Towards nationwide control of schistosomiasis in Yemen: a pilot project to expand treatment to the whole community

Both the urinary and intestinal forms of schistosomiasis are thought to be widespread in the Republic of Yemen, with estimates of 3 million people infected and 600 000 suffering clinical morbidity. Sub-national control has been ongoing since 2006 via the distribution of praziquantel (PZQ) against schistosomiasis and albendazole (ALB) against soil-transmitted helminths using school-based treatment. In preparation for a 6-year nationwide control programme with the aim of expanding treatment to the wider community, a new programmatic approach of complementing school-based distribution with community-based treatment was trialled in 10 highly endemic districts in three governorates in December 2009. The new approach achieved coverage of 90.1% of non-enrolled children: a 40% increase compared with the same districts in 2008, and coverage of 97.9% of enrolled children: a 2% increase compared to 2008. Coverage of females (children and adults) was 81.8%, and of adults in general was 73.9%. The total cost per person treated was US$0.66 (US$0.79 in 2008), which includes training, health education, social mobilization, distribution and drugs. These results provide hope that a combined school and community-based approach can be successfully implemented on a wider scale during the main control programme in 2010-2015, with approximately 10 million people targeted in the first year alone.     

Murine typhus in Tunisia: A neglected cause of fever as a single symptom

Objectives

We had for aim to describe the epidemiologic and clinic characteristics of murine typhus in a series of 43 serologically confirmed cases, in our region.

Patients and methods

Serologic screening for IgG and IgM against Rickettsia typhi was performed in 1024 patients during three years (2006–2008). The characteristics of patients with a positive serology were examined retrospectively. One hundred and seventy sera obtained from blood donors were tested to detect IgG against R. typhi to determine the seroprevalence of the infection.

Results

There was evidence of recent R. typhi infection in 43 patients (4.2%) during the study period, and 3.7% of blood donors had IgG against R. typhi. The mean age of patients was 43.1 years and the sex-ratio was 1.04. Among the patients, 58.1% were from rural areas. No patient reported any exposure to rats or rat-fleas. There were more cases during the summer and fall. The most frequent complaint was fever as a single symptom (67.5%). A cutaneous rash was reported in 44.1% and headache in 60.5% of patients. Among the patients, 44.1% presented with thrombopenia and 47.2% with elevated liver enzymes.

Conclusion

Murine typhus seems to be frequent in Tunisia. This infection could be a threat for travellers. Serology should be performed systematically in patients with fever as a single symptom since its clinical presentation is non-specific.     

Azathioprine for prevention of postoperative recurrence in Crohn's disease

BACKGROUND: Crohn's disease is a chronic inflammatory bowel disease that can involve any portion of the gastrointestinal tract. Up to 74% of patients require surgery. However, although resective surgery improves the clinical situation, relapses is frequent in most cases. THE AIM of this clinical trial was to evaluate the profile of patient who received AZA after surgical treatment in order to prevent postoperative recurrence. METHODS: This was a retrospective study including 17 patients with severe Crohn's disease attending our gastrointestinal unit from September 1998 to June 2004. Patients were eligible if they have severe Crohn's disease, undergoing curative surgical treatment and received azathioprine for the first time after surgery to prevent postoperative recurrence. RESULTS: The study population comprised 17 patients with Crohn's disease (10 men and 7 women; mean age, 27 years). The Crohn's disease was ileo-colic in 10 cases with perineal manifestations for 2 patients and ileal in 7 cases. The indications for surgery were stenosis in 10 cases, fistula in 5 cases, perforation in 1 case and corticosteroid-resistance in 1 case. The median following-up period was 40 months (9-80 months). During this period, only 1 patient reported severe adverse event and discontinued treatment due to acute pancreatitis. 1 patient was lost to follow-up and 3 patients had moderate clinical relapse. Maintained remission was obtained for 12 patients. None of our patients had surgical relapse. CONCLUSION: The result of this study shows the effect of Azathioprine in preventing both clinical and surgical relapses in patients with Crohn's disease who have undergone surgery.     

