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Sample records for malaria outcome indicators

  1. Laboratory indicators of the diagnosis and course of imported malaria

    DEFF Research Database (Denmark)

    Gjørup, Ida E; Vestergaard, Lasse S; Møller, Kirsten

    2007-01-01

    When travellers return from malaria-endemic areas and present to hospital with fever, microscopy of blood smears remains the leading method to verify a suspected diagnosis of malaria. Additional laboratory abnormalities may, however, also be indicative of acute malaria infection. We monitored......, in particular thrombocyte counts, in guiding the clinician managing a returning traveller with fever....

  2. Hematological indices in febrile neonates with malaria parasitaemia in Calabar

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    Callistus O. A Enyuma

    2015-01-01

    Full Text Available Background: Normal hematological indices has been determined in Nigerian newborns and found to be lower compared to their Caucasian counterparts. This was attributed to genetic factors. Malaria is endemic in Nigeria and is one of the major causes of ill health and death. Anemia is an important manifestation of malaria. Resistance by malaria parasites to antimalarial drug exacerbates the situation by continuous hemolysis. Aim: To determine the hematological indices in febrile newborn with malaria parasitemia. Materials and Methods: One-hundred fifty neonates (0-28 days with fever admitted into the Newborn Unit of University of Calabar Teaching Hospital, over a 6 months period, were recruited consecutively. Blood film for malaria parasites and samples for full blood count were obtained and sent to the laboratory before commencement of the treatment. Data analysis was with SPSS version 14. Results: One-hundred fifty babies were recruited into the study. Most (85.3% of the babies were aged ≤7 days. Six babies (4% had malaria parasitemia. Plasmodium falciparum was the only species identified. All the babies that had parasitemia were anemic (mean hemoglobin [Hb] concentration of 12.6 g/dl even when parasite count was low (average of 30.6/µl though this could not be attributed solely to malaria. None of these neonates was transfused. All the other hematological indices were within the normal range of healthy newborn population irrespective of parasitization. Conclusion: Neonatal malaria does occur in our environment. While it does not affect the white blood indices, it lowers neonatal Hb. It is recommended that Hb concentration be estimated in newborns with malaria to reduce infant morbidity and mortality in our environment.

  3. Congenital clinical malaria: Incidence, management and outcome ...

    African Journals Online (AJOL)

    ... were the admitted neonates to the emergency paediatric unit and the Special ... no mortality occurred in congenital clinical malaria, however, a diverse pattern of ... mothers of the importance of ante natal clinic visits for prescription of malaria ...

  4. Malaria indicator survey 2007, Ethiopia: coverage and use of major malaria prevention and control interventions

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    Graves Patricia M

    2010-02-01

    Full Text Available Abstract Background In 2005, a nationwide survey estimated that 6.5% of households in Ethiopia owned an insecticide-treated net (ITN, 17% of households had been sprayed with insecticide, and 4% of children under five years of age with a fever were taking an anti-malarial drug. Similar to other sub-Saharan African countries scaling-up malaria interventions, the Government of Ethiopia set an ambitious national goal in 2005 to (i provide 100% ITN coverage in malarious areas, with a mean of two ITNs per household; (ii to scale-up indoor residual spraying of households with insecticide (IRS to cover 30% of households targeted for IRS; and (iii scale-up the provision of case management with rapid diagnostic tests (RDTs and artemisinin-based combination therapy (ACT, particularly at the peripheral level. Methods A nationally representative malaria indicator survey (MIS was conducted in Ethiopia between September and December 2007 to determine parasite and anaemia prevalence in the population at risk and to assess coverage, use and access to scaled-up malaria prevention and control interventions. The survey used a two-stage random cluster sample of 7,621 households in 319 census enumeration areas. A total of 32,380 people participated in the survey. Data was collected using standardized Roll Back Malaria Monitoring and Evaluation Reference Group MIS household and women's questionnaires, which were adapted to the local context. Results Data presented is for households in malarious areas, which according to the Ethiopian Federal Ministry of Health are defined as being located Plasmodium falciparum and Plasmodium vivax, respectively. Moderate-severe anaemia (haemoglobin Conclusions Since mid-2005, the Ethiopian National Malaria Control Programme has considerably scaled-up its malaria prevention and control interventions, demonstrating the impact of strong political will and a committed partnership. The MIS showed, however, that besides sustaining and

  5. Bayesian geostatistical modeling of Malaria Indicator Survey data in Angola.

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    Laura Gosoniu

    Full Text Available The 2006-2007 Angola Malaria Indicator Survey (AMIS is the first nationally representative household survey in the country assessing coverage of the key malaria control interventions and measuring malaria-related burden among children under 5 years of age. In this paper, the Angolan MIS data were analyzed to produce the first smooth map of parasitaemia prevalence based on contemporary nationwide empirical data in the country. Bayesian geostatistical models were fitted to assess the effect of interventions after adjusting for environmental, climatic and socio-economic factors. Non-linear relationships between parasitaemia risk and environmental predictors were modeled by categorizing the covariates and by employing two non-parametric approaches, the B-splines and the P-splines. The results of the model validation showed that the categorical model was able to better capture the relationship between parasitaemia prevalence and the environmental factors. Model fit and prediction were handled within a Bayesian framework using Markov chain Monte Carlo (MCMC simulations. Combining estimates of parasitaemia prevalence with the number of children under we obtained estimates of the number of infected children in the country. The population-adjusted prevalence ranges from in Namibe province to in Malanje province. The odds of parasitaemia in children living in a household with at least ITNs per person was by 41% lower (CI: 14%, 60% than in those with fewer ITNs. The estimates of the number of parasitaemic children produced in this paper are important for planning and implementing malaria control interventions and for monitoring the impact of prevention and control activities.

  6. Evaluating experimental cerebral malaria using oxidative stress indicator OKD48 mice.

    Science.gov (United States)

    Imai, Takashi; Iwawaki, Takao; Akai, Ryoko; Suzue, Kazutomo; Hirai, Makoto; Taniguchi, Tomoyo; Okada, Hiroko; Hisaeda, Hajime

    2014-09-01

    Cerebral malaria is a fatal complication of malaria. Conventional methods for evaluating experimental cerebral malaria have several drawbacks. Therefore, we aimed to develop an easy-to-use method for evaluating experimental cerebral malaria using OKD48 (Keap1-dependent Oxidative stress Detector, No-48-luciferase) mice to evaluate oxidative stress. OKD48 mice infected with Plasmodium berghei ANKA strain (PbA) suffered from experimental cerebral malaria and oxidative stress was successfully detected in the brains of living OKD48 mice developing experimental cerebral malaria. Oxidative stress in the brain was dependent on the development of experimental cerebral malaria, as prevention of experimental cerebral malaria did not elicit oxidative stress. We provide a novel evaluation method for experimental cerebral malaria using oxidative stress indicator OKD48 mice.

  7. Coagulation and Fibrinolysis Indicators and Placental Malaria Infection in an Area Characterized by Unstable Malaria Transmission in Central Sudan

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    Amged G. Mostafa

    2015-01-01

    Full Text Available This study aimed to investigate coagulation, fibrinolysis indicators, and malaria during pregnancy. Methods. A cross-sectional study was conducted at Medani, Sudan. Sociodemographic characteristics were gathered from each parturient woman (163 and malaria was investigated by blood film and placental histology. Protein C, protein S, antithrombin-III, tissue factor pathway inhibitor (TFPI, and plasminogen activator inhibitor-1 levels (PAI-1 were measured using ELISA. Results. One (0.6%, three (1.8, and 19 (11.7% of the placentae showed active, chronic, and past infection on a histopathological examination, respectively, while 140 (85.9% of them showed no signs of malaria infection. While the mean [SD] of the protein C, antithrombin-III, and TFPI was significantly lower, there was no significant difference in protein S and PAI-1 levels in women with placental malaria infection (n=23 compared to those without placental malaria infection (140. In linear regression, placental malaria infection was associated with antithrombin-III. There was no association between placental malaria infections and protein C, protein S, TFPI, and PAI-1 levels. There was no association between hemoglobin, birth weight, and the investigated coagulation and fibrinolysis indicators. Conclusion. This study showed significantly lower levels of protein C, antithrombin-III, and TFPI in women with placental malaria infections.

  8. Prognostic indicators influencing short term outcomes among ...

    African Journals Online (AJOL)

    Prognostic indicators influencing short term outcomes among operated head injury patients ... AFRICAN JOURNALS ONLINE (AJOL) · Journals · Advanced Search ... indicators for short term outcomes in operated head injury patients at KCMC.

  9. Malaria

    Science.gov (United States)

    Quartan malaria; Falciparum malaria; Biduoterian fever; Blackwater fever; Tertian malaria; Plasmodium ... now only suggested for use in areas where Plasmodium vivax , P. ... is becoming increasingly resistant to anti-malarial medications ...

  10. Spatially explicit burden estimates of malaria in Tanzania: bayesian geostatistical modeling of the malaria indicator survey data.

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    Laura Gosoniu

    Full Text Available A national HIV/AIDS and malaria parasitological survey was carried out in Tanzania in 2007-2008. In this study the parasitological data were analyzed: i to identify climatic/environmental, socio-economic and interventions factors associated with child malaria risk and ii to produce a contemporary, high spatial resolution parasitaemia risk map of the country. Bayesian geostatistical models were fitted to assess the association between parasitaemia risk and its determinants. bayesian kriging was employed to predict malaria risk at unsampled locations across Tanzania and to obtain the uncertainty associated with the predictions. Markov chain Monte Carlo (MCMC simulation methods were employed for model fit and prediction. Parasitaemia risk estimates were linked to population data and the number of infected children at province level was calculated. Model validation indicated a high predictive ability of the geostatistical model, with 60.00% of the test locations within the 95% credible interval. The results indicate that older children are significantly more likely to test positive for malaria compared with younger children and living in urban areas and better-off households reduces the risk of infection. However, none of the environmental and climatic proxies or the intervention measures were significantly associated with the risk of parasitaemia. Low levels of malaria prevalence were estimated for Zanzibar island. The population-adjusted prevalence ranges from 0.29% in Kaskazini province (Zanzibar island to 18.65% in Mtwara region. The pattern of predicted malaria risk is similar with the previous maps based on historical data, although the estimates are lower. The predicted maps could be used by decision-makers to allocate resources and target interventions in the regions with highest burden of malaria in order to reduce the disease transmission in the country.

  11. Malaria

    Science.gov (United States)

    ... and can even be fatal. SymptomsWhat are the symptoms of malaria?The symptoms of malaria include:High fever (can often be 104° F ... give someone else malaria?If I do get malaria, should I travel while I have symptoms? Other organizationsInternational Society of Travel MedicineCenters for Disease ...

  12. Baseline results of the first malaria indicator survey in Iran at the health facility level

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    Taghizadeh-Asl Rahim

    2011-10-01

    Full Text Available Abstract Background Malaria continues to be a global public health challenge, particularly in developing countries. Delivery of prompt and effective diagnosis and treatment of malaria cases, detection of malaria epidemics within one week of onset and control them in less than a month, regular disease monitoring and operational classification of malaria are among the major responsibilities of the national malaria programme. The study was conducted to determine these indicators at the different level of primary health care facilities in malaria-affected provinces of Iran Methods In this survey, data was collected from 223 health facilities including health centres, malaria posts, health houses and hospitals as well as the profile of all 5, 836 recorded malaria cases in these facilities during the year preceding the survey. Descriptive statistics (i.e. frequencies, percentages were used to summarize the results and Chi square test was used to analyse data. Results All but one percent of uncomplicated cases took appropriate and correctly-dosed of anti-malarial drugs in accordance to the national treatment guideline. A larger proportion of patients [85.8%; 95% CI: 84.8 - 86.8] were also given complete treatment including anti-relapse course, in line with national guidelines. About one third [35.0%; 95% CI: 33.6 - 36.4] of uncomplicated malaria cases were treated more than 48 hours after first symptoms onset. Correspondingly, half of severe malaria cases took recommended anti-malarial drugs for severe or complicated disease more than 48 hours of onset of first symptoms. The latter cases had given regular anti-malarial drugs promptly. The majority of malaria epidemics [97%; 95% CI: 90.6 - 100] in study areas were detected within one week of onset, but only half of epidemics were controlled within four weeks of detection. Just half of target districts had at least one health facility/emergency site with adequate supply and equipment stocks. Nevertheless

  13. Baseline results of the first malaria indicator survey in Iran at the health facility level.

    Science.gov (United States)

    Raiesi, Ahmad; Nikpour, Fatemeh; Ansari-Moghaddam, Alireza; Ranjbar, Mansoor; Rakhshani, Fatemeh; Mohammadi, Mahdi; Haghdost, Aliakbar; Taghizadeh-Asl, Rahim; Sakeni, Mohammad; Safari, Reza; Saffari, Mehdi

    2011-10-27

    Malaria continues to be a global public health challenge, particularly in developing countries. Delivery of prompt and effective diagnosis and treatment of malaria cases, detection of malaria epidemics within one week of onset and control them in less than a month, regular disease monitoring and operational classification of malaria are among the major responsibilities of the national malaria programme. The study was conducted to determine these indicators at the different level of primary health care facilities in malaria-affected provinces of Iran In this survey, data was collected from 223 health facilities including health centres, malaria posts, health houses and hospitals as well as the profile of all 5, 836 recorded malaria cases in these facilities during the year preceding the survey. Descriptive statistics (i.e. frequencies, percentages) were used to summarize the results and Chi square test was used to analyse data. All but one percent of uncomplicated cases took appropriate and correctly-dosed of anti-malarial drugs in accordance to the national treatment guideline. A larger proportion of patients [85.8%; 95% CI: 84.8 - 86.8] were also given complete treatment including anti-relapse course, in line with national guidelines. About one third [35.0%; 95% CI: 33.6 - 36.4] of uncomplicated malaria cases were treated more than 48 hours after first symptoms onset. Correspondingly, half of severe malaria cases took recommended anti-malarial drugs for severe or complicated disease more than 48 hours of onset of first symptoms. The latter cases had given regular anti-malarial drugs promptly.The majority of malaria epidemics [97%; 95% CI: 90.6 - 100] in study areas were detected within one week of onset, but only half of epidemics were controlled within four weeks of detection. Just half of target districts had at least one health facility/emergency site with adequate supply and equipment stocks. Nevertheless, only one-third of them [33% (95% CI: 0.00 - 67.8)] had

  14. Malaria.

    Science.gov (United States)

    Dupasquier, Isabelle

    1989-01-01

    Malaria, the greatest pandemia in the world, claims an estimated one million lives each year in Africa alone. While it may still be said that for the most part malaria is found in what is known as the world's poverty belt, cases are now frequently diagnosed in western countries. Due to resistant strains of malaria which have developed because of…

  15. Malaria.

    Science.gov (United States)

    Dupasquier, Isabelle

    1989-01-01

    Malaria, the greatest pandemia in the world, claims an estimated one million lives each year in Africa alone. While it may still be said that for the most part malaria is found in what is known as the world's poverty belt, cases are now frequently diagnosed in western countries. Due to resistant strains of malaria which have developed because of…

  16. Prediction of outcome in adults with severe falciparum malaria: a new scoring system

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    Mishra Rajalaxmi

    2007-02-01

    Full Text Available Abstract Background Mortality of falciparum malaria is related to the presence of severe complications. However, no scoring system is available to predict outcome of these patients. The aim of this paper was to devise a simple and reliable malaria prognosis score (MPS to predict the outcome of adults with severe malaria. Methods All slide-positive severe falciparum malaria patients admitted to Ispat General Hospital were studied. Eight clinical parameters that may potentially differentiate or influence the outcome were identified to predict recovery or death Results Of 248 severe malaria cases, 35 died. There were 212 adults (34 deaths and 36 children (one death. The malaria score for adults was (MSA = 1(severe anaemia + 2 (acute renal failure + 3(Respiratory distress +4 (cerebral malaria. The MSA ranges from 0 to 10. The mortality was 2% for MSA 0 – 2; 10% for MSA 3–4, 40% for MSA 5–6 and 90% for MSA 7 or more. The sensitivity is 89.9% and positive predictive value is 94.1% when 5 is taken as the cut off value. Conclusion MSA is a simple and sensitive predictor. It can be administered rapidly and repeatedly to prognosticate the outcome of severe malaria in adults. It can help the treating doctor to assess the patient as well as to communicate to the relatives of the patients about prognosis. The score needs revalidation in other geographical areas.

  17. Outcome indicators for direct and indirect caregiving.

    Science.gov (United States)

    Schoenfelder, D P; Swanson, E A; Specht, J K; Maas, M; Johnson, M

    2000-02-01

    Informal caregiving and outcomes for caregiving are an important part of health care and of particular importance in nursing. The purpose of this research is to report the results of a survey mailed to nursing experts for validation of the outcome labels Caregiver Role Performance: Direct Care and Caregiver Role Performance: Indirect Care and their accompanying indicators. Experts were asked to rate how important the identified indicators were for assessing those two outcomes. In addition, the respondents were asked to what extent nursing interventions influence the achievement of each identified indicator for Caregiver Role Performance: Direct Care and Caregiver Role Performance: Indirect Care. In general, the validity of the concept analysis work by the caregiver focus group was supported. Ten indicators for Caregiver Performance: Direct Care were retained, 1 was dropped that was considered most appropriate for indirect care, and 3 new indicators were added to reflect the nurse experts surveyed. For Caregiver Performance: Indirect Care, all of the indicators were retained.

  18. ABO blood groups and malaria related clinical outcom

    OpenAIRE

    Deepa, Vanamala A. Alwar, Karuna Rameshkumar & Cecil Ross

    2011-01-01

    Objectives: The study was undertaken to correlate the blood groups and clinical presentations in malaria patientsand to understand the differential host susceptibility in malaria.Methods: From October 2007 to September 2008, malaria positive patients’ samples were evaluated in thisstudy. Hemoglobin, total leukocyte count, and platelet count of each patient were done on an automated cellcounter. After determining the blood groups, malarial species and the severity of clinical course were corr...

  19. Serum transferrin receptor concentration indicates increased erythropoiesis in Kenyan children with asymptomatic malaria.

    Science.gov (United States)

    Verhoef, H; West, C E; Ndeto, P; Burema, J; Beguin, Y; Kok, F J

    2001-12-01

    Serum transferrin receptor concentrations indicate both erythropoietic activity and the deficit of functional iron in the erythron. In contrast with serum ferritin concentrations, serum transferrin receptor concentrations are not or are only marginally influenced by the inflammatory response to infection. We assessed iron status and examined the relation between serum transferrin receptor concentrations and malaria in children aged 2-36 mo who were asymptomatic for malaria. This was a community-based cluster survey (n = 318). Prevalences of malaria, anemia (hemoglobin concentration serum ferritin concentration Malaria was associated with lower mean hemoglobin concentrations (92.7 compared with 104.1 g/L; P = 0.0001) and higher geometric mean serum concentrations of transferrin receptor (11.4 compared with 7.8 mg/L; P = 0.005), ferritin (21.6 compared with 11.9 microg/L; P = 0.05), and C-reactive protein (12.5 compared with 6.8 mg/L; P = 0.004). There was no evidence for an association between serum concentrations of C-reactive protein and transferrin receptor. Children with malaria had higher serum transferrin receptor concentrations than expected for the degree of anemia, even after adjustment for inflammation indicated by serum C-reactive protein concentration quartiles (P = 0.02). Our findings are consistent with the notion that malaria-induced hemolysis is accompanied by increased erythropoiesis. Serum transferrin receptor concentration is not useful for detecting iron deficiency in individuals with malaria. Individuals with high concentrations of serum C-reactive protein or similar acute phase reactants should be excluded from analysis if serum ferritin concentrations malaria-endemic areas.

  20. Placental malaria and its effect on pregnancy outcomes in Sudanese women from Blue Nile State.

    Science.gov (United States)

    Omer, Samia A; Idress, Hagir E; Adam, Ishag; Abdelrahim, Mutasim; Noureldein, Ali N; Abdelrazig, Abdelrahim M; Elhassan, Mohammed O; Sulaiman, Suad M

    2017-09-16

    Malaria infection during pregnancy can result in placental malaria and is associated with adverse pregnancy outcomes particularly among primigravidae. The aim of this study was to assess the prevalence and risk factors for placental malaria and its effect on pregnancy outcomes in Blue Nile state, Sudan. A cross-sectional hospital-based study was conducted consecutively during January 2012-December 2015 in three main hospitals in Blue Nile State, Sudan. At delivery, peripheral and placental blood samples were collected from consenting women. Finger prick blood was used for preparation of peripheral smears and for haemoglobin measurement. Smears were stained with Giemsa and examined microscopically for malaria parasites. Pregnancy outcomes in association to placental malaria were investigated. A total of 1149 mothers and their newborns were recruited. The mean (SD) of the age was 23.3 (5.2) years. Detection of malaria parasites was confirmed in 37.8% of the peripheral blood films and 59.3% of the placental films with Plasmodium falciparum as the only species detected. In multivariate analysis, younger age ≤23.2 years old (AOR = 3.2, 95% CI 1.9-5.5; P Blue Nile State-Sudan, as the enhanced control activities were not practiced, leading to adverse pregnancy outcomes, such as maternal anaemia and LBW.

  1. Indicators of fatal outcome in severePlasmodium falciparummalaria:a study in a tertiary-care hospital in Thailand

    Institute of Scientific and Technical Information of China (English)

    NoppadonTangpukdee; KhinMyatWai; SantMuangnoicharoen; ShigeyukiKano; Nanthaporn Phophak; JanramTiemprasert; SrivichaKrudsood; PolratWilairatana

    2010-01-01

    Objective:To illustrate the clinical features and investigate the indicators associated with a fatal outcome in adult patients with severePlasmodium falciparum malaria admitted to the Hospital for Tropical Diseases, Bangkok, Thailand.Methods: We studied202adult malaria patients admitted to the Intensive Care Unit. A total of43 clinical variables were identified by univariate and logistic regression analyses, to eliminate confounding factors.Results: Regarding the statistical methods, only 6variables-jaundice, cerebral malaria, metabolic acidosis, body mass index, initial respiratory rate, and white blood cell count-were significant indicators of death, with adjusted odds ratios (95%CI)of 15.2 (2.1-32.3), 4.3 (2.3-12.6), 3.3 (2.3-5.7), 2.4 (1.9-3.5), 2.2 (1.5-2.6), and1.7 (1.2-3.1), respectively.Conclusions: Our study found that jaundice, cerebral malaria, metabolic acidosis, body mass index, initial respiratory rate and white blood cell count were indicators of fatal outcome in severe Plasmodiumfalciparum malaria. Further studies on the fatal indicators in severe malaria need to be compared with data from different geographical areas, to construct practical measures to address potentially fatal indicators in different settings.

  2. Differential kinetics of plasma procalcitonin levels in cerebral malaria in urban Senegalese patients according to disease outcome

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    Babacar Mbengue

    2011-11-01

    Full Text Available P. falciparum malaria continues as the serial killer of over a million lives yearly, mainly for children in sub-Saharan Africa. For severe malaria, we are still on the quest for a prognostic marker of fatal outcome. We analysed the association between serum levels of Procalcitonin (PCT, a marker of septic inflammation, and clinical outcome in Senegalese patients admitted with confirmed cerebral malaria in the intensive care facility of Hopital Principal. A total of 98 patients living in the hypoendemic urban area of Dakar, Senegal, were enrolled during transmission seasons. Levels of PCT were compared between surviving vs the 26.5 % fatal cases in blood samples of the 3 days following hospitalisation. Mean PCT levels were elevated in patients with active infection, with a large range of values (0.1 to 280 nanog per mL, significantly higher on day 0 in fatal cases than in surviving (53.6 vs 27.3; P=0.01. No exact individual threshold level could indicate occurrence of fatality, however mortality could be most accurately predicted by PCT level above 69 nanog per ML and there was a very clear different profile of evolution of PCT levels on the 3 days of observation decreasing early from day 1 in surviving patients (P<10–3, contrary to fatal cases. These results indicate that PCT kinetic rather than intrinsic level could be of use to predict a reduced risk of fatality in patient with cerebral malaria and could serve as potential predicting marker for severe malaria.

  3. Changes in white blood cells and platelets in children with falciparum malaria: relationship to disease outcome.

    Science.gov (United States)

    Ladhani, Shamez; Lowe, Brett; Cole, Andrew O; Kowuondo, Ken; Newton, Charles R J C

    2002-12-01

    Little is known about the changes in white blood cells and platelets in children with falciparum malaria in endemic areas. We measured the white cell count (WCC) and platelets of 230 healthy children from the community, 1369 children admitted to hospital with symptomatic malaria, and 1461 children with other medical conditions. Children with malaria had a higher WCC compared with community controls, and leucocytosis was strongly associated with younger age, deep breathing, severe anaemia, thrombocytopenia and death. The WCC was not associated with a positive blood culture. In children with malaria, high lymphocyte and low monocyte counts were independently associated with mortality. A platelet count of less than 150 x 109/l was found in 56.7% of children with malaria, and was associated with age, prostration and parasite density, but not with bleeding problems or mortality. The mean platelet volume was also higher in children with malaria compared with other medical conditions. This may reflect early release from the bone marrow in response to peripheral platelet destruction. Thus, leucocytosis was associated with both severity and mortality in children with falciparum malaria, irrespective of bacteraemia, whereas thrombocytopenia, although very common, was not associated with adverse outcome.

  4. Application of advanced very high resolution radiometer (AVHRR)-based vegetation health indices for estimation of malaria cases.

    Science.gov (United States)

    Rahman, Atiqur; Krakauer, Nir; Roytman, Leonid; Goldberg, Mitch; Kogan, Felix

    2010-06-01

    Satellite data may be used to map climatic conditions conducive to malaria outbreaks, assisting in the targeting of public health interventions to mitigate the worldwide increase in incidence of the mosquito-transmitted disease. This work analyzes correlation between malaria cases and vegetation health (VH) indices derived from satellite remote sensing for each week over a period of 14 years for Bandarban, Bangladesh. Correlation analysis showed that years with a high summer temperature condition index (TCI) tended to be those with high malaria incidence. Principal components regression was performed on patterns of weekly TCI during each of the two annual malaria seasons to construct a model as a function of the TCI. These models reduced the malaria estimation error variance by 57% if first-peak (June-July) TCI was used as the estimator and 74% if second-peak (August-September) was used, compared with an estimation of average number of malaria cases for each year.

  5. Elbow arthroscopy: indications, techniques, outcomes, and complications.

    Science.gov (United States)

    Adams, Julie E; King, Graham J W; Steinmann, Scott P; Cohen, Mark S

    2015-01-01

    Elbow arthroscopy is a tool useful for the treatment of a variety of pathologies about the elbow. The major indications for elbow arthroscopy include débridement for septic elbow arthritis, synovectomy for inflammatory arthritis, débridement for osteoarthritis, loose body extraction, contracture release, treatment of osteochondral defects and selected fractures or instability, and tennis elbow release. To achieve favorable outcomes after elbow arthroscopy, the surgeon should be aware of contraindications, technical considerations, anatomic principles, and the need for proper patient positioning and portal selection. Elbow arthroscopy is an effective procedure for the treatment of inflammatory arthritis, osteoarthritis, and lateral epicondylitis.

  6. Climate indices, rainfall onset and retreat, and malaria in Nigeri

    Directory of Open Access Journals (Sweden)

    A.J. Thomso

    2010-12-01

    Full Text Available Background & objectives: Rainfall in western sub-Saharan Africa is related to seasonal shifts ofthe Inter-tropical Convergence Zone, which moves northward early in the year, retreating in thesecond half of the year. The objective of the present study was to determine significant relationshipsbetween onset and retreat timing and climate indices. The relationship between timing and malariacase reporting was then evaluated.Methods: Relationships between published rainfall onset and retreat dates for Nigeria from 1971–2000 were evaluated in relation to pairs of climate indices using response surface analysis. Graphicalrepresentation of the response surface in relation to the underlying data was used to identify instancesof overfitting. Association of onset and retreat timing with published case reporting records wasevaluated using graphical and correlation analysis.Results: Onset timing and rate of advance were related to ENSO (El Niño-Southern Oscillation,in combination with the Northern Annular Mode (NAM, while retreat timing was related to NAO(North Atlantic Oscillation, in combination with the East Pacific (EP or West Pacific (WPindex, depending on location. Later onset was associated with faster northward progression ofonset. Retreat date at Kano, the most northerly of the study locations, increased over the period1990–2000, with higher case reporting for Nigeria as a whole being associated with the last threeyears of that period.Interpretation & conclusion: Rainfall retreat occurs much faster than onset, with onset and retreattiming and rate of onset advance being related to combinations of climate indices rather than to asingle index. Threshold for determining a “rainy” day would influence results. The increase innational case reporting with delayed retreat at Kano may be related to the extension of the shorttransmission period in the north.

  7. Malaria.

    Science.gov (United States)

    Heck, J E

    1991-03-01

    Human malaria is caused by four species of the genus plasmodium. The sexual stage of the parasite occurs in the mosquito and asexual reproduction occurs in man. Symptoms of fever, chills, headache, and myalgia result from the invasion and rupture of erythrocytes. Merozoites are released from erythrocytes and invade other cells, thus propagating the infection. The most vulnerable hosts are nonimmune travelers, young children living in the tropics, and pregnant women. P. falciparum causes the most severe infections because it infects RBCs of all ages and has the propensity to develop resistance to antimalarials. Rapid diagnosis can be made with a malarial smear, and treatment should be initiated promptly. In some regions (Mexico, Central America except Panama, and North Africa) chloroquine phosphate is effective therapy. In subsaharan Africa, South America, and Southeast Asia, chloroquine resistance has become widespread, and other antimalarials are necessary. The primary care physician should have a high index of suspicion for malaria in the traveler returning from the tropics. Malaria should also be suspected in the febrile transfusion recipient and newborns of mothers with malaria.

  8. CLINICO - HAEMATOLOGICAL PROFILE AND OUTCOME OF CEREBRAL MALARIA IN A TEACHING HOSPITAL OF SOUTH EAST RAJASTHAN

    Directory of Open Access Journals (Sweden)

    Gautam Lal

    2015-05-01

    Full Text Available AIM: Evaluation of Clinico - hematological profile and outcome of cerebral malaria in semi urban hospital situated in endemic area. MATERIAL AND METHODS : A cross - sectional hospital - based study was conducted from August to November, 2014 at Department of Paediatrics SRG Zanana Hospital, Jhalawar Rajasthan. Every child, except who was previously abnormal neurologically, of the age of six month to 12 years, presented with a history of fever in the last 7 days, with o r without convulsion, and/or impaired consciousness, screened for malaria by peripheral blood smear examination and rapid diagnostic test for malaria parasite. On the basis of this screening examination, these children were classified definite cerebral mal aria where the peripheral smear was positive and probable cerebral malaria where the peripheral smear was negative. If the patients presented with fever, convulsion, and/or impaired level of consciousness, they were treated with Artesunate intravenously em pirically. Patients were followed - up regularly till they regained consciousness and when, they were able to swallow, treated with oral Artisunate and single dose of Sulphadoxine and Pyrimethamine combination is also given. RESULTS: Of the3332 admissions, 8 69 (26.08% were admitted for fever. Out of these 869 febrile patients 352 patients were having other obvious clinical diagnosis for fever. In remaining 517(59.49% cases were suspected to be suffering from malaria, but all of these children who were admit ted with the diagnosis of fever, were screened for malaria and 74(08.51%were found to be positive for malaria parasite either by peripheral blood smear or rapid diagnostic test or both. Cerebral malaria developed in 37 patients. Most cases were of age gro up of 2 - 5 years, 14children had definite cerebral malaria and 9 were labelled as suspected to have probable cerebral malaria. Neurological symptoms of altered sensorium, convulsion and abnormal behaviour ranged from 35

  9. Malaria

    Science.gov (United States)

    2011-06-01

    ceived the Nobel prize in 1902. Grassi et al later proved that anopheline mosquitoes transmit malaria to humans.2 In 2002, researchers sequenced the...Malarial pigment is the end product of hemoglobin diges- tion into a porphyrin conjugated with a protein derived from the globin portion of...location, parasite strain, and the patient’s age, immune status, and treatment.27 Investigating the patient’s travel history may provide clues to the spe

  10. The incidence of malaria in travellers to South-East Asia: is local malaria transmission a useful risk indicator?

    Science.gov (United States)

    Behrens, Ron H; Carroll, Bernadette; Hellgren, Urban; Visser, Leo G; Siikamäki, Heli; Vestergaard, Lasse S; Calleri, Guido; Jänisch, Thomas; Myrvang, Bjørn; Gascon, Joaquim; Hatz, Christoph

    2010-10-04

    The presence of ongoing local malaria transmission, identified though local surveillance and reported to regional WHO offices, by S-E Asian countries, forms the basis of national and international chemoprophylaxis recommendations in western countries. The study was designed to examine whether the strategy of using malaria transmission in a local population was an accurate estimate of the malaria threat faced by travellers and a correlate of malaria in returning travellers. Malaria endemicity was described from distribution and intensity in the local populations of ten S-E Asian destination countries over the period 2003-2008 from regionally reported cases to WHO offices. Travel acquired malaria was collated from malaria surveillance reports from the USA and 12 European countries over the same period. The numbers of travellers visiting the destination countries was based on immigration and tourism statistics collected on entry of tourists to the destination countries. In the destination countries, mean malaria rates in endemic countries ranged between 0.01 in Korea to 4:1000 population per year in Lao PDR, with higher regional rates in a number of countries. Malaria cases imported into the 13 countries declined by 47% from 140 cases in 2003 to 66 in 2008. A total of 608 cases (27.3% Plasmodium falciparum (Pf)) were reported over the six years, the largest number acquired in Indonesia, Thailand and Korea. Four countries had an incidence > 1 case per 100,000 traveller visits; Burma (Myanmar), Indonesia, Cambodia and Laos (range 1 to 11.8-case per 100,000 visits). The remaining six countries rates were 1 case per 100,000 visits to consider targeted malaria prophylaxis recommendations to minimize use of chemoprophylaxis for low risk exposure during visits to S-E Asia. Policy needs to be adjusted regularly to reflect the changing risk.

  11. Exploring the use of routinely-available, retrospective data to study the association between malaria control scale-up and micro-economic outcomes in Zambia.

    Science.gov (United States)

    Comfort, Alison; Leegwater, Anthony; Nakhimovsky, Sharon; Kansembe, Henry; Hamainza, Busiku; Bwalya, Benson; Alilio, Martin; Johns, Ben; Olsho, Lauren

    2017-01-04

    Country-level evidence on the impact of malaria control on micro-economic outcomes is vital for mobilizing domestic and donor resources for malaria control. Using routinely available survey data could facilitate this investigation in a cost-efficient way. The authors used Malaria Indicator Surveys (MIS) and Living Conditions Monitoring Survey (LCMS) data from 2006 to 2010 for all 72 districts in Zambia to relate malaria control scale-up with household food spending (proxy for household well-being), educational attainment and agricultural production. The authors used two quasi-experimental designs: (1) a generalized propensity score for a continuous treatment variable (defined as coverage from owning insecticide-treated bed nets and/or receipt of indoor residual spraying); and, (2) a district fixed effects model to assess changes in the outcome relative to changes in treatment pre-post scale-up. The unit of analysis was at district level. The authors also conducted simulations post-analysis to assess statistical power. Micro-economic outcomes increased (33% increase in food spending) concurrently with malaria control coverage (62% increase) from 2006 to 2010. Despite using data from all 72 districts, both analytic methods yielded wide confidence intervals that do not conclusively link outcomes and malaria control coverage increases. The authors cannot rule out positive, null or negative effects. The upper bound estimates of the results show that if malaria control coverage increases from 60 to 70%, food spending could increase up to 14%, maize production could increase up to 57%, and years of schooling could increase up to 0.5 years. Simulations indicated that the generalized propensity score model did not have good statistical power. While it is technically possible to use routinely available survey data to relate malaria control scale-up and micro-economic outcomes, it is not clear from this analysis that meaningful results can be obtained when survey data are

  12. ABO blood groups and malaria related clinical outcom

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    Deepa, Vanamala A. Alwar, Karuna Rameshkumar & Cecil Ross

    2011-03-01

    Full Text Available Objectives: The study was undertaken to correlate the blood groups and clinical presentations in malaria patientsand to understand the differential host susceptibility in malaria.Methods: From October 2007 to September 2008, malaria positive patients’ samples were evaluated in thisstudy. Hemoglobin, total leukocyte count, and platelet count of each patient were done on an automated cellcounter. After determining the blood groups, malarial species and the severity of clinical course were correlated.Results: A total of 100 patients were included in the study, of which 63 cases were positive for Plasmodiumfalciparum and 37 cases were positive for P. vivax infection and 11 patients had mixed infection. The results ofthe blood groups showed 22 – ‘A’ group, 42 – ‘B’ group, 35 – ‘O’ group and 1 was ‘AB’ group. When the clinicalcourses between different groups were compared using the following parameters for severe infection—a parasiticload of >10/1000 RBCs, severe anemia with hemoglobin 101oF and other organ involvement, it wasobserved that ‘O’ group had an advantage over other the groups. The difference in rosetting ability between redblood cells of different ‘ABO’ blood groups with a diminished rosetting potential in blood group ‘O’ red bloodcells was due to the differential host susceptibility.Conclusion: ‘O’ group had an advantage over the other three blood groups. Based on literature and the results ofthis study, the diminished rosetting potential in blood group ‘O’ red blood cells is suggested as the basis for thedifferential host susceptibility.

  13. Meniscectomy: indications, procedure, outcomes, and rehabilitation

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    Anetzberger H

    2013-12-01

    Full Text Available Hermann Anetzberger,1 Christof Birkenmaier,2 Stephan Lorenz3 1Orthopädische Gemeinschaftspraxis am OEZ, Munich, Germany; 2Department of Orthopedics, Ludwig-Maximilian-University Munich, Munich, Germany; 3Department of Orthopedic Sports Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany Abstract: Meniscal injuries are among the most frequent reasons for knee problems. The goal of this manuscript is to review the biomechanical relevance of the human knee's menisci in relation to surgical indications, surgical techniques, rehabilitation, and outcomes. In order to identify the relevant literature, we performed a PubMed search for the years ranging from 1980–2013 using the following search terms: meniscus; biomechanical function; meniscectomy; meniscal repair; and clinical outcome. The meniscus helps to distribute the forces between the tibial and femoral articular cartilage layers in a load-sharing capacity. Meniscus damage or meniscectomy intuitively leads to an overloading of the cartilage and, hence, to the development of osteoarthrosis. Precise knowledge of meniscal shape and function, of the type of injury, of surgical techniques, as well as of postsurgical rehabilitative care are of decisive importance for an individually-adjusted treatment strategy. Other underlying coexisting knee pathologies also need to be considered. The diagnosis of a meniscal injury is based upon clinical history, physical examination, and imaging studies. The treatment of a meniscal lesion includes conservative, as well as operative, procedures. The goals of surgery are to reduce pain and disability, as well as to preserve meniscal function without causing additional cartilage damage. The resection of meniscal tissue should be restricted to as much as is necessary, and as little as is reasonably possible. Postoperative rehabilitation serves the purpose of improving functional deficits and pain, as well as of restoring a good range of

  14. Universal coverage with insecticide-treated nets - applying the revised indicators for ownership and use to the Nigeria 2010 malaria indicator survey data.

    Science.gov (United States)

    Kilian, Albert; Koenker, Hannah; Baba, Ebenezer; Onyefunafoa, Emmanuel O; Selby, Richmond A; Lokko, Kojo; Lynch, Matthew

    2013-09-10

    Until recently only two indicators were used to evaluate malaria prevention with insecticide-treated nets (ITN): "proportion of households with any ITN" and "proportion of the population using an ITN last night". This study explores the potential of the expanded set of indicators recommended by the Roll Back Malaria Monitoring and Evaluation Reference Group (MERG) for comprehensive analysis of universal coverage with ITN by applying them to the Nigeria 2010 Malaria Indicator Survey data. The two additional indicators of "proportion of households with at least one ITN for every two people" and "proportion of population with access to an ITN within the household" were calculated as recommended by MERG. Based on the estimates for each of the four ITN indicators three gaps were calculated: i) households with no ITN, ii) households with any but not enough ITN, iii) population with access to ITN not using it. In addition, coverage with at least one ITN at community level was explored by applying Lot Quality Assurance Sampling (LQAS) decision rules to the cluster level of the data. All outcomes were analysed by household background characteristics and whether an ITN campaign had recently been done. While the proportion of households with any ITN was only 42% overall, it was 75% in areas with a recent mass campaign and in these areas 66% of communities had coverage of 80% or better. However, the campaigns left a considerable intra-household ownership gap with 66% of households with any ITN not having enough for every family member. In contrast, the analysis comparing actual against potential use showed that ITN utilization was good overall with only 19% of people with access not using the ITN, but with a significant difference between the North, where use was excellent (use gap 11%), and the South (use gap 36%) indicating the need for enhanced behaviour change communication. The expanded ITN indicators to assess universal coverage provide strong tools for a comprehensive

  15. The incidence of malaria in travellers to South-East Asia: is local malaria transmission a useful risk indicator?

    Directory of Open Access Journals (Sweden)

    Jänisch Thomas

    2010-10-01

    Full Text Available Abstract Background The presence of ongoing local malaria transmission, identified though local surveillance and reported to regional WHO offices, by S-E Asian countries, forms the basis of national and international chemoprophylaxis recommendations in western countries. The study was designed to examine whether the strategy of using malaria transmission in a local population was an accurate estimate of the malaria threat faced by travellers and a correlate of malaria in returning travellers. Methods Malaria endemicity was described from distribution and intensity in the local populations of ten S-E Asian destination countries over the period 2003-2008 from regionally reported cases to WHO offices. Travel acquired malaria was collated from malaria surveillance reports from the USA and 12 European countries over the same period. The numbers of travellers visiting the destination countries was based on immigration and tourism statistics collected on entry of tourists to the destination countries. Results In the destination countries, mean malaria rates in endemic countries ranged between 0.01 in Korea to 4:1000 population per year in Lao PDR, with higher regional rates in a number of countries. Malaria cases imported into the 13 countries declined by 47% from 140 cases in 2003 to 66 in 2008. A total of 608 cases (27.3% Plasmodium falciparum (Pf were reported over the six years, the largest number acquired in Indonesia, Thailand and Korea. Four countries had an incidence > 1 case per 100,000 traveller visits; Burma (Myanmar, Indonesia, Cambodia and Laos (range 1 to 11.8-case per 100,000 visits. The remaining six countries rates were Conclusion The intensity of malaria transmission particularly sub-national activity did not correlate with the risk of travellers acquiring malaria in the large numbers of arriving visitors. It is proposed to use a threshold incidence of > 1 case per 100,000 visits to consider targeted malaria prophylaxis

  16. Lateral Transpsoas Fusion: Indications and Outcomes

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    Vishal C. Patel

    2012-01-01

    Full Text Available Spinal fusion historically has been used extensively, and, recently, the lateral transpsoas approach to the thoracic and lumbar spine has become an increasingly common method to achieve fusion. Recent literature on this approach has elucidated its advantage over more traditional anterior and posterior approaches, which include a smaller tissue dissection, potentially lower blood loss, no need for an access surgeon, and a shorter hospital stay. Indications for the procedure have now expanded to include degenerative disc disease, spinal stenosis, degenerative scoliosis, nonunion, trauma, infection, and low-grade spondylolisthesis. Lateral interbody fusion has a similar if not lower rate of complications compared to traditional anterior and posterior approaches to interbody fusion. However, lateral interbody fusion has unique complications that include transient neurologic symptoms, motor deficits, and neural injuries that range from 1 to 60% in the literature. Additional studies are required to further evaluate and monitor the short- and long-term safety, efficacy, outcomes, and complications of lateral transpsoas procedures.

  17. Plant Hormone Salicylic Acid Produced by a Malaria Parasite Controls Host Immunity and Cerebral Malaria Outcome.

    Science.gov (United States)

    Matsubara, Ryuma; Aonuma, Hiroka; Kojima, Mikiko; Tahara, Michiru; Andrabi, Syed Bilal Ahmad; Sakakibara, Hitoshi; Nagamune, Kisaburo

    2015-01-01

    The apicomplexan parasite Toxoplasma gondii produces the plant hormone abscisic acid, but it is unclear if phytohormones are produced by the malaria parasite Plasmodium spp., the most important parasite of this phylum. Here, we report detection of salicylic acid, an immune-related phytohormone of land plants, in P. berghei ANKA and T. gondii cell lysates. However, addition of salicylic acid to P. falciparum and T. gondii culture had no effect. We transfected P. falciparum 3D7 with the nahG gene, which encodes a salicylic acid-degrading enzyme isolated from plant-infecting Pseudomonas sp., and established a salicylic acid-deficient mutant. The mutant had a significantly decreased concentration of parasite-synthesized prostaglandin E2, which potentially modulates host immunity as an adaptive evolution of Plasmodium spp. To investigate the function of salicylic acid and prostaglandin E2 on host immunity, we established P. berghei ANKA mutants expressing nahG. C57BL/6 mice infected with nahG transfectants developed enhanced cerebral malaria, as assessed by Evans blue leakage and brain histological observation. The nahG-transfectant also significantly increased the mortality rate of mice. Prostaglandin E2 reduced the brain symptoms by induction of T helper-2 cytokines. As expected, T helper-1 cytokines including interferon-γ and interleukin-2 were significantly elevated by infection with the nahG transfectant. Thus, salicylic acid of Plasmodium spp. may be a new pathogenic factor of this threatening parasite and may modulate immune function via parasite-produced prostaglandin E2.

  18. Plant Hormone Salicylic Acid Produced by a Malaria Parasite Controls Host Immunity and Cerebral Malaria Outcome.

    Directory of Open Access Journals (Sweden)

    Ryuma Matsubara

    Full Text Available The apicomplexan parasite Toxoplasma gondii produces the plant hormone abscisic acid, but it is unclear if phytohormones are produced by the malaria parasite Plasmodium spp., the most important parasite of this phylum. Here, we report detection of salicylic acid, an immune-related phytohormone of land plants, in P. berghei ANKA and T. gondii cell lysates. However, addition of salicylic acid to P. falciparum and T. gondii culture had no effect. We transfected P. falciparum 3D7 with the nahG gene, which encodes a salicylic acid-degrading enzyme isolated from plant-infecting Pseudomonas sp., and established a salicylic acid-deficient mutant. The mutant had a significantly decreased concentration of parasite-synthesized prostaglandin E2, which potentially modulates host immunity as an adaptive evolution of Plasmodium spp. To investigate the function of salicylic acid and prostaglandin E2 on host immunity, we established P. berghei ANKA mutants expressing nahG. C57BL/6 mice infected with nahG transfectants developed enhanced cerebral malaria, as assessed by Evans blue leakage and brain histological observation. The nahG-transfectant also significantly increased the mortality rate of mice. Prostaglandin E2 reduced the brain symptoms by induction of T helper-2 cytokines. As expected, T helper-1 cytokines including interferon-γ and interleukin-2 were significantly elevated by infection with the nahG transfectant. Thus, salicylic acid of Plasmodium spp. may be a new pathogenic factor of this threatening parasite and may modulate immune function via parasite-produced prostaglandin E2.

  19. Parasitological Indices of Malaria Transmission in Children under Fifteen Years in Two Ecoepidemiological Zones in Southwestern Burkina Faso

    Science.gov (United States)

    Sangaré, Ibrahim; Coulibaly, Sanata; Namountougou, Moussa; Paré-Toé, Léa; Ouédraogo, Anicet Georges; Diabaté, Abdoulaye; Foy, Brian D.

    2017-01-01

    Twenty years after the latest publications performed on the parasitological indices of malaria transmission in northwest of the second city of Burkina Faso, it was important to update the epidemiological profile of malaria in children under the age of 15 years. The objective of this study was to determine and compare the parasitological parameters of malaria transmission by season, area, and age in the two zones (rice and savanna) in the northwest of Bobo-Dioulasso, Burkina Faso. Overall, the results showed that there was no significant difference in the parasitological indices of malaria transmission within children under fifteen years between the rice site and the savannah site and whatever the season (P > 0.05). The profound environmental modifications that occurred in the rice zone would have led to changes in vector behavior and consequently to changes in the epidemiological profile of malaria, contrary to the results obtained since the last publications. An entomological study correlated with this study is therefore necessary for effective decision-making for the malaria control in both areas. Future research must now focus on the impact that these profound environmental modifications of rice area are having on malaria control in Burkina Faso.

  20. Influence of common variants of TLR4 and TLR9 on clinical outcomes of Plasmodium falciparum malaria in Odisha, India.

    Science.gov (United States)

    Kar, Avishek; Panigrahi, Subhendu; Tripathy, Sagnika; Mohapatra, Manoj K; Tayung, Kumananda; Dhangadamajhi, Gunanidhi

    2015-12-01

    In malaria, the toll-like receptors (TLRs) have recently emerged as major player of innate immunity. However, implication of TLR variants on clinical manifestations of malaria is conflicting. The present study aims to provide relevant information of growing interest in understanding the role of TLR4D299G, TLR9T-1237C and TLR9T-1486C polymorphisms on clinical outcomes of malaria. We genotyped TLR4D299G, TLR9T-1237C and TLR9T-1486C polymorphisms by PCR-RFLP methods and subsequently analyzed in 200 uncomplicated patients and 200 severe patients. Further, the severe malaria categorized into sub-clinical groups such as cerebral malaria (CM), non-cerebral severe malaria (NCSM), single organ dysfunction (SOD) and multi-organ dysfunctions (MODS) are analyzed. The TLR9-1237CC genotype was observed at significantly low frequency in MODS (p=0.0008), while in heterozygous state (TC) it was proportionately more frequent in SOD (p=0.087) as compared to mild malaria. The TLR9T-1486C heterozygote was more common in all categories of severe malaria. However, pair wise LD analysis revealed significant linkage between T-1237C and T-1486C, whereas haplotype analysis showed significantly low frequency of C-T haplotype in CM (p=0.005, pc=0.02) and high frequency of T-C haplotype in NCSM as compared to mild malaria. Although TLR9-1237C could be a risk factor for severe malaria in heterozygous state, negative association of CC genotype with MODS warrants caution of segregating severe malaria into its sub-clinical groups while interpreting data. Further, clinical outcome in malaria was observed to be apparently modulated by LD between TLR9 promoter variants. Copyright © 2015 Elsevier B.V. All rights reserved.

  1. Indications and Outcomes of Amniotic Membrane Transplantation

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    Alime Güneş

    2014-03-01

    Full Text Available Objectives: To investigate the indications and outcomes of amniotic membrane transplantation (AMT. Materials and Methods: A total of 87 eyes who underwent amnion membrane transplantation in our clinic between February 2010 and April 2013 were included in this study. Mean follow-up period was 7.49±7.84 months (range 1-29 months. Amnion membrane defrosted at room temperature and washed three times with saline covered all over the cornea independent of the position and size of the lesion and was sutured to the peripheral cornea circumferentially by 10/0 monofilament suture. At the end of the operation, therapeutic contact lens was placed. All cases were evaluated with respect to duration of surface epithelial healing, visual acuity, presence of recurrence, and infection. Results: Forty-six of the 87 patients (52.8% were men and 41 (47.1% were women. The mean age was 57.02±19.74 years (range 31-89 years in men and 66.69±16.56 years (range 8-88 years in women. The indications were: ulcers in 27 eyes, keratitis in 24 eyes, topical anesthetic abuse in 10 eyes, bullous keratopathy in 7 eyes, conjunctival mass in 7 eyes, symblepharon in 3 eyes, chemical burns in 3 eyes, pterygium in 2 eyes, endophthalmitis in 2 eyes, dellen in 1 eye, and conjunctival laceration in 1 eye. After AMT, 12 patients required second AMT, and 2 cases required third AMT. 2 eyes were eviscerated, 1 eye was exenterated. At the final follow-up visit, except for patients who underwent evisceration and exenteration, improved visual acuity was observed in 45 of the 84 eyes (53.5%. The average of healing time was between 4 and 6 weeks. No infectious, inflammatory, immunologic, or toxic/allergic reactions related to AMT was observed. Conclusion: Amniotic membrane transplantation is a safe and effective technique in ocular surface diseases. (Turk J Ophthalmol 2014; 44: 123-6

  2. Predictive indices of empirical clinical diagnosis of malaria among under-five febrile children attending paediatric outpatient clinic

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    Hassan A Elechi

    2015-01-01

    Full Text Available Background: Malaria has remained an important public health problem in Nigeria with children under 5 years of age bearing the greatest burden. Accurate and prompt diagnosis of malaria is an important element in the fight against the scourge. Due to the several limitations of microscopy, diagnosis of malaria has continued to be made based on clinical ground against several World Health Organization (WHO recommendations. Thus, we aim to assess the performance of empirical clinical diagnosis among febrile children under 5 years of age in a busy pediatric outpatient clinic. Materials and Methods: The study was a cross-sectional study. Children aged <5 years with fever or 72 h history of fever were recruited. Children on antimalarial prophylaxis or on treatment for malaria were excluded. Relevant information was obtained from the caregiver and clinical note of the child using interviewer administered questionnaire. Two thick and two thin films were made, stained, and read for each recruited child. Data was analysed using SPSS version 16. Results: Of the 433 children studied, 98 (22.6% were empirically diagnosed as having malaria and antimalarial drug prescribed. Twenty-three (23.5% of these children were confirmed by microscopy to have malaria parasitemia, while 75 (76.5% were negative for malaria parasitemia. Empirical clinical diagnosis show poor predictive indices with sensitivity of 19.2%, specificity of 76.0%, positive predictive value of 23.5% and negative predictive value of 71%. Conclusion and Recommendations: Empirical clinical diagnosis of malaria among the under-five children with symptoms suggestive of acute malaria is highly not reliable and hence the need to strengthen parasitological diagnosis.

  3. Rib Fracture Fixation: Indications and Outcomes.

    Science.gov (United States)

    Senekjian, Lara; Nirula, Raminder

    2017-01-01

    Rib fractures are a frequently identified injury in the trauma population. Not only are multiple rib fractures painful, but they are associated with an increased risk of adverse outcomes. Pneumonia in particular can be devastating, especially to an elderly patient, but other complications such as prolonged ventilation and increased intensive care and hospital durations of stay have a negative impact on the patient. Computed tomography scan is the best modality to diagnosis rib fractures but the treatment of fractures is still evolving. Currently patient care involves a multidisciplinary approach that includes pain control, aggressive pulmonary therapy, and possibly surgical fixation. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Clinical features and outcome in children with severe Plasmodium falciparum malaria: a meta-analysis.

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    Laurens Manning

    Full Text Available BACKGROUND: Although global malaria mortality is declining, estimates may not reflect better inpatient management of severe malaria (SM where reported case fatality rates (CFRs vary from 1-25%. METHODS: A meta-analysis of prospective studies of SM was conducted to examine i whether hypothesized differences between clinical features and outcome in Melanesian compared with African or Asian children really exist, and ii to explore temporal changes in overall and complication-specific CFRs. The proportions of different SM complications and, overall and complication-specific CFRs were incorporated into the meta-analysis. Adjustments were made for study-level covariates including geographic region, SM definition, artemisinin treatment, median age of participants and time period. FINDINGS: Sixty-five studies were included. Substantial heterogeneity (I(2>80% was demonstrated for most outcomes. SM definition contributed to between-study heterogeneity in proportions of cerebral malaria (CM, metabolic acidosis (MA, severe anemia and overall CFR, whilst geographic region was a significant moderator in for CM and hypoglycemia (HG rates. Compared with their African counterparts, Melanesian children had lower rates of HG (10% [CI95 7-13%] versus 1% [0-3%], P<0.05, lower overall CFR (2% [0-4%] versus 7% [6-9%], P<0.05 and lower CM-specific CFR (8% [0-17%] versus 19% [16-21%], P<0.05. There was no temporal trend for overall CFR and CM-specific CFR but declining HG- and MA- specific CFRs were observed. INTERPRETATION: These data highlight that recent estimates of declining global malaria mortality are not replicated by improved outcomes for children hospitalized with SM. Significant geographic differences in the complication rates and subsequent CFRs exist and provide the first robust confirmation of lower CFRs in Melanesian children, perhaps due to less frequent HG.

  5. Global health diplomacy investments in Afghanistan: adaptations and outcomes of global fund malaria programs.

    Science.gov (United States)

    Kevany, Sebastian; Sahak, Omar; Workneh, Nibretie Gobezie; Saeedzai, Sayed Ataullah

    2014-01-01

    Global health programmes require extensive adaptation for implementation in conflict and post-conflict settings. Without such adaptations, both implementation success and diplomatic, international relations and other indirect outcomes may be threatened. Conversely, diplomatic successes may be made through flexible and responsive programmes. We examine adaptations and associated outcomes for malaria treatment and prevention programmes in Afghanistan. In conjunction with the completion of monitoring and evaluation activities for the Global Fund to Fight AIDS, Tuberculosis and Malaria, we reviewed adaptations to the structure, design, selection, content and delivery of malaria-related interventions in Afghanistan. Interviews were conducted with programme implementers, service delivery providers, government representatives and local stakeholders, and site visits to service delivery points were completed. Programmes for malaria treatment and prevention require a range of adaptations for successful implementation in Afghanistan. These include (1) amendment of educational materials for rural populations, (2) religious awareness in gender groupings for health educational interventions, (3) recruitment of local staff, educated in languages and customs, for both quality assurance and service delivery, (4) alignment with diplomatic principles and, thereby, avoidance of confusion with broader strategic and military initiatives and (5) amendments to programme 'branding' procedures. The absence of provision for these adaptations made service delivery excessively challenging and increased the risk of tension between narrow programmatic and broader diplomatic goals. Conversely, adapted global health programmes displayed a unique capacity to access potentially extremist populations and groups in remote regions otherwise isolated from international activities. A range of diplomatic considerations when delivering global health programmes in conflict and post-conflict settings are

  6. Quality Indicators and Outcomes of Emergency Caesarean ...

    African Journals Online (AJOL)

    AJRH Managing Editor

    Abstract. The objective of this research study is to identify quality indicators of cesarean deliveries and determine their ... Quality of Cesarean Deliveries at a District-level Maternity Hospital .... complex surgical management i.e. uterine rupture.

  7. Indication of pyrethroid resistance in the main malaria vectorAnopheles stephensi from Iran

    Institute of Scientific and Technical Information of China (English)

    Hassan Vatandoost; Ahmad Ali Hanafi-Bojd

    2012-01-01

    Objective:To investiagte insecticide resistance in target species for better insecticide resistance managemnet in malaria control programs.Methods:The status of insecticide resistance to different imagicides inAnopheles stephensi(An. stephensi) includingDDT4%, lambdacyhalothrin 0.50%, deltamethrin0.05%, permethrin0.75%, cyfluthrin0.15% and etofenprox0.50% was performed according toWHO standard method.Results:The mortality rate to lambdacyhalothrin, permethrin, cyfluthrin, deltamethrin, etofenprox andDDT was(88.0±3.2),(92.0±2.7),(52.0±5.0),(96.0±2.2),(90.0±3.0) and(41.0±5.7) percent, respectively at diagnostic dose for one hour exposure time followed by24 h recovery period.Conclusions:These results showed first indication of pyrethroid resistance inAn. stephensiin a malarious area, from southernIran.There is widespread, multiple resistances in the country inAn. stephensi to organochlorine and some report of tolerance to organophosphate insecticides and recently to pyrethroids.However, results of this paper will provide a clue for monitoring and mapping of insecticide resistance in the main malaria vector for implementation of any vector control.

  8. Relationship between ABO blood groups and malaria with clinical outcome in rural area of South India

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    Gayathri B.N.

    2013-05-01

    Full Text Available Background A number of studies have shown that susceptibility to several infectious diseases is related to the patient’s blood group. Although the relationship between blood group and susceptibility to malaria has been studied by several researchers, the results have been contradictory. Since malaria has re-emerged as a major problem in India during the past few years, it would be useful to know whether there is any relationship between blood group and infection. Objectives The study will be undertaken to correlate the blood groups and clinical presentations in malaria patients and to understand the differential host susceptibility in malaria. Method Over a period of 4 years malaria positive samples identified by peripheral smear (thin and thick smears will be evaluated in this study. Haemoglobin, total leucocyte count, differential leucocyte count and platelet count of each patient done on an automated cell counter will be retrieved from the data. Blood group was determined by forward and reverse method. The demographic details of the patients and clinical details were obtained from case records of the patients. Malarial species and the severity of clinical course were correlated with blood groups Results A total of 205 patients were included in the study, of which 123 cases were positive for plasmodium falciparum and 78 cases were positive for P. vivax infection and 4 patients had mixed infection. The results of blood groups showed 33 -‘A’ group, 84 -‘B’ group, 70 -‘O’ group and 18 were ‘AB’ group. When the clinical courses between different groups were compared using the following parameters for severe infection- a parasitic load of > 10/1000 RBCs, severe anemia with haemoglobin 101o F and the other organ involvement, it was observed that there was no significant relationship between ABO blood group and malaria in our population, this could be due to various demographic reasons. Conclusions The present study indicate that

  9. Geographical disparities in core population coverage indicators for roll back malaria in Malawi

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    Appleton Christopher C

    2007-07-01

    Full Text Available Abstract Background Implementation of known effective interventions would necessitate the reduction of malaria burden by half by the year 2010. Identifying geographical disparities of coverage of these interventions at small area level is useful to inform where greatest scaling-up efforts should be concentrated. They also provide baseline data against which future scaling-up of interventions can be compared. However, population data are not always available at local level. This study applied spatial smoothing methods to generate maps at subdistrict level in Malawi to serve such purposes. Methods Data for the following responses from the 2000 Malawi Demographic and Health Survey (DHS were aggregated at subdistrict level: (1 households possessing at least one bednet; (2 children under 5 years who slept under a bednet the night before the survey; (3 bednets retreated with insecticide within past 6–12 months preceding the survey; (4 children under 5 who had fever two weeks before the survey and received treatment within 24 hours from the onset of fever; and (5 women who received intermittent preventive treatment of malaria during their last pregnancy. Each response was geographically smoothed at subdistrict level by applying conditional autoregressive models using Markov Chain Monte Carlo simulation techniques. Results The underlying geographical patterns of coverage of indicators were more clear in the smoothed maps than in the original unsmoothed maps, with relatively high coverage in urban areas than in rural areas for all indicators. The percentage of households possessing at least one bednet was 19% (95% credible interval (CI: 16–21%, with 9% (95% CI: 7–11% of children sleeping under a net, while 18% (95% CI: 16–19% of households had retreated their nets within past 12 months prior to the survey. The northern region and lakeshore areas had high bednet coverage, but low usage and re-treatment rates. Coverage rate of children who received

  10. Impact of community-based interventions for the prevention and control of malaria on intervention coverage and health outcomes for the prevention and control of malaria.

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    Salam, Rehana A; Das, Jai K; Lassi, Zohra S; Bhutta, Zulfiqar A

    2014-01-01

    In this paper, we aim to evaluate the effectiveness of community-based interventions (CBIs) for the prevention and management of malaria. We conducted a systematic review and identified 42 studies for inclusion. Twenty-five of the included studies evaluated the impact of the community-based distribution of insecticide-treated nets (ITNs), indoor residual spraying (IRS), or impregnated bed sheets; 14 studies evaluated intermittent preventive therapy (IPT) delivered in community settings; two studies focused on community-based education for malaria prevention; and one study evaluated environmental management through drain cleaning. Our analysis suggests that, overall, the community-based delivery of interventions to prevent and control malaria resulted in a significant increase in ITNs ownership (RR: 2.16, 95% CI: 1.86, 2.52) and usage (RR: 1.77, 95% CI: 1.48, 2.11). However, usage of ITNs was limited to two-thirds of the population who owned them. Community-based strategies also led to a significant decrease in parasitemia (RR: 0.56, 95% CI: 0.42, 0.74), malaria prevalence (RR: 0.46, 95% CI: 0.29, 0.73), malaria incidence (RR: 0.70, 95% CI: 0.54, 0.90), and anemia prevalence (RR: 0.79, 95% CI: 0.64, 0.97). We found a non-significant impact on splenomegaly, birth outcomes (low birth weight, prematurity, stillbirth/miscarriage), anthropometric measures (stunting, wasting, and underweight), and mortality (all-cause and malaria-specific). The subgroup analysis suggested that community-based distribution of ITNs, impregnated bed sheets and IRS, and IPT are effective strategies. Qualitative synthesis suggests that high coverage could be achieved at a lower cost with the integration of CBIs with existing antenatal care and immunization campaigns. Community-based delivery of interventions to prevent and control malaria are effective strategies to improve coverage and access and reduce malaria burden, however, efforts should also be concerted to prevent over diagnosis and

  11. New records of Anopheles arabiensis breeding on the Mount Kenya highlands indicate indigenous malaria transmission

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    Githure John I

    2006-03-01

    Full Text Available Abstract Background Malaria cases on the highlands west of Mount Kenya have been noticed since 10 – 20 years ago. It was not clear whether these cases were introduced from the nearby lowland or resulted from local transmission because of no record of vector mosquitoes on the highlands. Determination of presence and abundance of malaria vector is vital for effective control and epidemic risk assessment of malaria among both local residents and tourists. Methods A survey on 31 aquatic sites for the malaria-vector mosquitoes was carried out along the primary road on the highlands around Mount Kenya and the nearby Mwea lowland during April 13 to June 28, 2005. Anopheline larvae were collected and reared into adults for morphological and molecular species identification. In addition, 31 families at three locations of the highlands were surveyed using a questionnaire about their history of malaria cases during the past five to 20 years. Results Specimens of Anopheles arabiensis were molecularly identified in Karatina and Naro Moru on the highlands at elevations of 1,720 – 1,921 m above sea level. This species was also the only malaria vector found in the Mwea lowland. Malaria cases were recorded in the two highland locations in the past 10 years with a trend of increasing. Conclusion Local malaria transmission on the Mount Kenya highlands is possible due to the presence of An. arabiensis. Land use pattern and land cover might be the key factors affecting the vector population dynamics and the highland malaria transmission in the region.

  12. Impact of insecticide-treated bed nets on malaria transmission indices on the south coast of Kenya

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    Mutuku Francis M

    2011-12-01

    -human vertebrates. Besides bed net use, malaria vector abundance was also influenced by type of house construction and according to whether one sleeps on a bed or a mat (both of these are associated with household wealth. Mosquito density was positively associated with presence of domestic animals. Conclusions These entomological indices indicate a much reduced human biting rate and a diminishing role of An. gambiae s.s. in malaria transmission following high bed net coverage. While increasing bed net coverage beyond the current levels may not significantly reduce the transmission potential of An. arabiensis, it is anticipated that increasing or at least sustaining high bed net coverage will result in a diminished role for An. funestus in malaria transmission.

  13. Impact of insecticide-treated bed nets on malaria transmission indices on the south coast of Kenya.

    Science.gov (United States)

    Mutuku, Francis M; King, Charles H; Mungai, Peter; Mbogo, Charles; Mwangangi, Joseph; Muchiri, Eric M; Walker, Edward D; Kitron, Uriel

    2011-12-13

    was also influenced by type of house construction and according to whether one sleeps on a bed or a mat (both of these are associated with household wealth). Mosquito density was positively associated with presence of domestic animals. These entomological indices indicate a much reduced human biting rate and a diminishing role of An. gambiae s.s. in malaria transmission following high bed net coverage. While increasing bed net coverage beyond the current levels may not significantly reduce the transmission potential of An. arabiensis, it is anticipated that increasing or at least sustaining high bed net coverage will result in a diminished role for An. funestus in malaria transmission.

  14. Malaria infection, poor nutrition and indoor air pollution mediate socioeconomic differences in adverse pregnancy outcomes in Cape Coast, Ghana.

