Biomedical subjects
E Fox
Publications and source records attributed to E Fox.
[Aeromonas hydrophila in the drinking water in Djibouti: commensal germ or diarrhea-causing agent?].
To investigate the bacteriological quality of drinking water used by inhabitants of the Republic of Djibouti who were not supplied with piped running water, we analysed 16 fresh-water samples from various sources. Only 3 samples were sterile; they were taken from village pumps and from a water-truck. Eleven samples yielded colonies of Aeromonas hydrophila too numerous to be counted; they were taken from water tanks, metal barrels, or wells dug in either dry river beds or along the seashore. We speculate that this high isolation frequency of Aeromonas hydrophila in fresh water samples may be related to conditions that are exceptionally favourable for the growth of the bacterium (e.g. high temperature and elevated concentrations of certain salts and minerals in the fresh water of Djibouti). We wonder nevertheless whether the infected water supplies were a source of diarrhoea for humans. Indeed, antibiotic resistance patterns were dissimilar when the 11 environmental strains were compared to 7 strains of Aeromonas hydrophila isolated from diarrhoeal patients in Djibouti during the same period. More studies are needed to determine if Aeromonas hydrophila is always a commensal inhabitant of fresh water in Djibouti, or if it can be a cause of infectious diarrhoea. Accordingly, Public Health authorities in Djibouti will be able to decide if water from wells and tanks is safe for drinking, or if it needs disinfection before consumption.
Predominance of vancomycin-sensitive strains of Neisseria gonorrhoeae in Djibouti.
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Incidence of HIV infection in Djibouti in 1988.
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Diagnostic usefulness of five screening assays for HIV in an east African city where prevalence of infection is low.
Five commercial screening assays for HIV-1, evaluated for their usefulness in detecting infection in high-risk groups in the East African country of Djibouti, produced varying degrees of performance when compared to Western blot and immunofluorescence confirmatory assays. In this population with a low prevalence of HIV infection (16/599), two enzyme-linked immunosorbent assays (ELISA; Abbott and Elavia) and two rapid assays (cambridge latex agglutination and Du Pont's HIV-CHEK) exhibited less than optimal sensitivities. However, with the exception of Elavia, these assays displayed excellent specificities. The fifth test (Serodia gelatin agglutination) produced the highest sensitivity (0.938) and negative predictive value but the lowest specificity and positive predictive value of all five tests. False positive reactions, which occurred only with the Elavia and Serodia tests, could not be explained on the basis of early infection in patients or cross-reactions with the related retroviruses HIV-2 and HTLV-I. We conclude that none of the five tests alone is sufficient in this testing situation, but that a combination of tests could satisfy most requirements for identifying HIV-1 reactive and non-reactive sera.
Trait anxiety and coping style as predictors of pre-operative anxiety.
A situationally specific measure of trait anxiety based on the Endler model was a better predictor of pre-operative state anxiety than the STAI trait anxiety scale in 54 patients undergoing colonoscopy. Lower self-reported pre-operative anxiety was found for (a) repressors, who report low trait anxiety and high defensiveness on the Marlowe-Crown scale, than for (b) truly low anxious patients, who report low trait anxiety and low defensiveness.
Repressive coping style and anxiety in stressful dental surgery.
Elevated state-anxiety prior to oral surgery is common and is associated with increased post-operative pain. This paper presents a psychological model of predicting elevated anxiety prior to dental surgery. Elevated anxiety and intraoperative stress can be predicted by measuring trait-anxiety. However, prediction may be improved by using a situationally specific measure of trait-anxiety, and by taking the patient's coping style into account. Thirty-nine patients undergoing wisdom-tooth extraction took part in the study. The Corah Dental Anxiety Scale was a better predictor of pre-operative anxiety than the STAI trait-anxiety scale. Coping style was measured by means of the Marlowe-Crowne Social Desirability Scale in conjunction with scores on trait-anxiety to define three coping style groups: sensitizers (high-anxious), truly low-anxious, and repressors who verbally deny anxiety. Two oral surgeons rated patient intra-operative state on 100 mm visual analogue scales. These ratings indicate that 'repressors' exhibit significantly more stress responses than the truly low-anxious group, in spite of similar (low) trait-anxiety scores. It is concluded that a situationally specific measure of trait-anxiety is the most appropriate predictor of differential state-anxiety elevations prior to oral surgery. Repressive coping style may be a confounding factor, in terms of predicting elevated anxiety, since some people verbally deny being anxious but express it behaviourally.
