bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pleural empyema due to Salmonella paratyphi in a patient with AIDS
Authors: Wolday Dawit , Seyoum Berhane 
Published: November 2003

SummaryPleural empyema due to Salmonella has rarely been reported in immunocompromised patients. Here, we present a case of a 25‐year old man infected with the human immunodeficiency virus type‐1 (HIV‐1) who presented with a left‐sided pleural effusion. The cause was confirmed bacteriologically to be due to Salmonella paratyphi. The outcome was favourable after antibiotic therapy coupled with pleural drainage. It should be recognised that pleural empyema due to Salmonella may occur in HIV‐infected subjects and we suggest that patients presenting with pleural empyema due to uncommon pathogens be tested for HIV‐1 antibodies.
Geographical and seasonal association between linamarin and cyanide exposure from cassava and the upper motor neurone disease konzo in former Zaire
Authors: Banea‐Mayambu Jean‐Pierre , Tylleskär Thorkild , Gitebo Nahimana , Matadi Nunga , Gebre‐Medhin Mehari , Rosling Hans 
Published: November 2003

SummaryHigh cyanide intake from consumption of insufficiently processed cassava has been advanced as a possible aetiology of the upper motor neurone disease konzo. However, similar neurodamage has not been associated with cyanide exposure from any other source. With an ecological study design, we compared 22 cases of konzo, 57 unaffected household members and 116 members from unaffected households, a total of 195 subjects, in konzo‐affected savanna villages with 103 subjects in adjacent non‐affected forest villages in the Paykongila area in the Bandundu Region. Zaire.In the dry season, the mean value (± SEM) of urinary thiocyanate, the main cyanide metabolite, was higher in the three groups in konzo‐affected villages (563 ± 105, 587 ± 44 and 629 ± 47 μmol*l) than in unaffected villages (241 ± 17 μmol*l). In affected villages in the dry season when konzo incidence was high, mean urinary thiocyanate was also higher than the levels found in the wet season when incidence was low. The wet season values (mean ± SEM) were 344 ± 60, 381 ± 35 and 351 ± 27 μmol*l. Urinary levels of inorganic sulphate were low in all groups, indicating low intake of the sulphur amino‐acids which provide a substrate for cyanide detoxification. These findings support an aetiological role for cyanide in konzo. However, urinary linamarin, the cyanogenic glucoside and source of cyanide in cassava, was more closely associated with the occurrence of konzo. The mean value (± SEM) of urinary linamarin in the konzo cases was 632 ± 105 μmol*l and in their household members 657 ± 52 μmol*l, which was significantly higher than in members of control households in the same village (351 ± 28 μmol*l) and in unaffected villages (147 ± 18 μmol/l). This suggests that a specific neurotoxic effect of linamarin, rather than the associated general cyanide exposure resulting from glucoside breakdown in the gut, may be the cause of konzo.
Accidental Leishmania mexicana infection in an immunosuppressed laboratory technician
Authors: Knobloch J. , Demar M. 
Published: November 2003

SummaryA 30 year‐old female laboratory technician under immunosuppressive treatment because of systemic lupus erythematosus (SLE) developed cutaneous leishmaniasis 8 months after accidental percutaneous inoculation of amastigote culture forms of Leishmania mexicana. Leishmania‐specific PCR and restriction analysis patterns were identical for both the laboratory strain and the clinical specimen. The lesion was resistant to local paromomycin and oral ketoconazole, but responded to local application of meglumine antimonate. No signs of dissemination or visceralization occurred during the 5‐month period of observation. However, a future recurrence cannot be excluded since a persistent infection even after clinical cure has always to be considered in leishmaniasis. Patients under immunosuppressive therapy are possibly at risk of clinical relapse or disseminating infection although there is no experience with regard to leishmaniasis mexicana. Serious infection may require interferon gamma as part of the treatment which may contribute to deterioration of concomitant diseases like SLE. In any case, the exposure of immunodeficient laboratory workers to Leishmania spp. should be avoided.
Immunohistological studies on macrophages in lymph nodes of onchocerciasis patients after treatment with ivermectin
Authors: Knab Julia , Darge Kassa , Büttner D.W. 
Published: November 2003

