bluuebunny/crossref_metadata_2025 huggingface dataset:
Acute hepatitis C complicated by pancreatitis: another extrahepatic manifestation of hepatitis C virus?
Authors: Álvares‐da‐Silva  , Francisconi  , Waechter
Published: March 2003

In hepatitis C virus (HCV) infection a number of extrahepatic manifestations have been described, generally caused by immune phenomena. Here we report a case of acute pancreatitis, detected during an acute hepatitis C infection, in an elderly female patient.
Impact of hepatitis C virus infection on healthy subjects on an Italian island
Authors: Coppola  , Masia  , Pradat  , Trepò  , Carboni  , Argiolas  , Rizzetto
Published: March 2003

Field studies in large numbers of subjects unselected for risk factors are needed to assess the true prevalence and health burden of hepatitis C virus (HCV) infection. We assessed the prevalence, virological characteristics, risk factors and evidence of liver disease in a population of healthy subjects from an urban area of Sardinia. Hepatitis B virus (HBV) markers were also studied. The prevalence of antibodies to HCV (anti‐HCV) (recombinant immunoblot assay [RIBA]‐confirmed positive results) was 3.19% in 3324 workers and 7.11% in 225 elderly subjects, with a cumulative anti‐HCV prevalence of 2.70% (95% CI 2.17–3.24). Males were more frequently positive than females (P < 0.01). The age‐specific prevalence of HCV infection increased progressively in females. It showed two peaks in males: one in the fourth decade, the other in the seventh decade. HCV RNA was detected in 63.16% of the RIBA‐positive sera, in 10% of the RIBA indeterminates and in none of the RIBA‐negative specimens. Only 1.75% of anti‐HCV‐positive subjects had elevated transaminases. The frequency of HCV genotype 1b was 32.79%; of 1a, 21.31%; of 3a, 19.67%; of 4, 13.11%; and of 2a, 13.11%. HBV markers were found in 28.03% of workers. On multivariate analysis, male gender and tattooing were significantly associated with HCV and HBV infections: transfusion and travel with HCV, and age over 40 with HBV. The age prevalence rates of HCV infection in the Cagliari area reflect different risk factors that have been operative at different times. In this urban area, the large majority of HCV infections run a subclinical course.
Hepatitis C virus co‐infection is a negative prognostic factor for clinical evolution in human immunodeficiency virus‐positive patients
Authors: Piroth  , Grappin  , Cuzin  , Mouton  , Bouchard  , Raffi  , Rey  , Peyramond  , Gourdon  , Drobacheff  , Lombart  , Lucht  , Besnier  , Bernard  , Chavanet  , Portier
Published: March 2003

A longitudinal study of human immunodeficiency virus (HIV)‐infected individuals followed‐up in 13 centres was performed to assess the influence of hepatitis C virus (HCV) on the clinical and immunological evolution of HIV‐infected patients. Eight‐hundred and twelve HIV‐infected patients with known HIV acquisition date, 89 co‐infected with HCV, were included in the cohort. Clinical progression was defined as: 30% decrease of Karnofsky’s index; and/or 20% body weight loss; and/or acquired immune deficiency syndrome (AIDS)‐defining illness; and/or death (except by accident, suicide, or overdose). Immunological progression was defined as a decrease of initial CD4 count to below 200 mm–3. If immunological progression was not statistically different between groups (P=0.25), clinical progression was significantly faster in HCV–HIV co‐infected patients in univariate (P=0.02) and multivariable survival analysis (hazard ratio=1.63, P=0.03). This argues for active management of hepatitis C chronic infection among HCV–HIV co‐infected patients.
Epidemiological survey and follow‐up of transfusion‐transmitted virus after an outbreak of enterically transmitted infection
Authors: Kangxian  , Weifang  , Lian  , Zhiying
Published: March 2003

An outbreak of enterically transmitted hepatitis occurred during 1996 among students at a vocational school. Viral fragments homologous to transfusion‐transmitted virus (TTV) were detected in faeces. To elucidate the endemic status, an epidemiological survey and case follow‐up after the outbreak were carried out. During and after the outbreak, virus carriers among staff were, respectively, 32.1% and 31.3% in serum, and 24.6% and 18.2% in faeces. After the last outbreak, attacks were still occurring among new students with an incidence of 2.4% in 1997 and 2.3% in 1998. There was also a small‐scale outbreak in 1998 with a prevalence of 17.9%. On follow‐up at 6 and 18 months after onset, alanine aminotransferase (ALT) elevation was found in 29.7% and 13.9% of patients. At 6 months, viral fragments were detected in serum in 78.1% and 46.7% of patients, with and without ALT elevation, respectively. At 18 months the corresponding figures were 55.6% and 19.2%, respectively. At the 18‐month follow‐up, viral fragments were detected in faeces in 29.6% and 19.3% of patients with and without ALT elevation. In conclusion, this disease might be transmitted from asymptomatic virus carriers. According to the laboratory data, both parenteral and non‐parenteral transmissions are involved, and the faecal–oral route might be more important.
Health care, treatment patterns and cost of services for patients infected with chronic hepatitis C virus in a large insured New England population
Authors: Rosenberg  , Cook  , Lanza
Published: March 2003

