bluuebunny/crossref_metadata_2025_split huggingface dataset:
Interactions between Schistosoma haematobium and Schistosoma mansoni in humans in north Cameroon
Authors: Cunin P. , Tchuem Tchuenté L.‐A. , Poste B. , Djibrilla K. , Martin P. M. V. 
Published: November 2003

SummaryObjectives  To analyse the relationships between the frequency of ectopic localizations of Schistosoma haematobium and S. mansoni eggs.Methods  Studies were conducted in 11 villages in north Cameroon, around Bessoum, a village where an epidemic of bloody diarrhoea caused by S. mansoni occurred in 1997.Results  The results revealed infection prevalence rates of 70.5% for S. haematobium and 30.8% for S. mansoni. Interestingly, S. mansoni eggs were found in 14.5% of the urine samples and S. haematobium eggs in 3% of the stool samples. These ectopic eliminations of schistosome eggs resulted from sexual interactions between the two species of schistosomes, and from a spill‐over of high infection loads. The clinical study showed that the morbidity was lower in individuals with mixed infections and high loads of S. haematobium than in those with S. mansoni infections only, suggesting a possible lowering effect of S. haematobium infection on S. mansoni morbidity.Discussion  The results obtained in human populations are discussed in relation to the known schistosome interspecific interactions in animal models.
The use of formal and informal curative services in the management of paediatric fevers in four districts in Kenya
Authors: Amin Abdinasir A. , Marsh Vicki , Noor Abdisalan M. , Ochola Sam A. , Snow Robert W. 
Published: November 2003

SummaryObjective  To assess the sources, costs, timing and types of treatment for fevers among children under 5 years of age in four ecologically distinct districts of Kenya.Methods  Structured questionnaires were administered to caretakers of one randomly selected child aged <5 years per homestead to establish whether the child had had a fever within the last 14 days and the types, sources, costs, and timing of treatment. Drug charts of common proprietary anti‐malarial and antipyretic drugs in Kenya were used as visual aids.Results  A total of 2655 fevers were reported among 6287 (42.2%) children with significant differences between the four districts (P < 0.01). A substantial number of fevers remained untreated (28.1%) across all districts and more fevers were treated in Greater Kisii than any other district (P < 0.01). The median delay to any treatment was 2 days [inter‐quartile range (IQR): 2, 4]. The informal retail sector had no transport costs associated with it and charged less for drugs than all the other sectors. Most antimalarial treated fevers occurred in the formal public sector (52.6%). Only 2.3% of fevers were treated within 24 h of onset with a sulphur‐pyrimethamine drug, the nationally recommended first‐line drug for the management of uncomplicated malaria.Conclusions  The Abuja target of ensuring that 60% of childhood fevers are treated with appropriate antimalarial drugs within 24 h of onset by 2010 is largely unmet and a major investment in improving prompt access to antimalarial drugs will be required to achieve this.
Inadvertent exposure of pregnant women to ivermectin and albendazole during mass drug administration for lymphatic filariasis
Authors: Gyapong John O. , Chinbuah Margaret A. , Gyapong Margaret 
Published: November 2003

SummaryThe current strategy for the interruption of transmission of lymphatic filariasis in areas where the disease is co‐endemic with onchocerciasis is repeated annual mass treatment of endemic communities with ivermectin and albendazole. These drugs are not recommended for use in pregnancy. Pregnant women are excluded on the basis of their last menses. This exclusion criterion based on recall carries some inherent errors, leading sometimes to inadvertent exposure of foetuses to these drugs. This study set out to document the extent of inadvertent exposure of pregnant women to albendazole and ivermectin and assess the relative risk of congenital malformations because of inadvertent treatment with these drugs in early pregnancy. The study was conducted in the Ahanta West District of Ghana. Local pregnancy revelation norms were studied, followed by a household survey of women aged 15–45 years to assess drug administration coverage. All infants born within 42 weeks of the mass drug treatment were examined to document any congenital malformations. Mothers who had lost any such infants responded to a verbal autopsy to ascertain the probable cause of death. Health facilities and local Traditional Birth Attendants were also visited to review maternity records. Of 2985 women of childbearing age (15–49 years) who were interviewed, 343 were pregnant during the mass drug administration. The sensitivity of the last menstrual period in detecting pregnancy and thus being excluded from treatment was 0.854 (293 of 343). Some pregnant women 50 of 343 (14.6%) had thus been inadvertently treated. This represents 1.7% of women in fertile age group (15–49 years). Of the six children found with some congenital malformations in these communities, one had been exposed to the drugs in‐utero. The relative risk for congenital malformation after exposure was 1.05 (P = 1.0). Two of nine reported spontaneous abortions had been exposed to the drugs (P = 0.62). We conclude that the local mode of excluding pregnancy in the current programme, while not perfect, is sufficiently effective and reliable for such a public health intervention; and importantly, that there is no evidence of a higher risk of congenital malformation or abortions in those who are inadvertently exposed.
Treatment costs and work time loss due to episodic adenolymphangitis in lymphatic filariasis patients in rural communities of Orissa, India
Authors: Babu B. V. , Nayak A. N. 
Published: November 2003

