Acanthocephaliasis by Plagiorhynchus sp. (Acanthocephala:Plagiorhynchidae) associated with necrotic enteritis in quetzals (Pharomachrus mocinno) maintained in captivity.

The present report describes a case of acanthocephaliasis associated with necrotic enteritis in quetzals (Pharomachrus mocinno). Three juvenile quetzals exhibited depression, anorexia, ruffled feathers, and sudden death. They were submitted to the laboratory for examination. The birds had hatched and lived in captivity in an aviary in Mexico. Gross lesions observed were hemorrhagic, fibrinoid necrotic enteritis, with acanthocephalans adhered to the intestinal mucosa. The specimens were identified by parasitology, electronic microscopy, and molecular biology as Plagiorhynchus (Prosthorhynchus) sp. Lesions compatible with necrotic enteritis were also confirmed by isolation and genotyping of Clostridium perfringens type E. This is the first report of Plagiorhynchus (Prosthorhynchus) sp. in quetzals in captivity in Mexico. The findings in this manuscript suggest that this parasite could be a predisposing factor for necrotic enteritis as well as a risk component in the breeding programs and survival of this avian species in captivity.

The European Exenatide study of long-term exenatide vs. glimepiride for type 2 diabetes: rationale and patient characteristics.

AIM: To describe the rationale for the European Exenatide (EUREXA) clinical study and describe the characteristics of the patient cohort. METHODS: EUREXA is a multinational study of long-term effects of add-on exenatide vs. glimepiride in patients with type 2 diabetes and failure of diet/lifestyle plus metformin monotherapy. Metformin failure was defined as hemoglobin A1c (HbA1c) > or = 6.5% and patients were overweight/obese (BMI > or = 25 to < 40 kg/m(2)). The primary end point is time to failure of combination treatment, defined from HbA1c concentration according to current criteria. At baseline, an oral glucose tolerance test (OGTT) was performed, fasting blood was taken for lipid profile and patients were randomized to add-on exenatide (5 microg b.i.d. for 4 weeks then 10 microg b.i.d.) or glimepiride (1 mg/day titrated to maximum dose). RESULTS: A total of 1039 patients were entered in the study, with mean (+/- s.d.) age 57.2 +/- 9.6 years, body mass index (BMI) 32.4 +/- 4.1 kg/m(2), duration of diabetes 5.6 +/- 4.5 years and HbA1c 7.4 +/- 0.7%. A history of cardiovascular disease (CVD) was present for 64.8% of patients overall and duration of diabetes was statistically significantly longer for patients with CVD than without (p = 0.010). Lipid abnormalities were reported for 48.9% of patients and 40.9% were taking at least one lipid-lowering medication. CONCLUSION: Patients included in the EUREXA study had early failure of glucose control with metformin and presented typical features of type 2 diabetes: overweight/obesity and high prevalence of lipid abnormalities and CVD. In this population, the effects of exenatide vs. glimepiride will be evaluated over at least 2.5 years.

The Detroit Community-Academic Urban Research Center: development, implementation, and evaluation.

There is increasing research evidence that stressors in the social and physical environment (e.g., poverty, inadequate housing, air pollution, and racism) are associated with poor health outcomes. Given the complex set of determinants of health status, the disproportionate burden of disease experienced within marginalized communities, and the limited effectiveness of traditional prevention research, particularly within communities of color, there have been growing calls for more comprehensive and participatory approaches to public health research and practice. The purpose of this article is to describe and analyze the process of establishing, implementing, and evaluating the Detroit Community-Academic Urban Research Center (URC), a community-based participatory research (CBPR) partnership involving community-based organizations, a local health department, academia, and an integrated health care system. Lessons learned and recommendations for creating effective CBPR partnerships are presented.

Obesity and gestational diabetes among African-American women and Latinas in Detroit: implications for disparities in women's health.

OBJECTIVE: to estimate the prevalence of gestational diabetes mellitus (GDM), obesity, and excessive weight gain during pregnancy among Latinas and African-American women in a large Detroit health system and explore risk factors associated with GDM and its implications. METHODS: Descriptive statistics, chi2 tests, analysis of variance, and logistic regression analyses were used to describe the prevalence of obesity, excessive pregnancy weight gain, and GDM and to assess factors associated with GDM risk in a cohort of 552 African-American women and 653 Latinas in a large Detroit health system. RESULTS: Women ranged in age from 14 to 47 years. Almost 47% of African-American women and 37% of Latinas were overweight or obese, and 53% of African-American women and 38% of Latinas gained excessive weight during pregnancy. The prevalence of GDM was 5.4% among Latinas and 3.9% among African-American women. After adjusting for other risk factors, Latinas were 2.5 times more likely than African Americans to develop GDM. Other independent risk factors were family history of diabetes, age, body mass index, and gestational weight gain before 28 weeks. CONCLUSION: Because most women have repeated contact with the health care system during and immediately after pregnancy, care providers have unique opportunities to identify and assist those who are at risk of obesity and diabetes.

Hyperimmunoglobulinemia E in the absence of atopy and filarial infection: the Huaorani of Ecuador.