The purpose of this study was to describe the cost of health care and the patterns of treatment of young patients (under 65 years of age) identified in health insurance claims as having received services for chronic hepatitis C virus (HCV) infection. We screened computerized claims from a US indemnity and managed care organization for out‐patient and in‐patient diagnoses related to HCV. Treatment patterns and costs of services were evaluated in the following sites of care: in‐patient care, emergency room, hospital out‐patient care, ambulatory office care and pharmaceuticals. There were 191 patients with chronic HCV‐related claims in this study population (25 per 100 000), during 1995–97. Medical services and pharmaceutical costs in total (US$ 7.1 million) constituted a considerable cost in patients with chronic HCV‐related claims during 1995–97. A subset of 98 patients were prescribed interferon‐α with substantial variability in treatment regimens. Claims data provides a unique opportunity to estimate dollars paid for treatment patterns and health services in a ‘real world’ insured population and contributes to the understanding of health services for chronic HCV.
NS5A mutations predict biochemical but not virological response to interferon‐α treatment of sporadic hepatitis C virus infection in European patients
Authors: Stratidaki I. , Skoulika E. , Kelefiotis D. , Matrella E. , Alexandrakis G. , Economou A. , Kouroumalis E.
Published: March 2003

The NS5A region of the hepatitis C virus (HCV) genome has been reported by Japanese but not European investigators to be a significant factor in predicting interferon (IFN) response patients with HCV of genotype 1. We correlated the NS5A region with treatment outcome in patients with sporadic HCV infection. Twenty‐eight patients (10 men, 18 women, mean age 60 ± 2 years) with histologically proven HCV chronic hepatitis, genotype 1b, were treated with 6 MU IFN‐α for 6 months. The 6954–7073 area of the NS5A region was directly sequenced for nucleotide and amino acids mutations and the results were related to biochemical and virological response. None of the patients had a strain with nucleotide sequence identical to the Japanese HCV‐J. However, in five strains the nucleotide mutations led to synonymous amino acids and the amino acid sequences were identical to the prototype Japanese strain. Only 2/28 patients had four or more amino acid mutations (mutant strains) while 21 demonstrated an intermediate type and five belonged to the wild‐type. The most frequent non‐synonymous substitution was at position 6982 (A→G) corresponding to an amino acid change at codon 2218 (His→Arg). All patients with the wild‐type were biochemical nonresponders while the two patients with the mutant strains had a sustained biochemical response. Twenty‐three percent of the intermediate type had a sustained biochemical response. NS5A mutations predict the biochemical but not the virological response of patients. Virological response was poor and unrelated to the type of HCV strain. Biochemical responders had significantly lower amino acid mutations (1.14 ± 0.19) compared with nonresponders (2.57 ± 1.4, P < 0.003) as well as lower aminotransferase values (P < 0.01). Hence, mutational analysis of the NS5A region showed that our patients have a mutational profile similar to the European studies with a wild‐type that is slightly different from the Japanese HCV‐J sequence. The biochemical, but not the virological response to IFN‐α is similar to the Japanese studies, with no response of the patients with wild‐type sequence, a good response in the limited number of patients with mutant strains and 23% response rate in the patients with intermediate type sequences.
Epidemiological changes in hepatitis C virus genotypes in France: evidence in intravenous drug users
Authors: Bourlière M. , Barberin J. M. , Rotily M. , Guagliardo V. , Portal I. , Lecomte L. , Benali S. , Boustière C. , Perrier H. , Jullien M. , Lambot G. , Loyer R. , LeBars O. , Daniel R. , Khiri H. , Halfon P.
Published: March 2003

Hepatitis C virus (HCV) genotypes are distributed differently depending on geography and route of infection. We characterized the distribution of genotypes in a large cohort of patients with chronic hepatitis C in the South‐east of France and evaluated the relative prevalence according to time of acquisition. One thousand, one hundred‐and‐eighty‐three patients who were anti‐HCV‐positive were studied. HCV genotype distribution has changed significantly from the 1960s to 2000. The prevalence of genotype 1b decreased from 47% before 1978 to 18.8% in the 1990s while the prevalence of genotype 1a and 3a increased during the same period from 18% and 15.3% to 28.8% and 26.3%, respectively. The logistic regression model showed that genotype 1a was significantly more common in patients infected through intravenous drug injection odds ratio ((OR): 2.08, P < 0.01) and after 1990 (OR: 1.98, P < 0.05). Genotype 1b was significantly less frequent in patients infected through intravenous drug injection (OR: 0.17, P < 0.001) and has decreased since 1978 (OR: 0.27, P < 0.001). Genotype 3a was independently associated with intravenous drug injection (OR: 6.1, P < 0.001) and tattooing (OR: 8.01, P < 0.001) and was more frequent in the 1979–90 period (OR: 2.05 and 1.74, P < 0.001 and P < 0.05). Our results show a modification of HCV genotypes distribution over the last four decades due to an increase of intravenous drug use (IVDU) contamination and an evolution of HCV genotypes distribution only in IVDU population characterized by a decrease of genotype 1b, an increase of genotype 3a from 1970 to 1990 and a higher increase of genotype 1a which is currently the predominant genotype in our population.
Quantification and duration of viraemia during hepatitis A infection as determined by real‐time RT‐PCR
Authors: Costa‐Mattioli M. , Monpoeho S. , Nicand E. , Aleman M.‐H. , Billaudel S. , Ferré V.
Published: March 2003

