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Comparison of five glucose meters for self-monitoring of blood glucose by diabetic patients.

This study collected data regarding the accuracy of five currently marketed meters for home use of self-monitoring of blood glucose (SMBG). Data regarding ease of operation of each glucose meter as well as cost and availability of meters and necessary materials were compiled. Fasting blood glucose (BG) samples were drawn from patients in the adult and pediatric diabetes clinics at the University of Kansas College of Health Sciences and Hospital. Specimens were tested by a clinical laboratory as well as by each meter. Unadjusted meter readings of whole BG were plotted against laboratory readings of serum glucose and displayed in scattergrams. Scattergrams showed decreased machine accuracy in upper and lower BG ranges. Whole BG values (meter readings) were adjusted to serum glucose levels by multiplication by 1.12. Adjusted values were compared with laboratory serum values using ANOVA for repeated measures and Dunnett's Multiple Comparisons Test: ANOVA and Dunnett's Multiple Comparisons Test showed only Glucochek II (Medistron, Ltd., West Sussex, England; distributed in U.S. by Larken Industries, Lenexa, Indiana) using Dextrostix reagent strips (Ames Division, Miles Laboratories, Elkhart, Indiana) having a statistically significant difference from laboratory values (P less than 0.01). This meter was recently revised and may show changed accuracy readings. Each meter exhibited inherent advantages and disadvantages regarding price, calibration, strip utilization, and ease of operation, which must be considered before recommendation by the health care provider.

Autoanalysis↗

An inter-laboratory survey of qualitative urinalysis.

An inter-laboratory survey of qualitative urinalysis was carried out in Australasia during 1981. Eighty-one laboratories analysed 6 samples of urine distributed in 3 batches of 2 at regular bimonthly intervals, mostly with commercially available reagent strips. Fewer than 30% of laboratories performed any form of quality control for analytes other than pH. Results indicated that improvement in the analysis of urine bilirubin, protein, glucose, ketones and blood is required, and recommendations to improve standards are made.

Asia↗

Renal morphology and function and urine electrolytes in experimental acute renal failure produced by cyclosporine and ischemia.

It has been difficult to produce a good animal model for cyclosporine nephrotoxicity. It has been suggested that by following 20 minutes of renal ischemia with four daily doses of cyclosporine 60 mg/kg intraperitoneally, one can create a model of reproducible renal failure. We observed excessive mortality (65%), due in part to cyclosporine's CNS effects, with these combined insults in the Munich Wistar rat. In contrast, cyclosporine alone in this dosage produced only 17% mortality and resulted in a similar degree of renal failure. Pair-fed and pair-watered vehicle and saline controls were used. The morphologic changes brought about by the castor oil vehicle of the parenteral cyclosporine solution were qualitatively similar to those brought about by cyclosporine by light microscopy, although the severity of the changes was considerably less in the vehicle-treated groups. However, by electron microscopy, pale lipid vacuoles were seen only in the cyclosporine-treated groups, whereas dense alterations in lysosomes and dilated endoplasmic reticulum also were seen in other groups. Urine sodium determined by flame photometry and urine chloride determined by Saltex reagent strips tended to be high in the initiation phase of cyclosporine-induced acute renal failure and low in the maintenance phase. In animals that developed acute renal failure following the combination of ischemia and cyclosporine, the initial urine sodium and chloride were significantly correlated with the eventual degree of renal failure. The use of Saltex urine chloride sticks in clinical urine samples showed that the readings correlated well with urine sodium and chloride determined by conventional methods, suggesting that these strips may be useful in making a quick diagnosis in the setting of acute renal failure.

Acute Kidney Injury↗

Cytodiagnostic urinalysis is very useful in the differential diagnosis of acute renal failure and can predict the severity.

Cytodiagnostic urinalysis was tested to determine its utility in the differential diagnosis of acute renal failure (ARF). Fifty-one patients with acute renal failure were included and evaluated clinically with regard to the etiology of the renal failure, whether underlying chronic renal failure was present, and if dialysis was required. Urine specimens were macroscopically examined and subjected to a multiparameter reagent-strip analysis. Papanicolaou stain was done on cytocentrifuge preparations and the number of blood cells, renal cells, and casts examined in a standardized fashion. The results showed that the 34 patients with acute tubular necrosis (ATN) of either ischemic or toxic origin had a higher number of collecting duct cells, and a higher total number of casts than the 17 non-ATN patients. Twelve patients requiring dialysis had a higher number of different types of casts (granular, waxy, leukocytic, broad casts) as well as more renal cells (mainly necrotic) than the 39 patients who did not require dialysis. A significant positive correlation was found between the magnitude of rise of serum creatinine and a number of cytodiagnostic parameters. We conclude that cytodiagnostic urinalysis may be valuable in addition to other tests in the evaluation of patients with acute renal failure.

