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PubMedDate not supplied

Age, temperature, and parasitaemia predict chloroquine treatment failure and anaemia in children with uncomplicated Plasmodium falciparum malaria.

The prevalence of chloroquine-resistant Plasmodium falciparum malaria has been increasing in sub-Saharan Africa and parts of South America over the last 2 decades, and has been associated with increased anaemia-associated morbidity and higher mortality rates. Prospectively collected clinical and parasitological data from a multicentre study of 788 children aged 6-59 months with uncomplicated P. falciparum malaria were analysed in order to identify risk factors for chloroquine treatment failure and to assess its impact on anaemia after therapy. The proportion of chloroquine treatment failures (combined early and late treatment failures) was higher in the central-eastern African countries (Tanzania, 53%; Uganda, 80%; Zambia, 57%) and Ecuador (54%) than in Ghana (36%). Using logistic regression, predictors of early treatment failure included younger age, higher baseline temperature, and greater levels of parasitaemia. We conclude that younger age, higher initial temperature, and higher baseline parasitaemia predict early treatment failure and a higher probability of worsening anaemia between admission and days 7 or 14 post-treatment.

Age Factors↗
PubMed2001

Social medicine in Latin America: productivity and dangers facing the major national groups.

There is little knowledge about Latin American social medicine in the English-speaking world. Social medicine groups exist in Argentina, Brazil, Chile, Colombia, Cuba, Ecuador, and Mexico. Dictatorships have created political and economic conditions which are more adverse in some countries than others; in certain instances, practitioners of social medicine have faced unemployment, arrest, torture, exile, and death. Social medicine groups have focused on the social determinants of illness and early death, the effects of social policies such as privatisation and public sector cutbacks, occupational and environmental causes of illness, critical epidemiology, mental health effects of political trauma, the impact of gender, and collaborations with local communities, labour organisations, and indigenous people. The groups' achievements and financial survival have varied, depending partly on the national context. Active professional associations have developed, both nationally and internationally. Several groups have achieved publication in journals and books, despite financial and technical difficulties that might be lessened through a new initiative sponsored by the US National Library of Medicine. The conceptual orientation and research efforts of these groups have tended to challenge current relations of economic and political power. Despite its dangers, Latin American social medicine has emerged as a productive field of work, whose findings have become pertinent throughout the world.

Aged↗
PubMed2000

Characterization of the heat-shock protein 60 chaperonin from Onchocerca volvulus.

Chaperonin 60 (cpn60) belongs to the group of ubiquitous molecular chaperones that comprise the heat shock proteins, nucleoplasmins and chaperonins. Antibodies to recombinant CPN60 from humans was used to screen a cDNA library of Onchocerca volvulus and antigen-positive clones were selected. Sequencing of the DNA inserts confirmed their identity as cpn60 transcripts. These are distinct from a cpn60 sequence recorded previously from O. volvulus (GenBank accession number Y09416) that appears to be of endobacterial origin, rather than derived from the parasite itself. The full-length sequence of the cDNA (designated Ov-cpn60) codes for a protein of 64.3kDa (598 amino acid residues) and shares significant identity with homologous gene products from Caenorhabditis elegans (72%), humans (69%), yeast (53%) and Escherichia coli (50%). The endobacterial and parasite sequences are 41% conserved. Ov-CPN60 migrates with an apparent molecular mass of 65kDa on SDS-PAGE and is present in all life-cycle stages, as determined by immunoblotting with rabbit antibodies raised against the recombinant protein. Immunogold electron microscopy identified the protein within mitochondria, as expected, but also in extra-mitochondrial sites, including inclusion bodies of the glandular oesophagus (in infective larvae), the uterine wall, cytosol of developing spermatids, and the hypodermis and cuticle. Endobacteria were also labelled, indicating cross-reactivity between CPN60 from the parasite and its intracellular symbiont. In human infections, serum antibodies to Ov-CPN60 were present in only 11% of cases from Ecuador, but in 81-89% of subjects in three separate foci from West Africa. There was no relationship between antibody levels and age, sex, or infection intensity, and no consistent association between the serological response and immune status. An evaluation of antibody specificities in individual sera revealed a mixture of parasite-specific and host crossreactive anti-CPN60 antibodies, the ratio of which varied amongst geographic areas. It is concluded that antibody responses to Ov-CPN60 are unlikely to contribute either to host protection or pathology in onchocerciasis.

