bluuebunny/crossref_metadata_2025 huggingface dataset:
AGL24 acts as a promoter of flowering in Arabidopsis and is positively regulated by vernalization
Authors: Michaels Scott D. , Ditta Gary , Gustafson‐Brown Cindy , Pelaz Soraya , Yanofsky Martin , Amasino Richard M.
Published: March 2003

MADS‐domain‐containing transcription factors comprise a large family of regulators that have diverse roles in plant development, including the regulation of flowering time. AGAMOUS‐LIKE 20/SUPPRESSOR OF OVEREXPRESSION OF CONSTANS1 (SOC1) and FRUITFUL act to promote flowering, whereas FLOWERING LOCUS C (FLC), FLOWERING LOCUS M/MADS AFFECTING FLOWERING1, and SHORT VEGETATIVE PHASE are inhibitors of flowering. Here we report that AGAMOUS‐LIKE 24 (AGL24) also plays a role in the regulation of flowering time. agl24 mutants are late flowering and overexpression of AGL24 causes early flowering in wild‐type and late‐flowering‐mutant backgrounds. The effect of AGL24 overexpression is most pronounced in autonomous‐pathway‐mutant and FRIGIDA‐containing backgrounds. The behavior of AGL24 is most similar to that of SOC1. Like SOC1, AGL24 mRNA levels are upregulated by vernalization. Unlike SOC1, however, AGL24 mRNA levels are not affected by FLC, and therefore AGL24 may represent an FLC‐independent target of the vernalization pathway. There is also evidence for cross‐talk between AGL24 and SOC1. When overexpressed, SOC1 and AGL24 are able to upregulate each other's expression. Thus, AGL24 represents another component in a network of MADS‐domain‐containing transcription factors that regulate flowering time.
Alternatives to standard blood transfusion: availability and promise
Authors: Prowse
Published: March 2003

Largely due to concerns over safety, a wide variety of alternatives to the conventional blood bank products of red cells, platelet concentrates, plasma and fractionated plasma products are under development. This review attempts to survey the alternative therapies that are being developed, whether they provide viable solutions and what impact they might have on transfusion practice.
The reduction of HIV transfusion risk in southern Brazil in the 1990s
Authors: Kupek E. J.
Published: March 2003

A retrospective study of blood donor records was undertaken to obtain risk estimates for transfusing HIV‐contaminated blood due to an infectious window period in a large blood bank in the south of Brazil in the 1990s. An incidence/window period model was used to estimate HIV incidence and risk of seroconversion among 11 286 repeat donors with 8917 person‐years of follow‐up. Separate estimates were calculated for the periods of 1991–94, 1995–96 and 1997–99. Although the residual risk of HIV‐positive transfusion decreased from 1 : 5000 in 1991–94 and 1 : 3794 in 1995–96 to 1 : 48 777 in 1997–99, this is still almost 10 times higher than in developed countries. The risk reduction is likely to have resulted from improved donor selection. Despite a 10‐fold reduction in the risk of transfusing HIV‐contaminated blood because of the screening test's failure to detect the virus during the infectious window period in the 1990s, additional measures are urgently needed to reduce the risk further. To this end, PCR screening of pooled blood donations might be considered in areas of high HIV prevalence when justified by cost‐effectiveness calculations.
National audit of citrate toxicity in plateletpheresis donors
Authors: Makar Y. F. , Butler M. O. , Cockersole G. M. , Gabra G. , Serevitch J. M.
Published: March 2003

Summary  Citrate toxicity complicating plateletpheresis is not uncommon. However, the scale and severity of the problem have never been formally addressed. In order to answer these questions we undertook a national audit of 13 070‐platelet procedures throughout 17 apheresis centres in England over a 3‐month period from 1 April to 30 June 2000. A standard form was distributed to each centre to record the symptoms/signs of citrate toxicity which were then graded (grades 1–5) according to their severity. The following variables were studied to determine whether they influenced the frequency and severity of citrate toxicity:

The type of manufacturer's cell separator used (Cobe Spectra, Haemonetics, Baxter Amicus and Trima).

The type of procedure: single needle, dual needle, single, double or triple dose.

The way in which donors were instructed to report symptoms of citrate toxicity.

 Outcome  Plateletpheresis is a relatively safe procedure provided that donors who experience severe reactions receive appropriate treatment.

The incidence of severe citrate toxicity (0·03% procedures) is comparable to that of severe faints following whole blood donation, indicating a comparable margin of safety.

Donors should be warned of the symptoms of citrate toxicity at their first attendance only. More frequent reminders encourage donors to over‐report symptoms of mild citrate toxicity.
Effect of diaspirin cross‐linked haemoglobin (DCLHb™) on mean arterial pressure during cardiopulmonary bypass in swine
Authors: Ferrera R. , Hadour G. , Chiari P. , Montagna P. , Jegaden O. , Burhop K. , Lehot J. J.
Published: March 2003

Summary Diaspirin cross‐linked haemoglobin (DCLHb™) is a haemoglobin‐based oxygen carrier which had been proposed as a resuscitative solution to replace red cell transfusion in many clinical situations. The present study was designed to evaluate the effect of different volumes of DCLHb™ 10% (1, 5 and 10 mL kg−1) on the cardiovascular system during cardiopulmonary bypass (CPB), and to determine the effect of DCLHb™ (18 mL kg−1) when added directly to the CPB prime in anaesthetized swine. DCLHb™, when used as a priming solution, induced a significant increase (around 20%) in mean arterial pressure (MAP), which persisted during the entire period of CPB (P < 0·05) as compared with controls. Administration of increasing doses of DCLHb™ during the time course of CPB resulted in a progressive increase in MAP (P < 0·05), suggesting a linear dose–response relationship. Nicardipine, a calcium channel blocker, returned MAP to baseline. Finally, weaning of CPB was easier in animals that received DCLHb™, thereby suggesting a potential protective effect of free haemoglobin in this particular clinical situation.
Indirect haemagglutination test using monoclonal antibody‐affinity purified antigens for diagnosis of human paragonimiasis due to Paragonimus heterotremus
Authors: Maleewong W. , Intapan P. M. , Wongkam C , Pajongthanasaris M. P. , Morakote N. , Chaicumpa W.
Published: March 2003

