Temperate Climate Countries Research Articles

The Clinical Features of Hand‐arm Vibration Syndrome in a Warm Environment—A Review of the Literature

The internationally accepted limit values and the health effects of hand-transmitted vibration exposure have been described extensively in the literature from temperate climate countries but not from a tropical climate environment. We conducted a systematic review of the health effects of hand-transmitted vibration exposure in tropical countries to determine the characteristics of hand-arm vibration syndrome in a warm environment and compared the findings with the results of the systematic reviews published by the US NIOSH. We searched major medical databases including MEDLINE, PubMed, Embase, CINAHL, Ovid and Cochrane based on the terms "hand arm vibration syndrome," "hand transmitted vibration," "vibration white finger" and "Raynaud" up to January 2011. Only studies conducted in a tropical or subtropical environment were selected for the review. The quality of the selected papers was assessed independently by two investigators using predefined criteria. A standard set of information was abstracted from the papers for review. Only six papers from tropical countries and three papers from subtropical countries were available in the literature. No vibration white finger was reported in the tropical countries. Neurological symptoms were prevalent in the vibration-exposed workers. Finger coldness seems to be an important surrogate for vascular disorder in a tropical environment. Meta-analysis could not be performed due to inadequacy of the information reported in these papers. The current dose-response relationship in ISO5349-1 for hand-transmitted vibration exposure is not applicable to a tropical environment. Further studies on hand-arm vibration syndromes in tropical countries are needed.

Transmission Potential of Chikungunya Virus and Control Measures: The Case of Italy

During summer 2007 Italy has experienced an epidemic caused by Chikungunya virus – the first large outbreak documented in a temperate climate country – with approximately 161 laboratory confirmed cases concentrated in two bordering villages in North–Eastern Italy comprising 3,968 inhabitants. The seroprevalence was recently estimated to be 10.2%. In this work we provide estimates of the transmission potential of the virus and we assess the efficacy of the measures undertaken by public health authorities to control the epidemic spread. To such aim, we developed a model describing the temporal dynamics of the competent vector, known as Aedes albopictus, explicitly depending on climatic factors, coupled to an epidemic transmission model describing the spread of the epidemic in both humans and mosquitoes. The cumulative number of notified cases predicted by the model was 185 on average (95% CI 117–278), in good agreement with observed data. The probability of observing a major outbreak after the introduction of an infective human case was estimated to be in the range of 32%–76%. We found that the basic reproduction number was in the range of 1.8–6 but it could have been even larger, depending on the density of mosquitoes, which in turn depends on seasonal meteorological effects, besides other local abiotic factors. These results confirm the increasing risk of tropical vector–borne diseases in temperate climate countries, as a consequence of globalization. However, our results show that an epidemic can be controlled by performing a timely intervention, even if the transmission potential of Chikungunya virus is sensibly high.

Radioecological risk assessment in tropical climate countries

Since the 90’s the relevance of considering environmental aspects in development industrial activities has been steadily growing. The anthropocentric philosophy of radiological protection has been questioned and research and development on ecological risk assessment has now an import role in overall risk assessment procedures. However, most development up to now has focused temperate climate country biota and cannot be directly applied to tropical climate countries, due to the very different environmental characteristics and biodiversity. A preliminary survey focusing the area surrounding the Brazilian nuclear power plant site has shown that very few of the ICRP’s reference animals and plants can be used to characterize environmental protection in tropical climate areas. The development of such lists and all the research needed on parameter values to fulfill a risk assessment procedure would be extremely expensive, and more pragmatic approaches are needed to turn the process reliable in a more global way.

Mycetoma (Madura foot): A case report

IntroductionMycetoma is a chronic disease, which is endemic in tropical and subtropical countries. We report a rare case of mycetoma located on the foot of a patient living in a temperate-climate country followed by a short discussion. ObservationA 50-year-old woman with painless swelling in her left foot. The swelling started after a banal penetrating injury on the sole of her left foot 23 years ago. X-rays images showed multiple osteolytic lesions of the tarsus. The histological analyses identified the fungus madurella mycetomatis. The treatment was radical surgery (amputation). The patient had a tibial prosthesis and recovered an autonomous gait. DiscussionMycetoma is a chronic granulomatous inflammatory response often with sinus tract formations due to fungal or bacterial organisms. The infection of the forefoot is quite typical. It is a slowly progressing disease affecting the deep dermis and subcutaneous tissues that can extent to the underlying bones. ConclusionIf it is not diagnosed early on, mycetoma can cause functional and esthetical impairments.

