Significant differences in access to tests and treatments for multiple myeloma between public and private systems in Latin America. Results of a Latin American survey. GELAMM (Grupo de Estudio Latino Americano de Mieloma Múltiple).

The incidence of multiple myeloma (MM) has increased in the last 20 years, particularly in middle and low-middle income countries. Access to diagnostic and prognostic tests and the availability of effective care is highly variable globally. Latin America represents 10% of the world population, distributed in countries of varied size, population, and socio-economic development. In the last decade, great improvements have been made in the diagnosis and treatment of MM. Applying these advances in real life is a challenge in our region. Local data regarding MM standards of care and outcomes are limited. A survey was carried out among hematologists from 15 Latin American countries to describe access to MM diagnostic and prognostic tests and the availability of effective care options. This study provides real-world data for MM in our region, highlighting striking differences between public and private access to essential analyses and therapeutic options.

Morphofunctional description of mucous cells in the gills of the Arapaimidae Arapaima gigas (Cuvier) during its development.

The gill structure of the Amazonian fish Arapaima gigas (Cuvier 1829) shows ontogenetic changes during development, particularly due the transition from the aquatic to the obligatory air breathing mode of respiration. However, three main cell types can be found in the gills: mitochondrial rich cells, pavement cells and mucous cells (MCs). The MCs are involved in the secretory pathway. The functions of the secreted molecules include mechanical protection of epithelia, protection against parasites and bacterial infection, and role on ion regulation. In this study, we analysed mucous cell location and mucous cell type, based on pH, during the development of A. gigas. Using samples obtained from the environment, gills were collected and fixed in buffered solution. Histological techniques for the identification of MCs were performed Alcian Blue (AB) and periodic acid-Schiff (PAS). The results showed the presence of PAS+ and AB+ cells in the whole filament in all examined fish. In animals less than 50 g, few MCs were present, and no differences were observed in AB+ and PAS+ cells. In animals weighing close to 500 g, more PAS+ cells than AB+ cells were observed, and in animals that weighed more than 1,000 g, more AB+ cells than PAS+ cells were observed. These observations may be a result of the ontogenetic changes in the gill epithelia, which can change the osmorespiratory compromise in ion regulation functions as well the glycosaminoglycans secreted by PAS cells, which in large animals can play a role in the protection against parasites and bacterial infection.

[Severe pulmonary thromboembolism caused by contraceptives in adolescents]. / Tromboembolismo pulmonar grave secundário ao uso de anticoncepcional em adolescente.

A 16 year-old female patient on oral contraceptive (gynera-ethynilestradiol+gestadone) for 4 months, presented with acute and severe pulmonary thromboembolism (PT), and was successfully treated with IV streptokinase. The contraceptive use was an importante risk factor for PT and the thrombolytic therapy provided early clinical improvement. Blood pressure, heart rate, and hypoxemia, along with echocardiography and pulmonary arteriography abnormalities, improved after this treatment.

Impact of AIDS on patients attending the family physician - abstract

For four weeks during March and April 19, this study on the knowledge, attitudes and practices of patients in relation to AIDS was carried out in three government-operated Family Medicine Centres in Barbados. Persons between the ages of 16 and 60 years, who agreed to take part, were interviewed, using a standardised pretested coded questionnaire. Of three hundred and thirty-seven patients who were interviewed, 134 were males and 203 females. One hundred and seventy-six patients (52 percent) identified AIDS as an STD, more often than syphilis or gonorrhoea was so identified. On the other hand, only 117, (35 percent), said it was true that "a person with the AIDS virus may remain in good health for many years". Fifty-two percent of patients said that TV contributed a lot to their knowledge of AIDS; 42 percent said radio contribute a lot, but only 7 percent said the doctor, nurse or clinic setting taught them a lot. In respect of lifestyle change, 81 percent knew that using a condom reduced the chances of getting AIDS, yet only 18 percent were currently using condoms. Similarly, 88 percent knew that reducing the number of sexual partners was important, whilst 51 percent only said that "since the AIDS epidemic they now have less sexual partners". The main conclusion is that the Primary Care Team has an important support role in AIDS education, which at this time is not being carried out in Barbados (AU)

