Captopril-induced agranulocytosis: a case report

1,000 refugees living in Strasbourg have had a stoll parasitologic exam between 1986 and 1990. We have not retained results of South America and other areas of Asia subjects because of their scarce total number. Proportionally, the most numerous are the South East Asia Nationals (51.7%); followed by those from Middle East and Africa (20 and 15.5%) and more recently by those from East of Europe (5.2%). Their parasitic infestation's rate remains important (60.9%) but variable depending on their origin. Thus, people coming from Middle East and Africa are parasited mainly by protozoan, although those from South East Asia are parasited by helminths. It's interesant to notify that the prevalence of D. fragilis is ten times higher among East European people than in the common people.     

Practices and beliefs of traditional birth attendants: lessons for obstetrics in the north?

The majority of mothers in countries in Africa, Asia and Latin America are supported by Traditional Birth Attendants (TBAs) during pregnancy and childbirth. TBAs do more than just deliver babies. As part of the local community they are acquainted with the women and their families with whom they share the cultural ideas about how the birth has to be prepared for and performed. They know the local medicines and rituals which are used before, during and after delivery. The work of the TBAs is adapted and strictly bound to the social and cultural matrix to which they belong, their practices and beliefs being in accordance with the needs of the local community. Therefore they may not be able to assist women at childbirth outside their own socio-cultural environment. Comparison of the practices and beliefs of TBAs in Africa, Asia and Latin America revealed a large variation among the different cultures of the three continents. Surprisingly, in spite of the cultural differences there were clearly some common practices and beliefs which may occur in all three continents. It is assumed that these common practices are due to the expression people give to the basic events of life such as pregnancy, labour and lactation. A short review of common practices is presented as they may be of value in obstetrical practice in the northern countries.     

Brain enzyme activities after intracerebroventricular injection of streptozotocin in rats receiving acetyl-L-carnitine

BACKGROUND: Scant data exists on melanoma in blacks from Africa. This study was undertaken to define factors affecting outcome of blacks from South Africa with melanoma. STUDY DESIGN: A retrospective analysis of the management and outcome of 63 black patients with malignant melanoma treated at a major referral center during a 14 year period is presented. Data evaluated included patient demographic and clinical characteristics, stage at presentation, tumor site, histologic type, treatment, and subsequent cure. Survival curves were calculated for stage and site of disease. RESULT: The mean age at presentation of the 39 women and 24 men was 60.5 years (range of 30 to 85 years), with a peak incidence in the sixth decade. The foot was the most common site of disease (45 patients). Seven patients had subungual melanoma, seven had primary mucosal lesions, and in six, the primary lesion could not be found. Thirty patients presented with stage I disease, two with stage II, 23 with stage III, and nine with disseminated metastatic disease. Acral lentiginous melanoma was the most common histogenetic type (34 patients), nodular melanoma occurred in ten patients, and superficial spreading melanoma occurred in three patients. The mean Breslow depth was 6.15 mm (range of 1 to 25 mm). Patients with localized disease were treated by wide local excision and split skin graft, while patients with melanoma in the nailbed were treated by amputation of the involved digit. Sixteen patients are alive after a mean follow-up period of 82.1 months, 44 have died after a mean of 12.7 months, and five patients have been unavailable for follow-up evaluation. CONCLUSIONS: The poor prognosis in black patients in South Africa is the result of delayed presentation with thick primary lesions and advanced disease. An active education program may reduce mortality by detecting the disease earlier.     

The dermal and naso-pharyngo-oral leishmaniasis (author's transl)

The naso-pharyngo-oral leishmaniasis is not limited to South America. Cases have been reported in Africa showing that its prevalence in this area has been underrated. Its diagnosis is easy and early treatment will prevent facial lesions.     

Pyramido-lunar fusion in black Africans. Apropos of 32 cases

Lunotriquetral coalition is a congenital carpal anomaly rarely discovered in a white population. In the black population, most cases have concerned blacks in America, Australia and South Africa. In the Sub-Saharia area, in Senegal, the authors, after 8 incidental cases, report 32 lunotriquetral coalitions collected in 20 patients. This retrospective study comparatively analysed 361 X-rays of the wrist performed between February 1989 and July 1992 in the Orthopaedic and Traumatologic Center (CTO) in Dakar. The bony coalition was bilateral in 12 patients and unilateral in the other 8 cases. The complete form (type III) was the most frequent (46.8%). In the bilateral forms, 5 patients presented this complete form. Lunotriquetral coalition was associated, in absence of congenital abnormalities, with a synovial cyst of the wrist (2 cases), scaphoid fracture (1 case), non-union of a scaphoid fracture (1 case) and osteoarthritis of the wrist (2 cases). After review of the literature, the authors discuss racial factors, anatomo-radiographic forms and associated injuries.     

