Malaria: current status of control,diagnosis, treatment,and a proposed agenda for research and development

Rolling back malaria is possible. Tools are available but they are not used. Several countries deploy, as their national malaria control treatment policy, drugs that are no longer effective. New and innovative methods of vector control, diagnosis, and treatment should be developed, and work towards development of new drugs and a vaccine should receive much greater support. But the pressing need, in the face of increasing global mortality and general lack of progress in malaria control, is research into the best methods of deploying and using existing approaches, particularly insecticide-treated mosquito nets, rapid methods of diagnosis, and artemisinin-based combination treatments. Evidence on these approaches should provide national governments and international donors with the cost-benefit information that would justify much-needed increases in global support for appropriate and effective malaria control.     

Disclosing a dementia diagnosis: a review of opinion and practice, and a proposed research agenda

PURPOSE: The ethical and practical issues in disclosing a dementia diagnosis remain subjects of some debate. In this review of the literature we document previous opinion and practice in the area of diagnostic disclosure. DESIGN AND METHODS: We identified sources for this review with a MEDLINE and PsycINFO database search, followed by collection of additional articles from reference lists. RESULTS: Across sources we were able to identify a broad list of arguments both for and against diagnostic disclosure. We briefly discuss some of the ethical principles that undergird those reasons. IMPLICATIONS: Practice guidelines and professional opinion regarding disclosure appear to depart from the actual experience reported by clinicians, patients, and family members. At a more detailed level, process issues in disclosure, such as who is told, how and what they are told, and the impact of disclosure, are poorly understood. Sensitivity to individual differences may promote an optimal approach to disclosure. Research in this area is sparse and often contradictory, and throughout the review we propose research questions that, when answered, could clarify issues in disclosure that are essential to sound dementia care.     

Visceral leishmaniasis: a difficult diagnosis and unusual causative agent.

In a young man who had a prolonged fever of unknown origin, hepatosplenomegaly, and progressive pancytopenia, stained smears, blood-agar cultures of bone marrow, and serologic testing for antileishmanial antibodies were negative. Biopsies from liver and bone marrow were uninformative. Visceral leishmaniasis was diagnosed only after splenectomy, when amastigotes were finally cultured from the spleen. The parasite was shown to be an unusual leishmanial parasite, possessing a mixture of intrinsic biochemical and serologic characteristics displayed independently by Leishmania tropica and Leishmania donovani sensu lato, the latter being the usual cause of visceral leishmaniasis. After splenectomy, parasites were also demonstrated in stained bone marrow aspirate smears. Recovery was uneventful after treatment with antimony for 28 days. Visceral leishmaniasis can be a cause of fever of unknown origin and should be considered in its differential diagnosis in endemic areas.     

Visceral leishmaniasis: a case report

Visceral leishmaniasis is diagnosed in a Thai worker returning home from the Middle East. A 39-year-old Thai male who had abdominal swelling, weight loss, hepatosplenomegaly and hyperglobulinemia, was diagnosed by demonstration of organism in liver biopsy and bone marrow aspiration specimen. Amphotericin B was administered in this case.     

From advance directives to advance care planning: current legal status, ethical rationales and a new research agenda

This paper uses a case example to review the current legal status of advance directives, as well as their ethical rationale. We draw attention to ongoing efforts to institutionalize advance directives, and to some of the tractable and intractable reasons why advance directives are ineffective. We then introduce the concept of advance care planning, and argue that we should not assume that advance care directives have a place in this process. We conclude by offering three reasons why this assumption may operate, and by suggesting that contingency and uncertainty may sometimes overwhelm all rational approaches to medical care.     

Visceral leishmaniasis in Brazil: revisiting paradigms of epidemiology and control

In the last 20 years, despite the known underestimation of cases, Brazil registered a marked increase in the incidence of visceral leishmaniasis. The main goal of this review is to reflect on some aspects of this zoonosis in Brazil and also to encourage the discussion in order to find more viable, effective and affordable strategies to be implemented by the Brazilian Leishmaniasis Control Program. The current situation of visceral leishmaniasis in Brazil might be seen as a paradox: the most important aspects of the disease are known, but so far the control of this disease has not yet been achieved. The current control strategies have not been able to prevent the geographical expansion, and even a rise in the incidence and lethality of visceral leishmaniasis. There is a need not only for a better definition of priority areas, but also for the implementation of a fieldwork monitoring system to the disease surveillance that could permit a further evaluation of the control program in areas where visceral leishmaniasis is endemic.     

Aging, culture and control: setting a new research agenda.

In the context of reviewing the current status of research on aging and control, we put forth five propositions: (1) Striving for primary control is a human universal invariant across historical time and diverse cultural settings; (2) the expression of control striving is in part shaped by culture; (3) the field needs to move away from the study of perceived control and its correlates to the study of motivational aspects of control; (4) control should be studied in a life span context and the focus should be on key transitions that redefine opportunities for control striving; and (5) inasmuch as primary control striving is such a central element of human functioning, research on its demise at the end of life should receive high priority.     