An indirect haemagglutination test (IHA) using antigens purified by monoclonal antibody‐affinity chromatography was developed for the diagnosis of human paragonimiasis caused by Paragonimus heterotremus. Sera from patients with paragonimiasis (n= 30) were evaluated, along with sera from other parasitic infections (n= 92), pulmonary tuberculosis (n= 18) and healthy controls (n = 30). The sensitivity, specificity as well as positive and negative predictive value of the IHA, calculated at the prevalence of disease at 17.6%, were all 100%.
Cytopathic effects of Blastocystis hominis on Chinese hamster ovary (CHO) and adeno carcinoma HT29 cell cultures
Authors: Walderich Brigitte , Bernauer Sabine , Renner Markus , Knobloch Jürgen , Burchard Gerd‐Dieter
Published: March 2003

Blastocystis hominis isolates from asymptomatic carriers and symptomatic patients were cultured in vitro, purified from the co‐cultivated bacterial flora and tested for cytopathic effects on monolayers of Chinese Hamster Ovary (CHO) cells and Adeno Carcinoma HT29 cells. In the case of the CHO cells, living B. hominis cells and B. hominis cell lysates were able to cause significant cytopathic effects, which were dependent on the concentration of cells employed. Destruction of the cell monolayers was observed to the same extent with patient isolates derived from healthy or symptomatic B. hominis carriers. HT29 cells were less susceptible: B. hominis cells and cell lysates caused only minor effects which were not statistically significant. Culture filtrates of B. hominis exhibited cytopathic potential on CHO and HT29 cells; however, the control which consisted of filtrates from Robinson's cultures in which B. hominis failed to grow showed similar effects, too. Therefore the culture supernatants could not be proven to produce a specific cytopathic effect on CHO and HT29 cells.
Albendazole plus praziquantel versus albendazole alone as a pre‐operative treatment in intra‐abdominal hydatidosis caused by Echinococcus granulosus
Authors: Cobo  , Yarnoz  , Sesma  , Fraile  , Aizcorbe  , Trujillo  , Diaz‐de‐Liaño  , Ciga
Published: March 2003

Summary
objective To compare the effects of a combined medication of albendazole (10 mg/kg/day) plus praziquantel (25 mg/kg/day) to those of albendazole alone at different doses (10 and 20 mg/kg/day).

method The protoscoleces9 viability was studied in a consecutive series of patients affected by intra‐abdominal hydatidosis caused by Echinococcus granulosus. In all cases the drugs were given during the month prior to surgery.

results A significant increase of patients with nonviable protoscoleces was observed in the group treated with the scolicides combination compared to those treated with albendazole alone, both at a dose of 10 mg/kg/day (P = 0.004) and at a dose of 20 mg/kg/day (P = 0.03). Albendazole sulphoxide levels in serum and in cyst fluid were higher in patients given the combined therapy than in those who received only albendazole (10 mg/kg/day: P = 0.016; 20 mg/kg/day: P = 0.034). Levels in the cysts were not significantly different probably due to the sample size; nevertheless a lineal relation between the values obtained in serum and inside the cysts could be discerned in the patients treated with the combined medication.

conclusion Albendazole plus praziquantel is more effective than monotherapy with albendazole in the preoperative treatment of intra‐abdominal hydatidosis.
Chloroquine in Africa: critical assessment and recommendations for monitoring and evaluating chloroquine therapy efficacy in sub‐Saharan Africa
Authors: Bloland P. B. , Kazembe P. N. , Oloo A. J. , Himonga B. , Barat L. M. , Ruebush T. K.
Published: March 2003

Chloroquine‐resistant malaria is a major public health threat in sub‐Saharan Africa. While a few countries have already replaced chloroquine as the first‐line therapy for uncomplicated malaria or are in the process of doing so, other countries are faced with the complicated task of assessing the current status of drug resistance, making national policy‐level decisions about whether to replace chloroquine or not, and initiating a monitoring system to track changes in the efficacy of malaria therapy. There is currently no standardized approach for collecting and interpreting data on therapy efficacy. There is also no agreement as to how much chloroquine resistance or treatment failure is acceptable and how much warrants a change in treatment policy. Using data collected in 10 sites in eastern and southern Africa between 1990 and 1996, we have assessed the therapeutic response to chloroquine and investigated predictors of clinical success or failure. Based on these experiences and analyses, a standardized protocol for in vivo studies of the efficacy of malaria therapy and for approaches to designing monitoring systems are proposed. The process of making policy‐level decisions based on data collected by these systems is also discussed.
Upregulation of the chemokines Rantes, MCP‐1, MIP‐1a and MIP‐2 in early infection with Trypanosoma brucei brucei and inhibition by sympathetic denervation of the spleen
Authors: Li Yajuan Liu, Zhilun , Bakhiet Moiz
Published: March 2003