Increases in summer serum 25-hydroxyvitamin D (25OHD) concentrations in elderly subjects in São Paulo, Brazil vary with age, gender and ethnicity

BackgroundHypovitaminosis D is a common condition among elderly individuals in temperate-climate countries, with a clear seasonal variation on 25 hydroxyvitamin D levels, increasing after summer and decreasing after winter, but there are few data from sunny countries such as Brazil. Many factors can interfere on vitamin D cutaneous synthesis. We aimed at studying the 25OHD variations during winter and summer in an outdoor physically active elderly population living in São Paulo city, and analysed their determining factors.MethodsNinety-nine individuals (52 women and 47 men, from 55 to 83 years old) from different ethnic groups were selected from an outdoor physical activity group. Data are reported as Mean ± SD, and we used Pearson Linear Correlation, Student's t-test for non-related samples, Chi-square (χ²) test and One-way ANOVA for analysis.ResultsMean 25OHD value for the whole group was 78.9 ± 30.9 nmol/L in the winter and 91.6 ± 31.7 nmol/L in the summer (p = 0.005). Mean winter serum 25OHD concentrations were not different between men and women (81.2 ± 30.1 nmol/L vs. 76.7 ± 31.8 nmol/L, respectively), and 19.2% of the individuals showed values < 50 nmol/L. In the summer, we noticed an increase only for men (107.6 ± 31.4 nmol/L) compared to women (76.7 ± 24.0 nmol/L), and 6.5% showed values < 50 nmol/L. A decrease in the mean PTH in the summer compared to the winter was noticed, with PTH levels showing a relationship with 25OHD concentrations only in the winter (r = -0.208, p = 0.041). White individuals showed an increase in mean serum 25OHD in the summer (p = 0.016) which was not noticed for other ethnic groups (Asians, native Brazilians and blacks). An increase in 25OHD values in the summer was observed in the age groups ranging from 51-60 and 61-70 years old (p < 0.05), but not in the age group from 71 years old on.Conclusions25OHD values increased during the summer in elderly residents of São Paulo, but to different extents depending on ethnicity, gender and age. This season-dependent increase was noticed only among men, white and who were in the youngest group of individuals.

Assessment of Imprecision in Gamma Interferon Release Assays for the Detection of Exposure to Mycobacterium tuberculosis

New gamma interferon (IFN-gamma) release assays (IGRAs) to detect an exposure to Mycobacterium tuberculosis have recently been launched. The majority of the studies in temperate-climate countries agree that these methods have superior specificity and equal or even superior sensitivity over tuberculin skin tests (TSTs) in the diagnosis of latent tuberculosis (TB) infection (LTBI). However, reproducibility data of IGRAs are virtually missing. We assessed within-run, between-run, and total imprecision of two commercial IGRAs by testing samples from subjects with a stable state of TB infection or treated pulmonary TB, a sample from a healthy volunteer, and internal quality control samples. We calculated coefficients of variance (CV%s) to describe assays variability and compared the obtained results to the reported CV%s for other commercial immunodiagnostic methods. We illustrate an example of assay variability near the cutoff zone to demonstrate the necessity of a gray zone. Due to the strict adherence to the standard operation procedures (SOP) adopted in our laboratory, the total imprecision of enzyme-linked immunospot (ELISPOT)- and enzyme immunoassay (EIA)-based IGRAs was at a maximum CV% of 37.8% for the samples with moderate and high reactivities. Imprecision of testing samples with very low reactivity levels or nonreactive samples may, however, exceed 100%. In conclusion, despite multiple steps of the method performance, the analytical imprecision of IGRAs, which in our study design included also between-lot variability and had a component of normal biological variation, was well in accordance with the reported imprecisions of other manual immunodiagnostic tests. The recognition of the variability around the cutoff point advocates the use of a gray zone to avoid ambiguous result interpretations.

