Feasibility of two active case finding approaches for detection of tuberculosis in Bandung City, Indonesia.

Setting: A community health clinic catchment area in the eastern part of Bandung City, Indonesia. Objective: To evaluate the feasibility of two different screening interventions using community health workers (CHWs) in detecting tuberculosis (TB) cases. Design: This was a feasibility study of 1) house-to-house TB symptom screening of five randomly selected 'neighbourhoods' in the catchment area, and 2) selected screening of household contacts of TB index patients and their neighbouring households. Acceptability was assessed through focus group discussions with key stakeholders. Results: Of 5100 individuals screened in randomly selected neighbourhoods, 48 (0.9%) reported symptoms, of whom 38 provided sputum samples; no positive TB was found. No TB cases were found among the 88 household contacts or the 423 neighbourhood contacts. With training, regular support and supervision from research staff and local community health centre staff, CHWs were able to undertake screening effectively, and almost all householders were willing to participate. Conclusion: The use of CHWs for TB screening could be integrated into routine practice relatively easily in Indonesia. The effectiveness of this would need further exploration, particularly with the use of improved diagnostics such as chest X-ray and sputum culture.

Contexte : Une zone de desserte d'un centre de santé communautaire dans la partie est de la ville de Bandung, Indonésie.Objectif : Evaluer la faisabilité de deux différentes interventions de dépistage recourant à des travailleurs de santé communautaire (CHW) dans la détection des cas de la tuberculose (TB).Schéma : Une étude de faisabilité : 1) du dépistage des symptômes de TB en porte à porte dans cinq quartiers sélectionnés au hasard dans la zone de desserte, et 2) recherche des contacts familiaux des patients TB index et leur voisinage. L'acceptabilité a été évaluée grâce à des groupes focaux avec les partenaires clés.Résultats : Sur 5100 individus dépistés dans des quartiers sélectionnés au hasard, 48 (0,9%) ont rapporté des symptômes, dont 38 ont fourni des crachats : aucune TB n'a été découverte. Aucun cas de TB n'a été trouvé parmi les 88 contacts familiaux ni parmi les 423 personnes du voisinage. Avec une formation, un soutien régulier et une supervision par le personnel de recherche et le personnel du centre de santé communautaire local, les CHW pourraient efficacement entreprendre le dépistage, et presque tous les habitants ont accepté de participer.Conclusion : Le recours aux CHW pour le dépistage de la TB pourrait assez facilement être intégré dans la pratique de routine en Indonésie. L'efficacité de cette stratégie mériterait d'être explorée davantage, en particulier en recourant à des outils diagnostiques améliorés comme une radiographie pulmonaire et une culture de crachats.

Marco de referencia: La zona de influencia de un consultorio comunitario en la parte oriental de la ciudad de Bandung, en Indonesia.Objetivo: Evaluar la factibilidad de dos intervenciones diferentes de detección sistemática practicadas por los agentes de salud comunitarios (CHW) en la búsqueda de casos de tuberculosis (TB).Método: Se llevó a cabo un estudio de factibilidad que examinó: 1) la detección sistemática de los síntomas de TB, de puerta a puerta, en cinco barrios de la zona de influencia escogidos de manera aleatoria y 2) la investigación de contactos de los casos nuevos de TB en sus hogares y en el vecindario. Se organizaron grupos de opinión con interesados directos clave a fin de evaluar la factibilidad de la intervención.Resultados: De las 5100 personas participantes en los vecindarios escogidos, 48 refirieron síntomas (0,9%) y 38 aportaron muestras de esputo, de las cuales ninguna fue positiva para TB. No se detectaron casos de TB en los 88 hogares de los contactos ni en los 423 contactos del vecindario. Con la capacitación, el apoyo periódico y la supervisión por parte del grupo de investigación y del personal de salud del centro comunitario local, los CHW emprendieron de manera eficaz una detección sistemática y casi todos los miembros de los hogares aceptaron participar.Conclusión: La participación de los CHW en la detección sistemática de la TB se puede integrar sin dificultad en la práctica corriente en Indonesia. Se precisa un examen más detenido de la eficacia práctica de esta medida, en especial con la utilización de métodos diagnósticos mejorados como la radiografía de tórax y el cultivo de muestras de esputo.

Analyses of Ehrlichia canis and a canine granulocytic Ehrlichia infection.

Ehrlichia canis and canine granulocytic Ehrlichia sp. (CGE) infect canine monocytes and granulocytes, respectively. E. canis has been cultured in vitro and used to develop an immunofluorescence assay. CGE has not been cultured, and a serologic assay is not available. The sera of dogs infected with CGE were reported to react with E. canis by immunofluorescence. In this study, the temporal response of immunoglobulin G (IgG) was determined by an enzyme-linked immunosorbent assay (ELISA) with purified E. canis antigen in four dogs experimentally infected with E. canis, in two dogs experimentally infected with CGE, and in one dog infected with E. canis and subsequently infected with CGE. E. canis-infected dogs developed an IgG ELISA result of 1.5 or greater for the optical density signal/noise ratio by 2 months postinfection. CGE challenge of a dog with a previous E. canis infection induced an anamnestic increase in the IgG ELISA result; however, CGE infection alone did not induce a significant IgG ELISA response. Western immunoblot analysis showed that dogs infected with E. canis developed antibodies initially that reacted with low-molecular-mass proteins (30, 24, and 21 kDa) and subsequently with higher-molecular-mass proteins (160, 100, 78, 64, 47, and 40 kDa). In contrast, CGE-infected dogs showed reactions with the same higher-molecular-mass proteins of E. canis but, unlike E. canis-infected dogs, not with the low-molecular-mass proteins of E. canis. Of 10 serum samples collected in the field of Indonesia from dogs with tropical canine pancytopenia, all had an optical density signal minus noise value of 2.54 or greater in the IgG ELISA and reacted with E. canis antigen in a pattern similar to that of serum samples from dogs experimentally infected with E. canis in Western immunoblotting. This study suggests that the IgG ELISA and Western immunoblotting with purified E. canis as the antigen are useful in distinguishing between E. canis and CGE infections in dogs.