Summary We examined the induction of 4 chemokines during early experimental African trypanosomiasis using in situ hybridization and immunocytochemistry. mRNA expression and protein production of Rantes, MCP‐1, MIP‐1a and MIP‐2 were studied in splenocytes obtained at 0 h, 4 h and 12 h post‐infection. Splenic denervation was performed to study the role of the central nervous system in early infection. The mRNA for Rantes increased at 4 h and declined at 12 h, but the protein level was high at both time‐points. MCP‐1 and MIP‐1a had elevated mRNA and protein levels at 12 h post‐infection. MIP‐2 mRNA was high at both 4 h and 12 h, but the protein level was only increased at 12 h. Splenic denervation, but not sham operation, suppressed these responses. The upregulation of these chemokines during very early infection suggests a chemokine role in the developing immunopathology. The sympathetic nervous system may, however, participate in modulation of such early immune responses.
Community prevalence study of taeniasis and cysticercosis in Bali, Indonesia
Authors: Sutisna I. Putu , Fraser Alasdair , Kapti I. Nengah , Rodriguez‐Canul Rossanna , Widjana D. Putu , Craig Philip S. , Allan James C.
Published: March 2003

Summary Taenia solium, a human cestode parasite endemic throughout most of South‐east Asia, causes a number of public health and economic problems. The parasite is endemic in Bali due to a mix of cultural and religious practices. Immunoepidemiological investigation of three rural communities revealed a taeniasis prevalence of 0.72% (3/415). One of the three cases was due to Taenia solium, the other two to Taenia saginata. A further nine cases of Taenia infection were identified from patients from villages surrounding the chosen communities, suggesting that prevalence levels may be higher in other areas. Seroprevalence of human cysticercosis by immunoblot was 1.65% (6/363), though all cases were detected within a single community (6/115; prevalence 5.22%). Several other cases of subcutaneous cysticercosis were identified from local clinics, suggesting continued transmission of Taenia solium in the region. Other intestinal helminth parasites identified within the communities were Ascaris lumbricoides (29.9%), Trichuris trichiuria (33.9%) and hookworm (8.2%).
Little effect of praziquantel or artemisinin on clonorchiasis in northern Vietnam. A pilot study
Authors: Tinga Niels , Van De Nguyen , Vien Ha Viet , Van Chau Le , Toan Nguyen Duy , Kager Piet A. , de Vries Peter J.
Published: March 2003

Summary The first choice for treatment of Clonorchis sinensis infections is praziquantel. Experimental data suggest that artemisinin derivatives are active against C. sinensis.

The efficacy of both drugs against clonorchiasis was evaluated in a pilot study in clonorchiasis patients in an endemic area in the North of Vietnam. Twenty‐one patients received praziquantel 25 mg/kg o.d. for three days, the regular regimen in that area, and 21 patients were treated with artemisinin 500 mg b.i.d. for 5 days. Faecal egg counts were performed before as well as 6 days and 5 weeks after treatment. In the praziquantel group the faecal egg count decreased significantly from a mean value of 1632 eggs per gram faeces (epg) to 37 epg 5 weeks after treatment (P < 0.01) but, surprisingly, the eradication rate (95% confidence limit) at week 5 was only 29% (11–52%). In the artemisinin‐treated group the reduction of the egg count was insignificant: from 1103 to 542 epg (P > 0.05). The proportion of patients (95% c.l.) with C. sinensis eggs in their stool on week 5 was 90% (70–99%) in the artemisinin group and 71% (48–89%) in the praziquantel group (P > 0.05) and the eradication rate (95% c.l.) at week 5 was only 10% (1–30%). With a sensitivity of detection of eggs in stool > 0.89, this implies a statistically significant but clinically unsatisfactory reduction for treatment with praziquantel. Sensitivity is probably less. For artemisinin there was no significant reduction. In conclusion, for human clonorchiasis in the North of Vietnam, the efficacy of praziquantel 25 mg/kg o.d. for 3 days was unsatisfactory and artemisinin for 5 days is not an effective alternative.
Red cell glucose‐6‐phosphate dehydrogenase status and pyruvate kinase activity in a Nigerian population
Authors: May Jürgen , Meyer Christian G. , Großterlinden Lars , Ademowo Olusegun G. , Mockenhaupt Frank P. , Olumese Peter E. , Falusi Adeyinka G. , Luzzatto Lucio , Bienzle Ulrich
Published: March 2003

Summary Glucose‐6‐phosphate dehydrogenase A− (G6PD A−) deficiency is a common enzymopathy in Africa that sporadically leads to manifest haemolytic anaemia. It is not exactly known how far the haematological status of individuals with either homozygous or heterozygous G6PD A− deficiency differs from that of individuals with normal G6PD activity. In a field study in Nigeria, we determined G6PD gene variants, the corresponding G6PD and pyruvate kinase (PK) activities, and basic haematological parameters in clinically healthy individuals, who were, in part, asymptomatically infected by malaria parasites. Red blood cell counts and haemoglobin levels were lower in G6PD A− deficient than in G6PD normal subjects. PK activities were higher in G6PD deficients, indicating a younger red cell population in these individuals. These findings suggest that G6PD A− deficiency is accompanied by chronic subclinical haemolysis. As a consequence, the reduced life span of red cells leads to an impaired diagnosis of G6PD heterozygosity when applying routine biochemical methods.
Outbreak of cutaneous larva migrans in a group of travellers
Authors: Tremblay A. , MacLean J. D. , Gyorkos T. , MacPherson D. W.
Published: March 2003

Summary introduction  We describe an outbreak of cutaneous larva migrans (CLM) in a group of 140 holidaymakers to a resort in Barbados and the index case.

methods  A two‐page questionnaire was mailed to holidaymakers and 90% responded.

results  25.4% of respondents developed a rash consistent with CLM. Risk factors for developing the illness were younger age and less frequent use of protective footwear while walking to the beach. Patients had difficulty in obtaining a correct diagnosis during their initial medical consultation and in obtaining medication from pharmacies. Efficacious treatments were oral and topical thiabendazole.

