bluuebunny/crossref_metadata_2025 huggingface dataset:
Transient depression of LWa antigen with coincident production of anti‐LWa repeated in relapses of malignant lymphoma
Authors: Komatsu F. , Kajiwara M.
Published: November 2003

Three years ago, a 71‐year‐old female was admitted because of general lymphadenopathy. She had been on medication for hypothroidism, but had no history of pregnancy or blood transfusion. T‐cell lymphoma was found. Since then, she has been treated with intermittent chemotherapy. The patient's LWa antigen was depressed during two relapses of the lymphoma and anti‐LWa was detected simultaneously on both occasions. When she entered remission after therapy, her LW phenotype converted from LW(a−) to LW(a+), and this was accompanied by the disappearance of anti‐LWa. This suggests that LW(a−) was a transient phenotype. In the first relapse, a total of 8 units of D− LW(a+) packed red cells and 20 units of platelets were transfused during 1 month without any haemolytic reaction. In these relapses, nonhaemolytic anaemia, hyper‐gamma‐globulinaemia and remarkable bone‐marrow infiltration with lymphoplasma cells were recognized. She also possessed antithyroglobulin and antimicrosomal antibodies; however, these autoantibodies did not change with the relapses. These results suggests that the recurrent depressions of LWa may be closely related to the underlying disease.
Recovery of extra plasma during preparation of platelet concentrates using a new centrifugation support
Authors: Whisson M. , Cheng A.
Published: November 2003

During blood component preparation of standard blood donations a major loss of plasma occurs whenever platelet concentrates (PC) are produced, especially when the platelets are prepared by the platelet‐rich plasma (PRP) method. This loss is partly due to the use of plasma for resuspension of the platelet pellet but the main loss is associated with the slow first spin used to prepare PRP. This slow first spin results in an undesirably low haematocrit and a red‐cell concentrate which contains a large volume of trapped plasma which is lost to the fractionation plant. We have developed a method of recovering most of this plasma from the soft‐spun red cells by including the red‐cell concentrate (RCC) in the second spin during preparation of the platelet pellet. To allow recovery of the second spin plasma from the half‐full RCC bag we have developed a simple bag support, the Perth BagRap. Development of the method proved difficult due to the high g forces but the final technique evolved was simple and inexpensive. The method was easily introduced into routine use and resulted in a 53% increase in plasma per three‐product unit.
Further analysis of Del (D‐elute) using polymerase chain reaction (PCR) with RHD gene‐specific primers
Authors: Fukumori Y. , Hori Y. , Ohnoki S. , Nagao N. , Shibata H. , Okubo Y. , Yamaguchi H.
Published: November 2003

Del (D‐elute) in the Rh blood group system is a variant with very weak D antigen and no agglutination is found by the indirect antiglobulin test. This variant is characterized by the presence of anti‐D eluate obtained after an adsorption‐elution test using anti‐D antibodies. We studied here the molecular genetic status of Del by using polymerase chain reaction with sequence‐specific primers (PCR‐SSP).

We screened 306 serologically apparent D‐negative Japanese donors comprising 102 Del types for exons 7, 4 and 10 of the RHD gene. No PCR product was found in all 204 non‐Del samples from the D‐seronegative donors. However, PCR products were found in all 102 Del samples and all 70 D‐seropositive samples tested by the three PCR methods for exons 7, 4 and 10 analysis.

Del was found with CCee, CcEe and Ccee, but not with CCEe, CcEE, ccEE, ccEe or ccee phenotype. The incidences of Del in the samples with the serological phenotypes CCee, CcEe and Ccee were 80.0% (4/5), 68.2% (45/66) and 61.6% (53/86), respectively.

The results provide evidence that Del samples have exons 4, 7 and 10 of an RHD gene present in some form. This is consistent with the evidence that D antigen is present on the cells although only detected by antibody adsorption and elution. The PCR‐SSP method in the present study is useful to confirm Del among serologically apparent D‐negative samples.
A new high‐molecular‐weight glycophorin C variant with a duplication of exon 2 in the glycophorin C gene
Authors: Uchikawa M. , Tsuneyama H. , Onodera T. , Murata S. , Juji T.
Published: November 2003

Glycophorin C (GPC) and glycophorin D (GPD) are closely related sialoglycoproteins in the human red blood cell (RBC) membrane. Both are thought to be encoded by the GPC gene (GYPC). We report here the new GPC variant, MAT, with a high‐molecular‐weight form of GPC and GPD. The murine monoclonal antibody to GPC (CBC‐96), which had specificity for the N‐terminal region of GPC, gave a stronger reactivity with the MAT RBCs than did normal RBCs in direct agglutination tests. Immunoblotting of the MAT RBC membranes with anti‐GPC antibodies showed the apparent molecular weight of GPC.MAT and GPD.MAT was 5000 greater than that of their normal counterparts. cDNA was synthesized from total RNA obtained from three unrelated, heterozygous MAT blood donors and analysed by the polymerase chain reaction with primers that spanned sequences encoded by GYPC. Two fragments were generated: one was 510 bp, the other was 453 bp and corresponded to the normal GPC. Sequencing of the mutant 510‐bp fragment showed an insert of 57 nucleotides that corresponds to the entire sequence of exon 2 in GYPC. These results show that MAT is the result of a duplication of exon 2 in GYPC, which probably encodes the two high‐molecular weight forms GPC.MAT and GPD.MAT. The MAT mutation is found with a frequency of 0.02% in the Japanese population.
Iron pre‐load for major joint replacement
Authors: Andrews C. M. , Lane D. W. , Bradley J. G.
Published: November 2003

Patients undergoing total hip or knee replacement frequently receive blood transfusion. Homologous blood transfusion carries appreciable risks and should therefore be reduced to a minimum. We have investigated the use of preoperative oral iron supplements to optimize haemoglobin concentration and iron stores prior to surgery.

