bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of HIV and Chlamydia trachomatis infection in 15–19‐year olds in rural Tanzania
Authors: Obasi Angela I. , Balira Rebecca , Todd Jim , Ross David A. , Changalucha John , Mosha Frank , Grosskurth Heiner , Peeling Rosanna , Mabey David C. W. , Hayes Richard J. 
Published: March 2003

OBJECTIVE To estimate the prevalence of HIV and Chlamydia trachomatis (CT) infections amongst adolescents in rural Mwanza Region, Tanzania and their association with demographic variables. DESIGN Population‐based cross‐sectional survey. METHODS All 15–19‐year olds living in households selected by random cluster sampling were invited to participate. After interview, urine was tested for HIV and CT. RESULTS 9445 15–19‐year olds were enrolled. HIV prevalence was 0.6% (95% CI: 0.4–0.8%) in males and 2.4% (95% CI: 2.0–2.8%) in females, and increased steeply with age (trend: P < 0.006 and P < 0.001, respectively). After adjustment for age, risk of HIV infection was significantly associated with female sex (OR=4.3), never having been to primary school in males (OR=2.7), and current symptoms of genital discharge (OR=2.3) or genital ulcer (OR=5.3) in females. The prevalence of CT was 1.0% (95% CI: 0.8–1.4%) in males and 2.4% (95% CI: 2.0–2.9%) in females. After adjustment for age, CT infection was associated with female sex (OR=2.4), reported current symptoms of STD (males OR=2.5, females OR=1.9) and positive leucocyte esterase (LE) test (males OR=3.1, females OR=2.6). Eighty‐two percent of males and 79% of females with CT were asymptomatic. There was no association between CT and HIV infection in either sex. CONCLUSIONS There is a high prevalence of HIV and CT amongst adolescents, especially young women, in this rural population, highlighting the need for effective interventions to improve adolescent reproductive health. The high rates of asymptomatic infection imply that innovative strategies are needed to reach and treat young people with STD.
A longitudinal study of Giardia lamblia infection in north‐east Brazilian children
Authors: Newman Robert D. , Moore Sean R. , Lima Aldo A. M. , Nataro James P. , Guerrant Richard L. , Sears Cynthia L. 
Published: March 2003

OBJECTIVE To evaluate the epidemiology of Giardia lamblia infection, investigate factors which might be associated with clinical manifestations and recurrence, and examine the role of copathogens in disease course. METHODS Prospective 4‐year cohort study of children born in an urban slum in north‐eastern Brazil. RESULTS Of 157 children followed for ≥ 3 months, 43 (27.4%) were infected with Giardia. The organism was identified in 8.8% of all stool specimens, and although found with similar frequency in non‐diarrhoeal (7.4%) and diarrhoeal stools (9.7%), was more common in children with persistent (20.6%) than acute diarrhoea (7.6%, P=0.002). Recurrent or relapsing infections were common (46%). Children with symptomatic infections had significantly lower weight‐for‐age and height‐for‐age than asymptomatic children. Copathogens were not associated with disease course. CONCLUSION With its protean clinical manifestations, Giardia may be associated with substantial morbidity amongst children in Brazil.
Epidemiological aspects of mycetoma from a retrospective study of 264 cases in West Bengal
Authors: Maiti P. K. , Ray A. , Bandyopadhyay S. 
Published: March 2003

SummaryBetween 1981 and 2000, 264 cases of mycetoma were diagnosed clinically and microbiologically at Calcutta School of Tropical Medicine. Retrospective analysis of the records revealed that the ratio of actinomycetomas and eumycetomas was 197 : 67; the male to female ratio was 183 : 81. Ninety‐four cases occurred in the 1980s and 170 in 1990s, with significantly more infections of Actinomadura spp. (P < 0.01) and fewer with Nocardia caviae (P < 0.01) during the last decade. Pricking was the most common injury associated with eumycetomas (P < 0.01). A total of 196 infections were in exposed body parts and 68 in covered areas. The localization of mycetomas differed significantly (P < 0.01) according to sex, incidence of actinomycetomas or eumycetomas, and obvious history of trauma. Exposed area cases were more common among agricultural workers (P < 0.01), while covered area mycetomas were almost always actinomycetomas with a remarkably lower incidence of N. caviae, A. madurae and Madurella grisea infections. The peak age of onset was between 16 and 25 years. The delay of diagnosis for the 80th percentile of cases was around 6 years for cases caused by N. brasiliensis and Streptomyces spp.; 8 years for N. caviae and N. asteroides; and 10 years for M. grisea and Actinomadura spp. From the history of trauma in 130 patients, the 80th percentile incubation period (IP) was calculated for N. brasiliensis, N. caviae and N. asteroides as 3 years; for Actinomadura spp. 7 years and for M. grisea 9 years. The minimum IP for all organisms was around 3 months.
The absence of HIV seropositivity contrasts with a high prevalence of markers of sexually transmitted infections among registered female sex workers in Toliary, Madagascar
Authors: Xueref Serge , Holianjavony Jeanine , Daniel Raymond , Kerouedan Dominique , Fabry Jacques , Vanhems Philippe 
Published: March 2003