Acute Kidney Injury↗

Relative density of urine: methods and clinical significance.

The physical properties and chemical composition of urine are highly variable and are determined in large measure by the quantity and the type of food consumed. The specific gravity is the ratio of the density to that of water, and it is dependent on the number and weight of solute particles and on the temperature of the sample. The weight of solute particles is constituted mainly of urea (73%), chloride (5.4%), sodium (5.1%), potassium (2.4%), phosphate (2.0%), uric acid (1.7%), and sulfate (1.3%). Nevertheless, urine osmolality depends only on the number of solute particles. The renal production of maximally concentrated urine and formation of dilute urine may be reduced to two basic elements: (1) generation and maintenance of a renal medullary solute concentration hypertonic to plasma and (2) a mechanism for osmotic equilibration between the inner medulla and the collecting duct fluid. The interaction of the renal medullary countercurrent system, circulating levels of antidiuretic hormone, and thirst regulates water metabolism. Renin, aldosterone, prostaglandins, and kinins also play a role. Clinical estimation of the concentrating and diluting capacity can be performed by relatively simple provocative tests. However, urinary specific gravity after taking no fluids for 12 h overnight should be 1.025 or more, so that the second urine in the morning is a useful sample for screening purposes. Many preservation procedures affect specific gravity measurements. The concentration of solids (or water) in urine can be measured by weighing, hydrometer, refractometry, surface tension, osmolality, a reagent strip, or oscillations of a capillary tube. These measurements are interrelated, not identical. Urinary density measurement is useful to assess the disorders of water balance and to discriminate between prerenal azotemia and acute tubular necrosis. The water balance regulates the serum sodium concentration, therefore disorders are revealed by hypo- and hypernatremia. The disturbances are due to renal and nonrenal diseases, mainly liver, cardiovascular, intestinal, endocrine, and iatrogenic. Fluid management is an important topic of intensive care medicine. Moreover, the usefulness of specific gravity measurement of urine lies in interpreting other findings of urinalysis, both chemical and microscopical.

Biophysical Phenomena↗

Control of morbidity due to Schistosoma haematobium on Pemba Island: egg excretion and hematuria as indicators of infection.

The variability of Schistosoma haematobium egg excretion using a quantitative syringe filtration technique and the variability of hematuria detected visually and by reagent strips were studied in a population of 520 subjects from the village of Pujini (Pemba Island, Zanzibar, Tanzania) for 6 consecutive days. A high degree of day-to-day variability of egg excretion within subjects was found both in the whole population and in the 5-19 year age group. Subjects with 1 urinary egg count of greater than or equal to 50 eggs/10 ml urine were not similarly classified in 36-61% of the other 5 examinations and 4-16% of their other examinations were negative. Gross hematuria had a specificity of almost 100%, when related to a positive filtration on any day, and was closely related to egg counts of greater than or equal to 50 eggs/10 ml urine. The finding of a strongly positive reaction for hematuria on a given single day was closely associated with the subject having a high egg count (greater than or equal to 50 eggs/10 ml urine) on at least one of the 6 days of the study. At the primary health care level, single highly positive semiquantitative values for hematuria were a more useful diagnostic indicator than a single egg count to select patients with heavy infections for selective population chemotherapy.

Adolescent↗

Day-to-day variation of egg output and schistosome circulating antigens in urine of Schistosoma haematobium-infected school children from Gabon and follow-up after chemotherapy.

