High prevalence anti-Trypanosoma cruzi antibodies, among blood donors in the State of Puebla, a non-endemic area of Mexico

Blood transfusion is the second most common transmission route of Chagas disease in many Latin American countries. In Mexico, the prevalence of Chagas disease and impact of transfusion of Trypanosoma cruzi-contaminated blood is not clear. We determined the seropositivity to T. cruzi in a representative random sample, of 2,140 blood donors (1,423 men and 647 women, aged 19-65 years), from a non-endemic state of almost 5 millions of inhabitants by the indirect hemagglutination (IHA) and enzyme linked immunosorbent assay (ELISA) tests using one autochthonous antigen from T. cruzi parasites, which were genetically characterized like TBAR/ME/1997/RyC-V1 (T. cruzi I) isolated from a Triatoma barberi specimen collected in the same locality. The seropositivity was up to 8.5% and 9% with IHA and ELISA tests, respectively, and up to 7.7% using both tests in common. We found high seroprevalence in a non-endemic area of Mexico, comparable to endemic countries where the disease occurs, e.g. Brazil (0.7%), Bolivia (13.7%) and Argentina (3.5%). The highest values observed in samples from urban areas, associated to continuous rural emigration and the absence of control in blood donors, suggest unsuspected high risk of transmission of T. cruzi, higher than those reported for infections by blood e.g. hepatitis (0.1%) and AIDS (0.1%) in the same region.

Clinical and epidemiological aspects of human parvovirus B19 infection in an urban area in Brazil (Niterói city area, State of Rio de Janeiro, Brazil)

This study was designed to analyse the clinical and epidemiological data from human parvovirus B19 cases in a six-year study of rash diseases conduct in an urban area in Brazil (Niterói city area, State of Rio de Janeiro). A total of 673 patients with acute rash diseases were seen at two primary health care units and at a general hospital. A clotted blood sample was collected from all subjects at the time of consultation. Forty-nine per cent (330 cases) of the patients were negative for dengue, rubella and measles IgM or for low avidity IgG to HHV-6. Of these 330, 105 (31.8%) were identified as IgM positive to parvovirus B19 by using an antibody capture EIA. During the study period, three distinct peaks of parvovirus infection were detected, suggesting that the disease appears to cycle in approximately 4-5 years. B19 infection was characterized by variable combinations of fever, flu-like symptoms, arthropathy, and gastrointestinal symptoms. Frequency of fever and arthropathy was substantially higher in adults, 75% [chi2 (1 D.F.) = 11.39, p = 0.0007] and 62.5% [chi2 (1 D.F.) = 29.89, p = 0.0000], respectively. "Slapped-cheek" appearance and reticular or lace-like rash were seen in only 30.1% of the children. No adult presented this typical rash. The lack of the typical rash pattern in a large proportion of parvovirus B19 and the similarity of clinical manifestations to other rash diseases, specially to rubella, highlight the difficulty of diagnosing B19 infection on clinical grounds alone.

Statistical tests for scaling in the inter-event times of earthquakes in California

We explore in depth the validity of a recently proposed scaling law for earthquake inter-event time distributions in the case of the Southern California, using the waveform cross-correlation catalog of Shearer et al. Two statistical tests are used: on the one hand, the standard two-sample Kolmogorov-Smirnov test is in agreement with the scaling of the distributions. On the other hand, the one-sample Kolmogorov-Smirnov statistic complemented with Monte Carlo simulation of the inter-event times, as done by Clauset et al., supports the validity of the gamma distribution as a simple model of the scaling function appearing on the scaling law, for rescaled inter-event times above 0.01, except for the largest data set (magnitude greater than 2). A discussion of these results is provided.

Ticks (Acari: Ixodidae) on wild animals from the Porto-Primavera Hydroelectric power station area, Brazil

From June 2000 to June 2001, a total of 741 ticks were collected from 51 free-living wild animals captured at the Porto-Primavera Hydroelectric power station area, located alongside an approximately 180 km course of the Paraná river, between the states of São Paulo and Mato Grosso do Sul, comprising 9 species of 3 genera: Ambly-omma (7 species), Boophilus (1) and Anocentor (1). A total of 421 immature Amblyomma ticks were reared in laboratory until the adult stage, allowing identification of the species. A. cajennense was the most frequent tick species (mostly immature stages) collected on 9 host species: Myrmecophaga tridactyla, Tamandua tetradactyla,Cerdocyon thous, Puma concolor,Tayassu tajacu, Mazama gouazoubira,Hydrochaeris hydrochaeris,Alouatta caraya, Cebus apella. Other tick species were less common, generally restricted to certain host taxa.

