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Biomedical subjects

C Menendez

Publications and source records attributed to C Menendez.

53 records · Page 3Linked to original sources
PubMed1994

Effects of oestradiol administration via different routes on the lipid profile in women with bilateral oophorectomy.

To determine the influence of various oestrogenenic administrations on lipid response, 63 women with total abdominal hysterectomy and bilateral anexectomy were studied before and 6 and 12 months after receiving 17 beta-oestradiol by different means. The effect on the levels of lipids and lipoproteins of the 2 mg/24 h administration of oestradiol valerate was compared with 1.5 mg/day of percutaneous 17 beta-oestradiol and 0.05 mg/day of transdermic oestradiol. The treatments were given continuously over a year. The oestradiol valerate produced a statistically significant increase (P < 0.05) of the HDL-C levels both after 6 and 12 months (10.6% vs. 11.6%). A significant increase was also observed (P < 0.05) in the Apo AI levels during the treatment (18 and 25%). On the other hand, unfavorable side effects with oestradiol were not produced, either percutaneous or transdermic, on lipid plasmatic or lipoprotein levels. These data show the benefit of oral oestrogenic therapy and the maintenance of the lipid profile in percutaneous and transdermic therapies in oophorectomized women.

Administration, Cutaneous↗
PubMed1994

Malaria chemoprophylaxis, infection of the placenta and birth weight in Gambian primigravidae.

A randomized, double blind, placebo-controlled community based trial of Maloprim (pyrimethamine 12.5 mg+dapsone 100 mg) administered to primigravid pregnant women by Traditional Birth Attendants was carried out in a rural area of The Gambia, West Africa. Placental histology showed less malaria infection in women who received chemoprophylaxis than in those who received placebo. The birth weight of children born to women who received chemoprophylaxis was increased by an average of 153 g. Within the treatment groups, there were no significant differences in the birthweights of babies born to women who had histological evidence of malaria infection of the placenta compared to those who had no malaria infection. This study confirms the beneficial effect of malaria prophylaxis for primigravid pregnant women but questions the mechanism by which malaria affects foetal development.

Acute Disease↗
PubMed1994

Poor response to primaquine in two cases of Plasmodium vivax malaria from Guatemala.

Two cases of relapsing malaria infection by Plasmodium vivax from Guatemala are presented in patients treated with current standard doses of chloroquine and primaquine. The difficulties in recognizing resistance to chloroquine versus poor response to standard primaquine schedules are discussed. The recent recommendations of adopting a schedule of 6 mg/kg as a total dose of primaquine proved in our cases to be effective in obtaining a radical cure of the infection.

Chloroquine↗
PubMed1993

Suppressed peripheral and placental blood lymphoproliferative responses in first pregnancies: relevance to malaria.

An understanding of processes that predispose pregnant women, and in particular primigravidae, to malaria infection is essential to improve malaria management in pregnancy. Lymphoproliferative responses to malaria-specific (F32, 190L, and 190N) as well as other antigens (Candida and purified protein derivative [PPD]) were examined in the peripheral and placental blood of 102 Gambian women at the time of delivery. The lymphoproliferative responses of placental cells were poor to all antigens compared with those of peripheral blood (Candida P < 0.001, PPD P < 0.001, F32 P = 0.008, 190L P = 0.003, and 190N P = 0.10). Reduced proliferative capacity of placental mononuclear cells may contribute to heavy parasite colonization of this organ. Proliferation to malarial and PPD but not Candida antigens was selectively suppressed in peripheral and placental blood of primiparae relative to multiparae (F32 P = 0.07, 190L P = 0.09, 190N P = 0.007, PPD P = 0.09). Autologous plasma contained factors that suppressed lymphoproliferative responses to the same series of antigens to which the primiparae responded poorly (F32 P < 0.001, 190L P < 0.001, 190N P < 0.001, PPD P = 0.03). Malarial antibody levels were comparable among women of different parities and between peripheral and placental blood. Primigravidae may be more susceptible to malaria because of unique physiologic factors, such as higher levels of circulating immunosuppressive corticosteroids (P < 0.001), rather than differences in levels of acquired immunity.

Adolescent↗
PubMed1993

The contribution of Gambian traditional birth attendants to field research.

One thousand, one hundred and forty-seven pregnant women from a rural area of The Gambia were followed throughout pregnancy. In order to determine the incidence of malaria infection of the placenta, traditional birth attendants (TBAs) from 18 villages were trained to collect placental biopsies and to prepare thick smears of placental blood at delivery. Nine hundred and eighty-eight of 1112 term deliveries (89%) occurred at home. Eight hundred and fifty-nine (87%) of these home deliveries were assisted by a TBA. TBAs collected 829 placental biopsies and 800 thick blood smears from the 859 women whom they assisted. Seven hundred and forty-seven thick blood films (93%) and 807 placental samples (97%) were satisfactory. TBAs are an important resource for clinical research; in this case they made a major contribution to a community study of the impact of malaria on pregnancy.

Biopsy↗
PubMed1988

Neonatal and maternal platelets: activation at time of birth.

