bluuebunny/crossref_metadata_2025_split huggingface dataset:
Roll Back Malaria in the aftermath of complex emergencies: the example of Afghanistan
Authors: Kolaczinski Jan 
Published: August 2005

SummaryThe Roll Back Malaria (RBM) partnership was established in 1998 to address the worldwide malaria burden through a new approach. It was founded by four multilateral agencies that were already committed to supporting malaria control: the United Nations Development Programme, the United Nations Children's Fund, the World Bank and the World Health Organization. In contrast to previous campaigns, RBM focuses on strengthening existing health services to ensure that malaria can be controlled through an integrated approach, rather than through creation and maintenance of a separate structure. Field experience of RBM is rarely documented in the open scientific literature, making it difficult to judge its success and apply lessons learned to other settings. This paper aims at improving on this by documenting experience of RBM support in Afghanistan during initial post‐conflict reconstruction. From the analysis some recommendations emerged: (i) technical in‐country support needs to be provided for a number of years, as short postings are likely to provide only temporary solutions and may fail to contribute towards medium or long‐term development; (ii) the role and responsibilities of support staff need to be clear to all RBM partners; (iii) part of this role should be to act as focal point, in an attempt to improve on coordination and (iv) if possible, support staff should be seconded to the MoH, to avoid association of the RBM initiative with a specific international organization and to further the multi‐sectorial partnership approach.
Quantifying the level of under‐detection of Trypanosoma brucei rhodesiense sleeping sickness cases
Authors: Odiit M. , Coleman P. G. , Liu W.‐C. , McDermott J. J. , Fèvre E. M. , Welburn S. C. , Woolhouse M. E. J. 
Published: August 2005

SummaryTo formally quantify the level of under‐detection of Trypanosoma brucei rhodesiense sleeping sickness (SS) during an epidemic in Uganda, a decision tree (under‐detection) model was developed; concurrently, to quantify the subset of undetected cases that sought health care but were not diagnosed, a deterministic (subset) model was developed. The values of the under‐detection model parameters were estimated from previously published records of the duration of symptoms prior to presentation and the ratio of early to late stage cases in 760 SS patients presenting at LIRI hospital, Tororo, Uganda during the 1988–1990 epidemic of SS. For the observed early to late stage ratio of 0.47, we estimate that the proportion of under‐detection in the catchment area of LIRI hospital was 0.39 (95% CI 0.37–0.41) i.e. 39% of cases are not reported. Based on this value, it is calculated that for every one reported death of SS, 12.0 (95% CI 11.0–13.0) deaths went undetected in the LIRI hospital catchment area – i.e. 92% of deaths are not reported. The deterministic (subset) model structured on the possible routes of a SS infection to either diagnosis or death through the health system or out of it, showed that of a total of 73 undetected deaths, 62 (CI 60–64) (85%) entered the healthcare system but were not diagnosed, and 11 (CI 11–12) died without seeking health care from a recognized health unit. The measure of early to late stage presentation provides a tractable measure to determine the level of rhodesiense SS under‐detection and to gauge the effects of interventions aimed at increasing treatment coverage.
Plasmodium falciparum dhfr but not dhps mutations associated with sulphadoxine‐pyrimethamine treatment failure and gametocyte carriage in northern Ghana
Authors: Mockenhaupt Frank P. , Teun Bousema J. , Eggelte Teunis A. , Schreiber Jonas , Ehrhardt Stephan , Wassilew Nasstasja , Otchwemah Rowland N. , Sauerwein Robert W. , Bienzle Ulrich 
Published: August 2005

