"The kissing bug" is the deceptively innocent name of the bloodsucking triatomine vector that transmits Trypanosoma cruzi to man. The infection, which can lead to the potentially fatal Chagas’
disease, threatens 90 million inhabitants of 17 Latin American1 countries. Blood transfusion comes after the insect bite as the most
t important method of acquiring the disease. In some cities, donatedI blood is HIV.
MV, Naftalin R. Exposure of rat colonic mucosa to human semen in vivo induces mucosal cytolysis, abolishes fluid absorption and raises paracellular permeability. Clin Sci 1992; 82: 277-82.
Control of Chagas’ disease
be infected with T cruzi than
How can Chagas’ disease be eliminated? Emphasis is on the need1 for compulsory blood screening and vector control in endemic countries. Two vector-control agents have produced encouraging’ results. A four-year programme using fumigant canisters in1 Argentina’s Santiago del Estero reduced infant seropositivity to) zero. In addition, one application of slow-release insecticide paint has remained effective for two years in 85% of treated dwellings in Central Brazil. Currently, these methods are being compared in selected areas of Latin America for their efficacy, social acceptability, and cost. The initial results are encouraging. Furthermore, in Santiago del Estero, the WHO’s Tropical Disease’ Research programme (TDR) is supporting renewed action on the disease vectors in rural areas. This programme, using fumigant canisters and insect sensor boxes, will cover 380 000 dwellings in 16 endemic provinces in Argentina. ,
Raising the status of women in developing countries by giving; them access to adequate education, health care, and work at a fair, wage is an essential part of slowing population growth and thus; reducing poverty, says the latest United Nations Population Fundl Report.’ In 1990,300 million women in developing countries couldl not get safe and effective contraception. Almost 9 out of 10 women surveyed wanted to space their pregnancies two or more years apart, but only two-thirds achieved this goal. If women were able to control birth spacing, maternal mortality could be cut by half. In the 25 developing countries studied, child mortality could be cut by an average of 24% by avoiding early and numerous pregnancies. Providing women access to the labour market could lower fertility by postponing age of marriage as well as give them financial independence. The report points out that economic growth has been fastest in areas where women have an adequate status. Unfortunately, despite strenuous efforts to increase the numbers receiving education in developing countries, girls are still spending less time at school than boys. Each extra year of education for a mother could reduce her children’s mortality risk by 7-9%, says the report. The world population in mid-1992 is expected to be 5-5 billion. The most likely projection of population growth implies a near doubling to 10 billion in 2050. The report predicts that if adequate steps are taken, this estimate could be reduced to about 8 billion. Such steps might result from next week’s technical discussions at the World Health Assembly, entitled "Women, health, and development". The discussion will consider deficiencies not only in women’s health care, but also in their educational, political, and socioeconomic status. 1 The state of the World Population 1992. New York: United Nations (220 East 42nd Street, New York, NY 10017, USA).
Effect of semen
Does semen facilitate entry of viral particles from the lumen of the systemic circulation? As a first step towards answering this question, Mendizabal and Naftalin have examined. the effect of human semen on rat colon. They found that semen abolished fluid absorption by the colon, altered colonic permeability to polyethylene glycol, and caused cytolysis of the mucosa. The control, Locke’s solution, did not produce these effects. The changes are consistent with loss of intercellular junctional integrity and so far seem to be due to collagenase and gelatinase activity. Whether semen increases the rate of viral transmission across the wall of the colon has, however, yet to be shown. rectum or colon into the
There is now compelling evidence that severe hepatitis after exposure to an inhaled anaesthetic is an immune response to a metabolite of the anaesthetic. Halothane is metabolised to the
greatest degree (about 20% of an inhaled dose) and is the cause of of hepatic failure. All exposed individuals metabolise halothane to trifluoroacetyl (TFA) halide, thereby producing TFA-labelled proteins. Antibodies to these proteins are detectable in about 70% of patients with severe hepatitis and are specific to such patients; their presence therefore is of diagnostic value. Other anaesthetics are also metabolised to TFA and it is possible that patients may become cross-sensitised to inhaled anaesthetics. To identify susceptibility factors, Prof R. M. Jones and Dr J. G. Kenna of St Mary’s Hospital, London, are setting up a national database of patients who have had severe hepatitis after exposure to an inhaled anaesthetic and an antibody-testing service. They would like to be informed of relevant patients, past and present. most cases
Information should be sent to the Department of Anaesthetics, St Mary’s Hospital, London W2 1NY (telephone 071-725 1681).
Keeping Women’s status and world
away from the disabled
Imagine the shock and horror that would be elicited if the public be advised to give people with a disability a wide berth. A survey1 by the Automobile Association does, however, indicate one instance when such people would prefer others to keep their were to
distance. Please do not park too close to sticker. 1.
Mobility for All. Available from Public Policy Department, Automobile Association. Fanum House, Basingstoke, Hants RG21 2EA.
College Presidents Prof L. A. Turnberg, University of Manchester, Manchester, will take over from Dame Margaret Turner-Warwick as President of the Royal College of Physicians on July 30, and Prof Norman Browse, St Thomas’ Hospital Medical School, London, will succeed Sir Terence English as President of the Royal College of Surgeons of England on July 9.
I enjoy going to court: perhaps I was set a bad example by the first time I appeared as a medical witness. I had volunteered to testify about some bruises one of my patients had sustained in a tussle with the police. I was a very young GP in those days, but anxious to fulfill my duty as a citizen and give up a whole day to hang around the court. My patient had carefully explained to me that he was no ordinary poacher, but a "professional". He illustrated this with a photograph of his freezer full to the brim with salmon. For some complicated reason two policemen had had a scuffle with him in his own hallway: ordinarily he accepted the occasional punch-up with the constabulary, but knocking over his hall table was not on. This time he refused to plead guilty, and found himself up before a judge for resisting arrest. After giving my evidence I sat in the gallery to hear Joe give his. His manner was forthright. When he was asked if he had struck the constable, he said in a very loud clear voice. "That’s their bloody lies". At the end of ninety minutes the judge said the match was a draw, and bound Joe over to keep the peace. "Well done, Doc. Good bit of evidence that", he said when we met outside. He produced a hip flask of whisky and we toasted each other. Hip flasks always cause a frisson in polite society, and a passing policeman shook his head. The solicitors’ jaws dropped collectively. Joe looked round and again in his very clear voice pronounced "Hip flasks are a privilege of us professional gentlemen". I noticed, however, that he didn’t offer any of his hospitality to the solicitors.