SummaryIn a cross‐sectional study in 1998 we assessed human immunodeficiency virus (HIV) and syphilis infections and their risk factors among the 316 registered female sex workers (FSWs) of Toliary, south‐west Madagascar. No case of HIV infection was detected, but 18.4% of registered FSWs had syphilis. Only half of these women regularly used condoms. In a multiple logistic regression analysis, risk factors for syphilis infection were multiple clients per week and, paradoxically, regular use of condoms. The variables associated with irregular use of condoms were younger ages of registered FSWs, multiple clients per week and Malagasy clients. The high prevalence of syphilis infection associated with irregular use of condoms might facilitate a very fast spread of HIV infection among these FSWs. Promotion of condom use and surveillance of sexually transmitted infections and HIV infection incidence are needed in the south of Madagascar.
Comparison of cyclosporine A with methylprednisolone for treatment of canine atopic dermatitis: a parallel, blinded, randomized controlled trial
Authors: Steffan Jean , Alexander Deborah , Brovedani Fabienne , Fisch Roland D. 
Published: March 2003

Abstract The objective of this multicentre, parallel, blinded, randomized controlled study was to evaluate the efficacy and the safety of cyclosporine (CsA group, 117 dogs) in comparison with methylprednisolone (MP group, 59 dogs) in the treatment of atopic dermatitis for 4 months. Mean induction dose of both drugs (5 mg/kg CsA, 0.75 mg/kg MP) was tapered over time according to the clinical response. At the end of the study, the mean estimated percentage reduction from baseline (confidence interval) of lesion scores was 52% (44–59) and 45% (35–56), and the reduction in pruritus score was 36% (27–43) and 33% (23–43) in dogs in the CsA and MP groups, respectively. These percentages were not significantly different between groups. A significantly better overall assessment of efficacy was obtained in the CsA‐treated dogs (76 vs. 63% responses excellent or good in the CsA compared with MP group). CsA‐treated dogs presented a higher frequency of gastrointestinal disorders, mainly vomiting, but MP dogs tended to be more susceptible to infections. There was no remarkable change over baseline of the haematological and biochemical parameters in the two groups.
Community health workers reduce skin diseases in East African children
Authors: Schmeller MD Wilfried 
Published: March 2003

Background Epidemiologic data concerning skin diseases in many rural areas in sub‐Saharan Africa are not available. Little is known about the effect of regular treatment schedules by paramedical staff (especially community health workers) in the primary healthcare system on the severity and prevalence of dermatoses. Methods 5780 school and pre‐school children from 13 primary schools in four sublocations in rural western Kenya (Kisumu District) were examined for dermatoses by the author, together with community health workers in 1993. On‐the‐spot training and weekend seminars about important and common dermatoses were also given. In 1994 a dermatology program was started within the primary healthcare system. Twelve trained community health workers carried out regular school visits once a week and diagnosed and treated pupils with dermatoses. Treatment was performed with gentian violet 1% solution for bacterial skin infections, Whitfield’s ointment for dermatophytoses, benzylbenzoate emulsion 25% for scabies, and hydrocortisone acetate 1% cream for eczemas. All schools were visited again in 1995 to evaluate the long‐term effects of the program. Results In 1993, the prevalence rate for dermatoses was 32.4%. Most of the skin diseases found were of infective origin (27.1% were caused by bacteria, 21.6% by fungi, and 17.6% by arthropods, mainly scabies mites). Dermatitis accounted for 3.5%. In 1995, the prevalence of dermatoses declined to 29.6% (p<0.05), and this reduction was most strongly observed for tropical ulcers and tinea capitis. Additionally, there was an improvement in the extent and severity of skin diseases. Conclusions This study defines, for the first time, the number and extent of skin diseases in children in rural Kisumu District; most dermatoses were of infective origin. The study demonstrates that community health workers in the primary healthcare system are capable of dealing successfully with the most common dermatoses in children following a short training period.
Topical hydroquinone in the treatment of some hyperpigmentary disorders
Authors: Amer Mohamed , Metwalli Mohamed 
Published: March 2003