SummaryThe role of macrophages in the killing and elimination of microfilariae (mf) was studied immunohistologically in 14 lymph nodes from 10 patients with generalized onchocerciasis 20–68 h after treatment with a single oral dose of 150 μg/kg ivermectin. Mf with signs of damage at light microscopical level were surrounded by a cellular infiltrate comprising macrophages, eosinophils and neutrophils, whereas light microscopically intact mf mostly showed no cellular reaction. Resident mature macrophages expressing the CD 68 epitope usually neither migrated nor attached to damaged mf, especially on the first and second day after ivermectin treatment. However, many young invading macrophages labelled for the L1 protein (antibodies 27 E 10, MAC 387, S 36.48 and 8.5C2) were found within the cellular infiltrate around damaged mf and in adherence to the mf in all lymph nodes after ivermectin treatment. Free L1 protein was observed on the cuticle of the mf. The attacking macrophages contained increased amounts of the enzymes lysozyme, α‐1‐antichymotrypsin and α‐1‐antitrypsin compared to resident macrophages. Free enzymes were found on the cuticle of the mf and around them, indicating a role of these enzymes in the inflammatory reaction to the parasites. The attacking macrophages were strongly labelled for human HLA‐DR and they showed further an increased expression of the complement receptors CR1 (CD 35) for C3b and CR3 (CD 11b) for C3 bi in comparison to resident macrophages and thus were considered as activated macrophages. Rarely fragments of mf were seen within multinuclear macrophages. We conclude that young activated macrophages play a major role in the elimination of mf transported to the regional lymph nodes after ivermectin treatment. The immunohistological findings are in accordance with the assumption that these activated macrophages together with granulocytes contribute to the killing of the damaged mf. They also help to limit the damage of the host tissue by release of α‐1‐antichymotrypsin and α‐1‐antitrypsin.
Early reduction of the challenge recovery rate following immunization with irradiated infective larvae in a filaria mouse system
Authors: Goff L. Le , Maréchal P. , Petit G. , Taylor D.W. , Hoffmann W. , Bain O. 
Published: November 2003

SummaryThe filaria Litomosoides sigmodontis, which develops a patent infection in BALB/c mice, was used to determine the fate of a challenge inoculum following immunization of mice with irradiation attenuated infective larvae (3 subcutaneous inoculations at weekly intervals with 25 L3 irradiated at 60 krad, and challenge with 25 L3 two weeks after the final immunization). The adult worm burden of vaccinated mice was reduced to 50% of that of controls although the pattern of larval migration and microfilaraemia were not affected. Necropsies showed that the increased killing of the filariae of the challenge inoculum occurred at the L3 stage within the first 2 days of challenge. This result draws attention on the protective mechanisms operating very early and probably in the subcutaneous region.
Practices and beliefs of traditional birth attendants: lessons for obstetrics in the north?
Authors: Lefèber Yvonne , Voorhoever Henk 
Published: November 2003

SummaryThe majority of mothers in countries in Africa, Asia and Latin America are supported by Traditional Birth Attendants (TBAs) during pregnancy and childbirth. TBAs do more than just deliver babies. As part of the local community they are acquainted with the women and their families with whom they share the cultural ideas about how the birth has to be prepared for and performed. They know the local medicines and rituals which are used before, during and after delivery. The work of the TBAs is adapted and strictly bound to the social and cultural matrix to which they belong, their practices and beliefs being in accordance with the needs of the local community. Therefore they may not be able to assist women at childbirth outside their own socio‐cultural environment.Comparison of the practices and beliefs of TBAs in Africa, Asia and Latin America revealed a large variation among the different cultures of the three continents. Surprisingly, in spite of the cultural differences there were clearly some common practices and beliefs which may occur in all three continents. It is assumed that these common practices are due to the expression people give to the basic events of life such as pregnancy, labour and lactation. A short review of common practices is presented as they may be of value in obstetrical practice in the northern countries.
Improving the efficiency of district hospitals: is contracting an option?
Authors: Mills Anne , Hongoro Charles , Broomberg Jonathan 
Published: November 2003