Amino Acid Sequence↗
PubMedDate not supplied

Validation of the Cross-Cultural Alcoholism Screening Test (CCAST).

BACKGROUND: When screening instruments that are used in the assessment and diagnosis of alcoholism of individuals from different ethnicities, some cultural variables based on norms and societal acceptance of drinking behavior can play an important role in determining the outcome. The accepted diagnostic criteria of current market testing are based on Western standards. METHODS: In this study, the Munich Alcoholism Test (31 items) was the base instrument applied to subjects from several Hispanic-American countries (Bolivia, Chile, Ecuador, Mexico, and Peru). After the sample was submitted to several statistical procedures, these 31 items were reduced to a culture-free, 31-item test named the Cross-Cultural Alcohol Screening Test (CCAST). RESULTS: The results of this Hispanic-American sample (n = 2,107) empirically demonstrated that CCAST measures alcoholism with an adequate degree of accuracy when compared to other available cross-cultural tests. CONCLUSIONS: CCAST is useful in the diagnosis of alcoholism in Spanish-speaking immigrants living in countries where English is spoken. CCAST can be used in general hospitals, psychiatric wards, emergency services and police stations. The test can be useful for other professionals, such as psychological consultants, researchers, and those conducting expertise appraisal.

Alcoholism↗
PubMed1988

Electric shock does not save snakebitten rats.

A team of missionary doctors from Ecuador recently described striking success in the treatment of venomous snakebites with a series of brief, high-voltage, low-current electric shocks applied to the bit site. We designed a randomized, controlled, blinded test of their methods in laboratory rats. Venom of the fer-de-lance, Bothrops atrox, was injected subcutaneously into rats in a series of increasing doses. Half of each dose group then was shocked with a device used by the Ecuadoran group. Envenomated animals developed hemorrhagic ulcers at the injection sites, the size of which was strongly related to venom dose. Electric shock did not influence the development of morbidity or the eventual ulcer size in sublethally envenomated animals, nor did shocks reduce mortality in lethally envenomated animals. We conclude that shocks are without effect on snakebitten rats, and we discuss implications of our findings for the treatment of snakebitten human beings.

Animals↗
PubMedDate not supplied

[Diabetes mellitus and pancreatic tumor].

A 68 year old Ecuadorian man was investigated for polyuria, polydipsia and weight loss of 3 kg during the previous two months. Insulin dependent diabetes mellitus was diagnosed 10 year before admission and treated with appropriate diet and insulin (35 U/d). 18 months before was diagnosed in El Ecuador of "multiple liver nodes non-suggestive of malignancy". Physical examination showed a large multinodular petrous hepatomegaly. There was no evidence of skin lesions. Results of laboratory studies included a basal plasma glucose level that ranged between 275-367 mg/dl (N=60-100), glycosylated haemoglobin of 8.9% (N<5) and a serum albumin of 2.8 gr./dl (N=3.4-4.8). At admission non-other laboratory alterations were detected. Computed tomography showed a mass on the head of the pancreas with loco-regional lymph nodes and liver metastases. Tumor markers were normal. Fine-needle aspiration cytology of the liver masses revealed the presence of liver metastases of a non-differentiated malignant tumor. A 111In-DTPAOC scintigraphy revealed the presence of somatostatin receptors in the liver metastases, also detecting the presence of multiple bone metastases in the axial and appendicular skeleton. Plasma glucagon level was 678 pg/ml (N<250). A diagnosis of metastatic glucagonoma was established and therapy with streptozocin, 5-FU, insulin and synthetic somatostatin analogs was initiated. Three months after the therapy initiation the patient was symptom free. Some weeks after the patient suffered from left hip pain, and a control 111In-DTPA scintigraphy showed progression of his bone metastases. In conclusion, glucagonoma must be suspected in all diabetic patients with metastatic liver, even in absence of necrotic migratory erythema. In these circumstances, plasmatic glucagon level and somatostatin receptors scintigraphy will be a useful tool for establishing the final diagnosis.