conclusions  CLM can occur in a large proportion of people exposed to contaminated soil or sand. Protective footwear is effective in reducing infection. Thiabendazole is an efficacious treatment.
ELISA and Western Blotting tests in the detection of IgG antibodies to Taenia solium metacestodes in serum samples in human neurocysticercosis
Authors: Shiguekawa Kely Yoshiko Martins , Mineo José Roberto , de Moura Leandro Pajuaba , Costa‐Cruz Julia Maria
Published: March 2003

Summary A comparative study of total saline extract (SE) and cyst vesicular fluid (VF) of Taenia solium metacestodes by ELISA and Western blotting assay (WB) tests was conducted to detect IgG in sera for diagnosis of human cysticercosis. Sera were obtained and analysed by ELISA in 1 : 20 and 1 : 100 dilutions from 208 individuals: 22 confirmed neurocysticercosis (NC) (group 1), 101 suspected NC (group 2), 55 with various intestinal parasitosis (group 3) and 30 healthy individuals (group 4). The WB test was carried out on SE and VF extracts with and without reducing agent, 2‐β‐mercaptoethanol (2‐ME) in 20 sera of each group. WB using extracts without 2‐ME and ELISA at 1 : 100 dilution were compared in 20 sera from each group; sensitivity and specificity were calculated using samples from groups 1, 3 and 4. By ELISA, in the 1 : 100 sera dilution reactivity was reduced for both antigens without changes in the sensitivity of the test. By WB, antigens treated with 2‐ME demonstrated low specificity. For SE and VF antigens, the proteins of 24, 39–42, 47–52, 56, 64–68, 126–155 kDa and 18, 24, 26–28, 32–36, 47–52, 75 kDa, respectively, were considered immunodominant markers, with high indices of specificity, suggesting a profile for NC patients. However, as the sensitivity was found to be low, it might still not be a definitive test for NC when used alone. These data suggest WB as an indicative test to determine exposure to T. solium. ELISA and WB together may supply reliable results for the diagnosis of human cysticercosis, since appropriate purified antigens are not available yet.
Are there simple measures to reduce the risk of HIV infection through blood transfusion in a Zambian district hospital?
Authors: van Hoogstraten M. J. , Consten E. C. J. , Henny Ch P. , Heij H. A. , van Lanschot J. J. B.
Published: March 2003

Summary objective  To quantify the potential impact of simple measures to reduce the risk of iatrogenic HIV infection through blood transfusion in a Zambian district hospital.

methods  Three studies were conducted at St. Francis' Hospital, Katete, Zambia: (1) From 1991 to 1995 HIV seroprevalence among all listed blood donors and the impact of proper subgroup selection were studied retrospectively; (2) the sensitivity of locally used rapid antibody assays (HIV‐spot/Wellcozyme HIV 1 & 2) for the detection of HIV in donor blood and the influence of the expiration date of the tests on this sensitivity were determined prospectively from June 1993 until March 1994 by screening all consecutive surgical patients and blood donors; (3) the number of unnecessary blood transfusions was determined retrospectively from January 1995 through January 1996 and prospectively from February 1996 through March 1996, and possibilities to reduce the total number of blood transfusions were considered.

results  (1) Excluding prisoners, who have an HIV seroprevalence of 19–25%, from the donor population significantly reduces the overall HIV seroprevalence from 13–16% to 8–9% (P < 0.01). (2) Under local circumstances the sensitivity of the used rapid antibody assays was 6.8–17.9% lower than claimed by the manufacturer. Usage of non‐expired tests increased the sensitivity significantly from 88.2% to 91.7% (P < 0.05). (3) None of the 294 studied blood transfusions can be classified as inappropriate according to international standards.

conclusions  Simple measures such as proper subgroup selection among blood donors and correct use of non‐expired tests may decrease the risk of iatrogenic HIV transmission. Stricter indications for blood transfusions will not substantially reduce the number of transfusions.
Exposure to Schistosoma mansoni infection in a rural area in Brazil. II: Household risk factors
Authors: Bethony Jeffrey , Williams Jeff T. , Kloos Helmut , Blangero John , Alves‐Fraga Lucia , Buck Germaine , Michalek Arthur , Williams‐Blangero Sarah , LoVerde Philip T. , Corréa‐Oliveira Rodrigo , Gazzinelli Andrea
Published: March 2003

A number of studies have pointed out the potential importance of the household in the transmission of schistosomiasis. The clustering of domestic activities associated with water collection, storage, and usage can result in the sharing of transmission sites and infective water contact behaviours. In this study, we employed a variance component method to estimate effects due to individual risk factors and shared residence on the variance in faecal egg counts during Schistosoma mansoni infection. A suite of covariates, which included demographic, socioeconomic, water supply, and water contact behaviour terms, contributed 15% to the variance in faecal egg counts. Shared residence alone accounted for 28% of the variance in faecal egg excretion. When both the suite of covariates and shared residence were considered in the same model, shared residence still contributed 22% to the variance in infection intensity. These results point to the importance of shared residence as a means of capturing the complex interrelationship between shared demographic, socioeconomic, physical environmental, and behavioural factors that influence transmission of schistosomiasis at the household level.
Detection of IgG in cerebrospinal fluid for diagnosis of neurocysticercosis: evaluation of saline and SDS extracts from Taenia solium and Taenia crassiceps metacestodes by ELISA and immunoblot assay
Authors: Barcelos Ivanildes Solange da Costa , Mineo José Roberto , Silva Deise Aparecida de Oliveira , Ferreira Marcelo Simão , De Moura Leandro Pajuaba , Biondi Germano Francisco , Costa‐Cruz Julia Maria
Published: March 2003

