bluuebunny/crossref_metadata_2025 huggingface dataset:
Stable solid‐phase Rh antigen
Authors: Yared M. A. , Moise K. J. , Rodkey L. S.
Published: November 2003

Numerous investigators have attempted to isolate the Rh antigens in a stable, immunologically reactive form since the discovery of the Rh system over 56 years ago. We report here a successful and reproducible approach to solubilizing and adsorbing the human Rh antigen(s) to a solid‐phase matrix in an antigenically active form. Similar results were obtained with rabbit A/D/F red blood cell antigens. The antigen preparation was made by dissolution of the red blood cell membrane lipid followed by fragmentation of the residual cytoskeleton in an EDTA solution at low ionic strength. The antigenic activity of the soluble preparations was labile in standard buffers but was stable in zwitterionic buffers for extended periods of time. Further studies showed that the antigenic activity of these preparations was enhanced, as was their affinity for plastic surfaces, in the presence of acidic zwitterionic buffers. Adherence to plastic surfaces at low pH maintained antigenic reactivity and specificity for antibody was retained. The data show that this approach yields a stable form of antigenically active human Rh D antigen that could be used in a red blood cell‐free assay for quantitative analysis of Rh D antibody and for Rh D antibody immunoadsorption and purification.
Haemolytic disease of the fetus and newborn due to anti‐Fya and the potential clinical value of Duffy genotyping in pregnancies at risk
Authors: Goodrick M. J. , Hadley A. G. , Poole G.
Published: November 2003

Haemolytic disease of the newborn (HDN) caused by anti‐Fya is uncommon and usually mild. Current guidelines recommend that pregnant women with anti‐Fya are monitored less rigorously than those with anti‐D, ‐c or ‐K. However, in a review of our recent experience of 68 pregnancies where anti‐Fya was detected, three were identified where the fetus was severely anaemic; in two cases the fetus received intrauterine transfusions. Our data suggest that pregnancies in which anti‐Fya is detected at significant titres (> 64) should be closely monitored in a similar way to pregnancies where other ‘significant’ antibodies are present. Moreover, in the presence of high or rising antibody titres, if the father is heterozygous and functional assays suggest the antibody is active, then fetal genotyping should be offered to help plan the future management of that pregnancy.
Post‐transfusion purpura (PTP) associated with anti‐HPA‐1a, anti‐HPA‐2b and anti‐HPA‐3a antibodies
Authors: Lucas G. F. , Pittman S. J. , Davies S. , Solanki T. , Brüggemann K.
Published: November 2003

The serum from an 85‐year‐old man with a clinical diagnosis of post‐transfusion purpura (PTP) was investigated for the presence of platelet‐specific antibodies. Clinically, the case was typical of PTP but, unusually, the serum was found to contain multiple platelet‐specific alloantibodies. Anti‐HPA‐1a, anti‐HPA‐2b and anti‐HPA‐3a antibodies were detected together with multispecific anti‐HLA (class I) antibodies. Additional (but weaker) antibody reactivity was also observed with platelet glycoproteins (Gp) IIb/IIIa, GpIb and GpIa/IIa which lacked the antigens recognized by the alloantibodies, suggesting the presence of auto‐ or cross‐reacting antibodies. The patient's genotype was HPA‐1b/1b, HPA‐2a/2a, HPA‐3b/3b, HPA‐5a/5b and was consistent with the platelet alloantibodies detected. The patient made a complete recovery following treatment with intravenous gamma‐globulin.
Isolation of human mannan binding lectin, serum amyloid P component and related factors from Cohn Fraction III
Authors: Kilpatrick D. C.
Published: November 2003

Cohn Fraction III, a waste product of plasma fractionation, is a source of several proteins involved in host defence as part of the innate immune system. Here a procedure is described for purifying mannan binding lectin and serum amyloid P component to virtual homogeneity from Cohn Fraction I + III, and their separation from other mannan‐binding factors and from C‐reactive protein. It is suggested that products derived from Cohn Fraction III could have therapeutic potential, either for specific substitution therapy or as a combined package of innate immune factors.
Survey of the information given to patients about blood transfusion and the need for consent before transfusion
Authors: Murphy M. F. , Docherty S. , Greenfield P.
Published: November 2003

There is no current requirement in the United Kingdom to provide patients with information about blood transfusion or to seek their written consent to transfusion. To study patients' attitudes to these questions, a questionnaire survey was carried out on 51 patients during an admission to hospital in which they received a blood transfusion. The patients in this survey, although mostly satisfied about the information they were given before they were transfused, would have welcomed more general information about transfusion, mainly because of concerns about the risk of viral infections. Nearly 40% of patients thought that written consent should be obtained before transfusion, but the ethical and practical aspects of this issue are complex. Further debate would be required before implementation of written consent to transfusion could be considered as a routine policy.
Cell salvage auto transfusion in total knee replacement surgery
Authors: Shenolikar A. , Wareham K. , Newington D. , Thomas D. , Hughes J. , Downes M.
Published: November 2003