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    Adeladza K Amegah

    Full Text Available BACKGROUND: The epidemiological evidence linking socioeconomic deprivation with adverse pregnancy outcomes has been conflicting mainly due to poor measurement of socioeconomic status (SES. Studies have also failed to evaluate the plausible pathways through which socioeconomic disadvantage impacts on pregnancy outcomes. We investigated the importance of maternal SES as determinant of birth weight and gestational duration in an urban area and evaluated main causal pathways for the influence of SES. METHODS: A population-based cross-sectional study was conducted among 559 mothers accessing postnatal services at the four main health facilities in Cape Coast, Ghana in 2011. Information on socioeconomic characteristics of the mothers was collected in a structured questionnaire. RESULTS: In multivariate linear regression adjusting for maternal age, parity and gender of newborn, low SES resulted in 292 g (95% CI: 440-145 reduction in birth weight. Important SES-related determinants were neighborhood poverty (221 g; 95% CI: 355-87, low education (187 g; 95% CI: 355-20, studentship during pregnancy (291 g; 95% CI: 506-76 and low income (147 g; 95% CI: 277-17. In causal pathway analysis, malaria infection (6-20%, poor nutrition (2-51% and indoor air pollution (10-62% mediated substantial proportions of the observed effects of socioeconomic deprivation on birth weight. Generalized linear models adjusting for confounders indicated a 218% (RR: 3.18; 95% CI: 1.41-7.21 risk increase of LBW and 83% (RR: 1.83; 95% CI: 1.31-2.56 of PTB among low income mothers. Low and middle SES was associated with 357% (RR: 4.57; 95% CI: 1.67-12.49 and 278% (RR: 3.78; 95% CI: 1.39-10.27 increased risk of LBW respectively. Malaria infection, poor nutrition and indoor air pollution respectively mediated 10-21%, 16-44% and 31-52% of the observed effects of socioeconomic disadvantage on LBW risk. CONCLUSION: We provide evidence of the effects of socioeconomic deprivation

  15. Prevalence and hematological indicators of G6PD deficiency in malaria-infected patients

    Institute of Scientific and Technical Information of China (English)

    Manas Kotepui; Kwuntida Uthaisar; Bhukdee PhunPhuech; Nuoil Phiwklam

    2016-01-01

    Background:This study aimed to evaluate the prevalence and alteration of hematological parameters in malaria patients with a glucose-6-phosphate dehydrogenase (G6PD) deficiency,in the western region of Thailand,an endemic region for malaria.Methods:Data about patients with malaria hospitalized between 2013 and 2015 were collected.Clinical and sociodemographic characteristics such as age and gender,diagnosis on admission,and parasitological results were mined from medical records of the laboratory unit of the Phop Phra Hospital in Tak Province,Thailand.Venous blood samples were collected at the time of admission to hospital to determine G6PD deficiency by fluorescence spot test and detect malaria parasites by thick and thin film examination.Other data such as complete blood count and parasite density were also collected and analyzed.Results:Among the 245 malaria cases,28 (11.4 %) were diagnosed as Plasmodium falciparum infections and 217 cases (88.6 %) were diagnosed as P.vivax infections.Seventeen (6.9 %) patients had a G6PD deficiency and 228 (93.1%) patients did not have a G6PD deficiency.Prevalence of male patients with G6PD deficiency was higher than that of female patients (P < 0.05,OR =5.167).Among the patients with a G6PD deficiency,two (11.8 %) were infected with P.falciparum,while the remaining were infected with P.vivax.Malaria patients with a G6PD deficiency have higher monocyte counts (0.6 × 103/μL) than those without a G6PD deficiency (0.33 × 103/μL) (P< 0.05,OR=5.167).Univariate and multivariate analyses also confirmed that malaria patients with a G6PD deficiency have high monocyte counts.The association between G6PD status and monocyte counts was independent of age,gender,nationality,Plasmodium species,and parasite density (P < 0.005).Conclusion:This study showed a prevalence of G6PD deficiency in a malaria-endemic area.This study also supported the assertion that patients with G6PD-deficient red blood cells had no protection

  16. Potential impact of host immunity on malaria treatment outcome in Tanzanian children infected with Plasmodium falciparum

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    Theander Thor G

    2007-11-01

    Full Text Available Abstract Background In malaria endemic areas children may recover from malaria after chemotherapy in spite of harbouring genotypically drug-resistant Plasmodium falciparum. This phenomenon suggests that there is a synergy between drug treatment and acquired immunity. This hypothesis was examined in an area of moderately intense transmission of P. falciparum in Tanzania during a drug trail with sulphadoxine-pyrimethamine (SP or amodiaquine (AQ. Methods One hundred children with uncomplicated malaria were treated with either SP or AQ and followed for 28 days. Mutations in parasite genes related to SP and AQ-resistance as well as human sickle cell trait and alpha-thalassaemia were determined using PCR and sequence-specific oligonucleotide probes and enzyme-linked immunosorbent assay (SSOP-ELISA, and IgG antibody responses to a panel of P. falciparum antigens were assessed and related to treatment outcome. Results Parasitological or clinical treatment failure (TF was observed in 68% and 38% of children receiving SP or AQ, respectively. In those with adequate clinical and parasitological response (ACPR compared to children with TF, and for both treatment regimens, prevalence and levels of anti-Glutamate-rich Protein (GLURP-specific IgG antibodies were significantly higher (P Conclusion These findings suggest that GLURP-specific IgG antibodies in this setting contribute to clearance of drug-resistant infections and support the hypothesis that acquired immunity enhances the clinical efficacy of drug therapy. The results should be confirmed in larger scale with greater sample size and with variation in transmission intensity.

  17. Plasmodium falciparum multiple infections in Mozambique, its relation to other malariological indices and to prospective risk of malaria morbidity.

    Science.gov (United States)

    Mayor, Alfredo; Saute, Francisco; Aponte, John J; Almeda, Jesús; Gómez-Olivé, F Xavier; Dgedge, Martinho; Alonso, Pedro L

    2003-01-01

    We describe the frequency of Plasmodium falciparum clones infecting individuals living in a rural area of southern Mozambique and analyse the relationship between multiplicity of infection, age and other malariometric indices, including prospective risk of clinical malaria. The genotyping was based on the use of restriction fragment length polymorphism-polymerase chain reaction (RFLP-PCR) analysis of P. falciparum merozoite surface protein 2 (msp2). We analysed 826 samples collected during five cross-sectional surveys from residents of Manhiça ranging in age from 4 months to 83 years. We also determined the multiplicity of infection in samples obtained from 6-month-old infants (n = 79) and children <10 years (n = 158) who were then treated and followed prospectively for 1 year or 75 weeks, respectively. Multiplicity of infection did not vary significantly during the first year of life, but increased thereafter, and decreased during adulthood to the levels found in infants. With increasing multiplicity of infection, there was a statistically significant decrease in the risk of submicroscopic infections. There was also a significant correlation between multiplicity of infection and parasite density in infants, children <4 years of age and adults, suggesting that high densities increase the probability of discriminating more clones in complex infections. We found that the relationship between multiple infections and malaria morbidity is age-dependent. In infants, the risk of subsequent episodes of clinical malaria was related to the parasite density but not to baseline multiplicity of infection. In older children, however, the more clones a child carried, the more likely they were to have a clinical malaria episode, and this was true after adjusting for parasite densities. This change in the association between multiplicity and risk of clinical malaria may indicate a shift in the host response to P. falciparum.

  18. The epidemiological indices of malaria in Kermanshah province (1996-2010

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    Naser Nazari

    2016-01-01

    Full Text Available Background: Malaria is a major health problem in tropical and subtropical countries worldwide. According to the World Health Organization report, in the year 2011, approximately 791000 persons died due to malaria. To introduce the features of this disease in the province of Kermanshah, the registered characteristics of this disease were analyzed during 1996-2010. Methods: In this descriptive- analytical study, the data of 168 patients, based on the report forms of malaria cases, were collected from urban and rural health centers, health center of cities, and Kermanshah province health center. Data such as age, sex, place of disease, plasmodium type, transmission type, nationality and type of slide preparation were recorded. Data were analyzed by SPSS 16 software using descriptive statistics (mean, percentage and one and two-dimensional tables. Results: During 15 years, 168 malaria cases were reported in Kermanshah province with about 2 million populations. 94 (78.3% of them were male and in 163 cases (97% of P. vivax was the etiologic agent and P. falciparum was found in 5 other cases. Most cases were reported in 1375, 87 patients (51.8% and most of the cases 43 (25.6% were found in Paveh city. Conclusion: Malaria in Kermanshah province is now limited to cases traveling to or entering the Southeast areas of Iran. Although local transmission of malaria in the country, especially in the Southeast of the country continues to be a big problem, Kermanshah province is now considered a part of country where this disease is going to be eradicated and malaria control programs are being run successfully.

  19. Chitinase 3-like 1 is induced by Plasmodium falciparum malaria and predicts outcome of cerebral malaria and severe malarial anaemia in a case-control study of African children.

    Science.gov (United States)

    Erdman, Laura K; Petes, Carlene; Lu, Ziyue; Dhabangi, Aggrey; Musoke, Charles; Cserti-Gazdewich, Christine M; Lee, Chun Geun; Liles, Wayne Conrad; Elias, Jack A; Kain, Kevin C

    2014-07-21

    Severe and fatal malaria are associated with dysregulated host inflammatory responses to infection. Chitinase 3-like 1 (CHI3L1) is a secreted glycoprotein implicated in regulating immune responses. Expression and function of CHI3L1 in malaria infection were investigated. Plasma levels of CHI3L1 were quantified in a case-control study of Ugandan children presenting with Plasmodium falciparum malaria. CHI3L1 levels were compared in children with uncomplicated malaria (UM; n = 53), severe malarial anaemia (SMA; n = 59) and cerebral malaria (CM; n = 44) using the Kruskall Wallis-test, and evaluated for utility in predicting fatal (n = 23) versus non-fatal (n = 80) outcomes in severe disease using the Mann Whitney U test, receiver operating characteristic curves, and combinatorial analysis. Co-culture of P. falciparum with human peripheral blood mononuclear cells and the Plasmodium berghei ANKA experimental model of cerebral malaria were used to examine the role of CHI3L1 in severe malaria. In children presenting with falciparum malaria, CHI3L1 levels were increased in SMA and CM versus UM (p Plasmodium falciparum stimulated CHI3L1 production by human peripheral blood mononuclear cells in vitro. CHI3L1 was increased in plasma and brain tissue in experimental cerebral malaria, but targeted Chi3l1 deletion did not alter cytokine production or survival in this model. These data suggest that plasma CHI3L1 measured at presentation correlates with malaria severity and predicts outcome in paediatric SMA and CM, but do not support a causal role for CHI3L1 in cerebral malaria pathobiology in the model tested.

  20. Relationship of annual entomological inoculation rates to malaria transmission indices, Bayelsa State, Nigeria

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    Amawulu Ebenezer

    2016-01-01

    Results: The estimated mean man-biting rate (MBR over a 2-yr period was 6.88 bites/person/night. The highest MBR of 16.9 was in the mangrove coastal water forest and the least, 11.3, was in brackish water swamp forest; differences were significant (t = 12.083; p1.5 or unstable when EIR was ≤ 1.5. Although, earlier studies have shown correlation between EIRs and malaria PR, this study demonstrated a significant correlation between EIRs and malaria incidence rates.

  1. Photoacoustic detection of hemozoin in human mononuclear cells as an early indicator of malaria infection

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    Custer, Jonathan R.; Kariuki, Michael; Beerntsen, Brenda T.; Viator, John A.

    2010-02-01

    Malaria is a blood borne infection affecting hundreds of millions of people worldwide2. The parasites reproduce within the blood cells, eventually causing their death and lysis. This process releases the parasites into the blood, continuing the cycle of infection. Usually, malaria is diagnosed only after a patient presents symptoms, including high fever, nausea, and, in advanced cases, coma and death. While invading the bloodstream of a host, malaria parasites convert hemoglobin into an insoluble crystal, known as hemozoin. These crystals, approximately several hundred nanometers in size, are contained within red blood cells and white blood cells that ingest free hemozoin in the blood. Thus, infected red blood cells and white blood cells contain a unique optical absorber that can be detected in blood samples using static photoacoustic detection methods. We separated the white blood cells from malaria infected blood and tested it in a photoacoustic set up using a tunable laser system consisting of an optical parametric oscillator pumped by an Nd:YAG laser with pulse duration of 5 ns. Our threshold of detection was 10 infected white blood cells per microliter, which is more sensitive than current diagnosis methods using microscopic analysis of blood.

  2. Development of Outcome-based, Multipollutant Mobile Source Indicators

    Science.gov (United States)

    Pachon, Jorge E.; Balachandran, Sivaraman; Hu, Yongtao; Mulholland, James A.; Darrow, Lyndsey A.; Sarnat, Jeremy A.; Tolbert, Paige E.; Russell, Armistead G.

    2013-01-01

    Multipollutant indicators of mobile source impacts are developed from readily available CO, NOx, and elemental carbon (EC) data for use in air quality and epidemiologic analysis. Two types of outcome-based integrated mobile source indicators (IMSI) are assessed. The first is derived from analysis of emissions of EC, CO and NOx such that pollutant concentrations are mixed and weighted based on emission ratios for both gasoline and diesel vehicles. The emission-based indicators (IMSIEB) capture the impact of mobile sources on air quality estimated from receptor models and their uncertainty is comparable to measurement and source apportionment uncertainties. The IMSIEB have larger correlation between two different receptor sites impacted by traffic than single pollutants, suggesting they are better indicators of the local impact of mobile sources. A sensitivity analysis of fractions of pollutants in a two-pollutant mixture and the inclusion in an epidemiologic model is conducted to develop a second set of indicators based on health outcomes. The health-based indicators (IMSIHB) are weighted combinations of CO, NOx and EC pairs that have the lowest p-value in their association with cardiovascular disease emergency department visits, possibly due to their better spatial representativeness. These outcome-based, multipollutant indicators can provide support for the setting of multipollutant air quality standards and other air quality management activities. PMID:22616285

  3. A HOSPITAL-BASED RETROSPECTIVE COMPARATIVE STUDY OF COMPLICATIONS, OUTCOMES, CLINICAL AND LABORATORY PARAMETERS OF MALARIA WITH AND WITHOUT NEUROLOGICAL INVOLVEMENT

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    Sohaib Ahmad

    2017-01-01

    Full Text Available Background & Objectives: Classically associated with Plasmodium falciparum, neurological complications in severe malaria is associated with increased morbidity and mortality. However, reports implicate the long considered benign Plasmodium vivax for causing severe malaria as well. We aimed to analyze the cerebral complications in malaria, and study if there is a specie-related difference in the presentation and outcomes. Methods: We retrospectively compared patients of malaria hospitalised from 2009-15, with (n=105 and without (n=1155 neurological involvement in terms of outcomes, complications, demographic attributes, clinical features, and laboratory parameters. Subsequently, the same parameters were studied in those with cerebral malaria due to mono-infections of vivax or falciparum and their co-infection. Results: Cerebral malaria was observed in 8.3% (58/696, 7.4% (38/513 and 17.6% (6/51 of vivax, falciparum and combined plasmodial infections respectively. Those with cerebral malaria had significantly (p0.05. P. vivax emerged as the predominant cause of cerebral malaria and its virulence was comparable to P. falciparum.

  4. Impact of asymptomatic Plasmodium falciparum parasitemia on the imunohematological indices among school children and adolescents in a rural area highly endemic for Malaria in southern Mozambique

    OpenAIRE

    Gudo, Eduardo Samo; Prista, António; Jani, Ilesh V

    2013-01-01

    Background Asymptomatic Plasmodium falciparum parasitemia (APFP) has been reported to be highly prevalent in Sub-Saharan Africa, a region heavily burdened by malaria, yet, the impact of APFP on the immunological reference values have not yet been established. This study was aimed at i) determine the prevalence of APFP in children and adolescents living in a region highly endemic for malaria in southern Mozambique and its impact on the immuno-hematological indices and ii) determine the factors...

  5. Identifying malaria vector breeding habitats with remote sensing data and terrain-based landscape indices in Zambia

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    Shiff Clive

    2010-11-01

    Full Text Available Abstract Background Malaria, caused by the parasite Plasmodium falciparum, is a significant source of morbidity and mortality in southern Zambia. In the Mapanza Chiefdom, where transmission is seasonal, Anopheles arabiensis is the dominant malaria vector. The ability to predict larval habitats can help focus control measures. Methods A survey was conducted in March-April 2007, at the end of the rainy season, to identify and map locations of water pooling and the occurrence anopheline larval habitats; this was repeated in October 2007 at the end of the dry season and in March-April 2008 during the next rainy season. Logistic regression and generalized linear mixed modeling were applied to assess the predictive value of terrain-based landscape indices along with LandSat imagery to identify aquatic habitats and, especially, those with anopheline mosquito larvae. Results Approximately two hundred aquatic habitat sites were identified with 69 percent positive for anopheline mosquitoes. Nine species of anopheline mosquitoes were identified, of which, 19% were An. arabiensis. Terrain-based landscape indices combined with LandSat predicted sites with water, sites with anopheline mosquitoes and sites specifically with An. arabiensis. These models were especially successful at ruling out potential locations, but had limited ability in predicting which anopheline species inhabited aquatic sites. Terrain indices derived from 90 meter Shuttle Radar Topography Mission (SRTM digital elevation data (DEM were better at predicting water drainage patterns and characterizing the landscape than those derived from 30 m Advanced Spaceborne Thermal Emission and Reflection Radiometer (ASTER DEM. Conclusions The low number of aquatic habitats available and the ability to locate the limited number of aquatic habitat locations for surveillance, especially those containing anopheline larvae, suggest that larval control maybe a cost-effective control measure in the fight

  6. Residual antimalarial concentrations before treatment in patients with malaria from Cambodia: indication of drug pressure.

    Science.gov (United States)

    Hodel, Eva Maria; Genton, Blaise; Zanolari, Boris; Mercier, Thomas; Duong, Socheat; Beck, Hans-Peter; Olliaro, Piero; Decosterd, Laurent Arthur; Ariey, Frédéric

    2010-10-01

    The Thai-Cambodian border has been known as the origin of antimalarial drug resistance for the past 30 years. There is a highly diverse market for antimalarials in this area, and improved knowledge of drug pressure would be useful to target interventions aimed at reducing inappropriate drug use. Baseline samples from 125 patients with falciparum malaria recruited for 2 in vivo studies (in Preah Vihear and Pursat provinces) were analyzed for the presence of 14 antimalarials in a single run, by means of a liquid chromatography-tandem mass spectrometry assay. Half of the patients had residual drug concentrations above the lower limit of calibration for at least 1 antimalarial at admission. Among the drugs detected were the currently used first-line drugs mefloquine (25% and 35% of patients) and piperaquine (15% of patients); the first-line drug against vivax malaria, chloroquine (25% and 41% of patients); and the former first-line drug, quinine (5% and 34% patients). The findings demonstrate that there is high drug pressure and that many people still seek treatment in the private and informal sector, where appropriate treatment is not guaranteed. Promotion of comprehensive behavioral change, communication, community-based mobilization, and advocacy are vital to contain the emergence and spread of parasite resistance against new antimalarials.

  7. Indications and outcome of mandibular condylar and ramus surgeries

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    Babatunde O Akinbami

    2014-01-01

    Full Text Available Background: Different surgical procedures are utilized for treatment of various diseases of the posterior mandible depending on the type of disease, site, duration and age of the patient. A thorough knowledge of the anatomical relations of structures and adequate surgical skills are needed to minimize complications. The purpose of this study was to evaluate the indications and outcome of surgical techniques for diseases affecting the condyle and ramus of the mandibles. Patients and Methods: Data were retrieved from the case files of patients who had surgeries for diseases involving the ramus/condylar area of the mandible. The diagnosis/indications for surgery, procedure and postoperative outcomes were documented. Outcomes assessed were related to mouth opening, esthetics (appearance of scar and jaw symmetry and function (occlusion, Jaw movements. Complications such as nerve dysfunction were documented. Paresthesia was tested by simple tactile stimulations. Results: There were a total of 27 procedures done either on the condyle or ramus in 23 (100% patients between May 2006 and October, 2013. 16 procedures were done for tumors in 16 (69.6% patients, 14 (60.9% patients had Ameloblastoma, 1 (4.3% had central neurofibroma and one had keratocystic odontogenic tumor, two procedures for unilateral condylar fractures in 2 (8.6% patients, five procedures for ankylosis in 3 (13.0% patients and four procedures were done for dislocation in 2 (8.6% patients. There was no permanent nerve dysfunction; mouth opening, jaw movements and mastication were remarkably satisfactory. Conclusion: Esthetic and functional outcome were quite satisfactory when compared with the preoperative status.

  8. ABO phenotypes and malaria related outcomes in mothers and babies in The Gambia: a role for histo-blood groups in placental malaria?

    NARCIS (Netherlands)

    M.P. Loscertales; B.J. Brabin

    2006-01-01

    Background: Host susceptibility to P. falciparum is critical for understanding malaria in pregnancy, its consequences for the mother and baby, and for improving malaria control in pregnant women. Yet host genetic factors which could influence placental malaria risk are little studied and there are n

  9. The european primary care monitor: structure, process and outcome indicators

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    Wilson Andrew

    2010-10-01

    Full Text Available Abstract Background Scientific research has provided evidence on benefits of well developed primary care systems. The relevance of some of this research for the European situation is limited. There is currently a lack of up to date comprehensive and comparable information on variation in development of primary care, and a lack of knowledge of structures and strategies conducive to strengthening primary care in Europe. The EC funded project Primary Health Care Activity Monitor for Europe (PHAMEU aims to fill this gap by developing a Primary Care Monitoring System (PC Monitor for application in 31 European countries. This article describes the development of the indicators of the PC Monitor, which will make it possible to create an alternative model for holistic analyses of primary care. Methods A systematic review of the primary care literature published between 2003 and July 2008 was carried out. This resulted in an overview of: (1 the dimensions of primary care and their relevance to outcomes at (primary health system level; (2 essential features per dimension; (3 applied indicators to measure the features of primary care dimensions. The indicators were evaluated by the project team against criteria of relevance, precision, flexibility, and discriminating power. The resulting indicator set was evaluated on its suitability for Europe-wide comparison of primary care systems by a panel of primary care experts from various European countries (representing a variety of primary care systems. Results The developed PC Monitor approaches primary care in Europe as a multidimensional concept. It describes the key dimensions of primary care systems at three levels: structure, process, and outcome level. On structure level, it includes indicators for governance, economic conditions, and workforce development. On process level, indicators describe access, comprehensiveness, continuity, and coordination of primary care services. On outcome level, indicators

  10. Outcomes after physical examination-indicated cerclage in twin gestations.

    Science.gov (United States)

    Miller, Emily S; Rajan, Priya V; Grobman, William A

    2014-07-01

    To compare outcomes of physical examination-indicated cerclage in women with twin gestations to those with singleton gestations and to identify whether risk factors for extremely preterm birth (before 28 weeks) differ between these 2 groups. This is a single institution retrospective cohort study of women who underwent a physical examination-indicated cerclage between Jan. 1, 1980, and Aug. 15, 2012. Differences in characteristics and outcomes were compared between women with twin and singleton gestations. A multivariable analysis was performed to examine whether twin gestation was independently associated with delivery before 28 weeks and whether any effect modification was present between risk factors for preterm birth and the presence of a twin gestation. Of the 442 women who underwent a cerclage during the period of study, 104 (23.5%) had twins. Mean gestational age and digital cervical length at placement did not differ by plurality. Although twins were more likely to deliver at a slightly earlier median gestation than singletons (31.9 weeks; interquartile range, 24.9-35.1 vs 32.7 weeks; interquartile range, 24.6-38.3; P = .015), the frequency of delivery before 28 weeks did not differ between these 2 groups (33.7% vs 35.8%, P = .69). Greater cervical dilation and prolapsing membranes were identified as risk factors for birth digital cervical length twin gestations. Women with a twin pregnancy who received a physical examination-indicated cerclage had similar risk factors for extreme preterm birth and may experience similar obstetric outcomes as women with singleton gestations. Copyright © 2014 Mosby, Inc. All rights reserved.

  11. Revision of reversed total shoulder arthroplasty. Indications and outcome

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    Farshad Mazda

    2012-08-01

    Full Text Available Abstract Background The complications of reversed total shoulder arthroplasty (RTSA requiring an additional intervention, their treatment options and outcome are poorly known. It was therefore the purpose of this retrospective study, to identify the reasons for revision of RTSA and to report outcomes. Methods Four hundred and forty-one performed RTSA implanted between 1999 and 2008 were screened. Sixty-seven of these cases had an additional intervention to treat a complication. Causes were identified in these 67 cases and the outcome of the first 37 patients who could be followed for more than two years after their first additional intervention was analyzed. Results Of 441 RTSA, 67 cases (15% needed at least one additional intervention to treat a complication, 30 of them needed a second, eleven a third and four a fourth additional intervention. The most common complication requiring a first intervention was instability (18% followed by hematoma or superficial wound complications (15% and complications of the glenoid component (12%. Patients benefitted from RTSA despite the need of additional interventions as indicated by a mean increase in total Constant-Murley score from 23 points before RTSA to 46 points at final follow-up (p  Conclusions Instability, hematoma or superficial wound complications and complications of the glenoid component are the most common reasons for an additional intervention after RTSA. Patients undergoing an additional intervention as treatment of these complications profit significantly as long as the prosthesis remains in place.

  12. Cerebral Malaria; Mechanisms Of Brain Injury And Strategies For Improved Neuro-Cognitive Outcome

    OpenAIRE

    Idro, Richard; Marsh, Kevin; John, Chandy C.; Newton, Charles RJ

    2010-01-01

    Cerebral malaria is the most severe neurological complication of infection with Plasmodium falciparum. With over 575,000 cases annually, children in sub-Saharan Africa are the most affected. Surviving patients have an increased risk of neurological and cognitive deficits, behavioral difficulties and epilepsy making cerebral malaria a leading cause of childhood neuro-disability in the region. The pathogenesis of neuro-cognitive sequelae is poorly understood: coma develops through multiple mech...

  13. Renal histology in the elderly: indications and outcomes.

    LENUS (Irish Health Repository)

    2012-02-01

    Background: Renal disease is being increasingly diagnosed in the elderly. However, reports on biopsy-confirmed renal disease in this population are limited. The aim of this study was to give an overview of the most important indications, diagnoses and outcomes of renal biopsies in the elderly in our center. Methods: This was a retrospective review of all elderly renal biopsies over 5 years. Patients were eligible for inclusion if they were aged =65 years and had had a native kidney biopsy performed. The data recorded included age, sex, indications for biopsy, histological diagnoses and outcomes. Results: During this time, 1,372 native renal biopsies were performed. Of these, 236 (17%) were in patients aged =65 years; 150 male (64%) and 86 female (36%). The most common indications for biopsy were acute renal failure and nephrotic syndrome. Common diagnoses included pauci-immune crescentic glomerulonephritis, tubulointerstitial nephritis, membranous nephropathy, IgA nephropathy and chronic thrombotic microangiopathy. Long-term follow-up of 3 years was available for 102 patients; median serum creatinine at the time of biopsy was 427 micromol\\/L (interquartile range 204-702) and at 3 years post biopsy had fallen to 192 micromol\\/L (interquartile range 152-408). Conclusions: In our center, 17% of native kidney biopsies are performed in elderly patients aged =65 years. In our experience, this procedure was safe and had a 97% diagnostic rate. The available follow-up data of patients suggest that renal histology is not only of benefit in diagnosis but also of potential value in terms of prognosis and treatment.

  14. Renal histology in the elderly: indications and outcomes.

    LENUS (Irish Health Repository)

    Brown, Catherine M

    2011-06-28

    Background: Renal disease is being increasingly diagnosed in the elderly. However, reports on biopsy-confirmed renal disease in this population are limited. The aim of this study was to give an overview of the most important indications, diagnoses and outcomes of renal biopsies in the elderly in our center. Methods: This was a retrospective review of all elderly renal biopsies over 5 years. Patients were eligible for inclusion if they were aged =65 years and had had a native kidney biopsy performed. The data recorded included age, sex, indications for biopsy, histological diagnoses and outcomes. Results: During this time, 1,372 native renal biopsies were performed. Of these, 236 (17%) were in patients aged =65 years; 150 male (64%) and 86 female (36%). The most common indications for biopsy were acute renal failure and nephrotic syndrome. Common diagnoses included pauci-immune crescentic glomerulonephritis, tubulointerstitial nephritis, membranous nephropathy, IgA nephropathy and chronic thrombotic microangiopathy. Long-term follow-up of 3 years was available for 102 patients; median serum creatinine at the time of biopsy was 427 µmol\\/L (interquartile range 204-702) and at 3 years post biopsy had fallen to 192 µmol\\/L (interquartile range 152-408). Conclusions: In our center, 17% of native kidney biopsies are performed in elderly patients aged =65 years. In our experience, this procedure was safe and had a 97% diagnostic rate. The available follow-up data of patients suggest that renal histology is not only of benefit in diagnosis but also of potential value in terms of prognosis and treatment.

  15. Features and outcomes of malaria infection in glucose-6-phosphatedehydrogenase normal and deficient Nigerian children

    Directory of Open Access Journals (Sweden)

    Adebola Emmanuel Orimadegun

    2014-01-01

    Full Text Available Background & objectives: Malaria and G6PD deficiency-related haemolyses are known causes of hospital admissions in Nigeria and pose great danger to child survival but data on interactions of these two pathologies are scarce. This study was carried out to determine the association between features of Plasmodium falciparum infection and G6PD status. Methods: G6PD and haemoglobin were typed by fluorescent spot test and electrophoresis respectively, in 1120 children with microscopically-proven falciparum malaria. Clinical features of malaria were compared between G6PD normal and deficient children. Results: There were 558 males and 562 females with median age of 35 months (range, 6 months-12 yr. In males, prevalence of G6PD-deficiency in patients with uncomplicated malaria (UM, severe malarial anaemia (SMA and cerebral malaria (CM was 23.4, 7 and 16.7%, respectively compared with 11.1, 7.3 and 4.4%, respectively among females. In both males and females, convulsion and rectal temperature above 38°C were less likely presentations among G6PD-deficient compared with G6PD-normal children (p <0.05. The proportions of children with pallor, convulsion and impaired consciousness were significantly lower among G6PD-deficient than normal males (p <0.05 but these features were not different between deficient and normal females (p >0.05. Interpretation & conclusion: Convulsions, pallor and elevated temperature were more frequent features of malaria in G6PD normal than deficient children. G6PD-deficient male children are protected against impaired consciousness. These differences may offer useful hints in malaria treatment and researches in endemic regions.

  16. Combined Right Nephrectomy and Pancreaticoduodenectomy. Indications and Outcomes

    Directory of Open Access Journals (Sweden)

    Mehrdad Nikfarjam

    2008-07-01

    Full Text Available Context Nephrectomy and pancreaticoduodenctomy are operations often performed for the treatment of malignancy. However, the combination of both procedures is rarely reported. Objectives The indications and outcomes of combined right nephrectomy and pancreaticoduodenectomy were assessed. Study design Patients were identified from a prospective operative database between 2002 and 2008. Setting A tertiary care center. Patients One-hundred and 80 patients undergoing pancreaticoduodenectomy. There were 5 (2.8% patients treated by combined right nephrectomy and pancreaticoduodenal resection. Main outcome measure Description of these 5 patients. Results Three patients had retroperitoneal sarcomas adherent to the right kidney and duodenum, one patient had a locally advanced transitional-cell carcinoma and the remaining patient presented with an ampullary malignancy and concurrent right renal tumor All patients underwent en bloc resection with clear margins. Median operating time was 13 hours (range: 9-21 hours. There was no perioperative mortality in this series.Complications were noted in 3 (60% patients related to pancreaticoduodenal resection and all were managed conservatively without significant clinical impact. Median postoperative hospital stay was 8 days (range: 7- 11 days. At a median follow-up of 14 months (range: 3-36 months all patients were alive without evidence of disease recurrence. Conclusion En bloc right nephrectomy combined with pancreaticoduodenal resection can be performed in selected patients with malignant tumors with acceptable morbidity to achieve clear resection margins.

  17. Malaria related knowledge, practices and behaviour of people in Nepal

    Directory of Open Access Journals (Sweden)

    A.B. Joshi

    2008-02-01

    Full Text Available Background & objectives: The information on malaria related knowledge, practices and behaviour of the people of Nepal living in malaria endemic areas are essential to develop behavioural change communication messages and for producing policy to prevent and control malaria in the country. The objective of this study was to assess knowledge, practices and behaviour of the people living in malaria endemic districts and relate with malaria control policy in Nepal. Methods: The paper utilizes data from a cross-sectional study of 1330 households conducted during December 2004 to April 2005 in rural areas of Jhapa, Kailali and Kanchanpur districts. The method used includes structured questionnaire and focus group discussions. Results: The results revealed that 40% respondents were illiterates. Eighty-six percent respondents have heard about malaria but only 50% responded fever with chills as the sign and symptom of malaria. Seventy-three percent responded that mosquito bite causes malaria transmission and 74% respondents considered that malaria is the fatal disease but very few have knowledge that the treatment of malaria in time can save life. More than 50% did not have information on availability of free treatment of malaria in Nepal. Still 16% were found consulting traditional healers for the treatment. The outside sleeping habit was found in almost one fourth of the population mainly in summer season indicating no knowledge about prevention of malaria. Although bednet use practice was higher, only 4% had knowledge on insecticide impregnated bednets and 23% of them practicing it. Issues regarding the proper and regular use of bednets, the quality of the bednet and use of free treatment provided by the government, since these districts are reporting high incidence of malaria.Interpretation & conclusion: Health education must be taken into account for communities in malaria endemic areas to produce desired outcomes in malaria control.

  18. Malaria risk factors in women on intermittent preventive treatment at delivery and their effects on pregnancy outcome in Sanaga-Maritime, Cameroon.

    Directory of Open Access Journals (Sweden)

    Calvin Tonga

    Full Text Available Malaria is known to have a negative impact on pregnant women and their foetuses. The efficacy of Sulfadoxine-Pyrimethamine (SP used for intermittent preventive treatment (IPT is being threatened by increasing levels of resistance. This study assessed malaria risk factors in women on intermittent preventive treatment with SP (IPTp-SP at delivery and their effects on pregnancy outcome in Sanaga-Maritime Division, Cameroon. Socio-economic and obstetrical data of mothers and neonate birth weights were documented. Peripheral blood from 201 mothers and newborns as well as placental and cord blood were used to prepare thick and thin blood films. Maternal haemoglobin concentration was measured. The overall malaria parasite prevalence was 22.9% and 6.0% in mothers and newborns respectively. Monthly income lower than 28000 FCFA and young age were significantly associated with higher prevalence of placental malaria infection (p = 0.0048 and p = 0.019 respectively. Maternal infection significantly increased the risk of infection in newborns (OR = 48.4; p<0.0001. Haemoglobin concentration and birth weight were lower in infected mothers, although not significant. HIV infection was recorded in 6.0% of mothers and increased by 5-folds the risk of malaria parasite infection (OR = 5.38, p = 0.007. Attendance at antenatal clinic and level of education significantly influenced the utilisation of IPTp-SP (p<0.0001 and p = 0.018 respectively. Use of SP and mosquito net resulted in improved pregnancy outcome especially in primiparous, though the difference was not significant. Malaria infection in pregnancy is common and increases the risk of neonatal malaria infection. Preventive strategies are poorly implemented and their utilization has overall reasonable effect on malaria infection and pregnancy outcome.

  19. Nuclear factor kappa B in urine sediment: a useful indicator to detect acute kidney injury in Plasmodium falciparum malaria.

    Science.gov (United States)

    Punsawad, Chuchard; Viriyavejakul, Parnpen

    2014-03-07

    Acute kidney injury (AKI) is one of the major complications of Plasmodium falciparum malaria, especially among non-immune adults. It has recently been revealed that activation of transcription factor nuclear factor kappa B (NF-κB) induces pro-inflammatory gene expression involved in the development of progressive renal inflammatory diseases. The aim of this study was to determine whether urinary sediment NF-κB p65 can act as a biomarker for AKI in patients with P. falciparum malaria. Urinary sediments from malaria patients, including Plasmodium vivax malaria, uncomplicated P. falciparum malaria, complicated P. falciparum malaria without AKI (serum creatinine-Cr falciparum malaria with AKI (Cr ≥3 mg/dl) were used to determine NF-κB p65 level by sandwich enzyme-linked immunosorbent assay (ELISA). Urinary sediments obtained from healthy controls were used as a normal baseline. Correlations between levels of urinary sediment NF-κB p65 and pertinent clinical data were analysed. Urinary sediment NF-κB p65 levels were significantly increased on the day of admission (day 0) and on day 7 post-treatment in complicated P. falciparum malaria patients with AKI, compared with those without AKI (p=0.001, p falciparum malaria.

  20. Global priorities for research and the relative importance of different research outcomes: an international Delphi survey of malaria research experts.

    Science.gov (United States)

    Mulligan, Jo-Ann; Conteh, Lesong

    2016-12-06

    As global research investment increases, attention inevitably turns to assessing and measuring the outcomes and impact from research programmes. Research can have many different outcomes such as producing advances in scientific knowledge, building research capacity and, ultimately, health and broader societal benefits. The aim of this study was to test the use of a Delphi methodology as a way of gathering views from malaria research experts on research priorities and eliciting relative valuations of the different types of health research impact. An international Delphi survey of 60 malaria research experts was used to understand views on research outcomes and priorities within malaria and across global health more widely. The study demonstrated the application of the Delphi technique to eliciting views on malaria specific research priorities, wider global health research priorities and the values assigned to different types of research impact. In terms of the most important past research successes, the development of new anti-malarial drugs and insecticide-treated bed nets were rated as the most important. When asked about research priorities for future funding, respondents ranked tackling emerging drug and insecticide resistance the highest. With respect to research impact, the panel valued research that focuses on health and health sector benefits and informing policy and product development. Contributions to scientific knowledge, although highly valued, came lower down the ranking, suggesting that efforts to move research discoveries to health products and services are valued more highly than pure advances in scientific knowledge. Although the Delphi technique has been used to elicit views on research questions in global health this was the first time it has been used to assess how a group of research experts value or rank different types of research impact. The results suggest it is feasible to inject the views of a key stakeholder group into the research

  1. Quality indicators in digestive endoscopy: introduction to structure, process, and outcome common indicators.

    Science.gov (United States)

    López-Picazo, Julio; Alberca de Las Parras, Fernando; Sánchez Del Río, Antonio; Pérez Romero, Shirley; León Molina, Joaquín; Júdez, Francisco Javier

    2017-06-01

    The general goal of the project wherein this paper is framed is the proposal of useful quality and safety procedures and indicators to facilitate quality improvement in digestive endoscopy units. This initial offspring sets forth procedures and indicators common to all digestive endoscopy procedures. First, a diagram of pre- and post-digestive endoscopy steps was developed. A group of health care quality and/or endoscopy experts under the auspices of the Sociedad Española de Patología Digestiva (Spanish Society of Digestive Diseases) carried out a qualitative review of the literature regarding the search for quality indicators in endoscopic procedures. Then, a paired analysis was used for the selection of literature references and their subsequent review. Twenty indicators were identified, including seven for structure, eleven for process (five pre-procedure, three intra-procedure, three post-procedure), and two for outcome. Quality of evidence was analyzed for each indicator using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification.

  2. Emergency peripartum hysterectomy: Incidence, indications, risk factors and outcome

    Directory of Open Access Journals (Sweden)

    Lovina S.M. Machado

    2011-01-01

    Full Text Available Background: Peripartum hysterectomy is a major operation and is invariably performed in the presence of life threatening hemorrhage during or immediately after abdominal or vaginal deliveries. Material and Methods: A Medline search was conducted to review the recent relevant articles in English literature on emergency peripartum hysterectomy. The incidence, indications, risk factors and outcome of emergency peripartum hysterectomy were reviewed. Results: The incidence of emergency peripartum hysterectomy ranged from 0.24 to 8.7 per 1000 deliveries. Emergency peripartum hysterectomy was found to be more common following cesarean section than vaginal deliveries. The predominant indication for emergency peripartum hysterectomy was abnormal placentation (placenta previa/accreta which was noted in 45 to 73.3%, uterine atony in 20.6 to 43% and uterine rupture in 11.4 to 45.5 %. The risk factors included previous cesarean section, scarred uterus, multiparity, older age group. The maternal morbidity ranged from 26.5 to 31.5% and the mortality from 0 to 12.5% with a mean of 4.8%. The decision of performing total or subtotal hysterectomy was influenced by the patient′s condition. Conclusion: Emergency peripartum hysterectomy is a most demanding obstetric surgery performed in very trying circumstances of life threatening hemorrhage. The indication for emergency peripartum hysterectomy in recent years has changed from traditional uterine atony to abnormal placentation. Antenatal anticipation of the risk factors, involvement of an experienced obstetrician at an early stage of management and a prompt hysterectomy after adequate resuscitation would go a long way in reducing morbidity and mortality.

  3. Speech Outcomes After Clinically Indicated Posterior Pharyngeal Flap Takedown.

    Science.gov (United States)

    Katzel, Evan B; Shakir, Sameer; Naran, Sanjay; MacIsaac, Zoe; Camison, Liliana; Greives, Matthew; Goldstein, Jesse A; Grunwaldt, Lorelei J; Ford, Matthew D; Losee, Joseph E

    2016-10-01

    Velopharyngeal insufficiency affects as many as one in three patients after cleft palate repair. Correction using a posterior pharyngeal flap (PPF) has been shown to improve clinical speech symptomatology; however, PPFs can be complicated by hyponasality and obstructive sleep apnea. The goal of this study was to assess if speech outcomes revert after clinically indicated PPF takedown. The cleft-craniofacial database of the Children's Hospital of Pittsburgh at the University of Pittsburgh Medical Center was retrospectively queried to identify patients with a diagnosis of velopharyngeal insufficiency treated with PPF who ultimately required takedown. Using the Pittsburgh Weighted Speech Score (PWSS), preoperative scores were compared to those after PPF takedown. Outcomes after 2 different methods of PPF takedown (PPF takedown alone or PPF takedown with conversion to Furlow palatoplasty) were stratified and cross-compared. A total of 64 patients underwent takedown of their PPF. Of these, 18 patients underwent PPF takedown alone, and 46 patients underwent PPF takedown with conversion to Furlow Palatoplasty. Patients averaged 12.43 (range, 3.0-22.0)(SD: 3.93) years of age at the time of PPF takedown, and 58% were men. Demographics between groups were not statistically different. The mean duration of follow-up after surgery was 38.09 (range, 1-104) (SD, 27.81) months. For patients undergoing PPF takedown alone, the mean preoperative and postoperative PWSS was 3.83 (range, 0.0-23.0) (SD, 6.13) and 4.11 (range, 0.0-23.0) (SD, 5.31), respectively (P = 0.89). The mean change in PWSS was 0.28 (range, -9.0 to 7.0) (SD, 4.3). For patients undergoing takedown of PPF with conversion to Furlow palatoplasty, the mean preoperative and postoperative PWSS was 6.37 (range, 0-26) (SD, 6.70) and 3.11 (range, 0.0-27.0) (SD, 4.14), respectively (P speech. Although there is concern that PPF takedown may degrade speech, this study finds that surgical takedown of PPF, when clinically

  4. Differential immune response associated to malaria outcome is detectable in peripheral blood following Plasmodium yoelii infection in mice.

    Directory of Open Access Journals (Sweden)

    Isabel G Azcárate

    Full Text Available Malaria infection in humans elicits a wide range of immune responses that can be detected in peripheral blood, but we lack detailed long-term follow-up data on the primary and subsequent infections that lead to naturally acquired immunity. Studies on antimalarial immune responses in mice have been based on models yielding homogenous infection profiles. Here, we present a mouse model in which a heterogeneous course of Plasmodium yoelii lethal malaria infection is produced in a non-congenic ICR strain to allow comparison among different immunological and clinical outcomes. Three different disease courses were observed ranging from a fatal outcome, either early or late, to a self-resolved infection that conferred long-term immunity against re-infection. Qualitative and quantitative changes produced in leukocyte subpopulations and cytokine profiles detected in peripheral blood during the first week of infection revealed that monocytes, dendritic cells and immature B cells were the main cell subsets present in highly-parasitized mice dying in the first week after infection. Besides, CD4(+CD25(high T cells expanded at an earlier time point in early deceased mice than in surviving mice and expressed higher levels of intracellular Foxp3 protein. In contrast, survivors showed a limited increase of cytokines release and stable circulating innate cells. From the second week of infection, mice that would die or survive showed similar immune profiles, although CD4(+CD25(high T cells number increased earlier in mice with the worst prognosis. In surviving mice the expansion of activated circulating T cell and switched-class B cells with a long-term protective humoral response from the second infection week is remarkable. Our results demonstrate that the follow-up studies of immunological blood parameters during a malaria infection can offer information about the course of the pathological process and the immune response.

  5. Serum transferrin receptor concentration indicates increased erythropoiesis in Kenyan children with asymptomatic malaria

    NARCIS (Netherlands)

    Verhoef, H.; West, C.E.; Ndeto, P.; Burema, J.; Benguin, Y.; Kok, F.J.

    2001-01-01

    Background: Serum transferrin receptor concentrations indicate both erythropoietic activity and the deficit of functional iron in the erythron. In contrast with serum ferritin concentrations, serum transferrin receptor concentrations are not or are only marginally influenced by the inflammatory

  6. Protective Antibodies against Placental Malaria and Poor Outcomes during Pregnancy, Benin

    DEFF Research Database (Denmark)

    Ndam, Nicaise Tuikue; Denoeud-Ndam, Lise; Doritchamou, Justin;

    2015-01-01

    Placental malaria is caused by Plasmodium falciparum-infected erythrocytes that bind to placental tissue. Binding is mediated by VAR2CSA, a parasite antigen coded by the var gene, which interacts with chondroitin sulfate A (CSA). Consequences include maternal anemia and fetal growth retardation....... Antibody-mediated immunity to placental malaria is acquired during successive pregnancies, but the target of VAR2CSA-specific protective antibodies is unclear. We assessed VAR2CSA-specific antibodies in pregnant women and analyzed their relationships with protection against placental infection, preterm...... birth, and low birthweight. Antibody responses to the N-terminal region of VAR2CSA during early pregnancy were associated with reduced risks for infections and low birthweight. Among women infected during pregnancy, an increase in CSA binding inhibition was associated with reduced risks for placental...

  7. Shaped versus Round Implants for Breast Reconstruction: Indications and Outcomes

    Directory of Open Access Journals (Sweden)

    Maurice Y. Nahabedian, MD

    2014-03-01

    Conclusions: Both shaped and round silicone gel devices can result in natural aesthetic outcomes. Shaped devices are preferred for contouring the upper pole and for optimizing breast projection. Round devices are preferred when the upper pole is not deficient and the patient desires softer breasts. Longer follow-up studies will be necessary.

  8. Malaria Facts

    Science.gov (United States)

    ... CDC Malaria Branch clinician. malaria@cdc.gov Malaria Facts Recommend on Facebook Tweet Share Compartir Malaria in ... to determine definitively which species are involved. Other Facts Five times, the Nobel Prize in Physiology or ...

  9. Incidence, severity, prognostic significance of thrombocytopenia in malaria

    Directory of Open Access Journals (Sweden)

    Bezwada Srinivasa Rao

    2015-01-01

    Full Text Available Background: Malaria is an infectious disease caused by plasmodium parasite. P. falciparum account for majority of morbidity and mortality. Thrombocytopenia and anaemia are the most frequently associated hematological complications in malaria. The low platelet count together with acute febrile syndrome emerged as the strongest predictor of malaria a finding that is frequent and present even before anemia and splenomegaly sets in. Severe thrombocytopenia is a good predictor of poor prognosis than mild and moderate thrombocytopenia. The aim is to study the incidence, severity, prognostic significance of thrombocytopenia in malaria. Methods: This was an observational and prospective study. The study enrolled 100 patients with thrombocytopenia and fever who were proven to have malaria either by peripheral smear or Quantitative Buffy Coat (QBC test or malarial antigen assay were included in the study and patients with thrombocytopenia due to other causes were excluded from the study. Platelet count was estimated on a fully automated quantitative analyzer. All the 100 patients were followed during the hospital stay and upto discharge or till the outcome. Results: The incidence of thrombocytopenia was 73% indicating a common association in malaria. Complicated malaria was observed in 58.80% of P. falciparum infection whereas 66% of P. vivax infection was associated with uncomplicated malaria. Severe thrombocytopenia showed positive correlation with severity of malaria. Thrombocytopenic patients with effective anti-malarial treatment showed 95.90% recovery and 3 patients 4.10% had mortality. Patients with severe thrombocytopenia were 8.5 times more likely to have complicated malaria with P <0.001 according to student and lsquo;t' test. Conclusion: Thrombocytopenia is the most common hematological finding in malaria. Severe thrombocytopenia showed positive correlation with complicated malaria and a good predictor of poor prognosis. Patients with classical

  10. Evaluation of leptin, interleukin-1 beta and tumor necrosis factor alpha in serum of malaria patients as prognostic markers of treatment outcome

    Institute of Scientific and Technical Information of China (English)

    Mariam Abdulrhman Al-Fadhli; Mohammad Ahmed Saraya; Jafar Abdulrida Qasem

    2014-01-01

    Objective: To analyze serum leptin levels in patients with malaria falciparum and compare them with healthy controls and correlate with development and outcome of malaria infection.Methods:healthy individuals of comparable age, racial and body mass index were taken as controls. All patients were diagnosed by clinical picture and the presence of malaria parasites in blood film. Estimation of liver function test, kidney function test, complete blood count, fasting blood sugar, fasting serum insulin, pro-inflammatory cytokine tumor necrosis factor alpha (TNFα) and interleukin 1 (IL1), estimation of morning serum leptin and calculation of body mass index (kg/m2) were done in both groups on the day of admission, on discharge and 7 d after discharge.Results:Sixty cases of malaria falciparum were included in this study as patients. Thirty while fasting serum insulin levels were not significantly different between the two groups. There were significant increases as regard to TNFα and IL1 in malaria patients. Significant differences were observed between the control and the patient group for leptin, TNFα and IL1 at the time of admission and discharge. After discharge for 7 d, a significant decline in serum leptin levels, TNFα and IL1 in the patients group was observed as compared with time of admission and time of discharge, a positive correlation between serum leptin levels and TNFα and IL1. At admission, leptin levels were significantly higher in patients group than in control Conclusions: Leptin hormone level might play an important role in development and outcome of malaria infection.

  11. A Program Evaluation Model: Using Bloom's Taxonomy to Identify Outcome Indicators in Outcomes-Based Program Evaluations

    Science.gov (United States)

    McNeil, Rita C.

    2011-01-01

    Outcomes-based program evaluation is a systematic approach to identifying outcome indicators and measuring results against those indicators. One dimension of program evaluation is assessing the level of learner acquisition to determine if learning objectives were achieved as intended. The purpose of the proposed model is to use Bloom's Taxonomy to…

  12. Operative Fixation of Rib Fractures Indications, Techniques, and Outcomes.

    Science.gov (United States)

    Galos, David; Taylor, Benjamin; McLaurin, Toni

    2017-01-01

    Rib fractures are extremely common injuries and vary in there severity from single nondisplaced fractures to multiple segmental fractures resulting in flail chest and respiratory compromise. Historically, rib fractures have been treated conservatively with pain control and respiratory therapy. However this method may not be the best treatment modality in all situations. Operative fixation of select rib fractures has been increasing in popularity especially in patients with flail chest and respiratory compromise. Newer techniques use muscle sparing approaches and precontoured locking plate technology to obtain stable fixation and allow improved respiration. Current reports shows that rib fracture fixation offers the benefits of improved respiratory mechanics and improved pain control in the severe chest wall injury with resultant improvement in patient outcomes by decreasing time on the ventilator, time in the intensive care unit, and overall hospital length of stay.

  13. Adherence to intermittent preventive treatment for malaria with sulphadoxine-pyrimethamine and outcome of pregnancy among parturients in South East Nigeria

    Directory of Open Access Journals (Sweden)

    Onyebuchi AK

    2014-04-01

    Full Text Available Azubike Kanario Onyebuchi,1 Lucky Osaheni Lawani,2 Chukwuemeka Anthony Iyoke,3 Chukwudi Robinson Onoh,1 Nwabunike Ekene Okeke4 1Department of Obstetrics and Gynecology, Federal Teaching Hospital, Abakaliki, Nigeria; 2School of Postgraduate Studies, Department of Community Medicine, University of Nigeria; 3Department of Obstetrics and Gynecology, University of Nigeria Teaching Hospital, Enugu, Nigeria; 4Department of Obstetrics and Gynecology, Mile Four Catholic Hospital, Abakaliki, Nigeria Background: Intermittent preventive treatment of malaria for pregnant women (IPTp is a very important strategy for the control of malaria in pregnancy in malaria-endemic tropical countries, where mosquito bites easily occur during evening outdoor activities. Issues related to provision, cost, and acceptability may affect the use of IPTp in some developing countries. The aim of the study was to assess the uptake and adherence to sulphadoxine-pyrimethamine-based intermittent preventive treatment of malaria during pregnancy and the relationship of IPTp use to pregnancy outcomes in two major obstetric centers in South East Nigeria. Methods: This was a prospective descriptive study involving women who received antenatal and delivery services. All recruited women were followed-up from booking until delivery, and statistical analysis was done with Epi Info version 7. Results: A total of 516 parturients were studied. The mean gestational age at booking was 21.8±6.9 weeks while the mean number of antenatal visits throughout the pregnancy was 5.5±3.1. The rate of uptake of at least one dose of prescribed IPTp was 72.1% (367/516. Of the 367 who took prescribed IPTp, adherence to second doses of IPTp was 59.7% (219/367, and only 4.9% (18/367 took a third dose. Clinical malaria occurred in 85% (127/149 of women who did not receive IPTp at all compared to 20.5% of those who received at least one dose of IPTp. All those who had clinical malaria despite IPTp had only one

  14. Residual complaints following lumbar disc surgery: prognostic indicators of outcome

    NARCIS (Netherlands)

    Ostelo, R.W.J.G.; Vlaeyen, J.W.S.; Brandt, van den P.A.; Vet, de H.C.W.

    2005-01-01

    Physical as well as psychological features might be important prognostic factors for residual complaints following lumbar disc surgery in primary care. No studies have yet investigated both factors simultaneously. The aim of this prospective cohort study was to identify indicators of the short and l

  15. Distribution of FcγR gene polymorphisms among two sympatric populations in Mali: differing allele frequencies, associations with malariometric indices and implications for genetic susceptibility to malaria.

    Science.gov (United States)

    Cherif, Mariama; Amoako-Sakyi, Daniel; Dolo, Amagana; Pearson, Jan-Olov; Gyan, Ben; Obiri-Yeboah, Dorcas; Nebie, Issa; Sirima, Sodiomon B; Doumbo, Ogobara; Troye-Blomberg, Marita; Bakary, Maiga

    2016-01-19

    Genetic polymorphisms in the complex gene cluster encoding human Fc-gamma receptors (FcγRs) may influence malaria susceptibility and pathogenesis. Studying genetic susceptibility to malaria is ideal among sympatric populations because the distribution of polymorphic genes among such populations can help in the identification malaria candidate genes. This study determined the distribution of three FcyRs single nucleotide polymorphisms (SNPs) (FcγRIIB-rs1050519, FcγRIIC-rs3933769 and FcγRIIIA-rs396991) among sympatric Fulani and Dogon children with uncomplicated malaria. The association of these SNPs with clinical, malariometric and immunological indices was also tested. This study involved 242 Fulani and Dogon volunteers from Mali age under 15 years. All SNPs were genotyped with predesigned TaqMan(®) SNP Genotyping Assays. Genotypic and allelic distribution of SNPs was compared across ethnic groups using the Fisher exact test. Variations in clinical, malariometric and immunologic indices between groups were tested with Kruskal-Wallis H, Mann-Whitney U test and Fisher exact test where appropriate. The study confirmed known malariometric and immunologic differences between sympatric Fulani and non-Fulani tribes. Parasite density was lower in the Fulani than the Dogon (p Dogon (p Dogon (p = 0.0043). The difference in the mutant allele frequency of FcγRIIB (rs1050519) between the two ethnic groups was however not statistically significant (p = 0.064). The mutant allele of rs396991 was associated with high malaria-specific IgG1 and IgG3 in the entire study population and Dogon tribe, p = 0.023 and 0.015, respectively. Parasite burden was lower in carriers of the FcγRIIC (rs3933769) mutant allele than non-carriers in the entire study population (p Dogon indirectly suggest that these SNPs may influence malaria susceptibility and pathogenesis in the study population. The high frequency of the FcγRIIC (rs3933769) mutant allele in the Fulani and its

  16. The use of digital spaceborne SAR data for the delineation of surface features indicative of malaria vector breeding habitats

    Science.gov (United States)

    Imhoff, M. L.; Vermillion, C. H.; Khan, F. A.

    1984-01-01

    An investigation to examine the utility of spaceborne radar image data to malaria vector control programs is described. Specific tasks involve an analysis of radar illumination geometry vs information content, the synergy of radar and multispectral data mergers, and automated information extraction techniques.

  17. Intraocular lens explantation or exchange: indications, postoperative interventions, and outcomes

    Directory of Open Access Journals (Sweden)

    Refik Oltulu

    2015-06-01

    Full Text Available ABSTRACT Purpose: To analyze the indications for explantation or exchange of intraocular lenses (IOLs, which were originally implanted for the correction of aphakia during cataract extraction. Methods: All cases that involved intraocular lens explantation or exchange in one institution between January 2008 and December 2014 were analyzed retrospectively. Results: In total, 93 eyes of 93 patients were analyzed. The median time interval between implantation and explantation of the anterior chamber intraocular lenses (AC IOL and posterior chamber intraocular lenses (PC IOL was 83.40 ± 83.14 months (range: 1-276 months and 55.14 ± 39.25 months (range: 1-168 months, respectively. Pseudophakic bullous keratopathy (17 eyes, 38.6% and persistent iritis (12 eyes, 27.8% in the AC IOL group and dislocation or decentration (30 eyes, 61.2% and incorrect IOL power (nine eyes, 18.4% in the PC IOL group were the most common indications for explantation of IOLs. The mean logMAR best corrected visual acuity (BCVA improved significantly from 1.30 preoperatively to 0.62 postoperatively in the PC IOL group (p<0.001 but did not improve significantly in the AC IOL group (p=0.186. Conclusions: The primary indication for IOL explantation or exchange was pseudophakic bullous keratopathy in the AC IOL group and was dislocation or decentration in the PC IOL group. PC IOL explantation or exchange is safe and improves visual acuity.

  18. Malaria has no effect on birth weight in Rwanda

    NARCIS (Netherlands)

    Rulisa, S.; Mens, P.F.; Karema, C.; Schallig, H.D.F.H.; Kaligirwa, N.; Vyankandondera, J.; de Vries, P.J.

    2009-01-01

    Background: Malaria has a negative effect on pregnancy outcome, causing low birth weight, premature birth and stillbirths, particularly in areas with high malaria transmission. In Rwanda, malaria transmission intensity ranges from high to nil, probably associated with variable altitudes. Overall,

  19. Female Pelvic Vein Embolization: Indications, Techniques, and Outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Lopez, Anthony James, E-mail: consultant@radiologist.co.uk [The Imaging Clinic (United Kingdom)

    2015-08-15

    Until recently, the main indication for pelvic vein embolization (PVE) in women was to treat pelvic venous congestion syndrome (PVC) but increasingly, patients with refluxing pelvic veins associated with leg varicosities are also being treated. A more unusual reason for PVE is to treat pelvic venous malformations, although such lesions may be treated with sclerotherapy alone. Embolotherapy for treating PVC has been performed for many years with several published studies included in this review, whilst an emerging indication for PVE is to treat lower limb varicosities associated with pelvic vein reflux. Neither group, however, has been subjected to an adequate randomized, controlled trial. Consequently, some of the information presented in this review should be considered anecdotal (level III evidence) at this stage, and a satisfactory ‘proof’ of clinical efficacy remains deficient until higher-level evidence is presented. Furthermore, a wide range of techniques not accepted by all are used, and some standardization will be required based on future mandatory prospective studies. Large studies have also clearly shown an unacceptably high recurrence rate of leg varicose veins following venous surgery. Furthermore, minimally or non-invasive imaging is now revealing that there is a refluxing pelvic venous source in a significant percentage of women with de novo leg varicose veins, and many more with recurrent varicosities. Considering that just over half the world’s population is female and a significant number of women not only have pelvic venous reflux, but also have associated leg varicosities, minimally invasive treatment of pelvic venous incompetence will become a common procedure.

  20. STUDY OF INDICATION, COMPLICATION AND FUNCTIONAL OUTCOME IN ENDOSCOPIC SEPTOPLASTY

    Directory of Open Access Journals (Sweden)

    Ritesh

    2014-03-01

    Full Text Available Introduction of nasal endoscope has revolutionized the field of rhinology. Endoscopic septoplasty is a minimally invasive technique that helps us to correct the deformity of the septum under excellent direct visualization using an endoscope. AIMS: Studied indication, technique result and complication of endoscopic septoplasty. METHODS AND MATERIAL: It was a prospective study carried out at our institute from August 2011 to December 2013 RESULTS: 57 patients having nasal obstruction were selected for the study. In present study 24(42.1% patients had only cartilagenous deviation, 9(15.7% patients had bony deviation, 15(26.3% had both bony and cartilage deviation, while 12(21% had spur and 5(8.7% had caudal dislocation. Minor complications were seen during study, no major occurred during endoscopic septoplasty or post- operative period. In 40(70% cases endoscopic septoplasty was performed as primary procedure and in 9(15.7% cases performed as conjugation with FESS, also in 8(14% patients septoplasty performed prior to endonasal DCR for good assess to lateral nasal. CONCLUSIONS: Endoscopic septoplasty is an effective technique that can be performed safely alone or in combination with endoscopic sinus surgery. It reduces the complication, hospital stay and has fast recovery of the patients postoperatively. It facilitates accurate identification of the pathology, and it is associated with significant reduction in patient’s morbidity in the postoperative period

  1. Vagus nerve stimulation therapy: indications, programing, and outcomes.

    Science.gov (United States)

    Yamamoto, Takamichi

    2015-01-01

    Vagus nerve stimulation (VNS) provides palliation of seizure reduction for patients with medically refractory epilepsy. VNS is indicated for symptomatic localization-related epilepsy with multiple and bilateral independent foci, symptomatic generalized epilepsy with diffuse epileptogenic abnormalities, refractory idiopathic generalized epilepsy, failed intracranial epilepsy surgery, and other several reasons of contraindications to epilepsy surgery. Programing of the parameters is a principal part in VNS. Output current and duty cycle should be adjusted to higher settings particularly when a patient does not respond to the initial setting, since the pivotal randomized trials performed in the United States demonstrated high stimulation made better responses in seizure frequency. These trials revealed that a ≥ 50% seizure reduction occurred in 36.8% of patients at 1 year, in 43.2% at 2 years, and in 42.7% at 3 years in 440 patients. Safety of VNS was also confirmed because side effects including hoarseness, throat discomfort, cough, paresthesia, and headache improved progressively during the period of 3 years. The largest retrospective study with 436 patients demonstrated the mean seizure reduction of 55.8% in nearly 5 years, and also found 75.5% at 10 years in 65 consecutive patients. The intermediate analysis report of the Japan VNS Registry showed that 60% of 164 cases got a ≥ 50% seizure reduction in 12 months. In addition to seizure reduction, VNS has positive effects in mood and improves energy level, memory difficulties, social aspects, and fear of seizures. VNS is an effective and safe option for patients who are not suitable candidates for intracranial epilepsy surgery.

  2. The Social Outcomes of Older Adult Learning in Taiwan: Evaluation Framework and Indicators

    Science.gov (United States)

    Lin, Li-Hui

    2015-01-01

    The purpose of this study is to explore the social outcomes of older adult learning in Taiwan. In light of our society's aging population structure, the task of establishing evaluation framework and indicators for the social outcomes of learning (SOL) as applied to older adults is urgent. In order to construct evaluation indicators for older adult…

  3. The Social Outcomes of Older Adult Learning in Taiwan: Evaluation Framework and Indicators

    Science.gov (United States)

    Lin, Li-Hui

    2015-01-01

    The purpose of this study is to explore the social outcomes of older adult learning in Taiwan. In light of our society's aging population structure, the task of establishing evaluation framework and indicators for the social outcomes of learning (SOL) as applied to older adults is urgent. In order to construct evaluation indicators for older adult…

  4. Malaria risk factors in north-east Tanzania

    Directory of Open Access Journals (Sweden)

    Mtove George

    2011-04-01

    Full Text Available Abstract Background Understanding the factors which determine a household's or individual's risk of malaria infection is important for targeting control interventions at all intensities of transmission. Malaria ecology in Tanzania appears to have reduced over recent years. This study investigated potential risk factors and clustering in face of changing infection dynamics. Methods Household survey data were collected in villages of rural Muheza district. Children aged between six months and thirteen years were tested for presence of malaria parasites using microscopy. A multivariable logistic regression model was constructed to identify significant risk factors for children. Geographical information systems combined with global positioning data and spatial scan statistic analysis were used to identify clusters of malaria. Results Using an insecticide-treated mosquito net of any type proved to be highly protective against malaria (OR 0.75, 95% CI 0.59-0.96. Children aged five to thirteen years were at higher risk of having malaria than those aged under five years (OR 1.71, 95% CI 1.01-2.91. The odds of malaria were less for females when compared to males (OR 0.62, 95% CI 0.39-0.98. Two spatial clusters of significantly increased malaria risk were identified in two out of five villages. Conclusions This study provides evidence that recent declines in malaria transmission and prevalence may shift the age groups at risk of malaria infection to older children. Risk factor analysis provides support for universal coverage and targeting of long-lasting insecticide-treated nets (LLINs to all age groups. Clustering of cases indicates heterogeneity of risk. Improved targeting of LLINs or additional supplementary control interventions to high risk clusters may improve outcomes and efficiency as malaria transmission continues to fall under intensified control.

  5. Malaria control at the district level in Africa: the case of the muheza district in northeastern Tanzania

    DEFF Research Database (Denmark)

    Alilio, Martin S; Kitua, Andrew; Njunwa, Kato;

    2004-01-01

    An assessment was done in Tanzania to determine the extent to which the primary health care services have contributed to reducing the burden of malaria since the system was initiated in the 1980s. Seven descriptive processes and outcome indicators of effectiveness were used: changes of malaria tr...

  6. Clinical manifestations and outcomes of severe malaria among children admitted at Rungwe and Kyela district hospitals in south-western Tanzania.

    Science.gov (United States)

    Kalinga, Akili; Mayige, Mary; Kagaruki, Gibson; Shao, Amani; Mwakyusa, Brighton; Jacob, Frank; Mwesiga, Charles

    2012-01-01

    Malaria remains as an important public health and a major cause of childhood death and paediatric hospital admission in sub-Saharan Africa. This prospective hospital based cross sectional study was conducted from April 2007 to April 2008. The main objective was to assess clinical manifestations and outcomes of severe malaria in children admitted to district hospital in Rungwe and Kyela in south-western Tanzania. A total of 1371 children were selected as screening group of which 409 (29.8%) were tested positive for malaria. Mean age of the children was 2.7 (95%CI= 2.5, 2.8) years and the majority (86%) were under five years of age. The proportion of children severe malaria in Rungwe was significantly higher than that of Kyela by 21.3% (P=0.002). The common symptoms of severe malaria during admission were convulsions (50.9%) compensated shock (30.6%), prostration (29.1%) and symptomatic severe anaemia (14.9%). The case fatality rate (CFR) was 4.6% and the cure rate (CR) was 95.4%. Children with suspected severe acidosis and symptomatic severe anemia were 4.8 (95%CI=1.6, 14.6) and 5.5 (95%CI 1.1, 28.2), respectively, more likely to die compared to those without these symptoms. The proportion of deaths among children presenting ≥5 symptoms was 32.1% higher than among those presenting one symptom (OR =0.50, 95%CI 0.125-2.000; P=0.000). Convulsions and compensated shock were the leading symptoms at admission. Suspected severe acidosis and symptomatic severe anemia were the predictors of mortality for children. In order to reduce mortality among admitted children with severe malaria there is a need for health providers to deploy strategic management of fatal prognostic factors. In conclusion, convulsion and compensated shock were the leading symptoms among children at admission and that suspected severe acidosis and symptomatic severe anemia were the predictors of mortality. It is therefore important to emphasis early diagnosis and prompt treatment of severe cases of

  7. Impact of climate change on global malaria distribution.

    Science.gov (United States)

    Caminade, Cyril; Kovats, Sari; Rocklov, Joacim; Tompkins, Adrian M; Morse, Andrew P; Colón-González, Felipe J; Stenlund, Hans; Martens, Pim; Lloyd, Simon J

    2014-03-04

    Malaria is an important disease that has a global distribution and significant health burden. The spatial limits of its distribution and seasonal activity are sensitive to climate factors, as well as the local capacity to control the disease. Malaria is also one of the few health outcomes that has been modeled by more than one research group and can therefore facilitate the first model intercomparison for health impacts under a future with climate change. We used bias-corrected temperature and rainfall simulations from the Coupled Model Intercomparison Project Phase 5 climate models to compare the metrics of five statistical and dynamical malaria impact models for three future time periods (2030s, 2050s, and 2080s). We evaluated three malaria outcome metrics at global and regional levels: climate suitability, additional population at risk and additional person-months at risk across the model outputs. The malaria projections were based on five different global climate models, each run under four emission scenarios (Representative Concentration Pathways, RCPs) and a single population projection. We also investigated the modeling uncertainty associated with future projections of populations at risk for malaria owing to climate change. Our findings show an overall global net increase in climate suitability and a net increase in the population at risk, but with large uncertainties. The model outputs indicate a net increase in the annual person-months at risk when comparing from RCP2.6 to RCP8.5 from the 2050s to the 2080s. The malaria outcome metrics were highly sensitive to the choice of malaria impact model, especially over the epidemic fringes of the malaria distribution.

