bluuebunny/crossref_metadata_2025_split huggingface dataset:
Yellow fever outbreak in Kaffrine, Senegal 1996: epidemiological and entomological findings
Authors: Thonnon  , Spiegel  , Diallo  , Sylla  , Fall  , Mondo  , Fontenille  
Published: March 2003

In November 1996 a yellow fever (YF) outbreak occurred near Kaffrine in the central part of Senegal. Thirty‐six deaths were notified, all children under 15 years of age. The YF diagnosis was confirmed by MAC‐ELISA or by virus isolation. The immune status against YF virus of a sample population of 449 individuals was determined, and 31 confirmed cases and 69 asymptomatic cases were reported. Distribution of YF cases and incidence rate decreased with age, while the attack rate was stable in all age groups. Larva indices were high and Aedes aegypti was common in all villages, causing man‐to‐man transmission. The greatest risk of YF disease was lack of immunity, especially in individuals <20 years of age. The outbreak was rapidly controlled by an emergency immunization campaign. YF epidemics occurred in Senegal over two consecutive years. The last outbreak reached the main road to Dakar and the risk of spread to urban areas has increased.
Latent class analysis permits unbiased estimates of the validity of DAT for the diagnosis of visceral leishmaniasis
Authors: Boelaert Marleen , El Safi Sayda , Goetghebeur Els , Gomes‐Pereira Sandra , Le Ray Dominique , Van der Stuyft Patrick 
Published: March 2003

Summary background Substantial uncertainty surrounds the specificity of the Direct Agglutination Test (DAT) for visceral leishmaniasis (VL) in clinical suspects, since no good gold standard exists for unequivocally identifying diseased subjects. We explored the Latent Class Analysis (LCA) modelling technique to circumvent this problem. patients and methods Data on 149 clinical suspects recruited in 1993–96 during a multicentre study in Sudan were re‐examined. Clinical data, lymph node and bone marrow aspirate and DAT results were available. IFAT was performed in 1997 on stored filter paper blood of 80 individuals. Classical Validity Analysis (CVA) in a 2 × 2 contingency table with parasitology as a gold standard was compared with the parameter estimates produced by the best fitting LCA model. results The sensitivity estimates of DAT produced by CVA (98% (89%‐100%)) were almost exactly reproduced by LCA. The specificity estimates by LCA were substantially higher than those obtained in CVA. Specificity of DAT depended, however, on whether the subject was treated for VL before. In subjects without prior treatment, CVA estimated DAT specificity at 68% (56%– 79%), whereas LCA estimated it at 85% (63%– 100%). conclusion LCA modelling proved a useful tool, as it gave consistent estimates of test characteristics and allowed for control of confounding factors and interaction effects. Since VL is a life‐threatening disease for which expensive but effective and safe treatment exists, a clinical suspect in an endemic area should be treated on the basis of a positive DAT result.
A randomized, double‐blind, placebo‐controlled clinical trial of vitamin A in Mozambican children hospitalized with nonmeasles acute lower respiratory tract infections
Authors: Julien Manuel Romano , da Cruz Gomes Aurélio , Varandas Luis , Rodrigues Paula , Malveiro Filomena , Aguiar Pedro , Kolsteren Patrick , Van der Stuyft Patrick , Hildebrand Katherine , Labadarios Demetre , Ferrinho Paulo 
Published: March 2003

Summary objective The objective of this study was to test the potential of routine vitamin A supplementation at admission to speed up recovery during hospitalization for acute lower respiratory tract infections (ALRI) and to decrease the levels of morbidity at 6 weeks after discharge. The study was conducted in the Central Hospital of Maputo (CHM), Mozambique, from 1995 to 1997. methods Children aged 6–72 months with ALRI admitted to the paediatric wards of the CHM were assigned to a supplementation group (n = 71, receiving 200000 IU of vitamin A) or a control group (n = 93, receiving a placebo). results The prevalence of vitamin A deficiency was very high and similar between the two groups. The median number of inpatient days for the supplementation group was 3, for the placebo group 4 days. On day 5 the rate of clinical discharge was 88.4% (n = 61/69) in the experimental intervention group and 73.9% (n = 65/88) in the placebo group (P = 0.023). conclusion We found a statistically significant reduction in duration of admission among vitamin A‐supplemented children with ALRI. This effect is in line with what is known about the role of vitamin A in human defence and immune mechanisms and with the serological evidence of the extent of vitamin A deficiency among the children in this trial.
A randomized comparison of branded sodium stibogluconate and generic sodium stibogluconate for the treatment of visceral leishmaniasis under field conditions in Sudan
Authors: Veeken Hans , Ritmeijer Koert , Seaman Jill , Davidson Robert 
Published: March 2003

