Surveillance of wild polioviruses in patients with acute flaccid paralysis in Malta during 1998 and 1999.

Certification of global poliomyelitis eradication can only be accomplished when all countries have been certified as having achieved wild poliovirus eradication. In order to achieve certification of eradication of poliomyelitis in Malta an active acute flaccid paralysis (AFP) surveillance system comprising the whole population was set up. Surveillance became effective in January 1998. During 1998, there were nine reported cases of AFP (non-polio AFP rate: 2.38 per 100,000 population) two of whom were children under 15 years of age (non-polio AFP rate: 2.52 per 100,000 for the population aged <15 years). In 1999 five cases of AFP were reported (non-polio AFP rate: 1.32 per 100,000 population). One case occurred in a child under 15 years (non-polio AFP rate: 1.28 per 100,000 for population aged <15 years). Virological investigation did not detect any wild or Sabin-like polioviruses.

Tropical medicine: 100 years of progress.

Over the past century, tropical medicine has passed through several overlapping phases. Initially, the picture was of endemic and epidemic diseases that wreaked havoc on people living in warm climates and visitors to these areas. High morbidity and mortality associated with these diseases reflected the poor state of knowledge about their causes and epidemiology and the lack of effective technologies for their control. At this stage, tropical medicine was dominated by parasitic and infectious diseases that had affinity for warm climates and some specific nutritional disorders. The next phase involved the steady accumulation of knowledge about the aetiological agents and, in the case of parasitic and infectious diseases, identification of reservoirs and vectors. The development of new and improved technologies for the control of tropical diseases characterised the third phase. The new products included drugs, diagnostic tools, vector control measures and vaccines. In the fourth phase, the new technologies are being deployed in programmes aimed at achieving disease control and, where feasible, total elimination of the problem. In the course of these operations, many useful lessons have been learnt from both the successes and failures of major schemes. In particular, experience has shown the important role of research not only in providing new technologies but also in optimising their effectiveness when applied in control programmes. The role of social and behavioural factors in the epidemiology and control of tropical diseases has drawn attention to the value of a multidisciplinary approach in designing and implementing control programmes. There is a sense of cautious optimism that, if the lessons learnt over the past century are carefully applied, further gains can be made in controlling and eliminating the classical problems that characterised tropical medicine at the beginning of this century.

Tratamiento del paludismo grave y complicado: guía práctica / Tratamiento del paludismo grave y complicado: guía práctica / Treatment of malaria complications: practical guidelines

El paludismo sigue planteando un importante problema sanitario en muchas partes del mundo, ya que pasan de 2000 millones las personas que están expuestas a la infección en un centenar aproximadamente de países. Cualquier demora en el tratamiento del paludismo por falciparum--que es la forma más grave de la enfermedad--puede traducirse en un deterioro grave del estado del paciente, con aparición de diversas complicaciones potenciamente mortales

En esta guía se dan orientaciones prácticas sobre el diagnóstico y el tratamiento del paludismo grave y complicado. Después de exponer los cuidados de enfermería general que necesitan estos pacientes, se analizan las posibles complicaciones (anemia, insuficiencia renal, hipoglucemia y edema pulmonar) y se dan consejos concretos y concisos acerca del tratamiento. La guía está destinada principalmente a médicos y demás personal de salud con responsabilidad en hospitales u otros establecimientos sanitarios dotados de camas para atender a los pacientes en los paises con paludismo endémico, pero también será de utilidad práctica para los que ejercen en zonas no endémicas, obligados cada vez más a asistir a enfermos infectados durante un viaje por una zona palúdica

The chemotherapy of onchocerciasis. XV. Studies with albendazole.

Ninety-two males, infected with Onchocerca volvulus, from an area of on-going transmission in the forest zone of southern Ghana were treated with albendazole. 31 patients received 800 mg daily x 3, 31 received 1200 mg daily x 3 and 30 others received 800 mg daily x 7. Albendazole was given as a single daily dose with a fatty breakfast. Detailed systemic, ocular and laboratory examinations were performed pretreatment and at intervals over one year. Nodules were extirpated on days 30 and 60 and examined by histopathology. All the dose regimes were well tolerated but were neither microfilaricidal nor macrofilaricidal. The main effect was embryotoxicity affecting all intra-uterine stages. The most encouraging results were obtained in the 800 mg daily x 3 group in which a prolonged suppression of skin microfilarial counts occurred. Controlled studies in combination with ivermectin are recommended to determine whether an additive effect of the two drugs would result in permanent sterilisation of the adult worms.

The conquest of 'river blindness'.

Studies carried out at the WHO/OCP Onchocerciasis Chemotherapeutic Centre in Tamale, Ghana, are reported, culminating in the clinical trials of ivermectin (Mectizan), which has revolutionized our approach to the treatment of the disease. It is concluded that the conquest of 'river blindness' is an eminently achievable goal.

Tratamento da malaria grave e complicada: condutas prática / Tratamento da malaria grave e complicada: condutas prática / Management of severe and complicated malaria: practical guidelines

El paludismo sigue planteando un importante problema sanitario en muchas partes del mundo, ya que pasan de 2000 millones las personas que están expuestas a la infección en un centenar aproximadamente de países. Cualquier demora en el tratamiento del paludismo por falciparum--que es la forma más grave de la enfermedad--puede traducirse en un deterioro grave del estado del paciente, con aparición de diversas complicaciones potenciamente mortales

En esta guía se dan orientaciones prácticas sobre el diagnóstico y el tratamiento del paludismo grave y complicado. Después de exponer los cuidados de enfermería general que necesitan estos pacientes, se analizan las posibles complicaciones (anemia, insuficiencia renal, hipoglucemia y edema pulmonar) y se dan consejos concretos y concisos acerca del tratamiento. La guía está destinada principalmente a médicos y demás personal de salud con responsabilidad en hospitales u otros establecimientos sanitarios dotados de camas para atender a los pacientes en los paises con paludismo endémico, pero también será de utilidad práctica para los que ejercen en zonas no endémicas, obligados cada vez más a asistir a enfermos infectados durante un viaje por una zona palúdica

The chemotherapy of onchocerciasis. XIII. Studies with ivermectin in onchocerciasis patients in northern Ghana, a region with long lasting vector control.