Determination of the plasma concentrations of beta-thromboglobulin (BTG), thromboxane B2 (TxB2) and platelet factor 4 (PF4) were made at the time of birth in 18 newborns and their respective mothers. Both groups show significant elevation of all these molecular markers, suggesting marked platelet activation. The elevated TxB2 levels in the newborn group, 25 +/- 8 pg/ml, are compatible with a normally functioning and activated platelet prostaglandin pathway. Mode of delivery, vaginal or caesarean section, does not significantly influence the degree of activation in either group. Ultrastructural platelet examination did not reveal any morphologic differences between maternal and newborn platelets. There appears to be marked activation of the newborn and maternal platelet systems at the time of birth, and we postulate that this may explain in part the transient platelet dysfunction observed in newborns.

Blood Platelets↗
PubMedDate not supplied

The distribution of birth weights in Gambian women who received malaria chemoprophylaxis during their first pregnancy and in control women.

The distribution of birth weights among the infants of 172 Gambian primigravidae who had received chemoprophylaxis with Maloprim (pyrimethamine+dapsone) during pregnancy was compared with that of the infants of 149 primigravidae who had received placebo. Administration of chemoprophylaxis led to a reduction in the prevalence of low birth weight babies and to an increase in the median birth weight. However, these changes were not accompanied by a comparable increase in the prevalence of high birth weight babies. The perinatal mortality rate was lower, although not significantly so, among the babies of women who had received chemoprophylaxis. Thus, no evidence was found to support the view that administration of chemoprophylaxis might increase the risks of delivery by causing cephalo/pelvic disproportion.

Antimalarials↗
PubMedDate not supplied

The effects of iron supplementation during pregnancy, given by traditional birth attendants, on the prevalence of anaemia and malaria.

A randomized, double-blind, placebo-controlled community-based trial of oral iron supplementation (200 mg ferrous sulphate daily) administered to multigravid pregnant women by traditional birth attendants (TBAs) was carried out in a rural area of The Gambia. Iron supplementation led to a significant reduction in the prevalence of anaemia and of iron deficiency. Iron supplementation was not accompanied by increased susceptibility to malaria infection; there was no difference in the prevalence and severity of peripheral blood or placental malaria infection between the 2 groups of women. The birth weight of children born to women who received iron prophylaxis was increased by an average of 56 g. It is concluded that oral iron prophylaxis can be successfully delivered through TBAs integrated into a primary health care programme. This simple intervention can produce significant beneficial effects on the health of the mother without inducing increased susceptibility to malaria and has the potential for reducing perinatal mortality by increasing birth weight.

Adult↗
PubMedDate not supplied

Can malaria chemoprophylaxis be restricted to first pregnancies?

The harmful effects of malaria are most pronounced during first pregnancies and chemoprophylaxis is most effective when given at this time. However, restriction of chemoprophylaxis to first pregnancies might lead to enhanced susceptibility to malaria during second pregnancies. We have investigated this possibility by studying the outcome of second pregnancies in 165 Gambian women who had received either malaria chemoprophylaxis with Maloprim or placebo during their first pregnancy. Many of these primigravidae did not present until the third trimester of pregnancy so that some are likely to have experienced a malaria infection before they started medication. The prevalence of malaria infection of the blood and of the placenta during second pregnancies was similar in women who had received chemoprophylaxis during their first pregnancy and in those who had not, and the mean birth weights of babies born to women in each group were almost identical. Thus, in areas where the epidemiology of malaria is similar to that of The Gambia and where most women present relatively late in pregnancy, it may be possible to restrict malaria chemoprophylaxis to first pregnancies with consequent savings in cost and a reduction in drug pressure on Plasmodium falciparum.

Antimalarials↗
PubMedDate not supplied

Diurnal variation in body temperature of Gambian children.

Measured fever often forms the basis for defining clinical malaria episodes in children from endemic areas. We measured body temperature every 3 h from 08:00 to 20:00 in 69 children aged 1-5 years during the malaria season in a rural area of The Gambia. Body temperature varied on average by more than one degree Celsius during the course of a day. Mean temperatures were lowest in the early morning and highest in the afternoon. There was a strong positive association between air temperature and body temperature. In highly endemic areas, researchers who use measured fever to assess clinical malaria episodes in population-based surveys should standardize the time of day at which temperature is assessed.

Body Temperature↗
PubMedDate not supplied

The response to iron supplementation of pregnant women with the haemoglobin genotype AA or AS.

The influence of haemoglobin genotype on the response to iron supplementation was studied in a randomized, double blind, placebo-controlled trial involving 497 multigravid pregnant women from a rural area of The Gambia. Women were randomly allocated to receive either oral iron (60mg elemental iron per day) or placebo. At 36 weeks of pregnancy, women who had received oral iron during pregnancy had higher mean haemoglobin, packed cell volume, plasma iron and ferritin levels than did women who received placebo. Iron supplementation of pregnant women with the AA haemoglobin genotype also resulted in increases in the packed cell volume (PCV) and haemoglobin level measured after delivery, and in the birth weight of the infant. However, in AS women PCV and haemoglobin level at delivery were lower in the supplemented group and supplementation was also associated with reduced birth weights. In malaria endemic areas, pregnant women with the haemoglobin genotype AS may not benefit from iron supplementation during pregnancy.

