bluuebunny/crossref_metadata_2025 huggingface dataset:
Expression of the Arabidopsis histone H2A‐1 gene correlates with susceptibility to Agrobacterium transformation
Authors: Yi HoChul , Mysore Kirankumar S. , Gelvin Stanton B.
Published: March 2003

Transformation of plant cells by Agrobacterium tumefaciens involves both bacterial virulence proteins and host proteins. We have previously shown that the Arabidopsis thaliana gene H2A‐1 (RAT5), which encodes histone H2A‐1, is involved in T‐DNA integration into the plant genome. Mutation of RAT5 results in a severely decreased frequency of transformation, whereas overexpression of RAT5 enhances the transformation frequency (Mysore et al., 2000b). We show here that the expression pattern of RAT5 correlates with plant root cells most susceptible to transformation. As opposed to a cyclin‐GUS fusion gene whose expression is limited to meristematic tissues, the H2A‐1 gene is expressed in many non‐dividing cells. Under normal circumstances, the H2A‐1 gene is expressed in the elongation zone of the root, the region that is most susceptible to Agrobacterium transformation. In addition, when roots are incubated on medium containing phytohormones, a concomitant shift in H2A‐1 expression and transformation susceptibility to the root base is observed. Inoculation of root segments with a transfer‐competent, but not a transformation‐deficient Agrobacterium strain induces H2A‐1 expression. Furthermore, pre‐treatment of Arabidopsis root segments with phytohormones both induces H2A‐1 expression and increases the frequency of Agrobacterium transformation. Our results suggest that the expression of the H2A‐1 gene is both a marker for, and a predictor of, plant cells most susceptible to Agrobacterium transformation.
Controlling gene expression in plants using synthetic zinc finger transcription factors
Authors: Stege Justin T. , Guan Xuen , Ho Thao , Beachy Roger N. , Barbas Carlos F.
Published: March 2003

Synthetic zinc finger proteins can be fused to transcriptional regulatory domains to create artificial transcription factors that modulate the expression of a specific target gene. Recent studies have demonstrated that synthetic zinc finger domains can be constructed to bind DNA sequences with a high degree of specificity. To devise a general strategy for controlling plant gene expression with artificial transcription factors, a rapid transient assay was developed to test the regulatory activity of synthetic zinc finger transcription factors (effectors) on target plasmids (reporters) in plant cells. Effective activation was demonstrated with zinc finger proteins fused to a derivative of the VP16 activation domain. The mSin3 interaction domain (SID) of the human MAD1 protein provided moderate repression of target reporters. Unlike many naturally occurring transcription factors, these synthetic effectors exhibit a strong dependence on binding site position. Reporter genes that are stably integrated into plant cells responded similarly to transiently transfected reporter plasmids, verifying that this assay accurately reflects the behavior of these transcription factors on an endogenous target within the context of chromosomal DNA. These results provide evidence that synthetic zinc finger proteins can be used to manipulate the expression of endogenous genes in plants.
Heparin‐induced thrombocytopenia: detection of antiheparin/PF4 antibodies by means of heparin/PF4‐coated beads and flow cytometry
Authors: Tazzari P. L. , Ricci F. , Vitale M. , Malferrari F. , Salama A. , Schwind P. , Conte R.
Published: March 2003

Summary  A total of 70 serum samples from heparin‐induced thrombocytopenia (HIT II) patients, non‐HIT patients and healthy subjects, respectively, were studied for the presence of antiheparin/PF4 antibodies. Two enzyme‐linked immunosorbent assay (ELISA) assays were compared with the particle gel immunoassay (PaGIA). Beads of the PaGIA kit were also used to evaluate the feasibility of flow cytometric detection of antiheparin/PF4 antibodies in patient samples. Experiments have shown that all samples found positive by ELISA and PaGIA, were also positive when analysed by flow cytometry by an indirect test using the high‐density particles coated with heparin/PF4 complexes and a second step fluorescein isothiocyanate (FITC) antihuman immunoglobulin (Ig)G reagent. The procedure was easy to perform, repetitive and beads were promptly visualized by physical parameters, with a very low background. In conclusion, the results of this study suggest that flow cytometry is a reliable method for the detection of antiheparin/PF4 antibodies.
Pleural tuberculosis in Harare, Zimbabwe: the relationship between human immunodeficiency virus, CD4 lymphocyte count, granuloma formation and disseminated disease
Authors: Heyderman R. S. , Makunike R. , Muza T. , Odwee M. , Kadzirange G. , Manyemba J. , Muchedzi C. , Ndemera B. , Gomo Z. A. R. , Gwanzura L. K. Z. , Mason P. R.
Published: March 2003

objective
 
 To elucidate the relationship between HIV, CD41 count and pleural TB.method  In a prospective study, 94 patients presenting at two large Harare hospitals with clinically suspected pleural TB were enrolled over a 10‐month period. All underwent standardized evaluation, closed pleural aspiration and biopsy. Patients receiving directly observed anti‐TB therapy were followed‐up.results  Pleural TB was diagnosed in 90 individuals (median age 33 years; range 18‐65; 64 males); the seroprevalence of HIV was 85%. HIV‐positive patients were older than HIV‐negative individuals (median age 33 vs 23 years, P= 0.013) and had a significantly lower median CD41 count (191 vs 1106 × 106/l respectively, P= 0.004). A CD41 count of <200 × 106/l was associated with a length of illness >30 days (65% vs 37%; P= 0.05), a positive pleural fluid smear (37% vs 0%; P= 0.0006) and a positive pleural biopsy Ziehl‐Neelsen stain (35% vs 7%; P= 0.021). However, a relationship between CD41 count and either pleural granuloma formation or radiological evidence of disseminated disease was not observed.conclusion  In sub‐Saharan Africa, TB pleural effusions have become associated with older age, a chronic onset, and an increased mycobacterial load. These data emphasize the complex relationship between pleural TB, HIV infection and a low CD41 count.
Prolonged macrophage activation and persistent anaemia in children with complicated malaria
Authors: Biemba G. , Gordeuk V. R. , Thuma P. E. , Mabeza G. F. , Weiss G.
Published: March 2003