注射疗法治疗直肠脱垂的研究现状

注射疗法是目前治疗直肠脱垂的一项重要方法.常用的注射药物有酒精、50%葡萄糖、石碳酸杏仁油、5%鱼肝油酸钠、明矾注射液、芍倍注射液、消痔灵注射液等.注射方法有直肠黏膜下层注射法、直肠周围注射法、双层四步注射法,以及点状注射法、柱状注射法与扇形注射法等多种,注射疗法国外多用于婴幼儿及不完全性直肠脱垂,国内运用于各种直肠脱...     

Visceral leishmaniasis in a patient with systemic lupus erythematosus: Dilemma in diagnosis and management

Patients with systemic lupus erythemasus (SLE) have an increased risk of bacterial, viral, fungal or parasitic infections, especially if they are receiving immunosuppressive therapy. Leishmaniasis is a group of diseases caused by intracellular flagellate protozoan parasites belonging to the genus Leishmania. We present a 48-year-old female patient, diagnosed with SLE many years ago, who presented with high fever and pancytopenia. We thought that the patient's hematologic findings were related to SLE hematologic involvement. However, we investigated other possible causes when there was no response to drugs for the treatment of SLE. A second bone marrow biopsy showed Leishmania amastigotes and the patient was diagnosed with leishmaniasis. The patient was treated with liposomal amphotericin-B (treatment completed at 40 days). She showed rapid clinical improvement and showed no signs of disease after 4 months.     

Visceral leishmaniasis in pregnancy: a case report

Visceral leishmaniasis (VL) is endemic in the island of S?o Luis, State of Maranh?o, Brazil. Despite an increase in the number of VL cases, the frequency of the disease is low among pregnant women. We present here the case of a pregnant woman followed up by our group, who was treated with amphotericin B with excellent outcome.     

Amebiasis: introduction, current status, and research questions

This series of five papers on the worldwide problem of amebiasis, its current status, research needs, and opportunities for progress has grown out of a renewal of investigative interest in amebiasis. The recent development of in vitro culture methods and of means to distinguish strain differences and the application of modern tools of cellular biology and biochemistry have raised new questions regarding strain definitions, virulence traits, host defenses, and the mechanism of invasive disease sometimes caused by Entamoeba histolytica. The clinical manifestations of amebic infections range from prolonged asymptomatic carriage to extensive, invasive intestinal and extraintestinal disease. The virulence traits of the parasite, whether stable in each strain or alterable by environmental or genetic factors, and the host factors involved in the development of disease and in protection have been investigated. From this series of reviews on the definition of amebiasis, its manifestations, its global magnitude, the methods for its detection, and the current understanding of its epidemiology, pathogenesis, cellular biology, and host defenses, a list of key questions that can now be addressed in work on amebiasis has been derived. Amebiasis is the third leading parasitic cause of death in the world. The need for work in this field is great, and the time is ripe for the application of new research tools to a better understanding of this remarkable tissue-lysing protozoan parasite and to the control of the disease it causes.     

Visceral leishmaniasis and HIV in Tigray,Ethiopia

OBJECTIVES: To identify characteristics that increased the risk of mortality in Ethiopian visceral leishmaniasis patients in a treatment programme managed by Médecins sans Frontières, in Tigray, Northern Ethiopia. METHODS: Retrospective review of a cohort of 791 patients treated for visceral leishmaniasis. RESULTS: The cohort displayed all the classical signs and symptoms of the disease. The case fatality rate was 18.5% (146) (95% CI: 15.8-21.3%). Logistic regression showed that individuals who experienced at least one episode of vomiting or haemorrhage were more likely to die than those who did not. A subcohort of individuals who tested human immunodeficiency virus (HIV)-positive were more than four times more likely to die than those who tested HIV-negative (OR 4.5, 95% CI: 1.8-11.4). CONCLUSION: This study identifies characteristics associated with death in this population and highlights the devastating effect of co-infection with visceral leishmaniasis and HIV in the African context.     

Visceral leishmaniasis in southern Sudan: status of healthy villagers in epidemic conditions.

A combination of interview, serology and skin testing was used to investigate the status of apparently healthy villagers during a visceral leishmaniasis epidemic in southern Sudan. The number of people who had died equalled the number who were alive at the time of the survey. The direct agglutination test (DAT) identified 10% of the people as being serologically positive. Most young children (36/39) and 34% (22/64) of adults had neither positive serology nor skin test. About 64% (42/66) of adults had positive skin tests. In two villages, 54% and 76% of those over four years of age showed evidence of having been infected. The mortality associated with infection was estimated as at least 69%; 25% of those infected appeared to have cured spontaneously. The outcome for the remaining 6% was still doubtful. Even in this devastating epidemic there is, therefore, evidence of a considerable amount of infection without severe disease. Serological tests, while useful clinically, are apparently not useful for detecting early cases. Combined skin testing and serology produces a comprehensive though partially hypothetical picture.