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Biomedical subjects

C Hatz

Publications and source records attributed to C Hatz.

At least 55 records · Page 3Linked to original sources
PubMed1997

Travel advice: a study among Swiss and German general practitioners.

Travelling to tropical and subtropical destinations is common among European citizens. Many of them consult their general practitioners (GPs) for pre-travel advice. Little is known about the knowledge, the sources of information and the needs of physicians. One hundred and fifty Swiss and I50 German GPs giving travel advice were interviewed using pretested telephone interviews and questionnaires to assess their knowledge about travel advice to be given for 2 frequent holiday destinations (Kenya and Thailand), and to ask which information sources were available to them. Ninety-six per cent and 89%, respectively, of GPs in 2 neighbouring areas of Switzerland and Germany gave travel advice to their clients. In telephone interviews, standard recommendations on malaria medication, as approved by the national travel advice committees, were stated by 45 and 25% of Swiss GPs, and 22 and 9% of German GPs for Kenya and Thailand. The figures for correct advice on vaccination requirements were 23 and 47% for the Swiss GPs, and 2 and 25% for the German GPs. Half of the GPs wanted to consult their documents before giving advice. The main source of information used by Swiss GPs was the monthly updated Bulletin of the Federal Office of Public Health (BFOPH). A variety of different sources was recorded among German practitioners. Regular, concise information on travel advice tops the list of requested information material in both countries. The extent of correct pre-travel advice is unsatisfactory in both study groups. Use of standardized, regularly updated and readily available sources of information on travel advice for the GP could avoid uncertainties of both the provider and the recipient of advice.

Family Practice↗
PubMed1996

Immunogenicity and adverse effects of inactivated virosome versus alum-adsorbed hepatitis A vaccine: a randomized controlled trial.

Immunogenicity and adverse effects of a novel inactivated hepatitis A vaccine based on virosomes (IRIV-HAV) was compared with a standard vaccine adsorbed to aluminium (Al-HAV). Seronegative volunteers (n = 301) were randomly allocated to one injection of IRIV-HAV or to two injections of Al-HAV, followed by a booster injection at 12 months. Two hundred and ninety-eight (99%) completed the first month and 215 (71%) could be evaluated at 1 year. Geometric mean antibody concentrations at days 0, 14 and at 12 months were similar in the two vaccine groups. Lower antibody concentrations were recorded with IRIV-HAV at day 28 (P < 0.0001) and at 13 months (P = 0.02). Seroconversion to protective antibody levels, however, was similar (98% at day 28, 94% at 12 months, 100% at 13 months). Local adverse effects were reported in 17% with IRIV-HAV but in 66% with Al-HAV (P < 0.0001) after the initial vaccination and in 32% and 42% following the booster vaccination (P = 0.05). In conclusion, IRIV-HAV may provide similar protection but cause less local adverse effects.

Alum Compounds↗
PubMed1996

A comparative trial of a single-dose ivermectin versus three days of albendazole for treatment of Strongyloides stercoralis and other soil-transmitted helminth infections in children.

A randomized trial carried out in rural Zanzibar comparing a single dose of 200 micrograms/kg of ivermectin and 400 mg/day for three days of albendazole for treatment of strongyloidiasis and other intestinal nematodes is described. In 301 children with Strongyloides stercoralis infection, treatment with ivermectin or albendazole resulted in cure rates of 83% and 45%, respectively. While both drugs were very effective against Ascaris lumbricoides, Trichuris trichiura was cured only in 11% (ivermectin) and 43% (albendazole) of the subjects, although the mean eggload was reduced by 59% and 92%, respectively. Ivermectin was ineffective against hookworms, while albendazole resulted in a cure rate of 98%. No severe side effects were recorded and mild side effects were of transient nature for both treatments. Therefore, ivermectin provides a safe and a highly effective single dose treatment for S. stercoralis and A. lumbricoides, while it is not an alternative for the treatment of T. trichiura and hookworm infections.

Adolescent↗
PubMed1995

[The traveler returning from the tropics in clinical practice].

Travellers returning from the tropics frequently consult a physician even if they have no actual symptoms. Physical check-ups in asymptomatic returnees rarely detect dangerous conditions. The most common laboratory finding is intestinal parasites. Blood eosinophilia may indicate helminthic infections, such as strongyloidosis, filariasis, schistosomiasis and others. If there are no diagnostically suggestive symptoms a systematic, step-by-step workup is recommended (stool parasitology, serology, and special methods to demonstrate parasites in blood or tissues). The most common symptom of returnees from the tropics is diarrhea, or other disorders of intestinal motility. Appropriate investigations include parasitological and bacteriological tests, and--if the course is more chronic--endoscopy. If diarrhea is associated with fever, systemic infections (e.g. falciparum malaria) must be considered. Fever as a leading sign may mask a number of potentially dangerous infections. If there are no other obvious signs or symptoms indicating a particular etiology, the diagnostic approach should consider first of all those systemic infections, which are potentially life-threatening and can be cured by specific therapy, i.e. bacterial meningitis, falciparum malaria, septicemia (including typhoid fever), extraintestinal amebiasis, and African trypanosomiasis.

