World Health Organization Protocol Research Articles

Variability of the Susceptibility to Deltamethrin in Triatoma infestans: The Female Factor

We analyzed the variability of susceptibility to deltamethrin in putatively susceptible Triatoma infestans Klug (Hemiptera: Reduviidae), and evaluated the sample size implications on the hypotheses used in the current World Health Organization protocol for the measure of insecticide resistance in Triatominae. Following the protocol, using topical application of deltamethrin to unfed first instar nymphs of T. infestans, we found that susceptibility showed significant differences between offspring from different females, a significant association with female age, and significant interaction female x female age. Considering individual female data, three patterns of nymphal mortality were identified: one showed a strong positive relation between nymphal mortality and their mother's age, another showed high mortality with low variability and the third showed intermediate mortality with high variability along female age. The analysis suggests revision of the World Health Organization protocol for resistance detection in Triatominae, not only to take into consideration the sources of variation in susceptibility, but also the effects of sample size in relation to the significance and power probabilities of the test.

English

Neisseria meningitidis serogroup B outer membrane vesicle (OMV) was revealed to be an efficient carrier for polysaccharide antigens such as capsular antigens. Also, OMV of N. meningitidis was shown to be able to induce high levels of antibodies when applied as an adjuvant for T-independent antigens. In this study OMV was used as an adjuvant with group A meningococcal capsular polysaccharide (GAMP) and tested in New zealand white rabbits to evaluate bactericidal antibody response and opsonophagocytosis activity against serogroup A meningococci. Non-covalent combination of OMV and GAMP and three controls including GAMP, OMV and normal saline were injected intramuscularly into groups of four female New Zealand rabbits with boosters on days 14 and 28 after primary immunization. The serum samples were collected on days 0, 14, 28 and 42 and tested by complement mediated bactericidal assay and opsonophagocytosis activity against serogroup A meningococci according to the world health organization protocol. The results indicate that the combination of OMV with GAMP, in noncovalent form, would be able to induce a high level of bactericidal antibody and opsonophagocytosis activity response in comparison with GAMP alone after 42 days (P< 0.05).  The OMV of N. meningitidis showed to be a potent carrier protein in the induction of immune system but in this article the role of OMV is studied as an adjuvant to promote immune system in non-covalent form and without any conjugation process in order to induce immune response against three prevalent serogroups of N. meningitidis.   Key words: OMV, Adjuvant, Neisseria meningitidis serogroup A, Bactericidal activity.

Brief interventions are effective in reducing alcohol consumption in opiate‐dependent methadone‐maintained patients: Results from an implementation study

An implementation study to test the feasibility and effectiveness of brief interventions (BIs) to reduce hazardous and harmful alcohol consumption in opiate-dependent methadone-maintained patients. Before and after intervention comparison of Alcohol Use Disorders Identification Test (AUDIT-C) scores from baseline to 3month follow up. Seven hundred and ten (82%) of the 863 eligible methadone-maintained patients within three urban addiction treatment clinics were screened. A World Health Organization protocol for a clinician-delivered single BI to reduce alcohol consumption was delivered. The full AUDIT questionnaire was used at baseline (T1) to measure alcohol consumption and related harms; and in part as a screening tool to exclude those who may be alcohol-dependent. AUDIT-C was used at 3month follow up (T2) to assess any changes in alcohol consumption. RESULTS. One hundred and sixty (23% of overall sample screened) 'AUDIT-positive' cases were identified at baseline screening with a mean total full AUDIT score of 13.5 (SD 6.7). There was a statistically significant reduction in AUDIT-C scores from T1 ( , SD=2.35) to T2 (, SD=2.66) for the BI group (z=-3.98, P<0.01). There was a statistically significant decrease in the proportion of men who were AUDIT-positive from T1 to T2 (χ(2) =8.25, P<0.003). It is feasible for a range of clinicians to screen for problem alcohol use and deliver BI within community methadone clinics. Opiate-dependent patients significantly reduced their alcohol consumption as a result of receiving a BI.