Inhabitants' and professionals' social representations of health determinants in a disadvantaged urban area in France: a qualitative analysis = représentations sociales des déterminants de santé dans une zone urbaine défavorisée en France : analyse qualitative auprès d'habitants et de professionnels

Background and objective. - Access to care in French disadvantaged urban areas remains an issue despite the implementation of local healthcare structures. To understand this contradiction, we investigated social representations held by inhabitants of such areas, as well as those of social and healthcare professionals, regarding events or behaviours that can impact low-income individuals' health. Method. - In the context of a health diagnosis, 288 inhabitants living in five disadvantaged districts of Aix-les-Bains, as well as 28 professionals working in these districts, completed an open-ended questionnaire. The two groups of respondents were asked to describe what could have an impact on health status from the inhabitants' point of view. The textual responses were analyzed using the Alceste method. Results. - We observed a number of differences in the way the inhabitants and professionals represented determinants of health in disadvantaged urban areas: the former proposed a representation mixing personal responsibility with physiological, social, familial, and professional aspects, whereas the latter associated health issues with marginalization (financial, drug, or alcohol problems) and personal responsibility. Both inhabitants and professionals mentioned control over events and lifestyle as determinants of health. Discussion. - The results are discussed regarding the consequences of these different representations on the beneficiary - healthcare-provider relationship in terms of communication and trust.

Diversity of biting midges of the genus Culicoides Latreille (Diptera: Ceratopogonidae) in the area of the Yacyretá Dam Lake between Argentina and Paraguay

The Culicoides communities have been analyzed between 1993/1998 in the area influenced by the Yacyretá Dam Lake (Paraná River, Argentina-Paraguay). Adults of Culicoides were collected monthly by using CDC light traps exposed for 24 h in 9 sampling sites located at both margins of the river; 21 species were recorded. Highest values of species richness were recorded during 1993/1994, being Quiteria and Corpus the sites with the higest number of species (10 and 11, respectively). The species diversity was elevated in Quiteria, Zaimán, Candelaria, Santa Tecla, Capitán Meza and Corpus (Shannon's diversity index 1.0-1.9) while Corateí, Ituzaingó and Aguapey showed less richness and diversity. The more abundant species were C. insignis, C. venezuelensis, C. leopoldoi, C. limai, C. flinti, C. debilipalpis, C. paraensis and C. guttatus. C. insignis, potential vector of bluetongue virus (BTV) to domestic and wild rumiants in the Neotropical region, is the predominant species in the area and was the only species widely distributed. C. paraensis, a proven vector of Oropouche virus to humans, is a common and abundant species. C. pusillus and C. lahillei, potential vectors of BTV and a filarial parasite, respectively, were occasionally collected. The taxonomic structure of communities was constant during the study period. The occasional species were not characteristic to one particular site and their presence could be related to non-intrinsic conditions.

Estudi del sistema reptroductor de la guatlla (Coturnix coturnix) i de la hibridació amb la guatlla japonesa (Coturnix japonica) domèstica i híbrids

La guatlla (Coturnix coturnix) és actualment una espècie amb un estat de conservació desfavorable. Una amenaça per a la seva conservació és la hibridació que pot produir-se degut als alliberaments massius amb finalitats cinegètiques de la guatlla japonesa (Coturnix japonica) o híbrids provinents de granges de cria. Els objectius d’estudi són: a) Aprofundir en el sistema sexual de la guatlla, ja que el seu coneixement pot permetre entendre els mecanismes d’hibridació amb la guatlla japonesa o híbrids. b) Conèixer la taxa de supervivència i l’eficàcia biològica dels individus no nadius a àrees de reproducció de la guatlla. c) Buscar evidències directes d’hibridació en condicions naturals i caracteritzar-la. d) Determinar si existeix competència espermàtica interespecífica mitjançant experiments en captivitat. S’ha seguit el comportament en condicions naturals de parelles homospecífiques i heterospecífiques de mascles i femelles de guatlla i de guatlla japonesa o híbrids. S’ha analitzat la paternitat dels polls d’aquestes parelles i s’ha pogut conèixer quins aspectes del comportament (segons l’espècie) es relacionen amb l’eficàcia biològica dels adults. S’han analitzat el mateix tipus de dades obtingudes durant cinc temporades reproductives, en les que hi van participar només individus de guatlla. Així s’ha pogut comparar el comportament de l’espècie en presència i absència dels individus al•lòctons. Els resultats indiquen que existeixen dues estratègies sexuals entre els mascles de guatlla. L’estat físic del mascle en relació al dels altres mascles coetanis i el temps de permanència amb la femella determinen la seva taxa de paternitat. Existeix una fracció relativament petita però significativa de guatlla japonesa de granja que sobreviu en condicions naturals i s’hibrida amb la guatlla silvestre, predominantment de forma unidireccional, entre femella japonesa i mascle de guatlla. Aquestes femelles presenten un sistema d’aparellament majoritàriament monògam. Els anàlisis sobre els experiments de competència espermàtica s’estan realitzant a l’actualitat.

