Surveillance of lymphatic filariasis 5 years after stopping mass drug administration in Menoufiya Governorate, Egypt.

The World Health Organization recommends that before lymphatic filariasis elimination in an area can be confirmed, an additional survey should be performed at least 5 years after stopping mass drug administration. The current study aimed to determine the status of lymphatic filariasis 5 years after cessation ofthe mass drug administration in 3 sentinel Egyptian villages in Menoufiya Governorate. The rapid immunochromatographic card test (ICT) and a new commercial antibody detection kit (CELISA®) were used. All 1321 primary-school children aged 6-7 years old were ICT negative but 27 children were antibody positive. All households surveyed in one village with the highest antibody prevalence were ICT negative, indicating an absence of lymphatic filariasis. The CELISA antibody kit needs more standardization and development to be useful under field conditions. We conclude that lymphatic filariasis is no longer a public health problem in these villages and other villages with similar epidemiological conditions.

Surveillance of lymphatic filariasis 5 years after stopping mass drug administration in Menoufiya governorate, Egypt

توصي منظمة الصحة العالمية بإجراء مسوحات إضافية بعد مرور 5 سنوات على الأقل على إيقاف الإعطاء الجموعي للأدوية قبل تأكيد التخلص من داء الخيطيات اللمفاوي. وتهدف الدراسة الحالية إلى التعرف على الوضع الذي آل إليه داء الخيطيات اللمفاوي بعد مرور 5 سنوات على إيقاف إعطاء الأدوية الجموعي في 3 قرى خافرة في محافظة المنوفية في مصر. واستخدم الباحثون اختبار البطاقة السريعة للاستشراب المناعي ICT، وحقيبة تجارية لكشف الأضداد هي سيليسا [CELISA[R]. واتضح للباحثين أن جميع الأطفال في المرحلة الابتدائية والذين تتراوح أعمارهم بين 6 - 7 سنوات وعددهم 1321 طفا كانوا سلبيين، وأن هناك 27 طفلا لديهم إيجابية في الأضداد. كما أن جميع الأسر التي أجري المسح عليها في إحدى القرى التي كانت الأعلى من حيث معدل انتشار الأضداد كانوا سلبيين باختبار البطاقة السريعة الاستشراب المناعي، مما يشير إلى غياب داء الخيطيات اللمفاوي. أما حقيبة سيليسا التجارية فتحتاج إلى المزيد من المعايرة والتطور حتى تصبح مفيدة في العمل الميداني. واستنتج الباحثون أن داء الخيطيات اللمفاوي لم يعد من مشكلات الصحة العامة في هذه القرى وفي القرى الأخرى التي تشابهها في الظروف الوبائية

ABSTRACT The World Health Organization recommends that before lymphatic filariasis elimination in an area can be confirmed, an additional survey should be performed at least 5 years after stopping mass drug administration. The current study aimed to determine the status of lymphatic filariasis 5 years after cessation of the mass drug administration in 3 sentinel Egyptian villages in Menoufiya Governorate. The rapid immunochromatographic card test (ICT) and a new commercial antibody detection kit (CELISA®) were used. All 1321 primary-school children aged 6–7 years old were ICT negative but 27 children were antibody positive. All households surveyed in one village with the highest antibody prevalence were ICT negative, indicating an absence of lymphatic filariasis. The CELISA antibody kit needs more standardization and development to be useful under field conditions. We conclude that lymphatic filariasis is no longer a public health problem in these villages and other villages with similar epidemiological conditions.