Suscetibilidade de larvas de Culex quinquefasciatus a diferentes inseticidas

This study aimed to assess the susceptibility of Culex quinquefasciatus larvae to two pyrethroids (Cypermethrin and Deltamethrin), two derivatives of Avermectin (Ivermectin and Abamectin) and an organophosphate (Temephos). Third- and fourth-instar larvae of C. quinquefasciatus were exposed to different concentrations of insecticides (eleven repetitions) according to the World Health Organization's protocol. One hour after exposure, larvae were washed in dechlorinated tap water, transferred to plastic containers containing water without chlorine, fed and observed for periods of 24h until reaching adulthood. To determine lethal concentrations, the obtained values were submitted to regression analysis using the probit model with the Minitab 15 program. The highest concentration used for the LC50 from probit analysis was for Temephos. The evaluated insecticides caused more pronounced larvae mortality in the first 24h with the exception of those exposed to ivermectin. This study demonstrates that larvae are susceptible to all tested insecticides and that there is a need for monitoring the use of insecticides.

Prevalence of intestinal parasites and bacteria among food handlers in a tertiary care hospital

Objectives:The aim of this work is to determine the prevalence of intestinal parasites and bacteria among the food handlers.Materials and Methods:Two hundred food-handlers were subjected to a cross-sectional study working in the kitchen of a tertiary care hospital, i.e., Alnoor Specialist Hospital, Makkah, Saudi Arabia from February 2 to 27, 2009. The stool samples were examined for intestinal parasites following direct microscopic examination, formol ether concentration (Ritchie), and staining with modified acid fast staining techniques. For enteropathogenic bacteria samples were inoculated onto MacConkey's agar, deoxycholate citrate agar, xylose lysine deoxycholate agar as per the World Health Organization protocol. Fingernail materials were examined microscopically for enteropathogenic bacteria and parasites.Results:The majority (80%) of the food-handlers were young adults aged from 22 to 42 years. No intestinal parasites were detected from fingernail contents. Forty six (23%) stool specimens were positive for intestinal para¬sites. Giardia lamblia 18 (9%) was most frequent among the 10 different types of detected intestinal parasites followed by Entamoeba histolytica 9 (4.5%). No pathogenic bacteria were detected in all stool samples, whereas finger nails showed isolation of microorganisms as coagulase-negative staphylococci 79 (39.5%), followed by Staphylococcus aureus 35 (17.5%).Conclusion:The findings emphasized the importance of food handlers as potential sources of infections and suggested health institutions for appropriate hygienic and sanitary control measures.

Tracoma em crianças do ensino fundamental no município de Bauru: Estado de São Paulo, Brasil

A survey was carried out with schoolchildren in Bauru, São Paulo State. The purpose of this study was to determine the prevalence of trachoma. One thousand, seven hundred and forty-nine children from 6 to 14 years old were examined during the year of 2005. The schools were randomly chosen, according to the number of schoolchildren and the school region according to the local of the city (downtown, middle and periphery). The diagnosis was performed according to the World Health Organization (WHO) protocol and patients with clinical trachoma detection were submitted to laboratory confirmation by direct smear fluorescent antibodies cytology for Chlamydia trachomatis. Trachoma prevalence was 3.8%. Follicular trachoma was diagnosed in 3.7% of children, and intense trachoma in one child (0.06%). Children with trachoma were living mainly in the middle and peripheral region of the city, places with discontinuous water supply and absence of sewerage system in part of the residences. Trachoma prevalence in Bauru - São Paulo State - is 3.8%. The authors point out the survey results and also treated trachoma carriers. Other positive aspect of the survey was the community mobilization to prevent trachoma blindness.

