Managing an epidemic: Zika interventions and community responses in Belize

Implementing effective health interventions in recent epidemics has been difficult due to the potentially global nature of their spread and sociocultural dynamics, raising questions concerning how to develop culturally-appropriate preventive measures, and how these health threats are understood locally. In Belize, health policy makers have only been marginally effective in managing infections and mosquito vectors, and Zika has been declared endemic in certain regions, particularly on the island of Caye Caulker. Based on ethnographic research conducted primarily in 2017, we examine how perspectives of Zika-related health consequences are shaped, and how state interventions to manage Zika are understood. We argue that despite its declared endemic status, Zika is not perceived as a true health concern for community members due to numerous neoliberal structural challenges. Moreover, the state’s restrictive form of reproductive governance which limits family planning services is forcing individuals to weigh conflicting conceptions of health consequences. This also contributes to an ambiguous healthcare environment for health practitioners, giving them an unclear picture of the scope of Zika as a public health concern. We also consider how critical medical anthropology and feminist analytical approaches are useful in exploring these questions and contributing to understandings of the health impacts of Zika.     

Cutaneous presentation of disseminated histoplasmosis as a solitary peri‐anal ulcer. Case report and discussion

Disseminated histoplasmosis has a diverse and non‐specific range of clinical signs and symptoms. In a significant minority of patients, cutaneous lesions are apparent at the time of initial presentation, affording an opportunity to establish the diagnosis from a skin biopsy. The most frequently reported clinical scenario in immunocompromised patients with cutaneous involvement is that of multiple papulo‐nodular lesions on the face, trunk or extremities. The following report features an immunocompetent patient who presented with a solitary ulcerated plaque on the buttocks close to the anal verge. This case presentation underscores the broad spectrum of clinical presentations as well as the potential for diagnostic confusion with protozoa such as Leishmania or Trypanosoma species during histopathologic examination if special stains for fungal organisms are not performed.     

Hemodialysis Treatment in Patients with Balkan Endemic Nephropathy: An Epidemiological Study

Aim. To analyze hemodialysis (HD) treatment of patients with Balkan endemic nephropathy (BEN) from five endemic villages in the South Morava Region of Serbia. Analyses of patterns of incidence may generate hypotheses about the underlying causes of BEN, and prevalence data provide information on the current and likely future burden on health services for managing BEN. Methods. A total of 143 end-stage kidney disease patients (ESKD) with BEN were admitted to the renal replacement program from 1974 to 2004: 121 to HD, 15 peritoneal dialysis, and 7 kidney transplantation. As a control group, 117 patients with other kidney disease (chronic pyelonephritis, glomerulonephritis, and ischemic nephropathy) admitted to HD at the time of BEN patients and matched by age and gender were studied. Results. Most of the BEN patients (93.4%) treated by HD were born from 1917 to 1941. The majority of patients (79.3%) started HD from 1977 to 1991 (period of 15 years). The mean age of BEN patients starting HD treatment was 49.1 years in the period from 1974 to 1978, and increased steadily in the following years, being 72.5 years in the last period of study (2004–2006) The mean survival time of BEN males was 4.70 (95% CI 3.66–5.75) and for females was 5.02 (95% CI 1.47–4.53). Difference between males and females was not statistically significant (log rank 0.14, p?=?0.7, P > 0.5). Mean survival times of 4.84 (95% CI 3.97–5.70) in BEN patients and 3.1 (95% CI 2.78–3.84) in other kidney disease patients were found. Difference between BEN patients and controls was statistically significant (log rank 8.38, p?=?0.0038, P < 0.01). Conclusion. The population of endemic villages around the South Morava River admitted to HD treatment after 1974 was exposed to environmental toxicant(s) from 1917 to 1941. The most intense effect of environmental exposure was in that period, with ESKD in patients in their forties. The exposure to environmental toxicants has diminished, so ESKD of BEN has become less frequent and manifested in the older age, mean 72.5 in the period from 2004 to 2006. Different type of exposure was registered in some other endemic regions in Serbia and abroad.     

Evidence of exposure to aristolochic acid in patients with urothelial cancer from a Balkan endemic nephropathy region of Romania

Recently, chronic Aristolochia poisoning was found responsible for the aetiology of Balkan endemic nephropathy (BEN) in Croatia, Serbia, and Bosnia, and diet was the likely route of exposure to aristolochic acid (AA). BEN, often associated with an increased incidence of upper urinary tract carcinoma (UUC), also affects residents of certain rural villages in Romania. AA is a nephrotoxin and human carcinogen that forms DNA adducts after metabolic activation, which induce characteristic TP53 mutations in urothelial tumours. Here we present the first evidence linking AA exposure to UUC in residents of an endemic region in the Romanian Mehedinti County. DNA was extracted from kidney and tumour tissue of seven patients who underwent nephroureterectomy for UUC and resided in BEN villages (endemic group). Five patients with UUC from nonendemic villages served as controls. AA‐DNA adducts (7‐(deoxyadenosin‐N⁶‐yl)‐aristolactam I), established biomarkers of AA exposure, were identified by ³²P‐postlabelling in renal DNA of six patients from the endemic group and in one of the nonendemic group (adduct levels ranged from 0.3 to 6.5 adducts per 10⁸ nucleotides). Additionally, an A to T transversion in TP53, a base substitution characteristic of AA mutagenic activity was found in urothelial tumour DNA of one patient from the endemic group. Our results provide a molecular link to the cause of urothelial tumours in BEN regions of Romania indicating that AA is the common aetiological agent for BEN across its numerous geographical foci. Environ. Mol. Mutagen., 2012. © 2012 Wiley Periodicals, Inc.     