All patients attending a preadmission clinic 4 weeks prior to primary hip or knee replacement had a haemoglobin measurement. If the haemoglobin concentration (Hb) was less than 12 g dL−1 they were given a four week course of ferrous sulphate. If it was greater than or equal to 12 g dL−1 they were randomized to a control group or given a supplementation course of ferrous sulphate.

One hundred patients were seen. Of these 18 (18%) had haemoglobin less than 12 g dL−1 and 16 were treated with iron. The mean Hb was 10.8 g dL−1 and mean cell volume (MCV) 86. These patients increased their Hb by a mean 1.1 g dL−1 prior to admission (P = 0.008). MCV was the best predictor of response (r = −0.63, P < 0.02). This group dropped their haemoglobin by a mean 1.4 g dL−1 in the first post‐operative week.

In the study groups there was no significant preoperative rise in Hb. However, the control group dropped their Hb by a mean 1.3 g dL−1 in the week following surgery compared with 0.4 g dL−1 in the group which had received iron supplements (P < 0.001).

We conclude that at least 18% of patients attending for hip or knee replacement in this region are frankly anaemic and benefit significantly from preoperative iron supplements over 4 weeks. Iron supplementation in patients without obvious anaemia protects against a fall in Hb during the immediate post‐operative period, suggesting a widespread underlying depletion of iron stores in this group despite a normal Hb. Preoperative iron supplements may reduce transfusion requirements as part of a co‐ordinated strategy in this group of patients.
Completed hepatitis C lookback in Northern Ireland
Authors: Morris K. , Bharucha C.
Published: November 2003

Hepatitis C virus screening of blood donors was introduced in September 1991 using a second‐ generation enzyme‐linked immunoassay (ELISA) and subsequent confirmatory testing with immunoblot (RIBA) and polymerase chain reaction (PCR). In April 1995 a lookback exercise was announced by the Department of Health, the purpose of which was to trace, counsel, investigate and, if necessary, treat individuals who may have been infected with HCV through blood and blood products prior to screening. A total of 231 321 donations have been screened, of which 553 were found to be reactive. Subsequent confirmatory tests identified 24 HCV‐positive donors; 13 were repeat donors who had given a total of 164 units. Ninety‐three units were traced and 117 components were identified as having been issued to hospitals. Twenty‐five recipients requiring follow‐up were identified, of which three were assessed by their GPs as not requiring counselling. Of 22 recipients of potentially infectious units 12 showed no evidence of exposure to HCV. We discuss these results in detail.
A prospective randomized study of three types of platelet concentrates in patients with haematological malignancy: corrected platelet count increments and frequency of nonhaemolytic febrile transfusion reactions
Authors: Anderson N. A. , Gray S. , Copplestone J. A. , Chan D. C. , Hamon M. , Prentice A. G. , Johnson S. A. N. , Phillips M. , Van Waeg G. , Oakhill A. , Abeyasekera S. , Pamphilon D. H.
Published: November 2003

We prospectively randomized 51 patients with haematological malignancy requiring platelet concentrates (PCs) to receive either single donor plateletpheresis products (SD‐PC), PCs made from pooled buffy coats (BC‐PC) or pooled units of platelets made by the platelet‐rich plasma method (PRP‐PC). The leucocyte content of each type of PC was 0.33 (0.03–13.5), 5.68 (0.19–99.0) and 365 (65–910) × 106; median (range), respectively; P < 0.0001. All red cell transfusions were leucodepleted by filtration. Statistical comparison of the probability of the occurrence of a nonhaemolytic febrile transfusion reaction (NHFTR) following transfusion of PCs in patients in each group showed a significant decrease for the SD‐PC and BC‐PC groups (0.031 and 0.038, respectively) when compared with PRP‐PC (0.171); P =0.001. The actual corrected platelet count increments (CCI) at 1–6 and 18–24 h post‐transfusion for all three types of PC did not differ significantly. We conclude that transfusion of PRP‐PC is associated with a significant increase in NHFTR.
Identification of HLA class II antigens as the targets of effector clones which may cause transfusion‐associated graft‐versus‐host disease
Authors: Nishimura M. , Uchida S. , Mitsunaga S. , Yahagi Y. , Nakajima K. , Tadokoro K. , Juji T.
Published: November 2003

We established T cell clones, which were considered to be the possible cause of transfusion‐associated graft‐versus‐host disease (TA‐GVHD), from the peripheral blood lymphocytes (PBLs) of two patients. In both cases, several CD4+ cytotoxic T‐cell (CTL) clones were established. In case I, the target antigen of the established CD4+ clones was a DRB1*0403‐related antigen serologically typed as HLA DR4, which was one of the patient HLA antigens. In case II, the target of four out of five established CD4+ CTL was a DRB1*1302‐related antigen. One CD4+ CTL clone showed cytotoxicity against cells carrying A*2402, B*4403, Cw*1403 and DPB1*0401. A monoclonal antibody (mAb) blocking study showed only anti‐DP mAb inhibited the cytotoxicity of this clone. Thus, it might be considered that this clone recognizes HLA‐DP with its binding peptides derived from either A*2402, B*4403, Cw*1403 or DRB1*1302. Our findings indicate that CD4+ CTLs may play important roles in the aetiology of TA‐GVHD and that the antigens of patients recognized by donor‐derived effector cells may not always recognize a single HLA antigen.
Sustainability of a nutrition education programme to prevent night‐blindness in Bangladesh
Authors: Hussain A. , Kvåle G.
Published: November 2003

