A socioenvironmental composite index as a tool for identifying urban areas at risk of lymphatic filariasis.

OBJECTIVE: To describe the spatial distribution of lymphatic filariasis and its relationship with the socioenvironmental risk indicator, thus identifying priority localities for interventions in endemic urban areas. METHODS: The study area was the municipality of Jaboatão dos Guararapes, State of Pernambuco, Brazil. The data sources were a parasitological survey and the 2000 demographic census. From these data, a socioenvironmental composite risk indicator was constructed using the 484 census tracts (CT) as the analysis units, based on the score-formation technique. Census tracts with higher indicator values presented higher risk of occurrences of filariasis. RESULTS: Six thousand five hundred and seven households were surveyed and 23 673 individuals were examined, among whom 323 cases of microfilaremia were identified. The mean prevalence rate for the municipality was 1.4%. The indicator showed that 73% (237/323) of the cases of microfilaremia were in high-risk areas (third and fourth quartiles) with worse socioenvironmental conditions (RR = 4.86, CI = 3.09-7.73, P < 0.05). CONCLUSIONS: The socioenvironmental composite risk indicator demonstrated sensitivity, since it was able to identify the localities with greater occurrence of infection. Because it can stratify spaces by using official and available data, it constitutes an important tool for use in the worldwide program for eliminating lymphatic filariasis.

Acute attacks in the extremities of persons living in an area endemic for bancroftian filariasis: differentiation of two syndromes.

The natural history of lymphatic disease in human filariasis remains unclear, but recurrent episodes of acute lymphangitis are believed to constitute a major risk factor for the development of chronic lymphoedema and elephantiasis. Prospective analysis of 600 patients referred to the filariasis clinic of the Centro de Pesquisas Aggeu Magalhães/FIOCRUZ in Recife, Brazil, indicated that 2 distinct acute syndromes accompanied by lymphangitis occur in residents of this filariasis-endemic area. One syndrome, which we call acute filarial lymphangitis (AFL), is caused by the death of adult worms. It is relatively uncommon in untreated persons, usually is asymptomatic or has a mild clinical course, and rarely causes residual lymphoedema. The second syndrome, of acute dermatolymphangioadenitis (ADLA), is not caused by filarial worms per se, but probably results from secondary bacterial infections. ADLA is a common cause of chronic lymphoedema and elephantiasis in Recife as well as in other areas of Brazil where lymphatic filariasis is not present. The syndromes of AFL and ADLA can be readily distinguished from each other by simple clinical criteria.

Risk alleles for multiple sclerosis in multiplex families.

OBJECTIVE: We assessed the hypotheses that non-major histocompatibility complex multiple sclerosis (MS) susceptibility loci would be common to sporadic cases and multiplex families, that they would have larger effects in multiplex families, and that the aggregation of susceptibility loci contributes to the increased prevalence of MS in such families. METHODS: A set of 43 multiplex families comprising 732 individuals and 211 affected subjects was genotyped for 13 MS candidate genes identified by genome-wide association. A control data set of 182 healthy individuals was also genotyped to perform a case-control analysis alongside the family-based pedigree disequilibrium association test, although this may have been underpowered. RESULTS: An effect of the IL2RA and CD58 loci was shown in multiplex families as in sporadic MS. The aggregate of the IL2RA, IL7R, EVI5, KIAA0350, and CD58 risk genotypes in affected individuals from multiplex families was found to be notably different from controls (chi(2) = 112, p = 1 x 10(-22)). CONCLUSIONS: Although differences between individual families can only be suggested, the aggregate results in multiplex families demonstrate effect sizes that are increased as compared with those reported in previous studies for sporadic cases. In addition, they imply that concentrations of susceptibility alleles at IL2RA, IL7R, EVI5, KIAA0350, and CD58 are partly responsible for the heightened prevalence of multiple sclerosis within multiplex families.

The epidemiological delimitation of lymphatic filariasis in an endemic area of Brazil, 41 years after the first recorded case.