Hospital Health Care Cost of Diarrheal Disease in Northern Ghana

Diarrhea caused by rotaviruses is one of the most frequent causes of hospitalization among pediatric patients in rural communities of developing countries in sub-Saharan Africa and Southeast Asia, and it is a major cause of death in these communities. The complexity of diarrhea and the increasing cost of treatment puts additional burden on the health sector. To demonstrate the economic burden of diarrhea to policy makers, this study was conducted to estimate the treatment cost of diarrhea in children <5 years old in Ghana using the World Health Organization protocol for cost data collection and estimation. The study was undertaken in Navrongo War Memorial Hospital in northern Ghana. Cost estimates were made for 3 treatment scenarios observed: (1) treatment by rehydration, (2) treatment by rehydration and antibiotics, and (3) treatment of diarrhea and other diseases. The average outpatient treatment costs for the 3 treatment scenarios were US$3.86, $4.10, and $4.35 respectively, and the average treatment costs for hospitalization (inpatient care) were $65.14, $97.40, and $133.86 respectively. The annual national treatment costs, based on the 3 treatment scenarios, ranged from $907,116 to $1,851,280 for outpatients clinic visits and from $701,833 to $4,581,213 for hospitalizations. The average length of stay for the inpatients ranged from 2.3 to 4.9 days. The study did not cover patient costs (ie, household costs).

Schistosoma mansoni: magnetic resonance analysis of liver fibrosis according to WHO patterns for ultrasound assessment of schistosomiasis-related morbidity

For the last two decades, ultrasound (US) has been considered a surrogate for the gold standard in the evaluation of liver fibrosis in schistosomiasis. The use of magnetic resonance imaging (MRI) is not yet standardised for diagnosing and grading liver schistosomal fibrosis. The aim of this paper was to analyse MRI using an adaptation of World Health Organization (WHO) patterns for US assessment of schistosomiasis-related morbidity. US and MRI were independently performed in 60 patients (42.1 +/- 13.4 years old), including 37 men and 23 women with schistosomiasis. Liver involvement appraised by US and MRI was classified according to the WHO protocol from patterns A-F. Agreement between image methods was evaluated by kappa index (k). The correlation between US and MRI was poor using WHO patterns [k = 0.14; confidence interval (CI) 0.02; 0.26]. Even after grouping image patterns as "A-D", "Dc-E" and "Ec-F", the correlation between US and MRI remained weak (k = 0.39; CI 0.21; 0.58). The magnetic resonance adaptation used in our study did not confirm US classification of WHO patterns for liver fibrosis.

Imaging techniques and histology in the evaluation of liver fibrosis in hepatosplenic schistosomiasis mansoni in Brazil: a comparative study

Few publications have compared ultrasound (US) to histology in diagnosing schistosomiasis-induced liver fibrosis (LF); none has used magnetic resonance (MR). The aim of this study was to evaluate schistosomal LF using these three methods. Fourteen patients with hepatosplenic schistosomiasis admitted to hospital for surgical treatment of variceal bleeding were investigated. They were submitted to upper digestive endoscopy, US, MR and wedge liver biopsy. The World Health Organization protocol for US in schistosomiasis was used. Hepatic fibrosis was classified as absent, slight, moderate or intense. Histology and MR confirmed Symmers' fibrosis in all cases. US failed to detect it in one patient. Moderate agreement was found comparing US to MR; poor agreement was found when US or MR were compared to histology. Re-classifying LF as only slight or intense created moderate agreement between imaging techniques and histology. Histomorphometry did not separate slight from intense LF. Two patients with advanced hepatosplenic schistosomiasis presented slight LF. Our data suggest that the presence of the characteristic periportal fibrosis, diagnosed by US, MR or histology, associated with a sign of portal hypertension, defines the severity of the disease. We conclude that imaging techniques are reliable to define the presence of LF but fail in grading its intensity.

