Political violence in the Third World: a public health issue

The impact of political violence on health and health servicesis substantial in many parts of the world. A variety of typesof political violence are discernible and may be broadly categorizedas structural, repressive, reactive and combative. These differenttypes of violence are described. Particular emphasis is givento a discussion of state repressive violence, including itsaetiology and magnitude. An agenda for research, policy and action is described arguingthat health personnel have a role to play in documenting theform and impact of political violence, providing treatment andcare for its victims, developing training and education packagesfor health workers who may deal with situations of violenceand advocacy work aimed at prevention.     

Individual Housing From Rearing Modifies the Performance of Young Rats on the Elevated Plus-Maze Apparatus

Previous studies from our laboratory have demonstrated that male and female rats exhibit a differential pattern of behavior in the elevated plus-maze as a function of age. In the present study, the influence of individual housing conditions on young animals treated with one of two classical anxioselective drugs, diazepam or pentylenetetrazole, was investigated in the elevated plus-maze. In Experiment 1, males and females were housed for 30 days after weaning either individually or in groups, and tested in the elevated plus-maze at 60 days of age. In Experiment 2, the effects of diazepam (0.75 or 1.0 mg/kg) or of pentylenetetrazole (20 or 30 mg/kg) on the behavior of isolated or grouped rats were studied at 60 days of age in the elevated plus-maze. The results show that isolated housed animals tested with diazepam at 60 days of age exhibited increased frequency and time spent on the open arms of the apparatus compared to control rats. The effect of diazepam was not observed in grouped animals tested at 60 days of age. Pentylenetetrazole produced a decrease in the frequency and time spent on the open arms. This effect was more prominent in grouped animals. The results suggest that 60-day-old rats deprived of playfighting experience present high basal anxiety levels and also that rearing conditions (isolated or grouped) are able to interact with both anxiolytic and anxiogenic effects of experimental drugs.     

CHLORACNE IN THE 1990s

Background. Chloracne is a disease associated with toxicity of halogenated compounds used in some industrial processes. A patient affected by chloracne led us to study a total of nine cases from a single factory. Methods. We studied the clinical features of nine patients exposed chronically to chlorobenzenes. On all of them blood samples were drawn and biopsies of affected skin and liver were taken. Their work environment was visited and studied. Results. All nine patients were men and had polymorphic skin lesions, characterized mainly by comedones and cysts. They had chronic conjunctivitis and seven had cysts in the Meibomian glands. All of them had polyneuropathy and liver damage and seven had hypertriglyceridemia. Compounds known to cause chloracne were found in exceedingly high concentrations in the water used in the workplace. Conclusions. Every patient exposed to halogenated compounds with the cutaneous manifestations of chloracne should be carefully investigated for systemic complications (such as ophthalmic, neuropathic, hepatic, and lipoprotein abnormalities).     

Incidence of Atrial Fibrillation in Patients with Different Mode of Pacing. Long-term Follow-up

We evaluated the incidence of atrial fibrillation in 189 patients (92males, 97females, mean age 75 ± 12yrs, range 41–100yrs) with pacemaker, during a mean follow-up of 5.5yrs (range 1–24yrs). The indications for implant were: complete AV block (115pts), second degree Möbilz 2 AV block (51pts). bifascicular block (5pts). sick sinus syndrome (14pts), symptomatic bradycardia (4pts). The mode of stimulation considered were VVI (105pt), VVI rate responsive (21pts), single lead VDD (43pts), DDD (20pts). The occurrence of retrograde VA conduction in patients with VVI or VVI rate responsive pacing was also evaluated. Atrial fibrillation occurred in 40 pts (21%). The highest incidence was evidenced in patients with sick sinus syndrome (9pts, 64%), and in patients with VVI stimulation (28pts, 27%). On the contrary, the lowest incidence was found in single lead VDD stimulation (4pts, 9%). The patients with dual chamber pacing showed a relatively high incidence of the arrhythmia (5pts, 25%). Atrial fibrillation occurred in 9 out of 32 patients with retrograde VA conduction, and in 22 out of 94 patients without retrograde conduction (28% versus 23%, p=NS). In conclusion, it is confirmed that patients with sick sinus syndrome are at high risk for atrial fibrillation. Single lead VDD stimulation seems to be the better mode of pacing in preventing atrial fibrillation, while dual chamber pacing showed minor efficacy. The presence of retrograde VA conduction could not predict the occurrence of the arrhythmia.     

A case of optic atrophy possibly induced by quinoline in acrodermatitis enteropathica

A 2-year-old girl with acrodermatitis enteropathica, developed optic atrophy during quinoline treatment (600 mg/day, later gradually increased to 1700 mg/day; a total dose of 280 g was given). The optic atrophy developed rapidly 9 months after the start of the quinoline treatment. The right eye was blinded and developed a convergent strabismus. Eight months after the quinoline had been stopped, the left eye began a slow and partial recovery of vision with an improvement in the appearance of the optic disc.     

AMERICAN CUTANEOUS LEISHMANIASIS: INTERMEDIATE FORM

A man of Portuguese nationality presented with increased volume of the forehead and multiple pustules, which subsequently ulcerated. The pustules appeared progressively on the rest of the face and in the right scapular region during a period of 2 years.
Physical examination revealed multiple rounded ulcers of different sizes with erythematous and infiltrated borders covered by serosanguineous scabs on the face and right scapular region (Figs. 1 and 2).
The otorhinolaryngologic examination showed an infiltrate of granulomatous aspect in the anterior third of the septum. Posterior rhinoscopy was normal.
When the patient was first seen, complete hematology and hepatic and renal tests were normal. Additional tests included: HIV, nonreactive; venereal disease reference laboratory test, nonreactive; chest x-ray, normal; Montenegro skin test, 14 mm; purified protein derivative, 0 mm.
The skin biopsy revealed a granulomatous infiltrate with a dense infiltrate composed principally of plasmocytes, with few lymphocytes (Fig. 3).
A skin smear stained with Giemsa and culture of biopsy material in blood agar were positive for the presence of Leishmania. Antibodies against Leishmania measured in an ELISA test were strongly positive, titer 1:6400. Typing of the isolate using absorbed polyclonal antisera revealed Leishmania braziiiensis .
During hospitalization, the patient received systemic immunotherapy with a combined vaccine containing heat-killed Leishmania mexicana promastigotes and bcg ,^1,2 as well as chemotherapy with meglumine antimoniate in a dose of 50 mg/kg/day IM, two cycles of 20 days with an in-terval of 7 days of rest.
The patient presented clinical healing of his lesions without relapse during a 2 year follow up after completion of therapy.