SummaryObjective  To determine the economic loss in terms of treatment costs and loss of productive time because of acute episodes of adenolymphangitis (ADL) caused by lymphatic filariasis (LF) in a rural population of coastal Orissa, India.Methods  Data on expenditure on treatment and loss of work along with other epidemiological information were collected through a 1‐year surveillance of 113 acute episodes of ADL from 72 individuals of the study population (5.42%). The activity patterns of patients for 24 h of one episode were documented, and data on age‐ and sex‐matched controls were also collected. Standardized Z‐test, paired t‐test, logistic and multiple regressions were used.Results  Those patients who did incur expenses spent Indian Rupees 92 on average (approximately US$ 1.85) on each episode. The ADL episodes curtailed the productive activity of patients. Patients (88%) were unable to attend to any economic activity compared with 47% of controls who had no history of disease. Similarly during 55% of episodes, females (vs. 8% of controls) could not attend to any domestic work. The mean number of hours spent on economic or domestic activities was significantly lower among patients. Disease status and sex had significant influence on total absenteeism from gainful employment; and similarly, age, family type and disease status influenced total domestic work hours among women.Conclusions  The results demonstrate the extent of the economic burden caused by acute LF and provide justification for strengthening the ongoing LF elimination programme.
Uncoupling of the order of the S and M phases: effects of staurosporine on human cell cycle kinases
Authors: Stokke T. , Smedshammer L. , Jonassen T. S. , Blomhoff H. K. , Skarstad K. , Steen H. B. 
Published: November 2003

AbstractThe protein kinase inhibitor staurosporine (SSP) was employed to study the involvement of kinases in human cell cycle progression. Thirty to 100 ng/ml SSP blocks entry into S phase and M phase. Lack of entry into S phase is due to impaired activity of the retinoblastoma protein kinase. The requirement for any of the SSP‐sensitive kinases for cell cycle progression can be abrogated in tumour cells. Therefore, these kinases act in a checkpoint network negatively controlling the initiation of S phase, M phase and cytokinesis, rather than being inherent parts of a substrate‐product chain required for the initiation of the cell cycle phases. As a consequence of the lack of certain checkpoint effectors, tumour cells may endoreduplicate or binucleate in the presence of SSP. The latter processes, as well as meiosis, are naturally occurring in specialized cell types, leading to the idea that this checkpoint network controls the order of the cell cycle phases in normal cells. A model is presented where the cell cycle is envisioned as two independently running cycles, the S and the M cycle, which are controlled by intra and intercycle‐dependent checkpoints in human somatic cells. The model accounts for the dependency of S and M phase initiation on the successful completion of the previous M and S phase, respectively, as well as entry into a resting state.
Hexarelin, a synthetic growth hormone releasing peptide, stimulates prolactin secretion in acromegalic but not in hyperprolactinaemic patients
Authors: Ciccarelli E. , Grottoli S. , Razzore P. , Gianotti L. , Arvat E. , Deghenghi R. , Camanni G. , Ghigo E. 
Published: November 2003