Rates of radiologically confirmed pneumonia as defined by the World Health Organization in Northern Territory Indigenous children

To determine the burden of hospitalised, radiologically confirmed pneumonia (World Health Organization protocol) in Northern Territory Indigenous children. Historical, observational study of all hospital admissions for any diagnosis of NT resident Indigenous children, aged between > or = 29 days and < 5 years, 1 April 1997 to 31 March 2005. All chest radiographs taken during these admissions, regardless of diagnosis, were assessed for pneumonia in accordance with the WHO protocol. The primary outcome was endpoint consolidation (dense fluffy consolidation [alveolar infiltrate] of a portion of a lobe or the entire lung) present on a chest radiograph within 3 days of hospitalisation. We analysed data on 24,115 hospitalised episodes of care for 9492 children and 13,683 chest radiographs. The average annual cumulative incidence of endpoint consolidation was 26.6 per 1000 population per year (95% CI, 25.3-27.9); 57.5 per 1000 per year in infants aged 1-11 months, 38.3 per 1000 per year in those aged 12-23 months, and 13.3 per 1000 per year in those aged 24-59 months. In all age groups, rates of endpoint consolidation in children in the arid southern region of NT were about twice that of children in the tropical northern region. The rates of severe pneumonia in hospitalised NT Indigenous children are among the highest reported in the world. Reducing this unacceptable burden of disease should be a national health priority.

Hospitalisation of Indigenous children in the Northern Territory for lower respiratory illness in the first year of life

To describe the epidemiology of acute lower respiratory infection (ALRI) and bronchiectasis in Northern Territory Indigenous infants hospitalised in the first year of life. A historical cohort study constructed from the NT Hospital Discharge Dataset and the NT Immunisation Register. All NT resident Indigenous infants, born 1 January 1999 to 31 December 2004, admitted to NT public hospitals and followed up to 12 months of age. Incidence of ALRI and bronchiectasis (ICD-10-AM codes) and radiologically confirmed pneumonia (World Health Organization protocol). Data on 9295 infants, 8498 child-years of observation and 15 948 hospitalised episodes of care were analysed. ALRI incidence was 426.7 episodes per 1000 child-years (95% CI, 416.2-437.2). Incidence rates were two times higher (relative risk, 2.12; 95% CI, 1.98-2.27) for infants in Central Australia compared with those in the Top End. The median age at first admission for an ALRI was 4.6 months (interquartile range, 2.6-7.3). Bronchiolitis accounted for most of the disease burden, with a rate of 227 per 1000 child-years. The incidence of first diagnosis of bronchiectasis was 1.18 per 1000 child-years (95% CI, 0.60-2.16). One or more key comorbidities were present in 1445 of the 3227 (44.8%) episodes of care for ALRI. Rates of ALRI and bronchiectasis in NT Indigenous infants are excessive, with early onset, frequent repeat episodes, and a high prevalence of comorbidities. These high rates of disease demand urgent attention.

Aspectos ultrassonográficos e hemodinâmicos da esquistossomose mansônica: avaliação pela ultrassonografia Doppler em áreas endêmicas

OBJETIVO: Este estudo de campo objetivou identificar as alterações ultrassonográficas e hemodinâmicas indicativas da morbidade da esquistossomose mansônica em áreas endêmicas. MATERIAIS E MÉTODOS: Foram examinados pela ultrassonografia Doppler 554 pacientes esquistossomóticos em três áreas com níveis distintos de endemicidade: baixa endemicidade (n = 109); média endemicidade (n = 255) e alta endemicidade (n = 190). Para o estudo ultrassonográfico foi utilizado o protocolo da Organização Mundial da Saúde (Niamey Working Group, 2000). Pelo Doppler foram avaliados: vasos portais, artérias hepática e esplênica, veias hepáticas e vasos colaterais. RESULTADOS: Houve correlação significativa entre a frequência das alterações ultrassonográficas e o nível de endemicidade das áreas, exceto a hipertrofia do lobo esquerdo. As veias hepáticas apresentaram padrão de fluxo alterado em 23,7% dos casos, alteração esta relacionada à presença e à intensidade de espessamento periportal. A artéria hepática não apresentou alterações nos parâmetros avaliados. Os vasos colaterais foram identificados apenas na área de alta endemicidade. A artéria esplênica apresentou alterações (aumento do calibre, da velocidade e do índice de resistência) mais frequentes na área de alta endemicidade, com diferença significativa entre os grupos. CONCLUSÃO: A ultrassonografia Doppler mostrou-se ferramenta auxiliar importante no estudo da morbidade relacionada à esquistossomose mansônica, contribuindo para definição mais precisa do perfil da doença nas áreas endêmicas.