We conducted a prospective, randomized study to assess the impact of cell salvage, auto transfusion on the requirements for allogeneic blood for patients undergoing a total knee replacement (TKR). One hundred consecutive TKR patients were randomly allocated to receive either autologous blood (using cell salvage) or an allogeneic blood transfusion as necessary. Patients allocated to the autologous group were rescued with allogeneic blood if the postoperative haemoglobin fell below 9 g dL−1. Forty‐two (84%) of 50 patients in the autologous group required no supplementary blood transfusion. Forty (80%) of 50 patients allocated to receive allogeneic blood required transfusion. There were no detrimental effects of autologous blood transfusion. We conclude that autologous blood transfusion, using the cell saver system, is a safe and effective method of reducing the need for allogeneic blood transfusion and, in doing so, reduces the risk of transmission of infections associated with allogeneic blood transfusion, whilst decreasing demand on precious allogeneic blood reserves.
Does GB virus C (‘hepatitis G virus’) threaten the safety of our blood supply?
Authors: Barbara John A. J.
Published: November 2003

Molecular ‘fishing’ for viruses has now become a scientifically fashionable pastime. Following the striking success of Chiron Corporation in identifying hepatitis C virus (the causative agent of the majority of non‐A, non‐B hepatitis cases) by cloning techniques (Choo et al., 1989) two companies have independently cloned a distinct flavivirus‐like virus, itself related to HCV. This brief editorial is not to discuss the scientifically elegant molecular manipulations that led to the cloning of this newly recognized virus: this is briefly reviewed by Karayiannis & Thomas (1996). Suffice to say the GBV‐C agent discovered at Abbott Laboratories (Simons et al., 1995) was identified in human sera that reacted with two similar viruses (GBV‐A and GBV‐B). These had been cloned from serum of a tamarin inoculated with the GB agent derived from a surgeon who developed acute hepatitis 30 years ago. HGV was cloned by Genelabs Technologies (Linnen et al., 1996) from the plasma of a patient with chronic hepatitis, co‐infected with HCV. Both GBV‐C and HGV are single positive‐stranded RNA viruses of ∼9400 nucleotides. Their genomic organization is consistent with the Flaviviridae; they have 25% nucleotide homology with HCV. GBV‐C and HGV are different isolates of the same virus (Masuko et al., 1996) showing 86% nucleotide homology and 96% amino acid similarity.
Analysis of Knops blood group antigens on CR1 (CD35) by the MAIEA test and by immunoblotting
Authors: Petty A. C. , Green C. A. , Poole J. , Daniels G. L.
Published: November 2003

Kna, McCa, Sla and Yka are red cell antigens of relatively high frequency, located on complement receptor 1 (CR1, CD35). Antibodies to these Knops system antigens are not uncommon. They are not haemolytic and do not reduce the survival of transfused incompatible red cells, but they are a nuisance in transfusion laboratories as they can cause an incompatible crossmatch and must be identified before they can be dismissed as clinically insignificant. Human red cell alloantibodies can be shown to be Knops system antibodies by the monoclonal‐antibody‐specific immobilization of erythrocyte antigens (MAIEA) test, using murine monoclonal anti‐CR1.  In addition to confirming that Kna, McCa, Sla and Yka are located on CR1, the MAIEA test was used to confirm that Csa is not on CR1. Red cells of the Helgeson phenotype, the null phenotype of the Knops system by conventional serological methods, have levels of Kna, McCa, Sla and Yka intermediate between those of α‐chymotrypsin‐treated cells (which lack Knops system antigens) and those of positive control cells. Level of expression of Knops system antigens is very variable and intensity of staining of immunoblots probed with monoclonal anti‐CR1 correlated with strength of Knops system antigens, as determined by the MAIEA test. In individuals heterozygous for alleles producing different allotypes, separate bands representing each allotype on an immunoblot showed identical intensity of staining, suggesting that the quantity of CR1 on red cells is controlled, at least in part, by a locus independent of CR1. An analysis of CR1 on red cells of individuals who have made Knops system antibodies suggested that the Knops system antigens and the antibodies that detect them are complex and heterogeneous.
HPA genotyping by PCR sequence‐specific priming (PCR–SSP): a streamlined method for rapid routine investigations
Authors: Cavanagh G. , Dunn A. N. , Chapman C. E. , Metcalfe P.
Published: November 2003

We describe a streamlined method for the simultaneous identification of alleles of the human platelet antigens (HPA) 1–5. The method employs the polymerase chain reaction with sequence specific primers (PCR–SSP). Although PCR–SSP has been applied to HPA genotyping, all methods previously described have required different reaction mixes and PCR conditions. We have designed a set of sequence‐specific primers for HPA 1–5 which react optimally under identical reaction and PCR conditions. Comparative testing with reference samples gave 100% concordance.  The advantages of this method include speed; accuracy; smaller sample requirements and no reliance on human typing sera or platelet integrity. The method also has the potential to be applied to amniotic fluid. Simplified DNA techniques will lead to more extensive and proficient platelet antigen typing. This will facilitate accurate laboratory diagnosis of alloimmune thrombocytopenia and the provision of HPA‐matched blood products.
A new tool in white blood cell reduction for packed red cells:5 Log depletion
Authors: Bontadini A. , Fruet F. , Conte R.
Published: November 2003

The recent development of new filters used for leucocyte reduction aims at restricting the number of leucocytes to a threshold where their undesirable effects can be minimized or excluded. In this paper we describe the performance of a new filter named BIO R01 MAX and claimed by the manufacturer to perform 5 Log10 depletion. The results show that the efficiency of the filter reached 5 Log10 depletion and the absolute number of white blood cells in the post‐filtration units is always less than 2 × 104 with considerable safety in the prevention of transfusion reactions.
The kinetics of G‐CSF mobilization of CD34+ cells in healthy people
Authors: Stroncek D. F. , Clay M. E. , Herr G. , Smith J. , Jaszcz W. B. , Ilstrup S. , McCullough J.
Published: November 2003