Cross‐sectional surveys were conducted to assess prevalence of night‐blindness and dietary habits prior to intervention (in 1986), after 3 years of intervention (in 1989) and 3 years after the termination of active intervention (in 1992.), in the northern part of Bangladesh. The prevalence of night‐blindness per thousand children decreased from 1986 to 1989 (during intervention) and rose from 1989 to 1991, but remained significantly lower in 1992 than the 1986 prevalence. Household income declined from 1989 to 1992, and lower consumption of (3‐carotene rich food, protein items and vitamin A capsules was registered in 1992 despite almost the same level of awareness relating to the prevention of night‐blindness in the community during the period 1989–1992. The results indicate that the long‐term impact of a health education programme to prevent night‐blindness is uncertain. Improvement in socioeconomic conditions, in addition to relevant knowledge, is probably a precondition for maintaining a sustainable impact of health education.
Exploring the interface between first and second level of care: referrals in rural Africa
Authors: Nordberg E. , Holmberg S. , Kiugu S.
Published: November 2003

The studies aimed to determine the referral rate, the characteristics of patients referred, the reasons for referral and, in a sub‐sample, its outcome. Study I recorded data on 602 patients referred to hospital from 13 rural clinics; follow‐up interviews were conducted with a sub‐sample of 57 referred patients. Study II interviewed 97 consecutive outpatients seeking care at Meru District Hospital. Both studies were carried out in a rural area of Meru district in central Kenya. The 602 referred cases represent between 0.3 and 1.8% of all new patients at the respective clinic with a mean of 0.5%, or 8.7 referrals annually per 1000 catchment area population. More than half of the referrals were for treatment only while 13% were for investigation, 63% were considered urgent, and 85% were referred in writing. Of the 57 subsequently interviewed, all except one had complied, and 52 patients, mostly with infections, injuries or obstetric disorders, reported improvement at the time of interview. The second study found that only 19 (20%) of the 97 outpatients had been referred (11 in writing and 8 verbally). Rates of formal clinic‐to‐hospital referral were very low. Reasons included poor access to transport; patient inability to pay user fees, transport outlays, and other expenses; time constraints in emergency situations; and lack of feedback information from hospital to clinic. Verbal referral was common. Further research should focus on the selection of patients for referral, on follow‐up of cases referred, on the communication between institutions involved, and on options for the financing of emergency transport to hospital.
A community trial of ivermectin for onchocerciasis in Sierra Leone: compliance and parasitological profiles after three and a half years of intervention
Authors: Whitworth J. A. G. , Downham M. D. , Lahai G. , Maude G. H.
Published: November 2003

We have studied the compliance patterns and the long‐term effects of repeated ivermectin at various dosing intervals in a randomized controlled trial. The setting for the trial was six neighbouring communities hyperendemic for onchocerciasis in southern Sierra Leone. A total of 335 subjects attended a survey 18 months after the fifth treatment round. Of those randomized to ivermectin, over 85 % had received at least three doses. There was no evidence that women of childbearing age were consistently under‐treated, despite the criteria for exclusion from treatment. An intention‐to‐treat analysis showed that a 6‐monthly ivermectin treatment regime satisfactorily suppressed microfilarial loads. Microfilarial repopulation was significantly slower over an 18‐month period after multiple doses compared to a single dose. Further analysis of microfilarial repopulation suggests that there is a cumulative suppressive effect after at least the first three doses of ivermectin, and that an annual treatment interval is as effective for short‐term microfilarial suppression as a 6‐monthly interval.
Field tests of a village‐based mollusciciding programme for the control of snail hosts of human schistosomes in Cameroon
Authors: Greer G. J. , Tchounwou P‐B. , Takougang I. , Monkiedje A.
Published: November 2003

The feasibility of using unskilled workers at the district or village level to perform mollusciciding activities in arid regions of northern Cameroon was investigated. A simplified procedure for application to temporary ponds, the principal sites of schistosomiasis transmission in that region, was tested. This consisted of mixing the required quantitity of niclosamide (Bayluscide, Bayer AG, Leverkusen) with pond water in a plastic watering can and applying the mixture around the circumference. To aid dispersion, the can was repeatedly swept from the perimeter toward the centre of the pond. Two ponds each were treated once near the end of the rainy season at 1 of 3 concentrations: 0.5, 1.0 and 1.5 p.p.m. Following treatment, 100% snail mortality was recorded at all concentrations. A simple, rapid method for determining the quantity of niclosamide needed to treat temporary ponds was also devised.

Physical characteristics were determined for 16 potential schistosomiasis transmission sites in the region. An integration of those characteristics was used to develop a simplified scale indicating the quantity of niclosamide needed to treat ponds based on their circumference.