Interactions of minute virus of mice and adenovirus with host nucleoli.
Biochemical evidence is presented that both minute virus of mice (MVM) and adenovirus interact with the nucleolus during lytic growth and that MVM can also target specific changes involving nucleolar components in adenovirus-infected cells. These virus-nucleolus interactions were studied by analysis of intranuclear compartmentalization of both viral DNAs and host nucleolar proteins: (i) MVM in mouse cells (its normal host) replicates its DNA in the host nucleoli; (ii) specific nucleolar proteins as well as small nuclear ribonucleoprotein antigens are recompartmentalized to multiple intranuclear foci in adenovirus-infected HeLa cells; and (iii) when adenovirus helps MVM DNA replication in a nonpermissive human cell (HeLa), the MVM DNA is also recompartmentalized for synthesis. The data suggest mechanisms for disruption of nucleolar function common to oncogenic or oncolytic virus lytic growth and cell transformation.
Health, history and tin openers - a further comment on domestic practice.
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Observations on sexually transmitted diseases in promiscuous males in Djibouti.
Observations are reported on 7 sexually transmitted diseases in a heterosexual population of 105 promiscuous males in Djibouti, East Africa. Neisseria gonorrhoeae was cultured from urethral swabs from 34 subjects. Six isolates were beta lactamase positive (18%). High levels of resistance to antimicrobials were noted with penicillin, spectinomycin and cotrimoxazole, while tetracyclines and erythromycin were unvariably effective. Six patients had Chlamydia urethritis, one of whom had concomitant gonococcal urethritis. Half of the sera reacted positive for antibodies to Chlamydia. A total of 31 subjects had a positive treponemal FTA-Abs test; of these, only 14 had a reactive RPR test. Nineteen individuals were positive for HBsAg. One subject had a western blot confirmed HIV-1 infection, while none had antibodies to HIV-2 or HTLV-I.
AIDS: the situation in Mogadishu during spring 1987.
To determine if AIDS was present in Mogadishu during spring 1987, we screened hospital patients for the presence of diseases compatible with acquired immunodeficiency. Twenty-nine such patients were identified and had their serum tested for antibodies to HIV by standard serologic techniques. All these sera were negative for HIV antibodies. During the same time, at the Mogadishu clinic for sexually transmitted diseases, 48 individuals were examined for evidence of HIV infection. No patient had clinical signs compatible with AIDS, but one serum was anti-HIV antibodies positive in both the ELISA and western blot assay. We conclude that there was no clinical AIDS in Mogadishu in early 1987 and that prevalence of HIV infection in high risk individuals was very low.
[Knowledge of sexually transmitted diseases and attitudes towards them in populations at risk in Djibouti].
Sexually transmitted diseases (STDs) are an increasing public health problem in Djibouti. The authors have attempted to obtain basic information on the level of knowledge concerning STDs and on the sexual behaviour of highly sexually promiscuous individuals for use in the organization of future STD control programmes; the information was obtained from a population of 213 bar hostesses, 66 unlicensed prostitutes, and 115 male sufferers from STDs. The level of knowledge of these diseases was very high among the prostitutes and the bar hostesses, except that little was known about syphilis by the bar hostesses; the male sufferers were relatively ignorant concerning both syphilis and AIDS. Medical and paramedical personnel do not figure among the sources given for knowledge of STDs. On the other hand, friends play an important role in this knowledge, especially among unlicensed prostitutes. The second most frequently instanced source was radio and TV. The bar hostesses and the unlicensed prostitutes often exhibited distinct social characteristics. Neither education nor marriage appeared to prevent men from contracting STDs. The use of condoms is extremely rare among STD patients and not very common among unlicensed prostitutes. Half the bar hostesses report their frequent use.