Adolescent↗
PubMedDate not supplied

Inter-observer variation in the assessment of clinical signs in sick Tanzanian children.

We assessed the inter-observer agreement in identification of a range of 24 clinical signs associated with disease presentation in 327 children aged < 5 years admitted to hospital in January-June 1999 in Ifakara, southern Tanzania. Children with diagnoses of malaria, pneumonia, diarrhoea, anaemia and malnutrition were examined independently by 2 clinical officers. Findings were recorded on a standard proforma. The Kappa-statistic was used to assess inter-observer agreement for each sign. Physical signs were more likely to be agreed upon by clinicians if they involved inspection than if they involved auscultation. The signs included in the Integrated Management of Childhood Illness (IMCI) algorithm were found to be largely appropriate (Kappa-scores > 0.41) although there was only fair agreement (Kappa-score 0.21-0.40) in the detection of neck stiffness and chest indrawing and slight agreement in the detection of dehydration (Kappa-score 0.199). All objective neurological signs were less reliably assessed in infants than in older children. The difficulties surrounding the diagnosis of impaired consciousness in young children should increase vigilance in the diagnosis and management of neurological complications of illnesses in infancy.

Age Distribution↗
PubMedDate not supplied

The incidence of clinical malaria detected by active case detection in children in Ifakara, southern Tanzania.

Between July 2000 and June 2001, we used weekly active case detection (ACD) of clinical malaria episodes in 618 children aged < 5 years to describe the epidemiology of malaria in Ifakara, southern Tanzania. Plasmodium falciparum-positive blood slides prepared from children with axillary temperature 37.5 degrees C were used to define clinical malaria and a rolling cross-sectional survey documented the prevalences of parasitaemia and anaemia. A random subsample of children was visited daily for 1 month at the end of the study to assess the effect of more frequent visits on estimated incidence rates. Only 50 (8%) children had 1 or more episodes of clinical malaria during the year, an overall incidence of 0.275 episodes/100 child-weeks-at-risk, with no age dependence. The maximum parasite prevalence of 25% was reached in children aged 4 years. The incidence of illness was significantly lower in children visited daily than in those visited weekly, suggesting a marked effect of frequent visits on estimated incidence rates. We conclude that the age pattern of malaria detected through ACD is a more robust epidemiological indicator than absolute incidence rate estimates and that, in contrast to the surrounding area, Ifakara town is subject to only moderate perennial malaria transmission.

Anemia↗
PubMedDate not supplied

The burden of malaria in pregnancy in malaria-endemic areas.

Pregnant women in malarious areas may experience a variety of adverse consequences from malaria infection including maternal anemia, placental accumulation of parasites, low birth weight (LBW) from prematurity and intrauterine growth retardation (IUGR), fetal parasite exposure and congenital infection, and infant mortality (IM) linked to preterm-LBW and IUGR-LBW. We reviewed studies between 1985 and 2000 and summarized the malaria population attributable risk (PAR) that accounts for both the prevalence of the risk factors in the population and the magnitude of the associated risk for anemia, LBW, and IM. Consequences from anemia and human immunodeficiency virus infection in these studies were also considered. Population attributable risks were substantial: malaria was associated with anemia (PAR range = 3-15%), LBW (8-14%), preterm-LBW (8-36%), IUGR-LBW (13-70%), and IM (3-8%). Human immunodeficiency virus was associated with anemia (PAR range = 12-14%), LBW (11-38%), and direct transmission in 20-40% of newborns, with direct mortality consequences. Maternal anemia was associated with LBW (PAR range = 7-18%), and fetal anemia was associated with increased IM (PAR not available). We estimate that each year 75,000 to 200,000 infant deaths are associated with malaria infection in pregnancy. The failure to apply known effective antimalarial interventions through antenatal programs continues to contribute substantially to infant deaths globally.

Africa↗
PubMedDate not supplied

The central nervous system and HRT.

In postmenopausal women, both the aging process and the hypoestrogenism due to the loss of ovarian function seem to be related to the progressive impairment of cognitive functions and to a higher risk of developing Alzheimer's disease (AD). This paper reviews the potentially beneficial effects of hormonal replacement therapy (HRT) on cognition and on the risk of developing AD. Articles relevant to the topic were selected by reviewing MEDLINE data and references of previous published reviews on this subject. Epidemiological studies on the effects of HRT on cognitive functioning have yielded disparate results, perhaps because of varying methodology and designs. However, the available data suggest that the use of HRT could be associated with a lower risk for AD. This conclusion should be interpreted with caution, since most of the studies were case-control studies, and thus subjected to several sources of bias. Further well-designed and conducted clinical trials and longitudinal studies would be required to clarify the effects of estrogens on cognition and AD.

Aged↗