bluuebunny/crossref_metadata_2025_split huggingface dataset:
A comparative analysis of the cost‐effectiveness of treatment based on parasitological and symptomatic screening for Schistosoma mansoni in Burundi
Authors: Carabin Hélène , Guyatt Helen , Engels Dirk 
Published: March 2003

Summary OBJECTIVES  To assess the cost‐effectiveness of three alternative screening strategies in delivering treatment to patients presenting with symptoms suggestive of S. mansoni, using data collected from 17 PHCCs in the Rusizi Plain, Burundi. The three strategies were: (1) screening all symptomatic patients using a Kato‐Katz smear and treating only the ones found positive; (2) treating all symptomatic patients or (3) treating only those presenting with symptoms of severe diarrhoea (blood in stool). METHODS  The database consisted of 41 051 visits of symptomatic patients to the 17 PHCCs during 1990. Effectiveness was measured as the number of infected patients treated (gold standard: 25‐mg Kato‐Katz smear). Cost‐effectiveness ratios (CERs) (cost in US$ per infected patient treated) were used to compare the control strategies. Sensitivity analysis was performed to assess the effect of drug price and prevalence of infection on the CERs. RESULTS  The overall prevalence of S. mansoni infection was 9.5% (95% CI = 9.1%, 9.9%). Treating only those with severe symptoms of infection would have left 92% of infected patients untreated. Performing a Kato‐Katz smear to confirm the diagnosis was more cost‐effective than treating all symptomatic patients on a presumptive basis, with CERs of 4.2 US$ and 12.43 US$ per infected person treated, respectively. Sensitivity analysis showed that, for a cost of 0.99 US$ per dose of praziquantel, the Kato‐Katz option remained the most cost‐effective approach for prevalences under 76%. For a drug price of 0.21 US$ per dose, both strategies would have become equivalent. The latter value varied extensively per PHCC (range 0.17 US$ to 0.51 US$), due to the different prevalences of infection (range 0.5% to 34.3%). CONCLUSION  We found that using severe diarrhoea as an indicator for infection was not appropriate, and that screening symptomatic patients with the Kato‐Katz method remained the most cost‐effective approach in the given setting. The CER of treating all symptomatic patients on a presumptive basis depended very much on the drug price and the endemic level.
What does a single determination of malaria parasite density mean? A longitudinal survey in Mali
Authors: Delley Véronique , Bouvier Paul , Breslow Norman , Doumbo Ogobara , Sagara Issaka , Diakite Mahamadou , Mauris Anne , Dolo Amagana , Rougemont André 
Published: March 2003

Summary Temporal variations of blood parasite density were evaluated in a longitudinal study of young, asymptomatic men in a village with endemic malaria in Mali (West Africa). Our main intention was to challenge the value of a single measure of parasite density for the diagnosis of malaria, and to define the level of endemicity in any given area. Parasitaemia and body temperature were recorded three times a day in the wet season (in 39 subjects on 12 days) and in the dry season (in 41 subjects on 13 days). Two thousand nine hundred and fifty seven blood smears (98.5% of the expected number) were examined for malaria parasites. We often found 100‐fold or greater variations in parasite density within a 6‐hour period during individual follow‐up. All infected subjects had frequent negative smears. Although fever was most likely to occur in subjects with a maximum parasite density exceeding 10000 parasites/mm3 (P = 0.009), there was no clear relationship between the timing of these two events. Examples of individual profiles for parasite density and fever are presented. These variations (probably due to a ‘sequestration‐release’ mechanism, which remains to be elucidated) lead us to expect a substantial impact on measurements of endemicity when only a single sample is taken. In this study, the percentage of infected individuals varied between 28.9% and 57.9% during the dry season and between 27.5% and 70.7% during the wet season. The highest rates were observed at midday, and there were significant differences between days. Thus, high parasite density sometimes associated with fever can no longer be considered as the gold standard in the diagnosis of malaria. Other approaches, such as decision‐making processes involving clinical, biological and ecological variables must be developed, especially in highly endemic areas where Plasmodium infection is the rule rather than the exception and the possible causes of fever are numerous.
Serum ferritin and other haematological measurements in apparently healthy adults with malaria parasitaemia in Lagos, Nigeria
Authors: Odunukwe N. N. , Salako L. A. , Okany C. , Ibrahim M. M. 
Published: March 2003

