Reiki Therapy Definition

Yellow fever: risk of extensive outbreaks in urban Africa

The risk of an explosion of cases of yellow fever in African cities is real. As you know, the yellow fever virus infects humans and several species of nonhuman primates and is transmitted by the bite of insect vectors. The transmission to humans may occur through three cycles:

- the jungle or forest, in the tropical forests of Africa and South America: the virus circulates between apes and is occasionally transmitted to humans who, for whatever reason, he ventures into the rainforest;

- Intermediate: occurs in the villages of the African savannah, where mosquitoes semidomestiche bite either apes and humans;

- urban: the virus is introduced in areas of high population density and the carrier transmits the infection from person to person, causing large outbreaks. In Africa

carriers are more frequently involved

- Aedes africanus in the cycle of the jungle is a nocturnal predator and prefers to obtain its blood meal from monkeys rarely bites humans, are so rare in the real jungle yellow fever in Africa;

- Aedes Simpson and other species of Aedes in the intermediate cycle, in which case we speak of "bridging vector (carrier deck) for the propensity to bite humans and monkeys either: the transmission of virus to humans occurs in villages near the jungle

- Aedes aegypti in the urban cycle: a person who was infected in the jungle, when he returned to town can give rise to an initial outbreak that spreads rapidly through the urban vector. Other times it is the carrier that is infected accidentally introduced in the city (for es. through used tires).

Experts fear an explosion epidemic in African cities including area considered at risk according to the possible simultaneous presence of the virus and the vector (indicated in the map of CDC - Yellow Book 2010).

Two factors combine to increase the risk of epidemic:

- rapid urbanization: every year in Africa's urban population increases by about 4%. It is susceptible to the disease that are concentrated in areas characterized by poor housing, inadequate hygienic conditions, poor access to clean water causes residents to stock up water in open containers, the ideal site for the proliferation of Aedes aegypti;

- the poor vaccination coverage of the population in the 40s of last century the universal vaccination with the vaccine FNV (French Neurotropic Vaccine) had significantly reduced the incidence of the disease. Vaccination was discontinued in the '80s because it had been found an increased risk of encephalitis in children: it is a vaccine prepared in cell cultures of rat brain. The current vaccine (referred to as 17D), despite having a very high safety profile, has never reached a satisfactory vaccine coverage in the population.

These two factors are behind the increase in cases of yellow fever in Africa during the last decade. It should however be noted that outbreaks were concentrated in West Africa, while in East Africa the situation is less dramatic. What impact does this different epidemiological situation in the assessment of risk for the traveler? And what are the implications for our business counseling, particularly with respect to a traveler who goes to Kenya or Tanzania? This will be the topic for a future post.

For those who wish to deepen: it signals the valuable reviews on the yellow fever Christina Gardner and Kate Ryman recently appeared in The Journal of Laboratory and Clinical Medicine, and from which I suddenly a lot of information contained in this post.
Christina L. Gardner, Kate D. Ryman. Yellow fever: a reemerging threat. Clin Lab Med 30 (2010) 237-260 doi: 10.1016/j.cll.2010.01.001
http://www.labmed.theclinics.com/

Meagan Good 2010 Short Hair

A Cochrane review on new drugs for malaria chemoprophylaxis

E 'was published in a Cochrane review on the drugs used for chemoprophylaxis of malaria in non immune subjects.

Objectives of the review: To evaluate efficacy, safety and tolerability of the drugs most commonly used in the chemoprophylaxis of malaria, namely

- the combination of atovaquone + proguanil
- mefloquine
- doxycycline

comparing these drugs with each other, as well as the association chloroquine + proguanil and with primaquine.

As you would expect from a Cochrane review, the selection criteria were rigorous clinical trials, as well as the analysis methodology.

What are the results of the review?

8 clinical trials are included in the review, a total of 4240 participants. The overall quality of evidence was low to moderate, due to the limited number of studies that have compared the regimes of their standard of chemoprophylaxis and the limited number of participants / events for each study. No trial compared a standard regimen with any primaquine, so it was excluded from the analysis.

Effectiveness: the review has not produced conclusive evidence about which drugs, including those considered to be more effective in preventing malaria in non-immune individuals who travel in areas where Plasmodium falciparum is resistant to chloroquine.

What have we learned from the analysis of effectiveness?