One hundred and ninety eight patients with moderate to heavy infections with Onchocerca volvulus were randomly assigned to receive single doses of 100, 150 or 200 mcg/kg of ivermectin or matching placebo capsules. Detailed systemic, ocular and parasitological examinations were carried out at intervals over a period of one year. Nodules were excised twelve months after treatment to evaluate the effect of the treatment with ivermectin in adult O. volvulus. The three ivermectin-treated groups produced massive reductions in skin microfilariae (over 97%) with low levels being maintained over one year. The 150 and 200 mcg/kg doses were however superior to the 100 mcg/kg dose in achieving a greater reduction in skin microfilarial counts initially and in maintaining significant lower levels throughout the period of observation. There was no difference between the 150 and 200 mcg/kg doses at anytime. The three ivermectin doses were equally effective in the clearance of ocular microfilariae. The proportion of dead adult worms was very high in all treatment groups, which is effected by the successful ten years lasting vector control in northern Ghana. In spite of this superannuation of the worm population, an impact of the treatment with ivermectin on the reproductivity of the parasite could be shown. Systemic total clinical reaction was mild and was similar in the ivermectin treated groups. However, severe symptomatic postural hypotension (SSPH) was limited to patients treated with 150 or 200 mcg/kg of ivermectin. Ocular reactions were mild in all patients and no ocular deficiency occurred.(ABSTRACT TRUNCATED AT 250 WORDS)

Inter-subject variability in the metabolism of proguanil to the active metabolite cycloguanil in man.

1. The metabolism of proguanil to the active metabolite cycloguanil has been evaluated in 135 British Troops and 26 Kenyan schoolchildren. 2. Large inter-subject variability was observed in both plasma and urinary concentrations of proguanil and cycloguanil after standard doses of drug. 3. Based on the ratio of proguanil to cycloguanil (P/C) in urine the British troops formed a non-normal distribution. 90% of the population formed a discrete distribution with P/C ranging from 0.5 to 9.0 while the remaining 10% were scattered throughout the distribution to an extreme value of 39. A similar pattern of variability was observed using P/C from a 6 h plasma sample. 4. This variability was due to differences in the ability of individuals to metabolise proguanil to cycloguanil. 5. Thirteen schoolchildren who had experienced malaria during prophylaxis with proguanil and thirteen matched controls each received proguanil (100 mg). We could not discriminate between the two groups based on P/C ratio in either a 6 h plasma or 0-6 h urine sample.

Malaria--an overview.

The epidemiology, clinical features, diagnosis, prognosis, management, chemotherapy and chemoprophylaxis of malaria are reviewed.

Efficacy of multiple-dose halofantrine in treatment of chloroquine-resistant falciparum malaria in children in Kenya.

Halofantrine hydrochloride given to 46 Kenyan children with falciparum malaria at 10 mg/kg for two doses, and to 60 other children at 8 mg/kg for three doses, resulted in rapid parasite clearance, mean parasite clearance times being 45.4 h and 54.8 h, respectively. In-vitro chemosensitivity tests showed that most infections were due to chloroquine-resistant parasites, and that parasite maturation was inhibited by considerably lower concentrations of halofantrine than of chloroquine.

Clinical trials with halofantrine hydrochloride in Malawi.

Two clinical trials of the phenanthrene methanol compound halofantrine in the treatment of Plasmodium falciparum were conducted in Malawi, in areas where the parasite was known to be chloroquine resistant. In the first trial all 46 patients had symptoms of malaria and parasite densities ranging from 2500/microliter to 212,000/microliter. They were given a single dose of halofantrine hydrochloride, 16 mg/kg body weight. The recrudescence rate on day 14 of follow up was unacceptably high (38%). In the second trial the dose given was 8 mg/kg 6 hourly for three doses. Of the 49 children followed up for 14 days, 47 became aparasitaemic--ie, the cure rate was 96%. In both trials the drug was very well tolerated. Halofantrine hydrochloride seems to be effective against P falciparum chloroquine sensitive and resistant strains in Africa.

Clinical trials with halofantrine hydrochloride in Malawi

Two clinical trials of the phenanthrene treatment of Plasmodium falciparum were conducted in Malawi; in areas where the parasite was known to be chloroquine resistant. Of 49 children followed up for 14 days; 47 became aparasitaemic -ie; the cure rate was 96 percent. In both trials the drug was very well tolerated. Halofantrine hydrochloride seems to be effective against P. falciparum chloroquine sensitive and resistant strains in Africa

The chemotherapy of onchocerciasis. XII. The prediction of microfilarial loads in patients with onchocerciasis after treatment with diethylcarbamazine in northern Ghana.

This paper presents some statistical problems of analysing changes in patterns of microfilarial loads in onchocerciasis patients after chemotherapeutic treatment. Analyses are made of a pooled set of data from ten separate studies of diethylcarbamazine (DEC) conducted at the Onchocerciasis Chemotherapeutic Research Centre, Tamale, between 1978 and 1983. Regression models of microfilarial load at different intervals post-treatment are fitted with initial microfilarial load, total dose of DEC, duration of treatment and age of the patient as the independent variables. Appropriate transformations of the variables are chosen by examination of plots of residuals for violations of the assumptions underlying the regression models. A dose response curve for DEC is produced.