A group of 31 school children from Gabon infected with Schistosoma haematobium was examined before praziquantel therapy and followed on days 3, 9, 14, 21, 24, 28, 31 and 35 after therapy. The day-to-day variation of schistosome circulating antigens, urinary egg output, and the reagent strip index (RSI, a pathologic marker) was studied in six consecutive pretreatment urine samples collected under standardized conditions. The geometric mean pretreatment for egg output ranged between 97 and 223 eggs per 10 ml of urine; for urine circulating anodic antigen (CAA) levels this was 44-154 pg/ml and for circulating cathodic antigen (CCA) levels this was 180-601 pg/ml. On the day of treatment, 97% of the children had viable eggs in their urine, 87% had a positive RSI; positive CAA levels were detected in 61% of the children and positive CCA levels in 77%. A significant correlation was consistently found between RSI and egg counts. Five weeks after chemotherapy egg output, levels of CAA and CCA and the severity of pathologic findings in the lower renal tract, as indicated by the RSI, had decreased significantly in all cases. Our results indicate that egg output in urine is an accurate method for diagnosis of S. haematobium, and additionally show less day-to-day variation than detection by ELISA of schistosome circulating antigens in urine.

Adolescent↗

The epidemiology of schistosomiasis in Egypt: Assiut governorate.

In the Assiut, Egypt Epidemiology 1, 2, 3 investigation, a sample of 14,204 persons in 10 villages, 31 ezbas (satellite communities), and 2,286 households was drawn from a rural population of 1,598,607. Parasitologic examination of urine and stool were made for Schistosoma haematobium and S. mansoni, and physical and ultrasound examinations were made on a 20% subsample. The overall estimated prevalence of S. haematobium was 5.2 +/- 0.5 (+/- SE). This varied considerably by village and ezba, ranging from 1.5% to 20.9%, with ezbas having a slightly higher overall prevalence than villages. The overall estimated geometric mean egg count was 6.6 +/- 0.5 eggs per 10 ml of urine and was consistently low throughout the communities. Infection with S. haematobium was associated with age (peak prevalence of 10.6 +/- 1.5% in 15-19-year-old age group) males, children playing in the canals, a history of blood in the urine, and reagent strip positivity for hematuria and proteinuria. The prevalence of either hepatomegaly or splenomegaly detected by physical examination was low (4.0% and 1.5%, respectively). The prevalence of hepatomegaly determined by ultrasonography was substantially higher, 24.1%. The prevalence of periportal fibrosis (PPF) was 12.0%, but grade II or III PPF was present in less than 1%. Ultrasonography-determined hepatomegaly, in both the midclavicular line and the midsternal line, increased by age to more than 30%. Periportal fibrosis was more common in the age groups in which infection rates were the highest. At the village and ezba level of analysis, the prevalence of hepatomegaly, splenomegaly, and PPF tended to be higher in communities having the highest prevalence of infection with S. haematobium.

Adolescent↗

[Relationship between the prevalence of proteinuria and obesity in Japanese men].

5174 Japanese male workers were studied cross-sectionally to examine a possible relationship between obesity and the prevalence of proteinuria (1 + or greater), determined using a reagent strip. The subjects were divided into three groups with body-mass indexes (BMIs) of < 23, 23-24.9 and > or = 25, and the prevalence of proteinuria was compared among the three groups, after adjustments for age, blood pressure and blood levels of HbA1c. Among subjects with hypertension and/or a high level of HbA1c, i.e., > or = 5.9%, the group with a BMI of > or = 25 had a higher prevalence of proteinuria than the group with a BMI of < 23. In contrast, the prevalence of proteinuria was not affected by obesity in the subjects with neither hypertension nor a high level of HbA1c. These results suggest that for obese men with hypertension or diabetes, reducing body weight is important not only as part of the treatment for those diseases, but also to prevent proteinuria.

Adult↗

New instrumentation in urinalysis.

Automated instrumentation and electronic data processing now assist in performing and standardizing urinalyses. These innovations include specific gravity instruments and reagent "strip readers," and one system designed to automate the physical, chemical, and microscopic urinalysis. In this article, the author reviews the features of some examples of these new instruments.

Autoanalysis↗

[Use of a questionnaire for screening people with undiagnosed diabetes].

