bluuebunny/crossref_metadata_2025_split huggingface dataset:
European study of the antenatal management of fetomaternal alloimmune thrombocytopenia (FMAIT)
Authors: Birchall J. , Murphy M. F. , Kaplan C. , Kroll H. 
Published: March 2003

FMAIT occurs in ∼1 in 1200 births, of which 10–20% have serious bleeding, i.e. intracranial haemorrhage (ICH). Management of such pregnancies needs to balance the risk of bleeding against the known risk of fetal blood sampling (FBS).S tudy This was a nonrandomised observational study of FMAIT due to anti‐HPA‐1a. All cases were managed by an initial FBS, then a) intravenous immunoglobulin (IVIgG), b) regular intrauterine platelet transfusions (IUT), c) neither of above, but FBS ± 1 IUT predelivery, d) no treatment. All babies with a previous sibling known to have platelets < 20 × 109/L or an ICH were considered high risk.R esults 43 pregnancies (44 babies) were analysable giving 49 results in total (more than 1 management in 5).In (a) there was one case with ICH. The resultant platelet count was ≥ 50 × 109/L in 10 cases, and 6 of these were high risk (5 ICH, 1plts < 20 × 109/L). No significant side‐effects of treatment occurred. In (b) the number of high risk cases was greater than (a) and there were 2 cases of ICH. The pre‐IUT platelet count was < 20 × 109/L on at least 50% of occasions in 10 cases. Overall 12 babies needed to be delivered because of complications caused by FBS/IUT, 4 at less than 32 weeks gestation. There were few cases in (c) and no cases in (d).C onclusions The incidence of ICH in the study group is less than the incidence of ICH in untreated siblings. However, complications from FBS/IUT were significant, and the platelet count was not consistently maintained at > 20 × 109/L. Further studies are required to define the optimal antenatal management of FMAIT.
Large‐scale HPA‐1 epidemiological study in scotland: an up‐date
Authors: Bessos H. , Fagge T. , Wilson D. , Duncan J. , Harkness M. , Rentoul F. , Ahya R. , Armstrong‐Fisher S. , Urbaniak S. , Turner M. 
Published: March 2003

Neonatal alloimmune thrombocytopenia (NAIT) in the Caucasian population is mainly due to a mismatch in the HPA‐1 marker between mother and foetus. About 10% of pregnant HPA‐1b women develop anti‐HPA‐1a antibodies (ab) which may lead to NAIT with possible intracranial haemorrhage and death or life long morbidity. The ab development is significantly correlated with HLA‐DRB3*0101. Although the frequency of homozygous HPA‐1b varies between 1·5 and 4·5%, the frequency of HPA‐1 NAIT detection in our laboratories was very low suggesting either that the epidemiology was different in Scotland or that the disease was being under‐reported. In August 1999 we began a two year study of HPA‐1 NAIT involving 25 000 pregnant women in Scotland. The aim of the study is to determine the frequency of HPA‐1b homozygosity, monitor ab levels during pregnancy, and assess the cost effectiveness of routine screening across Scotland. The HPA‐1 antigen and antibody assays consist of internationally validated ELISAs (Bessos et al. Transfusion, 38, 73S, 1998). The laboratory and clinical data are being collated using a Microsoft Access database. Of 11,500women screened to date in 3 Scottish regions, 216 are HPA‐1b homozygous (1·9%): 136/6841(2%) in Edinburgh; 67/3973 (1·69%) in Aberdeen; and 13/686 (1·9%) in Glasgow. So far, 11/145 (about 8%) consented HPA‐1b women are ab positive, with ab titres ranging from 1 : 2 to 1 : 256, but staying low or decreasing during pregnancy. Two have had previously affected babies and are being managed according to current guidelines. One woman with no previously affected children but with an ab titre declining from 1 : 256 to 1 : 32 during pregnancy, delivered recently a severely thrombocytopenic baby whose platelet counts rose to 137 × 109/L 3 days later. The mother's ab titre two weeks postdelivery rose back to 1 : 128. Due to observed interregional differences, our results caution prudence in the interpretation of regional vs. national epidemiological studies. Moreover, the overall HPA‐1b frequency in Scotland appears to be considerably higher than earlier indications, suggesting that NAIT may be under‐reported.
Clinical management and outcome for mother and child in suspected cases of NAITP
Authors: Husebekk A. , Jaegtvik S. , Killie M. K. , Aune B. , Oian P. , Dahl L.B. , Skogen B. R. 
Published: March 2003