Aged↗
PubMed2001

Managed care in Latin America: the new common sense in health policy reform.

This article presents the results of the comparative research project, "Managed Care in Latin America: Its Role in Health System Reform." Conducted by teams in Argentina, Brazil, Chile, Ecuador, and the United States, the study focused on the exportation of managed care, especially from the United States, and its adoption in Latin American countries. Our research methods included qualitative and quantitative techniques. The adoption of managed care reflects the process of transnationalization in the health sector. Our findings demonstrate the entrance of the main multinational corporations of finance capital into the private sector of insurance and health services, and these corporations' intention to assume administrative responsibilities for state institutions and to secure access to medical social security funds. International lending agencies, especially the World Bank, support the corporatization and privatization of health care services, as a condition of further loans to Latin American countries. We conclude that this process of change, which involves the gradual adoption of managed care as an officially favored policy, reflects ideologically based discourses that accept the inexorable nature of managed care reforms.

Diffusion of Innovation↗
PubMed2000

Comparative risk assessment: an international comparison of methodologies and results.

Comparative risk assessment (CRA) is a systematic procedure for evaluating the environmental problems affecting a geographic area. This paper looks beyond the U.S. border and examines the experience with CRAs conducted in various developing countries and economies in transition, including Bangkok, Thailand, Cairo, Egypt and Quito, Ecuador, as well as other locations in Eastern Europe, Asia and Central and South America. A recent pilot CRA conducted in Taiwan is also considered. Comparisons are made of both the methodologies and the results across the relatively diverse international literature. The most robust finding is that conventional air pollutants (e.g., particulate matter and lead) consistently rank as high health risks across all of the CRAs examined. Given the varied nature of the settings studied in the CRAs, including level of economic development, urban-rural differences, and climate, this finding is particularly significant. Problems involving drinking water are also ranked as a high or medium health risk in almost all the countries studied. This is consistent with the results of analyses conducted by the World Bank suggesting contamination, limited coverage and erratic service by water supply systems. Beyond the major air pollutants and drinking water, the CRA results diverge significantly across countries. A number of problems involving toxic chemicals, e. g., hazardous air pollutants, rank as high health risks in the US but do not appear as consistent areas of concerns in the other countries studied. This likely reflects the so-called "risk transition" - the shift from sanitation and infection disease problems to those involving industry, vehicles and toxic substances - that often occurs with economic development. It may also reflect the greater information about sources of toxic pollutants in the U.S. For other problems, there are important differences across the developing countries and economies in transition. For example, hazardous and (industrial) non-hazardous waste issues ranked as medium or low health risks in all the countries studied, except for Taiwan where unmanaged toxic waste sites were considered to pose high risks. While the generally low ranking is consistent with the notion that few people are directly exposed to hazardous and (industrial) non-hazardous waste, it is not entirely surprising that views might be different in Taiwan, where space is so limited and population density is so high. We suggest that the wide range of findings likely reflect genuine differences among the countries studied. However, we cannot entirely rule out the possibility that some of the observed similarities (and differences) arise from the (relatively) common methodologies employed.

Animals↗
PubMed2003

Amblyomma aureolatum (Pallas, 1772) and Amblyomma ovale Koch, 1844 (Acari: Ixodidae): hosts, distribution and 16S rDNA sequences.

