bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving private practitioner sick‐child case management in two urban communities in Pakistan
Authors: Luby Stephen , Zaidi Najam , Rehman Simi , Northrup Robert 
Published: March 2003

OBJECTIVE To evaluate if INFECTOM, a multicomponent behaviour change strategy, would alter the care received by children visiting private healthcare providers so that it was more consistent with the IMCI algorithm. METHODS Community surveys in two low income communities in Pakistan identified children who had visited healthcare providers in the preceding 2 weeks complaining of diarrhoea, cough or rapid breathing, or fever. Interviewers asked the mothers of these children whether providers performed specific behaviours recommended by the Integrated Management of Childhood Illness (IMCI) algorithm. These data were analysed to generate provider‐specific IMCI‐related behaviour profiles. A team including community representatives met with the providers, discussed the correct IMCI algorithm behaviour, reviewed the percentage of time each of their practices was consistent with IMCI recommendations, and negotiated a contract with a numerical target for improved practices. This cycle of survey, discussion of results and contracting was repeated three times over 10 months. RESULTS Twenty‐two providers, 13 of whom (59%) had a medical degree, regularly treated children in the two communities. Sixteen of the 21 targeted behaviours (76%) occurred with significantly increased frequency during the course of the intervention. Of the 10 practices that ill children with any of the syndromes should have received, at baseline children averaged receiving 4.3. In the final model, each subsequent round of evaluation was associated with a 0.57 increase in the number of appropriate practices performed at visits to non‐Bachelor's Degree in Medicine (MBBS) qualified providers (P < 0.001) and a 0.75 increase among visits to MBBS qualified providers (P=0.004). The percentage of children who received an injection decreased from 70 to 56% (P=0.03). CONCLUSIONS INFECTOM altered the practices of private providers so that they were more consistent with the IMCI algorithm. Efforts to further develop this approach could improve the quality of clinical healthcare in other settings.
Socioeconomic status and risk of HIV infection in an urban population in Kenya
Authors: Hargreaves James R. , Morison Linda A. , Chege Jane , Rutenburg Naomi , Kahindo Maina , Weiss Helen A. , Hayes Richard , Buvé Anne ,   for the Study Group on Heterogeneity of HIV Epidemics in African Cities
Published: March 2003

SummaryObjective To examine the relationship between socioeconomic status (SES), risk factors for HIV infection and HIV status in an urban population with high prevalence of HIV infection in sub‐Saharan Africa.Methods  Cross‐sectional population survey of adults from the city of Kisumu, Kenya, in 1996. Around 1000 men and 1000 women aged 15–49 years were interviewed using a structured questionnaire, and most gave a venous blood sample for HIV testing. SES was represented by a composite variable of educational status, occupation and household utilities. Multiple regression was used to examine whether SES was associated with HIV infection or with risk factors for HIV infection.Results  Human immunodeficiency virus prevalence was 19.8% in males and 30.2% in females. Higher SES was associated with a more mobile lifestyle, later sexual debut and marriage among both sexes, and with circumcision among men aged 25–49 and condom use among women aged 25–49. Higher levels of alcohol consumption were associated with an increased risk of HIV infection and were more common amongst those of higher SES. HSV‐2 infection was strongly associated with an increased risk of HIV infection and was more common among those of lower SES. HIV was associated with a lower SES among females aged 15–24 whereas in males aged 15–24 and females aged 25–49 there was some indication that it was associated with higher SES. Among males aged 25–49 there was no association between HIV infection and SES.Conclusions  Risk of infection was high among groups of all SES. Risk profiles suggested men and women of lower SES maybe at greater risk of newly acquired HIV infection. New infections may now be occurring fastest among young women of the lowest SES.
Artemisinin or chloroquine for blood stage Plasmodium vivax malaria in Vietnam*
Authors: Phan Giao T. , De Vries Peter J. , Tran Binh Q. , Le Hung Q. , Nguyen Nam V. , Nguyen Thang V. , Heisterkamp Siem H. , Kager Piet A. 
Published: March 2003