五华县地方性氟中毒病情现状调查分析

目的掌握五华县地方性氟中毒的病情现状，为今后预防地方性氟中毒提供科学依据。方法在19个病区村中随机抽取9个，采用分层整群抽样方法，对轻、中、重病区分别随机抽取各3个病区村为调查点。调查8-12岁儿童氟斑牙、成人氟骨症患病情况；检测饮水氟含量、8～12岁儿童尿氟含量；调查改水情况。结果8～12岁儿童的氟斑牙总患病率为18．03％，未检出重度氟骨症患者；饮水氟平均浓度为0．54mg／L；8～12岁儿童尿氟含量的几何均值为1．02mg／L；调查点总改水率100％。结论五华县地方性氟毒病情基本得到控制，原有氟中毒患者病情逐渐减轻的趋势，个别病区村的改水设施需要进一步加强管理。     

西安市阎良区降氟改水工程预防地方性氟中毒效果评价

目的了解西安市阎良区(饮水型地方性氟中毒病区)降氟改水工程15年来地方性氟中毒病情变化趋势,评价降氟改水防病效果,为调整饮水型氟中毒策略提供依据。方法对全区农村饮水现状和改水工程正常使用情况进行调查,测定末梢水和儿童尿氟含量;儿童进行氟斑牙诊断,成人进行氟骨症诊断。结果病区村全部改水,管道入户率为100%,病区村改水工程设备10年来运转正常,受益人口达26.3万人。儿童氟斑牙患病率为4.13%;成人氟骨症临床患病率为1.82%;水氟含量合格工程52个,合格率为100%。结论降氟改水是降低饮水型氟中毒发病的有效措施;儿童氟斑牙患病率和成人氟骨症临床患病率比改水前明显下降,应继续注意病情动态变化。     

血吸虫病家畜传染源控制对感染性钉螺的效果观察

目的研究湖沼型血吸虫病流行区控制家畜传染源对垸外感染性钉螺的控制效果,为制定防治策略及干预措施提供参考。方法在湖南、湖北省3个典型的湖沼型地区选取15个乡镇21个血吸虫病流行村,调查家畜传染源控制前后垸外钉螺感染状况及其控制效果,应用logistic步回归法分析钉螺阳性率与相关影响因素的关系。结果2009-2011年累计调查564户家畜4077头次、垸外钉螺面积10624．51hm2有螺洲滩野粪污染14处130．73hm2,结果显示,钉螺阳性率与家畜感染率（r=0．832,P〈0．01）及野粪阳性率（r=0．903,P〈0．01）有高度相关关系。采取家畜传染源控制措施后,家畜、钉螺和野粪感染（阳性）率分别下降了74．90％、92．42％和84．51％。结论结合当地经济发展,因地制宜地采取以家畜传染源控制为主的综合性防治措施,对控制垸外感染性钉螺具有重要作用。     

Severe Murine Typhus with Pulmonary System Involvement

We encountered a case of severe murine typhus complicated by acute respiratory distress syndrome. To determine worldwide prevalence of such cases, we reviewed the literature and found that respiratory symptoms occur in ≈30% of murine typhus patients. In disease-endemic areas, murine typhus should be considered for patients with respiratory symptoms and fever.     

云南省防治亚洲无钩绦虫病试点研究

目的　了解亚洲无钩绦虫病流行因素及流行环节,掌握流行特征,探索综合防治方法。　方法　选择带绦虫病流行区兰坪县河西乡箐花村和三界村为防治试点,开展亚洲无钩绦虫流行病学调查。采用药物驱虫及健康教育(箐花村)等措施控制亚洲无钩绦虫病。　结果　病史访问 2 214 人, 查到近期排亚洲无钩绦虫节片者 886 人,感染率分别为箐花村42.12%(489/1161),三界 37. 70% ( 397/1053 )。未发现有癫痫病史者和皮下结节者。人群感染率,男性38.55%,女性 41. 44%,差异无显著性;最小感染年龄为 9 个月,最大 90 岁; 30 ~ 50 岁组感染率最高,在 55. 99% ~60.66%之间;普米族居民感染率为46.69%,高于其他民族;农民感染率为 51.77%,高于其他职业人群。饮食习惯调查,生食猪肝者占调查人数的95.12%,感染率为41.55%,显著高于不生食猪肝者(6.48%)。不同牲畜饲养户亚洲无钩绦虫感染率差异有显著性(χ2=299.266,P<0.01)。3年累计复查7 771人次,驱虫3 285人次,药物驱虫治愈率分别为驱绦胶囊82.50%(509/617),吡喹酮75.00%(150/200)。采取综合性防治措施后,箐花村居民生食猪肝者所占比例从防治前的95.95%下降至36.32%,厕所普及率从 1.48%上升至 39.41%,亚洲无钩绦虫人群感染率从 42.12%下降至17.67%。三界村防治后上述指标无显著变