Since evidence has emerged on what is the best drug, the choice of chemoprophylaxis regime must take into account other factors such as the profile of drug resistance of Plasmodium falciparum in the area where the traveler will travel, security, tolerability and cost of treatment.

Safety and tolerability: despite the revision did not produce conclusive evidence on what is the drug safer and better tolerated in individuals with no immunity who travel to areas where Plasmodium falciparum is resistant to chloroquine, however, showed that

- atovaquone + proguanil and doxycycline have a better tolerability compared to mefloquine;

- atovaquone + proguanil and doxycycline have a tolerability profile similar;

- atovaquone + proguanil, mefloquine and doxycycline are better tolerated in comparison to the association chloroquine + proguanil.

mefloquine is associated with neuropsychiatric adverse reactions.

patients treated with atovaquone + proguanil had a significantly lower frequency of any adverse reaction, as well as less gastrointestinal and neuropsychiatric events, as well as better scores in surveys that detect the presence of any mood changes.

What have we learned from the safety and tolerability?

The fact that some important differences emerged between the drugs in question allows us to use these data to choose the most suitable drug for each individual traveler, both in relation to his medical history and travel characteristics (in particular route and duration). What impact

This Cochrane review has on our daily activities?

Although the audit results must be interpreted with caution due to suboptimal quality of the evidence, it is still a valuable work of great interest to those who daily are to recommend and prescribe medications for malaria chemoprophylaxis .

The review contains an important confirmation to the observations that each of us over the years has performed at the clinic, through the feedback provided by travelers: the atovaquone + proguanil combination is better tolerated than other regimens in current use.

were influenced by two other findings of the review: The first concerns the doxycycline. Some operators have some qualms when prescribing doxycycline, fearing the occurrence of side effects such as photosensitivity ol'esofagite reflux, probably we can now consider a different way this drug, which also has a major limitation: it must be continued for four weeks after return, and the administration is daily. This fact has obvious implications in terms of compliance.

The second result concerns the association chloroquine + proguanil: I have met several times during the pre-travel counseling clinic, travelers believe they have found a drug "alternative" and "better tolerated" by what I proposed to them. Almost always it was chloroquine + proguanil, often in the French version that combines both drugs in the same preparation. We already knew that the efficacy of chloroquine + proguanil in chloroquine-resistant areas is unsatisfactory, but we now have a figure that also shows the low tolerability.

Finally, as regards the mefloquine, this is a drug for its mode of recruitment is still valuable in several situations, such as in long-term travelers, and can still be used with a certain tranquility in individuals who have previously taken without significant adverse events. The fact that both were associated with certain adverse reactions should not obscure both the practical benefits and the benefits arising from its use in the prevention of a serious and potentially fatal disease such as malaria. Bibliographic Reference



Jacquerioz FA, Croft AM. Drugs for Preventing malaria in travelers. Cochrane Database of Systematic Reviews 2009, Issue 4. Art No.: CD006491.
DOI: 10.1002/14651858.CD006491.pub2.
http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD006491/frame.html

Biology Sweatshirt At Uw

Where, how and why fall ill with malaria Italians?

A study published in Travel Medicine and Infectious Disease provides valuable information on where, how and the contract because the Italians malaria.

on 5219 cases of malaria diagnosed in Italy in 2000-2006, 1518 occurred in Italian travelers, foreigners in 3696, while 5 cases were autochthonous (from accidental exposure). The incidence of malaria in Italian travelers by region was calculated on the basis of data provided by the Ministry of Transport, using as denominator the number of passengers who have flights from Italy to countries where malaria is endemic.


As we have changed the incidence of malaria in Italy during the period under study?

The trend is decreasing, with a 36% reduction (44% among Italians and 32% among travelers of foreign origin).

In such areas the Italians have been infected and what are the Plasmodium species responsible?

In Africa 86% of cases (incidence 01/02/1000). Followed by Asia (incidence 0.08/1000), Central America (0.03/1000) and southern (0.003/1000). Plasmodium falciparum is the predominant species (73% and 82% of the total cases of malaria infections acquired in Africa). Following Plasmodium vivax (16% of all cases), prevalent outside of Africa. Finally, Plasmodium ovale (9%) and malariae (2%). The cases acquired in Africa and on Italian travelers have been divided into two groups, respectively, from West Africa (56%) and South East (44%) the average rate of incidence was equal to 4.1.1000 in the first group and 0.6/1000 in the second. In the first group the incidence was particularly high in Burkina Faso and Mali (06/01/1000), the second in Madagascar (1/6/1000) and Mozambique (01/04/1000).
E 'unique situation in Kenya, which saw a decrease in the incidence (from 0.4/1000 to 0.1/1000), but the continuous growth of Italian visitors, the absolute number of cases is still high.