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

Summaryobjective  To obtain baseline information for designing a community‐based intervention programme aimed at increasing the cervical cancer screening coverage of women most at risk.methods  A population‐based survey, using proportional stratified two‐stage cluster sampling in Rivas, one of the 16 Departments of Nicaragua. The individuals selected were interviewed at home by one of 26 interviewers, using a structured questionnaire. The questionnaire was designed to elicit (1) knowledge, attitudes and practices concerning sexual and reproductive health and behaviour, (2) risk factors for cervical cancer and (3) the use of health and cervical cancer screening services.results  A total of 612 men and 634 women participated in the survey. Of the women who had been sexually active at least 3 years, only 41.1% had undergone screening within that period and were considered adequately screened. Correlates of inadequate screening status included low educational level, exclusive use of public health facilities and lack of knowledge about prevention and symptoms of cervical cancer. Negligence, absence of medical problems, fear, lack of knowledge and economic reasons were the main reasons given for not being screened. Reluctance to be screened in the future was related to lack of knowledge of the disease, inadequate screening status, older age and low educational level.conclusions  The current screening programme is not effective in reaching the majority of the population. Complementary activities such as education and information, as well as a more pro‐active approach to invite women for screening are necessary.
Malaria and amphetamine ‘horse tablets’ in Thailand
Authors: Newton Paul N. , Chierakul Wirongrong , Ruangveerayuth Ronatrai , Abhigantaphand Duangporn , Looareesuwan Sornchai , White Nicholas J. 
Published: March 2003

SummaryDuring recent clinical malaria research in Thailand we found a high frequency of amphetamine misuse and withdrawal amongst patients admitted to hospital with Plasmodium falciparum malaria. This comorbidity may cause diagnostic confusion, alter malaria pathophysiology and lead to drug interactions.
Comparison of the average percentage of thyroid colloid and selected serum thyroid analyses in healthy euthyroid and severely ill dogs
Authors: Torres S. M. F. , Feeney D. A. , Lekcharoensuk C. , Fletcher T. F. , Clarkson C. E. , Nash N. L. , Hayden D. W. 
Published: March 2003

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

The purpose of this retrospective study was to evaluate the efficacy of various therapeutic options in dogs with lupoid onychodystrophy. The treatment records of 30 dogs with lupoid onychodystrophy diagnosed by clinical and histological changes at three institutions (Animal Skin and Allergy Clinic: Melbourne, Colorado State University and Denver Veterinary Specialists) were evaluated retrospectively. The response to various treatments was graded as excellent (normal claws), good (claws still dystrophic, but no associated clinical signs or onychomadesis), partial (still occasional onychomadesis) or poor (no change with treatment). Dogs were treated with either fatty acid supplementation (n = 17), doxycycline and niacinamide (n = 13), tetracycline and niacinamide (n = 10), pentoxifylline (n = 5), prednisolone (n = 4), azathioprine (n = 1) or clofazimine (n = 1) or with combinations thereof. Most dogs initially were treated with antibiotics typically effective against cutaneous pathogens, and in most dogs this led to partial improvement only. An excellent or good response was seen in approximately half of the patients treated with tetra‐ or doxycycline in combination with niacinamide. Six of the dogs were maintained successfully on fatty acid supplementation, two on pentoxifylline. An excellent response was seen in two of the three dogs treated exclusively with antibiotics. Spontaneous remissions and recurrences made evaluation of success rates difficult. A variety of medications may be useful in the treatment of lupoid onychodystrophy, although the high success rate of fatty acids previously reported could not be confirmed. The study emphasized the varied and often unclear aetiology and natural course of the syndrome. This study was supported financially by Colorado State University.
The significance ofDemodex folliculorumdensity in rosacea
Authors: Erbagˇci Zülal , Özgöztaşi Orhan 
Published: March 2003