Pre-travel health advice for human immunodeficiency virus-infected travelers, from Rio de Janeiro

Counseling for human immunodeficiency virus infected travelers is becoming increasingly specialized. Previous studies have reported the experience of HIV-infected travelers from temperate-climate countries but little is known about HIV-infected travelers from tropical countries. A retrospective study was conducted on HIV-infected travelers presenting at a travel health clinic in Rio de Janeiro. Eleven journeys by ten people were recorded. Brazil (Amazon region and Northeast) was the destination for six journeys. Other destinations were Peru, Angola, Europe and Asia. Nine attendees were undergoing antiretroviral therapy. Few HIV-infected people from Rio de Janeiro consulted a travel medicine specialist before traveling. Since they travel to destinations in Brazil and abroad where there are endemic diseases not encountered in Rio de Janeiro, careful pre-travel planning needs to be undertaken. Strategies for increasing the frequency of pre-travel consultations need to be developed, such as closer collaboration between HIV clinics and travel health clinics.

Identification of Malassezia species from pityriasis versicolor in Indonesia and its relationship with clinical characteristics

Pityriasis versicolor (PV) is a chronic superficial fungal disease caused by Malassezia spp. The incidence is as high as 30-40% in tropical climates. Previous studies indicate that the geographic factor has influence on the main species isolated from PV. Our aim was to identify Malassezia spp. from PV patients in Indonesia and their correlation to clinical characteristics. Isolates of Malassezia were collected from 98 PV patients (62 males and 36 females). Identification was based on morphological observation and biochemical evaluation. Leeming Notman agar was used as isolation culture medium. The biochemical evaluation consisted of specimen culture onto Sabouraud dextrose agar, Cremophor EL, Esculin, Dixon's agar at 37 degrees C and catalase reaction. The isolates found were Malasseziafurfur (42.9%), M. sympodialis (27.5%), M. globosa (13.3%), M. slooffiae (7.7%), M. obtusa (7.7%) and M. restricta (2.2%), and 7.14% specimens were unidentified. There was no statistically significant association between Malassezia spp. and demographic characteristics and clinical characteristics of the patients. Unlike reports from temperate climate countries, this study in Indonesia found M. furfur as the most frequently isolated Malassezia spp. in PV patients.

Microbiological patterns in sepsis: what happened in the last 20 years?

Changes in the microbiological characteristics of sepsis have been observed over the past few decades. Infections caused by Gram-positive bacteria and fungi have become more common in some areas, possibly as a consequence of the increased use of intravascular and other medical devices, an increase in invasive procedures and the use of immunosuppressant agents. As observed with other infections there has been an emergence of multiresistant Gram-positive and Gram-negative pathogens. Most of the published data come from wealthy countries in temperate climates, and although many of the same changes have been observed in developing countries, there are important regional differences in the microbiology of sepsis. For example, typhoidal salmonellae remain the most important cause of bloodstream infection in parts of South Asia, nontyphoidal salmonella infections are predominant in parts of sub-Saharan Africa and melioidosis is important in endemic areas. The microbiological pattern of sepsis has also been influenced by the rise in prevalence of HIV infection in many regions.

The impact of major heat waves on all-cause and cause-specific mortality in France from 1971 to 2003

The aim of the study was to identify the major heat waves (HW) that occurred in France from 1971 to 2003 and describe their impact on all-cause and cause-specific mortality. Heat waves were defined as periods of at least three consecutive days when the maximum and the minimum temperature, averaged over the whole France, were simultaneously greater than their respective 95th percentile. The underlying causes of death were regrouped into 18 categories. Heatstroke, hyperthermia and dehydration were assigned to the "heat-related causes" (HRC) category. The numbers of deaths observed (O) during the identified HW were compared to those expected (E) on the basis of the mortality rates reported for the three preceding years. Six HW were identified from the period 1971 to 2003. They were associated with great excess mortality (from 1,300 to 13,700 deaths). The observations are compatible with a moderate harvesting effect for four of the six HW. The mortality ratios increased with age for subjects aged over 55 years and were higher for women than for men over 75 years. For the six HW, the excess mortality was significant for almost all the causes of death: (1) the greatest excess mortality (O-E) were observed for cardiovascular diseases, neoplasms, respiratory system diseases, HRC, ill-defined conditions and injury and poisoning, and (2) the mortality ratios (O/E) were highest for HRC, respiratory diseases, nervous system diseases, mental disorders, infectious diseases, and endocrine and nutritional diseases. Heat waves associated with excess mortality are not rare events in this temperate-climate country. The excess mortality is much greater than HRC mortality. Some populations are particularly vulnerable to HW: the elderly, women and people with some specific diseases. However, no segment of the population may be considered protected from the risks associated with HW.

