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Middle eastern clinical medicine. A concise text-book
TRANSACTIONS OF THE ROYAL SOCIETY OF TROPICAL MEDICINE AND HYGIENE (1995) 89, BOOK REVIEWS
1Book Reviews 1 Vaccination and World Health. F. T. Cutts & P. G. Smith (editors). Chichester & New York: John Wiley & Sons, 1994. xiv + 294 pp. Price E32.95. ISBN O-471-95242-7. This timely volume summarizes the proceedings of the London School of Hygiene and Tropical Medicine’s Fourth Annual Public Health-Forum which took place between 18 and 20 Anril 1994. There were 11 ‘Plenarv Session Addresses’, 6 ‘Workshop Reports’, and 2 ‘Closing Session Addresses’. In all, 45 contributorswith 9 exceptions (Congo, Thailand, India, Uganda, Peru, Zimbabwe, Cameroon, and Ghana [2]), from
701
This book is essentially a Saudi Arabian production, since the 2 editors and 4 contributors were based in either Rivadh or Jeddah, the 2 major cities. The result is a balanced hew of internal (or general) adult medicine as it presents in Saudi Arabia per se, but the general principles are applicable to neighbouring countries. In the Preface, the editors state that they have given most attention to diseases which are a major problem in the region, or in which there are differences in presentation, features, or management from the same disease observed elsewhere. This intention has been implemented in much of the text, but in some sections, standard ‘western’ medicine has been reproduced with only a token reference to regional differences. Hopefully this will be rectified in further editions. The 13 chapters consider the major branches of medicine in turn, beginning with the largest section, ‘Communicable and tropical diseases’, which constitutes one-fifth of the book. Neurology, and ‘diseases of the blood and lymphoid system’, are also detailed at length (haematological problems, particularly the haemoglobinopathies, are a major problem in the Middle East). After the chapter on ‘Diseases of the endocrine system’, ‘Diabetes mellitus,’ which figures so prominently in Middle Eastern medicine., is appropriately accorded a chapter to itself. The difficulties that diabetics face during the Holy Month of Ramadan (when adult Muslims fast from dawn to dusk) are elucidated. The book concludes with a chapter on ‘Diseases caused by physical, chemical and animal agents,’ which include heat stroke, snake bite and scorpion sting, all of which are of regional importance. At the end of each chapter, under ‘Further reading,’ 2 or 3 speciality textbooks are recommended, and under ‘Key references’ there is a list of a dozen or more journal references on relevant regional studies, many from Saudi Arabian journals. The latter is a particularly valuable feature of this book, providing information that cannot easily be obtained elsewhere. Inevitably, there are a few minor controversial points or important omissions in the text. For example, in the treatment of a comatose patient with cerebral malaria who presents anywhere in the region, because chloroquine resistance is now widespread (and may appear unexpectedly anywhere), intravenous quinine and not chloroquine should be administered immediately (p. 77). In addition, a diagnostic lumbar puncture should be performed to exclude coexistent meningitis, and a single dose of phenobarbitone (3.5-5 mg/kg) given by intramuscular or intravenous injection, since prevention of seizures significantly improves the prognosis. Falciparum malaria is widely endemic in Oman (p. 74). Although it has been suspected that an unidentified virus may contribute to the pathogenesis of multiple sclerosis, evidence that a prion (slow virus) is involved is lacking (p. 368). It is generally accepted that there are no sea snakes in the Red Sea (p. 535). It would be of value to add a section on the medical implications of the annual pilgrimage to Mecca (the Hujj>. During this week-long period, when over one million pilgrims from overseas flock to Mecca, epidemics of various disease-including cholera, meningococcal meningitis, influenza and, more recently, dengue-have been a recurring event, and these are of clinical and epidemiological importance to the whole of the Middle East. In Middle Eastern countries (as elsewhere), students whose first language is not English have the daunting task of choosing a basic study text from the many large textbooks. Most of these are filled with a welter of facts, are difficult to read, and are really suitable only for reference. This small text, on the other hand, provides the essential facts of internal medicine in a nutshell, and a senior student who knew this text thoroughly would be well equipped. The book is well written and concise, and the information is logically presented with clear listing of key points, which make it easy to refer to and to assimilate. It will also be suitable for busy young doctors as a primer and handbook, and for clinicians in specialties other than internal medicine who require a speedy desk reference. It will be useful for expatriate doctors coming to work in the Middle East, or those based in the