Human transmission studies and molecular techniques have provided evidence that transient viraemia occurs during infection with hepatitis A virus (HAV). However, the duration of its presence and levels during the phases of clinical disease and convalescence has not yet been well studied in human patients. Real‐time RT‐PCR techniques are increasingly used to quantify RNA viruses for diagnosis and/or research purposes. We have optimized a one‐step RT‐PCR that contains a dual‐labelled fluorogenic probe to quantify the 5′ noncoding region (5′NCR) of HAV. This method has a dynamic range (5–5 × 106 copies). The coefficient of regression of the standard curve was, on average 0.978. Intra‐assay CVs% varied from 6.1% to 0.98%, and interassay CVs% from 6.46% to 2.1%. In the currently reported study 41 HAV IgM positive serum samples and 200 serum samples from healthy blood donors were tested by the quantitative RT‐PCR method. The mean values on the first day of diagnosis found was 6.38 × 105 copies/mL. In a longitudinal study, viraemia persisted for an average of 60 days after clinical onset. These results show that viraemia in HAV infection lasts for many weeks.
Passive immunization of chronic hepatitis B patients on lamivudine therapy: a feasible issue?
Authors: Van Nunen A. B. , De Man R. A. , Heijtink R. A. , Vossen A. C. T. M. , Schalm S. W.
Published: March 2003

In view of the limited efficacy of lamivudine monotherapy for chronic hepatitis B (HBV) infection, combination with other drugs seems logical. Intravenous neutralization of circulating HBsAg by specific hepatitis B immunoglobulin (HBIg) has been shown to protect hepatocytes against (re‐)infection with HBV in the setting of liver transplantation and postexposure prophylaxis. Large controlled vaccination trials have revealed that HBV can be prevented by HBIg therapy in the majority of newborns after perinatal infection. A benefit of anti‐HBs in HBV patients has so far only been investigated in three small studies. In this pilot study we investigated the effects of polyclonal i.v. HBIg (HepatectR, Biotest) administration in HBV‐infected patients. Six liver biopsy‐proven HBV‐infected patients, all on lamivudine treatment and HBV DNA negative by PCR, were investigated. Pre‐treatment HBsAg levels varied between 120 and 9760 ng/mL. On day 1, 10.000 IU HBIg was given, followed by 10.000 IU once, twice or three times on day 29. Long‐term follow‐up lasted at least 4 months. HBsAg and anti‐HBs were measured quantitatively by standard MEIA and also by an experimental EIA. In vitro neutralization of HBsAg by Hepatect was mimicked in an `inhibition in solution assay'.

Complete neutralization of HBsAg by HBIg in vitro was possible, 50% inhibition concentrations varied between 100 and 250 IU/L HBIg with HBsAg levels of 68 and 120 ng/mL. No HBIg‐related side‐effects were observed. In two patients with low pretreatment HBsAg levels HBsAg reached levels below the detection limit of the assay, which persisted a maximum of 31 and 7.5 h, respectively. Peak anti‐HBs concentrations were 5100 and 4648 IU/L. In the other four patients, with higher pretreatment HBsAg levels, HBsAg concentrations in serum hardly changed. For the whole population, the drop in HBsAg did not reach statistical significance. However, in four of the six patients a further decrease in HBsAg [18%–66%] was observed.

In conclusion, HBIg was well tolerated; however, efficacy was limited due to high HBsAg levels in spite of maximum inhibition of virion production. `Neutralization' was achieved only in two patients with low HBsAg levels. Passive immunization in HBV‐DNA negative patients is not a feasible option. This strategy seems only feasible if agents inhibiting both the production of viral proteins and Dane particles more selectively, become available.
Performance of TRUGENE™ hepatitis C virus 5′ noncoding genotyping kit, a new CLIP™ sequencing‐based assay for hepatitis C virus genotype determination
Authors: Roque‐Afonso A. M. , Férey M.‐P. , Poveda J.‐D. , Marchadier E. , Dussaix E.
Published: March 2003

summary. The performance of the recently developed, standardized direct sequencing assay for hepatitis C virus (HCV) genotyping [TRUGENETM HCV 5′‐NC (noncoding)] was assessed in comparison with the reverse hybridization‐based assay INNO‐LIPA HCV II. Both assays allow HCV genotyping starting from amplification products generated by the diagnostic Roche AMPLICOR HCV test. HCV amplicons from 205 patients were used for this study: 34 were tested prospectively by both methods, while 171 had been stored at −20 °C for up to 2 years after LiPA genotyping. The TRUGENE procedure failed to determine a genotype in six low‐titered samples (3.5 ± 0.3 log UI/mL vs. 5.2 ± 0.5 UI/mL for typable samples). Type and subtype could be determined by sequencing for 199 samples (97%). Among them, five were considered as coinfections by the LiPA method. Three LiPA patterns suggesting type 1 and 4 coinfection were not supported by sequence analysis while one 1a/2b and one 1a/3a coinfection was backed up by direct sequencing. For the remaining 194 samples, type assignment was concordant in 100% of the cases. LiPA subtyping was available for 162 samples (83.5%). Sub‐typing results concurred in 128 cases (79%). NS5B sequencing of discrepant samples underscored the limitation of the 5′‐noncoding region (NCR) in correct subtype assignment. In conclusion, the TRUGENE HCV 5′‐NC genotyping kit appeared to be a specific and reliable method that can be used in the current indication of HCV genotyping.
In vivo immunization following virus suppression: a novel approach for inducing immune control in chronic hepatitis B*
Authors: Sprengers D. , Janssen H. L. A. , Kwekkeboom J. , Niesters H. G. M. , de Man R. A. , Schalm S. W.
Published: March 2003

