Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0024530 (malaria)
 44,886 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Multiple-antigen peptide (MAP) constructs containing different T- and B-cell epitopes were assessed for their ability to be specifically recognized by murine and human T-cell clones. The different synthetic MAP constructs consisted of a malaria T-cell epitope or of a human universal tetanus toxin helper T-cell epitope collinearly synthesized with B-cell epitopes from the circumsporozoite proteins of different malaria parasites. All constructs were able to stimulate specifically T-cell clones. Interestingly, T-cell epitopes assembled as MAP constructs did not require processing for the specific stimulation of murine and human T-cell clones, as shown by retention of their stimulatory effect in the presence of glutaraldehyde-fixed antigen-presenting cells. However, processing was required for most of the synthetic constructs containing both T- and B-cell epitopes. Thus, the requirement for processing of these constructs seems to be dictated by the nature of the B-cell epitope present.
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PMID:Presentation of T-cell epitopes assembled as multiple-antigen peptides to murine and human T lymphocytes. 768 41

Over an 18-month period, from October 1991 through early 1993, a study was carried out in two phases in the pediatric wards of the Eldoret District Hospital to document infant and child morbidity and mortality in the Uasin Gishu district and parts of several surrounding districts in western Kenya. Patient discharge summaries and ward registers were analyzed for age, sex, diagnosis, length of hospitalization, and outcome. There were a total 4720 pediatric admissions over the period. The most frequent 20 diseases were identified and their respective case fatalities were calculated. 74.5% of the admissions were due to only four diseases: malaria (33.0%), pneumonia (26.8%), gastroenteritis (10%), and measles (7.6%). Malaria was responsible for only 9 (9.1%) of all deaths. The disease specific mortality rate for malaria was 2.2%, 11th among the top 15 diseases. 20 (20.4%) out of a total of 98 deaths were due to pneumonia. Measles was becoming less important as a cause of morbidity because of immunization: in 1991, over 20 cases/per month were admitted, but by 1993 only 6.5 cases/month were admitted, a decrease of 68%. Neonatal tetanus was responsible for 43.2% of neonatal mortality during the 18 months. In addition, 47 infants and children had severe anemia (hemoglobin 4.0 gm%); 8 (17%) of these children died despite emergency blood transfusions. The overall mortality rate in the hospital during the study was 8.2%, which compares with 9.6% reported in Tanzania in 1987. 61 (64.9%) deaths occurred within 24 hours of hospitalization owing to delay in seeking medical care. In a 1988 study in Harare, 201 (43.7%) of 460 deaths occurred within the first 24 hours of admission. Furthermore, during February through June 1992, 29 of 57 children under 2 years of age admitted for gastroenteritis tested positive for HIV antibodies. A retrospective review of the ward register also showed that in 20% of the admissions the outcome was not recorded, in 25% the length of stay could not be determined, and for 8.3% the age of the patient was not recorded.
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PMID:Paediatric morbidity and mortality at the Eldoret District Hospital, Kenya. 779 68

A febrile convulsion is a generalized seizure occurring during a febrile illness whose cause is extracranial. Most scholars agree that strong evidence exists of familial predisposition to febrile seizures. The events are more common among men, with the pattern of such convulsions in Europe and North America apparently different from that in Africa. The authors report their findings from an examination of the pattern of febrile seizures at the Children's Emergency Room of the University of Benin Teaching Hospital in Benin City, Nigeria. 1046 children were admitted over the course of the study conducted January-September, 1988. Seven of the 202 patients with febrile convulsions died, five from aspiration pneumonia and two from tetanus following traditional treatment. 5% of patients with febrile convulsions were younger than 5 months or older than 5 years. The male:female ratio was 1.3:1. 140 children had a family history of febrile convulsion; in 55% the relative was a close family member. The authors point out that the number of families with a positive history of febrile convulsions may have been underreported because the average Nigerian family is loathe to admit that any member suffers from a socially stigmatized illness. These findings confirm the view that a strong familial predisposition exists for febrile seizures. Major causes of the rise in temperature in those studied included malaria, which accounted for 32.7%, followed by bronchopneumonia among 16.8%, measles at 15.4%, otitis media at 13.4%, and tonsillitis at 10.5%. Observed morbidity and mortality could be attributed to the sociocultural background of this community which practices modes of therapy which are often detrimental to patient health.
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PMID:Childhood febrile seizures (Benin City experience). 782 94