Malaria and splenomegaly in the Punjab.
Splenomegaly and parasitaemia were correlated in 2891 children examined in outpatient clinics during 13 consecutive months in 4 Punjabi villages. The average monthly splenomegaly rate varied from 0.05-0.13 before the monsoon malaria transmission season to 0.18-0.27 during and after this season. Moderate splenic enlargement reached a peak during the malaria transmission season, while the highest proportion of very enlarged spleens occurred towards the end of, and after, the transmission season. Children with splenomegaly were 3 times more likely to have Plasmodium falciparum and 1.5 times more likely to have P. vivax parasitaemias than were children without palpable spleens. The larger the spleen the more likely a P. falciparum infection, whereas P. vivax was more commonly associated with minimal spleen enlargement. Although the probability of a child with splenomegaly having a malaria parasitaemia was highest (0.58-0.72) during and immediately following periods of malaria transmission, the odds ratio of malaria infections among those with splenomegaly to those without was at its lowest (1.41-2.11) during those months. Mean P. falciparum parasitaemias were significantly higher in infected children with moderately enlarged spleens than in infected children with nonpalpable spleens or in those with minimal or extensive splenomegaly. These results are compatible with splenomegaly being a result of both the malaria infection and the immune response. Early in infection many children had parasitaemia without splenomegaly; after the parasitaemia had cleared splenomegaly often persisted.
Viral hepatitis markers in Djibouti: an epidemiological survey.
A serosurvey involving 656 individuals revealed that hepatitis A infection was virtually universal in Djibouti in 1987, and more than half of the people investigated had serum markers of hepatitis B infection. The rate of chronic HBsAg carriers was 7.3% and was higher for males than for females. Both HBsAg and anti-HBs positivity rates were directly related to increasing age. No uniform mechanism could be found to account for transmission of the hepatitis B virus, and no correlation was noted between HBV-marker status and sexual promiscuity or the classic blood exposure risks. However, a significant association existed between the abuse of khat and the chronic HBsAg carrier state.
Controlled comparison of a new sublingual lormetazepam formulation and i.v. diazepam in outpatient minor oral surgery.
In a randomized, double-blind, parallel groups study, 40 patients undergoing surgical removal of impacted 3rd molar teeth received either sublingual lormetazepam 2.5 mg (n = 20) in a new cellulose wafer formulation followed at 35 min by i.v. saline; or sublingual placebo followed at 35 min by i.v. diazepam 10 mg (Diazemuls). Rapid onset of sedation was seen after sublingual lormetazepam, while the course and duration of postoperative sedation, measured using standard psychometric tests, was similar following both treatments. Surgeons' ratings indicated that sublingual lormetazepam was comparable to i.v. diazepam but patients' ratings indicated greater satisfaction with and preference for i.v. diazepam. Significant anterograde amnesia was found following both treatments. Both treatments were tolerated well, with no significant cardiovascular complications. These results indicate that sublingual lormetazepam may have a role in anaesthesia as a premedicant and for conscious sedation.
Health education needed to improve public STD awareness in Somalia.
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Status of AIDS in Khartoum in 1986.
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Benzodiazepine--induced event amnesia following a stressful surgical procedure.
In a randomised, double-blind, parallel groups study, 40 patients undergoing surgical removal of impacted third molar teeth received either midazolam 15 mg orally followed at 35 min by intravenous saline or oral placebo followed by intravenous diazepam 10 mg (Diazemuls). Episodic (event) memory was assessed by showing patients photographs of dental and neutral objects both before and after sedation and by testing subsequent recognition at 1 week. Recall of actual surgical events was assessed by questionnaire. Both treatments induced significant amnesia for visual stimuli and for surgical events. However, the degree of amnesia was more profound for artificial stimuli and no relationship was found between the extent of amnesia for the two types of event. Drilling of bone was found to provoke the greatest cardiovascular stress response and a significant relationship was found between the degree of cardiovascular activation and subsequent memory for drilling. It is concluded that the extent of benzodiazepine-induced event-amnesia may be modified by cognitive factors and especially by the extent to which the event is cognitively encoded and elaborated.