We compared saline (S) and sodium dodecyl sulphate (SDS) extracts from Taenia solium (homologous species – HO) and Taenia crassiceps (heterologous species – HE) metacestodes in order to detect IgG by ELISA and immunoblot assay (IBA) in cerebrospinal fluid (CSF) for the diagnosis of human neurocysticercosis (NC). CSF samples were obtained from 93 patients. Of these, 40 had NC, five had a diagnosis of probable NC, nine had central nervous system schistosomiasis or strongyloidiasis and 39 had other neurological alterations. Samples were analysed by ELISA and the results were compared with IBA in all samples with confirmed and probable NC diagnosis, in all samples with other central nervous system parasitic infection, and in 10 of those with another neurological alterations. ELISA sensitivity was 100%, 85%, 95% and 87.5% for the S‐HO, S‐HE, SDS‐HO and SDS‐HE extracts, respectively, and ELISA specificity was 100% for S‐HO, S‐HE, SDS‐HO extracts and 97.9% for SDS‐HE antigen. Immunodominant peptides detected by IBA were, by decreasing percentage of recognition: 64–68 and 45 kDa for S‐HO; 108–114, 92–95, 64–68, 83 and 88 kDa for S‐HE; 64–68, 108–114, 77 and 86 kDa for SDS‐HO; and 108–114, 88 and 92–95 kDa for SDS‐HE. Overall the homologous antigenic extracts showed higher sensitivity than the heterologous extracts in the diagnosis of NC in CSF samples. The heterologous extracts contained most of the immunodominant peptides presented in the homologous extracts, which are recognized by IgG antibodies in CSF samples.
Pharmacokinetic investigations in patients from northern Angola refractory to melarsoprol treatment
Authors: Burri C. , Keiser J.
Published: March 2003

Melarsoprol, an organo‐arsenical drug, has been the drug of choice for late‐stage trypanosomiasis for 50 years. Because of the lack of alternatives any abatement of this medication will have a dramatic negative impact on the perspectives for patients. As a large number of patients refractory to melarsoprol treatment was recently reported from northern Uganda and northern Angola, we investigated in northern Angola whether interpatient pharmacokinetic differences influence the outcome of melarsoprol treatment. Drug levels were determined by a biological assay in serum and cerebrospinal fluid (CSF) of 22 patients. Nine patients could be successfully treated, eight were refractory and the outcome was unclear or no adequate follow‐up information was available for five patients. No differences in the pharmacokinetic parameters (maximum serum concentration Cmax, half‐life t1/2β, total clearance CL and the volume of distribution Vss) could be detected between the groups. Serum and CSF concentrations for all patients were in the expected range. This result indicates that other underlying factors are responsible for treatment failures.
Controlling malaria: challenges and solutions
Authors: Olliaro Piero , Taylor Walter R. J. , Rigal Jean
Published: March 2003

Antimalarial drug resistance is a major public health challenge and the principal reason for the erosion of efficacious treatments. Cost and the limited number of antimalarial drugs in current use impose considerable constraints on malaria control, especially in sub‐Saharan Africa. The paper describes a multilateral, multidisciplinary research project on artemisinin‐based combination therapy, which offers a new and potentially highly effective way to prevent or retard the development of drug resistance.
Vaccine‐modified measles in previously immunized children in Accra, Ghana: clinical, virological and serological parameters
Authors: Ishiwada Naruhiko , Addae Michael M. , Tetteh John K. A. , Yempewu Sena M. , Ofori‐Adjei David , Kamiya Hitoshi , Akanmori Bartholomew D.
Published: March 2003

Despite rapidly increasing measles immunization coverage, epidemics of measles occurred from January to March 2000 in some parts of Accra, the capital of Ghana. 44 cases of acute measles were diagnosed at three health facilities during the outbreaks, which we examined clinically and serologically. The peak incidence occurred among 6–12‐year‐olds, clinical symptoms were milder than the typical symptoms of measles, and fever was significantly less common. None of the cases developed complications and all recovered completely. Thirty‐eight (86.4%) were tested serologically; IgM antibodies were detected in 73.7% and IgG antibodies in 84.2% during the acute phase. Milder symptoms in a significant number of cases with measles IgG antibodies suggest that these are vaccine‐modified measles, attributable to waning antibodies and low circulation of wild type virus in an area of high vaccine coverage. Serological confirmation will be required for accurate diagnosis, if measles is to be eradicated or kept under control. It also seems likely that multiple dose immunization schedules will be needed in the future to maintain protective antibody levels and to protect children against measles in Ghana. This will eliminate the frequent outbreaks of measles involving immunized children.
Feasibility of an ultrasound service on district health care level in Botswana
Authors: Bussmann Hermann , Koen Emy , Arhin‐Tenkorang Dyna , Munyadzwe Grace , Troeger Jochen
Published: March 2003

OBJECTIVE To assess the clinical benefit and financial feasibility of an ultrasound service in a district hospital in Botswana.

METHOD An ultrasound service was established in the study hospital. Clinical and ultrasound‐aided diagnoses were compared in patients who met eligibility criteria laid down in an indication list.

RESULTS We enrolled 2309 patients over 18 months. The most frequent indications for ultrasound were pregnancy‐related diagnoses followed by gynaecological and hepato‐biliary disorders. Ultrasound assistance improved case management in 696 cases (30%) and led to an immediate change in management in 151 patients. Ultrasound diagnosis was used as gold standard to assess the accuracy of the clinical diagnosis of incomplete abortion (sensitivity 24%; positive predictive value, PPV 66%), pelvic mass (sensitivity 53%; PPV 69%), ectopic pregnancy (sensitivity 75%; PPV 28%), and gall bladder stones (sensitivity 30%; PPV 32%).