OBJECTIVE: To evaluate a screening questionnaire to identify individuals with undiagnosed diabetes. DESIGN AND METHODS: We conducted a community survey to detect people at increased risk for diabetes using a questionnaire proposed by Herman et al. (1995), that incorporates major risk factors as age, obesity, family history of diabetes, sedentary lifestyle and personal history of delivering a macrosomic infant. Blood glucose test was made by means of reagent strip and a reflectance meter system. We used the ADA recommendations and cut-points for screening programs, adjusted for fasting and random blood glucose. RESULTS: We included 360 participants older than 20 years of age. A total of 200 subjects (55.5%) were at risk for diabetes according to the questionnaire, of whom 31 (15.5%) had an abnormal glucose test compared to the 4.4% of the low-risk group (p < 0.001). The 1995 Herman et al. Questionnaire had sensitivity of 81.6%, specificity of 47.5, positive predictive value of 15.5 and negative predictive value of 95.6%. The high-risk group was older (44.9 vs. 34.6 y, p < 0.001) and heavier (30.5 vs. 24.4 kg/m2, p < 0.001) than the low-risk group. There were 38/360 (10.5%) abnormal glucose readings, of which 31 (81.5%) had a positive questionnaire (p < 0.01). The mean fasting glucose in the high-risk group was higher (90.6 vs. 84.2 mg/dL, p = 0.015) than in those with low risk by questionnaire, as well as for random blood glucose (116.1 vs. 100 mg/dL, p < 0.01). CONCLUSIONS: The questionnaire proposed by Herman et al. combined with capillary blood glucose testing performance good in mexican population to identify people at high risk for undiagnosed diabetes, and improved the detection rate.

Adult↗

Comparative post-operative study of prostheses, with and without an anti-reflux valve system, in the palliative treatment of esophageal carcinoma.

BACKGROUND/AIMS: Palliative treatment of advanced esophageal carcinoma by esophageal tunnelization with a prosthesis allows immediate relief of dysphagia. However, the procedure is subject to a high rate of morbidity, including gastroesophageal reflux (GER) present in all patients with a prosthesis positioned through the gastroesophageal junction, resulting in complications (pyrosis, aspiration pneumonias, sleep disorders) and reduced quality of life in these patients who already have a lower rate of survival. In an attempt to reduce GER and its complications, the authors created a surgical prosthesis coupled to an anti-reflux valve system, comparing it to the use of an esophageal prosthesis without an anti-reflux valve mechanism. METHODOLOGY: Twenty-two patients were allocated to 2 tunnelization groups: esophageal prosthesis without an anti-reflux valve mechanism (group 1) and surgical prosthesis coupled to an anti-reflux valve system (group 2). The GER was quantified measuring esophageal-gastric pH, and using fluoroscopy, contrast radiographs and esophageal emptying scintigraphy. Initially, the pH of secretions in S1 (esophagus) and S2 (stomach) was determined using reagent strips after aspirating their contents with different syringes. First with the patient seated at rest in bed, later performing a Valsalva maneuver, deep breathing and forced coughing. The same procedure was performed with the patient in left lateral decubitus, right lateral decubitus, and dorsal decubitus with the head of the bed lowered to 20 degrees. After finishing these maneuvers, 15 ml of 1 molar acetic acid were infused through the catheter positioned in the antrum, and, after 5 min, S1 and S2 material sampling was repeated in the same positions as mentioned above. RESULTS: The pH values between the various positions and maneuvers performed in each group separately were not significantly different, but, if we compare the 2 groups, and the secretions obtained in S1 and S2, there was a significant difference in pH measures in all positions. In the patients in group 1, S1 presented a mean pH ranging from 2.87-3.62 in the initial measures, and between 2.17 and 3.5 after the infusion of 15 ml of 1 molar acetic acid. On the other hand, in group 2, the mean pH of S1 remained between 6.34 and 8.32 in the initial measures and between 4.99 and 7.33 in the presence of acid infusion. At the level of S2, the pH remained unchanged between 2 and 2.7, in both groups. CONCLUSIONS: The authors conclude that the association of an esophageal prosthesis with a valve system significantly reduces GER, as compared with its use alone. Furthermore, it allows marked reduction of the symptoms and resulting complications, and does not interfere clinically with esophageal emptying. It thus significantly improves the quality of life of these patients.

Equipment Failure Analysis↗

[Acute bacterial cystitis].

It is now important to differentiate lower urinary tract infection also known as classical acute cystitis (because it involves a healthy genitourinary system) from complicated or potentially complicated urinary tract infection. The bacteriology of lower urinary tract infection is dominated by enterobacteria and Escherichia coli in particular. Since E. coli are now commonly resistant to amoxicillin and cotrimoxazole, those antibiotics cannot be used as first-intention. Fluoroquinolones, fosfomycin trometamol or furans must be preferred instead. The clinical problem here is trying to avoid overzealous diagnoses and remembering that symptom-free bacteriuria is very frequent, particularly in elderly patients. The management of uncomplicated lower urinary tract infection should remain simple (urinalysis with reagent strips and more cell bacteriology tests); the treatment should be simple too [single-dose or short treatment (3 days)]. The management of complicated lower urinary tract infection is very different however and requires a more extensive workup followed by a dual therapy, namely antibiotics and eradication of the complicating factor, if possible.