The operational feasibility of a village based mollusciciding programme using those simplified procedures was then evaluated in 2 villages. Village health workers demonstrated a high accuracy (87%) in identifying potential schistosomiasis transmission foci and snail host populations were virtually eliminated from treated sites.
Prevalence of blindness and visual impairment in the region of Ségou, Mali. A baseline survey for a primary eye care programme
Authors: Kortlang C. , Koster J. C. A. , Coulibaly S. , Dubbeldam R. P.
Published: November 2003

A community‐based cross‐sectional study on the prevalence and causes of blindness and visual impairment was conducted between July and August 1990 in three rural districts in Ségou region, Mali. The study population consisted of 5871 villagers. In the study area, the overall prevalence of bilateral blindness was 1.7% (standardized rate for age 2.0%± 0.4%), of bilateral visual impairment 1.7% (2.1%± 0.4%), of unilateral blindness 1.7% (2.2%± 0.4%) and of unilateral visual impairment 1.0% (1.2 ± 0.3%). No important differences were found between districts.

Cataract was the most common cause of visual loss (54%) and was most prevalent among those over 50 years of age. In 43%, unilateral blindness was associated with trauma. Other major eye diseases accounting for high percentages of visual impairment were trachoma and glaucoma. Xerophthalmia appeared to be a major public health problem among children in the age group 0–5.

It was concluded that blindness is a major public health problem in this region. Some recommendations are given for strengthening integrated primary eye care at the district level in Ségou region.
Topical chemotherapy for experimental African trypanosomiasis with cerebral involvement: the use of melarsoprol combined with the 5‐nitroimidazole, megazol
Authors: Jennings F. W. , Chauvière G. , Viode C. , Murray M.
Published: November 2003

Megazol, one of a number of related 5‐nitroimidazoles, can be dissolved in dimethylsulphoxide and the solution can be converted into a gel by the addition of hydroxypropylcellulose which facilitates the ease and accuracy of administration. This megazol gel, when used in combination with melarsoprol (3.6%) in propylene glycol gel, will cure experimental CNS‐trypanosomiasis in mice. A single application of 0.1 ml of melarsoprol (3.6%) gel plus 0.1 ml of either 8 or 16 mg/ml megazol gel successfully treated experimental CNS‐trypanosomiasis while two consecutive days' treatment with 0.05 ml melarsoprol and 0.1 ml of 16 or 32 mg/ml megazol gels also produced satisfactory cures.
Impact of a mass vaccination campaign against a meningitis epidemic in a refugee camp
Authors: Haelterman Edwige , Boelaert Marleen , Suetens Carl , Blok Lucie , Henkens Myriam , Toole Michael J.
Published: November 2003

Serogroup A meningococcus epidemics occurred in refugee populations in Zaire in August 1994. The paper analyses the public health impact of a mass vaccination campaign implemented in a large refugee camp. We compared meningitis incidence rates from 2 similar camps. In Kibumba camp, vaccination was implemented early in the course of the epidemic whilst in the control camp (Katale), vaccination was delayed. At a threshold of 15 cases per 100000 population per week an immunization campaign was implemented. Attack rates were 94 and 134 per 100000 in Kibumba and Katale respectively over 2 months. In Kibumba, one week after crossing the threshold, 121 588 doses of vaccine were administered covering 76% of all refugees. Vaccination may have prevented 68 cases (30% of the expected cases). Despite its rapid institution and the high coverage achieved, the vaccination campaign had a limited impact on morbidity due to meningitis. In the early phase in refugee camps, the relative priorities of meningitis vaccination and case management need to be better defined.
Malaria control and fever management in Henan Province, China, 1992
Authors: Liu Xili , Jackson Sukhan , Song Jinduo , Sleigh Adrian C.
Published: November 2003

Henan Province, which once had the highest malaria prevalence in China, had only 318 reported cases in 1992. Our purpose was to investigate this late ‘consolidation phase’ of malaria control in Henan with reference to malaria surveillance. We conducted a questionnaire survey of village doctors in Shang Shi Qiao Township during the transmission period of 1992. Of the 732 recorded fever cases, 16 were probable malaria cases by clinical and treatment response criteria, but only one received a full course of antimalarials. Of the 732 patients, 61% had fever every day, 37% went for treatment the first day, 52% waited 2–3 days and 10% waited longer. One hundred and twenty‐eight patients took self‐medication before seeing the doctor. Blood examination was carried out in 526 (71%) fever cases but only four were positive, all for Plasmodium vivax. Our findings highlight problems relating to patient behaviour and motivation of village doctors, malaria treatment, surveillance and microscopy, rural migration, economic development and malaria transmission. All need to be considered for reforming the malaria control strategy in Henan Province.
Plasmodium berghei mouse model: antimalarial activity of new alkaloid salts and of thiosemicarbazone and acridine derivatives
Authors: Loiseau P. M. , Xuong Nguyen Dat
Published: November 2003

Sixteen compounds were synthesized and evaluated on Plasmodium berghei in CD1 mouse. The nature of the salt associated to the active principle can give some advantages in the field of activity, bioavailability and toxicity. β‐Resorcylic acid was chosen in this study because of its previously described antimalarial activity and its expected enhancement of quinine antimalarial activity. While treatment with subcutaneous quinine sulphate at 1 mmol/kg cured 6/10 mice, quinine β‐resorcylate cured all the mice under identical conditions.

