bluuebunny/crossref_metadata_2025_split huggingface dataset:
Maternal mortality and access to obstetric services in West Africa
Authors: Ronsmans C. , Etard J. F. , Walraven G. , Høj L. , Dumont A. , de Bernis L. , Kodio B. 
Published: October 2003

Summary Objectives Process evaluation has become the mainstay of safe motherhood evaluation in developing countries, yet the extent to which indicators measuring access to obstetric services at the population level reflect levels of maternal mortality is uncertain. In this study we examine the association between population indicators of access to obstetric care and levels of maternal mortality in urban and rural West Africa.Methods In this ecological study we used data on maternal mortality and access to obstetric services from two population‐based studies conducted in 16 sites in eight West African countries: the Maternal Mortality and Obstetric Care in West Africa (MAMOCWA) study in rural Sénégal, Guinea‐Bissau and The Gambia and the Morbidité Maternelle en Afrique de l'Ouest (MOMA) study in urban Burkina Faso, Côte d'Ivoire, Mali, Mauritanie, Niger and Sénégal.Results In rural areas, maternal mortality, excluding early pregnancy deaths, was 601 per 100 000 live births, compared with 241 per 100 000 for urban areas [RR = 2.49 (CI 1.77–3.59)]. In urban areas, the vast majority of births took place in a health facility (83%) or with a skilled provider (69%), while 80% of the rural women gave birth at home without any skilled care. There was a relatively close link between levels of maternal mortality and the percentage of births with a skilled attendant (r = −0.65), in hospital (r = −0.54) or with a Caesarean section (r = −0.59), with marked clustering in urban and rural areas. Within urban or rural areas, none of the process indicators were associated with maternal mortality.Conclusion Despite the limitations of this ecological study, there can be little doubt that the huge rural–urban differences in maternal mortality are due, at least in part, to differential access to high quality maternity care. Whether any of the indicators examined here will by themselves be good enough as a proxy for maternal mortality is doubtful however, as more than half of the variation in mortality remained unexplained by any one of them.
Defining equity in physical access to clinical services using geographical information systems as part of malaria planning and monitoring in Kenya
Authors: Noor A. M. , Zurovac D. , Hay S. I. , Ochola S. A. , Snow R. W. 
Published: October 2003

SummaryDistance is a crucial feature of health service use and yet its application and utility to health care planning have not been well explored, particularly in the light of large‐scale international and national efforts such as Roll Back Malaria. We have developed a high‐resolution map of population‐to‐service access in four districts of Kenya. Theoretical physical access, based upon national targets, developed as part of the Kenyan health sector reform agenda, was compared with actual health service usage data among 1668 paediatric patients attending 81 sampled government health facilities. Actual and theoretical use were highly correlated. Patients in the larger districts of Kwale and Makueni, where access to government health facilities was relatively poor, travelled greater mean distances than those in Greater Kisii and Bondo. More than 60% of the patients in the four districts attended health facilities within a 5‐km range. Interpolated physical access surfaces across districts highlighted areas of poor access and large differences between urban and rural settings. Users from rural communities travelled greater distances to health facilities than those in urban communities. The implications of planning and monitoring equitable delivery of clinical services at national and international levels are discussed.
Rapid diagnostic testing for malaria
Authors: Murray Clinton K. , Bell David , Gasser Robert A. , Wongsrichanalai Chansuda 
Published: October 2003

SummaryMalaria rapid diagnostic devices (MRDD) have been developed with the hope that they would offer accurate, reliable, rapid, cheap and easily available alternatives to traditional methods of malaria diagnosis. The results from early malaria rapid diagnostic studies were quite promising, especially for detecting Plasmodium falciparum at densities of more than 100–500 parasites/μl. Despite the introduction of these devices over a decade ago, only a few target antigens have been introduced. Of greater concern, these devices have shown limitations in sensitivity, ability to differentiate species and robustness under field conditions in the tropics. Recent trials have revealed wide variability in sensitivity both within and between products. We review the recent trials assessing MRDD use for the diagnosis of P. falciparum and non‐P. falciparum infections in endemic and non‐endemic countries and describe the various aspects of these devices which need further improvement. High quality, accurate, rapid and affordable diagnostic tools are urgently needed now that new antimalarial regimens, characterized by higher cost and increased toxicity, have been introduced more widely in response to emerging multi‐drug resistance.
La maladie de sommeil dans la région Ville de Kinshasa: une analyse rétrospective des données de surveillance sur la période 1996–2000
Authors: Ebeja A. Kadima , Lutumba P. , Molisho D. , Kegels G. , Miaka mia Bilenge C. , Boelaert M. 
Published: October 2003

