Radial artery occlusion by a paradoxical embolism: a case report.
Explore the source record for details and available documents.
Arterial Occlusive Diseases↗
Biomedical subjects
C C Campbell
Publications and source records attributed to C C Campbell.
Malaria in east African refugees resettling to the United States: development of strategies to reduce the risk of imported malaria.
Resettlement to the United States of malaria-infected refugees can pose problems for both the refugees and their resettlement communities. To formulate malaria management strategies for East African refugees before resettlement to the United States, epidemiologic data were reviewed and malaria prevalence surveys were conducted among refugees awaiting resettlement in Mombasa, Kenya, and Khartoum, Sudan, in 1993. Overall, 279 Somali (Mombasa) and 127 Ethiopian (Khartoum) refugees were surveyed. Malaria contributed significantly to morbidity in Mombasa: 15% (43/279) of Somalis were parasitemic; 39 infections (91%) were due to Plasmodium falciparum. Sulfadoxine-pyrimethamine was effective treatment. In Khartoum, only 0.8% (1/127) were parasitemic; recent fever or antimalarial use were uncommon. Presumptive sulfadoxine-pyrimethamine treatment before departure was recommended for all resettling refugees from Mombasa; in Khartoum, individual assessment of febrile illness was recommended. Prevention of malaria parasitemia by mass drug administration or individual therapy can minimize the burden of malarial illness to refugees and their resettlement communities.
Africa, Eastern↗
Self-treatment of malaria in a rural area of western Kenya.
Reported are the results of a study of residents' knowledge about malaria and antimalarial drugs and of their treatment-seeking behaviour in a rural area of western Kenya. The study subjects were generally well-informed about the symptoms of the disease. Malaria was perceived as a relatively mild illness, much less severe than acquired immunodeficiency syndrome (AIDS), measles, difficulty in breathing, and diarrhoea. Self-treatment was extremely common: of 138 episodes of febrile illness, 60% were treated at home with herbal remedies or medicines purchased at local shops, and only 18% received treatment at a health centre or hospital; no treatment was sought by the remainder. Commercially available chloroquine preparations were perceived as more effective than either antipyretics or herbal remedies for the treatment of malaria, and injections were regarded as more effective than oral medications. 4-Amino-quinolines were used to treat 58% of febrile illnesses but in only 12% of the cases was a curative dose of > or = 25 mg/kg body weight employed. Even attendance at a health centre did not ensure adequate treatment because of the common practice of sharing medication among family members. Greatly increased attention should be paid to the role of home treatment of malaria when policies are being developed for the management of febrile illnesses in sub-Saharan Africa.
Adolescent↗
Overweight schoolchildren in New York State: prevalence and characteristics.
OBJECTIVES: Childhood overweight is an increasing public health concern. This study was undertaken to determine the prevalence of overweight in elementary school children in New York State and to identify characteristics associated with child fatness. METHODS: Weight, height, triceps skinfold, midarm circumference, and a 24-hour dietary recall were taken on 1797 second- and fifth-grade students from 51 randomly selected schools in New York State outside of New York City. Parents completed a brief questionnaire. RESULTS: In comparison with 1974 and 1980 national reference data, up to twice the expected percentages of children had values above the 85th, 90th, and 95th percentiles for body mass index, triceps skinfold, and arm fat area. Regression analyses suggested that children who tended to be fatter were members of low socioeconomic status, two-parent (but not single-parent) households; those with few or no siblings; those who ate school lunch; and those who skipped breakfast. CONCLUSIONS: The findings suggest that overweight is a problem among many elementary school children in New York State and that sociodemographic characteristics may be useful for targeting preventive efforts.
Body Mass Index↗
Long-term malaria prophylaxis with weekly mefloquine.
The spread of chloroquine-resistant Plasmodium falciparum malaria has led to increased use of mefloquine prophylaxis by US Peace Corps volunteers in sub-Saharan Africa. We compared long-term mefloquine with other drug regimens for effectiveness and tolerance. The incidence of Plasmodium falciparum infections and of adverse reactions was compared in Peace Corps volunteers who took chloroquine weekly, mefloquine weekly, mefloquine every other week, or weekly chloroquine plus daily proguanil. Weekly mefloquine was 94% more effective than chloroquine (95% CI 86% to 97%), 86% more effective than chloroquine plus proguanil (95% CI 67% to 94%), and 82% more effective than prophylaxis with mefloquine when taken every other week (95% CI 68% to 90%). No serious adverse reactions were observed. Mild adverse events were equally frequent in mefloquine users and chloroquine users, and the frequency of these events declined with increasing duration of prophylaxis. Mefloquine is an effective and well-tolerated drug for prophylaxis of malaria by short-term and long-term travellers.
