bluuebunny/crossref_metadata_2025 huggingface dataset:
The influence of different erythrocyte lysing procedures on flow cytometric determination of CD34+ cells in umbilical cord blood transplants
Authors: Cassens  , Gutensohn  , Garritsen  , Kelsch  , Kuehnl  , Sibrowski
Published: March 2003

Since the correct determination of CD34+ cells is of great clinical importance for successful transplantation with haematopoietic progenitor cells (HPCs) from cord blood, we investigated the influence of different erythrocyte lysing techniques on the quantification of CD34+ cells in umbilical cord blood.

Flow cytometric determinations of CD34+ cells were performed from 20 cord blood samples, using three different erythrocyte lysing procedures and two monoclonal CD34 antibodies (n = 360).

Flow cytometric analysis showed characteristic patterns of the forward (FSC) and side (SSC) scatter light properties for the leucocyte subsets for each of the investigated erythrocyte lysing procedures, indicating that these reagents cause different morphological changes on leucocytes. Furthermore, significant differences of CD34+ cell counts were obtained for identical samples using different lysing techniques (P = 0.001 and P = 0.002). In some cases, a more than 100% difference was found comparing different erythrocyte lysing procedures. In contrast, the determination of CD34+ cells by two CD34 antibodies showed a good reproducibility without significant differences between both antibodies for each of the erythrocyte lysing techniques.

We conclude that the erythrocyte lysing procedure represents a very critical and important step for accurate determination of CD34+ cells in whole blood samples. Especially for the quantification of HPCs in cord blood transplants, this influence may be of high clinical relevance.
Glycophorin A mutation Ala65  →  Pro gives rise to a novel pair of MNS alleles ENEP (MNS39) and HAG (MNS41) and altered Wrb expression: direct evidence for GPA/band 3 interaction necessary for normal Wrb expression
Authors: Poole  , Banks  , Bruce  , Ring  , Levene  , Stern  , Overbeeke  , Tanner
Published: March 2003

We report here a novel Glycophorin A (GPA) mutation Ala65 → Pro which gives rise to a low‐incidence antigen HAG, lack of a high‐incidence antigen ENEP and aberrant expression of the high‐incidence Wrb antigen. Anti‐ENEP was identified in the serum of a transfused male patient (E.H.) who was homozygous for a GPA Ala65 → Pro mutation and possessed a novel low‐incidence antigen which we have called HAG. An unrelated HAG‐positive individual, heterozygous for the Ala65 → Pro mutation, has also been identified. Anti‐HAG was present in several multispecific antisera to low‐incidence antigens and in one monospecific serum.

Normal expression of the Wrb antigen depends on the presence of amino acid Glu658 of band 3 and on the presence of GPA. However, a specific epitope on GPA has not previously been implicated. DNA sequence analysis of band 3 from patient E.H. was normal in the region of Wra/Wrb polymorphism with homozygous presence of Glu658 and therefore the abnormal Wrb expression results from the Ala65 → Pro mutation in GPA.

The ENEP and HAG antigens have been assigned the MNS blood group system numbers 002.039 and 002.041, respectively, by the ISBT Working Party on Terminology for Red Cell Surface Antigens.
Prevention of transfusion‐transmitted cytomegalovirus infection
Authors: Pamphilon  , Rider  , Barbara  , Williamson
Published: March 2003

Cytomegalovirus (CMV) is a double‐stranded DNA virus which can be transmitted by blood transfusion. Its seroprevalence in adults ranges from 40% to 100% depending on geographical and socioeconomic conditions. Seropositive individuals have latent CMV infection with viral DNA present in peripheral blood leucocytes. CMV can be associated with considerable morbidity and mortality in susceptible individuals, e.g. CMV‐seronegative bone marrow allograft patients. Evidence, from a number of reports, suggests that provision of leucodepleted blood components may be as effective as the use of components from CMV‐seronegative donors in preventing CMV infection and disease. This is relevant in the UK because Blood Transfusion Services are implementing universal leucodepletion of cellular blood components to minimize the theoretical risk of transmission of new variant Creutzfeldt–Jakob disease. This review examines data on the biology of CMV, discusses options for testing and summarizes the impact of CMV‐seronegative and leucodepleted blood components on transfusion‐transmitted CMV.
Robotic selective sampling and total automation for anti‐CMV screening
Authors: McDonald  , Cook  , Engel  , Robbins  , Rayfield  , Barbara
Published: March 2003

The provision of anti‐cytomegalovirus (CMV)‐negative blood products causes the blood banking community considerable logistical problems. This is due firstly to the fact that only a select group of patients require anti‐CMV‐negative units, namely the immunocompromised. Secondly, the prevalence of CMV antibody in the blood donor population is high and, thirdly, the demand for anti‐CMV‐negative blood components continues to increase.  To address this problem, a system of robotic selective sampling and total assay automation for anti‐CMV screening has been developed. An in‐house computer program generates a worklist from the donation database of samples requiring screening to meet clinical demand. Algorithms incorporated in the program ensure that the minimum number of samples possible are selected for provision of anti‐CMV‐negative products. This ‘intelligent’ selection of samples substantially reduces reagent cost. Robotic pipetting from the electronically derived worklist, masterplate to test plate robotic transfer and use of an automated assay processor maintains specific sample identification throughout. Results are read mechanically and transmitted directly to the main computer system.  Robotic selective sampling and total assay automation produces an efficient, secure, auditable and completely traceable system for the provision of anti‐CMV‐negative units. The system produced a substantial reduction in labour costs with a 40% reduction in reagent usage. This system can be readily adapted for screening other markers on a selective basis.
A chemiluminescence test for predicting the outcome of transfusing incompatible blood
Authors: Hadley  , Wilkes  , Poole  , Arndt  , Garratty
Published: March 2003

