Who pays for measles? The economic arguments for sustained immunization

Increasing international commitment to Universal Child Immunization(UCI) intensifies pressures on already scarce health resources.The costs of the 1989/90 measles epidemic were measured in theState of Guerrero, Mexico, from the perspective of the healthservices and 43 representative communities. Financial loss wasincurred from illness in families of 70% of the 1211 measlescases in a study population of 50294. Some 30% of these familiesdid not have sufficient cash reserves and sold labour, farmanimals or other assets. Among those families, 20% took loansin order to pay the health care costs of their children's measles,19% sold grain stores and 4% indentured their future labour. Standardizing household expenditure on local labour costs, itwas possible to quantify out-of-pocket expenditure and lossof work time. The average cost of a measles case to the communityamounted to the local equivalent of 18.8 work days of an unskilledlabourer, with 27 work days per household affected, excludingincome foregone due to early deaths. Hastings and colleaguescalculated the average cost of measles to British families in1985 to be UK£11.09, considerably less than a day's wagefor a British unskilled labourer at that time. Applying thecosts in the 43 communities to the whole State of Guerrero,without placing a cash value on some 4000 children aged underfive who died from measles, the epidemic cost the communitythe equivalent of 1.6 million work days. The health servicesspent 10% of this value on the epidemic. The cost of vaccinatingall children in the State could be sustained for five years,and increase by 10% per year, and it would still be lower thanthe economic cost of an epidemic to the communities.     

Echocardiographic Aspects of Restrictive Cardiomyopathy

Background and Methods: We studied 17 patients with restrictive cardiomyopathy; eight had biventricular restriction (type A), four had left ventricular restriction (type B), and five had only right ventricular restriction (type C). Results: Type A disease was characterized by pulmonary and systemic venous congestion. The restrictive pattern was found in the inlet of both ventricles. Both atria were enormous, with small or normal-size ventricles. Differential diagnosis included constrictive pericarditis and systolic pump dysfunction. Type B restriction disease was characterized by venous pulmonary congestion, pulmonary hypertension, and important dilatation of the left atrium and right cavities with a small or normal-size left ventricle; the restrictive pattern was found only in the affected left ventricle. Conclusions: The clinical picture resembles that of rheumatic mitral valve disease with right ventricular failure. Type C disease had restriction only in the inlet of right ventricle, with giant right atrium, systemic venous hypertension with low flow, and normal pressure of pulmonary artery and left heart. Differential diagnosis included Ebstein's anomaly of tricuspid valve. The etiology of type A disease was amyloid, endomyocardial fibrosis of ventricles and idiopathic interstitial fibrosis. Asymmetric types were always caused by Davies' disease.     

Entrainment of Ventricular Tachycardia by Sinus Rhythm

Entrainment of ventricular tachycardia (VT) may be manifest as fixed and progressive QRS fusion with ventricular and, rarely, atrial pacing. Only a single example of spontaneous VT entrainment by another rhythm, rapid atrioventricular nodal tachycardia, has been reported. This article describes an example of fixed and progressive QRS fusion between conducted sinus rhythm and VT consistent with entrainment. In contrast to entrainment with pacing, entrainment of VT by sinus rhythm occurred with drug-mediated arrhythmia slowing and demonstrated progressive QRS fusion at a constant cycle length. However, it did not demonstrate unfused but entrained QRS complexes. The resulting short PR interval and wide QRS mimicked a preexcited rhythm.     

Therapy burden, drug resistance, and optimal treatment regimen for cancer chemotherapy

Email: boldrini{at}ime.unicamp.brAuthor to whom correspondence should be addressed. Email: michel{at}Incc.br Three nonlinear models of tumour cell growth under continuousdelivery of cycle nonspecific anticancer agents are studied.A dynamical optimization problem with the objective of minimizingthe final level of tumour cells is posed for these mathematicalsetups. The simplest setup does not possess toxicity constraints,whereas the other setups contain a dynamical equation describingthe therapy burden as a toxicity criterion. In addition, thethird setting contains the dynamics of drug resistant cells.A discussion conceming the optimal strategies of the respectivemodels is performed.     

Cryoglobulins III: FURTHER STUDIES ON THE NATURE, INCIDENCE, CLINICAL, DIAGNOSTIC, PROGNOSTIC, AND IMMUNOPATHOLOGIC SIGNIFICANCE OF CRYOPROTEINS IN RENAL DISEASE

Serial serum samples from a large number of patients with immunologicrenal disease, normal healthy controls, acute infections aswell as non-immunological renal disease were studied for thepresence, nature and properties of cryoproteins, and these correlatedwith serial renal functional, morphologic, immunohistologicand clinical findings as well as serologic observations. A highincidence of cryoproteins were found in renal disease thoughtto be mediated by immune complexes. Cryoprecipitates were notdetected in the other patients. The presence of fibrinogen ina serum cryoprecipitate was always associated with rapidly progressivedisease and poor prognosis. An association between the detectionof cryoproteins and the clinical and morphological activityof disease was observed. Persistence of cryoproteinemia wasassociated with progression and apparent disappearance withresolution or progression to end stage renal disease. In patientswith hematuria or proteinuria of questionable significance cryoproteindetection was always associated with immune complex nephritis.Renal transplantation in the presence of cryoproteinemia wasassociated with recurrent nephritis in the graft. Cryoproteins were found to have biologic properties attributableto antigen—antibody complexes, to contain immune complexesof antigen and antibody and to have serologic factors concentrated.The detection of serum cryoglobulins was found to be a betterindex of clinical and morphologic activity of immune complexrenal disease than was serum complement. As in our previousstudies, these proteins appear to be of diagnostic and prognosticvalue in renal disease and provide a method of antigen identificationin these disorders.     

Anomalous Panleukocytic Granulation

Anomalous panleukocytic granulation is described in the peripheral blood,bone marrow and spleen of a 3 year old girl. Myeloid leukocytes showedgiant peroxidase and Sudan Black B-positive granules. Lymphocyte corpuscles were positive in the periodic acid-Schiff test. Deviations in thestructure and segmentation of the neutrophil nuclei were observed. Increaseof gamma globulins and decrease of lipoproteins were found in the bloodserum.

Hepatosplenomegaly, psychomotor underdevelopment, respiratory tract infections, roentgenologic changes of bones, lungs and heart were also found.The parents were first cousins, and anomalous corpuscles were seen in thefather’s lymphocytes.

At necropsy diffuse or focal infiltration of the organs by lymphoid, plasmaand reticular cells suggested a systemic condition.

Submitted on July 26, 1958 Accepted on April 11, 1959     

Colonoscopic Polypectomy

A total of 87 polyps were treated during 62 colonoscopic examinations on 60 patients; 69 polyps were resected and 18 were fulgurated with the hot-biopsy forceps. Fifteen patients were under 13 years old, and the average age was 38 years. Twelve patients had more than one polyp. There were no complications and the method could be carried out in all patients, whenever it was indicated. Sixteen polyps were hamartomas, 13 shistosomatic, six hyperplastic, two lymphoid and 36 adenomas. Among these adenomas, six showed evidence of foci carcinoma, one in situ and five, invasive. Surgical resection was indicated in only one patient with sessile polyp with invasive focus of carcinoma. No metastasis was detected whatsoever.