Seventy patients (50 with melasma, 10 with freckles, and 10 with post‐inflammatory hyperpigmentation) were admitted to this trial. Treatment in the form of 4% hydroquinone (HQ) was applied topically twice daily for a maximum of 12 weeks. Patients were advised to avoid sun exposure and/or to use topical sunscreen during the entire period of treatment.All patients were examined at week 0 and at weeks 4, 8, and 12 of therapy. At each visit, the lesion size was determined and the pigmentary intensity of melasma, freckles, and the area of post‐inflammatory hyperpigmentation (PIH) relative to a non‐affected area of skin was rated on a four‐point scale: 1, no difference; 2, mild pigmentation; 3, moderate pigmentation; 4, severe pigmentation. At the last visit, the overall response was rated as excellent, good, fair, or poor.
Comparison of histopathologic and clinical evaluations of pathergy test in Behçet’s disease
Authors: Akmaz Özlem , Erel Arzu , Gürer Mehmet Ali 
Published: March 2003

Abstract Background The pathergy test, an important test in the diagnosis of Behçet’s disease, is currently applied with disposable/sharp needles and evaluated only clinically (no histopathologic evaluation). In this study, the usefulness of the pathergy test conducted intradermally and intravenously with disposable/sharp needles in the diagnosis and determination of the activation of the disease is studied in comparison with the test conducted with nondisposable/blunt needles. In addition, histopathologic evaluation of the pathergy test is compared with the clinical evaluation. Methods The study group consists of 43 Behçet’s disease patients together with 15 patients with dermatosis as the control group. The pathergy test was applied to the Behçet’s disease patients and the control group intradermally and intravenously with disposable/sharp and nondisposable/blunt needles. Results The results of the pathergy test on the patients and the control group were evaluated clinically and histopathologically. Conclusions Clinical evaluation of the pathergy test conducted intradermally with nondisposable/blunt needles is sufficient for both the diagnosis and determination of the activation of Behçet’s disease. Histopathologic evaluation of the test is not found to be more sensitive than the clinical evaluation.
Which intercurrent infections are associated with maculopapular cutaneous drug reactions? A case‐control study
Authors: Cohen Arnon D. , Friger Michael , Sarov Batia , Halevy Sima 
Published: March 2003

Abstract Background  Patients with lymphotrophic viral infections are at increased risk for cutaneous drug reactions (CDRs). However, the association between other intercurrent infections and maculopapular CDRs has not been evaluated by epidemiologic methods.Objective  We conducted a case‐control study in order to evaluate the exposure to intercurrent infections in patients with maculopapular CDRs.Methods  Data were obtained through assessment of files of 53 patients hospitalized for maculopapular CDRs in the Department of Dermatology and 159 control patients. Exposure to intercurrent infections was recorded in patients and controls.Results  An intercurrent infectious disease was documented in 31/53 (58.5%) of patients with CDRs, as compared to 12/159 (7.5%) patients in the control group (OR 17.26, 95% CI: 7.24–42.00). Maculopapular CDRs were associated with respiratory tract infections (OR 20.53, 95% CI: 5.20–94.45), and urinary tract infections (OR 20.61, 95% CI: 2.36–465.99), but not with skin infections (OR 3.83, 95% CI: 0.85–17.87) or other infections.Conclusions  Our study implies that maculopapular CDRs are associated with respiratory tract infections as well as urinary tract infections. Further study is needed to evaluate the role of intercurrent infections in the pathogenesis of CDRs.
Efficacy and safety of terbinafine for nondermatophyte and mixed nondermatophyte and dermatophyte toenail onychomycosis
Authors: Lebwohl Mark G. , Daniel C. Ralph , Leyden James , Mormon Manuel , Shavin Joel S. , Tschen Eduardo , Weiss Jonathan , Zone John 
Published: March 2003