702 UK, Europe or elsewhere, who need a quick briefing when they encounter Middle Eastern patients. The print is large and easy to read, and there is a wide margin at the foot of the page where a note or 2 can be made. The book measures 17.5x9.5 cm, and is 3 cm thick; thus it can easily be carried in a small bag or briefcase, or a commodious pocket. Euan M. Scrimgeour Department of M edicine Sultan Qaboos Universiry Al-Khod 123 Muscat Sultanate of Oman Travel-associated Disease. G. C. Cook (editor). London: Royal College of Physicians of London, 1995. xii + 180~~. Price f15.00 (UK), f17.50 (elsewhere). ISBN l86016-012-3. Many people find diseases associated with travel interesting but that, of itself, does not make the subject one which need concern those who plan health care or educate health carers. Is travel really a significant threat to the health of the public or is so-called travel medicine actually little more than an excuse for annual junkets in places like Acapulco? Or, if you were to accept that 31 million visits abroad by UK residents in 1990 gave international travel a dimension which was bound to impact significantly on health, then is not travel medicine a subject which is little more than a particular application of tropical medicine and hygiene? In my opinion, travel medicine is a legitimate special interest. Travel is now responsible for literally millions of episodes of illness amongst British travellers each year - and most of these were acquired outside the tropics. The breadth of travel-related illness tends to perplex doctors accustomed to organ-based specialization, with trauma and degenerative vascular diseases causing most deaths and diarrhoea most morbidity away from home, and 3 very different infections, HIV, malaria and legionellosis, leading to most travel-related deaths after return. The breadth of the field, the great scope for prevention at a personal level, and the importance of early recognition of imported disease, all mean that general practitioners have the most need for knowledge of travel-associated disease and are entitled to be considered a prime audience when the subject is written or spoken about. Travel-associated Disease is a well presented book which consists of the edited presentations to a symposium held at the Royal College of Physicians in June 1994. There are chapters on the epidemiology and economics of travellers’ diseases, on more or less specific diseases such as malaria and travellers’ diarrhoea, on accidents, sex tourism, and prevention. The only obvious omissions to my eyes are melanoma and legionellosis. The latter merits just 2 brief passing nods whereas malaria, which kills no more travellers, deservedly rates its own chapter and much attention in others. The large subject of prevention of disease in travellers is very well handled by Robert Steffen, who eschews the ‘if there’s a vaccine we should give it’ philosophy for as logical a riskbenefit assessment as the evidence allows. Unfortunately the chapter on prevention of viral hepatitis is not related to travel at all and, for example, makes no mention of the possible travel risks of hepatitis C. As a textbook, as opposed to a symposium, this work would be improved by a more systematic approach to what the risks are, how the traveller should be educated in order to minimize them, and how doctors back home can minimize the morbidity and mortality of imported disease. Even as it stands, however, there is no better compendium of relevant data currently available. C. J. Ellis Debartment of Infection and TroPical Medicine Bihningham kle&lands Hospital Bordesley Green East Birmingham, B9 SST, UK Parasites in Human Tissues. T. C. Orihel & L. R. Ash. Chicago: ASCPL [American Society of Clinical Pathologists]
Press, 1995. xxi + 386 pp. Price US$ 165 ($145 to ASCP members). ISBN O-89189-379-2. This beautifully produced book is a joy to look at and a delight to possess. It consists essentially of over 700 excellent colour photomicrographs of protozoan, hehninth and arthropod parasites, mostly photographed (as the title implies) in sections of human tissues but also, when appropriate, in blood films, faecal preparations, etc. In addition there is a page or two of concise descriptive text for each group of organisms, and a rather longer section (up to half a dozen or so pages) on each major group. There are also 4 Tables, each spread over two 2 1x 28 cm pages, showing with the aid of rather luridly coloured boxes which parasites inhabit which tissues, a short introduction, a short section on identilication, a useful glossary (41/z pages), 70-80 ‘recommended references’ and a good index (8 pages). A few clinical photographs (e.g., that old standby elephant&is) and electron micrographs (Cyptosporidium and Microsporida) are included. It is genuinely hard to find fault with this book. It is not, nor is it intended to be, a reference or text book. But it complements these, and contains a truly unsurpassed collection of micrographs which will be invaluable in assisting clinicians and laboratory workers to make