SummaryBoth use of sulphadoxine‐pyrimethamine (SP) and SP‐resistance of Plasmodium falciparum are increasing in sub‐Saharan Africa. Mutations in the P. falciparum dihydrofolate reductase (dhfr) and dihydropteroate synthase (dhps) genes can predict treatment failure of SP, however, the degree of this relationship varies regionally. In northern Ghana, pre‐treatment dhfr/dhps genotypes were examined in 126 children and associations with PCR‐corrected SP treatment outcome and gametocyte carriage were analysed. SP treatment failure within 4 weeks of follow‐up occurred in 28%. Among all pre‐treatment isolates, the dhfr triple mutation (Ile‐51 + Arg‐59 + Asn‐108) was detected in 47%. Compared with dhfr wildtype parasites, the presence of the dhfr triple mutation increased the risk of treatment failure tenfold. Likewise, parasite clearance was delayed in the presence of dhfr variants. Dhfr mutants and dhps Gly‐437 were selected in treatment failure isolates. Gametocytaemia 1 week following treatment was strongly associated with dhfr mutations. Remarkably, this was also true for the prevalence of gametocytes at recruitment. Dhps alleles did neither influence treatment outcome nor gametocyte carriage. In northern Ghana, the prevalence of the dhfr triple mutation can be used as a tool to screen for and to monitor SP resistance. The lack of association between dhps alleles and SP treatment outcome suggests a minor role of these molecular markers in this region at present.
Early diagnosis and treatment of uncomplicated malaria and patterns of health seeking in Vietnam
Authors: Giao Phan T. , de Vries Peter J. , Binh Tran Q. , Nam Nguyen V. , Kager Piet A. 
Published: August 2005

SummaryEarly diagnosis and treatment of malaria (EDTM) is a key component of malaria control. The success of EDTM depends on health seeking behaviour and the quality of the health service. This study assessed self‐diagnosis, treatment and treatment delay after the introduction of EDTM in 1993. In southern Vietnam EDTM comprises microscopic diagnosis and free treatment with artemisinin derivatives at public health facilities. Until 2001, 1698 questionnaires had been completed by patients participating in randomized treatment trials of uncomplicated malaria. The presumptive self diagnosis ‘malaria’ increased from 68% in 1993 to 100% in 2001 and self‐treatment decreased, from 74% to 8% in 2000 and 24% in 2001. The median (maximum) delay between first symptoms and seeking treatment at a public health facility decreased from 3 (23) to 1.3 (3) days (P < 0.001) Concomitant was a significant decline of reported incidence of malaria‐associated mortality, severe malaria and uncomplicated malaria. If offered an attractive package of EDTM, patients become sensitized to the possibility of malaria and less likely to self‐treat. EDTM should be provided as soon as possible to all symptomatic patients, aiming at reducing treatment delay to a maximum of 2 days.
Economic evaluation of a policy change from single‐agent treatment for suspected malaria to artesunate‐amodiaquine for microscopically confirmed uncomplicated falciparum malaria in the Oussouye District of south‐western Senegal
Authors: Agnamey P. , Brasseur P. , Cisse M. , Gaye O. , Dumoulin J. , Rigal J. , Taylor W. R. J. , Olliaro P. 
Published: August 2005

SummarySenegal is changing policy for case management of uncomplicated falciparum malaria, which hitherto is diagnosed clinically and treated with chloroquine or intramuscular quinine. The WHO recommends artemisinin‐based combinations for treating falciparum malaria, preferably based on a parasitological diagnosis. There are no economic projections if such a policy were introduced in Senegal. We have conducted a preliminary economic assessment of such a policy change. The study took place in the chloroquine‐resistant district of Oussouye in south‐western Senegal. We reviewed clinic registers of the district health posts (n = 5) from 1996 to 2001, and piloted artesunate combined with amodiaquine (at 4 and 10 mg/kg/day × 3 days respectively) (AS‐AQ) for treating slide‐proven falciparum malaria during two rainy seasons (2000 and 2001) at one health centre. These data were used to calculate current direct patient costs (clinic visit, diagnosis, drugs) of malaria treatment and project future costs for the district. The robustness of the model was tested by allowing for different drug failure rates and costs of diagnosis. During 1996–2001, the mean number of primary treatments per year was 7654 for a mean, direct cost of US$17 452 to the community. Clinical diagnosis resulted in over‐treatment: 56% and 66% in the wet and dry seasons respectively. Current policy leads to substantial drug wastage and excess direct costs for the community. The direct costs of implementing AS‐AQ for slide‐proven malaria would be US$8150 (53% less expensive). Studies examining the public health effect and economics of deploying AS‐AQ on a wider scale are underway in Senegal.
Erythroderma in adults: a report of 80 cases
Authors: Rym Benmously Mlika , Mourad Mokni , Bechir Zouari , Dalenda Eleuch , Faika Cherif , Iadh Azaiz Mohamed , Amel Ben Osman‐Dhahri 
Published: August 2005