A chemiluminescent test (CLT) which measures the metabolic response of human monocytes to sensitized red cells was developed to distinguish antibodies capable of causing the increased destruction of transfused incompatible red cells from antibodies which are clinically benign. Thirty sera containing IgG antibodies to high‐frequency antigens were tested; 27 of these sera were also tested using the monocyte monolayer assay (MMA). The clinical significance of antibodies in 14 of the sera was known: three (anti‐Ata (two), ‐JMH) caused accelerated clearance of 51Cr‐labelled cells, five (anti‐‘MiIII’, ‐Yta, three unidentified) caused haemolytic transfusion reactions and six (anti‐Yta, ‐Ge, ‐JMH, ‐Xga, ‐Kna (two)) did not appear to affect red cell survival. Overall, results from the MMA and CLT showed good agreement; seven sera were negative in both assays, 18 sera were positive in both assays and two sera were positive in the MMA but negative in the CLT. There was no clear relationship between the activity of different antibodies and the level of sensitization as determined by flow cytometry. Antibody activity could be either increased or decreased by incubation of sensitized red cells with fresh serum. MMA results were in concordance with the clinical significance of antibodies where known in eight of 10 cases. CLT results were in concordance with clinical significance in 12 of 14 cases. Both assays gave false‐positive results with serum from a patient with anti‐Kna who had received red cell transfusions without adverse effect. This appeared to be due to the ability of anti‐Kna to cross‐link complement receptor 1 (CR1) on red cells to CR1 on monocytes; negative results were obtained using autologous monocytes.
Variation of pH‐measurement in platelet concentrates
Authors: Van Der Meer P. F. , Van Zanten A. P. , Pietersz R. N. I. , Reesink H. W.
Published: March 2003

. To measure pH in platelet concentrates, blood gas analysers with different calibration principles may be used. In this study, variances observed in pH measurements with two types of blood gas analysers were investigated. pH was measured in crystalloid solutions (platelet additive solution (PAS‐II), phosphate‐buffered solutions) and two types of platelet concentrates (containing 100% plasma, or 65% PAS‐II/35% plasma) with two blood gas analysers: either using liquid and gas calibration (AVL 945), or only liquid calibration (AVL OMNI). These measurements were compared with a reference method. Especially for PAS‐II, large variation in pH was observed between AVL 945, AVL OMNI and the reference method: 6·91 ± 0·02, 7·35 ± 0·02 and 7·188 ± 0·010, respectively (mean ± SD; n = 12, P < 0·0001, paired t‐test). A significant difference in pH was also found for platelet concentrates in 65% PAS/35% plasma (6·88 ± 0·09 on AVL 945 and 7·02 ± 0·09 on AVL OMNI, n = 134, P < 0·0001). Comparison with the reference method revealed minor differences with AVL 945, whereas AVL OMNI gave a mean difference in pH of + 0·17. Platelets in 100% plasma revealed smaller differences (6·93 ± 0·13 for AVL 945 and 6·99 ± 0·13 for AVL OMNI, n = 95, P < 0·0001). We conclude that different blood gas analysers can yield different pH values, especially in weak buffered solutions such as platelet concentrates in PAS‐II. Validation of blood gas analysers for pH measurement of these solutions is therefore mandatory.
Platelet washing to prevent recurrent febrile reactions to leucocyte‐reduced transfusions
Authors: Vo T. D. , Cowles J. , Heal J. M. , Blumberg N.
Published: March 2003

Symptoms of fever and/or rigours after transfusion continue to occur commonly in patients receiving platelets leucocyte‐reduced after storage. A cohort of 24 consecutive patients who had experienced severe or repeated febrile nonhaemolytic reactions to post‐storage leucocyte‐reduced platelet transfusions were treated with saline‐washed, post‐storage leucocyte‐reduced platelets. The frequency of reactions declined from 20% of transfusions (n = 191) to 0·6% (n = 331) after instituting saline‐washed, post‐storage leucocyte‐reduced platelet transfusions. These results support the hypothesis that substances present in the supernatant of stored platelet concentrates mediate febrile nonhaemolytic transfusion reactions, and provide one strategy for preventing their occurrence.
Transfusion practice in elective orthopaedic surgery
Authors: Feagan B. G. , Wong C. J. , Lau C. Y. , Wheeler S. L. , Sue‐A‐Quan G. , Kirkley A.
Published: March 2003

. The transfusion requirements of 2233 patients who underwent total hip or knee joint arthroplasty procedures at nine Canadian hospitals during 1995–1996 were evaluated. Although 64% of patients were eligible for participation in an autologous blood donation (ABD) programme, only 8% predonated blood. Patients who were eligible for ABD were younger (62 years vs. 70 years) and had fewer medical illnesses (18% vs. 44%) than those who did not predonate. The rate of allogeneic transfusion was 9·0% (95% confidence interval 4·9–13·1%) in patients who predonated as compared with 24·1% (95% confidence interval 22·2–25·9%) in those who did not. Risk factors for the occurrence of an allogeneic transfusion were type of procedure (primary or revision hip arthroplasty), lower baseline haemoglobin, lower body weight, older age and presence of rheumatoid arthritis (P < 0·001). Only patients without risk factors were predicted to have a less than 10% risk of receiving an allogeneic transfusion. Use of preventive strategies was minimal. Two models designed to predict the occurrence of an allogeneic transfusion were evaluated. If allogeneic transfusion rates are to be reduced, eligible patients should be encouraged to participate in ABD programmes. For patients who are ineligible, other preventative strategies should be introduced.
Detection of hepatitis C core antigen in serum or plasma as a marker of hepatitis C viraemia in the serological window‐phase
Authors: Widell A. , Molnegren V. , Pieksma F. , Calmann M. , Peterson J. , Lee S. R.
Published: March 2003