Efficacy of non-artemisinin- and artemisinin-based combination therapies for uncomplicated falciparum malaria in Cameroon

BackgroundThe use of drug combinations, including non-artemisinin-based and artemisinin-based combination therapy (ACT), is a novel strategy that enhances therapeutic efficacy and delays the emergence of multidrug-resistant Plasmodium falciparum. Its use is strongly recommended in most sub-Saharan African countries, namely Cameroon, where resistance to chloroquine is widespread and antifolate resistance is emerging.MethodsStudies were conducted in Cameroonian children with acute uncomplicated P. falciparum malaria according to the standard World Health Organization protocol at four sentinel sites between 2003 and 2007. A total of 1,401 children were enrolled, of whom 1,337 were assigned to randomized studies and 64 were included in a single non-randomized study. The proportions of adequate clinical and parasitological response (PCR-uncorrected on day 14 and PCR-corrected on day 28) were the primary endpoints to evaluate treatment efficacy on day 14 and day 28. The relative effectiveness of drug combinations was compared by a multi-treatment Bayesian random-effect meta-analysis.FindingsThe results based on the meta-analysis suggested that artesunate-amodiaquine (AS-AQ) is as effective as other drugs (artesunate-sulphadoxine-pyrimethamine [AS-SP], artesunate-chlorproguanil-dapsone [AS-CD], artesunate-mefloquine [AS-MQ], dihydroartemisinin-piperaquine [DH-PP], artemether-lumefantrine [AM-LM], amodiaquine, and amodiaquine-sulphadoxine-pyrimethamine [AQ-SP]). AM-LM appeared to be the most effective with no treatment failure due to recrudescence, closely followed by DH-PP.ConclusionAlthough AM-LM requires six doses, rather than three doses for other artemisinin-based combinations, it has potential advantages over other forms of ACT. Further studies are needed to evaluate the clinical efficacy and tolerance of these combinations in different epidemiological context.

Die operative Behandlung von Streckdefiziten am Kniegelenk

Restoration of full knee extension in patients with chronic extension deficits, especially in posttraumatic and postoperative cases. Chronic knee extension deficits of more than 10 degrees . Local intraarticular problems caused by cyclops syndrome, graft hypertrophy or graft impingement after anterior cruciate ligament reconstruction (notch impingement). These patients should be treated with arthroscopic procedures. Spastic flexion contracture. Noncompliant patients. Acute or chronic infections. Poor soft-tissue conditions on site of surgery. If necessary, arthroscopy before arthrolysis to assure that the extension deficit is not caused by a local problem (cyclops, osteophytes, graft hypertrophy or graft impingement after anterior cruciate ligament reconstruction). Anterior skin incision at the medial border of the patellar ligament. Resection of Hoffa's fat pad, which is extremely fibrotic in almost all cases. Second skin incision at the posteromedial side of the knee joint. Incision of the medial retinaculum between the posterior border of the medial collateral ligament and the posterior oblique ligament. Posteromedial arthrotomy between the distal part of the tendon of the adductor magnus muscle and the posterior horn of the medial meniscus. Release of all adhesions in the posterior recess of the knee joint. Complete release of the posterior joint capsule from the femoral shaft. Immobilization for 48 h after surgery in full extension (no knee motion allowed in the first 48 h). For 48 h after surgery only short walks to the bathroom are allowed. Special dynamic extension brace (Dynasplint((R)), CDS((R)) Forte, Albrecht company, Stephanskirchen, Germany) for 4-6 weeks after surgery 6-8 h per day. Painkillers following WHO (World Health Organization) protocol. Manual lymph drainage and electric muscle stimulation help to decrease pain and swelling. Physiotherapy twice daily starting at the 2nd postoperative day. No flexion exercises for the first 7 days after surgery. 15 kg partial weight bearing for 4-6 weeks. Daily physiotherapy is recommended after discharge. 121 patients underwent anterior and posterior arthrolysis between 1990 and 2000. 86 of these patients could be included in this study. The average follow-up was 4.6 years (1-10 years). The extension deficit before surgery averaged 20 degrees compared with the opposite side. At follow-up, the average extension had increased by 17 degrees , no patient had more than 5 degrees of flexion contracture. The Lysholm Score was 84 postoperatively. The Tegner Activity Scale increased from 1.9 to 4.0 after arthrolysis. In the AOSSM Subjective Outcome Score, 35 patients showed excellent and 60 good results. 14 patients were satisfied after surgery and nine were not. Three patients required revision surgery (two synovial fistulas, one hematoma).