Although such a result appeared promising, in vitro investigation should be performed to draw clear conclusions regarding a synergy between quinine and β‐resorcylate. Cinchonidine β‐resorcylate was also active; all mice were cured at 1 mmol/kg and the mean survival time was 13.8 ± 2.4 days after a subcutaneous treatment at 0.5 mmol/kg in a single dose. In the series of acridines, (N‐α, ε‐dioxopentyl)‐5‐amino‐1,2,3,4‐tetrahydroacridine cured all mice at 50 μmol/kg under the same conditions. The maximum tolerated doses in mice ranged from 100 to 150 μmol/kg for these acridine derivatives. The chemotherapeutic index of (N‐α, ε‐dioxopentyl)‐5‐amino‐1,2,3,4‐tetrahydroacridine was estimated at 2–3. Other salts expected to reduce the toxicity, such as α‐ketoglutarate and p‐chlorophenoxyacetate, did not enhance the activity of the active principles. These results prompt us to further investigations including plasma kinetic evaluation in rats and in vitro on Plasmodium falciparum.
Direct amplification and species determination of microsporidian DNA from stool specimens
Authors: Katzwinkel‐Wladarsch S. , Lieb M. , Heise W. , Löscher T. , Rinder H.
Published: November 2003

Microsporidia are recognized as a major aetiological agent in chronic diarrhoea of immunocompromised patients. Their detection by light microscopy is hampered by the small size of the spores. A simple and rapid DNA extraction method has been developed for the detection of microsporidian DNA by PCR directly from stool specimens. It can be performed at room temperature in a 1.5‐ml microcentrifuge tube format in less than 1 hour. The subsequent nested polymerase chain reaction permits the detection of 3–100 spores in a 0.1‐g stool sample. The amplification products can be verified and the species Enterocytozoon bieneusi, Encephalitozoon cuniculi and Encephalitozoon (Septata) intestinalis distinguished by a simple restriction endonuclease digest.
The EI Niño Southern Oscillation and the historic malaria epidemics on the Indian subcontinent and Sri Lanka: an early warning system for future epidemics?
Authors: Bouma Menno J. , van der Kaay Hugo J.
Published: November 2003

The recurrent great malaria epidemics which occurred in the Punjab province of former British India and Ceylon before the introduction of residual insecticides have been related to excessive and failing monsoon rains respectively. In the arid Punjab, rainfall facilitated breeding and increased the lifespan of the mosquito vector and, in the wet part of Ceylon, failing monsoon rains caused rivers to pool, creating more favourable breeding conditions. The periodic fluctuations in monsoon rainfall and epidemic malaria are here explained in relation to the El Niño Southern Oscillation. In the Punjab, epidemic malaria between 1868 and 1943 correlates significantly (r=0.34, P<0.005) with the sea surface temperature anomalies in the Eastern Equatorial Pacific, a parameter of the oscillation, and epidemics were significantly more prevalent in a year with a wet monsoon following a dry El Niño year than in other years. In Ceylon, epidemics were significantly more prevalent during El Niño years, when the same south‐west monsoon tends to fail. With the reduced reliance on residual insecticides and the recurrence of epidemic malaria on the Indian subcontinent, advances made in predicting El Niño events may be used to forecast high and low risk years for future malaria epidemics.
Ultrasonographic assessment of the adulticidal efficacy of repeat high‐dose ivermectin in bancroftian filariasis
Authors: Dreyer G. , Addiss D. , Noroes J. , Amaral F. , Rocha A. , Coutinho A.
Published: November 2003

Since diethylcarbamazine, the drug recommended for treatment of lymphatic filariasis, seems only partially effective against the adult worm, intense interest persists in identifying a macrofilaricidal drug for this infection. To evaluate directly in vivo the macrofilaricidal activity of repeat high‐dose ivermectin, 15 men who had living adult Wucbereria bancrofti detected in the scrotal area by ultrasound were treated with 400 μg/kg of ivermectin at 2‐week intervals for 6 months (total dose, 4.8 mg/kg). Serial ultrasound examinations were performed before, during, and for 6 months after treatment. Profound suppression of microfilaraemia followed the first dose of ivermectin, but movements characteristic of the adult worm on ultrasound remained unchanged both in location and pattern. Even when given in total doses of 4.8 mg/kg, ivermectin appears to have no observable activity against adult W. bancrofti, although its ability to suppress microfilaraemia makes it potentially useful for the control of lymphatic filariasis.
Autochthonous cutaneous larva migrans in Germany
Authors: Klose C. , Mravak S. , Geb M. , Bienzle U. , Meyer C. G.
Published: November 2003

Cutaneous larva migrans syndrome is extremely rare in Germany. However, three cases of this syndrome were diagnosed in patients from Berlin, Germany, in the summer of 1994. Exposure to the infective agent in endemic areas and close contact with animals were excluded. It is assumed that the extreme temperatures in summer 1994 favoured the conditions of infection.
Plasmodium falciparum malaria in the first year of life in an area of intense and perennial transmission
Authors: Kitua A. Y. , Smith T. , Alonso P. L. , Masanja H. , Urassa H. , Menendez C. , Kimario J. , Tanner M.
Published: November 2003

A longitudinal study of Plasmodium falciparum malaria in infants in Idete village, south‐eastern Tanzania, was conducted over a period of 14 months in order to determine the incidence of P. falciparum infection and clinical malaria in the first year of life. Of 1356 blood slides from cross‐sectional surveys, 52.1% were positive for asexual stages of P. falciparum. There were marked increases in P. falciparum prevalence, parasite densities, overall fever incidence and the incidence of malaria fevers with age for the first 6 months of life. The average attack rate, estimated from a reversible catalytic model, was 0.029 per day with a slight increase with age but there was no initial period of protection against infection in neonates. Estimated average duration of infections was 64 days, with infections in older infants lasting much longer than those contracted during the first 2 months of life.

