利什曼病的防制

人体利什曼病的病原至少有利什曼属的13个种和亚种。这些利什曼原虫都是通过白蛉吸血从其它感染的人或哺乳动物传给人的。已有约80个国家有利什曼病的报告。每年的新病人可能有40万。利什曼病在临床上可分为3大类:内脏利什曼病,如不治疗,可导致死亡;皮肤利什曼病,常产生永久性面部损形;新世界的粘膜皮肤利什曼病,可产生严重的鼻、口、咽腔残缺,有时致死。由于各型利什曼病相互之间在流行学上有其本质上     

Western印迹分析可早期诊断流行区犬利什曼病

利什曼病的诊断一般依靠直接检查病原体、淋巴结或骨髓培养及血清学技术,如ELISA、Dot-ELISA、免疫荧光法(IFA)。活动期利什曼病因特异性抗体浓度较高易用血清学方法测出;但是抗体水平较低或接近临界值时,用血清学方法难以判断疾病的不同期。本文作者用Western印迹分析法能较好地解决这个问题。 在西班牙,犬的利什曼病较为流行,约有5％的犬感染利什曼原虫。作者从西班牙的利     

在巴西里约热内卢的美洲皮肤利什曼病和内脏利什曼病流行区对1,342头犬的调查

巴西里约热内卢城周围,有美洲皮肤利什曼病和内脏利什曼病的流行,两种利什曼病的病原体曾经鉴定为巴西利什曼巴西亚种和杜氏利什曼。作者在流行区内用加有PRMI的NNN培养基培养七天的巴西利什曼前鞭毛体制备的抗原作间接荧光试验(IFT),共检测了1,342头犬的抗利什曼抗体。试验用的抗犬免疫球蛋白(Ig)荧光结合物由圣保罗大学热带医学研究所提供。从犬耳用滤纸采集血液数滴,干后将每份滤纸血样置于0.7ml PBS(60°～80℃)内浸泡16小时,浸脱液相当于血清的1:40稀释度,而后再稀释一倍(1:80)。IFT为半定量法,试验以滴度1:40或1:40以上的为阳性。试验结果:在内脏利什曼病区内从脾脏内检出利什曼原虫的6头犬均阳性;从皮肤损害内检出病原体的14     

用套式PCR检测外周血、淋巴液和骨髓液诊断犬利什曼病

动物利什曼病在临床上和免疫学方面的表现多样,而且很多属于隐性感染,因而诊断比较困难。用于诊断利什曼病的传统方法有病原学检查(淋巴结、骨髓穿刺物镜检、培养或动物接种),免疫学检查(ELISA、Western印迹分析)和淋巴液、骨髓液的PCR。但是     

犬利什曼病：新的控制策略

本介绍了第二届犬利什曼病国际论坛的内容。     

犬利什曼病:新的控制策略

本文介绍了第二届犬利什曼病国际论坛的内容。     

皮肤组织印迹杂交法诊断犬利什曼病研究初报

用利什曼病原虫KDNA印迹杂交法对采自甘肃省文县黑热病流行区的30只家犬耳缘皮肤组织印迹样品进行杂交试验。结果30份犬样品中有8份呈现阳性反应,阳性率为26.7％。同时进行骨髓涂片检查,有5只犬查见原虫,阳性率为16.7％。以上两种方法的符合率达76.7％(23/30)。印迹杂交法具有特异性高,取材方便,快速和结果易于观察等优点,在诊断犬利什曼病中有一定应用前途。     

甘肃省武都县犬利什曼病的调查

武都县是甘肃省黑热病流行严重的地区。近年来黑热病发病人数逐年增加,1991年全县共发病82例,是1990年的2.34倍,发病人数跃居全省之首。据以往的调查证明,该地的黑热病流行与犬利什曼病有着密切的关系。为此,我们于1992年3～5月在武都县近年来黑热病发病人数较多的石门、桔柑、三河、透防和外纳五个乡进行了犬利什曼病的调查,现将结果报告如下。 一、一般情况 本次调查的五个乡皆分布在白龙江沿岸及其支流河谷地带,海拔1000米左右,气候属亚热带湿润地区。年均气温为14.5℃～15℃,山高谷深,洞穴石缝遍布,是野栖中华白蛉的良好孳生环境。     