Method of minimizing hemorrhage in excising hemangioma.

Subtotal excision of hemangioma may be indicated to improve contour and minimize body image distortion. A method has been employed to minimize intraoperative hemorrhage. The surgical excision is easily accomplished by using hemostatic sutures. The method is described.

Arrhythmias and conduction disturbances in children at the Department of Child Health, School of Medicine University of North Sumatra/Dr. Pirngadi Hospital Medan.

A retrospective study on arrhythmias and conduction disturbances was conducted in 1986 in the Division of Pediatric Cardiology of Dr. Pirngadi Hospital, Medan. There were 106 (35.33%) cases with arrhythmias and conduction disturbances out of 300 patients studied. The most common type of arrhythmia among the patients under 5 was intraventricular conduction defects, whilst in the age group of 5-10 were sinus tachycardia and intraventricular conduction defects, and in the age group of 10-15 was first degree A-V block. Rheumatic heart diseases and VSD were the most common cardiac diseases associated with arrhythmias, where the frequency were 18.86% and 10.37%, respectively. Arrhythmias associated with several extracardiac diseases were found in 60 (56.61%). Two out of 7 cases treated with antiarrhythmic agents died with SVT associated with bronchopneumonia, and atrial fibrillation associated with gastroenteritis, dehydration and malnutrition. Treatment against the main diseases (without antiarrhythmic agents) was done in the remainder. Even though the overall mortality rate was 13.20%, it was not due to arrhythmia itself but most of them died of non-arrhythmic origin.

Rheumatic fever and rheumatic heart disease at the Department of Child Health, School of Medicine, University of North Sumatera/Dr. Pirngadi Hospital, Medan (1983-1985).

A retrospective study on rheumatic fever and rheumatic heart disease in children was conducted at the Department of Child Health, Dr. Pirngadi Hospital Medan, during 1983-1985. The patients consisted of 43 females and 30 males. Most of the patients were over 12 years of age. Of the 73 patients there were 60 patients (82.19%) accompanied by valvular disorders. The most frequent major criteria of Jones found in this study were carditis and polyarthritis. Thirty one patients (42.46%) had functional status (NYHA) of grade II-IV, and 43 patients (58.90%) had cardiomegaly. The major ECG findings were enlargement of the atria or ventricles and first degree AV block. Compliance was only achieved in 25 (34.24%) cases. Rheumatic fever and rheumatic heart disease still remain a challenge for the medical professionals to cope with in the region.

Circumcision: a review and a new technique.

Numerous techniques for circumcision have been described in the literature. They range from the dorsal slit incision, the squeeze technique using the Gomco clamp or Plastibell, the sleeve resection technique, and the guillotine technique. An alternative technique, which has not been previously described, is presented.

A comparison of the energy and nitrogen metabolism of starved ducklings and chickens.

1. Respiration chambers were used to measure, over 24 h, the heat production of groups of starved ducklings from two batches and of starved broiler chickens from one batch up to 28 and 39 d of age, respectively. Duration of starvation prior to measurements and ambient temperature were adjusted according to the age of the birds. 2. Respiratory quotient of 0.705 for chickens was significantly lower than that of 0.713 for ducklings. 3. Starvation heat production (kJ/d) of ducklings was 804 kgW0-70 compared with 675 kgW0-74 for chickens. There were differences in heat production between the two batches of ducklings used when expressed per kg body weight (W). 4. Ducklings lost more body weight, body fat and protein than chickens during starvation. Gaseous ammonia-N was on average 9% of N excreted by ducklings and 4% of N excreted by chickens.

A comparison of the energy and nitrogen metabolism of fed ducklings and chickens.

1. Energy measurements were made over 4 d on groups of three ducklings (aged from 5 to 22 d), and three broiler chickens (aged from 11 to 32 d) offered high- or low-energy diets. 2. Food, metabolisable energy (ME) and water intakes were significantly higher for ducklings than for chickens. The ratio of water:food was 4-2:1 and 2-3:1 for ducklings and chickens, respectively. The food conversion ratio differed between diets but not species. Performance was generally better for both species on the high-energy diet. 3. Heat production, energy, fat and protein retentions were higher for ducklings than chickens, and ducklings retained 0.44 of their energy as fat compared with 0.37 for chickens. Overall the ratio of protein (g) to fat (g) retention was 2.2:1 and 2.8:1 for ducklings and chickens respectively. 4. For ducklings, metabolisability of the high-energy diet declined from 0.774 to 0.747, and to a lesser extent of the low-energy diet, as they aged. There was no such decline for chickens. Net efficiency of utilisation of ME for gain was 0.64 for ducklings compared with 0.50 for chickens. 5. Fractional retention of dietary nitrogen (N) was 0.62 for ducklings and 0.55 for chickens. Gaseous ammonia-N was 4.5 and 2.2%, respectively, of N retained. 6. In a second experiment groups of ducklings only, were offered high- and low-protein diets from 12 to 22 d of age. Comparisons among four diets showed that food and energy intake was lower on the low-protein diet than on the other three. Energy retention on the high-energy diet was greater (P less than 0.05) than on the other three diets. 7. It was concluded that a high-energy diet is important for ducklings and chickens for maximum biological performance during the first 4 weeks of life.