Africa, Western↗
Food pattern, diet quality, and related characteristics of schoolchildren in New York State.
OBJECTIVES: To examine the food patterns and diet quality of elementary schoolchildren in New York State (outside of New York City) and to determine sociodemographic characteristics correlated with diet quality. DESIGN: A nonquantitative 24-hour recall administered to students and a brief questionnaire completed by parents. SAMPLE: 1,797 second and fifth graders (51% of those asked) in 51 randomly selected schools (46% of those asked) in New York State outside of New York City. STATISTICAL ANALYSES: Multiple regression analyses, chi 2, and t tests. RESULTS: On the day they were surveyed, 40% of students did not eat vegetables, except for potatoes or tomato sauce; 20% did not eat fruit; 36% ate at least four different types of snack foods, and 16% of fifth graders did not eat breakfast. Children who ate a school lunch ate significantly more dairy foods and fruits and vegetables, and fewer snack-foods than those who brought lunch from home. Fifth graders ate significantly more snack foods and were more likely to skip breakfast than second graders; boys had lower food-group pattern scores than girls; children of lower socioeconomic status had less diverse diets but ate less snack foods than children of higher socioeconomic status; children with single parents were more likely to skip breakfast and to eat fewer vegetables than those with two parents; and children with mothers employed outside the home had less diverse diets than those with mothers at home. APPLICATIONS/CONCLUSIONS: The findings indicate that nutrition interventions are clearly needed for this age group and that targeted messages should be based on sociodemographic characteristics.
Child↗
Beyond chloroquine: implications of drug resistance for evaluating malaria therapy efficacy and treatment policy in Africa.
Emphasis on retaining chloroquine as the first-line therapy for Plasmodium falciparum infections in most of sub-Saharan Africa for as long as it remains effective has resulted in widespread reliance on chloroquine in areas where it can have little effect on P. falciparum parasitemia. To address this issue, clinical, parasitologic, and hematologic responses to chloroquine or pyrimethamine/sulfadoxine treatment were assessed among very young children in Malawi (n = 153) and Kenya (n = 73). The median time to resumption of clinical symptoms in chloroquine-treated children was 13.5 days in Malawi and 9.5 days in Kenya. Children treated with pyrimethamine/sulfadoxine maintained clinical improvement and had greater increases in their hemoglobin concentration during the follow-up period than did children treated with chloroquine. Treatment with chloroquine failed to produce either a durable clinical improvement or optimal hematologic recovery. Consequently, chloroquine can no longer be considered adequately effective therapy of clinical P. falciparum malaria in very young children in these areas of Africa.
Child, Preschool↗
Blood transfusion practices and blood-banking services in a Kenyan hospital.
OBJECTIVES: To identify ways to improve the operation of blood-screening programs and to decrease the inappropriate use of blood by evaluating blood-transfusion practices and blood-banking services in a Kenyan hospital. DESIGN: Prospective cohort. SETTING: The study was conducted in a rural district hospital in western Kenya between September 1990 and July 1991. METHODS: We collected data on all transfusion requests (blood donation, grouping, HIV screening) and blood recipients (age, sex, diagnosis, and for a 3-month period on the pediatric, maternity, and female wards, admission hemoglobin and outcome). RESULTS: During the 11-month study period, 799 patients received 927 transfusions: 67% were children < 15 years of age, 27% were adult women and 6% were adult men. Transfusions were often delayed due to reliance on patient-recruited donors. Patients who received blood donated on or after the date of request waited longer for transfusion (median, 3 days) than patients who received blood that had been banked and screened before the request (median, 1 day). Patient-recruited donors had a higher HIV-seropositivity rate than volunteer donors (13.4 and 4.6%, respectively; chi 2 test, P < 0.001). Overall, 47% of pediatric transfusions were classified as inappropriate: 23% did not meet the criteria of having hemoglobin < 5.0 g/dl and clinical evidence of respiratory distress, and 27% were transfused 2 or more days after requested. Among adults, 68% received one unit of blood or less. CONCLUSIONS: Improved laboratory services, reduction of unnecessary transfusions, and increased recruitment of volunteer donors are critical for improving the appropriate and timely use of blood and reducing transfusion-associated HIV transmission.
Adolescent↗
Malaria. Principles of prevention and treatment.