summary. Antiviral treatment of patients with active chronic hepatitis B may lead to significant reduction in morbidity and mortality. However, after stopping nucleoside therapy, relapse rates are high in those without acquired specific immunity. We have treated two chronic hepatitis B patients with in vivo immunization. In vivo immunization aims to optimize conditions for an effective immune response: following rapid and profound virus suppression by interferon‐lamivudine combination therapy, lamivudine is withdrawn intermittently for 4 weeks during continued interferon therapy. In both patients with profound virus suppression a rapid rebound in viral replication was observed after lamivudine withdrawal; despite continued interferon. These periods of renewed viral replication were followed by rises in hepatitis activity. After re‐introduction of lamivudine HBV DNA became undetectable by PCR followed by normalization of serum ALT. These observations are a stimulus to further explore the concept of in vivo immunization as a novel therapeutic approach for chronic hepatitis B.
First phase hepatitis c viral kinetics in previous nonresponders patients
Authors: Cotler S. J. , Layden J. E. , Neumann A. U. , Jensen D. M.
Published: March 2003

summary.  A large proportion of patients fails to respond to treatment for hepatitis C. Initiation of interferon therapy is associated with a rapid first phase decline in viremia, reflecting inhibition of viral production or release from infected cells. We characterized first phase viral kinetics in previous nonresponder patients and compared the antiviral efficacy of interferon in nonresponders to that observed in naive patients. Twenty nonresponders with genotype 1 infection were evaluated. Ten received a single 15 mcg dose of interferon alfacon‐1 and ten were given a 30 mcg dose. Viral kinetic data from previously untreated historical control patients with genotype 1 infection who received 9 mcg (n = 12) or 15 mcg (n = 13) of interferon alfacon‐1 provided a basis for comparison. Antiviral efficacy was evaluated by calculating the reduction in HCV RNA levels during the first 24 h after interferon administration (log effectiveness). Hepatitis C virus levels decreased exponentially in previous nonresponder patients. Non‐responders treated with 30 mcg of interferon alfacon‐1 exhibited a greater log drop than non‐responders receiving 15 mcg (P = 0.01). The log effectiveness of 15 mcg of interferon alfacon‐1 in nonresponders was similar to 9 mcg in naives and was significantly < 15 mcg (P = 0.04) in naïve patients. The 30 mcg dose provided similar log effectiveness in nonresponders compared with 15 mcg in naive patients and exceeded the log effectiveness of 9 mcg in previously untreated patients (P = 0.035). Nonresponders who had greater than a 50% decrease in HCV RNA level from baseline at the end of previous treatment had a larger reduction in viral load at 24 h compared with those who had not achieved that level of response with prior therapy (P = 0.04). In conclusion, the log effectiveness of interferon was lower in nonresponders compared with treatment naive patients. The difference in antiviral effectiveness in previous nonresponders was overcome by higher interferon doses.
An estimate of the impact of predators on the British Field Vole Microtus agrestis population
Authors: Dyczkowski Jerzy , Yalden D. W.
Published: March 2003

The productivity of the British Field Vole population is estimated to be between 677 000 and 982 000 voles per year, depending on the precise basis of the calculation. The total consumption of Field Voles by all the major predators, mammalian and avian, is estimated to be around 980 000, if the very uncertain consumption by Feral Cats is included. Two specialist vole predators (Weasel, Kestrel) and two generalist predators (Red Fox, Feral Cat) consume 85% of the total between them, the other 10 species share the rest between them. However important voles might be for owls, owl predation is unimportant to voles. The slight evidence for cyclicity in Field Vole populations in Britain might be explained by the overall take of voles by the predators, and by the rather generalized diet of even the vole specialists.
Geographical variation in genet (Genetta genetta L.) diet: a literature review
Authors: Virgós E. , Llorente M. , Cortésá Y.
Published: March 2003

The geographical variation in the Genet Genetta genetta L. diet was analysed from 12 locations covering its entire range. Data were obtained from the available literature on food studies in this species. We studied the general food spectrum of this species and compared the importance of different prey items in each area through PCA analysis. The possible influence of some large‐scale environmental factors (latitude, altitude, Mediterraneity) on diet were studied by means of regression analysis and
anova. The study assessed the frequency of occurrence of each prey group and diet diversity. Results show the existence of two ‘food’ groups: (i) Genets which feed on a wide food spectrum, especially arthropods and (ii) Genets which feed on small mammals at a high frequency, while the remaining prey items are scarce or absent. At the intraspecific level, Genets behave as generalist species, with the small mammals (especially, the Woodmouse) as the most outstanding prey item. However, when compared with the diet of other medium‐sized Palaearctic carnivores, we can say that the Genet is intermediate between typical generalists (Martens Martes spp., Red Foxes Vulpes vulpes and Badgers Meles meles) and specialists (Otters Lutra lutra, Stoat Mustela erminea and Weasel Mustela nivalis). Finally,
anova shows the existence of a relationship between diet diversity and Mediterraneity (associated with taxa such as arthropods, reptiles and amphibians), but no relationship was found for latitude or altitude. The importance of interspecific competition, based on island data, is discussed.
The use of fumigants and anticoagulant rodenticides on game estates in Great Britain
Authors: Mcdonald Robbie A. , Harris Stephen
Published: March 2003

