Drug resistance in Indian visceral leishmaniasis.
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Throughout the world, pentavalent antimonial compounds (Sb(v)) have been the mainstay of antileishmanial therapy for more than 50 years. Sb(v) has been highly effective in the treatment of Indian visceral leishmaniasis (VL: kala-azar) at a low dose (10 mg/kg) for short durations (6-10 days). But in the early 1980s reports of its ineffectiveness emerged, and the dose of Sb(v) was eventually raised to 20 mg/kg for 30-40 days. This regimen cures most patients with VL except in India, where the proportion of patients unresponsive to Sb(v) has steadily increased. In hyperendemic districts of north Bihar, 50-65% patients fail treatment with Sb(v). Important reasons are rampant use of subtherapeutic doses, incomplete duration of treatment and substandard drugs. In vitro experiments have established emergence of Sb(v) resistant strains of Leishmania donovani, as isolates from unresponsive patients require 3-5 times more Sb(v) to reach similarly effectiveness against the parasite as in Sb(v) responders. Anthroponotic transmission in India has been an important factor in rapid increase in the Sb(v) refractoriness. Pentamidine was the first drug to be used and cured 99% of these refractory patients, but over time even with double the amount of initial doses, it cures only 69-78% patients now and its use has largely been abandoned in India. Despite several disadvantages, amphotericin B is the only drug available for use in these areas and should be used as first-line drug instead of Sb(v). The new oral antileishmanial drug miltefosine is likely to be the first-line drug in future. Unfortunately, development of newer antileishmanial drugs is rare; two promising drugs, aminosidine and sitamaquine, may be developed for use in the treatment of VL. Lipid associated amphotericin B has an excellent safety and efficacy profile, but remains out of reach for most patients because of its high cost. (+info)
History and characteristics of Okinawan longevity food.
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Okinawan food culture in the Ryukyu island is one of the world's most interesting culture because its consumers have the longest life expectancies and low disability rates. It is a product of cultural synthesis, with a core of Chinese food culture, inputs through food trade with South-East Asia and the Pacific and strong Japanese influences in eating style and presentation. The Satsamu sweet potato provides the largest part of the energy intake (and contributes to self-sufficiency), there is a wide array of plant foods including seaweed (especially konbu) and soy, and of herbaceous plants, accompanied by fish and pork, and by green tea and kohencha tea. Infusing multiple foodstuff and drinking the broth is characteristic. Raw sugar is eaten. The concept that 'food is medicine' and a high regard accorded medical practice are also intrinsic of Okinawan culture. Again, food-centered and ancestral festivities keeep the health dimensions well-developed. Pork, konbu and tofu (soy bean-curd) are indispensable ingredients in festival menus, and the combination of tofu and seaweed are used everyday. Okinawan food culture is intimately linked with an enduring belief of the system and highly developed social structure and network. (+info)
Fifty years of epidemiology at the Centers for Disease Control and Prevention: significant and consequential.
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The Epidemic Intelligence Service (EIS) was the vision of Alexander Langmuir, who developed a program with a vital mission to address an unmet need in the United States. The Communicable Disease Center, now the Centers for Disease Control and Prevention (CDC; Atlanta, Georgia), and the EIS steadily expanded from focusing on infectious disease to address chronic diseases, health statistics, occupational and environmental health and safety, injury prevention and control, and reproductive health. Langmuir recognized the need for epidemiologists to collaborate with others, initially from the laboratory and later including veterinarians, demographers, statisticians, nutritionists, behavioral and social scientists, industrial hygienists, and sanitarians. These partnerships stimulated the further evolution of the EIS Program to include sophisticated statistical analysis, economics, and the tools of the behavioral and social sciences. A mixture of analytical rigor and practical application characterizes the practice of epidemiology at CDC and in the EIS. Thus, the "significant" in the title of this paper refers to the analytical rigor of the public health approach and the validity of the results, while the "consequential" reflects the practical application of the results, trying to make a difference in health outcomes. (+info)
Epidemic intelligence service of the Centers for Disease Control and Prevention: 50 years of training and service in applied epidemiology.
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The Epidemic Intelligence Service (EIS) was established in 1951 at the Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, as a combined training and service program in the practice of applied epidemiology. Since then, nearly 2,500 professionals have served in this 2-year program of the US Public Health Service. The experience of an EIS Officer has been modified because of the increased need for more sophisticated analytical methods and the use of microcomputers, as well as CDC's expanded mission into chronic diseases, environmental health, occupational health, and injury control. Officers who have entered the EIS in the past 20 years are more likely than their predecessors to stay in public health either at the federal level or in state and local health departments. The EIS Program continues to be a critical source for health professionals trained to respond to the demand for epidemiologic services both domestically and internationally. (+info)
Partnerships in international applied epidemiology training and service, 1975-2001.