CONCLUSIONS Ultrasound improved case management for a wide diversity of clinical problems encountered on district health care level. The service proved to be affordable for the Botswana health care system.
Chrysops silacea biting densities and transmission potential in an endemic area of human loiasis in south‐west Cameroon
Authors: Wanji Samuel , Tendongfor Nicholas , Esum Mathias Eyong , Enyong Peter
Published: March 2003

We studied the biting densities of Chrysops silacea and the transmission of loiasis over 1 year in a regenerated forest in the south‐west province of Cameroon. A total of 3015 flies caught near a wood fire at ground level during rainy and dry seasons were identified morphologically and 1975 caught during the rainy season were dissected to determine their physiological age and infection rate. The prevalence of microfilaraemia in the human population in the study area was determined using the thick blood smear method. Chrysops silacea was the only species caught. The daily and seasonal biting cycle of C. silacea showed two peaks of activities, 9–11 a.m. and 2–4 p.m. The biting cycles of parous and nulliparous flies showed the same trends, but the density of nulliparous flies biting at all time of the day was 2–3 times higher. Chrysops silacea biting density was high during the rainy season (9.06 ± 6.88 flies/man/h) and lowest during the dry season (0.44 ± 0.75 flies/man/h). An infection rate of 1.72% and a monthly morning and afternoon transmission potentials of 120769.11 and 139016.64 infective head L3/man were observed, respectively, in the rainy season. Even though few Chrysops carried Loa loa infective larvae (0.7%), their parasite load was high, giving a high level of transmission of L. loa in the area. A total of 20.37% of the people examined for blood microfilariae were positive. These results suggest that the study area is an active focus of loiasis transmission.
Short Communication: Rabies post‐exposure management in South Africa: a telephonic survey used as a rapid tool for operational research
Authors: Durrheim D. N. , Speare R. , Petzer M.
Published: March 2003

Rabies is an important disease in rural South Africa, and vaccine and immunoglobulin are provided, at the State's expense, to humans following suspected exposure to rabies virus by bite, scratch or mucosal splash. Health facilities where post‐exposure treatment is available are listed, with contact telephone numbers, in national rabies guidelines. To verify the accuracy of this recently updated information, members of the national Rabies Advisory Group were tasked to complete a rapid survey. A simple standardized telephone interview technique was used. This revealed startling deficiencies in the availability of vaccine and immunoglobulin at the indicated sites and led to decisive corrective action. This `quick and dirty' survey technique provided valuable information for improving an important public health programme, and should be considered when auditing other health programmes, particularly where a means for validating responses is readily available.
Malaria prevention during pregnancy in unstable transmission areas: the highlands of Madagascar
Authors: Cot M. , Brutus L. , Pinell V. , Ramaroson H. , Raveloson A. , Rabeson D. , Rakotonjanabelo A. L.
Published: March 2003

Malaria transmission in Madagascar is highly variable from one region to the next, and the consequences of the disease on pregnant women and their foetuses are not fully documented. In midwestern Madagascar, the high‐transmission lowlands in the west of the country meet the central plateaux, where malaria is unstable because of the high altitude and annual indoor spraying of DDT since 1993. We studied five of the region's main maternity clinics. We began by interviewing sample groups of women of childbearing age living within the vicinity of each clinic. This enabled us to determine the extent to which they had accessed and made use of available maternal health services during pregnancy and delivery, and, hence, to estimate the feasibility of boosting the prophylaxis. We then spent a whole year (from June 1996 to May 1997) observing deliveries at the five clinics in order to gauge the prevalence of placental infection and its consequences on birthweight in various transmission situations. Although only between 2 and 15% of the women said that they had taken prophylaxis during their previous pregnancy, the vast majority had benefited from preventive care: 97% had attended an antenatal visit on at least one occasion and 84% had had the assistance of medical or paramedical staff during delivery, even when their homes were situated relatively far away from the clinic (76%). In total, we observed 1637 deliveries with a mean placental malaria prevalence rate of 8.1%. Individual prevalence rates, however, were found to differ significantly between the maternity clinics situated in the east (minimum 2.1%) and west (maximum 26.2%) of the region. There were also marked variations in line with the seasonal fluctuations in entomological transmission. On the whole, a greater percentage of low birthweights (LBWs) was recorded at the lowland clinics than at the highland ones (17.1% vs. 9.7%), possibly because of the higher malaria infection rate in low altitude areas. On the other hand, the relative risk of LBW linked to placental infection was far greater in the highlands [4.9 (3.3–7.3)] than in the lowlands [1.9 (1.2–3.0)]. Although the rate of placental malaria among women inhabiting the country's central plateaux may be low, it means that transmission – and, hence, the risk of LBW because of placental infection – still persists in spite of the indoor DDT spraying programme. For maximum efficacy, we recommend a combination of vector control (extended to lower altitude areas outside the current OPID zone) and preventive care – i.e. individual chemoprophylaxis – for all highland women during pregnancy.
Pharmacokinetics of sequential and simultaneous treatment with the combination chloroquine and sulfadoxine‐pyrimethamine in acute uncomplicated Plasmodium falciparum malaria in the Philippines
Authors: Bustos Dorina G. , Lazaro Jose Enrico , Gay Frederick , Pottier Anne , Laracas Catherine J. , Traore Boubacar , Diquet Bertrand
Published: March 2003