In February 1992 in Nigeria, pediatricians and community health workers interviewed parents living in 1263 households in the rural tropical rainforest community of Nko in Ugep Local Government Area of Cross River State to determine the pattern of infant and child mortality in a typical rural community and to examine family and social patterns which may influence child mortality. There were no records of birth and death in Nko. They identified 471 pediatric deaths (=or 15 year olds) that occurred during 1991. Children between 1 and 5 years old comprised the largest group of pediatric deaths (43.3%) followed by those older than 5 years (33.3%), 1-12 month old infants (18.1%), and newborns (5.1%). The leading causes of neonatal death were septicemia (37.5%), tetanus (20.8%), and birth asphyxia (20.8%). The leading causes of infant death included malaria (46.5%), protein energy malnutrition (PEM) (10.5%), pneumonia (10.5%), and diarrhea (10.5%). Among preschoolers (1-5 year olds), the major causes of death were malaria (35.8%), PEM (18.1%), and diarrhea (13.7%). Pneumonia (16.6%), malaria (15.3%), and tuberculosis (13.4%) were the chief causes of death among school-aged children. Among all 471 pediatric deaths, malaria was the leading cause of death. Pediatric deaths peaked in the months of March and August, periods of high malaria transmission during the transitional period from dry to wet season and from wet to dry season. Only 5% of the deceased children had adequate immunization coverage. 52.9% of the children were not treated in health facilities, as the nearest health facility was in the town of Ugep, 15 km away from Nko. Insufficient waste disposal, lack of potable water, and streams polluted with human wastes contribute to the diarrhea deaths. An open toilet system, bushes littered with domestic wastes, and no water drainage system are breeding grounds for mosquitoes. Overcrowding in the homes foster the spread of infections. Protein-poor root crops predominate, leading to PEM.
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PMID:Community-based surveillance of paediatric deaths in Cross River State, Nigeria. 785 18

This paper opens by briefly tracing the development of vaccines from Edward Jenner's work in 1796 to the present. The proportion of deaths from communicable diseases in developed and developing countries is discussed, and it is noted that, in 1990, communicable diseases killed 575,000 people in industrialized countries and 16 million people in developing countries. In developed countries, there were no deaths from measles, malaria, tetanus, or pertussis, and only seven from diarrheal disease as compared to 1,006,000, 926,000, 505,000, 321,000, and 2,866,000, respectively, in developing countries. By the end of the century, AIDS will overshadow the communicable disease profile. Annual mortality figures from bites by rabid animals, snakes, insects, etc. are also grossly underreported. A look at the common biologicals used in developing countries shows that at least eight bacterial and eight viral vaccines are in common use globally. The origin and indications for each vaccine are tabulated. Data on anti-serum vaccines, plasma-derived preparations, and biological response modifiers (available in industrialized countries) are similarly tabulated. Consideration of the industrial production of immunogens in developing countries reveals that most production relies on outdated technology. Vaccines exhibit suboptimal performance in these settings either due to factors relating to individual vaccines or to community circumstances. Individual vaccines which exhibit inadequate potency in adverse circumstances include liquid vaccines and lyophilized vaccines and prophylactics. This situation is exacerbated by unsatisfactory vaccine administration practices, malnutrition, and cases of immunosuppression. Suboptimal performance at the community level is due to procurement procedure, the cost of vaccines, poverty, population growth, failures in the cold chain, lack of trained personnel, religion and gender bias, and political factors, such as war. A suitable remedial action plan requires integrated action at the international, national, and community levels. Such an effort would be aided by improved mortality data collection techniques and by multidisciplinary research to update indigenous manufacturing technology.
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PMID:Human immunization in developing countries: practical and theoretical problems and prospects. 788 21

Placental malaria may limit antibody transfer to the fetus. We compared concentrations of tetanus antibody in paired maternal-cord sera from 224 women living in a malarious area of Papua New Guinea. With heavy placental infection (> 35 parasites per 200 white cells) the average cold tetanus antibody corresponding to a maternal level of 1 IU/mL was 0.18 (95% CI 0.12-0.26); corresponding figures after light (< 35 parasites per 200 white cells) or no infection were 0.23 (0.14-0.34) and 0.82 (0.57-1.21), respectively. About 10% of babies born to mothers with a placenta heavily infected with Plasmodium falciparum may fail to acquire protective levels of tetanus antibody despite adequate maternal antibody.
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PMID:Reduced transfer of tetanus antibodies with placental malaria. 790 69