Hypertension prevalence and control in Ulaanbaatar,Mongolia

This study examines the prevalence, awareness, treatment, and control of hypertension in Ulaanbaatar, Mongolia, using both the American Heart Association and conventional thresholds (130/80 and 140/90 mm Hg, respectively). In this randomized cross‐sectional study, two‐stage cluster sampling was used to obtain a sample of 4515 individuals aged ≥20 years. Hypertension was defined by the use of antihypertensives in the last 2 weeks or a blood pressure at or above the thresholds of 140/90 and 130/80 mm Hg. The mean age of the participants was 41.1 ± 14.0 years and 54.5% were women. Hypertension prevalence was 25.6% (using 140/90 mm Hg) and 46.5% (using 130/80 mm Hg). Prevalence increased with age and below 50 years men were consistently more likely to be hypertensive. Among hypertensive participants, the rates of awareness, treatment, and control were 69.7%, 46.8%, and 24.0% (using 140/90 mm Hg) and 49.1%, 25.8%, and 6.4% (using 130/80 mm Hg, respectively). Men had lower rates of awareness, treatment, and control compared with women, with the most pronounced differences at younger ages. This study shows that awareness, treatment, and control rates in Ulaanbaatar are better than in most low‐ and middle‐income countries but are still suboptimal. The largest “care gap” was in young men where a regulatory requirement for annual workplace blood pressure screening has the potential to enhance care. A major hypertension control program has just been initiated in Ulaanbaatar.     

Anaplastic thyroid cancer: prevalence, diagnosis and treatment

Anaplastic thyroid cancer (ATC) is a rare aggressive tumor arising from the follicular cells of the thyroid gland (as does well differentiated thyroid cancer, WDTC), but ATC cells do not retain any of the biological features of the original follicular cells, such as uptake of iodine and synthesis of thyroglobulin. Prognosis is almost invariably fatal. In this article the Authors review the pathology, epidemiology, clinical presentation, diagnosis and treatment options of ATC. ATC incidence typically peaks at the 6-7th decade of life (mean age at diagnosis 55-65 years), women representing 55-77% of all patients. ATC represents 2-5% of all thyroid tumors, with a decreasing trend with respect to the incidence of WDTC. The histologic patterns of ATC include giant-cell, spindle-cell and squamoid-cell tumors; these subtypes frequently coexist and are not predictive of patients' outcome. Immuno-cyto-chemistry for thyroglobulin is usually negative or weakly positive and some cases are also negative for keratin, particularly in the spindle-cell areas. ATC may arise de novo, but in most cases it develops from a pre-existing WDTC, especially the follicular subtype. Most ATC patients complain of local compressive symptoms, such as dysphagia, dysphonia, stridor and dyspnea in addition to neck pain and tenderness; in over 70% of the patients the tumor infiltrates surrounding tissues, such as fat, trachea, muscle, esophagus, and larynx. The clinical course of a rapidly enlarging mass that is firm and fixed to surrounding structures in an elderly patient is quite suggestive for ATC. Diagnosis can be confirmed by fine needle aspiration cytology or, in doubtful cases, by histology on core biopsy. Computed tomography (CT) scan and magnetic resonance imaging (MRI) are useful for defining the local extent of disease and for identifying distant metastases, as is also positron-emission tomography (PET) with [(18)F]FDG. Tracheoscopy and esophagoscopy should be performed every two months, or whenever patients refer the appearance or worsening of local symptoms. Bone scintigraphy may be included in the follow-up of patients with a longer survival and relatively good health. Because of its aggressive behavior, the latest American Joint Committee on Cancer Staging Manual classifies all ATCs as T4 and Stage IV tumors, regardless of their actual overall tumor burden. Treatment of ATC has not been standardized because it is not clear whether or not therapy is effective in prolonging survival; most patients die within six momths from diagnosis, primarily because of asphyxiation caused by local tumor invasion. When employed alone, surgery, radiotherapy, or chemotherapy are seldom adequate to achieve overall control of the disease, but a combination of these treatments may improve local control. Surgical treatment of local disease offers the best opportunity for prolonged survival if the tumor is intrathyroidal. When the tumor is extrathyroidal, the surgical approach to ATC is controversial. Some favourable results have recently been reported with newly developed chemotherapy agents and hyper-fractioned radiation therapy. Tracheostomy should be performed in patients with impending airway obstruction when death is not imminent from other sites of disease, and if patients are not candidates for local resection or chemoradiation. Interventional bronchoscopy, including Nd-YAG laser and airways stenting are alternatives to surgery in inoperable ATC-induced tracheal obstruction. Gene therapy is under investigation. Although very rare, ATC is a highly aggressive tumor that belongs to the group of killer tumors with median survival time not longer than 6-8 months. Surgery, chemotherapy and radiotherapy are the conventional therapeutic strategies performed in the attempt to improve survival. Unfortunately, very often they do not succeed any clinical benefit but only palliative RESULTS: New therapeutic strategies based on molecular approaches are desirable.     

