Spontaneous regression of hepatic metastases from gastric carcinoma.
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Biomedical subjects
Publications and source records attributed to E Fox.
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Analysis of data obtained from Giemsa-stained blood films from patients with mixed Plasmodium vivax and P. falciparum parasitaemias seen in outpatient clinics held over 20 consecutive months in 4 villages in the Pakistani Punjab suggest that infections with P. falciparum and P. vivax were independent of each other. There was no evidence to support the hypothesis that P. falciparum suppressed P. vivax. A likely explanation for the seasonal variation in species parasitaemia rates in the Punjab is that P. vivax was predominant early in the transmission season due to late relapses, while P. falciparum was predominant later in the transmission season because of community-wide development of immunity to P. vivax.
To determine if the HIV-epidemic had reached Djibouti by autumn 1987, we investigated 645 subjects belonging to various risk groups; 150 were patients with a disease compatible with acquired immune deficiency or with a mycobacterial infection, 115 were young males having a sexually transmitted disease, 295 were female prostitutes, and 69 were villagers from a rural area; the remaining 16 belonged to other groups. All subjects answered an epidemiological questionnaire and had their serum tested for evidence of HIV antibodies. Eight sera were HIV-antibody positive by both ELISA and Western blot. Of these, 2 were from young men while 6 were from young women who admitted to prostitution. This accounts for an HIV seropositivity rate of 2.0% +/- 1.6% in the prostitute population. Also, one antibody-positive subject was positive for circulating HIV antigen. Seven of the seropositive individuals had no general complaints or abnormal clinical signs. The eighth subject was a 28 year old man in hospital for pneumonia. We conclude that in Djibouti, in late 1987, the prevalence of both AIDS and HIV infection in high risk individuals was much lower than that reported from other East African countries.
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Human herpesvirus type six (HHV-6), previously called human B-cell lymphotropic virus (HBLV), was first isolated in 1986 from patients with various lymphoproliferative disorders, some related to the acquired immunodeficiency syndrome. In order to investigate the epidemiology of HHV-6 in the Horn of Africa, we studied 281 young adults living in the city of Djibouti during June 1988. Of these, 181 belonged to various groups at risk for human immunodeficiency virus (HIV), while 100 represented the normal young adult population. Sera were screened and titrated for antibodies against HHV-6 by an indirect fluorescent antibody assay. The percentage seropositivity for HHV-6 was 71 in the normal population, 75 in the population at risk for HIV, and 93 in the population of subjects with a confirmed positive HIV Western blot. Mean titres of positive sera were similar in all population groups. No correlation existed between HHV-6 seropositivity and age, sex, tribe, habitat, and risk factors for HIV. A positive correlation was noted between HHV-6 and patients complaining of fatigue.
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In order to determine whether HTLV-I (a recently discovered retrovirus causing T-cell leukaemias and lymphomas, as well as tropical spastic paraparesis) was present in Djibouti in 1988, we investigated 576 subjects belonging to various groups at risk of acquiring HIV, a related retrovirus transmitted analogously to HTLV-I. Sera were screened by a commercial agglutination assay and confirmation of repeatedly reactive sera was performed by specific Western blot analysis. Four sera were strongly positive for HTLV-I by Western blotting, while one serum displayed equivocal reactivity. All positive sera came from young women who engaged in prostitution. This accounted for an HTLV-I seropositivity rate of 0.7% (95% CI, 0.03-1.4%) in the total study population and 1.2% (95% CI, 0.02-2.4%) in the population engaged in prostitution. We concluded that in Djibouti in June 1988, HTLV-I was present but that the prevalence of infection in high risk individuals was very low.
Who is fighting for the right to die? Past literature has been mixed as to the membership of this social movement. In the current study, 6,398 Hemlock Society members were surveyed in an effort to answer questions concerning who is participating in the right to die movement, whether these participants are rapidly approaching their own death or reacting to the death of a loved one, and whether the movement is invigorated by singular activists. The findings indicate that older, white, wealthy, highly educated, economically and politically active women are in the forefront of the right to die movement. These women report currently being mentally and physically healthy, yet already having taken the steps that will allow them to have an element of control over their death. Finally, right to die support seems to be part of a larger collective network concerning health care and political policy issues.
To follow the progression of HIV seropositivity among heterosexual adults at risk for HIV infection in the country of Rwanda prospectively, up to 100 patients with sexually transmitted diseases (STD) were tested each month from 1988 to 1991 at the health centre of Biryogo, which is located in a very crowded sector of the capital city, Kigali. Each patient had a blood sample tested anonymously for the presence of HIV antibodies. HIV seropositivity was defined as a reactive ELISA test combined to a reactive Western blot test. The overall HIV seropositivity among the 2058 subjects tested was 61%. It was higher (73%) among the 688 women tested as compared to the 1362 men tested (55%; P < 0.001). The per cent HIV seropositivity did not increase between 1988 and 1991, neither among the male nor among the female clinic attenders. However, the per cent seropositivity was higher in the older age groups, especially among the males. This exceedingly high proportion of HIV-infected STD patients in Kigali re-emphasizes the urgent need to include STD treatment, prevention and control among the priority actions for decreasing HIV transmission in African towns. Also, as the per cent seropositivities did not show any trend to increase over the 4-year period considered, we propose that our intensive HIV serosurveillance strategy among STD patients in Kigali be modified, since the plateau of HIV infection appears to have been attained in this particular high-risk population.
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To investigate the role of the Djibouti-Ethiopian railway as a potential vehicle for inter-regional spread of malaria vectors and malaria parasites, we performed a double-sided study, both entomological and parasitological, during November 1989, at the frontier post of Guelile where the trains from Ethiopia enter the Republic of Djibouti. No malaria-transmitting mosquitoes were collected either from the daily passenger train or from the weekly vegetables train. One hundred and five passengers entering Djibouti by train from Ethiopia had a thick film examined for malaria parasites. Five smears were positive for Plasmodium falciparum, among them two showed gametocytes. We conclude that the railway may be an effective route for the propagation of the human malaria parasite between Ethiopia and Djibouti. Indeed, passengers infected abroad could import plasmodia into Djibouti and thus become the index cases for local malaria outbreaks, in case the climatic and entomological prerequisites essential for sustaining malaria transmission are present.
In order to determine the prevalence of deficient activity of the enzyme glucose-6-phosphate dehydrogenase (G-6-PD) among the inhabitants of the east African Republic of Djibouti, we analyzed by the methaemoglobin reduction test the blood of 170 Djiboutian males, 81 Afars and 89 Somalis. Eight subjects were found to be G-6-PD deficient, 1 Afar and 7 Somalis (1.2% versus 8%; P = 0.02). We conclude that in Djibouti, health care providers should consider the presence of potential G-6-PD deficiency in their patients, especially in males of the Somali ethnic group. Indeed, many medications are contraindicated in the G-6-PD deficient subjects, and primaquine and pyrimethamine-sulfadoxine (FANSIDAR) have to be considered dangerous anti-malarial drugs for Somali males as long as their level of G-6-PD activity has not been determined. Since in Djibouti many acute falciparum cases are presenting with severe icteric anaemia, we hypothesize that some of these haemolytic anaemias might not be caused by the parasitic infection alone, but that some malaria patients might become aggravated through the administration of haemolytic drugs in case they are G-6-PD deficient. Finally, we propose that our study should be expanded to include the systematic determination of the variants of the enzyme in all subjects found G-6-PD deficient, since the clinical manifestations of G-6-PD deficiency are directly related to the type of variant present.