When healthy people are given granulocyte colony stimulating factor (G‐CSF) for 10 days the number of CD34+ cells in the peripheral blood begins to increase on the fourth day, reaches a maximum on the sixth day and then decreases. In this study, we further define the time and variability of peak mobilization of CD34+ cells. Twenty‐two healthy people were given G‐CSF (7.5 or 10 μg kg−1 day−1) subcutaneously each morning for 5 days and peripheral blood CD34+ cell counts were analysed immediately prior to the fourth (day 4) and fifth (day 5) G‐CSF injection and 24 h after the fifth injection (Day 6). White blood cell (WBC) and neutrophil counts were greatest on day 6 [WBC = 43.8 ± 13.9 × 109 L−1 (mean ± 1 SD) and neutrophils = 36.6 ± 12.8 × 109 L−1]. In contrast the CD34+ cell counts on day 6 (107 ± 104 × 106 L−1) were less than on day 5 (128 ± 136 × 106 L−1) (P= 0.048) but still greater than on day 4 (60.7 ± 40.2 × 106 L−1) (P < 0.0001). The CD34+ cell counts of 10 donors were measured 2, 4 and 6 h after the fifth injection to determine if the counts increased further between days 5 and 6. The number of CD34+ cells in the blood on day 5 2 h after the fifth injection (193 ± 277 × 106 L−1) was greater than the number prior to the injection (158 ± 190 × 106 L−1), 4 h post‐injection (139 ± 158 × 106 L−1) and 6 h post‐injection (170 ± 236 × 106 L−1), but the differences were not significant (P= 0.29, 0.25 and 0.45). The number of CD34+ cells in the blood of 12 people were measured before and after the fourth G‐CSF dose. Prior to the day 4 injection the CD34+ count was 61 ± 40 × 106 L−1. At 2, 4 and 6 h the counts were 60 ± 40, 61 ± 29 and 64 ± 30 × 106 L−1, respectively, and the differences were not significant (P= 0.99, P= 0.98, and P= 0.73). In conclusion, when healthy volunteers are given daily G‐CSF injections, the number of mobilized CD34+ cells was the greatest on day 5, slightly less on day 6 and the least on day 4. If only one PBSC component is needed, PBSCs can be collected on day 5 after only 4 days of G‐CSF. If PBSC components are collected on both days 5 and 6, the fifth dose can be given either before or after the collection of the first PBSC component.
Assays for heparin‐induced thrombocytopenia
Authors: Griffiths E. , Dzik W. H.
Published: November 2003

Tests for the presence of heparin‐dependent antibodies (heparin‐Ig) have evolved in parallel with improved understanding of the pathophysiology of heparin‐induced thrombocytopenia (HIT). The first group of tests relied upon platelet aggregation or activation. Among tests in this group, the serotonin release assay has been reported to demonstrate the best performance characteristics. However, this test has not been widely adopted outside a few specialized laboratories owing to its complexity and need for radioactive materials. As a result, the less sensitive and specific platelet aggregation test is more commonly used for the diagnosis of heparin‐Ig. The literature suggests that test sensitivity can be improved by the use of the patient’s own platelets, platelets from selected donors known to be reactive in the assay, or washed platelets. Test specificity has been enhanced by the use of two point assays that include neutralization of the reaction by a high dose of heparin. A second group of assays have focused on detection of heparin‐dependent binding of immunoglobulins to the platelet membrane. Most of these tests are hampered by the fact that platelets in patients with suspected HIT and in conditions that are in the differential diagnosis of HIT frequently express high levels of platelet‐associated immunoglobulin. The most recent tests for heparin‐Ig are based on the recognition that patient antibodies are directed against the heparin‐PF4 complex. This has led to the development of the PF4/heparin EIA assay. Because whole platelets are not used in this assay, problems related to under‐reactivity or nonspecific reactivity are avoided. In addition, the ability of the test to predict clinical complications may be improved because the test can distinguish IgM from IgG heparin‐Ig.  Currently the laboratory diagnosis of heparin‐Ig remains inexact. The sensitivity and specificity of laboratory assays cannot be firmly established. Much like the diagnosis of the phospholipid syndrome — where use of both the cardiolipin EIA and the lupus anticoagulant test offer overlapping advantages — the combination of the heparin‐PF4 EIA plus either a test of platelet activation or a heparin‐dependent antibody binding assay may prove to be a more sensitive and specific approach to the diagnosis of heparin‐Ig. Despite the progress that has been made in the area of laboratory diagnosis of heparin‐Ig, further improvement is needed. Heparin‐induced thrombocytopenia is not rare and may be associated with devastating morbidity as well as mortality. Low‐molecular‐weight heparins usually cross‐react with heparin‐Ig. Therapy with Org 10172 appears to be the most promising alternative for patients with HIT. Because the clinical diagnosis is uncertain in sick hospitalized patients, further improvements in laboratory assays for heparin‐Ig allowing earlier and more accurate diagnosis of patients at risk for HIT will be welcome.
Comparison of in vivo red cell survival of donations collected by Haemonetics MCS versus conventional collection
Authors: Regan F. , Teesdale P. , Garner S. , Callaghan T. , Brennan M. , Contreras M.
Published: November 2003

