Birth prevalence and characteristics of congenital toxoplasmosis in Sergipe,North‐east Brazil

Objectives To estimate, by neonatal screening, the birth prevalence of congenital toxoplasmosis among live‐born infants in Sergipe state, Brazil, and to investigate the clinical features of affected infants. Methods Dried blood spot specimens obtained from 15 204 neonates were assayed for the presence of anti‐T. gondii IgM antibodies. Duplicate retesting was done in infants with positive and borderline results. Confirmatory testing in peripheral blood samples consisted of testing for anti‐T. gondii IgG and IgM in infants and mothers. Those with possible congenital toxoplasmosis were evaluated and followed up to a median age of 20 months. Congenital infection was confirmed in the presence of persisting anti‐T. gondii IgG antibodies beyond 12 months of age. All infants with confirmed infection were treated with pyrimethamine, sulfadiazine and folinic acid for 1 year. Results Fifty‐three infants had detectable IgM in dried blood spot specimens. Confirmatory testing was reactive in 39/50, of which, 38 completed follow‐up. Six of 15 204 newborns were diagnosed with congenital toxoplasmosis, resulting in an estimated birth prevalence of four per 10 000 [CI 95% 1.4–8.0]. Four infants (67%) showed signs of congenital toxoplasmosis in their first year of life; three (75%) had retinochoroidal scars, and one had cerebral calcifications. Two infants remained asymptomatic until 20 months of age. Conclusions The birth prevalence of congenital toxoplasmosis is high in the Brazilian state of Sergipe, with most of the infants showing ocular lesions. Preventive measures are strongly warranted.     

Civil defence in the United Kingdom

What must be avoided in the nuclear age is wishful thinking. Wishful thinking occurs in an atmosphere of maximum terror (as in Mutual Assured Destruction), and where there is little opportunity for reality testing (as in the East‐West communication barrier). In the small, densely populated island of Britain, the size of today's growing nuclear threat will create responses where delusional thinking can easily dominate. A belief in effective civil defence may induce a sense of false security which may in turn direct attention from the fundamental problem of East‐West mistrust.     

A dilemma for doctors

Community physicians have recently, albeit often reluctantly, been involved in preparations for nuclear war. This paper suggests an alternative: that they should use their skills in epidemiology and in preventive and social medicine in the prevention of nuclear war.     

Global thinking,local action

This article examines the risk of proliferation of nuclear weapons to several Third World countries, exemplified by recent events in Iraq, and the possibility of rapid acquisition of a nuclear weapons capability in developed countries. It considers the role of the International Atomic Energy Agency and the United Nations in preventing proliferation and calls for wider powers for the latter. The role of the civil nuclear power industry and of reprocessing of nuclear fuel to produce plutonium is stressed, with emphasis on the part played by nuclear power in Japan and the THORP reprocessing plant at Sellafield.     

Cough Frequency in a Group of Males

An epidemiologic study by questionnaire was undertaken in Great Britain and the United States, to provide data on diabetes mellitus in Down’s syndrome. Among 20,362 patients with Down’s syndrome, 88 living diabetics were found.

A high prevalence of diabetes in the population with Down’s syndrome, particularly In the younger age groups, was noted. In these age groups the prevalence of diabetes in the population with Down’s syndrome exceeded that of the general population by factors 6.8, 3.3, and 3.0. Insufficient data exist to determine the exact statistical significance of these ratios. Further investigation is necessary. Nevertheless, a definitive association between Down’s Syndrome and diabetes mellitus is suggested. The role of prediabetes, autoimmunity and genetics in this association is discussed.     

Long-Term Tobacco Smoking and Mucociliary Clearance

The rate of mucociliary clearance was estimated from the removal of inhaled radioactive particles in 79 elderly subjects of whom 50 had healthy lungs and 29 had respiratory impairment that was obstructive in 13 and restrictive in 16. The 29 impaired subjects had on the average a faster clearance than the normal group, a difference that almost approached significance (5% level) at six hours after the inhalation of the aerosol. The obstructed subjects showed the fastest clearance with the restricted group intermediate between these and the normal group. No significant difference was found between the rates of clearance of smokers, nonsmokers, and exsmokers in either healthy or “diseased” groups.