What is the trend in mortality?

During the period under study were stable the number of deaths from malaria is the case fatality rate (0.5-1.7%), despite the decrease in the incidence of malaria.

What data are emerging with regard to foreign nationals?

represent about 2 / 3 of the total. Most (96%) became infected in Africa, especially in the West (88.7%). The deaths were 6 (corresponding to an average fatality rate of 0.2% from Plasmodium falciparum). In particular, it is a constant number of travelers on Immigrants VFR (visiting friends and relatives), who are not aware of the short length of semi-immunity in people from endemic areas.

What are the factors risk in Italian travelers?

E 'analysis was made of the main risk factors, not summarized here due to space. Among the risk factors examined, I think are particularly interesting are the following:

a) lack of awareness of risk, many travelers are not aware that in Africa, malaria is a disease of only rural but can also occur in urban centers and tourist areas hotels and resorts with a high level: 119 cases in Kenya and 21 contracts on the island of Zanzibar (Tanzania) involving Italian tourists who stay in hotels located on the coast for an average of 6-8 days;

b) how to conduct the chemoprophylaxis: 27% (299 subjects) of Italians who have contracted malaria chemoprophylaxis claims to have done. However, one third of the 299 patients had not completed chemoprophylaxis, while the remaining 2 / 3 claimed to have taken the correct profile. The latter had used a drug appropriate? Not always, it appears that 40% had used drugs inadequate in relation to the area visited, or drugs not listed in the official recommendations.

The findings in turn raise some questions, including the following:


Because the incidence of malaria in Italian travelers is declining?

likely contributed to this reduction a greater awareness of the risk for travelers in a wider dissemination of information on malaria, on the internet, together with the availability of Travel Medicine clinics in all ASL. I should note, however, that in recent years there has been a reduction in the incidence of malaria in sub-Saharan African populations, as reported by Wendy Prudhomme O'Meara et al. in a review recently published in the Lancet Infectious Diseases (Changes in the burden of malaria in sub-Saharan Africa. The Lancet Infectious Diseases 2010, 8:545-555 doi: 10.1016/S1473-3099 (10) 70096-7
www.thelancet.com / journals / LanInfo / issue / current ).

Why, despite a decrease in the incidence, the fatality rate among Italian travelers is almost the same?

The authors put forward two hypotheses: the first is that the phenomenon is linked to certain strains particularly virulent Plasmodium falciparum, the second is that it involved a delay in diagnosis. This in turn could be the result of a delay in the patient's medical advice; also the presence of nonspecific symptoms and sometimes, especially in winter, superimposed on a flu-like clinical picture, can mislead the physician.

What actions can be taken to reduce the incidence and mortality from malaria among travelers and among the Italian immigrants who return to their country of origin?

actions are threefold: to inform travelers, increasing risk awareness and knowledge of the symptoms that require immediate medical attention, proper prophylaxis (both pharmacological and antivettoriale), an early diagnosis that allows treatment to begin soon drug.

Bibliographic Reference

Roberto Romi, Daniela Boccolini, Stefania D'Amato, Corrado Cenci, Mario Peragallo, Fortunato D'Ancona, Maria Grazia Pompa, and Giancarlo Majori. Incidence and risk factors of malaria in Italian travelers to malaria endemic countries. Travel Medicine and Infectious Disease Volume 2010:8;
144-154 doi: 10.1016/j.tmaid.2010.02.001
www.elsevier.com / locate / tmaid

Campbells Cheesy Chicken Rice

Who are the recipients of this blog?

The blog is aimed at workers health dealing Travel Medicine and Migration. It is not a blog for international travelers: not hosting advice to the public about immunizations or malaria prophylaxis of travelers. Health professionals will find a series of articles: summaries of studies and scientific publications, case studies and reflections on topics relating to this branch of medicine and disciplines that are closely related with it (and tropical infectious diseases, vaccinology and epidemiology).