A world‐wide revolution in thinking about public sector management has occurred in recent years, termed the ‘new public management’. It aims to improve the efficiency of service provision primarily through the introduction of market mechanisms into the public sector. The earliest form of marketization in developed countries has tended to be the introduction of competitive tendering and contracts for the provision of public services. In less wealthy countries, the language of contracting is heard with increasing frequency in discussions of health sector reform despite the lack of evidence of the virtues (or vices) of contracting in specific country settings. This paper examines the economic arguments for contracting district hospital care in two rather different settings in Southern Africa: in South Africa using private‐for‐profit providers, and in Zimbabwe using NGO (mission) providers. The South African study compared the performance of three ‘contractor’ hospitals with three government‐run hospitals, analysing data on costs and quality. There were no significant differences in quality between the two sets of hospitals, but contractor hospitals provided care at significantly lower unit costs. However, the cost to the government of contracting was close to that of direct provision, indicating that the efficiency gains were captured almost entirely by the contractor. A crucial lesson from the study is the importance of developing government capacity to design and negotiate contracts that ensure the government is able to derive significant efficiency gains from contractual arrangements.In other parts of Africa, contracts for hospital care are more likely to be agreed with not‐for‐profit providers. The Zimbabwean study compared the performance of two government district hospitals with two district ‘designated’ mission hospitals. It found that the two mission hospitals delivered similar services to those of the two government hospitals but at substantially lower unit cost. The nature of the contract between government and missions was implicit rather than explicit and of long standing. On the whole the mission organizations felt the informal nature of the agreement was advantageous, though the government plans to introduce service contracts at district level with all hospitals, both government and mission. The paper concludes by identifying concerns raised by the case‐studies that are of relevance to other countries considering the introduction of explicit contractual arrangements for district hospital provision.
How African doctors make ends meet: an exploration
Authors: Roenen C. , Ferrinho P. , Van Dormael M. , Conceição M. C. , Van Lerberghe W. 
Published: November 2003

This paper is an attempt to identify individual coping strategies of doctors in sub‐Saharan Africa. It also provides some indication of the ‘effectiveness’ of these strategies in terms of income generation, and analyses their potential impact on the functioning of the health care system. It is based on semi‐structured interviews of 21 doctors working in the public health sector in sub‐Saharan Africa and attending in 1995 an international Master's course in Public Health in Belgium or in Portugal.This small sample of physicians yielded reports about 28 different types of individual strategies. Most of these potentially affect health service delivery more through reduced availability of staff than through the more blatant misappropriations. Activities related to the health field are mentioned most often. Allowances and per diems seem to be top regarding frequency and effectiveness, followed by secondary jobs, private practice or gifts from patients. None of the interviewees, however, admits using public resources for private purposes. Side activities may bring in very considerable amounts of income, out of proportion to the official salary, and can also be very time consuming. Nevertheless, all interviewees identify themselves in the first place as civil servants.Individual coping strategies may lead to undesirable side‐effects for health care delivery, through a net transfer of resources (qualified personnel‐time and material resources) from the public to the private‐for‐profit sector. There may also be positive effects though, be it in terms of mobilization of additional resources, of stabilization of qualified personnel or of realization of professional goals. However, these emerging strategies call for innovative mechanisms, likely to shape coping strategies in such a way that they remain compatible with equity and quality of care to the population.
Schistosoma mansoni‐related morbidity on Ukerewe Island, Tanzania: clinical, ultrasonographical and biochemical parameters
Authors: Kardorff R. , Gabone R. M. , Mugashe C. , Obiga D. , Ramarokoto C. E. , Mahlert C. , Spannbrucker N. , Lang A. , Günzler V. , Gryseels B. , Ehrich J. H. H. , Doehring E. 
Published: November 2003