AbstractBackgroundDemodex folliculorumhas been reported in rosacea in a number of clinical studies. As theDemodexmite is also present in many healthy individuals, it has been suggested that the mite may have a pathogenic role only when it is present in high densities. Moreover, some authors have proposed that a mite density above 5/cm2may be a criterion for the diagnosis of inflammatory rosacea. In this study, the possible role ofD. folliculorumand the importance of mite density in rosacea were investigated using a skin surface biopsy technique.MethodsThirty‐eight patients with rosacea and 38 age‐and‐sex‐matched healthy subjects entered the study. With the skin surface biopsy technique, we obtained samples from three facial sites. We then determined the mite positivities, the mean mite counts in both study groups, the mean mite densities at each facial site and in the rosacea subgroups, and the mite densities above 5/cm2.ResultsThe mean mite count in the rosacea group (6.684) was significantly higher than that in controls (2.868;p< 0.05). The cheek was the most frequently and heavily infested facial region. Ten rosacea patients and five normal subjects had mite densities over 5/cm2; the difference was not statistically significant (p> 0.05).ConclusionsRosacea is a disease of multifactorial origin, and individual properties may modify the severity of the inflammatory response toDemodex. We suggest that a certain mite density is not an appropriate criterion in the diagnosis of the disease; nevertheless, large numbers ofD. folliculorummay have an important role in the pathogenesis of rosacea, together with other triggering factors.
Value of routine diagnostic criteria of bullous pemphigoid
Authors: Chaidemenos MD George Ch. , Maltezos MD Efstratios , Chrysomallis MD Fotis , Kouskoukis MD Konstantinos , Kapetis MD Evangelos , Mourellou MD Olga , Gotsis MD Nikos 
Published: March 2003

Background and designThe clinical, histologic, and direct (DIF) and indirect (IIF) immunofluorescence findings are used in a critical, although arbitrary, manner in the routine diagnostic process of bullous pemphigoid (BP). Our purpose was to estimate their relative value. In the present retrospective study, a follow‐up of at least 18 months was used as a prerequisite for the final diagnosis of BP (63 patients) and controls (n = 159). ResultsThe clinical, histologic, DIF, and IIF diagnostic criteria of BP were found to vary independently of each other. Positive DIF was the most sensitive (90.5%) typical for BP histology and positive IIF were the most specific (99%). Immunopathologic tests were the most valuable, especially in the atypical varieties of BP. Nearly 25% of patients in this group would have been misdiagnosed if IF tests had not been performed. Atypical cases (40%) seemed to represent a clinical continuum over the whole spectrum of the disease. Patients with exclusively immunoglobulin G (IgG) and C3 basal membrane zone (BMZ) deposits were significantly more often seropositive than the rest of the DIF‐positive cases; however, the class of BMZ immunoreactants varied according to the site of biopsy. C3 was almost invariably deposited at the BMZ of DIF‐positive patients. When Igs were also present, they were only exceptionally (5% of cases) of greater fluorescence intensity than C3. ConclusionsThe combination of clinical data plus one positive immunopathologic test provide the best combination of sensitivity and specificity (98%), and seem to be most appropriate in defining patient populations for study purposes. The relationship between the classes of immunoreactants should be better evaluated with reference to the site of skin biopsy. It may be suggested, however, that the likelihood of BP existence is very low when in vivo C3 is absent or of lower intensity of fluorescence than the concomitant Ig(s).
Etiologic aspects of chronic urticaria
Authors: Liutu Mervi , Kalimo Kirsti , Uksila Jaakko , Kalimo Hannu 
Published: March 2003

Abstract Background Urticaria is a common disease that is always a challenge to the dermatologist due to its evasive etiology. Patients and methods One hundred and seven chronic urticaria patients were studied. Routine laboratory investigations were performed and Helicobacter pylori (H. pylori) immunoglobulin G (IgG) antibody determinations, autoimmune reactivity, infections, allergies, and hyperreactivities were investigated. Results Pathologic findings were seen in 92 patients. Concomitant diseases suggesting autoimmune reactivity were detected in nine patients and, in 16 patients, infections including maxillary sinusitis, streptococcal tonsillitis, and tooth infection were found. Elevated total IgE level was detected in 37 out of 75 patients and positive skin prick test results in 47 out of 91 patients. Fifty‐five patients had a history of recent dyspeptic symptoms. A diagnosis of adult celiac disease was made in two patients and, additionally, IgA antigliadin antibodies were seen in four patients. H. pylori IgG antibodies were found in 40 out of 107 patients. Active gastritis was verified by esophagogastroduodenoscopy in 30 out of 32 patients with positive Helicobacter staining in 24 samples. An elevated IgE level was detected in 64% of H. pylori‐positive and in 39% of H. pylori‐negative patients. Conclusions In this study, several findings suggesting aberrant immunologic activation were detected in chronic urticaria patients. Inflammation in the gastrointestinal tract, e.g. caused by H. pylori infection, may have an important role in the etiology of chronic urticaria.
Eccrine angiomatous hamartoma
Authors: Kwon Oh‐Chan , Oh Shin‐Taek , Kim Sung‐Wook , Park Gun‐Su , Cho Baik‐Kee 
Published: March 2003