  8. High Iron Stores in the Low Malaria Season Increase Malaria Risk in the High Transmission Season in a Prospective Cohort of Rural Zambian Children.

    Science.gov (United States)

    Barffour, Maxwell A; Schulze, Kerry J; Coles, Christian L; Chileshe, Justin; Kalungwana, Ng'andwe; Arguello, Margia; Siamusantu, Ward; Moss, William J; West, Keith P; Palmer, Amanda C

    2017-08-01

    Background: Higher iron stores, defined by serum ferritin (SF) concentration, may increase malaria risk.Objective: We evaluated the association between SF assessed during low malaria season and the risk of malaria during high malaria season, controlling for inflammation.Methods: Data for this prospective study were collected from children aged 4-8 y (n = 745) participating in a biofortified maize efficacy trial in rural Zambia. All malaria cases were treated at baseline (September 2012). We used baseline SF and malaria status indicated by positive microscopy at endline (March 2013) to define exposure and outcome, respectively. Iron status was defined as deficient (corrected or uncorrected SF iron status assessed in the low malaria seasons (baseline).Results: We observed an age-dependent, positive dose-response association between ferritin in the low malaria season and malaria incidence during the high malaria season in younger children. In children aged iron status [incidence rate ratio (IRR) with SF: 1.56; 95% CI: 0.64, 3.86; IRR with inflammation-corrected SF: 1.92; 95% CI: 0.75, 4.93] and high iron status (IRR with SF: 2.66; 95% CI: 1.10, 6.43; or IRR with corrected SF: 2.93; 95% CI: 1.17, 7.33) categories compared with the deficient iron status category. The relative increase in malaria risk for children with high iron status was statistically significant only among those with a concurrently normal serum soluble transferrin receptor concentration (Iron adequacy in 4- to 8-y-old children in rural Zambia was associated with increased malaria risk. Our findings underscore the need to integrate iron interventions with malaria control programs. This trial was registered at clinicaltrials.gov as NCT01695148. © 2017 American Society for Nutrition.

  9. [Prevalence of malaria in Dakar, Senegal. Comparative study of the plasmodial indices in pregnant and non-pregnant women].

    Science.gov (United States)

    Diallo, S; Ndir, O; Dieng, Y; Ba, F D; Bah, I B; Diop, B M; Gaye, O; Dieng, T

    1995-01-01

    The comparison of the prevalence of malaria in pregnant and non pregnant women living in Dakar has interested 1819 women among whom 950 pregnant and 869 non pregnant. For all the examined women, the global plasmoidic index was 2.6% and the gametocytic index 0.1%. Plasmodium falciparum was the only observed species. According to the obtained results, pregnant women, with a plasmoidic index of 4.5% are more often parasited than the non pregnant women, only affected in a proportion of 0.5% Whatever the age, the number of previous pregnancy, the place of residence, the duration of the stay in Dakar may be, the pregnant women are always more often parasited than the non pregnant women and the registered differences are statistically significant. That situation could come from a greater receptivity of the pregnant women what is admitted by some authors. But a more important proportion of natives from rural area was observed among the pregnant women, from where a difference in the exposure to the risk of impaludation between the two groups that could explain the registered results. The global plasmoidic index of 2.6% obtained in the examined women, reflects well the present situation of the malaria endemy in Dakar, a weak hypo-endemic area.

  10. Pregnancy outcome and placenta pathology in Plasmodium berghei ANKA infected mice reproduce the pathogenesis of severe malaria in pregnant women.

    Directory of Open Access Journals (Sweden)

    Rita Neres

    Full Text Available Pregnancy-associated malaria (PAM is expressed in a range of clinical complications that include increased disease severity in pregnant women, decreased fetal viability, intra-uterine growth retardation, low birth weight and infant mortality. The physiopathology of malaria in pregnancy is difficult to scrutinize and attempts were made in the past to use animal models for pregnancy malaria studies. Here, we describe a comprehensive mouse experimental model that recapitulates many of the pathological and clinical features typical of human severe malaria in pregnancy. We used P. berghei ANKA-GFP infection during pregnancy to evoke a prominent inflammatory response in the placenta that entails CD11b mononuclear infiltration, up-regulation of MIP-1 alpha chemokine and is associated with marked reduction of placental vascular spaces. Placenta pathology was associated with decreased fetal viability, intra-uterine growth retardation, gross post-natal growth impairment and increased disease severity in pregnant females. Moreover, we provide evidence that CSA and HA, known to mediate P. falciparum adhesion to human placenta, are also involved in mouse placental malaria infection. We propose that reduction of maternal blood flow in the placenta is a key pathogenic factor in murine pregnancy malaria and we hypothesize that exacerbated innate inflammatory responses to Plasmodium infected red blood cells trigger severe placenta pathology. This experimental model provides an opportunity to identify cell and molecular components of severe PAM pathogenesis and to investigate the inflammatory response that leads to the observed fetal and placental blood circulation abnormalities.

  11. Associations between HIV-RNA-based indicators and virological and clinical outcomes

    DEFF Research Database (Denmark)

    Laut, Kamilla G.; Shepherd, Leah C.; Pedersen, Court

    2016-01-01

    Objectives: To evaluate and compare the performance of six HIV-RNA-based quality of care indicators for predicting short-term and long-term outcomes. Design: Multinational cohort study. Methods: We included EuroSIDA patients on antiretroviral therapy (ART) with at least three viral load...... rate ratios for all outcomes tended to increase with increasing viraemia copy years, number of consecutive months with viral load ≥50 copies/ml, current viral load and with lower %FS, but the gradient of increased risk was weak across strata. None of the indicators reliably identified those at risk...... of long-term outcomes (AUC 0.54-0.58), but performed consistently better with short-term outcomes [triple class failure (AUC 0.67-0.76) and resistance (AUC 0.64-0.79)]. Goodness of fit varied with the outcome evaluated, but differences between indicators were small. Conclusion: Differences between quality...

  12. Understanding Program Monitoring: The Relationships among Outcomes, Indicators, Measures, and Targets. REL 2014-011

    Science.gov (United States)

    Malone, Nolan; Mark, Lauren; Narayan, Krishna

    2014-01-01

    This guide offers educators, program managers, administrators, and researchers a resource for building capacity for monitoring program outcomes. It provides concise definitions of program monitoring components and a framework for assessing program progress. Examples demonstrate the relationships among program components: outcomes, indicators,…

  13. Linking Ecosystem Health Indicators and Collaborative Management: a Systematic Framework to Evaluate Ecological and Social Outcomes

    Directory of Open Access Journals (Sweden)

    Tischa A. Muñoz-Erickson

    2007-12-01

    Full Text Available Collaborative management has gained popularity across the United States as a means of addressing the sustainability of mixed-ownership landscapes and resolving persistent conflicts in public lands management. At the same time, it has generated skepticism because its ecological and social outcomes are seldom measured. Evaluating the success of collaborative efforts is difficult because frameworks to assess on-the-ground outcomes are poorly developed or altogether lacking. Ecosystem health indicators are valuable tools for evaluating site-specific outcomes of collaboration based on the effects of collaboration on ecological and socioeconomic conditions. We present the holistic ecosystem health indicator, a promising framework for evaluating the outcomes of collaborative processes, which uses ecological, social, and interactive indicators to monitor conditions through time. Finally, we draw upon our experience working with the Diablo Trust, a community-based collaborative group in northern Arizona, USA, to illustrate the development of an indicator selection model generated through a stakeholder-driven process.

  14. Stereotactic radiotherapy and radiosurgery in pediatric patients: analysis of indications and outcome

    DEFF Research Database (Denmark)

    Mirza, Bilal; Mønsted, Anne; Jensen, Josephine Harding

    2010-01-01

    We describe indications, outcomes, and risk profiles of fractionated stereotactic radiotherapy (SRT) and single fraction "radiosurgery" (SRS) in pediatric patients compared to the adult population and evaluate the causal role of SRS and SRT in inducing new neurological complications.......We describe indications, outcomes, and risk profiles of fractionated stereotactic radiotherapy (SRT) and single fraction "radiosurgery" (SRS) in pediatric patients compared to the adult population and evaluate the causal role of SRS and SRT in inducing new neurological complications....

  15. Feasibility of a community health worker strategy for providing near and appropriate treatment of malaria in southeast Nigeria: an analysis of activities, costs and outcomes.

    Science.gov (United States)

    Onwujekwe, Obinna; Uzochukwu, Benjamin; Ojukwu, Juliana; Dike, Nkem; Shu, Elvis

    2007-02-01

    Community health workers (CHWs) could be used to bring appropriate and timely treatment of malaria closer to home and there is the need to increase the body of knowledge about the feasibility of implementing the strategy. To determine the processes, costs and outcomes of design and implementation of a strategy based on use of CHWs for near and appropriate treatment of malaria. The CHW strategy was implemented in two villages (Adu and Ahani) in Enugu state, southeast Nigeria. Adu and Ahani have a population of approximately 3500 and 5000 residents, respectively. The study was conducted in four phases: (1) baseline survey; (2) design; (3) implementation, supervision and monitoring; and (4) evaluation. Interactive meeting with all the stakeholders were used to fine-tune the design of the CHW strategy. Community members that were selected by the project team with the help of community leaders were trained to become CHWs and their remuneration was through commissions on their drug sales. Community and provider's financial and non-financial costs of the startegy were computed. Non-financial costs were the highest contributor to consumer costs, while financial costs constituted more than 90% of provider costs. The total consumer cost in Ahani was US$2548, while the consumer cost in Adu was US$1585. The total provider cost in Ahani was US$4515, while in Adu it was US$4302. The unit cost cost per villager was US$1.40 in Ahani and US$1.70 in Adu, while the unit financial consumer cost per treated patient was $0.05 in both villages, respectively. The CHWs were acceptable to the people and had an increased market share out of existing malaria treatment provision strategies. The cost of starting up the CHW strategy is low and should be affordable to malaria control programs and communities. The CHW strategy is also economically viable and a potential cost-effective source for providing timely, and appropriate treatment of malaria in rural areas. It should be fine-tuned and

  16. Oral iron supplements for children in malaria-endemic areas

    Science.gov (United States)

    Neuberger, Ami; Okebe, Joseph; Yahav, Dafna; Paul, Mical

    2016-01-01

    , Development and Evaluation (GRADE) approach. We performed a fixed-effect meta-analysis for all outcomes and random-effects meta-analysis for hematological outcomes, and adjusted analyses for cluster RCTs. We based the subgroup analyses for anaemia at baseline, age, and malaria prevention or management services on trial-level data. Main results Thirty-five trials (31,955 children) met the inclusion criteria. Overall, iron does not cause an excess of clinical malaria (risk ratio (RR) 0.93, 95% confidence intervals (CI) 0.87 to 1.00; 14 trials, 7168 children, high quality evidence). Iron probably does not cause an excess of clinical malaria in both populations where anaemia is common and those in which anaemia is uncommon. In areas where there are prevention and management services for malaria, iron (with or without folic acid) may reduce clinical malaria (RR 0.91, 95% CI 0.84 to 0.97; seven trials, 5586 participants, low quality evidence), while in areas where such services are unavailable, iron (with or without folic acid) may increase the incidence of malaria, although the lower CIs indicate no difference (RR 1.16, 95% CI 1.02 to 1.31; nine trials, 19,086 participants, low quality evidence). Iron supplementation does not cause an excess of severe malaria (RR 0.90, 95% CI 0.81 to 0.98; 6 trials, 3421 children, high quality evidence). We did not observe any differences for deaths (control event rate 1%, low quality evidence). Iron and antimalarial treatment reduced clinical malaria (RR 0.54, 95% CI 0.43 to 0.67; three trials, 728 children, high quality evidence). Overall, iron resulted in fewer anaemic children at follow up, and the end average change in haemoglobin from base line was higher with iron. Authors' conclusions Iron treatment does not increase the risk of clinical malaria when regular malaria prevention or management services are provided. Where resources are limited, iron can be administered without screening for anaemia or for iron deficiency, as long as malaria

  17. Malaria in pregnancy.

    Science.gov (United States)

    Seal, Subrata Lall; Mukhopadhay, Sima; Ganguly, Rajendra Prasad

    2010-08-01

    Malaria during pregnancy is a recognised risk factor for maternal and foetal complications and it is endemic in certain areas of our country. Pregnancy also enhances the severity of malaria particularly with P falciparum infestation. The outcome of effects of malaria in pregnancy on the mother and foetus is studied here. This is a prospective observational study conducted in the department of obstetrics and gynaecology of RG Kar Medical College during the period from 1st January 2001 to 31st December 2006. Forty pregnant women with malaria in pregnancy were studied. Another 40 non- pregnant women during the same period were served as control. The maternal complications were compared with the controls and the outcome of pregnancy was studied. There was statistically significant (p renal failure, hepatic failure, hypoglycaemia, hypotension and death in the pregnant women in comparison to non-pregnant women. P falciparum infection was also more during pregnancy. There was also increased incidence of abqrtion, preterm labour, intra-uterine growth restriction and intra-uterine foetal death. Treatment with antimalarial drugs particularly in cerebral malaria does not give good results as there were 12 maternal deaths in this series. Every attempt should be made to prevent malaria during pregnancy by various measures as it is associated with high maternal morbidity and mortality and adversely affects the neonatal outcome.

  18. Framework and indicator testing protocol for developing and piloting quality indicators for the UK quality and outcomes framework

    Directory of Open Access Journals (Sweden)

    Burke Martyn

    2011-08-01

    Full Text Available Abstract Background Quality measures should be subjected to a testing protocol before being used in practice using key attributes such as acceptability, feasibility and reliability, as well as identifying issues derived from actual implementation and unintended consequences. We describe the methodologies and results of an indicator testing protocol (ITP using data from proposed quality indicators for the United Kingdom Quality and Outcomes Framework (QOF. Methods The indicator testing protocol involved a multi-step and methodological process: 1 The RAND/UCLA Appropriateness Method, to test clarity and necessity, 2 data extraction from patients' medical records, to test technical feasibility and reliability, 3 diaries, to test workload, 4 cost-effectiveness modelling, and 5 semi-structured interviews, to test acceptability, implementation issues and unintended consequences. Testing was conducted in a sample of representative family practices in England. These methods were combined into an overall recommendation for each tested indicator. Results Using an indicator testing protocol as part of piloting was seen as a valuable way of testing potential indicators in 'real world' settings. Pilot 1 (October 2009-March 2010 involved thirteen indicators across six clinical domains and twelve indicators passed the indicator testing protocol. However, the indicator testing protocol identified a number of implementation issues and unintended consequences that can be rectified or removed prior to national roll out. A palliative care indicator is used as an exemplar of the value of piloting using a multiple attribute indicator testing protocol - while technically feasible and reliable, it was unacceptable to practice staff and raised concerns about potentially causing actual patient harm. Conclusions This indicator testing protocol is one example of a protocol that may be useful in assessing potential quality indicators when adapted to specific country health

  19. Disease-specific quality indicators, guidelines, and outcome measures in systemic lupus erythematosus (SLE).

    Science.gov (United States)

    Mosca, M; Bombardieri, S

    2007-01-01

    The assessment of quality of care is becoming increasingly important, but as yet no standard set of measures to assess quality has been developed. The ACR Quality Measures Committee has selected the following areas of study to develop quality indicators: diagnostic/classification criteria, outcome measures/response criteria, treatment guidelines/management recommendations, definition of quality indicators, and definition of data collection systems. The aim of the present review is to evaluate existing guidelines and outcome measures concerning disease/activity monitoring, autoantibody and laboratory assessment, outcomes, and therapy in systemic lupus erythematosus (SLE) that could be used to define disease-specific quality indicators. Much data is available in the literature that could serve to define a starter set of quality indicators for SLE. Monitoring issues are discussed in the ACR and EULAR recommendations. As far as therapy is concerned, the ACR has provided indicators for rheumatoid arthritis that could also be applied to SLE, as well as indications for anti-malarial monitoring. The outcomes measures most frequently used in SLE are damage and death, but organ-specific definitions of outcome and response are being evaluated. The development of quality measures for SLE is just beginning; existing information could serve to construct a starter set of indicators such as the one proposed here. Certainly much progress will be made in the near future. A practical, user-friendly tool for physicians that will help them deliver high quality care to populations is also needed.

  20. Malaria cerebral Cerebral malaria

    OpenAIRE

    Carlos Hugo Zapata Zapata; Silvia Blair Trujillo

    2003-01-01

    La malaria Cerebral (MC) es la complicación más frecuente de la malaria por P. falciparum; aproximadamente el 90% de las personas que la han padecido se recuperan completamente sin secuelas neurológicas. Aún no se conoce con claridad su patogénesis pero se han postulado cuatro hipótesis o mecanismos posibles: 1) citoadherencia y secuestro de glóbulos rojos parasitados en la microvasculatura cerebral; 2) formación de rosetas y aglutinación de glóbulos rojos parasitados; 3) producción de citoqu...

  1. Establishing the outcome indicators for the essential nursing competencies and curricula guidelines for genetics and genomics.

    Science.gov (United States)

    Calzone, Kathleen A; Jenkins, Jean; Prows, Cynthia A; Masny, Agnes

    2011-01-01

    The translation of genetics/genomics to clinical care has implications for nurses. The Essential Nursing Competencies and Curricula Guidelines for Genetics and Genomics, established by consensus, apply to all registered nurses. Learning outcomes and clinical practice indicators have been developed to provide additional guidance. The Essentials Advisory Group (EAG) established a team to establish the Outcome Indicators. A draft was developed based on published peer-reviewed documents and syllabi. The draft underwent three layers of review: (a) critique by the EAG; (b) review by representatives at a Genetics/Genomics Toolkit for Faculty meeting; and (c) review by workshop attendees of the American Association of Colleges of Nursing's baccalaureate and master's education conferences, followed by EAG's final approval. Outcome Indicators clarify specific knowledge areas and suggest clinical performance indicators for each competency. They provide the foundation to establish a competency-based education repository with outcome indicator mapping matrixes for genetic/genomic education resources. A gap analysis of education resources identified resource deficits, and online unfolding case studies were developed. Outcome Indicators assist the academic and continuing education nurse community to prepare the nursing workforce in genetics/genomics and provide a platform from which to build tools needed to achieve this goal.

  2. Clinical symptoms, treatment and outcome of highlands malaria in Eldoret (2420 m a.s.l.) and comparison to malaria in hyper-immune population in endemic region of Southern Sudan.

    Science.gov (United States)

    Benca, J; Dubai, A; Sladeckova, V

    2007-11-01

    Malaria should not be present in altitudes more than 1,800 m a.s.l. However due to global warming, highlands malaria (HM) occurs up to 2,000 m. The purpose of this study is comparison of clinical picture and prognosis of HM and compare it to malaria in endemic region of southern Sudan (endemic malaria - EM) among hyper-immune population.

  3. Relation Between Quality-of-Care Indicators for Diabetes and Patient Outcomes : A Systematic Literature Review

    NARCIS (Netherlands)

    Sidorenkov, Grigory; Haaijer-Ruskamp, Flora M.; de Zeeuw, Dick; Bilo, Henk; Denig, Petra

    The authors conducted a systematic literature review to assess whether quality indicators for diabetes care are related to patient outcomes. Twenty-four studies were included that formally tested this relationship. Quality indicators focusing on structure or processes of care were included.

  4. Relation Between Quality-of-Care Indicators for Diabetes and Patient Outcomes : A Systematic Literature Review

    NARCIS (Netherlands)

    Sidorenkov, Grigory; Haaijer-Ruskamp, Flora M.; de Zeeuw, Dick; Bilo, Henk; Denig, Petra

    2011-01-01

    The authors conducted a systematic literature review to assess whether quality indicators for diabetes care are related to patient outcomes. Twenty-four studies were included that formally tested this relationship. Quality indicators focusing on structure or processes of care were included. Descript

  5. An Evaluation of Multiple Single-Case Outcome Indicators Using Convergent Evidence Scaling

    Science.gov (United States)

    McGill, Ryan J.; Busse, R. T.

    2014-01-01

    The purpose of this article is to evaluate the consistency of five single-case outcome indicators, used to assess response-to-intervention data from a pilot Tier 2 reading intervention that was implemented at an elementary school. Using convergent evidence scaling, the indicators were converted onto a common interpretive scale for each case…

  6. Improving outcomes using German Inpatient Quality Indicators in conjunction with peer review procedures.

    Science.gov (United States)

    Mansky, Thomas; Völzke, Tatjana; Nimptsch, Ulrike

    2015-01-01

    Some hospital comparisons seem to generate confusion because different methods of outcome comparisons lead to different results in hospital rankings. This article questions the concept of overall comparisons of hospitals, which are multiproduct enterprises and may have specialties that provide good results in some areas despite having worse outcomes in others. Therefore, the authors argue for a disease specific view of outcome measurement. The concept of the German Inpatient Quality Indicators is explained. These indicators cover volume, mortality, and other information by a disease specific approach, which includes information for potential patients as well as specific feedback to the physicians responsible for the respective specialty. This article focuses on the feedback to the hospitals and explains how these indicators can be used for improvement in conjunction with a peer review process. The indicators provide information to the hospitals regarding their relative position because German reference values are available for all indicators. Thus, the indicators can serve as a trigger instrument for identifying possible quality problems. Based on these indications, peer review can be used to analyze the treatment processes and to eventually verify weaknesses and define actions for improvement. The first studies indicate that the use of this approach within hospital quality management can largely improve hospital outcomes in hospitals with subpar results compared to the German average.

  7. Malaria paediatric hospitalization between 1999 and 2008 across Kenya.

    Science.gov (United States)

    Okiro, Emelda A; Alegana, Victor A; Noor, Abdisalan M; Mutheu, Juliette J; Juma, Elizabeth; Snow, Robert W

    2009-12-09

    Intervention coverage and funding for the control of malaria in Africa has increased in recent years, however, there are few descriptions of changing disease burden and the few reports available are from isolated, single site observations or are of reports at country-level. Here we present a nationwide assessment of changes over 10 years in paediatric malaria hospitalization across Kenya. Paediatric admission data on malaria and non-malaria diagnoses were assembled for the period 1999 to 2008 from in-patient registers at 17 district hospitals in Kenya and represented the diverse malaria ecology of the country. These data were then analysed using autoregressive moving average time series models with malaria and all-cause admissions as the main outcomes adjusted for rainfall, changes in service use and populations-at-risk within each hospital's catchment to establish whether there has been a statistically significant decline in paediatric malaria hospitalization during the observation period. Among the 17 hospital sites, adjusted paediatric malaria admissions had significantly declined at 10 hospitals over 10 years since 1999; had significantly increased at four hospitals, and remained unchanged in three hospitals. The overall estimated average reduction in malaria admission rates was 0.0063 cases per 1,000 children aged 0 to 14 years per month representing an average percentage reduction of 49% across the 10 hospitals registering a significant decline by the end of 2008. Paediatric admissions for all-causes had declined significantly with a reduction in admission rates of greater than 0.0050 cases per 1,000 children aged 0 to 14 years per month at 6 of 17 hospitals. Where malaria admissions had increased three of the four sites were located in Western Kenya close to Lake Victoria. Conversely there was an indication that areas with the largest declines in malaria admission rates were areas located along the Kenyan coast and some sites in the highlands of Kenya. A

  8. Further evidence for periodontal disease as a risk indicator for adverse pregnancy outcomes.

    Science.gov (United States)

    Turton, Mervyn; Africa, Charlene W J

    2017-06-01

    Although there is increasing evidence to suggest an association between periodontal disease and adverse pregnancy outcomes, the issue remains controversial. This study tested the hypothesis that periodontal disease is a risk indicator for preterm delivery of low-birthweight infants. The study sample comprised 443 pregnant women with a mean (± standard deviation) age of 24.13 (±5.30) years. At first visit, maternal oral health status was assessed by the measurement of probing pocket depth and clinical attachment loss, and periodontal status was graded as absent, mild, moderate or severe. An association was sought between pregnancy outcomes and maternal periodontal status. While controlling for other factors, significant associations were found between pregnancy outcomes and maternal periodontal index scores. This study provides further evidence that periodontal disease is a risk indicator for adverse pregnancy outcomes. © 2016 FDI World Dental Federation.

  9. Determining utility values related to malaria and malaria chemoprophylaxis

    Directory of Open Access Journals (Sweden)

    Coyle Doug

    2010-04-01

    Full Text Available Abstract Background Chemoprophylaxis for travellers' malaria is problematic. Decision modeling may help determine optimal prevention strategies for travellers' malaria. Such models can fully assess effect of drug use and disease on quality of life, and help travellers make informed values based decisions. Such models require utility values reflecting societal preferences over different health states of relevance. To date, there are no published utility values relating to clinical malaria or chemoprophylaxis adverse events. Methods Utility estimates for health states related to falciparum malaria, sequelae and drug-related adverse events were obtained using a self-administered visual analogue scale in 20 individuals. Utility values for health states related to clinical malaria were obtained from a survey of 11 malaria experts questioned about length of hospital stay or equivalent disability with simple and severe travellers' malaria. Results The general public (potential travellers, were more tolerant of taking prophylaxis if associated with no or mild AEs and least tolerant of mild sequelae from malaria and severe drug related events. The rating value reported for taking no prophylaxis was quite variable. Tropical medicine specialists estimated a mean hospital stay 3.23 days (range 0.5-4.5 days for simple and 6.36 days (range 4.5 - 7 days for severe malaria. Conclusions This study provides a benchmark for important utility value estimates for modeling malaria and drug-related outcomes in non-immune travellers.

  10. Malaria during pregnancy in Rwanda

    NARCIS (Netherlands)

    Rulisa, S.

    2014-01-01

    It appears that malaria in Rwanda is not a major contributor to adverse outcomes of pregnancy anymore from a public health perspective but it can still give problems in individual patients, also in areas of low malaria transmission. This thesis shows that for individual cases the current treatment o

  11. Evaluating social outcomes of HIV/AIDS interventions: a critical assessment of contemporary indicator frameworks

    Science.gov (United States)

    Mannell, Jenevieve; Cornish, Flora; Russell, Jill

    2014-01-01

    Introduction Contemporary HIV-related theory and policy emphasize the importance of addressing the social drivers of HIV risk and vulnerability for a long-term response. Consequently, increasing attention is being given to social and structural interventions, and to social outcomes of HIV interventions. Appropriate indicators for social outcomes are needed in order to institutionalize the commitment to addressing social outcomes. This paper critically assesses the current state of social indicators within international HIV/AIDS monitoring and evaluation frameworks. Methods We analyzed the indicator frameworks of six international organizations involved in efforts to improve and synchronize the monitoring and evaluation of the HIV/AIDS response. Our analysis classifies the 328 unique indicators according to what they measure and assesses the degree to which they offer comprehensive measurement across three dimensions: domains of the social context, levels of change and organizational capacity. Results and discussion The majority of indicators focus on individual-level (clinical and behavioural) interventions and outcomes, neglecting structural interventions, community interventions and social outcomes (e.g. stigma reduction; community capacity building; policy-maker sensitization). The main tool used to address social aspects of HIV/AIDS is the disaggregation of data by social group. This raises three main limitations. Indicator frameworks do not provide comprehensive coverage of the diverse social drivers of the epidemic, particularly neglecting criminalization, stigma, discrimination and gender norms. There is a dearth of indicators for evaluating the social impacts of HIV interventions. Indicators of organizational capacity focus on capacity to effectively deliver and manage clinical services, neglecting capacity to respond appropriately and sustainably to complex social contexts. Conclusions Current indicator frameworks cannot adequately assess the social

  12. Malaria in pregnancy: ultrasound studies of fetal growth

    NARCIS (Netherlands)

    Rijken, M.J.

    2012-01-01

    Malaria has been a plague for human mankind. Each year roughly 125 million pregnancies are at risk for malaria infection. This thesis demonstrates the detrimental effects of malaria in pregnancy on the mother and the baby. To determine the effects of malaria in pregnancy on birth outcomes, accurate

  13. Are diagnosis specific outcome indicators based on administrative data useful in assessing quality of hospital care?

    Science.gov (United States)

    Scott, I; Youlden, D; Coory, M

    2004-01-01

    Background: Hospital performance reports based on administrative data should distinguish differences in quality of care between hospitals from case mix related variation and random error effects. A study was undertaken to determine which of 12 diagnosis-outcome indicators measured across all hospitals in one state had significant risk adjusted systematic (or special cause) variation (SV) suggesting differences in quality of care. For those that did, we determined whether SV persists within hospital peer groups, whether indicator results correlate at the individual hospital level, and how many adverse outcomes would be avoided if all hospitals achieved indicator values equal to the best performing 20% of hospitals. Methods: All patients admitted during a 12 month period to 180 acute care hospitals in Queensland, Australia with heart failure (n = 5745), acute myocardial infarction (AMI) (n = 3427), or stroke (n = 2955) were entered into the study. Outcomes comprised in-hospital deaths, long hospital stays, and 30 day readmissions. Regression models produced standardised, risk adjusted diagnosis specific outcome event ratios for each hospital. Systematic and random variation in ratio distributions for each indicator were then apportioned using hierarchical statistical models. Results: Only five of 12 (42%) diagnosis-outcome indicators showed significant SV across all hospitals (long stays and same diagnosis readmissions for heart failure; in-hospital deaths and same diagnosis readmissions for AMI; and in-hospital deaths for stroke). Significant SV was only seen for two indicators within hospital peer groups (same diagnosis readmissions for heart failure in tertiary hospitals and inhospital mortality for AMI in community hospitals). Only two pairs of indicators showed significant correlation. If all hospitals emulated the best performers, at least 20% of AMI and stroke deaths, heart failure long stays, and heart failure and AMI readmissions could be avoided

  14. Nursing outcome "Severity of infection": conceptual definitions for indicators related to respiratory problems

    Directory of Open Access Journals (Sweden)

    Alba Luz Rodríguez-Acelas

    Full Text Available Objective.Build conceptual definitions for some indicators of the nursing outcome Infection Severity in the Nursing Outcomes Classification (NOC related to respiratory problems, based on scientific evidence of signs and symptoms of infection in adults. Methods. Integrative literature review with search in the databases PubMed, CINAHL, LILACS and SCOPUS. Studies whose full texts were available, published in Spanish, Portuguese or English, using the descriptors infection severity, nursing outcomes classification NOC, respiratory infections and respiratory signs and symptoms. Results. Nine publications were analyzed that supported the elaboration of the conceptual definitions for eight indicators of the Nursing Outcome Infection Severity: purulent drainage, fever, chilling, unstable temperature, pain, colonization of drainage cultivation, white blood cell count elevation and white blood cell count drop. Conclusion. This study contributed to understand the terms used in the nursing outcome Infection Severity, in order to improve and facilitate the use of the NOC, as it enhances the conceptual clarity of the selected indicators with a view to producing better scientific evidence.

  15. Monitoring and evaluation of sport-based HIV/AIDS awareness programmes: Strengthening outcome indicators

    Directory of Open Access Journals (Sweden)

    Elma Nelisiwe Maleka

    2017-01-01

    Full Text Available There are number of Non-Governmental Organisations (NGOs in South Africa that use sport as a tool to respond to Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS, however, little is reported about the outcomes and impact of these programmes. The aim of this study is to contribute to a generic monitoring and evaluation framework by improving the options for the use of outcome indicators of sport-based HIV/AIDS awareness programmes of selected NGOs in South Africa. A qualitative method study was carried out with seven employees of five selected NGOs that integrate sport to deliver HIV/AIDS programmes in South Africa. The study further involved six specialists/experts involved in the field of HIV/AIDS and an official from Sport Recreation South Africa (SRSA. Multiple data collection instruments including desktop review, narrative systematic review, document analysis, one-on-one interviews and focus group interview were used to collect information on outcomes and indicators for sport-based HIV/AIDS awareness programmes. The information was classified according to the determinants of HIV/AIDS. The overall findings revealed that the sport-based HIV/AIDS awareness programmes of five selected NGOs examined in this study focus on similar HIV prevention messages within the key priorities highlighted in the current National Strategic Plan for HIV/AIDS, STIs and TB of South Africa. However, monitoring and evaluating outcomes of sport-based HIV/AIDS programmes of the selected NGOs remains a challenge. A need exists for the improvement of the outcome statements and indicators for their sport-based HIV/AIDS awareness programmes. This study proposed a total of 51 generic outcome indicators focusing on measuring change in the knowledge of HIV/AIDS and change in attitude and intention towards HIV risk behaviours. In addition, this study further proposed a total of eight generic outcome indicators to measure predictors of HIV risk behaviour

  16. Monitoring and evaluation of sport-based HIV/AIDS awareness programmes: Strengthening outcome indicators.

    Science.gov (United States)

    Maleka, Elma Nelisiwe

    2017-12-01

    There are number of Non-Governmental Organisations (NGOs) in South Africa that use sport as a tool to respond to Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS), however, little is reported about the outcomes and impact of these programmes. The aim of this study is to contribute to a generic monitoring and evaluation framework by improving the options for the use of outcome indicators of sport-based HIV/AIDS awareness programmes of selected NGOs in South Africa. A qualitative method study was carried out with seven employees of five selected NGOs that integrate sport to deliver HIV/AIDS programmes in South Africa. The study further involved six specialists/experts involved in the field of HIV/AIDS and an official from Sport Recreation South Africa (SRSA). Multiple data collection instruments including desktop review, narrative systematic review, document analysis, one-on-one interviews and focus group interview were used to collect information on outcomes and indicators for sport-based HIV/AIDS awareness programmes. The information was classified according to the determinants of HIV/AIDS. The overall findings revealed that the sport-based HIV/AIDS awareness programmes of five selected NGOs examined in this study focus on similar HIV prevention messages within the key priorities highlighted in the current National Strategic Plan for HIV/AIDS, STIs and TB of South Africa. However, monitoring and evaluating outcomes of sport-based HIV/AIDS programmes of the selected NGOs remains a challenge. A need exists for the improvement of the outcome statements and indicators for their sport-based HIV/AIDS awareness programmes. This study proposed a total of 51 generic outcome indicators focusing on measuring change in the knowledge of HIV/AIDS and change in attitude and intention towards HIV risk behaviours. In addition, this study further proposed a total of eight generic outcome indicators to measure predictors of HIV risk behaviour. The selected

  17. Inadequate prenatal care and its association with adverse pregnancy outcomes: A comparison of indices

    OpenAIRE

    Green Chris G; Newburn-Cook Christine V; Heaman Maureen I; Elliott Lawrence J; Helewa Michael E

    2008-01-01

    Abstract Background The objectives of this study were to determine rates of prenatal care utilization in Winnipeg, Manitoba, Canada from 1991 to 2000; to compare two indices of prenatal care utilization in identifying the proportion of the population receiving inadequate prenatal care; to determine the association between inadequate prenatal care and adverse pregnancy outcomes (preterm birth, low birth weight [LBW], and small-for-gestational age [SGA]), using each of the indices; and, to asse...

  18. Cerebral malaria Malaria cerebral

    OpenAIRE

    Silvia Blair Trujillo; Carlos Hugo Zapata Zapata

    2003-01-01

    Is the most common complication of P. falciparum malaria; nearly 90% of people who have suffered CM can recover without neurological problems. Currently there are four hypotheses that explain pathogenesis of CM: cytoadherence and sequestering of parasitized red blood cells to cerebral capillaries; rosette formation and parasitized red blood cells agglutination; production of cytokines and activation of second messengers and opening of the blood-brain barrier. However the main question remains...

  19. Relationships Between Training Load Indicators and Training Outcomes in Professional Soccer

    NARCIS (Netherlands)

    Jaspers, Arne; Brink, Michel S.; Probst, Steven G M; Frencken, Wouter G. P.; Helsen, Werner F.

    Background In professional senior soccer, training load monitoring is used to ensure an optimal workload to maximize physical fitness and prevent injury or illness. However, to date, different training load indicators are used without a clear link to training outcomes. Objective The aim of this

  20. A Conceptualization of Intended Learning Outcomes Supporting Self-Regulated Learners in Indicating Learning Paths

    Science.gov (United States)

    Tangworakitthaworn, P.; Gilbert, L.; Wills, G.B.

    2015-01-01

    Intended learning outcomes (ILOs) indicate what learners will be able to achieve after they are taught. Traditionally, ILOs are expressed as plain text or unstructured documents. What if all ILOs of a specific course of study can be conceptualized through a structured diagrammatic technique? It was hypothesized that learners can benefit from this…

  1. 76 FR 14024 - Guidance for Industry on Hypertension Indication: Drug Labeling for Cardiovascular Outcome Claims...

    Science.gov (United States)

    2011-03-15

    ... are indicated to treat hypertension. With few exceptions, current labeling for antihypertensive drugs... preventing serious cardiovascular events, and inadequate treatment of hypertension is acknowledged as a... Outcome Claims.'' The intent of the guidance is to provide common labeling for antihypertensive drugs...

  2. Explaining match outcome in elite Australian Rules football using team performance indicators.

    Science.gov (United States)

    Robertson, Sam; Back, Nicole; Bartlett, Jonathan D

    2016-01-01

    The relationships between team performance indicators and match outcome have been examined in many team sports, however are limited in Australian Rules football. Using data from the 2013 and 2014 Australian Football League (AFL) regular seasons, this study assessed the ability of commonly reported discrete team performance indicators presented in their relative form (standardised against their opposition for a given match) to explain match outcome (Win/Loss). Logistic regression and decision tree (chi-squared automatic interaction detection (CHAID)) analyses both revealed relative differences between opposing teams for "kicks" and "goal conversion" as the most influential in explaining match outcome, with two models achieving 88.3% and 89.8% classification accuracies, respectively. Models incorporating a smaller performance indicator set displayed a slightly reduced ability to explain match outcome (81.0% and 81.5% for logistic regression and CHAID, respectively). However, both were fit to 2014 data with reduced error in comparison to the full models. Despite performance similarities across the two analysis approaches, the CHAID model revealed multiple winning performance indicator profiles, thereby increasing its comparative feasibility for use in the field. Coaches and analysts may find these results useful in informing strategy and game plan development in Australian Rules football, with the development of team-specific models recommended in future.

  3. Do treatment quality indicators predict cardiovascular outcomes in patients with diabetes?

    Directory of Open Access Journals (Sweden)

    Grigory Sidorenkov

    Full Text Available BACKGROUND: Landmark clinical trials have led to optimal treatment recommendations for patients with diabetes. Whether optimal treatment is actually delivered in practice is even more important than the efficacy of the drugs tested in trials. To this end, treatment quality indicators have been developed and tested against intermediate outcomes. No studies have tested whether these treatment quality indicators also predict hard patient outcomes. METHODS: A cohort study was conducted using data collected from >10.000 diabetes patients in the Groningen Initiative to Analyze Type 2 Treatment (GIANTT database and Dutch Hospital Data register. Included quality indicators measured glucose-, lipid-, blood pressure- and albuminuria-lowering treatment status and treatment intensification. Hard patient outcome was the composite of cardiovascular events and all-cause death. Associations were tested using Cox regression adjusting for confounding, reporting hazard ratios (HR with 95% confidence intervals. RESULTS: Lipid and albuminuria treatment status, but not blood pressure lowering treatment status, were associated with the composite outcome (HR = 0.77, 0.67-0.88; HR = 0.75, 0.59-0.94. Glucose lowering treatment status was associated with the composite outcome only in patients with an elevated HbA1c level (HR = 0.72, 0.56-0.93. Treatment intensification with glucose-lowering but not with lipid-, blood pressure- and albuminuria-lowering drugs was associated with the outcome (HR = 0.73, 0.60-0.89. CONCLUSION: Treatment quality indicators measuring lipid- and albuminuria-lowering treatment status are valid quality measures, since they predict a lower risk of cardiovascular events and mortality in patients with diabetes. The quality indicators for glucose-lowering treatment should only be used for restricted populations with elevated HbA1c levels. Intriguingly, the tested indicators for blood pressure-lowering treatment did not predict patient

  4. Pregnancy outcomes and nutritional indices after 3 types of bariatric surgery performed at a single institution.

    Science.gov (United States)

    Mead, Nancy C; Sakkatos, Panagiotis; Sakellaropoulos, George C; Adonakis, George L; Alexandrides, Theodore K; Kalfarentzos, Fotis

    2014-01-01

    Nutritional status during pregnancy and the effects of nutritional deficiencies on pregnancy outcomes after bariatric surgery is an important issue that warrants further study. The objective of this study was to investigate pregnancy outcomes and nutritional indices after restrictive and malabsorptive procedures. We investigated pregnancy outcomes of 113 women who gave birth to 150 children after biliopancreatic diversion (BPD), Roux-en-Y gastric bypass (RYGB), and sleeve gastrectomy (SG) between June 1994 and December 2011. Biochemical indices and pregnancy outcomes were compared among the different types of surgery and to overall 20-year hospital data, as well as to 56 presurgery pregnancies in 36 women of the same group. Anemia was observed in 24.2% and 15.6% of pregnancies after BPD and RYGB, respectively. Vitamin B12 levels decreased postoperatively in all groups, with no further decrease during pregnancy; however, low levels were observed not only after BPD (11.7%) and RYGB (15.6%), but also after SG (13.3%). Folic acid levels increased. Serum albumin levels decreased in all groups during pregnancy, but hypoproteinemia was seen only after BPD. Neonates after BPD had significantly lower average birth weight without a higher frequency of low birth weight defined aspregnancy outcomes in this sample population after all types of bariatric surgery provided nutritional supplement guidelines are followed. Closer monitoring is required in pregnancies after malabsorptive procedures especially regarding protein nutrition. Copyright © 2014 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  5. Do radiographic indices of distal radius fracture reduction predict outcomes in older adults receiving conservative treatment?

    Energy Technology Data Exchange (ETDEWEB)

    Jaremko, J.L. [Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta (Canada); Lambert, R.G.W. [Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta (Canada); Rowe, B.H. [Department of Emergency Medicine, University of Alberta, Edmonton, Alberta (Canada); Department of Public Health Sciences, University of Alberta, Edmonton, Alberta (Canada); Johnson, J.A. [Department of Public Health Sciences, University of Alberta, Edmonton, Alberta (Canada); Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta (Canada); Majumdar, S.R. [Department of Public Health Sciences, University of Alberta, Edmonton, Alberta (Canada) and Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta (Canada)]. E-mail: me2.majumdar@ualberta.ca

    2007-01-15

    Aim: To investigate whether radiographic deformities suggesting inadequate reduction would be associated with adverse clinical outcomes. Materials and methods: Consecutive patients over 50 years of age (n = 74) with non-operatively managed distal radius fractures were enrolled in a prospective cohort study. They had radiographs at cast removal ({approx}6 weeks) and completed DASH (Disabilities of the Arm, Shoulder and Hand), SF-12 (health-related quality of life), and satisfaction surveys 6-months post-fracture. A reference-standard musculoskeletal radiologist, blinded to outcomes status, measured palmar (dorsal) tilt, radial angle, radial height, ulnar height, and intra-articular step and gap. Radiographic indices were correlated to each other and to the various patient-reported outcomes in univariate and multivariate regression analyses. DASH score was the primary study outcome. Results: Of the cohort studied (n = 74, mean age 68.5 years, primarily white women), 71% had at least one 'unacceptable' radiographic deformity by traditional criteria. Acceptable reduction varied from 60-99% depending on which single index was reported, and 44% of patients had more than two indices reported as unacceptable. Despite these radiographic findings, 6-months post-reduction, self-reported disability was low (DASH = 24 {+-} 17), health-related quality of life was near normal, and 72% were satisfied with their care. No radiographic index of wrist deformity (alone or in combination) was significantly correlated to any of the patient-reported outcomes. Conclusion: Self-reported outcomes in older adults with conservatively managed wrist fractures were not related to the 'acceptability' of radiographic fracture reduction. The proportion of acceptable reductions varied by 40% depending on which index was reported. Consequently, detailed reporting of these indices in older adults with distal radius fracture may be inefficient or perhaps even unnecessary.

  6. Explaining match outcome and ladder position in the National Rugby League using team performance indicators.

    Science.gov (United States)

    Woods, Carl T; Sinclair, Wade; Robertson, Sam

    2017-04-21

    To examine the extent at which match outcome and ladder position could be explained using team performance indicators in the National Rugby League (NRL). The dataset consisted of 13 performance indicators acquired from each NRL team across the 2016 season (n=376 observations). Data was sorted according to apriori match outcome (win/loss) and ladder position (one to 16). Given the binary and categorical nature of the response variables, two analysis approaches were used; a conditional interference classification tree and ordinal regression. Five performance indicators ('try assists', 'all run meters', 'offloads', 'line breaks' and 'dummy half runs') were retained within the classification tree, detecting 66% of the losses and 91% of the wins. A significant negative relationship was noted between ladder position and 'kick metres' (β (SE)=-0.002 (performance indicators provided the greatest explanation of match outcome and ladder position in the NRL. These results could be used by NRL coaches and analysts as a basis for the development of practice conditions and game strategies that may increase their teams' likelihood of success. Beyond rugby league, this study presents analytical techniques that could be applied to other sports when examining the relationships between performance indicators and match derivatives. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  7. Malaria (For Parents)

    Science.gov (United States)

    ... Old Feeding Your 1- to 2-Year-Old Malaria KidsHealth > For Parents > Malaria A A A What's ... Prevention Diagnosis and Treatment en español Malaria About Malaria Malaria is a common infection in hot, tropical ...

  8. The ethics of attribution: the case of health care outcome indicators.

    Science.gov (United States)

    Russell, E

    1998-11-01

    The ethical basis of clinical outcomes measurement is a desire to improve care in a way which will increase both clinical effectiveness and value for money-beneficence as well as competence. To date in the U.K., any debate about producing comparative indicators of clinical outcomes has been concerned mainly with the unfairness to individual doctors or clinical teams of judging their performance on this basis. There has been less interest in the prime purpose of such production, which is to increase the accountability and effectiveness of the NHS as a publicly funded service. Rather than working to improve clinical effectiveness and outcomes within clinical services, health authorities which wish to improve outcomes for their populations have been encouraged simply to shift the contract to another provider of care. The key issue on which the ethics of either action rests is the extent to which the attribution of outcome to intervention is valid and reliable and, therefore, that judgements about performance are just and thus ethical. The consequence of unjust judgements may be to increase the inequalities that medical care resource allocation should attempt to reduce.

  9. The fishery performance indicators: a management tool for triple bottom line outcomes.

    Directory of Open Access Journals (Sweden)

    James L Anderson

    Full Text Available Pursuit of the triple bottom line of economic, community and ecological sustainability has increased the complexity of fishery management; fisheries assessments require new types of data and analysis to guide science-based policy in addition to traditional biological information and modeling. We introduce the Fishery Performance Indicators (FPIs, a broadly applicable and flexible tool for assessing performance in individual fisheries, and for establishing cross-sectional links between enabling conditions, management strategies and triple bottom line outcomes. Conceptually separating measures of performance, the FPIs use 68 individual outcome metrics--coded on a 1 to 5 scale based on expert assessment to facilitate application to data poor fisheries and sectors--that can be partitioned into sector-based or triple-bottom-line sustainability-based interpretative indicators. Variation among outcomes is explained with 54 similarly structured metrics of inputs, management approaches and enabling conditions. Using 61 initial fishery case studies drawn from industrial and developing countries around the world, we demonstrate the inferential importance of tracking economic and community outcomes, in addition to resource status.

  10. The fishery performance indicators: a management tool for triple bottom line outcomes.

    Science.gov (United States)

    Anderson, James L; Anderson, Christopher M; Chu, Jingjie; Meredith, Jennifer; Asche, Frank; Sylvia, Gil; Smith, Martin D; Anggraeni, Dessy; Arthur, Robert; Guttormsen, Atle; McCluney, Jessica K; Ward, Tim; Akpalu, Wisdom; Eggert, Håkan; Flores, Jimely; Freeman, Matthew A; Holland, Daniel S; Knapp, Gunnar; Kobayashi, Mimako; Larkin, Sherry; MacLauchlin, Kari; Schnier, Kurt; Soboil, Mark; Tveteras, Sigbjorn; Uchida, Hirotsugu; Valderrama, Diego

    2015-01-01

    Pursuit of the triple bottom line of economic, community and ecological sustainability has increased the complexity of fishery management; fisheries assessments require new types of data and analysis to guide science-based policy in addition to traditional biological information and modeling. We introduce the Fishery Performance Indicators (FPIs), a broadly applicable and flexible tool for assessing performance in individual fisheries, and for establishing cross-sectional links between enabling conditions, management strategies and triple bottom line outcomes. Conceptually separating measures of performance, the FPIs use 68 individual outcome metrics--coded on a 1 to 5 scale based on expert assessment to facilitate application to data poor fisheries and sectors--that can be partitioned into sector-based or triple-bottom-line sustainability-based interpretative indicators. Variation among outcomes is explained with 54 similarly structured metrics of inputs, management approaches and enabling conditions. Using 61 initial fishery case studies drawn from industrial and developing countries around the world, we demonstrate the inferential importance of tracking economic and community outcomes, in addition to resource status.

  11. Plasma concentrations of soluble urokinase-type plasminogen activator receptor are increased in patients with malaria and are associated with a poor clinical or a fatal outcome

    DEFF Research Database (Denmark)

    Ostrowski, Sisse R; Ullum, Henrik; Goka, Bamenla Q

    2005-01-01

    PAR are associated with disease severity in malaria. METHODS: At admission to the hospital, plasma concentrations of suPAR were measured by ELISA in samples from 645 African children with clinical symptoms of malaria: 478 had malaria, and 167 had a blood film negative for Plasmodium parasites. Fourteen healthy...

  12. Local topographic wetness indices predict household malaria risk better than land-use and land-cover in the western Kenya highlands

    Directory of Open Access Journals (Sweden)

    Vulule John M

    2010-11-01

    Full Text Available Abstract Background Identification of high-risk malaria foci can help enhance surveillance or control activities in regions where they are most needed. Associations between malaria risk and land-use/land-cover are well-recognized, but these environmental characteristics are closely interrelated with the land's topography (e.g., hills, valleys, elevation, which also influences malaria risk strongly. Parsing the individual contributions of land-cover/land-use variables to malaria risk requires examining these associations in the context of their topographic landscape. This study examined whether environmental factors like land-cover, land-use, and urban density improved malaria risk prediction based solely on the topographically-determined context, as measured by the topographic wetness index. Methods The topographic wetness index, an estimate of predicted water accumulation in a defined area, was generated from a digital terrain model of the landscape surrounding households in two neighbouring western Kenyan highland communities. Variables determined to best encompass the variance in this topographic wetness surface were calculated at a household level. Land-cover/land-use information was extracted from a high-resolution satellite image using an object-based classification method. Topographic and land-cover variables were used individually and in combination to predict household-level malaria in the communities through an iterative split-sample model fitting and testing procedure. Models with only topographic variables were compared to those with additional predictive factors related to land-cover/land-use to investigate whether these environmental factors improved prediction of malaria based on the shape of the land alone. Results Variables related to topographic wetness proved most useful in predicting the households of individuals contracting malaria in this region of rugged terrain. Other variables related to human modification of the

  13. [Malaria websites].

    Science.gov (United States)

    Genton, B

    2007-05-16

    One click on google.com, key-word "Malaria", 24,900,000 entries. How to choose among this jungle of websites? Ten sites are proposed to meet the needs of the general practitioner They are categorized by focus of interest, namely 1) detailed information on pre- and post-travel advice and management of travelers with illness upon return, 2) the essential on the parasite, the diagnosis and the treatment, 3) the malaria problem worldwide and 4) malaria maps.

  14. CBCT in orthodontics: assessment of treatment outcomes and indications for its use

    OpenAIRE

    S. D. Kapila; Nervina, J M

    2014-01-01

    Since its introduction into dentistry in 1998, CBCT has become increasingly utilized for orthodontic diagnosis, treatment planning and research. The utilization of CBCT for these purposes has been facilitated by the relative advantages of three-dimensional (3D) over two-dimensional radiography. Despite many suggested indications of CBCT, scientific evidence that its utilization improves diagnosis and treatment plans or outcomes has only recently begun to emerge for some of these applications....

  15. Role of serum lactate and malarial retinopathy in prognosis and outcome of falciparum and vivax cerebral Malaria: A prospective cohort study in adult assamese tribes

    Directory of Open Access Journals (Sweden)

    Kaustubh Suresh Chaudhari

    2016-01-01

    Full Text Available Introduction: There is no comprehensive data or studies relating to clinical presentation and prognosis of cerebral malaria (CM in the tribal settlements of Assam. High rates of transmission and deaths from complicated malaria guided us to conduct a prospective observational cohort study to evaluate the factors associated with poor outcome and prognosis in patients of CM. Materials and Methods: We admitted 112 patients to the Bandarpara and Damodarpur Tribal Health Centers (THCs between 2011 and 2013 with a strict diagnosis of CM. We assessed the role of clinical, fundoscopy and laboratory findings (mainly lactic acid in the immediate outcome in terms of death and recovery, duration of hospitalization, neurocognitive impairment, cranial nerve palsies and focal neurological deficit. Results: The case fatality rate of CM was 33.03% and the prevalence of residual neurological sequelae at discharge was 16.07%. These are significantly higher than the previous studies. The mortality rate and neurological complications rate in patients with retinal whitening was 38.46% and 23.07%, with vessel changes was 25% and 18.75%, with retinal hemorrhage was 55.55% and 11.11% and with hyperlactatemia was 53.85% and 18.46%, respectively. Three patients of papilledema alone died. Conclusion: Our study suggests a strong correlation between hyperlactatemia, retinal changes (whitening, vessel changes and hemorrhage and depth and duration of coma with longer duration of hospitalization, increased mortality, neurological sequelae and death. Plasmodium vivax mono-infection as a cause of CM has been confirmed. Prognostic evaluation of CM is useful for judicious allocation of resources in the THC.

  16. Chemokines responses to Plasmodium falciparum malaria and co-infections among rural Cameroonians.

    Science.gov (United States)

    Che, Jane Nchangnwi; Nmorsi, Onyebiguwa Patrick Goddey; Nkot, Baleguel Pierre; Isaac, Clement; Okonkwo, Browne Chukwudi

    2015-04-01

    Malaria remains the major cause of disease morbidity and mortality in sub-Saharan Africa with complex immune responses associated with disease outcomes. Symptoms associated with severe malaria have generally shown chemokine upregulation but little is known of responses to uncomplicated malaria. Eight villages in central Cameroon of 1045 volunteers were screened. Among these, malaria-positive individuals with some healthy controls were selected for chemokine analysis using Enzyme-Linked Immunosorbent Assay (ELISA) kits. Depressed serum levels of CXCL5 and raised CCL28 were observed in malarial positives when compared with healthy controls. The mean concentration of CXCL11 was higher in symptomatic than asymptomatic group, while CCL28 was lower in symptomatic individuals. Lower chemokine levels were associated with symptoms of uncomplicated malaria except for CXCL11 which was upregulated among fever-positive group. The mean CXCL5 level was higher in malaria sole infection than co-infections with HIV and Loa loa. Also, there was a raised mean level of malaria+HIV co-infection for CXCL9. This study hypothesises a situation where depressed chemokines in the face of clinical presentations could indicate an attempt by the immune system in preventing a progression process from uncomplicated to complicated outcomes with CXCL11 being identified as possible biomarker for malarial fever.

  17. Imported childhood malaria: the Dublin experience, 1999-2006.

    LENUS (Irish Health Repository)

    Leahy, T R

    2009-09-01

    Imported childhood malaria has never been studied in Ireland. We aimed to document the incidence and species of malaria in children presenting to paediatric hospitals in Dublin and to examine management and outcome measures.

  18. A comparative study of neonatal outcomes in placenta previa versus cesarean for other indication at term.

    Science.gov (United States)

    Schneiderman, Megan; Balayla, Jacques

    2013-07-01

    Currently, no ACOG guidelines address the issue of the optimal timing of delivery in placenta previa. Though there is an increased risk of neonatal morbidity and mortality when electively delivered preterm, it is unclear whether adverse neonatal outcomes exist when these pregnancies make it beyond term. By comparing neonatal outcomes amongst pregnancies with placenta previa versus those from cesarean for another indication at term, the objective of this study was to determine whether placenta previa is an independent risk factor for adverse neonatal outcomes at term. We conducted a population-based cohort-study using the CDC's Linked Birth-Infant Death data from the United States. The effect of placenta previa on the risk of adverse neonatal outcomes was estimated using unconditional logistic regression analysis, adjusting for relevant confounders. Our cohort consisted of 3,550,842 deliveries meeting inclusion criteria. The incidence of placenta previa at term was 1.3/1000 (n = 4,492), accounting for 40.6% of all previa cases. Relative to cesareans for other indications, pregnancies with placenta previa had an increased risk of IUGR 3.20 [2.50-4.10], SGA 2.70 [2.45-2.97], respiratory distress 3.82 [2.91-5.00], prolonged ventilation 3.41 [2.70-4.32] and neonatal anemia 6.87 [4.43-10.65]. Rates of meconium aspiration syndrome, seizures, birth injury and overall infant mortality do not appear to be affected by this condition. Relative to cesareans for other indications, placenta previa is associated with increased morbidity, but not mortality, at term. This information might be helpful in the development of future guidelines, which are currently needed to guide and standardize clinical practice regarding the optimal timing of delivery in placenta previa.

  19. Nursing outcome "Severity of infection": conceptual definitions for indicators related to respiratory problems.

    Science.gov (United States)

    Rodríguez-Acelas, Alba Luz; Reich, Rejane; de Abreu Almeida, Miriam; Oliveira Crossetti, Maria da Graça; de Fátima Lucena, Amália

    2016-04-01

    Build conceptual definitions for some indicators of the nursing outcome Infection Severity in the Nursing Outcomes Classification (NOC) related to respiratory problems, based on scientific evidence of signs and symptoms of infection in adults. Integrative literature review with search in the databases PubMed, CINAHL, LILACS and SCOPUS. Studies whose full texts were available, published in Spanish, Portuguese or English, using the descriptors infection severity, nursing outcomes classification NOC, respiratory infections and respiratory signs and symptoms. Nine publications were analyzed that supported the elaboration of the conceptual definitions for eight indicators of the Nursing Outcome Infection Severity: purulent drainage, fever, chilling, unstable temperature, pain, colonization of drainage cultivation, white blood cell count elevation and white blood cell count drop. This study contributed to understand the terms used in the nursing outcome Infection Severity, in order to improve and facilitate the use of the NOC, as it enhances the conceptual clarity of the selected indicators with a view to producing better scientific evidence.Objetivo.Construir definições conceituais para alguns indicadores do resultado de enfermagem Gravidade de Infecção da Nursing Outcomes Classification (NOC) relacionados aos problemas respiratórios, a partir de evidências científicas sobre sinais e sintomas de infecção em pessoas adultas. Métodos. Revisão integrativa da literatura com busca nas bases de dados PubMed, CINAHL, LILACS e SCOPUS. Foram incluídos estudos com textos na integra, publicados em espanhol, português ou inglês, usando os descritores gravidade da infecção, classificação dos resultados de enfermagem da NOC, infecções respiratórias, e sinais e sintomas respiratórios. Resultados. Analisaram-se nove publicações que embasaram a elaboração das definições conceituais de oitos indicadores do Resultado de Enfermagem Gravidade de Infec

  20. Placental malaria and lack of prenatal care in an area of unstable malaria transmission in eastern Sudan.

    Science.gov (United States)

    Adam, Ishag; Adamt, Gamal K; Mohmmed, Ahmed A; Salih, Magdi M; Ibrahuim, Salah A; Ryan, C Anthony

    2009-06-01

    A cross-sectional study was conducted in Gadarif Hospital in eastern Sudan to determine the prevalence, and evaluate the risk factors, of placental malaria. Two hundred and thirty-six delivering women were enrolled in the study. Socio-demographic characteristics were gathered through questionnaires. Maternal hemoglobin was measured, ABO blood groups were determined, and placental histological examinations for malaria were performed. The birth weight of the newborn was also recorded. The mean (SD) maternal age was 25.5 (6.0) yr and the mean (SD) hemoglobin was 9.8 (0.9) g/dl. Placental histology showed acute malaria infections in 13 (5.5%) and chronic infections in 5 (2.1%) women; 28 (11.9%) of the placentas revealed past infection and 190 (80.5%) indicated no infection. Lack of prenatal care was significantly associated with placental infections (OR = 12.0, 95% CI = 2.3-16.2; P = 0.003). There was no significant association between placental malaria infections and maternal age, parity, and blood group. Thirty-two (13.5%) of these pregnancy outcomes resulted in low birthweight babies. There was, however, no significant association between placental malaria and low birth weight (OR = 2.0, 95% CI = 0.4-4.1; P = 0.1). Thus, placental malaria infections affect pregnant women in this area of eastern Sudan regardless of their age or parity. Prenatal care should be encouraged to reduce malaria in the area. Much more research regarding malaria and pregnancy is needed.

  1. Key Performance Indicators in Irish Hospital Libraries: Developing Outcome-Based Metrics

    Directory of Open Access Journals (Sweden)

    Michelle Dalton

    2012-12-01

    Full Text Available Objective – To develop a set of generic outcome-based performance measures for Irishhospital libraries.Methods – Various models and frameworks of performance measurement were used as atheoretical paradigm to link the impact of library services directly with measurablehealthcare objectives and outcomes. Strategic objectives were identified, mapped toperformance indicators, and finally translated into response choices to a single-questiononline survey for distribution via email.Results – The set of performance indicators represents an impact assessment tool whichis easy to administer across a variety of healthcare settings. In using a model directlyaligned with the mission and goals of the organization, and linked to core activities andoperations in an accountable way, the indicators can also be used as a channel throughwhich to implement action, change, and improvement.Conclusion – The indicators can be adopted at a local and potentially a national level, asboth a tool for advocacy and to assess and improve service delivery at a macro level. Toovercome the constraints posed by necessary simplifications, substantial further research is needed by hospital libraries to develop more sophisticated and meaningful measures of impact to further aid decision making at a micro level.

  2. CBCT in orthodontics: assessment of treatment outcomes and indications for its use.

    Science.gov (United States)

    Kapila, S D; Nervina, J M

    2015-01-01

    Since its introduction into dentistry in 1998, CBCT has become increasingly utilized for orthodontic diagnosis, treatment planning and research. The utilization of CBCT for these purposes has been facilitated by the relative advantages of three-dimensional (3D) over two-dimensional radiography. Despite many suggested indications of CBCT, scientific evidence that its utilization improves diagnosis and treatment plans or outcomes has only recently begun to emerge for some of these applications. This article provides a comprehensive and current review of key studies on the applications of CBCT in orthodontic therapy and for research to decipher treatment outcomes and 3D craniofacial anatomy. The current diagnostic and treatment planning indications for CBCT include impacted teeth, cleft lip and palate and skeletal discrepancies requiring surgical intervention. The use of CBCT in these and other situations such as root resorption, supernumerary teeth, temporomandibular joint (TMJ) pathology, asymmetries and alveolar boundary conditions should be justified on the basis of the merits relative to risks of imaging. CBCT has also been used to assess 3D craniofacial anatomy in health and disease and of treatment outcomes including that of root morphology and angulation; alveolar boundary conditions; maxillary transverse dimensions and maxillary expansion; airway morphology, vertical malocclusion and obstructive sleep apnoea; TMJ morphology and pathology contributing to malocclusion; and temporary anchorage devices. Finally, this article utilizes findings of these studies and current voids in knowledge to provide ideas for future research that could be beneficial for further optimizing the use of CBCT in research and the clinical practice of orthodontics.

  3. Indications, outcome and complications with axial pattern skin flaps in dogs and cats: 73 cases.

    Science.gov (United States)

    Field, E J; Kelly, G; Pleuvry, D; Demetriou, J; Baines, S J

    2015-12-01

    To determine the indications, frequency of complications and long term outcome associated with axial pattern flaps used to repair wound defects in dogs and cats. Medical records from two independent referral centres for dogs and cats undergoing wound repair with an axial pattern flap were reviewed. Seventy-three animals were included, 49 dogs: 24 cats. Indications for axial pattern flaps were chronic wounds (43/73; 59%) and closure following tumour resection (30/73; 41%). Axial pattern flaps used were: thoracodorsal, caudal superficial epigastric, reverse saphenous conduit, superficial brachial, deep circumflex iliac, superficial cervical, caudal auricular, lateral thoracic, cranial superficial epigastric, genicular and superficial temporal. Postoperative complications occurred in 64 patients (89%) and 8 patients (11%) had no complications. Complications were: dehiscence, swelling of the flap, necrosis, infection, discharge and seroma. Flap outcome was excellent in 16 patients (23%), good in 29 (41%), fair in 21 (30%) and poor in 5 (7%). There is a high complication rate associated with axial pattern flaps but these are usually easily managed and long term outcome is excellent, in either species. © 2015 British Small Animal Veterinary Association.

  4. Cerebral malaria Malaria cerebral

    Directory of Open Access Journals (Sweden)

    Silvia Blair Trujillo

    2003-03-01

    Full Text Available Is the most common complication of P. falciparum malaria; nearly 90% of people who have suffered CM can recover without neurological problems. Currently there are four hypotheses that explain pathogenesis of CM: cytoadherence and sequestering of parasitized red blood cells to cerebral capillaries; rosette formation and parasitized red blood cells agglutination; production of cytokines and activation of second messengers and opening of the blood-brain barrier. However the main question remains to be answered; how the host-parasite interaction in the vascular space interferes transiently with cerebral function? Recently, the beta amyloid precursor peptide has been employed as marker of neural injury in CM. It is expected that the beta amyloid precursor peptide will help to understand the pathogenesis of CM in complicated patients of endemic areas of Colombia. La malaria Cerebral (MC es la complicación más frecuente de la malaria por P. falciparum; aproximadamente el 90% de las personas que la han padecido se recuperan completamente sin secuelas neurológicas. Aún no se conoce con claridad su patogénesis pero se han postulado cuatro hipótesis o mecanismos posibles: 1 citoadherencia y secuestro de glóbulos rojos parasitados en la microvasculatura cerebral; 2 formación de rosetas y aglutinación de glóbulos rojos parasitados; 3 producción de citoquinas y activación de segundos mensajeros y, 4 apertura de la barrera hematoencefálica. Sin embargo, queda un interrogante sin resolver aún: ¿qué proceso se lleva a cabo para que el parásito, desde el espacio microvascular, pueda interferir transitoriamente con la función cerebral? Recientemente se ha utilizado el precursor de la proteína b-Amiloide como un marcador de daño neuronal en MC; este precursor será de gran ayuda en futuras investigaciones realizadas en nuestro medio que aporten información para comprender la patogénesis de la MC.