One thousand six hundred and ninety‐five inhabitants of 3 rural villages on Ukerewe Island, Lake Victoria, Tanzania, were examined by clinical, parasitological, ultrasonographic and—in part—serological means to evaluate Schistosoma (S.) mansoni‐related morbidity on a community level. Villagers frequently complained of typical colitis symptoms (abdominal pain 80.1%, bloody stools 43.1%, diarrhoea 35.1%); haematemesis, on the other hand, was rare (and reports doubtful in most cases). 16.9% of the population had been given praziquantel previously. Overall S. mansoni prevalence was 86.3%, with a median egg output of 176 eggs per gram (e.p.g.) and a maximum output of 17 984 e.p.g. Children and adolescents were infected more severely than adults, men more severely than women. Pretreated individuals excreted significantly fewer ova (median 124 vs 192e.p.g., P<0.001).Hepatomegaly (determined by ultrasonography) was present in 35%, splenomegaly in 80%. Organomegaly was significantly related to egg output. Pretreated persons had lower rates of splenomegaly and left lobe hepatomegaly. Low‐degree periportal fibrosis was common, while severe grades of fibrosis (MANAGIL score II and III) were present in about 6%. About 10% had other abnormalities on liver sonography (irregular parenchymal texture and/or shape); these persons passed significantly more S. mansoni ova than others. Clear sonographic signs of portal hypertension were seen in 2.1%. Serum procollagen‐IV‐peptide and γ‐glutamyl‐transferase levels were increased in persons with severe periportal fibrosis, irregular liver texture or portofugal collateral vessels.Thus, S. mansoni infection in the western part of Ukerewe Island is frequent and often severe, leading to a high prevalence of gastrointestinal symptoms. Hepatosplenic involvement does occur, although symptomatic cases of portal hypertension were not identified beyond doubt. The overall level of schistosomal morbidity is thus considered intermediate. Serum procollagen‐IV‐peptide may be a promising marker of schistosomal liver disease. Our data suggest that S. mansoni infection may also be related to diffuse liver parenchyma alterations in this area.
Operational aspects of bednet impregnation for community‐based malaria control in Nicaragua, Ecuador, Peru and Colombia
Authors: Kroeger A. , Meyer R. , Mancheno M. , Gonzalez M. , Pesse K. 
Published: November 2003

Community intervention projects with pyrethroid (permethrin and lambdacyhalothrin) impregnated bednets and an accompanying community education programme were carried out in 6 malaria endemic areas on the Pacific coast of Nicaragua, Ecuador, Peru and Colombia as well as in the Peruvian Amazon basin. In this paper the operational aspects are analysed: bednet coverage, results of promotional activities for increased bednet use, the sale of low‐cost bednets, techniques and difficulties with impregnation, acceptance of the programme (including washing of impregnated nets), side‐effects, residual concentrations of the chemical in the nets, costs of the impregnation programme and insecticide resistance of the malaria vectors.We found that the local manufacture of bednets and their sale through village health workers, even in communities with low cash income, is a viable way of increasing bednet coverage; the impregnation of bednets is well accepted if villagers perceive a direct benefit; pretesting of the soaking capacity of different net materials should be done at central level; the instructions for the impregnation procedures of different net materials (cotton and synthetic) should be simple and unambiguous; very cheap thin net materials should be avoided, particularly in the case of lambdacyhalothrin impregnation; educational methods and/or promotion of dark‐colour nets should be further tested in order to decrease the washing frequency of bednets at household level; in areas with early‐biting mosquitoes further studies on the protective efficacy of bednets are necessary; careful monitoring of side‐effects, particularly those of last‐generation pyrethroids, is necessary; and the community‐based impregnation programme is a powerful tool for strengthening community involvement in health actions.
Geophagy among school children in Western Kenya
Authors: Geissler P. W. , Mwaniki David L. , Thiong'o Frederick , Friis Henrik 
Published: November 2003