objective
 
 To determine if prolonged immune activation may be associated with the persistence of anaemia after treatment for severe malaria, we measured serum concentrations of neopterin and interleukin‐4 during one week of antimalarial therapy and determined haemoglobin levels one month later. Neopterin is a clinically valuable marker for monitoring activation of macrophages by gamma‐interferon and thus reflects the TH‐1 immune response. Interleukin‐4 is a major cytokine that tends to be inhibited by TH‐1 activity.method  The study population consisted of 26 Zambian children <6 years of age who presented with cerebral malaria to a rural hospital in 1994 and who were treated with quinine for seven days. Six children (23%) were anaemic (haemoglobin < 11 g/dl) one month after completing antimalarial therapy.results  On admission, concentrations of neopterin were markedly elevated in all patients. During the seven days of anti‐malarial therapy, neopterin levels remained elevated in the 6 children who proved to have persistent anaemia one month after finishing treatment but declined significantly (P = 0.008) in the 20 children who corrected their haemoglobin levels by that time. Conversely, interleukin‐4 levels declined in the children with persistent anaemia (P= 0.043) but not in the other children.conclusion  Persistence of the TH‐1 mediated immune response and associated activation of macrophages may be involved in the pathogenesis of lingering anaemia after treatment of malaria.
Schistosoma mansoni infection in a recently exposed community in Senegal: lack of correlation between liver morphology in ultrasound and connective tissue metabolites in serum
Authors: Burchard G.‐D , Guissé‐Sow  , Diop  , Ly  , Lanuit  , Gryseels  , Gressner
Published: March 2003

SummaryFour hundred and seventy villagers of Ndombo, a village with recently established intensive transmission of Schistosoma mansoni in the Senegal River Basin, were enrolled in a study with the intention to assess hepatosplenic morbidity. All patients were examined parasitologically and by ultrasound. Hepatic fibrosis serum markers were determined in 153 adult patients (aminoterminal propeptide of procollagen type III, hyaluronan and laminin). By ultrasound, about 60% of the patients showed early stages of hepatic involvement, 3% of the patients unequivocally showed severe hepatosplenic pathology (grade 3 according to the Managil classification), whereas in another study performed in the same village 3 years earlier, no patients with severe hepatosplenic pathology had been found. No correlation between the aminoterminal propeptide of procollagen type III, hyaluronan or laminin and the ultrasound findings could be established. These hepatic fibrosis serum markers do not seem to be a sensitive method to detect early hepatic fibrosis in schistosomiasis.
Patterns of treatment for malaria in Tayabas, The Philippines: Implications for control
Authors: Miguel Cynthia A. , Manderson Lenore , Lansang Mary Ann
Published: March 2003

This paper describes local understandings of illness and documents treatment‐seeking behaviour in Tayabas, Quezon, The Philippines. Data were collected using focus group discussions and narrative interviews with adults, and with mothers of children, who had had confirmed malaria during a two‐month surveillance period. Signs and symptoms of malaria are important in directing individual diagnosis, treatment‐seeking and therapy. Household therapy with antimalarials, and more commonly antipyretics and herbs, as used before seeking care from either the formal or informal sector. Care outside the home was sought where symptoms continued and/or worsened, with an average period of time from onset of symptoms to presentation to a clinic of six days. Accessibility to clinics is not a problem in the study area and hence the primary reason for delay was propensity to self‐treat first and to discontinue medication when feeling better. These factors affect the control of malaria and the potential to reduce transmission. Better advice to the community regarding the importance of diagnosis and compliance with antimalarial therapy is indicated.
A school‐based schistosomiasis and intestinal helminthiasis control programme in Nigeria: acceptability to community members
Authors: Nwaorgu Obioma C. , Okeibunor Joseph , Madu Ephraim , Amazigo Uche , Onyegegbu Nkeadi , Evans David
Published: March 2003

In a population with high prevalences in schoolchildren of infection with hookworm (32.4%), Ascaris (22.9%) and Trichuris (2.5%), visible haematuria (17.9%), micro‐haematuria (17%) and proteinuria (47.3%), the knowledge about transmission of schistosomiasis and acceptability of a school‐based control programme were assessed. The community perceived schistosomiasis (80.6%) and intestinal helminthiasis (66.5%) as important health problems in school‐age children and most people would prefer placement of the control programme in school because it would eliminate transportation cost to the health facility. They welcomed the idea of using teachers for detection of infection and drug administration. The health staff, on the other hand, were willing to work with teachers, but emphasized that teachers should be limited to organizational and supervisory roles while they do tests and administer the drug. This view was also shared by the officials in the state ministries of health and education.
Antibiotic resistance of Escherichia coli isolated from poultry workers, patients and chicken in the eastern province of Saudi Arabia
Authors: Al‐Ghamdi Mastour S. , El‐Morsy Fikry , Al‐Mustafa Zaki H. , Al‐Ramadhan Mustafa , Hanif Mohammad
Published: March 2003