Summary A new immunoassay for the detection of hepatitis C core antigen (HCVcoreAg) in peripheral blood during serological window‐phase was evaluated among healthy blood donors, commercially available hepatitis C virus (HCV) seroconversion panels and in‐house specimens from individuals undergoing seroconversion. Among 1964 low‐risk blood donor samples, seven samples were initially reactive but only one was repeat reactive. Reactivity of this specimen was not confirmable by neutralization with specific anti‐HCV core antibody, and the sample was negative for HCV RNA by polymerase chain reaction (PCR). The specificity of the HCVcoreAg enzyme‐linked immunosorbent assay (ELISA) was 99·95%. In seven commercially available HCV seroconversion panels, HCVcoreAg appeared 23–46 days earlier than anti‐HCV antibody by third generation assay. Additional testing with specimens from patients undergoing anti‐HCV seroconversion indicated that HCVcoreAg becomes undetectable by the present test format soon after the onset of antibody. This test may be considered as an alternative to nucleic amplification techniques (NAT) for blood donor HCV screening. Additional development of technology for detecting HCVcoreAg may be useful for patient diagnosis and therapy monitoring.
Stability of strain genotypes of Burkholderia pseudomallei from patients with single and recurrent episodes of melioidosis
Authors: Vadivelu Jamuna , Puthucheary S. D. , Drasar B. S. , Dance D. A. B. , Pitt T. L.
Published: March 2003

The constancy of strain genotypes of multiple isolates of Burkholderia pseudomallei from 13 patients with melioidosis was examined by BamHI ribotyping and pulsed‐field gel electrophoresis (PFGE) of XbaI digests of DNA. Seven of 8 patients with single episodes of melioidosis each yielded genetically identical isolates and only one of five patients with recurrent episodes was infected with a new strain clearly distinct from the original primary strain. Variation was observed in PFGE patterns of primary and relapse isolates of another patient but this was insufficient to define genetically distinct strains. We conclude that most patients with single or multiple episodes of melioidosis retain a single strain.
Schistosomiasis screening and health education for children: action research in Nile delta villages
Authors: El Katsha Samiha , Watts Susan
Published: March 2003

In Egypt an important component of the national schistosomiasis control policy is the regular screening of school children through the rural health units. In the Nile delta, a major challenge for the programme is the increasing predominance of Schistosoma mansoni, as compared to Schistosoma haematobium over the past 20 years, and the need to adjust strategies to this new reality. The action research project, growing out of an in‐depth study of schistosomiasis in two Nile delta villages, is intended to provide recommendations for schistosomiasis control to the Egyptian Ministry of Health and Population. This paper explores the practice of school‐based screening. We then describe the designing and testing of a revised screening procedure, which focuses on the collection of stool specimens to diagnose S. mansoni and which is comprehensive and gender‐sensitive. Opportunities for health education are discussed briefly, as this is necessary for an effective screening procedure and to prevent reinfection. In conclusion, we mention the need to incorporate screening and health education into an integrated control strategy.
Recurrence of blackwater fever: triggering of relapses by different antimalarials
Authors: Van den Ende Jef , Van den Ende Jef , Coppens Guy , Verstraeten Tom , Van Haegenborgh Tine , Depraetere Katrien , Van Gompel Alfons , Van den Enden Erwin , Clerinx Jan , Colebunders Robert , Colebunders Robert , Peetermans Willy E. , Schroyens Wilfried
Published: March 2003

Five cases of blackwater fever (BWF) are described, all of whom had a history of recent quinine therapy. In two cases a second haemolytic crisis was induced by halofantrine, in one case also a third. Increasing frequency of this syndrome with its dramatic clinical presentation is to be expected as imported P. falciparum infection, parasite resistance to chloroquine and the use of quinine and other related antimalarials become more frequent.
Pooling sera to reduce the cost of HIV surveillance: a feasibility study in a rural Kenyan district
Authors: Verstraeten  , Farah  , Duchateau  , Matu
Published: March 2003

Summary Seroprevalence studies are crucial in HIV control programs but too expensive at district level. We evaluated the applicability of pooling sera and how it can reduce cost and affect accuracy at district level. 740 samples collected from antenatal clinic attendants for a sentinel survey in a rural Kenyan district were screened individually and in pools of 10. The seroprevalence when measured individually was 7.30%, while the calculated seroprevalence from pooled testing was 7.49%. Pooling was practicable and reduced costs by 62% for a marginal loss of accuracy. It is a useful tool in increasing the affordability of surveillance at district level. A pool size of 8 would have resulted in optimal cost reduction at minimal loss of accuracy.
Sensitive ELISA dipstick test for the detection of chloroquine in urine under field conditions
Authors: Schwick P. , Eggelte T. A. , Hess F. , Tueumuna T. T. , Payne D. , Nothdurft H. D. , Von Sonnenburg F. , Löscher T.
Published: March 2003

Objective To evaluate a new enzyme‐linked immunosorbent assay (ELISA) dipstick test for detecting chloroquine (CQ) in urine in a malaria‐endemic region of north‐western Namibia.