The Haemonetics Multicomponents System (MCS) cell separator allows concurrent donation of red cells in addition to platelets and/or plasma, thus increasing the versatility of apheresis donations. In vivo survival of autologous red cells obtained by MCS was compared with red cells collected conventionally. In this cross‐over controlled study, five male volunteers donated one unit of red cells by MCS and one unit of whole blood by the conventional manual method, 3 months apart. After storing donations in SAG‐M for 35 days under standard conditions, radioactive (51Cr)‐labelled autologous red cells were injected into each donor. The post‐transfusion recovery (PTR) of red cells at 24 and 48 h did not show any significant difference between red cells obtained manually and by MCS, indicating that processing differences have no detrimental effects on red cell survival.
An explanation and the clinical significance of the failure of microcolumn tests to detect weak ABO and other antibodies
Authors: Phillips P. , Voak D. , Knowles S. , Campbell G. , Crane B. , Downie D. M. , Haigh T. , Whitton C.
Published: November 2003

Shear forces are proposed to explain the failure of antiglobulin and ‘neutral’ (no antiglobulin) microcolumn tests at 37 °C to detect weak ABO incompatibilities and other weak antibodies, clearly detectable by spin‐tube methods. These shear forces can be minimized in a microcolumn test using a biphasic centrifugation phase. Although this biphasic test is not suitable for routine use, it may be of use as an investigational method for reference laboratories. This failure of microcolumn test to detect weak ABO incompatibilities is of little clinical significance as the antibodies are dubiously active at 37 °C.
Case report and review of disseminated histoplasmosis in South‐East Asia: clinical and epidemiological implications
Authors: Wang T. L. , Cheah J. S. , Holmberg K.
Published: November 2003

The South‐East Asian region is not known to be a major endemic area for histoplasmosis. We have recently diagnosed several cases of disseminated histoplasmosis in patients from this region. We report on a well documented indigenous case of disseminated histoplasmosis in a 62‐year‐old poultry farmer and review the literature for other reported cases of clinical histoplasmosis in the South‐East Asian region. Sporadic cases of indigenous chronic pulmonary and non‐meningeal disseminated histoplasmosis in immunocompetent hosts have been reported as well as examples of disseminated histoplasmosis in immunocompromised hosts. These reports suggest that histoplasmosis is endemic to certain areas in South‐East Asia and that there may be a large number of undiagnosed and subclinical cases. The recent advances in diagnostic tests for histoplasmosis are also reviewed with reference to the experience of using these tests in the reported case.
Hamadryas baboons Papio hamadryas as maintenance hosts of Schistosoma mansoni in Saudi Arabia
Authors: Zahed N. Z. , Ghandour A. M. , Banaja A. A. , Banerjee R. K. , Dehlawi M. S.
Published: November 2003

Free ranging hamadryas baboons (Papio hamadryas) in four localities in the west and north of Saudi Arabia were examined for natural infection with Schistosoma mansoni. Faecal examination revealed infection with S. mansoni on four occasions within one year (at a prevalence rate of 2.5‐4.0%) in only one locality, the Al‐Baha area. The eggs were viable, as shown by miracidial hatching tests, and were recorded at a density of 140–280 eggs/g of faeces (7000–14000 eggs/day). Post‐mortem examination of 13‐2.4 baboons from each locality revealed infection with S. mansoni (adult worms and eggs in tissue) in only one locality, the Al‐Baha area, at a prevalence rate of 4.16%. Viable eggs were found in the faeces and tissue of the infected baboons. The low prevalence rate of S. mansoni in hamadryas baboons in Saudi Arabia is in accordance with the low prevalence rate of S. mansoni in humans in the area. This natural baboon isolate was highly infective to snail intermediate hosts and mammalian hosts under experimental conditions. The epidemiological significance of the role of P. hamadryas (considering their large overall population of 250 000) as maintenance hosts of S. mansoni in Saudi Arabia is discussed.
Sleeping sickness in Zaire: a nested polymerase chain reaction improves the identification of Trypanosoma (Trypanozoon) brucei gambiense by specific kinetoplast DNA probes
Authors: Schares G. , Mehlitz D.
Published: November 2003

Blood samples collected in the sleeping sickness focus of Boma, Zaire, from human patients and domestic animals were analysed by polymerase chain reaction (PCR) for the presence of trypanosome DNA. The comparison of PCR and miniature anion exchange centrifugation technique (m‐AECT) results clearly shows that in domestic animals mixed infections (Trypanozoon/Trypanosoma [Nannomonas] congolense) are more frequently diagnosed by PCR than by m‐AECT. Trypanozoon positive blood samples were further analysed for Trypanosoma (Trypanozoon) brucei gambiense. For that purpose amplified minicircle kinetoplast DNA (minicircle kDNA) was differentiated in gambiense and non‐gambiense by hybridization with DNA probes. To analyse blood samples, especially those with low parasite numbers, the amplification step had to be improved by a nested PCR. Subsequent hybridization was done with kDNA probes generated by PCR from blood samples which had been obtained from a human patient infected with T. (T.) b. gambiense and a pig infected with Trypanozoon. The hybridization results clearly show that at least two genotypes of Trypanozoon parasites occur in the sleeping sickness focus of Boma, Bas‐Zaire. One obviously corresponds to T. (T.) b. gambiense and was present in humans and two domestic animals (pig, dog). The other genotype seems to be associated with T. (T.) b. brucei and could be detected only in the blood of domestic animals. This is the first time that field samples could be analysed by a technique which facilitates the molecular identification of T. (T.) b. gambiense without prior cloning, propagation, and/or isolation of the parasites. Therefore, this technique seems to be a promising tool to elucidate the significance of the animal reservoir for the epidemiology of the gambiense sleeping sickness in Africa.
Post‐natal incidence of HIV‐1 infection among children in a rural Ugandan population: no evidence for transmission other than mother to child
Authors: Mulder Daan W. , Nunn Andrew , Kamali Anatoli , Kengeya‐Kayondo Jane F.
Published: November 2003