Adult↗
PubMed1994

[Erroneous tracks in the diagnosis of cutaneous and mucocutaneous leishmaniasis].

Cutaneous leishmaniasis is an uncommon finding among patients seen in Central Europe. We report on three patients with cutaneous leishmaniasis who were initially misdiagnosed. Case 1, a woman who had returned from South America, was first thought to have an ulcer due to immunosuppression. Spread of the lesions to the nasal mucosa and a cosmetically disturbing scar were partly caused by delayed diagnosis and treatment. Case 2 shows a patient who has developed red papules on both legs after a trip to Spain. The lesions were misinterpreted as a residual reaction to insect bites. In case 3, a patient who had travelled in Nicaragua, the diagnosis of leishmaniasis was delayed because of coexisting acne vulgaris. In all three patients the final diagnosis of cutaneous leishmaniasis was confirmed by culture of the parasite. The only case with positive serology was the patient with mucocutaneous involvement. Two patients were radically cured, and one patient showed a substantial improvement of the lesions. The importance of a broad history including previous travel is emphasized to avoid the fallacies of missing a rare, but important disease among people travelling to countries with endemic leishmaniasis.

Adult↗
PubMed1994

Morbidity markers for Schistosoma haematobium infection.

A description is given of a field study design, including pretreatment and short and long-term posttreatment measurements, which is conducted as a case-control study among school children in Kaloleni District, Kenya, and Kilosa District, Tanzania, including 500 school children from each endemic setting. The aim of the study is to evaluate eosinophil cationic protein (ECP) in urine as a marker for Schistosoma haematobium morbidity by comparing levels of ECP in urine with S. haematobium egg counts in urine, level of excreted S. haematobium egg antigen in urine, microhaematuria and urinary tract pathology assessed by ultrasonography. Initial results have been promising and are now subject to an extensive evaluation. Strong training components and transfer of technology are included in the project, thus contributing to the strengthening of the research capacity of the collaborating African institutions. Simple non-invasive assays for ECP and excreted S. haematobium egg antigen could provide new tools for evaluation of chemotherapy effects and morbidity in urinary schistosomiasis, helping to understand the dynamic process of posttreatment resolution and reappearance of pathological changes.

Adolescent↗
PubMed1994

[Prevention for travel to the tropics].

The Swiss Working Group for Health Advice to Travellers regularly publishes its recommendations for malaria prophylaxis and vaccination as supplement to the 'Bulletin' of the Federal Office of Public Health. In this review the strategy with respect to information, to clever behavior abroad, to chemoprophylaxis and immunization prophylaxis is analyzed. A critical evaluation of emergency self-therapy describes remaining questions in particular.

Antimalarials↗
PubMed1993

Hypoglycaemia and counterregulatory hormone responses in severe falciparum malaria: treatment with Sandostatin.

The mechanism and response to treatment of severe life-threatening hypoglycaemia (plasma glucose 1.15 +/- 0.73 mM/l [+/- SD]) was studied in eight Thai patients with falciparum malaria. Plasma insulin concentrations were inappropriately high (range 1.0-21.8 mU/l), lactic acidosis was common (arterial blood lactic acid concentration 1.44-17.8 mM/l), but the glucose counterregulatory response, indicated by plasma cortisol, growth hormone, catecholamines and glucagon concentrations, was intact. Hyperinsulinaemia was successfully treated in five patients by a continuous intravenous infusion of the long-acting somatostatin analogue Sandostatin (SMS 201-995), 50 micrograms/h. In volunteer studies a single intramuscular injection of Sandostatin (100 micrograms) suppressed quinine-induced hyperinsulinaemia within 15 min; this effect was maintained for 6 h. These results suggest that Sandostatin may be a safe and effective way of correcting the hyperinsulinaemic hypoglycaemia complicating quinine treatment of falciparum malaria. This treatment could be particularly useful in fluid-overloaded patients with recurrent hypoglycaemia despite dextrose infusions.

Adolescent↗
PubMed1992

[Cerebral trypanosomiasis: epidemiology, clinical aspects, therapy and illness course].

More than 20,000 people are infected with one of the two forms of African trypanosomiasis each year. Without treatment the outcome is almost always fatal. There are, however, problems involved in drug treatment. Reactive encephalitis is recorded in up to 18% of all cases treated for cerebral trypanosomiasis. Recently a lack of response to treatment has been reported with increasing frequency from endemic areas. Relapses occur in up to 10% of cases. Reasons for relapses include insufficient treatment due to poor compliance or lack of drugs, reinfection in endemic areas, pharmacokinetic problems, the parasite's evasive mechanisms, and primary and/or secondary drug resistance.

Africa↗
PubMed1992

A review of the literature on the use of ultrasonography in schistosomiasis with special reference to its use in field studies. 1. Schistosoma haematobium.