Summary The prevalence of antibiotic‐resistant Escherichia coli isolates from faecal samples from 117 poultry industry workers, 100 patients and119 healthy chicken were compared. Resistance of E. coli chicken isolates to ampicillin, chloramphenicol, gentamicin, spectinomycin, tetracycline and trimethoprim + sulphamethoxazole (TMP + SMX) (range 57%– 99.1%) were significantly higher than those isolated from patients (range 21.9%– 71.4%) and workers (range 35%– 71.8%). However, for drugs not used in poultry, such as amoxicillin + cluvalanate (AMX + CLV), ceftazidime and nitrofurantoin, resistance rates of chicken isolates (range 0%– 2.6%) were significantly lower than those of patient isolates (range 8.7%– 30%). Resistance to spectinomycin reached 96% in E. coli chicken isolates and 71% in organisms isolated from humans. Use of this drug in Saudi Arabia is mostly limited to veterinary purposes. Multidrug resistance is alarmingly high in all groups but was highest in chicken isolates (77.4%). Serotyping of E. coli isolates showed that 27% of the organisms isolated from patients were overlapping with 10.9% of the chicken isolates, indicating the possibility of chicken being a source of the resistance pool for humans. We therefore call for the banning of antibiotics in the poultry industry as growth promoters and recommend that their use be restricted to treating infections.
Field trials of a rapid test for G6PD deficiency in combination with a rapid diagnosis of malaria
Authors: Tantular I. S. , Iwai K. , Lin Khin , Basuki S. , Horie T. , Htay H. H. , Matsuoka H. , Marwoto H. , Wongsrichanalai C. , Dachlan Y. P. , Kojima S. , Ishii A. , Kawamoto F.
Published: March 2003

Summary A rapid single‐step screening method for detection of glucose‐6‐phosphate dehydrogenase (G6 PD) deficiency was evaluated on Halmahera Island, Maluku Province, Indonesia, and in Shan and Mon States, Myanmar, in combination with a rapid diagnosis of malaria by an acridine orange staining method. Severe deficiency was detected by the rapid test in 45 of 1126 volunteers in Indonesia and 54 of 1079 in Myanmar, but it was difficult to distinguish blood samples with mild deficiency from those with normal activity. 89 of 99 severely deficient cases were later confirmed by formazan ring method in the laboratory, but 5 with mild and 5 with no deficiency were misdiagnosed as severe. Of the samples diagnosed as mild and no deficiency on‐site, none was found to be severely deficient by the formazan method. Malaria patients were simultaenously detected on‐site in 273 samples on Halmahera island and in 277 samples from Shan and Mon States. In Mon State, primaquine was prescribed safely to G6 PD‐normal malaria patients infected with Plasmodium vivax and/or gametocytes of P. falciparum. The new rapid test for G6 PD deficiency may be useful for detecting severe cases under field conditions, and both rapid tests combined are can be useful in malaria‐endemic areas, facilitating early diagnosis, prompt and radical treatment of malaria and suppression of malaria transmission.
Evaluation of the SPf66 vaccine for malaria control when delivered through the EPI scheme in Tanzania
Authors: Acosta C. J. , Galindo C. M. , Schellenberg D. , Aponte J. J. , Kahigwa E. , Urassa H. , Schellenberg J. R. M. Armstrong , Masanja H. , Hayes R. , Kitua A. Y. , Lwilla F. , Mshinda H. , Menendez C. , Tanner M. , Alonso P. L.
Published: March 2003

Summarybackground Malaria control programmes need to protect young children, who bear the brunt of malaria disease and death in Africa. The development of a vaccine is a priority if improved and sustained malaria control is to be achieved. The best use of a vaccine in Africa will be achieved if it can be delivered through the expanded programme of immunization (EPI). We conducted a trial designed to evaluate the efficacy of SPf66 vaccine for malaria control when delivered through the EPI scheme in Tanzania.

methods The study was a two‐arm, double blind, individually randomized placebo controlled trial involving 1207 infants. The primary objective of the trial was to estimate the efficacy of three doses of SPf66 given at 1, 2 and 7 months of age in preventing clinical episodes of malaria. These were documented through a health facility‐based passive case detection system.

results Among 1207 randomized children, overall compliance for third dose was 91%. SPf66 was safe, immunogenic and did not interfere with the humoral immune responses to EPI vaccines. There were 294 children among SPf66 recipients and 288 among placebo recipients with at least one malaria episode, yielding a vaccine efficacy estimate of 2% (95% CI: −16, 16;P = 0.84).

conclusion This has been the first trial of a malaria vaccine among very young infants. It provides information on the safety of peptide vaccines administered at this early age as well as their capacity to induce immune responses without negatively interacting with EPI vaccines. Given the modest protection previously documented in older age groups and the lack of efficacy in younger infants, this vaccine in its current alum‐based formulation does not appear to have a role in malaria control in sub‐Saharan Africa. The lack of efficacy found in this trial also raises concerns about potential difficulties of inducing protective immune responses against malaria through immunization in infants.
Safety in infants of SPf66, a synthetic malaria vaccine, delivered alongside the EPI
Authors: Schellenberg D. M. , Acosta C. J. , Galindo C. M. , Kahigwa E. , Urassa H. , Masanja H. , Aponte J. J. , Schellenberg J. R. M. Armstrong , Fraser‐Hurt N. , Lwilla F. , Menendez C. , Mshinda H. , Tanner M. , Alonso P. L.
Published: March 2003