Several studies have highlighted the potential risk to nontarget wildlife associated with accidental exposure to vertebrate control agents. In order to provide information that may assist in the mitigation of this problem, we questioned 215 gamekeepers in Great Britain about the use of vertebrate control agents on the land for which they were responsible. Fumigants were used to control Rabbits Oryctolagus cuniculus by 59% of gamekeepers. Use of fumigants was more common than on farms in general. 91% of gamekeepers reported the use of rodenticides, 95% of which were anticoagulants. Patterns of rodenticide use were similar to those on arable farms, though chlorophacinone and warfarin were used more commonly on game estates. Future studies of the exposure of nontarget wildlife to anticoagulants should be expanded to include these compounds. Rodenticides were apparently used in accordance with label recommendations in most cases. However, better information and guidelines for users may improve standards of agent application and reduce potential risks to nontarget wildlife.
The palaeoecology of the Vombatidae: did giant wombats burrow?
Authors: Woolnough Andrew P. , Steele Vernon R.
Published: March 2003

Debate over the origins of burrowing in the Vombatidae has continued since the discovery of the remains of the largest of all wombats, Phascolonus gigas, in the nineteenth century. In this paper, we argue that the largest of the ancestors of extant wombats did not burrow due to physical and physiological limitations of burrows. Further, we suggest that the burrowing characteristics of the extant wombats were derived from an ancestor of similar body size (20–40 kg) that is presently not represented in the fossil record.
Bark consumption by small rodents in the northern and southern hemispheres
Authors: Baxter R. , Hansson L.
Published: March 2003

The distribution and environmental conditions of bark consumption by small rodents were compiled for the northern and southern hemispheres. Main bark consumption occurred under snow at peak cyclic density and in the dry season of annually fluctuating rodent populations, respectively. The species responsible appeared more folivorous in the north. Among woody species that are damaged, a large number were in both cases exotics. Various defences against bark consumption have evolved, including secondary compounds. However, this defence appears inadequate when indigenous trees are grown under new environmental conditions. It is pointed out that the stem and bark are very sensitive components of perennial trees and bushes and that this potential but usually well protected resource will only be used in crucial situations by various mammals. In view of the many unsuccessful attempts to prevent small rodent damage by bark consumption, costs for rodent damage should be included in any cost–benefit analyses for plantations of exotic species or indigenous species under new conditions. Screening and even selection for resistant varieties may be needed at large scale plantations.
The beaver's reconquest of Eurasia: status, population development and management of a conservation success
Authors: HALLEY D. J. , ROSELL F.
Published: March 2003

Overhunting reduced Eurasian Beaver (Castor fiber) populations to c. 1200 animals, in eight isolated populations, around the end of the 19th century. Protection, natural spread and reintroductions led to a powerful recovery in both range and populations during the 20th century, which continues at a rapid pace. The minimum population estimate is 593 000. There are also c. 12 500 North American Beaver (C. canadensis) established in Finland and Russian Karelia; however, other populations of C. canadensis introduced in Austria, Poland and France ap‐pear to be extinct. Castor fiber is now established throughout Europe with the exception of the British Isles, Iberia, Italy and the southern Balkans; reintroductions are continuing. Considerable further expansion in range and population, especially in western Europe and the lower Danube basin, can be expected. If current trends continue, C. fiber will, within a few decades, be a fairly common mammal in much of Europe. Following initial recolonization, populations typically show a pattern of rapid range extension within a watershed, followed only later by rapid population growth, and a barrier effect of watershed divides, which can be strongly isolating where physical or habitat barriers (such as mountains or intensive farmland) intrude between watersheds. Management of beaver distribution should therefore operate at the watershed scale, except where large human‐made dams form significant bar‐riers to spread. The period of rapid population increase, if unchecked, leads to a phase of population decline as marginal habitats are occupied and exhausted. This coincides with a peak in conflicts with human land‐use interests. A regulated hunting take of healthy beaver populations is recommended as the optimal management regime in managed landscapes. Early provision of interpretation and public viewing opportunities has been a feature of several recent reintroductions. This provides a benefit to the local economy through wildlife tourism, and helps foster positive attitudes to beavers.
Culicoides in relation to transmission of African Horse Sickness virus in The Gambia
Authors: RAWLINGS  , SNOW  , BOORMAN  , DENISON  , HAMBLIN  , MELLOR
Published: March 2003

Twelve light trap collections made near overnight shelters of horses and donkeys in four villages in the Central River Division of The Gambia captured fourteen species of biting midge of the genus Culicoides. Five species new to The Gambia were identified. This brought the number of recognized species of Culicoides (after a revision of C. schultzei) to twenty‐nine in The Gambia. Species known or suspected as vectors of African horse sickness virus (AHSV) and bluetongue virus (BTV) comprised 83% of female captures, 65% of captures being C. imicola or its sibling species, C. miombo. Captures of female Culicoides in the late dry season were almost as large as in the early dry season, despite the extreme heat and dryness at this time of the year.