  5. Inadequate prenatal care and its association with adverse pregnancy outcomes: A comparison of indices

    Directory of Open Access Journals (Sweden)

    Green Chris G

    2008-05-01

    Full Text Available Abstract Background The objectives of this study were to determine rates of prenatal care utilization in Winnipeg, Manitoba, Canada from 1991 to 2000; to compare two indices of prenatal care utilization in identifying the proportion of the population receiving inadequate prenatal care; to determine the association between inadequate prenatal care and adverse pregnancy outcomes (preterm birth, low birth weight [LBW], and small-for-gestational age [SGA], using each of the indices; and, to assess whether or not, and to what extent, gestational age modifies this association. Methods We conducted a population-based study of women having a hospital-based singleton live birth from 1991 to 2000 (N = 80,989. Data sources consisted of a linked mother-baby database and a physician claims file maintained by Manitoba Health. Rates of inadequate prenatal care were calculated using two indices, the R-GINDEX and the APNCU. Logistic regression analysis was used to determine the association between inadequate prenatal care and adverse pregnancy outcomes. Stratified analysis was then used to determine whether the association between inadequate prenatal care and LBW or SGA differed by gestational age. Results Rates of inadequate/no prenatal care ranged from 8.3% using APNCU to 8.9% using R-GINDEX. The association between inadequate prenatal care and preterm birth and LBW varied depending on the index used, with adjusted odds ratios (AOR ranging from 1.0 to 1.3. In contrast, both indices revealed the same strength of association of inadequate prenatal care with SGA (AOR 1.4. Both indices demonstrated heterogeneity (non-uniformity across gestational age strata, indicating the presence of effect modification by gestational age. Conclusion Selection of a prenatal care utilization index requires careful consideration of its methodological underpinnings and limitations. The two indices compared in this study revealed different patterns of utilization of prenatal care

  6. Inadequate prenatal care and its association with adverse pregnancy outcomes: a comparison of indices.

    Science.gov (United States)

    Heaman, Maureen I; Newburn-Cook, Christine V; Green, Chris G; Elliott, Lawrence J; Helewa, Michael E

    2008-05-01

    The objectives of this study were to determine rates of prenatal care utilization in Winnipeg, Manitoba, Canada from 1991 to 2000; to compare two indices of prenatal care utilization in identifying the proportion of the population receiving inadequate prenatal care; to determine the association between inadequate prenatal care and adverse pregnancy outcomes (preterm birth, low birth weight [LBW], and small-for-gestational age [SGA]), using each of the indices; and, to assess whether or not, and to what extent, gestational age modifies this association. We conducted a population-based study of women having a hospital-based singleton live birth from 1991 to 2000 (N = 80,989). Data sources consisted of a linked mother-baby database and a physician claims file maintained by Manitoba Health. Rates of inadequate prenatal care were calculated using two indices, the R-GINDEX and the APNCU. Logistic regression analysis was used to determine the association between inadequate prenatal care and adverse pregnancy outcomes. Stratified analysis was then used to determine whether the association between inadequate prenatal care and LBW or SGA differed by gestational age. Rates of inadequate/no prenatal care ranged from 8.3% using APNCU to 8.9% using R-GINDEX. The association between inadequate prenatal care and preterm birth and LBW varied depending on the index used, with adjusted odds ratios (AOR) ranging from 1.0 to 1.3. In contrast, both indices revealed the same strength of association of inadequate prenatal care with SGA (AOR 1.4). Both indices demonstrated heterogeneity (non-uniformity) across gestational age strata, indicating the presence of effect modification by gestational age. Selection of a prenatal care utilization index requires careful consideration of its methodological underpinnings and limitations. The two indices compared in this study revealed different patterns of utilization of prenatal care, and should not be used interchangeably. Use of these indices to

  7. [How to quantify the qualitative aspects of nursing outcomes classification scales with psychosociocultural indicators].

    Science.gov (United States)

    Pérez, Paloma Echevarria; Oliveira, Adriana Catarina de Souza

    2013-06-01

    Working necessarily with Likert scales to measure Nursing Outcomes Classification (NOC) outcomes has the advantage of unification, but also presents difficulty in reducing the rating from 1 to 5, especially when the research is qualitative and thus includes the use of words and expressions, as well as observations and perceptions. What exactly does a score of 2 or 3 mean with regard to the NOC Health beliefs? In this paper, we make a number of different proposals for operationalizing concepts and transforming them to numbers; however, it should be noted that such proposals always end in a quantitative analysis. Thus, we propose the use of emic/etic qualitative observations for psychosocial and cultural indicators, following ethnographic principles. Basic and applied research on nursing languages must have correct methodological foundations and seek to satisfy the same criteria of methodological suitability as any other research.

  8. Outcome, revision rate and indication for revision following resurfacing hemiarthroplasty for osteoarthritis of the shoulder

    DEFF Research Database (Denmark)

    Rasmussen, J V; Polk, A; Sorensen, A K

    2014-01-01

    In this study, we evaluated patient-reported outcomes, the rate of revision and the indications for revision following resurfacing hemiarthroplasty of the shoulder in patients with osteoarthritis. All patients with osteoarthritis who underwent primary resurfacing hemiarthroplasty and reported...... to the Danish Shoulder Arthroplasty Registry (DSR), between January 2006 and December 2010 were included. There were 772 patients (837 arthroplasties) in the study. The Western Ontario Osteoarthritis of the Shoulder (WOOS) index was used to evaluate patient-reported outcome 12 months (10 to 14) post......-operatively. The rates of revision were calculated from the revisions reported to the DSR up to December 2011 and by checking deaths with the Danish National Register of Persons. A complete questionnaire was returned by 688 patients (82.2%). The mean WOOS was 67 (0 to 100). A total of 63 hemiarthroplasties (7...

  9. Malaria Matters

    Centers for Disease Control (CDC) Podcasts

    2008-04-18

    This podcast gives an overview of malaria, including prevention and treatment, and what CDC is doing to help control and prevent malaria globally.  Created: 4/18/2008 by National Center for Zoonotic, Vector-Borne, and Enteric Diseases (NCZVED).   Date Released: 4/18/2008.

  10. Plasmodium vivax malaria: An unusual presentation

    Directory of Open Access Journals (Sweden)

    Kasliwal Prasad

    2009-01-01

    Full Text Available Acute renal failure, disseminated intravascular coagulation (DIC, acute respiratory distress syndrome (ARDS, hypoglycemia, coma, or epileptic seizures are manifestations of severe Plasmodium falciparum malaria. On the other hand, Plasmodium vivax malaria seldom results in pulmonary damage, and pulmonary complications are exceedingly rare. We report the case of a 42-year-old male living in a malaria-endemic area who presented with ARDS and was diagnosed as having Plasmodium vivax malaria. A diagnosis of Plasmodium vivax malaria was established by a positive Plasmodium LDH immunochromatographic assay while a negative PfHRP2 based assay ruled out P. falciparum malaria. After specific anti-plasmodial therapy and intensive supportive care, the patient recovered and was discharged from hospital. The use of NIPPV in vivax-malaria related ARDS was associated with a good outcome.

  11. Social media indicators of the food environment and state health outcomes.

    Science.gov (United States)

    Nguyen, Q C; Meng, H; Li, D; Kath, S; McCullough, M; Paul, D; Kanokvimankul, P; Nguyen, T X; Li, F

    2017-07-01

    Contextual factors can influence health through exposures to health-promoting and risk-inducing factors. The aim of this study was to (1) build, from geotagged Twitter and Yelp data, a national food environment database and (2) to test associations between state food environment indicators and health outcomes. This is a cross-sectional study based upon secondary analyses of publicly available data. Using Twitter's Streaming Application Programming Interface (API), we collected and processed 4,041,521 food-related, geotagged tweets between April 2015 and March 2016. Using Yelp's Search API, we collected data on 505,554 unique food-related businesses. In linear regression models, we examined associations between food environment characteristics and state-level health outcomes, controlling for state-level differences in age, percent non-Hispanic white, and median household income. A one standard deviation increase in caloric density of food tweets was related to higher all-cause mortality (+46.50 per 100,000), diabetes (+0.75%), obesity (+1.78%), high cholesterol (+1.40%), and fair/poor self-rated health (2.01%). More burger Yelp listings were related to higher prevalence of diabetes (+0.55%), obesity (1.35%), and fair/poor self-rated health (1.12%). More alcohol tweets and Yelp bars and pub listings were related to higher state-level binge drinking and heavy drinking, but lower mortality and lower percent reporting fair/poor self-rated health. Supplemental analyses with county-level social media indicators and county health outcomes resulted in finding similar but slightly attenuated associations compared to those found at the state level. Social media can be utilized to create indicators of the food environment that are associated with area-level mortality, health behaviors, and chronic conditions. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  12. Indications and Early Outcomes for Total Pancreatectomy at a High-Volume Pancreas Center

    Directory of Open Access Journals (Sweden)

    Monika S. Janot

    2010-01-01

    Full Text Available Background. This study aimed to analyse the most common current indications for total pancreatectomy (TP at a high-volume pancreas center. Method. Prospectively collected data on indications and short-term outcome of all TP's performed from January 2004 until June 2008 were analysed. Results. The total pancreatectomies (TP were 63, i.e., 6.7% of all pancreatic procedures (=948. Indications for TP were classified into 4 groups: tumors of advanced stage, =23 (36.5%, technical problems due to soft pancreatic tissue, =18 (28.6%, troubles due to perioperative surgical complications, =15 (23.8%, and therapy-resistant pain due to chronic pancreatitis, =7 (11.1%. Surgical complications occurred in 23 patients (36.5%. The mortality in elective TP was 6.25%. Median postoperative stay was 21 days. Mortality, morbidity and the other perioperative parameters differed substantially according to the indication for pancreatectomy. Conclusion. Total pancreatectomy is definitely indicated for a limited range of elective and emergency situations. Indications can be: size or localisation of pancreatic tumor, trouble, technical diffuculties and therapy-refractory pain in chronic pancreatitis. A TP due to perioperative complications (troubles after pancreatic resections is doomed by extremely high morbidity and mortality and should be avoided.

  13. [Requirements for quality indicators. The relevance of current developments in outcomes research for quality management].

    Science.gov (United States)

    Schmitt, Jochen; Petzold, Thomas; Eberlein-Gonska, Maria; Neugebauer, Edmund A M

    2013-01-01

    The assessment of the health state in patients and changes in their health state for the purpose of diagnosis, prognosis and monitoring of treatment response plays a central role in clinical practice. Quality criteria for measurements in medicine include validity, reliability, responsiveness, interpretability, and feasibility. High-quality measurement instruments are a prerequisite for evidence-based medicine. Therefore, international outcomes research groups have developed methods for quality assurance and for the standardisation of measurement instruments. Quality indicators are instruments to measure the quality of care. Due to the increasing relevance of quality assessment for all stakeholders in healthcare and due to the political intention to draw relevant conclusions from the assessment of the quality of care, quality indicators must at least meet the same high standards that are required for clinical trial end points. However, independent researchers and clinicians do not engage in the validation and standardisation of quality indicators in Germany; currently, only the AQUA institute (as assigned by the German GBA) deals with this important issue. Current activities concerning the validation of quality indicators do not meet the requirements of evidence-based healthcare. This is a critical barrier to achieving the political goals of quality medicine. Therefore, the authors propose a multi-step, multi-professional, evidence-driven and evidence-generating consensus process on the basis of established methods of outcomes research for the advancement of quality assessment with quality indicators in Germany. All relevant stakeholders should participate in this process. Copyright © 2013. Published by Elsevier GmbH.

  14. Clinical illness and outcomes in Nigerian children with late-appearing anaemia after artemisinin-based combination treatments of uncomplicated falciparum malaria.

    Science.gov (United States)

    Sowunmi, Akintunde; Akano, Kazeem; Ayede, Adejumoke I; Ntadom, Godwin; Aderoyeje, Temitope; Adewoye, Elsie O; Fatunmbi, Bayo

    2016-06-01

    Late-appearing anaemia (LAA) following treatment with artemisinins for severe malaria has been reported and well described, but there are limited clinical and parasitological data on LAA in African children with uncomplicated falciparum malaria following oral artemisinin-based combination therapies (ACTs). This was an open label study with the main objectives of evaluating the clinical features, the risk factors for, the temporal changes in haematocrit and the outcomes of a LAA in malarious children treated with artesunate-amodiaquine (AA), artemether-lumefantrine (AL) or dihydroartemisinin-piperaquine (DHP). The diagnosis of LAA was made using the criteria: clearance of parasitaemia, fever and other symptoms within 1 week of commencing treatment; adequate clinical and parasitological response at 4-6 weeks after treatment began; haematocrit ≥30 % 1 and/or 2 weeks after treatment began; and haematocrit 10(4) 2 days after treatment began (AOR = 2.1, 95 % CI 1.1-3.9, P = 0.03) and spleen enlargement at presentation (AOR = 2.0, 95 % CI 1.1-3.9, P anaemia occurred in 56 children [mean recovery time of 11.8 days (95 % CI 10.3-13.3)]. The only independent predictor of failure of recovery was LAA occurring 4 weeks after starting treatment (AOR = 7.5, 95 % CI 2.5-22.9, P anaemia and for anaemia control efforts in sub-Saharan Africa where ACTs have become first-line antimalarials. Pan African Clinical Trial Registry PACTR201508001188143, 3 July 2015; PACTR201510001189370, 3 July 2015; PACTR201508001191898, 7 July 2015 and PACTR201508001193368, 8 July 2015 http://www.pactr.org .

  15. Indications and outcome for obstetric patients' admission to intensive care unit: a 7-year review.

    Science.gov (United States)

    Lataifeh, I; Amarin, Z; Zayed, F; Al-Mehaisen, L; Alchalabi, H; Khader, Y

    2010-05-01

    The objective of this retrospective study was to investigate the indications, interventions and clinical outcome of pregnant and newly delivered women admitted to the multidisciplinary intensive care unit at the King Abdullah University Hospital in Jordan over a 7-year period from January 2002 to December 2008. The collected data included demographic characteristics of the patients, mode of delivery, pre-existing medical conditions, reason for admission, specific intervention, length of stay and maternal outcome. A total of 43 women required admission to the intensive care unit (ICU), which represented 0.37% of all deliveries. The majority (95.3%) of patients were admitted to the ICU postpartum. The most common reasons for admissions were (pre)eclampsia (48.8%) and obstetric haemorrhage (37.2). The remainder included adult respiratory distress syndrome (6.9%), pulmonary embolism (2.3%) and neurological disorders (4.6%). Mechanical ventilation was required to support 18.6% of patients and transfusion of red blood cells was needed for 48.8% of patients. There were three maternal deaths (6.9%). A multidisciplinary team approach is essential to improve the management of hypertensive disorders and postpartum haemorrhage to achieve significant improvements in maternal outcome. A large, prospective study to know which women are at high risk of admission to the intensive care units and to prevent serious maternal morbidity and mortality is warranted.

  16. Secondary intraocular lens implantation following infantile cataract surgery: intraoperative indications, postoperative outcomes.

    Science.gov (United States)

    Wood, K S; Tadros, D; Trivedi, R H; Wilson, M E

    2016-09-01

    PurposeThe purpose of this study was to determine the long-term complications and outcomes of secondary intraocular lens (IOL) implantation in patients with congenital cataracts.Patients and MethodsThe medical records of children operated for secondary IOL implantation surgery between 2000 and 2014 were retrospectively reviewed. Those who had undergone their initial congenital cataract surgery before 7 months of age were included and were analyzed for intra- and postoperative factors and postoperative refractive outcomes. We focused on three complications: visual axis opacification (VAO), glaucoma, and IOL exchange after at least 1 year of follow-up.ResultsA total of 49 eyes of 49 patients were analyzed for intraoperative indications. Of those, 37 eyes of 37 patients had at least 1 year of follow-up and were analyzed for postoperative outcomes. The mean age at secondary implantation was 55.2±21.6 months. At secondary implantation, 69.4% of eyes were implanted in the capsular bag, 28.6% in the sulcus, and 2.0% that were angle-supported. There was no significant correlation between the site of secondary IOL implantation and age at implantation (P=0.216). The mean follow-up after implantation was 57.6±33.6 months. The rate of VAO was 5.4%, the rate of glaucoma occurring after secondary implantation was 16.2%, and the rate of IOL exchange was 2.7%. The median visual acuity at final follow-up was 20/40. For patients with unilateral cataracts it was 20/60 and for bilateral patients it was 20/30.ConclusionsThe secondary IOL implantation in children is a relatively safe procedure associated with low rates of postoperative complications. Visual outcomes are acceptable and are better for bilateral patients than for unilateral patients.

  17. CBCT in orthodontics: assessment of treatment outcomes and indications for its use

    Science.gov (United States)

    Nervina, J M

    2015-01-01

    Since its introduction into dentistry in 1998, CBCT has become increasingly utilized for orthodontic diagnosis, treatment planning and research. The utilization of CBCT for these purposes has been facilitated by the relative advantages of three-dimensional (3D) over two-dimensional radiography. Despite many suggested indications of CBCT, scientific evidence that its utilization improves diagnosis and treatment plans or outcomes has only recently begun to emerge for some of these applications. This article provides a comprehensive and current review of key studies on the applications of CBCT in orthodontic therapy and for research to decipher treatment outcomes and 3D craniofacial anatomy. The current diagnostic and treatment planning indications for CBCT include impacted teeth, cleft lip and palate and skeletal discrepancies requiring surgical intervention. The use of CBCT in these and other situations such as root resorption, supernumerary teeth, temporomandibular joint (TMJ) pathology, asymmetries and alveolar boundary conditions should be justified on the basis of the merits relative to risks of imaging. CBCT has also been used to assess 3D craniofacial anatomy in health and disease and of treatment outcomes including that of root morphology and angulation; alveolar boundary conditions; maxillary transverse dimensions and maxillary expansion; airway morphology, vertical malocclusion and obstructive sleep apnoea; TMJ morphology and pathology contributing to malocclusion; and temporary anchorage devices. Finally, this article utilizes findings of these studies and current voids in knowledge to provide ideas for future research that could be beneficial for further optimizing the use of CBCT in research and the clinical practice of orthodontics. PMID:25358833

  18. Malaria and Travelers

    Science.gov (United States)

    ... a CDC Malaria Branch clinician. malaria@cdc.gov Malaria and Travelers Recommend on Facebook Tweet Share Compartir ... may be at risk for infection. Determine if malaria transmission occurs at the destinations Obtain a detailed ...

  19. Malaria Treatment (United States)

    Science.gov (United States)

    ... a CDC Malaria Branch clinician. malaria@cdc.gov Malaria Treatment (United States) Recommend on Facebook Tweet Share Compartir Treatment of Malaria: Guidelines For Clinicians (United States) Download PDF version ...

  20. UK malaria treatment guidelines.

    Science.gov (United States)

    Lalloo, David G; Shingadia, Delane; Pasvol, Geoffrey; Chiodini, Peter L; Whitty, Christopher J; Beeching, Nicholas J; Hill, David R; Warrell, David A; Bannister, Barbara A

    2007-02-01

    ); quinine is highly effective but poorly tolerated in prolonged dosage and is always supplemented by additional treatment, usually with oral doxycycline. ALL patients treated for P. falciparum malaria should be admitted to hospital for at least 24 h, since patients can deteriorate suddenly, especially early in the course of treatment. Severe falciparum malaria, or infections complicated by a relatively high parasite count (more than 2% of red blood cells parasitized), should be treated with intravenous therapy until the patient is well enough to continue with oral treatment. In the UK, the treatment of choice for severe or complicated malaria is currently an infusion of intravenous quinine. This may exacerbate hypoglycaemia that can occur in malaria; patients treated with intravenous quinine therefore require careful monitoring. Intravenous artesunate reduces high parasite loads more rapidly than quinine and is more effective in treating severe malaria in selected situations. It can also be used in patients with contra-indications to quinine. Intravenous artesunate is unlicensed in the EU. Assistance in obtaining artesunate may be sought from specialist tropical medicine centres, on consultation, for named patients. Patients with severe or complicated malaria should be managed in a high dependency or intensive care environment. They may require haemodynamic support and management of acute respiratory distress syndrome, disseminated intravascular coagulation, renal impairment/failure, seizures, and severe intercurrent infections including gram-negative bacteraemia/septicaemia. Falciparum malaria in pregnancy is more likely to be severe and complicated: the placenta contains high levels of parasites. Stillbirth or early delivery may occur and diagnosis can be difficult if parasites are concentrated in the placenta and scanty in the blood. The treatment of choice for falciparum malaria in pregnancy is quinine; doxycycline is contraindicated in pregnancy but clindamycin can be

  1. CLINICAL ASPECTS OF UNCOMPLICATED AND SEVERE MALARIA

    Directory of Open Access Journals (Sweden)

    Alessandro Bartoloni

    2012-05-01

    Full Text Available The first symptoms of malaria, common to all the different malaria species, are nonspecific and mimic a flu-like syndrome. Although fever represents the cardinal feature, clinical findings in malaria are extremely diverse and may range in severity from mild headache to serious complications leading to death, particularly in falciparum malaria. As the progression to these complications can be rapid, any malaria patient must be assessed and treated rapidly, and frequent observations are needed to look for early signs of systemic complications. In fact, severe malaria is a life threatening but treatable disease.  The protean and nonspecific clinical findings occurring in malaria (fever, malaise, headache, myalgias, jaundice and sometimes gastrointestinal symptoms of nausea, vomiting and diarrhoea may lead physicians who see malaria infrequently to a wrong diagnosis, such as influenza (particularly during the seasonal epidemic flu, dengue, gastroenteritis, typhoid fever, viral hepatitis, encephalitis. Physicians should be aware that malaria is not a clinical diagnosis but must be diagnosed, or excluded, by performing microscopic examination of blood films. Prompt diagnosis and appropriate treatment are then crucial to prevent morbidity and fatal outcomes. Although Plasmodium falciparum malaria is the major cause of severe malaria and death, increasing evidence has recently emerged that Plasmodium vivax and Plasmodium knowlesi can also be severe and even fatal.

  2. Outcome of retinopathy of prematurity patients following adoption of revised indications for treatment

    Directory of Open Access Journals (Sweden)

    Ingvoldstad David D

    2008-11-01

    Full Text Available Abstract Background The Early Treatment for Retinopathy of Prematurity study (ETROP, published in 2003, established new guidelines for treatment of retinopathy of prematurity (ROP and demonstrated improved outcomes compared to previous guidelines. We examined outcomes before and after implementing the ETROP recommendations. Methods A retrospective chart review was performed using records of infants who had laser ablations for ROP performed from January, 2000 through December, 2005. Data collected included date of birth; birth weight; estimated gestational age (EGA; grading of ROP; date of laser ablation; and outcome of laser surgery. Univariate association with threshold or prethreshold treatment (Pre-ETROP and Post-ETROP, respectively were assessed using t-tests or Wilcoxon tests. Additional comparison between groups was performed using Fisher's exact tests. Results 581 patients were examined before and 464 after December 2003. Of these, 29/581 (5% – Pre-ETROP Group and 53/464 (11% – Post-ETROP Group patients advanced to criteria requiring laser treatment respectively (P = 0.0001. The average estimated gestational age (EGA at birth was 26.3 and 25.2 weeks, with an average birth weight of 888 and 707 grams for Pre and Post-ETROP Groups, respectively. Stage 5 retinal detachment (RD developed in 10.3% of eyes in the Pre-ETROP Group and 1.9% of eyes in the Post-ETROP Group (P = 0.02. Conclusion After the ETROP guidelines were implemented, there was a decrease from 10.3% to 1.9% of eyes developing Stage 5 retinal detachment, despite this group having a lower average EGA and lower average birth weight. These results underscore the importance of adoption of the Revised Indications.

  3. Emergency Coronary Artery Bypass Grafting: Indications and Outcomes from 2003 through 2013.

    Science.gov (United States)

    Schumer, Erin M; Chaney, John H; Trivedi, Jaimin R; Linsky, Paul L; Williams, Matthew L; Slaughter, Mark S

    2016-06-01

    Emergency coronary artery bypass grafting (CABG) is associated with increased in-hospital mortality rates and adverse events. This study retrospectively evaluated indications and outcomes in patients who underwent emergency CABG. The Society of Thoracic Surgeons database for a single center (Jewish Hospital) was queried to identify patients undergoing isolated CABG. Univariate analysis was performed. From January 2003 through December 2013, 5,940 patients underwent CABG; 212 presented with emergency status. A high proportion of female patients (28.2%) underwent emergency surgery. Emergency CABG patients experienced high rates of intra-aortic balloon pump support, bleeding, dialysis, in-hospital death, and prolonged length of stay. The proportion of emergency coronary artery bypass grafting declined during years 2008-2013 compared with 2003-2007 (2.2% vs. 4.5%, P emergency CABG, yet the incidence of angiographic accident has greatly increased. In-hospital mortality rates and adverse events remain high. If we look specifically at emergency CABG cases arising from angiographic accident, we find that 14 (15%) of all 93 emergency CABG deaths occurred in that subset of patients. Efforts to improve outcomes should therefore be focused on this high-risk group.

  4. Surgical indication for functional tricuspid regurgitation at initial operation: judging from long term outcomes.

    Science.gov (United States)

    Pozzoli, Alberto; Elisabetta, Lapenna; Vicentini, Luca; Alfieri, Ottavio; De Bonis, Michele

    2016-09-01

    The assessment and management of tricuspid valve disease have evolved substantially during the past several years. Whereas tricuspid stenosis is uncommon, tricuspid regurgitation is frequently encountered and it is most often secondary due to annular dilatation and leaflet tethering from right ventricular remodelling. The indications for tricuspid valve surgery to treat tricuspid regurgitation are several and mainly related to the underlying disease, to the severity of insufficiency and to the right ventricular function. Surgical tricuspid repair has been avoided for years, because of the misleading concept that tricuspid regurgitation should disappear once the primary left-sided problem has been eliminated. Instead, during the last decade, many investigators have reported evidence in favor of a more aggressive surgical approach to functional tricuspid regurgitation, recognising the risk of progressive tricuspid insufficiency in patients with moderate or lesser degrees of tricuspid regurgitation and tricuspid annular dilatation. This concept, along with the long-term outcomes of principal surgical repair techniques are reported and discussed. Last, novel transcatheter therapies have begun to emerge for the treatment of severe tricuspid regurgitation in high-risk patients. Hence, very preliminary pre-clinical and clinical experiences are illustrated. The scope of this review is to explore the anatomic basis, the pathophysiology, the outcomes and the new insights in the management of functional tricuspid regurgitation.

  5. Is Plasmodium vivax malaria a severe malaria?: a systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    Cho Naing

    2014-08-01

    Full Text Available Plasmodium vivax is one of the major species of malaria infecting humans. Although emphasis on P. falciparum is appropriate, the burden of vivax malaria should be given due attention. This study aimed to synthesize the evidence on severe malaria in P. vivax infection compared with that in P. falciparum infection.We searched relevant studies in electronic databases. The main outcomes required for inclusion in the review were mortality, severe malaria (SM and severe anaemia (SA. The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale. Overall, 26 studies were included. The main meta-analysis was restricted to the high quality studies. Eight studies (n = 27490 compared the incidence of SM between P. vivax infection and P. falciparum mono-infection; a comparable incidence was found in infants (OR: 0.45, 95% CI:0.04-5.68, I2:98%, under 5 year age group (OR: 2.06, 95% CI: 0.83-5.1, I2:83%, the 5-15 year-age group (OR: 0.6, 95% CI: 0.31-1.16, I2:81% and adults (OR: 0.83, 95% CI: 0.67-1.03, I2:25%. Six studies reported the incidences of SA in P. vivax infection and P. falciparum mono-infection; a comparable incidence of SA was found among infants (OR: 3.47, 95%:0.64-18.94, I2: 92%, the 5-15 year-age group (OR:0.71, 95% CI: 0.06-8.57, I2:82%. This was significantly lower in adults (OR:0.75, 95% CI: 0.62-0.92, I2:0%. Five studies (n = 71079 compared the mortality rate between vivax malaria and falciparum malaria. A lower rate of mortality was found in infants with vivax malaria (OR:0.61, 95% CI:0.5-0.76, I2:0%, while this was comparable in the 5-15 year- age group (OR: 0.43, 95% CI:0.06-2.91, I2:84% and the children of unspecified-age group (OR: 0.77, 95% CI:0.59-1.01, I2:0%.Overall, the present analysis identified that the incidence of SM in patients infected with P. vivax was considerable, indicating that P. vivax is a major cause of SM. Awareness of the clinical manifestations of vivax malaria should prompt

  6. Transcatheter arterial embolization for acute nonvariceal upper gastrointestinal bleeding: Indications, techniques and outcomes.

    Science.gov (United States)

    Loffroy, R; Favelier, S; Pottecher, P; Estivalet, L; Genson, P Y; Gehin, S; Cercueil, J P; Krausé, D

    2015-01-01

    Over the past three decades, transcatheter arterial embolization has become the first-line therapy for the management of acute nonvariceal upper gastrointestinal bleeding that is refractory to endoscopic hemostasis. Advances in catheter-based techniques and newer embolic agents, as well as recognition of the effectiveness of minimally invasive treatment options, have expanded the role of interventional radiology in the treatment of bleeding for a variety of indications. Transcatheter arterial embolization is a fast, safe, and effective minimally invasive alternative to surgery, when endoscopic treatment fails to control acute bleeding from the upper gastrointestinal tract. This article describes the role of arterial embolization in the management of acute nonvariceal upper gastrointestinal bleeding and summarizes the literature evidence on the outcomes of endovascular therapy in such a setting. Copyright © 2015 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.

  7. The current state of intestine transplantation: indications, techniques, outcomes and challenges.

    Science.gov (United States)

    Sudan, D

    2014-09-01

    Intestine transplantation is the least common form of organ transplantation in the United States and often deemed one of the most difficult. Patient and graft survival have historically trailed well behind other organ transplants. Over the past 5-10 years registry reports and single center series have demonstrated improvements to patient survival after intestinal transplantation that now match patient survival for those without life-threatening complications on parenteral nutrition. For various reasons including improvements in medical care of patients with intestinal failure and difficulty accessing transplant care, the actual number of intestine transplants has declined by 25% over the past 6 years. In light of the small numbers of intestine transplants, many physicians and the lay public are often unaware that this is a therapeutic option. The aim of this review is to describe the current indications, outcomes and advances in the field of intestine transplantation and to explore concerns over future access to this important and life-saving therapy.

  8. Indications for Cardiopulmonary Bypass During Pregnancy and Impact on Fetal Outcomes

    Science.gov (United States)

    Yuan, S.-M.

    2014-01-01

    Background: Cardiac operations in pregnant patients are a challenge for physicians in multidisciplinary teams due to the complexity of the condition which affects both mother and baby. Management strategies vary on a case-by-case basis. Feto-neonatal and maternal outcomes after cardiopulmonary bypass (CPB) in pregnancy, especially long-term follow-up results, have not been sufficiently described. Methods: This review was based on a complete literature retrieval of articles published between 1991 and April 30, 2013. Results: Indications for CPB during pregnancy were cardiac surgery in 150 (96.8 %) patients, most of which consisted of valve replacements for mitral and/or aortic valve disorders, resuscitation due to amniotic fluid embolism, autotransfusion, and circulatory support during cesarean section to improve patient survival in 5 (3.2 %) patients. During CPB, fetuses showed either a brief heart rate drop with natural recovery after surgery or, in most cases, fetal heart rate remained normal throughout the whole course of CPB. Overall feto-neonatal mortality was 18.6 %. In comparison with pregnant patients whose baby survived, feto-neonatal death occurred after a significantly shorter gestational period at the time of onset of cardiac symptoms, cardiac surgery/resuscitation under CPB in the whole patient setting, or cardiac surgery/resuscitation with CPB prior to delivery. Conclusions: The most common surgical indications for CPB during pregnancy were cardiac surgery, followed by resuscitation for cardiopulmonary collapse. CPB was used most frequently in maternal cardiac surgery/resuscitation in the second trimester. Improved CPB conditions including high flow, high pressure and normothermia or mild hypothermia during pregnancy have benefited maternal and feto-neonatal outcomes. A shorter gestational period and the use of CPB during pregnancy were closely associated with feto-neonatal mortality. It is therefore important to attempt delivery ahead of

  9. Antibody responses to a panel of Plasmodium falciparum malaria blood-stage antigens in relation to clinical disease outcome in Sudan

    DEFF Research Database (Denmark)

    Iriemenam, Nnaemeka C; Khirelsied, Atif H; Nasr, Amre

    2009-01-01

    Despite many intervention programmes aimed at curtailing the scourge, malaria remains a formidable problem of human health. Immunity to asexual blood-stage of Plasmodium falciparum malaria is thought to be associated with protective antibodies of certain immunoglobulin classes and subclasses. We...

  10. Malaria has no effect on birth weight in Rwanda

    NARCIS (Netherlands)

    Rulisa, S.; Mens, P.F.; Karema, C.; Schallig, H.D.F.H.; Kaligirwa, N.; Vyankandondera, J.; de Vries, P.J.

    2009-01-01

    Background: Malaria has a negative effect on pregnancy outcome, causing low birth weight, premature birth and stillbirths, particularly in areas with high malaria transmission. In Rwanda, malaria transmission intensity ranges from high to nil, probably associated with variable altitudes. Overall, th

  11. Malaria has no effect on birth weight in Rwanda

    NARCIS (Netherlands)

    Rulisa, S.; Mens, P.F.; Karema, C.; Schallig, H.D.F.H.; Kaligirwa, N.; Vyankandondera, J.; de Vries, P.J.

    2009-01-01

    Background: Malaria has a negative effect on pregnancy outcome, causing low birth weight, premature birth and stillbirths, particularly in areas with high malaria transmission. In Rwanda, malaria transmission intensity ranges from high to nil, probably associated with variable altitudes. Overall, th

  12. Development of quality indicators for monitoring outcomes of frail elderly hospitalised in acute care health settings: Study Protocol

    OpenAIRE

    Travers Catherine M; Morris John N; Jones Richard N; Wright Olivia; Martin-Khan Melinda; Brand Caroline A; Tropea Joannne; Gray Leonard C

    2011-01-01

    Abstract Background Frail older people admitted to acute care hospitals are at risk of a range of adverse outcomes, including geriatric syndromes, although targeted care strategies can improve health outcomes for these patients. It is therefore important to assess inter-hospital variation in performance in order to plan and resource improvement programs. Clinical quality outcome indicators provide a mechanism for identifying variation in performance over time and between hospitals, however to...

  13. Combining indoor residual spraying and insecticide-treated nets for malaria control in Africa: a review of possible outcomes and an outline of suggestions for the future

    Directory of Open Access Journals (Sweden)

    Okumu Fredros O

    2011-07-01

    Full Text Available Abstract Insecticide-treated nets (ITNs and indoor residual spraying (IRS are currently the preferred methods of malaria vector control. In many cases, these methods are used together in the same households, especially to suppress transmission in holoendemic and hyperendemic scenarios. Though widespread, there has been limited evidence suggesting that such co-application confers greater protective benefits than either ITNs or IRS when used alone. Since both methods are insecticide-based and intradomicilliary, this article hypothesises that outcomes of their combination would depend on effects of the candidate active ingredients on mosquitoes that enter or those that attempt to enter houses. It is suggested here that enhanced household level protection can be achieved if the ITNs and IRS have divergent yet complementary properties, e.g. highly deterrent IRS compounds coupled with highly toxic ITNs. To ensure that the problem of insecticide resistance is avoided, the ITNs and IRS products should preferably be of different insecticide classes, e.g. pyrethroid-based nets combined with organophosphate or carbamate based IRS. The overall community benefits would however depend also on other factors such as proportion of people covered by the interventions and the behaviour of vector species. This article concludes by emphasizing the need for basic and operational research, including mathematical modelling to evaluate IRS/ITN combinations in comparison to IRS alone or ITNs alone.

  14. High-Throughput Testing of Antibody-Dependent Binding Inhibition of Placental Malaria Parasites

    DEFF Research Database (Denmark)

    Nielsen, Morten A; Salanti, Ali

    2015-01-01

    The particular virulence of Plasmodium falciparum manifests in diverse severe malaria syndromes as cerebral malaria, severe anemia and placental malaria. The cause of both the severity and the diversity of infection outcome, is the ability of the infected erythrocyte (IE) to bind a range......-throughput assay used in the preclinical and clinical development of a VAR2CSA based vaccine against placental malaria....

  15. Potential impact of host immunity on malaria treatment outcome in Tanzanian children infected with Plasmodium falciparum

    DEFF Research Database (Denmark)

    Enevold, Anders; Nkya, Watoky M M M; Theisen, Michael

    2007-01-01

    -resistance as well as human sickle cell trait and alpha-thalassaemia were determined using PCR and sequence-specific oligonucleotide probes and enzyme-linked immunosorbent assay (SSOP-ELISA), and IgG antibody responses to a panel of P. falciparum antigens were assessed and related to treatment outcome. RESULTS...

  16. How to define successful transition? An exploration of consensus indicators and outcomes in young adults with chronic conditions

    NARCIS (Netherlands)

    Sattoe, J.N.T.; Hilberink, S.R.; Staa, A.L. van

    2017-01-01

    Abstract - In this short report, we use data from a previous cohort study to explore the relationship between five out of eight consensus indicators for successful transition and patient-reported outcomes in young adulthood.

  17. Colorectal stenting for colonic obstruction: The indications, complications, effectiveness and outcome-5-Year review

    Energy Technology Data Exchange (ETDEWEB)

    Athreya, S. [Department of Radiology, Gartnavel General Hospital, Great Western Road, Glasgow (United Kingdom)]. E-mail: harshavbs@yahoo.com; Moss, J. [Department of Radiology, Gartnavel General Hospital, Great Western Road, Glasgow (United Kingdom)]. E-mail: j.moss@clinmed.gla.ac.uk; Urquhart, G. [Department of Radiology, Southern General Hospital, Glasgow (United Kingdom); Edwards, R. [Department of Radiology, Gartnavel General Hospital, Great Western Road, Glasgow (United Kingdom); Downie, A. [Department of Radiology, Victoria Infirmary, Glasgow (United Kingdom); Poon, F.W. [Department of Radiology, Royal Infirmary, Glasgow (United Kingdom)

    2006-10-15

    Introduction: Currently self-expanding metallic stents are being used for palliation and acute decompression of colonic obstruction. The aim of this study is to review our experience of using these metallic stents over a 5-year period. Materials and methods: Case records of 102 patients who had colorectal stenting between 1998 and 2004 were reviewed retrospectively. The indications for colorectal stenting, efficacy of the procedure in relieving the obstruction, complications and clinical outcome were analysed. Results: Ninety-nine patients had malignant disease and in three patients a benign cause of obstruction was demonstrated. All procedures were performed during normal working hours. Stenting was technically successful in 87 patients (85%). A single stent was placed in 80 patients. Seven patients required two stents. Of the successful cases, 67 had stents placed by fluoroscopy alone and 20 by a combined fluoroscopy/endoscopy procedure. Four percent had early complications (within 30 days) which included four perforations. There were late complications (over 30 days) in 9% which included five stent migrations, two blocked stents and one colovesical fistula. Ninety percent (n = 76) of the successful patients needed no further radiological or surgical intervention later. Survival ranged from 14 days to 2 years. Conclusion: Colorectal stenting when technically successful is an effective procedure for both preoperative and palliative decompression of colonic obstruction.

  18. Indications and outcome of subtotal petrosectomy for active middle ear implants.

    Science.gov (United States)

    Verhaert, Nicolas; Mojallal, Hamidreza; Schwab, Burkard

    2013-03-01

    The aim of this study was to describe the outcome and possible complications of subtotal petrosectomy (SP) for Vibrant Soundbridge (VSB) device surgery in a tertiary referral center. A secondary objective was the evaluation of hearing results in a subgroup of subjects who received the VSB device. Between 2009 and early 2011, 22 adult subjects with chronic otitis media (COM) underwent a SP, blind sac closure of the external auditory canal and abdominal fat obliteration to facilitate the application of an active middle ear implant (AMEI) in a staged procedure. Indications consisted of mixed hearing loss after previous tympanomastoplasty and failure of hearing rehabilitation with a hearing aid or bone conduction device in COM. Pre- and postoperative pure-tone audiograms were analyzed in respect to deterioration of inner ear function, unaided and aided (hearing aid, bone-anchored hearing aid and VSB) speech audiograms were compared to verify improvements in communications skills and functional gains. Incidence and type of complications were reviewed. No significant change was observed regarding mean bone conduction thresholds after the first stage procedure. Some minor wound healing problems were noted. Speech perception using the VSB (n = 16) showed a mean aided speech discrimination at 65-dB SPL of 75 % [standard deviation (SD) 28.7], at 80-dB SPL of 90 % (SD 25.1). Our results suggest that for selected patients with open mastoid cavities and chronic middle ear disease, SP with abdominal fat obliteration is an effective and safe technique to facilitate safe AMEI placement.

  19. An open source business model for malaria.

    Science.gov (United States)

    Årdal, Christine; Røttingen, John-Arne

    2015-01-01

    Greater investment is required in developing new drugs and vaccines against malaria in order to eradicate malaria. These precious funds must be carefully managed to achieve the greatest impact. We evaluate existing efforts to discover and develop new drugs and vaccines for malaria to determine how best malaria R&D can benefit from an enhanced open source approach and how such a business model may operate. We assess research articles, patents, clinical trials and conducted a smaller survey among malaria researchers. Our results demonstrate that the public and philanthropic sectors are financing and performing the majority of malaria drug/vaccine discovery and development, but are then restricting access through patents, 'closed' publications and hidden away physical specimens. This makes little sense since it is also the public and philanthropic sector that purchases the drugs and vaccines. We recommend that a more "open source" approach is taken by making the entire value chain more efficient through greater transparency which may lead to more extensive collaborations. This can, for example, be achieved by empowering an existing organization like the Medicines for Malaria Venture (MMV) to act as a clearing house for malaria-related data. The malaria researchers that we surveyed indicated that they would utilize such registry data to increase collaboration. Finally, we question the utility of publicly or philanthropically funded patents for malaria medicines, where little to no profits are available. Malaria R&D benefits from a publicly and philanthropically funded architecture, which starts with academic research institutions, product development partnerships, commercialization assistance through UNITAID and finally procurement through mechanisms like The Global Fund to Fight AIDS, Tuberculosis and Malaria and the U.S.' President's Malaria Initiative. We believe that a fresh look should be taken at the cost/benefit of patents particularly related to new malaria

  20. An open source business model for malaria.

    Directory of Open Access Journals (Sweden)

    Christine Årdal

    Full Text Available Greater investment is required in developing new drugs and vaccines against malaria in order to eradicate malaria. These precious funds must be carefully managed to achieve the greatest impact. We evaluate existing efforts to discover and develop new drugs and vaccines for malaria to determine how best malaria R&D can benefit from an enhanced open source approach and how such a business model may operate. We assess research articles, patents, clinical trials and conducted a smaller survey among malaria researchers. Our results demonstrate that the public and philanthropic sectors are financing and performing the majority of malaria drug/vaccine discovery and development, but are then restricting access through patents, 'closed' publications and hidden away physical specimens. This makes little sense since it is also the public and philanthropic sector that purchases the drugs and vaccines. We recommend that a more "open source" approach is taken by making the entire value chain more efficient through greater transparency which may lead to more extensive collaborations. This can, for example, be achieved by empowering an existing organization like the Medicines for Malaria Venture (MMV to act as a clearing house for malaria-related data. The malaria researchers that we surveyed indicated that they would utilize such registry data to increase collaboration. Finally, we question the utility of publicly or philanthropically funded patents for malaria medicines, where little to no profits are available. Malaria R&D benefits from a publicly and philanthropically funded architecture, which starts with academic research institutions, product development partnerships, commercialization assistance through UNITAID and finally procurement through mechanisms like The Global Fund to Fight AIDS, Tuberculosis and Malaria and the U.S.' President's Malaria Initiative. We believe that a fresh look should be taken at the cost/benefit of patents particularly related

  1. Segmental Maxillary Osteotomies in Conjunction With Bimaxillary Orthognathic Surgery: Indications - Safety - Outcome.

    Science.gov (United States)

    Posnick, Jeffrey C; Adachie, Anayo; Choi, Elbert

    2016-07-01

    The purpose of the present study was to evaluate the indications, safety, and treating orthodontists' assessment of outcomes after bimaxillary orthognathic surgery that included segmental osteotomies. We performed a retrospective cohort study of patients treated by a single surgeon from 2004 to 2013. The index group consisted of a consecutive series of subjects with a bimaxillary dentofacial deformity (DFD) involving the chin and symptomatic chronic obstructive nasal breathing. All the subjects underwent Le Fort I osteotomy, bilateral sagittal ramus osteotomy, septoplasty, inferior turbinate reduction, and osseous genioplasty. The predictor variables included age, gender, pattern of presenting DFD, type of maxillary osteotomy, and maxillary premolar extractions. The outcome variables included orthodontist assessment of the results achieved and the occurrence of maxillary complications. The orthodontist assessment was documented through a survey questionnaire completed 1 to 11 years after surgery. The maxillary complications studied included gingival recession, pulpal injury, oronasal fistula, and the need for hardware removal. During the study period, 262 subjects met the inclusion criteria. Their age at surgery averaged 25 years (range 13 to 63), and 134 were female (51%). The major patterns of the presenting DFD included long face (30%) and maxillary deficiency (25%). Of the 262 subjects, 66 (25%) underwent maxillary premolar extractions to relieve dental compensations. Also, 30% of the subjects presented for preoperative reassessment with a posterior arch form of skeletal anomaly. They underwent 2-segment Le Fort I osteotomy, and 34% presented with both posterior arch form and curve of Spee skeletal anomalies. They underwent 3-segment Le Fort I osteotomy. The subjects who had not undergone preoperative maxillary premolar extractions were more likely to have undergone 3-segment Le Fort I osteotomy (P = .008). No direct surgical injury occurred to a dental root

  2. Effect of meteorological variables on Plasmodium vivax and Plasmodium falciparum malaria in outbreak prone districts of Rajasthan, India.

    Science.gov (United States)

    Lingala, Mercy A L

    2017-03-09

    Malaria is a public health problem caused by Plasmodium parasite and transmitted by anopheline mosquitoes. Arid and semi-arid regions of western India are prone to malaria outbreaks. Malaria outbreak prone districts viz. Bikaner, Barmer and Jodhpur were selected to study the effect of meteorological variables on Plasmodium vivax and Plasmodium falciparum malaria outbreaks for the period of 2009-2012. The data of monthly malaria cases and meteorological variables was analysed using SPSS 20v. Spearman correlation analysis was conducted to examine the strength of the relationship between meteorological variables, P. vivax and P. falciparum malaria cases. Pearson's correlation analysis was carried out among the meteorological variables to observe the independent effect of each independent variable on the outcome. Results indicate that malaria outbreaks have occurred in Bikaner and Barmer due to continuous rains for more than two months. Rainfall has shown to be an important predictor of malaria outbreaks in Rajasthan. P. vivax is more significantly correlated with rainfall, minimum temperature (P<0.01) and less significantly with relative humidity (P<0.05); whereas P. falciparum is significantly correlated with rainfall, relative humidity (P<0.01) and less significantly with temperature (P<0.05). The determination of the lag period for P. vivax is relative humidity and for P. falciparum is temperature. The lag period between malaria cases and rainfall is shorter for P. vivax than P. falciparum. In conclusion, the knowledge generated is not only useful to take prompt malaria control interventions but also helpful to develop better forecasting model in outbreak prone regions. Copyright © 2017 The Author. Published by Elsevier Ltd.. All rights reserved.

  3. The Effect of Indoor Residual Spraying on the Prevalence of Malaria Parasite Infection, Clinical Malaria and Anemia in an Area of Perennial Transmission and Moderate Coverage of Insecticide Treated Nets in Western Kenya.

    Science.gov (United States)

    Gimnig, John E; Otieno, Peter; Were, Vincent; Marwanga, Doris; Abong'o, Daisy; Wiegand, Ryan; Williamson, John; Wolkon, Adam; Zhou, Ying; Bayoh, M Nabie; Lobo, Neil F; Laserson, Kayla; Kariuki, Simon; Hamel, Mary J

    2016-01-01

    Insecticide treated nets (ITNs) and indoor residual spraying (IRS) have been scaled up for malaria prevention in sub-Saharan Africa. However, there are few studies on the benefit of implementing IRS in areas with moderate to high coverage of ITNs. We evaluated the impact of an IRS program on malaria related outcomes in western Kenya, an area of intense perennial malaria transmission and moderate ITN coverage (55-65% use of any net the previous night). The Kenya Division of Malaria Control, with support from the US President's Malaria Initiative, conducted IRS in one lowland endemic district with moderate coverage of ITNs. Surveys were conducted in the IRS district and a neighboring district before IRS, after one round of IRS in July-Sept 2008 and after a second round of IRS in April-May 2009. IRS was conducted with pyrethroid insecticides. At each survey, 30 clusters were selected for sampling and within each cluster, 12 compounds were randomly selected. The primary outcomes measured in all residents of selected compounds included malaria parasitemia, clinical malaria (P. falciparum infection plus history of fever) and anemia (Hbmalaria parasitemia, clinical malaria or anemia. After two rounds of IRS, the prevalence of malaria parasitemia was 6.4% in the IRS district compared to 16.7% in the comparison district (OR = 0.36, 95% CI = 0.22-0.59, pmalaria was also lower in the IRS district (1.8% vs. 4.9%, OR = 0.37, 95% CI = 0.20-0.68, p = 0.001). The prevalence of anemia was lower in the IRS district but only in children under 5 years of age (2.8% vs. 9.3%, OR = 0.30, 95% CI = 0.13-0.71, p = 0.006). Multivariate models incorporating both IRS and ITNs indicated that both had an impact on malaria parasitemia and clinical malaria but the independent effect of ITNs was reduced in the district that had received two rounds of IRS. There was no statistically significant independent effect of ITNs on the prevalence of anemia in any age group. Both IRS and ITNs are effective

  4. Heritability of malaria in Africa.

    Directory of Open Access Journals (Sweden)

    Margaret J Mackinnon

    2005-12-01

    Full Text Available While many individual genes have been identified that confer protection against malaria, the overall impact of host genetics on malarial risk remains unknown.We have used pedigree-based genetic variance component analysis to determine the relative contributions of genetic and other factors to the variability in incidence of malaria and other infectious diseases in two cohorts of children living on the coast of Kenya. In the first, we monitored the incidence of mild clinical malaria and other febrile diseases through active surveillance of 640 children 10 y old or younger, living in 77 different households for an average of 2.7 y. In the second, we recorded hospital admissions with malaria and other infectious diseases in a birth cohort of 2,914 children for an average of 4.1 y. Mean annual incidence rates for mild and hospital-admitted malaria were 1.6 and 0.054 episodes per person per year, respectively. Twenty-four percent and 25% of the total variation in these outcomes was explained by additively acting host genes, and household explained a further 29% and 14%, respectively. The haemoglobin S gene explained only 2% of the total variation. For nonmalarial infections, additive genetics explained 39% and 13% of the variability in fevers and hospital-admitted infections, while household explained a further 9% and 30%, respectively.Genetic and unidentified household factors each accounted for around one quarter of the total variability in malaria incidence in our study population. The genetic effect was well beyond that explained by the anticipated effects of the haemoglobinopathies alone, suggesting the existence of many protective genes, each individually resulting in small population effects. While studying these genes may well provide insights into pathogenesis and resistance in human malaria, identifying and tackling the household effects must be the more efficient route to reducing the burden of disease in malaria-endemic areas.

  5. Heritability of Malaria in Africa.

    Directory of Open Access Journals (Sweden)

    2005-11-01

    Full Text Available BACKGROUND: While many individual genes have been identified that confer protection against malaria, the overall impact of host genetics on malarial risk remains unknown. METHODS AND FINDINGS: We have used pedigree-based genetic variance component analysis to determine the relative contributions of genetic and other factors to the variability in incidence of malaria and other infectious diseases in two cohorts of children living on the coast of Kenya. In the first, we monitored the incidence of mild clinical malaria and other febrile diseases through active surveillance of 640 children 10 y old or younger, living in 77 different households for an average of 2.7 y. In the second, we recorded hospital admissions with malaria and other infectious diseases in a birth cohort of 2,914 children for an average of 4.1 y. Mean annual incidence rates for mild and hospital-admitted malaria were 1.6 and 0.054 episodes per person per year, respectively. Twenty-four percent and 25% of the total variation in these outcomes was explained by additively acting host genes, and household explained a further 29% and 14%, respectively. The haemoglobin S gene explained only 2% of the total variation. For nonmalarial infections, additive genetics explained 39% and 13% of the variability in fevers and hospital-admitted infections, while household explained a further 9% and 30%, respectively. CONCLUSION: Genetic and unidentified household factors each accounted for around one quarter of the total variability in malaria incidence in our study population. The genetic effect was well beyond that explained by the anticipated effects of the haemoglobinopathies alone, suggesting the existence of many protective genes, each individually resulting in small population effects. While studying these genes may well provide insights into pathogenesis and resistance in human malaria, identifying and tackling the household effects must be the more efficient route to reducing the burden

  6. falciparum malaria?

    African Journals Online (AJOL)

    Wassermann reactions and then lupus anticoagu- lant are now known ... ACA levels in the patient group, or between the ... bral malaria could lead to more effective therapy and an improved ... each patient and a physical examination performed. Particular .... a thrombotic subset of SLE: distinct profiles for epitope specificiry.

  7. Kompliceret malaria

    DEFF Research Database (Denmark)

    Rønn, A M; Bygbjerg, Ib Christian; Jacobsen, E

    1989-01-01

    An increasing number of cases of malaria, imported to Denmark, are caused by Plasmodium falciparum and severe and complicated cases are more often seen. In the Department of Infectious Diseases, Rigshospitalet, 23 out of 32 cases, hospitalized from 1.1-30.6.1988, i.e. 72%, were caused by P...

  8. Smoking outcome expectancies: A multiple indicator and multiple cause (MIMIC) model.

    Science.gov (United States)

    Urbán, Róbert; Demetrovics, Zsolt

    2010-06-01

    The present study was carried out to assess the construct validity of the short form of the Smoking Consequences Questionnaire, a brief measure of smoking outcome expectancies on a large sample of adolescents (N = 953). The results of this study support a four-factor structure of smoking outcome expectancies, including expectancies of negative consequences, positive reinforcement, negative reinforcement and appetite-weight control, as well as the assertion that gender, smoking status and sensation-seeking have a distinct pattern of associations with the four outcome expectancy factors.

  9. Indications and Outcomes of Prophylactic and Therapeutic Extracranial-to-intracranial Arterial Bypass for Cerebral Revascularization

    Directory of Open Access Journals (Sweden)

    Emre Gazyakan, MD, MSc

    2015-04-01

    Conclusions: The collaboration of neurosurgeons and plastic surgeons in performing EC-IC bypass can result in excellent outcomes with a high bypass patency rate and few complications, particularly for prophylactic EC-IC bypass.

  10. Identification of appropriate outcome indices in head and neck cancer and factors influencing them.

    Science.gov (United States)

    Tighe, D; Kwok, A; Putcha, V; McGurk, M

    2014-09-01

    Audit of early postoperative outcomes adjusted for patient case mix is still in its infancy in head and neck surgery. Nevertheless the role for audit of early postoperative outcomes is obvious. The primary outcome measure of this study was to identify factors that are associated with early mortality or morbidity after surgery for head and neck squamous cell carcinoma (HNSCC). The secondary outcome measure was to develop a pilot score that allows for risk-adjustment of outcome data to facilitate departmental audit. In this series the mortality rate was low (2.8%), in keeping with other published series. Complications, including those causing death, occurred after 38.1% of operations. Independent risk factors for mortality on logistic regression were shown to be previous HNSCC (P=0.03), estimated blood loss (l) (P=0.03), and extracapsular spread (P=0.05). Age (P=0.01), tracheostomy (Prisk demonstrated good discrimination (area under the curve statistics) for mortality (0.86) and morbidity (0.81). These pilot scores need external validation and may herald a means of facilitating risk-adjustment in the audit of early outcomes, allowing meaningful comparison of surgeons and their units over time.

  11. Malaria ecology and climate change

    Science.gov (United States)

    McCord, G. C.

    2016-05-01

    Understanding the costs that climate change will exact on society is crucial to devising an appropriate policy response. One of the channels through while climate change will affect human society is through vector-borne diseases whose epidemiology is conditioned by ambient ecology. This paper introduces the literature on malaria, its cost on society, and the consequences of climate change to the physics community in hopes of inspiring synergistic research in the area of climate change and health. It then demonstrates the use of one ecological indicator of malaria suitability to provide an order-of-magnitude assessment of how climate change might affect the malaria burden. The average of Global Circulation Model end-of-century predictions implies a 47% average increase in the basic reproduction number of the disease in today's malarious areas, significantly complicating malaria elimination efforts.

  12. Lymphocyte Perturbations in Malawian Children with Severe and Uncomplicated Malaria.

    Science.gov (United States)

    Mandala, Wilson L; Msefula, Chisomo L; Gondwe, Esther N; Gilchrist, James J; Graham, Stephen M; Pensulo, Paul; Mwimaniwa, Grace; Banda, Meraby; Taylor, Terrie E; Molyneux, Elizabeth E; Drayson, Mark T; Ward, Steven A; Molyneux, Malcolm E; MacLennan, Calman A

    2015-11-18

    Lymphocytes are implicated in immunity and pathogenesis of severe malaria. Since lymphocyte subsets vary with age, assessment of their contribution to different etiologies can be difficult. We immunophenotyped peripheral blood from Malawian children presenting with cerebral malaria, severe malarial anemia, and uncomplicated malaria (n = 113) and healthy aparasitemic children (n = 42) in Blantyre, Malawi, and investigated lymphocyte subset counts, activation, and memory status. Children with cerebral malaria were older than those with severe malarial anemia. We found panlymphopenia in children presenting with cerebral malaria (median lymphocyte count, 2,100/μl) and uncomplicated malaria (3,700/μl), which was corrected in convalescence and was absent in severe malarial anemia (5,950/μl). Median percentages of activated CD69(+) NK (73%) and γδ T (60%) cells were higher in cerebral malaria than in other malaria types. Median ratios of memory to naive CD4(+) lymphocytes were higher in cerebral malaria than in uncomplicated malaria and low in severe malarial anemia. The polarized lymphocyte subset profiles of different forms of severe malaria are independent of age. In conclusion, among Malawian children cerebral malaria is characterized by lymphocyte activation and increased memory cells, consistent with immune priming. In contrast, there are reduced memory cells and less activation in severe malaria anemia. Further studies are required to understand whether these immunological profiles indicate predisposition of some children to one or another form of severe malaria. Copyright © 2016 Mandala et al.

  13. Eliminating malaria in Malaysia: the role of partnerships between the public and commercial sectors in Sabah

    Science.gov (United States)

    2014-01-01

    Background Countries in the Asia Pacific region have made great progress in the fight against malaria; several are rapidly approaching elimination. However, malaria control programmes operating in elimination settings face substantial challenges, particularly around mobile migrant populations, access to remote areas and the diversity of vectors with varying biting and breeding behaviours. These challenges can be addressed through subnational collaborations with commercial partners, such as mining or plantation companies, that can conduct or support malaria control activities to cover employees. Such partnerships can be a useful tool for accessing high-risk populations and supporting malaria elimination goals. Methods This observational qualitative case study employed semi-structured key informant interviews to describe partnerships between the Malaysian Malaria Control Programme (MCP), and private palm oil, rubber and acacia plantations in the state of Sabah. Semi-structured interview guides were used to examine resource commitments, incentives, challenges, and successes of the collaborations. Results Interviews with workers from private plantations and the state of Sabah MCP indicated that partnerships with the commercial sector had contributed to decreases in incidence at plantation sites since 1991. Several plantations contribute financial and human resources toward malaria control efforts and all plantations frequently communicate with the MCP to help monitor the malaria situation on-site. Management of partnerships between private corporations and government entities can be challenging, as prioritization of malaria control may change with annual profits or arrival of new management. Conclusions Partnering with the commercial sector has been an essential operational strategy to support malaria elimination in Sabah. The successes of these partnerships rely on a common understanding that elimination will be a mutually beneficial outcome for employers and the

  14. Eliminating malaria in Malaysia: the role of partnerships between the public and commercial sectors in Sabah.

    Science.gov (United States)

    Sanders, Kelly C; Rundi, Christina; Jelip, Jenarun; Rashman, Yusof; Smith Gueye, Cara; Gosling, Roly D

    2014-01-21

    Countries in the Asia Pacific region have made great progress in the fight against malaria; several are rapidly approaching elimination. However, malaria control programmes operating in elimination settings face substantial challenges, particularly around mobile migrant populations, access to remote areas and the diversity of vectors with varying biting and breeding behaviours. These challenges can be addressed through subnational collaborations with commercial partners, such as mining or plantation companies, that can conduct or support malaria control activities to cover employees. Such partnerships can be a useful tool for accessing high-risk populations and supporting malaria elimination goals. This observational qualitative case study employed semi-structured key informant interviews to describe partnerships between the Malaysian Malaria Control Programme (MCP), and private palm oil, rubber and acacia plantations in the state of Sabah. Semi-structured interview guides were used to examine resource commitments, incentives, challenges, and successes of the collaborations. Interviews with workers from private plantations and the state of Sabah MCP indicated that partnerships with the commercial sector had contributed to decreases in incidence at plantation sites since 1991. Several plantations contribute financial and human resources toward malaria control efforts and all plantations frequently communicate with the MCP to help monitor the malaria situation on-site. Management of partnerships between private corporations and government entities can be challenging, as prioritization of malaria control may change with annual profits or arrival of new management. Partnering with the commercial sector has been an essential operational strategy to support malaria elimination in Sabah. The successes of these partnerships rely on a common understanding that elimination will be a mutually beneficial outcome for employers and the general public. Best practices included

  15. TERT promoter mutations are a major indicator of poor outcome in differentiated thyroid carcinomas.

    Science.gov (United States)

    Melo, Miguel; da Rocha, Adriana Gaspar; Vinagre, João; Batista, Rui; Peixoto, Joana; Tavares, Catarina; Celestino, Ricardo; Almeida, Ana; Salgado, Catarina; Eloy, Catarina; Castro, Patrícia; Prazeres, Hugo; Lima, Jorge; Amaro, Teresina; Lobo, Cláudia; Martins, Maria João; Moura, Margarida; Cavaco, Branca; Leite, Valeriano; Cameselle-Teijeiro, José Manuel; Carrilho, Francisco; Carvalheiro, Manuela; Máximo, Valdemar; Sobrinho-Simões, Manuel; Soares, Paula

    2014-05-01

    Telomerase promoter mutations (TERT) were recently described in follicular cell-derived thyroid carcinomas (FCDTC) and seem to be more prevalent in aggressive cancers. We aimed to evaluate the frequency of TERT promoter mutations in thyroid lesions and to investigate the prognostic significance of such mutations in a large cohort of patients with differentiated thyroid carcinomas (DTCs). This was a retrospective observational study. We studied 647 tumors and tumor-like lesions. A total of 469 patients with FCDTC treated and followed in five university hospitals were included. Mean follow-up (±SD) was 7.8 ± 5.8 years. Predictive value of TERT promoter mutations for distant metastasization, disease persistence at the end of follow-up, and disease-specific mortality. TERT promoter mutations were found in 7.5% of papillary carcinomas (PTCs), 17.1% of follicular carcinomas, 29.0% of poorly differentiated carcinomas, and 33.3% of anaplastic thyroid carcinomas. Patients with TERT-mutated tumors were older (P < .001) and had larger tumors (P = .002). In DTCs, TERT promoter mutations were significantly associated with distant metastases (P < .001) and higher stage (P < .001). Patients with DTC harboring TERT promoter mutations were submitted to more radioiodine treatments (P = .009) with higher cumulative dose (P = .004) and to more treatment modalities (P = .001). At the end of follow-up, patients with TERT-mutated DTCs were more prone to have persistent disease (P = .001). TERT promoter mutations were significantly associated with disease-specific mortality [in the whole FCDTC (P < .001)] in DTCs (P < .001), PTCs (P = .001), and follicular carcinomas (P < .001). After adjusting for age at diagnosis and gender, the hazard ratio was 10.35 (95% confidence interval 2.01-53.24; P = .005) in DTC and 23.81 (95% confidence interval 1.36-415.76; P = .03) in PTCs. TERT promoter mutations are an indicator of clinically aggressive tumors, being correlated with worse outcome and

  16. The complexities of malaria disease manifestations with a focus on asymptomatic malaria

    Science.gov (United States)

    2012-01-01

    Malaria is a serious parasitic disease in the developing world, causing high morbidity and mortality. The pathogenesis of malaria is complex, and the clinical presentation of disease ranges from severe and complicated, to mild and uncomplicated, to asymptomatic malaria. Despite a wealth of studies on the clinical severity of disease, asymptomatic malaria infections are still poorly understood. Asymptomatic malaria remains a challenge for malaria control programs as it significantly influences transmission dynamics. A thorough understanding of the interaction between hosts and parasites in the development of different clinical outcomes is required. In this review, the problems and obstacles to the study and control of asymptomatic malaria are discussed. The human and parasite factors associated with differential clinical outcomes are described and the management and treatment strategies for the control of the disease are outlined. Further, the crucial gaps in the knowledge of asymptomatic malaria that should be the focus of future research towards development of more effective malaria control strategies are highlighted. PMID:22289302

  17. Association between early childhood exposure to malaria and children’s pre-school development: evidence from the Zambia early childhood development project

    Directory of Open Access Journals (Sweden)

    Fink Günther

    2013-01-01

    Full Text Available Abstract Background Despite major progress made over the past 10 years, malaria remains one of the primary causes of ill health in developing countries in general, and in sub-Saharan Africa in particular. Whilst a large literature has documented the frequency and severity of malaria infections for children under-five years, relatively little evidence is available regarding the impact of early childhood malaria exposure on subsequent child development. Methods The objective of the study was to assess the associations between early childhood exposure to malaria and pre-school development. Child assessment data for 1,410 children in 70 clusters collected through the 2010 Zambian Early Childhood Development Project was linked with malaria parasite prevalence data from the 2006 Zambia Malaria Indicator Survey. Linear and logistic models were used to estimate the effect of early childhood exposure to malaria on anthropometric outcomes as well as on a range of cognitive and behavioural development measures. Results No statistically significant associations were found between parasite exposure and children’s height and weight. Exposure to the malaria parasite was, however, associated with lower ability to cope with cognitive tasks administered by interviewers (z-score difference −1.11, 95% CI −2.43–0.20, as well as decreased overall socio-emotional development as assessed by parents (z-score difference −1.55, 95% CI −3.13–0.02. No associations were found between malaria exposure and receptive vocabulary or fine-motor skills. Conclusions The results presented in this paper suggest potentially large developmental consequences of early childhood exposure to malaria. Continued efforts to lower the burden of malaria will not only reduce under-five mortality, but may also have positive returns in terms of the long-term well-being of exposed cohorts.

  18. Predictors of antidepressant treatment outcome in melancholia: psychosocial, clinical and biological indicators.

    Science.gov (United States)

    Vallejo, J; Gasto, C; Catalan, R; Bulbena, A; Menchon, J M

    1991-03-01

    Predictive variables of response to imipramine and to phenelzine at 6 weeks and 6 months were studied in 116 patients suffering from major depression with melancholia (DSM-III). Several sociodemographic, clinical, and biological variables were studied. For imipramine-treated patients, high social support predicted a better response at 6 weeks, while development of hypomania during follow-up was associated with a better response at 6 weeks; absence of life events during the 6-month follow-up and initial non-suppression of dexamethasone predicted a better outcome at 6 months. For phenelzine-treated patients, development of hypomania during follow-up was associated with a better outcome at 6 months and absence of life events prior to the onset of the episode was associated with a worse outcome at 6 months.

  19. Early Indicators of Later English Reading Comprehension Outcomes among Children from Spanish-Speaking Homes

    Science.gov (United States)

    Mancilla-Martinez, Jeannette; Lesaux, Nonie K.

    2017-01-01

    In this longitudinal study, we examined the relationship between primary grade (K-2) Spanish and English language- and word-based skills and later English reading comprehension (RC) outcomes (Grades 5 and 8) among children (n = 148) from immigrant, Spanish-speaking, low-income homes in English instructional contexts since kindergarten entry. As…

  20. Trauma as a Predictive Indicator of Clinical Outcome in Residential Treatment

    Science.gov (United States)

    Boyer, Susan N.; Hallion, Lauren S.; Hammell, Carrie L.; Button, Suzanne

    2009-01-01

    The present study was conducted to identify predictors of residential treatment outcome for youth. Data were collected and analyzed on multiple variables including each subject's psychiatric diagnoses, previous treatment attempts and success or failure in these respective settings, length of stay in prior treatment settings, past psychiatric…

  1. Actionable indicators for short and long term outcomes in rectal cancer

    NARCIS (Netherlands)

    Gort, Marjan; Otter, Renee; Plukker, John Th. M.; Broekhuis, Manda; Klazinga, Niek S.; Broekhuis, Manda

    Aim of the study: Although patient and tumour characteristics are the most important determinants for outcomes in rectal cancer care, actionable factors for improving these are still unclear. Therefore, the purpose of this study was to assess the impact of surgeon and hospital factors which can

  2. Symptomatic malaria diagnosis overestimate malaria prevalence, but underestimate anaemia burdens in children: results of a follow up study in Kenya.

