Iodine status and thyroid volume changes during pregnancy: results of a survey in Aran Valley (Catalan Pyrenees).

The Aran Valley (Catalan Pyrenees, Spain) has a long-standing history of iodine deficiency. A survey was performed to determine the prevalence of iodine deficiency (urinary iodine<150 microg/l) in pregnant women from this region during the 1st and 3rd trimesters of gestation and to evaluate the changes in thyroid volume (TV). Of all the registered pregnancies in the area, in the first semester of the year 2000, 35 women (90%) were studied. Urinary iodine (UI) was measured and a thyroid ultrasonography performed during the 1st and 3rd trimester and their iodized salt consumption was recorded. Of the whole group, 77.1% of pregnant women reported regular intake of iodized salt.Median UI in the first trimester was 134.5 microg/l. Iodine deficiency was observed in 57.1%of women in the 1st trimester and in 46.7% in the 3rd trimester (p=0.1). In 10 women supplemented with iodine (150 microg/day) from the 1st trimester, median UI increased from 138.5 microg/l in the 1st trimester to 168 mug/l in the 3rd trimester (p=0.037), and no changes were observed in the rest. TV increased in the whole group during pregnancy (median 7.5 ml in the 1st trimester vs 9.5 ml in the 3rd trimester; p<0.001). The change in TV was significant in those cases with iodine deficiency in the 1st trimester, 3rd trimester or both (median 7.5ml in the 1st trimester vs 10.01 ml in the 3rd trimester; p=0.001) and between multiparous women (8.2 vs 10.9 ml; p=0.005). In 2000, iodine deficiency among pregnant women in the Aran Valley was still very high. Iodine deficiency as well as multiparity contributes to goitrogenesis during pregnancy. Taking this data in account, pre-conceptional supplements with iodine are required for its prevention.

Leishmaniasis con fenómeno de eliminación transepidérmica. Descripción de dos casos en pacientes con sida / Leishmaniasis with transepidermal elimination phenomenon. Description of two cases in patients with aids

A continuación se describen 2 casos de leishmaniasis visceral en pacientes con sida que mostraron "eliminación transepidérmica". En uno de ellos se observó el parásito en los queratinocitos a lo largo de toda la epidermis y a todos los niveles de ésta, con independencia de las glándulas sudoríparas ecrinas y también en el interior de los queratinocitos alrededor de los acrosiringios, en el interior de las células de los ductos ecrinos y de las glándulas ecrinas, lo cual sugiere eliminación de leishmanias a través de los queratinocitos epidérmicos y de las glándulas ecrinas. En el otro caso, el parásito se encontró en las glándulas, ductos ecrinos y en los queratinocitos alrededor de los acrosiringios, sugiriendo la eliminación a través de las glándulas sudoríparas ecrinas. Se revisa este fenómeno en el conjunto de enfermedades infecciosas y más concretamente en los casos de leishmaniasis descritos. (AU)

Early human infection with Onchocerca volvulus is associated with an enhanced parasite-specific cellular immune response.

The immune response after early exposure to or infection with Onchocerca volvulus was investigated in an autochthonous focus caused by the migration of infected persons to a previously unaffected area in Ecuador. Peripheral blood mononuclear cell (PBMC) proliferative and cytokine responses (interferon [IFN]-gamma and interleukin [IL]-5) to filarial antigens were measured in 14 subjects with serologic evidence of exposure and in 7 subjects with evidence of dermal microfilarial DNA and were compared with responses in 43 subjects with chronic O. volvulus infections. PBMC proliferative and cytokine responses (IFN-gamma and IL-5) to parasite antigens were elevated in the early exposure/infection group, compared with those in the chronic infection group. Addition of an IL-10-neutralizing antibody to filaria antigen-stimulated cultures resulted in significantly elevated proliferative responses in the chronic infection group. The findings suggest that early exposure and early parasite patency are associated with a vigorous cellular response, but, as infections become chronic, the cellular response becomes down-regulated, partly through an IL-10-dependent mechanism.

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.

Human onchocerciasis and tetanus vaccination: impact on the postvaccination antitetanus antibody response.

To investigate whether helminth infections may affect the efficacy of vaccines by impairing the immune response to nonparasite vaccine antigens, we compared the antibody responses to tetanus toxoid (TT) after tetanus vaccination in 193 subjects with Onchocerca volvulus infection with 85 comparable noninfected controls. After vaccination, the proportions of subjects in each group attaining protective levels of antitetanus antibodies were similar (96.9% infected versus 97.6% noninfected). Postvaccination increases in antitetanus immunoglobulin G (IgG) and the predominant IgG isotype, IgG1, were equivalent in both groups, as were increases in specific IgG4 and IgE; however, significantly greater increases in specific IgG2 (P < 0.05) and IgG3 (P < 0.001) were observed in the noninfected group. Stratification of the O. volvulus-infected group into two groups representing light and heavy infections revealed a significantly impaired antitetanus IgG response in those with heavy infections compared to those with light infections (P < 0.01) or no infection (P < 0.05). The impact of concurrent intestinal helminth infections on the antitetanus response was also examined; an increased IgG4/IgE ratio was seen in those infected with Strongyloides stercoralis (P < 0.05) and when all helminth infections were combined as a single group (P < 0.05). These findings indicate that concurrent infection with O. volvulus does not prevent the development of a protective antitetanus response, although heavier O. volvulus infections are able to alter the magnitude of this response, and concurrent helminth infections (O. volvulus and intestinal helminths) may alter TT-specific antibody isotype responses.

