Schistosomiasis: past, present and future.
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Biomedical subjects
Publications and source records attributed to K S Warren.
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The present status of and priorities for vaccine development are described, and the historical conditions under which vaccines have been developed are contrasted with newer technologies for such development. Current programs, the opportunities they present, and the obstacles to their implementation are summarized.
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Egyptian school children infected with Schistosoma haematobium and treated with a single dose of metrifonate, 10 mg/kg body weight, had a marked reduction in urine egg counts reaching 90% during a 30-week follow-up. While cure rate was higher among lightly infected persons, percentage reduction in egg counts was greater among the heavily infected. After a summer period of probable high risk exposure reinfection rate in those children who were treated and cured was 4.7% as compared to 6% in previously uninfected children.
The importance of humanities in general education is generally acknowledged. With respect to premedical education, a major impediment has been the belief that gaining admittance to medical school is exceedingly difficult and, therefore, a student must major in the sciences. In compensation, the humanities have been introduced in medical schools either through compressed 6-year programs or as curricular or extracurricular options. Studies have shown, however, that approximately 50% of all applicants are admitted to medical schools and that the relatively small proportion of students who have majored in the humanities do somewhat better than average. With respect to medical schools, results of an examination of programs throughout the country suggest that strong extracurricular rather than curricular programs should be developed for the humanities.
Schistosomiasis japonica remains endemic in several provinces south of the Yangtze River in China because of relatively sparse populations of human beings and dense populations of snails. We studied two brigades in a rural commune in Gui-chi County, Anhui Province, to determine the prevalence, intensity, and morbidity associated with this infection before concerted control efforts were instituted. Quantitative fecal examinations, histories, and physical examinations relevant to schistosomiasis japonica were performed in 96 per cent of the available population 2 to 65 years of age. The prevalence was 26.3 per cent in Brigade A (778 persons) and 14.4 per cent in Brigade B (1532 persons). Clinical symptoms and signs were compared among uninfected persons and persons at three levels of infection as determined by fecal egg output. Some increased weakness was seen only at the heaviest levels of infection; abdominal pain was not an important symptom. Hepatomegaly was somewhat more frequent in moderate and heavy infections, but splenomegaly was rare and unrelated to intensity of infection. Neither stool consistency nor occult blood was related to the presence or intensity of infection. Approximately 50 per cent of the population had been treated for schistosomiasis japonica, 25 per cent repeatedly.
The effect of targeted mass treatment, a new strategy for cost-effective control of schistosomiasis mansoni based on administering single-dose chemotherapeutic agents to individuals with disease manifestations (hepatosplenomegaly) or heavy infections, was evaluated in an endemic area in Kenya. Two years after treatment of subjects with hepatosplenomegaly, the mean liver midsternal-line measurement decreased from 6 x 5 +/- 0 x 6 to 2 x 9 +/- 0 x 5 cm and the mean faecal egg count dropped significantly from its pretreatment level of 1090 +/- 290/g to 88 +/- 31/g. Targeted chemotherapy was then administered to a group of 122 subjects with faecal egg counts greater than or equal to 400/g. A similar maintained decrease in egg counts after chemotherapy was demonstrated in this group; mean egg count after one year was 115 +/- 17/g compared with 1250 +/- 232/g before treatment. The yearly rate of acquisition of heavy infection in this community was low (7%) and did not differ significantly in the uninfected, lightly infected, or heavily infected (and treated) groups.
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A study of the prevalence and intensity of opisthorchiasis viverrini in relation to morbidity as determined by standard medical examination was carried out in Nong Ranya, a small village containing 309 people in northeastern Thailand. Opisthorchis viverrini infection as determined by Stoll's quantitative egg count method had an overall prevalence of 94% and reached 100% prevalence in most age groups above the age of 10 years. With respect to intensity, 6% were uninfected, 26% had light (less than or equal to 1 eggs per mg [epmg] of feces), 37% moderate (greater than 1-10 epmg), 25% heavy (greater than 10-50 epmg), and 5% very heavy (greater than 50 epmg) infections. Peak intensity in both males and females occurred at age 40 and above. A history of eating "koipla" (a sauce consisting of ground up raw fish), of feeling weak, and of having right upper quadrant abdominal pains occurred most frequently in the infected groups and was correlated with intensity of infection. Regardless of intensity of infection, only a small proportion of the population were unable to carry out their routine activities. Anorexia, nausea or vomiting bore little relationship to the presence or intensity of infection. Hepatomegaly at the mid-clavicular line occurred in 14% of the population, mainly in the more heavily infected groups. Neither jaundice nor splenomegaly was observed in the population.
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The growth and rising cost of bibliographic materials require that attempts to make all medical libraries comprehensive and self-contained be replaced by the provision of selective collections devoted to the most used and useful materials, particularly in developing countries with limited resources. Journals constitute the most important and expensive component of a biomedical collection. While use data are important, a method is presented to guide selection in the absence of this information. The method identifies 35 nucleus journals and uses citation analysis to generate a list of 92 journals, partitioned into 31 medical specialty classes. Local expert consensus can guide selection of important local or regional literature not in the international archives. Careful selection results in efficient collections. Access to less used materials can be provided to individual libraries through resource sharing networks with affiliations to major comprehensive international libraries.
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The 50-mg Kato thick smear was modified by using stainless steel templates which deliver 20 mg of stools accurately; fecal material can thus be processed in the field and the smears cleared within 15 minutes. The counts obtained from the 20-mg quick Kato were proportional to those obtained by the 50-mg thick smear.
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