Severe thrombocytopenia of the newborn is most often caused by alloantibodies to platelet antigens (a‐HPA 1a).The presence of alloantibodies may be suspected in newborns with signs or symptoms of thrombocytopenia. When a‐HPA 1a is detected in a pregnant woman, there is no general agreement on follow up in pregnancy or about time and mode of delivery. The aim of the present study was to identify pregnancies at risk, follow the women with a‐HPA 1a antibodies determinations and clinical evaluations and plan the delivery as safe as possible with respect to severe bleedings.R esults The frequency of HPA 1bb was found to be 2·1% (n=17,000) and in 12·0% of the HPA 1bb women, anti‐HPA 1a antibodies were detected. Fourteen babies were born with thrombocytopenia of < 35 × 109 L−1 and transfused. There was a clear correlation between antibody level in the mother and the severity of thrombocytopenia in the newborns. Beside from one clinical insignificant intracranial bleeding (ICH) detected by CT, all the children were healthy.D iscussion Based on earlier publications, 5–6 babies in our material should have had ICH with neurological sequels. We believe that the combination of early detection of antibodies, close clinical follow up, termination of the pregnancy at week 38 by Caesarean section and immediate compatible platelet transfusion may explain the profitable clinical outcome for the babies. This relatively simple regimen is beneficial for improvement of perinatal morbidity and mortality.
Genetic changes in D weak Spanish donors
Authors: Torres P. , García F. , Jurado M. , Calle C. , Rodriguez M. A. 
Published: March 2003

I ntroduction Recently some mutations were described in RHD gene associated to D weak. We have studied these changes in our blood donors.M aterial and M
ethod 56 D weak samples from our donors were studied in the following way: DNA extraction with DNAzol, PCR‐SSP of some fragments of RHD gene and digestion with Alw44I, Sac I, Alu l, Msp l restriction enzymes (F. Wagner, Blood 1999; 93: 385–393). In two samples with fenotipe ce, exons 4 and 5 of gene RHD were sequenced. In 6 samples, which seemed to be antigen D variant, all the exons of the RHD gene were amplified by PCR‐SSP. We also sequenced exons 4, 5 and 7 of the RHD gene and exon 5 of RHCE gene in one case. In two other cases, DVl atipical variants, RNA was extracted from reticulocytes and then cDNA of RHD gene was sequenced.R esults 28 samples have fenotype cEe and in all of them the mutation described in nucleotide 1154(G‐C) was detected. Of 17 samples with fenotype Cce 15 showed the described mutation in nucleotide 809(T‐G) and the remaining 2 showed a mutation in nucleotide 8(C‐G) as was previously pointed out. Two samples have ce fenotype and mutations in nucleotides 602(C‐G) and 667(T‐G). No mutations were located in 3 donors carrying Cce fenotype.Six of our cases belong to antigen D variants; one case is a caucasian cDe donor with a DAR variant with ceAR. Another case, cDEe fenotype, is a type l DVI variant. Two other CcDe fenotypes are DVl atypical variants due to the fact that they present a sustitution of RHD gene exons 3,4 and 5 for those corresponding to the RHCE gene. The study of the last two variants is being completed at present.C onclusions 1. We confirm in our study that D weak is associated to changes, previously described by Wagner et al. in RHD gene. 2. There is a strong correlation between haplotypes and genetic mutations. 3. The most frecuent haplotype associated to D weak in our donors is cDE(R2) showing a mutation in nucleotide 1154. 4. A DAR variant with ceAR has been detected in a caucasian donor. 5. We find ourselves in the position to confirm the existence of a new type of D Vl variant.
The relationship between ABO histo‐blood group, factor VIII and von Willebrand factor
Authors: O'Donnell J. , Laffan M. A. 
Published: March 2003