In the United States, effective malaria prevention strategies for short-term travelers are available. Monitoring trends in imported malaria and continued evaluation of the effectiveness and chemoprophylaxis will allow prevention recommendations to evolve as the risk of infection and effectiveness of antimalarial drugs change. Our challenge is to increase the number of prospective travelers receiving pre-travel advice, to disseminate this information to health care providers, and to improve the quality of the advice given. The early recognition of Plasmodium infection and the institution of prompt and effective treatment will reduce morbidity and mortality from malaria in this country.
Adult↗
Usefulness of clinical case-definitions in guiding therapy for African children with malaria or pneumonia.
The World Health Organisation has developed disease-specific clinical case-definitions to guide management of children with fever or cough, the cardinal signs of malaria and pneumonia. To assess the usefulness of the case-definitions and to investigate their interaction, we studied children with fever or cough brought to a hospital in Lilongwe, Malawi. For all children, a thick blood smear was examined for Plasmodium falciparum parasites. Chest radiography was done only for children with parasitaemia and those who satisfied the clinical case-definition for pneumonia; others were assumed to have normal chest radiographs. Of 1599 enrolled children, 566 (35%) had parasitaemia and 116 had radiographic evidence of pneumonia; 43 had both pneumonia and parasitaemia. Of the 471 children who met the clinical definition for pneumonia, 449 (95%) also met the malaria clinical definition. Among children with radiographic evidence of pneumonia, the clinical definition for malaria was not predictive of parasitaemia (sensitivity 93%, specificity 5%). Whether malaria parasitaemia was present or absent, the pneumonia clinical definition distinguished children with and without radiographic evidence of pneumonia (sensitivity and specificity > 60%). Children who satisfied the pneumonia clinical definition were more likely to have radiographic evidence of pneumonia (odds ratio 10.4, 95% confidence interval 5.2-20.7), parasitaemia (1.6, 1.2-2.2), or both at the same time (4.2, 2.1-8.4) than were children who did not meet the definition. Children who satisfy the malaria and pneumonia clinical definitions need treatment for both disorders. Scarce diagnostic methods, especially microscopy, are needed for more specific treatment of children with fever and cough.
Algorithms↗
Effect of blood transfusion on survival among children in a Kenyan hospital.
In Africa, blood transfusions are frequently given to treat severe paediatric anaemia. Because of the risk of HIV transmission, identification of when transfusion will reduce the risk of death for severely anaemic children has become increasingly important. For all children admitted to a Kenyan hospital from October, 1989, to October, 1990, we collected data on clinical presentation, haemoglobin (Hb), receipt of transfusion, and in-hospital survival. Of 2433 admissions, 29% (684) had severe anaemia (Hb less than 5.0 g/dl), and 20% (483) received blood transfusions. Based on laboratory criteria only, children with Hb less than 3.9 g/dl who were transfused had lower mortality than those with Hb less than 3.9 g/dl who were not transfused, but this finding applied only to children transfused on the day of admission (odds ratio [OR] 0.30; 95% Cl 0.14, 0.61) or the day after admission (OR 0.37; 95% Cl 0.14, 1.00). Based on a combination of laboratory and clinical criteria, children with clinical signs of respiratory distress and Hb less than 4.7 g/dl who were transfused had lower morality than those who were not (OR 0.19; 95% Cl 0.09, 0.41). Among children without respiratory distress, there was no association between receipt of transfusion and mortality, irrespective of admission Hb. The frequency of blood transfusion can be reduced and survival enhanced by targeting blood to those children with severe anaemia and clinical signs of respiratory distress, and by using transfusion early in the course of hospitalisation.
Anemia↗
Smear-negative cerebral malaria due to mefloquine-resistant Plasmodium falciparum acquired in the Amazon.
Explore the source record for details and available documents.
Animals↗
Malaria and pregnancy in Cameroonian women. Effect of pregnancy on Plasmodium falciparum parasitemia and the response to chloroquine.