    Science.gov (United States)

    Choge, Joseph K; Magak, Ng'wena G; Akhwale, Willis; Koech, Julius; Ngeiywa, Moses M; Oyoo-Okoth, Elijah; Esamai, Fabian; Osano, Odipo; Khayeka-Wandabwa, Christopher; Kweka, Eliningaya J

    2014-04-09

    The commonly accepted gold standard diagnostic method for detecting malaria is a microscopic reading of Giemsa-stained blood films. However, symptomatic diagnosis remains the basis of therapeutic care for the majority of febrile patients in malaria endemic areas. This study aims to compare the discrepancy in malaria and anaemia burdens between symptomatic diagnosed patients with those diagnosed through the laboratory. Data were collected from Western Kenya during a follow-up study of 887 children with suspected cases of malaria visiting the health facilities. In the laboratory, blood samples were analysed for malaria parasite and haemoglobin levels. Differences in malaria prevalence between symptomatic diagnosis and laboratory diagnosis were analysed by Chi-square test. Bayesian probabilities were used for the approximation of the malaria and anaemia burdens. Regression analysis was applied to: (1) determine the relationships between haemoglobin levels, and malaria parasite density and (2) relate the prevalence of anaemia and the prevalence of malaria. The prevalence of malaria and anaemia ranged from 10% to 34%, being highest during the rainy seasons. The predominant malaria parasite was P. falciparum (92.3%), which occurred in higher density in children aged 2‒5 years. Fever, high temperature, sweating, shivering, vomiting and severe headache symptoms were associated with malaria during presumptive diagnosis. After conducting laboratory diagnosis, lower malaria prevalence was reported among the presumptively diagnosed patients. Surprisingly, there were no attempts to detect anaemia in the same cohort. There was a significant negative correlation between Hb levels and parasite density. We also found a positive correlation between the prevalence of anaemia and the prevalence of malaria after laboratory diagnosis indicating possible co-occurrence of malaria and anaemia. Symptomatic diagnosis of malaria overestimates malaria prevalence, but underestimates the

  3. Procalcitonin serum levels in tertian malaria

    Directory of Open Access Journals (Sweden)

    Chiwakata Collins B

    2003-10-01

    Full Text Available Abstract Background Procalcitonin (PCT is closely correlated with parasite burden and clinical outcome in falciparum malaria. The role of PCT in tertian malaria has not previously been investigated. Patients and methods PCT serum levels in 37 patients with tertian malaria were analysed. Clinical and laboratory parameters were assessed and statistically correlated both to the initial PCT levels and during the course of the disease. Results PCT levels rose for one day after commencing treatment and declined thereafter. However, there was no significant correlation with parasite burden, clinical parameters, laboratory values, or the presence of semi-immunity. Before treatment, the majority of patients showed normal or slightly elevated PCT levels ( Conclusions There is a fundamental difference in the relationship of PCT with tertian malaria not seen in other infectious diseases in which elevated PCT levels have been observed. This suggests distinct pathophysiological pathways in malaria.

  4. Development of quality indicators for monitoring outcomes of frail elderly hospitalised in acute care health settings: Study Protocol

    Directory of Open Access Journals (Sweden)

    Travers Catherine M

    2011-10-01

    Full Text Available Abstract Background Frail older people admitted to acute care hospitals are at risk of a range of adverse outcomes, including geriatric syndromes, although targeted care strategies can improve health outcomes for these patients. It is therefore important to assess inter-hospital variation in performance in order to plan and resource improvement programs. Clinical quality outcome indicators provide a mechanism for identifying variation in performance over time and between hospitals, however to date there has been no routine use of such indicators in acute care settings. A barrier to using quality indicators is lack of access to routinely collected clinical data. The interRAI Acute Care (AC assessment system supports comprehensive geriatric assessment of older people within routine daily practice in hospital and includes process and outcome data pertaining to geriatric syndromes. This paper reports the study protocol for the development of aged care quality indicators for acute care hospitals. Methods/Design The study will be conducted in three phases: 1. Development of a preliminary inclusive set of quality indicators set based on a literature review and expert panel consultation, 2. A prospective field study including recruitment of 480 patients aged 70 years or older across 9 Australian hospitals. Each patient will be assessed on admission and discharge using the interRAI AC, and will undergo daily monitoring to observe outcomes. Medical records will be independently audited, and 3. Analysis and compilation of a definitive quality indicator set, including two anonymous voting rounds for quality indicator inclusion by the expert panel. Discussion The approach to quality indicators proposed in this protocol has four distinct advantages over previous efforts: the quality indicators focus on outcomes; they can be collected as part of a routinely applied clinical information and decision support system; the clinical data will be robust and will

  5. The usefulness of twenty-four molecular markers in predicting treatment outcome with combination therapy of amodiaquine plus sulphadoxine-pyrimethamine against falciparum malaria in Papua New Guinea

    Directory of Open Access Journals (Sweden)

    Reeder John C

    2008-04-01

    Full Text Available Abstract Background In Papua New Guinea (PNG, combination therapy with amodiaquine (AQ or chloroquine (CQ plus sulphadoxine-pyrimethamine (SP was introduced as first-line treatment against uncomplicated malaria in 2000. Methods We assessed in vivo treatment failure rates with AQ+SP in two different areas in PNG and twenty-four molecular drug resistance markers of Plasmodium falciparum were characterized in pre-treatment samples. The aim of the study was to investigate the association between infecting genotype and treatment response in order to identify useful predictors of treatment failure with AQ+SP. Results In 2004, Day-28 treatment failure rates for AQ+SP were 29% in the Karimui and 19% in the South Wosera area, respectively. The strongest independent predictors for treatment failure with AQ+SP were pfmdr1 N86Y (OR = 7.87, p pfdhps A437G (OR = 3.44, p pfcrt K76T, A220S, N326D, and I356L did not help to increase the predictive value, the most likely reason being that these mutations reached almost fixed levels. Though mutations in SP related markers pfdhfr S108N and C59R were not associated with treatment failure, they increased the predictive value of pfdhps A437G. The difference in treatment failure rate in the two sites was reflected in the corresponding genetic profile of the parasite populations, with significant differences seen in the allele frequencies of mutant pfmdr1 N86Y, pfmdr1 Y184F, pfcrt A220S, and pfdhps A437G. Conclusion The study provides evidence for high levels of resistance to the combination regimen of AQ+SP in PNG and indicates which of the many molecular markers analysed are useful for the monitoring of parasite resistance to combinations with AQ+SP.

  6. Treatment quality indicators predict short-term outcomes in patients with diabetes : a prospective cohort study using the GIANTT database

    NARCIS (Netherlands)

    Sidorenkov, Grigory; Voorham, Jaco; de Zeeuw, Dick; Haaijer-Ruskamp, Flora M.; Denig, Petra

    2013-01-01

    Objective To assess whether quality indicators for treatment of cardiovascular and renal risk factors are associated with short-term outcomes in patients with diabetes. Design A prospective cohort study using linear regression adjusting for confounders. Setting The GIANTT database (Groningen Initiat

  7. Percutaneous vertebroplasty for painful long-standing osteoporotic vertebral compression fractures : indication, clinical outcome, cement Leakage & classification

    NARCIS (Netherlands)

    Muijs, Sander Paul Jan

    2012-01-01

    This thesis focuses on indications for and the clinical outcome of PVP for the treatment of long-standing OVCFs (i.e. after more than 8 weeks after onset of symptoms). Secondly, emphasis is made on the value of vertebral body biopsy during the vertebroplasty procedure in order to aid in early diagno

  8. Missing paternal demographics: A novel indicator for identifying high risk population of adverse pregnancy outcomes

    Directory of Open Access Journals (Sweden)

    Wen Shi

    2004-11-01

    Full Text Available Abstract Background One of every 6 United Status birth certificates contains no information on fathers. There might be important differences in the pregnancy outcomes between mothers with versus those without partner information. The object of this study was to assess whether and to what extent outcomes in pregnant women who did not have partner information differ from those who had. Methods We carried out a population-based retrospective cohort study based on the registry data in the United States for the period of 1995–1997, which was a matched multiple birth file (only twins were included in the current analysis. We divided the study subjects into three groups according to the availability of partner information: available, partly missing, and totally missing. We compared the distribution of maternal characteristics, maternal morbidity, labor and delivery complications, obstetric interventions, preterm birth, fetal growth restriction, low birth weight, congenital anomalies, fetal death, neonatal death, post-neonatal death, and neonatal morbidity among three study groups. Results There were 304466 twins included in our study. Mothers whose partner's information was partly missing and (especially totally missing tended to be younger, of black race, unmarried, with less education, smoking cigarette during pregnancy, and with inadequate prenatal care. The rates of preterm birth, fetal growth restriction, low birth weight, Apgar score Conclusions Mothers whose partner's information was partly and (especially totally missing are at higher risk of adverse pregnant outcomes, and clinicians and public health workers should be alerted to this important social factor.

  9. Potential Serological Biomarkers of Cerebral Malaria

    Directory of Open Access Journals (Sweden)

    Naomi W. Lucchi

    2011-01-01

    Full Text Available Biomarkers have been used to diagnose and prognosticate the progress and outcome of many chronic diseases such as neoplastic and non communicable diseases. However, only recently did the field of malaria research move in the direction of actively identifying biomarkers that can accurately discriminate the severe forms of malaria. Malaria continues to be a deadly disease, killing close to a million people (mostly children every year. One life-threatening complication of malaria is cerebral malaria (CM. Studies carried out in Africa have demonstrated that even with the best treatment, as high as 15–30% of CM patients die and about 10–24% of CM survivors suffer short-or long-term neurological impairment. The transition from mild malaria to CM can be sudden and requires immediate intervention. Currently, there is no biological test available to confirm the diagnosis of CM and its complications. It is hoped that development of biomarkers to identify CM patients and potential risk for adverse outcomes would greatly enhance better intervention and clinical management to improve the outcomes. We review here what is currently known regarding biomarkers for CM outcomes.

  10. Surgical decompression of thoracic spinal stenosis in achondroplasia: indication and outcome.

    Science.gov (United States)

    Vleggeert-Lankamp, Carmen; Peul, Wilco

    2012-08-01

    The achondroplastic spinal canal is narrow due to short pedicles and a small interpedicular distance. Compression of neural structures passing through this canal is therefore regularly encountered but rarely described. Symptomatology, radiological evaluation, and treatment of 20 patients with achondroplasia who underwent decompression of the thoracic spinal cord are described and outcome is correlated with the size of the spinal canal and the thoracolumbar kyphotic angle. Scores from the modified Japanese Orthopaedic Association scale, Nurick scale, European Myelopathy scale, Cooper myelopathy scale for lower extremities, and Odom criteria before and after surgery were compared. Magnetic resonance imaging was evaluated to determine the size of the spinal canal, spinal cord compression, and presence of myelomalacia. The thoracolumbar kyphotic angle was measured using fluoroscopy. Patient symptomatology included deterioration of walking pattern, pain, cramps, spasms, and incontinence. Magnetic resonance images of all patients demonstrated spinal cord compression due to degenerative changes. Surgery resulted in a slight improvement on all the ranking scales. Surgery at the wrong level occurred in 15% of cases, but no serious complications occurred. The mean thoracolumbar kyphotic angle was 20°, and no correlation was established between this angle and outcome after surgery. No postoperative increase in this angle was reported. There was also no correlation between size of the spinal canal and outcome. Decompressive surgery of the thoracic spinal cord in patients with achondroplasia can be performed safely if anatomical details are taken into consideration. Spondylodesis did not appear essential. Special attention should be given to the method of surgery, identification of the level of interest, and follow-up of the thoracolumbar kyphotic angle.

  11. Simulation of malaria epidemiology and control in the highlands of western Kenya

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    Stuckey Erin M

    2012-10-01

    Full Text Available Abstract Background Models of Plasmodium falciparum malaria epidemiology that provide realistic quantitative predictions of likely epidemiological outcomes of existing vector control strategies have the potential to assist in planning for the control and elimination of malaria. This work investigates the applicability of mathematical modelling of malaria transmission dynamics in Rachuonyo South, a district with low, unstable transmission in the highlands of western Kenya. Methods Individual-based stochastic simulation models of malaria in humans and a deterministic model of malaria in mosquitoes as part of the OpenMalaria platform were parameterized to create a scenario for the study area based on data from ongoing field studies and available literature. The scenario was simulated for a period of two years with a population of 10,000 individuals and validated against malaria survey data from Rachuonyo South. Simulations were repeated with multiple random seeds and an ensemble of 14 model variants to address stochasticity and model uncertainty. A one-dimensional sensitivity analysis was conducted to address parameter uncertainty. Results The scenario was able to reproduce the seasonal pattern of the entomological inoculation rate (EIR and patent infections observed in an all-age cohort of individuals sampled monthly for one year. Using an EIR estimated from serology to parameterize the scenario resulted in a closer fit to parasite prevalence than an EIR estimated using entomological methods. The scenario parameterization was most sensitive to changes in the timing and effectiveness of indoor residual spraying (IRS and the method used to detect P. falciparum in humans. It was less sensitive than expected to changes in vector biting behaviour and climatic patterns. Conclusions The OpenMalaria model of P. falciparum transmission can be used to simulate the impact of different combinations of current and potential control interventions to help plan

  12. 1H NMR metabonomics indicates continued metabolic changes and sexual dimorphism post-parasite clearance in self-limiting murine malaria model.

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    Arjun Sengupta

    Full Text Available Malaria, a mosquito-borne disease caused by Plasmodium spp. is considered to be a global threat, specifically for the developing countries. In human subjects considerable information exists regarding post-malarial physiology. However, most murine malarial models are lethal, and most studies deal with acute phases occurring as disease progresses. Much less is known regarding physiological status post-parasite clearance. We have assessed the physiological changes at the organ levels using (1H NMR based metabonomics in a non lethal self-clearing murine malarial model of P. chabaudi parasites and Balb/C, far beyond the parasite clearance point. The results showed distinct metabolic states between uninfected and infected mice at the peak parasitemia, as well as three weeks post-parasite clearance. Our data also suggests that the response at the peak infection as well as recovery exhibited distinct sexual dimorphism. Specifically, we observed accumulation of acetylcholine in the brain metabolic profile of both the sexes. This might have important implication in understanding the pathophysiology of the post malarial neurological syndromes. In addition, the female liver showed high levels of glucose, dimethylglycine, methylacetoacetate and histidine after three weeks post-parasite clearance, while the males showed accumulation of branched chain amino acids, lysine, glutamine and bile acids.

  13. Effects of Psychiatric Disorders on Labor Market Outcomes: A Latent Variable Approach Using Multiple Clinical Indicators.

    Science.gov (United States)

    Banerjee, Souvik; Chatterji, Pinka; Lahiri, Kajal

    2017-02-01

    In this paper, we estimate the effect of psychiatric disorders on labor market outcomes using a structural equation model with a latent index for mental illness, an approach that acknowledges the continuous nature of psychiatric disability. We also address the potential endogeneity of mental illness using an approach proposed by Lewbel (2012) that relies on heteroscedastic covariance restrictions rather than questionable exclusion restrictions for identification. Data come from the US National Comorbidity Survey - Replication and the National Latino and Asian American Study. We find that mental illness adversely affects employment and labor force participation and also reduces the number of weeks worked and increases work absenteeism. To assist in the interpretation of findings, we simulate the labor market outcomes of individuals meeting diagnostic criteria for mental disorder if they had the same mental health symptom profile as individuals not meeting diagnostic criteria. We estimate potential gains in employment for 3.5 million individuals, and reduction in workplace costs of absenteeism of $21.6 billion due to the resultant improvement in mental health. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  14. A Global View on Output and Outcomes of Cataract Surgery With National Indices of Socioeconomic Development.

    Science.gov (United States)

    Wang, Wei; Yan, William; Müller, Andreas; He, Mingguang

    2017-07-01

    Cataract blindness accounts for a substantial proportion of blindness worldwide. Understanding the correlations between national levels of socioeconomic development with the quantity and quality of cataract surgery may provide insight for the prioritization and resource allocation for blindness prevention programs. The relationships between human development index (HDI), gross domestic product (GDP) per capita, and cataract surgical coverage (CSC) and visual outcome of cataract surgery were examined in a multinational study utilizing secondary data from the repository for Rapid Assessment of Avoidable Blindness (RAAB), World Health Organization, Global Burden of Disease, United Nations, and the World Bank. A total of 266 RAAB studies across 73 countries/territories were retrieved. Linear regression model results revealed strong associations of HDI with prevalence of cataract blindness (β = -7.056, P service delivery.

  15. Combining process indicators to evaluate quality of care for surgical patients with colorectal cancer: are scores consistent with short-term outcome?

    NARCIS (Netherlands)

    Kolfschoten, N.E.; Gooiker, G.A.; Bastiaannet, E.; Leersum, N.J. van; Velde, C.J. van de; Eddes, E.H.; Marang-van de Mheen, P.J.; Kievit, J.; Harst, E. van der; Wiggers, T.; Wouters, M.W.; Tollenaar, R.A.E.M.; Krieken, J.H. van

    2012-01-01

    OBJECTIVE: To determine if composite measures based on process indicators are consistent with short-term outcome indicators in surgical colorectal cancer care. DESIGN: Longitudinal analysis of consistency between composite measures based on process indicators and outcome indicators for 85 Dutch hosp

  16. Combining process indicators to evaluate quality of care for surgical patients with colorectal cancer : are scores consistent with short-term outcome?

    NARCIS (Netherlands)

    Kolfschoten, N. E.; Gooiker, G. A.; Bastiaannet, E.; van Leersum, N. J.; van de Velde, C. J. H.; Eddes, E. H.; Marang-van de Mheen, P. J.; Kievit, J.; van der Harst, E.; Wiggers, T.; Wouters, M. W. J. M.; Tollenaar, R. A. E. M.

    2012-01-01

    Objective: To determine if composite measures based on process indicators are consistent with short-term outcome indicators in surgical colorectal cancer care. Design: Longitudinal analysis of consistency between composite measures based on process indicators and outcome indicators for 85 Dutch hosp

  17. Pathogenesis of malaria revisited.

    Science.gov (United States)

    Dasari, Prasad; Bhakdi, Sucharit

    2012-11-01

    Plasmodium falciparum malaria claims 1 million lives around the globe every year. Parasitemia can reach remarkably high levels. The developing parasite digests hemoglobin and converts the waste product to hemozoin alias malaria pigment. These processes occur in a vesicular compartment named the digestive vacuole (DV). Each parasitized cell releases one DV upon rupture. Myriads of DVs thus gain entry into the blood, but whether they trigger pathobiological events has never been investigated. We recently discovered that the DV membrane simultaneously activates the two major enzyme cascades in blood, complement and coagulation. Activation of both is known to occur in patients with severe malaria, so discovery of the common trigger has large consequences. The DV membrane but not the merozoite has the capacity to spontaneously activate the alternative complement and intrinsic clotting pathway. Ejection of merozoites and the DV into the bloodstream, therefore, results in selective opsonization and phagocytosis of the DV, leaving merozoites free to invade new cells. The DV membrane furthermore has the capacity to assemble prothrombinase, the key convertase of the intrinsic clotting pathway. The dual capacity of the DV to activate both complement and coagulation can be suppressed by low-molecular-weight dextran sulfate. This agent protects experimental animals from the detrimental consequences, resulting from intravenous application of purified DVs. Phagocytosis of DVs not only deploys PMN away from merozoites, but also drives the cells into a state of functional exhaustion. This may be one reason for the enhanced susceptibility of patients with severe malaria toward systemic bacterial infections. Together, these findings indicate that the DV may represent a hitherto unrecognized, important determinant of parasite pathogenicity.

  18. Do Treatment Quality Indicators Predict Cardiovascular Outcomes in Patients with Diabetes?

    NARCIS (Netherlands)

    Sidorenkov, Grigory; Voorham, Jaco; de Zeeuw, Dick; Haaijer-Ruskamp, Flora M.; Denig, Petra

    2013-01-01

    Background: Landmark clinical trials have led to optimal treatment recommendations for patients with diabetes. Whether optimal treatment is actually delivered in practice is even more important than the efficacy of the drugs tested in trials. To this end, treatment quality indicators have been devel

  19. Swallowing difficulties in Duchenne muscular dystrophy: indications for feeding assessment and outcome of videofluroscopic swallow studies

    DEFF Research Database (Denmark)

    Aloysius, A.; Born, P.; Kinali, M.

    2008-01-01

    Feeding difficulties are known to occur with advancing age in Duchenne muscular dystrophy (DMD). We evaluated the role of videofluoroscopy swallow study (VFSS) in a group of 30 DMD patients with feeding difficulties. Indications for feeding assessment were: respiratory infections potentially...

  20. Outcome and complications of retropubic and transobturator midurethral slings translated into surgical therapeutic indices

    NARCIS (Netherlands)

    R.M. Houwert; J.P.W.R. Roovers; P.L. Venema; H.W. Bruinse; M.G.W. Dijkgraaf; H.A.M. Vervest

    2010-01-01

    OBJECTIVE: We sought to determine and compare surgical therapeutic indices (STIs) of the retropubic tension-free vaginal tape (TVT) and 2 kinds of transobturator tape (TOT), Monarc (American Medical Systems, Minneapolis, MN), and tension-free vaginal tape obturator. STUDY DESIGN: This was a retrospe

  1. [Current malaria situation in Turkey].

    Science.gov (United States)

    Gockchinar, T; Kalipsi, S

    2001-01-01

    are important in transmitting the diseases. The districts where malaria cases occur are the places where population moves are rapid, agriculture is the main occupation, the increase in the population is high and the education/cultural level is low. Within years, the districts with high malaria cases also differ. Before 1990 Cucurova and Amikova were the places that showed the highest incidence of malaria. Since 1990, the number of cases from south-eastern Anatolia has started to rise. The main reasons for this change are a comprehensive malaria prevention programme, regional development, developed agricultural systems, and lower population movements. The 1999 statistical data indicate that 83 and 17% of all malaria cases are observed in the GAP and other districts, respectively. The distribution of malaria cases in Turkey differs by months and climatic conditions. The incidence of malaria starts to rise in March, reaching its peak in July, August and September, begins to fall in October. In other words, the number of malaria cases is lowest in winter and reaches its peak in summer and autumn. This is not due to the parasite itself, but a climatic change is a main reason. In the past years the comprehensive malaria prevention programme has started bearing its fruits. Within the WHO Roll Back Malaria strategies, Turkey has started to implement its national malaria control projects, the meeting held on March 22, 2000, coordinated the country's international cooperation for this purpose. The meeting considered the aim of the project to be introduced into other organizations. In this regards, the target for 2002 is to halve the incidence of malaria as compared to 1999. The middle--and long-term incidence of malaria will be lowered to even smaller figures. The objectives of this project are as follows: to integrate malaria services with primary health care services to prove more effective studies; to develop early diagnosis and treatment systems, to provide better

  2. Prognostic indicators of poor outcome in horses with laminitis at a tertiary care hospital

    Science.gov (United States)

    Orsini, James A.; Parsons, Corrina Snook; Capewell, Linda; Smith, Gary

    2010-01-01

    This retrospective study investigated the factors associated with a poor outcome (death by euthanasia or from other causes) in horses treated for laminitis at a tertiary care hospital. Cases (n = 247) were defined as patients with laminitis that were euthanized or that died of other causes during hospitalization. Controls (n = 344) were patients with laminitis that survived to be discharged from the hospital. In the final multivariate analysis, the factors significantly associated with an increased risk for death and their respective odds ratios (OR) were as follows: Thoroughbred (OR = 1.57); racehorse (OR = 1.76); treatment with flunixin meglumine (OR = 1.76); vascular pathology (OR = 2.12); distal displacement of the third phalanx (OR = 2.68); pneumonia (OR = 2.87); and lameness of Obel grade II (OR = 2.99), grade III (OR = 9.63), or grade IV (OR = 20.48). The use of glue-on shoes significantly reduced the risk for death (OR = 0.36). PMID:20808574

  3. Education, outreach, and inclusive engagement: Towards integrated indicators of successful program outcomes in participatory science.

    Science.gov (United States)

    Haywood, Benjamin K; Besley, John C

    2014-01-01

    The use and utility of science in society is often influenced by the structure, legitimacy, and efficacy of the scientific research process. Public participation in scientific research (PPSR) is a growing field of practice aimed at enhancing both public knowledge and understanding of science (education outreach) and the efficacy and responsiveness of scientific research, practice, and policy (participatory engagement). However, PPSR objectives focused on "education outreach" and "participatory engagement" have each emerged from diverse theoretical traditions that maintain distinct indicators of success used for program development and evaluation. Although areas of intersection and overlap among these two traditions exist in theory and practice, a set of comprehensive standards has yet to coalesce that supports the key principles of both traditions in an assimilated fashion. To fill this void, a comprehensive indicators framework is proposed with the goal of promoting a more integrative and synergistic PPSR program development and assessment process.

  4. Indications and outcome of childhood preventable bowel resections in a developing country

    Directory of Open Access Journals (Sweden)

    Uchechukwu Obiora Ezomike

    2014-01-01

    Full Text Available Background: While many bowel resections in developed countries are due to congenital anomalies, indications for bowel resections in developing countries are mainly from preventable causes. The aim of the following study was to assess the indications for, morbidity and mortality following preventable bowel resection in our centre. Patients and Methods: Retrospective analysis of all cases of bowel resection deemed preventable in children from birth to 18 years from June 2005 to June 2012. Results: There were 22 preventable bowel resections with an age range of 7 days to 17 years (median 6 months and male:female ratio of 2.1:1. There were 2 neonates, 13 infants and 7 older children. The indications were irreducible/gangrenous intussusceptions (13, abdominal gunshot injury (2, gangrenous umbilical hernia (2, blunt abdominal trauma (1, midgut volvulus (1, necrotizing enterocolitis (1, strangulated inguinal hernia (1, post-operative band intestinal obstructions (1. There were 16 right hemicolectomies, 4 small bowel resections and 2 massive bowel resections. Average duration of symptoms before presentation was 3.9 days (range: 3 h-14 days. Average time to surgical intervention was 42 h for survivors and 53 h for non-survivors. Only 19% presented within 24 h of onset of symptoms and all survived. For those presenting after 24 h, the cause of delay was a visit to primary or secondary level hospitals (75% and ignorance (25%. Average duration of post-operative hospital stay is 14 days and 9 patients (41% developed 18 complications. Seven patients died (31.8% mortality which diagnoses were irreducible/gangrenous intussusceptions (5, necrotising enterocolitis (1, midgut volvulus (1. One patient died on the operating table while others had overwhelming sepsis. Conclusion: There is a high rate of morbidity and mortality in these cases of preventable bowel resection. Typhoid intestinal perforation did not feature as an indication for bowel resection in this

  5. The effectiveness of a nationwide universal coverage campaign of insecticide-treated bed nets on childhood malaria in Malawi.

    Science.gov (United States)

    Zamawe, Collins O F; Nakamura, Kanan; Shibanuma, Akira; Jimba, Masamine

    2016-10-18

    Although the universal coverage campaign of insecticide-treated mosquito bed nets (ITNs) has been associated with improved malaria outcomes, recent reports indicate that the campaign is losing its sparkle in some countries. In Malawi, the universal coverage campaign was implemented in 2012, but its impacts are yet to be ascertained. Thus, this study examined the effects of the campaign on malaria morbidity among children in Malawi. This is a repeated cross-sectional study. The study used nationally-representative malaria indicator survey (MIS) data collected in 2012 and 2014. In total, the analysis included 4193 children between the ages of 6 and 59 months (2171 from 2012 MIS and 2022 from 2014 MIS). ITNs coverage and malaria morbidity before (2012 = pre-test/control) and after (2014 = post-test/treated) the universal coverage campaign of ITNs were compared. The treated and control samples were matched on measured relevant covariates using propensity scores. The mean number of ITNs per household improved significantly from 1.1 (SD 1.0) in 2012 to 1.4 (SD 1.1) in 2014 (p universal coverage campaign of ITNs was not associated with a reduced burden of malaria among children in Malawi. This was likely due to increased insecticide resistance, inconsistent use of bed nets and under-utilization of other methods of malaria control. This calls for a multifaceted approach in the fight against malaria instead of simple dependence on ITNs. In particular, local or community level malaria interventions should go hand in hand with the universal coverage campaign.

  6. Myocarditis associated with Plasmodium vivax malaria: a case report

    Directory of Open Access Journals (Sweden)

    Ana Maria Revoredo da Silva Ventura

    2014-12-01

    Full Text Available Malaria remains a major public health problem in Brazil where Plasmodium vivax is the predominant species, responsible for 82% of registered cases in 2013. Though benign, P. vivax infection may sometimes evolve with complications and a fatal outcome. Here, we report a severe case of P. vivax malaria in a 35-year-old Brazilian man from a malaria endemic area, who presented with reversible myocarditis.

  7. Adiponectin expression in patients with inflammatory cardiomyopathy indicates favourable outcome and inflammation control.

    Science.gov (United States)

    Bobbert, Peter; Scheibenbogen, Carmen; Jenke, Alexander; Kania, Gabriele; Wilk, Sabrina; Krohn, Stefanie; Stehr, Jenny; Kuehl, Uwe; Rauch, Ursula; Eriksson, Urs; Schultheiss, Heinz Peter; Poller, Wolfgang; Skurk, Carsten

    2011-05-01

    Circulating adiponectin (APN) is an immunomodulatory, pro-angiogenic, and anti-apoptotic adipocytokine protecting against acute viral heart disease and preventing pathological remodelling after cardiac injury. The purpose of this study was to describe the regulation and effects of APN in patients with inflammatory cardiomyopathy (DCMi). Adiponectin expression and outcome were assessed in 173 patients with DCMi, 30 patients with non-inflammatory DCM, and 30 controls. Mechanistic background of these findings was addressed in murine experimental autoimmune myocarditis (EAM), a model of human DCMi, and further elucidated in vitro. Adiponectin plasma concentrations were significantly higher in DCMi compared with DCM or controls, i.e. 6.8 ± 3.9 µg/mL vs. 5.4 ± 3.6 vs. 4.76 ± 2.5 µg/mL (P< 0.05, respectively) and correlated significantly with cardiac mononuclear infiltrates (CD3+: r(2)= 0.025, P= 0.038; CD45R0+: r(2)= 0.058, P= 0.018). At follow-up, DCMi patients with high APN levels showed significantly increased left ventricular ejection fraction improvement, decreased left ventricular end-diastolic diameter, and reduced cardiac inflammatory infiltrates compared with patients with low APN levels. A multivariate linear regression analysis implicated APN as an independent prognostic factor for inhibition of cardiac inflammation. In accordance with these findings in human DCMi, EAM mice exhibited elevated plasma APN. Adiponectin gene transfer led to significant downregulation of key inflammatory mediators promoting disease. Mechanistically, APN acted as a negative regulator of T cells by reducing antigen specific expansion (P< 0.01) and suppressed TNFα-mediated NFκB activation (P< 0.01) as well as release of reactive oxygen species in cardiomyocytes. Our results implicate that APN acts as endogenously upregulated anti-inflammatory cytokine confining cardiac inflammation and progression in DCMi.

  8. Regional anesthesia for pediatric knee surgery: a review of the indications, procedures, outcomes, safety, and challenges

    Directory of Open Access Journals (Sweden)

    Muhly WT

    2015-11-01

    Full Text Available Wallis T Muhly, Harshad G Gurnaney, Arjunan GaneshDepartment of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Pennsylvania, PA, USAAbstract: The indications for surgery on the knee in children and adolescents share some similarity to adult practice in that there are an increasing number of sports-related injuries requiring surgical repair. In addition, there are some unique age-related conditions or congenital abnormalities that may present as indications for orthopedic intervention at the level of the knee. The efficacy and safety of peripheral nerve blocks (PNBs for postoperative analgesia following orthopedic surgery has been well established in adults. Recent studies have also demonstrated earlier functional recovery after surgery in patients who received PNBs. In children, PNB is gaining popularity, and increasing data are emerging to demonstrate the feasibility, efficacy, and safety in this population. In this paper, we will review some of the most common indications for surgery involving the knee in children and the anatomy of knee, associated dermatomal and osteotomal innervation, and the PNBs most commonly used to produce analgesia at the level of the knee. We will review the evidence in support of regional anesthesia in children in terms of both the quality conferred to the immediate postoperative care and the role of continuous PNBs in maintaining effective analgesia following discharge. Also we will discuss some of the subtle challenges in utilizing regional anesthesia in the pediatric patient including the use of general anesthesia when performing regional anesthesia and the issue of monitoring for compartment syndrome. Finally, we will offer some thoughts about areas of practice that are in need of further investigation.Keywords: pediatric surgery, regional anesthesia, analgesia, knee surgery

  9. Total pancreatectomy for the treatment of chronic pancreatitis: indications, outcomes, and recommendations.

    Science.gov (United States)

    Behrman, Stephen W; Mulloy, Matthew

    2006-04-01

    Total pancreatectomy (TP) for chronic pancreatitis (CP) has not gained widespread acceptance because of concerns regarding technical complexity, diabetic complications, and uncertainty with respect to long-term pain relief. Records of patients having TP from 1997 to 2005 were reviewed. Patient presentation, etiology of disease, and the indication for TP were examined. Operative results were analyzed. Long-term results were critically assessed, including narcotic usage and the need for re-admission. Postoperative quality of life (QOL) was assessed by the SF-36 health survey. During the study period, 7 patients with CP had TP, and 28 had other operations. The etiology of CP was alcohol in four and hereditary pancreatitis in three. The indication for surgery was pain and weight loss. Preoperatively, all patients used narcotics chronically and two had insulin-dependent diabetes. Four had TP after failed previous surgical procedures. Endoscopic retrograde cholangiopancreatography and computed tomography demonstrated small ducts and atrophic calcified glands. The mean length of the operation was 468 minutes, and only two patients required transfusion. There were no biliary anastomotic complications. The mean length of stay was 14 days. Major morbidity was limited to a single patient with a leak from the gastrojejunal anastomosis. Thirty-day mortality was zero, with one late death unrelated to the surgical procedure or diabetes. The mean length of follow-up was 46 months. All patients remained alcohol and narcotic free. No patient was readmitted with a diabetic complication. When compared with the general population, QOL scores were diminished but reasonable. We conclude that TP is indicated in hereditary pancreatitis and in those with an atrophic, calcified pancreas with small duct disease; that TP is technically arduous but can be completed with very low morbidity and mortality; and that on long-term follow-up, pain relief and abstinence from alcohol and narcotics was

  10. Performance indicators analysis at Brazilian and Italian women's volleyball leagues according to game location, game outcome, and set number.

    Science.gov (United States)

    Campos, Fabio A D; Stanganélli, Luiz C R; Campos, Leandra C B; Pasquarelli, Bruno N; Gómez, Miguel-Angel

    2014-04-01

    This study was done to investigate the advantage of playing at home in elite women's volleyball leagues and the influence of performance indicators in the game score according to set number. The sample consisted of 240 games of the Brazilian Volleyball League (n = 132 games) and the Italian Volleyball League (n = 108 games) from the 2011-2012 season. The relationship of performance indicators (including serve, attack, block, and opponents' errors) with the game outcome (win or lose) was assessed. The results showed that there was a home advantage effect in women's volleyball leagues, with a higher prevalence of victory for the home teams in Brazilian and Italian leagues (58 and 56%, respectively). When related to the performance indicators and among the aspects that were most highly correlated with victory, the attack was the technical indicator that explained most of the results of volleyball games.

  11. Bayesian modelling of geostatistical malaria risk data

    Directory of Open Access Journals (Sweden)

    L. Gosoniu

    2006-11-01

    Full Text Available Bayesian geostatistical models applied to malaria risk data quantify the environment-disease relations, identify significant environmental predictors of malaria transmission and provide model-based predictions of malaria risk together with their precision. These models are often based on the stationarity assumption which implies that spatial correlation is a function of distance between locations and independent of location. We relax this assumption and analyse malaria survey data in Mali using a Bayesian non-stationary model. Model fit and predictions are based on Markov chain Monte Carlo simulation methods. Model validation compares the predictive ability of the non-stationary model with the stationary analogue. Results indicate that the stationarity assumption is important because it influences the significance of environmental factors and the corresponding malaria risk maps.

  12. Bayesian modelling of geostatistical malaria risk data.

    Science.gov (United States)

    Gosoniu, L; Vounatsou, P; Sogoba, N; Smith, T

    2006-11-01

    Bayesian geostatistical models applied to malaria risk data quantify the environment-disease relations, identify significant environmental predictors of malaria transmission and provide model-based predictions of malaria risk together with their precision. These models are often based on the stationarity assumption which implies that spatial correlation is a function of distance between locations and independent of location. We relax this assumption and analyse malaria survey data in Mali using a Bayesian non-stationary model. Model fit and predictions are based on Markov chain Monte Carlo simulation methods. Model validation compares the predictive ability of the non-stationary model with the stationary analogue. Results indicate that the stationarity assumption is important because it influences the significance of environmental factors and the corresponding malaria risk maps.

  13. Indications and outcome of abdominal myomectomy in University of Maiduguri Teaching Hospital: Review of ten year

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    A D Geidam

    2011-01-01

    Full Text Available Background: Abdominal myomectomy is a common modality of treatment for large and symptomatic uterine fibroid in women who wish to retain their fertility. Though frequently performed the procedure may still be associated with complications. Materials and Methods: A retrospective review of all patients who had abdominal myomectomy from January 1999 to December 2008 at the University of Maiduguri Teaching Hospital. Information on the Sociodemographic characteristics, indication for the myomectomy, uterine size, pre and post operative packed cell volume (PCV, intraoperative findings, cadre of surgeon, duration of hospital stay and complications were obtained. Results: The rate of abdominal myomectomy was 3.34%. Majority of the patients (79.8% aged 30-49 years, and most (58.9% were nulliparas. Abdominal mass (63.7%, menorrhagia (57.7%, and subfertility 55.2% were the leading indications for abdominal myomectomy. Complications were seen in 10.9% of the cases, 55.5 % of which were wound infections. Clinical and intra operative factors associated with complications included menorrhagia (P=0.003, estimated blood loss (EBL ≥500mls (P=0.005 and post operative PCV of <30% (P=0.081. Conclusion: Complication rate after myomectomy was low with menorrhagia and EBL ≥ 500 mls being significantly associated with development of complication.

  14. Surgery and Radiosurgery for Acromegaly: A Review of Indications, Operative Techniques, Outcomes, and Complications

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    Yvette Marquez

    2012-01-01

    Full Text Available Among multimodality treatments for acromegaly, the goals of surgical intervention are to balance maximal tumor resection while preserving normal pituitary function and maintaining patient safety. The resection of growth hormone-(GH- secreting pituitary adenomas in the hands of experienced surgeons results in hormonal remission in 50–70% of patients. Acromegalic patients often have medical comorbidities and anatomical variations complicating anesthesia and surgical management. Despite these challenges, complications such as CSF leak or new hypopituitarism following surgery remain uncommon. Over the past decade, endoscopic approaches to pituitary tumors have improved visualization and facilitated identification of additional tumor using angled telescopes. Patients with persistent acromegaly following surgery require continued medical and/or radiation-based interventions. The adjunctive use of stereotactic radiosurgery offers hormonal remission in 40–50% of patients. In this article, the current preoperative evaluation, indications for surgery, surgical approaches, role of radiosurgery, complications, and remission criteria following operative resection of GH adenomas are reviewed.

  15. Standard outcome indicators after colon cancer resection. Creation of a nomogram for autoevaluation.

    Science.gov (United States)

    Sancho-Muriel, Jorge; Frasson, Matteo; Hervás, David; Flor-Lorente, Blas; Ramos Rodriguez, José Luis; Romero Simó, Manuel; Escoll Rufino, Jordi; Santamaría Olabarrieta, Marta; Viñas Martinez, José; López Bañeres, Manolo; García-Granero, Eduardo

    2017-01-01

    Lately there has been an increasing interest in identifying quality standards in different pathologies, among them colon cancer due to its great prevalence. The main goal of this study is to define the quality standards of colon cancer surgery based on a large prospective national study dataset. Data from the prospective national study ANACO were used. This study included a consecutive series of patients operated on for colon cancer in 52 Spanish hospitals (2011-2012). Centers with less than 30 patients were excluded. The present analysis finally included 42 centers (2975 patients). Based on the results obtained in 4main indicators from each hospital (anastomotic leak, lymph-nodes found in the specimen, mortality and length of stay), a nomogram that allows the evaluation of the performance of each center was designed. Standard results for further 5 intraoperative and 5 postoperative quality indicators were also reported. Median of anastomotic leak and mortality rate was 8.5% (25(th)-75(th) percentiles 6.1%-12.4%) and 2.5% (25(th)-75(th) percentiles 0.6%-4.7%), respectively. Median number of nodes found in the surgical specimen was 15,1 (25(th)-75(th) percentiles 18-14 nodes). Median length of postoperative stay was 7.7 days (25(th)-75(th) percentiles 6.9-9.2 days). Based on these data, a nomogram for hospital audit was created. Standard surgical results after colon cancer surgery were defined, creating a tool for auto-evaluation and allowing each center to identify areas for improvement in the surgical treatment of colon cancer. Copyright © 2016 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  16. Programme level implementation of malaria rapid diagnostic tests (RDTs use: outcomes and cost of training health workers at lower level health care facilities in Uganda

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    Kyabayinze Daniel J

    2012-04-01

    Full Text Available Abstract Background The training of health workers in the use of malaria rapid diagnostic tests (RDTs is an important component of a wider strategy to improve parasite-based malaria diagnosis at lower level health care facilities (LLHFs where microscopy is not readily available for all patients with suspected malaria. This study describes the process and cost of training to attain competence of lower level health workers to perform malaria RDTs in a public health system setting in eastern Uganda. Methods Health workers from 21 health facilities in Uganda were given a one-day central training on the use of RDTs in malaria case management, including practical skills on how to perform read and interpret the test results. Successful trainees subsequently integrated the use of RDTs into their routine care for febrile patients at their LLHFs and transferred their acquired skills to colleagues (cascade training model. A cross-sectional evaluation of the health workers’ competence in performing RDTs was conducted six weeks following the training, incorporating observation, in-depth interviews with health workers and the review of health facility records relating to tests offered and antimalarial drug (AMD prescriptions pre and post training. The direct costs relating to the training processes were also documented. Results Overall, 135 health workers were trained including 63 (47% nursing assistants, a group of care providers without formal medical training. All trainees passed the post-training concordance test with ≥ 80% except 12 that required re-training. Six weeks after the one-day training, 51/64 (80% of the health workers accurately performed the critical steps in performing the RDT. The performance was similar among the 10 (16% participants who were peer-trained by their trained colleagues. Only 9 (14% did not draw the appropriate amount of blood using pipette. The average cost of the one-day training was US$ 101 (range $92-$112, with the

  17. A Weather-Based Prediction Model of Malaria Prevalence in Amenfi West District, Ghana

    Science.gov (United States)

    Larbi, John Aseidu; Lawer, Eric Adjei

    2017-01-01

    This study investigated the effects of climatic variables, particularly, rainfall and temperature, on malaria incidence using time series analysis. Our preliminary analysis revealed that malaria incidence in the study area decreased at about 0.35% annually. Also, the month of November recorded approximately 21% more malaria cases than the other months while September had a decreased effect of about 14%. The forecast model developed for this investigation indicated that mean minimum (P = 0.01928) and maximum (P = 0.00321) monthly temperatures lagged at three months were significant predictors of malaria incidence while rainfall was not. Diagnostic tests using Ljung-Box and ARCH-LM tests revealed that the model developed was adequate for forecasting. Forecast values for 2016 to 2020 generated by our model suggest a possible future decline in malaria incidence. This goes to suggest that intervention strategies put in place by some nongovernmental and governmental agencies to combat the disease are effective and thus should be encouraged and routinely monitored to yield more desirable outcomes. PMID:28255497

  18. Caesarean delivery in the Limbé and the Buea regional hospitals, Cameroon: frequency, indications and outcomes

    Science.gov (United States)

    Tanyi, Tanyi John; Atashili, Julius; Fon, Peter Nde; Robert, Tchounzou; Paul, Koki Ndombo

    2016-01-01

    Introduction Neonatal outcomes can be directly and indirectly affected by caesarean delivery (CD). Data on CD rates in semi-urban and rural hospitals in resource-limited settings are scarce and yet are needed to better guide the care of women and neonates in these settings. we carried out this study to determine the frequency of CD, its indications and the frequency of the various adverse neonatal outcomes (ANO) in the Limbe Regional Hospital (LRH) and the Buea Regional Hospital (BRH), Cameroon. We also assessed the relationship between the indication for CD and ANO in the said hospitals. Methods This was a hospital-based retrospective and prospective cross-sectional study using descriptive and analytic methods conducted in the LRH and the BRH maternity units within a nine months period in 2015. Informed consent was obtainedfrom mothers of the neonates. Data analyses were performed using Epi-Info 3.5.4 software. Results We recruited 199 neonates born through CD. The prevalence of CD was 13.3% with cephalopelvic disproportion (CPD) being the most frequent (32.2%) indication for CD. There were 52 (26.1%) ANO following CD and respiratory distress was the most common 24 (46.2%) of all ANO. Emergency indications for CD were associated with more ANO 49 (34.5%) as compared to elective indications for CD 3 (5.3%) [p-value<0.001]. We noted a significant association between indications for CD and the various type of ANO, with CPD having the worse prognostic neonatal outcomes 30.8% [p-value=0.02]. Conclusion The prevalence of ANO associated with CD in our hospitals was high with a worrying prognosis. While the exact reasons are unknown, the creation of well-equipped neonatal units with trained staff, may contribute to reduce neonatal morbidity and fatalities. Furthermore, the association of CPD to worse prognostic neonatal outcomes calls for clinicians, to consider additional management options, such as antibiotic prophylaxis and oxygen therapy to the neonates, prior to CD.

  19. High expression of GPR116 indicates poor survival outcome and promotes tumor progression in colorectal carcinoma.

    Science.gov (United States)

    Yang, Li; Lin, Xiao-Lu; Liang, Wei; Fu, Seng-Wang; Lin, Wen-Feng; Tian, Xiao-Qing; Gao, Yun-Jie; Chen, Hao-Yan; Dai, Jun; Ge, Zhi-Zheng

    2017-07-18

    Previous studies have found that G-protein-coupled receptor 116 (GPR116) is a regulator of breast cancer metastasis. However, the role of GPR116 in colorectal carcinoma (CRC) carcinogenesis and progression is unknown. In this study, We found GPR116 expression was significantly up-regulated in CRC specimens compared with corresponding non-cancerous tissues. Increased GPR116 expression in CRC was correlated with histological differentiation and distant metastasis. In addition, high expression of GPR116 was significantly associated with poor overall survival of CRC patients, which was also confirmed by GSE14333, GSE17536 and GSE33113 datasets from the Gene Expression Omnibus (GEO). Furthermore, we demonstrated that the ability of proliferation and invasion of CRC cell lines HCT116 and LOVO was markedly reduced after transfected with siRNA-GPR116. Meanwhile, GPR116 may drive EMT in CRC cells through AKT/EKR signaling pathway, resulting in metastasis. Thus, GPR116 may be a novel reliable prognostic indicator and a risk factor in CRC progression.

  20. Moderators and mediators of outcome in Internet-based indicated prevention for eating disorders.

    Science.gov (United States)

    Völker, Ulrike; Jacobi, Corinna; Trockel, Mickey T; Taylor, C Barr

    2014-12-01

    The objective of this study was to investigate moderators and mediators of the effect of an indicated prevention program for eating disorders (ED) on reduction of dysfunctional attitudes and specific ED symptoms. 126 women (M age = 22.3; range 18-33) reporting subthreshold ED symptoms were randomized to the Student Bodies™+ (SB+) intervention or an assessment-only control condition. Assessments took place at pre-intervention, mid-intervention (mediators), post-intervention, and 6-month follow-up. Mixed effects modeling including all available data from all time points were used for the data analysis. Intervention effects on the reduction of binge rate were weaker for participants with higher baseline BMI and for participants with a lower baseline purge rate. Intervention effects on reduction of eating disorder pathology were weaker for participants with higher baseline purge rate and with initial restrictive eating. No moderators of the intervention effect on restrictive eating were identified. An increase in knowledge mediated the beneficial effect of SB+ on binge rate. The results suggest that different moderators should be considered for the reduction of symptoms and change in attitudes of disturbed eating and that SB+ at least partially operates through psychoeducation.

  1. Mortality, Morbidity, and Developmental Outcomes in Infants Born to Women Who Received Either Mefloquine or Sulfadoxine-Pyrimethamine as Intermittent Preventive Treatment of Malaria in Pregnancy: A Cohort Study

    Science.gov (United States)

    Rupérez, María; González, Raquel; Mombo-Ngoma, Ghyslain; Kabanywanyi, Abdunoor M.; Sevene, Esperança; Ouédraogo, Smaïla; Kakolwa, Mwaka A.; Vala, Anifa; Accrombessi, Manfred; Briand, Valérie; Aponte, John J.; Manego Zoleko, Rella; Adegnika, Ayôla A.; Cot, Michel; Kremsner, Peter G.; Massougbodji, Achille; Abdulla, Salim; Ramharter, Michael; Macete, Eusébio; Menéndez, Clara

    2016-01-01

    Background Little is known about the effects of intermittent preventive treatment of malaria in pregnancy (IPTp) on the health of sub-Saharan African infants. We have evaluated the safety of IPTp with mefloquine (MQ) compared to sulfadoxine-pyrimethamine (SP) for important infant health and developmental outcomes. Methods and Findings In the context of a multicenter randomized controlled trial evaluating the safety and efficacy of IPTp with MQ compared to SP in pregnancy carried out in four sub-Saharan countries (Mozambique, Benin, Gabon, and Tanzania), 4,247 newborns, 2,815 born to women who received MQ and 1,432 born to women who received SP for IPTp, were followed up until 12 mo of age. Anthropometric parameters and psychomotor development were assessed at 1, 9, and 12 mo of age, and the incidence of malaria, anemia, hospital admissions, outpatient visits, and mortality were determined until 12 mo of age. No significant differences were found in the proportion of infants with stunting, underweight, wasting, and severe acute malnutrition at 1, 9, and 12 mo of age between infants born to women who were on IPTp with MQ versus SP. Except for three items evaluated at 9 mo of age, no significant differences were observed in the psychomotor development milestones assessed. Incidence of malaria, anemia, hospital admissions, outpatient visits, and mortality were similar between the two groups. Information on the outcomes at 12 mo of age was unavailable in 26% of the infants, 761 (27%) from the MQ group and 377 (26%) from the SP group. Reasons for not completing the study were death (4% of total study population), study withdrawal (6%), migration (8%), and loss to follow-up (9%). Conclusions No significant differences were found between IPTp with MQ and SP administered in pregnancy on infant mortality, morbidity, and nutritional outcomes. The poorer performance on certain psychomotor development milestones at 9 mo of age in children born to women in the MQ group compared

  2. Adding a single low-dose of primaquine (0.25 mg/kg) to artemether-lumefantrine did not compromise treatment outcome of uncomplicated Plasmodium falciparum malaria in Tanzania: a randomized, single-blinded clinical trial.

    Science.gov (United States)

    Mwaiswelo, Richard; Ngasala, Billy; Jovel, Irina; Aydin-Schmidt, Berit; Gosling, Roland; Premji, Zul; Mmbando, Bruno; Björkman, Anders; Mårtensson, Andreas

    2016-08-26

    The World Health Organization (WHO) recently recommended the addition of a single low-dose of the gametocytocidal drug primaquine (PQ) to artemisinin-based combination therapy (ACT) in low transmission settings as a component of pre-elimination or elimination programmes. However, it is unclear whether that influences the ACT cure rate. The study assessed treatment outcome of artemether-lumefantrine (AL) plus a single PQ dose (0.25 mg/kg) versus standard AL regimen for treatment of acute uncomplicated Plasmodium falciparum malaria in Tanzania. A randomized, single-blinded, clinical trial was conducted in Yombo, Bagamoyo district, Tanzania. Acute uncomplicated P. falciparum malaria patients aged ≥1 year, with the exception of pregnant and lactating women, were enrolled and treated with AL plus a single PQ dose (0.25 mg/kg) or AL alone under supervision. PQ was administered together with the first AL dose. Clinical and laboratory assessments were performed at 0, 8, 24, 36, 48, 60, and 72 h and on days 7, 14, 21, and 28. The primary end-point was a polymerase chain reaction (PCR)-adjusted adequate clinical and parasitological response (ACPR) on day 28. Secondary outcomes included: fever and asexual parasitaemia clearance, proportion of patients with PCR-determined parasitaemia on day 3, and proportion of patients with Pfmdr1 N86Y and Pfcrt K76T on days 0, 3 and day of recurrent infection. Overall 220 patients were enrolled, 110 were allocated AL + PQ and AL, respectively. Parasite clearance by microscopy was fast, but PCR detectable parasitaemia on day 3 was 31/109 (28.4 %) and 29/108 (26.9 %) in patients treated with AL + PQ and AL, respectively (p = 0.79). Day 28 PCR-adjusted ACPR and re-infection rate was 105/105 (100 %) and 101/102 (99 %) (p = 0.31), and 5/107 (4.7 %) and 5/8 (4.8 %) (p = 0.95), in AL + PQ and AL arm, respectively. There was neither any statistically significant difference in the proportion of Pfmdr1 N86Y or Pfcrt K76T

  3. [WHO's malaria program Roll Back Malaria].

    Science.gov (United States)

    Myrvang, B; Godal, T

    2000-05-30

    Malaria is one of the main health problems in the world with 300-500 millions cases yearly and about one million deaths, mainly children in Sub-Saharan Africa. In the 1990s the malaria problem in Africa has increased, although we have methods to control the disease. In 1998 the new secretary general of WHO, Gro Harlem Brundtland, established the Roll Back Malaria programme, with the aim to markedly reduce malaria morbidity and mortality. Governments in malaria-affected countries have to take the lead in Roll Back Malaria. Their health systems must be improved and malaria control integrated into the general health system, and the methods available for prevention and treatment have to be intensified and improved. At the same time, Roll Back Malaria will encourage and promote malaria research which hopefully will result in new medicines, vaccines and other tools which will improve the chances of reducing malaria-related deaths and suffering. Roll Back Malaria is a cabinet project within the WHO, and the organisation has a key role as manager, co-ordinator and monitor of the project. However, it depends for resources on international support and commitment from other UN bodies, the World Bank, governments in the western world, pharmaceutical industry, philanthropists and other sources. At present an optimistic view prevails, and the preliminary aim, to halve the malaria mortality by the year 2010, seems realistic even with the control methods of today. However, if research efforts result in new and better tools to combat the disease, the task will definitely be easier.

  4. "Extended" radical cholecystectomy for gallbladder cancer:Long-term outcomes, indications and limitations

    Institute of Scientific and Technical Information of China (English)

    Yoshio Shirai; Jun Sakata; Toshifumi Wakai; Taku Ohashi; Katsuyoshi Hatakeyama

    2012-01-01

    AIM:To delineate indications and limitations for "extended" radical cholecystectomy for gallbladder cancer:a procedure which was instituted in our department in 1982.METHODS:Of 145 patients who underwent a radical resection for gallbladder cancer from 1982 through 2006,52 (36%) had an extended radical cholecystectomy,which involved en bloc resection of the gallbladder,gallbladder fossa,extrahepatic bile duct,and the regional lymph nodes (first-and second-echelon node groups).A retrospective analysis of the 52 patients was conducted including at least 5 years of follow up.Residual tumor status was judged as no residual tumor (R0) or microscopic/macroscopic residual tumor (R1-2).Pathological findings were documented according to the American Joint Committee on Cancer Cancer Staging Manual (7th edition).RESULTS:The primary tumor was classified as pathological T1 (pT1) in 3 patients,pT2 in 36,pT3 in 12,and pT4 in 1.Twenty-three patients had lymph node metastases; 11 had a single positive node,4 had two positive nodes,and 8 had three or more positive nodes.None of the three patients with pT1 tumors had nodal disease,whereas 23 of 49 (47%) with pT2 or more advanced tumors had nodal disease.One patient died during the hospital stay for definitive resection,giving an in-hospital mortality rate of 2%.Overall survival (OS) after extended radical cholecystectomy was 65% at 5 years and 53% at 10 years in all 52 patients.OS differed according to the pT classification (P < 0.001)and the nodal status (P =0.010).All of 3 patients with pT1 tumors and most (29 of 36) patients with pT2 tumors survived for more than 5 years.Of 12 patients with pT3 tumors,8 who had an R1-2 resection,distant metastasis,or extensive extrahepatic organ involvement died soon after resection.Of the remaining four pT3 patients who had localized hepatic spread through the gallbladder fossa and underwent an R0 resection,2 survived for more than 5 years and another survived for 4 years and 2 mo

  5. The effectiveness of a nationwide universal coverage campaign of insecticide-treated bed nets on childhood malaria in Malawi

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    Collins O. F. Zamawe

    2016-10-01

    Full Text Available Abstract Background Although the universal coverage campaign of insecticide-treated mosquito bed nets (ITNs has been associated with improved malaria outcomes, recent reports indicate that the campaign is losing its sparkle in some countries. In Malawi, the universal coverage campaign was implemented in 2012, but its impacts are yet to be ascertained. Thus, this study examined the effects of the campaign on malaria morbidity among children in Malawi. Methods This is a repeated cross-sectional study. The study used nationally-representative malaria indicator survey (MIS data collected in 2012 and 2014. In total, the analysis included 4193 children between the ages of 6 and 59 months (2171 from 2012 MIS and 2022 from 2014 MIS. ITNs coverage and malaria morbidity before (2012 = pre-test/control and after (2014 = post-test/treated the universal coverage campaign of ITNs were compared. The treated and control samples were matched on measured relevant covariates using propensity scores. Results The mean number of ITNs per household improved significantly from 1.1 (SD 1.0 in 2012 to 1.4 (SD 1.1 in 2014 (p < 0.001. Nonetheless, the prevalence of malaria among children increased considerably from 27.7 % (2012 to 32.0 % (2014 (p = 0.002. The risk of malaria was also significantly higher in 2014 compared to 2012 (RR = 1.14; 95 % CI 1.01–1.29. Besides, the use of bed nets was not significantly associated with malaria morbidity in 2014 (RR = 0.92; 95 % CI 0.76–1.12, but it was in 2012 (RR = 0.83; 95 % CI 0.70–1.00. Conclusions The universal coverage campaign of ITNs was not associated with a reduced burden of malaria among children in Malawi. This was likely due to increased insecticide resistance, inconsistent use of bed nets and under-utilization of other methods of malaria control. This calls for a multifaceted approach in the fight against malaria instead of simple dependence on ITNs. In particular, local or community level

  6. STUDY OF RENAL FAILURE IN MALARIA

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    Girish Pamappa

    2016-01-01

    Full Text Available Renal failure is a serious complication of malaria, with a mortality of 14 to 33%. In view of the significant morbidity and mortality due to acute renal failure in malaria, there is need to identify patients at an early stage and to intensify care given to reduce morbidity and mortality. AIMS  To evaluate the clinical profile of Acute Renal Failure (ARF in malaria.  To evaluate the factors associated with adverse outcome, relation of severity of renal impairment on final outcome in patients with ARF due to malaria. MATERIAL AND METHODS This study was conducted at a tertiary care hospital over a period of 12 months. STUDY DESIGN  Type of study: Prospective Analytical, Observational Study.  Sample Size: 50 patients admitted to ICU, Kidney Unit, and the Medicine Wards with Malaria and ARF. Inclusion Criteria Clinically screened patients with evidence of malarial parasites in the blood smears or by antigen detection with clinical features or biochemical evidence of acute renal failure. Exclusion Criteria  Presence of any disease or condition leading to ARF or affecting the outcome of malarial ARF.  Other causes of Fever, Jaundice and Oliguria, like Leptospirosis, Dengue. METHODOLOGY Fifty patients who fulfilled the inclusion criteria were interrogated with regards to the complaints, clinical signs. Blood tests were sent on admission. Details were recorded as per the clinical proforma. The patients were followed until their discharge/death. RESULTS Oliguria was present in only 30% of patients. 30% of patients received haemodialysis. The mortality was 12% for severe renal failure. On Univariate analysis, Acidosis and Cerebral malaria were highly significant predictors of mortality. Other significant predictors were Renal failure, Oliguria, Shock, DIC, Hyperparasitemia, Leukocytosis (TLC. On Multivariate analysis, Oliguria, Cerebral malaria, Acidosis, Shock and two or more complications were the independent predictors of mortality

  7. [Physiopathology of cerebral malaria].

    Science.gov (United States)

    Ringwald, P

    1995-01-01

    Physiopathology of severe malaria is extremely complex and misappreciated. Sequestration of parasited red cells and role of cytokines are now accepted but we still have to discover why only a few people develop a severe malaria. A better knowledge of that physiopathology would allow the conception of new therapeutic strategies to reduce malaria mortality.

  8. Fractal dimension and lacunarity of tumor microscopic images as prognostic indicators of clinical outcome in early breast cancer.

    Science.gov (United States)

    Pribic, Jelena; Vasiljevic, Jelena; Kanjer, Ksenija; Konstantinovic, Zora Neskovic; Milosevic, Nebojsa T; Vukosavljevic, Dragica Nikolic; Radulovic, Marko

    2015-01-01

    Research in the field of breast cancer outcome prognosis has been focused on molecular biomarkers, while neglecting the discovery of novel tumor histology structural clues. We thus aimed to improve breast cancer prognosis by fractal analysis of tumor histomorphology. This retrospective study included 92 breast cancer patients without systemic treatment. Fractal dimension and lacunarity of the breast tumor microscopic histology possess prognostic value comparable to the major clinicopathological prognostic parameters. Fractal analysis was performed for the first time on routinely produced archived pan-tissue stained primary breast tumor sections, indicating its potential for clinical use as a simple and cost-effective prognostic indicator of distant metastasis risk to complement the molecular approaches for cancer risk prognosis.

  9. Vacuolar proton pumps in malaria parasite cells.

    Science.gov (United States)

    Moriyama, Yoshinori; Hayashi, Mitsuko; Yatsushiro, Shouki; Yamamoto, Akitsugu

    2003-08-01

    The malaria parasite is a unicellular protozoan parasite of the genus Plasmodium that causes one of the most serious infectious diseases for human beings. Like other protozoa, the malaria parasite possesses acidic organelles, which may play an essential role(s) in energy acquisition, resistance to antimalarial agents, and vesicular trafficking. Recent evidence has indicated that two types of vacuolar proton pumps, vacuolar H+-ATPase and vacuolar H+-pyrophosphatase, are responsible for their acidification. In this mini-review, we discuss the recent progress on vacuolar proton pumps in the malaria parasite.

  10. Malaria. Can WHO roll back malaria?

    Science.gov (United States)

    Balter, M

    2000-10-20

    In October 1998, World Health Organization Director-General Gro Harlem Brundtland announced Roll Back Malaria, a multiagency crusade that aims to cut malaria mortality in half over the next 10 years. Brundtland might just be the one to pull it off, say numerous public health experts, although some researchers question whether the goal is realistic.

  11. Malaria haplotype frequency estimation.

    Science.gov (United States)

    Wigger, Leonore; Vogt, Julia E; Roth, Volker

    2013-09-20

    We present a Bayesian approach for estimating the relative frequencies of multi-single nucleotide polymorphism (SNP) haplotypes in populations of the malaria parasite Plasmodium falciparum by using microarray SNP data from human blood samples. Each sample comes from a malaria patient and contains one or several parasite clones that may genetically differ. Samples containing multiple parasite clones with different genetic markers pose a special challenge. The situation is comparable with a polyploid organism. The data from each blood sample indicates whether the parasites in the blood carry a mutant or a wildtype allele at various selected genomic positions. If both mutant and wildtype alleles are detected at a given position in a multiply infected sample, the data indicates the presence of both alleles, but the ratio is unknown. Thus, the data only partially reveals which specific combinations of genetic markers (i.e. haplotypes across the examined SNPs) occur in distinct parasite clones. In addition, SNP data may contain errors at non-negligible rates. We use a multinomial mixture model with partially missing observations to represent this data and a Markov chain Monte Carlo method to estimate the haplotype frequencies in a population. Our approach addresses both challenges, multiple infections and data errors.

  12. Coexistence of Malaria and Thalassemia in Malaria Endemic Areas of Thailand

    Science.gov (United States)

    Kuesap, Jiraporn; Chaijaroenkul, W.; Rungsihirunrat, K.; Pongjantharasatien, K.; Na-Bangchang, Kesara

    2015-01-01

    Hemoglobinopathy and malaria are commonly found worldwide particularly in malaria endemic areas. Thalassemia, the alteration of globin chain synthesis, has been reported to confer resistance against malaria. The prevalence of thalassemia was investigated in 101 malaria patients with Plasmodium falciparum and Plasmodium vivax along the Thai-Myanmar border to examine protective effect of thalassemia against severe malaria. Hemoglobin typing was performed using low pressure liquid chromatography (LPLC) and α-thalassemia was confirmed by multiplex PCR. Five types of thalassemia were observed in malaria patients. The 2 major types of thalassemia were Hb E (18.8%) and α-thalassemia-2 (11.9%). There was no association between thalassemia hemoglobinopathy and malaria parasitemia, an indicator of malaria disease severity. Thalassemia had no significant association with P. vivax infection, but the parasitemia in patients with coexistence of P. vivax and thalassemia was about 2-3 times lower than those with coexistence of P. falciparum and thalassemia and malaria without thalassemia. Furthermore, the parasitemia of P. vivax in patients with coexistence of Hb E showed lower value than coexistence with other types of thalassemia and malaria without coexistence. Parasitemia, hemoglobin, and hematocrit values in patients with coexistence of thalassemia other than Hb E were significantly lower than those without coexistence of thalassemia. Furthermore, parasitemia with coexistence of Hb E were 2 times lower than those with coexistence of thalassemia other than Hb E. In conclusion, the results may, at least in part, support the protective effect of thalassemia on the development of hyperparasitemia and severe anemia in malaria patients. PMID:26174819

  13. Clinical malaria in African pregnant women.

    Science.gov (United States)

    Bardají, Azucena; Sigauque, Betuel; Bruni, Laia; Romagosa, Cleofé; Sanz, Sergi; Mabunda, Samuel; Mandomando, Inacio; Aponte, John; Sevene, Esperança; Alonso, Pedro L; Menéndez, Clara

    2008-01-30

    There is a widespread notion, based on limited information, that in areas of stable malaria transmission most pregnant women with Plasmodium falciparum infection are asymptomatic. This study aim to characterize the clinical presentation of malaria in African pregnant women and to evaluate the adequacy of case management based on clinical complaints. A hospital-based descriptive study between August 2003 and November 2005 was conducted at the maternity clinic of a rural hospital in Mozambique. All women attending the maternity clinic were invited to participate. A total of 2,330 women made 3,437 eligible visits, 3129 were analysed, the remainder were excluded because diagnostic results were unavailable or they were repeat visits. Women gave a standardized clinical history and had a medical exam. Malaria parasitaemia and haematocrit in capillary blood was determined for all women with signs or symptoms compatible with malaria including: presence and history of fever, arthromyalgias, headache, history of convulsions and pallor. Outcome measure was association of malaria symptoms or signs with positive blood slide for malaria parasitaemia. In 77.4% of visits pregnant women had symptoms suggestive of malaria; 23% (708/3129) were in the first trimester. Malaria parasitaemia was confirmed in 26.9% (842/3129) of visits. Headache, arthromyalgias and history of fever were the most common symptoms (86.5%, 74.8% and 65.4%) presented, but their positive predictive values for malaria parasitaemia were low [28% (27-30), 29% (28-31), and 33% (31-35), respectively]. Symptoms suggestive of malaria were very frequent among pregnant women attending a rural maternity clinic in an area of stable malaria transmission. However, less than a third of them were parasitaemic. In the absence of microscopy or rapid diagnostic tests, a large proportion of women, including those in the first trimester of gestation, would be unnecessarily receiving antimalarial drugs, often those with unknown

  14. Clinical malaria in African pregnant women

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    Aponte John

    2008-01-01

    Full Text Available Abstract Background There is a widespread notion, based on limited information, that in areas of stable malaria transmission most pregnant women with Plasmodium falciparum infection are asymptomatic. This study aim to characterize the clinical presentation of malaria in African pregnant women and to evaluate the adequacy of case management based on clinical complaints. Methods A hospital-based descriptive study between August 2003 and November 2005 was conducted at the maternity clinic of a rural hospital in Mozambique. All women attending the maternity clinic were invited to participate. A total of 2,330 women made 3,437 eligible visits, 3129 were analysed, the remainder were excluded because diagnostic results were unavailable or they were repeat visits. Women gave a standardized clinical history and had a medical exam. Malaria parasitaemia and haematocrit in capillary blood was determined for all women with signs or symptoms compatible with malaria including: presence and history of fever, arthromyalgias, headache, history of convulsions and pallor. Outcome measure was association of malaria symptoms or signs with positive blood slide for malaria parasitaemia. Results In 77.4% of visits pregnant women had symptoms suggestive of malaria; 23% (708/3129 were in the first trimester. Malaria parasitaemia was confirmed in 26.9% (842/3129 of visits. Headache, arthromyalgias and history of fever were the most common symptoms (86.5%, 74.8% and 65.4% presented, but their positive predictive values for malaria parasitaemia were low [28% (27–30, 29% (28–31, and 33% (31–35, respectively]. Conclusion Symptoms suggestive of malaria were very frequent among pregnant women attending a rural maternity clinic in an area of stable malaria transmission. However, less than a third of them were parasitaemic. In the absence of microscopy or rapid diagnostic tests, a large proportion of women, including those in the first trimester of gestation, would be

  15. Malaria in Children.

    Science.gov (United States)

    Cohee, Lauren M; Laufer, Miriam K

    2017-08-01

    Malaria is a leading cause of morbidity and mortality in endemic areas, leading to an estimated 438,000 deaths in 2015. Malaria is also an important health threat to travelers to endemic countries and should be considered in evaluation of any traveler returning from a malaria-endemic area who develops fever. Considering the diagnosis of malaria in patients with potential exposure is critical. Prompt provision of effective treatment limits the complications of malaria and can be life-saving. Understanding Plasmodium species variation, epidemiology, and drug-resistance patterns in the geographic area where infection was acquired is important for determining treatment choices. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Conquering the intolerable burden of malaria: what's new, what's needed: a summary.