SummaryWe studied 300 apparently healthy residents of Lagos aged 16–57 years. Their mean ferritin levels were 99.6 ± 50.5 µg/l (men aged 20–57) and 66.5 ± 44 µg/l (women aged 20–53) in aparasitaemic individuals. In parasitaemic subjects, mean ferritin levels were 133.1 ± 48.3 µg/l (men aged 20–56) and 114.8 ± 51.1 µg/l (women aged 16–50). Mean haematocrit values for aparasitaemic males were 45.7 ± 5.6% and 37.9 ± 5% for females, while mean haemoglobin levels were 153.2 ± 1.5 µg/l and 124 ± 3 µg/l, respectively. The mean values for MCV (mean corpuscular volume), MCH (mean corpuscular haemoglobin) , MCHC (mean corpuscular haemoglobin concentration) were 101.7 ± 8 fl, 30.6 ± 2.2 pg, 335 ± 0.4 g/l and 99.8 ± 10.1fl, 29.1 ± 6.5 pg, 335 ± 6 g/l. Serum iron levels were 34.2 ± 5 µmol/l and 29.5 ± 7.7 µmol/l. All haematological parameters measured were similar in both malaria parasitaemia positive and negative subjects, except ferritin level which was significantly higher in parasitaemic individuals (P < 0.05). Ferritin concentration and malaria density (r = 0.76 in males, r = 0.74 in females, P < 0.05) were positively correlated. Ferritin levels of subjects infected with Plasmodium falciparum were significantly higher than of those infected with P. malariae (P < 0.05). Hence ferritin estimation without examination for malaria parasitaemia in a malaria‐endemic region such as Nigeria is not reliable. Asymptomatic malaria parasitaemia increases the ferritin level. Considering the mean ferritin level we found in normal subjects on a balanced diet, routine iron supplementation may not be necessary in the treatment of malaria‐induced anaemia in Nigeria.
What is the effect of combining artesunate and praziquantel in the treatment of Schistosoma mansoni infections?
Authors: De Clercq D. , Vercruysse J. , Verlé P. , Kongs A. , Diop M. 
Published: March 2003

Summary A group of 110 individuals with Schistosoma mansoni infection was investigated. Patients were allocated to one of three treatment groups and given artesunate or praziquantel alone or both in combination. Combined artesunate–praziquantel significantly increased the number of individuals cured at 5 weeks post‐treatment, but at 12 weeks was only better than artesunate alone and at 24 weeks there was no statistically significant difference between the three groups. Egg count reduction rate was similar to the rate obtained with praziquantel used alone.
Therapeutic injections in Pakistan: from the patients' perspective
Authors: Raglow Gregory J. , Luby Stephen P. , Nabi Naheed 
Published: March 2003

Summary objective  To investigate the behaviour, knowledge of risks, and attitudes towards injections among patients at a clinic in Karachi. methods  In March 1995, trained staff administered a structured questionnaire to 198 consecutive new adult patients attending a university clinic in Karachi, Pakistan. results  Half (97; 49%) of the patients received injections at their last visit to a health care provider. 35% had received 10 or more injections in the last year. 64% felt that injections were more powerful and were willing to pay more for them than for pills. 84% preferred pills or advice over injections if told they were equally effective, 83% believed that a used needle could transmit a fatal disease, and 86% believed that it is usually possible to get better without an injection. 91% reported that the doctor always recommends an injection; few patients (9%) ever asked for one. Injections were given without much regard for the chief complaint of the patient. Some needles (n = 21) for the injection came from bowls of water: of those from closed packets (n = 116), 68 were ‘cleaned’ by wiping or placing them in water. 91% of patients (180) knew at least one risk of reuse of needles. Patients who knew three or more risks of using unclean needles were 0.14 times as likely to have had more than five injections per year in the last 5 years but only if the patients had 8 or more years of education. conclusion  Patients receive injections from doctors in Pakistan frequently, indiscriminately and often without proper safety precautions. They are aware of both positive and negative aspects of injections but are likely to do what the doctor suggests. Interventions to reduce risky overuse of injections should focus on patients' general education and knowledge of the risks of injections to empower them to choose healthier therapies.
Putative drug‐related pemphigus foliaceus in four dogs
Authors: White Stephen D. , Carlotti Didier N. , Pin Didier , Bonenberger Terri , Ihrke Peter J. , Monet Eric , Nishifuji Koji , Iwasaki Toshiroh , Papich Mark G. 
Published: March 2003