OBJECTIVE In man, new synthetic peptides such as hexarelin have been shown to have a potent and dose dependent GH releasing activity. Furthermore, a significant PRL releasing activity has also been demonstrated, but this has been investigated in less detail. We have therefore evaluated the effect of hexarelin on PRL and GH secretion in patients with active acromegaly or pathological hyperprolactinaemia.DESIGN Hexarelin (2 μg/kg i.v.), a modified derivative of GHRP‐6 of the following structure: His‐2‐Me‐D‐Trp‐Ala‐Trp‐D‐Phe‐Lys‐NH2, or placebo, was administered in random order on two separate occasions.PATIENTS Eight patients with active acromegaly (ACRO, 6 F and 2 M, mean age 61.7 years, range 56–73), 6 with macroadenomas and 2 without radiological signs of tumour, and 6 female patients with pathological hyperprolactinaemia (HPRL, mean age 31.2 years, range 18–47) 5 with microadenomas and 1 with empty sella, were studied. Fourteen normal subjects (NS, 8 F and 6 M, 27.1 years, 24–30) were studied as controls.MEASUREMENTS GH and PRL levels were evaluated every 15 minutes for 2 hours after hexarelin or placebo. Both hormones were measured using commercial IRMA kits. Basal IGF‐I was measured in all subjects using an RIA following acid–ethanol extraction.RESULTS Hexarelin induced a significant increase in PRL levels in NS (median, range, Δ peak HEX vs placebo: 150 (−14–402) vs 10 (−34–24) mU/l; Δ AUC HEX vs placebo: 7710 (2 100–3 2540) vs 30 (−2 566–2 040) mU min/l, P < 0.01) and in ACRO (190 (−10–496) vs 6 (−100–34) mU/l; 10 170 (−5 310–51 436) vs−82 (−6 030–1 410) mU min/l, P < 0.02), but not in HPRL (10 (−180–80) vs 50 (−100–240) mU/l; −600 (−16 996–10 140) vs−1 950 (−8 540–14 160) mU min/l). Hexarelin also induced a lower increase of GH in HPRL (60 (30–82) vs 1.8 (−0.2–2.2) mU/l; 2 853 (1 477.6–4 372.6 vs 91.6 (−160.6–174) mU min/l, P < 0.05) than in NS (90.8 (50.6–181) vs 0.8 (−1.2–6.8) mU/l; 6642 (2 004–13 252.6 vs 42 (456–900) mU min/l, P < 0.01) or in ACRO (117.2 (21.2–420.6 vs 3.8 (−2.2–18) mU/l; 6645 (1 554–22 138.6 vs 334.6 (−324–1 065) mU min/l, P < 0.02).CONCLUSIONS Our data show that the PRL releasing effect of hexarelin is preserved in acromegaly but lost in pathological hyperprolactinaemia. In contrast with acromegaly, the GH releasing effect of hexarelin is also blunted in hyperprolactinaemic patients. These data demonstrate that patients with pathological hyperprolactinaemia are partially refractory to the activity of hexarelin.
Association of HLA‐DQA1*0501 with Graves’ disease in English Caucasian men and women
Authors: Barlow A. B. T. , Wheatcroft N. , Watson P. , Weetman A. P. 
Published: November 2003

OBJECTIVE A recent report has demonstrated a stronger association between the HLA‐DQA1*0501 allele and Graves’ disease in Caucasian men than in women. Our aim was to confirm this association in a larger series of male Caucasian patients.DESIGN Polymerase chain reaction/sequence specific oligonucleotide probing (PCR/SSOP).PATIENTS Fifty men and 70 women with Graves’ disease were studied as well as a control group consisting of 57 healthy, unrelated men and women.METHODS Genomic DNA was derived from venous blood samples. Appropriately primed DNA was amplified by PCR and the products were subjected to SSOP. The presence of the allele was demonstrated by enhanced chemiluminescence.RESULTS A significant association between HLA‐DQA1* 0501 and Graves’ disease was demonstrated among both the men and women as well as in the combined disease cohort, with HLA‐DQA1*0501 conferring a greater relative risk than HLA‐DR3 in all three groups. This association persisted when the results from the DR3‐negative Graves’ patients were analysed in isolation. HLA‐DQA1*0501 was heterogeneously distributed between the sexes with significantly more female Graves’ patients carrying this allele.CONCLUSIONS There is a significant association between HLA‐DQA1*0501 and Graves’ disease which may be unrelated to the inheritance of this allele on an extended haplotype with HLA‐DR3. In contrast to a recent report, HLA‐DQA1*0501 was significantly more prevalent among women with Graves’ disease than men.
β‐Cell function and glucose and lipid oxidation in Graves’ disease
Authors: Bech K. , Damsbo P. , Eldrup E. , Beck‐Nielsen H. , Røder M. E. , Hartling S. G. , Vølund Aa. , Madsbad S. 
Published: November 2003