Summary objective  To compare the outcome of treatment of Sudanese kala‐azar patients treated under field conditions with either branded sodium stibogluconate (SSG) (Pentostam GlaxoWellcome) or generic SSG (Albert David Ltd, Calcutta, supplied by International Dispensary Association, Amsterdam). method  Randomised comparison. 271 patients were treated with Pentostam and 245 with generic SSG. results  No statistically significant differences in cure rate or mortality were detected between Pentostam and generic SSG. No differences in side‐effects between the two drugs were noted. The initial cure rate at the time of discharge was 93.7 and 97.6%, respectively; the death rate during treatment 5.9 and 2.4%. Six months follow up was achieved in 88.5% of the discharged patients. Two patients had died in the Pentostam group and two had died in the generic SSG group, giving a final death rate of 7.5 and 3.7%. The number of relapses in the Pentostam and generic SSG groups were 3 and 1, respectively. The final cure rates, calculated at 6 months after discharge, were 91.3% and 95.9%. conclusion  No difference was observed in the performance of generic SSG compared to Pentostam for the treatment of visceral leishmaniasis in Sudan. Generic SSG can be routinely and safely used for the treatment of kala‐azar. Generic SSG costs only 1/14 of the price of Pentostam. The use of generic SSG may make treatment of kala‐azar affordable for national governments in Africa.
The impact of educational videotapes on water contact behaviour of primary school students in the Dongting Lakes region, China
Authors: Yuan Liping , Manderson Lenore , Tempongko Ma Sandra B. , Wei Wangyuan , Aiguo Pen 
Published: March 2003

SummaryMultimedia has become increasingly important in educational programmes in schools in all societies, and has potential value for health education. We developed a video and a comic book on the transmission and prevention of schistosomiasis for use in primary schools in endemic areas of China. The material was designed to increase children’s knowledge of schistosomiasis as an environmental disease and to encourage them to reduce their contact with unsafe water sources. To test the effectiveness of the video and booklet, a quasi‐experimental study was conducted among 1739 children in 50 primary schools in the Dongting Lake region. A self‐administered questionnaire pre‐ and post‐intervention showed a significant increase in knowledge about schistosomiasis in the intervention schools. Significantly, this change was associated with a decrease in contact with unsafe water sources, as established from water contact observations. This behavioural change suggests the value of short, targeted educational interventions to decrease risk of infection.
Prevalence of point mutations in the dihydrofolate reductase and dihydropteroate synthetase genes of Plasmodium falciparum isolates from India and Thailand: a molecular epidemiologic study
Authors: Biswas S. , Escalante A. , Chaiyaroj S. , Angkasekwinai P. , Lal A. A. 
Published: March 2003