The efficacy and kinetics of the combination chloroquine plus sulfadoxine‐pyrimethamine (CQ + SP), given sequentially and simultaneously, were investigated in 32 patients with acute uncomplicated Plasmodium falciparum malaria in Palawan Island, the Philippines. Group 1 with 11 patients received oral CQ 25 mg/kg bw over 3 days followed by a single dose of SP (three tablets 250 mg S + 25 mg P) on Day 4 (CQ0 + SP4). Group 2 with 21 patients received a loading dose of CQ 10 mg/kg plus a single dose of SP three tablets on Day 0, and doses of CQ on Days 1 and 2 (CQ0 + SP0). Patients were followed‐up for 28 days until after the clinical and parasitological remission of the disease. Serum samples for CQ, des‐ethylchloroquine (DCQ), S and P levels were assayed by high‐pressure liquid chromatography with UV and spectrofluorometric detection (HPLC‐SF) to determine effective therapeutic concentrations achieved. Parasite and fever clearance times (PCT and FCT) in Group 1 were 48 and 33.5 h, respectively, and 39 and 24 h in Group 2. The parasite elimination half‐life (pt1/2) in the CQ + SP0 group was 2.5 h, significantly shorter than the CQ + SP4 group of 5.7 h (P=0.006). Late‐treatment failures (R I) were observed in 2/11 patients in Group 1 and in 2/21 patients in Group 2. Serum CQ and DCQ concentrations were effectively adequate. Group 1 pharmacokinetic parameters showed a median maximum concentration (Cmax), area under the curve (AUC) and elimination half‐life (t1/2) of 285 ng/ml, 2299 day ng/ml and 5.7 days for CQ, and 89 ng/ml 1845 day ng/ml and 7.3 days for DCQ, respectively. SP was not assayed in Group 1 because of very limited time points. In Group 2, the median Cmax, AUC and t1/2 for CQ and DCQ were at 283 ng/ml 1980 day ng/ml and 5.9 days for CQ and 220 ng/ml, 2680 day ng/ml and 8.5 days for DCQ, respectively. For S and P, the median Cmax, AUC and t1/2 were at 169 μg/ml, 2758 day ng/ml and 10.9 days for sulfadoxine, and 591 ng/ml, 3029 day ng/ml and 2.9 days for pyrimethamine, respectively. Both regimens were well tolerated with a minimum of side‐effects, mainly nausea and vomiting. The combination CQ + SP administered simultaneously on Day 0 is more efficacious than when administered sequentially. In the absence of an alternative treatment for acute uncomplicated malaria, this combination is well tolerated, and has an advantage over CQ or SP monotherapy, especially in countries where one drug is still highly effective.
First nationwide survey of the health of schoolchildren in Chad
Authors: Beasley Michael , Brooker Simon , Ndinaromtan Montanan , Madjiouroum Ester M. , Baboguel Marie , Djenguinabe Elie , Bundy Don A. P.
Published: March 2003

Survey data are presented from a nationwide survey of the health of schoolchildren in Chad. The country was stratified into distinct ecological zones based on satellite sensor environmental data. Twenty schools were visited and 1024 children aged between 6 and 15 years were included in the study. The overall prevalence of stunting, underweight, anaemia and goitre was 18.7, 16.5, 25.1 and 23.3%, respectively. Schistosoma haematobium, Schistosoma mansoni and hookworm were the only helminth species found with prevalences of 13.2, 1 and 32.7%, respectively. A greater proportion of boys were stunted, underweight, anaemic and infected with S. haematobium and hookworm than girls. Older children were more stunted, underweight and infected with S. haematobium and hookworm than younger children, but less anaemic. The prevalence of infection showed marked geographical heterogeneity, with hookworm prevalence being highest in the Sudanian and tropical zone, and S. haematobium being most prevalent in the Sahelian zone and the Logone and Chari basins in the west of the country. These data show that there is a high prevalence of helminth infection in Chad, but that treatment for S. haematobium and hookworm should be targeted to different geographical areas.
Plasmodium falciparum: use of a NANP19 antibody‐test for the detection of infection in non‐immune travellers
Authors: Knappik M. , Peyerl‐Hoffmann G. , Jelinek T.
Published: March 2003

Circumsporozoite (CS) antibodies are a reliable serological marker for the infection of Plasmodium falciparum. The purpose of this investigation was to construct and evaluate an enzyme‐linked immunosorbent assay test for the detection of CS antibodies. While the sensitivity of the newly developed test reached 78%, the specificity was 99%. In addition, the optimized kit was used to test for infection with P. falciparum in 1903 travellers that were recruited from a prospective study for malaria chemoprophylaxis. Sixty‐six of the 1903 patients (3.5%) showed elevated CS antigen antibody titres. However, seroconversion could only be demonstrated in 18 (0.95%) patients. Among those seroconverting, there was a significantly higher percentage of male travellers (1.28%) than female travellers (0.56%). Positive reactions were more frequent among returnees from West and East Africa (1.49 and 1.14%, respectively) than among those from other endemic areas, e.g. South America (n=0). Despite its limited sensitivity, this newly developed kit for CS antibody testing may be a valuable tool for the estimation of the risk for travellers in malarious regions to acquire an infection with P. falciparum. It may also be useful for the determination of the efficacy of malaria chemoprophylaxis for inhibiting outbreak of disease.
Lower levels of the circulating neuropeptide somatostatin in Schistosoma mansoni infected patients may have pathological significance
Authors: Chatterjee Shyama , Mbaye Amadou , Van Marck Eric
Published: March 2003