We conducted a prospective cohort study to determine the post‐natal incidence of and possible transmission routes for HIV‐1 infection in rural Ugandan children. The cohort consisted of the population of a cluster of 15 villages in Masaka District, south‐west Uganda, and was enrolled in 1989–1990 through a demographic and serological survey. During the period 1991–1993 the population was resurveyed annually. A total of 5492 children aged O‐12 years were enrolled; of these, 41 (0.7%) were seropositive infants. A total of 3941 (72%) children were HIV‐negative on enrolment and had at least one follow‐up specimen. During 8596 person‐years of observation only 1 seroconversion was observed, an incidence rate of 0.12 (95% CI 0.00‐0.35) per 1000 years of observation. The transmission of HIV was most probably through breast milk. The case corresponds to a rate of 1.1 per 1000 in households with one or more HIV‐positive adults (874 years of observation); no incident case was observed in households with only seronegative adults (6423 years of observation). Thus, HIV infection among children aged 0–12 years in this population is virtually exclusively the result of mother‐to‐child transmission. No infections were observed attributable to parenteral exposure, non‐sexual casual or household contact, or insects.
A randomized trial of chloroquine, amodiaquine and pyrimethamine‐sulphadoxine in Gambian children with uncomplicated malaria
Authors: Müller O. , van Hensbroek M. Boele , Jaffar S. , Drakeley C. , Okorie C. , Joof D. , Pinder M. , Greenwood B.
Published: November 2003

The increasing occurrence of chloroquine‐resistant Plasmodium falciparum in sub‐Saharan Africa makes it essential to reconsider current recommendations for the treatment of uncomplicated P. falciparum malaria. In an open, randomized trial, we have compared chloroquine (CQ), amodiaquine (AQ), and pyrimethamine‐sulphadoxine (PS) in rural Gambian children with uncomplicated P. falciparum malaria. Three hundred children were randomly assigned at the time of consultation (Do) to oral treatment with 25 mg/kg CQ, 25 mg/kg AQ (both given over 3 days), or 1.25/25 mg/kg PS. They were reviewed on day 7 (D7) and day 28 (D28) for symptoms, malaria parasitaemia, and packed cell volume (PCV). Significantly more children treated with PS compared to CQ (17 vs 7%, P=0.03) or AQ (17 vs 3%, P=0.001) returned with clinical complaints during the first 3 days after treatment. Five of these patients had a generalized convulsion (4 from the AQ group, 4 from the PS group), of whom 4 developed cerebral malaria. At D7, significantly more patients treated with CQ compared to AQ (25 vs 7%, P=0.0009) or PS (25 vs 4%, P=0.0001) were parasitaemic. By D28, the cumulative number of parasitological failures was significantly higher in the CQ group compared to the AQ group (65 vs 35%, P=0.0001), and significantly higher in the AQ group compared to the PS group (35 vs 14%, P=0.001). Overall, 91% of parasitological failures observed during the study period were symptomatic and were consequently treated with an alternative anti‐malarial drug. Over the 28‐day study period the mean PCV increased significantly less in the CQ group than in the PS group (1.2 vs 3.8%, P=0.016) and was lower in the CQ group than in the AQ group (1.2 vs 2.7%, P=0.12, not significant). These results suggest that PS acts more slowly than 4‐aminoquinolines in controlling the clinical features of malaria, and that AQ can be considered as an interim alternative to CQ in the first‐line therapy of uncomplicated malaria in African areas of high CQ resistance.
The impact of HIV‐1 infection on child health in sub‐Saharan Africa: the burden on the health services
Authors: Walraven Gijs , Nicoll Angus , Njau Mathew , Timæus Ian
Published: November 2003

HIV‐I infection in sub‐Saharan Africa is resulting in substantial child mortality and an increase in the number of sick children presenting to health services. Many of the sick children come to health centres and hospitals, inflating numbers on paediatric wards. The presentations of childhood HIV‐I infection are many and varied so that HIV‐I infection is the new ‘great imitator’ of other conditions. Some other infections are more severe in HIV‐I infected children (specifically bacterial infections and measles). However, there is no clear evidence of consequent rises in the incidence of other childhood infections, though this is likely to be the case for tuberculosis. HIV‐I infected children with other infections often respond to locally available anti‐microbials, but may require longer courses. Treatment is problematic because of the impossibility of distinguishing infected from uninfected children and because of shortages of medicines, which are being intensified further by the child and adult HIV‐I epidemics. Severe HIV disease in adult family members is adding to child morbidity and creating substantial orphanhood. Staff fear nosocomial infection, while simultaneously experiencing falling personal incomes and lacking resources to care for their patients. Substantial numbers of trained staff are being lost because of HIV‐I caused disease and death. The reality of HIV‐I infection through breast‐feeding is not yet appreciated. When this becomes generally apparent, there is a risk that a lethal increase in bottle feeding could occur in some areas. Reduction in the number of new paediatric HIV‐I infections in sub‐Saharan Africa can be achieved only by ameliorating the adult HIV‐I epidemic, reducing unnecessary blood transfusions and ensuring a safe blood supply.
Editorial: Change and Continuity in Tropical Medical Science and International Health
Authors: Bradley David
Published: November 2003