The interaction between malaria and pregnancy was investigated in an epidemiologic study conducted in Mfou, a rural community in Cameroon. The study consisted of both cross-sectional and longitudinal analyses involving 225 pregnant women and 75 nonpregnant controls. Information was obtained by a standardized questionnaire to determine the pattern of antimalarial drug use. The parasitologic response to chloroquine was also determined. A dosage of chloroquine base (25 mg/kg of body weight) was given to women over a 3-day period, followed by 5 mg/kg doses administered weekly for 4 weeks. The results showed that Plasmodium falciparum infections occurred more frequently in pregnant (45%) than in nonpregnant (31%) women in terms of parasite rates (p = 0.03) and density (p less than 0.003), especially in primigravidae as compared with multigravidae matched for parity and age. Levels of parasitemia were also higher in the second trimester than in the first trimester of pregnancy (p less than 0.01). Failure to clear parasitemia after a chloroquine regimen was more frequent in pregnant than in nonpregnant women (p less than 0.01), particularly in primigravidae. Higher parasitemia and a lower parasitologic response to chloroquine in pregnant women, especially in primigravidae, suggest a relatively low level of clinical immunity and emphasize the need to target this group of women for malaria control strategies.
Cameroon↗
Excision of the radial head for congenital dislocation.
Eight elbows in six patients who had had excision of the radial head for congenital dislocation were evaluated an average of seven years postoperatively. The average age of the patients at the time of the excision was thirteen years (range, ten to 15.5 years). The dislocation was posterior in five elbows and posterolateral in three. The over-all increase in the arc of flexion-extension postoperatively compared with preoperatively was 11 degrees (p greater than 0.1): The over-all increase in the arc of rotation was significant at 53 degrees (p less than 0.002). Pain in the elbow had decreased compared with preoperatively, but all patients had minor pain in the wrist. The result was rated good in five elbows, fair in two, and poor in one. One patient had a repeat excision of the radial head after it re-formed, and this was the reason for the poor result. All patients were satisfied with the outcome of the operation. Contrary to previously published data, excision of the radial head for congenital dislocation resulted in an increased range of motion and a decrease in pain in the elbow in our patients.
Adolescent↗
Co-trimoxazole for childhood febrile illness in malaria-endemic regions.
The efficacy of co-trimoxazole for the treatment of Plasmodium falciparum parasitaemia in children younger than 5 years of age was evaluated in Malawi. 46 children with P falciparum parasitaemia, 37% of whom also met clinical criteria for a diagnosis of acute lower respiratory tract infection, were treated with 20 mg/kg co-trimoxazole twice daily for five days. Parasitaemia (mean clearance time 2.7 days) and symptoms were rapidly abolished and improvement was maintained during follow-up for 14 days. Co-trimoxazole may be an effective single treatment for febrile illness in young children in areas where malaria is endemic, resources are few, and diagnosis must rely on clinical findings alone.
Acute Disease↗
Effectiveness and tolerance of long-term malaria prophylaxis with mefloquine. Need for a better dosing regimen.
To measure the effectiveness and tolerance of long-term malaria prophylaxis with mefloquine, the incidence of Plasmodium falciparum malaria and of adverse reactions was compared in Peace Corps volunteers in West Africa who took mefloquine every 2 weeks and in volunteers who took chloroquine phosphate weekly. Mefloquine was only 63% more effective than chloroquine; the monthly incidence of P falciparum infections was one case per 100 volunteers who took mefloquine and 2.7 cases per 100 volunteers who took chloroquine. Using daily proguanil (chloroguanide) hydrochloride in addition to chloroquine did not provide additional protection. All mefloquine prophylaxis failures occurred during the second week of the every-2-weeks dosing regimen in volunteers who had used mefloquine for more than 2 months. Blood concentrations of mefloquine were lower during the second week of the alternate-week regimen than during the first week, suggesting that blood levels are too low during the second week to suppress parasitemia. No serious adverse reactions were observed. The results indicate that a dosing regimen of 250 mg of mefloquine weekly should be considered for travelers to areas with chloroquine-resistant P falciparum malaria.
Adult↗
Imported Plasmodium falciparum malaria in American travelers to Africa. Implications for prevention strategies.
Data from the US National Malaria Surveillance System were analyzed to assess characteristics of travelers who acquired Plasmodium falciparum infections in Africa and evaluate the impact of chloroquine resistance on the incidence of imported malaria. Although the number of cases acquired in East Africa has stabilized, the number of imported P falciparum infections acquired in West Africa increased threefold from 1985 to 1988, and the proportion of travelers who reported failure of chloroquine prophylaxis increased from 10% to 48%. Fifty-eight percent of patients who acquired malaria in West Africa had not used chemoprophylaxis. To curb the rising incidence of P falciparum infections in American travelers, the Centers for Disease Control revised malaria prophylaxis recommendations to include the use of mefloquine in areas of chloroquine resistance. Use of malaria protection measures by travelers to West Africa must also be improved.
Africa, Eastern↗
Challenges facing antimalarial therapy in Africa.
Explore the source record for details and available documents.
Africa↗