Summary The most likely mechanism to deliver a malaria vaccine in African countries is through the Expanded Program of Immunization (EPI). So far only SPf66, a multistage synthetic peptide, has shown any evidence of protection in Phase III field trials. In Tanzania, SPf66 reduced the risk of clinical malaria by 31% in children aged 1–5 years. In order to progress in the critical path of vaccine development and testing towards the implementation of a new vaccine in malaria control programs, we carried out a randomized double‐blind placebo controlled efficacy trial of SPf66 when given alongside the EPI scheme. Monitoring of safety and reactogenicity during this trial included detailed clinical and laboratory assessments on 98 infants and assessment of adverse effects within 1 h of vaccination for all 1207 children vaccinated. Surveillance systems monitored attendances as outpatients, admissions to hospital and fatal events in the community. No serious adverse effects were detected more frequently amongst SPf66 recipients compared to placebo. This first assessment in very young infants of a synthetic vaccine provides evidence of a good safety profile.
Is there a role for glycosuria testing in sub‐Saharan Africa?
Authors: van der Sande Marianne A. B. , Walraven Gijs E. L. , Bailey Robin , Rowley Jane T. F. , Banya Winston A. S. , Nyan Ousman A. , Faal Hannah , Ceesay Sana M. , Milligan Paul J. M. , McAdam Keith P. W. J.
Published: March 2003

Summary background With increasing urbanization and westernization, rates of diabetes in sub‐Saharan Africa (sSA) are likely to rise. Early detection and intervention plays an important role in delaying development of complications. In sSA in particular there is need for an affordable, reliable, safe, feasible test to avert human suffering and exhausting already stressed health facilities.

methods Data from two large community‐based studies were used to assess the value of glycosuria testing in the detection of diabetes in adults in a sub‐Saharan country. A first study (A) tested participants for glycosuria by dipstick; if positive, fasting capillary glucose was measured. A later study (B) measured glucose concentration in venous blood 2 h after a 75‐g glucose load; if glycaemia was ≥ 10 mmol/l, urine was tested for glycosuria.

results The positive predictive value of glycosuria for a diagnosis of diabetes (fasting glucose ≥ 6.7 mmol/l) was 48%. Sensitivity was 64% (57% if a 2‐h‐value ≥ 10 mmol/l was used as gold standard). Sensitivity was higher among overweight and/or hypertensive subjects, among elderly people in the urban area, and among subjects with higher blood glucose levels. Extrapolated specificity was 99.7%, and the likelihood ratio 190.

conclusions Glycosuria testing can identify a considerable number of undiagnosed diabetic patients when specially targeted at high‐risk groups (obese, hypertensive, or elderly people). Dipstick glycosuria testing is an appropriate, safe, feasible test for sSA, where the prevalence of diabetes is expected to increase considerably in the near future.
Glucose‐6‐phosphate dehydrogenase deficiency in northern Vietnam
Authors: Verlé P. , Nhan D. H. , Tinh T. T. , Uyen T. T. , Thuong N. D. , Kongs A. , Van der Stuyft P. , Coosemans M.
Published: March 2003

Summary Glucose‐6‐phosphate dehydrogenase (G6PD) deficiency was evaluated in 1676 schoolboys in northern Vietnam. The trait was nearly absent in boys of the Kinh (0.5%) and the Mong (0.7%) ethnic groups that traditionally have lived outside malaria transmission areas. Prevalences among ethnic groups living in the foothills, the breeding area of the main malaria vector Anopheles minimus, ranged from 9.7% to 31%. These findings support the hypothesis of a selective advantage of the trait in Plasmodium falciparum‐endemic areas.
Isolation and partial characterization of dengue virus type 2 and 4 strains from dengue fever and dengue haemorrhagic fever patients from Mindanao, Republic of the Philippines
Authors: ter Meulen J. , Grau M. , Lenz O. , Emmerich P. , Schmitz H. , Oh F. , Jaspert R. , Niedrig M.
Published: March 2003

Summary objective  Isolation of dengue virus from dengue fever and dengue haemorrhagic fever cases from Mindanao, Republic of the Philippines.

methods  12 patients with clinically suspected dengue fever (DF) or dengue haemorrhagic fever (DHF) presenting in four regional hospitals between August and September 1995 on Minadano were enrolled in the study. Dengue virus was isolated by inoculation of Vero/E6 or C6/36 cells with patient serum. IgM antibodies were measured using a commercial test system. Up to 454 bp of the capsid region and 240 bp of the E/NS1 gene junction of different viral isolates were sequenced and phylogenetically analyzed.

results  Virus could be isolated from seven patients, five isolates were typed as dengue virus type 2 and two as dengue virus type 4 by immunostaining with monoclonal antibodies or by RT/PCR. Phylogenetic analysis confirmed a close relationship of the dengue virus type 2 isolates with viruses isolated in the Philippines in 1983 and 1988.

conclusion  As observed in studies from other parts of South East Asia, dengue virus type 2 was readily isolated from dengue haemorrhagic fever cases. Dengue virus type 2 and 4 circulate in Mindanao, Philippines, with dengue type 2 being responsible for most of our severe DF or DHF cases.
Review: Mycobacterium leprae – millennium resistant! Leprosy control on the threshold of a new era
Authors: Visschedijk Jan , van de Broek Jacques , Eggens Henk , Lever Peter , van Beers Stella , Klatser Paul
Published: March 2003

