Social marketing of pre-packaged treatment for men with urethral discharge (Clear Seven) in Uganda.

We implemented social marketing of pre-packaged treatment for men with urethral discharge (Clear Seven) in Uganda, and studied its feasibility, acceptability and effectiveness as a possible means to treat STDs and thereby prevent HIV. Clear Seven was distributed at private health care outlets in three rural districts and two divisions of the capital. Comparisons were made with a pre-intervention period in the same sites plus one additional rural district. There were almost universally positive attitudes to Clear Seven. Cure rate (84% versus 47%), treatment compliance (93% versus 87%), and condom use during treatment (36% versus 18%) were significantly higher among Clear Seven users (n=422) than controls (n=405). Partner referral was similar but fewer Clear Seven partners were symptomatic when seeking treatment. Distribution of socially marketed pre-packaged treatment for male urethritis should be expanded in sub-Saharan Africa. Consideration should be given to developing similar kits for women.

Human T cell lymphotropic virus infection in Guaymi Indians from Panama.

Preliminary studies found that 9% of Guaymi Indians from Bocas del Toro province have antibody to human T cell lymphotropic virus (HTLV-I/II). The present study enrolled 317 (21% of the population) Guaymi Indians from Changuinola, the capital of Bocas del Toro province and 333 (70% of the population) from Canquintu, an isolated rural village. Demographic information and family relationships were ascertained and subjects were screened for neurologic diseases. Serum specimens were screened by an enzyme-linked immunosorbent assay for HTLV-I/II antibody and positives were confirmed according to U.S. Public Health Service criteria. Twenty-five (8%) Guaymi residing in Changuinola and 7 (2.1%) from Canquintu were confirmed seropositive. In Changuinola, antibody was virtually limited to residents greater than or equal to 15 years of age (24 [16%] of 153) and rates were slightly higher in males than in females; in Canquintu, antibody rates did not increase significantly with age and appeared higher in females than in males. In Changuinola, there was no evidence for household clustering of infection. In contrast, HTLV antibody among Canquintu residents clustered significantly by household. HTLV-associated neurologic disease was not detected in either population. The atypical seroepidemiology observed in both locations might be explained if the virus endemic to the Guaymi differed from HTLV-I previously described in the Caribbean basin and Japan.

Evaluation of patients with multiple sclerosis by evoked potentials and magnetic resonance imaging: a comparative study.

We compared the diagnostic usefulness of evoked potential (EP) studies and magnetic resonance imaging (MRI) in the evaluation of 27 patients with definite or probable multiple sclerosis (MS). MRI scans demonstrated multiple lesions in 21 patients whereas EP studies showed multiple abnormalities in 14 patients (4 of whom had only somatosensory EP abnormalities). Eighteen patients had similar MRI and EP results (e.g., normal or multiple abnormalities), 8 had multiple abnormalities shown by MRI but normal or single-modality abnormal EPs, and 1 had multiple abnormal EPs but a normal MRI scan. There was no significant difference in the sensitivity of the two techniques in detecting multiple lesions in the patients with definite MS, whereas among those with probable MS, MRI had a significantly higher yield. Seventeen patients showed clinical evidence of posterior fossa involvement, 6 patients had abnormal brainstem auditory evoked potentials (BAEPs), and 4 patients had areas of increased signal intensity revealed by MRI of the brainstem. There was no clinical evidence of brainstem involvement in 2 patients with BAEP abnormalities, 2 with an abnormal posterior fossa shown by MRI, and one patient with abnormalities shown by both BAEP and MRI. We conclude that MRI is more sensitive in detecting multiple lesions than are multimodality EP studies, but that BAEP assessment may be slightly more sensitive than MRI in detecting brainstem lesions.

Failure of naloxone to reverse vascular neurologic deficits.

Naloxone failed to improve motor strength in any of 19 patients with acute stroke, even though 4 patients eventually demonstrated complete recovery. Two patients worsened, and sensory abnormalities increased in two others. Motor tone increased in eight patients. Naloxone amelioration of stroke deficits is therefore not common, and this treatment may not be entirely benign.