Drug therapy in an isolated rural community - abstract

This study was conducted in Carriacou, one of the Grenadine islands affiliated to Grenada, between October 1985 and Janaury 1986, to determine the extent and pattern of drug-prescribing in the island. Three doctors on the island provided general practitioner services at five clinics. From the case-notes, the name, age, sex, diagnosis, treatment and duration of treatment were collected. The diagnosis and treatment were coded and the information processed by computer. A total of 1,349 patients was seen 2,034 times: 17.1 percent of attending patients received no medication, 54.6 percent received one drug per prescription and only 3.4 percent per cent three or more drugs per prescription; 49.2 percent of prescriptions were for less than 14 days whilst 37.3 percent were for 28 days or more. Penicillins were most commonly prescribed, accounting for 10.1 percent of all prescribed drugs. This was followed by aspirin (8.1 percent) and antacids (7.3 percent). Pencillins were the most frequently prescribed drugs for patients under 45 years of age. Antihypertensives were the most frequently prescribed drugs for patients over 45 years of age. There was not excessive prescribing of psychotropic drugs, antibiotics and analgesics when compared with more developed countries. The most frequently recorded health problems were hypertension (14.2 percent), upper respiratory tract infection (8.7 percent) and dyspepsia (6.5 percent). The high incidence of dyspepsia was related to the high alchohol intake and the use of aspirin to treat osteoarthritis. An examination of prescribing practices, increased community education and patient participation can result in more effective and economical use of drugs (AU)

Primary health care delivery in Carriacou, Grenada

The people of Carriacou utilize curative more than preventative services. Over a four month period of study a total of 1349 patients made encounters at the District Medical Officer's clinics. Most of the encounters were for problems which required treatment e.g. circulatory system diseases, respiratory system diseases, musculo-skeletal system diseases. Other clinics, including the chronic disease, dental, dressing clinics and casualty, were also involved in curative work. However, the low percentage of check-ups (2.2 percent), the limited number of Pap smears done (91 or 5.7 percent of females over 15 years old), the poor immunisation status and low contraceptive use all express the need for preventive care. The distribution of health problems in this lesser developed country appears to be similar to more developed countries. Problems which tend to affect developing countries such as infective and parasitic disease are not a cause of significant morbidity on this island. These illnesses rank seventh in the list of most common diseases. Hypertension, upper respiratory tract infections, and dyspepsia are among the three most common health problems. The position dyspepsia occupies is unlike findings in other countries. This may be the result of dietary factors, alcohol abuse or excessive use of aspirin. The problem needs further investigation. There appears to be rational drug prescribing in Carriacou. No prescriptions were written for more than three drugs during the study and 3.4 percent of prescriptions were for three drugs. Poly-pharmacy is avoided. Compared to some more developed countries there is limited use of psychotropic drugs. There is a need for back-up services in instituting health measures. This is brought out by the cessation of clinics at times when the health personnel assigned to certain duties is absent. Immunisation was one such activity that was affected. Carriacou has great potential to become a healthier nation in the Caribbean. One must, therefore alert health planners of the need for: (1) Upgrading the present system of disease reporting (2) Health education programs (3) Cancer screening activities (4) Improved maternal and child health activities (AU)

The time-course of contractions induced by acetylcholine and barium in the vas deferens of normal and castrated guinea-pigs.

1. The influence of castration on contraction of the guinea pig vas deferens induced by acetylcholine was investigated regarding facilitation of endogenous neurotransmitter release, changes in post-synaptic events and modification in acetylcholine metabolization. 2. Castration prolonged the duration of the isometric contraction of the vas deferens induced by acetylcholine (3 mM) but not the duration of that induced by barium chloride (10 mM). 3. Reserpinization (0.5 mg/kg) of normal and castrated guinea pigs did not change the time-course of acetylcholine-induced contraction in the vas deferens. 4. 4-Aminopyridine (0.05 mM) prolonged the contraction induced by acetylcholine and barium chloride. This effect was blocked by reserpine pretreatment, indicating that in the presence of 4-AP, both acetylcholine and barium release endogenous noradrenaline. Since there was no difference between the effects of 4-AP on organs from normal and castrated animals, prolongation of the acetylcholine-induced contraction is not related to an increase in neutransmitter release. 5. Total cholinesterase and acetylcholinesterase activities were reduced after castration and the time-course of carbachol contraction was not changed. Thus, this decrease in enzyme activity appears to play a relevant role in the prolongation of acetylcholine-induced contraction.