Tests on batches of formalin‐preserved female midges, using AHSV or BTV antigen capture ELISAs, did not show the presence of any virus amongst 2286 females in 240 aliquots. Nearly all Gambian equines are reportedly seropositive to AHSV and these results suggest that virus challenge from Culicoides vectors may be a factor in the health of Gambian horses and donkeys.
Characterization of amplified esterase Estβ12 associated with organophosphate resistance in a multi‐resistant population of the mosquitoCulex quinquefasciatus from Cuba
Authors: SMALL  , KARUNARATNE  , HEMINGWAY
Published: March 2003

Esterase amplification is the major organophosphorus (OP) insecticide resistance mechanism in Culex mosquitoes. The amplified Estα21\Estβ21 esterases are found in > 90% of resistant populations worldwide, whereas amplified DNAs (amplicons) containing Estβ1s are much rarer. Individuals with the Estβ1 amplicons appear to be at a selective disadvantage in competition with those carrying the Estα21\Estβ21 amplicons. To test the hypothesis that this is because Estβ1 is less able to bind insecticide than the common amplified esterases, Estβ12 was purified from the multi‐resistant Habana strain of Culex quinquefasciatus, from Cuba. In its native form Estβ1 is a monomeric enzyme of 66 kDa, with a pI of 4.8. The bimolecular rate constants for interaction of Estβ12 with several OP insecticides were similar to those for the commonly elevated esterases Estα21 and Estβ21, and much higher than for the electrophoretically identical non‐elevated Estβ13 and Estα3. Hence the apparent selective advantage of the Estα21\Estβ21 amplicon is not due to its greater efficiency of insecticide binding, as OP insecticides are significantly better inhibitors of all the amplified esterases than of their non‐amplified counterparts and therefore should be equally effective at conferring resistance.
Pyrethroid resistance inCulex quinquefasciatusfrom West Africa
Authors: Chandre F. , Darriet F. , Darder M. , Cuany A. , Doannio J. M. C. , Pasteur N. , Guillet P.
Published: March 2003

Laboratoire de Lutte contre les Insectes Nuisibles, ORSTOM, Montpellier, France, *OCCGE, Institut Pierre Richet, BP 1500, Bouaké 01, Côte d'Ivoire, †INRA, Laboratoire de Biologie des Invertébrés, 123 Bd Meilland, 06606 Antibes, France, and ‡CNRS UMR 5554, Laboratoire de Génétique et Environnement, Institut des Sciences de l'Environnement, Université de Montpellier II (CC 065), 34095 Montpellier, France

Abstract.Pyrethroid resistance was investigated in thirty‐three samples of Culex quinquefasciatus Say from twenty‐five cities in Côte d'Ivoire and Burkina Faso. Permethrin resistance ratios at LC50 ranged from 9.5‐ to 82‐fold in Côte d'Ivoire and from 17‐ to 49‐fold in Burkina Faso. For deltamethrin, resistance ratios were lower and ranged from nine to thirty‐eight in both countries. A strain was selected with permethrin to investigate resistance mechanisms. After forty‐two generations of selection, permethrin resistance level reached 3750‐fold, but deltamethrin resistance remained unexpectedly unchanged. This indicated that a specific mechanism was involved in permethrin resistance. Synergist assays and biochemical tests indicated that resistance was partly due to P450‐dependent oxidases. A target site insensitivity (kdr) was also involved, associated with DDT cross resistance and a dramatic loss of permethrin knockdown effect on adults. This resistance should be taken into consideration when planning the use of pyrethroid‐impregnated materials in urban areas, as Culex is by far the main source of nuisance. Any failure in nuisance control due to resistance is likely to demotivate people in using impregnated materials.
Efficiency and cost of strategic use of acaricide for tick control in N’Dama cattle in The Gambia
Authors: Mattioli R. C. , Jaitner J. , Bah M.
Published: March 2003

The efficiency of strategic and strategic/selective applications of flumethrin spray formulation for controlling ticks were assessed, respectively, in two groups of fourteen N’Dama cattle (Group S and Group S/S) by comparison of the number of feeding ticks with thirteen untreated N’Dama cattle (Group U) over a period of 11 months (June 1996 to April 1997). During the expected peak of tick abundance, acaricide was applied fortnightly on the whole body in animals in Group S and only on the most infested body areas in cattle in Group S/S. Weight changes and skin lesions, directly associated with tick attachment, were recorded in cattle in the three groups. The costs of the two tick control schemes were estimated. Maximum level of ticks, all species together, feeding on cattle was observed in the rainy season. Both in Group S/S and Group S, cattle carried a lower (P < 0.001) number of feeding ticks than animals in Group U over the whole study period. Percentage of tick control, over the entire period of tick investigation, was satisfactory in both acaricide‐treated groups, reaching 61.2 and 75.2% in Groups S/S and S, respectively. However, the proportion of control varied according to tick species or genus. Significantly lower prevalence of skin lesions was observed on the ano‐genital and udder region in cattle in Group S/S (P < 0.05) and Group S (P < 0.01) in comparison with cattle in Group U. Mean amount of acaricide solution used and relative estimated cost of treatment in cattle in Group S/S were, respectively, 25‐ and 14‐fold lower than those in cattle in Group S. At the end of the study, animals in Groups S/S and S were, respectively, 7.2 and 15.9 kg heavier than animals in Group U. The difference was statistically significant (P < 0.02) only between Groups S and U. However, the efficiency, low cost and derived benefits of the strategic/selective acaricide application scheme indicated that it might be the most cost effective.
Distribution of domestic Triatominae and stratification of Chagas Disease transmission in Oaxaca, Mexico
Authors: Ramsey J. M. , Ordoñez R. , Cruz‐Celis A. , Alvear A. L. , Chavez V. , Lopez R. , Pintor J. R. , Gama F. , Carrillo S.
Published: March 2003