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In 1951 the Centers for Disease Control and Prevention created the Epidemic Intelligence Service to provide training and epidemiologic service on the model of a clinical residency program. By January 2001, an additional 28 applied epidemiology and training programs (AETPs) had been implemented around the globe (with over 945 graduates and 420 persons currently in training). Field Epidemiology Training Programs and Public Health Schools Without Walls are the most common models. Applied epidemiologists, or field epidemiologists, use science as the basis for intervention programs designed to improve public health. AETPs train people by providing them with health competencies through providing service to public health intervention programs and strengthening health systems. AETPs are relatively expensive to create and maintain, but they are highly sustainable and can produce immediate benefits. Of the 19 programs that began before 1997, 18 (95%) continue to produce graduates. The Training Programs in Epidemiology for Public Health Interventions Network was organized in 1997 to provide support, peer review, and quality assurance for AETPs. In 2001, new programs are planned or in development in India, Argentina, China, and Russia. (+info)
Clinical chemistry since 1800: growth and development.
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The 19th and 20th centuries witnessed the growth and development of clinical chemistry. Many of the individuals and the significance of their contributions are not very well known, especially to new members of the profession. This survey should help familiarize them with the names and significance of the contributions of physicians and chemists such as Fourcroy, Berzelius, Liebig, Prout, Bright, and Rees. Folin and Van Slyke are better known, and it was their work near the end of the second decade of the 20th century that brought the clinical chemist out of the annex of the mortuary and into close relationship with the patient at the bedside. However, the impact on clinical chemistry and the practice of medicine by the 1910 expose written by Abraham Flexner is not as well known as it deserves to be, nor is the impetus that World War I gave to the spread of laboratory medicine generally known. In the closing decades of the 20th century, automated devices produced an overabundance, and an overuse and misuse, of testing to the detriment of careful history taking and bedside examination of the patient. This is attributable in part to a fascination with machine-produced data. There was also an increased awareness of the value of chemical methods of diagnosis and the need to bring clinician and clinical chemist into a closer partnership. Clinical chemists were urged to develop services into dynamic descriptions of the diagnostic values of laboratory results and to identify medical relevance in interpreting significance for the clinician. (+info)
The tortuous road to the adoption of katal for the expression of catalytic activity by the General Conference on Weights and Measures.
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BACKGROUND: The "unit" for "enzymic activity" (U = 1 micromol/min) was recommended by the International Union of Biochemistry and Molecular Biology (IUB) in 1961 and is widely used in medical laboratory reports. The general trend in metrology, however, is toward global standardization through defining units coherent with the International System of Units (SI). APPROACH: Several proposals were advanced from the IFCC, International Union of Pure and Applied Chemistry, and IUB regarding the definition for enzymic activity as well as the terms for kind-of-quantity, units, symbol, and dimension. In 1977, international agreement was reached between these bodies and WHO that "catalytic activity" (z), of a catalyst in a given system is defined by the rate of conversion in a measuring system (in mol/s) and expressed in "katal" (symbol, kat; equal to 1 mol/s). The katal is invariant of the measurement procedure, but the numerical quantity value is not. Gaining support for the katal from the final arbiter, the General Conference on Weights and Measures, was slow, but Resolution 12 of 1999 adopted the katal (symbol, kat) as a special name and symbol for the SI-derived unit, mol/s, used in measuring catalytic activity. CONCLUSIONS: Laboratory results for amounts of catalysts, including enzymes, measured by their catalytic activity can now officially be expressed in katals and are traceable to the SI provided that the specified indicator reaction reflects first-order kinetics. The conversion from "unit" is: 1 U = 16.667 x 10(-9) kat. Further derived quantities have coherent units such as kat/L, kat/kg, and kat/kat = 1. (+info)
Protean nature of mass sociogenic illness: from possessed nuns to chemical and biological terrorism fears.
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BACKGROUND: Episodes of mass sociogenic illness are becoming increasingly recognised as a significant health and social problem that is more common than is presently reported. AIMS: To provide historical continuity with contemporary episodes of mass sociogenic illness in order to gain a broader transcultural and transhistorical understanding of this complex, protean phenomenon. METHOD: Literature survey to identify historical trends. RESULTS: Mass sociogenic illness mirrors prominent social concerns, changing in relation to context and circumstance. Prior to 1900, reports are dominated by episodes of motor symptoms typified by dissociation, histrionics and psychomotor agitation incubated in an environment of preexisting tension. Twentieth-century reports feature anxiety symptoms that are triggered by sudden exposure to an anxiety-generating agent, most commonly an innocuous odour or food poisoning rumours. From the early 1980s to the present there has been an increasing presence of chemical and biological terrorism themes, climaxing in a sudden shift since the 11 September 2001 terrorist attacks in the USA. CONCLUSIONS: A broad understanding of the history of mass sociogenic illness and a knowledge of episode characteristics are useful in the more rapid recognition and treatment of outbreaks. (+info)