Descriptive study on the efficacy of artemether-lumefantrine in the treatment of uncomplicated Plasmodium falciparum malaria in Sudan

The aim of this study was to investigate the efficacy of artemether-lumefantrine in treating uncomplicated Plasmodium falciparum malaria in four sentinel areas in Sudan with different malaria transmission (Damazin, Sinnar, and Kosti in the north, and Juba in the south). World Health Organization protocol for assessing antimalarial drug efficacy in treating uncomplicated P. falciparum malaria was employed. A total of 2,139 patients were screened, and 771 had P. falciparum monoinfection. Only 291 met the enrollment criteria and gave written consent to be recruited in the study. Patients were treated with artemether-lumefantrine tablets in a six-dose regimen calculated according to body weight. Tablets were given at 0, 8, 24, 36, 48, and 60 h. Patients were followed up for 28 days. A total of 291 patients were recruited to the study, of whom ten [3.4; 95% confidence interval (CI):1.8-6.4%] patients showed early treatment failure (ETF) or late clinical failure (LCF) and were excluded from further follow-up. Of the remaining 281 patients, 276 (98.2%; 95% CI: 95.7-99.3%) completed the 28-day follow-up. Of these, 274 (99.3%; 95% CI: 97.1-99.9%) had adequate clinical and parasitological response (ACPR), and two (0.7%; 95% CI: 0.13-2.9%) showed late parasitological failure (LPF) at days 21 and 28. The overall mean +/- standard deviation (SD) of parasitemia and fever clearance times were 36.4 (23.7) h and 34.6 (19.2) h, respectively. Mild and reversible adverse effects were reported by 11 patients (3.8%; CI: 2.0- 7.0%) and were relieved without the need for termination of drug therapy or supportive treatment. Our findings showed that artemether-lumefantrine was an effective and safe drug for treating uncomplicated P. falciparum malaria in northern and southern Sudan.

Considerations for Introduction of a Rotavirus Vaccine in Oman: Rotavirus Disease and Economic Burden

Rotavirus is the most common cause of fatal childhood diarrhea worldwide. We provide the first estimates of the health care and economic burden of severe rotavirus disease in Oman. We conducted active, hospital-based surveillance of rotavirus disease at 11 regional public hospitals in Oman, using the guidelines suggested by the generic World Health Organization protocol. From July 2006 through June 2008, all children aged <5 years who were hospitalized for acute gastroenteritis were enrolled in the surveillance program, and their stool samples were tested for rotavirus using a commercially available enzyme immunoassay (ID EIA Rotavirus Test; Dako Diagnostics). Rotavirus was detected in samples from 1712 (49%) of 3470 children. These children were hospitalized for a median of 3 days for severe diarrhea. A marked seasonal peak was evident with a majority of the cases occurring from December through May. Of the rotavirus cases, 69% occurred in children aged 6-17 months. We identified a diverse strain pattern in Oman, with G2 (37%), G1 (38%), and G9 (11%) accounting for most of typeable strains. By our burden estimates, the Omani government spends an estimated US$791,817 and US$1.8 million annually to treat rotavirus-associated diarrhea in the outpatient and hospital settings, respectively. A rotavirus vaccination program might substantially reduce the burden of severe diarrhea among children in Oman.