What is the infant mortality rate in South Africa? The need for improved data

OBJECTIVE: To review recent infant mortality and birth registration data in South Africa and to investigate geographical differences. OUTCOME MEASURES: Estimates of infant mortality rates, proportion of births not registered, and proportion of births recorded in health services. METHODS: 1. Published infant mortality data for South Africa were collated. Demographic data from national household surveys (1993 and 1994 October Household Surveys and the 1993 Poverty Survey by the Southern African Labour and Development Research Unit (SALDRU) at UCT) were analysed using the indirect method developed by Brass. 2. Birth registration data were analysed and compared with the estimated number of births to identify regions with greater under-registration. The number of births recorded in the health services was analysed by province in order to assess and explore alternatives within health authorities that could complement the existing system. RESULTS: 1. Published estimates of infant mortality for the period from 1990 range from 40 to 71/1,000 births and estimates based on national household surveys conducted in this period from 11 to 81/1,000 births. 2. Completeness of birth registration in the nine provinces ranges from less than 10% in the Eastern Cape, North West and Northern Province to 60% in the Western Cape. An overall improvement from 19% to 60% could be achieved if births recorded through the health services were included in the vital registration system. CONCLUSIONS: The infant mortality rate in South Africa is not known with any certainty. The extent of completeness of the birth registration system was 19%, which indicates a need for urgent improvement in order to provide key health status indicators. This study indicates that there is some potential for improving the extent of birth registration if it could be facilitated through the health service. However, this alone would not achieve complete registration. RECOMMENDATIONS: Surveys will have to be relied upon until such time as routinely available statistics are accurate. The October Household Survey conducted annually by the Central Statistical Service as potentially an important source of health status information. It is imperative that either the design of the birth history questionnaire be improved or that it be replaced by a less frequent but more specialised demographic and health survey.     

南非深井岩爆控制技术与中国引进应用评述

南非拥有世界上开采深度最深的矿井和先进的深井开采技术.叙述了南非Driefontein金矿地质及开采简况,详细介绍了南非深井岩爆控制技术(行为规范)主要特点及综合地震监测系统在Driefontein金矿的应用情况.简要总结了中国冬瓜山铜矿自引进该系统对于开展地震(岩爆)监测技术应用以来所取得的主要经验.     

International Humanitarian Award: Michael G. Wessells.

Michael G. Wessells, recipient of the International Humanitarian Award, is cited for his pioneering and sustained contributions to the protection of children affected by armed conflict and to the development of international guidelines for the provision of community-based, culturally responsive psychosocial support in emergencies. Wessells has served as an eminent professor, researcher, and author, developing and promoting the most advanced strategies for providing psychological support for children and families. He has contributed extensively to peace and reconciliation efforts and has provided direct humanitarian services in conflict areas in Asia, Africa, Central America, Europe, and South America, where his efforts on behalf of children often placed him in personal jeopardy. In addition to the citation, a biography and selected bibliography of Wessells' works are provided. Also included is Wessells' paper, entitled "Do no harm: Toward contextually appropriate psychosocial support in international emergencies," a version of which was presented at the American Psychological Association's annual convention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dengue: a re-emerging disease. A clinical and epidemiological study in 57 Spanish travelers