Successful control of onchocerciasis with community-based ivermectin distribution in the Rio Santiago focus in Ecuador.

Onchocerciasis is a major blinding disease in equatorial Africa and Central and South America. Ivermectin is a safe and effective drug in the treatment of this disease and now forms the basis of disease control in most endemic areas. We report the findings of long-term control of this infection in the Río Santiago focus in Ecuador, between January 1990 and December 1996, using a strategy of giving ivermectin treatments biannually in hyperendemic communities and annually in meso- and hypoendemic communities. Ivermectin was administered by local health workers from each community. A high level of compliance to ivermectin was achieved, with 81.9% to 98.0% of those eligible receiving the drug at each treatment instance. The impact of ivermectin therapy was monitored using a cohort of 120 randomly selected infected individuals from 8 hyperendemic communities. The geometric mean microfilarial density of this group declined from 19.3 to 0 mf/mg over the 84-month observation period. Ivermectin had a significant impact on anterior segment ocular disease, acute onchodermatitis and sowda. The rate of infection of blackflies declined from 1.1% in 1989-0.08% in 1996, which is below the vectorial capacity of the Simulium vector and, as no new nodules were detected after 1994 and no children under 5 became infected over the observation period, it is likely that the transmission of this infection was interrupted in the study area.

Onchocerciasis in Ecuador: prevalence of infection on the Ecuador-Colombia border in the Province of Esmeraldas.

The prevalence of onchocerciasis infection was determined in communities on 7 rivers located in the northern area of the canton San Lorenzo, province of Esmeraldas. Diagnosis of the infection was obtained by skin biopsies and recombinant-antigen based-serology. No evidence of infection was detected in 9 communities studied along the Rio Mataje, which forms the frontier between Ecuador and Colombia, nor in 10 adjacent communities located on 5 interior rivers. Evidence for Onchocerca volvulus infection was found in 4 communities on the Rio Tululvi with the following prevalence: La Boca (3.5% by biopsy and 3.9% by serology), Guayabal (9.1% by both biopsy and serology), La Ceiva (51.5% by biopsy and 53% by serology), and Salidero (4% by biopsy and 7.7% by serology). A few individuals in these communities were seropositive for O. volvulus in the absence of detectable dermal microfilariae: these might harbor very light or prepatent infections. No clinical disease attributable to onchocerciasis was found. The infected communities will be included in the ivermectin-based National Control Program for the disease, with no evidence of the infection having extended north of the Ecuadorian-colombian border.

Bartonellosis in Zamora Chinchipe province in Ecuador.

Human bartonellosis was investigated in the Ecuadorian province of Zamora Chinchipe; 17 cases were identified retrospectively from hospital records over the period 1984-1995, mostly from 6 communities in the provincial district of Zumba. A questionnaire concerning risk factors for disease transmission was administered in these 6 communities. Blood samples were taken from individuals with current febrile illnesses or skin lesions suggestive of bartonellosis. Samples for detection of Bartonella bacilliformis were also taken from all school-age children in communities where historical cases had been identified by questionnaire. No bacteriologically positive case was identified and no evidence of asymptomatic infection was detected. Risk factors for disease transmission, identified by the questionnaire, included the presence of sick or dying chickens and guinea-pigs. It was suggested that bartonellosis is a zoonosis with wild animals, probably rodents, as the reservoir. The widespread use of residual insecticides and the easy availability of antibiotics is likely to have modified the epidemiology of this disease over the last decade.

Malignant hidroacanthoma simplex. A case report and literature review.

A 73-year-old woman with a malignant hidroacanthoma simplex on her right lower limb is reported. The lesion was immunohistochemically studied. Carcino-embryonic antigen and epithelial membrane antigen were found in the luminal border of ductal structures within the aggregations of neoplastic cells. We review the literature on this subject.

A facial variant of steatocystoma multiplex.

A case of steatocystoma multiplex confined to the face is reported. Review of the literature disclosed similar cases in this striking location. We therefore believe that this facial variant is a distinctive but less well known variant of steatocystoma multiplex. We review the relationship between steatocystoma multiplex and eruptive vellus hair cysts.

Metodos anticonceptivos actuales. / Present contraceptive methods

Se realiza una revision actualizada de algunos metodos anticonceptivos, que se utilizan actualmente sobre todo los hormonales y aquellos que se encuentran en fase de experimentacion. En muchos de los metodos anticonceptivos se exponen sus efectos favorables y desfavorables.Como la mayoria de los metodos anticonceptivos revisados, de tipo hormonal, antes de analizar cada uno de ellos se hace una breve resena de la fisiologia de la menstruacion