Variations in the refuge-seeking behaviour of four strains of Cryptolestes ferrugineus (stephens) (Coleoptera: Cucujidae) at different temperatures

The refuge-seeking behaviour of insecticide resistant and susceptible strains of Cryptolestes ferrugineus (Stephens) was investigated in the laboratory by confining adults in arenas containing a refuge filled with wheat. Three strains had been collected from grain stores and mills, and the fourth (Insectary) had been reared in constant conditions for over 25 years. The effect of temperature on behaviour, in the range 15–30°C, was also examined. The Insectary strain was particularly affected by low temperatures with far fewer adults being recorded in the refuge at the end of the 2-week test period compared to other strains. Differences in refuge-seeking behaviour between strains increased with decreasing temperature, and were greatest below 20°C; this corresponds with the temperatures at which grain is usually stored in Britain and in other countries of temperate climate. These differences in behaviour appear to be unconnected with the biochemical/physiological resistance of the strains to malathion.

Role of my cooperation with Soviet scientists in the elimination of polio: possible lessons for relations between the U.S.A. and the USSR.

The purpose of this communication is threefold: (1) to bring into perspective the important role ofmy cooperation with Soviet scientists in the development of the oral poliovirus vaccine used for more than 25 years for the elimination of paralytic poliomyelitis; (2) to describe the obstacles to worldwide eradication of the disease; and (3) to describe a hope I have derived from this experience that cooperative endeavors between the U.S.A. and the Soviet Union against the larger common enemy of poverty in more than half the world's population may become a means of breaking the dangerous impasse ofjustifiable, mutual distrust that causes the U.S.A. and the USSR to continue preparing for a barbaric war against each other, a war that neither nation wants and the whole world dreads, a war that cannot be won but can lead to the greatest tragedy ever inflicted on the human species. Some people think that poliomyelitis, the crippling disease that has been part of the human heritage since earliest evolutionary times, has already been conquered, that is, eliminated, brought under control, or even eradicated. This conception is partly true and partly false. It is true for about 2,000 million of the world's population living in temperateclimate countries where it is reasonably estimated that during the past 20 years the oral polio vaccine has prevented about 5 million cases ofpersistent paralysis and perhaps 500,000 deaths [I]. But it is not true for most tropical and subtropical, economically undeveloped countries inhabited by about 3,000 million people, where much polio has undoubtedly been This paper is a slightly modified version of the Twenty-third Cosmos Award Lecture presented April 15, 1986, at the Cosmos Club, Washington, D.C. ?Fogarty International Center for Advanced Studies in the Health Sciences, National Institutes of Health, Bethesda, Maryland 20892.

Strategies for elimination of poliomyelitis in different parts of the world with use of oral poliovirus vaccine.

Since its first mass use in 1960, oral polio vaccine ( OPV ) has largely eliminated paralytic poliomyelitis from temperate-climate and subtropical regions of the world that have good health services and a combined total population of almost 2,000 million people. The various strategies used in these countries have been highly successful even where, as in the USA, large numbers of children received no vaccine or only a single dose of OPV . During the period of 1981-1982, only 2.8 cases per 100 million total population per year were reported in the USA. The main challenge in the present era is the economically undeveloped tropical and subtropical regions with inadequate health services that are inhabited by more than half of the world population, where recent surveys for residual paralysis due to poliomyelitis have shown that the incidence of the disease has been higher than it was in the USA and other predominantly temperate-climate countries before the vaccine era. The problem in these countries is that the majority of children receive no vaccine and that the extensive year-round dissemination of virulent polioviruses requires a different strategy of vaccination from that used in the temperate-climate countries. The special point about the annual mass vaccinations with OPV for all children younger than three, four, or five years of age-which have proven highly successful in Cuba (for the past 20 years), in Brazil (during the past three years), and recently also in Mexico-is that all the children are usually vaccinated within one or two days, which quickly breaks the chain of transmission of the virulent viruses, and the annual campaigns create and maintain the maximum number of children with resistant intestinal tracts.