Dengue infection is nowadays considered a re-emergent disease. It has a worldwide tropical and subtropical distribution. The dengue virus in a member of the flavivirus family composed by 4 different serotypes. The virus is transmitted by mosquitos of the Aedes genus. With the increment of travels to the endemic areas, dengue is now observed frequently in our country. We analyzed 57 patients, 30 with imported dengue (ID) and 27 with dengue fever suffered during the trip (DDT). This series is compared with other published ones and a review of the subject is presented. Patients with ID followed a protocol as a febril syndrome returning from the tropics. Dengue was diagnosed through a compatible clinico-epidemiological history, the absence of other ferbil illness and positivity of specific serology. All patients had travelled to endemic areas (Central America 28 cases, Indian subcontinent 15, South-East Asia 10, South America 2, West Africa one, and Pacific one). The following were the most important clinical characteristics: fever and asthenia (100%), headache (98%), mialgia (84%), arthralgia (72%), morbilliform rash (61%) and retroocular pain (65%). For ID cases, the most helpful analitical results were: leucopenia (70%), reactive lymphocytes in peripheral blood smear (70%), thrombocytopenia (70%), and increased hepatic enzymes ALAT (53%), ASAT (63%) and LDH (100% in the 7 patients tested for this enzyme). Dengue must be included in differential diagnosis of fever in patients coming back to travels to tropical areas.     

Diversity components of impending primate extinctions

Many extant species are at risk to go extinct. This impending loss of species is likely to cause changes in future ecosystem functions. Ecological components of diversity, such as dietary or habitat specializations, can be used to estimate the impact of extinctions on ecosystem functions. As an approach to estimate the impact of future extinctions, we tested interdependency between ecological and taxonomic change based on current predictions of extinction rates in primates. We analyzed the ecological characteristics of extant primate faunas having species in various categories of endangerment of extinction and forecasted the future primate faunas as if they were paleontological faunas. Predicting future faunas combines the wealth of ecological information on living primates with large, fossil record-like changes in diversity. Predicted extinction patterns of living primates in Africa, Asia, Madagascar, and South America show that changes in ecology differ among the regions in ways that are not reducible to taxonomic measures. The ecological effects of primate extinctions are initially least severe in South America and larger in Asia and Africa. Disproportionately larger ecological changes are projected for Madagascar. The use of taxonomy as a proxy for ecology can mislead when estimating competence of future primate ecosystems.     

Cerebral hypoperfusion and leukomalacia

Tunga penetrans is a burrowing flea that is prevalent in Central and South America, the Caribbean, tropical Africa, India, and Pakistan, and rarely is imported to the United States. Tungiasis results from the cutaneous infestation of humans by the gravid female flea, T. penetrans. We report a case of tungiasis in a female who had been on a missionary expedition along the Brazilian Amazon River. The clinical presentation, life cycle, differential diagnosis, military and historical aspects, and treatment are discussed.     

Feedback systems for nontraditional medicines: a case for the signal flow diagram

The signal flow diagram is a graphic method used to represent complex data that is found in the field of biology and hence the field of medicine. The signal flow diagram is analyzed against a table of data and a flow chart of data and evaluated on the clarity and simplicity of imparting this information. The data modeled is from previous clinical studies and nontraditional medicine from Africa, China, and South America. This report is a development from previous presentations of the signal flow diagram.1-4     

Oral submucous fibrosis. The South African experience

A review of research related to oral submucous fibrosis (OSF) among South Africans of Indian descent shows a certain uniqueness compared to other countries. In South Africa the betel habit is more common among women, only 60% of chewers prefer the betel quid while the rest like the nut by itself, the majority of chewers prefer the baked (black) nut variety and a minority add tobacco to their chew. This pattern reflects in the distribution of OSF and the practice of the habit by OSF subjects. Compared to chewers without OSF, OSF subjects are younger and have shorter histories of chewing. Yet the profile of systemic diseases were similar among subjects with and without OSF. The habit as practised in South Africa also determines the pattern of oral squamous carcinomas. They are more common in women, with buccal mucosa cancers being the most frequent. The latter are commonly found in subjects not using any tobacco, indicating the carcinogenicity of the areca nut. It was also shown that oral cancer can develop in chewers without an intermediate precancerous OSF phase. A follow-up of OSF cases after cessation of the habit revealed that once present the disease is permanent. An analysis of cultured OSF fibroblasts demonstrated a permanent shift to larger cells theoretically capable of producing larger amounts of collagen. Thus the agents in the nut could be the initiators of the disease and its permanent character the result of a phenotypic alteration in cells from changes in gene expression.     

