bluuebunny/crossref_metadata_2025 huggingface dataset:
Persisting effects on fasting glucose levels and insulin sensitivity after 6 months of discontinuation of a very low‐dose GH therapy in adults with severe GH deficiency
Authors: Yuen Kevin C. J. , Dunger David B.
Published: March 2006

Objective  We recently reported that, in contrast to the standard GH (SGH) replacement dose titrated to normalize serum IGF‐I levels, 12‐month treatment with a fixed low GH dose (LGH) (0·1 mg/day) decreased fasting glucose levels and improved insulin sensitivity with little effect on body composition in severely GH‐deficient adults. In this study, we have subsequently examined the effects after 6 months of discontinuation of these variable GH doses (LGH: n = 8; fixed dose 0·10 mg/day and SGH: n = 8; mean dose 0·50 mg/day) on glucose metabolism, body composition and other surrogate cardiovascular risk markers.

Methods  Fasting insulin sensitivity using the homeostasis model assessment, and body composition using dual‐energy X‐ray absorptiometry scans were assessed at baseline, after 12 months of therapy (month 12) and after 6 months following discontinuation of therapy (month 18).

Results  At month 12, the LGH decreased fasting glucose levels and improved insulin sensitivity without altering body composition, whereas the SGH improved body composition without modifying insulin sensitivity. Six months after discontinuation of the LGH treatment (month 18), fasting glucose levels remained decreased and the enhanced insulin sensitivity persisted. In contrast, after discontinuation of SGH treatment (month 18), body composition reverted to baseline without changes in either fasting glucose levels or insulin sensitivity.

Conclusion  In contrast to the SGH, the LGH induces effects on fasting glucose levels and insulin sensitivity, which persist after 6 months of discontinuation of therapy. The exact molecular mechanisms are unclear but may involve the modulation of hepatic and muscle insulin sensitivity, possibly by altering insulin and IGF‐I receptor responsiveness and/or density.
Type I cytokine profiles of human naïve and memory B lymphocytes: a potential for memory cells to impact polarization
Authors: Gagro Alenka , Servis Drazen , Cepika Alma‐Martina , Toellner Kai‐Michael , Grafton Gillian , Taylor Dale R. , Branica Srecko , Gordon John
Published: March 2006

B cells bifurcating along ‘type 1’ or ‘type 2’ pathways under the influence of polarizing cytokines can, in turn, influence the direction of an immune response. Here, we compare the capacity of human B cells residing within naïve and memory compartments to participate in type 1 polarizing responses. B‐cell receptor (BCR) engagement provided the main signal for interleukin (IL)‐12Rβ1 expression in the two subsets: this was potentiated by CD154 together with interferon‐γ (IFN‐γ) but inhibited by IL‐12. IL‐12Rβ2 could be induced on a minority of B cells by the same signals, and also by IFN‐γ alone. WSX‐1, a receptor for IL‐27, was expressed in both subsets with no evidence for its regulation by the signals studied. While neither subset was capable of secreting much IL‐12 p70, memory B cells could produce a small amount of IL‐12 p40 on CD40 ligation. Memory B cells also, exclusively, expressed IL‐23 p19 mRNA on BCR triggering. Importantly, products of appropriately stimulated memory – but not naive – B cells were shown to promote the synthesis of IFN‐γ in uncommitted T‐helper cells. The data indicate an equal capacity for naïve and memory B cells to respond within a type 1 polarizing environment. Although poorly equipped for initiating type 1 responses, B cells – by virtue of the memory subset – reveal a capacity for their maintenance and amplification following T‐dependent signalling.
Genetic control of immune‐mediated necrosis of Mycobacterium avium granulomas
Authors: Flórido Manuela , Appelberg Rui
Published: March 2006

Intravenous infection of C57BL/6 and C57BL/10 mice with low doses of a highly virulent strain of Mycobacterium avium (ATCC 25291) led to the development of granulomas that underwent necrosis. In contrast, neither BALB/c nor DBA/1 mice developed granuloma necrosis after such infection despite a similar course of mycobacterial proliferation. Studies with C57BL/10 mice congenic for the Hc locus revealed that an intact complement C5 gene is required for granuloma necrosis. On the other hand, genetic disruption of the interleukin‐10 gene in BALB/c mice made this strain susceptible to granuloma necrosis.
Comprehensive osteoporosis management with easy access to bone mineral density measurements
Authors: Kullenberg Ragnar , Hanson Bengt , Sandberg Rolf , Dahlberg Hans
Published: March 2006

Background  The majority of people with osteoporosis are never evaluated even though effective treatments are available. The County Council of Värmland in Sweden has implemented an osteoporosis management model that has been shown to be effective in promoting awareness and providing care for osteoporosis patients. Discussions among a prevention group on osteoporosis in the county council were opened in 1997. The county of Värmland covers a large area, and the distances from the peripheral parts to the main city are approximately 300 km and cumbersome for the inhabitants. The importance of having an osteoporosis service that could reach the county inhabitants in a convenient way was therefore recognized.

Methods  Three thousand four hundred patients were evaluated between March 2001 and December 2003. Guidelines for patient selection for bone density testing and treatment guidelines were formulated. Promoting awareness was an important prerequisite for the model to function. This was accomplished by having the measurement devices where the patients showed up and by regular education of the primary care doctors.