Mexico has 18 species of Triatomine bugs (Hemiptera: Reduviidae) reported to be vectors of Trypanosoma cruzi. Chagas Disease is widespread in Mexico, with up to 3.5% seropositivity of human transfusion blood. The State of Oaxaca has the longest history of endemic Chagas Disease, based on acute and chronic case reports, and of entomological surveys in the country. However, the State health care services need more information on current risks of vector transmission. In order to identify and characterize areas of transmission in Oaxaca and to stratify the vector potential, the distribution of domestic Triatominae was surveyed during 1996–98 in collaboration with the primary health care services and local communities. Villages were studied in 11% of 570 municipalities in Oaxaca. Eight triatomine species were found in domestic and peri‐domestic habitats: Triatoma barberi Usinger, T. bolivari Carcavallo et al. T. dimidiata (Latreille), T. mazzottii Usinger, T. nitida Usinger, T. pallidipennis (Stal), T. phyllosoma (Burmeister) and Rhodnius prolixus Stal. For each triatomine species in Oaxaca, the range of distribution and habitat characteristics are described. Habitat partitioning, principally based on altitude and mean annual precipitation, limited the overlap of distribution between species. Relatively consistent altitude of human settlements facilitates the dispersion of individual species within microregions. Entomological indices of house infestation were used to estimate that ∼50% of the human population (1874 320 inhabitants) would be at risk of vector transmission, with a minimum of 134 320 infected people and 40 280 chronic cases of Chagas Disease currently in Oaxaca.
Dynamics of cypermethrin resistance in the field in the horn fly, Haematobia irritans
Authors: GUGLIELMONE A. A. , CASTELLI M. E. , VOLPOGNI M. M. , ANZIANI O. S. , MANGOLD A. J.
Published: March 2003

Abstract The toxicity of cypermethrin to the horn fly Haematobia irritans (L.) (Diptera: Muscidae) was determined for samples collected from untreated herds at a farm in central Argentina from October 1997 to May 2001. Field tests of the efficacy of cypermethrin against horn flies were first carried out at this farm in 1993, when the fly was shown to be susceptible to pyrethroids. Subsequently the horn fly populations on this farm were shown to have become resistant and, since 1997, the use of cypermethrin has been restricted to experimental purposes. In this study, fly samples collected in 1999, 2000 and 2001 were subjected to a polymerase chain reaction (PCR) to detect the presence of a specific nucleotide substitution in the sodium channel gene sequence, which has been associated with target site insensitivity to pyrethroids. This analysis showed that the level of cypermethrin resistance had diminished between 1997 and 2001. However, this was not sufficient to restore the efficacy of this pyrethroid to the level found prior to the onset of resistance. Heterozygous and homozygous resistant flies were detected in all samples of flies subjected to PCR diagnosis of alleles conferring target site resistance.
Shared goals, shared learning: evaluation of a multiprofessional course for undergraduate students
Authors: Parsell Glennys , Spalding Robert , Bligh John
Published: March 2003

Twenty‐eight undergraduate degree students from seven health care professions attended a two‐day pilot course. Using small multiprofessional groups, final‐year students from occupational therapy, orthoptics, therapy radiography, nursing, physiotherapy, medicine and dentistry explored professional roles and clinical problem‐solving using a theme‐based approach. A balance of didactic and interactive small‐group learning enabled them to identify issues surrounding multiprofessional teamworking and collaboration in the National Health Service. Evaluation results showed that the course increased knowledge and understanding of other health care professions, developed more positive attitudes and demonstrated the importance of multiprofessional teamwork and communication. Participating students believed that both early and regular opportunities for shared learning should be essential aspects of undergraduate courses.
Innovations in teaching obstetrics and gynaecology – the Theme Afternoon
Authors: Kevelighan  , Duffy  , Walker
Published: March 2003

The Theme Afternoon is an exciting and popular new innovation in teaching that we have successfully introduced in Obstetrics and Gynaecology. It utilizes many of the elements of the SCORPIO and SPICES models of teaching. In particular, it involves problem‐based learning and an integrated approach to teaching. One afternoon per week is set aside for each theme. So far we have introduced Theme Afternoons in Contraception and Sterilization, The Menopause and Hormone Replacement Therapy, Screening for Disease in O&G, and Examination Techniques. All Theme Afternoons follow a similar structure: a targeted tutorial, 10 MCQs, a 15‐minute coffee break, OSCEs, and role‐play with feedback. An evaluation form is completed by each student assessing the session and the tutor. The Theme Afternoon provides the student with stimulation to learn. It has a wide appeal and has been well received by learners. Students learn at a more controlled pace and in a more sheltered environment, which may be less stressful to them. It evaluates well and is flexible in its structure. The changes that occur are student‐led and the desire for it to continue is student‐driven. It is easily adaptable to other medical specialities or even non‐medical curriculums. We recommend it as a realistic opportunity to raise standards and enthusiasm in medical education.
Providing early clinical experience in primary care
Authors: Hampshire
Published: March 2003