Summary Over the past decades, the conditions of leprosy control implementation have changed dramatically. Introduction of multidrug therapy, together with the global effort of the World Health Organization to eliminate leprosy as a public health problem, had a tremendous impact on leprosy control, particularly by decreasing the registered prevalence of the disease. At the beginning of the new millennium, leprosy control programmes face several new challenges. These relate not only to changes in the prevalence of the disease, but also to changes in the context of leprosy control, such as those created by health sector reforms and other disease control programmes. This review discusses current knowledge on the epidemiology of Mycobacterium leprae and some important aspects of leprosy control. It is argued that our understanding is still insufficient and that, so far, no consistent evidence exists that the transmission of leprosy has been substantially reduced. Sustainable leprosy control, rather than elimination, should be our goal for the foreseeable future, which also includes care for patients on treatment and for those released from treatment. This, however, requires new strategies.
Toxic activities of the plant Jatropha curcas against intermediate snail hosts and larvae of schistosomes
Authors: Rug Melanie , Ruppel Andreas
Published: March 2003

Summary The aim of studies on plant molluscicides is to complement methods for controlling snails acting as intermediate hosts of schistosomes. We report on the toxic activity of extracts from Jatropha curcas L. (Euphorbiaceae) against snails transmitting Schistosoma mansoni and S. haematobium. We studied different extracts' effects on infectious larvae, cercariae and miracidia of S. mansoni. Compared to aqueous extract, methanol extract showed the highest toxicity against all tested organisms with LC100‐values of 25 p.p.m. for cercariae and the snail Biomphalaria glabrata and 1 p.p.m. for the snails Bulinus truncatus and B. natalensis. Attenuation of cercariae leading to reduced infectivity in mice could be achieved in concentrations below those exerting acute toxicity. In view of our results and the ongoing exploitation of J. curcas for other purposes, this plant could become an affordable and effective component of an integrated approach to schistosomiasis control.
Treatment for clinical malaria is sought promptly during an epidemic in a highland region of Uganda
Authors: Lindblade Kim A. , O'neill Devin B. , Mathanga Don P. , Katungu Justus , Wilson Mark L.
Published: March 2003

Summary Early diagnosis of malaria followed by appropriate treatment can help reduce related morbidity and mortality as well as interrupt transmission. Previous studies of household responses to malaria have tended to focus on endemic areas where the burden of this disease is greatest. With the apparent increasing frequency of epidemics in African highlands, a better understanding of treatment behaviours in areas of unstable transmission may be important to future public health interventions. This study was undertaken following a serious epidemic of malaria in the highlands of south‐western Uganda. Our objectives were to characterize actions taken by both adults and caretakers of children ≤5 years old during their most recent episode of self‐diagnosed malaria, and to identify factors that were associated with prompt treatment at a health facility. A survey of 300 households selected in a 2‐stage cluster sampling procedure produced 453 adult respondents and 133 caretakers of children ≤5 years old. We found that almost 65% of adults and 62% of children who had experienced an episode of malaria in the last year (most during the epidemic) had sought treatment from a health facility first as opposed to self‐treatment. Most of these people had visited the health facility within 1 day of symptom onset. By the end of their malaria episode, over 87% of adults and 80% of children had visited a health facility at least once. Factors associated with prompt presentation at a health facility included severity of illness, household proximity to a health facility, and knowledge of malaria prevention methods. Our results indicate that there is an important role for the formal health care system in mitigating morbidity and mortality and reducing transmission during malaria epidemics in Uganda.
The phenomenon of treatment failures in Human African Trypanosomiasis
Authors: Brun Reto , Schumacher Reto , Schmid Cecile , Kunz Christina , Burri Christian
Published: March 2003

Treatment of Human African Trypanosomiasis (HAT or sleeping sickness) relies on a few drugs which are old, toxic and expensive. The most important drug for the treatment of second stage infection is melarsoprol. During the last 50 years treatment failures with melarsoprol were not a major problem in Trypanosoma brucei gambiense patients. Commonly a relapse rate of 5–8% was reported, but in recent years it has increased dramatically in some important foci of T. b. gambiense sleeping sickness. Treatment failures for T. b. rhodesiense are much less of a problem apart from some reports between 1960 and 1985 of refractoriness in T. b. rhodesiense patients in East Africa. Analysis of those isolates revealed that their in vitro sensitivity to melarsoprol was one‐tenth that of sensitive isolates, and complete failure to cure the infection in the acute mouse model with melarsoprol levels comparable with those in human patients. There was very little indication of resistance in T. b. gambiense isolates from Côte d’Ivoire and NW Uganda. The in vitro melarsoprol sensitivities for populations from relapsing and from curable patients were in the same range. Melarsoprol concentrations in the plasma and cerebrospinal fluid of patients 24 h after treatment did not show any difference between patients who relapsed and those who could be cured. The reason for relapses in the recent T. b. gambiense epidemics are not known. Other parasite‐related factors might be involved, e.g. affinity to extravascular sites other than the CNS which are less accessible to the drug. In conclusion, a combination of factors rather than a single one may be responsible for the phenomenon of melarsoprol treatment failures in T. b. gambiense patients.
Improving private practitioner sick‐child case management in two urban communities in Pakistan
Authors: Luby Stephen , Zaidi Najam , Rehman Simi , Northrup Robert
Published: March 2003

OBJECTIVE To evaluate if INFECTOM, a multicomponent behaviour change strategy, would alter the care received by children visiting private healthcare providers so that it was more consistent with the IMCI algorithm.