Method Urine samples from 92 patients attending the outpatient department of Kamhaku Hospital with suspected malaria infection were tested for CQ with both the Dill‐Glazko test and the ELISA dipstick test. Results were compared to the history of CQ intake as documented in the patients' health passes.

Results The dipstick test proved an easy‐to‐handle and very sensitive tool for the detection of CQ with a lower limit of detection at 120 nmol/l. It showed high agreement with the history of CQ intake within the last 6 months. The specificity in a negative control group was 100%. The Dill‐Glazko test was far less sensitive and specific with a lower detection limit of 150 μmol/l.

Conclusion The dipstick test can be used in pharmacological studies to evaluate the use of CQ, and as an inclusion criterion for in vivo and in vitro sensitivity tests, whereas the Dill‐Glazko test is appropriate to test compliance during and a few days after CQ intake.
Independent evaluation of onchocerciasis rapid assessment methods in Benue State, Nigeria
Authors: Whitworth JAG , Gemade EII
Published: March 2003

Summary objective  To evaluate the prevalence of palpable nodules or skin depigmentation as rapid indicators of onchocerciasis epidemicity in at‐risk communities.

method  We examined data collected in Benue State on 11035 individuals in 32 villages to evaluate these rapid assessment methods.

results  The prevalence of palpable nodules correlates more closely with microfilarial prevalence (r= 0.68, P < 0.001) and community microfilarial load (r= 0.64, P < 0.001) than the prevalences of skin depigmentation or other potential rapid indicators. The recommended cut‐off value for palpable nodules of 20% or more in males aged > 20 years had a sensitivity of 94% and specificity of 50% compared to a cut‐off of 40% or more for microfilarial prevalence in all ages. This would mean that in these 32 villages 17 of 18 would have been correctly identified for treatment, and a further 7 at lesser risk would have been targeted for treatment.

conclusions  Skin snipping and parasitological examination can be replaced by the simpler method of palpating onchocercal nodules to identify communities at serious risk of onchocerciasis. This has important operational benefits for onchocerciasis control programmes.
Is orphan drug status beneficial to tropical disease control? Comparison of the American and future European orphan drug acts
Authors: Trouiller P. , Battistella C. , Pinel J. , Pecoul B.
Published: March 2003

Summary objectives To quantify past outcomes of tropical pharmacology research and development (R & D) and to assess past benefits of the American orphan drug act and potential benefits of the future European orphan drug regulation on tropical diseases.

methods This paper presents two analyses: a 1983–97 retrospective study of the United States Orphan Drug Act concerning rare diseases and a prospective study of the European Proposal for a Regulation Concerning Orphan Drugs and its possible impact on tropical diseases.

results Different programmes have in the past tried to stimulate R & D in this area, but results remain limited. Of 1450 new chemical entities marketed between 1972 and 1997, 13 were specifically for tropical diseases and considered as essential drugs. Between 1983 & 1997, the US Orphan Drug Act approved 837 drugs and marketing of 152 new molecular entities (NMEs). Three NMEs have been designated for malaria and human African trypanosomiasis. Seven others, already commonly used in tropical diseases, received either orphan designation or an orphan approval for another indication. Pharmaceutical companies benefit from the US framework only when the US market exclusivity clause was applicable. Future European orphan drug regulation appears to be similar to the US Orphan Drug Act.

conclusion The orphan drug programmes relating to rare diseases have met with some success. Considering tropical diseases rare diseases seems inadequate to boost pharmaceutical R & D. However, some provisions of the European text may be relevant to tropical diseases, admitting the need for a more specific rule for evaluations of this kind of drug and recognizing the existence of ‘diseases of exception’.
The eosinophilic response and haematological recovery after treatment for Plasmodium falciparum malaria
Authors: Camacho Luis H. , Wilairatana Polarat , Weiss Günter , Mercader Marco A. , Brittenham Gary M. , Looareesuwan Sornchai , Gordeuk Victor R.
Published: March 2003

SummaryTo examine a possible relationship between the immune response and haematological recovery after acute falciparum malaria, we followed peripheral blood eosinophil counts and haemoglobin concentrations for 4 weeks after starting effective treatment in 70 adult Thai patients. Eosinophils are induced by Th‐2 cytokines as well as other stimuli. Eosinophil counts were elevated in only 8 (11%) of the subjects at presentation, but were increased in 65 (93%) by day 7. Eosinophil counts then decreased markedly by day 14, followed by a second increase until day 28. A significant positive correlation was found between peak eosinophil counts on day 7 and the haemoglobin concentration on day 28, both in 16 subjects without stool parasites (r = 0.65, P = 0.006) and in 54 patients with stool parasites (r = 0.32; P = 0.0019). These results suggest that a robust eosinophilic response shortly after completing antimalarial therapy predicts a good recovery from malaria‐associated anaemia.
Validity of data‐derived algorithms for ascertaining causes of adult death in two African sites using verbal autopsy
Authors: Quigley Maria A. , Chandramohan Daniel , Setel Philip , Binka Fred , Rodrigues Laura C.
Published: March 2003