OBJECTIVE Abnormal glucose metabolism with impaired glucose tolerance has been documented in patients with thyrotoxicosis but the pathogenesis is not fully understood. Therefore, the aim of the present study was to study the β‐cell function and the meal induced oxidative glucose and lipid metabolism in patients with thyrotoxicosis.DESIGN  After an overnight fast the impact of hyperthyroidism on standard mixed meal induced glucose oxidation, lipid oxidation and β‐cell function was studied.PATIENTS  Nine untreated patients with Graves’ disease were compared to 9 age and weight matched healthy controls.MEASUREMENTS  Glucose and lipid oxidation were studied by indirect calorimetry before and after the meal. The insulin secretion rate was calculated by the ‘combined model’ approach, after which the insulin secretion rates and the ambient glucose levels were cross‐correlated. The slope of these regression lines was used as a measure of β‐cell sensitivity to glucose and denotes the insulin secretory capacity. β‐Cell function was further evaluated by measurement of proinsulin and its conversion intermediates. Glucoregulatory hormones were also measured. The findings were correlated to the thyroid hormone levels.RESULTS  Fasting blood glucose and post‐prandial glucose response were increased in patients (P < 0.01). The hyperthyroid patients displayed a ‘dual’β‐cell defect: (a) inability to increase the insulin response appropriately to hyperglycaemia and (b) increased proinsulin levels both in the fasting state and in response to a meal. Indirect calorimetry showed increased lipid oxidation in the fasting state and at the end of the meal (P < 0.01).No difference in glucose oxidation was demonstrated in the fasting state but the post‐prandial glucose oxidation was enhanced in the patients (P < 0.01). The adrenaline response was normal, whereas the noradrenaline response was impaired or absent in the patients. The thyroid hormone levels were significantly correlated to fasting levels of blood glucose, insulin, free fatty acids and lipid oxidation, but not to fasting C‐peptide, glucose oxidation or catecholamines.CONCLUSIONS  Untreated Graves’ disease was associated with glucose intolerance due to quantitative as well as qualitative β‐cell defects. The lipid oxidation was increased in the fasting state and at the end of the meal; after the meal the increase in glucose oxidation was more pronounced in the patients. Thyroid hormones thus increased the oxidation but not by an increase in catecholamines. Indeed, the post‐prandial sympathetic response was blunted.
High prolactin levels may be missed by immunoradiometric assay in patients with macroprolactinomas
Authors: St‐Jean Edith , Blain François , Comtois Ronald 
Published: November 2003

OBJECTIVE Large amounts of antigen may produce falsely low values in immunoradiometric assays due to the so‐called high dose, hook effect. The study was designed to identify the clinical and biochemical features of patients with pituitary macroadenomas in whom a high dose PRL hook effect was documented.DESIGN The clinical and biochemical features of four patients with the high dose PRL hook effect were compared with those of 54 patients with pituitary non‐functioning adenomas and 11 with macroprolactinomas who underwent transsphenoidal microsurgery between 1989 and 1994.MEASUREMENTS The presence of the high dose PRL hook effect was confirmed by an increase in the initial PRL concentration when the immunoradiometric assay was processed after dilutions of the serum. This phenomenon was observed in 5.8% (4/69) of patients with pituitary macroadenomas. Undiluted median (range) PRL levels were 9140 (l530–83850), 1530 (162–3210) and 2110 mU/l (1470–45 000) in patients with macroprolactinoma, non‐functioning macroadenoma and the hook effect, respectively. In patients with the hook effect, the median PRL levels increased to 384720 (317520–950 000) mU/l when the assay was performed after serum dilution. The proportion of males was 9.9% (1/11) in the macroprolactinoma group, 46.3% (25/54) in the non‐functioning macroadenoma group and 100% (4/4) in patients with the hook effect. Patients with prolactinoma and non‐functioning adenoma had mean tumour sizes of 20±9 and 27±11mm (SD), respectively, while in the hook effect group it was 51±10mm.CONCLUSION This study suggests that the high dose PRL hook effect is observed particularly in patients with very large tumours. The immunoradiometric PRL assay must be performed with serum dilution in order to overcome the high dose PRL hook effect in all new patients with pituitary macroadenomas who may have a prolactinoma.
Apparent mineralocorticoid excess due to 11β‐hydroxysteroid dehydrogenase deficiency: a possible cause of intrauterine growth retardation
Authors: Kitanaka S. , Tanae A. , Hibi I. 
Published: November 2003