SummaryPyrimethamine‐sulfadoxine (PS) is used as a second‐line treatment for P. falciparum malaria patients who fail to respond to chloroquine. Resistance to these drugs has been shown to encode with point mutations in dihydrofolate reductase (DHFR) and dihydropteroate synthetase (DHPS) genes. Our aim was to assess the comparative rate of point mutation occurring in DHFR and DHPS genes among P. falciparum isolates from India and Thailand where the use of PS is at a different rate. We used the mutation‐specific polymerase chain reaction (PCR) technique and mutation‐specific restriction digestion to determine the prevalence of DHFR and DHPS gene mutations at codons 16, 51, 59, 108, 164 and at 436, 437, 581 and 613, respectively. In the 89 clinical isolates from India, in the case of the DHFR gene, we found 71 of S108N, 10 of N51I, 28 of C59R and four of I164L types. Among the 50 isolates from Thailand the rate of point mutations in the DHFR gene was higher at four codon positions. We found 47 of S108N, 18 of N51I, 23 of C59R and 12 of I164L types. None of the isolates from either country possessed the paired mutations S108T and A16V. Mutations of the DHPS gene were less frequent among the Indian isolates: 4.5% showed DHPS gene mutation, two of S436F, A437G, A613T and two of S436F, A613T; whereas 66% (33/50) of the Thai isolates had mutated at codons 436, 437, 581 and 613 which include 13 of S436F, 15 of A437G, 19 of A581G and 25 of A613S/T, ranging from single to quadruple mutant types. Among the Indian isolates, DHFR point mutations were very frequent and 85/89 had a wild type DHPS genetic profile. The pattern of mutations in the samples from Thailand was different, as most were associated with point mutations in DHFR and DHPS genes.
Malaria in pregnancy in rural Mozambique: the role of parity, submicroscopic and multiple Plasmodium falciparum infections
Authors: Saute Francisco , Menendez Clara , Mayor Alfredo , Aponte John , Gomez‐Olive Xavier , Dgedge Martinho , Alonso Pedro 
Published: March 2003

BACKGROUND Falciparum malaria affects pregnant women, especially primigravidae, but before malaria control programmes targeted to them can be designed, a description of the frequency and parity pattern of the infection is needed. There is little information on the frequency and effect of submicroscopic malaria infection, as well as on multiplicity of Plasmodium falciparum genotypes in pregnancy. This study aimed to describe the prevalence of malaria parasitaemia and anaemia and their relation to parity and age in pregnant women, during two malaria transmission seasons in a rural area of southern Mozambique. It also tried to assess the frequency and effect on anaemia of submicroscopic and multiple falciparum infections. METHODS A total of 686 pregnant women were enrolled in three cross‐sectional community‐based surveys during different transmission seasons in rural southern Mozambique. In each survey a questionnaire was administered on previous parity history, the gestational age was assessed, the axillary temperature recorded and both haematocrit and malaria parasitaemia were determined. We used polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) analysis to determine submicroscopic and multiple P. falciparum infections in a subsample of women. FINDINGS A total of 156 women (23%) had microscopic parasitaemia, of which 144 (92%) were asexual forms of P. falciparum. The prevalence of clinical malaria was 18 of 534 (3%), that of anaemia, 382 of 649 (59%). In a multivariate analysis age but not parity was associated with an increased risk of microscopic parasitaemia. Anaemia was associated with microscopic P. falciparum parasitaemia. Both malaria parasitaemia and anaemia were more frequent during the rainy season. Although not statistically significant, submicroscopic infections tended to be more frequent among grand‐multiparous pregnant women. Subpatent infections were not associated with increased anaemia. Multiplicity of infection was not associated with either parity, age or anaemia. Likewise, there was no correlation between P. falciparum density and multiplicity of infection. INTERPRETATION We did not observe a clear parity pattern of malaria and anaemia in our study. It is possible although unlikely that selection bias may have influenced these findings; but in which direction is unclear. The importance of locally based research before implementation of public health measures needs to be highlighted. According to our findings, a more cost‐effective malaria control approach in this area would be targeting all pregnant women regardless of their parity. This would be also more feasible logistically as it would not rely on accurate ascertainment of parity, something that is not always easy in busy antenatal clinics.
A controlled study of postpartum depression among Nepalese women: validation of the Edinburgh Postpartum Depression Scale in Kathmandu
Authors: Regmi Shishir , Sligl Wendy , Carter Diana , Grut William , Seear Michael 
Published: March 2003