This review presents an outline of the pathology resulting from Schistosoma haematobium infections, and the ways in which the lesions can be investigated. The use of ultrasonography is covered in detail. Ultrasonography can provide direct information about lesions in internal organs, and thus provide information about patterns of morbidity and about the regression of pathological changes after treatment. The method has the advantages that it is non-invasive, and is also relatively inexpensive and can be used under field conditions. Ultrasonography has already been used in a number of epidemiological studies in areas where S. haematobium is endemic. The method has proved to be feasible and useful. However, the methodology used for ultrasound studies has varied considerably, so that it is difficult to make valid comparisons between results obtained in different places or at different times. A standardized methodology for making observations and recording the results is needed if the full potential benefit of using ultrasound in the monitoring of schistosomiasis control projects is to be realised. The correlation of results obtained using ultrasound with the results of clinical, parasitological and other observations has been investigated in a number of studies, but many questions remain to be answered.

Confounding Factors, Epidemiologic↗
PubMed1992

A review of the literature on the use of ultrasonography in schistosomiasis with special reference to its use in field studies. 2. Schistosoma mansoni.

This review presents an outline of the pathology resulting from Schistosoma mansoni infections, and the ways in which it can be investigated. The use of ultrasonography is covered in detail. Ultrasonography can provide direct information about lesions in internal organs, and thus provide information about patterns of morbidity and about the regression of pathological changes after treatment. The method is non-invasive, and can be used under field conditions. Ultrasonography is valuable for the study of hepatosplenic pathology, to detect lesions such as the development of periportal fibrosis and the enlargement of the portal vein, which can indicate the development of portal hypertension. This may lead to a severe outcome, including bleeding from oesophageal varices, which is a principal cause of death from S. mansoni infection. A problem with the use of ultrasonography is that the mild lesions likely to be observed in population surveys are not always easy to assess. Ultrasonography has already been used in a number of epidemiological studies of S. mansoni infection, and has proved to be feasible and useful. However, the methodology used for ultrasound studies has varied considerably, so that it is difficult to make valid comparisons between results obtained in different places or at different times. A standardized methodology for making observations and recording the results is needed if the full potential benefit of using ultrasound in the monitoring of schistosomiasis control projects is to be realised.

Diagnosis, Differential↗
PubMed1992

A review of the literature on the use of ultrasonography in schistosomiasis with special reference to its use in field studies. 3. Schistosoma japonicum.

This paper gives a brief description of the pathology resulting from Schistosoma japonicum infection, and ways in which it can be investigated. It then reviews reports of the application of ultrasound in investigating lesions in schistosomiasis japonica, including papers published in Chinese and Japanese. Ultrasonography has been widely used for the diagnosis of schistosomiasis and for the investigation of pathological changes resulting from the infection. Marked and characteristic changes are observed in the structure of the liver parenchyma in advanced disease. Chronic pathology may be seen as a result of past infection. Animal studies have been used to compare ultrasound images with actual pathological changes. Ultrasonography can also be used to detect early changes, for example periportal fibrosis, which can indicate the development of portal hypertension. The problem of differential diagnosis is discussed.

Confounding Factors, Epidemiologic↗
PubMed1992

Studies on ultrasonographic diagnosis of schistosomiasis japonica in China--a review of selected Chinese studies.

Diagnostic ultrasound has been used in China since the early 1960's in the investigation of Schistosoma japonicum infection. This paper presents an overview of selected papers from the Chinese literature on the use of ultrasound in studies of schistosomiasis japonica, and briefly reports the results of studies not yet published elsewhere. The method is compared with other diagnostic procedures, and the benefits and limitations of using ultrasound are discussed.

Adult↗
PubMed1992

Ultrasound in schistosomiasis--a critical look at methodological issues and potential applications.

This is the concluding paper of a series on the use of diagnostic ultrasound in the investigation of schistosomiasis. An earlier chapter in the volume discussed standardization of the methodology, and of recording, when ultrasound is used for epidemiological purposes. The present paper discusses some other requirements for obtaining ultrasound data which can be used to make valid comparisons within and between studies. Since there is an inherent variability in the interpretation of results from ultrasound images, quality control and the training of observers are both essential. It is also necessary to collect more information for each endemic setting about possible concomitant diseases which might lead to misinterpretation of results. Furthermore, the analysis of the data obtained must be uniform if valid comparisons are to be made. A final section considers applications of ultrasonography in research and control programmes. The technique should make it possible to obtain a better understanding of the extent and distribution of organ damage due to schistosomal infection in different geographical areas, and of the way in which lesions develop over time, or may regress in response to treatment. Since ultrasonography will always remain a relatively labour-intensive and expensive technique, it is necessary to establish, in different settings, how its findings correlate with the results of parasitological, serological and biochemical tests. The ultimate aim is to build up a body of information on the potential of ultrasonography, in combination with other procedures, in the various possible approaches to morbidity control.

Clinical Protocols↗