Abstract Four dogs developed cutaneous lesions following the administration of various antibiotics. Histopathology of the lesions was compatible with pemphigus foliaceus, although apoptotic cells suggestive of erythema multiforme were seen in two cases. In two dogs the lesions resolved after 7.5–8.5 months of immune‐suppressive treatment. No recurrence was seen during the follow‐up period (3 and 4.5 years). The lesions in the other two dogs resolved within 3 weeks to 3 months following discontinuation of the antibiotic. No recurrence of clinical signs occurred during the follow‐up period (1 and 4 years, respectively).
Immediate intradermal flea‐antigen reactivity in dogs in a flea‐scarce environment
Authors: Sævik B. K. , Ulstein T. L. 
Published: March 2003

The aim of this study was to determine the prevalence of intradermal test (IDT) reactions to flea antigen in dogs in a flea‐scarce environment. Seventy‐three client‐owned dogs without present or prior exposure to fleas were used. Forty dogs had a history of, and clinical signs compatible with, atopic dermatitis (AD), after exclusion of other causes of pruritus, and 33 dogs were healthy or had some disease other than AD. A questionnaire was used to collect information about previous ectoparasitic infestations. An aqueous extract of whole bodies of Ctenocephalides spp. (Nelco Laboratories Inc., NY, USA) was used for IDT at a concentration of 1:1000 w/v. None of the dogs had been treated with corticosteroids or antihistamines within the previous 3 months. A positive reaction was defined as a wheal that was equal to or larger in diameter than the average of the saline and histamine controls. Two of the dogs with clinically diagnosed AD and none of the nonatopic dogs had immediate skin‐test reactions to flea antigen. The prevalence (2.7%) for positive IDT against flea extract found in this study is low compared with studies performed in a flea‐rich environment. Immediate skin‐test reactivity against flea antigen in clinically normal dogs in flea‐endemic areas could represent subclinical hypersensitivity or true false‐positive reactions (due to skin irritation). Thus, these findings indicate that false‐positive reactions against whole‐body flea antigen from Nelco in dogs not exposed to fleas are rare.
Butenafine, a fungicidal benzylamine derivative, used once daily for the treatment of interdigital tinea pedis
Authors: Reyes Blas A. , Beutner Karl R. , Cullen Stanley I. , Rosen Theodore , Shupack Jerome L. , Weinstein Mark B. 
Published: March 2003

A multi‐center, randomized, double‐blind, placebo‐controlled trial was performed to evaluate the effectiveness of butenafine, a fungicidal benzylamine derivative, in the once daily treatment of interdigital tinea pedis.One hundred and fifty patients with interdigital tinea pedis characterized by a minimum erythema score of 2 and a minimum score of 2 for either pruritus or scaling (on a scale of 0–3, where ‘2’ defines moderate severity) were initially enrolled, pending confirmation by mycologic culture and KOH testing. Patients were excluded if the evaluation of tinea pedis might have been impaired by concomitant conditions, if they were hypersensitive to allylamines or ingredients of the study medications, or if they had clinically significant abnormal laboratory values. Women of childbearing potential were also excluded if they were pregnant, lactating, or not using adequate contraceptive measures.The patients were randomized and given study formulations in coded tubes containing either butenafine hydrochloride cream 1% (butenafine) or the vehicle. They were instructed to apply the formulation to all tinea pedis lesions one daily, for 4 weeks. They were evaluated after 1, 2, and 4 weeks of treatment, and again 4 weeks post‐treatment, using the following measures: (i) mycologic cure: negative fungal culture and KOH test; (ii) effective treatment: mycologic cure and investigator global assessment of 80% or more improvement in signs and symptoms; (iii) investigator global assessment of clinical response: cleared (100% improvement in signs and symptoms), excellent (80–99% improvement), good (50–79% improvement), fair (25–49% improvement), poor (less than 25% improvement), unchanged, or worse, (iv) patient’s assessment of change since baseline: 5=greatly improved, 4=somewhat improved, 3=the same, 2=somewhat worse, and 1=much worse.Mycologic cure and effective treatment were each analyzed using the Cochran–Mantel–Haenszel (CMH) test of response by treatment partialled on investigator. Patient perceptions and investigator evaluations of global response were analyzed as ordered categorical data using the CMH mean score test with uniform scores.
Physiologic skin changes during pregnancy: a study of 140 cases
Authors: Muzaffar Farhana , Hussain I. , Fcps . , Haroon T. S. 
Published: March 2003