It has always been a fallacy to believe that the world can stand still, or even enter a steady state. This is today obvious to everyone. Tropical Medicine and International Health represents a large step forwards for several reasons. The countries of Europe are increasingly interdependent and work together. Collaboration and cooperation needs to replace competition and rivalry as we increasingly share common goals and common ways of approaching those goals. For almost a century there has been an array of separate national journals dealing with tropical medicine and the health problems of developing countries. There was a case for this in the colonial era, as countries of the tropics then mapped onto particular journals because work done in them related to specific colonial powers. But that is part of history. The boundaries no longer apply, while papers are increasingly written by nationals of tropical countries, or by multinational teams of research workers.
Isolation and characterization of a new subtype A variant of human immunodeficiency virus type I from Nigeria
Authors: Olaleye D. O. , Sheng Zhijuan , Howard T. M. , Rasheed S.
Published: November 2003

We have isolated a new variant of HIV‐1 from Nigeria, Africa. The virus was recovered from the peripheral blood mononuclear cells (PBMCs) of an apparently healthy 23‐year‐old male from Ibadan, Nigeria. The in vitro studies indicated that the virus was highly cytopathic and replicated well in normal PBMCs, established T‐cell lines and the monocytic cell line U937. The highest replicative titre of the virus was obtained in freshly isolated primary macrophage/monocyte cells which also showed the least cytopathology. Most other cultures showed single‐cell cytolysis and giant cells, and syncytia were not induced in the HTLV‐1 infected MT‐2 cells. Since no HIV strain has been isolated from Nigeria, we obtained cDNA clones containing the env gene, to further characterize the Nigerian virus. Based on the DNA sequence analysis of 14 clones containing the coding region for its gp 120 protein, the Nigerian HIV isolate has been classified as HIV‐1 subtype A. Only one subtype A virus from Rwanda has been characterized and this virus has not been shown to exhibit extreme cytopathicity in various cell types as was observed with the Nigerian strain. Further, the ability of this virus to grow well in lymphocytes, monocytes and macrophages and to exhibit cytopathicity without causing syncytia are uncommon properties distinguishing the Nigerian virus from other HIV‐1 strains. Since most macrophage‐tropic viruses have been associated with ‘neurotropism’, the isolation of an HIV‐1 strain from the blood of an individual with no known neurological disorder indicates that this rapidly replicating cytopathic virus, with a broad host range, may play an important role in the pathogenesis of HIV disease. This represents the first report of an HIV‐1 isolate from Nigeria.
Introducing insecticide impregnated bednets in an area of low bednet usage: an exploratory study in north‐east Ghana
Authors: Gyapong Margaret , Gyapong John O. , Amankwa Joseph , Asedem James , Sory Elias
Published: November 2003

To find out the acceptability of the use of insecticide impregnated bednets before launching a large‐scale trial to evaluate their impact on child mortality, 96 permethrin impregnated bednets were distributed in 4 communities within the Kassena Nankana district of the Upper East Region of Ghana, where previously only 4% of the people had owned a mosquito net. The nets were readily accepted and used by the recipients. The major benefit perceived by the users was the reduction of the nuisance effect of mosquitoes and other insects. The people in the study area normally sleep on mats in either an open courtyard or a sleeping room depending on the weather but this did not deter them from using the nets. The white nets distributed for this study became dirty with use, and users thought they needed to be washed. In order to discourage this, it is recommended that dark coloured nets be used in the main intervention trial. After having used the nets for a year, the community members expressed willingness to buy the nets if they were made available after the harvest season when they had sold their crops and had enough money to pay for them. The results of this study have been used to plan and conduct a large intervention trial.
MR findings in human fascioliasis
Authors: Han J. K. , Han D. , Choi B. I. , Han M. C.
Published: November 2003

Fasciola hepatica is a trematode of herbivorous mammals, and man is infected by accidental ingestion of contaminated raw aquatic vegetables or water. There have been many reports on computed tomographic and cholangiographic features of human fascioliasis. However, findings of magnetic resonance (MR) imaging have not been reported.

Hepatic fascioliasis produces three types of lesions in MR images arranged in tract‐like fashion. The outermost area presents as an iso‐signal area in T1WI, with slightly higher signal intensity in T2WI and diffuse enhancement after i.v. contrast. The second type presents as a well defined low signal area in T1WI, not enhanced, and also shows low signal intensity in T2WI. The third type has low signal intensity in T1WI, is not enhanced, and has high signal intensity in T2WI which is similar to fluid‐containing inflammatory lesions such as pyogenic abscess.