OBJECTIVES To measure the prevalence of depression amongst postpartum and non‐postpartum Nepalese women in Kathmandu using the Edinburgh Postpartum Depression Scale (EPDS) and to assess the ease of use and validity of the scale compared with Diagnostic and Statistical Manual of Mental Disorders (DSM‐IV) criteria for major depression. METHODS We screened 100 women 2–3 months post‐delivery and 40 control women using the EPDS. All those who screened positive for depression and 20% of the negatives also underwent a structured interview to assess depression by DSM‐IV criteria. RESULTS Predictive errors were minimized by using an EPDS score ≥13 to define depression. Using this threshold, there was no difference in depression prevalence between postpartum women (12%) and the control group (12.5%) (Fisher's exact test, P > 0.05). Compared with DSM‐IV, the sensitivity, specificity and positive predictive values were 100, 92.6 and 41.6%, respectively. CONCLUSIONS The prevalence of postpartum depression (PPD) in Nepalese women and the validity and ease of use of the EPDS in the setting of a postnatal clinic in Kathmandu are all surprisingly similar to the results of numerous studies in developed countries. Despite poor living conditions, PPD is no more common than the background depression rate amongst Nepalese women. It can be reliably detected by trained clinical nurses using the EPDS screening test. These results may have implications for the planning of mental health resources for women in other developing countries.
Efficacy and sustainability of a footcare programme in preventing acute attacks of adenolymphangitis in Brugian filariasis
Authors: Suma T. K. , Shenoy R. K. , Kumaraswami V. 
Published: March 2003

SummaryLymphatic filariasis is associated with considerable disability related to the intensity and frequency of acute adenolymphangitis (ADL) attacks. The global programme for elimination of lymphatic filariasis emphasizes the need to combine transmission control with alleviation of disability. Footcare aimed at the prevention of secondary bacterial infections is the mainstay of disability alleviation programmes. We evaluated the efficacy and sustainability of an unsupervised, personal footcare programme by examining and interviewing 127 patients who had previously participated in a trial that assessed the efficacy of diethylcarbamazine, penicillin and footcare in the prevention of ADL. During the trial period these patients had been educated in footcare and were supervised. During the unsupervised period, which lasted 1 year or longer, 47 patients developed no ADL, and ADL occurred less frequently in 72.5%. Most patients were practising footcare as originally advised, unsupervised and without cost, which proves that such a programme is sustainable and effective.
Do insecticide‐treated bednets have an effect on malaria vectors?
Authors: Takken Willem 
Published: March 2003

SummaryThe use of insecticide‐treated bednets (ITNs) has been widely adopted as an important method for malaria control. Few data exist on effects of ITNs on mosquito biology and ecology, other than the development of insecticide resistance against the insecticides used. There is no hard evidence that the insecticide resistance recorded is the result of insecticidal use on bednets or from agricultural use. Resistance against pyrethroids, the preferred class of insecticides for ITN use, has been recorded from countries in Asia, Africa and South America. Resistance is expressed as reduced excito‐repellency and mortality of mosquitoes exposed to insecticide‐treated materials. In the absence of resistance, however, most studies on ITN effects report a reduced survival of adult mosquitoes as well as mass killing. Other effects are highly variable, and shifts in time of biting, feeding site and blood hosts have occasionally been reported, but not in proportion to the scale of ITN use. In general, a reduced sporozoite rate is recorded in ITN programmes. Because many of the anticipated behavioural effects caused by insecticidal use will be avoided by the use of untreated nets, studies on the efficacy of untreated nets are required. Examples are presented in which untreated nets provided a reasonable degree of protection against malaria.
Human water contacts patterns in Schistosoma mansoni epidemic foci in northern Senegal change according to age, sex and place of residence, but are not related to intensity of infection
Authors: Scott J. T. , Diakhaté M. , Vereecken K. , Fall A. , Diop M. , Ly A. , De Clercq D. , De Vlas S. J. , Berkvens D. , Kestens L. , Gryseels B. 
Published: March 2003

SummaryIn an epidemic focus in northern Senegal, adults had lower intensities of infection than adolescents, a phenomenon that could not be attributed to immunity acquired over the previous 10–15 years of exposure to the parasite because all age groups had had the same number of years' experience of the worm. This article considers whether this pattern could have been because of higher levels of exposure to the parasite in younger age groups. Personal contact with infected water was recorded using a questionnaire in Schistosoma mansoni foci not more than 3 years old and in another, 10‐year‐old focus. Many aspects of contact (e.g. frequency, duration or time of day of contact) may contribute to the number of encounters with infective cercariae (true exposure), so various assumptions regarding the relationship between water contact and true exposure were tested resulting in a range of exposure indices. People reported a mean of 4.4 separate contacts, and spent a median of 57 min per day in water. Patterns of water contact differed depending on the exposure index used, e.g. considering duration, males spent a longer time in water than females (P < 0.001). But using frequency, females had more contacts with water than males in most villages (P < 0.001). Generally, exposure levels dropped as people become aged (P < 0.001) and residents of the older focus were more exposed than residents of other foci (P < 0.002). Intensity of (re)infection was not related to exposure either alone or in models incorporating age, sex and/or village irrespective of the index used. There is therefore evidence that age, sex and place of residence determine exposure but none to suggest that exposure had an influence on the relationship between these factors and intensity of infection. We propose therefore that in this population other factors have principal importance in determining intensity of infection.
Plasma glucose and tumour necrosis factor‐α in adult patients with severe falciparum malaria
Authors: Manish R. , Tripathy R. , Das B. K. 
Published: March 2003