AbstractBackground  Erythroderma is a generalized erythema of the skin accompanied by a variable degree of scaling. However, most of the published series originate from Western countries. There is only one report from Africa, conducted in Dakar in 1979. The aim of our study was to provide information about this condition in our country.Patients and methods  Our study was retrospective, dealing with 80 erythrodermic adults, examined between January 1981 and December 2000. Patient information included clinical, laboratory, histopathologic and therapeutic data. We also noted patients’ outcomes within an average follow‐up period of 30 months. Thus, we calculated the mortality rate and estimated the probability of survival without relapses according to the Kaplan‐Meier method.Results  The frequency of erythroderma in our dermatology department was 0.3. The sex ratio (male/female) was 2.2. The average age of our patients was 53.78 ± 18 years. Previous history of skin disease was found in 49/80 patients (61.2%) and 32 of them were suffering from psoriasis. Hyperthermia was significantly associated with drug reactions (P = 0.013). Hypereosinophilia was not a specific finding. The mortality rate was higher than that of an age‐matched population.Conclusion  Adult erythroderma is a rare condition. Its most common cause in our study was psoriasis. No cases of atopic dermatitis were found. Prognosis was adversely affected by the presence of erythroderma.
Childhood melanoma: update and treatment
Authors: Huynh Phung M. , Grant‐Kels Jane M. , Grin Caron M. 
Published: August 2005

AbstractChildhood melanoma is a rare but potentially fatal disease that is important to include in the differential diagnosis of any pigmented lesion in a child. The best prognosis is achieved with early diagnosis and definitive surgical excision. Adjuvant chemotherapy and immunotherapy are options for those with more advanced tumors. Melanoma in children must be treated as aggressively as in adults because childhood melanoma may be equally devastating.
Treatment of keloids and hypertrophic scars with dermojet injections of bleomycin: a preliminary study
Authors: Saray Yasemin , Güleç A. Tülin 
Published: August 2005

AbstractBackground  Numerous treatment modalities have been used to treat keloids and hypertrophic scars, but the optimal treatment has not been established.Objective  The aim of this study was to determine the efficacy and safety of intralesional jet injection of bleomycin as therapy for keloids and hypertrophic scars that are unresponsive to intralesional steroid injection.Methods  The study included 14 patients with 15 keloids or hypertrophic scars that had not responded to a minimum of three intralesional injections of triamcinolone acetonide. Multiple jet injections of 0.1 ml of bleomycin (1.5 IU/ml) were administered to each lesion, with injection sites spaced 0.5 mm apart. Injections were repeated each month. Scar height was measured, and scar pliability and erythema were scored at baseline and then monthly during the treatment and follow‐up periods.Patients’ self‐assessments of subjective symptoms (pruritus and pain) were also scored. Clinical improvement was defined primarily on the basis of scar height reduction (percentage reduction from baseline), and was classified using the following scale: complete flattening (100%), highly significant flattening (> 90%), significant flattening (75–90%), moderate flattening (50–75%), and minimal flattening (< 50%). Pre‐ and post‐treatment mean values for scar height, scar pliability, erythema, pruritus and pain were statistically compared.Results  The number of sessions required to successfully treat the lesions ranged from two to six. Eleven lesions (73.3%) showed complete flattening, one (6.7%) showed highly significant flattening, two (13.3%) showed significant flattening, and one scar (6.7%) showed moderate flattening. The mean scar height was significantly lower, and the mean scores for scar pliability and erythema were significantly better at the end of treatment (P < 0.001, P < 0.001 and P < 0.001, respectively). The mean scores for pruritus and pain also improved significantly (P < 0.001 and P = 0.01, respectively). The observed side‐effects were hyperpigmentation (four lesions) and skin atrophy (three lesions). No recurrences were noted during follow up (mean duration of 19 months).Conclusions  Intralesional jet injection of bleomycin is an effective and safe method of treating keloids and hypertrophic scars that are unresponsive to intralesional steroid therapy.
Effects of anaesthesia using endotracheal intubation or the laryngeal mask airway, or spinal anaesthesia, on oral mucosal host defences during minor surgery
Authors: Lähteenmäki M. , Salo M. , Tenovuo J. , Vahlberg T. 
Published: August 2005