Summary background  Verbal autopsy (VA) is used to ascertain causes of death using information obtained from bereaved relatives. Causes of death can be ascertained from VA questionnaires by a panel of physicians or from predefined algorithms. In a previous study, we developed data‐derived algorithms using VA data from 796 adult deaths in hospitals in Tanzania, Ethiopia, and Ghana (primary sites). These computerized algorithms accurately estimated the cause‐specific mortality fractions (CSMFs) for deaths due to injuries, meningitis, TB/AIDS and diarrhoeal diseases in the primary sites. Since the same data were used to generate and to validate the algorithms, the accuracy of our algorithms may have been overestimated. We report here on the validity of the algorithms when they were applied to VA data from two secondary sites in Ghana and Tanzania. Here, ‘validity’ is taken to mean the degree to which the algorithms replicated the physician‐generated CSMF for major causes of death, when applied to the same VA data.

methods  VA interviews were conducted in two secondary sites: in Navrongo, Ghana, on 406 adult deaths, where three local physicians independently reviewed the questionnaires and assigned a cause of death. In Morogoro, Tanzania, VA interviews were conducted on 209 adult deaths, and a panel of physicians independently reviewed the VA questionnaires together with the hospital death certificates or hospital records to determine the cause of death. The CSMF obtained using each algorithm was compared with the CSMF obtained using physician review.

results  For injuries and meningitis, the algorithms and physician review estimated a similar CSMF in the Morogoro and Navrongo data. For TB/AIDS, the algorithm estimated a similar CSMF as the physicians in Morogoro. The algorithm for diarrhoeal diseases did not agree closely with the physicians in Morogoro or Navrongo.

conclusions  In general, our data‐derived algorithms for assigning causes of death due to injuries, meningitis, and TB/AIDS estimated a similar CSMF as the physicians in the secondary sites. Recommendations for further validation and refinement are discussed. Computerized algorithms offer a potentially quick, affordable, and feasible method for assigning causes of death in mortality surveillance or studies using VA.
Health‐seeking behaviour for child illness in Guatemala
Authors: Goldman Noreen , Heuveline Patrick
Published: March 2003

Summary Relying on data from the 1995 Guatemalan Survey of Family Health (EGSF), we analyse the relationship between child illness and health‐seeking behaviour. Information on illness was collected for 3193 children. This analysis is based on 870 of these who became ill with diarrhoeal or respiratory disease during a 13‐day period prior to interview. Estimates are derived from logistic models of the probability of seeing any or a specific type of health care provider as a function of characteristics of the illness on a given day and the child. The results indicate that modern medical care plays a major role in the treatment of infectious illness among children in rural Guatemala, with visits to pharmacists, doctors and the staff at government health facilities occurring much more frequently than visits to curers and other traditional practitioners. In general, families are much more likely to seek out a health care provider when a child experiences fever and gastrointestinal symptoms than when suffering from respiratory and other symptoms, and when a mother perceives the illness to be serious. The results also indicate that infants, low parity children, and children assessed as having generally been in good health are more likely to visit health care providers than other children. However, the particular associations often vary by type of health care provider.
Single small enhancing CT lesion in Thai patients with acute symptomatic seizures: a clinico‐radiological study
Authors: Yodnopaklow Praphan , Mahuntussanapong Arunee
Published: March 2003

Summary OBJECTIVE   To identify the frequency of single small enhancing CT lesion cases (SSECTL) in a provincial hospital in Thailand and verify a set of clinico‐radiological criteria for the diagnosis of benign SSECTL.

METHODS   All patients who fulfilled the following criteria were recruited: acute symptomatic focal seizures with or without secondary generalization; minimal or no neurological deficit; no evidence of raised intracranial pressure; no evidence of systemic disease; CT scan showing SSECTL of < 20 mm diameter. After recruitment, patients received antiepileptic drugs and other symptomatic treatment. A CT scan of the brain was repeated every 2 weeks until the lesion had significantly resolved, which was defined as a 50% decrease in size. A CT scan was then taken every 4 weeks until the lesion had completely disappeared or turned into a calcified spot. The data from all other patients presenting with seizures and solitary enhancing lesion on the CT scan who did not fulfil the inclusion criteria were also reviewed.

RESULTS   972 patients with seizure disorder were recruited. 110 patients (11.3%) presented with seizure and solitary enhancing lesion on the CT scan, 22 of whom (20%) fulfilled the inclusion criteria. 20 of the 22 patients had SSECTL with a spontaneous resolution: 14 (70%) within 4 weeks and 18 (90%) within 8 weeks. Two patients had a progressive course. One patient with a solitary enhancing CT lesion > 20 mm had spontaneous resolution. 87 patients had another diagnoses. The diagnostic criteria for benign SSECTL were 95.23% sensitive, 97.75% specific, had a positive predictive value of 90.91% and a negative predictive value of 98.86%.