Abstract Background The endocrine, metabolic, and immunologic changes during pregnancy give rise to a number of physiologic cutaneous changes. Objective We evaluated 140 pregnant women to determine the pattern of pregnancy‐induced physiologic skin changes in our community. Results The various changes observed include: increased pigmentation (90.7%), striae (77.1%), edema (48.5%), melasma (46.4%), vascular changes (34.2%), and others. Conclusions Pigmentary changes were the most common finding, whereas the incidence of vascular changes was quite low (p < 0.01).
Oral treatment schedules for onychomycosis: a study of patient preference
Authors: Nolting Siegfried K. , Carazo Jose Sanchez , De Boulle Koenrad , Lambert Julien R. 
Published: March 2003

Abstract Background An improved understanding of patients’ attitudes to medication may help promote compliance with oral medications for onychomycosis. This study was performed to assess patients’ preference between continuous and intermittent oral treatment schedules for onychomycosis and to determine the reasons underlying the selections made. Methods Patients were eligible for inclusion if they had current onychomycosis and were willing to take oral medication for this condition. In a 30‐min, face‐to‐face interview, each patient answered questions about four possible treatment schedules for onychomycosis: regimen 1 – continuous (daily regular intake) for 12 weeks; regimen 2 – intermittent 1 week/month for 3 months (last week of therapy is week 9); regimen 3 – intermittent once weekly for 21 weeks; regimen 4 – intermittent 1 week/month for 4 months (last week of therapy is week 13). Results A total of 102 patients from Germany and Spain participated in the study. When asked to choose between regimens 1, 2, and 3, 46% of patients favored the 9‐week intermittent schedule, 42% selected the 12‐week continuous schedule, and 12% preferred the 21‐week intermittent schedule. The preference for the 9‐week intermittent schedule was more notable among younger patients (<45 years), possibly because they are less used to taking regular medication, and among Spanish patients, an effect that could not be attributed to age because the average age of patients was similar in the participating countries (Germany 47.2 years; Spain 48.0 years). When the patients who preferred regimen 2 were asked to choose between regimens 1, 3, and 4 (both intermittent schedules longer than the continuous schedule), most (57%) favored the shortest treatment schedule (regimen 2). Conclusions Overall, patients favored an intermittent schedule lasting 9 weeks. Treatment duration is the critical factor in determining patients’ preference for treatment schedules for onychomycosis.
EB virus‐related angiocentric T‐cell lymphoma
Authors: Ken‐ichi Isoda  , Mizutani Hitoshi , Nishiguchi Takeshi , Shimizu Masayuki 
Published: March 2003

A 61‐year‐old woman developed an asymptomatic tumor on her right cheek. She had a history of surgical removal of a similar tumor on her left arm 2 years earlier. The facial lesions were flesh‐colored, with 2×2 cm ulcers (Fig. 1). The left arm had ulcerative nodular lesions around the operation scar. Laboratory examinations revealed marked leukocytosis (19,510/μL) with lymphocytosis (54.6%). A few abnormal blastoid cells with large nuclei were detected by hemogram (Fig. 2). The red blood cell count, platelet count, coagulation tests, liver, and renal functions, including serum lysozyme, lipase, α1anti‐trypsin, and angiotensin‐converting enzyme activities, were normal, but a moderate elevation of thymidinekinase activity was observed. Anti‐nuclear human T‐cell leukemia virus type 1 (HTLV‐1), human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) antibodies were not detected. Mantoux reaction was negative and no DNA of tuberculosis was detected by polymerase chain reaction. Epstein–Barr virus (EBV) titers revealed EBV viral capsid antigen (VCA)‐immunoglobulin G (IgG): ×160; VCA‐IgM: undetectable level; early antigen (EA)‐IgG: ×10; and EBNA: ×80. The lymphocytes showed normal proliferation responses to lectins.The tumor biopsy specimen revealed marked lymphocyte infiltration around vessels and focal necrosis in the deep dermis (Fig. 3a). The infiltrate was composed mainly of large blastoid lymphocytes with mitotic figures. Around the destroyed dermal vessels, tumor cells and denatured endothelial cells concentrated characteristically and formed glomeruloid lesions (Fig. 3b). Many auto‐phagocytes forming “bean bag cells” were electron microscopically detected in the tumor.The proliferated cells in the dermis were CD3+, CD4+, CD7+, CD2+, CD5+, WT31+, and CD45RO+; however, CD1, CD8, TCRd1, CD16, CD56, CD57, CD19, CD20, CD10, L26, and LMP‐1 were negative. Bone marrow cells showed lymphocytosis (39%) mixed with abnormal lymphoid cells. Rearrangement of T cell receptor (TCR)‐β or TCR‐γ chain was not detected in the samples from dermal tumors and peripheral blood.EBV‐encoded small nuclear RNA (EBER) was detected in the tumor cells from the forearm by in situ hybridization.Thus, the patient was diagnosed as having EB virus‐related angiocentric lymphoma with leukemic change, and was treated with bi‐weekly cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) combination chemotherapy. The facial tumor responded to CHOP markedly, and the peripheral blood leukemic cell count declined after two cycles of CHOP. After the sixth cycle of CHOP, however, the patient developed acute interstitial pneumonitis, and died from an intracranial hemorrhage.The autopsy specimens revealed thickening of the alveolar wall, septal fibrosis, and alveolar epithelial necrosis with focal lymphocyte infiltration. The bone marrow was hypocellular, but infiltrated with blastoid tumor cells.
Skin surgery in patients 90 years of age and over
Authors: Taniguchi Yoshiki , Shimizu Yoshiharu , Inachi Shin , Shimizu Masayuki 
Published: March 2003