METHODS Community surveys in two low income communities in Pakistan identified children who had visited healthcare providers in the preceding 2 weeks complaining of diarrhoea, cough or rapid breathing, or fever. Interviewers asked the mothers of these children whether providers performed specific behaviours recommended by the Integrated Management of Childhood Illness (IMCI) algorithm. These data were analysed to generate provider‐specific IMCI‐related behaviour profiles. A team including community representatives met with the providers, discussed the correct IMCI algorithm behaviour, reviewed the percentage of time each of their practices was consistent with IMCI recommendations, and negotiated a contract with a numerical target for improved practices. This cycle of survey, discussion of results and contracting was repeated three times over 10 months.

RESULTS Twenty‐two providers, 13 of whom (59%) had a medical degree, regularly treated children in the two communities. Sixteen of the 21 targeted behaviours (76%) occurred with significantly increased frequency during the course of the intervention. Of the 10 practices that ill children with any of the syndromes should have received, at baseline children averaged receiving 4.3. In the final model, each subsequent round of evaluation was associated with a 0.57 increase in the number of appropriate practices performed at visits to non‐Bachelor's Degree in Medicine (MBBS) qualified providers (P < 0.001) and a 0.75 increase among visits to MBBS qualified providers (P=0.004). The percentage of children who received an injection decreased from 70 to 56% (P=0.03).

CONCLUSIONS INFECTOM altered the practices of private providers so that they were more consistent with the IMCI algorithm. Efforts to further develop this approach could improve the quality of clinical healthcare in other settings.
Unstable malaria transmission and maternal mortality – experiences from Rwanda
Authors: Hammerich Asmus , Campbell Oona M. R. , Chandramohan Daniel
Published: March 2003

Data on malaria in pregnancy in unstable transmission areas are scarce. We investigated malaria in pregnancy at Byumba District Hospital, Rwanda, over 3 years (January 1997–December 1999). Byumba, at an altitude of 2300 m, has low levels of malaria transmission. A malaria epidemic in February 1998 led to a fourfold increase in malaria admissions among pregnant women and to a fivefold increase in maternal deaths because of malaria. Safe Motherhood programmes should note that even in non‐epidemic years malaria can cause a large proportion of maternal deaths, and that national and international responses to malaria in pregnancy need strengthening.
Bacterial superinfection in human tungiasis
Authors: Feldmeier H. , Heukelbach J. , Eisele M. , Sousa A. Queiroz , Barbosa L. Marilac Meireles , Carvalho C. B. M.
Published: March 2003

Tungiasis is caused by penetration of the female sand flea Tunga penetrans into the epidermis of its host. It is endemic in many countries in Latin America, the Caribbean and sub‐Saharan Africa. Although superinfection is a common clinical observation, the frequency and the pattern of bacterial pathogens associated with tungiasis have never been investigated systematically. We conducted a prospective clinico‐bacteriological study with patients living in a shantytown in Fortaleza, capital of Ceará State (Northeast Brazil), where tungiasis is hyperendemic. Swabs were taken from 78 patients with multiple lesions after surgical extraction of the parasite, and the specimens were cultured for aerobic and anaerobic microorganisms. Ninety‐nine specimens were investigated for aerobic bacteria, from which 146 pathogens were identified. The most common species were Staphyloccous aureus (35.5%) and various enterobacteriaceae (29.5%). Bacillus sp., Enteroccous faecalis, Streptococcus pyogenes and Pseudomonas sp. were also isolated. Eighty‐four anaerobic cultures yielded 20 pathogens: in eight cases we detected Peptostreptococcus sp., in seven cases Clostridium sp., and in five cases non‐identifiable gram‐negative bacilli. These results show that secondary infection is very common in tungiasis, and caused by a variety of highly pathogenic microorganisms. It is proposed that T. penetrans acts as a foreign body facilitating biofilm formation within the epidermis. To prevent spreading of pathogens to the surrounding tissue and/or the systemic circulation, sand fleas should be surgically extracted immediately after penetration.
Socioeconomic status and risk of HIV infection in an urban population in Kenya
Authors: Hargreaves James R. , Morison Linda A. , Chege Jane , Rutenburg Naomi , Kahindo Maina , Weiss Helen A. , Hayes Richard , Buvé Anne ,   for the Study Group on Heterogeneity of HIV Epidemics in African Cities
Published: March 2003

Objective To examine the relationship between socioeconomic status (SES), risk factors for HIV infection and HIV status in an urban population with high prevalence of HIV infection in sub‐Saharan Africa.

Methods  Cross‐sectional population survey of adults from the city of Kisumu, Kenya, in 1996. Around 1000 men and 1000 women aged 15–49 years were interviewed using a structured questionnaire, and most gave a venous blood sample for HIV testing. SES was represented by a composite variable of educational status, occupation and household utilities. Multiple regression was used to examine whether SES was associated with HIV infection or with risk factors for HIV infection.

Results  Human immunodeficiency virus prevalence was 19.8% in males and 30.2% in females. Higher SES was associated with a more mobile lifestyle, later sexual debut and marriage among both sexes, and with circumcision among men aged 25–49 and condom use among women aged 25–49. Higher levels of alcohol consumption were associated with an increased risk of HIV infection and were more common amongst those of higher SES. HSV‐2 infection was strongly associated with an increased risk of HIV infection and was more common among those of lower SES. HIV was associated with a lower SES among females aged 15–24 whereas in males aged 15–24 and females aged 25–49 there was some indication that it was associated with higher SES. Among males aged 25–49 there was no association between HIV infection and SES.