The direct and indirect costs of cardiovascular disease in South Africa in 1991

BACKGROUND: In South Africa, cardiovascular disease (CVD) is the leading cause of death among all population groups, other than blacks, among whom it ranks third. CVD therefore has a severe impact on the South African economy. OBJECTIVES: To ascertain the availability and quality of South African data on the cost of CVD and to estimate the impact of CVD on the South African economy during 1991. METHODS: The direct health care costs and the indirect costs related to loss of productivity were estimated. Where no direct or complete detailed South African data were available, projections were made based on reasonable assumptions of data and models developed in other countries; these were applied to the limited available South African data. The major disease outcomes considered for this cost estimation were: expenditure on ischaemic heart disease, cerebrovascular disease (stroke), venous thrombosis and embolism, and peripheral vascular diseases and related conditions. These diseases are responsible for the majority of fatal cases of CVD reported in South Africa. RESULTS: The estimated total cost of CVD in South Africa in 1991 was between R4.135 billion and R5.035 billion. This does not include the cost of rehabilitation and follow-up of CVD patients since the necessary data were not available to estimate it. About three-quarters of the direct health care costs were carried by the private sector. The direct health care costs were estimated to be approximately 42% of the total cost. The rest reflects the indirect cost of earnings foregone as a result of premature morbidity and mortality. CONCLUSION: To determine accurately the total economic burden of CVD on the South African economy, additional data will have to be collected. The estimated economic burden of CVD in South Africa clearly highlights the need for a broad-based population strategy, part of an overall national effort to prevent, diagnose and cost-effectively treat CVD.     

Spotted fever after travel to South Africa

Three patients developed fever, malaise and a typical maculopapular rash a few days after returning to Norway from South Africa. In South Africa they had been bitten by ticks several times while hunting. Two patients, with lesions compatible with eschar, were hospitalized, and a diagnosis of rickettsial spotted fever was established based on the clinical presentation and positive Rickettsia conorii serology. Rickettsial diseases are extremely rare in Scandinavia, and a survey on rickettsioses is presented in this paper.     

Cross-cultural consultation in a South African cancer setting.

Describes a project involving an international cross-cultural health psychology consultation with American consultants assisting highly educated, urban Afrikaner medical and health care professionals in enhancing the cancer treatment provided primarily to rural, low-income Zulu, Tswana, and Pedi patients in South Africa. Today, South Africa struggles with the meaning of equality, not only in a political sense but also in terms of health care, education, and employment. Building a bridge of conversation and cultural understanding between the health care profession and traditional patients is a crucial 1st step to delivery of improved medical services in South Africa. This article is divided into 4 sections. The 1st describes the very rapidly changing context of medical care provision in South Africa. The 2nd presents 2 important. cross-cultural perspectives: the 5-dimensional research model of G. Hofstede (1991) and key consultee dimensions as informed by multicultural psychology. In addition, the program and process models of consultation are outlined. In the 3rd section, details of the project are conveyed, and in the 4th section a summary of implications and recommendations for other consultants interested in similar types of consultation is presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pulmonary melioidosis

Melioidosis is the name given to all diseases caused by the bacterium Pseudomonas pseudomallei. Melioidosis is a tropical disease and prevails in parts of Southeast Asia, northern Australia, and Central and South America. However, in recent years, cases of melioidosis have been reported in the United States and other areas. The organism can infect any organ system, although the lung is the most common organ affected. Pulmonary melioidosis presents either as an acute fulminant pneumonia or as an indolent cavitary disease. In northeastern Thailand, the incidence of P pseudomallei infection is extremely high with significant mortality. One of the key problems with treating melioidosis is its recalcitrance to therapy and high relapse rate. In addition, this Gram-negative rod is resistant to aminoglycosides. In nonendemic regions, patients with melioidosis more typically present with reactivation disease occurring months to years after initial exposure to the organism. The pulmonary disease is mainly in the apices and resembles tuberculosis. With the increasing mobility of people throughout the world and the influx of immigrants from endemic to nonendemic areas, it is important that clinicians be aware of this disease. This article will review the epidemiology, clinical presentations, diagnosis, and treatment of pulmonary melioidosis.     

Ethical codes in South African psychology: Contribution of the Canadian code.

Discusses the regulation of professional psychology in South Africa, and the changes that professional psychology associations there have undergone. The author discusses the Psychological Society of South Africa's review of its outdated ethical code and states that the Canadian Code of Ethics for Psychologists is a major model for the development of a new code. (PsycINFO Database Record (c) 2010 APA, all rights reserved)