18 research outputs found
Changing causes of death in the West African town of Banjul, 1942-97
No full textObjective: To determine trends in the causes of death in a West African town. Mortality caused by infectious diseases is reported to be declining while degenerative and man-made mortality factors are increasingly significant. Most mortality analyses for sub-Saharan Africa have involved extrapolation and have not been derived from
community-based data.Methods: Historical data on causes of death coded by physicians were analysed for the urban population of Banjul for the period 1942–97. As the calculation of rates is not possible in the absence of a reliable population denominator, age-standardized proportional mortality ratios (PMRs) for men and women by major groups of
causes of death were calculated, using the 1942–49 data for reference purposes.Findings: Most deaths were attributable to communicable diseases. There was a shift in proportional mortality over the study period: the contribution of communicable diseases declined and that of noncommunicable diseases and injuries increased. These trends were more marked among men than women.Conclusion: The data illustrate that while noncommunicable diseases and injuries are emerging as important contributors to mortality in sub-Saharan Africa, communicable diseases remain significant causes of mortality and should not be neglected
Recent progress in bacterial vaccines: Tuberculosis
No full textAbstractBacille Calmette-Guérin (BCG) is the most widely used vaccine worldwide. However, its efficacy varies from 80% to zero among studies. Meta-analysis of all the published prospective trials and case-control studies indicates approximately 50% efficacy against all forms of tuberculosis, but it is even more effective against the invasive forms of the disease, meningitis and miliary tuberculosis. Geographic latitude accounts for 41% of the variance between studies. The variability between different BCG preparations and the role of environmental nontuberculous mycobacteria are discussed as mayor factors in the inconsistent results of BCG vaccine trials. New studies to define human genes that code for susceptibility to tuberculosis are reviewed. Despite the great strides being made in identifying vaccine candidates, there is still no reliable surrogate marker of protective immunity to tuberculosis. Human efficacy trials to document prevention of tuberculosis cannot possibly be mounted to test all the vaccine candidates that show promise in animal studies. Recent developments discussed include: the focus on secreted proteins of Mycobacterium tuberculosis as vaccine candidates, the genetic differences between BCG and virulent Mycobacterium bovis, the ability to create recombinant BCG-expressing cytokines that enhance the immune response and express vaccine candidate antigens, the availability of auxotrophic mutants of BCG as vaccine carriers, and the ongoing debate about other potential vaccine carriers, such as Salmonella, vaccinia (particularly modified vaccine Ankara [MVA]) and other avirulent pox viruses that do not replicate in humans
Book Review Clinical Tuberculosis Edited by P.D.O. Davies. 426 pp., illustrated. New York, Chapman & Hall, 1994. 179.95. 0-8493-4825-0 Tuberculosis: Pathogenesis, protection, and control Edited by Barry R. Bloom. 637 pp., illustrated. Washington, D.C., ASM Press, 1994. $72. 1-55581-072-1
No full textAmyloid neuropathy in multiple myeloma and other plasma cell dyscrasias : a hypothesis of the pathogenesis of amyloid neuropathies
No full textThe development of amyloid neuropathy is an uncommon complication of multiple myeloma. The clinical, electrophysiological and pathological features of 3 such patients are described. The small fiber neuropathy in these 3 cases was similar to that in patients with primary amyloidosis and with the Andrade-type of familial neuropathy, and differed from the large fiber neuropathy which more commonly develops in patients with multiple myeloma. We advance the hypothesis that the absence of the blood-nerve barrier in the dorsal root and sympathetic ganglia allows the access of amyloidogenic proteins to these ganglia, and that these ganglia are the primary site of damage to the peripheral nervous system in the amyloid neuropathies
Nh2-terminal analysis of four of the polymorphic forms of human serum amyloid a proteins
No full textPolyspecificity of human monoclonal antibodies reactive with Mycobacterium leprae, mitochondria, ssDNA, cytoskeletal proteins, and the acetylcholine receptor
No full textAssociation of the interleukin-1b-511polymorphism with tuberculosis in a Gambian population sample
No full textinfo:eu-repo/semantics/publishe
Coping with TB immune reconstitution inflammatory syndrome
No full textThe TB immune reconstitution inflammatory syndrome (IRIS) is a relatively frequent complication in HIV–TB-coinfected patients after they start highly active antiretroviral therapy (HAART). There are two forms of TB IRIS: the ‘paradoxical’ type (clinical worsening of a patient on TB treatment) and the ‘unmasking’ type (undiagnosed TB becoming apparent after starting HAART). Their pathogeneses are not fully understood, although, as the name suggests, IRIS following initiation of HAART is accompanied by an increase in immune responses to Mycobacterium tuberculosis. The diagnosis of TB IRIS is mainly clinical; so far there are no laboratory tests able to diagnose or predict TB IRIS. Risk factors for TB IRIS include a low CD4+ lymphocyte count, disseminated TB infection at HAART initiation and a short interval between TB treatment and HAART initiation. TB IRIS complicates the treatment and care for HIV–TB-coinfected patients. In this paper, we discuss some aspects of pathogenesis and options for the treatment and prevention of TB IRIS
The Economics of HIV/AIDS in Low-Income Countries: The Case for Prevention
No full textThere are two approaches to reducing the burden of sickness and death associated with HIV/AIDS: treatment and prevention. With limited resources, should the focus be on prevention or treatment? I discuss the range of prevention and treatment alternatives, examine their cost effectiveness, and consider various arguments that have been raised against the use of cost-effectiveness analysis in setting priorities for health. I conclude that promoting AIDS treatment using antiretrovirals in resource-constrained countries comes at a huge cost in terms of avoidable deaths that could be prevented through interventions that would substantially lower the scale of the epidemic.HIV, AIDS, low income countries, treatment, prevention