RésuméEn République Démocratique du Congo, la réémergence de la maladie du sommeil n'est plus limitée aux zones rurales. Au cours de la dernière décennie, de plus en plus de cas sont déclarés dans des centres urbains comme Kinshasa, Mbuji‐mayi, Matadi et Boma. Nous présentons une analyse rétrospective de l'information disponible pour la région Ville de Kinshasa sur la période 1996–2000. Nous avons procédéà une revue de toute l'information du système de surveillance épidémiologique, y compris les fiches individuelles des malades, ainsi que des données entomologiques disponibles. Nous avons classé les 22 zones de santé de la région comme urbaine si la densité de population dépassait 5.000 habitants/km2. Le programme de contrôle a déclaré 2.451 nouveaux cas de T.H.A. parasitologiquement confirmés entre 1996–2000 pour l'ensemble de la région Ville de Kinshasa. Soixante‐six pour‐cent des cas ont entre 15 et 49 ans. Chacune des 22 zones de santé a déclaré des cas, et 956 cas (39%) résidaient dans une zone de santé classée comme urbaine. Des captures de glossines ont mis en évidence la présence de Trypanosoma spp. en 1999. La transmission locale de la T.H.A. dans la région est plausible mais non confirmée. Le nombre important de cas nécessite la conception de stratégies de lutte adaptées au milieu urbain.
Plasmodium falciparum multiplicity correlates with anaemia in symptomatic malaria
Authors: Mockenhaupt Frank P. , Ehrhardt Stephan , Eggelte Teunis A. , Markert Miriam , Anemana Sylvester , Otchwemah Rowland , Bienzle Ulrich 
Published: October 2003

SummaryIn 366 Ghanaian children with symptomatic Plasmodium falciparum malaria, low haemoglobin levels and severe anaemia were associated with a high multiplicity of infection (MOI) and with distinct merozoite surface protein alleles. High MOI not only reflects premunition but may also contribute to anaemia in symptomatic malaria.
Prevalence of intestinal parasitic infections in northern Vietnam
Authors: Verle P. , Kongs A. , De N. V. , Thieu N. Q. , Depraetere K. , Kim H. T. , Dorny P. 
Published: October 2003

SummaryWe surveyed the prevalence of parasitic infections in the mountainous province of Hoa Binh, north‐west Vietnam, involving 526 households of six ethnic groups: Muong, Kinh, Dao, Thai, Tay and Hmong. Eggs or cysts of at least one parasite species were detected in 88% of stool samples (n = 2522). Prevalences of nematodes were high among all ethnic groups: hookworm (52%), Trichuris trichiura (50%) and Ascaris lumbricoides (45%). Ascaris infection appeared to be lower in households owning a latrine, was highest among children and decreased with age. Prevalence of hookworm rose during childhood, remained high until old age, was highest among adult women, but was not linked to anaemia. Eggs of Chlonorchis spp. were found in 126 (5%) individuals (of the Muong, Kinh or Thai groups only). Chlonorchiasis increased with age and was highest among adult men. Taenia eggs were found in three individuals (0.1%). Giardia lamblia was found in all districts and among all groups and the prevalence of infection was estimated at 3%.
Chagas’ disease diagnosis: comparative analysis of recombinant ELISA with conventional ELISA and the haemagglutination test
Authors: Gadelha A. Á. M. , Verçosa A. F. A. , Lorena V. M. B. , Nakazawa M. , Carvalho A. B. , Souza W. V. , Ferreira A. G. P. , Silva E. D. , Krieger M. A. , Goldenberg S. , Gomes Y. M. 
Published: October 2003