RÉSUMÉ L'Organisation mondiale de la Santé recommande de mener une enquête supplémentaire au moins cinq ans après l'arrêt de l'administration massive de médicaments avant de confirmer l'élimination de la filariose lymphatique dans une zone donnée. La présente étude visait à déterminer le statut de la filariose lymphatique cinq ans après l'arrêt de l'administration massive de médicaments dans trois villages sentinelles égyptiens du Gouvernorat de Menoufiya. Le test immunochromatographique sur carte (ICT) rapide et un nouveau kit de détection d'anticorps commercial (CELISA®) ont été utilisés. L'ensemble des 1321 écoliers du primaire âgés de 6 à 7 ans avaient des résultats négatifs à l'ICT mais 27 enfants avaient des résultats positifs aux anticorps. Tous les ménages qui ont fait l'objet d'une enquête dans un village où la prévalence des anticorps était la plus élevée ont eu des résultats négatifs à l'ICT, ce qui indique une absence de filariose lymphatique. Le kit de détection d'anticorps CELISA doit faire l'objet d'un développement et d'une normalisation plus poussés pour être utile dans des conditions de terrain. Nous en concluons que la filariose lymphatique ne représente plus un problème de santé publique dans ces villages ainsi que dans d'autres villages ayant des conditions épidémiologiques similaires.

Adrenal insufficiency in high-risk surgical ICU patients.

STUDY OBJECTIVES: To examine the incidence and response to treatment of adrenal insufficiency (AI) in high-risk postoperative patients. DESIGN: Prospective observational case series. SETTING: Large urban tertiary-care surgical ICU (SICU). PARTICIPANTS: Adults > 55 years of age who required vasopressor therapy after adequate volume resuscitation in the immediate postoperative period. INTERVENTIONS: Each patient underwent a cosyntropin (ACTH) stimulation test; at the discretion of the clinical team, some patients were empirically given hydrocortisone (100 mg IV q8h for three doses) before serum cortisol values became available. MEASUREMENTS: Adrenal dysfunction (AD), defined as serum cortisol < 20 microg/dL at all time points, with Delta cortisol (60 min post-ACTH minus baseline) of < or = 9 microg/dL; functional hypoadrenalism (FH), defined as serum cortisol < 30 microg/dL at all time points or Delta cortisol (60 min post-ACTH minus baseline) < or = 9 microg/dL; and AI, as the presence of either AD or FH. RESULTS: One hundred four patients were enrolled with a mean age (SD) of 65.2 +/- 16.9 years. AI (AD plus FH) was found in 34 of 104 patients (32.7%): AD was found in 9 patients (8.7%), FH in 25 patients (24%), and normal adrenal function in 70 patients (67.3%). The absolute eosinophil count was significantly higher in the combined AD and FH groups compared with the group with normal adrenal function (p < 0.05). Forty-six of 104 patients (44.2%) received hydrocortisone; 29 (63%) could be weaned from treatment with vasopressors within 24 h. This beneficial effect of hydrocortisone reached statistical significance in the FH group when compared with untreated patients (p < 0.031); a similar trend was seen in the AD group (p = 0.083). Mortality was also lower in the hydrocortisone-treated AI patients (5 of 23 [21%] vs 5 of 11 [45%] in those not receiving hydrocortisone; p < 0.01). CONCLUSION: There is a high incidence of AI among SICU patients > 55 years of age with postoperative hypotension requiring vasopressors. There is also a significant association between hydrocortisone replacement therapy, resolution of vasopressor requirements, and improved survival.

Evaluation of the effect of a plant alkaloid (berberine derived from Berberis aristata) on Trichomonas vaginalis in vitro.

Berberine is a quaternary alkaloid derived from the plant Berberis aristata having antibacterial, antiamoebic, antifungal, antihelminthic, leishmanicidal and tuberculostatic properties. The effect of berberine sulphate salt on the growth of Trichomonas vaginalis in vitro was compared to the efficacy of metronidazole as a reference drug. Results showed that berberine sulphate was comparable to metronidazole as regards potency with the advantage of being more safe and possible replacement in metronidazole resistant cases.

Wandering intravascular missiles: report of five cases from the Lebanon war.

From 1980 to 1986, during the Lebanon war, five patients with missile embolization were seen at the American University of Beirut Medical Center. Three had entry in the heart or thoracic aorta with peripheral embolization, and two had entry in the internal carotid artery and inferior vena cava with embolization to the middle cerebral artery and heart, respectively. Embolization was suspected when, in the absence of an exit, routine x-ray films showed the missile in a distant location. Angiography and echocardiography confirmed the diagnosis. Peripheral arterial emboli were extracted while cerebral and venous emboli were kept, as they caused transient symptoms and remained silent.