These results support the hypotheses that the main effect of passively transferred maternal immunity to malaria is in the control of asexual stage parasites, and that the level of clinical immunity depends upon the extent of recent exposure to parasites. Infants as young as 4 months of age are at high risk of clinical attacks. Intervention programmes against malaria in areas of the highest transmission should therefore be designed to include this group.
Clinical audit in a developing country
Authors: Maher Dermot
Published: November 2003

The advantages of health care audits in developing countries with severe resource constraints are discussed, citing examples from Malawi. Measuring quality in health care raises the standard of care through decreased uncertainty in health care provision, rationalized choice, appropriate direction of limited resources, increased job satisfaction and improved ethical standards.
Effects of cow's milk supplementation on milk output of protein deficient lactating mothers and on their infants' energy and protein status
Authors: Donnen Ph. , Brasseur D. , Dramaix M. , Assimbo V. , Hennart P.
Published: November 2003

A cow's milk supplement providing 500 kcal (2093 kJ) and 18 g of protein a day was given during 2 months to 83 lactating Zairian mothers suffering from protein malnutrition. The mothers′ nutritional status improved significantly after 2 months. The initial 24‐hour mother′s milk output was on average 607 ml (s.d.: 182) and did not change significantly after 2 months (604 ml; s.d.: 178). Initial milk output and change in milk output did not differ according to mothers' nutritional status at inclusion. Breast‐fed infants showed a significant improvement of their mean serum albumin concentration while their growth was similar to the mean growth of children of the same age.
An evaluation of dipstick‐dot immunoassay in the detection of antibodies to HIV‐1 and 2 in Zimbabwe
Authors: Ray C. , Mason Peter , Smith Heather , Rogers Luanne , Tobaiwa Ocean , Katzenstein David
Published: November 2003

There is a need, in many developing countries, for simple and inexpensive HIV serology tests for use at the district level of health care. The Programme for Appropriate Technology in Health has developed a simple dipstick ELISA to detect antibodies to HIV‐1 and 2, at a cost considerably lower than current ELISAs, which requires no specialized washing or reading equipment. In order to evaluate this dipstick under local conditions we used a panel of 546 sera selected from frozen stocks maintained by the Zimbabwe AIDS Prevention Project in Harare, Zimbabwe. Prior to storage, the sera had been tested by Abbott recombinant peptide HIV‐1 and 2 ELISA and Enzygnost synthetic peptide HIV‐1 and 2 ELISA. The panel included sera that were positive by both (including symptomatics and asymptomatics), negative by both, and sera showing discrepant test results. The panel was not representative of a ‘normal’ batch of sera in Zimbabwe, and in particular included an abnormally high number of sera showing discrepant results. Thawed sera were retested using the Abbott recombinant peptide HIV‐1 and 2 ELISA and concurrently with the synthetic peptide ICL Dipstick ELISA. Both the sensitivity and specificity of the ICL Dipstick exceeded 99% when using sera that were positive or negative in all 3 plate ELISAs as the gold standard. When using sera that gave discrepant results between the two pre‐storage ELISAs, most results with the ICL Dipstick concurred with findings from other test systems, including Western blot and p24 antigen detection. Considering the accuracy, low cost and ease of operation of the ICL Dipstick ELISA, this test can be recommended for use for the rapid detection of antibodies to HIV at district level in developing countries.
Trypanocidal effect of Ir‐(COD)‐pentamidine tetraphenylborate on Trypanosoma brucei and T. b. gambiense rodent models and serum kinetics in sheep
Authors: Loiseau P. M. , Dreyfuss G. , Daulouède S. , Lachâtre G. , Vincendeau P. , Craciunescu D. G.
Published: November 2003

Pentamidine di‐(iridium cyclo‐octadiene)tetraphenylborate, called Ir‐(COD)‐pentamidine tetraphenylborate, was selected from a primary screening as a promising trypanocidal compound. The compound was evaluated against three isolates: Trypanosoma brucei brucei CMP, T. b. brucei GVR 35 and T. b. gambiense Feo. On the T. b. brucei GVR 35 murine CNS model, no mouse was cured when the treatment was commenced 21 days post‐infection whatever the treatment regimen. Nevertheless, in vitro the compound killed the trypomastigote forms of T. b. gambiense Feo at 0.6 μm. In vivo, the compound cured all mice infected 1 hour previously with T. b. gambiense Feo after a 10 mg/kg (6.3 μmol/kg) treatment subcutaneously administered in a single dose. Moreover, the compound was active at 1 mg/kg (0.6 μmol/kg) in a single dose against the early stage of the T. b. brucei Antat 1‐9 sheep model. Serum kinetics data showed that pentamidine di‐(iridium cyclo‐octadiene) tetraphenylborate was distributed within deep compartment according to a monocompartmental model. The maximum iridium serum concentration was 198 μg/l corresponding to 1 μmol/kg of iridium derivative and this value remained stable for 30–50 hours post‐treatment. Iridium was completely eliminated from the serum 700 hours post‐treatment. All data obtained from these models are in favour of an activity in the early stage of the disease but indicate that the compound could not cross the blood–brain barrier despite its lipophilicity. Although iterative treatments with the compound rapidly induced the selection of iridium derivative refractory populations, the compound could be studied on pentamidine refractory strains.
Changes in the pattern of infant and childhood mortality in Upper River Division, The Gambia, from 1989 to 1993
Authors: Jaffar S. , Leach A. , Greenwood A. M. , Jepson A. , Muller O. , Ota M.O.C. , Bojang K. , Obaro S. , Greenwood B. M.
Published: November 2003