Background and Objectives  Serological screening for Chagas’ disease in the blood banks of South America is carried out by using two different assays that generally show a high number of inconclusive results. To establish a combination of two tests that can minimize the number of inconclusive results, we compared a recombinant enzyme‐linked immunosorbent assay (ELISA) with two conventional tests.Materials and Methods  Serum samples from chagasic patients (n = 112), from non‐chagasic individuals (n = 143) and from patients with other diseases (n = 32) were tested using three assays: recombinant ELISA (Rec‐ELISA); conventional ELISA (Con‐ELISA); and the indirect haemagglutination (IHA) test.Results  When we evaluated the data by matching the Rec‐ELISA and the IHA test, 52 inconclusive results were obtained. When Rec‐ELISA and Con‐ELISA were matched, only four inconclusive results were observed.Conclusions  Our investigation indicates that the use of two ELISAs with different antigen preparations provides an effective test combination for blood bank screening of Chagas’ disease.
Elastic properties of stored red blood cells from sickle trait donor units
Authors: Brandão M. M. , Saad S. T. O. , Cezar C. L. , Fontes A. , Costa F. F. , Barjas‐Castro M. L. 
Published: October 2003

Background and Objectives  Red blood cells (RBCs) from patients with sickle cell disease present reduced deformability. The aim of this study was to analyse the elasticity of stored RBCs from patients with the sickle cell trait (AS).Materials and Methods  The cell elasticity was studied, using laser optical tweezers, on storage days 1, 14, 21, 28 and 35.Results  The elasticity of RBC from AS units stored for 1, 14 and 21 days was significantly greater compared with that of control RBC cells stored for the same time‐period. More than 30% of the cells from AS units stored for 28 or 35 days were very rigid and escaped from the optical trap.Conclusions  RBCs became rigid during storage, suggesting that haemoglobin S might compromise the cell elasticity.
Alanine aminotransferase cut‐off values for blood donor screening using the new International Federation of Clinical Chemistry reference method at 37 °C
Authors: Brinkmann T. , Dreier J. , Diekmann J. , Götting C. , Klauke R. , Schumann G. , Kleesiek K. 
Published: October 2003

Background and Objectives  Serum alanine aminotransferase (ALT) determination is recommended, or even required by law, in the screening of blood donors in many countries, and donors with an increased catalytic activity of ALT are excluded from blood donation. In most countries, the ALT cut‐off value for blood donor screening for men and women is twice the upper limit of the normal range. The introduction, in 2002, of the new International Federation of Clinical Chemistry (IFCC) reference method, performed at 37 °C, required new ALT reference values to be established for healthy individuals and a new cut‐off point to be determined for blood donor screening.Materials and Methods  We compared ALT values of donor blood units using the previous German standard method, which measures ALT values at 25 °C, and the new IFCC reference procedure, where ALT levels are measured at 37 °C.Results  We found a linear correlation between the ALT values obtained by the method at 25 °C and the new IFCC reference method (37 °C) (r = 0·983), and a gender‐ and age‐independent ratio of 0·523. Using this ratio we calculated the new ALT cut‐off for blood donations and now propose a new upper limit of 132 U/l (2·20 µkat/l) for men and 86 U/l (1·43 µkat/l) for women. Only 220 of 151 678 blood donations collected over a period of 5 years showed an ALT value higher than the cut‐off. None were hepatitis C virus (HCV) positive in serological or nucleic acid amplification technology (NAT) assays. Only 0·006% of all blood donations were positive for antibody to HCV and thus excluded.Conclusions  With the implementation of the new IFCC reference method for ALT determination at 37 °C, we propose a new ALT cut‐off for blood donor screening, which, for men, is about three times the upper limit of the normal range and for women about 2·5 times. Our results show that a lower cut‐off would probably not yield a higher safety of blood products in terms of detecting viral infections, but would result in a loss of ≈ 0·75% of suitable blood donors.
Preclinical safety profile of plasma prepared using the INTERCEPT Blood System
Authors: Ciaravino V. , McCullough T. , Cimino G. , Sullivan T. 
Published: October 2003

Background and Objectives  The newly developed INTERCEPT Blood System for plasma uses the addition of a new psoralen, amotosalen HCl (AMOTOSALEN), followed by illumination with ultraviolet A light, to inactivate viruses, bacteria, protozoa and leucocytes that may contaminate fresh‐frozen plasma (FFP). Extensive toxicology studies were performed to characterize the safety of the photochemical treatment process for its intended use with plasma.Materials and Methods  The studies of general toxicology, safety pharmacology, phototoxicity, reproductive toxicity and venous irritation, summarized in this review, provide a comprehensive toxicology profile for photochemically treated 100% plasma.Results  No specific target organ toxicity (based on clinical or histological pathology), phototoxicity, or reproductive toxicity was observed.Conclusions  The results of an extensive series of studies have demonstrated no toxicologically relevant effects of photochemically treated 100% plasma prepared using the INTERCEPT Blood System for plasma.
Storage of platelets in additive solutions: a multicentre study of the in vitro effects of potassium and magnesium
Authors: Gulliksson H. , AuBuchon J. P. , Cardigan R. , Van Der Meer P. F. , Murphy S. , Prowse C. , Richter E. , Ringwald J. , Smacchia C. , Slichter S. , De Wildt‐Eggen J. 
Published: October 2003