Background:  Oral mucosal host defences are altered after anaesthesia and surgery. The effects of endotracheal intubation (ET) and the use of the laryngeal mask airway (LMA) on oral mucosal host defences after minor surgery were compared.Methods:  Immunological (immunoglobulin A (IgA), IgG and IgM) and non‐immunological (myeloperoxidase, total peroxidase, thiocyanate) oral host defence factors, and amylase and protein concentrations, were measured from saliva pre‐operatively and on the first post‐operative day in 60 ASA I–II patients undergoing minor surgery. The patients underwent general anaesthesia using oral ET or LMA. Spinal anaesthesia (S) was used as control. Serum IgG, IgM and IgA concentrations were determined.Results:  Protein‐related salivary secretion of amylase and salivary concentration of IgM showed the only statistically significant overall differences between the groups. By contrast, changes were observed within the ET group in the salivary flow rate, protein concentration, amylase activity and immunological host defence factors. Some changes were also observed in the LMA group, but none in the S group. Most non‐immunological test values did not change within any of the groups.Conclusions:  ET and LMA induced similar oral mucosal host defence responses. There were, however, observations in this study that indicated a stronger response during ET than when LMA was used.
Comparison of alfetanil and ketamine in combination with propofol for patient‐controlled sedation during fiberoptic bronchoscopy
Authors: Hwang J. , Jeon Y. , Park H.‐P. , Lim Y.‐J. , Oh Y.‐S. 
Published: August 2005

Background:  During fiberoptic bronchoscopy, propofol, ketamine, benzodiazepines, and opiates are most commonly used, alone or in combination for sedation. The aim of this study was to compare the clinical efficacy of propofol/ketamine with propofol/alfentanil for patient‐controlled sedation (PCS) during fiberoptic bronchoscopy.Method:  Patients undergoing fiberoptic bronchoscopy were randomly assigned to receive either propofol/alfentanil (PA group; n = 138) or propofol/ketamine (PK group; n = 138) via a patient‐controlled analgesia (PCA) device for sedation and analgesia. Changes in blood pressure, heart rate (HR), and oxygen saturation were monitored. Degree of patient and bronchoscopist satisfaction was evaluated using a 10‐cm visual analog scale (VAS) (0 = extremely uncomfortable to 10 = extremely comfortable).Results:  After sedation, systolic arterial pressure (SAP) decreased in the PA group, but SAP was stable in the PK group. Compared with values immediately before starting bronchoscopy, SAP and HR increased during the procedure in both groups (P < 0.05). Patients in the PK group showed more satisfaction [(9.5 (6–10) vs. 9.0 (6–10)), P < 0.05] and amnesia (82% vs. 61%, P < 0.01). Despite these differences, the majority (greater than 90%) of the patients in both groups stated that they were comfortable during the procedure.Conclusion:  Our results show that although both techniques proved effective for sedation in patients undergoing fiberoptic bronchoscopy, ketamine is superior to alfentanil when used in combination with propofol because of the high patient satisfaction and amnesia.
Evaluation of the airway of the SimMan™ full‐scale patient simulator
Authors: Hesselfeldt R. , Kristensen M. S. , Rasmussen L. S. 
Published: August 2005

Background: SimMan™ is a full‐scale patient simulator, capable of simulating normal and pathological airways. The performance of SimMan™ has never been critically evaluated.Methods: Sixty subjects (anesthesiologists, nurse anesthetists, and anesthesia residents) performed mask ventilation, laryngeal mask insertion and endotracheal intubation on SimMan™. The simulator's airway was evaluated using visual analog scales (VAS) and by measuring the subject's performances.Results: The SimManTMfull‐scale patient simulator's airway is generally acceptably realistic but it significantly differs from the human airway in important aspects. Mask seal was more difficult than in humans whereas Laryngeal mask (LMATM) insertion and function was acceptable. The distance from the teeth to the vallecula was too short. Cervical spine mobility was significantly reduced in the ‘reduced neck movement’ mode but the intubation was only slightly more difficult than in the ‘normal’ mode.Conclusion: The SimManTMfull‐scale patient simulator's airway is generally acceptably realistic but it significantly differs from the human airway in important aspects. The user must be aware of these aspects in order to obtain maximum benefit from training and evaluation scenarios and when using the simulator for testing new equipment and techniques.
The coagulopathy of massive transfusion
Authors: Hardy J.‐F. , De Moerloose P. , Samama C. M. 
Published: August 2005