A surveillance system was used to detect births and deaths in children in a large, rural, West African population from 1989 to 1993. Cause of death was investigated using post‐mortem questionnaires. Overall infant (age 0–11 months) and child (age 1–4 years) mortality rates of 80.1 and 18.8 per 1000 per year were recorded. These were reasonably consistent over the period of surveillance. The most frequent cause of death in infants was acute respiratory infection (ARI), whereas in children it was malaria: these two conditions accounted for 41% of the deaths in children under 5 years old. Other leading causes of death were acute gastroenteritis, malnutrition, and septicaemia. Deaths attributed to ARI decreased over the 5‐year period, but mortality rates from other causes were either unchanged or increased slightly. Mortality from all causes peaked in the rainy season and was slightly higher in villages which were part of a primary health care programme than in those which were not. There were also no differences between male and female mortality rates beyond one year of age. Despite the introduction of a number of health interventions, there has been no major change in the overall pattern of mortality in children in a rural area of The Gambia. Malaria and ARI remain the main causes of death.
Konzo associated with war in Mozambique
Authors: Cliff J , Nicala D , Saute F , Givragy R , Azambuja G , Taela A , Chavane L , Howarth J
Published: November 2003

We report an epidemic of konzo, symmetric spastic paraparesis associated with cassava consumption and cyanide exposure: 384 patients were treated in rehabilitation centres; the prevalence rate in a badly affected area was 30/1000. Most patients were children over 3 and women. Owing to war, communities turned to bitter cassava as their staple and took shortcuts in its processing. When the war ended, they continued to depend on inadequately processed bitter cassava. The epidemic lasted 2 years (the last year of war and the first of peace) with peaks each year during the cassava harvest. Although most cases were reported from rural inland areas, patients also came from small towns and the coast. School children had raised urinary thiocyanate and linamarin and low inorganic sulphate concentrations. Urinary thiocyanate values were lower than those previously reported in konzo epidemics, probably because we collected specimens before the cassava harvest and epidemic peak. The necessary conditions for konzo were present: intensive cultivation of bitter cassava, insufficient processing, a probable high cyanide intake, and a low intake of protein‐rich foods.
Maternal nutrition and socio‐economic status as determinants of birthweight in chronically malnourished African women
Authors: Andersson Roland , Bergström Staffan
Published: November 2003

The birthweight is the most important determinant of mortality and morbidity in the neonatal period and may have an influence on health in adult life. The high rate of low birthweight in developing countries is therefore a major health problem. Maternal malnutrition is usually assumed to be a causal factor but other environmental factors are also involved. In this study we analysed maternal nutritional and socio‐economic factors as determinants of birthweight in term infants from a rural African society characterised by a high rate of chronic malnutrition. Relations of maternal weight, gestational weight gain, parity, socio‐economic status and infant sex with birthweight were analysed in 1 477 women and child pairs. The selected women were followed from early pregnancy and had an uncomplicated delivery at term of a living singleton child. The gestational weight gain was 5.6 (SD 6.0) kg and the mean birthweight 2.933 kg (SD 408). Maternal weight, representing the maternal long‐term nutritional situation, was the most important independent determinant of birthweight, accounting for 13.0% of the variance in birthweight. The weight gain, representing the short‐term nutritional situation, explained only 5.6% of the variance. Birthweight increased by 20 g (CI 18–23) for each kg maternal weight and by 15g (CI 12–18) for each kg gestational weight gained. The socio‐economic difference in birth‐weight was 153 g (CI 109–196) 88 of which (CI 48–128) remained unexplained after adjustment for differences in maternal weight, parity and gender. Improved long‐term nutritional situation and living conditions seems to be the most important prerequisites to counteract low birthweight in developing countries.
Optimizing the malaria data recording system through a study of case detection and treatment in Sri Lanka
Authors: Abeysekera T. , Wickremasinghe A. R. , Gunawardena D. M. , Mendis K. N.
Published: November 2003

The potential of using malaria incidence data routinely collected from endemic regions for disease control and research has increased with the availability of advanced computer‐based technologies, but will depend on the quality of the data itself. We report here an investigation into the relevance of malaria statistics provided by the routine data collection system in Moneragala, a rural malaria‐endemic region in Sri Lanka. All patients (n = 321) treated for malaria in 2 clusters of health care centres (HCCs) of both the private and the public sector in the administrative regions of Moneragala and Buttala Divisional Secretariat (D.S.). Divisions were studied in December 1995/January 1996. The catchment area of these HCCs included a population resident in 53 Grama Niladhari (GN) areas, the smallest administrative units of the country. Almost equal numbers of malaria patients were detected and treated at Government and private health care institutions, and in 70% of them treatment was based on a diagnosis confirmed by microscopy. The routine data recording system, however, included only statistics from the Government sector, and only of patients whose diagnosis was microscopically confirmed. In compiling data, the origin of a case of malaria is attributed to the D.S. Division in which the institution (at which the patient was treated) was located, rather than the area in which the patient was resident, which was inaccurate because 90% of malaria patients sought health care at institutions located closest to their residence, thus crossing administrative boundaries. It also led to a loss of resolution of spatial data because patients' addresses recorded at the Government HCCs to the village‐level are replaced in the statistics by the D.S. Division, which is a coarse spatial unit. Modifications to the system for malaria case recording needed to correct these anomalies are defined here. If implemented, these could result in major improvements to the quality of data, a valuable resource for the future of malaria control. The paper reiterates the call for the use of a standard spatial unit within a country to facilitate exchange of data among health and other sectors for the control of tropical diseases.
Nationwide prevalence study of hypertension and related non‐communicable diseases in The Gambia
Authors: Van Der Sande Marianne A. B. , Bailey Robin , Faal Hannah , Banya Winston A. S. , Dolin Paul , Nyan Ousman A. , Ceesay Sana M. , Walraven Gijs E. L. , Johnson Gordon J. , McAdam Keith P. W. J.
Published: November 2003