There has been considerable uncertainty about the risks and severity of tetanus after intramuscular quinine, a widely used treatment of severe malaria in the rural tropics. We have compared the clinical features and outcome of tetanus in which injection was the only apparent site of infection with tetanus acquired by other routes in patients admitted to the Centre for Tropical Diseases, Ho Chi Minh City, Vietnam. In 1081 consecutive patients with tetanus treated between Jan 26, 1989, and May 27, 1991, 27 followed intramuscular quinine and 15 followed injections of other drugs. Overall mortality was 26% (285/1081). Mortality in patients who had not had preceding injections was 24% (250/1039) compared with 96% (26/27) in the quinine group (relative risk 4.0, 95% CI 3.5-4.6) (p < 0.0001), and 60% (9/15) in the other injections group (2.5, 1.6-3.8) (p < 0.005). 21 patients (78%) in the quinine group died within 72 h of admission compared with 5 (33%) in the other intramuscular injections group (p < 0.01) and 4 (7%) of 54 matched controls (p < 0.0001). Tetanus that follows intramuscular injections has a poor prognosis, but when it follows intramuscular quinine it is usually rapidly fatal.
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PMID:Role of quinine in the high mortality of intramuscular injection tetanus. 796 20

A proposed method is presented by which the cost-effectiveness of investing in the physical and human infrastructure of the health system can be evaluated. The role of health systems infrastructure in studies of cost-effectiveness analysis and health resource allocation is discussed, and previous health sector cost-effectiveness analyses are cited. Two substantial difficulties concerning the nature of health system costs and the policy choices are presented. First, the issue of health system infrastructure can be addressed by use of computer models such as the Health Resource Allocation Model (HRAM) developed at Harvard in the General Algebraic Modeling System (GAMS), which integrates cost-effectiveness and burden of disease data. It was found that a model which allows for expansion in health infrastructure yields nearly 40% more total disability-adjusted life years (DALYs) for a hypothetical Sub-Saharan African country with a population of 10 million and GDP per capita of $340, than a model which neglects infrastructure expansion. The most important interventions by expenditure are screening and treatment of acute respiratory infections, malaria, tuberculosis, measles as well as promotion of oral rehydration therapy, breast-feeding, tetanus, and hygiene. Widespread use of cost-effectiveness databases for resource allocations in the health sector will require that cost-effectiveness analyses shift from reporting costs to reporting production functions. Distinct policy questions can be addressed with cost-effectiveness analysis, each necessitating its own inputs and constraints: 1) allocations when given a fixed budget and health infrastructure, or 2) when given resources for marginal expansion, or 3) when given a politically constrained situation of expanding resources. The development of a consistent approach to using cost-effectiveness data for informing resource allocations precludes confusion concerning which question must be addressed. Finally, some implications for future cost-effectiveness studies are highlighted.
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PMID:Cost-effectiveness analysis and policy choices: investing in health systems. 792 45

International travels are increasingly frequent. Beside malaria prophylaxis, the general practitioner will review several vaccinations.e Tetanus and poliomyelitis vaccines should be administered once every ten years. It will often be useful to give a protection against hepatitis A, and less often, against typhoid fever. The yellow fever vaccine, which may be required or recommended to visit several African and South American countries, is injected only by officially recognised centres. For some travels, vaccination against hepatitis B, meningococcal meningitis or, rarely, against rabies may be considered. The vaccine against cholera will never be administered, due to its lack of efficacy and high frequency of side effects. Travellers diarrhoea will be discussed, and a "pocket" treatment prescribed. Finally, general information will be provided, including those on STD.
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PMID:[Vaccinations and useful advice for travelers]. 793 82

This study provides the age specific prevalence rates of diseases using data from 1152 infants by reviewing clinic records, which have been maintained from 1963 till 1984 (grouped according to households) at Kasangati Health Centre near Kampala, Uganda. On the average, each child reported 3 disease episodes per year. The conditions that brought a child to clinic for the first time were: respiratory infection 46.2%; clinical malaria 14.4%; skin infections 9.8%; diarrhoeal diseases 8.5% and, others 21.1%. The prevalence of diseases in infants at the age of less than one month old were, respiratory tract infection 78/1000, skin conditions 29/1000, clinical malaria/fever 18/1000, eye infection 15/1000, diarrhoea 5/1000 and others 67/1000. At the age of one month till the age of 18 months, four conditions consistently topped the disease prevalence list: respiratory tract infection with a range of 175/1000 to 29/1000, being higher in early childhood; clinical malaria/fever with a range of 79/1000 to 23/1000; diarrhoeal diseases with a range of 55/1000 to 10/1000 and skin conditions with a range of 42/1000 to 10/1000. Other disease conditions including urinary tract infection, burns/accidents, eye infections, ear infections, measles and tetanus had age specific prevalence of less than 10/1000 at each age. Most of the diseases showed decreasing level of prevalence as the age increased. Relatively more people used the clinic and at a higher rate in the 1970s compared to the 1960s, mirroring the general economic and political situation of the two periods. There were no sex specific differences in either the frequency of utilization of the clinic or in the prevalence of disease over time.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Record keeping on early childhood diseases in two decades, at the health centre level in Uganda. 795 70


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