Results and conclusions  A multidisciplinary team was established and consisted of primary care doctors, orthopaedic surgeons, internists, physiotherapists, a patient organization member, a county health care representative and nurses. Team members met every third month and agreed upon clinical guidelines for implementing the system. The presented osteoporosis management system is not a screening approach as all patients had risk factors for osteoporosis before they were suggested for bone density testing. This study shows that providing a comprehensive package of measures makes it possible to establish an effective osteoporosis management system with limited economical resources.
Performance of sequence analysis, INNO‐LiPA line probe assays and AFFIGENE assays in the detection of hepatitis B virus polymerase and precore/core promoter mutations
Authors: Olivero A. , Ciancio A. , Abate M. L. , Gaia S. , Smedile A. , Rizzetto M.
Published: March 2006

Summary.  In this study, we compare results obtained by sequences analysis and commercial kits in the detection of hepatitis B virus (HBV) polymerase and precore (PC) and core promoter mutations. A total of 23 serum samples from lamivudine treated patients were tested for polymerase mutations by direct sequencing, INNO‐LiPA HBV DR and AFFIGENE HBV DE/3TC. Full concordance among the three assays was observed in 63% of the total analysed codons. Concordant results were obtained between sequencing and LiPA in 80%, between sequencing and AFFIGENE in 73% and between LiPA and AFFIGENE in 74% of all tested codons. All discrepancies were observed in mixed population samples in which AFFIGENE and LiPA detected additional viral variants not revealed by sequence. In two patients, with serial samples, LiPA detected earlier than sequence and AFFIGENE an emerging mutate strain. PC and core promoter viral variants were detected in 28 serum samples collected from 14 HBV inactive carriers and from 14 hepatitis B patients with chronic liver disease. Direct sequencing, INNO‐LiPA HBV PreCore and AFFIGENE HBV MUTANT VL 19 showed fully coincident results in 88% of tested positions. These findings showed that all assays evaluated were sensitive and accurate tools to analyse HBV genomic variability. Sequence analysis is essential to study new emerging mutations as LiPA and AFFIGENE assays are more easily useful in clinical laboratories to detect the appearance of well‐characterized HBV variants.
NGC 2401: a template of the young population of the Norma–Cygnus arm in the Third Galactic Quadrant
Authors: Baume G. , Moitinho A. , Vázquez R. A. , Solivella G. , Carraro G. , Villanova S.
Published: March 2006

Based on a deep optical CCD [UBV(RI)C] photometric survey and on the Two-Micron All Sky Survey (2MASS) data, we derived the main parameters of the open cluster NGC 2401. We found that this cluster is placed at 6.3 ± 0.5 kpc (VO−MV= 14.0 ± 0.2) from the Sun and is 25 Myr old, which allows us to identify NGC 2401 as a member of the young population belonging to the innermost side of the extension of the Norma–Cygnus spiral arm in the Third Galactic Quadrant. A spectroscopic study of the emission star LSS 440 that lies in the cluster area revealed that it is a B0Ve star; however, we could not confirm that it is a cluster member. We also constructed the cluster luminosity function (LF) down to V∼ 22 and the cluster initial mass function (IMF) for all stars with masses above M∼ 1–2 M⊙. It was found that the slope of the cluster IMF is x≈ 1.8 ± 0.2. The presence of a probable pre-main-sequence (PMS) star population associated with the cluster is weakly revealed.
Antenatal rubella serosurvey in Maputo, Mozambique
Authors: Barreto Jorge , Sacramento Isadora , Robertson Susan E. , Langa Judite , de Gourville Esther , Wolfson Lara , Schoub Barry D.
Published: March 2006

Objective  To describe the epidemiology of rubella in Mozambique.

Methods  Cross‐sectional serosurvey of rubella IgG antibodies among women attending antenatal clinics in Maputo in February–April 2002 to assess the prevalence and titres.

Results  Rubella IgG antibodies were detected in 95.3% (95% confidence interval 94.0%–96.6%) of 974 pregnant women. Age and residence did not significantly affect the prevalence of rubella IgG antibodies. However, the mean titre of rubella IgG antibodies was higher in women <20 years of age than in women ≥30 years of age (P < 0.01), and women living in urban areas had higher antibody titres than those living in suburban areas (P < 0.0001).

Conclusions  The seroprevalence of rubella IgG antibodies among pregnant women in Maputo is high. Whether this is due to recent exposure to wild rubella virus or to exposure to rubella virus earlier in life is unclear. Studies on the burden of congenital rubella syndrome could address this matter.
Are intestinal helminths risk factors for developing active tuberculosis?
Authors: Elias Daniel , Mengistu Getahun , Akuffo Hannah , Britton Sven
Published: March 2006

Objectives  To determine the prevalence of intestinal helminth infections in active tuberculosis patients and their healthy household contacts and to assess its association with active TB in an area endemic for both types of infections.

Methods  Smear‐positive pulmonary TB patients and healthy household contacts were tested for intestinal helminths using direct microscopy and the formol‐ether concentration techniques. Three consecutive stool samples were examined before the start of TB chemotherapy. Sputum microscopy was done using the sodium hypochlorite concentration techniques. Participants were also tested for HIV by commercial sandwich enzyme linked immunosorbent assay.

Results  The study population consisted of 230 smear‐positive TB patients and 510 healthy household contacts. The prevalence of intestinal helminths was 71% in patients and 36% in controls. HIV seroprevalence was significantly higher in patients than in controls (46.7%vs. 11.6%, P < 0.001). Conditional logistic regression analysis showed a strong association between TB and intestinal helminth infection (OR = 4.2, 95% CI 2.7–5.9, P < 0.001), and between TB and HIV infection (OR = 7.8, 95% CI 4.8–12.6, P < 0.0001). The odds of being a TB patient increased with the number of helminth species per person: in individuals with mono‐infection it was 4.3 (95% CI 2.8–6.8); in people infected with two species was 4.7 (95% CI 2.5–8.7), and in patients infected with three or more helminths was 12.2 (3.9–52.6).