SummaryPlasma glucose was assessed in 81 patients with severe falciparum malaria at the time of presentation along with tumour necrosis factor‐α (TNF‐α). The lowest plasma glucose value was 3.38 mmol/l and none of the patients had hypoglycaemia at admission. Plasma glucose values were not significantly lower in those with multiple organ dysfunction (MOD) than in patients with single organ dysfunction (cerebral malaria only) and in those who died compared with patients who survived. Conversely, TNF‐α showed a good correlation with depth of coma and was significantly higher in patients who had MOD and those who died. There was no correlation between plasma glucose and TNF‐α values.
Contact sensitization to cyanoacrylate adhesive as a cause of severe onychodystrophy
Authors: Guin Jere D. , Baas Kelly , Nelson‐Adesokan Paula 
Published: March 2003

BackgroundThe technology used for artificial nails, the chemistry of cyanoacrylates and the reported reactions to these products are briefly reviewed. Materials and methodsWe studied three patients with prominent fingernail dystrophy, nail bed hyperkeratosis, fingertip eczema, and onycholysis, two of whom also had eczematous lesions at distant sites, ostensibly from hand transfer. Patch testing was performed with a standard screening tray, dried cyanoacrylate adhesives, and, in one case, with fingernail clippings. ResultsAll three patients were prominently patch‐test positive to the polymerized 2‐ethylcyanoacrylate, used as an adhesive on artificial (plastic) fingernails. One patient was also mildly formaldehyde sensitive, one was mildly reactive to two acrylate allergens, and one was extremely allergic to toluenesulfonamide formaldehyde resin. One patient had a positive patch test to her fingernail clippings 2 months after use of the adhesive was discontinued and an attempt was made to remove it. ConclusionsReactions to cyanoacrylate adhesives used for artificial nails can cause both nail dystrophy and fingertip eczema, and may produce eczema elsewhere, probably from hand transfer. Persistence is likely due to retained polymer, which slowly degrades in the presence of water probably releasing antigens. Patch testing with the dried adhesive on an adhesive plaster seems to be reliable.
Epidemiologic analysis and clinical course of 84 consecutive cases of pemphigus in eastern Sicily
Authors: Micali MD Giuseppe , Musumeci MD Maria, Letizia , Nasca MD Maria Rita 
Published: March 2003

BackgroundThe purpose of this study was to examine the clinical and epidemiologic features of pemphigus in eastern Sicily. MethodsAll new cases of pemphigus seen in the Dermatology Clinic at the University of Catania during the period January 1982 to June 1996 were studied retrospectively. ResultsEighty‐four patients with pemphigus represented 1.3% of 6653 patients admitted to our clinic in a 13.5‐year period, with an average annual incidence of six cases per year. The most common form of presentation was pemphigus vulgaris (PV) (75%), followed by pemphigus erythematosus (17%), pemphigus herpetiformis (6%), and pemphigus vegetans (2%). In 6% of PV patients, the oral lesions were not followed by skin involvement, and the lag time between the onset of illness and the final diagnosis in five PV cases was prolonged, ranging from 4 to 7 years, probably due to the mild clinical presentation of the disease. Two trauma‐related PV cases were documented; in one case, the blisters were located in a surgical scar and in the other in a burn scar. ConclusionsOur findings showed that pemphigus has a relatively high prevalence in eastern Sicily compared with other Italian regions; PV is the most common variant, and may have a mild course not always requiring aggressive therapy.