dramatically. This situation was aggravated after the failure of Opium Wars that occurred between the United Kingdom and the Qing Empire in China with the aim of forcing China to import British Opium; this war made China open the door to a free flowing opium trade, with disastrous social and public health consequences. The subsequent rise of the new China created drug-free atmosphere by strict legislation and punishment, in which drug use greatly decreased. However, in the context of governmental reform and the open-door policies of the 1980s, drug abuse has re-emerged as a major public health problem. Today, drug abuse is highly linked to the spread of HIV/AIDS and to drug-related crimes in China. To combat the severe drug problem facing the nation, the Chinese government has adopted the Methadone Maintenance Treatment program, a multi-faceted therapeutic approach that aims to reduce the health and social problem induced by drug epidemics. In addition, traditional Chinese medicine, including herbal therapy and acupuncture, both found to be effective in the prevention of relapse and causes few side effects, making them useful for the treatment of opiate addiction. With continuous application of these therapies and managements that have been proved to be effective in harm reduction in the western countries, we believe that drug abuse and its related problems in China will be brought under control.

De miasmas a mosquitos: el pensamiento médico sobre la fiebre amarilla en Yucatán, 1890-1920 / From miasmas to mosquitoes: medical thought on yellow fever in Yucatan, 1890-1920

La fiebre amarilla fue un problema de salud pública desde la época colonial debido a la frecuencia con que se presentaba en forma epidémica y a su alta letalidad. El objetivo de este trabajo es analizar el pensamiento médico y su evolución con respecto al vómito prieto entre 1890 y 1921 en Yucatán. Dos aspectos serán abordados: algunos antecedentes con respecto a la enfermedad y las ideas predominantes hasta 1881; y la propuesta de Carlos Finlay para vencer el escepticismo ante su teoría por parte de la comunidad médica. En segundo lugar se analizará la mezcla de las ideas miasmáticas y bacterianas. En tercer lugar, se mostrará cómo, a partir de la demostración de sus postulados, la mirada médica se dirigió al exterminio del mosquito transmisor de este padecimiento.

Yellow fever has been a public health concern since colonial days because of its frequent epidemics and high mortality rate. This analysis of medical thought about "the black vomit" in the Yucatan and the evolution of this thinking from 1890 through 1921 first addresses some of the disease's antecedents and preponderant ideas prior to 1881 as well as Carlos Finlay's efforts to convince the medical community that his theory was right. The article goes on to analyze the co-existence of miasmatic and bacterial ideas and to show how medical initiatives began focusing on eradication of the mosquito transmitter once Finlay's postulates had been demonstrated.

Las ideas médicas sobre la epidemia de gripa de 1918 en Bogotá / Medical ideas in the 1918 flu epidemic

El presente artículo busca analizar cómo los médicos bogotanos entendieron la gripa como entidad patológica a comienzos del siglo XX. Para ello se examinan algunos de los recursos cognitivos que los galenos utilizaron para abordar y atender la epidemia de 1918 en la ciudad de Bogotá. En este abordaje, se puede vislumbrar cómo la epidemia de gripa se tornó en un fenómeno social de enorme complejidad y cómo su definición médica se forjó en un campo de debate enmarcado por los grandes cambios paradigmáticos que vivió la medicina de finales del siglo XIX.El texto explora algunos de los conceptos centrales que sirvieron de sustento para la comprensión etiopatológica de la gripa, presenta una descripción del saber clínico que se tenía acerca de la enfermedad y se detiene, de manera especial, en el debate que suscitó la identificación de un microorganismo específico como agente causal de la gripa.

Homeopatia na Índia: educação, atendimento e pesquisa / Homeopathy in India: education, care and research

Este artigo apresenta uma síntese do desenvolvimento e institucionalização da homeopatia na Ìndia, desde sua introdução em 1839 aos nossos dias. Na atualidade, a homeopatia está incluída num programa governamental (AYUSH) para promoção das medicinas tradicionais e alternativas. A homeopatia conta com dois referentes institucionais: o Conselho Central de Homeopatia, focando a formação dos homeopatas, e o Conselho Central para Pesquisa em Homeopatia, que desenvolve diversos programas de investigação. Além disso, o país ainda conta com um Instituto Nacional de Homeopatia, um Laboratório destinado a padronizar a Farmacopéia Indiana e clínicas homeopáticas nos diversos níveis da administração política. Igualmente, a homeopatia tem parte significativa no Programa Nacional de Saúde Materno-Infantil.(AU)

This article presents a summary of the development and institutionalization of homeopathy in India since its introduction in 1839 to the present time. Nowadays, homeopathy is included in a governmental program (AYUSH) aiming at the promotion of traditional and alternative medicines. Homeopathy is represented by two main offices: the Central Council of Homeopathy, focused on training, and the Central Council for Research in Homeopathy, which develops several research programs. Moreover, there are a National Institute of Homeopathy, a Laboratory devoted to the standardization of India Pharmacopoea and homeopathic clinics distributed among all levels of the political administration. Similarly, homeopathy plays a significant role in the National Program for Mother-Infant Health.(AU)

The homoepathic management of cholera in the nineteenty century with special reference to the epidemic in London, 1854.

During the nineteenth century homoeopaths claimed better results than their conventional colleagues did for the treatment of epidemic cholera. Those of the London Homoeopathic Hospital in 1854 have been put forward, for 150 years, as evidence of the efficacy of homoeopathy. The evidence is examined in this paper. Failure to inflict exhausting allopathic treatments must have contributed considerably to the homoeopathic success. However it appears probable that the homoeopathic remedies themselves played an active part in the successful treatment of cholera cases.

An epidemic of opium dependence among Asian refugees in Minnesota: characteristics and causes.

After several decades absence, opium smoking has reappeared in the U.S. Introduced by Indochinese refugees in the early 1980's, it has spread to several regions of the country. In this report the characteristics of refugee opium addicts is described. In addition, the factors contributing to a fertile situation for opium addiction are presented. Finally, implications of these findings and remedial recommendations are suggested.