Conclusion  Intestinal helminth infection may be one of the risk factors for the development of active pulmonary TB in addition to HIV infection. This finding may have important implications in the control of TB in helminth endemic areas of the world.
The effect of Plasmodium falciparum on cognition: a systematic review
Authors: Kihara Michael , Carter Julie A. , Newton Charles R. J. C.
Published: March 2006

Objective  Systematic review to investigate the relationship between Plasmodium falciparum infection and cognitive function.

Method  We searched MEDLINE, EMBASE and PsycINFO, and hand‐searched journals and PhD theses. The inclusion criteria were (1) use of standardized tests for the specific populations and/or appropriate controls; (2) clear differentiation between children and adults. Eighteen studies were eligible, of which three gave information on all cognitive domains considered in the review.

Results  Deficits in attention, memory, visuo‐spatial skills, language and executive functions may occur after malaria infection. These deficits are not only caused by cerebral falciparum malaria, but also appear to occur in less severe infections. P. falciparum seems to affect the brain globally, not in a localised fashion. Outcome depends on both biological and social risk factors.

Conclusion  Future research should seek to establish the extent of these cognitive deficits using culturally appropriate techniques and well‐defined criteria of disease.
Operational response to malaria epidemics: are rapid diagnostic tests cost‐effective?
Authors: Rolland Estelle , Checchi Francesco , Pinoges Loretxu , Balkan Suna , Guthmann Jean‐Paul , Guerin Philippe J
Published: March 2006

Objective  To compare the cost‐effectiveness of malaria treatment based on presumptive diagnosis with that of malaria treatment based on rapid diagnostic tests (RDTs).

Methods  We calculated direct costs (based on experience from Ethiopia and southern Sudan) and effectiveness (in terms of reduced over‐treatment) of a free, decentralised treatment programme using artesunate plus amodiaquine (AS + AQ) or artemether‐lumefantrine (ART‐LUM) in a Plasmodium falciparum epidemic. Our main cost‐effectiveness measure was the incremental cost per false positive treatment averted by RDTs.

Results  As malaria prevalence increases, the difference in cost between presumptive and RDT‐based treatment rises. The threshold prevalence above which the RDT‐based strategy becomes more expensive is 21% in the AS + AQ scenario and 55% in the ART‐LUM scenario, but these thresholds increase to 58 and 70%, respectively, if the financing body tolerates an incremental cost of 1 € per false positive averted. However, even at a high (90%) prevalence of malaria consistent with an epidemic peak, an RDT‐based strategy would only cost moderately more than the presumptive strategy: +29.9% in the AS + AQ scenario and +19.4% in the ART‐LUM scenario. The treatment comparison is insensitive to the age and pregnancy distribution of febrile cases, but is strongly affected by variation in non‐biomedical costs. If their unit price were halved, RDTs would be more cost‐effective at a malaria prevalence up to 45% in case of AS + AQ treatment and at a prevalence up to 68% in case of ART‐LUM treatment.

Conclusion  In most epidemic prevalence scenarios, RDTs would considerably reduce over‐treatment for only a moderate increase in costs over presumptive diagnosis. A substantial decrease in RDT unit price would greatly increase their cost‐effectiveness, and should thus be advocated. A tolerated incremental cost of 1 € is probably justified given overall public health and financial benefits. The RDTs should be considered for malaria epidemics if logistics and human resources allow.
Trend and causes of neonatal mortality in the Kassena–Nankana district of northern Ghana, 1995–2002
Authors: Baiden F. , Hodgson A. , Adjuik M. , Adongo P. , Ayaga B. , Binka F.
Published: March 2006

Objectives  To describe the trend and causes of neonatal deaths in a rural district in northern Ghana.

Methods  Descriptive analysis of data collected from the Navrongo Demographic Surveillance System and verbal autopsies conducted on all neonatal deaths from 1995–2002.

Results  Of 1118 recorded neonatal deaths 1068 (95.5%) could be analysed. Only 13.2% of deaths occurred at the health facility; 62.7% occurred in the early neonatal period, with prematurity (38%) and birth injuries (19%) as leading causes. Infectious causes (66%) were the major contributors to late neonatal deaths. Infanticide accounted for 4.9% of all neonatal deaths. The cause‐specific mortality rate for neonatal tetanus remained under 2.5% throughout the 8‐year period. Overall, the neonatal mortality rate declined at an average of 2.5 per 1000 live births per year: Down by nearly 50% from 40.9 (95%C.I. 34.1–46.8) in 1995 to 20.5 (95%C.I.17.3–22.7) in 2002.

Conclusion  The various health interventions undertaken in this district have had the collateral effect of causing decline in neonatal mortality. Neonatal mortality could be further reduced by preventing and treating neonatal infections, having skilled attendance at delivery and the elimination of infanticide. Data from demographic surveillance sites may be useful in monitoring trends in child mortality.
Relationship between expressed HIV/AIDS‐related stigma and HIV‐beliefs/knowledge and behaviour in families of HIV infected children in Kenya
Authors: Hamra Mary , Ross Michael W. , Orrs Mark , D'Agostino Angelo
Published: March 2006

Objectives To quantify expressed stigma in clients of the Kangemi program for HIV+ children, and to characterize the association between stigma and other population characteristics.