Acute Disease↗

[Complicated urinary tract infections--from the perspective of the medical technologist].

We would like to propose re-establishment of the protocol for ordering a clinical microbiology laboratory test after a bedside screening test using urine reagent strip when urinary tract infection is suspected. Media for isolation shall be chosen by the clinical microbiology laboratory after checking turbidity and microscopic examination of the urine specimen. In cases of complicated urinary tract infections, quantitative culture should be performed to investigate changes in the number of microorganism to grasp condition of super infection. In such infections, there are many cases in which multiple microorganism growth including glucose non-fermenting gram-negative bacilli can be recognized. Therefore, it is necessary to inspect colonies on media as long as possible (24 hrs culture may be short in some cases). The protocol for microorganism identification and susceptibility test for such specimen varies in each laboratory, considering the Health Insurance Point System (reimbursement system by MHW). It is necessary to communicate with physicians and to refer to past results to proceed with the laboratory test properly. Therefore, a Certified Clinical Microbiology Medical Technologist is needed and the role played by such staff is important.

Bacteriological Techniques↗

The clinical spectrum of acute renal infarction.

BACKGROUND: Acute renal infarction is an oft-missed diagnosis. As a result, its true incidence, although presumed to be low, is actually unknown. Surprisingly, the medical literature on the subject, other than anecdotal case reports, is scarce. OBJECTIVES: To increase physician awareness of the diagnosis and to identify predictive clinical and laboratory features of the entity. METHOD: Between 1 November 1997 and 31 October 2000, 11 cases of acute renal infarction in 10 patients were diagnosed in our center by contrast-enhanced computerized tomography. The medical charts of these patients were reviewed regarding risk factors, clinical presentation, possible predictive laboratory examinations, and outcome. RESULTS: During the 36 month observation period, the incidence of acute renal infarction was 0.007%. The mean age of the patients (5 men and 5 women) was 67.4 +/- 21.1 (range 30-87 years). In four cases the right and in five the left kidney was involved; in the other two cases bilateral involvement was seen. In 7/10 patients, an increased risk for thromboembolic events was found. Six had chronic atrial fibrillation and one had a combined activated protein C resistance and protein S deficiency. Three patients had suffered a previous thromboembolic event. Two cases were receiving anticoagulant therapy with an INR of 1.6 and 1.8, respectively. On admission, flank pain was recorded in 10/11, fever in 5 and nausea/vomiting in 4 cases. Hematuria was detected in urine reagent strips in all cases. Serum lactate dehydrogenase and white blood cell count were elevated in all cases (1,570 +/- 703 IU/L and 12,988 +/- 3,841/microliter, respectively). In no case was the diagnosis of acute renal infarction initially entertained. The working diagnoses were renal colic in 2, pyelonephritis in 3, renal carcinoma, digitalis intoxication, and suspected endocarditis in one patient each, and an acute abdomen in 3. Time from admission to definitive CT diagnosis ranged from 24 hours to 6 days. Three patients were treated with intravenous heparin and another with a combination of i.v. heparin and renal intra-arterial urokinase infusion with, in the latter case, no recovery of function of the affected kidney. With the exception of this one patient (with a contralateral contracted kidney) who required maintenance dialysis, in all other cases serum creatinine levels remained unchanged or reverted to the baseline mean of 1.1 mg/dl (0.9-1.2). CONCLUSIONS: Acute renal infarction is not as rare as previously assumed. The entity is often misdiagnosed. Unilateral flank pain in a patient with an increased risk for thromboembolism should raise the suspicion of renal infarction. In such a setting, hematuria, leucocytosis and an elevated LDH level are strongly supportive of the diagnosis.

Acute Disease↗

Epidemiology and immunodiagnosis of schistosomiasis haematobium in low endemic area in Egypt.