Recently, the Groupe d’Intérêt en Hémostase Périopératoire reviewed the pathophysiology of coagulopathy in massively transfused, adult and previously haemostatically competent patients in both elective surgical and trauma settings. In this article, we focus on our main observations.First, in most cases, the onset and severity of coagulopathy associated with massive transfusion differs depending on whether haemorrhage occurs as a result of trauma or elective surgery. In trauma patients, tissue trauma is uncontrolled, the interval between haemorrhage and treatment can vary widely, hypovolemia, shock and hypothermia are frequent, and coagulopathy is often related to the development of disseminated intravascular coagulation. Monitoring of haemostasis occurs late, when coagulopathy is installed, and treatment can be very difficult. In elective surgery patients, the situation remains controlled and, in most cases, a decrease in fibrinogen concentration is observed initially while thrombocytopenia is a late occurrence. Monitoring of haemostasis is ongoing and treatment is usually much simpler.Second, blood products have changed over time and this has affected the management of the bleeding patient. Contrary to the recommendations of studies published at a time when whole blood was readily available, the first line of treatment (at least in elective surgery patients) ought to be with fresh‐frozen plasma to correct decreased levels of coagulation factors. The role of recombinant activated factor VII to treat bleeding that cannot be controlled by conventional measures remains to be clarified.Coagulopathy associated with massive transfusion remains an important clinical problem. Treatment strategies must be adapted to the context and to the blood products available. Nevertheless, the level of evidence supporting specific treatment options is low and more studies are required to guide our management of massively transfused patients.
Detection of HCV and HIV‐1 antibody negative infections in Scottish and Northern Ireland blood donations by nucleic acid amplification testing
Authors: Jarvis L. M. , Dow B. C. , Cleland A. , Davidson F. , Lycett C. , Morris K. , Webb B. , Jordan A. , Petrik J. 
Published: August 2005

Background and Objectives  To reduce the risk of transfusion‐transmissible viruses entering the blood supply, the nucleic acid amplification testing (NAT) was implemented to screen Scottish and Northern Irish blood donations in minipools. After 5 years of NAT for hepatitis C virus (HCV) and 2 years for human immunodeficiency virus‐1 (HIV‐1), the yield of serologically negative, nucleic acid positive ‘window donations’ and cost‐benefit of NAT is under review.Materials and Methods  When the Scottish National Blood Transfusion Service (SNBTS) implemented NAT in 1999, a fully automated ‘black box’ system was not available. Therefore, an ‘in‐house’ assimilated NAT assay was developed, validated and implemented. The system is flexible and allows testing for additional viral markers to be introduced with relative ease.Results  The HCV and HIV NAT assays have 95% detection levels of 7·25 IU/ml and 39·8 IU/ml, respectively, as determined by probit analysis. One HCV (1 in 1·9 million) and one HIV (1 in 0·77 million) window donation have been detected in 5 and 2 years, respectively, of NAT.Conclusion  The SNBTS NAT assays are robust and have performed consistently over the last 5 years. The design of the in‐house system allowed HIV NAT to be added in 2003 at a relatively small additional cost per sample, although for both assays, the royalty fee far exceeds the cost of the test itself. Clearly NAT has a benefit in improving the safety of the blood supply although the risks of transfusion‐transmitted viral infections, as reported in the Serious Hazards of Transfusion (SHOT) report, are extremely low. Also, in UK the yield of HCV antibody negative, NAT positive donations is far lower than predicted although the early detection of an HIV window period donation and the increase of HIV in the blood donor and general populations may provide a stronger case for HIV NAT.Summary sentence  The yield of HCV and HIV NAT in UK is significantly less than that anticipated from statistical models.