Methods By means of a household survey we created a stigma index and indices for other social and knowledge domains that influence HIV‐related healthcare. We usedχ2, anova, and correlation to identify associations between domains.

Results The mean (±SD) expressed stigma on a six points scale (6 = least stigma) was 3.65 ± 1.64. Composite scores on knowledge about AIDS were skewed toward more knowledge; and analysis of individual knowledge items indicates that most respondents reject erroneous traditional beliefs and myths about the causes and transmission routes of AIDS. Respondents who were younger, had never married, and had less education expressed greater stigma. Differences in stigma were associated with poor knowledge about AIDS and negative attitudes toward testing, but not with gender or tribal affiliation. Condom use at last intercourse, unrelated to stigma, was only 40% (n = 218).

Conclusions While this population has good knowledge about AIDS and appraises risks realistically, it fails to reduce these risks. Associations between stigma and other domains can inform interventions that improve HIV care and mitigate spread of HIV.
Reaching the Abuja target for intermittent preventive treatment of malaria in pregnancy in African women: a review of progress and operational challenges
Authors: Hill Jenny , Kazembe Peter
Published: March 2006

Objective  To review progress with the implementation of intermittent preventive treatment (IPT) for the control of malaria in pregnancy in sub‐Saharan Africa (SSA), in order to identify facilitating factors and operational challenges for scaling up IPT delivery.

Methods  Information on the status of IPT policy, programme and coverage indicators was extracted from published sources. Information on country experiences from both published and unpublished literature was supplemented with semi‐structured interviews with malaria programme managers.

Results  Whilst countries in SSA have made important progress with IPT implementation, coverage levels remain low. High antenatal clinic (ANC) attendance alone is not sufficient to ensure high IPT coverage. Staff shortages, poor drug supply, poor ANC access and poor health worker practices are some of the operational challenges in delivering IPT.

Conclusion  Country experiences show that IPT can be introduced and scaled up relatively quickly and effectively where there is political will, effective integration between malaria and reproductive health programmes, adequate funding and drug supply, high ANC attendance and community receptiveness. There is however urgent need to better document best practices and lessons as a basis for developing simplified guidelines for dissemination to countries embarking on IPT implementation.
Prevalence of malaria parasitemia among clients seeking treatment for fever or malaria at drug stores in rural Tanzania 2004
Authors: Patrick Kachur S. , Schulden Jeffrey , Goodman Catherine A. , Kassala Herry , Elling Berty Farida , Khatib Rashid A. , Causer Louise M. , Mkikima Saidi , Abdulla Salim , Bloland Peter B.
Published: March 2006

Objective  To determine the prevalence of malaria parasitemia and other common illnesses among drug store clients in one rural community, with a view to the potential role of specialist drug stores in expanding coverage of effective malaria treatment to households in highly endemic areas.

Method  Follow‐back study of 2466 client visits selected from all 10 drug stores operating in the town of Ikwiriri between May 30 and August 31 2004. Of these, 521 (21.2%) were made by or on behalf of persons ill with fever or malaria. Two hundred and ninety three were eligible as residents of the surrounding nine villages and all agreed to participate in the study. Each patient was evaluated by a clinical officer and provided a blood sample for malaria on the day of the shop visit, either at the shop or at home.

Results  Only 50 (17.1%) visits by or on behalf of febrile patients resulted in the purchase of an antimalarial drug, while an antipyretic medication was obtained at 226 visits (77.1%). Clinicians diagnosed malaria in 63.8% of patients. Malaria parasites were identified in blood film samples from 24.2% (95% CI: 19.6, 29.5). This is double the parasite prevalence rate of 10.7% (95% CI: 8.6, 13.1) obtained from a household survey of 1004 healthy individuals selected from these villages at the same time. It is not significantly lower than the prevalence observed among 880 clients presenting with fever at health facilities in the district: 29.7% (95% CI: 23.0, 37.3). The prevalence of malaria parasitemia among children younger than 5 years whose families sought fever treatment from drug stores (42.1%; 95% CI: 31.4, 53.5) was equal to that of children presenting with fever at health facilities (42.5%; 95% CI: 25.0, 62.2).

Conclusions  Currently, drug store clients do not obtain malaria‐specific treatment in the majority of cases where it might be warranted. Parasitological findings indicate that drug store clients, especially children, are as likely to be infected with malaria as patients seeking care for similar illnesses at health facilities. Drug stores may be attractive partners for policy makers eager to engage the private retail sector in expanding coverage of malaria treatment.
Validité, coût et faisabilité de la mAECT et CTC comme tests de confirmation dans la détection de la Trypanosomiase Humaine Africaine
Authors: Lutumba P. , Robays J. , Miaka C. , Kande V. , Mumba D. , Büscher P. , Dujardin B. , Boelaert M.
Published: March 2006

Resume

Objectifs  Evaluer la validité, le coût et la faisabilité de deux tests parasitologiques pour la confirmation de la maladie du sommeil; la mini Anion Exchange Centrifugation Technique (mAECT) et la Capillary Tube Centrifugation (CTC).

Méthodes Au cours d'une campagne de dépistage de la maladie du sommeil en 2004 nous avons examiné 6502 personnes à Kwamouth en République Démocratique du Congo (RDC). Les personnes testées positives au Card Agglutination Test for Trypanosomiasis sur sang total (CATT) ont reçu une ponction ganglionnaire, un examen de sang frais, une goutte épaisse colorée, un examen de mAECT, un examen de CTC et une titration de CATT. La sensibilité et spécificité des tests de confirmation ont été calculées en utilisant la combinaison de tous les tests parasitologiques comme référence standard. Le coût de chaque méthode a été calculé et leur faisabilité a étéévaluée par des interviews structurées avec les techniciens.