In recent years, cases of severe morbidity (fibrosis, haematemesis, hepatosplenomegaly, ascites) caused to Schistosoma mansoni infections are on the rise in Northern Senegal. The neuropeptide somatostatin is reported to decrease portal pressure, control variceal bleeding and fibrosis, and reduce Schistosoma‐caused clinical morbidity in the rodent model. The aim of this study was to delineate the role of somatostatin in S. mansoni‐caused pathogenesis, by studying host levels of somatostatin in the peripheral blood of uninfected and S. mansoni‐infected individuals. Subjects from the district dispensary at Richard Toll, in the Medical Region of Saint‐Louis, Senegal, infected with S. mansoni and suffering from severe morbidity were selected. A separate group consisted of individuals resident in the same region but uninfected at the time of the study. Significantly lower somatostatin levels were detected in severe morbidity patients, compared with the exposed but uninfected subjects. In patients with schistosomiasis physiological levels of somatostatin may determine disposition of particular individuals towards severe morbidity, as opposed to others. Host pathology can thus be alleviated by the therapeutic ability of somatostatin to treat bleeding oesophageal varices, reduce portal pressure and prevent progression to severe fibrosis.
The impact of adjustment for parity and mid‐upper‐arm circumference on sensitivity of symphysis‐fundus height measurements to predict SGA foetuses in Mozambique
Authors: Challis Kenneth , Osman Nafissa Bique , Nordahl Gunnar , Bergström Staffan
Published: March 2003

background 

With a new symphysis‐fundus height (SFH) growth chart, based on Mozambican women with ultrasound‐dated singleton pregnancies, the aim was to examine the possibility to enhance sensitivity of predicting small for gestational age (SGA) newborns by attempts to adjust the chart for parity and for mid‐upper‐arm circumference (MUAC).

methods  Two antenatal clinics were chosen in the suburban area of Maputo City. A cohort of 904 consecutively recruited antenatal clients was followed until birth. Gestational age was determined by ultrasound at enrolment. The growth of the SFH was measured every 2–3 weeks. Women with multiple pregnancy or with gestational age >21 weeks at enrolment were excluded. Attempts were made to adjust SFH measurements for parity and MUAC by developing a mathematical model to increase sensitivity of the SFH method to predict a foetus being SGA.

results  Parous women had on average 0.5–1 cm higher SFH readings than nulliparous women. Women with a body mass index (BMI) <19 and women with BMI >27 had approximately 1 cm lower and 1 cm higher readings, respectively, compared with women of normal BMI. There was a significant correlation between BMI and MUAC (r = 0.621; P < 0.001). The usefulness of SFH measurements to predict SGA newborns was analysed. The sensitivity was 49%, the specificity was 66%, the positive predictive value was 14% and the negative predictive value, 93%. By using the correlation between BMI and MUAC we tried to find a simple and useful method to improve the sensitivity of SFH to detect SGA foetuses. By reducing the SFH measurement by 1 cm for women with MUAC >29 and by 1 cm for multiparous women the sensitivity raised to 65% at the expense of reducing the specificity to 51%. Using a linear function of BMI, MUAC and parity to adjust the SFH measurement for each individual woman, it was possible to get a sensitivity of 70% with a corresponding specificity of 56%.

conclusion  By using BMI, MUAC and parity, it might be possible to improve the sensitivity of the SFH growth chart in predicting newborn being SGA but mostly at the expense of specificity.
Aspects of nasal, oropharyngeal and anal carriage of in normal dogs and dogs with pyoderma
Authors: Harvey  , Noble
Published: March 2003

Aspects of carriage of Staphylococcus intermedius were studied in three groups of dogs. In 150 normal dogs presenting for annual booster inoculations, carriage rates for S. intermedius in the anterior nares (36%) and on the anal ring (36%) were recorded. In 44 dogs presented for routine elective surgery, carriage of S. intermedius was higher on the caudal nares (41%) than on the anterior nares (34%), oropharynx (25%) or anal ring (30%) allowing an assessment of the accuracy of basing nasal carriage rates on swabbing the anterior nares alone. A new finding was that animals from multidog households had significantly higher (P < 0.005) nasal and anal carriage rates than dogs from single‐dog households. In 33 dogs with superficial pyoderma, carrier rates were similar to those reported by others and significantly higher than in the other two groups with regard to both nasal and anal carriage (P < 0.05 and P < 0.005, respectively).
Inhibition of histamine release from dispersed canine skin mast cells by cyclosporin A, rolipram and salbutamol, but not by dexamethasone or sodium cromoglycate
Authors: Garcia  , Ferrer  , Demora  , Puigdemont
Published: March 2003

Despite the important role that canine skin mast cells play in IgE‐mediated allergic inflammation, clinically useful compounds for modulating mediator release from these cells or for suppressing cell response are lacking in the dog. The ability of five compounds to inhibit histamine release induced by non immunological (calcium ionophore A23187 and substance P) and IgE‐dependent (concanavalin A) stimuli were compared. Sodium cromoglycate, a mast cell stabilizer, and dexamethasone, a glucocorticoid, failed to inhibit histamine release from isolated skin mast cells following any kind of stimulation. Salbutamol, a β‐adrenergic agonist, exhibited inhibitory activity (46.0%) only after concanavalin A activation. In contrast, rolipram, a selective phosphodiesterase IV inhibitor and cyclosporin A, an immunosuppressor, showed potent anti allergic actions, inhibiting both IgE‐dependent and ‐independent stimuli. Rolipram inhibited 42.8%, 44.7% and 19.2% of the mediator release induced by ionophore A23187, substance P and concanavalin A, respectively. Similarly cyclosporin A induced 85.9%, 14.9% and 67.3% inhibition after ionophore A23187, substance P and concanavalin A stimulation, respectively. These results suggest that rolipram and cyclosporin A merit to be clinically tested as agents for the treatment of chronic allergic diseases in the dog.