Conclusions  Risk of infection was high among groups of all SES. Risk profiles suggested men and women of lower SES maybe at greater risk of newly acquired HIV infection. New infections may now be occurring fastest among young women of the lowest SES.
Artemisinin or chloroquine for blood stage Plasmodium vivax malaria in Vietnam*
Authors: Phan Giao T. , De Vries Peter J. , Tran Binh Q. , Le Hung Q. , Nguyen Nam V. , Nguyen Thang V. , Heisterkamp Siem H. , Kager Piet A.
Published: March 2003

Chloroquine‐resistant Plasmodium vivax has not yet occurred in Vietnam. The efficacy of artemisinin for P. vivax was not established. We conducted a double‐blind randomized study involving 240 inpatients with P. vivax malaria who received artemisinin (40 mg/kg over 3 days) plus placebo chloroquine (Art) or chloroquine (25 mg/kg over 3 days) plus placebo artemisinin (Chl). Patients were followed up with weekly blood smears for 28 days. In each group 113 cases were analysed. All patients recovered rapidly. The median (range) parasite clearance time of regimen Art was 24 h (8–72) and of Chl 24 h (8–64; P = 0.3). Parasites reappeared in two cases in each group on day 14, in eight cases in each group (7%) on day 16 and in 25 (23%) and 18 (16%) cases, respectively, at the end of 4‐week follow‐up (P = 0.3). The population parasite clearance curve followed a mono‐exponential decline. The parasite reduction ratio per 48 h reproduction cycle was 2.3 × 104 for both regimens. We conclude that artemisinin and chloroquine are equally effective in the treatment of P. vivax infections in Vietnam. Reappearance of parasites before day 16 (7%) suggests the emergence of chloroquine resistance. Three days of artemisinin monotherapy does not prevent recrudescence.
Determinants of cervical cancer screening in a poor area: results of a population‐based survey in Rivas, Nicaragua
Authors: Claeys P. , Gonzalez C. , Gonzalez M. , Page H. , Bello R. E. , Temmerman M.
Published: March 2003

objective  To obtain baseline information for designing a community‐based intervention programme aimed at increasing the cervical cancer screening coverage of women most at risk.

methods  A population‐based survey, using proportional stratified two‐stage cluster sampling in Rivas, one of the 16 Departments of Nicaragua. The individuals selected were interviewed at home by one of 26 interviewers, using a structured questionnaire. The questionnaire was designed to elicit (1) knowledge, attitudes and practices concerning sexual and reproductive health and behaviour, (2) risk factors for cervical cancer and (3) the use of health and cervical cancer screening services.

results  A total of 612 men and 634 women participated in the survey. Of the women who had been sexually active at least 3 years, only 41.1% had undergone screening within that period and were considered adequately screened. Correlates of inadequate screening status included low educational level, exclusive use of public health facilities and lack of knowledge about prevention and symptoms of cervical cancer. Negligence, absence of medical problems, fear, lack of knowledge and economic reasons were the main reasons given for not being screened. Reluctance to be screened in the future was related to lack of knowledge of the disease, inadequate screening status, older age and low educational level.

conclusions  The current screening programme is not effective in reaching the majority of the population. Complementary activities such as education and information, as well as a more pro‐active approach to invite women for screening are necessary.
Malaria and amphetamine ‘horse tablets’ in Thailand
Authors: Newton Paul N. , Chierakul Wirongrong , Ruangveerayuth Ronatrai , Abhigantaphand Duangporn , Looareesuwan Sornchai , White Nicholas J.
Published: March 2003

During recent clinical malaria research in Thailand we found a high frequency of amphetamine misuse and withdrawal amongst patients admitted to hospital with Plasmodium falciparum malaria. This comorbidity may cause diagnostic confusion, alter malaria pathophysiology and lead to drug interactions.
Rhodococcus equi infection of cats
Authors: Fairley  , Fairley
Published: March 2003

Six cases of Rhodococcus equi infection in cats are described. One cat had pneumonia and died. The remaining five cats had cutaneous lesions affecting the feet in four of the cats and the metacarpus in one cat, and all these cats recovered with the aid of antibiotics. All the Rhodococcus equi isolates were sensitive to amoxycillin/clavulanic acid and, where used, at least 14–16 days of treatment was needed to help eliminate the infection. Histologically and cytologically the reaction was pyogranulomatous and many macrophages in the lesions contained large numbers of Gram‐positive bacteria.
The use of compound 48/80 as a positive control in equine intradermal allergy testing
Authors: Shipstone  , Mueller  , Bettenay  , Mason  , Friend
Published: March 2003

The macroscopic and microscopic effects following the intradermal injection of the mast cell degranulator compound 48/80 were investigated in horses. It was found that a 1000 μg mL−1 solution of compound 48/80 could be used as an alternative to histamine as a positive control in equine intradermal allergy tests. An inflammatory cell infiltration was noted on histological examination, following compound 48/80 injection. This inflammatory cell pattern was similar to that noted for Type‐I hypersensitivity.
Comparison of the average percentage of thyroid colloid and selected serum thyroid analyses in healthy euthyroid and severely ill dogs
Authors: Torres S. M. F. , Feeney D. A. , Lekcharoensuk C. , Fletcher T. F. , Clarkson C. E. , Nash N. L. , Hayden D. W.
Published: March 2003