Résultats  La sensibilité des méthodes parasitologiques classiques était de 44,8% (IC 95%: 36,8–53,0), pour la CTC 56,5% (IC 95%: 48,3–64,5) pour la mAECT 75,3 % (IC 95%: 67,7–81,9). Le coût par test était de 2,82€ pour la mAECT et 0,76€ pour la CTC. Le temps pour l'obtention du résultat était de 29,78 min pour la mAECT et 18,25 min pour la CTC. Ces deux tests ont été jugés faisables sous les conditions de terrain.

Conclusion  L'utilisation individuelle ou en combinaison de la CTC et de la mAECT comme tests de confirmation sur les personnes au CATT sur sang total apporterait une amélioration considérable de la détection des cas de trypanosomiase humaine africaine. Les deux tests se sont avérés faisables dans des conditions opérationnelles lorsque la disponibilité d'un courant de 220 V pouvait être garantie. Vue que le test mAECT est plus sensible mais considérablement plus coûteux, les analyses de coût‐efficacité de la faisabilité devraient guider au choix du meilleur algorithme.
Combining drinking water treatment and hand washing for diarrhoea prevention, a cluster randomised controlled trial
Authors: Luby Stephen P. , Agboatwalla Mubina , Painter John , Altaf Arshad , Billhimer Ward , Keswick Bruce , Hoekstra Robert M.
Published: March 2006

Objectives  To evaluate the effectiveness of point of use water treatment with flocculent‐disinfectant on reducing diarrhoea and the additional benefit of promoting hand washing with soap.

Methods  The study was conducted in squatter settlements of Karachi, Pakistan, where diarrhoea is a leading cause of childhood death. Interventions were randomly assigned to 47 neighbourhoods. Households in 10 neighbourhoods received diluted bleach and a water vessel; nine neighbourhoods received soap and were encouraged to wash hands; nine neighbourhoods received flocculent‐disinfectant water treatment and a water vessel; 10 neighbourhoods received disinfectant‐disinfectant water treatment and soap and were encouraged to wash hands; and nine neighbourhoods were followed as controls. Field workers visited households at least once a week from April to December 2003 to promote use of the interventions and to collect data on diarrhoea.

Results  Study participants in control neighbourhoods had diarrhoea on 5.2% of days. Compared to controls, participants living in intervention neighbourhoods had a lower prevalence of diarrhoea: 55% (95% CI 17%, 80%) lower in bleach and water vessel neighbourhoods, 51% (95% CI 12%, 76%) lower in hand washing promotion with soap neighbourhoods, 64% lower (95% CI 29%, 90%) in disinfectant‐disinfectant neighbourhoods, and 55% (95% CI 18%, 80%) lower in disinfectant‐disinfectant plus hand washing with soap neighbourhoods.

Conclusions  With an intense community‐based intervention and supplies provided free of cost, each of the home‐based interventions significantly reduced diarrhoea. There was no benefit by combining hand washing promotion with water treatment.
Bayesian spatial analysis and disease mapping: tools to enhance planning and implementation of a schistosomiasis control programme in Tanzania
Authors: Clements Archie C. A. , Lwambo Nicholas J. S. , Blair Lynsey , Nyandindi Ursuline , Kaatano Godfrey , Kinung'hi Safari , Webster Joanne P. , Fenwick Alan , Brooker Simon
Published: March 2006

Objective To predict the spatial distributions ofSchistosoma haematobiumandS. mansoniinfections to assist planning the implementation of mass distribution of praziquantel as part of an on‐going national control programme in Tanzania.

Methods Bayesian geostatistical models were developed using parasitological data from 143 schools.

Results In theS. haematobiummodels, although land surface temperature and rainfall were significant predictors of prevalence, they became non‐significant when spatial correlation was taken into account. In theS. mansonimodels, distance to water bodies and annual minimum temperature were significant predictors, even when adjusting for spatial correlation. Spatial correlation occurred over greater distances forS. haematobiumthan forS. mansoni. Uncertainties in predictions were examined to identify areas requiring further data collection before programme implementation.

Conclusion Bayesian geostatistical analysis is a powerful and statistically robust tool for identifying high prevalence areas in a heterogeneous and imperfectly known environment.
Ultrasound patterns and frequency of focal liver lesions after successful treatment of amoebic liver abscess
Authors: Blessmann Joerg , Khoa Nguyen Dinh , An Le Van , Tannich Egbert
Published: March 2006

Objective  To evaluate the frequency and morphology of residual liver lesions in patients successfully treated for amoebic liver abscess.

Methods  Retrospective ultrasound‐based study of 240 adult males from an amoebiasis‐endemic area in Vietnam with a documented clinical history of amoebic liver abscess. Subjects were re‐examined by hepatic ultrasound 1–13 years after abscess treatment.

Results  In 17 subjects (7.1%) focal hypo‐ or isoechoic areas were identified within the liver with a diameter of 8–48 mm surrounded by a hyperechoic wall. These lesions were associated with positive amoeba serology, were located at the site of the previous abscess and their sonographic appearances corresponded to post‐amoebic liver abscess residues. Residues were found in all groups of patients irrespectively of the time‐span since the abscess was treated. However, lesions older than 7 years showed some degree of calcification. Otherwise, lesions were apparently inactive, as patients had no clinical symptoms or signs of inflammation and follow‐up after one year revealed no changes in size or pattern.

