Cyclospora cayetanensis is emerging as an important cause of food-borne diarrheal outbreaks, especially in developed regions like the United States and Europe. We describe an outbreak of cyclosporiasis in Peruvian naval recruits that we believe to be the first among a local population in a developing region.
Protozoal diseases are increasingly recognized as the cause of diarrhoeal outbreaks in both developed and developing countries. Cyclospora cayetanensis has been responsible for several epidemics in the last decade. In March 2005, an outbreak of diarrhoea was identified in recruits at the Ancon Naval Base in Lima, Peru. A case-control study was carried out. The overall diarrhoea attack rate was 53% (45/85). Complete data from 52 recruits were available for the analysis; 37 met the criteria for case and 15 for control. The epidemic curve indicated a point source transmission, with cases occurring over 9 days with a peak on the fifth day. Cyclospora cayetanensis was found in 7/37(18.9%) cases and 1/15 (6.7%) controls via standard microscopic techniques. PCR for C. cayetanensis detected 20/35 (57.1%) cases and 3/15 (20%) controls, demonstrating the improved diagnostic yield of this technique. This is the second report to characterize an outbreak of diarrhoea due to C. cayetanensis in Peru among a local population. The epidemiology and clinical course were similar to other reported outbreaks in developed regions. PCR greatly increased the number of C. cayetanensis cases detected during this outbreak, allowing the correct identification of its aetiology.
In a double-blind, placebo-controlled comparative study in 60 patients with ankle sprains suffering from moderate to severe inflammation and tenderness, the efficacy and tolerability of 150 mg/day diclofenac potassium given for 7 days was superior to that of 1.2 g/day ibuprofen which was, in turn, superior to placebo. Efficacy was assessed by volumetric evaluation of inflammation of the injured ankle, tenderness on finger pressure, pain on movement and the severity of the joint injury. Patients used visual analogue scales to assess severity of pain at rest and on walking before and during treatment. Diclofenac potassium was significantly superior (P less than 0.02) to ibuprofen for all measures of efficacy (except severity of joint injury) and ibuprofen was consistently superior to placebo. No serious adverse effects were reported. In conclusion, diclofenac potassium has been demonstrated to be effective in the treatment of acute ankle sprains and it had a rapid onset of action and good tolerability.
An observer-blind comparative clinical study was carried out in 108 patients presenting with ankle sprains at an Accident and Emergency department. The efficacy and tolerability of diclofenac potassium (50 mg 3-times daily) was compared with that of piroxicam (20 mg once daily), and placebo. Patients were allocated at random to receive one or other of the three treatments for 7 days. There were 36 patients in each group. The analgesic and anti-inflammatory effects of treatment were assessed from volumetric measurements of inflammation at the injured ankle, tenderness, pain on passive movement, severity of the joint lesion, severity of pain at rest and on movement. The overall reductions in pain and inflammation were assessed at the end of the study. The results in patients treated with diclofenac potassium were significantly better than those in patients treated with piroxicam with respect to the improvement in pain on walking and the overall reduction in pain and inflammation, and both active treatments were superior to placebo. There was no significant difference between diclofenac potassium and piroxicam with respect to inflammation measured by volumetry, tenderness, and severity of pain at rest, but both active treatments were consistently superior to placebo. No serious adverse effects were reported. All the patients treated with diclofenac potassium and all those treated with piroxicam said that they would be willing to take the drug again; this was the case with only 27.8% of the placebo group. Diclofenac potassium can be considered an effective treatment for acute ankle sprains with a rapid onset of analgesic and anti-inflammatory action and good tolerability.
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