von Willebrand's disease and menorrhagia: prevalence, diagnosis, and management

The reported prevalence of von Willebrand's disease (vWD) is increased in women with menorrhagia, with current estimates ranging from 5% to 20%. The consistent results of multiple studies suggest testing should be included in the evaluation of patients with menorrhagia, especially in unexplained cases and prior to surgical intervention. Although a cyclic variation in von Willebrand's factor levels has not been confirmed, several studies suggest lower levels during menses and the early follicular phase. Menorrhagia is one of the most common bleeding manifestations of von Willebrand's disease, reported by 60-95% of women afflicted with this bleeding disorder. Menorrhagia is typically severe, often resulting in anemia and interfering with quality of life. Despite the frequency of menorrhagia, there is no consensus on optimal management. Although oral contraceptives are frequently prescribed, there are no studies confirming their efficacy using objective measures of response. Desmopressin was associated with an 80-92% response rate in several uncontrolled studies relying on patient assessment of efficacy. However, a small, randomized trial found no significant reduction in menstrual blood flow compared with placebo. There are anecdotal reports of the successful use of antifibrinolytic agents alone and in combination with other therapies. There are no studies comparing the relative efficacy and safety of the available medical therapies for von Willebrand's disease associated menorrhagia. Until these studies are completed, treatment should be individualized based on von Willebrand's disease subtype, patient age, contraceptive needs, and personal preference.     

Hypertension in Delhi: prevalence, awareness, treatment and control

Two cross-sectional, population-based studies were conducted to assess the prevalence, awareness, treatment and control of hypertension, among people aged 20-59 years and those over 60 years in Delhi. Study 1 (20-59 years): in total,1213 subjects from 120 clusters spread across Delhi were studied. The prevalence of hypertension was 27.5%. Of the hypertensives, 53.3% were aware of their diagnosis; 42.8% were taking treatment and only 10.5% had controlled blood pressure. About 9.0% of the hypertensives had coexisting diabetes mellitus and 8.4% were suffering from coronary disease. The prevalence of hypertension was significantly higher in urban areas, but there was no significant difference in levels of awareness, treatment and control between urban and slum areas. The prevalence of hypertension was comparable in both sexes. Women, however, were more likely to be aware of their condition. Study 2 (> or =60 years): in total,1105 subjects from 110 clusters were studied. Prevalence of hypertension was 63.8%. Isolated systolic hypertension (ISH) was found in 15.3% of the subjects. About 54% of the hypertensives were aware of their diagnosis; 43.4% were taking treatment and only 8.5% had controlled blood pressure. Prevalence of hypertension and ISH were comparable among sexes. Women were more aware and better treated. About 21.3% hypertensives had coexisting diabetes mellitus, and 14.3% were suffering from coronary disease. There was no significant difference between sexes. Urban and slum areas were also found to be comparable. Over 3% of the elderly were controlling their raised blood pressure by non-pharmacological measures. They belonged to the 'aware' category yet could not be labelled as 'hypertensives', highlighting an operational fault in the Joint National Committee definition.     