A Japanese boy with apparent mineralocorticoid excess (AME) is described. He was born with intrauterine growth retardation (IUGR) and elevated serum level of creatine phosphokinase (CPK). He was studied at 2 years of age because of polyurea and polydipsia of one year’s duration and was found to have hypokalaemic alkalosis and sustained hypertension. His plasma renin activity and aldosterone levels were always low and his ratio of urinary tetrahydrocortisol plus allo‐tetrahydrocortisol to that of tetrahydrocortisone was very high. Therefore, AME due to 11β‐hydroxysteroid dehydrogenase (11β‐HSD) deficiency was diagnosed. He was successfully treated with a combination of spironolactone and nifedipine for at least 16 months. His blood pressure, plasma pH and serum potassium levels were normalized by this treatment, but serum CPK level remained high.We researched the birth records of previously reported AME cases and found that IUGR is a characteristic feature of AME. The mechanism by which IUGR occurs in AME is discussed and we speculate that 11β‐HSD might be deficient in the placenta and/or fetal tissues, as well as in the kidney, in AME. An explanation for the elevated CPK could not be found.
Exophthalmos in Cushing's syndrome
Authors: Kelly William 
Published: November 2003

OBJECTIVE Exophthalmos was noted in 4 of the 12 patients reported by Harvey Cushing in 1932. Although exophthalmos has often been included in clinical descriptions, no previous study has reported actual measurements in patients with active and treated Cushing's syndrome, and in control patients. The aim of this study was to obtain these measurements. PATIENTS Thirty‐one patients with active Cushing's syndrome (19 iatrogenic), 15 with treated Cushing's syndrome, 18 with Graves' ophthalmopathy, 59 control patients, and 3 patients with active Cushing's syndrome plus a family or personal history of thyroid disease. DESIGN AND MEASUREMENTS A consecutive series of patients with active and treated Cushing's syndrome were assessed. They were compared with patients with Graves' ophthalmopathy, and with control patients. Exophthalmos was assessed by the author using a Hertel meter. Urinary free cortisol was measured on patients with Cushing's syndrome, and serum thyroxine was estimated for them, and for the patients with Graves' ophthalmopathy. RESULTS Exophthalmos exceeding 16 mm (>2 SD above normal mean) was found in 45% of active Cushing's syndrome, 21% of iatrogenic Cushing's syndrome, 20% of treated Cushing's syndrome, 2% of normal controls, and 77% of patients with Graves' ophthalmopathy. No patient with Cushing's syndrome had significant symptoms due to exophthalmos. CONCLUSION Patients with active Cushing's syndrome have statistically significant exophthalmos. This rarely causes symptoms, and diminishes when cortisol concentrations become normal. Cushing's syndrome and autoimmune thyroid disease may coexist in patients with exophthalmos.
Comparison of tests of stress‐released cortisol secretion in pituitary disease
Authors: Orme S. M. , Peacey S. R. , Barth J. H. , Belchetz P. E. 
Published: November 2003

OBJECTIVES We wished to compare peak and incremental rise in plasma cortisol in response to insulin induced hypoglycaemia (IIH) stress test, i.m. glucagon stimulation test (IMGST) and short Synacthen test (SST) in patients with pituitary disease, using a modern radioimmunoassay for cortisol. We compared the three stimulants using receiver operator characteristic (ROC) plots, assuming a cortisol threshold of 500 nmol/l or 580 nmol/l for the IIH stress test which we used as the standard from which to evaluate the SST and the IMGST. PATIENTS AND DESIGN We prospectively studied 16 patients (8F, 8M mean age 43.69 ± 3.72 years) admitted to the investigation ward for IIH stress test and who were asked to undergo two additional tests (IMGST and SST) on consecutive days. MEASUREMENTS We measured serum cortisol at baseline, 30, 45, 60, 90 and 120 minutes during the IIH stress test; baseline, 150 and 180 minutes during GST, and baseline and 30 minutes during the SST. RESULTS There was a significant rise in cortisol from baseline in all tests (P < 0.001). There was no significant difference among the peak plasma cortisol responses or the incremental rises in plasma cortisol following IMGST, SST and IIH stress test (repeated measures ANOVA F = 0.704, P = 0.503; F = 0.238, P = 0.79). The ROC plots clearly showed that the SST has poor diagnostic utility at both IIH thresholds, compared with the IMGST. CONCLUSION The peaks and incremental rises in cortisol following all three tests are comparable. Using the insulin induced hypoglycaemia stress test as a reference and peak cortisol thresholds of 500 and 580 nmol/l as discriminating variables, the short Synacthen displayed poor diagnostic utility when compared to the i.m. glucagon stimulation test. The short Synacthen may be misleading if used as a screening test as advocated by a number of authors.