A survey was performed in Behbeet village in Giza governorate including 370 individuals (172 males and 198 females) representing 10% of the house holds. Clinical, stool, urine and serological tests accompanied by a questionnaire were applied to all participants to find out the prevalence, intensity of infection of S. haematobium, underlying sociodemographic factors, morbidity indicators and the awareness and treatment status among the infected population. It was revealed that the overall prevalence of S. haematobium based on the detection of eggs in urine was 18.1% while the prevalence of antibodies to S. haematobium species specific microsomal antigen was 57.6% detected by enzyme-linked immuno-transfer blot (EITB). The highest age specific prevalence and intensity of infection were detected among school children in the early teenage. Males were at a higher risk of contracting infection than females with a sex ratio of 2.5:1. Occupational and recreational water contact were significantly more frequent among the egg positives than the negative ones. Present history of haematuria and microhaematuria detected by reagent strips had the strongest association with S. haematobium infection followed by leucocyturia and dysuria. Microhaematuria had the strongest negative predictive value (85.7%) in discrimination between egg positive and negative groups while its positive predictive value was the highest (92.9%) when seropositives and negatives were discriminated. Less than half of the infected population were aware of having the disease (43.3% and 41.8% among the egg positives and seropositives, respectively) and lower percentages reported receiving previous treatment for schistosomiasis. No significant differences were detected between groups (P>0.05). Culturally appropriate and effective health education of the population, and training of the staff of rural health units to improve diagnostic and outreach skills are recommended.

Adolescent↗

Achieving glycemic control in young children with type 1 diabetes: approaches, pitfalls and new technologies.

Advances in technologies for insulin administrations, glucose monitoring, development of an artificial pancreas and cell-based therapy will ultimately have a profound effect on the lives of people wit diabetes. There is both current success and substantial promise, indicating that these approches may offer, for the first time, real potential for achieving euglycemia without hypoglycemia. Given the physiological and psychosocial impact of type 1 diabetes in young children, this group of patients and their parents stand to gain especially great benefit from these developments. However, the potential for improvements in the mangement of diabetes in young children based on available technologies should not be overlooked and should be effectively utilized as the standard for patient care. Only twenty years ago blood glucose reagent strips were first coming into routine use. Current meters have greatly reduced the amount of blood required ( now less than 1 microliter for many meters) and greatly imporved precision. The advent modified, recombinant insulins, which became available only in the last several years, allows for an insulin regimen to better match the absorption of dietary carbohydrate. All technologies have improved our ability to attain glycemic control, thereby reducing the risk of long-term complication in even our youngest patients.

Adolescent↗

[Schistosomiasis endemic in Burkina Faso].

Burkina Faso, through the works of many teams of the OCCGE based in Bobo-Dioulasso, has signi-ficant data on several tropical endemics of which schistosomiasis. With the complementary works, it appears to be possible to establish a distribution of the schistosomiasis which reveals its importance. It will be the first stage of the planned national control program. The parasitologic data-gathering which covers the period of 1951 to 2000, used all the standard techniques. It is about Kato-Kartz and MIF for the intestinal schistosomiasis, centrifugation, filtration, serology reagent strips, macroscopy of urines and echography of the urinary system for the urinary schistosomiasis. All the eleven medical areas of the country have many sites submitted to parasitologic investigation. As regard the distribution of the two parasites involved with man (Schistosoma haematobium and S. mansoni), the data of prevalence (1% to 100%) and their distribution confirm their endemicity and the focal transmission. S. mansoni is located in eight medical areas particularly in the South and the West. S. haematobium is present in all the eleven medical areas of the country. In hydraulic planning as Sourou where the prevalences went from 23% to 70% for S. haematobium and from 0% to 69% for S. mansoni between 1987 and 1998. The situation requires a continuous monitoring. The spatial distribution of the six species of intermediate hosts shows that Bulinus truncatus and B. senegalensis Soudano-Sahelian species are present in all the ecological zones. B. globosus and Biomphalaria pfeifferi meet preferentially in the southern half of the country which reinforces the observation according to which the 14th northern parallel is often considered as the limit of septentrional extension of these two species. The other species Bulinus forskalii and B umbilicatus could have preference areas. All the species show a certain affinity with a type of biotope. The rarity and temporary aquatic systems lead to a concentration of the domestic and especially entertaining children activities around these biotopes very often contaminated. The phenomenon is amplified by the increase of contacts man-water, whose frequency and intensity are themselves dependent on activities related to hydro-agricultural planning. The analysis of the data shows, that in terms of colonization of the biotopes by molluscs and the relations between parasites and intermediate and final hosts, hydraulic planning turns out to be an amplifying factor of the species proliferation and parasitic flux host-parasite.

Agriculture↗