Basic patterns in national health expenditure

Analysed in this paper are national health accounts estimates for 191 WHO Member States for 1997, using simple comparisons and linear regressions to describe spending on health and how it is financed. The data cover all sources - out-of-pocket spending, social insurance contributions, financing from government general revenues and voluntary and employment-related private insurance - classified according to their completeness and reliability. Total health spending rises from around 2-3% of gross domestic product (GDP) at low incomes (< 1000 US dollars per capita) to typically 8-9% at high incomes (> 7000 US dollars). Surprisingly, there is as much relative variation in the share for poor countries as for rich ones, and even more relative variation in amounts in US dollars. Poor countries and poor people that most need protection from financial catastrophe are the least protected by any form of prepayment or risk-sharing. At low incomes, out-of-pocket spending is high on average and varies from 20-80% of the total; at high incomes that share drops sharply and the variation narrows. Absolute out-of-pocket expenditure nonetheless increases with income. Public financing increases faster, and as a share of GDP, and converges at high incomes. Health takes an increasing share of total public expenditure as income rises, from 5-6% to around 10%. This is arguably the opposite of the relation between total health needs and need for public spending, for any given combination of services. Within public spending, there is no convergence in the type of finance - general revenue versus social insurance. Private insurance is usually insignificant except in some rich countries.     

Cerebral venous thrombosis and Behcet's disease

Behcet's disease is a chronic relapsing multisystem disorder of unknown etiology. Neurological complications are frequent, occurring in 10 to 49% of cases. We report 4 cases with Behcet's disease (3 females and 1 male) who had symptomatic intracranial hypertension due to cerebral venous sinus thrombosis within a mean delay of 2 years. The mean age at onset was 31 years and the mean age on referral was 39.5 years. The predominant manifestation in our series were headache, papilledema, seizures and pyramidal syndromes. CT Scan showed non specific abnormalities in all of them and the sinus venous thrombosis was confirmed by MRI in 3 cases. The authors emphasize on the importance of MRI with angio MRI for the diagnosis, the outcome and the evaluation of the cerebral venous thrombosis after treatment.     

Glomus tumours of the hand. About 10 cases

BACKGROUND: The glomus tumour is a rare benign cutaneous tumour, it is characterized by its clinical and evolutive particular features. AIM: The aim of this work is to bring out the various characteristics of the glomus tumours of the hand which remain relatively ignored by practioners. METHODS: The authors report a series of 10 cases of glomus tumours of the hand, the mean age at the moment of diagnosis was 36 years with a female prevalence of 70% of the cases. The diagnosis delay average was 2 years and half. The tumour was located on the right side in 6 cases and on the left one in 4 cases. The glomus tumour was developed under the nail in 8 cases and was latero pulpar in the both other cases. The diagnosis of glomus tumour was clinical in front of the existence of the three painful symptoms: spontaneous pain, pain on the cold and pain on the pressure. An RMI complement was carried out for two patients having no univocal symptomatology what made possible to confirm the diagnosis and to locate the tumour. A surgical biopsy of the tumour was performed for all patients. The histological study confirmed our clinical and per operational presumptions and showed a glomus tumour. RESULTS: After one year and two months of average retreat, our patients announced a spectacular transformation of their daily activities because of the disappearance of painful symptomatology, two cases of nail dystrophia were noted and there was no recurrence. CONCLUSION: The glomus tumour are rare benign cutaneous tumours, its diagnostic is essentially clinical and the treatment is exclusively surgical.     

Adenocarcinoma at the site of ileo-anal anastomosis in Crohn's disease: report of a case

We reported a case of patient born in 1967 who has been operated on in 1987 on three years after the beginning of ulcerative colitis which became severe and resistant to the medical treatment. A total colectomy with an ileo-rectal anastomosis had been performed. The pathological diagnosis carried of the specimen was Ulcerative colitis Then a proctectomy, followed by ileo-anal anastomosis, was performed in 1993. After several episodes of pochitis and the appearance of intestinal lesions upstream the ileal pocket, the retained diagnosis was Crohn's colitis. Eight years after the ileo-anal anastomosis, the patient developed an adenocarcinoma in the ileal pocket. He has been operated on in 2002 and he had abdominoperineal resection, radiotherapy and chemotherapy. Re died in January 2003. The death was related to the recurrence of malignancy. Endoscopic controls with biopsies are mandatory doing to follow up dysplasia predictive of degeneration.     

Hexachlorobenzene in Tunisian mothers' milk, cord blood and foodstuffs

This paper reports some preliminary results concerning hexachlorobenzene (HCB) contamination of Tunisian human milk, human cord and adult blood and foodstuffs (cows' milk, meat, eggs). The analyses were performed by gas chromatography with electron-capture detection.