DNA sequences of Amblyomma aureolatum (Pallas, 1772) and Amblyomma ovale Koch, 1844 were obtained to determine genetic differences between these tick species. Collections of these species are discussed in relation to distribution and hosts. Seven ticks collections (four from Brazil, one from Argentina, one from Uruguay and one from USA) house a total of 1272 A. aureolatum (224 males, 251 females, 223 nymphs and 574 larvae) and 1164 A. ovale (535 males, 556 females, 66 nymphs and 7 larvae). The length of the sequenced mitochondrial 16S rRNA gene fragment for A. aureolatum was 370bp and for A. ovale was 373bp. The DNA sequence analysis showed a 13.1% difference between the two species. Apart from one male A. ovale found on a toad, all adult ticks were found on mammals. The majority of adult specimens of both tick species were removed from Carnivora (96.1 and 84.3% of A. aureolatum and A. ovale, respectively), especially from dogs (53.1% of A. aureolatum, and 46.4% of A. ovale). Collections on wild Canidae were higher for A. aureolatum (23.3%) than for A. ovale (7.1%). On the other hand, collections of A. ovale adults on wild Felidae were higher (18.3%) than findings of A. aureolatum (9.2%). The contribution of other mammalian orders as hosts for adults of A. aureolatum and A. ovale was irrelevant, with the exception of Perissodactyla because Tapiridae contributed with 13.0% of the total number of A. ovale adults. Adults of both tick species have been found occasionally on domestic hosts (apart of the dog) and humans. Most immature stages of A. aureolatum were found on Passeriformes birds, while rodents and carnivores were the most common hosts for nymphs and larvae of A. ovale. A. aureolatum has been found restricted to the Neotropical region, covering the eastern area of South America from Uruguay to Surinam, including northeastern Argentina, eastern Paraguay, southeastern Brazil and French Guiana. A. ovale showed a distribution that covers the Neotropical region from central-northern Argentina throughout the Neotropics into the Nearctic region of Mexico with a few records from the USA, also with collection sites in Paraguay, Bolivia, most Brazilian states, Peru, Ecuador, French Guiana, Surinam, Guyana, Trinidad & Tobago, Venezuela, Colombia, Panama, Costa Rica, Nicaragua, Belize, Guatemala and several states of Mexico.

Animals↗
PubMed1998

Rapid identification of Leishmania species from formalin-fixed biopsy samples by polymorphism-specific polymerase chain reaction.

The precise identification and classification of Leishmania species is important for public health surveillance since different species cause different clinical features of the disease. A highly specific polymerase chain reaction (PCR) panel was developed to enable the identification of the five major Leishmania species that cause New World cutaneous leishmaniases. The primers used for this panel were designed to distinguish the polymorphism in sequences of commonly amplified DNA bands of the parasites produced by arbitrarily primed PCR. These polymorphism-specific PCR diagnoses were performed with formalin-fixed biopsy specimens of the leishmanial lesions from four patients in Ecuador and one hamster skin lesion, and these lesions were determined to be caused by Leishmania (Viannia) panamensis, L. (Leishmania) mexicana, and L. (L.) amazonensis. The PCR panel may offer an important and practical approach to the standardized identification of Leishmania species in field examinations.

Animals↗
PubMed1992

Pseudohypopituitary syndromes.

In a child with short stature, the finding of normal or elevated GH levels in the presence of low concentrations of IGF-I raises the following possibilities. (1) A modification of the GH molecule, which is still detected by RIA, but inactive biologically. Therefore, an RRA or bioassay for hGH should result in considerably lower GH measurements compared with RIA determinations in the same sample. As both bioassays as well as RRAs are not widely available and are hampered by several difficulties, few children with this presumptive diagnosis have been described. So far, it has not been possible to define a specific molecular defect in one of these patients. (2) Abnormalities of the GH receptor or postreceptor mechanisms lead to a GH insensitivity syndrome. Laron-type dwarfism is usually due to a deletion in the gene for hepatic GH receptors: the serum binding protein for GH is absent. In three additional populations, the Pygmies of Zaire, the little women of Loja in Ecuador and the Mountain Ok people in Papua New Guinea, alterations of GH receptor function have been described. Finally, some reports describe patients with normal or elevated serum levels of both growth hormone and IGF-I in whom resistance to IGF has been implied in the pathogenesis of small stature.

