Médecine tropicale : revue du Corps de santé colonial
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The authors in the special issue devoted to humanitarian action use their own experience, analysis, and thought as a basis for identifying the challenges and stakes facing humanitarian action in the twenty-first century. They present their thoughts on the relevance of humanitarian intervention, on the need to combine emergency aid with development assistance, and on the development of governmental humanitarian action. In today's world there is a compelling obligation for communities with resources and means to undertake humanitarian action in the name of human dignity. ⋯ The need to coordinate action in the field is emphasized. Humanitarian actions are increasingly complex operations carried out in fast-changing situations by numerous players. As a result it has become more and more important that actors in the field know each other in order to work together efficiently and thus better reach their common goal of relieving and preventing human suffering in accordance with ethical principles.
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The classic definition of humanitarian action is any operation conducted for the purpose of helping to reduce human suffering. This concept can be expanded to include a notion of prevention. This expanded definition has opened a wide range of applications for humanitarian assistance. ⋯ The purpose of this article is to evaluate the need to make a clear-cut distinction between political and humanitarian objectives and thus between the actors associated with these goals. In this regard, the role of Military Health Corps Services will be presented in function of the principles underlying any humanitarian program. This article will also discuss areas of agreement and cooperation between the ICRC and Military Health Corps Services.
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Review Randomized Controlled Trial Comparative Study Clinical Trial
Malaria prophylaxis/radical cure: recent experiences of the Australian Defence Force.
Since the eighties, the Australian Defence Force has deployed soldiers in malaria-endemic areas: Cambodia, Somalia, Rwanda, Bougainville, and East Timor. Currently, doxycycline is used as first line prophylactic drug and mefloquine is recommended for those who cannot tolerate the antibiotic. In 1998, the Australian Defence Force participated in the evaluation of tafenoquine for prophylaxis of both falciparum and vivax malaria in Thai soldiers. ⋯ Seven soldiers in each arm developed vivax malaria after returning to Australia. These results indicate that tafenoquine is not superior to primaquine in preventing vivax malaria. However study participants preferred the shorter course using tafenoquine and operationally it was found to be more suitable than primaquine.
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Soldiers on duty in tropical areas are at high risk of malaria and need chemoprophylactic regimens which may ensure the best efficacy, tolerability and compliance. Current Italian Army guidelines are based on recent military experiences in tropical areas, where mefloquine prophylaxis was as well tolerated as combination treatment with chloroquine and proguanil but more effective and easier to comply with, at least among soldiers. ⋯ Doxycycline is the first choice regimen for mefloquine-resistant areas and an alternative to mefloquine when this medication is contraindicated or not tolerated. The combination chloroquine-proguanil represents the alternative chemoprophylactic regimen when mefloquine and doxycycline are contraindicated or not tolerated.
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A number of cases of Loa-encephalopathy have been reported following ivermectin (Mectizan) treatment for onchocerciasis in patients with high Loa microfilaraemia. A possible explanation for these severe reactions is the formation of micro-emboli in small brain vessels as a result of massive paralysis of Loa microfilariae in the blood. This suggests that encephalopathy might be prevented by giving an initial low dose of ivermectin to induce a more gradual action on the Loa microfilariae. ⋯ Blood smears were made daily from day 1 to 7 after treatment and then on days 15 and 30. Results showed no difference in the effect of the dosage level on Loa microfilaraemia. This finding suggests that an initial low dose of 3 mg Mectizan will not prevent encephalopathy following treatment for onchocerciasis.