. ABO histo‐blood group is a major determinant of plasma levels of factor VIII (FVIII) and von Willebrand factor (vWF). Blood group O individuals have significantly (approximately 25%) lower plasma levels of both glycoproteins. This association is of clinical significance. Low plasma levels of either FVIII or vWF have long been established as causes of excess bleeding. Conversely, there is accumulating evidence that elevated FVIII–vWF levels may represent an important risk factor for ischaemic heart disease and venous thromboembolic disease. In spite of the well‐documented association between ABO blood group and FVIII–vWF levels, the underlying mechanism remains unknown. However, it has been established that the ABO effect is primarily mediated through a direct functional effect of the ABO locus on plasma vWF levels.Theoretically, ABO blood group may alter the rate of vWF synthesis or secretion within endothelial cells. Alternatively, ABO group may affect vWF plasma clearance rates. ABH antigenic determinants have been identified on the N‐linked oligosaccharide chains of circulating vWF and FVIII, according to the blood group of the individual. It remains unclear whether these carbohydrate structures are responsible for mediating the effect of ABO blood group on plasma vWF levels.
Low overall mortality of Turkish residents in Germany persists and extends into a second generation: merely a healthy migrant effect?*
Authors: Razum Oliver , Zeeb Hajo , Akgün H. Seval , Yilmaz Selma 
Published: March 2003

Summaryobjective To test the hypothesis that as a minority with lower socio‐economic status, Turkish residents in Germany might experience a higher mortality than Germans. methods All‐cause mortality rates by age group and sex of Turkish and German adults for the time period 1980–94 were calculated from death registry data and mid‐year population estimates. results The age‐adjusted mortality rate (per 100000) of Turkish males aged 25–65 years resident in Germany was 299 in 1980 and 247 in 1990, consistently half that of German males. The mortality of Turkish females in Germany was 140 in 1990, half that of German females. Mortality of Turkish males/females in Ankara was 835 and 426 in 1990. conclusion In view of the socio‐economic status of Turkish residents in Germany the large mortality difference compared to Germans is unexpected. It cannot be fully explained by a selection at the time of hiring (healthy migrant effect) because it lasts over decades and extends into the second generation. A healthy worker effect is unlikely because Turkish residents have a lower employment rate than Germans. There is little evidence for movement of gravely ill persons back to Turkey. An ‘unhealthy re‐migration effect’ in which socially successful migrants with a lower mortality risk stay in the host country while less successful ones return home even before becoming manifestly ill would partly explain our findings.
Implications for school‐based health programmes of age and gender patterns in the Tanzanian primary school
Authors: Lansdown R. G. , Bundy D. A. P. , Eberstein T. , Hall A. , Kihamia C. M. , Yona E. , Issae W. , Mwanri L. , Magingo J. 
Published: March 2003

SummaryThis paper examines children's potential access to school health services by analysing data on the demographic structure, enrolment patterns and reported causes of early school‐leaving in 347 schools in Tanga Region, Tanzania served by a school‐based health programme. The analysis indicates that net enrolment ratios have risen over the previous 6 years, particularly among children under 10 years. However, in 1994 children were still much older than expected for a basic school population: 81% were adolescents ($10 years) and the mean age was 12 years. These data suggest that schools can provide equitable access to health education and school‐based health services for a majority of children, even in a low‐income country, and that the primary school population is predominantly adolescent and would benefit from health programmes targeted at that age group.
The performance of school‐based questionnaires of reported blood in urine in diagnosing Schistosoma haematobium infection: patterns by age and sex
Authors: Guyatt Helen , Brooker Simon , Lwambo Nicholas J. S. , Siza Julius E. , Bundy Donald A. P. 
Published: March 2003

Summary

This study investigates the performance of school‐based questionnaires of reported blood in urine as an indicator of the prevalence of Schistosoma haematobium infection in schools and the presence of infection in individuals. In most schools (87%), the prevalence of reported blood in urine underestimates the prevalence of S. haematobium infection. Predictive value analysis suggests that a threshold of 30% reported blood in urine would identify most of the high prevalence schools (i.e. those with 50% or more children infected with S. haematobium). Although the prevalence of S. haematobium infection was greater in males than females, girls reported a lower prevalence of blood in urine than boys even at comparable levels of infection. Reported blood in urine in females was more specific (identifying 10% more uninfected girls than the sign in boys), but was far less sensitive (identifying less than 20% of infected girls than boys). The sensitivity of reported blood in urine was also related to age, being significantly lower in girls over 14 years of age. The proportion of infected children who reported blood in urine was also lower in schools where the prevalence of reported blood in urine is less than 30%. The results suggest that the selective treatment of children based on reported blood in urine in low prevalence schools would miss a high proportion of infected children, particularly girls. It remains unclear whether other rapid assessment techniques, such as the use of reagent strips, would offer greater cost‐effectiveness.
Control of urinary schistosomiasis: an investigation into the effective use of questionnaires to identify high‐risk communities and individuals in Niger State, Nigeria
Authors: Mafe M. A. , von Stamm T. , Utzinger J. , N'goran E. K. 
Published: March 2003