Hypertension prevalence,control and survivorship in an Afro-Caribbean population

OBJECTIVE: To evaluate the prevalence, distribution, awareness, treatment and control of hypertension in an Afro-Caribbean population, and their relationship to 4-year survival.DESIGN Population-based prospective cohort study. SETTING AND PARTICIPANTS: Simple random sample of Barbados-born citizens (4709 persons; 84% participation), with 4-year follow-up. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Hypertension prevalence, awareness, treatment and control were evaluated at baseline. Four-year cumulative mortality was assessed by the product-limit method and relative risk of mortality by the Cox proportional hazards method. RESULTS: Mean systolic (SBP) and diastolic (DBP) blood pressure were higher among black than white participants. In the black population, age-specific prevalence of hypertension increased from 32.7% in men and 34.0% in women at 40-49 years of age to 63.4% in men and 85.5% in women at ages 80 years and older, with an overall prevalence of 55.4%. Hypertension awareness, treatment and control rates were 62.5, 53.8 and 18.5%, respectively. Compared to DBP 80 mmHg, the presence of a DBP between 80 and 84 mmHg, 100-109 mmHg and > or = 110 mmHg was associated with adjusted death rate ratios of 1.6, 1.7 and 2.0, respectively. Systolic blood pressure was not related to the risk of cardiovascular mortality, after adjustment for age or other potential confounders. Hypertensives were at modestly increased risk of 4-year cardiovascular mortality [RR = 1.4; 95% confidence inteval (CI) (1.0, 2.0)], while treated uncontrolled hypertensives were at increased risk of all cause [RR = 1.4; 95% CI (1.0, 1.9)] and cardiovascular [RR = 1.6; 95% CI (1.1, 2.5)] mortality. CONCLUSIONS: High rates of hypertension in this population coexist with conservative levels of treatment and low rates of blood pressure control. In contrast to other reports, elevated SBP was not independently associated with increased risk of cardiovascular mortality. The modest impact of elevated blood pressure might partly explain the comparatively lower hypertension-related mortality rates in populations of Caribbean-origin. Treated uncontrolled hypertensives are at increased risk of early mortality, signaling the need for strict blood pressure control in this group.     

Short segment Barrett''s oesophagus: prevalence, diagnosis and associations.

BACKGROUND: Prevalence of short segment Barrett's (SSB) oesophagus, defined as the absence of macroscopic Barrett's but histologically identifiable intestinal metaplasia, has been reported to be 18% based on haematoxylin and eosin (H&E) staining. AIMS: To define the prevalence of SSB oesophagus using H&E and alcian blue staining and to determine whether SSB oesophagus is associated with inflammation at the gastro-oesophageal junction (GOJ). SUBJECTS: Consecutive patients (n = 158) presenting for endoscopy completed a structured interview. METHODS: Two biopsy specimens taken from the GOJ were stained with H&E, alcian blue and Giemsa. A third specimen was obtained from the distal oesophagus. Intestinal metaplasia was diagnosed if goblet cells were definitely identified by two independent observers. RESULTS: SSB oesophagus was present in 46 (prevalence 36%, 95% confidence interval (CI) 28.5-43.5) using alcian blue staining. If H&E had been the sole staining method used, 50% cases of intestinal metaplasia would have been overlooked. There were no cases of intestinal metaplasia identified by H&E but missed by alcian blue staining. Logistic regression analysis identified age (odds ratio (OR) per decade 1.03, 95% CI 1.01-1.06), histological oesophagitis (OR 3.2, 95% CI 1.4-7.2) and inflammation at the gastrooesophageal junction (OR 5.9, 95% CI 2.2-15.6) as independent risk factors for SSB oesophagus. CONCLUSION: Unrecognised SSB oesophagus is highly prevalent in patients presenting for diagnostic upper endoscopy if alcian blue staining is applied.