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Biomedical subjects

L Fransen

Publications and source records attributed to L Fransen.

62 records · Page 4Linked to original sources
PubMedDate not supplied

Advances in the diagnosis and management of chancroid.

Improved technologies for the cultural diagnosis of chancroid have resulted in increased interest in the management and control of genital ulcer disease. New treatment regimens have been identified, and new control strategies have evolved. These strategies now permit localized introductions of chancroid into developed countries to be contained rapidly. However, additional work is still necessary in developing countries.

Anti-Bacterial Agents↗
PubMedDate not supplied

A comparison of single-dose spectinomycin with five days of trimethoprim-sulfamethoxazole for the treatment of chancroid.

In a controlled trial 32 patients with ulcers culture-positive for Haemophilus ducreyi were treated with a single 2-g dose of spectinomycin, and 20 patients were treated with a five-day course of trimethoprim-sulfamethoxazole (TMP-SMZ; 160/800 mg) twice daily. Both regimens rapidly eradicated H. ducreyi from ulcers, with subsequent healing of ulcers and buboes. The cure rates 14 days after initiation of therapy were 94% for spectinomycin and 95% for TMP-SMZ. Patients with H. ducreyi-negative ulcers who were treated with the same regimens also healed and did not show a significantly different efficacy for either regimen. Thus we found that the one-day regimen of spectinomycin was as effective for the treatment of chancroid as was TMP-SMZ given for five days. Further studies on a larger number of patients are needed to confirm our findings.

Adult↗
PubMedDate not supplied

Management of STDs and cost of treatment in primary health care centres in Pikine, Senegal.

We studied the current management of STD-related syndromes by urban health facilities in Pikine (Senegal) in 252 consecutive patients presenting with STD-related complaints, to assess the cost and effectiveness of services and to estimate the potential benefit by introducing management protocols. Most common presenting complaints for women were vaginal discharge and low abdominal pain, reported for 122 (82.9%) and 22 (15.0%) of 147 female patients. Urethral discharge and genital ulceration were reported for 80 (76.2%) and for 17 (16.2%) of 105 male patients. The average cost was 4.01 ECU (1 European Currency Unit = 1.2 US$ = 334 Franc CFA) for male patients (ranging from 0.57 to 25.70 ECU) and 12.75 ECU for female patients (ranging from 0.57 to 37.60 ECU). Only 20 of 80 patients with urethral discharge (25%) received effective treatment. Effectiveness was not related to cost of therapy or qualification of staff. Utilization of management protocols improves the quality and accessibility of care for STD, by potentially doubling effectiveness and reducing the costs for patients to 12% of the current level.

Adult↗
PubMedDate not supplied

Impact of counselling on safer sex and STD occurrence among STD patients in Malawi.

In developing countries where professional manpower and basic supplies are lacking for STD control, low-cost prevention strategies must be explored. This study assesses the impact of counselling on STD treatment and prevention in Malawi. Increases in safer sex practices are used as indicators of prevention behaviour. A pre-test post-test control group design over a 4-month interval was conducted in 1991 in 2 comparable hospitals approximately 100 km apart. STD was diagnosed symptomatically and Knowledge Attitude Practice and Behaviour (KAPB) data collected using a structured questionnaire. In one group, trained counsellors discussed modes of transmission and prevention of STD/AIDS including a condom demonstration; symptoms and treatment of STDs; partner notification; risk taking and reasons for doing so; and motivations for behaviour change. The results show that counselling reduces the occurrence of STDs; increases concern for sexual partners; increases knowledge about and use of condoms; reduces mean number of partners; and reduces health costs due to fewer hospital visits. Although the observed behaviour change was short term, these outcomes argue in favour of counselling as a low-cost effective strategy for STD control.

Adult↗
PubMedDate not supplied

Interleukin-2 induces tumor necrosis factor-alpha production by activated human T cells via a cyclosporin-sensitive pathway.

We examined requirements for TNF-alpha production by purified human blood T cells, completely depleted of monocyte-accessory cells, under different conditions of stimulation. Activation of T cells with immobilized anti-CD3 induced the appearance of mRNA for TNF-alpha and of functionally active TNF-alpha in the culture supernatant. Anti-CD3-induced TNF-alpha production could be inhibited by blocking the IL-2R with a combination of anti-Tac and Mik beta 1 (mAbs against the p55 and p75 chain of the IL-2R respectively) thus indicating an essential role of IL-2 in TNF-alpha induction. When purified T cells were activated with a combination of two anti-CD2 mAbs (9-1 and 9.6), additional signals (rIL-2 or rIL-1 beta or anti-CD28) were required for TNF-alpha mRNA production and protein secretion. rIL-1 beta supported anti-CD2-induced TNF-alpha production indirectly through an IL-2-dependent pathway. These same helper signals also enhanced TNF-alpha production by anti-CD3-stimulated T cells. IL-4, IL-6, GM-CSF and IFN-gamma had no effect on TNF-alpha production by T cells activated via either pathway. Addition of rIL-1 beta alone, rIL-2 alone or endotoxins to resting human T cells did not induce detectable amounts of TNF-alpha. Both helper/inducer CD4(+) and suppressor/cytotoxic CD8(+) subsets of T cells were shown to produce TNF-alpha upon stimulation. We conclude that CD3 or CD2 triggering are not sufficient for TNF-alpha production by T cells, but that the latter is dependent (apparently at the transcriptional level) on the interaction of IL-2 with its functionally active cell surface receptors. We could further demonstrate that TNF-alpha production was completely blocked by cyclosporin A. The inhibitory effect of this agent on TNF-alpha production was also observed in the presence of rIL-2, thus excluding an indirect effect through inhibition of IL-2 production.

Adult↗
PubMedDate not supplied

[Development and evaluation of screening algorithms for sexually transmitted diseases in pregnant women at Libreville, Gabon].

The struggle against sexually transmitted diseases (STD) constitutes a priority of public health in developing countries: STD cause complications, particularly in pregnant women, and facilitate the transmission of HIV. One of the strategies in the struggle against STD is the diagnosis and the early treatment of these infections. The STD, and in particular infections of Neisseria gonorrhea and Chlamydia trachomatis, are difficult to diagnose in women without complementary analyses, which primary health care may not be able to supply. Health care provided to patients could be standardized and improved by considering the signs and symptoms. We studied the prevalence and risk factors of STD among 192 pregnant women consulting the health clinic in Libreville, Gabon, in September 1993. The prevalence of STD was high (13.5% rate of cervical infection with gonorrhea or Chlamydia trachomatis). We then evaluated the different diagnostic strategies or algorithms. Regardless of the type of examination (medical interview, simple clinical examination or examination with a speculum), the use of scores integrating risk factors, the clinical signs and symptoms outperformed hierarchical algorithms. This approach was more sensitive and specific and easy to perform. Use of this method may enable more effective screening of STD and also avoid most maternal and perinatal complications.

Adolescent↗