Summary Schistosomiasis is a public health problem in Nigeria. Although there is a national programme for its control, there is the need for reliable and simple means of rapidly diagnosing communities to provide a detailed map on the distribution of the disease in the country, in order to prioritize control activities, as well as to monitor the effectiveness of control operations. A rapid assessment technique using school questionnaires was tested in Borgu Local Government Area (LGA), Niger State, north‐western Nigeria. Following a series of focus group discussions, the questionnaires were adapted before they were administered through the school system to 60 primary schools in Borgu LGA. Correctly completed questionnaires were returned from 58 schools (97%) within 4 weeks. Questionnaires were validated by reagent stick tests performed by trained teachers. Their results proved to be reliable compared to those obtained by our research team in 20 randomly selected schools. Overall prevalences of microhaematuria at 1+ and 2+ levels were 45.7% and 27.1%, respectively. Highly significant correlations were obtained between school prevalence of microhaematuria and reported schistosomiasis, as well as reported blood in urine. The diagnostic performance of the questionnaires at the 2+ level of microhaematuria was very good. The design of our study also allowed data analysis on an individual level, and multivariate analysis revealed highly significant odds ratios for reported schistosomiasis and reported blood in urine to detect an individual with urinary schistosomiasis. Our results are in good agreement with reports from other African countries, and questionnaires can be recommended for rapid identification of communities at highest risk of urinary schistosomiasis in Nigeria, so that scarce resources of the national control programme can be used most effectively.
Development of rapid assessment procedures for the delimitation of lymphatic filariasis‐endemic areas
Authors: Srividya A. , Lall R. , Ramaiah K. D. , Ramu K. , Hoti S. L. , Pani S. P. , Das P. K. 
Published: March 2003

Summary Lymphatic filariasis caused by Wuchereria bancrofti is a major public health problem in 73 tropical and subtropical countries including India. Delimitation of endemic areas is essential to plan control operations. The current method of night blood survey (NBS) for delimitation is cumbersome, time‐consuming and expensive. Therefore, there is a need to develop assessment procedures which can rapidly delimit endemic areas. For this purpose we evaluated three procedures: direct interviewing of key informants using structured questionnaires, an indirect method of a self‐administered questionnaires to key informants and physical examination by health workers for the presence of chronic filarial disease. Thirty rural communities in a filariasis‐endemic region in Cuddalore district in Tamil Nadu State in southern India constituted the study population. The determination of filariasis endemicity in the village communities assessed by the above procedures was compared in terms of rapidity, specificity, sensitivity and cost with the microfilaria rate and disease rate obtained by night blood sample survey and clinical examination by physicians. Prevalence score, control preference score and weighted mean number of cases with filarial disease per village were calculated using the key informant questionnaire techniques. While the prevalence and control preference score showed low sensitivity and moderate specificity, weighted mean number of cases showed high sensitivity and moderate specificity in identifying endemic villages. The prevalence of disease as determined by the physical examination of a sample population by health workers was highly sensitive in identifying communities endemic for filariasis. The degree of association between the disease rates estimated by physician and trained health workers was significant (r = 0.56; P < 0.05). These observations suggest that the weighted mean number of cases per village obtained through key informant techniques may be considered at a primary level to crudely identify endemic areas, followed by physical examination by health workers for filariasis, since it is relatively cheap and rapid.
Chloroquine is not a risk factor for seizures in childhood cerebral malaria
Authors: Crawley Jane , Kokwaro Gilbert , Ouma David , Watkins William , Marsh Kevin 
Published: March 2003

