Gene/Protein Disease Symptom Drug Enzyme Compound
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Insights gained by a group of American maternal and child helath (MCH) care nurses during a 1983 exchange tour to Kenya, sponsored by Professional Seminar Counsultants, are decribed. Kenya is a poor, predominantly rural country. The annual population growth rate is 4.1%, and 60% of the population is under the age of 16. The government's annual per capita health expenditure is only US$4, there is little emphasis on pediatrics as a speciality, and the linguistic diversity of the population complicates the delivery of health care services. As a result of these factors, the MCH care system in Kenya differed markedly from the systems observed in previous exchange tours to China and the USSR. Kenya's population is served by a variety of government, private, and missionary hospitals and by government health centers. The health centers are staffed by 2 nurses and 2 assistants who provide maternity, family planning, and immunization services. The staff also diagnoses and treats common illnesses. Service are provided free for patients under the age of 16, and minimal fees are collected from older patients. The largest hospital in the country is the 1600 bed, Joma Kenyatta National hospital which employs 900 nurses and serves as a refereal hospital for complicated cases and as a teaching and research center. 42% of the hospital staff nurses are registered nurses and 58% are enrolled nurses. Disease patterns in Kenya and the US are markedly different. In Kenya, infectious diseases are more common than chronic diseases, and amony children the major causes of death are starvation, measles, whooping cough, malaria, tubercluosis, and diarrhea. Marasmus and protein calorie deficiency are the 2 major types of childhood malnutrition found in Kenya. Nurses frequently provide health education services and even teach mothers how to grow nutritious foods for their children. Rh incompatibility is rare in Kenya, but ABO incompatibility is common. Othr common diseases, raraly found in temperate climates, include Burkitt's lymphoma, leprosy, and tropical ataxic neuropathies. The visiting nurses were at 1st shocked by some of the practices and customs they observed; however, as they learned more about the rationall behind these practices, shock gave way to appreciation. Children's wards lacked playthings, the walls were devoid of pictures, and the rooms were sparsely furnished. The lack of material items, however, was more than compensated for by the rich stimuli provided family members and friends, who not only visited the chilren, but performed a variety of nursing tasks. The family centered approach also provided a sense of security for the patients. A Masai paramedic explained how the custom of polygamy ensures adherence to the 2-year postpartum sexual taboo which, in turn, facilitates prolonged breast feeding. The nurses also became acquainted with the social value of adolescent circumcision rites. These rites are illegal but still performed in many rural areas. The rites are physically painful, but they provide a mechanism for easing the transition from adolescent to adult status. The rites help young people assume measningful roles in the society and provide them with clearly specified identities. As a result, adolescent suicide is rara among the rural villagers.
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PMID:Health care in Africa. 646 42

Therapeutic erythrocytapheresis (TEA) has been used in different diseases such as polycythemia vera (PV), secondary erythrocytosis or hemochromatosis as a process of the less cumbersome but more expensive phlebotomy. TEA is preferred in emergency conditions such as thrombocytosis or in conditions such as porphyria cutanea tarda (PCT) or erythropoietic porphyria when plasma exchange (PEX) is often combined with TEA to reduce extracellular levels of uroporphyrin which contribute to plasma hyperviscosity. TEA is often combined with drug therapy that varies from etoposide in PV to EPO and desferoxamine which are used to mobilize and reduce iron stores in hemochromatosis. Benefits from this combination may be more long lasting than expected. Nonetheless for TEA, there is no standard protocol and, clinical experience with this therapy remains highly anecdotal. Therapeutic red cell-exchange (TREX) has been used with much interest over the years, starting with the management of hemolytic disease of the newborn and later used to correct severe anemia in thalassemia patients thereby preventing iron overload. It has also been used for the management of complications of sickle cell disease such as priapism, chest syndrome, stroke, retinal, bone, splenic and hepatic infarction or in preparation for surgery by reducing HbS to less than 30%. Automated apheresis has also favored the use of TREX in conditions such as paroxysmal nocturnal hemoglobinuria and aniline poisoning, arsenic poisoning, Na chlorate intoxications and CO intoxications, hemoglobinopathies, autoimmune hemolytic anemia, reactions due to ABO incompatibility, in preparation for ABO incompatible bone marrow transplantation or for preventing anti-D immunization after the transfusion of D(+) cells to D(-) recipients. Another field of application has been in the emergency management of intraerythrocytic parasite infections such as malaria and babesiosis. Application of TREX may be wide but its real use remains limited. In our personal experience, in 16 years, only 167 TREX procedures have been carried out in a total of 13,747 therapeutic procedures. This represents only 1.21% of the total.
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PMID:Clinical application of therapeutic erythrocytapheresis (TEA). 1083 21

Systemic disease, either genetic or acquired, may prevent or decrease the severity of another disease. These observations have led to important therapeutic advances. The best-known examples are Edward Jenner's use in 1798 of cowpox to prevent smallpox and J.B. Haldane's 1942 observation that erythrocyte disorders such as thalassemia and sickle cell disease modify the severity of malaria. Patients with and carriers of cystic fibrosis may have genetic resistance to tuberculosis and/or secretory diarrhea. The beneficial effects of undernutrition have led to therapeutic diets for seizures, celiac disease, type 2 diabetes, and inflammatory bowel disease. Finasteride for prostatic hypertrophy was developed after the observation that patients with male pseudohermaphrodism resulting from 5-alpha-reductase mutations do not develop prostatic hypertrophy. Rh immunoglobulin for Rh hemolytic disease prevention followed the observation that ABO incompatibility prevented Rh sensitization. The natural immunosuppression of measles may cause remission of nephrosis, and that of leprosy prevents psoriasis. Patients with one form of agammaglobulinemia (X-linked) never get Epstein-Barr virus infection, and patients with another form (common variable) are seemingly cured by HIV infection. HIV/AIDS is prevented or modified by co-receptor mutations (notably the CCRDelta32 chemokine mutation), HIV-2, or GB virus C infection. Additional exploration of these genetic, infectious, and metabolic influences on disease severity may provide new therapeutic approaches to HIV and other diseases.
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PMID:Disease versus disease: how one disease may ameliorate another. 1639 76