The prevalence of hypertension, diabetes and obesity in The Gambia was assessed in a 1% population sample of 6048 adults over 15 years of age. 572 (9.5%) subjects were hypertensive according to WHO criteria (a diastolic blood pressure (DBP) of 95 mmHg or above and/or a systolic blood pressure (SBP) of 160 mmHg or above); 325 (5.4%) had a DBP of 95 mmHg or above, and 39 (2.3%) a DBP of 105 mmHg or above; 428 (7.1%) had a SBP of 160 mmHg or above. By less conservative criteria (a DBP of 90 mmHg or above and/or SBP of 140 mmHg or above), 24.2% of subjects were hypertensive. The prevalence of hypertension was similar in the major ethnic groups and in urban and rural communities. Age and obesity were risk factors for hypertension; female sex was an additional risk factor for diastolic hypertension. Several communities had a prevalence of diastolic hypertension double the national rate, and significant community clustering of diastolic hypertension (P < 0.01) was confirmed by Monte Carlo methods. Genetic and/or localized environmental factors (such as diet or Schistosoma haematobium infection), may be involved. 140 (2.3%) subjects were obese. Obesity was associated with female sex, increasing age, urban environment, non‐manual work and diastolic hypertension. Only 14 (0.3%) subjects were found to be diabetic. Hypertension appears to be very prevalent in The Gambia, with a substantial population at risk of developing target organ damage. Further studies to delineate this risk and appropriate interventions to reduce it are needed.
Resistance of falciparum malaria to chloroquine and sulfadoxine‐pyrimethamine in Afghan refugee settlements in western Pakistan: surveys by the general health services using a simplified in vivo test
Authors: Rowland Mark , Durrani Naeem , Hewitt Sean , Sondorp Egbert
Published: November 2003

Surveys of drug resistant falciparum malaria were conducted in several Afghan refugee settlements, distributed over a 700 km range in western Pakistan, during the transmission seasons of 1994 and 1995. Symptomatic malaria patients were recruited by a process of passive case detection at the refugees' basic health units. To facilitate follow‐up by local health workers, a modified version of the WHO extended in vivo test was adopted in which blood smears were taken from each subject, and clinical symptoms recorded, at weekly intervals. Resistance to chloroquine and sulfadoxine‐pyrimethamine was identified in every settlement. The frequency of chloroquine resistance ranged from 18% to 62%. Resistance occurred mostly as RI, with RII resistance never exceeding 11%. Resistance to sulfadoxine‐pyrimethamine occurred at much lower frequencies, ranging from 4% to 25%. There was a resumption of clinical symptoms at the onset of parasite recrudescence in over 90% of cases. The policy of using chloroquine as first‐line treatment might be changed in favour of sulfadoxine‐pyrimethamine in most camps and areas of western Pakistan. The modified in vivo test was almost as accurate as the normal WHO in vivo test in identifying the grade of resistance, and should prove a useful tool for the monitoring of resistance to common antimalarials by district health services.
AIDS and hospital bed occupancy: an overview
Authors: Buvé Anne
Published: November 2003

In several countries of sub‐Saharan Africa more than 10% of the adult population are infected with HIV, while in large towns such as Kampala, Lusaka, Blantyre, Kigali and Harare this proportion exceeds 25%. One of the most obvious consequences is the increased occupancy of hospital beds by patients with HIV infection, perhaps to the exclusion of patients with other ailments. This paper gives an overview of several hospital occupancy studies.
Severe anaemia in children living in a malaria endemic area of Kenya
Authors: Newton C. R. J. C. , Warn P. A. , Winstanley P. A. , Peshu N. , Snow R. W. , Pasvol G. , Marsh K.
Published: November 2003

Severe anaemia is an important cause of morbidity and mortality in African children, but the causes, particularly falciparum malaria, are difficult to determine. We assessed the contribution of falciparum malaria to anaemia in Kenyan children by clinical examination and measurement of parasitaemia and haemoglobin (Hb) concentration in 559 children in the community and in 2412 children admitted to Kilifi district hospital during a 2‐year period. We also attempted to characterize severe malarial anaemia by examining the causes and pathophysiology of anaemia in 101 children admitted with Hb concentration 50 g/l during a 1‐year period. Plasmodium falciparum infection was associated with reduced Hb concentration in children in the community and in those admitted to hospital irrespective of diagnosis. Falciparum malaria was the primary cause in 46 cases (46%) of severe anaemia admitted to hospital. There was no difference in the frequency of haemolysis or dyserythropoiesis in the children with malarial anaemia and those with anaemia from other causes, such as iron deficiency or sickle cell disease. The mortality rate in the children with severe malarial anaemia was 8.6% compared with 3.6% in children with severe anaemia due to other causes. Falciparum malaria does not present with a characteristic clinical or haematological picture, but is a major cause of the morbidity and mortality in children with severe anaemia who live on the Kenyan coast, a malaria endemic area.
Worm burden in intestinal obstruction caused by Ascaris lumbricoides
Authors: De Silva N. R. , Guyatt H. L. , Bundy D. A. P.
Published: November 2003

Examination of 24 case reports suggests the worm burden in those presenting to hospital with intestinal obstruction is >60 and is about tenfold higher in fatal cases.