These findings suggest various changes associated with traumatic hepatitis caused by the migration of the worm in the liver. This diverse signal intensity can be a suggestive finding of fascioliasis.
A follow‐up study on visual outcome after camp‐based intracapsular cataract extraction
Authors: Shri Verma Lalit , Gupta Sanjeev K. , Murthy G. V. S. , Goyal Mallika , Pant T. D.
Published: November 2003

The visual outcome of 164 intracapsular cataract extractions (ICCE) performed in 158 patients at an eye‐camp was evaluated. 93.3% had a preoperative visual acuity of less than 3/60. On the 4th/5th post‐operative day, 39.3% had a visual acuity between 6/18 and 6/36; 84.7% had vision better than 3/60. Six weeks post‐operatively, 44.1% had visual acuity better than 6/18 and a total of 84.1% better than 3/60. The vision of 40.7% improved between the 4th/5th post‐operative day and the follow‐up visit at 6 weeks. 46.4% of patients had post‐operative corrected visual acuity better than 6/18, 24.3% had vision between 6/18 and 6/36, and a total of 84.3% had vision better than 3/60. The patients' satisfaction in terms of improvement in mobility and ability to do housework at 6 weeks after the operation correlated better with the improvement in vision in terms of the number of Snellen's lines than with the actual post‐operative visual acuity.
HIV and India: looking into the abyss
Authors: Pais Prem
Published: November 2003

Serosurveillance of high risk groups started in India in October 1985. The first positive case were detected in 1986. As of mid‐1994, official figures stood at 15 000 HIV positive cases and 559 cases of AIDS. This is most certainly an underestimate because of under reporting. Among high risk groups, prevalence has risen rapidly. Between 1986 and 1994, prevalence has risen from 1.6 to 40.0% in sex workers, 1.4 to 40% in STD clinics and 0 to 70% in i.v. drug abusers in various studies. The penetration into the general population is uncertain.

As in Africa, infection has been mainly by heterosexual intercourse, with commercial sex workers, long distance truck drivers and migrant labour serving as vehicles of spread. Other routes of infection are transfusion of blood and blood products and i.v. drug use. Dependence on professional blood donors is the main cause of infected blood supplies. Ninety per cent of cases with HIV infection are aged between 15 and 45 years and belong to socioeconomically disadvantaged groups. The male to female ratio is 5:1, with female cases being mainly sex workers. The predominant virus is HIV‐1 but cases with HIV‐2 and mixed infection are being reported from port cities. The present situation in India is similar to the early pattern in Africa where a sharp increase in seroprevalence among high risk groups was followed by spread to the general population.

Clinical AIDS is still infrequent. From experience so far, pulmonary tuberculosis has been the most common clinical presentation. So far AIDS associated tuberculosis has responded to standard therapy but the development of multi‐drug resistant mycobacteria and their spread to the large tuberculous population in the country is a potential threat.

Key factors of AIDS/HIV prevention are public education and counselling about the infection and safe sex practices, especially in high risk groups; STD control; promotion of voluntary blood donation and adequate screening of blood products and general and equitable progress in the economic development of the country and its people—much high risk behaviour is driven by poverty.
Vaccination generates serum‐mediated protection against Onchocerca lienalis microfilariae in the mouse
Authors: Folkard S. G. , Jenkins R. E. , Bianco A. E.
Published: November 2003

Mice vaccinated with an aqueous extract of Onchocerca lienalis microfilariae (mf) plus adjuvant exhibited 51% protection against challenge with live mf. Protection was ablated by prior treatment of the extract with heat or proteinase K, indicating the involvement of proteinaceous epitope(s). A 54% level of protection was conferred on naive mice by passive transfer of serum from vaccinated donors, suggesting that host resistance was principally mediated by humoral components of the immune response. In contrast, the protection induced by sensitization of mice with living mf is transferable with cells, but not serum. Western blot data reveal different antigen recognition profiles for serum antibodies from these two groups of mice. These results indicate that vaccination and infection activate distinct protective mechanisms against Onchocerca mf in the mouse.
Histopathological observations in new and classic models of experimental Schistosoma haematobium infections
Authors: Vuong P. N. , Bayssade‐Dufour Ch. , Albaret J. L. , Farhati K.
Published: November 2003

The authors present marsh rat Holochilus brasiliensis, jirds Meriones shawi and M. unguiculatus as new models of Schistosoma haematobium infection. Histological findings were compared with those of classic models mouse Mus and hamster Mesocricetus. In new models, embryonated eggs were seen in the stool from 90 days post infestation (DPI) and active disease developed from 117 to 175 DPI. Seven out of 10 rodents presented granulomatous and/or chronic cystitis, fibrosis, polyps and urothelial changes: squamous metaplasia, precancerous dysplasia and squamous cell carcinoma of the urinary bladder. In the digestive tract of all new models, granulomas eroded the mucosa, formed inflammatory polyps, infiltrated the wall and accumulated into bilharziomas. In the liver, granulomatous hepatitis surrounded by bilharzial pigment deposit was apparent. Pipe‐stem fibrosis involved 4 rodents with precirrhotic changes in 1 and portal hypertension in 2. One female Meriones suffered from granulomatous endometritis and salpingitis. All new models developed pulmonary granulomatosis with associated vascular lesions: giant cell arteritis in 1 rodent, thromboses in 3 and pulmonary hypertension in 4 others. In classic models, 1 Mus presented a squamous cell carcinoma of the urinary bladder while Mesocricetus displayed diverse lesions in digestive and genital tracts, liver and lungs. All tissue lesions, resembling those seen in humans in all points, were far more frequent and severe in new models than in classic ones. Those involving the urinary bladder have never been reported in other models such as monkeys: Pan troglodytes, Cercopithecus aethiops and Cebus apella. A comparison was carried out between different models on the basis of experimental conditions: definitive hosts, number of cercariae used, type and duration of infection. This study clearly demonstrated that Holochilus brasiliensis, Meriones shawi and M. unguiculatus are perfectly adequate models in terms of laboratory facilities. They are helpful in investigating the pathogenic mechanism of some disorders in S. haematobium infection, particularly tumours of the urinary bladder, and this may enhance therapeutic assays.
Reduction of food intake during pregnancy in rural South India
Authors: Hutter Inge
Published: November 2003