Conclusion  The vast majority of amoebic liver abscesses resolve to a sonographically normal parenchymal pattern. However, in a small proportion of cases characteristic residues remain. These residues do not require further treatment or diagnostic intervention and should be considered in the differential diagnosis of space‐occupying liver lesions, in particular in patients from amoebiasis‐endemic areas.
A case of fulminant post‐transplant lymphoproliferative disorder and septicemia
Authors: Gouya Ghazaleh , Hartmann Gabriele , Faè Peter , Tauber Martina , Holzmüller Hannes , Benzer Werner , Lang Alois , Schuster Antonius , Drexel Heinz , Offner Felix Albert
Published: March 2006

Abstract: The fulminant form of post‐transplant lymphoproliferative disorder (PTLD) is very uncommon and occurs in approximately 1% of PTLD patients. Approximately 85% of these lesions are of B‐cell origin, and most of them are associated with Epstein–Barr virus infection. Fulminant PTLD is frequently associated with a systemic inflammatory response syndrome, and may be difficult to differentiate from septicemia. We describe the case of a 59‐yr‐old man who suffered from prolonged septicemia in the immediate post‐transplant period, and presented again four months after cardiac transplantation with fever, painful liver edge and gastrointestinal bleeding. The diagnosis of fulminant PTLD with advanced multiorgan infiltration by a diffuse large‐cell lymphoma of B‐cell phenotype was made. During treatment with rituximab, the patient died from Enterococcus faecium septicemia. The sequence of septicemia, PTLD and, finally again, septicemia is an unusual challenge and urges for an aggressive diagnostic approach, where markers like procalcitonin may aid in the discrimination of fulminant PTLD from septicemia.
ABO‐incompatible deceased donor liver transplantation with the use of antigen‐specific immunoadsorption and anti‐CD20 monoclonal antibody
Authors: Boberg K.M. , Foss A. , Midtvedt K. , Schrumpf E.
Published: March 2006

Abstract: In patients with fulminant liver failure requiring emergency liver transplantation, the only donor organ that becomes available may be ABO incompatible. The risk of graft failure because of antibody‐mediated acute rejection is high, but can be reduced by various means. We reported a deceased donor ABO‐incompatible liver allograft recipient who was treated with antigen‐specific immunoadsorption in combination with anti‐CD20 monoclonal antibody and conventional plasmapheresis and immunosuppression. The patient was a 33‐yr‐old male with blood group A who presented with subacute liver failure of unknown aetiology and received a blood group AB liver graft. Pretransplant he underwent plasmapheresis and received one dose of rituximab. The immunosuppressive regimen consisted of methylprednisolone, tacrolimus and mycophenolate mofetil. Despite regular post‐operative plasmapheresis sessions, anti‐B antibody titres increased. Antigen‐specific immunoadsorption with depletion of anti‐B antibodies was performed from day nine to day 17. Thereafter, anti‐B IgM and IgG antibody titres remained low. After one month the patient was reoperated with hepaticojejunostomy because of bile duct necrosis and with reconstruction of a stenotic hepatic artery. A mild rejection was successfully treated with methylprednisolone four months post‐transplant. At six months post‐transplant there was a stricture of the biliary‐enteric anastomosis, but the graft was well functioning. We conclude that antigen‐specific immunoadsorption can be an important adjuvant therapy to control recipient anti‐A/B antibody levels and prevent acute rejection in ABO‐incompatible deceased donor liver transplantation.
Monitoring of cyclosporine levels in transplant recipients using self‐administered fingerprick sampling
Authors: Yonan Nizar , Martyszczuk Ruth , Machaal Ali , Baynes Anna , Keevil Brian G.
Published: March 2006

Abstract:Use of C2monitoring for cyclosporine A (CsA) microemulsion results in improved clinical outcomes vs. trough (C0) monitoring. Logistical issues include accurate timing of the C2sample; requirement for sample dilution with most standard assay techniques; and inconvenience for patients. Recently, it has been shown that CsA concentrations in capillary blood correlate closely with levels in venepuncture samples, and that liquid chromatography tandem mass spectrometry (LC‐MS/MS) can analyse CsA concentration using undiluted capillary blood from fingerprick samples. In a study to assess the feasibility of CsA monitoring, 52 stable heart transplant patients were provided with kits to take fingerprick trough and C2blood samples at home, returning them to the laboratory by post for LC‐MS/MS analysis. In total, 225 samples were provided, of which 14 (6%) were unsuitable for analysis because of clotting (n=10) or insufficient volume (n=4). Discomfort was not a problem and initial difficulties that some patients reported in taking the samples resolved with experience. All samples were returned by the postal system in a timely manner. Use of fingerprick assays could allow transplant physicians to have access to C2levels when patients visit the clinic for review, and avoids the need for patients to attend the clinic or local healthcare centre solely for venepuncture. A barrier to more widespread introduction of fingerprick testing is likely to be lack of suitable MS facilities and trained personnel. In conclusion, self‐administered fingerprick testing for CsA blood levels is practical to implement and highly convenient for patients and offers advantages for the transplant team.
Predictive value of human leucocyte antigen epitope matching using HLAMatchmaker for graft outcomes in a predominantly African‐American renal transplant cohort
Authors: Haririan Abdolreza , Fagoaga Omar , Daneshvar Hamidreza , Morawski Katherina , Sillix Dale H. , El‐Amm Jose M. , West Miguel S. , Garnick James , Migdal Stephen D. , Gruber Scott A. , Nehlsen‐Cannarella Sandra
Published: March 2006