A cross‐sectional study was conducted among 285 school children aged 5–18 years in Nyanza Province, Western Kenya, to determine the prevalence of geophagy and the types and amounts of soil eaten. Stool samples were taken from a subsample of 53 (19%) and their silica content determined to compare the results with the reported geophagy. Geophagy was practised by 73% of the children. The prevalence decreased with age for both sexes up to age 15, then remained stable for girls between 15 and 18 years but continued to decrease for boys in that age range.Most children ate soil from the surface of termitaria; others preferred the edges of paths and gullies, material from the wall of huts, and a chalk‐like, soft stone commonly found in the area. The soil was eaten dry and was occasionally ground, but not processed in other ways. All but 4 of the children practising geophagy reported to eat soil at least once daily. The median amount reported eaten was 28 g daily, ranging from 8 to 108 g. The reported amount of soil eaten daily was significantly correlated to the results of the stool silica determinations. Using the median of 1% silica of faecal wet weight as a cut‐off point to distinguish geophageous children from non‐geophageous, the examination of a single stool sample had a sensitivity of 76% and a specificity of 80% to detect a geophageous child compared to the interview method.The cultural context of geophagy and its potential health impact in terms of infection and nutrition need to be further investigated, and it is suggested that more school and community‐based studies on geophagy in different societies should be undertaken.
From their own perspective. A Kenyan community's perception of tuberculosis
Authors: Liefooghe R. , Baliddawa J.B. , Kipruto E. M. , Vermeire C. , De Munynck A. O. 
Published: November 2003

Early passive case finding and treatment compliance are the cornerstones of tuberculosis (TB) control programs. As human behaviour plays a critical role in both strategies, a better understanding of it is important for the planning and implementation of a successful TB programme, especially for the health education component. Our qualitative study in Uasin Gishu, Kenya, aimed at a better understanding of the community's beliefs and perceptions of TB, recognition of early symptoms and health‐seeking behaviour. Five focus groups with a total of 49 people were held: one with hospitalised TB patients, two with rural and two with urban participants.Tuberculosis is well known in the communities and many vernacular names for the disease exist. TB is perceived as a contagious, ‘sensitive’ disease difficult to diagnose and treat. Community members believe that TB should be diagnosed and treated in a hospital or by a medical doctor and not at the peripheric level. TB treatment is perceived as long, agonising and cumbersome. Traditional treatment is considered a valid alternative to modern treatment, believed to be as effective and much shorter. Initial symptoms such as cough and fever are often overlooked and/or confused with malaria or a common cold. Symptoms associated with the disease refer to the later stage of TB. TB is attributed to causes such as smoking, alcohol, hard work, exposure to cold and sharing with TB patients. Many participants believe TB is hereditary. Prolonged self‐treatment and consultation with the traditional health sector as well as the social stigma attached to the disease increase patient’s delay. Only after symptoms persist for some time and/or the suspect’s health deteriorates, are modern health services consulted. These social conditions necessitate culturally sensitive health education, taking into account local perceptions of TB.
Feline acne and results of treatment with mupirocin in an open clinical trial: 25 cases (1994–96)
Authors: White Stephen D. , Bordeau Patrick B. , Blumstein Philippe , Ibisch Catherine , GuaguÈre Eric , Denerolle Philippe , Carlotti Didier N. , Scott Katherine V. 
Published: November 2003

Clinical and diagnostic parameters, and response to topical mupirocin in 25 cats with feline acne are described. The chin was the most common area affected, but the lower lip, upper lip and the commissure of the lips also frequently had lesions. The most common clinical sign was the presence of crusts, followed by comedones, erythema, alopecia, pruritus and nodules/fistulas. Deep skin scrapings for ectoparasites, cytological examination of superficial skin scrapings, and fungal cultures from the chin were performed on all cats. Dermatophytes were cultured from two cats and Malassezia pachydermatis was cultured (n = 2), seen on cytology smears (n = 1), or noted on histopathology (n = 1). Skin biopsies were obtained from three of the cats and most commonly showed dilatation of sebaceous gland ducts, neutrophilic or pyogranulomatous infiltration of the sebaceous glands, and pyogranulomatous inflammation of the dermis.All cats were treated with topical 2% mupirocin ointment twice daily for 3 weeks as the sole treatment. Treatment response was excellent in 15 cats and good in nine cats. One cat had a contact reaction to the mupirocin, necessitating stopping treatment. The response to treatment of the six cats with dermatophyte or years involvement was good (n = 3) or excellent (n = 3).