    Science.gov (United States)

    Breman, Joel G; Alilio, Martin S; Mills, Anne

    2004-08-01

    approach for countering the spread and intensity of Plasmodium falciparum resistance to chloroquine, sulfadoxine/pyrimethamine, and other antimalarial drugs. Although costly, ACT ($1.20-2.50 per adult treatment) becomes more cost-effective as resistance to alternative drugs increases; early use of ACT may delay development of resistance to these drugs and prevent the medical toll associated with use of ineffective drugs. The burden of malaria in one district in Tanzania has not decreased since the primary health care approach replaced the vertical malaria control efforts of the 1960s. Despite decentralization, this situation resulted, in part, from weak district management capacity, poor coordination, inadequate monitoring, and lack of training of key staff. Experience in the Solomon Islands showed that spraying with DDT, use of insecticide-treated bed nets (ITNs), and health education were all associated with disease reduction. The use of nets permitted a reduction in DDT spraying, but could not replace it without an increased malaria incidence. Baseline data and reliable monitoring of key outcome indicators are needed to measure whether the ambitious goals for the control of malaria and other diseases has occurred. Such systems are being used for evidence-based decision making in Tanzania and several other countries. Baseline cluster sampling surveys in several countries across Africa indicate that only 53% of the children with febrile illness in malarious areas are being treated; chloroquine (CQ) is used 84% of the time, even where the drug may be ineffective. Insecticide-treated bed nets were used only 2% of the time by children less than five years of age. Progress in malaria vaccine research has been substantial over the past five years; 35 candidate malaria vaccines are in development, many of which are in clinical trials. Development of new vaccines and drugs has been the result of increased investments and formation of public-private partnerships. Before malaria

  17. Malaria og graviditet

    DEFF Research Database (Denmark)

    Hoffmann, A L; Rønn, A M; Langhoff-Roos, J

    1992-01-01

    In regions where malaria is endemism, the disease is a recognised cause of complications of pregnancy such as spontaneous abortion, premature delivery, intrauterine growth retardation and foetal death. Malaria is seldom seen in pregnant women in Denmark but, during the past two years, the authors...... the patients but also their practitioners were unaware that malaria can occur several years after exposure. Three out of the four patients had employed malaria prophylaxis. As resistance to malarial prophylactics in current use is increasing steadily, chemoprophylaxis should be supplemented by mechanical...... protection against malaria and insect repellents. As a rule, malaria is treated with chloroquine. In cases of Falciparum malaria in whom chloroquine resistance is suspected, treatment with mefloquine may be employed although this should only be employed in cases of dire necessity in pregnant patients during...

  18. The Effect of Indoor Residual Spraying on the Prevalence of Malaria Parasite Infection, Clinical Malaria and Anemia in an Area of Perennial Transmission and Moderate Coverage of Insecticide Treated Nets in Western Kenya.

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    John E Gimnig

    Full Text Available Insecticide treated nets (ITNs and indoor residual spraying (IRS have been scaled up for malaria prevention in sub-Saharan Africa. However, there are few studies on the benefit of implementing IRS in areas with moderate to high coverage of ITNs. We evaluated the impact of an IRS program on malaria related outcomes in western Kenya, an area of intense perennial malaria transmission and moderate ITN coverage (55-65% use of any net the previous night.The Kenya Division of Malaria Control, with support from the US President's Malaria Initiative, conducted IRS in one lowland endemic district with moderate coverage of ITNs. Surveys were conducted in the IRS district and a neighboring district before IRS, after one round of IRS in July-Sept 2008 and after a second round of IRS in April-May 2009. IRS was conducted with pyrethroid insecticides. At each survey, 30 clusters were selected for sampling and within each cluster, 12 compounds were randomly selected. The primary outcomes measured in all residents of selected compounds included malaria parasitemia, clinical malaria (P. falciparum infection plus history of fever and anemia (Hb<8 of all residents in randomly selected compounds. At each survey round, individuals from the IRS district were matched to those from the non-IRS district using propensity scores and multivariate logistic regression models were constructed based on the matched dataset.At baseline and after one round of IRS, there were no differences between the two districts in the prevalence of malaria parasitemia, clinical malaria or anemia. After two rounds of IRS, the prevalence of malaria parasitemia was 6.4% in the IRS district compared to 16.7% in the comparison district (OR = 0.36, 95% CI = 0.22-0.59, p<0.001. The prevalence of clinical malaria was also lower in the IRS district (1.8% vs. 4.9%, OR = 0.37, 95% CI = 0.20-0.68, p = 0.001. The prevalence of anemia was lower in the IRS district but only in children under 5 years of age (2

  19. Perceptions and Attitudes of Resident Doctors about Malaria Treatment as Per National Drug Policy on Malaria

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    Ghanshyam Ahir, D V Bala

    2012-01-01

    Full Text Available Background: The involvement of public and private health care providers in malaria treatment, particularly understanding their knowledge and practices will aid in devising strategies to increase the rational use of antimalarial drugs. They should be aware about rationale and implement national drug policy on malaria to prevent morbidity and mortality of malaria as well as development of antimalarial drug resistance. Therefore, a study was planned on the same issue among resident doctors of a tertiary care teaching hospital. Objective: To study the perceptions and attitudes of resident doctors regarding use of anti malarial drugs for treatment of all types of malaria cases in accordance with national drug policy on malaria-2010. Methodology: This cross-sectional study was conducted at tertiary care teaching hospital with sixty four (64 resident doctors of medicine (24, pediatrics (24 and obstetrics (16 departments with the help of pre tested; semi-structured questionnaire based on national drug policy on malaria-2010 from 15th July to 30th August 2010. Results: Only 12 (18.8% residents were aware about drug policy. Dose and duration and indication of primaquine was known to 21 (32.8% of resident doctors. Artesunate (49.2% and Arteether (16.9% were commonly prescribed in case of uncomplicated P.falciparum and P.vivax malaria. Conclusion: It was noticeable that knowledge and awareness regarding drug policy among resident doctors was unsatisfactory. Regular sensitization programme on malaria drug policy should be conducted.

  20. Predictors of Outcome in Traumatic Brain Injury: New Insight Using Receiver Operating Curve Indices and Bayesian Network Analysis.

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    Zsolt Zador

    Full Text Available Traumatic brain injury remains a global health problem. Understanding the relative importance of outcome predictors helps optimize our treatment strategies by informing assessment protocols, clinical decisions and trial designs. In this study we establish importance ranking for outcome predictors based on receiver operating indices to identify key predictors of outcome and create simple predictive models. We then explore the associations between key outcome predictors using Bayesian networks to gain further insight into predictor importance.We analyzed the corticosteroid randomization after significant head injury (CRASH trial database of 10008 patients and included patients for whom demographics, injury characteristics, computer tomography (CT findings and Glasgow Outcome Scale (GCS were recorded (total of 13 predictors, which would be available to clinicians within a few hours following the injury in 6945 patients. Predictions of clinical outcome (death or severe disability at 6 months were performed using logistic regression models with 5-fold cross validation. Predictive performance was measured using standardized partial area (pAUC under the receiver operating curve (ROC and we used Delong test for comparisons. Variable importance ranking was based on pAUC targeted at specificity (pAUCSP and sensitivity (pAUCSE intervals of 90-100%. Probabilistic associations were depicted using Bayesian networks.Complete AUC analysis showed very good predictive power (AUC = 0.8237, 95% CI: 0.8138-0.8336 for the complete model. Specificity focused importance ranking highlighted age, pupillary, motor responses, obliteration of basal cisterns/3rd ventricle and midline shift. Interestingly when targeting model sensitivity, the highest-ranking variables were age, severe extracranial injury, verbal response, hematoma on CT and motor response. Simplified models, which included only these key predictors, had similar performance (pAUCSP = 0.6523, 95% CI: 0

  1. Introduction of an acute surgical unit: comparison of performance indicators and outcomes for operative management of acute appendicitis.

    Science.gov (United States)

    Lancashire, John F; Steele, M; Parker, D; Puhalla, H

    2014-08-01

    The Acute Surgical Unit (ASU) is a recent change in management of acute general surgical patients in hospitals worldwide. In contrast to traditional management of acute surgical presentations by a rotating on-call system, ASUs are shown to deliver improved efficiency and patient outcomes. This study investigated the impact of an ASU on operative management of appendicitis, the most common acute surgical presentation, by comparing performance indicators and patient outcomes prior to and after introduction of an ASU at the Gold Coast Hospital, Queensland, Australia. A retrospective study of patients admitted from the Emergency Department (ED) and who underwent emergency appendectomy from February 2010 to January 2011 (pre-ASU) and after introduction of the ASU from February 2011 to January 2012 (post-ASU). A total of 548 patients underwent appendectomy between February 2010 and January 2012, comprising 247 pre-ASU and 301 post-ASU patients. Significant improvements were demonstrated: reduced time to surgical review, fewer complications arising from operations commencing during ASU in-hours, and more appendectomies performed during the daytime attended by the consultant. There was no significant difference in total cost of admission or total admission length of stay. This study demonstrated that ASUs have potential to significantly improve the outcomes for operative management of acute appendicitis compared to the traditional on-call model. The impact of the ASU was limited by access to theaters and restricted ASU operation hours. Further investigation of site-specific determinants could be beneficial to optimize this new model of acute surgical care.

  2. Severe acute renal failure in malaria.

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    Mehta K

    2001-01-01

    Full Text Available BACKGROUND: We have noticed a recent rise in the incidence and severity of acute renal failure (ARF in malaria. AIM: To study the incidence, severity and outcome of ARF in malaria. SETTING and DESIGN: It is a retrospective analysis of data of one year from a tertiary medical centre in a metropolitan city. MATERIALS AND METHODS: Patients with ARF and smear positive malaria were evaluated. STATISTICAL ANALYSIS: Results were expressed as mean, range and standard deviation. RESULTS: Out of 402 detected smear positive malaria, 24 had ARF. Eighteen were of the age group 21-40 years. Plasmodium falciparum (PF was detected in 16, Plasmodium vivax in three, and mixed infection in five. Non-oliguric ARF was seen in 14. Eighteen showed severe ARF (Serum creatinine >5 mg%. Twenty-two patients needed dialysis. Prolonged ARF lasting for 2-6 weeks was seen in eight. Seventeen patients recovered completely, while seven showed fatal combination of disseminated intravascular coagulation (DIC, acute respiratory distress syndrome (ARDS, severe ARF and PF malaria. No response was seen to chloroquine and artesunate given alone and twenty patients required quinine. CONCLUSION: ARF necessitating dialysis was seen in 92% of patients with ARF in malaria. PF infection, severe ARF, DIC and ARDS were poor prognostic factors. Resistance was noted to both chloroquine and artesunate.

  3. Potential of using remote sensing for forecasting malaria in Tripura, India

    Science.gov (United States)

    Nizamuddin, Mohammad; Roytman, Leonid; Goldberg, Mitch; Kogan, Felix

    2010-08-01

    This study examined the relationship between environmental factors and malaria epidemic. The objective is to use NOAA environmental satellite data to produce weather seasonal forecasts as a proxy for predicting malaria epidemics in Tripura, India which has the one of the highest endemic of malaria cases in the country. An algorithm uses the Vegetation Health (VH) Indices (Vegetation Condition Index( VCI) and Temperature Condition Index (TCI)) computed from Advance Very High Resolution Radiometer (AVHRR) data flown on NOAA afternoon poler orbiting satellite.. A good correlation was found between malaria cases and TCI two months earlier than the malaria transmission period. Principal components regression (PCR) method was used to develop a model to predict malaria as a function of the TCI. The simulated results were compared with observed malaria statistics showing that the error of the estimates of malaria is small. Remote sensing therefore is a valuable tool for estimating malaria well in advance thus preventive measures can be taken.

  4. Ungulate malaria parasites

    Science.gov (United States)

    Templeton, Thomas J.; Asada, Masahito; Jiratanh, Montakan; Ishikawa, Sohta A.; Tiawsirisup, Sonthaya; Sivakumar, Thillaiampalam; Namangala, Boniface; Takeda, Mika; Mohkaew, Kingdao; Ngamjituea, Supawan; Inoue, Noboru; Sugimoto, Chihiro; Inagaki, Yuji; Suzuki, Yasuhiko; Yokoyama, Naoaki; Kaewthamasorn, Morakot; Kaneko, Osamu

    2016-01-01

    Haemosporida parasites of even-toed ungulates are diverse and globally distributed, but since their discovery in 1913 their characterization has relied exclusively on microscopy-based descriptions. In order to bring molecular approaches to bear on the identity and evolutionary relationships of ungulate malaria parasites, we conducted Plasmodium cytb-specific nested PCR surveys using blood from water buffalo in Vietnam and Thailand, and goats in Zambia. We found that Plasmodium is readily detectable from water buffalo in these countries, indicating that buffalo Plasmodium is distributed in a wider region than India, which is the only area in which buffalo Plasmodium has been reported. Two types (I and II) of Plasmodium sequences were identified from water buffalo and a third type (III) was isolated from goat. Morphology of the parasite was confirmed in Giemsa-reagent stained blood smears for the Type I sample. Complete mitochondrial DNA sequences were isolated and used to infer a phylogeny in which ungulate malaria parasites form a monophyletic clade within the Haemosporida, and branch prior to the clade containing bird, lizard and other mammalian Plasmodium. Thus it is likely that host switching of Plasmodium from birds to mammals occurred multiple times, with a switch to ungulates independently from other mammalian Plasmodium. PMID:26996979

  5. Malaria in Pregnancy

    Directory of Open Access Journals (Sweden)

    E E Okpere

    2010-01-01

    Full Text Available Malaria remains one of the highest contributors to the precarious maternal mortality figures in sub-Saharan Africa. At least 6 million women worldwide are at risk of malaria infection in pregnancy. Malaria contributes to at least 10, 000 maternal deaths and to at least 200, 000 newborn deaths annually. Malaria is a contributor or aetiologic factor in pregnancy complications including anaemia, spontaneous abortion, prematurity and stillbirths. Pregnancy results in increased incidence and severity of malaria. Cerebral malaria, acute renal failure and severe anaemia, rare complications in adults living in malaria endemic areas, may complicate malaria in pregnancy. Research implicate reduced maternal immunity from increased steroid levels in pregnancy, increased attractiveness of pregnant women to mosquito bites and increased adherence of parasitized erythrocytes to Chondroitin sulphate A expressed in the placentae. This is worse in the first and second pregnancies. With infection with the Human Immunodeficiency Virus [HIV], the effects of malaria in pregnancy are even worse. Over the decades, there have been concerted worldwide collaborative efforts, spearheaded by the World Health Organization [WHO] and including governments and allied agencies to tackle the scourge of malaria in pregnancy. The main thrusts of such efforts have been: to increase the use of insecticide treated mosquito bed nets [ITN]; intermittent preventive treatment of malaria [IPT]; and adequate case treatment of acute malaria attacks in pregnancy. While for IPT, Sulfadoxine-Pyrimethamine [SP] combination has been proven to be of benefit in preventing acute and latent malaria in pregnancy and its associated complications, the WHO has introduced the use of Artemisinin-Combination Therapy [ACT] for the first-line treatment of uncomplicated malaria in pregnancy, the need to confirm malaria before treatment and the enforcement of completion of therapy once started. The Roll Back

  6. Malaria vector research and control in Haiti: a systematic review.

    Science.gov (United States)

    Frederick, Joseph; Saint Jean, Yvan; Lemoine, Jean Frantz; Dotson, Ellen M; Mace, Kimberly E; Chang, Michelle; Slutsker, Laurence; Le Menach, Arnaud; Beier, John C; Eisele, Thomas P; Okech, Bernard A; Beau de Rochars, Valery Madsen; Carter, Keith H; Keating, Joseph; Impoinvil, Daniel E

    2016-07-22

    Haiti has a set a target of eliminating malaria by 2020. However, information on malaria vector research in Haiti is not well known. This paper presents results from a systematic review of the literature on malaria vector research, bionomics and control in Haiti. A systematic search of literature published in French, Spanish and English languages was conducted in 2015 using Pubmed (MEDLINE), Google Scholar, EMBASE, JSTOR WHOLIS and Web of Science databases as well other grey literature sources such as USAID, and PAHO. The following search terms were used: malaria, Haiti, Anopheles, and vector control. A total of 132 references were identified with 40 high quality references deemed relevant and included in this review. Six references dealt with mosquito distribution, seven with larval mosquito ecology, 16 with adult mosquito ecology, three with entomological indicators of malaria transmission, eight with insecticide resistance, one with sero-epidemiology and 16 with vector control. In the last 15 years (2000-2015), there have only been four published papers and three-scientific meeting abstracts on entomology for malaria in Haiti. Overall, the general literature on malaria vector research in Haiti is limited and dated. Entomological information generated from past studies in Haiti will contribute to the development of strategies to achieve malaria elimination on Hispaniola. However it is of paramount importance that malaria vector research in Haiti is updated to inform decision-making for vector control strategies in support of malaria elimination.

  7. KEMUNGKINAN MALARIA PRIMATA SEBAGAI MASALAH ZOONOSIS

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    Shinta Shinta

    2012-09-01

    Full Text Available Until today, four species of Plasmodium are pedicular to inan {Plasmodium falciparum, P. vivax, P. malariae, and P. ovale and at least five species are common in simian: Plasmodium inue, P. cynomolgy, P. knowlesi, P. brasilianum and P. simium. There is little doubts that simian Plasmodium can infect man, it is known as zoonosis. Number of cases of zoonosis infection of simian Plasmodium have been reported from several countries; P. knowlesi (1965, in America, P. simium (1966 in Brazilia, P. inui (1971 in Pahang Malaysia, P. cynomolgi (1973 in America and P. Brazilianum in Sao Paulo (1966, 1995. While pro and contra about zoonotic malaria still not clearly discussed, the new cases have occurred. This give an indication that this zoor >tic malaria will probably be in Indonesia where human, primate, Plasmodium (agents and vector live in the same ecosystem. This paper will discuss the simian Plasmodium and its possibility to be a zoonotic malaria.

  8. Management of imported malaria in Europe

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    Askling Helena H

    2012-09-01

    Full Text Available Abstract In this position paper, the European Society for Clinical Microbiology and Infectious Diseases, Study Group on Clinical Parasitology, summarizes main issues regarding the management of imported malaria cases. Malaria is a rare diagnosis in Europe, but it is a medical emergency. A travel history is the key to suspecting malaria and is mandatory in patients with fever. There are no specific clinical signs or symptoms of malaria although fever is seen in almost all non-immune patients. Migrants from malaria endemic areas may have few symptoms. Malaria diagnostics should be performed immediately on suspicion of malaria and the gold- standard is microscopy of Giemsa-stained thick and thin blood films. A Rapid Diagnostic Test (RDT may be used as an initial screening tool, but does not replace urgent microscopy which should be done in parallel. Delays in microscopy, however, should not lead to delayed initiation of appropriate treatment. Patients diagnosed with malaria should usually be hospitalized. If outpatient management is preferred, as is the practice in some European centres, patients must usually be followed closely (at least daily until clinical and parasitological cure. Treatment of uncomplicated Plasmodium falciparum malaria is either with oral artemisinin combination therapy (ACT or with the combination atovaquone/proguanil. Two forms of ACT are available in Europe: artemether/lumefantrine and dihydroartemisinin/piperaquine. ACT is also effective against Plasmodium vivax, Plasmodium ovale, Plasmodium malariae and Plasmodium knowlesi, but these species can be treated with chloroquine. Treatment of persistent liver forms in P. vivax and P. ovale with primaquine is indicated after excluding glucose 6 phosphate dehydrogenase deficiency. There are modified schedules and drug options for the treatment of malaria in special patient groups, such as children and pregnant women. The potential for drug interactions and the role of food in the

  9. Landscape ecology and epidemiology of malaria associated with rubber plantations in Thailand: integrated approaches to malaria ecotoping.

    Science.gov (United States)

    Kaewwaen, Wuthichai; Bhumiratana, Adisak

    2015-01-01

    The agricultural land use changes that are human-induced changes in agroforestry ecosystems and in physical environmental conditions contribute substantially to the potential risks for malaria transmission in receptive areas. Due to the pattern and extent of land use change, the risks or negatively ecosystemic outcomes are the results of the dynamics of malaria transmission, the susceptibility of human populations, and the geographical distribution of malaria vectors. This review focused basically on what are the potential effects of agricultural land use change as a result of the expansion of rubber plantations in Thailand and how significant the ecotopes of malaria-associated rubber plantations (MRP) are. More profoundly, this review synthesized the novel concepts and perspectives on applied landscape ecology and epidemiology of malaria, as well as approaches to determine the degree to which an MRP ecotope as fundamental landscape scale can establish malaria infection pocket(s). Malaria ecotoping encompasses the integrated approaches and tools applied to or used in modeling malaria transmission. The scalability of MRP ecotope depends upon its unique landscape structure as it is geographically associated with the infestation or reinfestation of Anopheles vectors, along with the attributes that are epidemiologically linked with the infections. The MRP ecotope can be depicted as the hotspot such that malaria transmission is modeled upon the MRP factors underlying human settlements and movement activities, health behaviors, land use/land cover change, malaria vector population dynamics, and agrienvironmental and climatic conditions. The systemic and uniform approaches to malaria ecotoping underpin the stratification of the potential risks for malaria transmission by making use of remotely sensed satellite imagery or landscape aerial photography using unmanned aerial vehicle (UAV), global positioning systems (GPS), and geographical information systems (GIS).

  10. Landscape Ecology and Epidemiology of Malaria Associated with Rubber Plantations in Thailand: Integrated Approaches to Malaria Ecotoping

    Directory of Open Access Journals (Sweden)

    Wuthichai Kaewwaen

    2015-01-01

    Full Text Available The agricultural land use changes that are human-induced changes in agroforestry ecosystems and in physical environmental conditions contribute substantially to the potential risks for malaria transmission in receptive areas. Due to the pattern and extent of land use change, the risks or negatively ecosystemic outcomes are the results of the dynamics of malaria transmission, the susceptibility of human populations, and the geographical distribution of malaria vectors. This review focused basically on what are the potential effects of agricultural land use change as a result of the expansion of rubber plantations in Thailand and how significant the ecotopes of malaria-associated rubber plantations (MRP are. More profoundly, this review synthesized the novel concepts and perspectives on applied landscape ecology and epidemiology of malaria, as well as approaches to determine the degree to which an MRP ecotope as fundamental landscape scale can establish malaria infection pocket(s. Malaria ecotoping encompasses the integrated approaches and tools applied to or used in modeling malaria transmission. The scalability of MRP ecotope depends upon its unique landscape structure as it is geographically associated with the infestation or reinfestation of Anopheles vectors, along with the attributes that are epidemiologically linked with the infections. The MRP ecotope can be depicted as the hotspot such that malaria transmission is modeled upon the MRP factors underlying human settlements and movement activities, health behaviors, land use/land cover change, malaria vector population dynamics, and agrienvironmental and climatic conditions. The systemic and uniform approaches to malaria ecotoping underpin the stratification of the potential risks for malaria transmission by making use of remotely sensed satellite imagery or landscape aerial photography using unmanned aerial vehicle (UAV, global positioning systems (GPS, and geographical information systems

  11. Geographical Disparities in the Health of Iranian Women: Health Outcomes, Behaviors, and Health-care Access Indicators

    Science.gov (United States)

    Bayati, Mohsen; Feyzabadi, Vahid Yazdi; Rashidian, Arash

    2017-01-01

    Background: Women's health is a key factor affecting the health of the whole population. Tackling inequality in determinants of health is recognized as the main path toward reducing the inequality in health outcomes. This study aimed to analyze the provincial inequality in determinants of women's health and health care in Iran. Methods: Using the Moss's model (2002) as a comprehensive framework of determinants of women's health, including “geopolitical environment,” “culture, norms, sanctions,” “women's roles in reproduction and production,” “health-related mediators,” and “health outcome” categories, we chose 13 indicators. Afterward, using data sources including the Iranian Multiple Indicators of Demographics and Health Survey, the National Organization for Civil Registration, and Statistics Centre of Iran, we analyzed provincial inequality in these indicators in Iran (2011). Gini coefficient and Lorenz curve were used for measuring inequality. Results: Gini coefficients calculated as follows; life satisfaction level (0.027), literate women (0.398), women with proper knowledge about HIV/AIDS prevention (0.483), unemployed women (0.380), women without an income (0.384), women who use at least one type of mass media (0.389), women who used computer or internet (0.467), women who had received pregnancy care from a skill birth attendant (SBA) (0.420), women who had delivered with the help of an SBA (0.426), women who currently smoke cigarettes (0.603), women who currently consume hookah (0.561), women with at least one chronic disease (0.438), and women's deaths in 2010 and 2011 (0.393 and 0.359, respectively). Conclusions: We found large provincial disparities in determinants of women's health in Iran. Determinants such as lifestyle, health behavior, health knowledge, and health-care services availability should be considered by health policymakers in addressing the inequality in women's health at a provincial level.

  12. Increase in annexin V-positive B cells expressing LILRB1/ILT2/CD85j in malaria.

    Science.gov (United States)

    Kalmbach, Yvonne; Boldt, Angelica B W; Fendel, Rolf; Mordmüller, Benjamin; Kremsner, Peter G; Kun, Jürgen F J

    2006-09-01

    The outcome of a Plasmodium falciparum infection differs greatly between patients, ranging from an asymptomatic carrier status to the most severe characteristics influenced by activating and inhibiting immune factors. The inhibitory leukocyte immunoglobulin-like receptor (LILRB1/CD85j) plays an important role in the immune response as regulator of cytotoxic T cells and of premature activation and clonal expansion of B cells. To investigate its role in malaria, we analyzed blood samples from malaria patients by cytometric analysis. We found a similar expression pattern of CD85j on PBMC in both patients and healthy children. However, malaria patients presented significantly more CD85j+ CD19+ B cells, which also bound annexin V an indicator of early cell death. We compared the plasma levels of several cytokines, since it was speculated that CD85j expression influences cytokine release. Production of inflammatory cytokines was significantly increased in severe malaria cases. We suggest that in malaria, dying B cells contribute to the overwhelming cytokine release and the impairment of the immune memory.

  13. Evaluation of the association between long-lasting insecticidal nets mass distribution campaigns and child malaria in Nigeria

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    Kyu Hmwe Hmwe

    2013-01-01

    Full Text Available Abstract Background Nigeria carries the greatest malaria burden among countries in the world. As part of the National Malaria Control Strategic Plan, free long-lasting insecticidal nets (LLINs were distributed in 14 states of Nigeria through mass campaigns led by different organizations (the World Bank, UNICEF, or the Global Fund between May 2009 and August 2010. The objective of this study was to evaluate the association between LLIN distribution campaigns and child malaria in Nigeria. Methods Data were from the Nigeria Malaria Indicator Survey which was carried out from October to December 2010 on a nationally representative sample of households. Participants were women aged 15–49 years and their children aged less than five years (N = 4082. The main outcome measure was the presence or absence of malaria parasites in blood samples of children (6–59 months. Results Compared with children living in communities with no campaigns, those in the campaign areas were less likely to test positive for malaria after adjusting for geographic locations, community- and individual-level characteristics including child-level use of insecticide-treated nets (ITNs. The protective effects were statistically significant for the World Bank Booster Project areas (OR = 0.18, 95% CI = 0.04-0.73 but did not reach statistical significance for other campaign areas. Results also showed that community-level wealth (OR = 0.51, 95% CI = 0.34-0.76, community-level maternal knowledge regarding malaria prevention (OR = 0.70, 95% CI = 0.50-0.97, and child-level use of ITNs (OR = 0.79, 95% CI = 0.63-0.99 were negatively associated with child malaria. Conclusions The observed protective effects on child malaria of these campaigns (statistically significant in the World Bank Booster Project areas and non-significant in the other areas need to be corroborated by future effectiveness studies. Results also show that improving community

  14. Plasmodium falciparum malaria in infants under 5 kg: retrospective surveillance of hospital records in five sub-saharan African countries.

    Science.gov (United States)

    Alao, Maroufou J; Gbadoé, Adama D; Meremikwu, Martin; Tshefu, Antoinette; Tiono, Alfred B; Cousin, Marc; Hamed, Kamal

    2013-04-01

    To investigate the disease burden, clinical features, treatment and outcomes of Plasmodium falciparum malaria in neonates and infants weighing Plasmodium falciparum malaria exists in this subpopulation. Further epidemiological data are needed to estimate malaria morbidity and mortality in young infants. Moreover, clinical evidence on the efficacy and safety of artemisinin-based combination therapies in this subpopulation is warranted.

  15. Loss of cellular immune reactivity during acute Plasmodium falciparum malaria

    DEFF Research Database (Denmark)

    Hviid, L; Theander, T G; Abu-Zeid, Y A;

    1991-01-01

    Sixteen patients suffering from acute Plasmodium falciparum malaria were studied. All were residents of an area of unstable malaria-transmission in Eastern Sudan. Blood-samples were drawn at diagnosis, and 7 and 30 days later. Blood-samples from thirteen donors, drawn outside the malaria...... convalescence. Five donors examined by fluorescence-activated cell sorting (FACS) showed no increase in surface expression of IL-2 receptor on peripheral lymphocytes. The data indicate that acute P. falciparum malaria causes a depletion of antigen-reactive T-cells from the peripheral circulation, probably due...

  16. Loss of cellular immune reactivity during acute Plasmodium falciparum malaria

    DEFF Research Database (Denmark)

    Hviid, L; Theander, T G; Abu-Zeid, Y A

    1991-01-01

    Sixteen patients suffering from acute Plasmodium falciparum malaria were studied. All were residents of an area of unstable malaria-transmission in Eastern Sudan. Blood-samples were drawn at diagnosis, and 7 and 30 days later. Blood-samples from thirteen donors, drawn outside the malaria...... convalescence. Five donors examined by fluorescence-activated cell sorting (FACS) showed no increase in surface expression of IL-2 receptor on peripheral lymphocytes. The data indicate that acute P. falciparum malaria causes a depletion of antigen-reactive T-cells from the peripheral circulation, probably due...

  17. Cerebral malaria: insight into pathogenesis, complications and molecular biomarkers

    Science.gov (United States)

    Yusuf, Farah Hafiz; Hafiz, Muhammad Yusuf; Shoaib, Maria; Ahmed, Syed Ahsanuddin

    2017-01-01

    Cerebral malaria is a medical emergency. All patients with Plasmodium falciparum malaria with neurologic manifestations of any degree should be urgently treated as cases of cerebral malaria. Pathogenesis of cerebral malaria is due to damaged vascular endothelium by parasite sequestration, inflammatory cytokine production and vascular leakage, which result in brain hypoxia, as indicated by increased lactate and alanine concentrations. The levels of the biomarkers’ histidine-rich protein II, angiopoietin-Tie-2 system and plasma osteoprotegrin serve as diagnostic and prognostic markers. Brain imaging may show neuropathology around the caudate and putamen. Mortality is high and patients who survive sustain brain injury which manifests as long-term neurocognitive impairments. PMID:28203097

  18. Malaria and Tropical Travel

    Centers for Disease Control (CDC) Podcasts

    2008-05-15

    Malaria is a serious mosquito-borne disease that can lead to death. This podcast discusses malaria risk when traveling to tropical areas, as well as how to protect yourself and your family from malaria infection.  Created: 5/15/2008 by National Center for Zoonotic, Vector-Borne, and Enteric Diseases (NCZVED).   Date Released: 5/29/2008.

  19. The development of leadership outcome-indicators evaluating the contribution of clinical specialists and advanced practitioners to health care: a secondary analysis.

    LENUS (Irish Health Repository)

    Elliott, Naomi

    2014-05-01

    To report a secondary analysis of data collected from the case study phase of a national study of advanced practitioners and to develop leadership outcome-indicators appropriate for advanced practitioners.

  20. Elevated plasma urokinase receptor predicts low birth weight in maternal malaria

    DEFF Research Database (Denmark)

    Ostrowski, S R; Shulman, C E; Peshu, N

    2007-01-01

    The blood level of soluble urokinase receptor (suPAR) is increased and associated with a poor clinical or fatal outcome in children with acute malaria. This study hypothesized that the suPAR level would be associated with foetal outcome in maternal malaria. suPAR was measured by ELISA in maternal...

  1. Progress towards implementation of ACT malaria case-management in public health facilities in the Republic of Sudan: a cluster-sample survey

    Directory of Open Access Journals (Sweden)

    Abdelgader Tarig M

    2012-01-01

    Full Text Available Abstract Background Effective malaria case-management based on artemisinin-based combination therapy (ACT and parasitological diagnosis is a major pillar within the 2007-2012 National Malaria Strategic Plan in the Sudan. Three years after the launch of the strategy a health facility survey was undertaken to evaluate case-management practices and readiness of the health facilities and health workers to implement a new malaria case-management strategy. Methods A cross-sectional, cluster sample survey was undertaken at public health facilities in 15 states of Sudan. Data were collected using quality-of-care assessment methods. The main outcomes were the proportions of facilities with ACTs and malaria diagnostics; proportions of health workers exposed to malaria related health systems support activities; and composite and individual indicators of case-management practices for febrile outpatients stratified by age, availability of ACTs and diagnostics, use of malaria diagnostics, and test result. Results We evaluated 244 facilities, 294 health workers and 1,643 consultations for febrile outpatients (425 Conclusions Five years following change of the policy from chloroquine to ACTs and 3 years before the end of the new malaria strategic plan chloroquine was successfully phased out from public facilities in Sudan, however, an important gap remained in the availability of ACTs, diagnostic capacities and coverage with malaria case-management activities. The national scale-up of diagnostics, using the findings of this survey as well as future qualitative research, should present an opportunity not only to expand existing testing capacities but also to implement effective support interventions to bridge the health systems gaps and support corrective case-management measures, including the discontinuation of artemether monotherapy treatment.

  2. Type III frontal sinusotomy: surgical technique, indications, outcomes, a multi-university retrospective study of 120 cases.

    Science.gov (United States)

    Eloy, P; Vlaminck, S; Jorissen, M; Hellings, P; Timmermans, M; Daele, J; Ransky, P; Hassid, S; Van Zele, T; Bachert, C; Poirrier, A L; Bertrand, B

    2011-01-01

    Draf in 1991. The procedure--which is also known as the modified endoscopic Lothrop procedure--aims to create the largest possible anteroposterior and lateral to lateral opening between both frontal sinuses and the nasal cavities. This requires the resection of the medial floor of both frontal sinuses, the intersinus septum and the superior nasal septum. The authors present a retrospective study including a cohort of 120 patients who underwent surgery in six Belgian university ENT departments. Mean follow-up was 24.6 months (range: 5-36 months). This paper describes the surgical procedure and reviews the indications, comorbidities, outcomes and complications of the type III frontal sinusotomy. Some correlations are also established with the data published in the worldwide literature. The authors conclude that the Draf III is a demanding procedure requiring considerable expertise in endoscopic sinus surgery. The procedure is effective with a success rate of 87.5%. Indeed, 12.5% of patients only experienced closure of the neoostium while 20% of all the patients had unchanged or worse symptomatology. The percentage of post-operative complications is 7.5%. All complications were managed successfully.

  3. Peer victimization during middle childhood as a lead indicator of internalizing problems and diagnostic outcomes in late adolescence.

    Science.gov (United States)

    Schwartz, David; Lansford, Jennifer E; Dodge, Kenneth A; Pettit, Gregory S; Bates, John E

    2015-01-01

    We examined evidence that peer victimization in middle childhood is a lead indicator of internalizing behavior problems and diagnostic outcomes during adolescence. This research was conducted as part of an ongoing multisite longitudinal investigation. The participants were 388 children (198 boys, 190 girls). Peer victimization was assessed with a peer nomination inventory that was administered when the average age of the participants was approximately 8.5 years. Internalizing problems were assessed using a behavior problem checklist completed by mothers in 9 consecutive years, and a structured clinical interview was administered to the participants in the summer following high school graduation (10-11 years after the victimization assessment). Peer victimization in middle childhood was correlated with internalizing problems on a bivariate basis through the late years of adolescence. Multilevel analyses also revealed associations between peer victimization and increases in internalizing problems over time. In addition, peer victimization had a modest link to unipolar depressive disorders in late adolescence. Victimization in the peer group during middle childhood appears to be a marker of long-term risk for internalizing behavior problems and unipolar depression.

  4. Molecular approaches to epidemiology and clinical aspects of malaria.

    Science.gov (United States)

    Brown, G V; Beck, H P; Molyneux, M; Marsh, K

    2000-10-01

    Malaria is a problem of global importance, responsible for 1-2 million deaths per year, mainly in African children, as well as considerable morbidity manifested as severe anaemia and encephalopathy in young children. Fundamental to the development of new tools for malaria control in humans is an increased understanding of key features of malaria infection, such as the diversity of outcome in different individuals, the understanding of different manifestations of the disease and of the mechanisms of immunity that allow clinical protection in the face of ongoing low-grade infection (concomitant immunity or premunition). Here, Graham Brown and colleagues review some of the ways in which molecular approaches might be used to increase our understanding of the epidemiology and clinical manifestations of malaria, as discussed at the Molecular Approaches to Malaria conference (MAM2000), Lorne, Australia, 2-5 February 2000.

  5. Assessment of Pregnancy Status, Malaria Knowledge and Malaria Fever Morbidity among Women of Reproductive Ages in Nigeria.

    Directory of Open Access Journals (Sweden)

    Abayomi Samuel Oyekale

    2014-09-01

    Full Text Available Malaria is one the major health problem in Nigeria. During pregnancy, it poses serious threat to the survival of both unborn foetus and the mothers. This study determined the effect of adequate malaria knowledge and pregnancy status of women on use of mosquito nets and reported malaria fever morbidity.The data were collected during the Malaria Indicator Survey (MIS from 4632 women. Data analyses were carried out with descriptive statistics and Seemingly Unrelated Bivariate Probit regression.Results show that 13.19% of the women were pregnant, of which about one-third slept under mosquito nets. Also, 25.26% reported malaria associated fever in the previous two weeks to the time of interview, while 78.28% correctly answered that mosquitoes are responsible for malaria. Knowledge on malaria prevention was low with 55.70% and 14.93% indicating sleeping under mosquito nets and ITN, respectively. Probability of sleeping under mosquito nets significantly increased with knowing that sleeping under mosquito nets and ITN could prevent malaria while it decreased with having fever, age, urban residence and knowing that use of mosquito spray and coil can prevent malaria. The probability of having fever increased significantly with household size, being pregnant and age at first birth but decreased with age, knowing that sleeping under ITN, cutting grasses and closing door/windows would prevent malaria.Use of mosquito nets among the women was low. Also, efforts to enhance their knowledge on malaria prevention and ensuring adequate access to mosquito nets especially for pregnant women would curtail the impact of malaria.

  6. Methods employed in the prevention and treatment of malaria ...

    African Journals Online (AJOL)

    onasoga olayinka

    Background: Malaria remains a major public health problem in Nigeria and ... addition to the hundreds of thousands of mortality each year, available evidence indicates .... Islam. Traditional. 149. 19. 10. 82.8. 10.5. 5.5. Ethnicity. Ijaw. Igbo. Yoruba ..... malaria in their study carried out among pregnant women in Eastern India.

  7. Spatial synchrony of malaria outbreaks in a highland region of Ethiopia.

    Science.gov (United States)

    Wimberly, Michael C; Midekisa, Alemayehu; Semuniguse, Paulos; Teka, Hiwot; Henebry, Geoffrey M; Chuang, Ting-Wu; Senay, Gabriel B

    2012-10-01

    To understand the drivers and consequences of malaria in epidemic-prone regions, it is important to know whether epidemics emerge independently in different areas as a consequence of local contingencies, or whether they are synchronised across larger regions as a result of climatic fluctuations and other broad-scale drivers. To address this question, we collected historical malaria surveillance data for the Amhara region of Ethiopia and analysed them to assess the consistency of various indicators of malaria risk and determine the dominant spatial and temporal patterns of malaria within the region. We collected data from a total of 49 districts from 1999-2010. Data availability was better for more recent years and more data were available for clinically diagnosed outpatient malaria cases than confirmed malaria cases. Temporal patterns of outpatient malaria case counts were correlated with the proportion of outpatients diagnosed with malaria and confirmed malaria case counts. The proportion of outpatients diagnosed with malaria was spatially clustered, and these cluster locations were generally consistent from year to year. Outpatient malaria cases exhibited spatial synchrony at distances up to 300 km, supporting the hypothesis that regional climatic variability is an important driver of epidemics. Our results suggest that decomposing malaria risk into separate spatial and temporal components may be an effective strategy for modelling and forecasting malaria risk across large areas. They also emphasise both the value and limitations of working with historical surveillance datasets and highlight the importance of enhancing existing surveillance efforts. © 2012 Blackwell Publishing Ltd.

  8. Prevalence and risk factors of malaria in Ethiopia

    Directory of Open Access Journals (Sweden)

    Ayele Dawit G

    2012-06-01

    Full Text Available Abstract Background More than 75% of the total area of Ethiopia is malarious, making malaria the leading public health problem in Ethiopia. The aim of this study was to investigate the prevalence rate and the associated socio-economic, geographic and demographic factors of malaria based on the rapid diagnosis test (RDT survey results. Methods From December 2006 to January 2007, a baseline malaria indicator survey in Amhara, Oromiya and Southern Nation Nationalities and People (SNNP regions of Ethiopia was conducted by The Carter Center. This study uses this data. The method of generalized linear model was used to analyse the data and the response variable was the presence or absence of malaria using the rapid diagnosis test (RDT. Results The analyses show that the RDT result was significantly associated with age and gender. Other significant covariates confounding variables are source of water, trip to obtain water, toilet facility, total number of rooms, material used for walls, and material used for roofing. The prevalence of malaria for households with clean water found to be less. Malaria rapid diagnosis found to be higher for thatch and stick/mud roof and earth/local dung plaster floor. Moreover, spraying anti-malaria to the house was found to be one means of reducing the risk of malaria. Furthermore, the housing condition, source of water and its distance, gender, and ages in the households were identified in order to have two-way interaction effects. Conclusion Individuals with poor socio-economic conditions are positively associated with malaria infection. Improving the housing condition of the household is one of the means of reducing the risk of malaria. Children and female household members are the most vulnerable to the risk of malaria. Such information is essential to design improved strategic intervention for the reduction of malaria epidemic in Ethiopia.

  9. CT-angiography source images indicate less fatal outcome despite coma of patients in the Basilar Artery International Cooperation Study

    NARCIS (Netherlands)

    Pallesen, Lars P.; Khomenko, Andrei; Dzialowski, Imanuel; Barlinn, Jessica; Barlinn, Kristian; Zerna, Charlotte; van der Hoeven, Erik J R J; Algra, Ale; Kapelle, L. Jaap; Michel, Patrik; Bodechtel, Ulf; Demchuk, Andrew M.; Schonewille, Wouter; Puetz, Volker

    2017-01-01

    Background: Coma is associated with poor outcome in patients with basilar artery occlusion. Aims: We sought to assess whether the posterior circulation Acute Stroke Prognosis Early CT Score and the Pons-Midbrain Index applied to CT angiography source images predict the outcome of comatose patients

  10. 2008 Key Student Outcomes Indicators for BC Diploma, Associate Degree, and Certificate Programs: Survey Results by Institution

    Science.gov (United States)

    Ministry of Advanced Education and Labour Market Development, 2009

    2009-01-01

    The BC Diploma, Associate Degree, and Certificate Student Outcomes (DACSO) Survey (formerly the BC College and Institute Student Outcomes Survey) collects and disseminates information about former students' post-secondary experiences and their subsequent labour market and further education experiences. The survey is administered annually to former…

  11. 2008 Key Student Outcomes Indicators for BC Diploma, Associate Degree, and Certificate Programs: Survey Results by Institution

    Science.gov (United States)

    Ministry of Advanced Education and Labour Market Development, 2009

    2009-01-01

    The BC Diploma, Associate Degree, and Certificate Student Outcomes (DACSO) Survey (formerly the BC College and Institute Student Outcomes Survey) collects and disseminates information about former students' post-secondary experiences and their subsequent labour market and further education experiences. The survey is administered annually to former…

  12. Concurrent dengue and malaria in an area in Kolkata

    Institute of Scientific and Technical Information of China (English)

    Amiya Kumar Hati; Indranil Bhattacharjee; Hiranmoy Mukherjee; Bhaswati Bandyopadhayay; Deban Bandyopadhyay; Rajyasree De; Goutam Chandra

    2012-01-01

    ABSTRACT Objective:To establish the nature and extent of dual dengue and malaria infections in an endemic area through a longitudinal study.Methods: A prospective study was conducted from August2005to December2010to document the nature and extent of concurrent dengue and malaria infections in an area in central Kolkata, endemic both for dengue and malaria.Results:Of2 971 suspected cases of dengue fever, in605 (20.36%)persons dengue infection was detected, of whom46 (7.60%, 46/605)patients (40 and6suffered from secondary and primary dengue fever respectively) were simultaneously suffering from malaria (28 and18 were infected with Plasmodium vivax (P.vivax) andPlasmodium falciparum (P. falciparum) respectively, such dual infections of dengue and malaria were detected in all the years of the study period, except 2007, indicating intense transmission of both dengue and malaria in the study area, and the phenomenon was not an isolated one, the rate of concomitant infections ranged from25% in2009 to4.9% in 2005. Out of total population surveyed,1.54% (46/2 971)had concurrent dengue and malaria infection.Conclusions: These findings added a new dimension in diagnosis, treatment, epidemiology and control of dengue and malaria. The possible risk of concurrent dengue and malaria infections should always be kept in mind in endemic areas for early diagnosis employing modern technology and prompt and effective treatment to avoid serious complications.

  13. Plasmodium vivax malaria during pregnancy, Bolivia.

    Science.gov (United States)

    Brutus, Laurent; Santalla, José; Schneider, Dominique; Avila, Juan Carlos; Deloron, Philippe

    2013-10-01

    Plasmodium vivax is a major cause of illness in areas with low transmission of malaria in Latin America, Asia, and the Horn of Africa. However, pregnancy-associated malaria remains poorly characterized in such areas. Using a hospital-based survey of women giving birth and an antenatal survey, we assessed the prevalence rates of Plasmodium spp. infections in pregnant women in Bolivia, and evaluated the consequences of malaria during pregnancy on the health of mothers and newborns. P. vivax infection was detected in 7.9% of pregnant women attending antenatal visits, and placental infection occurred in 2.8% of deliveries; these rates did not vary with parity. Forty-two percent of all P. vivax malaria episodes were symptomatic. P. vivax-infected pregnant women were frequently anemic (6.5%) and delivered babies of reduced birthweight. P. vivax infections during pregnancy are clearly associated with serious adverse outcomes and should be considered in prevention strategies of pregnancy-associated malaria.

  14. Household cost of malaria overdiagnosis in rural Mozambique

    Directory of Open Access Journals (Sweden)

    Armázio Luiz

    2008-02-01

    Full Text Available Abstract Background It is estimated that over 70% of patients with suspected malaria in sub-Saharan Africa, diagnose and manage their illness at home without referral to a formal health clinic. Of those patients who do attend a formal health clinic, malaria overdiagnosis rates are estimated to range between 30–70%. Methods This paper details an observational cohort study documenting the number and cost of repeat consultations as a result of malaria overdiagnosis at two health care providers in a rural district of Mozambique. 535 adults and children with a clinical diagnosis of malaria were enrolled and followed over a 21 day period to assess treatment regimen, symptoms, number and cost of repeat visits to health providers in patients misdiagnosed with malaria compared to those with confirmed malaria (determined by positive bloodfilm reading. Results Diagnosis based solely on clinical symptoms overdiagnosed 23% of children ( Conclusion Overdiagnosis of malaria results in a greater number of healthcare visits and associated cost for adult patients. Additionally, it is clear that the poorest individuals pay significantly more proportionally for their healthcare making it imperative that the treatment they receive is correct in order to prevent wastage of limited economic resources. Thus, investment in accurate malaria diagnosis and appropriate management at primary level is critical for improving health outcomes and reducing poverty.

  15. Effective coverage and systems effectiveness for malaria case management in sub-Saharan African countries.

    Directory of Open Access Journals (Sweden)

    Katya Galactionova

    Full Text Available Scale-up of malaria preventive and control interventions over the last decade resulted in substantial declines in mortality and morbidity from the disease in sub-Saharan Africa and many other parts of the world. Sustaining these gains will depend on the health system performance. Treatment provides individual benefits by curing infection and preventing progression to severe disease as well as community-level benefits by reducing the infectious reservoir and averting emergence and spread of drug resistance. However many patients with malaria do not access care, providers do not comply with treatment guidelines, and hence, patients do not necessarily receive the correct regimen. Even when the correct regimen is administered some patients will not adhere and others will be treated with counterfeit or substandard medication leading to treatment failures and spread of drug resistance. We apply systems effectiveness concepts that explicitly consider implications of health system factors such as treatment seeking, provider compliance, adherence, and quality of medication to estimate treatment outcomes for malaria case management. We compile data for these indicators to derive estimates of effective coverage for 43 high-burden Sub-Saharan African countries. Parameters are populated from the Demographic and Health Surveys and other published sources. We assess the relative importance of these factors on the level of effective coverage and consider variation in these health systems indicators across countries. Our findings suggest that effective coverage for malaria case management ranges from 8% to 72% in the region. Different factors account for health system inefficiencies in different countries. Significant losses in effectiveness of treatment are estimated in all countries. The patterns of inter-country variation suggest that these are system failures that are amenable to change. Identifying the reasons for the poor health system performance and

  16. Effective coverage and systems effectiveness for malaria case management in sub-Saharan African countries.

    Science.gov (United States)

    Galactionova, Katya; Tediosi, Fabrizio; de Savigny, Don; Smith, Thomas; Tanner, Marcel

    2015-01-01

    Scale-up of malaria preventive and control interventions over the last decade resulted in substantial declines in mortality and morbidity from the disease in sub-Saharan Africa and many other parts of the world. Sustaining these gains will depend on the health system performance. Treatment provides individual benefits by curing infection and preventing progression to severe disease as well as community-level benefits by reducing the infectious reservoir and averting emergence and spread of drug resistance. However many patients with malaria do not access care, providers do not comply with treatment guidelines, and hence, patients do not necessarily receive the correct regimen. Even when the correct regimen is administered some patients will not adhere and others will be treated with counterfeit or substandard medication leading to treatment failures and spread of drug resistance. We apply systems effectiveness concepts that explicitly consider implications of health system factors such as treatment seeking, provider compliance, adherence, and quality of medication to estimate treatment outcomes for malaria case management. We compile data for these indicators to derive estimates of effective coverage for 43 high-burden Sub-Saharan African countries. Parameters are populated from the Demographic and Health Surveys and other published sources. We assess the relative importance of these factors on the level of effective coverage and consider variation in these health systems indicators across countries. Our findings suggest that effective coverage for malaria case management ranges from 8% to 72% in the region. Different factors account for health system inefficiencies in different countries. Significant losses in effectiveness of treatment are estimated in all countries. The patterns of inter-country variation suggest that these are system failures that are amenable to change. Identifying the reasons for the poor health system performance and intervening to tackle

  17. Toll-like receptors, a double-edged sword in immunity to malaria

    Institute of Scientific and Technical Information of China (English)

    Chen Jide; He Ying; Xu Wenyue; Huang Fusheng

    2009-01-01

    Toll-like receptors (TLRs) are a central component of innate immune system and play a major role as the initiator of the innate immune responses to defend against bacteria, viruses, parasite and other pathogens. During malaria infection, TLRs signaling pathways are initialed with the recognition of Plasmodium glycosylphosphatidylinositols (GPI) and hemozoin as pathogen-associated molecular patterns (PAMPs). And then, activation of TLRs signaling induces specific biological responses against malaria parasites invasion. However, TLRs are also involved in malaria pathogenesis and enhancement of immune tolerance and evasion for malaria infection. Moreover, malaria parasites regulate selectively TLRs expression on immune cells.Thus, these evidences indicated that TLRs have contrary roles on malaria infection. Understanding the complicated roles of TLRs on malaria infection will contribute us to design more effective anti-malaria drugs or vaccines.

  18. EMIRA: Ecologic Malaria Reduction for Africa – innovative tools for integrated malaria control

    Directory of Open Access Journals (Sweden)

    Peter Dambach

    2014-11-01

    Full Text Available Background: Malaria control is based on early treatment of cases and on vector control. The current measures for malaria vector control in Africa are mainly based on long-lasting insecticide treated nets (LLINs and to a much smaller extent on indoor residual spraying (IRS. A third pillar in the fight against the malaria vector, larval source management (LSM, has virtually not been used in Africa since the ban of DDT in the 1960s. Within the light of recent WHO recommendations for Bacillus thuringiensis israelensis (Bti use against malaria and other vector species, larval source management could see a revival in the upcoming years. In this project we analyze the ecologic and health impacts as well as the cost effectiveness of larval source management under different larviciding scenarios in a health district in Burkina Faso. Methods: The project is designed as prospective intervention study with duration of three years (2013–2015. Its spatial scale includes three arms of interventions and control, comprising a total of 127 villages and the district capital Nouna in the extended HDSS (Health Demographic Surveillance System of the Kossi province. Baseline data on mosquito abundance, parasitemia in U5 children, and malaria related morbidity and mortality are gathered over the project duration. Besides the outcome on ecologic and health parameters, the economic costs are seized and valued against the achieved health benefits. Conclusions: Risk map based, guided larvicide application might be a possibility to further decrease economic cost of LSM and facilitate its faster incorporation to integrated malaria control programs. Given the limited resources in many malaria endemic countries, it is of utmost importance to relate the costs of novel strategies for malaria prevention to their effect on the burden of the disease. Occurring costs and the impact on the health situation will be made comparable to other, existing intervention strategies, allowing

  19. Malaria, malnutrition, and birthweight

    DEFF Research Database (Denmark)

    Cates, Jordan E.; Unger, Holger W.; Briand, Valerie

    2017-01-01

    were identified by the Maternal Malaria and Malnutrition (M3) initiative using a convenience sampling approach and were eligible for pooling given adequate ethical approval and availability of essential variables. Study-specific adjusted effect estimates were calculated using inverse probability...... be multiplicative interaction between malaria infection at enrollment and low MUAC within studies conducted in Africa; however, this finding was not consistent on the additive scale, when accounting for multiple comparisons, or when using other definitions of malaria and malnutrition. The major limitations...... of the study included availability of only 2 cross-sectional measurements of malaria and the limited availability of ultrasound-based pregnancy dating to assess impacts on preterm birth and fetal growth in all studies.  Conclusions : Pregnant women with malnutrition and malaria infection are at increased risk...

  20. Rapid Diagnosis of Malaria

    Directory of Open Access Journals (Sweden)

    Clinton K. Murray

    2009-01-01

    Full Text Available Malaria's global impact is expansive and includes the extremes of the healthcare system ranging from international travelers returning to nonendemic regions with tertiary referral medical care to residents in hyperendemic regions without access to medical care. Implementation of prompt and accurate diagnosis is needed to curb the expanding global impact of malaria associated with ever-increasing antimalarial drug resistance. Traditionally, malaria is diagnosed using clinical criteria and/or light microscopy even though both strategies are clearly inadequate in many healthcare settings. Hand held immunochromatographic rapid diagnostic tests (RDTs have been recognized as an ideal alternative method for diagnosing malaria. Numerous malaria RDTs have been developed and are widely available; however, an assortment of issues related to these products have become apparent. This review provides a summary of RDT including effectiveness and strategies to select the ideal RDT in varying healthcare settings.

  1. The association between malnutrition and the incidence of malaria among young HIV-infected and -uninfected Ugandan children: a prospective study

    Directory of Open Access Journals (Sweden)

    Arinaitwe Emmanuel

    2012-03-01

    Full Text Available Abstract Background In sub-Saharan Africa, malnutrition and malaria remain major causes of morbidity and mortality in young children. There are conflicting data as to whether malnutrition is associated with an increased or decreased risk of malaria. In addition, data are limited on the potential interaction between HIV infection and the association between malnutrition and the risk of malaria. Methods A cohort of 100 HIV-unexposed, 203 HIV-exposed (HIV negative children born to HIV-infected mothers and 48 HIV-infected children aged 6 weeks to 1 year were recruited from an area of high malaria transmission intensity in rural Uganda and followed until the age of 2.5 years. All children were provided with insecticide-treated bed nets at enrolment and daily trimethoprim-sulphamethoxazole prophylaxis (TS was prescribed for HIV-exposed breastfeeding and HIV-infected children. Monthly routine assessments, including measurement of height and weight, were conducted at the study clinic. Nutritional outcomes including stunting (low height-for-age and underweight (low weight-for-age, classified as mild (mean z-scores between -1 and -2 during follow-up and moderate-severe (mean z-scores Results The overall incidence of malaria was 3.64 cases per person year. Mild stunting (IRR = 1.24, 95% CI 1.06-1.46, p = 0.008 and moderate-severe stunting (IRR = 1.24, 95% CI 1.03-1.48, p = 0.02 were associated with a similarly increased incidence of malaria compared to non-stunted children. Being mildly underweight (IRR = 1.09, 95% CI 0.95-1.25, p = 0.24 and moderate-severe underweight (IRR = 1.12, 95% CI 0.86-1.46, p = 0.39 were not associated with a significant difference in the incidence of malaria compared to children who were not underweight. There were no significant interactions between HIV-infected, HIV-exposed children taking TS and the associations between malnutrition and the incidence of malaria. Conclusions Stunting, indicative of chronic malnutrition, was

  2. Physical health indicators in major mental illness: data from the Quality and Outcome Framework in the UK.

    Science.gov (United States)

    Martin, Julie Langan; Lowrie, Richard; McConnachie, Alex; McLean, Gary; Mair, Frances; Mercer, Stewart; Smith, Daniel

    2015-02-26

    In the UK, the Quality and Outcome Framework (QOF) has specific targets for general practictioners to record body-mass index (BMI) and blood pressure (BP) in major mental illness, diabetes, and chronic kidney disease. Although incentives are given for aspects of major mental illness (schizophrenia, bipolar disorder, and related psychoses), barriers to care can occur. Our aim was to compare recording of specific targets for BP and BMI in individuals with major mental illness relative to diabetes and chronic kidney disease across the UK. Using 2012 and 2013 QOF data from 9731 general practices across all four countries in the UK, we calculated median payment, population achievement, and exception rates for BP indicators in major mental illness and chronic kidney disease and BMI indicators in major mental illness and diabetes. Differences in unweighted rates between practices in the same UK country were tested with a sign test. Differences in population achievement rate between practices in different countries were compared with those in England by use of a quantile regression analysis. UK payment and population achievement rates for BMI recording in major mental illness were significantly lower than were those in diabetes (payment 92·7% vs 95·5% and population achievement 84·0% vs 92·5%, pUK payment and population achievement rates were significantly lower for major mental illness than for chronic kidney disease (94·1% vs 97·8% and 87·0% vs 97·1%, pUK countries. Median population achievement rates for BMI and BP recording in major mental illness were significantly lower in Scotland than in England (for BMI -1·5%, 99% CI -2·7 to -0·3, and for BP -1·8%, -2·7 to -0·9; pUK. We also found variation in these rates between countries. This finding is probably multifactorial, reflecting a combination of patient, clinician, and wider organisational factors; however, it might also suggest inequality in access to certain aspects of health care for people with major

  3. Mismatch negativity is a stronger indicator of functional outcomes than neurocognition or theory of mind in patients with schizophrenia.

    Science.gov (United States)

    Lee, Seung-Hwan; Sung, Kyongae; Lee, Kyong-Sang; Moon, Eunok; Kim, Chang-Gyu

    2014-01-03

    Mismatch negativity (MMN) is known to be associated with neurocognition, social cognition, and functional outcomes. The present study explored the relationships of MMN with neurocognition, theory of mind, and functional outcomes in patients with schizophrenia, first-degree relatives of patients with schizophrenia, and healthy controls. Twenty-five patients with schizophrenia, 21 first-degree relatives of patients with schizophrenia, and 29 healthy controls were recruited. We examined symptom severity, neurocognition, theory of mind, functional outcomes, and MMN. MMN amplitudes decreased in order of patients with schizophrenia, then first-degree relatives, then healthy controls. MMN amplitude was significantly correlated with measures of neurocognition, theory of mind, and functional outcome measurements in patients with schizophrenia. However, the most powerful correlations were those between MMN in the frontal region and measures of functional outcomes. The power and frequency of the correlations were weaker in first-degree relatives and healthy controls than in patients with schizophrenia. Hierarchical regression analysis revealed that functional outcomes (relative to measures of neurocognition and theory of mind) constituted the most powerful predictor of MMN. Our results suggest that MMN reflects functional outcomes more efficiently than do measures of neurocognition and theory of mind in patients with schizophrenia. © 2013.

  4. Thrombocytopenia in pregnant women with Plasmodium falciparum malaria in an area of unstable malaria transmission in eastern Sudan

    Directory of Open Access Journals (Sweden)

    Adam Mayyada B

    2012-08-01

    Full Text Available Abstract Background Blood platelet levels are being evaluated as predictive and prognostic indicators of the severity of malaria infections in humans. However, there are few studies on platelets and Plasmodium falciparum malaria during pregnancy. Methods A case–control study was conducted at Gadarif Hospital in Eastern Sudan, an area characterized by unstable malaria transmission. The aim of the study was to investigate thrombocytopenia in pregnant women with P. falciparum malaria (cases and healthy pregnant women (controls. Results The median (interquartile platelet counts were significantly lower in patients with malaria (N = 60 than in the controls (N = 60, 61, 000 (43,000–85,000 vs. 249,000 (204,000–300,000/μL, respectively, p P. falciparum malaria (N = 12 compared with those patients with uncomplicated P. falciparum malaria (N = 48, 68, 000 (33,000-88,000/μL vs. 61, 000 (45,000–85,000/μL, respectively, p = 0.8. While none of the control group had thrombocytopenia (platelet count p P. falciparum malaria, compared with the pregnant healthy control group, were at higher risk (OR = 10.1, 95% CI = 4.1–25.18; p  Conclusion P. falciparum malaria is associated with thrombocytopenia in pregnant women in this setting. More research is needed.

  5. Relative risk estimation for malaria disease mapping based on stochastic SIR-SI model in Malaysia

    Science.gov (United States)

    Samat, Nor Azah; Ma'arof, Syafiqah Husna Mohd Imam

    2016-10-01

    Disease mapping is a study on the geographical distribution of a disease to represent the epidemiology data spatially. The production of maps is important to identify areas that deserve closer scrutiny or more attention. In this study, a mosquito-borne disease called Malaria is the focus of our application. Malaria disease is caused by parasites of the genus Plasmodium and is transmitted to people through the bites of infected female Anopheles mosquitoes. Precautionary steps need to be considered in order to avoid the malaria virus from spreading around the world, especially in the tropical and subtropical countries, which would subsequently increase the number of Malaria cases. Thus, the purpose of this paper is to discuss a stochastic model employed to estimate the relative risk of malaria disease in Malaysia. The outcomes of the analysis include a Malaria risk map for all 16 states in Malaysia, revealing the high and low risk areas of Malaria occurrences.

  6. Malaria in Tunisian Military Personnel after Returning from External Operation

    Science.gov (United States)

    Ajili, Faïda; Battikh, Riadh; Laabidi, Janet; Abid, Rim; Bousetta, Najeh; Jemli, Bouthaina; Ben abdelhafidh, Nadia; Bassem, Louzir; Gargouri, Saadia; Othmani, Salah

    2013-01-01

    Introduction. Malaria had been eliminated in Tunisia since 1979, but there are currently 40 to 50 imported cases annually. Soldiers are no exception as the incidence of imported malaria is increasing in Tunisian military personnel after returning from malaria-endemic area, often in Sub-Saharan Africa. Methods. We retrospectively analyzed the clinical and biological presentations, treatment, and outcomes of 37 Tunisian military personnel hospitalized at the Department of Internal Medicine, the Military Hospital of Tunis, between January 1993 and January 2011, for imported malaria. The clinical and laboratory features were obtained from the medical records and a questionnaire was filled by the patients about the compliance of malaria prophylaxis. Results. Thirty-seven male patients, with a mean age of 41 years, were treated for malaria infection. Twenty-two were due to Plasmodium falciparum. The outcome was favourable for all patients, despite two severe access. The long-term use of chemoprophylaxis has been adopted by only 21 (51%) of expatriate military for daily stresses. Moreover, poor adherence was found in 32 patients. Conclusion. The risk of acquiring malaria infection in Tunisian military personnel can largely be prevented by the regular use of chemoprophylactic drugs combined with protective measures against mosquito bites. PMID:23766922

  7. Malaria in Tunisian Military Personnel after Returning from External Operation

    Directory of Open Access Journals (Sweden)

    Faïda Ajili

    2013-01-01

    Full Text Available Introduction. Malaria had been eliminated in Tunisia since 1979, but there are currently 40 to 50 imported cases annually. Soldiers are no exception as the incidence of imported malaria is increasing in Tunisian military personnel after returning from malaria-endemic area, often in Sub-Saharan Africa. Methods. We retrospectively analyzed the clinical and biological presentations, treatment, and outcomes of 37 Tunisian military personnel hospitalized at the Department of Internal Medicine, the Military Hospital of Tunis, between January 1993 and January 2011, for imported malaria. The clinical and laboratory features were obtained from the medical records and a questionnaire was filled by the patients about the compliance of malaria prophylaxis. Results. Thirty-seven male patients, with a mean age of 41 years, were treated for malaria infection. Twenty-two were due to Plasmodium falciparum. The outcome was favourable for all patients, despite two severe access. The long-term use of chemoprophylaxis has been adopted by only 21 (51% of expatriate military for daily stresses. Moreover, poor adherence was found in 32 patients. Conclusion. The risk of acquiring malaria infection in Tunisian military personnel can largely be prevented by the regular use of chemoprophylactic drugs combined with protective measures against mosquito bites.