Hyperimmunoglobulinemia E (HIGE) is associated with various conditions such as atopy, dermatitis, hypersensitivity reactions, and certain parasitic infections. In the course of vaccination initiatives in the province of Napo, eastern Ecuador, blood samples were collected from one of the two remaining rural subgroups of Huaorani Indians who in 1979 were reported to have the world's highest concentrations of IgE. One subgroup of Huaorani, the Dicaron, lives in a protected Amazonian region which has reportedly suffered from extensive pollution after petroleum industry exploration. Plasma was collected from 31 members of the Dicaron (age range 15-75 years), eight non-Dicaron Huaorani, and 16 Quichua Indians from the same province, and tested for IgE, IgG, IgM, IgA, and immunoglobulin allotypes. Subjects were examined for evidence of filariasis, a group of parasitic diseases associated with HIGE. Mean IgE concentration in the Dicaron was measured by CAP ELISA at 11,850 IU/mL (range 5000-33,000) while IgA and IgM concentrations were within normal limits compared to North American controls. IgG levels were slightly elevated and there was no evidence of filariasis. Compared to the Quichua and non-Dicaron Huaorani, two other Amerindian tribes in the Ecuadorian Amazon, the highest concentrations of IgE were recorded from the Dicaron who live within the allegedly polluted section of the Amazon. We conclude that an unexplained HIGE syndrome exists among only one subgroup of Huaorani, the Dicaron. Other eastern Ecuadorian Amerindians, such as the Quichua and resettled Huaorani, have IgE concentrations expected in a population with intestinal helminthiasis. Environmental factors cannot be excluded as the cause of HIGE in the Dicaron.

Using focus groups to identify diabetes care and education issues for Latinos with diabetes.

The purpose of this study was to identify diabetes care and education issues for Latinos with diabetes. Four focus groups of Latinos with diabetes were held in the Detroit area; these sessions were audiotaped. An expert panel of bilingual health professionals from the United States and Mexico reviewed the audiotapes and identified and prioritized 47 issues using a modified Delphi technique. The highest priority issue identified by a wide margin was the difficulty many Latina women with diabetes have with self-care because of other family responsibilities. Universal diabetes care issues have a specific cultural expression which, when identified, can be incorporated into diabetes care and education programs for a particular cultural group. Focus groups are a useful means for identifying and illuminating such issues.

[Extramedullary intracranial solitary plasmocytoma. Report of 2 cases]. / Plasmocitoma solitario intracraneal extramedular. Reporte de dos casos.

Multiple myeloma frequently affects the C.N.S with a high prevalence of spinal cord compression following vertebral neoplastic infiltration. On the other hand, solitary plasmacytomas, tumors that arise in a wide variety of locations due to the universal distribution of plasma cells, are infrequent within the cranial vault and rarely present as extramedullary lesions, arising from the intracranial soft tissues without affecting neighboring bony structures. Only 33 such cases have been reported in the medical literature. The authors report two additional cases of solitary intracranial, extramedullary plasmacytoma. Case 1.--54 year-old woman with a chief complaint of severe headache and behavioral changes of three months duration. C.N.S. imaging revealed a bifrontal mass lesion, arising from the anterior third of the falx cerebri. Case 2.--45 year old-man who complained of headache and blurred vision of a month duration C.N.S. imaging displayed a third ventricle mass lesion. In both cases the neuropathological diagnosis was extramedullary plasmacytoma. Postoperatively the confirmation of solitary intracranial plasmacytoma was achieved only after a thorough work-up to rule out the presence of neoplasm elsewhere in the body. Radiotherapy was given to both patients and follow-up has failed to reveal neoplastic disease 4 and 3 years, respectively, after the diagnosis.

Studies on a focus of yaws in the Santiago Basin, province of Esmeraldas, Ecuador.

A clinical and serological epidemiological study done on a yaws focus in the Santiago Basin area, province of Esmeraldas, showed a prevalence of 11.3% for active clinical lesions and a seropositivity of 94.9%. The Rio Santiago was hyperendemic for yaws (prevalence, 17.9%; seropositivity, 98.0%) while Rio Zapallito was found to be mesoendemic and the Rio Cayapas and Rio Onzoles hypoendemic. Active and latent evidence of yaws was found only in the black race. Children, ages 5-12 year, were found to have the highest incidence (55.8%) of clinical lesions, with the majority found on the legs (64.2%). Papilloma was the most prevalent lesion (55.4%). Mass treatment of the basin using benzathine penicillin G was done according to WHO recommendation.

Accidentes vasculares cerebrales en pacientes menores de 35 anos. / Cerobrovascular accidents in patients under 35 years-old

Se revisaron las historias clinicas de 21 pacientes menores de 35 anos ingresados por accidente vascular cerebral en el Hospital Coromoto, Maracaibo. Las causas encontradas fueron: Accidente vascular embolico: 9 pacientes (42,8%). Hemorragia subaracnoidea: 7 pacientes (33,3%). Isquemia cerebral transitoria: 3 pacientes (14,3%).Arterioesclerosis prematura: 1 paciente (5,3%). Vasculitis: 1 paciente (5,3%). En 11 de los 21 pacientes se encontro prolapso valvular mitral y en 10 de estos ultimos fue un factor determinante en la etiologia del accidente (7 episodios embolicos y 3 episodios isquemicos transitorios). La evolucion clinica fue satisfactoria en la mayoria de los pacientes con pocas secuelas neurologicas

Selective IgA deficiency and the HLA-B8 antigen. Report of two cases with familial data.

Two patients had IgA deficiency, giardiasis, and the HLA-B8 antigen. The family of patient 1 included members with juvenile-onset diabetes mellitus, adrenal insufficiency, pernicious anemia, and hypothyroidism, a combination of unusual diseases that has been reported previously to occur as a syndrome with IgA deficiency and the HLA-B8 antigen. This coincidence makes it likely that these two patients and the one family previously described have a common pathogenic base, the inheritance of an abnormal immune-response gene that is acquired with the HLA-B8 antigen as a result of genetic dysequilibrium.