Body Height↗
PubMed2003

Acute outbreak of gnathostomiasis in a fishing community in Sinaloa, Mexico.

An increasing number of human cases of gnathostomiasis have been reported in Sinaloa, Mexico, most of whom have a custom of eating of raw fish dishes such as 'cebiche'. Here we report five adult patients, three women and two men, having an acute episode of vomiting and abdominal pain a few minutes after eating a dish of cebiche prepared from a spotted sleeper perch (Eleotris picta) fished from a nearby lake in southern Sinaloa. All five patients experienced acute throat pain, chest and joint pains, headache and fever. One patient, a 55-year-old male, was hospitalized with suspected pancreatitis and pneumonia. By 8-9 days later, all five patients developed between three and 12 edematous, migrating skin lesions on the back, abdomen, upper and lower extremities, face, eye and scalp. By ELISA, all of them were sero-positive to Gnathostoma doloresi antigen and had elevated IgE levels. Eosinophilia was found in two patients. These patients lived in an agricultural and fishing community. In this community we carried out a sero-epidemiological survey and study of living conditions in a random sample of 309 individuals distributed in 74 households. Frequent consumption of raw fish was reported in 36% of households, and 12 individuals had a clinical history of migrating skin lesions. The sero-prevalence to Gnathostoma antigens was 34.95%. Five fish species and four species of ichthyophagous birds collected from three lakes in the village and a nearby estuary were infected with the advanced third-stage larvae of G. binucleatum, a species found in Ecuador and Mexico. The results describe the first known outbreak of acute gnathostomiasis on the American continent.

Acute Disease↗
PubMed2000

An analysis of the safety of the single dose, two drug regimens used in programmes to eliminate lymphatic filariasis.

This review of the safety of the co-administration regimens to be used in programmes to eliminate lymphatic filariasis (albendazole + ivermectin or albendazole + diethylcarbamazine [DEC]) is based on 17 studies conducted in Sri Lanka, India, Haiti, Ghana, Tanzania, Kenya, Ecuador, the Philippines, Gabon, Papua New Guinea, and Bangladesh. The total data set comprises 90,635 subject exposures and includes individuals of all ages and both genders. Results are presented for hospital-based studies, laboratory studies, active surveillance of microfilaria-positive and microfilaria-negative individuals, and passive monitoring in both community-based studies and mass treatment programmes of individuals treated with albendazole (n = 1538), ivermectin (9822), DEC (576), albendazole + ivermectin (7470), albendazole + DEC (69,020), or placebo (1144). The most rigorous monitoring, which includes haematological and biochemical laboratory parameters pre- and post-treatment, provides no evidence that consistent changes are induced by any treatment; the majority of abnormalities appear to be sporadic, and the addition of albendazole to either ivermectin or DEC does not increase the frequency of abnormalities. Both DEC and ivermectin show, as expected, an adverse event profile compatible with the destruction of microfilariae. The addition of albendazole to either single-drug treatment regimen does not appear to increase the frequency or intensity of events seen with these microfilaricidal drugs when used alone. Direct observations indicated that the level of adverse events, both frequency and intensity, was correlated with the level of microfilaraemia. In non microfilaraemic individuals, who form 80-90% of the 'at risk' populations to be treated in most national public health programmes to eliminate lymphatic filariasis (LF), the event profile with the compounds alone or in combination does not differ significantly from that of placebo. Data on the use of ivermectin + albendazole in areas either of double infection (onchocerciasis and LF), or of loiais (with or without concurrent LF) are still inadequate and further studies are needed. Additional data are also recommended for populations infected with Brugia malayi, since most data thus far derive from populations infected with Wuchereria bancrofti.

Albendazole↗
PubMed2002

A phylogenetic hypothesis for the distribution of two genotypes of the pig tapeworm Taenia solium worldwide.