A 50‐year‐old Korean man had an erythematous patch on the left side of his chest since birth ( Fig. 1). We first regarded this lesion as nevus flammeus because of the resemblance of the lesion to an erythematous patch that blanched with pressure. Physical examination revealed an 8×5 cm erythematous patch with a central profuse sweating zone surrounded by a flame‐like non‐sweating zone (
Fig. 2). The patch was sharply demarcated from the normal skin. Sweating was evoked by physical exercise or emotional stress. There was no history of pain or tenderness for the lesion. The patient had no history of any other vascular disease. Histopathologic examination of the central zone showed an increased number of eccrine glands in the mid and deep dermis. Some dilated vascular channels that were not associated with the eccrine glands were present in the upper dermis and subcutaneous tissue (
Fig. 3). Immunohistochemical stain with anti‐factor VIII‐related antigen showed reactivity on the endothelia of the vascular elements which were not associated with eccrine glands in the upper dermis. Histopathologic examination of the surrounding zone showed non‐specific findings, except for the dilated vascular channels in the upper dermis.(A) hyperhidrotic erythematous patch on the left side of the chestimage(A) sharply demarcated 8×5 cm erythematous patch with a central profuse sweating zone surrounded by a flame‐like non‐sweating zoneimageSeveral eccrine angiomatous lobules in the mid and deep dermis, and hyperplasia and dilation of vascular structures in the upper dermis and the subcutaneous fat (hematoxylin and eosin, ×100)image
Oral lichen planus and HCV infection: a clinical evaluation of 263 cases
Authors: Mignogna Michele D. , Lo Muzio Lorenzo , Favia Gianfranco , Mignogna Roberto E. , Carbone Roberto , Bucci Eduardo 
Published: March 2003

Abstract Background Hepatitis C virus (HCV) infection induces variable dermatologic manifestations. Our purpose was to determine whether there is an association between HCV infection and oral lichen planus (OLP). Methods Antibodies to HCV were determined in patients with OLP (263 patients; 156 women and 107 men, with a mean age of 55.5 years) and in a control population. Results Seventy six cases (28.8%) were positive for HCV antibodies with the second‐generation enzyme‐linked immunosorbent assay (ELISA II) test. All of these cases were confirmed with the second‐generation recombinant immunoblot assay (RIBA II) test. In 61 cases (23.1%), high levels of serum transaminase were found. Positivity for hepatitis B virus (HBV) markers was found in 31 patients (11.7%) and for hepatitis A virus (HAV) markers in 43 patients (16.3%). None had positivity for hepatitis D virus (HDV) markers. As a control group, we used 100 patients (58 women and 42 men, with a mean age of 55.3 years) referred to the School of Dentistry of the University of Naples “Federico II,” and treated for general dental caries. In the control group, HCV antibody positivity was found in three cases. Conclusions The high prevalence of HCV antibody in this group of patients with OLP, higher than in the healthy population, suggests a link (p = 1.423 × 10–7, chi‐squared test) between these two diseases. These findings stress the importance of liver examination in OLP patients, and the need for other studies on the high susceptibility to hepatitis viruses in the population in the southern part of Europe.
Microbiology of perianal cellulitis in children: comparison of skin swabs and needle aspiration
Authors: Brook Itzhak 
Published: March 2003

AbstractObjective To establish the aerobic and anaerobic microbiology of perianal cellulitis in children, comparing skin swab and needle aspirate methodology.Method Swabs of involved skin and needle aspirates of cellulitis were studied for aerobic and anaerobic bacteria.Results Specimens obtained from 10 patients with perianal cellulitis showed bacterial growth. Polymicrobial aerobic–anaerobic flora was found in all skin surface cultures, where the predominate isolates were Peptostreptococcus spp., Escherichia coli, and alpha hemolytic streptococci. The number of isolates in needle aspirates varied between one and two. The predominant ones were E.coli (3), Peptostreptococcus spp. (3), Staphylococcus aureus (2), and Bacteroides fragilis group (2). Complete or partial concordance in microbiology between skin swabs and needle aspirates was present in six instances. In four instances, isolates recovered from needle aspirates were not isolated from the skin surface.Conclusions This study demonstrates the diversity of aerobic and anaerobic organisms isolated from perianal cellulitis, and the superiority of needle aspirates in establishing the microbiology of the infection.