In 2002, the status of lymphatic filariasis (LF) in the district of Jaboatão, in north-eastern Brazil, was reviewed, 41 years after the first case of the disease was recorded in the area. Current data from Jaboatão were compared with older information from the district that had been published, as official reports on filariasis cases and mosquitoes and as the result of population surveys, between 1948 and 1997. Although the first microfilaria-positive cases were detected in the district in 1959, it was not until 1993 that the national Ministry of Health categorized Jaboatão as an endemic area. In 2002, fingerprick samples of blood, each of about 50 microl, were collected at night (23.00-01.00 hours) from 4365 individuals in the district and used to make thick smears. Microfilariae were detected in the smears of blood from 33 (0.8%) of the subjects, 12 of whom were considered autochthonous cases of LF. The male subjects were significantly more likely to be microfilaraemic than the female (1.1% v. 0.4%; P<0.05) but there was no direct relationship between prevalence and age, the microfilaraemics varying in age from 6-64 years. The Socorro sub-district had the highest prevalence, of 2.9%. It is recommended that the National Programme to Eliminate Filariasis uses mass drug administrations and vector control throughout the district, regardless of the prevalences recorded in the latest survey.

Cavernosometria de gravedad versus cavernosometria de bomba en la difuncion erectil veno-oclusiva / Gravity versus pump cavernosometry in the veno-oclusive dysfunction

Todavía hay muchas controversias relacionadas con laevaluación de la disfuncion eréctil veno-oclusiva. Aunque la cavernosometría ha sido considerada el método de elección para este diagnóstico, el mejor procedimiento para tal fin permanece en discución. Para comparar los valores de la cavernosometría por gravedad y por bomba en el diagnóstico de la fuga venosa, evaluamos 42 pacientes, 12 voluntarios con función eréctil normal y 30 con disfunción eréctil. Estos pacientes fueron asignados a dosd grupos distintos. Un grupo fue evaluado mediante la cavernosometría de bomba seguida por la cavernosometría de gravedad (o gravimétrica); en el otro grupo los procedimientos fueron invertidos. El valor promedio de la presión de infusión durante la cavernosometría de gravedad fue de 111,5 cm H2O (con una variación de 100 a 120 cm H2O). Considerando los pacientes con una presión de infusión de 100 cm H2O o más alta que lo normal, hemos tenido una concordancia del 100 por ciento entre ambas cavernosometrías, sin importar cuál fue hecha primero. La cavernosometría de gravedad es un método sencillo y simple, con una buena relación costo-beneficio para el diagnóstico de la disfunción eréctil veno-oclusiva

Cavernosometria de gravedad versus cavernosometria de bomba en la difuncion erectil veno-oclusiva / Gravity versus pump cavernosometry in the veno-oclusive dysfunction

Todavía hay muchas controversias relacionadas con laevaluación de la disfuncion eréctil veno-oclusiva. Aunque la cavernosometría ha sido considerada el método de elección para este diagnóstico, el mejor procedimiento para tal fin permanece en discución. Para comparar los valores de la cavernosometría por gravedad y por bomba en el diagnóstico de la fuga venosa, evaluamos 42 pacientes, 12 voluntarios con función eréctil normal y 30 con disfunción eréctil. Estos pacientes fueron asignados a dosd grupos distintos. Un grupo fue evaluado mediante la cavernosometría de bomba seguida por la cavernosometría de gravedad (o gravimétrica); en el otro grupo los procedimientos fueron invertidos. El valor promedio de la presión de infusión durante la cavernosometría de gravedad fue de 111,5 cm H2O (con una variación de 100 a 120 cm H2O). Considerando los pacientes con una presión de infusión de 100 cm H2O o más alta que lo normal, hemos tenido una concordancia del 100 por ciento entre ambas cavernosometrías, sin importar cuál fue hecha primero. La cavernosometría de gravedad es un método sencillo y simple, con una buena relación costo-beneficio para el diagnóstico de la disfunción eréctil veno-oclusiva(AU)