Undergraduate courses in British medical schools are changing following recommendations from the General Medical Council. Increasing emphasis has been placed on teaching in the community. Nottingham Medical School has pioneered the teaching of basic clinical skills in primary care during the pre‐clinical course to help produce an integrated curriculum. This qualitative study evaluated the first two years of the new early clinical experience course at Nottingham by using interviews with 19 students and their GP tutors. Students claimed to have gained confidence in talking to patients, their understanding of the role of the doctor and the importance of the doctor–patient relationship. Students were less confident about examining patients and some reported having had little opportunity to practice examination skills. Half the students thought that the early clinical visits had helped them to understand and be more motivated to learn their basic medical sciences course. The newly recruited GP teachers were highly motivated, very positive about the early clinical teaching and all wanted to continue to teach the pre‐clinical students. Difficulties in providing the course included communication with students and staff, organization of student travel and variation in the quality of teaching. However, the Nottingham early clinical experience course has shown that basic clinical skills can be successfully taught to pre‐clinical students in primary care.
The effect of problem‐based learning on the academic performance of students studying podiatric medicine in Ontario
Authors: Finch
Published: March 2003

Objectives

To investigate the effect of problem‐based learning (PBL) on student achievement.

Design

Two cohorts of students studying podiatric medicine in Ontario were compared – one having undertaken the traditional lecture‐based curriculum, and the other the problem‐based learning programme.

Setting

The Michener Institute for Applied Health Sciences and The Toronto Hospital.

Subjects

Chiropody students.

Results

The performance of the students on the written Provincial Registration Examinations of Ontario was analysed utilizing independent t‐tests and demonstrated that the PBL cohort of students achieved significantly higher overall examination scores (P < 0·005) than the traditional cohort. Further analysis revealed that no significant difference existed between student cohorts with respect to factual biomedical knowledge (P > 0·5), but that the PBL students performed significantly better in tests of deeper understanding and the cognitive skills related to patient management (P < 0·0005). Additionally, intragroup analysis using Spearman’s rank order correlation indicated that there was no rank ordered association between performance on the multiple‐choice and essay sections of the examination.

Conclusions

The above results suggest that the PBL cohort of students was more knowledgeable than, and possessed superior cognitively related patient management skills, to their traditional counterparts.
Junior doctors' views about careers in academic medicine
Authors: Goldacre Michael , Stear Sarah , Richards Rex , Sidebottom Eric
Published: March 2003

Objective

To investigate junior doctors' views about careers in academic medicine.

Design

Postal questionnaire survey.

Setting

National Health Service in England.

Subjects

Doctors in university posts at specialist registrar level, Medical Research Council and Wellcome Trust training fellows, and specialist registrars in National Health Service posts.

Results

Incentives to pursue an academic career which respondents rated as strong related to the challenge of research and the intellectual environment of research units. The strongest disincentives were perceived difficulties in obtaining research grants and uncertainty regarding pay parity with National Health Service colleagues. Medical Research Council and Wellcome fellows had much more protected research time than other academic doctors but were less satisfied with their clinical training. Academic doctors who were not fellows reported spending less than half their time on research and the great majority agreed that their research suffers when there is pressure on the service side.

Conclusions

The job content of academic posts should be kept under regular review to ensure that clinical service pressures do not inappropriately erode research time while also ensuring that postholders have adequate clinical training. Training programmes need flexibility to accommodate the needs of clinical academics in their progress through higher specialist training.
The indigenous coastal Californian population of the mushroom Agaricus bisporus, a cultivated species, may be at risk of extinction
Authors: KERRIGAN R. W. , CARVALHO D. B. , HORGEN P. A. , ANDERSON J. B.
Published: March 2003

This study employed nuclear and mitochondrial markers to assess the present‐day composition of the population of Agaricus bisporus in coastal California. Favourable weather in the fall, winter and spring of 1990–91 furnished an uncommon opportunity to collect and study field material of the ‘button mushroom’A. bisporus, a cultivated species, from the region. The previous such season occurred 13 years earlier. Ninety‐five nonredundant cultures from field material were prepared and genotypically characterized. These data were combined with data from earlier studies. Multilocus nuclear and mitochondrial genotypes were determined for 123 individuals. Genotypes were compared in pairwise fashion both within the sample and between this sample and others of diverse geographical origin or commercial provenance. Using parametric analysis and cluster analysis of nuclear similarities, and also mitochondrial data, two elements – indigenous and European – were apparent within the sample. This was consistent with our earlier results on a much smaller sample. At least 10 mitochondrial haplotypes (MTs) were present; based on genotypic similarities of associated nuclei, five (or six) MTs were Californian, four were European, and one was ambiguous. Based on MT origins, 54% of the 121 classifiable individuals in California were of European ancestry; natives constituted a minority at 46%. Even in the indigenous Monterey cypress habitat, where 84% of all individuals from California were sampled, non‐native A. bisporus appeared to have achieved parity (at 48–49%) with the native population. In all other habitats, which are far more extensive, European individuals outnumbered Californian natives by 4:1. Some evidence of hybridization between the two ancestral groups was found. European strains appear to have been resident in California for approximately one century. The extensive occupancy of the native habitat by non‐native germ plasm, the apparent inability of native strains to occupy or compete in non‐native habitats, and the disproportionately large inoculum reservoirs represented by non‐native habitat and agronomic activities all suggest that the native population is under considerable competitive pressure in what may be a very dynamic situation. If this surmise is correct, the native population may be at serious risk of further contraction, irreversible dilution through interbreeding, and possibly even extinction.