Genetic polymorphism was determined among 13 isolates of Taenia solium from various regions using PCR-amplified sequences of 2 mitochondrial genes: cytochrome c oxidase subunit 1 and cytochrome b. The 2 phylogenies obtained were similar to each other regardless of the genes examined. The isolates from Asia (China, Thailand, Irian Jaya and India) formed a single cluster, whereas the isolates from Latin America (Mexico, Peru, Ecuador, Bolivia and Brazil) combined with those from Africa (Tanzania, Mozambique and Cameroon) to form an additional cluster. These results and historical data of swine domestication, distribution of pigs and colonization suggest that T. solium was introduced recently into Latin America and Africa from different regions of Europe during the colonial age, which started 500 years ago, and that the tapeworm of another origin independently spread in Asian countries.

Animals↗
PubMed2004

A survey of Daldinia species with large ascospores.

Specimens of Daldinia (Xylariaceae) from around the world possessing large ascospores were studied for teleomorphic and anamorphic morphological characters and compared with authentic material of D. grandis. A culture made from a specimen of D. grandis collected from Ecuador produced stromatic structures, but no conidiogenous structures referable to known xylariaceous anamorphs were observed. D. grandis is reconsidered and viewed as a species of warmer climates in the Americas. Three new species are recognised from new combinations of anamorphic and teleomorphic characters: (1) D. novaezelandiae sp. nov. from New Zealand, a fungus obviously related to D. bakeri, which is also reported from that country; (2) D. dennisii sp. nov., from Australia and New Zealand, of which two varieties are erected; and (3) D. loculatoides sp. nov., from the UK and Canada with affinities to D. loculata. The type of Sphaeria durissima was identified as D. loculata. Notes on further Daldinia spp. are included.

Ascomycota↗
PubMed2000

Dispersal of the cotton boll weevil (Coleoptera: Curculionidae) in South America: evidence of RAPD analysis.

RAPD technique provides useful information on the geographic origin and dispersal of the boll weevil Anthonomus grandis in South America. Nine populations from Argentina, Brazil, Paraguay, Mexico and USA were analyzed. Weevils were captured on native plants (Misiones province, Argentina) and on cotton cultures, except the sample from the United States (USDA laboratory-reared colony). A sample of the 'Peruvian square weevil', A. vestitus, from Ecuador, was included in the analysis in order to compare interspecific variation. The four primers used in the analysis revealed 41 'anonymous loci'. The neighbor-joining tree based on Nei's distances and values of Nm (migrants per generation), indicate that genetic similarity between samples from Tecomán (Mexico) and Puerto Iguazú (Argentina), is higher than among remaining South American populations. This result supports an hypothesis of natural occurrence of the boll weevil in South America, prior to extensive cotton cultivation. Population outbreaks of the species would be associated with increase of agricultural lands.

Animals↗
PubMed1999

Isospora automoli, a new coccidian parasite (Apicomplexa: Eimeriidae) from the buff-throated foliage-gleaner Automolus ochrolaemus and the olive-backed foliage-gleaner A. infuscatus from South America.

A new species of isosporan parasite is described from the faecal contents of the buff-throated foliage-gleaner Automolus ochrolaemus and the olive-backed foliage-gleaner A. infuscatus collected in the rainforests of eastern Ecuador. Sporulated oöcysts are subspherical to ovoidal, 23.4 x 21.3 (18-28 x 17-24) microns, colourless, with a smooth, double-layered wall with the inner layer darker and thinner; the shape-index (length/width) is 1.1 (1-1.22). Oöcysts contain one polar granule, but lack a micropyle and an oöcyst residuum. Sporocysts are ovoidal, 15.4 x 9.9 (14-17 x 8-11) microns, with a smooth single-layered wall and a small nipple-like Stieda body attached to a small, inconspicuous, acentric substieda body. Sporozoites are vermiform with one prominent posterior, refractile body (c. 4 x 5 microns), and a centrally located nucleus of equal size. Sporozoites are randomly arranged in the sporocysts with a subspherical sporocyst residuum composed of coarse granules.

Animals↗