Paralytic poliomyelitis: Old dogmas and new perspectives.

No poliovirus vaccines can be expected to eliminate the paralytic poliomyelitis that is caused by nonpolio enteroviruses or the cases that have been and continue to be diagnosed erroneously as paralytic poliomyelitis. Polioviruses have been recovered from the feces of patients with paralytic disease that is definitely not poliomyelitis, and very rare cases of so-called "vaccine-associated" paralytic disease cannot be regarded as having been caused by the vaccine virus when it is present in the feces and even more so when no virus is recovered. Surveys for residual poliomyelitis paralysis in tropical countries indicate an average annual incidence that is as high or higher than in the United States in the prevaccine era. Oral poliovirus vaccine has eliminated paralytic poliomyelitis caused by polioviruses in many temperate-climate countries in which a large proportion of children remain unvaccinated or incompletely vaccinated. Oral poliovirus vaccine can also eliminate paralytic poliomyelitis from tropical countries but a different strategy is needed for using the vaccine.

77 ENVIRONMENTAL ENTEROPATHY IN CHILE

In tropical countries with poor environmental sanitation mild to severe non specific changes in the small intestinal morphology and function have been described. This study was carried out to investigate whether similar changes occur in countries of temperate climate and poor sanitation. Fifteen young healthy volunteers, who belonged to the lowest socioeconomic stratus were studied. They live in periurban slums in Santiago, where high contamination indexes prevail. Evaluation of the nutritional status (physical examination, anthropometry, biochemical), intestinal function (serum carotene and vit.A. blood xylose after 5g oral standard dose, disaccharidases, duodenal biopsy, nitrogen and fat balance), stool parasites and stool culture were performed. Nutritional status was normal in all cases.One subject had serum carotene below 60ug%. One hour blood xylose was below 20mg% in 67% of cases. Serum vitamin A and disaccharidases were normal in all cases. G. Lamblia and/or Ent.Hystolitica were obtained the stools in 7 subjects. Stool cultures was negative in all cases. Light microscopy of the mucosa showed mild unspecific changes. Electron microscopy revealed mild to moderate patchy changes in the brushborder and basal membrane Nitrogen and fat balance were normal in all cases. Mild nonspecific changes of the small intestinal morphology and function suggest a mild environmental enteropathy of lesser magnitude than those described in tropical countries.

Oral polio vaccination of children in the tropics. III. Intercurrent enterovirus infections, vaccine virus take and antibody response.

The effect of intercurrent enterovirus infections on host responses to oral polio vaccine (OPV) was studied in groups of infants and children who were without antibodies to one, two or three serotypes of poliovirus. The prevalence of enterovirus infections as detected in fecal specimens collected at weekly intervals and inoculated in primary monkey kidney cell culture, HEp 2 cells and newborn mice ranged between 60 and 70 per cent. The presence of such infections at the time of, 1 week prior to, or during the 3 weeks prior to the administration of OPV did not appear to inhibit either vaccine virus take or antibody response. However, in both the infected and uninfected children the rates of vaccine virus take and seroconversion were found to be considerably lower than those reported from several temperate climate countries.

Fluid and electrolyte observations in tropical surgical practice.

In countries of temperate climate, such as the United Kingdom, the fluid and electrolyte requirements for a patient recovering from surgery are well known. During the past decade much work has been done on the metabolic response to trauma, and a great deal of information has been documented (Moore and Ball, 1952). Those studies, however, have been carried out mainly in North America and Europe, and as such are strictly applicable only to patients under like conditions. The different circumstances of surgical patients in the tropics, both racial and climatic, make it probable that there are differences in their requirements to an extent that appears, as yet, to be insufficiently known.