Ninety‐seven healthy male and female subjects, 18–70 years of age, entered a randomized, double‐blind, placebo‐controlled, multicenter study conducted over a 24‐week treatment period and a 72‐week follow‐up (study week 96) period without treatment.Subjects  received: (1) terbinafine 250 mg for 12 weeks followed by placebo for 12 weeks; (2) terbinafine 250 mg for 24 weeks; or (3) placebo for 24 weeks.Clinical and mycologic evaluations of a target toenail were performed before, during, and after the treatment period. Evaluations consisted of measurements of nail growth, unaffected nail length, and estimated percentage of nail involvement. Cultures and KOH microscopy were used for mycologic evaluations.The primary efficacy variable was effective treatment, defined as negative mycology and either no nail involvement or at least 5 mm of new unaffected nail growth at 48 weeks. Complete cure, the secondary variable, was defined as negative mycology and zero nail involvement at 48 weeks. Overall efficacy was assessed after 12, 18, and 24 weeks of therapy and every 6 weeks up to week 48 by both investigator and subject using a five‐point scale (excellent, very good, good, fair, and poor).Adverse events were assessed after 4, 8, 12, 18, and 24 weeks of treatment and after a 6‐week follow‐up period with no treatment. Adverse events were graded by severity (mild, moderate, or severe) and relationship to the study drug (not related, remote or unlikely, possibly, probably, or definitely).
Subcutaneous pheohyphomycosis in India – a case report and review
Authors: Sharma Nand Lal , Mahajan Vikram , Sharma Ramesh Chander , Sharma Ashok 
Published: March 2003

AbstractBackground Pheohyphomycosis is a rare infection caused by dematiaceous fungi, affecting the skin and subcutis, paranasal sinuses, or central nervous system.Methods A case of subcutaneous pheohyphomycosis in the lumbar region is reported. The Indian literature on subcutaneous pheohyphomycosis is also reviewed.Results In India, 23 patients with subcutaneous pheohyphomycosis have been reported, distributed throughout the country in a belt from north to south, sparing the eastern and western regions. The age of the patients ranged from 3 to 60 years, with a male to female ratio of 1.3 : 1. A relatively early age of onset was observed. A history of prior injury was recalled by five patients. The lower extremities were involved in eight cases, upper extremities in five, gluteal region in two, lumbar area and submandibular area in one, face in two and disseminated disease was seen in four cases. Three of these cased died during follow up. Osteomyelitis was observed in two cases, hepatosplenomegaly in one, and lymph node involvement in two. Carcinomatous change developed in a long‐standing lesion of 33 years. Thirteen species from seven genera of dematiaceous fungi were isolated. Phialophora dermatidis was the most common isolate.Conclusions Indian patients with subcutaneous pheohyphomycosis are afflicted at an earlier age. Exophiala dermatidis seems to be associated with more fatalities. Treatment with newer azoles seems promising, and excision alone or combined with azoles is a good therapeutic modality.
Peculiar unilateral fixed drug eruption of the breast
Authors: Li Hong , Wiederkehr Michael , Rao Babar K. , Samady Joseph A. , Gardner Bernard , Lambert W. Clark , Schwartz Robert A. 
Published: March 2003

AbstractBackground Fixed drug eruption (FDE) is a common cutaneous disorder which develops within hours of taking the offending drug and recurs at the same site with subsequent exposure to the same drug. Non‐steroidal anti‐inflammatory drugs (NSAIDs) are common offending drugs.Methods A 14‐year‐old girl initially presented with a 1‐year history of a recurrent reddish‐brown plaque around her right areola. The lesion became pruritic and raised during menses, and subsided during the remainder of her menstrual cycle with the exception of persistent residual hyperpigmentation. The patient had a pattern of naproxen use during menses for dysmenorrhea.Results The skin biopsy specimen revealed focal bullae formation and scattered necrotic keratinocytes in epidermis, hydropic degeneration of the basal cell layer, pigmentary incontinence and a perivascular infiltrate composed of lymphocytes and eosinophils. These changes confirmed the diagnosis of fixed drug eruption.Conclusion Fixed drug eruption to nonsteroidal anti‐inflammatory drugs is common. However, FDE due to naproxen, one of the NSAIDs, is rarely reported. We describe an unusual case of FDE, which recurred at each menses.
Opinions of Swedish citizens, health‐care politicians, administrators and doctors on rationing and health‐care financing
Authors: Rosén Per , Karlberg Ingvar 
Published: March 2003