Abstract:The HLAMatchmaker program is based on the donor/recipient comparison of the polymorphic triplet amino‐acid sequences of the antibody‐accessible regions on the human leucocyte antigen (HLA) molecule. The previous reports on its predictive value for renal allograft outcomes are conflicting. We conducted a retrospective study in a predominantly African‐American (AA) cohort (N=101, 94% AA). HLA typing was performed by molecular methods and triplet matching using HLAMatchmaker. Study end points included graft survival and incidence of acute rejection. The relationship between the number of triplet mismatches (TMM) and the degree of HLA antigen MM was evaluated using Pearson's correlation coefficient. Logistic regression models were used to examine the association between triplet matching and the study end points. Kaplan–Meier and Cox proportional hazard models were used for graft survival analysis. The strongest relationship between the number of TMM and HLA antigen MM was observed for HLA‐DQ (r=0.88). The association between triplet matching at HLA‐A, ‐B, ‐DR and ‐DRw HLA loci and the study end points was not statistically significant. However, after grouping, the unadjusted estimates of graft survival for those with more than 10 Class I TMM were significantly worse than the others (p=0.03). Adjusting for the effect of donor source, recipient characteristics and the immunosuppressive regimen did not change this association (hazard ratio=0.2, confidence interval=0.04–1.1). We conclude that triplet matching using HLAMatchmaker can provide useful prognostic information in kidney transplantation and that more than 10 donor/recipient Class I HLA TMM is predictive of worse graft outcome.
Extent of hepatectomy on splenic hypertrophy and platelet count in live liver donors
Authors: Ishizawa Takeaki , Sugawara Yasuhiko , Hasegawa Kiyoshi , Ikeda Mami , Tamura Sumihito , Makuuchi Masatoshi
Published: March 2006

Abstract: The extent of donor hepatectomy may affect splenic hypertrophy and platelet count. The subjects were 50 live liver donors. The ratio of the graft weight to total liver volume (GW/TLV) and the splenic hypertrophy ratio, expressed as the splenic volume one month after surgery divided by that before surgery, were calculated. The platelet count one month after surgery was divided by that before surgery to determine the rate of the platelet count decrease. The correlation of GW/TLV to the splenic hypertrophy ratio and the rate of the platelet count decrease were examined. The median (range) GW/TLV was 54 (28–71)%. The splenic hypertrophy ratio and the rate of the platelet count decrease was 133 (99–191)% and 92 (71–129)%, respectively. GW/TLV positively correlated with the splenic hypertrophy ratio (Spearman's correlation coefficient (rs)=0.448, p=0.001), and negatively correlated with the rate of the platelet count decrease (rs=−0.471, p<0.001). Multivariate analysis revealed that GW/TLV influenced the splenic hypertrophy ratio [adjusted odds ratio (OR), 12.0; 95% confidence interval (CI), 1.32–9.04; p=0.01] and the ratio of the platelet count decrease (adjusted OR, 11.6; 95% CI, 1.40–8.33; p=0.01). Larger graft procurement might place living liver donors at higher risk for post‐operative thrombocytopenia.
Initial experience with bosentan therapy in patients considered ineligible for heart transplantation because of severe pulmonary hypertension
Authors: Perez‐Villa Felix , Cuppoletti Alfredo , Rossel Victor , Vallejos Isabel , Roig Eulalia
Published: March 2006

Abstract: Background: Pre‐operative elevated pulmonary vascular resistance (PVR) has been associated with increased right ventricular failure and mortality after heart transplantation. The aim of this study was to assess the efficacy of bosentan, an oral endothelin‐receptor antagonist, to reduce PVR in patients considered ineligible for heart transplantation because of severe pulmonary hypertension.

Methods: Seven patients with end‐stage congestive heart failure and considered ineligible for heart transplantation because of severe pulmonary hypertension (PVR>2.5 Wood units after nitroprusside infusion) were included in the study. They received bosentan 62.5 mg b.i.d. for four wk and 125 mg b.i.d. thereafter. Right heart catheterization was repeated after six wk of therapy.

Results: After six wk of bosentan therapy, there was a significant decrease in PVR (6.0±2 vs. 3.8±2 Wood units, before vs. after bosentan; p=0.02), in PVR during nitroprusside infusion (3.3±1 vs. 2.1±1 Wood units, before vs. after bosentan; p=0.02) and in diastolic pulmonary artery pressure (33±7 vs. 23±7 mmHg, before vs. after bosentan; p=0.04). No significant adverse events were observed. After bosentan therapy, five patients had PVR≤2.5 Wood units. They were included in the waiting list and all five had a successful heart transplantation, although two of them required bosentan after surgery.

Conclusions: In patients considered ineligible for heart transplantation because of high PVR, bosentan therapy significantly reduced PVR. These data suggest that therapy with endothelin‐receptor blockers might be useful to identify a subgroup of patients with high PVR who can benefit from heart transplantation.
The association between length of post‐kidney transplant hospitalization and long‐term graft and recipient survival
Authors: Lin Shih‐jui , Koford James K. , Baird Bradley C. , Habib Arsalan N. , Reznik Ilya , Chelamcharla Madhukar , Shihab Fuad S. , Goldfarb‐Rumyantzev Alexander S.
Published: March 2006

Abstract: Background:There has been a general trend towards shortened length of post‐kidney transplant hospitalization (LOH). The decision regarding patients's discharge from the hospital theoretically may be based on several factors, including, but not limited to, patient well being, insurance status, family situation and other, mostly socio‐economic factors, as opposed to hard medical evidence. However, the appropriate LOH in kidney transplant recipients is not well studied regarding long‐term outcomes.