The diagnosis of canine hypothyroidism is not straightforward because the results of thyroid tests can be influenced by severe illness and medications. The need to find diagnostic tests that are not affected by these factors is urgent. The objectives of this investigation can be summarized as follows: (1) to establish a reference range for percentage colloid from healthy euthyroid dogs; (2) to compare the mean percentage colloid of the healthy dogs with that of severely ill dogs; (3) to define a group of ill‐euthyroid dogs based on the percentage colloid and evaluate their serum concentrations of total thyroxine (TT4), free thyroxine by equilibrium dialyses (fT4d) and endogenous TSH (eTSH); and (4) to determine if the mean percentage colloid correlates with the serum concentrations of TT4, fT4d and eTSH. Sixty‐one healthy‐euthyroid dogs and 66 severely ill dogs were included on the study. Thyroid glands were removed immediately after death. Morphometric analyses were performed on each thyroid lobe to determine the percentage colloid. Serum hormone concentrations were analyzed using commercially available tests validated at our laboratory. Descriptive statistics were used to report the results of the average percentage colloid and hormone concentrations. Unpaired Student’s t‐test was applied to compare the percentage colloid between the group of healthy‐euthyroid dogs and the groups of sick dogs. Spearman’s rank correlation coefficient method was used to determine the correlation between each of the measured thyroid hormone values and the percentage colloid. The statistical analyses were carried out using Statistical Analysis System (SAS) software. A P‐value of < 0.05 was considered statistically significant. No statistically significant difference was observed in mean percentage colloid between the groups of severely ill and healthy‐euthyroid dogs. Serum TT4 and fT4d concentrations were below the reference range in 57.6 and 31.8% of severely ill dogs, respectively. Only 6.1% of severely ill dogs had increased eTSH concentrations. No clinically significant correlation was found between serum thyroid hormones and percentage colloid. In conclusion, serum TT4 and fT4d concentrations were more frequently altered by severe illness than eTSH in dogs with percentage thyroid colloid equivalent to normal dogs. Serum thyroid hormones did not have a direct correlation with percentage colloid.
A retrospective study regarding the treatment of idiopathic onychomadesis (lupoid onychodystrophy) in 30 dogs
Authors: Mueller R. S. , Rosychuk R. A. W. , Jonas L. D.
Published: March 2003

The purpose of this retrospective study was to evaluate the efficacy of various therapeutic options in dogs with lupoid onychodystrophy. The treatment records of 30 dogs with lupoid onychodystrophy diagnosed by clinical and histological changes at three institutions (Animal Skin and Allergy Clinic: Melbourne, Colorado State University and Denver Veterinary Specialists) were evaluated retrospectively. The response to various treatments was graded as excellent (normal claws), good (claws still dystrophic, but no associated clinical signs or onychomadesis), partial (still occasional onychomadesis) or poor (no change with treatment). Dogs were treated with either fatty acid supplementation (n = 17), doxycycline and niacinamide (n = 13), tetracycline and niacinamide (n = 10), pentoxifylline (n = 5), prednisolone (n = 4), azathioprine (n = 1) or clofazimine (n = 1) or with combinations thereof. Most dogs initially were treated with antibiotics typically effective against cutaneous pathogens, and in most dogs this led to partial improvement only. An excellent or good response was seen in approximately half of the patients treated with tetra‐ or doxycycline in combination with niacinamide. Six of the dogs were maintained successfully on fatty acid supplementation, two on pentoxifylline. An excellent response was seen in two of the three dogs treated exclusively with antibiotics. Spontaneous remissions and recurrences made evaluation of success rates difficult. A variety of medications may be useful in the treatment of lupoid onychodystrophy, although the high success rate of fatty acids previously reported could not be confirmed. The study emphasized the varied and often unclear aetiology and natural course of the syndrome.

 This study was supported financially by Colorado State University.
Quantitative study of ‘flame follicles’ in skin sections of Shar‐pei dogs
Authors: Ordeix Laura , Fondevila Dolors , Ferrer Lluis , Fondati Alessandra
Published: March 2003

Abstract This study determined the frequency of occurrence and the mean number of ‘flame follicles’ per skin section and assessed their diagnostic significance in cutaneous biopsies of Shar‐pei dogs. The number of ‘flame follicles’ per section was recorded in skin sections from 42 Shar‐pei dogs, of which 40 had non‐neoplastic skin disease and non‐atrophic dermatoses and 2 had healthy skin. Forty‐two skin sections from dogs of different breeds served as control specimens, 28 of which were examples of non‐neoplastic and non‐atrophic dermatoses and 14 were from dogs with healthy skin. Differences among groups were analysed by means of the unpaired Student's t‐test. It was concluded that ‘flame follicles’ were more frequent and found in significantly higher numbers in the Shar‐pei group when compared with the control group suggesting that ‘flame follicles’ in skin sections from Shar‐pei dogs do not have the same diagnostic significance as in other breeds.
A comparative review of cutaneous pH
Authors: Matousek Jennifer L. , Campbell Karen L.
Published: March 2003

AbstractThis review describes the role of pH in cutaneous structure and function. We first describe the molecules that contribute to the acidity or alkalinity of the skin. Next, differences in cutaneous pH among species, among individuals of the same species and within individuals are described. The potential functions of cutaneous pH in normal and diseased skin are analysed. For example, cutaneous pH has a role in the selection and maintenance of the normal cutaneous microbiota. In addition, cutaneous acidity may protect the skin against infection by microbes. Finally, there is evidence that a cutaneous pH gradient activates pH‐dependent enzymes involved in the process of keratinization.