correct diagnoses of parasitic infections. It is perhaps a pity that there is no series of micrographs illustrating the different species of Plasm+ dium which infect humans although it is true, as the authors state, that these have ‘been well described’; only two ‘rings’ and a macrogametocyte of P. fakiparum represent the bloodstream stages of malaria parasites. The book ends with a salutary section on artefacts [spelled, US style, ‘artifacts’], together with the misdiagnoses to which they gave rise. Commendably, all the illustrations grouped into Plates give the relevant stain used and the magnification. Oddly, however, this is not done for the relatively few micrographs printed singly in the introductory texts. In summary, a highly recommended acquisition for parasitologists, laboratory workers and tropical clinicians. Buy it, if you’re not lucky enough to get a review copy. John Baker Royal Society of Tropical Medicine and Hygizne Manson House 26 Portland Place London, WIN 4EY, UK Onchocerciasis and its Control. Report of a WHO Expert Committee on Onchocerciasis Control. Geneva: World Health Organization, 1995. WHO Technical Report Series, no. 852. viii + 103~~. Price SW. fr. 15/US$l3.50 (in developing countries SW. fr. 10.50). ISBN 91-4-120852-X. (Available in English and French: Soanish version in oreoaration). We hav; come to expectauthoritative accounts ;o be published in the WHO Technical Report Series and this one on onchocerciasis and its control is no exception. Although great strides have been made, particularly in West Africa, in controlling onchocerciasis the disease remains endemic in 34 countries, with an estimated 17.7 million infected people. The present publication provides an update on epidemiology and control of the disease in a format that can be understood by non-specialists. Following a brief introduction there are 11 chapters describing the parasites, vectors, disease, its social and economic impact, diagnosis and surveillance, treatment, vector control, chemotherapy, and evaluation of control, all of which end with useful suggestions for further study. There follows an important chapter on the sustain-ability of ivermectin programmes, another on training aspects, and finally lists of conclusions and recommendations. The publication concludes with 50 references and an appendix on a classification or grading system for recording the cutaneous changes caused by onchocerciasis. Understandably, and justifiably, there is considerable coverage of the Onchocerciasis Control Programme (OCP), which will cease operations in the year 2000 with devolution of responsibilities for control to the
1Book Reviews 1 Vaccination and World Health. F. T. Cutts & P. G. Smith (editors). Chichester & New York: John Wiley & Sons, 1994. xiv + 294 pp. Price E32.95. ISBN O-471-95242-7. This timely volume summarizes the proceedings of the London School of Hygiene and Tropical Medicine’s Fourth Annual Public Health-Forum which took place between 18 and 20 Anril 1994. There were 11 ‘Plenarv Session Addresses’, 6 ‘Workshop Reports’, and 2 ‘Closing Session Addresses’. In all, 45 contributorswith 9 exceptions (Congo, Thailand, India, Uganda, Peru, Zimbabwe, Cameroon, and Ghana [2]), from
701
This book is essentially a Saudi Arabian production, since the 2 editors and 4 contributors were based in either Rivadh or Jeddah, the 2 major cities. The result is a balanced hew of internal (or general) adult medicine as it presents in Saudi Arabia per se, but the general principles are applicable to neighbouring countries. In the Preface, the editors state that they have given most attention to diseases which are a major problem in the region, or in which there are differences in presentation, features, or management from the same disease observed elsewhere. This intention has been implemented in much of the text, but in some sections, standard ‘western’ medicine has been reproduced with only a token reference to regional differences. Hopefully this will be rectified in further editions. The 13 chapters consider the major branches of medicine in turn, beginning with the largest section, ‘Communicable and tropical diseases’, which constitutes one-fifth of the book. Neurology, and ‘diseases of the blood and lymphoid system’, are also detailed at length (haematological problems, particularly the haemoglobinopathies, are a major problem in the Middle East). After the chapter on ‘Diseases of the endocrine system’, ‘Diabetes mellitus,’ which figures so prominently in Middle Eastern medicine., is appropriately accorded a chapter to itself. The difficulties that diabetics face during the Holy Month of Ramadan (when adult Muslims fast from dawn to dusk) are elucidated. The book concludes with a chapter on ‘Diseases caused by physical, chemical and animal agents,’ which include heat stroke, snake bite and scorpion sting, all of which are of regional importance. At the end of each chapter, under ‘Further reading,’ 2 or 3 speciality textbooks are recommended, and under ‘Key references’ there is a list of a dozen or more journal references on