Background and Objectives  In a preliminary study, the presence of potassium and magnesium in a modified synthetic medium (PAS‐III) was found to have a significant influence on platelet metabolism (using apheresis‐derived, as well as buffy‐coat‐derived platelets) when compared with standard PAS‐III. The differences included reduced glycolysis, as evidenced by lower consumption of glucose and lower production of lactate, but also better preservation of pH and hypotonic shock response reactivity. The results suggested that storage in modified PAS‐III containing 20% plasma was comparable to storage in standard PAS‐III containing 30% plasma. To confirm the preliminary results and to evaluate the effects of different preparation protocols, an international multicentre study, which included 11 different sites, was conducted.Materials and Methods  Platelets from 30 pools of ≈ 20 buffy coat (BC) units each and 24 pooled apheresis platelet units were aliquoted for storage in plasma (reference) or synthetic medium using either a specific additive solution (PAS‐III) containing 30% plasma or a modification of PAS‐III containing 5·0 mm potassium and 1·5 mm magnesium (PAS‐IIIM) and either 30% or 20% plasma. Units were stored at room temperature with agitation for 7 days during which in vitro testing was carried out for biochemical, haematological and functional parameters.Results  Storage of platelets in PAS‐IIIM resulted in a reduction in the rate of glycolysis and better retention of pH and hypotonic shock response reactivity. Storage in PAS‐IIIM containing 20% plasma appeared to result in the retention of in vitro properties, similar to those observed during storage in standard PAS‐III containing 30% plasma.Conclusions  The results of this study confirm the preliminary results. Similar results were seen with platelets prepared by BC and apheresis methods, despite differences in equipment, the preparation technique and in the final platelet contents achieved in the platelet units. Storage of platelets in PAS‐IIIM should be considered to improve platelet function and allow plasma reduction to 20%.
The origin and identification of unknown events associated with low‐level leucocyte counting by flow cytometry
Authors: Bashir S. , Cardigan R. 
Published: October 2003

Background and Objectives  Flow cytometric enumeration of residual leucocytes (WBC) in leucocyte‐depleted components occasionally reveals a population of events that stain with propidium iodide, but which are outside the main counting region. These extraregional events may result in discrepancies in residual WBC counts.Materials and Methods  To identify the origin of these unknown events, separate populations of mononuclear cells and polymorphonuclear neutrophils (PMNs) (prepared by density‐gradient centrifugation) were spiked into leucocyte‐depleted red cell concentrates (RCC) to a concentration of 150 cells/µl and assessed, using LeucoCount and DNA Prep reagents, by flow cytometry. In addition, isolated WBC nuclei, DNA in saline, or enzymatically digested free DNA, was spiked into diluted whole blood (final concentration 5 µg/ml).Results  Isolated WBC nuclei fell in the main counting region of the dot plot. Extraregional events were generated in leucocyte‐depleted RCC spiked with PMN (17/µl by day 4), but not with mononuclear cells, and increased with sample storage (4 days). A significantly (P < 0·01) greater number of extraregional events was observed using the LeucoCount reagent, compared with the DNA Prep reagent. Enzymatically digested WBC nuclei or free DNA, added to diluted whole blood, generated extraregional events using LeucoCount, but not the DNA Prep reagent. When free DNA was enzymatically digested, no extraregional events were observed.Conclusions  These previously unidentified events are probably fragmented nuclei or free DNA originating from PMN owing to a combination of ageing and reagent addition. Currently, in our protocols, the region used for WBC enumeration counts intact WBC nuclei. To achieve WBC counting consistency, flow cytometric gating protocols must be standardized, and a decision taken as to whether to include extraregional events in the count.
Composition of the additive solution affects red blood cell integrity after photodynamic treatment
Authors: Besselink G. A. J. , Ebbing I. G. , Hilarius P. M. , De Korte D. , Verhoeven A. J. , Lagerberg J. W. M. 
Published: October 2003