Evaluation of a protocol for rapid diagnosis of enterovirus associated with acute flaccid paralysis cases

Background The virological surveillance of acute flaccid paralysis (AFP) is a critical component of the initiative of the World Health Organization (WHO) to eradicate poliomyelitis worldwide. Furthermore rapid methods are needed either to detect or rule out the presence of polioviruses during the late stages of eradication, especially in polio-free areas. Objectives The aim of this study was to evaluate a fast protocol combining one passage (5 days) in cell culture followed by RT-PCR and molecular typing in order to detect and type poliovirus (PV) and other enteroviruses associated with AFP cases. Study design A total of 216 fecal suspensions from AFP suspected cases were tested by using this approach and compared with the WHO gold standard. Results Using the WHO protocol enterovirus was detected in 12 out of the 216 AFP samples (5.55%) while with the proposed protocol enterovirus was detected in 15 out of the 216 AFP samples (6.94%). The additional positive samples detected by the proposed method were classified as non-polio enteroviruses (NPEV). Conclusions The proposed protocol showed higher sensitivity than the WHO gold standard, reducing the entire process of identification and typing of the isolates from the typically 14–21 days to only ∼6–8 days.

Decline in hospital mortality rate after the use of the World Health Organization protocol for management of severe malnutrition

We studied the implementation of the World Health Organization protocol for the treatment of malnourished children at the largest maternal and infant hospital in the northeast of Brazil. The implementation of the protocol resulted in a reduction in the mortality rate from 38.0% to 16.2%.

Nicotine, Tar, and Mutagenicity of Mainstream Smoke Generated by Machine Smoking with International Organization for Standardization and Health Canada Intense Regimens of Major Japanese Cigarette Brands

Based upon the Framework Convention on Tobacco Control (FCTC), the World Health Organization (WHO) ha sr ecommended that health authorities disclose toxicological properties of cigarette mainstream smoke (MSS) obtained not only according to US Federal Trade Commission (FTC)/International Organization for Standardization (ISO) conditions but also by more intense conditions such as the Health Canada Intense (HCI) condition. This is because smokers are believed to smoke more intensely than machine smoking under the ISO regimen. Because there are no previous reports on the toxicological properties of MSS of Japanese cigarettes under the HCI condition, we determined nicotine and water contents by gas chromatography (GC-MS and GC/Thermal Conductivity Detector (TCD)) for three product lots each of the ten bestselling brands of Japanese cigarettes following the WHO protocol. One of the three lots of each MSS condensate was also resolved in dimethylsulfoxide and investigated by Ames preincubation assay using Salmonella typhimurium TA100, TA98, and YG1024 strains with and without metabolic activation (rat liver S9 mix). Nicotine and tar yields with the HCI regimen were higher than those with ISO, the latter being very close to the values described on the packages of each cigarette brand. Mutagenicity was mainly observed in TA98 and YG1024 with metabolic activation. Mutagenic activity of MSS with the HCI regimen was 1.4–9 times higher than that with the ISO regimen. Based on YG1024 with activation, high activities were observed in several “low yield” brands. The activity of “low-yield” brands with the HCI regimen was not always lower than that of regular-yield brands with the ISO regimen. These results suggest that “low yield” cigarettes do not result in reduced exposure or reduced risk to humans.

Wheezing and Respiratory Infections in Brazilian Children: Does a Standard Management Work?

Wheezing associated with acute respiratory infections (ARI) is responsible for unnecessary use of antibiotics. To evaluate the response of children with ARI and wheezing managed according to the World Health Organization (WHO) protocol. Cross-sectional study of children aged 2-59 months conducted in a Brazilian pediatric public hospital. Children showing fast breathing received inhalations of bronchodilator. Those who persisted with fast breathing had chest radiographs taken. When appropriate, oral antibiotics were prescribed for pneumonia. Audible wheezing was also registered. We included 217 children: mean age 25.7 months (SD = 17.5) with 54.4% (118/217) being males. Audible wheezing was detected in 18.6% (40/217). In 87.6% (190/217) of children normal respiratory rates were reached after inhalations. In cases of pneumonia, 26% (7/27) persisted with fast breathing. A good response using WHO protocol suggests its usefulness in emergency rooms, although few cases will continue to receive antibiotics unnecessarily.