CONCLUSION   SSECTL is not uncommon in our provincial hospital. The clinico‐radiological criteria proposed by Rajshekhar (1991) are valid and reliable in predicting a benign outcome. CT follow‐up within the first 4 weeks is critical.
Cost‐effectiveness of management strategies for acute urethritis in the developing world
Authors: Crabbé François , Vuylsteke Bea , de Clerck Miguel , Laga Marie
Published: March 2003

Summary objective  To recommend a cost‐effective approach for the management of acute male urethritis in the developing world, based on the findings of a theoretical study.

methods  A model was developed to assess the cost‐effectiveness of three urethritis management strategies in a theoretical cohort of 1000 men with urethral syndrome. (1) All patients were treated with cefixime and doxycycline for gonococcal urethritis (GU) and nongonococcal urethritis (NGU), respectively, as recommended by WHO. (2) All patients were treated with doxycycline for NGU; treatment with cefixime was based on the result of direct microscopy of a urethral smear. (3) All patients were treated with cotrimoxazole or kanamycin for GU and doxycycline for NGU. Cefixime was kept for patients not responding to the first GU treatment. Strategy costs included consultations, laboratory diagnosis (where applicable) and drugs. The outcome was the rate of patients cured of urethritis. Cost‐effectiveness was measured in terms of cost per cured urethritis.

results  Strategy costs in our model depended largely on drug costs. The first strategy was confirmed as the most effective but also the most expensive approach. Cefixime should cost no more than US$ 1.5 for the strategy to be the most cost‐effective. The second strategy saved money and drugs but proved a valuable alternative only when laboratory performance was optimal. The third strategy with cotrimoxazole was the least expensive but a low follow‐up visit rate, poor treatment compliance or lower drug efficacy limited effectiveness. Maximizing compliance by replacing cotrimoxazole with single‐dose kanamycin had the single greatest impact on the effectiveness of the third strategy.

conclusion  Our model suggested that a cost‐effective approach would be to treat gonorrhoea with a single‐dose antibiotic selected from locally available products that cost no more than US$ 1.5.
A programme to eliminate lymphatic filariasis in Tamil Nadu state, India: compliance with annual single‐dose DEC mass treatment and some related operational aspects
Authors: Ramaiah K. D. , Das P. K. , Appavoo N. C. , Ramu K. , Augustin D. J. , Vijay Kumar K. N. , Chandrakala A. V.
Published: March 2003

Summary This paper reports on DEC distribution and compliance with treatment in a large‐scale annual single‐dose mass treatment programme to eliminate lymphatic filariasis in the south Indian state of Tamil Nadu. 76.9% of households (82.5% in rural areas and 58.0% in urban areas) were aware of drug distribution for control of filariasis. DEC was given to 70% (= distribution rate) (range 0–92%) of the population and 53.5% (range 12–89%) complied with treatment. The distribution rate was more than 75% in 74% of the villages and compliance was in the range of 51–75% in 76% of the villages. About 5% of the treated population reported side‐effects. Distribution and compliance were higher in rural than urban areas and similar between males and females. Qualitative data showed that some socio‐economic factors, logistic and drug‐related problems and people's poor knowledge and perceived benefits of treatment played a role in a proportion of the population not receiving or taking the drug. The Tamil Nadu programme showed that large‐scale repeated annual DEC mass treatment is feasible and that existing health services are capable of delivering the drug to all communities. While even poor to moderate compliance rates can reduce the vector transmission of infection to some extent, improved drug distribution and compliance with treatment are necessary to consolidate the gains of earlier rounds of treatment and achieve the goal of filariasis elimination within a reasonable time frame.
Effect of aggressive prolonged diethylcarbamazine therapy on circulating antigen levels in bancroftian filariasis
Authors: Freedman David O. , Plier D. Adam , De Almeida Adriana B. , De Oliveira Ana Luna , Miranda Janaina , Braga Cynthia
Published: March 2003

BACKGROUND Single dose diethylcarbamazine (DEC) as used in control programmes is effectively microfilaricidal for periods of up to a year or more but has incomplete ability to kill Wuchereria bancrofti adult parasites. These regimens can be effective in breaking transmission by suppression of circulating microfilariae available to mosquito vectors. Whether prolonged or aggressive therapy with DEC has a significant effect on adult worms, which may live up to 12 years or more, and is important in the context of the treatment of individual patients, is still incompletely understood.

METHODS In order to investigate the adulticidal effect of aggressive therapy, DEC was given at 6 mg/kg/day for 12‐day courses at 0, 6, 12, and 18 months and Og4C3 antigenaemia followed over two years in 38 CAg + Brazilians in a W. bancrofti endemic area.

RESULTS At two year follow‐up, the median level of antigenaemia was 21% of the pre‐treatment value. 92% of individuals had antigen levels < 50% of pretreatment values, but only 26% had completely cleared antigenaemia. The clearance rate at 24 months was only 12% (3/26) in the asymptomatic CAg + patients but 58% (7/12) in those with clinical manifestations of filariasis. The latter individuals cleared significantly more antigen (median of 0% pretreatment antigenaemia vs. 26%; P=0.02) than asymptomatic but infected individuals.

CONCLUSION Aggressive repeated therapy with DEC alone is ineffective in consistently eradicating adult W. bancrofti, especially in infected but asymptomatic individuals. Prolonged courses of combination therapy with other antifilarial drugs should be investigated for treatment of individual patients with the means to pursue aggressive personal medical care.
A clinical algorithm for the diagnosis of malaria: results of an evaluation in an area of low endemicity
Authors: Chandramohan D. , Carneiro I. , Kavishwar A. , Brugha R. , Desai V. , Greenwood B.
Published: March 2003