Background and Objectives  Photodynamic treatment is a promising technique for pathogen inactivation of red blood cell concentrates. For protocol optimization, the influence of the composition of the storage solution on the integrity of phototreated red cells was studied.Materials and Methods  Red blood cells were resuspended in the storage solutions SAG‐M or AS‐3 to a haematocrit (Hct) of 30%. After addition of the photosensitizer, 1,9‐dimethylmethylene blue (DMMB) (25 µm), the suspensions were illuminated with red light, and potassium leakage and delayed haemolysis were determined. In some experiments, the cells were washed after illumination and resuspended in modified storage solutions.Results  Illumination of red cells in the presence of DMMB resulted in an immediate, light‐dose‐dependent increase in potassium leakage. The illumination conditions used induced no detectable haemolysis immediately after photodynamic treatment. Potassium leakage was higher when the illumination was performed in AS‐3. In contrast, delayed haemolysis, measured after overnight storage, was considerably lower when cells were stored in AS‐3. This protection was mainly a result of the presence of citrate in AS‐3. In addition, other impermeant solutes protected against haemolysis.Conclusions  The additive solution strongly influences the integrity of red cells after photodynamic treatment. Whereas the solution in which the cells are illuminated has a small effect on red cell integrity, the main influence of the additive solution is during post‐treatment storage. Red cell integrity is best maintained when illumination is performed in SAG‐M followed by storage in AS‐3. The presence of non‐permeant solutes, such as citrate, in the solution used for storage, prevents haemolysis of the phototreated, cation‐permeable cells by counterbalancing the osmotic activity of haemoglobin.
Storage of platelets in additive solutions: the effects of magnesium and potassium on the release of RANTES, β‐thromboglobulin, platelet factor 4 and interleukin‐7, during storage
Authors: Shanwell A. , Falker C. , Gulliksson H. 
Published: October 2003

Background and Objectives  Several studies have suggested that the accumulation of cytokines during storage of platelet concentrates may mediate non‐haemolytic transfusion reactions. Prestorage leucodepletion can prevent the release of cytokines from white blood cells during storage, but not the release of platelet‐derived cytokines. Therefore, we investigated whether the addition of magnesium and potassium to platelets stored in a platelet additive solution (PAS) would affect the generation of cytokines during platelet storage.Materials and Methods  Platelets were prepared from buffy coats using different suspension media: plasma; 70% PAS‐III + 30% plasma; 70% PAS‐III supplemented with magnesium and potassium +30% plasma; and 80% PAS‐III supplemented with magnesium and potassium +20% plasma. The levels of certain cytokines – regulated on activation, normal, T‐cell expressed, and secreted (RANTES), β‐thromboglobulin (β‐TG), platelet factor 4 (PF4) and interleukin‐7 (IL‐7) – were measured by enzyme‐linked immunosorbent assay (ELISA) on days 1, 5 and 7.Results The concentrations of RANTES, β‐TG, PF4 and IL‐7 increased, during storage, in all units. The increase was significantly greater in units stored in 70% PAS‐III +30% plasma than in the other three suspension media. The storage of platelets in 70% PAS‐III supplemented with magnesium and potassium +30% plasma significantly reduced the concentrations of platelet derived‐cytokines during storage, as compared to platelets stored in 70% PAS‐III + 30% plasma alone.Conclusions  The concentrations of platelet‐derived cytokines increased, to a significantly greater extent, when platelets were stored in PAS‐III than in plasma. However, when magnesium and potassium were added to PAS‐III, the concentrations of platelet‐derived cytokines obtained during storage were about the same as those produced by platelets stored in plasma.
Synthesis and cytogenetic characterization of intergeneric hybrids of Diplotaxis siifolia with Brassica rapa and B. juncea
Authors: Ahuja I. , Bhaskar P. B. , Banga S. K. , Banga S. S. , Rakow G. 
Published: October 2003

AbstractIntergeneric hybrids involving a wild crucifer, Diplotaxis siifolia (2n = 20; DsDs), and two crop Brassica species, namely Brassica rapa (2n = 20; AA) and B. juncea (2n = 36; AABB), were developed through sequential ovary/ovule culture. Hybridization was successful only when D. siifolia was used as the female parent, indicating unilateral cross incompatibility. Hybrids were intermediate between the parents for morphological characteristics but had low male as well as female fertility. Meiotic studies of hybrids revealed partial homoeology between Ds and A/B genomes.