Methods:This study retrospectively analysed the association between LOH and graft and recipient survival based on United States Renal Data System dataset. In total, 100 762 patients who underwent transplant during 1995–2002 were included. Kaplan–Meier survival analysis and Cox models were applied to the whole patient cohort and on sub‐groups stratified by the presence of delayed graft function, patient comorbidity index and donor type (deceased or living).

Results:In recipient survival, both short (<4 d) and long (>5 d) LOH showed a significant adverse effect (p<0.01) on survival times. In the analysis of graft survival, long LOH (≥2 wk) also showed significant adverse effects (p<0.001) on survival times. However, short LOH (<4 d) did not reach statistical significance, although it was still associated with adverse effects on graft survival. These observations were consistent across the whole patient cohort and sub‐groups stratified by the presence of delayed graft function, patient comorbidity index and donor type.

Conclusion:Clinical considerations should be used to make the decision regarding appropriate time of post‐kidney transplant recipient discharge. Based on this study, shorter than four d post‐kidney transplant hospitalization may potentially be harmful to long‐term graft and recipient survival.
Efficacy of conventional immunosuppressive therapy in related and unrelated living renal transplantation
Authors: Thorban S. , Schwarznau A. , Hüser N. , Stangl M.
Published: March 2006

Abstract:  Background:  The application of antibody induction therapy in adult living‐related kidney transplantation remains under discussion. The purpose of this study was to compare the outcome of living‐related (LRT) and unrelated renal transplant recipients (LURT) using standardized immunosuppressive protocols. From October 2000 to October 2004, 72 adult LRT (TX) were performed at our institution. Thirty‐nine LRT (group A) and 33 LURT (group B) recipients received a standardized immunosuppressive therapy consisting of tacrolimus (Tac), steroids and mycophenolate mofetil (MMF) without antibody induction therapy. This prolective analysis included immediate graft function, rejection rate and loss of the transplanted organ. The incidence of post‐operative good graft function (>90%) was similar for both groups, as well as the rejection rate showed 57.8% for patients of group A and 58.8% for patients of group B (p<0.5). However, the number of rejections (>1 rejection) was significantly higher in group B (11.8%) compared to patients in group A (4.4%). No difference concerning loss of transplanted kidney was observed for both groups. Conventional Tac, MMF and steroid‐based immunosuppression therapy is equivalent in efficacy of therapy in living‐related and unrelated renal transplants. In our opinion, induction therapy in patients without immunologic risk factors has no favourable effect.
Understanding of and attitudes to organ donation and transplantation: a survey among Italian university students
Authors: Canova Daniele , De Bona Manuela , Ruminati Rino , Ermani Mario , Naccarato Remo , Burra Patrizia
Published: March 2006

Abstract: Background: Students have a positive attitude to organ donation and transplantation, usually associated with their personal willingness to donate their organs after death. The aim of this study was to evaluate the opinions of university students on transplantation and organ donation, at a single Italian university.

Methods: University undergraduates attending the first year on five different courses in 2001 were surveyed at Padua University by using an anonymous 13‐item questionnaire.

Results: 97.2% of the students completed the questionnaire (77.4% females, mean age 20.4 yr); they were attending Medicine (33.8%), Agriculture (5.9%), Veterinary Medicine (11.4%), Psychology (18.5%) and Educational Sciences (30.4%). The majority was aware of the problem of the paucity of organ donations and deaths on the waiting list in Italy. Most students would accept transplantation in the case of a human donor (97%), an artificial organ (95%) or an animal donor (76%); and 87% of them were prepared to donate their own organs after death. No differences were seen when students attending science courses were compared with those attending art courses. Italian university students have a very positive attitude and willingness to donate their own organs after death, with no differences emerging as regards type of university education.
The clinical impact of 1:1 conversion from Neoral to a generic cyclosporine (Gengraf) in renal transplant recipients with stable graft function
Authors: Qazi Yasir A. , Forrest Alan , Tornatore Kathleen , Venuto Rocco C.
Published: March 2006

Abstract:  The introduction of cyclosporine (CYA) to the immunosuppressive armamentarium has had a significant effect on graft survival. An improvement in the formulation from the oil‐based to a microemulsion‐based form has resulted in better absorption and more predictable CYA bioavailability. Since the introduction of the first microemulsion form (Neoral), several bioequivalent formulations are now available and are switched in a 1:1 fashion at pharmacies to curtail costs. The purpose of our study was to study the effect of a 1:1 switch from Neoral to Gengraf on CYA trough levels and serum creatinine (SRC) in renal transplant recipients with stable graft function. Eighty‐two renal transplant recipients with stable graft function were enrolled in the study, and of these, 73 were switched to Gengraf, whereas nine remained on Neoral. The 13 patients switched to Gengraf required a dosage change after the mean CYA trough levels changed from 234±96 ng/mL at baseline to 289±102 ng/mL (p<0.05) at 2 wk. With the adjustments in dosage, the levels approached the baseline trough concentrations (239±151 ng/dL). The nine patients who remained on Neoral had no change in the CYA levels or SCR. Nearly 20% of patients who switched to a bioequivalent CYA preparation required a dose adjustment to return to pre‐conversion CYA trough levels. Our study raises serious concerns regarding the switchability of generic CYA for Neoral without careful follow‐up therapeutic drug monitoring.