We conducted a study of 1945 children and 2885 adults who presented with fever to a hospital outpatients clinic in an urban area of India order to develop and evaluate a clinical algorithm for the diagnosis of malaria. Only 139 (7%) children and 349 (12%) adults had microscopically confirmed malaria. None of the symptoms or signs elicited from the respondents were good predictors of clinical malaria. Simple scores were derived through combining clinical features which were associated with slide positivity or were judged by clinicians to be important. The best‐performing algorithms were a score of 4 clinical features in children (sensitivity 60.0% and specificity 61.2%) and a score of 5 in adults (sensitivity 54.6% and specificity 57.5%). The clinical features differed and algorithm performances were poorer than in previous studies in highly endemic areas. The conclusion is that malaria diagnosis in areas of low endemicity requires microscopy to be accurate.
Short communication: Efficacy of DEC against Ascaris and hookworm infections in schoolchildren
Authors: Meyrowitsch D. W. , Simonsen P. E.
Published: March 2003

Diethylcarbamazine (DEC) is an important drug for treatment and control of lymphatic filariasis. To assess its possible effect on Ascaris and hookworm infections, we conducted a double‐blind two‐armed study with children in Tanzania. Twenty six Ascaris‐infected children were given a single dose of DEC (6 mg/kg body weight) and 25 were given a placebo. Twenty children in the treatment group and eighteen controls were also infected with hookworms. One month after treatment the geometric mean intensity (GMI) of Ascaris egg output was reduced by 60.2% in the treatment group; two children (7.7%) had stopped excreting Ascaris eggs, and some Ascaris worms were also expelled. In hookworm‐infected children in the treatment group, the geometric mean intensity of hookworm egg output was reduced by 6.7% 1 month after treatment. Neither for Ascaris nor for hookworm, however, was the observed reduction in egg output at 1 month after treatment statistically significant. The treatment efficacy of a single dose of DEC (6 mg/kg) in these infections therefore was low.
Has directly observed treatment improved outcomes for patients with tuberculosis in southern Thailand?
Authors: Pungrassami Petchawan , Johnsen Søren P. , Chongsuvivatwong Virasakdi , Olsen Jørn
Published: March 2003

OBJECTIVE To validate the practice of directly observed treatment (DOT) and evaluate its effect on treatment outcomes.

METHODS This follow‐up study conducted in 24 districts in southern Thailand included 411 new, smear‐positive, pulmonary tuberculosis (TB) patients who started treatment between February and September 1999. Patients and/or their observers were interviewed about their actual DOT practice during the first 2 months of treatment. Treatment outcomes were evaluated at the end of the second month and at the end of treatment.

RESULTS Of 411 patients, 379 were assigned to DOT but only 68 practised strict DOT for every dose during the first 2 months. Adjusted odds ratios (ORs) for `no sputum conversion' and `unsuccessful treatment' were 1.1 (95% CI 0.6–2.1) and 1.3 (95% CI 0.6–2.8), respectively, for those who practised strict DOT vs. the rest.

CONCLUSIONS Actual practice of DOT was quite different from what was intended at the assignment. Practice of strict DOT during the first 2 months was not associated with sputum conversion or treatment success in this study area.
Mortality patterns, 1993–98, in a rural area of Burkina Faso, West Africa, based on the Nouna demographic surveillance system
Authors: Kynast‐Wolf G. , Sankoh O. A. , Gbangou A. , Kouyaté B. , Becher H.
Published: March 2003

The Nouna demographic surveillance system database was analysed for the period 1993–98. Basic demographic parameters, age‐specific and age‐standardized mortality rates were calculated and a seasonal variation in mortality was analysed. Poisson regression was used to model the calculated mortality rates and to investigate the seasonal mortality pattern. Both the population distribution by age and the mortality rates reflect a typical pattern of population structures and total mortality in rural Africa as a whole: high childhood mortality and a young population (about 60% are up to age 25; about 10% above age 64). We identified a significant seasonal pattern with highest mortality rates in February. Demographic surveillance systems in Africa provide a viable method for the collection of reliable data on vital events in rural Africa and should therefore be established and supported.
Association of a missense mutation of the laminin α2 gene with tuberculoid type of leprosy in Indonesian patients
Authors: Wibawa Tri , Soebono Hardyanto , Matsuo Masafumi
Published: March 2003

Leprosy, an infection caused byMycobacterium leprae, has a specific tropism for the myelinating Schwann cells of peripheral nerves. Recently, the G domain of laminin α2 has been shown to be a mediator forM. lepraeto bind to α‐dystroglycan in Schwann cells. In order to analyse the association of leprosy with the mediator, three genetic polymorphisms encoding the G domain of the laminin α2 chain were analysed by direct sequencing in 53 leprosy patients and 58 healthy contact individuals from Indonesia. There was no significant difference in the incidence of the polymorphisms between patients and non‐patients. Remarkably, it was found that a missense mutation (T7809C) substituting valine with alanine (V2587A) was found to be more frequent in the tuberculoid type than in the lepromatous type leprosy. It is supposed that this missense mutation is one of the determinant factors in the early onset of peripheral nerve damage in Indonesian tuberculoid leprosy patients.
A seroepidemiological study of human cysticercosis in West Cameroon
Authors: Nguekam J. P. , Zoli A. P. , Zogo P. O. , Kamga A. C. T. , Speybroeck N. , Dorny P. , Brandt J. , Losson B. , Geerts S.
Published: March 2003