Summary objectives  There are a number of case reports in the medical literature suggesting an association between the ingestion of chloroquine and subsequent seizure activity. Our study was designed to investigate the relationship between blood levels of chloroquine (CQ), its metabolite desethylchloroquine (DCQ), and seizures in children admitted to hospital with cerebral malaria.methods  Serial blood levels of CQ and DCQ were measured over the first 24 h of hospital admission in children with cerebral malaria. The number and duration of all seizures was recorded, and statistical analysis subsequently performed to determine the relationship between seizure activity and blood concentrations of CQ and DCQ.results  Chloroquine was detected in 92% (100/109) of admission blood samples. 54% (59/109) of the patients had one or more seizures after admission, while 8% (9/109) had an episode of status epilepticus. Median (interquartile range) baseline concentrations of CQ and DCQ were, respectively, 169.4 μg/ml (75.1–374.9) and 352.3 μg/ml (81.9–580.1) for those children who had seizures after admission, compared to CQ 227.5 μg/ml (79.4–430.2) and DCQ 364.0 μg/ml (131.3–709.4) for those who did not have seizures (P > 0.5 for all comparisons). Baseline concentrations of CQ and DCQ were not significantly associated with the occurrence of seizures lasting for 5 min or more. The nine children who had an episode of status epilepticus had significantly lower median admission levels of CQ than those without status epilepticus: 75.1 μg/l (7.4–116.5) vs. 227.5 μg/l (85.6–441.2), P = 0.02. Multivariate logistic regression analysis, taking into account factors likely to affect the risk of seizures in hospital, failed to change the significance of these results.conclusions  These findings suggest that chloroquine does not play an important role in the aetiology of seizures in childhood cerebral malaria.
Elimination of bancroftian filariasis (Wuchereria bancrofti) in Santa Catarina state, Brazil
Authors: Schlemper B. R. , Steindel M. , Grisard E. C. , Carvalho‐Pinto C. J. , Bernardini O. J. , de Castilho C. V. , Rosa G. , Kilian S. , Guarneri A. A. , Rocha A. , Medeiros Z. , Ferreira Neto J. A. 
Published: March 2003

Summary During the 1950s, three foci of Wuchereria bancrofti transmission were identified in the State of Santa Catarina, Brazil. In Florianópolis, São José da Ponta Grossa and Barra da Laguna community treatment of bancroftian filariasis with diethylcarbamazine (DEC) was performed using two distinct approaches, without vector control or improvements in sanitation. In two of the three communities only microfilaraemic individuals were treated, while in Barra da Laguna the entire population received DEC treatment regardless of their infection status. In both cases, transmission of the parasite was blocked and no new cases were detected in all localities for up to 10 years. Recently, a new survey in São José da Ponta Grossa and Barra communities revealed no microfilaria‐positive individuals, including residents that were positive in the 1950s. These data confirm that transmission of W. bancrofti was interrupted in Santa Catarina, and mass treatment appears to be more effective than treatment of microfilaraemic individuals only.
Brain damage after neonatal tetanus in a rural Kenyan hospital
Authors: Barlow J. L. , Mung'Ala‐Odera V. , Gona J. , Newton C. R. J. C. 
Published: March 2003

OBJECTIVE Neonatal tetanus (NNT) is an important cause of mortality in resource poor countries, particularly sub‐Saharan Africa. There are no reports of the long‐term outcome of children who survive NNT in African hospitals. DESIGN In a retrospective study of children discharged from Kilifi District Hospital (KDH), Kenya with NNT, each child was linked with a comparative child (CC) in the community matched for age, sex and locality. PARTICIPANTS A total of 123 patients were admitted with NNT between 1992 and 1996, of whom 68% died. Twenty‐three (59%) of the 39 survivors were traced in the community, 10 had moved away, six had died. OUTCOME MEASURES NNT survivors underwent a neurological and developmental examination and a questionnaire was administered to the parents about the behaviour of the child. A verbal autopsy was used to determine the cause of death in children who had died after discharge. RESULTS The head circumference of NNT survivors was significantly smaller than that of CC (P=0.037); eight children had microcephaly compared with one CC (P=0.011). NNT survivors had more problems with hand–eye co‐ordination tasks (P=0.035), a lower summated developmental score (P=0.023) and more mild neurological abnormalities (P=0.008) than CC. Parents of NNT survivors reported more behavioural problems (P=0.02) than parents of CC. CONCLUSIONS Children who survive NNT have evidence of brain damage that manifests as microcephaly, mild neurological abnormalities, developmental impairment – particularly fine motor difficulties – and behaviour problems.