Abstract Background The number of aged people is increasing. It is conceivable that we will be treating considerably more aged patients with more surgical risk factors in the very near future. Methods During the period between 1976 and 1996, 212 patients of 80 years of age and older underwent skin surgery at the Mie University Hospital, Japan. Among them, 25 patients of 90 years of age and over were studied. Results Fourteen patients (56.0%) have undergone skin surgery in the past 5 years; 22 patients (88.0%) had skin tumors on the face and ears; squamous cell carcinoma was found in 17 patients (68.0%), while basal cell carcinoma was seen in four patients (16.0%). Despite their advanced ages, half of the patients had no medical contraindications to performing surgery. Conclusions Careful preoperative management may allow more cutaneous surgery to be carried out in aged people.
Autologous epidermal grafting with PUVA‐irradiated donor skin for the treatment of vitiligo
Authors: Lee Ai‐Young , Jang Jeong‐Hoon 
Published: March 2003

Abstract Background Epidermal autografting has been used to treat vitiligo. The pigmentation achieved at the recipient site can be variegated and incomplete compared with that of the surrounding normal skin, and sometimes remains that way for a fairly long time. Objective We investigated whether the clinical results from epidermal autografting are related to a change in the number of melanocytes. This was performed by counting the number of melanocytes in the epidermis obtained from biopsy and suction with and without psoralen plus UVA (PUVA) exposure of the donor sites before grafting. Methods The numbers of melanocytes in the epidermis were counted after staining with dopa. The epidermis from suction and biopsy was included. The biopsied specimen was treated with NaBr for dermo–epidermal separation before staining, whereas the epidermis obtained from suction was stained directly. Results The epidermis obtained from suction contained 40–60% of the number of melanocytes found in the biopsied epidermis. Melanocytes around the hair follicles seemed to be omitted. Treatment with PUVA 10–21 times caused the number of melanocytes to increase by 1.5–2 times the normal level with a promising clinical result. Conclusions The preparation of donor sites with PUVA before the treatment of vitiligo by epidermal autografting induced an increased number of melanocytes and improved the clinical result.
Outbreak of rat mite dermatitis in medical students
Authors: Chung Sang Lip , Hwang Sung Joo , Kwon Soon Baek , Kim Do Won , Jun Jae Bok , Cho Baik Kee 
Published: March 2003

Abstract Background The tropical rat mite, Ornithonyssus bacoti (O. bacoti), is an ectoparasite on many rodents, but when the rodent is not available, humans may become the victim of the mite's bite. The bite induces a nonspecific dermatitis; therefore, it is not easy to diagnose rat mite dermatitis unless the parasites are found. Materials and methods Ten cases of rat mite dermatitis were found in medical students who had studied in the same room of the library. Their nonspecific dermatitis consisted of small papules, and parasites were found in the skin or in the environment. The mites were collected and identified as O. bacoti, female. Histopathologic studies showed moderate perivascular lymphohistiocytic infiltrations intermingled with some eosinophils. The presence of rodents in or around the room was confirmed by the students, but there had been no preceding rodent eradication. Although the rats were not captured in the library, insecticides were sprayed, and no further problem with either mites or dermatitis developed during the follow‐up period. Conclusions Rat mite dermatitis can occur in clusters that involve a common source of exposure to the rat mite epidemiologically. Prompt identification of rat mites and the eradication of mites and rodents from the environment can prevent further spreading of the disease.