We studied the occurrence of human cysticercosis in 4993 individuals from three rural communities of Menoua Division, West Province of Cameroon. Circulating antigens of Taenia solium metacestodes were detected in 0.4%, 1.0% and 3.0% of the serum samples taken in Bafou, Bamendou and Fonakekeu, respectively, and examined using a monoclonal antibody‐based enzyme‐linked immunosorbent assay. This test detects only carriers of living cysticerci and gives thus a good idea of the presence of active cysticercosis. The percentage of persons infected with cysticercosis increased with age. Twenty‐two of the 34 seropositives underwent computed tomography (CT) of the brain. Thirteen of them were CT‐scan positive, which shows that neurocysticercosis was present in 59.1% of the tested seropositive persons. No living cysticerci were detected among 20 seronegative people. About 20.6% of the seropositives had a history of or current taeniasis against only 1.9% of the seronegatives. Based on these figures and on the data on porcine cysticercosis (prevalence: 11%) and human taeniasis (prevalence: 0.13%) collected in the same region, we conclude that T. solium cysticercosis is an endemic, but overlooked public health problem in West Cameroon.
Reduced prevalence of Plasmodium falciparum infection and of concomitant anaemia in pregnant women with heterozygous G6PD deficiency
Authors: Mockenhaupt Frank P. , Mandelkow Jantina , Till Holger , Ehrhardt Stephan , Eggelte Teunis A. , Bienzle Ulrich
Published: March 2003

Glucose‐6‐phosphate dehydrogenase (G6PD) deficiency confers protection against malaria in children, yet its role in malaria in pregnancy is unknown. In a cross‐sectional study among 529 pregnant Ghanaian women, Plasmodium falciparum infection, anaemia and G6PD genotypes were assessed. Of these, 30.4% were heterozygous and 2.6% were homozygous for G6PD deficiency. The prevalence of P. falciparum infection decreased from 66% in G6PD‐normal women to 58% in heterozygotes, and to 50% in individuals with homozygous G6PD deficiency (, P = 0.04). Multivariate analysis revealed that in multigravid women but not in primigravidae, heterozygous G6PD deficiency was associated with a reduced risk of P. falciparum infection (Odds ratio (OR), 0.6; 95% confidence interval (95% CI), [0.4–0.9]). This protection against infection was limited to the third trimenon of pregnancy. In addition, heterozygous G6PD deficiency was associated with a reduced risk of anaemia among infected multigravidae (OR, 0.5 [0.3–1.0]). Pregnancy is a period of high vulnerability to malaria. The results of this study provide evidence for protection against malaria in pregnancy caused by heterozygous G6PD deficiency. This advantage, even if confined to multigravid women, may contribute to the selection of G6PD variants in malaria‐endemic regions.
Chronic radiant heat dermatitis (Erythema ab igne) in two dogs
Authors: Declercq  , Vanstapel
Published: March 2003

Two dogs presented with an asymptomatic, drip‐like configuration of alopecia over the dorsolateral thoracic reion. The exposed skin showed erythema or hypopigmentation bordered by hyperpigmentation. The skin changes extended into the pelage with a sharp demarcation between affected and unaffected skin. Crusted and ulcerated lesions were occasionally present. Histopathological lesions included dyskaryosis and dyskeratosis of keratinocytes, focal basal layer vacuolation, pigmentary incontinence, and dermal mucinosis. Two different evolution stages were recognized. The condition was associated with repetitive exposure to a heat source in winter and shared similarities with Erythema ab igne in humans.
Passive antibody transfer on human leukocytes: application to small animal allergy diagnosis by flow cytometry
Authors: Sainte‐Laudy
Published: March 2003

Animal allergy diagnosis is based mainly on clinical history, skin tests and, at least for dogs, specific IgE antibodies. The quality of anti‐canine IgE antibodies is variable and monoclonal antibodies have been recently characterized. The allergen panel tested in humans and in dogs is similar except for flea and for Staphylococcus. Allergen‐induced basophil activation may be measured by the release of mediators such as histamine and leukotriene C4 and by the expression of the CD63 marker on basophil membrane. This latter method is based on the flow cytometric analysis of leukocyte suspensions after double anti‐IgE FITC, anti‐CD63 PE labelling of human basophils, and has been validated for aero‐allergens, food allergens, venoms and several drugs for human allergy diagnosis. After having demonstrated that, in the dog, anaphylactic anti‐ bodies were capable of binding to human basophil high‐affinity receptors for IgE, we went up a flow cytometric method for animal allergy diagnosis based on passive sensitization of human basophils. Prelim‐ inary results obtained by this method for allergens such as house dust mite or pollen were very encouraging. This method is faster and less expensive than the methods based on mediator release but is still dependent on the availability of fresh human leukocytes. This method may represent a new sensitive and specific method for animal allergy diagnosis.
A case of canine cutaneous listeriosis
Authors: Loncarevic  , Artursson  , Johansson
Published: March 2003

The aetiology of dermatitis in dogs is often complex, and primary or secondary bacterial infections are common. In this report we describe a case where Listeria monocytogenes was proposed to be the bacteriological cause of a pyoderma in a 4‐year‐old Giant Schnauzer. The infection manifested as a cutaneous listeriosis with multiple pustulae on the dog’s back. The dog was treated with clindamycin and recovered within 1 week. The source of infection was suggested to be a carcass or the faeces of a wild animal, or a decomposed placenta from an infected animal.
Trachyonychia associated with alopecia areata in a Rhodesian Ridgeback
Authors: De Jonghe  , Ducatelle  , Mattheeuws
Published: March 2003

Trachyonychia associated with alopecia areata was diagnosed in an 8‐year‐old Rhodesian Ridgeback. Clinical and histological findings are described in this respectively unreported and rare condition in the dog.