relevant regional studies, many from Saudi Arabian journals. The latter is a particularly valuable feature of this book, providing information that cannot easily be obtained elsewhere. Inevitably, there are a few minor controversial points or important omissions in the text. For example, in the treatment of a comatose patient with cerebral malaria who presents anywhere in the region, because chloroquine resistance is now widespread (and may appear unexpectedly anywhere), intravenous quinine and not chloroquine should be administered immediately (p. 77). In addition, a diagnostic lumbar puncture should be performed to exclude coexistent meningitis, and a single dose of phenobarbitone (3.5-5 mg/kg) given by intramuscular or intravenous injection, since prevention of seizures significantly improves the prognosis. Falciparum malaria is widely endemic in Oman (p. 74). Although it has been suspected that an unidentified virus may contribute to the pathogenesis of multiple sclerosis, evidence that a prion (slow virus) is involved is lacking (p. 368). It is generally accepted that there are no sea snakes in the Red Sea (p. 535). It would be of value to add a section on the medical implications of the annual pilgrimage to Mecca (the Hujj>. During this week-long period, when over one million pilgrims from overseas flock to Mecca, epidemics of various disease-including cholera, meningococcal meningitis, influenza and, more recently, dengue-have been a recurring event, and these are of clinical and epidemiological importance to the whole of the Middle East. In Middle Eastern countries (as elsewhere), students whose first language is not English have the daunting task of choosing a basic study text from the many large textbooks. Most of these are filled with a welter of facts, are difficult to read, and are really suitable only for reference. This small text, on the other hand, provides the essential facts of internal medicine in a nutshell, and a senior student who knew this text thoroughly would be well equipped. The book is well written and concise, and the information is logically presented with clear listing of key points, which make it easy to refer to and to assimilate. It will also be suitable for busy young doctors as a primer and handbook, and for clinicians in specialties other than internal medicine who require a speedy desk reference. It will be useful for expatriate doctors coming to work in the Middle East, or those based in the
702 UK, Europe or elsewhere, who need a quick briefing when they encounter Middle Eastern patients. The print is large and easy to read, and there is a wide margin at the foot of the page where a note or 2 can be made. The book measures 17.5x9.5 cm, and is 3 cm thick; thus it can easily be carried in a small bag or briefcase, or a commodious pocket. Euan M. Scrimgeour Department of M edicine Sultan Qaboos Universiry Al-Khod 123 Muscat Sultanate of Oman Travel-associated Disease. G. C. Cook (editor). London: Royal College of Physicians of London, 1995. xii + 180~~. Price f15.00 (UK), f17.50 (elsewhere). ISBN l86016-012-3. Many people find diseases associated with travel interesting but that, of itself, does not make the subject one which need concern those who plan health care or educate health carers. Is travel really a significant threat to the health of the public or is so-called travel medicine actually little more than an excuse for annual junkets in places like Acapulco? Or, if you were to accept that 31 million visits abroad by UK residents in 1990 gave international travel a dimension which was bound to impact significantly on health, then is not travel medicine a subject which is little more than a particular application of tropical medicine and hygiene? In my opinion, travel medicine is a legitimate special interest. Travel is now responsible for literally millions of episodes of illness amongst British travellers each year - and most of these were acquired outside the tropics. The breadth of travel-related illness tends to perplex doctors accustomed to organ-based specialization, with trauma and degenerative vascular diseases causing most deaths and diarrhoea most morbidity away from home, and 3 very different infections, HIV, malaria and legionellosis, leading to most travel-related deaths after return. The breadth of the field, the great scope for prevention at a personal level, and the importance of early recognition of imported disease, all mean that general practitioners have the most need for knowledge of travel-associated disease and are entitled to be considered a prime audience when the subject is written or spoken about. Travel-associated Disease is a well presented book which consists of the edited presentations to a symposium held at the Royal College of Physicians in June 1994. There are chapters on the epidemiology and economics of travellers’ diseases, on more or less specific diseases such as malaria and travellers’ diarrhoea, on accidents, sex tourism, and prevention. The only obvious omissions to my eyes are melanoma and legionellosis. The latter merits just 2 brief