Objective  To compare the views of citizens and health‐care decision‐makers on health‐care financing, the limits of public health‐care, and resource allocation. Design  A postal survey based on a randomized sample of adults taken by the national registration and stratified samples of health‐care politicians, administrators, and doctors in five Swedish counties. Participants  A total number of 1194 citizens (response rate 60%) and 427 decision‐makers (response rate 69%). Results  The general public have high expectations of public health‐care, expectations that do not fit with the decision‐makers' views on what should be offered. To overcome the discrepancy between demand and resources, physicians prefer increased patient fees and complementary private insurance schemes to a higher degree than do the other respondents. Physicians take a more favourable view of letting politicians on a national level exert a greater influence on resource allocation within public health‐care. A majority of physicians want politicians to assume a greater responsibility for the exclusion of certain therapies or diagnoses. Most politicians, on the other hand, prefer physicians to make more rigorous decisions as to which medical indications should entitle a person to public health‐care. Conclusions  The gap between public expectations and health‐care resources makes it more important to be clear about who should be accountable for resource‐allocation decisions in public health‐care. Significant differences between physicians' and politicians' opinions on financing and responsibility for prioritization make the question of accountability even more important.
Generic physical mechanisms of tissue morphogenesis: A common basis for development and evolution
Authors: Newman Stuart A. 
Published: March 2003

AbstractMorphological evolution is usually considered to occur by the selection of small heritable variations in the expression of anatomical traits, on the basis of improved adaptation to new environmental conditions. An alternative mode of morphological evolution is proposed here: the production of a spectrum of forms by the action of intrinsic physical properties of cell aggregates, followed by intense selection for biochemical mechanisms that make the generation of a subset of viable morphologies, and pathways of transition between morphologies, more reliable. This view provides an account of the origins of important features of metazoan body plans and organ forms, including gastrulation and other types of tissue multilayering, lumen formation, and segmentation. It also implies that most major morphological innovations would occur early in phylogeny, often more than once, with much subsequent genetic selection being of a stabilizing or canalizing variety. Consistent with recent findings, this view predicts that functional redundancy among developmentally important genes and genetic circuits should be prevalent.
How geitonogamous selfing affects sex allocation in hermaphrodite plants
Authors: Jong T. J. De , Klinkhamer  , Rademaker  
Published: March 2003

Abstract
Does the mode of self-pollination affect the evolutionarily stable allocation to male vs. female function? We distinguish the following scenarios. (1) An ‘autogamous’ species, in which selfing occurs within the flower prior to opening. The pollen used in selfing is a constant fraction of all pollen grains produced. (2) A species with ‘abiotic pollination’, in which selfing occurs when pollen dispersed in one flower lands on the stigma of a nearby flower on the same plant (geitonogamy). The selfing rate increases with male allocation but a higher selfing rate does not mean a reduced export of pollen. (3) An ‘animal-pollinated’ species with geitonogamous selfing. Here the selfing rate also increases with male allocation, but pollen export to other plants in the population is a decelerating function of the number of simultaneously open flowers.
In all three models selfing selects for increased female allocation. For model 3 this contradicts the general opinion that geitonogamous selfing does not affect evolutionarily stable allocations. In all models, the parent benefits more from a female-biased allocation than any other individual in the population. In addition, in models 2 and 3, greater male allocation results in more local mate competition.
In model 3 and in model 2 with low levels of inbreeding depression, hermaphroditism is evolutionarily stable. In model 2 with high inbreeding depression, the population converges to a fitness minimum for the relative allocation to male function. In this case the fitness set is bowed inwards, corresponding with accelerating fitness gain curves.
If the selfing rate increases with plant size, this is a sufficient condition for size-dependent sex allocation (more allocation towards seeds in large plants) to evolve.
We discuss our results in relation to size-dependent sex allocation in plants and in relation to the evolution of dioecy.