Rapid diagnostic tests for the home-based management of malaria, in a high-transmission area.

Rapid diagnostic tests (RDT) are sometimes recommended to improve the home-based management of malaria. The accuracy of an RDT for the detection of clinical malaria and the presence of malarial parasites has recently been evaluated in a high-transmission area of southern Mali. During the same study, the cost-effectiveness of a 'test-and-treat' strategy for the home-based management of malaria (based on an artemisinin-combination therapy) was compared with that of a 'treat-all' strategy. Overall, 301 patients, of all ages, each of whom had been considered a presumptive case of uncomplicated malaria by a village healthworker, were checked with a commercial RDT (Paracheck-Pf). The sensitivity, specificity, and positive and negative predictive values of this test, compared with the results of microscopy and two different definitions of clinical malaria, were then determined. The RDT was found to be 82.9% sensitive (with a 95% confidence interval of 78.0%-87.1%) and 78.9% (63.9%-89.7%) specific compared with the detection of parasites by microscopy. In the detection of clinical malaria, it was 95.2% (91.3%-97.6%) sensitive and 57.4% (48.2%-66.2%) specific compared with a general practitioner's diagnosis of the disease, and 100.0% (94.5%-100.0%) sensitive but only 30.2% (24.8%-36.2%) specific when compared against the fulfillment of the World Health Organization's (2003) research criteria for uncomplicated malaria. Among children aged 0-5 years, the cost of the 'test-and-treat' strategy, per episode, was about twice that of the 'treat-all' (U.S.$1.0. v. U.S.$0.5). In older subjects, however, the two strategies were equally costly (approximately U.S.$2/episode). In conclusion, for children aged 0-5 years in a high-transmission area of sub-Saharan Africa, use of the RDT was not cost-effective compared with the presumptive treatment of malaria with an ACT. In older patients, use of the RDT did not reduce costs. The question remains whether either of the strategies investigated can be made affordable for the affected population.

Report of Inter-sectoral Group on the Implementation of the Recommendations of the National Task Force on Obesity

Report of Inter-sectoral Group on the Implementation of the Recommendations of the National Task Force on Obesity Click here to download PDF 1.25mb

Dispersal of Aedes aegypti and Aedes albopictus (Diptera: Culicidae) in an urban endemic dengue area in the State of Rio de Janeiro, Brazil

Experimental releases of female Aedes (Stegomyia) aegypti and Aedes (Stegomyia) albopictus were performed in August and September 1999, in an urban area of Nova Iguaçu, State of Rio de Janeiro, Brazil, to estimate their flight range in a circular area of 1,600 m where 1,472 ovitraps were set. Releases of 3,055 Ae. aegypti and 2,225 Ae. albopictus females, fed with rubidium (Rb)-marked blood and surgically prevented from subsequent blood-feeding, were separated by 11 days. Rb was detected in ovitrap-collected eggs by atomic emission spectrophotometry. Rb-marked eggs of both species were detected up to 800 m from the release point. Eggs of Ae. albopictus were more numerous and more heterogeneously distributed in the area than those of Ae. aegypti. Eggs positively marked for Rb were found at all borders of the study area, suggesting that egg laying also occurred beyond these limits. Results from this study suggest that females can fly at least 800 m in 6 days and, if infected, potentially spread virus rapidly.