A common custom in developing countries is reduction of food intake during pregnancy, especially in the last trimester. In the research area in South India, women mentioned that they reduce food intake late in pregnancy. This paper explores whether the reported reduction could be confirmed by quantitative data on food intake; by how much intake was reduced; and whether all women ate less. A group of 186 women in a rural area of Karnataka were followed throughout pregnancy. Most did not achieve the daily food intake recommended by the Indian Council of Medical Research (ICMR), not even that of non‐pregnant women. Their average daily energy intake during pregnancy was 1700 kcal. A trend of declining daily energy intake within subjects over the whole period of pregnancy was observed, the biggest change taking place between month 5/6/7 and month 8/9. The major determinant of change in energy intake turned out to be prepregnancy nutritional status, i.e. chronic energy deficiency (CED), measured by body mass index (BMI). Results indicate that women who were better nourished before they became pregnant were more likely to reduce energy intake during pregnancy.
Vibrio cholerae O139: How great is the threat of a pandemic?
Authors: Siddique A. K. , Akram K. , Zaman K. , Mutsuddy P. , Eusof A. , Sack R. B.
Published: November 2003

The emergence of the new strain Vibrio cholerae O139 and its rapid spread in Bangladesh and India together with its detection in several other countries, have raised the question whether this constitutes the beginning of the eighth pandemic of cholera, and if so, how large a threat it poses. In an attempt to answer this question, epidemic spread patterns of Vibrio cholerae O139 strain in Bangladesh were studied. Initially the epidemic moved quickly and affected the entire coastal and estuarine tidal plains of southern Bangladesh. In the flood plains of the northern regions it affected mostly the north‐eastern and north‐central areas, at a slower pace than in the southern areas. In the beginning the new strain totally displaced both biotypes (classic and El Tor) of Vibrio cholerae O1. Nearly 2 years after its initial detection, striking differences in the distribution of V. cholerae O139 and O1 were observed. In most northern areas, the new strain was replaced by V. cholerae O1, whereas in the southern coastal regions, the O139 strain continues to dominate epidemics. The study suggests that the O139 strain may become endemic in the coastal ecosystem. The threat of a pandemic, therefore, may not be as large as it first seemed.
Drinking water sources, mortality and diarrhea morbidity among young children in Northern Ghana
Authors: Shier R. P. , Dollimore N. , Ross D. A. , Binka F. N. , Quigley M. , Smith P. G.
Published: November 2003

In the Upper East Region of Ghana, considerable resources have been invested in the provision of boreholes. As part of the Ghana Vitamin A Supplementation Trials' Survival Study which was carried out in one of the districts of the Upper East Region between January 1989 and December 1991, data were collected over a period of one calendar year on the drinking water sources used by approximately 13 000 mothers/guardians of over 20 000 children and on the morbidity and mortality experiences of these children. These data were used to describe seasonal and geographical variations in drinking water sources; to look for other predictors of water source use; and to establish whether the drinking water source was associated with the risk of child death or the period prevalence of diarrhea among young children.

Boreholes were used as the main source of drinking water by about 60–70% of respondents. They were used slightly more frequently in the dry season. In the rainy season, the use increased of more traditional sources such as rainwater or holes dug in stream beds. The use of boreholes was greatest in the northern zone of the study area and was more common in those who had had some formal education and were of higher socioeconomic status. Some association was found between reported drinking water source and diarrhoeal morbidity, although this association appeared to be seasonal. No significant association was found between drinking water source and child mortality.
Potential interventions for preventing pneumonia among young children in developing countries: promoting maternal education
Authors: van Ginneken Jeroen K. , Lob‐Levyt Julian , Gove Sandy
Published: November 2003

The views of various disciplines on the role of education in improving the health and survival of young children in developing countries are discussed, as well as the factors and processes explaining this impact of education and the influence which education could have on risk factors especially relevant to acute respiratory infections (ARI) and pneumonia. This is by reviews of the available evidence on the impact of maternal education on mortality and morbidity. Since there are hardly any data dealing with the impact of education on pneumonia mortality, we focus on post‐neonatal mortality, assuming that it is a suitable proxy for pneumonia mortality. Evidence is summarized on several processes or mechanisms which could explain why there is such an impact of education on ARI mortality (and morbidity) in children below 5. An attempt is made to quantify the reduction in pneumonia mortality which has occurred during the past 10–15 years as a result of improvement in women's education. This will also give an indication of the magnitude of the potential benefits of education for health and survival in the years ahead. Throughout this report we define maternal education as the regular schooling received by women during their youth. Some may have followed additional adult education classes before they became mothers.