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