Facilitation Process Concerning the Difficulties in Implementing A Vision For Change in the South Tipperary and Carlow Kilkenny Catchment Area Mental Health Service

Facilitation Process Concerning the Difficulties in Implementing A Vision For Change in the South Tipperary and Carlow Kilkenny Catchment Area Mental Health Service Click here to download PDF 4.27MB

Human mixed infections of Leishmania spp. and Leishmania-Trypanosoma cruzi in a sub Andean Bolivian area: identification by polymerase chain reaction/hybridization and isoenzyme

Parasites belonging to Leishmania braziliensis, Leishmania donovani, Leishmania mexicana complexes and Trypanosoma cruzi (clones 20 and 39) were searched in blood, lesions and strains collected from 28 patients with active cutaneous leishmaniasis and one patient with visceral leishmaniasis. PCR-hybridization with specific probes of Leishmania complexes (L. braziliensis, L. donovani and L. mexicana) and T. cruzi clones was applied to the different DNA samples. Over 29 patients, 8 (27.6%) presented a mixed infection Leishmania complex species, 17 (58.6%) a mixed infection Leishmania-T. cruzi, and 4 (13.8%) a multi Leishmania-T. cruzi infection. Several patients were infected by the two Bolivian major clones 20 and 39 of T. cruzi (44.8%). The L. braziliensis complex was more frequently detected in lesions than in blood and a reverse result was observed for L. mexicana complex. The polymerase chain reaction-hybridization design offers new arguments supporting the idea of an underestimated rate of visceral leishmanisis in Bolivia. Parasites were isolated by culture from the blood of two patients and lesions of 10 patients. The UPGMA (unweighted pair-group method with arithmetic averages) dendrogram computed from Jaccard's distances obtained from 11 isoenzyme loci data confirmed the presence of the three Leishmania complexes and undoubtedly identified human infections by L. (V.) braziliensis, L. (L.) chagasi and L. (L.) mexicana species. Additional evidence of parasite mixtures was visualized through mixed isoenzyme profiles, L. (V.) braziliensis-L. (L.) mexicana and Leishmania spp.-T. cruzi.The epidemiological profile in the studied area appeared more complex than currently known. This is the first report of parasitological evidence of Bolivian patients with trypanosomatidae multi infections and consequences on the diseases' control and patient treatments are discussed.

Characteristics and origin of agates in sedimentary rocks from the Dryhead area, Montana, USA

Agates from the Bighorn district in Montana (USA), the so-called Dryhead area, and their adjacent host rocks have been examined in the present study. Analyses by XRD, polarizing microscopy, LA-ICP-MS, cathodoluminescence (CL), SEM and of oxygen isotopes were performed to obtain information surrounding the genesis of this agate type. Investigations of the agate microstructure by polarizing microscopy and CL showed that chalcedony layers and macrocrystalline quartz crystals may have formed by crystallization from the same silica source by a process of self-organization. High defect densities and internal structures (e. g. sector zoning) of quartz indicate that crystallization went rapidly under non-equilibrium conditions. Most trace-element contents in macrocrystalline quartz are less than in chalcedony due to a process of `self-purification', which also caused the formation of Fe oxide inclusions and spherules. Although the agates formed in sedimentary host rocks, analytical data indicate participation of hydrothermal fluids during agate formation. Trace elements (REE distribution patterns, U contents up to 70 ppm) and CL features of agate (transient blue CL), as well as associated minerals (fluorite, REE carbonates) point to the influence of hydrothermal processes on the genesis of the Dryhead agates. However, formation temperatures <120 degrees C were calculated from O-isotope compositions between 28.9 parts per thousand (quartz) and 32.2 parts per thousand (chalcedony).

The inter-rater reliability of the Pulmonary Embolism Severity Index.

The Pulmonary Embolism Severity Index (PESI) is a validated clinical prognostic model for patients with acute pulmonary embolism (PE). Our goal was to assess the PESI's inter-rater reliability in patients diagnosed with PE. We prospectively identified consecutive patients diagnosed with PE in the emergency department of a Swiss teaching hospital. For all patients, resident and attending physician raters independently collected the 11 PESI variables. The raters then calculated the PESI total point score and classified patients into one of five PESI risk classes (I-V) and as low (risk classes I/II) versus higher-risk (risk classes III-V). We examined the inter-rater reliability for each of the 11 PESI variables, the PESI total point score, assignment to each of the five PESI risk classes, and classification of patients as low versus higher-risk using kappa (κ) and intra-class correlation coefficients (ICC). Among 48 consecutive patients with an objective diagnosis of PE, reliability coefficients between resident and attending physician raters were > 0.60 for 10 of the 11 variables comprising the PESI. The inter-rater reliability for the PESI total point score (ICC: 0.89, 95% CI: 0.81-0.94), PESI risk class assignment (κ: 0.81, 95% CI: 0.66-0.94), and the classification of patients as low versus higher-risk (κ: 0.92, 95% CI: 0.72-0.98) was near perfect. Our results demonstrate the high reproducibility of the PESI, supporting the use of the PESI for risk stratification of patients with PE.