  8. Malaria: Global progress 2000 - 2015 and future challenges.

    Science.gov (United States)

    Cibulskis, Richard E; Alonso, Pedro; Aponte, John; Aregawi, Maru; Barrette, Amy; Bergeron, Laurent; Fergus, Cristin A; Knox, Tessa; Lynch, Michael; Patouillard, Edith; Schwarte, Silvia; Stewart, Saira; Williams, Ryan

    2016-06-09

    2015 was the target year for malaria goals set by the World Health Assembly and other international institutions to reduce malaria incidence and mortality. A review of progress indicates that malaria programme financing and coverage have been transformed since the beginning of the millennium, and have contributed to substantial reductions in the burden of disease. Investments in malaria programmes increased by more than 2.5 times between 2005 and 2014 from US$ 960 million to US$ 2.5 billion, allowing an expansion in malaria prevention, diagnostic testing and treatment programmes. In 2015 more than half of the population of sub-Saharan Africa slept under insecticide-treated mosquito nets, compared to just 2 % in 2000. Increased availability of rapid diagnostic tests and antimalarial medicines has allowed many more people to access timely and appropriate treatment. Malaria incidence rates have decreased by 37 % globally and mortality rates by 60 % since 2000. It is estimated that 70 % of the reductions in numbers of cases in sub-Saharan Africa can be attributed to malaria interventions. Reductions in malaria incidence and mortality rates have been made in every WHO region and almost every country. However, decreases in malaria case incidence and mortality rates were slowest in countries that had the largest numbers of malaria cases and deaths in 2000; reductions in incidence need to be greatly accelerated in these countries to achieve future malaria targets. Progress is made challenging because malaria is concentrated in countries and areas with the least resourced health systems and the least ability to pay for system improvements. Malaria interventions are nevertheless highly cost-effective and have not only led to significant reductions in the incidence of the disease but are estimated to have saved about US$ 900 million in malaria case management costs to public providers in sub-Saharan Africa between 2000 and 2014. Investments in malaria programmes can not

  9. Geographical patterns of malaria transmission based on serological markers for falciparum and vivax malaria in Ratanakiri, Cambodia

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    Karen Kerkhof

    2016-10-01

    Full Text Available Abstract Background Malaria transmission is highly heterogeneous, especially in low endemic countries, such as Cambodia. This results in geographical clusters of residual transmission in the dry, low transmission season, which can fuel the transmission to wider areas or populations during the wet season. A better understanding of spatial clustering of malaria can lead to a more efficient, targeted strategy to reduce malaria transmission. This study aims to evaluate the potential of the use of serological markers to define spatial patterns in malaria exposure. Methods Blood samples collected in a community-based randomized trial performed in 98 high endemic communities in Ratanakiri province, north-eastern Cambodia, were screened with a multiplex serological assay for five serological markers (three Plasmodium falciparum and two Plasmodium vivax. The antibody half-lives range from approximately six months until more than two years. Geographical heterogeneity in malaria transmission was examined using a spatial scan statistic on serology, PCR prevalence and malaria incidence rate data. Furthermore, to identify behavioural patterns or intrinsic factors associated with malaria exposure (antibody levels, risk factor analyses were performed by using multivariable random effect logistic regression models. The serological outcomes were then compared to PCR prevalence and malaria incidence data. Results A total of 6502 samples from two surveys were screened in an area where the average parasite prevalence estimated by PCR among the selected villages is 3.4 %. High-risk malaria pockets were observed adjacent to the ‘Tonle San River’ and neighbouring Vietnam for all three sets of data (serology, PCR prevalence and malaria incidence rates. The main risk factors for all P. falciparum antigens and P. vivax MSP1.19 are age, ethnicity and staying overnight at the plot hut. Conclusion It is possible to identify similar malaria pockets of higher malaria

  10. Geographical patterns of malaria transmission based on serological markers for falciparum and vivax malaria in Ratanakiri, Cambodia.

    Science.gov (United States)

    Kerkhof, Karen; Sluydts, Vincent; Heng, Somony; Kim, Saorin; Pareyn, Myrthe; Willen, Laura; Canier, Lydie; Sovannaroth, Siv; Ménard, Didier; Sochantha, Tho; Coosemans, Marc; Durnez, Lies

    2016-10-19

    Malaria transmission is highly heterogeneous, especially in low endemic countries, such as Cambodia. This results in geographical clusters of residual transmission in the dry, low transmission season, which can fuel the transmission to wider areas or populations during the wet season. A better understanding of spatial clustering of malaria can lead to a more efficient, targeted strategy to reduce malaria transmission. This study aims to evaluate the potential of the use of serological markers to define spatial patterns in malaria exposure. Blood samples collected in a community-based randomized trial performed in 98 high endemic communities in Ratanakiri province, north-eastern Cambodia, were screened with a multiplex serological assay for five serological markers (three Plasmodium falciparum and two Plasmodium vivax). The antibody half-lives range from approximately six months until more than two years. Geographical heterogeneity in malaria transmission was examined using a spatial scan statistic on serology, PCR prevalence and malaria incidence rate data. Furthermore, to identify behavioural patterns or intrinsic factors associated with malaria exposure (antibody levels), risk factor analyses were performed by using multivariable random effect logistic regression models. The serological outcomes were then compared to PCR prevalence and malaria incidence data. A total of 6502 samples from two surveys were screened in an area where the average parasite prevalence estimated by PCR among the selected villages is 3.4 %. High-risk malaria pockets were observed adjacent to the 'Tonle San River' and neighbouring Vietnam for all three sets of data (serology, PCR prevalence and malaria incidence rates). The main risk factors for all P. falciparum antigens and P. vivax MSP1.19 are age, ethnicity and staying overnight at the plot hut. It is possible to identify similar malaria pockets of higher malaria transmission together with the potential risk factors by using serology

  11. [Severe malaria in Palmas, State of Tocantins: case report].

    Science.gov (United States)

    Parise, Eldi Vendrame

    2009-01-01

    Plasmodium falciparum causes the most severe clinical form of malaria. In this study, we report a severe case of malaria, through following up the patient and from notes in the medical files at the Palmas General Hospital. We discuss the outcome of this case and the complications caused by this infection, recognizing the potential risk of occurrences of severe malaria in not-endemic areas because of the delay in treatment, and the importance of intensifying surveillance measures involving all health unit employees, with emphasis on the reception areas for migrants from endemic regions.

  12. Clinical audit indicators of outcome following admission to hospital with acute exacerbation of chronic obstructive pulmonary disease

    OpenAIRE

    2002-01-01

    Background: The 1997 BTS/RCP national audit of acute chronic obstructive pulmonary disease (COPD) in terms of process of care has previously been reported. This paper describes from the same cases the outcomes of death, readmission rates within 3 months of initial admission, and length of stay. Identification of the main pre-admission predictors of outcome may be used to control for confounding factors in population characteristics when comparing performance between units.

  13. A global model of malaria climate sensitivity: comparing malaria response to historic climate data based on simulation and officially reported malaria incidence.

    Science.gov (United States)

    Edlund, Stefan; Davis, Matthew; Douglas, Judith V; Kershenbaum, Arik; Waraporn, Narongrit; Lessler, Justin; Kaufman, James H

    2012-09-18

    The role of the Anopheles vector in malaria transmission and the effect of climate on Anopheles populations are well established. Models of the impact of climate change on the global malaria burden now have access to high-resolution climate data, but malaria surveillance data tends to be less precise, making model calibration problematic. Measurement of malaria response to fluctuations in climate variables offers a way to address these difficulties. Given the demonstrated sensitivity of malaria transmission to vector capacity, this work tests response functions to fluctuations in land surface temperature and precipitation. This study of regional sensitivity of malaria incidence to year-to-year climate variations used an extended Macdonald Ross compartmental disease model (to compute malaria incidence) built on top of a global Anopheles vector capacity model (based on 10 years of satellite climate data). The predicted incidence was compared with estimates from the World Health Organization and the Malaria Atlas. The models and denominator data used are freely available through the Eclipse Foundation's Spatiotemporal Epidemiological Modeller (STEM). Although the absolute scale factor relating reported malaria to absolute incidence is uncertain, there is a positive correlation between predicted and reported year-to-year variation in malaria burden with an averaged root mean square (RMS) error of 25% comparing normalized incidence across 86 countries. Based on this, the proposed measure of sensitivity of malaria to variations in climate variables indicates locations where malaria is most likely to increase or decrease in response to specific climate factors. Bootstrapping measures the increased uncertainty in predicting malaria sensitivity when reporting is restricted to national level and an annual basis. Results indicate a potential 20x improvement in accuracy if data were available at the level ISO 3166-2 national subdivisions and with monthly time sampling. The

  14. Physiological and behavioral indices of emotion dysregulation as predictors of outcome from cognitive behavioral therapy and acceptance and commitment therapy for anxiety.

    Science.gov (United States)

    Davies, Carolyn D; Niles, Andrea N; Pittig, Andre; Arch, Joanna J; Craske, Michelle G

    2015-03-01

    Identifying for whom and under what conditions a treatment is most effective is an essential step toward personalized medicine. The current study examined pre-treatment physiological and behavioral variables as predictors and moderators of outcome in a randomized clinical trial comparing cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) for anxiety disorders. Sixty individuals with a DSM-IV defined principal anxiety disorder completed 12 sessions of either CBT or ACT. Baseline physiological and behavioral variables were measured prior to entering treatment. Self-reported anxiety symptoms were assessed at pre-treatment, post-treatment, and 6- and 12-month follow-up from baseline. Higher pre-treatment heart rate variability was associated with worse outcome across ACT and CBT. ACT outperformed CBT for individuals with high behavioral avoidance. Subjective anxiety levels during laboratory tasks did not predict or moderate treatment outcome. Due to small sample sizes of each disorder, disorder-specific predictors were not tested. Future research should examine these predictors in larger samples and across other outcome variables. Lower heart rate variability was identified as a prognostic indicator of overall outcome, whereas high behavioral avoidance was identified as a prescriptive indicator of superior outcome from ACT versus CBT. Investigation of pre-treatment physiological and behavioral variables as predictors and moderators of outcome may help guide future treatment-matching efforts. Copyright © 2014 Elsevier Ltd. All rights reserved.

  15. Investigation of host candidate malaria-associated risk/protective SNPs in a Brazilian Amazonian population.

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    Simone da Silva Santos

    Full Text Available The Brazilian Amazon is a hypo-endemic malaria region with nearly 300,000 cases each year. A variety of genetic polymorphisms, particularly in erythrocyte receptors and immune response related genes, have been described to be associated with susceptibility and resistance to malaria. In order to identify polymorphisms that might be associated with malaria clinical outcomes in a Brazilian Amazonian population, sixty-four human single nucleotide polymorphisms in 37 genes were analyzed using a Sequenom massARRAY iPLEX platform. A total of 648 individuals from two malaria endemic areas were studied, including 535 malaria cases (113 individuals with clinical mild malaria, 122 individuals with asymptomatic infection and 300 individuals with history of previous mild malaria and 113 health controls with no history of malaria. The data revealed significant associations (p<0.003 between one SNP in the IL10 gene (rs1800896 and one SNP in the TLR4 gene (rs4986790 with reduced risk for clinical malaria, one SNP in the IRF1 gene (rs2706384 with increased risk for clinical malaria, one SNP in the LTA gene (rs909253 with protection from clinical malaria and one SNP in the TNF gene (RS1800750 associated with susceptibility to clinical malaria. Also, a new association was found between a SNP in the CTL4 gene (rs2242665, located at the major histocompatibility complex III region, and reduced risk for clinical malaria. This study represents the first association study from an Amazonian population involving a large number of host genetic polymorphisms with susceptibility or resistance to Plasmodium infection and malaria outcomes. Further studies should include a larger number of individuals, refined parameters and a fine-scale map obtained through DNA sequencing to increase the knowledge of the Amazonian population genetic diversity.

  16. Combining performance and outcome indicators can be used in a standardized way: a pilot study of two multidisciplinary, full-scale major aircraft exercises

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    Rådestad Monica

    2012-08-01

    Full Text Available Abstract Background Disaster medicine is a fairly young scientific discipline and there is a need for the development of new methods for evaluation and research. This includes full-scale disaster exercisers. A standardized concept on how to evaluate these exercises, could lead to easier identification of pitfalls caused by system-errors in the organization. The aim of this study was to demonstrate the feasibility of using a combination of performance and outcome indicators so that results can be compared in standardized full-scale exercises. Methods Two multidisciplinary, full-scale exercises were studied in 2008 and 2010. The panorama had the same setup. Sets of performance indicators combined with indicators for unfavorable patient outcome were recorded in predesigned templates. Evaluators, all trained in a standardized way at a national disaster medicine centre, scored the results on predetermined locations; at the scene, at hospital and at the regional command and control. Results All data regarding the performance indicators of the participants during the exercises were obtained as well as all data regarding indicators for patient outcome. Both exercises could therefore be compared regarding performance (processes as well as outcome indicators. The data from the performance indicators during the exercises showed higher scores for the prehospital command in the second exercise 15 points and 3 points respectively. Results from the outcome indicators, patient survival and patient complications, demonstrated a higher number of preventable deaths and a lower number of preventable complications in the exercise 2010. In the exercise 2008 the number of preventable deaths was lower and the number of preventable complications was higher. Conclusions Standardized multidisciplinary, full-scale exercises in different settings can be conducted and evaluated with performance indicators combined with outcome indicators enabling results from exercises to be

  17. Undernutrition and malaria in pregnancy – a dangerous dyad?

    OpenAIRE

    Unger, Holger W.; Ashorn, Per; Cates, Jordan E; Dewey, Kathryn G.; Rogerson, Stephen J.

    2016-01-01

    Background In low-resource settings, malaria and macronutrient undernutrition are major health problems in pregnancy, contributing significantly to adverse pregnancy outcomes such as preterm birth and fetal growth restriction. Affected pregnancies may result in stillbirth and neonatal death, and surviving children are at risk of poor growth and infection in infancy, and of non-communicable diseases in adulthood. Populations exposed to macronutrient undernutrition frequently reside in malaria-...

  18. [Malaria in Algerian Sahara].

    Science.gov (United States)

    Hammadi, D; Boubidi, S C; Chaib, S E; Saber, A; Khechache, Y; Gasmi, M; Harrat, Z

    2009-08-01

    Thanks to the malaria eradication campaign launched in Algeria in 1968, the number of malaria cases fell down significantly from 95,424 cases in 1960 to 30 cases in 1978. At that time the northern part of the country was declared free of Plasmodium falciparum. Only few cases belonging to P. vivax persisted in residual foci in the middle part of the country. In the beginning of the eighties, the south of the country was marked by an increase of imported malaria cases. The resurgence of the disease in the oases coincided with the opening of the Trans-Saharan road and the booming trade with the neighbouring southern countries. Several authors insisted on the risk of introduction of malaria or its exotic potential vectors in Algeria via this new road. Now, the totality of malaria autochthonous cases in Algeria are located in the south of the country where 300 cases were declared during the period (1980-2007). The recent outbreak recorded in 2007 at the borders with Mall and the introduction of Anopheles gambiae into the Algerian territory show the vulnerability of this area to malaria which is probably emphasized by the local environmental changes. The authors assess the evolution of malaria in the Sahara region and draw up the distribution of the anopheles in this area.

  19. MALARIA IN CHILDREN

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    Richard-Fabian Schumacher

    2012-01-01

    Full Text Available

    This review is focused on childhood specific aspects of malaria, especially in resource-poor settings. We summarise the actual knowledge in the field of epidemiology, clinical presentation, diagnosis, management and prevention.

    These aspects are important as malaria is responsible for almost a quarter of all child death in sub-Saharan Africa. Malaria control is thus one key intervention to reduce childhood mortality, especially as malaria is also an important risk factor for other severe infections, namely bacteraemia.

    In children symptoms are more varied and often mimic other common childhood illness, particularly gastroenteritis, meningitis/encephalitis, or pneumonia. Fever is the key symptom, but the characteristic regular tertian and quartan patterns are rarely observed. There are no pathognomonic features for severe malaria in this age group. The well known clinical (fever, impaired consciousness, seizures, vomiting, respiratory distress and laboratory (severe anaemia, thrombocytopenia, hypoglycaemia, metabolic acidosis, and hyperlactataemia features of severe falciparum malaria in children, are equally typical for severe sepsis.

    Appropriate therapy (considering species, resistance patterns and individual patient factors – possibly a drug combination of an artemisinin derivative with a long-acting antimalarial drug - reduces treatment duration to only three days and should be urgently started.

    While waiting for the results of ongoing vaccine trials, all effort should be made to better implement other malaria-control measures like the use of treated bed-nets and new chemoprophylaxis regimens.

  20. MALARIA IN CHILDREN

    Directory of Open Access Journals (Sweden)

    Richard-Fabian Schumacher

    2012-11-01

    Full Text Available This review is focused on childhood specific aspects of malaria, especially in resource-poor settings. We summarise the actual knowledge in the field of epidemiology, clinical presentation, diagnosis, management and prevention. These aspects are important as malaria is responsible for almost a quarter of all child death in sub-Saharan Africa. Malaria control is thus one key intervention to reduce childhood mortality, especially as malaria is also an important risk factor for other severe infections, namely bacteraemia. In children symptoms are more varied and often mimic other common childhood illness, particularly gastroenteritis, meningitis/encephalitis, or pneumonia. Fever is the key symptom, but the characteristic regular tertian and quartan patterns are rarely observed. There are no pathognomonic features for severe malaria in this age group. The well known clinical (fever, impaired consciousness, seizures, vomiting, respiratory distress and laboratory (severe anaemia, thrombocytopenia, hypoglycaemia, metabolic acidosis, and hyperlactataemia features of severe falciparum malaria in children, are equally typical for severe sepsis. Appropriate therapy (considering species, resistance patterns and individual patient factors – possibly a drug combination of an artemisinin derivative with a long-acting antimalarial drug - reduces treatment duration to only three days and should be urgently started. While waiting for the results of ongoing vaccine trials, all effort should be made to better implement other malaria-control measures like the use of treated bed-nets and new chemoprophylaxis regimens.

  1. Effectiveness of Provider and Community Interventions to Improve Treatment of Uncomplicated Malaria in Nigeria: A Cluster Randomized Controlled Trial.

    Directory of Open Access Journals (Sweden)

    Obinna Onwujekwe

    Full Text Available The World Health Organization recommends that malaria be confirmed by parasitological diagnosis before treatment using Artemisinin-based Combination Therapy (ACT. Despite this, many health workers in malaria endemic countries continue to diagnose malaria based on symptoms alone. This study evaluates interventions to help bridge this gap between guidelines and provider practice. A stratified cluster-randomized trial in 42 communities in Enugu state compared 3 scenarios: Rapid Diagnostic Tests (RDTs with basic instruction (control; RDTs with provider training (provider arm; and RDTs with provider training plus a school-based community intervention (provider-school arm. The primary outcome was the proportion of patients treated according to guidelines, a composite indicator requiring patients to be tested for malaria and given treatment consistent with the test result. The primary outcome was evaluated among 4946 (93% of the 5311 patients invited to participate. A total of 40 communities (12 in control, 14 per intervention arm were included in the analysis. There was no evidence of differences between the three arms in terms of our composite indicator (p = 0.36: stratified risk difference was 14% (95% CI -8.3%, 35.8%; p = 0.26 in the provider arm and 1% (95% CI -21.1%, 22.9%; p = 0.19 in the provider-school arm, compared with control. The level of testing was low across all arms (34% in control; 48% provider arm; 37% provider-school arm; p = 0.47. Presumptive treatment of uncomplicated malaria remains an ingrained behaviour that is difficult to change. With or without extensive supporting interventions, levels of testing in this study remained critically low. Governments and researchers must continue to explore alternative ways of encouraging providers to deliver appropriate treatment and avoid the misuse of valuable medicines.ClinicalTrials.gov NCT01350752.

  2. Indicaciones, técnicas y resultados del trasplante de intestino delgado Indications, techniques and outcomes of small bowel transplant

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    M. López Santamaría

    2007-05-01

    costes y permiten ofrecer un tratamiento individualizado y adaptado a las necesidades individuales.The most recent outcomes on bowel transplantation (BT, with a survival rate immediately after transplant higher than 80% and a great rate of survivors achieving complete digestive autonomy and able to carry out activities according to their age allow for considering BT as the first choice therapy in patients with irreversible intestinal failure in whom poor prognosis with parenteral nutrition is foreseen. Parenteral nutrition-associated liver damage is the most frequent indication for BT, especially in children that are more susceptible than adults to develop this complication. Other accepted indications for BT are irreversible intestinal failure in association with loss of deep venous accesses, life-threatening severe infections associated with the use of central catheters, and those cases of intestinal failure usually leading to early death, such as ultra-short bowel syndromes, refractory diarrheas, and intestinal failure associated to high morbidity and poor quality of life. BT is performed in human clinical practice under three technical modalities: isolated bowel transplant, combined liver-bowel transplant, and multi-visceral transplantation. Currently, refinements of original techniques including reduction of liver and/or intestinal grafts, grafts from living donors, etc., allow for overcoming the different needs as well as increasing the likelihood of having access to transplantation, which is a desirable goal specially in very young or very low-weighted children candidate to liver-bowel transplant. One of the most interesting issues in BT programs is having given access to the Intestinal Rehabilitation Units, which comprise the three therapeutic modalities by means of a multidisciplinary team: nutritional support, pharmacotherapy, and surgery. These Units optimize the outcomes, minimize costs, and allow for offering a management adapted to individual needs.

  3. Iron incorporation and post-malaria anaemia.

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    Conor P Doherty

    Full Text Available BACKGROUND: Iron supplementation is employed to treat post-malarial anaemia in environments where iron deficiency is common. Malaria induces an intense inflammatory reaction that stalls reticulo-endothelial macrophagal iron recycling from haemolysed red blood cells and inhibits oral iron absorption, but the magnitude and duration of these effects are unclear. METHODOLOGY/PRINCIPAL FINDINGS: We examined the red blood cell incorporation of oral administered stable isotopes of iron and compared incorporation between age matched 18 to 36 months old children with either anaemia post-malaria (n = 37 or presumed iron deficiency anaemia alone (n = 36. All children were supplemented for 30 days with 2 mg/kg elemental iron as liquid iron sulphate and administered (57Fe and (58Fe on days 1 and 15 of supplementation respectively. (57Fe and(58Fe incorporation were significantly reduced (8% vs. 28%: p<0.001 and 14% vs. 26%: p = 0.045 in the malaria vs. non-malaria groups. There was a significantly greater haemoglobin response in the malaria group at both day 15 (p = 0.001 and 30 (p<0.000 with a regression analysis estimated greater change in haemoglobin of 7.2 g/l (s.e. 2.0 and 10.1 g/l (s.e. 2.5 respectively. CONCLUSION/SIGNIFICANCE: Post-malaria anaemia is associated with a better haemoglobin recovery despite a significant depressant effect on oral iron incorporation which may indicate that early erythropoetic iron need is met by iron recycling rather than oral iron. Supplemental iron administration is of questionable utility within 2 weeks of clinical malaria in children with mild or moderate anaemia.

  4. Malaria prevention in travelers.

    Science.gov (United States)

    Genton, Blaise; D'Acremont, Valérie

    2012-09-01

    A common approach to malaria prevention is to follow the "A, B, C, D" rule: Awareness of risk, Bite avoidance, Compliance with chemoprophylaxis, and prompt Diagnosis in case of fever. The risk of acquiring malaria depends on the length and intensity of exposure; the risk of developing severe disease is primarily determined by the health status of the traveler. These parameters need to be assessed before recommending chemoprophylaxis and/or stand-by emergency treatment. This review discusses the different strategies and drug options available for the prevention of malaria during and post travel.

  5. Malaria and Vascular Endothelium

    Energy Technology Data Exchange (ETDEWEB)

    Alencar, Aristóteles Comte Filho de, E-mail: aristoteles.caf@gmail.com [Universidade Federal do Amazonas, Manaus, AM (Brazil); Lacerda, Marcus Vinícius Guimarães de [Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, AM (Brazil); Okoshi, Katashi; Okoshi, Marina Politi [Faculdade de Medicina de Botucatu (Unesp), Botucatu, SP (Brazil)

    2014-08-15

    Involvement of the cardiovascular system in patients with infectious and parasitic diseases can result from both intrinsic mechanisms of the disease and drug intervention. Malaria is an example, considering that the endothelial injury by Plasmodium-infected erythrocytes can cause circulatory disorders. This is a literature review aimed at discussing the relationship between malaria and endothelial impairment, especially its effects on the cardiovascular system. We discuss the implications of endothelial aggression and the interdisciplinarity that should guide the malaria patient care, whose acute infection can contribute to precipitate or aggravate a preexisting heart disease.

  6. Prevalence of HIV and malaria: a cross-sectional study on Bioko Island, Equatorial Guinea.

    Science.gov (United States)

    Zheng, Xiangbin; Lin, Min; Xie, Dong-De; Li, Jian; Chen, Jiang-Tao; Eyi, Urbano Monsuy; Monte-Nguba, Santiago-M; Ehapo, Juan Carlos Sala; Yang, Hui; Yang, Hui-Tian; Yang, Li-Ye

    2017-03-01

    Malaria and HIV are two of the most severe public health problems in Africa. However, epidemiological data on Bioko Island is scarce. To investigate the prevalence of malaria and HIV infections and assess association of malaria and HIV infections and possible confounding factors, we performed a cross-sectional survey of people of malaria-endemic Bioko Island, Equatorial Guinea. A cross-sectional study of 1 526 subjects was carried out to determine the prevalence of malaria and HIV infection in Malabo region hospital on Bioko Island. Questionnaires were administered and venous blood samples were drawn for malaria parasites and HIV detection. The prevalence of participants infected with malaria and HIV in this area were 13.8% and 6.6% respectively. The average prevalence of co-infection for malaria and HIV was 0.92%. HIV-infection was significantly associated with the age and gender. Malaria infections were significantly associated with the age. This study showed that the prevalence of HIV and malaria on Bioko Island was higher than expected, although the co-infection prevalence of malaria and HIV was low. The results also indicated that malaria and HIV infections lead to more public health risk to youngsters and women.

  7. Pre-referral rectal artesunate in severe malaria: flawed trial

    Directory of Open Access Journals (Sweden)

    Premji Zulfiqarali G

    2011-08-01

    Full Text Available Abstract Background Immediate injectable treatment is essential for severe malaria. Otherwise, the afflicted risk lifelong impairment or death. In rural areas of Africa and Asia, appropriate care is often miles away. In 2009, Melba Gomes and her colleagues published the findings of a randomized, placebo-controlled trial of rectal artesunate for suspected severe malaria in such remote areas. Enrolling nearly 18,000 cases, the aim was to evaluate whether, as patients were in transit to a health facility, a pre-referral artesunate suppository blocked disease progression sufficiently to reduce these risks. The affirmative findings of this, the only trial on the issue thus far, have led the WHO to endorse rectal artesunate as a pre-referral treatment for severe malaria. In the light of its public health importance and because its scientific quality has not been assessed for a systematic review, our paper provides a detailed evaluation of the design, conduct, analysis, reporting, and practical features of this trial. Results We performed a checklist-based and an in-depth evaluation of the trial. The evaluation criteria were based on the CONSORT statement for reporting clinical trials, the clinical trial methodology literature, and practice in malaria research. Our main findings are: The inclusion and exclusion criteria and the sample size justification are not stated. Many clearly ineligible subjects were enrolled. The training of the recruiters does not appear to have been satisfactory. There was excessive between center heterogeneity in design and conduct. Outcome evaluation schedule was not defined, and in practice, became too wide. Large gaps in the collection of key data were evident. Primary endpoints were inconsistently utilized and reported; an overall analysis of the outcomes was not done; analyses of time to event data had major flaws; the stated intent-to-treat analysis excluded a third of the randomized subjects; the design-indicated

  8. Adjuvants for malaria vaccines.

    Science.gov (United States)

    Coler, R N; Carter, D; Friede, M; Reed, S G

    2009-09-01

    There is a renewed enthusiasm about subunit vaccines for malaria coincident with the formation of new alliances and partnerships raising international public awareness, attracting increased resources and the re-focusing of research programs on adjuvant development for infectious disease vaccines. It is generally accepted that subunit vaccines for malaria will require adjuvants to induce protective immune responses, and availability of suitable adjuvants has in the past been a barrier to the development of malaria vaccines. Several novel adjuvants are now in licensed products or in late stage clinical development, while several others are in the earlier development pipeline. Successful vaccine development requires knowing which adjuvants to use and knowing how to formulate adjuvants and antigens to achieve stable, safe, and immunogenic vaccines. For the majority of vaccine researchers this information is not readily available, nor is access to well-characterized adjuvants. In this minireview, we outline the current state of adjuvant research and development as it pertains to effective malaria vaccines.

  9. Malaria prevention and treatment

    African Journals Online (AJOL)

    to allow prompt and accurate treatment of malaria in areas out of .... Other psychiatric problems ... If possible blood smears should be performed if a reliable laboratory is available. ... If any of the above signs are present, this is an emergency.

  10. Bioinformatics approaches to malaria

    DEFF Research Database (Denmark)

    Hansen, Daniel Aaen

    Malaria is a life threatening disease found in tropical and subtropical regions of the world. Each year it kills 781 000 individuals; most of them are children under the age of five in sub-Saharan Africa. The most severe form of malaria in humans is caused by the parasite Plasmodium falciparum......, which is the subject of the first part of this thesis. The PfEMP1 protein which is encoded by the highly variablevargene family is important in the pathogenesis and immune evasion of malaria parasites. We analyzed and classified these genes based on the upstream sequence in seven......Plasmodium falciparumclones. We show that the amount of nucleotide diversity is just as big within each clone as it is between the clones. DNA methylation is an important epigenetic mark in many eukaryotic species. We are studying DNA methylation in the malaria parasitePlasmodium falciparum. The work is still in progress...

  11. Pregnancy malaria: cryptic disease, apparent solution

    Directory of Open Access Journals (Sweden)

    Patrick Emmet Duffy

    2011-08-01

    Full Text Available Malaria during pregnancy can be severe in non-immune women, but in areas of stable transmission, where women are semi-immune and often asymptomatic during infection, malaria is an insidious cause of disease and death for mothers and their offspring. Sequelae, such as severe anaemia and hypertension in the mother and low birth weight and infant mortality in the offspring, are often not recognised as consequences of infection. Pregnancy malaria, caused by Plasmodium falciparum, is mediated by infected erythrocytes (IEs that bind to chondroitin sulphate A and are sequestered in the placenta. These parasites have a unique adhesion phenotype and distinct antigenicity, which indicates that novel targets may be required for development of an effective vaccine. Women become resistant to malaria as they acquire antibodies against placental IE, which leads to higher haemoglobin levels and heavier babies. Proteins exported from the placental parasites have been identified, including both variant and conserved antigens, and some of these are in preclinical development for vaccines. A vaccine that prevents P. falciparum malaria in pregnant mothers is feasible and would potentially save hundreds of thousands of lives each year.

  12. Disentangling quality and safety indicator data: a longitudinal, comparative study of hand hygiene compliance and accreditation outcomes in 96 Australian hospitals

    Science.gov (United States)

    Mumford, Virginia; Greenfield, David; Hogden, Anne; Debono, Deborah; Gospodarevskaya, Elena; Forde, Kevin; Westbrook, Johanna; Braithwaite, Jeffrey

    2014-01-01

    Objectives The study aims are twofold. First, to investigate the suitability of hand hygiene as an indicator of accreditation outcomes and, second, to test the hypothesis that hospitals with better accreditation outcomes achieve higher hand hygiene compliance rates. Design A retrospective, longitudinal, multisite comparative survey. Setting Acute public hospitals in New South Wales, Australia. Participants 96 acute hospitals with accreditation survey results from two surveys during 2009–2012 and submitted data for more than four hand hygiene audits between 2010 and 2013. Outcomes Our primary outcome comprised observational hand hygiene compliance data from eight audits during 2010–2013. The explanatory variables in our multilevel regression model included: accreditation outcomes and scores for the infection control standard; timing of the surveys; and hospital size and activity. Results Average hand hygiene compliance rates increased from 67.7% to 80.3% during the study period (2010–2013), with 46.7% of hospitals achieving target compliance rates of 70% in audit 1, versus 92.3% in audit 8. Average hand hygiene rates at small hospitals were 7.8 percentage points (pp) higher than those at the largest hospitals (phygiene rates, accreditation outcomes and infection control scores is less clear. Conclusions Our results indicate that accreditation outcomes and hand hygiene audit data are measuring different parts of the quality and safety spectrum. Understanding what is being measured when selecting indicators to assess the impact of accreditation is critical as focusing on accreditation results would discount successful hand hygiene implementation by smaller hospitals. Conversely, relying on hand hygiene results would discount the infection control related research and leadership investment by larger hospitals. Our hypothesis appears to be confounded by an accreditation programme that makes it more difficult for smaller hospitals to achieve high infection control

  13. Cytokines and dysregulation of the immune response in human malaria

    Directory of Open Access Journals (Sweden)

    M. Fátima C. Alves

    1992-01-01

    Full Text Available The dysregulation of the immune response by malaria parasite has been considered as a possible constraint to the effectiveness of malaria vaccination. In spite of the important role interleukin-I (IL-1 in malaria are lacking. We found that only 2 out of 35 subjectswith acute malaria showed increased levels of serum IL-1 alpha by enzyme immunoassay. To assess whether IL-1 could interfere with T- lymphocyte responses, blood mononuclear cells from patients infected with Plasmodium falciparum, P. vivax, or healthy subjects were cultured with phytohemagglutinin, and lymphocyte proliferation measured 72h later by 3H-thymidine incorporation. Our data showed that T-lymphocyte responses are depressed both in P. falciparum (10,500 ñ 2,900 and P. vivax malaria (13,000 ñ 3,300, as compared to that of healthy individuals (27,000 ñ 3,000. Addition of IL-1 partially reserved depression of malaria lymphocytes, but had no effect on normal cells. On the other hand, T-lymphocytes from malaria infected-subjects presented a minimal decrease in proliferation, when cultured in the presence of exogenous PGE2. These data indicate the occurrence of two defects of immunoregulation in malaria: a deficiency of IL-1 production by monocytes/macrophages, and an increased resistance of lymphocytes to the antiproliferative effect of PGE2.

  14. Avian malaria in New Zealand.

    Science.gov (United States)

    Schoener, E R; Banda, M; Howe, L; Castro, I C; Alley, M R

    2014-07-01

    Avian malaria parasites of the genus Plasmodium have the ability to cause morbidity and mortality in naïve hosts, and their impact on the native biodiversity is potentially serious. Over the last decade, avian malaria has aroused increasing interest as an emerging disease in New Zealand with some endemic avian species, such as the endangered mohua (Mohua ochrocephala), thought to be particularly susceptible. To date, avian malaria parasites have been found in 35 different bird species in New Zealand and have been diagnosed as causing death in threatened species such as dotterel (Charadrius obscurus), South Island saddleback (Philesturnus carunculatus carunculatus), mohua, hihi (Notiomystis cincta) and two species of kiwi (Apteryx spp.). Introduced blackbirds (Turdus merula) have been found to be carriers of at least three strains of Plasmodium spp. and because they are very commonly infected, they are likely sources of infection for many of New Zealand's endemic birds. The spread and abundance of introduced and endemic mosquitoes as the result of climate change is also likely to be an important factor in the high prevalence of infection in some regions and at certain times of the year. Although still limited, there is a growing understanding of the ecology and epidemiology of Plasmodium spp. in New Zealand. Molecular biology has played an important part in this process and has markedly improved our understanding of the taxonomy of the genus Plasmodium. This review presents our current state of knowledge, discusses the possible infection and disease outcomes, the implications for host behaviour and reproduction, methods of diagnosis of infection, and the possible vectors for transmission of the disease in New Zealand.

  15. Towards a strategy for malaria in pregnancy in Afghanistan: analysis of clinical realities and women's perceptions of malaria and anaemia.

    Science.gov (United States)

    Howard, Natasha; Enayatullah, Sayed; Mohammad, Nader; Mayan, Ismail; Shamszai, Zohra; Rowland, Mark; Leslie, Toby

    2015-11-04

    Afghanistan has some of the worst maternal and infant mortality indicators in the world and malaria is a significant public health concern. Study objectives were to assess prevalence of malaria and anaemia, related knowledge and practices, and malaria prevention barriers among pregnant women in eastern Afghanistan. Three studies were conducted: (1) a clinical survey of maternal malaria, maternal anaemia, and neonatal birthweight in a rural district hospital delivery-ward; (2) a case-control study of malaria risk among reproductive-age women attending primary-level clinics; and (3) community surveys of malaria and anaemia prevalence, socioeconomic status, malaria knowledge and reported behaviour among pregnant women. Among 517 delivery-ward participants (1), one malaria case (prevalence 1.9/1000), 179 anaemia cases (prevalence 346/1000), and 59 low-birthweight deliveries (prevalence 107/1000) were detected. Anaemia was not associated with age, gravidity, intestinal parasite prevalence, or low-birthweight at delivery. Among 141 malaria cases and 1010 controls (2), no association was found between malaria infection and pregnancy (AOR 0.89; 95 % CI 0.57-1.39), parity (AOR 0.95; 95 % CI 0.85-1.05), age (AOR 1.02; 95 % CI 1.00-1.04), or anaemia (AOR 1.00; 95 % CI 0.65-1.54). Those reporting insecticide-treated net usage had 40 % reduced odds of malaria infection (AOR 0.60; 95 % CI 0.40-0.91). Among 530 community survey participants (3), malaria and anaemia prevalence were 3.9/1000 and 277/1000 respectively, with 34/1000 experiencing severe anaemia. Despite most women having no formal education, malaria knowledge was high. Most expressed reluctance to take malaria preventive medication during pregnancy, deeming it potentially unsafe. Given the low malaria risk and reported avoidance of medication during pregnancy, intermittent preventive treatment is hard to justify or implement. Preventive strategy should instead focus on long-lasting insecticidal nets for all pregnant

  16. Malaria Genome Sequencing Project

    Science.gov (United States)

    2004-01-01

    million cases and up to 2.7 million A whole chromosome shotgun sequencing strategy was used to deaths from malaria each year. The mortality levels are...deaths from malaria each year. The mortality levels are greatest in determine the genome sequence of P. falciparum clone 3D7. This sub-Saharan Africa...aminolevulinic acid dehydratase. Cura . Genet. 40, 391-398 (2002). 15. Lasonder, E. et al Analysis of the Plasmodium falciparum proteome by high-accuracy mass

  17. Malaria in Pregnancy

    OpenAIRE

    Apuzzio, Joseph J.; Abdulla Al-Khan; Jesus R. Alvarez

    2005-01-01

    Recently, there has been a resurgence of malaria in densely populated areas of the United States secondary to human migration from endemic areas where factors such as cessation of vector control, vector resistance to insecticides, disease resistance to drugs, environmental changes, political instability, and indifference, have played a role for malaria becoming an overwhelming infection of these tropical underdeveloped countries. It is important for health care providers of gravida to be aler...

  18. Malaria in pregnancy.

    OpenAIRE

    Jesus R. Alvarez; Al-Khan, Abdulla; Apuzzio, Joseph J.

    2005-01-01

    Recently, there has been a resurgence of malaria in densely populated areas of the United States secondary to human migration from endemic areas where factors such as cessation of vector control, vector resistance to insecticides, disease resistance to drugs, environmental changes, political instability, and indifference, have played a role for malaria becoming an overwhelming infection of these tropical underdeveloped countries. It is important for health care providers of gravida to be aler...

  19. Malaria in Pregnancy

    Directory of Open Access Journals (Sweden)

    Jesus R. Alvarez

    2005-01-01

    Full Text Available Recently, there has been a resurgence of malaria in densely populated areas of the United States secondary to human migration from endemic areas where factors such as cessation of vector control, vector resistance to insecticides, disease resistance to drugs, environmental changes, political instability, and indifference, have played a role for malaria becoming an overwhelming infection of these tropical underdeveloped countries. It is important for health care providers of gravida to be alert of the disease and its effects on pregnancy.

  20. Malaria in pregnancy.

    Science.gov (United States)

    Alvarez, Jesus R; Al-Khan, Abdulla; Apuzzio, Joseph J

    2005-12-01

    Recently, there has been a resurgence of malaria in densely populated areas of the United States secondary to human migration from endemic areas where factors such as cessation of vector control, vector resistance to insecticides, disease resistance to drugs, environmental changes, political instability, and indifference, have played a role for malaria becoming an overwhelming infection of these tropical underdeveloped countries. It is important for health care providers of gravida to be alert of the disease and its effects on pregnancy.

  1. A cost-effectiveness analysis of artemether lumefantrine for treatment of uncomplicated malaria in Zambia

    Directory of Open Access Journals (Sweden)

    Hawela Moonga

    2007-02-01

    Full Text Available Abstract Background Malaria remains a leading cause of morbidity, mortality and non-fatal disability in Zambia, especially among children, pregnant women and the poor. Data gathered by the National Malaria Control Centre has shown that recently observed widespread treatment failure of SP and chloroquine precipitated a surge in malaria-related morbidity and mortality. As a result, the Government has recently replaced chloroquine and SP with combination therapy as first-line treatment for malaria. Despite the acclaimed therapeutic advantages of ACTs over monotherapies with SP and CQ, the cost of ACTs is much greater, raising concerns about affordability in many poor countries such as Zambia. This study evaluates the cost-effectiveness analysis of artemether-lumefantrine, a version of ACTs adopted in Zambia in mid 2004. Methods Using data gathered from patients presenting at public health facilities with suspected malaria, the costs and effects of using ACTs versus SP as first-line treatment for malaria were estimated. The study was conducted in six district sites. Treatment success and reduction in demand for second line treatment constituted the main effectiveness outcomes. The study gathered data on the efficacy of, and compliance to, AL and SP treatment from a random sample of patients. Costs are based on estimated drug, labour, operational and capital inputs. Drug costs were based on dosages and unit prices provided by the Ministry of Health and the manufacturer (Norvatis. Findings The results suggest that AL produces successful treatment at less cost than SP, implying that AL is more cost-effective. While it is acknowledged that implementing national ACT program will require considerable resources, the study demonstrates that the health gains (treatment success from every dollar spent are significantly greater if AL is used rather than SP. The incremental cost-effectiveness ratio is estimated to be US$4.10. When the costs of second line

  2. Indices of Impaired Self-Awareness in Traumatic Brain Injury Patients with Focal Frontal Lesions and Executive Deficits : Implications for Outcome Measurement

    NARCIS (Netherlands)

    Spikman, Jacoba M.; van der Naalt, Joukje

    2010-01-01

    In patients with moderate to severe traumatic brain injury (TBI), impairments of self-awareness are frequently found and associated with worse functional outcome and poor compliance with rehabilitation. The aim of this study was to investigate whether indications of impaired self-awareness could be

  3. Engaging the learner by bridging the gap between theory and clinical competence: the impact of concept mapping and simulation as innovative strategies for nurse-sensitive outcome indicators.

    Science.gov (United States)

    Jamison, Therese; Lis, Gail A

    2014-03-01

    Concept mapping and simulation provide professional nurses in the academic and practice environment with an opportunity for experiential learning. This integral combination allows for learning to be congruent with the national clinical practice guidelines that support and promote nurse-sensitive indicators. Implications for practice are forthcoming as data are collected on the impact on health outcomes when using concept mapping and simulation.

  4. Indices of Impaired Self-Awareness in Traumatic Brain Injury Patients with Focal Frontal Lesions and Executive Deficits : Implications for Outcome Measurement

    NARCIS (Netherlands)

    Spikman, Jacoba M.; van der Naalt, Joukje

    2010-01-01

    In patients with moderate to severe traumatic brain injury (TBI), impairments of self-awareness are frequently found and associated with worse functional outcome and poor compliance with rehabilitation. The aim of this study was to investigate whether indications of impaired self-awareness could be

  5. A clinical study of rate and indications of cesarean section, maternal and fetal outcomes at tertiary care center in north western Rajasthan

    Directory of Open Access Journals (Sweden)

    Suniti Verma

    2016-08-01

    Conclusions: The rate of cesarean section is progressively increasing in the last 5 years. The most common indication is previous cesarean section. The outcome in elective is better than emergency. [Int J Reprod Contracept Obstet Gynecol 2016; 5(8.000: 2791-2794

  6. Combined anterior lumbar interbody fusion and instrumented posterolateral fusion for degenerative lumbar scoliosis: indication and surgical outcomes

    OpenAIRE

    Hsieh, Ming-Kai; Chen, Lih-Huei; Niu, Chi-Chien; Fu, Tsai-Sheng; Lai, Po-Liang; Chen, Wen-Jer

    2015-01-01

    Background Traditional approaches to deformity correction of degenerative lumbar scoliosis include anterior-posterior approaches and posterior-only approaches. Most patients are treated with posterior-only approaches because the high complication rate of anterior approach. Our purpose is to compare and assess outcomes of combined anterior lumbar interbody fusion and instrumented posterolateral fusion with posterior alone approach for degenerative lumbar scoliosis with spinal stenosis. Methods...

  7. Evaluation of Students' Conceptual Understanding of Malaria

    Science.gov (United States)

    Cheong, Irene Poh-Ai; Treagust, David; Kyeleve, Iorhemen J.; Oh, Peck-Yoke

    2010-01-01

    In this study, a two-tier diagnostic test for understanding malaria was developed and administered to 314 Bruneian students in Year 12 and in a nursing diploma course. The validity, reliability, difficulty level, discriminant indices, and reading ability of the test were examined and found to be acceptable in terms of measuring students'…

  8. Evaluation of Students' Conceptual Understanding of Malaria

    Science.gov (United States)

    Cheong, Irene Poh-Ai; Treagust, David; Kyeleve, Iorhemen J.; Oh, Peck-Yoke

    2010-01-01

    In this study, a two-tier diagnostic test for understanding malaria was developed and administered to 314 Bruneian students in Year 12 and in a nursing diploma course. The validity, reliability, difficulty level, discriminant indices, and reading ability of the test were examined and found to be acceptable in terms of measuring students'…

  9. Early detection and monitoring of Malaria

    Science.gov (United States)

    Rahman, Md Z.; Roytman, Leonid; Kadik, Abdelhamid; Miller, Howard; Rosy, Dilara A.

    2015-05-01

    Global Earth Observation Systems of Systems (GEOSS) are bringing vital societal benefits to people around the globe. In this research article, we engage undergraduate students in the exciting area of space exploration to improve the health of millions of people globally. The goal of the proposed research is to place students in a learning environment where they will develop their problem solving skills in the context of a world crisis (e.g., malaria). Malaria remains one of the greatest threats to public health, particularly in developing countries. The World Health Organization has estimated that over one million die of Malaria each year, with more than 80% of these found in Sub-Saharan Africa. The mosquitoes transmit malaria. They breed in the areas of shallow surface water that are suitable to the mosquito and parasite development. These environmental factors can be detected with satellite imagery, which provide high spatial and temporal coverage of the earth's surface. We investigate on moisture, thermal and vegetation stress indicators developed from NOAA operational environmental satellite data. Using these indicators and collected epidemiological data, it is possible to produce a forecast system that can predict the risk of malaria for a particular geographical area with up to four months lead time. This valuable lead time information provides an opportunity for decision makers to deploy the necessary preventive measures (spraying, treated net distribution, storing medications and etc) in threatened areas with maximum effectiveness. The main objective of the proposed research is to study the effect of ecology on human health and application of NOAA satellite data for early detection of malaria.

  10. Evaluation of the Global Fund-supported National Malaria Control Program in Papua New Guinea, 2009-2014.

    Science.gov (United States)

    Hetzel, Manuel W; Pulford, Justin; Maraga, Seri; Barnadas, Celine; Reimer, Lisa J; Tavul, Livingstone; Jamea-Maiasa, Sharon; Tandrapah, Tony; Maalsen, Anna; Makita, Leo; Siba, Peter M; Mueller, Ivo

    2014-01-01

    The Global Fund to Fight AIDS, Tuberculosis and Malaria is the major funaer Of the National Malaria Control Program in Papua New Guinea (PNG). One of the requirements of a Global Fund grant is the regular and accurate reporting of program outcomes and impact. Under-performance as well as failure to report can result in reduction or discontinuation of program funding. While national information systems should be in a position to provide accurate and comprehensive information for program evaluation, systems in developing countries are often insufficient. This paper describes the five-year plan for the evaluation of the Global Fund Round 8 malaria grant to PNG (2009-2014) developed by the Papua New Guinea Institute of Medical Research (PNGIMR). It builds on a complementary set of studies including national surveys and sentinel site surveillance for the assessment of program outcomes and impact. The PNGIMR evaluation plan is an integral part of the Global Fund grant. The evaluation program assesses intervention coverage (at individual, household and health facility levels), antimalarial drug efficacy, indicators of malaria transmission and morbidity (prevalence, incidence), and all-cause mortality. Operational research studies generate complementary information for improving the control program. Through the evaluation, PNGIMR provides scientific expertise to the PNG National Malaria Control Program and contributes to building local capacity in monitoring and evaluation. While a better integration of evaluation activities into routine systems would be desirable, it is unlikely that sufficient capacity for data analysis and reporting could be established at the National Department of Health (NDoH) within a short period of time. Long-term approaches should aim at strengthening the national health information system and building sufficient capacity at NDoH for routine analysis and reporting, while more complex scientific tasks can be supported by the PNGIMR as the de facto

  11. Disentangling quality and safety indicator data: a longitudinal, comparative study of hand hygiene compliance and accreditation outcomes in 96 Australian hospitals.

    Science.gov (United States)

    Mumford, Virginia; Greenfield, David; Hogden, Anne; Debono, Deborah; Gospodarevskaya, Elena; Forde, Kevin; Westbrook, Johanna; Braithwaite, Jeffrey

    2014-09-23

    The study aims are twofold. First, to investigate the suitability of hand hygiene as an indicator of accreditation outcomes and, second, to test the hypothesis that hospitals with better accreditation outcomes achieve higher hand hygiene compliance rates. A retrospective, longitudinal, multisite comparative survey. Acute public hospitals in New South Wales, Australia. 96 acute hospitals with accreditation survey results from two surveys during 2009-2012 and submitted data for more than four hand hygiene audits between 2010 and 2013. Our primary outcome comprised observational hand hygiene compliance data from eight audits during 2010-2013. The explanatory variables in our multilevel regression model included: accreditation outcomes and scores for the infection control standard; timing of the surveys; and hospital size and activity. Average hand hygiene compliance rates increased from 67.7% to 80.3% during the study period (2010-2013), with 46.7% of hospitals achieving target compliance rates of 70% in audit 1, versus 92.3% in audit 8. Average hand hygiene rates at small hospitals were 7.8 percentage points (pp) higher than those at the largest hospitals (phygiene rates, accreditation outcomes and infection control scores is less clear. Our results indicate that accreditation outcomes and hand hygiene audit data are measuring different parts of the quality and safety spectrum. Understanding what is being measured when selecting indicators to assess the impact of accreditation is critical as focusing on accreditation results would discount successful hand hygiene implementation by smaller hospitals. Conversely, relying on hand hygiene results would discount the infection control related research and leadership investment by larger hospitals. Our hypothesis appears to be confounded by an accreditation programme that makes it more difficult for smaller hospitals to achieve high infection control scores. Published by the BMJ Publishing Group Limited. For permission to

  12. Costs of eliminating malaria and the impact of the global fund in 34 countries.

    Directory of Open Access Journals (Sweden)

    Brittany Zelman

    elimination provide policymakers with an indication of the level of financial resources that should be mobilized to achieve malaria elimination goals.

  13. Pyrimethamine/sulfadoxine combination in the treatment of uncomplicated falciparum malaria: relation between dihydropteroate synthase/dihydrofolate reductase genotypes, sulfadoxine plasma levels, and treatment outcome

    DEFF Research Database (Denmark)

    Khalil, Insaf; Alifrangis, Michael; Rønn, Anita M;

    2002-01-01

    in relation to the frequency of dhfr and dhps mutations in 37 Plasmodium falciparum isolates sampled before treatment. Plasma levels of SDX measured at days 0, 3, 7, and 14 ascertained drug absorption. Point mutations were detected only at codons 51 and 108 of dhfr and codon 436 of dhps. The frequency of dhfr...... 51/108 and dhps 436 mutations was 79% and 8%. The plasma levels of SDX indicated adequate drug absorption by all patients. The presence of Ile 51 and Asn 108 mutations among parasites that cleared after treatment indicates that these mutations alone are insufficient to cause in vivo resistance......Several in vitro studies have shown the correlation between mutations in dhfr and dhps genes and resistance to pyrimethamine/sulfadoxine (PYR/SDX) combination, but the in vivo correlates of these mutations with PYR/ SDX efficacy have not been investigated fully. We assessed PYR/SDX efficacy...

  14. A study of the TNF/LTA/LTB locus and susceptibility to severe malaria in highland papuan children and adults

    Directory of Open Access Journals (Sweden)

    Granger Donald L

    2010-10-01

    Full Text Available Abstract Background Severe malaria (SM syndromes caused by Plasmodium falciparum infection result in major morbidity and mortality each year. However, only a fraction of P. falciparum infections develop into SM, implicating host genetic factors as important determinants of disease outcome. Previous studies indicate that tumour necrosis factor (TNF and lymphotoxin alpha (LTα may be important for the development of cerebral malaria (CM and other SM syndromes. Methods An extensive analysis was conducted of single nucleotide polymorphisms (SNPs in the TNF, LTA and LTB genes in highland Papuan children and adults, a population historically unexposed to malaria that has migrated to a malaria endemic region. Generated P-values for SNPs spanning the LTA/TNF/LTB locus were corrected for multiple testing of all the SNPs and haplotype blocks within the region tested through 10,000 permutations. A global P-value of Results No associations between SNPs in the TNF/LTA/LTB locus and susceptibility to SM in highland Papuan children and adults were found. Conclusions These results support the notion that unique selective pressure on the TNF/LTA/LTB locus in different populations has influenced the contribution of the gene products from this region to SM susceptibility.

  15. [EQA-17: proposing a synthetic indicator to measure the outcomes of primary care teams in people over 14 years].

    Science.gov (United States)

    Vila Córcoles, Angel; Ansa Echevarría, Xabier; Gómez Sorribes, Albert; Fort Sabaté, Joan; Llorens, Jordi Grifoll; Pascual Morón, Ignacio

    2006-01-01

    There are many indicators to measure different aspects of the Primary Health Care activities. However, the interpretation of most of them it is difficult because the majority give partial information. This work proposes a standardised model to calculation of a synthetic indicator to measure the product of primary care teams. We made this work based on the sequential realization of a bibliographical review, a retrospective study to know registered morbidity, and the consent of a working group. For the design of the synthetic indicator we carried out a sequential working methodology in six phases: (1) identification and selection of components for the indicator; (2) determination of theoretical prevalences and coverages; (3) ponderation of the components; (4) establishment of standards; (5) formulation of the components; (6) application of the scale and calculation of the indicator. Ten health problems were selected; that supposed a standardised scale of 17 items (EQA-17). The 10 problems of health which composed this synthetic indicator contemplate the realization of activities of promotion of the health (smoking cessation), activities of primary prevention (tetanus and influenza vaccination), care of acute problems (prescription of antibiotics), and care of chronic diseases (diabetes, chronic obstructive pulmonary disease, hypertension, patients with high-risk cardiovascular index, atrial fibrillation, and heart failure). The concept of a synthetic indicator to measure the level of quality of the product generated by the primary care teams could be useful for the improvement of the current evaluation models in primary care services.

  16. Indications for admission, treatment and improved outcome of paediatric haematology/oncology patients admitted to a tertiary paediatric ICU.

    LENUS (Irish Health Repository)

    Owens, C

    2012-02-01

    BACKGROUND: Overall survival in paediatric cancer has improved significantly over the past 20 years. Treatment strategies have been intensified, and supportive care has made substantial advances. Historically, paediatric oncology patients admitted to an intensive care unit (ICU) have had extremely poor outcomes. METHODS: We conducted a retrospective cohort study over a 3-year period in a single centre to evaluate the outcomes for this particularly vulnerable group of patients admitted to a paediatric ICU. RESULTS: Fifty-five patients were admitted a total of 66 times to the ICU during the study period. The mortality rate of this group was 23% compared with an overall ICU mortality rate of 5%. 11\\/15 patients who died had an underlying haematological malignancy. Twenty-eight percent of children with organism-identified sepsis died. CONCLUSIONS: While mortality rates for paediatric oncology patients admitted to a ICU have improved, they are still substantial. Those with a haematological malignancy or admitted with sepsis are most at risk.

  17. Allopurinol Use during Pregnancy - Outcome of 31 Prospectively Ascertained Cases and a Phenotype Possibly Indicative for Teratogenicity.

    Directory of Open Access Journals (Sweden)

    Maria Hoeltzenbein

    Full Text Available Allopurinol is a purine analogue that inhibits xanthine oxidase. It is mainly used for the treatment of hyperuricemia in patients with gout or tumor lysis syndrome. Experience with allopurinol in pregnancy is scarce. In 2011, Kozenko et al. reported on a child with multiple malformations after maternal treatment with allopurinol throughout pregnancy. Possible teratogenicity of allopurinol was proposed due to the similarity of the pattern of malformations in children with mycophenolate embryopathy. A possible common mechanism of both drugs, i.e. disruption of purine synthesis, was discussed. We report on the outcome of 31 prospectively ascertained pregnancies with allopurinol exposure at least during first trimester. Pregnancy outcomes were 2 spontaneous abortions, 2 elective terminations of pregnancy and 27 live born children. The overall rate of major malformations (3.7% and of spontaneous abortions (cumulative incidence 11%, 95%-CI 3-40 were both within the normal range. However, there was one child with severe malformations including microphthalmia, cleft lip and palate, renal hypoplasia, low-set ears, hearing deficit, bilateral cryptorchidism, and micropenis. The striking similarity of the anomalies in this child and the case described by Kozenko et al. might be considered as a signal for teratogenicity. Thus, we would recommend caution with allopurinol treatment in the first trimester, until further data are available.

  18. Monkey malaria kills four humans.

    Science.gov (United States)

    Galinski, Mary R; Barnwell, John W

    2009-05-01

    Four human deaths caused by Plasmodium knowlesi, a simian malaria species, are stimulating a surge of public health interest and clinical vigilance in vulnerable areas of Southeast Asia. We, and other colleagues, emphasize that these cases, identified in Malaysia, are a clear warning that health facilities and clinicians must rethink the diagnosis and treatment of malaria cases presumed to be caused by a less virulent human malaria species, Plasmodium malariae.

  19. Alternative transmission routes in the malaria elimination era: an overview of transfusion-transmitted malaria in the Americas.

    Science.gov (United States)

    Alho, Regina M; Machado, Kim Vinícius Amaral; Val, Fernando F A; Fraiji, Nelson A; Alexandre, Marcia A A; Melo, Gisely C; Recht, Judith; Siqueira, André M; Monteiro, Wuelton M; Lacerda, Marcus V G

    2017-02-15

    Transfusion-transmitted (TT) malaria is an alternative infection route that has gained little attention from authorities, despite representing a life-threatening condition. There has been no systematic review of this health problem in American countries. The aim of this study was to describe the clinical and epidemiological characteristics of TT malaria in the Americas and identify factors associated with lethality based on the studies published in the literature. Potentially relevant papers in all languages were retrieved from MEDLINE and LILACS. Additional articles were obtained from reviews and original papers. Publications on screening of candidate blood donors and on surveillance of TT malaria cases were included. Odds ratios with respective 95% confidence intervals (95% CI) were calculated. Epidemiological characteristics of blood donors of TT malaria cases, including a pooled positivity of different tests for malaria diagnosis, were retrieved. A total of 63 publications regarding TT malaria from seven countries were included, from 1971 to 2016. A total of 422 cases of TT malaria were recorded. Most TT malaria cases were in females (62.0%) and 39.5% were in the ≥61 years-old age group. About half of all cases were from Mexico (50.7%), 40.3% from the United States of America (USA) and 6.6% from Brazil. Gyneco-obstetrical conditions (67.3%), surgical procedures (20.6%) and complications from neoplasias (6.1%) were the most common indications of transfusion. Packed red blood cells (RBCs) (50.7%) and whole blood (43.3%) were the blood products mostly associated with TT malaria. Cases were mostly caused by Plasmodium malariae (58.4%), followed by Plasmodium vivax (20.7%) and Plasmodium falciparum (17.9%). A total of 66.6% of cases were diagnosed by microscopy. Incubation period of 2-3 weeks was the most commonly observed (28.6%). Lethality was seen in 5.3% of cases and was associated with living in non-endemic countries, P. falciparum infection and concomitant

  20. Treatment and prevention of malaria in pregnancy in the private health sector in Uganda

    DEFF Research Database (Denmark)

    Mbonye, Anthony K; Buregyeya, Esther; Rutebemberwa, Elizeus;

    2016-01-01

    and prevention practices for malaria among pregnant women. The main study outcome was the proportion of private health facilities who prescribe treatment of fever among pregnant women as recommended in the guidelines. RESULTS: A total of 241 private health facilities were surveyed; 70.5 % were registered drug...... clinics and pharmacies for prevention of malaria in pregnancy. Few facilities had malaria treatment guidelines; (44.1 % of private clinics, 17.9 % of drug shops, and 41.7 % at pharmacies. Knowledge of people at risk of malaria, P = 0.02 and availability of malaria treatment guidelines, P = 0.03 were......BACKGROUND: Malaria in pregnancy is a major public health problem in Uganda; and it is the leading cause of anaemia among pregnant women and low birth weight in infants. Previous studies have noted poor quality of care in the private sector. Thus there is need to explore ways of improving quality...

  1. Joint spatial time-series epidemiological analysis of malaria and cutaneous leishmaniasis infection.

    Science.gov (United States)

    Adegboye, O A; Al-Saghir, M; Leung, D H Y

    2017-03-01

    Malaria and leishmaniasis are among the two most important health problems of many developing countries especially in the Middle East and North Africa. It is common for vector-borne infectious diseases to have similar hotspots which may be attributed to the overlapping ecological distribution of the vector. Hotspot analyses were conducted to simultaneously detect the location of local hotspots and test their statistical significance. Spatial scan statistics were used to detect and test hotspots of malaria and cutaneous leishmaniasis (CL) in Afghanistan in 2009. A multivariate negative binomial model was used to simultaneously assess the effects of environmental variables on malaria and CL. In addition to the dependency between malaria and CL disease counts, spatial and temporal information were also incorporated in the model. Results indicated that malaria and CL incidence peaked at the same periods. Two hotspots were detected for malaria and three for CL. The findings in the current study show an association between the incidence of malaria and CL in the studied areas of Afghanistan. The incidence of CL disease in a given month is linked with the incidence of malaria in the previous month. Co-existence of malaria and CL within the same geographical area was supported by this study, highlighting the presence and effects of environmental variables such as temperature and precipitation. People living in areas with malaria are at increased risk for leishmaniasis infection. Local healthcare authorities should consider the co-infection problem by recommending systematic malaria screening for all CL patients.

  2. Behavioral change communication strategy vital in malaria prevention interventions in rural communities: Nakasongola district, Uganda.

    Science.gov (United States)

    Mugisa, Margaret; Muzoora, Abel

    2012-01-01

    Malaria is a leading killer disease in Uganda and it accounts for significant morbidity in pregnant women and children. Pregnant women are more susceptible to malaria, which causes adverse effects including abortion, low birth weight and maternal anaemia. Children with severe malaria frequently develop one of these symptoms including: severe anaemia, respiratory distress, Prostration, convulsions and cerebral malaria. Due to the severity of the disease there is need for multiple interventions to reduce the disease burden. African Medical and Research Foundation (AMREF) adopted community based approaches to improve malaria prevention. Behavioral change communication (BCC) was fundamental at every process of Project implementation. This paper shares AMREF's experience in using BCC strategies amidst other interventions in malaria prevention approaches involving use of insecticide treated nets and environment management. AMREF through a Malaria project (2007-2010) in Nakasongola district supported BCC activities through training, community mobilization, mass media, health promotion and advocacy. Program performance was measured through baseline and evaluation surveys in 2007 and 2010. The final project evaluation indicated improvement from baseline values as follows: knowledge on prevention of malaria among school children from 76.6% to 90%, under five children sleeping under bed net the previous night from 51% to 74.7%, and from 24% to 78% among pregnant women. Mobilization of malaria prevention interventions can be successful once BCC approaches are adequately planned and coordinated. Malaria prevention through BCC strategies are likely to be more effective with integration of other malaria interventions, and involvement of community based structures.

  3. Reconnecting urban planning with health: a protocol for the development and validation of national liveability indicators associated with noncommunicable disease risk behaviours and health outcomes.

    Science.gov (United States)

    Giles-Corti, Billie; Badland, Hannah; Mavoa, Suzanne; Turrell, Gavin; Bull, Fiona; Boruff, Bryan; Pettit, Chris; Bauman, Adrian; Hooper, Paula; Villanueva, Karen; Astell-Burt, Thomas; Feng, Xiaoqi; Learnihan, Vincent; Davey, Rachel; Grenfell, Rob; Thackway, Sarah

    2014-11-28

    Liveable communities create the conditions to optimise health and wellbeing outcomes in residents by influencing various social determinants of health - for example, neighbourhood walkability and access to public transport, public open space, local amenities, and social and community facilities. This study will develop national liveability indicators that are (a) aligned with state and federal urban policy, (b) developed using national data (where available), (c) standard and consistent over time, (d) suitable for monitoring progress towards creating more liveable, equitable and sustainable communities, (e) validated against selected noncommunicable disease risk behaviours and/or health outcomes, and (f) practical for measuring local, national and federal built environment interventions. Protocol. Over two years, the National Liveability Study, funded through The Australian Prevention Partnership Centre (TAPPC), will develop and validate a national set of spatially derived built environment liveability indicators related to noncommunicable disease risk behaviours and/or health outcomes, informed by a review of relevant policies in selected Australian state and territory governments. To create national indicators, we will compare measures developed using national data with finer-grained state-level data, which have been validated against a range of outcomes. Finally, we will explore the creation of a national database of built environment spatial indicators. A national advisory group comprising stakeholders in state and federal government, federal nongovernment organisations and state-based technical working groups located in the ACT, Victoria, NSW, Queensland and WA has been established; a policy analysis is under way and work programs are being prepared. This project seeks to build the capacity for built environment and health systems research by developing national indicators to monitor progress towards creating healthy and liveable communities. This ambition

  4. Identifying the Educational Needs Regarding Malaria Prophylaxis in Expatriates in Zambia%居住在赞比亚的侨民对疟疾预防教育的需求

    Institute of Scientific and Technical Information of China (English)

    Therese Maarschalk; M.H Ross

    2002-01-01

    @@ Falciparum malaria is a major cause of mortality and morbidity amongst the indigenous as well as the expatriate population in Atica. Malaria prevention is based on health education regarding the seriousness of malaria, the several previous studies have however indicated that expatriates seem to ignore this advice in spite of being aware of the threat of malaria.

  5. Towards A Malaria Vaccine?

    Directory of Open Access Journals (Sweden)

    B S GARG

    1990-12-01

    Full Text Available The last few years have seen a marked change in the understanding of malaria mmunology.We have very little knowledge on immunity of Malaria based on experiments in humanbeings due to ethical reasons. Whatsoever our knowledge exists at present is based onexperimentas in mice and monkey. However it is clear that it is sporzoite or merozoitewhich is directly exposed to our immune system in the life cycle of Malaria parasite. On thebasis of human experiments we can draw inference that immunity to malaria is species.specific (on cross immunity, stage specific and strain specific as well acquired in the response to surface antigen and relapsed antigen although the parasite also demonstrates escape machanism to immune system.So the host system kills or elimi nate the parasite by means of (a Antbody to extracell~ular form of parasite with the help of mechanism of Block invasion, Agglutination or opsonization and/or (b Cellular machanism-either by phago-cytosis of parasite or by antibody dependent cellular cytotoxicity ABCC (? or by effects of mediators like tumor necrosis fJ.ctor (TNF in cerebaral malaria or crisis forming factor as found in sudan or by possible role of lysis mechanism.However, inspite of all these theories the parasite has been able to invade the immunesystem by virtue of its intracellular development stage specificity, sequestration in capillaries and also by its unusual characteristics of antigenic diversity and antigenic variation.

  6. Knowledge, attitudes and practices of malaria in Colombia.

    Science.gov (United States)

    Forero, David A; Chaparro, Pablo E; Vallejo, Andres F; Benavides, Yoldy; Gutiérrez, Juan B; Arévalo-Herrera, Myriam; Herrera, Sócrates

    2014-05-01

    Although Colombia has witnessed an important decrease in malaria transmission, the disease remains a public health problem with an estimated ~10 million people currently living in areas with malaria risk and ~61,000 cases reported in 2012. This study aimed to determine and compare the level of knowledge, attitudes and practices (KAP) about malaria in three endemic communities of Colombia to provide the knowledge framework for development of new intervention strategies for malaria elimination. A cross-sectional KAP survey was conducted in the municipalities of Tierralta, Buenaventura and Tumaco, categorized according to high risk (HR) and moderate risk (MR) based on the annual parasite index (API). Surveys were managed using REDCap and analysed using MATLAB and GraphPad Prism. A total of 267 residents, mostly women (74%) were surveyed. Although no differences were observed on the knowledge of classical malaria symptoms between HR and MR regions, significant differences were found in knowledge and attitudes about transmission mechanisms, anti-malarial use and malaria diagnosis. Most responders in both regions (93.5% in MR, and 94.3% in HR areas) indicated use of insecticide-treated nets (ITNs) to protect themselves from malaria, and 75.5% of responders in HR indicated they did nothing to prevent malaria transmission outdoors. Despite a high level of knowledge in the study regions, significant gaps persisted relating to practices. Self-medication and poor adherence to treatment, as well as lack of both indoor and outdoor vector control measures, were significantly associated with higher malaria risk. Although significant efforts are currently being made by the Ministry of Health to use community education as one of the main components of the control strategy, these generic education programmes may not be applicable to all endemic regions of Colombia given the substantial geographic, ethnic and cultural diversity.

  7. Indications and Outcomes of the Components Separation Technique in the Repair of Complex Abdominal Wall Hernias: Experience From the Cambridge Plastic Surgery Department

    OpenAIRE

    Adekunle, Shola; Pantelides, Nicholas M.; Hall, Nigel R; Praseedom, Raaj; Malata, Charles M.