passing nods whereas malaria, which kills no more travellers, deservedly rates its own chapter and much attention in others. The large subject of prevention of disease in travellers is very well handled by Robert Steffen, who eschews the ‘if there’s a vaccine we should give it’ philosophy for as logical a riskbenefit assessment as the evidence allows. Unfortunately the chapter on prevention of viral hepatitis is not related to travel at all and, for example, makes no mention of the possible travel risks of hepatitis C. As a textbook, as opposed to a symposium, this work would be improved by a more systematic approach to what the risks are, how the traveller should be educated in order to minimize them, and how doctors back home can minimize the morbidity and mortality of imported disease. Even as it stands, however, there is no better compendium of relevant data currently available. C. J. Ellis Debartment of Infection and TroPical Medicine Bihningham kle&lands Hospital Bordesley Green East Birmingham, B9 SST, UK Parasites in Human Tissues. T. C. Orihel & L. R. Ash. Chicago: ASCPL [American Society of Clinical Pathologists]
Press, 1995. xxi + 386 pp. Price US$ 165 ($145 to ASCP members). ISBN O-89189-379-2. This beautifully produced book is a joy to look at and a delight to possess. It consists essentially of over 700 excellent colour photomicrographs of protozoan, hehninth and arthropod parasites, mostly photographed (as the title implies) in sections of human tissues but also, when appropriate, in blood films, faecal preparations, etc. In addition there is a page or two of concise descriptive text for each group of organisms, and a rather longer section (up to half a dozen or so pages) on each major group. There are also 4 Tables, each spread over two 2 1x 28 cm pages, showing with the aid of rather luridly coloured boxes which parasites inhabit which tissues, a short introduction, a short section on identilication, a useful glossary (41/z pages), 70-80 ‘recommended references’ and a good index (8 pages). A few clinical photographs (e.g., that old standby elephant&is) and electron micrographs (Cyptosporidium and Microsporida) are included. It is genuinely hard to find fault with this book. It is not, nor is it intended to be, a reference or text book. But it complements these, and contains a truly unsurpassed collection of micrographs which will be invaluable in assisting clinicians and laboratory workers to make correct diagnoses of parasitic infections. It is perhaps a pity that there is no series of micrographs illustrating the different species of Plasm+ dium which infect humans although it is true, as the authors state, that these have ‘been well described’; only two ‘rings’ and a macrogametocyte of P. fakiparum represent the bloodstream stages of malaria parasites. The book ends with a salutary section on artefacts [spelled, US style, ‘artifacts’], together with the misdiagnoses to which they gave rise. Commendably, all the illustrations grouped into Plates give the relevant stain used and the magnification. Oddly, however, this is not done for the relatively few micrographs printed singly in the introductory texts. In summary, a highly recommended acquisition for parasitologists, laboratory workers and tropical clinicians. Buy it, if you’re not lucky enough to get a review copy. John Baker Royal Society of Tropical Medicine and Hygizne Manson House 26 Portland Place London, WIN 4EY, UK Onchocerciasis and its Control. Report of a WHO Expert Committee on Onchocerciasis Control. Geneva: World Health Organization, 1995. WHO Technical Report Series, no. 852. viii + 103~~. Price SW. fr. 15/US$l3.50 (in developing countries SW. fr. 10.50). ISBN 91-4-120852-X. (Available in English and French: Soanish version in oreoaration). We hav; come to expectauthoritative accounts ;o be published in the WHO Technical Report Series and this one on onchocerciasis and its control is no exception. Although great strides have been made, particularly in West Africa, in controlling onchocerciasis the disease remains endemic in 34 countries, with an estimated 17.7 million infected people. The present publication provides an update on epidemiology and control of the disease in a format that can be understood by non-specialists. Following a brief introduction there are 11 chapters describing the parasites, vectors, disease, its social and economic impact, diagnosis and surveillance, treatment, vector control, chemotherapy, and evaluation of control, all of which end with useful suggestions for further study. There follows an important chapter on the sustain-ability of ivermectin programmes, another on training aspects, and finally lists of conclusions and recommendations. The publication concludes with 50 references and an appendix on a classification or grading system for recording the cutaneous changes caused by onchocerciasis. Understandably, and justifiably, there is considerable coverage of the Onchocerciasis Control Programme (OCP), which will cease operations in the year 2000 with devolution of responsibilities for control to the