    2013-01-01

    Objectives: The components separation technique (CST) is a widely described abdominal wall reconstructive technique. There have, however, been no UK reports of its use, prompting the present review. Methods: Between 2008 and 2012, 13 patients who underwent this procedure by a single plastic surgeon (C.M.M.) were retrospectively evaluated. The indications, operative details, and clinical outcomes were recorded. Results: There were 7 women and 6 men in the series with a mean age of 53 years (ra...

  8. Lymphocytes as an Indicator for Initial Kidney Function: A Single Center Analysis of Outcome after Alemtuzumab or Basiliximab Induction

    Directory of Open Access Journals (Sweden)

    Annemarie Weissenbacher

    2015-01-01

    Full Text Available Alemtuzumab, an anti-CD52 T-cell and B-cell depleting monoclonal antibody, is established for induction therapy in renal transplantation (KTx. We herein provide a comparative analysis between alemtuzumab and basiliximab induction therapy and correlate lymphocyte depletion and recovery with the clinical course after KTx. This is a single center retrospective analysis of 225 patients/consecutive kidney transplantations treated with alemtuzumab for lymphocyte depletion and 205 recipients treated with basiliximab. Mean lymphocyte counts were 22.8 ± 9.41% before Tx and 2.61 ± 3.11% between week 1 and week 3 in the alemtuzumab group and 23.77 ± 10.42% before Tx and 13.92 ± 8.20% in the basiliximab group. Delayed graft function (DGF, cytomegalovirus (CMV status, and recipient age showed a significant correlation with lymphocyte counts in the alemtuzumab group only. The outcome was read in reference to the velocity of lymphocyte recovery and in comparison to the control group. Lymphocyte counts early after transplantation, following alemtuzumab treatment, could be identified as a predictive factor for kidney function early after transplantation. A detailed analysis of phenotype and function of lymphocytes after alemtuzumab induction together with a correlation with the clinical course is warranted.

  9. Lymphocytes as an Indicator for Initial Kidney Function: A Single Center Analysis of Outcome after Alemtuzumab or Basiliximab Induction.

    Science.gov (United States)

    Weissenbacher, Annemarie; Hautz, Theresa; Kimelman, Michael; Oberhuber, Rupert; Ulmer, Hanno; Bösmüller, Claudia; Maglione, Manuel; Schneeberger, Stefan

    2015-01-01

    Alemtuzumab, an anti-CD52 T-cell and B-cell depleting monoclonal antibody, is established for induction therapy in renal transplantation (KTx). We herein provide a comparative analysis between alemtuzumab and basiliximab induction therapy and correlate lymphocyte depletion and recovery with the clinical course after KTx. This is a single center retrospective analysis of 225 patients/consecutive kidney transplantations treated with alemtuzumab for lymphocyte depletion and 205 recipients treated with basiliximab. Mean lymphocyte counts were 22.8 ± 9.41% before Tx and 2.61 ± 3.11% between week 1 and week 3 in the alemtuzumab group and 23.77 ± 10.42% before Tx and 13.92 ± 8.20% in the basiliximab group. Delayed graft function (DGF), cytomegalovirus (CMV) status, and recipient age showed a significant correlation with lymphocyte counts in the alemtuzumab group only. The outcome was read in reference to the velocity of lymphocyte recovery and in comparison to the control group. Lymphocyte counts early after transplantation, following alemtuzumab treatment, could be identified as a predictive factor for kidney function early after transplantation. A detailed analysis of phenotype and function of lymphocytes after alemtuzumab induction together with a correlation with the clinical course is warranted.

  10. Comparative Study of Pregnancy Outcome in Premature Rupture of Membranes With Amniotic Fluid Indices of less and more than 5

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    F Tavassoli

    2010-03-01

    Full Text Available Introduction: Preterm premature rupture of the membranes (PPROM is one of the most important causes of perinatal morbidity and mortality. The aim of this study was to evaluate pregnancy outcome in preterm premature rupture of the membranes with amniotic fluid index less than 5 and more than 5. Methods: This prospective study was performed on 137 pregnant women with gestational age of 28-34 weeks with PPROM from Oct 2006 to Oct 2008. The patients were divided in two groups according to amniotic fluid index: AFI<5 (77 cases, AFI≥5 (60 cases. Chi-square test was used for qualitative variables, while T-student test was used for quantitative test. Results: Both groups were similar with respect to number of pregnancies, gestational age at rupture of the membranes and birth weight. In the group with AFI<5, applied latency was significantly shorter (PV=0.049, rate of cesarean section was higher due to fetal distress (PV=0.008, neonatal Apgar score in first minute was lower during the first week (PV=0.0127 and the rate of neonatal death was higher (PV=0.045 during the first week. Conclusion: An AFI<5 cm after PPROM is associated with earlier delivery, higher rate of cesarean due to fetal distress, higher rate of neonatal death, and lower neonatal Apgar score in first minute during the first week

  11. [Study on malaria vectors in malaria endemic areas of Tibet autonomous region].

    Science.gov (United States)

    Wu, Song; Huang, Fang; Zhou, Shui-Sen; Tang, Lin-Hua

    2012-12-01

    The malaria situation in Tibet has been in an active status and the malaria incidence reached the second in China in 2010. Malaria vector prevention and control is one of the important methods for malaria control, while the malaria vectors are still unknown in Tibet. The author summarized the past researches on malaria vectors in Tibet, so as to provide the evidence for improving malaria control investigation in malaria endemic areas of Tibet, with hopes to provide useful vector message for other researcher.

  12. Large-scale malaria survey in Cambodia: Novel insights on species distribution and risk factors

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    Doung Socheat

    2007-03-01

    Full Text Available Abstract Background In Cambodia, estimates of the malaria burden rely on a public health information system that does not record cases occurring among remote populations, neither malaria cases treated in the private sector nor asymptomatic carriers. A global estimate of the current malaria situation and associated risk factors is, therefore, still lacking. Methods A large cross-sectional survey was carried out in three areas of multidrug resistant malaria in Cambodia, enrolling 11,652 individuals. Fever and splenomegaly were recorded. Malaria prevalence, parasite densities and spatial distribution of infection were determined to identify parasitological profiles and the associated risk factors useful for improving malaria control programmes in the country. Results Malaria prevalence was 3.0%, 7.0% and 12.3% in Sampovloun, Koh Kong and Preah Vihear areas. Prevalences and Plasmodium species were heterogeneously distributed, with higher Plasmodium vivax rates in areas of low transmission. Malaria-attributable fevers accounted only for 10–33% of malaria cases, and 23–33% of parasite carriers were febrile. Multivariate multilevel regression analysis identified adults and males, mostly involved in forest activities, as high risk groups in Sampovloun, with additional risks for children in forest-fringe villages in the other areas along with an increased risk with distance from health facilities. Conclusion These observations point to a more complex malaria situation than suspected from official reports. A large asymptomatic reservoir was observed. The rates of P. vivax infections were higher than recorded in several areas. In remote areas, malaria prevalence was high. This indicates that additional health facilities should be implemented in areas at higher risk, such as remote rural and forested parts of the country, which are not adequately served by health services. Precise malaria risk mapping all over the country is needed to assess the

  13. Large-scale malaria survey in Cambodia: novel insights on species distribution and risk factors.

    Science.gov (United States)

    Incardona, Sandra; Vong, Sirenda; Chiv, Lim; Lim, Pharath; Nhem, Sina; Sem, Rithy; Khim, Nimol; Doung, Socheat; Mercereau-Puijalon, Odile; Fandeur, Thierry

    2007-03-27

    In Cambodia, estimates of the malaria burden rely on a public health information system that does not record cases occurring among remote populations, neither malaria cases treated in the private sector nor asymptomatic carriers. A global estimate of the current malaria situation and associated risk factors is, therefore, still lacking. A large cross-sectional survey was carried out in three areas of multidrug resistant malaria in Cambodia, enrolling 11,652 individuals. Fever and splenomegaly were recorded. Malaria prevalence, parasite densities and spatial distribution of infection were determined to identify parasitological profiles and the associated risk factors useful for improving malaria control programmes in the country. Malaria prevalence was 3.0%, 7.0% and 12.3% in Sampovloun, Koh Kong and Preah Vihear areas. Prevalences and Plasmodium species were heterogeneously distributed, with higher Plasmodium vivax rates in areas of low transmission. Malaria-attributable fevers accounted only for 10-33% of malaria cases, and 23-33% of parasite carriers were febrile. Multivariate multilevel regression analysis identified adults and males, mostly involved in forest activities, as high risk groups in Sampovloun, with additional risks for children in forest-fringe villages in the other areas along with an increased risk with distance from health facilities. These observations point to a more complex malaria situation than suspected from official reports. A large asymptomatic reservoir was observed. The rates of P. vivax infections were higher than recorded in several areas. In remote areas, malaria prevalence was high. This indicates that additional health facilities should be implemented in areas at higher risk, such as remote rural and forested parts of the country, which are not adequately served by health services. Precise malaria risk mapping all over the country is needed to assess the extensive geographical heterogeneity of malaria endemicity and risk

  14. Overexpression of vascular endothelial growth factor indicates poor outcomes of glioma: a systematic review and meta-analysis

    Science.gov (United States)

    Chen, Wenjie; He, Deshen; Li, Zuyun; Zhang, Xin; Pan, Denghua; Chen, Gang

    2015-01-01

    Background: Accumulated studies have revealed that vascular endothelial growth factor (VEGF) plays an essential role in the progression of glioma, but the prognostic significance of VEGF expression for patients with glioma remains unknown. Method and material: A literature search of public databases (PubMed, ISI Web of Science, Science Direct, Cochrane Central Register of Controlled Trials, Wiley Online Library, China National Knowledge Infrastructure, China Biology Medicine disc, Chongqing VIP and Wan Fang Data) was conducted. A meta-analysis was performed to evaluate the association between the overexpression of VEGF and the survival for the glioma patients. Subsequently we evaluated the impact of VEGF expression on the pathological grade of glioma. Results: A total of 32 articles with 2307 cases contributed to this analysis, of which 31 reported overall survival (OS) and 5 reported progression-free survival (PFS). In this meta-analysis, VEGF overexpression significantly identified the unfavorable outcome on OS (HR = 1.647, 95% CI: 1.324~2.048, P < 0.001, Z = 4.48) but not on PFS (HR = 1.021, 95% CI: 0.974~1.070, P = 0.393). Subgroup analyses also revealed that high level of VEGF was associated with the poor OS for the patients with glioma according to region, case number, specimen type, method to detect VEGF and statistical method. Furthermore, the significant correlation was achieved between VEGF expression and the pathological grade of glioma (r = 0.307, P < 0.001). Conclusion: This study suggests that VEGF expression is significantly correlated with the glioma progression and may be a valuable prognostic factor on OS for the glioma patients. PMID:26309522

  15. The Modified Early Warning Score (MEWS): an instant physiological prognostic indicator of poor outcome in acute pancreatitis.

    Science.gov (United States)

    Suppiah, Aravind; Malde, Deep; Arab, Tameem; Hamed, Mazin; Allgar, Victoria; Morris-Stiff, Gareth; Smith, Andrew

    2014-11-28

    The Modified Early Warning Score (MEWS) is a bedside scoring system that is non-invasive, simple and repeatable to reflect dynamic changes in physiological state. This study aims to assess accuracy of MEWS and determine an optimal MEWS value in predicting severity in acute pancreatitis (AP). A prospective database of consecutive admissions with AP to a single institution was analysed to determine value of MEWS in identifying severe acute pancreatitis (SAP) and predicting poor outcome. Receiver operator curves (ROC) were used to determine optimal accuracy. Sensitivity, specificity, negative predictive value (NPV), and positive predictive values (PPV) were calculated for the optimal MEWS values obtained. One-hundred and 42 patients with AP were included. The optimal highest MEWS per 24 hours period (hMEWS) and mean MEWS per 24 hour period (mMEWS) in predicting SAP as determined by ROC were 2.5 and 1.625 respectively; with hMEWS ≥3 and mMEWS >1 utilised in this cohort as MEWS scores are whole numbers. On admission, sensitivity, specificity, NPV, PPV, and accuracy of hMEWS ≥3 was 95.5%, 90.8%, 99.0%, 65.6% and 92.0%; and for mMWES >1 was 95.5%, 87.5%, 99.0%, 58.3% and 88.7%, both superior than the Imrie score: 31.5%, 92.1%, 88.9%, 40.0% and 83.5%. The accuracy of hMEWS ≥3 and mMEWS >1 increased over the subsequent 72 hours (days 0-2) from 92 to 96%, and 89% to 94%, respectively. MEWS provides a novel, easy, instant, repeatable, reliable prognostic score that may be superior to existing scoring systems. A larger cohort is required to validate these findings.

  16. MIGRATION AND MALARIA IN EUROPE

    Directory of Open Access Journals (Sweden)

    Begoña Monge-Maillo

    2012-03-01

    Full Text Available The proportion of imported malaria cases due to immigrants in Europe has increased during the lasts decades, being the higher rates for those settled immigrants who travel to visit friends and relatives (VFRs at their country of origin. Cases are mainly due to P. falciparum and Sub-Saharan Africa is the most common origin. Clinically, malaria in immigrants is characterized by a mild clinical presentation with even asymptomatic o delayed malaria cases and low parasitemic level. These characteristics may be explained by a semi-immunity acquired after long periods of time exposed to stable transmission of malaria. Malaria cases among immigrants, even those asymptomatic patients with sub-microscopic parasitemia, could increase the risk of transmission and reintroduction of malaria in certain areas with the adequate vectors and climate conditions. Moreover imported malaria cases by immigrants can also play an important role in the non-vectorial transmission out of endemic area, by blood transfusions, organ transplantation or congenital or occupational exposures. Probably, out of endemic areas, screening of malaria among recent arrived immigrants coming from malaria endemic countries should be performed. These aim to reduce the risk of clinical malaria in the individual as well as to prevent autochthonous transmission of malaria in areas where it had been eradicated.

  17. The use of outcome and process indicators to incentivize integrated care for frail older people: a case study of primary care services in Sweden

    Directory of Open Access Journals (Sweden)

    Anders Lars Anell

    2014-12-01

    Full Text Available Background: A number of reforms have been implemented in Swedish health care to support integrated care for frail older people and to reduce utilization of hospital care by this group. Outcomes and process indicators have been used in pay-for-performance (P4P schemes by both national and local governments to support developments.Objective: To analyse limitations in the use of outcome and process indicators to incentivize integrated care for elderly patients with significant health care needs in the context of primary care.Method: Data were collected from the Region Skåne county council. Eight primary care providers and associated community services were compared in a ranking exercise based on information from interviews and registered data. Registered data from 150 primary care providers were analysed in regression models.Results and conclusion: Both the ranking exercise and regression models revealed important problems related to risk-adjustment, attribution, randomness and measurement fixation when using indicators in P4P schemes and for external accountability purposes. Instead of using indicators in incentive schemes targeting individual providers, indicators may be used for diagnostic purposes and to support development of new knowledge, targeting local systems that move beyond organizational boundaries.

  18. Research toward Malaria Vaccines

    Science.gov (United States)

    Miller, Louis H.; Howard, Russell J.; Carter, Richard; Good, Michael F.; Nussenzweig, Victor; Nussenzweig, Ruth S.

    1986-12-01

    Malaria exacts a toll of disease to people in the Tropics that seems incomprehensible to those only familiar with medicine and human health in the developed world. The methods of molecular biology, immunology, and cell biology are now being used to develop an antimalarial vaccine. The Plasmodium parasites that cause malaria have many stages in their life cycle. Each stage is antigenically distinct and potentially could be interrupted by different vaccines. However, achieving complete protection by vaccination may require a better understanding of the complexities of B- and T-cell priming in natural infections and the development of an appropriate adjuvant for use in humans.

  19. Pathophysiological Mechanisms in Gaseous Therapies for Severe Malaria.

    Science.gov (United States)

    Kayano, Ana Carolina A V; Dos-Santos, João Conrado K; Bastos, Marcele F; Carvalho, Leonardo J; Aliberti, Júlio; Costa, Fabio T M

    2016-04-01

    Over 200 million people worldwide suffer from malaria every year, a disease that causes 584,000 deaths annually. In recent years, significant improvements have been achieved on the treatment of severe malaria, with intravenous artesunate proving superior to quinine. However, mortality remains high, at 8% in children and 15% in adults in clinical trials, and even worse in the case of cerebral malaria (18% and 30%, respectively). Moreover, some individuals who do not succumb to severe malaria present long-term cognitive deficits. These observations indicate that strategies focused only on parasite killing fail to prevent neurological complications and deaths associated with severe malaria, possibly because clinical complications are associated in part with a cerebrovascular dysfunction. Consequently, different adjunctive therapies aimed at modulating malaria pathophysiological processes are currently being tested. However, none of these therapies has shown unequivocal evidence in improving patient clinical status. Recently, key studies have shown that gaseous therapies based mainly on nitric oxide (NO), carbon monoxide (CO), and hyperbaric (pressurized) oxygen (HBO) alter vascular endothelium dysfunction and modulate the host immune response to infection. Considering gaseous administration as a promising adjunctive treatment against severe malaria cases, we review here the pathophysiological mechanisms and the immunological aspects of such therapies.

  20. Asymptomatic malaria infections among foreign migrant workers in Thailand

    Institute of Scientific and Technical Information of China (English)

    Kanyanan Kritsiriwuthinan; Warunee Ngrenngarmlert

    2011-01-01

    Objective:To determine the prevalence of malaria infections among foreign migrant workers in Thailand. Methods:Giemsa-stained thin and thick blood films were prepared from blood samples of294 foreign migrant workers recruited in the study. Microscopic examination of these blood films was performed for malaria detection.Results: Blood film examination revealed 1.36%malaria infections in these294 subjects. All positive cases were male Myanmar workers in which their blood films only ring stage ofPlasmodium spp. was found at low parasite density (mean=144parasites/μL of blood). The prevalence of malaria infections was not significantly different among foreign migrant workers classified by age, gender, and resident province (P>0.05). Thin blood films of these workers also showed78.91%hypochromic erythrocytes and 61.9%relative Eosinophilia.Conclusions:These findings indicate a high risk of malaria transmission. Therefore active malaria surveillance by using molecular methods with more sensitive and specific than microscopy should be considered for malaria control in foreign migrant workers.

  1. Plasmodium interspersed repeats: the major multigene superfamily of malaria parasites

    Science.gov (United States)

    Janssen, Christoph S.; Phillips, R. Stephen; Turner, C. Michael R.; Barrett, Michael P.

    2004-01-01

    Functionally related homologues of known genes can be difficult to identify in divergent species. In this paper, we show how multi-character analysis can be used to elucidate the relationships among divergent members of gene superfamilies. We used probabilistic modelling in conjunction with protein structural predictions and gene-structure analyses on a whole-genome scale to find gene homologies that are missed by conventional similarity-search strategies and identified a variant gene superfamily in six species of malaria (Plasmodium interspersed repeats, pir). The superfamily includes rif in P.falciparum, vir in P.vivax, a novel family kir in P.knowlesi and the cir/bir/yir family in three rodent malarias. Our data indicate that this is the major multi-gene family in malaria parasites. Protein localization of products from pir members to the infected erythrocyte membrane in the rodent malaria parasite P.chabaudi, demonstrates phenotypic similarity to the products of pir in other malaria species. The results give critical insight into the evolutionary adaptation of malaria parasites to their host and provide important data for comparative immunology between malaria parasites obtained from laboratory models and their human counterparts. PMID:15507685

  2. A climate distribution model of malaria transmission in Sudan.

    Science.gov (United States)

    Musa, Mohammed I; Shohaimi, Shamarina; Hashim, Nor R; Krishnarajah, Isthrinayagy

    2012-11-01

    Malaria remains a major health problem in Sudan. With a population exceeding 39 million, there are around 7.5 million cases and 35,000 deaths every year. The predicted distribution of malaria derived from climate factors such as maximum and minimum temperatures, rainfall and relative humidity was compared with the actual number of malaria cases in Sudan for the period 2004 to 2010. The predictive calculations were done by fuzzy logic suitability (FLS) applied to the numerical distribution of malaria transmission based on the life cycle characteristics of the Anopheles mosquito accounting for the impact of climate factors on malaria transmission. This information is visualized as a series of maps (presented in video format) using a geographical information systems (GIS) approach. The climate factors were found to be suitable for malaria transmission in the period of May to October, whereas the actual case rates of malaria were high from June to November indicating a positive correlation. While comparisons between the prediction model for June and the case rate model for July did not show a high degree of association (18%), the results later in the year were better, reaching the highest level (55%) for October prediction and November case rate.

  3. Use of H-Index and Other Bibliometric Indicators to Evaluate Research Productivity Outcome on Swine Diseases.

    Science.gov (United States)

    Díaz, Ivan; Cortey, Martí; Olvera, Àlex; Segalés, Joaquim

    2016-01-01

    H-index is the most commonly applied tool to evaluate scientific productivity. In this study, the use of the H-index to evaluate scientific production in swine veterinary medicine was explored. A database of 137 pig infectious agents was constructed, including its taxonomic division, zoonotic potential, status as emerging pathogen and whether it was OIE-listed. The H-index and the total number of citations were calculated for those pathogens, the location of the affiliation of the first author of each paper included in the H-index core was registered and, for the ten pathogens with the highest H-index, evolution over time was measured. H-index values were compared to the M quotient, A-index, G-index, HG-index and the G/H ratio. H-indices were found to be severely affected by search accuracy and the database was hand curated. Swine pathogen H-indexes were highly dispersed ranging from 0 to 106 and were generally higher for pathogens causing endemic diseases in large pig producing countries. Indeed, the three top pathogens were Escherichia coli, Porcine reproductive and respiratory syndrome virus and Porcine circovirus type 2 with H-indices 106, 95 and 85, respectively. H-indices of viruses and bacteria were significantly higher (Pdiseases, only non-emerging viruses had higher H-index (p = 0.02). The study of H-indexes over time revealed three general patterns and that they had increased mainly after the 1980's. As expected, there were strong geographic patterns in terms of authorship and North America (38%) and Europe (46%) coped the majority of the papers. Finally, in order to quantify the contribution of a subject to a specific field, a new index "Deciphering Citations Organized by Subject" (Dcos) is proposed.

  4. Background: apolipoprotein-a1 (apoa1 has been proposed as indicator of nutritional state, but controversy exists on the matter. Apolipoproteína A1 para evaluar el estado nutricional en niños con y sin malaria

    Directory of Open Access Journals (Sweden)

    Silvia Blair Trujillo

    2007-04-01

    Full Text Available Objective: to compare serum apoA1 with anthropometric evaluation as a diagnostic test to of nutritional state in children with or without malaria. Material and methods: descriptive, prospective and cross-sectional design, with blind and simultaneous use of diagnostic tests. Serum ApoA1 was measured with a nephelometric method (APOA, Beckman® Laboratory. Results: 262 children were evaluated. The frequency of some anthropometric risk of malnutrition was 72% in malaric children, and 70% in the non-malaric ones. Two out of every three children had less than 0,94 g/L (lowest normal limit of apoA1. There was no significant correlation between apoA1 and each one of the anthropometric indicators, and the Spearman's coefficients were lower than 0,1 in every instance. Sensitivity and specificity of apoA1 were, respectively, 31% and 83% among non-malaric children, as compare with the anthropometrical nutritional classification; the corresponding figures among malaric children were 83% and 27%, respectively. Conclusion: apoA1 is not a useful tool for diagnosis of the nutritional state, either in malaric or nonmalaric children. Antecedentes: la apolipoproteína A1 (apoA1 se ha propuesto como indicador del estado nutricional, pero existe controversia al respecto. Objetivo: comparar la apoA1 sérica con la evaluación antropométrica como prueba diagnóstica del estado nutricional de niños (4-11 años con malaria y sin ella. Metodología: diseño descriptivo, prospectivo y transversal, con uso ciego y simultáneo de las dos pruebas diagnósticas. ApoA1 sérica se midió con método nefelométrico (APOA, Laboratorio Beckman®. Resultados: fueron evaluados 262 niños. La frecuencia de algún riesgo antropométrico de desnutrición fue 72% en niños maláricos y 70% en niños sin malaria. Dos de cada tres niños presentaron menos de 0,94 g/L (límite inferior normal de apoA1. No hubo correlación significativa entre apoA1 y cada indicador antropométrico y los

  5. Use of H-Index and Other Bibliometric Indicators to Evaluate Research Productivity Outcome on Swine Diseases.

    Directory of Open Access Journals (Sweden)

    Ivan Díaz

    Full Text Available H-index is the most commonly applied tool to evaluate scientific productivity. In this study, the use of the H-index to evaluate scientific production in swine veterinary medicine was explored. A database of 137 pig infectious agents was constructed, including its taxonomic division, zoonotic potential, status as emerging pathogen and whether it was OIE-listed. The H-index and the total number of citations were calculated for those pathogens, the location of the affiliation of the first author of each paper included in the H-index core was registered and, for the ten pathogens with the highest H-index, evolution over time was measured. H-index values were compared to the M quotient, A-index, G-index, HG-index and the G/H ratio. H-indices were found to be severely affected by search accuracy and the database was hand curated. Swine pathogen H-indexes were highly dispersed ranging from 0 to 106 and were generally higher for pathogens causing endemic diseases in large pig producing countries. Indeed, the three top pathogens were Escherichia coli, Porcine reproductive and respiratory syndrome virus and Porcine circovirus type 2 with H-indices 106, 95 and 85, respectively. H-indices of viruses and bacteria were significantly higher (P<0.001 than other pathogen types. Also, non-zoonotic pathogens had higher H-indices than zoonotic pathogens (p<0.009 while no differences could be found for being listed by the OIE. For emerging diseases, only non-emerging viruses had higher H-index (p = 0.02. The study of H-indexes over time revealed three general patterns and that they had increased mainly after the 1980's. As expected, there were strong geographic patterns in terms of authorship and North America (38% and Europe (46% coped the majority of the papers. Finally, in order to quantify the contribution of a subject to a specific field, a new index "Deciphering Citations Organized by Subject" (Dcos is proposed.

  6. Food insecurity and other poverty indicators among people living with HIV/AIDS: effects on treatment and health outcomes.

    Science.gov (United States)

    Kalichman, Seth C; Hernandez, Dominica; Cherry, Chauncey; Kalichman, Moira O; Washington, Christopher; Grebler, Tamar

    2014-12-01

    Health disparities in access to antiretroviral therapy (ART) as well as the demands of long-term medication adherence have meant the full benefits of HIV treatment are often not realized. In particular, food insecurity has emerged as a robust predictor of ART non-adherence. However, research is limited in determining whether food insecurity uniquely impedes HIV treatment or if food insecurity is merely a marker for poverty that interferes more broadly with treatment. This study examined indicators of poverty at multiple levels in a sample of 364 men and 157 women living with HIV recruited through an offering of a free holiday food basket. Results showed that 61 % (N = 321) of participants had experienced at least one indicator of food insecurity in the previous month. Multivariate analyses showed that food insecurity was closely tied to lack of transportation. In addition, food insecurity was associated with lacking access to ART and poor ART adherence after adjusting for neighbourhood poverty, living in an area without a supermarket (food desert), education, stable housing, and reliable transportation. Results therefore affirm previous research that has suggested food insecurity is uniquely associated with poor ART adherence and calls for structural interventions that address basic survival needs among people living with HIV, especially food security.

  7. The Molecular Epidemiology of Malaria in Western Kenya

    Science.gov (United States)

    2002-09-01

    pregnancy malaria-related low birthweight (109). Thus, an allele that decreases IFN-γ expression could be favorably selected as a consequence of both...the absence of fever and at very low levels of parasitemia. Differences in amplitude in the current study could indicate that factors affecting...determination of epidemiologic risk factors for severe and complicated malaria; and 2) characterizing parasite and human variability as they relate to the

  8. Nature or nurture in mosquito resistance to malaria?

    OpenAIRE

    Hurd, Hilary

    2007-01-01

    The genetic basis of mosquito resistance to malaria parasites is well established and currently receives a lot of attention. However this is not the sole determinant of the success or failure of an infection. In a recent article, Lambrechts and colleagues report the influence of the quality of the external environment of a mosquito on infection. They indicate that external variations could substantially reduce the importance of resistance genes in determining infection by malaria parasites. F...

  9. Malaria and water resource development: the case of Gilgel-Gibe hydroelectric dam in Ethiopia

    Directory of Open Access Journals (Sweden)

    Kloos Helmut

    2009-01-01

    significant (OR = 2.40, 95% CI = 0.84, 6.88. A classification tree revealed insights in the importance of the dam as a risk factor for malaria. Assuming that the relationship between the dam and malaria is causal, 43% of the malaria occurring in children was due to living in close proximity to the dam. Conclusion This study indicates that children living in close proximity to a man-made reservoir in Ethiopia are at higher risk of malaria compared to those living farther away. It is recommended that sound prevention and control programme be designed and implemented around the reservoir to reduce the prevalence of malaria. In this respect, in localities near large dams, health impact assessment through periodic survey of potential vectors and periodic medical screening is warranted. Moreover, strategies to mitigate predicted negative health outcomes should be integral parts in the preparation, construction and operational phases of future water resource development and management projects.

  10. A multicenter prospective study of neonatal outcomes at less than 32 weeks associated with indications for maternal admission and delivery.

    Science.gov (United States)

    Garite, Thomas J; Combs, C Andrew; Maurel, Kimberly; Das, Anita; Huls, Kevin; Porreco, Richard; Reisner, Dale; Lu, George; Bush, Melissa; Morris, Bruce; Bleich, April

    2017-07-01

    Counseling for patients with impending premature delivery traditionally has been based primarily on the projected gestational age at delivery. There are limited data regarding how the indications for the preterm birth affect the neonatal outcome and whether this issue should be taken into account in decisions regarding management and patient counseling. We performed a prospective study of pregnancies resulting in premature delivery at less than 32 weeks to determine the influence of both the indications for admission and their associated indications for delivery on neonatal mortality and complications of prematurity. This is a multicenter, prospective study in 10 hospitals where all data from the neonatal intensive care unit routinely was imported to a deidentified data warehouse. Maternal data were collected prospectively at or near the time of delivery. Eligible subjects included singleton deliveries in these hospitals between 23 0/7 and 31 6/7 weeks. The primary hypothesis of the study was to determine whether there was a difference in the primary outcome, which was defined as neonatal composite morbidity, between those neonates delivered after admission for premature labor vs premature rupture of membranes, because these were expected to be the 2 most frequent diagnoses leading to premature birth. The sample size was calculated based on a 10% difference in outcomes for these 2 entities. We based this hypothesis on the knowledge that premature rupture of membranes has a greater incidence of intra-amniotic infection and inflammation than premature labor and that outcomes for premature neonates are worse when delivery is associated with intra-amniotic infection. Additional outcomes were analyzed for all other indications for admission and delivery. Composite morbidity was defined as ≥1 of the following: respiratory distress syndrome (oxygen requirement, clinical diagnosis, and consistent chest radiograph), bronchopulmonary dysplasia (requirement for oxygen

  11. Selective Intermittent Preventive Treatment of Vivax Malaria: Reduction of Malaria Incidence in an Open Cohort Study in Brazilian Amazon

    Science.gov (United States)

    Gil, Luiz Herman Soares; de Lima, Alzemar Alves; Freitag, Elci Marlei; dos Santos, Tatiana Marcondes; do Nascimento Filha, Maria Teixeira; dos Santos Júnior, Alcides Procópio Justiniano; da Silva, Josiane Mendes; Rodrigues, Aline de Freitas; Tada, Mauro Shugiro; Fontes, Cor Jesus Fernandes; Pereira da Silva, Luiz Hildebrando

    2013-01-01

    In children, the Intermittent Preventive Treatment (IPTc), currently called Seasonal Malaria Chemoprevention (SMC), was considered effective on malaria control due to the reduction of its incidence in Papua New Guinea and in some areas with seasonal malaria in Africa. However, the IPT has not been indicated because of its association with drug resistance and for hindering natural immunity development. Thus, we evaluated the alternative IPT impact on malaria incidence in three riverside communities on Madeira River, in the municipality of Porto Velho, RO. We denominate this scheme Selective Intermittent Preventive Treatment (SIPT). The SIPT consists in a weekly dose of two 150 mg chloroquine tablets for 12 weeks, for adults, and an equivalent dose for children, after complete supervised treatment for P. vivax infection. This scheme is recommend by Brazilian Health Ministry to avoid frequent relapses. The clinic parasitological and epidemiological surveillance showed a significant reduction on vivax malaria incidence. The results showed a reduction on relapses and recurrence of malaria after SIPT implementation. The SIPT can be effective on vivax malaria control in localities with high transmission risk in the Brazilian Amazon. PMID:23577276

  12. Selective Intermittent Preventive Treatment of Vivax Malaria: Reduction of Malaria Incidence in an Open Cohort Study in Brazilian Amazon

    Directory of Open Access Journals (Sweden)

    Tony Hiroshi Katsuragawa

    2013-01-01

    Full Text Available In children, the Intermittent Preventive Treatment (IPTc, currently called Seasonal Malaria Chemoprevention (SMC, was considered effective on malaria control due to the reduction of its incidence in Papua New Guinea and in some areas with seasonal malaria in Africa. However, the IPT has not been indicated because of its association with drug resistance and for hindering natural immunity development. Thus, we evaluated the alternative IPT impact on malaria incidence in three riverside communities on Madeira River, in the municipality of Porto Velho, RO. We denominate this scheme Selective Intermittent Preventive Treatment (SIPT. The SIPT consists in a weekly dose of two 150 mg chloroquine tablets for 12 weeks, for adults, and an equivalent dose for children, after complete supervised treatment for P. vivax infection. This scheme is recommend by Brazilian Health Ministry to avoid frequent relapses. The clinic parasitological and epidemiological surveillance showed a significant reduction on vivax malaria incidence. The results showed a reduction on relapses and recurrence of malaria after SIPT implementation. The SIPT can be effective on vivax malaria control in localities with high transmission risk in the Brazilian Amazon.

  13. A description of malaria sentinel surveillance: a case study in Oromia Regional State, Ethiopia.

    Science.gov (United States)

    Yukich, Joshua O; Butts, Jessica; Miles, Melody; Berhane, Yemane; Nahusenay, Honelgn; Malone, Joseph L; Dissanayake, Gunawardena; Reithinger, Richard; Keating, Joseph

    2014-03-11

    In the context of the massive scale up of malaria interventions, there is increasing recognition that the current capacity of routine malaria surveillance conducted in most African countries through integrated health management information systems is inadequate. The timeliness of reporting to higher levels of the health system through health management information systems is often too slow for rapid action on focal infectious diseases such as malaria. The purpose of this paper is to: 1) describe the implementation of a malaria sentinel surveillance system in Ethiopia to help fill this gap; 2) describe data use for epidemic detection and response as well as programmatic decision making; and 3) discuss lessons learned in the context of creating and running this system. As part of a comprehensive strategy to monitor malaria trends in Oromia Regional State, Ethiopia, a system of ten malaria sentinel sites was established to collect data on key malaria morbidity and mortality indicators. To ensure the sentinel surveillance system provides timely, actionable data, the sentinel facilities send aggregate data weekly through short message service (SMS) to a central database server. Bland-Altman plots and Poisson regression models were used to investigate concordance of malaria indicator reports and malaria trends over time, respectively. This paper describes three implementation challenges that impacted system performance in terms of: 1) ensuring a timely and accurate data reporting process; 2) capturing complete and accurate patient-level data; and 3) expanding the usefulness and generalizability of the system's data to monitor progress towards the national malaria control goals of reducing malaria deaths and eventual elimination of transmission. The use of SMS for reporting surveillance data was identified as a promising practice for accurately tracking malaria trends in Oromia. The rapid spread of this technology across Africa offers promising opportunities to collect

  14. The Current Situation on Malaria in Astrakhan Region

    Directory of Open Access Journals (Sweden)

    R.S. Arakelian

    2016-07-01

    Full Text Available The purpose of the study. To describe the current situation on malaria in Astrakhan region for 2000–2014. Materials and methods. The first data on malarious situation in the Astrakhan region belongs to 1894, when in the Astrakhan province there were registered 54 952 cases of malaria. The results of the study. In Astrakhan region for the period from 2000 to 2014 there were registered 90 cases of human malaria, including imported cases from the CIS — 70 (78 %, secondary from imported — 11 (12 % and relapse — 9 (10 %. Geographically, the foci of malaria were distributed as follows: Astrakhan — 58 foci (65 %, including Leninskyi district — 27 cases (46 % of all urban cases, the Kirov and the Soviet districts — 15 foci (26 % and Truso district — 1 case (2 % and passing through Astrakhan — 2 foci (2 %; Astrakhan region — 30 sites (33 %, including Krasnoyarsk district — 9 sites (30 %, Narimanov district — 8 CL. (27 % of all rural cases, Akhtubinsky district — 5 cases (17 %, Kharabalinskyi district — 4 sites (13 %, Chernoyarskyi district — 2 sites (7 %, Kamyziakskyi and Limansky districts 1 site (3 %. Conclusions. On the territory of Astrakhan region throughout the transmission season of effective contamination of mosquitoes (May — September over the last 10 years there have been imported cases of malaria. The maximum number of reported imported malaria cases was observed in 2001 — 35 cases. In Astrakhan region the most frequently recorded is the three-day malaria — 94 %. The importation of malaria in the region was carried out in 78 % of cases from Azerbaijan and Tajikistan. After a long break, in Astrakhan region there were registered new active lesions, indicating the presence of secondary from imported malaria cases and the emergence of new active foci of the 1st degree. The disease was recorded more often in the warmer months, as evidenced by the incidence — 80 % of all reported cases.

  15. Role of information and communication networks in malaria survival

    Directory of Open Access Journals (Sweden)

    Marathe Achla

    2007-10-01

    Full Text Available Abstract Background Quite often symptoms of malaria go unrecognized or untreated. According to the Multilateral Initiative on Malaria, 70% of the malaria cases that are treated at home are mismanaged. Up to 82% of all malaria episodes in sub-Saharan Africa are treated outside the formal health sector. Fast and appropriate diagnosis and treatment of malaria is extremely important in reducing morbidity and mortality. Method Data from 70 different countries is pooled together to construct a panel dataset of health and socio-economic variables for a time span of (1960–2004. The generalized two-stage least squares and panel data models are used to investigate the impact of information and communication network (ICN variables on malaria death probability. The intensity of ICN is represented by the number of telephone main lines per 1,000 people and the number of television sets per 1,000 people. Results The major finding is that the intensity of ICN is associated with reduced probability of deaths of people that are clinically identified as malaria infected. The results are robust for both indicators i.e. interpersonal and mass communication networks and for all model specifications examined. Conclusion The results suggest that information and communication networks can substantially scale up the effectiveness of the existing resources for malaria prevention. Resources spent in preventing malaria are far less than needed. Expanded information and communication networks will widen the avenues for community based "participatory development", that encourages the use of local information, knowledge and decision making. Timely information, immediate care and collective knowledge based treatment can be extremely important in reducing child mortality and achieving the millennium development goal.

  16. Towards a Job Demands-Resources Health Model: Empirical Testing with Generalizable Indicators of Job Demands, Job Resources, and Comprehensive Health Outcomes

    Directory of Open Access Journals (Sweden)

    Rebecca Brauchli

    2015-01-01

    Full Text Available Studies using the Job Demands-Resources (JD-R model commonly have a heterogeneous focus concerning the variables they investigate—selective job demands and resources as well as burnout and work engagement. The present study applies the rationale of the JD-R model to expand the relevant outcomes of job demands and job resources by linking the JD-R model to the logic of a generic health development framework predicting more broadly positive and negative health. The resulting JD-R health model was operationalized and tested with a generalizable set of job characteristics and positive and negative health outcomes among a heterogeneous sample of 2,159 employees. Applying a theory-driven and a data-driven approach, measures which were generally relevant for all employees were selected. Results from structural equation modeling indicated that the model fitted the data. Multiple group analyses indicated invariance across six organizations, gender, job positions, and three times of measurement. Initial evidence was found for the validity of an expanded JD-R health model. Thereby this study contributes to the current research on job characteristics and health by combining the core idea of the JD-R model with the broader concepts of salutogenic and pathogenic health development processes as well as both positive and negative health outcomes.

  17. Towards a Job Demands-Resources Health Model: Empirical Testing with Generalizable Indicators of Job Demands, Job Resources, and Comprehensive Health Outcomes.

    Science.gov (United States)

    Brauchli, Rebecca; Jenny, Gregor J; Füllemann, Désirée; Bauer, Georg F

    2015-01-01

    Studies using the Job Demands-Resources (JD-R) model commonly have a heterogeneous focus concerning the variables they investigate-selective job demands and resources as well as burnout and work engagement. The present study applies the rationale of the JD-R model to expand the relevant outcomes of job demands and job resources by linking the JD-R model to the logic of a generic health development framework predicting more broadly positive and negative health. The resulting JD-R health model was operationalized and tested with a generalizable set of job characteristics and positive and negative health outcomes among a heterogeneous sample of 2,159 employees. Applying a theory-driven and a data-driven approach, measures which were generally relevant for all employees were selected. Results from structural equation modeling indicated that the model fitted the data. Multiple group analyses indicated invariance across six organizations, gender, job positions, and three times of measurement. Initial evidence was found for the validity of an expanded JD-R health model. Thereby this study contributes to the current research on job characteristics and health by combining the core idea of the JD-R model with the broader concepts of salutogenic and pathogenic health development processes as well as both positive and negative health outcomes.

  18. The position of mefloquine as a 21st century malaria chemoprophylaxis

    Directory of Open Access Journals (Sweden)

    Regep Loredana

    2010-12-01

    Full Text Available Abstract Background Malaria chemoprophylaxis prevents the occurrence of the symptoms of malaria. Travellers to high-risk Plasmodium falciparum endemic areas need an effective chemoprophylaxis. Methods A literature search to update the status of mefloquine as a malaria chemoprophylaxis. Results Except for clearly defined regions with multi-drug resistance, mefloquine is effective against the blood stages of all human malaria species, including the recently recognized fifth species, Plasmodium knowlesi. New data were found in the literature on the tolerability of mefloquine and the use of this medication by groups at high risk of malaria. Discussion Use of mefloquine for pregnant women in the second and third trimester is sanctioned by the WHO and some authorities (CDC allow the use of mefloquine even in the first trimester. Inadvertent pregnancy while using mefloquine is not considered grounds for pregnancy termination. Mefloquine chemoprophylaxis is allowed during breast-feeding. Studies show that mefloquine is a good option for other high-risk groups, such as long-term travellers, VFR travellers and families with small children. Despite a negative media perception, large pharmaco-epidemiological studies have shown that serious adverse events are rare. A recent US evaluation of serious events (hospitalization data found no association between mefloquine prescriptions and serious adverse events across a wide range of outcomes including mental disorders and diseases of the nervous system. As part of an in-depth analysis of mefloquine tolerability, a potential trend for increased propensity for neuropsychiatric adverse events in women was identified in a number of published clinical studies. This trend is corroborated by several cohort studies that identified female sex and low body weight as risk factors. Conclusion The choice of anti-malarial drug should be an evidence-based decision that considers the profile of the individual traveller and the

  19. A review of malarial retinopathy in severe malaria

    Directory of Open Access Journals (Sweden)

    H. L. Sithole

    2011-12-01

    Full Text Available The ocular manifestations of severe malaria in patients with cerebral malaria (CM include retinal whitening, vessel discolouration, retinal haemorrhages and papilloedema. A large prospective study of Malawian children with CM found that the severity of retinal signs, including the number of retinal haemorrhages, was related to the outcome and length of coma in survivors of malaria. In a smaller number of Kenyan children with cerebral malaria, retinal haemorrhages were associated with deep coma and severe anaemia. A study on the effect of malarial retinopathy on vision found no detectable effect on visual acuity (VA but where malaria isaggravated by failure to receive treatment this may possibly affect VA. The failure to receive treatment may be directly linked to the socio-economic status (SES of those affected and this may occur in the KwaZulu-Natal, Mpumalanga and Limpopo provinces of South Africa where malaria is endemic. This suggests the need for effective health education and health promotion amongst those affected by malaria especially in severely affected provinces of South Africa. Also, in view of the direct ocular consequences of severe malaria, optometrists should engage communities in health education and health promotion. This is particularly relevant because in some communities, a large majority of those suffering from malarial infections do not visit formal health facilities for treatment. In so doing, optometrists in South Africa will be contributing positively to the Millennium Development Goals which seek, amongst others, to reduce unwarranted sources of morbidity worldwide. (S Afr Optom 2011 70(3 129-135 

  20. Haemoglobinopathies and the clinical epidemiology of malaria: a systematic review and meta-analysis.

    Science.gov (United States)

    Taylor, Steve M; Parobek, Christian M; Fairhurst, Rick M

    2012-06-01

    Haemoglobinopathies can reduce the risk of malaria syndromes. We aimed to quantify the relation between different haemoglobin mutations and malaria protection to strengthen the foundation for translational studies of malaria pathogenesis and immunity. We systematically searched the Medline and Embase databases for studies that estimated the risk of malaria in patients with and without haemoglobinopathies up to Sept 9, 2011, and identified additional studies from reference lists. We included studies that enrolled mainly children or pregnant women and had the following outcomes: Plasmodium falciparum severe malaria, uncomplicated malaria, asymptomatic parasitaemia, or pregnancy-associated malaria, and Plasmodium vivax malaria. Two reviewers identified studies independently, assessed quality of the studies, and extracted data. We produced odds ratios (ORs; 95% CIs) for case-control studies and incidence rate ratios (IRRs; 95% CIs) for prospective studies. We did the meta-analysis with a random-effects model when equivalent outcomes were reported in more than one study. Of 62 identified studies, 44 reported data for haemoglobin AS, 19 for haemoglobin AC and CC, and 18 for α-thalassaemia. Meta-analysis of case-control studies showed a decreased risk of severe P. falciparum malaria in individuals with haemoglobin AS (OR 0·09, 95% CI 0·06-0·12), haemoglobin CC (0·27, 0·11-0·63), haemoglobin AC (0·83, 0·67-0·96), homozygous α-thalassaemia (0·63, 0·48-0·83), and heterozygous α-thalassaemia (0·83, 0·74-0·92). In meta-analysis of prospective trials only haemoglobin AS was consistently associated with protection from uncomplicated malaria (IRR 0·69, 95% CI 0·61-0·79); no haemoglobinopathies led to consistent protection from asymptomatic parasitaemia. Few clinical studies have investigated β-thalassaemia, haemoglobin E, P. vivax malaria, or pregnancy-associated malaria. Haemoglobin AS, CC, and AC genotypes and homozygous and heterozygous

  1. Prevention and treatment practices and implications for malaria control in Mukono District Uganda

    OpenAIRE

    Mbonye, A K; Bygbjerg, I C; Magnussen, P

    2008-01-01

    Udgivelsesdato: 2008-Mar Available data in Uganda indicate a resurgence of malaria morbidity and mortality countrywide. This study assessed the burden of malaria, treatment and prevention practices in order initiate a policy debate on the scaling-up of current interventions. A triangulation of methods using a cross-sectional survey and key informant interviews was used to assess self-reported malaria at a household level in Mukono District, Uganda. A total of 5583 households were surveyed,...

  2. Independent Associations of Maternal Education and Household Wealth with Malaria Risk in Children

    OpenAIRE

    2014-01-01

    Despite evidence that they play similar but independent roles, maternal education and household wealth are usually conflated in studies of the effects of socioeconomic status (SES) on malaria risk. Demographic and Health Survey and Malaria Indicator Survey data from nine countries in sub-Saharan Africa were used to explore the relationship of malaria parasitemia in children with SES factors at individual and cluster scales, controlling for urban/rural residence and other important covariates....

  3. A retrospective study of the indications and outcomes of capsular tension ring insertion during cataract surgery at a tertiary teaching hospital

    Directory of Open Access Journals (Sweden)

    Wang BZ

    2013-03-01

    Full Text Available Bob Z Wang, Elsie Chan, Rasik B Vajpayee The Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia; Centre for Eye Research Australia, University of Melbourne, East Melbourne, Victoria, Australia Background: The purpose was to determine preoperative indications, intraoperative procedures, and outcomes of capsular tension ring (CTR insertion during cataract surgery. Methods: A review of all patients undergoing cataract surgery with insertion of a CTR between July 2000 and June 2010 was conducted at The Royal Victorian Eye and Ear Hospital, a large tertiary teaching hospital in Victoria, Australia. Information relating to each patient's demographic details, preoperative assessment, surgical procedure, and postoperative assessment were obtained. Results: Eighty-four eyes of 82 patients were included in this study. The main indications for CTR insertion were previous trauma, pseudoexfoliation syndrome, and mature cataracts. Twenty-one eyes (25.0% did not have any obvious preoperative indication. A posterior capsule tear was the most common intraoperative complication (3.6%. An intraocular lens was successfully implanted in the bag in 72 eyes (85.7%. Postoperatively, the most common complications were a decentered intraocular lens (8.3% and persistent corneal edema (6.0%. Overall, 61 eyes (72.6% had better postoperative visual acuity compared with preoperative acuity, with 67 patients (79.8% achieving vision of 20/40 or better. Conclusion: For the majority of cases, CTR use in complex cataract surgeries is associated with improved postoperative outcomes. CTR implantation is most commonly required in patients with known risk factors for zonular instability. Keywords: capsular tension ring, cataract extraction, indications, outcomes

  4. Analysis of the Clinical Profile in Patients with Plasmodium falciparum Malaria and Its Association with Parasite Density.

    Science.gov (United States)

    Mangal, Praveen; Mittal, Shilpa; Kachhawa, Kamal; Agrawal, Divya; Rath, Bhabagrahi; Kumar, Sanjay

    2017-01-01

    Malaria remains a major health hazard in the modern world, particularly in developing countries. In Plasmodium falciparum malaria, there is a direct correlation between asexual erythrocytic stage parasite density and disease severity. Accordingly, the correlations between parasite density and various clinical presentations, severity, and outcome were examined in falciparum malaria in India. The study was conducted in a tertiary health-care center in North India. Of 100 cases of falciparum malaria, 65 patients were male and 35 were female. A total of 54 patients were in the uncomplicated group and 46 patients were in the complicated malaria group. Fever, anemia, icterus, splenomegaly, hepatomegaly, and hepatosplenomegaly were common clinical findings. All clinical findings were significantly more common in the complicated malaria group and patients with a high parasite density than in the uncomplicated group and those with a low parasite density. All patients in the uncomplicated malaria group had a parasite density of 5%, and the difference between groups was statistically significant. The incidence of cerebral malaria was significantly higher in cases with a high parasite density; 58.33% mortality was observed in these cases. Cerebral malaria and hyperbilirubinemia was the most frequently encountered combination of complications. In P. falciparum malaria, parasite density was associated with complications and poor clinical outcomes. These results may inform treatment decisions and suggest that a threshold parasite density of 5% is informative.

  5. Impact of haemoglobinopathies on the clinical epidemiology of malaria: a systematic review and meta-analysis

    Science.gov (United States)

    Taylor, Steve M; Parobek, Christian M; Fairhurst, Rick M

    2012-01-01

    SUMMARY Background Haemoglobinopathies variously reduce the risk of developing malaria syndromes. Quantifying these relationships may strengthen the foundation for translational studies of malaria pathogenesis and immunity. Methods The databases of MEDLINE and Embase (1950 – September 9, 2011) were searched to identify studies that estimated the risk of malaria in patients with and without haemoglobinopathies. Additional studies were identified from reference lists. Included outcomes were Plasmodium falciparum-related outcomes of severe malaria, uncomplicated malaria, asymptomatic parasitaemia, or pregnancy-associated malaria, and P. vivax malaria. Two independent reviewers identified studies, assessed their quality, and extracted data; data were meta-analyzed when outcomes were reported in more than one study. Findings Of 62 identified studies, 44 reported on HbAS, 19 on HbAC and HbCC, and 18 on α-thalassaemia. Case-control studies showed a decreased risk of severe malaria for HbAS (summary Odds Ratio [OR] 0.09; 95% confidence interval [CI] 0.06 – 0.12), HbCC (summary OR 0.27; 95% CI 0.11 – 0.63), homozygous α-thalassaemia (summary OR 0.63; 95% CI 0.48 – 0.83), HbAC (summary OR 0.83; 95% CI 0.74 – 0.92), and heterozygous α-thalassaemia (summary OR 0.83; 95% CI 0.74 – 0.92). Only HbAS was consistently associated with protection from uncomplicated malaria (summary Incidence Rate Ratio 0.69; 95% CI 0.61 – 0.79); none demonstrated protection from asymptomatic parasitaemia. There was a paucity of clinical studies investigating β-thalassaemia, HbE, P. vivax malaria, and pregnancy-associated malaria. Interpretation Protection from severe malaria syndromes is significant for HbAS, HbCC, HbAC, and homozygous and heterozygous α-thalassaemia, but these haemoglobinopathies differ substantially in the degrees of protection. Protection from uncomplicated malaria and asymptomatic parasitaemia is mild or absent. By attenuating the severity of malaria

  6. Characterisation of the opposing effects of G6PD deficiency on cerebral malaria and severe malarial anaemia

    Science.gov (United States)

    Clarke, Geraldine M; Rockett, Kirk; Kivinen, Katja; Hubbart, Christina; Jeffreys, Anna E; Rowlands, Kate; Jallow, Muminatou; Conway, David J; Bojang, Kalifa A; Pinder, Margaret; Usen, Stanley; Sisay-Joof, Fatoumatta; Sirugo, Giorgio; Toure, Ousmane; Thera, Mahamadou A; Konate, Salimata; Sissoko, Sibiry; Niangaly, Amadou; Poudiougou, Belco; Mangano, Valentina D; Bougouma, Edith C; Sirima, Sodiomon B; Modiano, David; Amenga-Etego, Lucas N; Ghansah, Anita; Koram, Kwadwo A; Wilson, Michael D; Enimil, Anthony; Evans, Jennifer; Amodu, Olukemi K; Olaniyan, Subulade; Apinjoh, Tobias; Mugri, Regina; Ndi, Andre; Ndila, Carolyne M; Uyoga, Sophie; Macharia, Alexander; Peshu, Norbert; Williams, Thomas N; Manjurano, Alphaxard; Sepúlveda, Nuno; Clark, Taane G; Riley, Eleanor; Drakeley, Chris; Reyburn, Hugh; Nyirongo, Vysaul; Kachala, David; Molyneux, Malcolm; Dunstan, Sarah J; Phu, Nguyen Hoan; Quyen, Nguyen Ngoc; Thai, Cao Quang; Hien, Tran Tinh; Manning, Laurens; Laman, Moses; Siba, Peter; Karunajeewa, Harin; Allen, Steve; Allen, Angela; Davis, Timothy ME; Michon, Pascal; Mueller, Ivo; Molloy, Síle F; Campino, Susana; Kerasidou, Angeliki; Cornelius, Victoria J; Hart, Lee; Shah, Shivang S; Band, Gavin; Spencer, Chris CA; Agbenyega, Tsiri; Achidi, Eric; Doumbo, Ogobara K; Farrar, Jeremy; Marsh, Kevin; Taylor, Terrie; Kwiatkowski, Dominic P

    2017-01-01

    Glucose-6-phosphate dehydrogenase (G6PD) deficiency is believed to confer protection against Plasmodium falciparum malaria, but the precise nature of the protective effect has proved difficult to define as G6PD deficiency has multiple allelic variants with different effects in males and females, and it has heterogeneous effects on the clinical outcome of P. falciparum infection. Here we report an analysis of multiple allelic forms of G6PD deficiency in a large multi-centre case-control study of severe malaria, using the WHO classification of G6PD mutations to estimate each individual’s level of enzyme activity from their genotype. Aggregated across all genotypes, we find that increasing levels of G6PD deficiency are associated with decreasing risk of cerebral malaria, but with increased risk of severe malarial anaemia. Models of balancing selection based on these findings indicate that an evolutionary trade-off between different clinical outcomes of P. falciparum infection could have been a major cause of the high levels of G6PD polymorphism seen in human populations. DOI: http://dx.doi.org/10.7554/eLife.15085.001 PMID:28067620

  7. Coadaptation and malaria control

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    Carlos Eduardo Tosta

    2007-06-01

    Full Text Available Malaria emerges from a disequilibrium of the system 'human-plasmodium-mosquito' (HPM. If the equilibrium is maintained, malaria does not ensue and the result is asymptomatic plasmodium infection. The relationships among the components of the system involve coadaptive linkages that lead to equilibrium. A vast body of evidence supports this assumption, including the strategies involved in the relationships between plasmodium and human and mosquito immune systems, and the emergence of resistance of plasmodia to antimalarial drugs and of mosquitoes to insecticides. Coadaptive strategies for malaria control are based on the following principles: (1 the system HPM is composed of three highly complex and dynamic components, whose interplay involves coadaptive linkages that tend to maintain the equilibrium of the system; (2 human and mosquito immune systems play a central role in the coadaptive interplay with plasmodium, and hence, in the mainten-ance of the system's equilibrium; the under- or overfunction of human immune system may result in malaria and influence its severity; (3 coadaptation depends on genetic and epigenetic phenomena occurring at the interfaces of the components of the system, and may involve exchange of infectrons (genes or gene fragments between the partners; (4 plasmodia and mosquitoes have been submitted to selective pressures, leading to adaptation, for an extremely long while and are, therefore, endowed with the capacity to circumvent both natural (immunity and artificial (drugs, insecticides, vaccines measures aiming at destroying them; (5 since malaria represents disequilibrium of the system HPM, its control should aim at maintaining or restoring this equilibrium; (6 the disequilibrium of integrated systems involves the disequilibrium of their components, therefore the maintenance or restoration of the system's equilibrium depend on the adoption of integrated and coordinated measures acting on all components, that means

  8. Low red cell production may protect against severe anemia during a malaria infection – insights from modeling

    OpenAIRE

    Cromer, Deborah; Stark, Jaroslav; P Davenport, Miles

    2009-01-01

    Abstract The malaria parasite causes lysis of red blood cells, resulting in anemia, a major cause of mortality and morbidity. Intuitively, one would expect the production of red blood cells to increase in order to compensate for this loss. However, it has been observed that this response is weaker than would be expected. Furthermore iron supplementation for iron deficient children in malaria endemic regions can paradoxically adversely affect the clinical outcome of malaria infectio...

  9. Contemporary epidemiological overview of malaria in Madagascar: operational utility of reported routine case data for malaria control planning.

    Science.gov (United States)

    Howes, Rosalind E; Mioramalala, Sedera Aurélien; Ramiranirina, Brune; Franchard, Thierry; Rakotorahalahy, Andry Joeliarijaona; Bisanzio, Donal; Gething, Peter W; Zimmerman, Peter A; Ratsimbasoa, Arsène

    2016-10-18

    Malaria remains a major public health problem in Madagascar. Widespread scale-up of intervention coverage has led to substantial reductions in case numbers since 2000. However, political instability since 2009 has disrupted these efforts, and a resurgence of malaria has since followed. This paper re-visits the sub-national stratification of malaria transmission across Madagascar to propose a contemporary update, and evaluates the reported routine case data reported at this sub-national scale. Two independent malariometrics were evaluated to re-examine the status of malaria across Madagascar. First, modelled maps of Plasmodium falciparum infection prevalence (PfPR) from the Malaria Atlas Project were used to update the sub-national stratification into 'ecozones' based on transmission intensity. Second, routine reports of case data from health facilities were synthesized from 2010 to 2015 to compare the sub-national epidemiology across the updated ecozones over time. Proxy indicators of data completeness are investigated. The epidemiology of malaria is highly diverse across the island's ecological regions, with eight contiguous ecozones emerging from the transmission intensity PfPR map. East and west coastal areas have highest transmission year-round, contrasting with the central highlands and desert south where trends appear more closely associated with epidemic outbreak events. Ecozones have shown steady increases in reported malaria cases since 2010, with a near doubling of raw reported case numbers from 2014 to 2015. Gauges of data completeness suggest that interpretation of raw reported case numbers will underestimate true caseload as only approximately 60-75 % of health facility data are reported to the central level each month. A sub-national perspective is essential when monitoring the epidemiology of malaria in Madagascar and assessing local control needs. A robust assessment of the status of malaria at a time when intervention coverage efforts are being

  10. A review of malaria vaccine clinical projects based on the WHO rainbow table

    Directory of Open Access Journals (Sweden)

    Schwartz Lauren

    2012-01-01

    Full Text Available Abstract Development and Phase 3 testing of the most advanced malaria vaccine, RTS,S/AS01, indicates that malaria vaccine R&D is moving into a new phase. Field trials of several research malaria vaccines have also confirmed that it is possible to impact the host-parasite relationship through vaccine-induced immune responses to multiple antigenic targets using different platforms. Other approaches have been appropriately tested but turned out to be disappointing after clinical evaluation. As the malaria community considers the potential role of a first-generation malaria vaccine in malaria control efforts, it is an apposite time to carefully document terminated and ongoing malaria vaccine research projects so that lessons learned can be applied to increase the chances of success for second-generation malaria vaccines over the next 10 years. The most comprehensive resource of malaria vaccine projects is a spreadsheet compiled by WHO thanks to the input from funding agencies, sponsors and investigators worldwide. This spreadsheet, available from WHO's website, is known as "the rainbow table". By summarizing the published and some unpublished information available for each project on the rainbow table, the most comprehensive review of malaria vaccine projects to be published in the last several years is provided below.

  11. Distribution of Malaria Case in Simpenan Public Health Centre Sukabumi District in 2011

    Directory of Open Access Journals (Sweden)

    Hubullah Fuadzy

    2012-12-01

    Full Text Available The number of malaria in Simpenan public health centre area needs a quick step in the patients finding by malaria microscopic officers, both by Active Case Detection (ACD and Passive Case Detection (PCD. The objective of th is article is to determine the distribution of malaria cases at Simpenan public health centre in Sukabumi during 2011. Data collection was carried out by malaria officersfrom Simpenan public health centre by identifying malaria parasite with microscope to any gold miners who just got home and was having a highfever. Malaria cases during the year 2011 experienced an increasing trend (R2 = 0.0175 from January (8.86% to December (15.18%, 79 cases of malaria was found and the peak of cases happened in December. Malaria was notfound in the age group of 0-14 years, but cases ofmalaria were found in productive age group (15-44 years old = 83%, 45-59 years old = 14%, 2: 60 years old = 3%, and also to all people working as gold miners in malaria-endemic areas i.e. Aceh, Bangka, Jambi, Kalimantan, Medan, Papua, Riau, and Sumbawa. This indicated that malaria in Simpenan was predicted as import cases.

  12. Nanomedicine against malaria.

    Science.gov (United States)

    Urbán, Patricia; Fernàndez-Busquets, Xavier

    2014-01-01

    Malaria is arguably one of the main medical concerns worldwide because of the numbers of people affected, the severity of the disease and the complexity of the life cycle of its causative agent, the protist Plasmodium sp. The clinical, social and economic burden of malaria has led for the last 100 years to several waves of serious efforts to reach its control and eventual eradication, without success to this day. With the advent of nanoscience, renewed hopes have appeared of finally obtaining the long sought-after magic bullet against malaria in the form of a nanovector for the targeted delivery of antimalarial drugs exclusively to Plasmodium-infected cells. Different types of encapsulating structure, targeting molecule, and antimalarial compound will be discussed for the assembly of Trojan horse nanocapsules capable of targeting with complete specificity diseased cells and of delivering inside them their antimalarial cargo with the objective of eliminating the parasite with a single dose. Nanotechnology can also be applied to the discovery of new antimalarials through single-molecule manipulation approaches for the identification of novel drugs targeting essential molecular components of the parasite. Finally, methods for the diagnosis of malaria can benefit from nanotools applied to the design of microfluidic-based devices for the accurate identification of the parasite's strain, its precise infective load, and the relative content of the different stages of its life cycle, whose knowledge is essential for the administration of adequate therapies. The benefits and drawbacks of these nanosystems will be considered in different possible scenarios, including cost-related issues that might be hampering the development of nanotechnology-based medicines against malaria with the dubious argument that they are too expensive to be used in developing areas.

  13. Use of integrated malaria management reduces malaria in Kenya.

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    Bernard A Okech

    Full Text Available BACKGROUND: During an entomological survey in preparation for malaria control interventions in Mwea division, the number of malaria cases at the Kimbimbi sub-district hospital was in a steady decline. The underlying factors for this reduction were unknown and needed to be identified before any malaria intervention tools were deployed in the area. We therefore set out to investigate the potential factors that could have contributed to the decline of malaria cases in the hospital by analyzing the malaria control knowledge, attitudes and practices (KAP that the residents in Mwea applied in an integrated fashion, also known as integrated malaria management (IMM. METHODS: Integrated Malaria Management was assessed among community members of Mwea division, central Kenya using KAP survey. The KAP study evaluated community members' malaria disease management practices at the home and hospitals, personal protection measures used at the household level and malaria transmission prevention methods relating to vector control. Concurrently, we also passively examined the prevalence of malaria parasite infection via outpatient admission records at the major referral hospital in the area. In addition we studied the mosquito vector population dynamics, the malaria sporozoite infection status and entomological inoculation rates (EIR over an 8 month period in 6 villages to determine the risk of malaria transmission in the entire division. RESULTS: A total of 389 households in Mwea division were interviewed in the KAP study while 90 houses were surveyed in the entomological study. Ninety eight percent of the households knew about malaria disease while approximately 70% of households knew its symptoms and methods to manage it. Ninety seven percent of the interviewed households went to a health center for malaria diagnosis and treatment. Similarly a higher proportion (81% used anti-malarial medicines bought from local pharmacies. Almost 90% of households reported

  14. Differential miRNA Expression in the Liver of Balb/c Mice Protected by Vaccination during Crisis of Plasmodium chabaudi Blood-Stage Malaria

    Science.gov (United States)

    Dkhil, Mohamed A.; Al-Quraishy, Saleh A.; Abdel-Baki, Abdel-Azeem S.; Delic, Denis; Wunderlich, Frank

    2017-01-01

    MicroRNAs are increasingly recognized as epigenetic regulators for outcome of diverse infectious diseases and vaccination efficacy, but little information referring to this exists for malaria. This study investigates possible effects of both protective vaccination and P. chabaudi malaria on the miRNome of the liver as an effector against blood-stage malaria using miRNA microarrays and quantitative PCR. Plasmodium chabaudi blood-stage malaria takes a lethal outcome in female Balb/c mice, but a self-healing course after immunization with a non-infectious blood-stage vaccine. The liver robustly expresses 71 miRNA species at varying levels, among which 65 miRNA species respond to malaria evidenced as steadily increasing or decreasing expressions reaching highest or lowest levels toward the end of the crisis phase on day 11 p.i. in lethal malaria. Protective vaccination does not affect constitutive miRNA expression, but leads to significant (p malaria.

  15. Frequently Asked Questions (FAQs) about Malaria

    Science.gov (United States)

    ... disease maintains a vicious cycle of disease and poverty. Top of Page How People Get Malaria (Transmission) ... a list of all the places in the world where malaria transmission occurs and the malaria drugs ...

  16. Prevalence and Parasite Density of Asymptomatic Malaria ...

    African Journals Online (AJOL)

    Prevalence and Parasite Density of Asymptomatic Malaria Parasitemia among Unbooked .... of two experienced laboratory scientists dedicated to the study to ensure quality control. .... Roll Back Malaria Annual Report. Abuja: Malaria Control.

  17. Evaluation of an open access echocardiography service in the Netherlands: a mixed methods study of indications, outcomes, patient management and trends

    Directory of Open Access Journals (Sweden)

    Streppel Marjolijn

    2010-02-01

    Full Text Available Abstract Background In our region (Eastern South Limburg, The Netherlands an open access echocardiography service started in 2002. It was the first service of this kind in The Netherlands. Our study aims were: (1 to evaluate demand for the service, participation, indications, echocardiography outcomes, and management by the general practitioner (GP; (2 to analyse changes in indications and outcomes over the years. Methods (1 Data from GP request forms, echocardiography reports and a retrospective GP questionnaire on management (response rate 83% of 625 consecutive patients (Dec. 2002 - March 2007 were analysed cross-sectionally. (2 For the analysis of changes over the years, data from GP request forms and echocardiography reports of the first and last 250 patients that visited the service between Dec. 2002 and Feb. 2008 (n = 1001 were compared. Results The echocardiography service was used by 81% of the regional GPs. On average, a GP referred one patient per year to the service. Intended indications for the service were dyspnoea (32%, cardiac murmur (59%, and peripheral oedema (17%. Of the other indications (22%, one-third was for evaluation of suspected left ventricular hypertrophy (LVH. Expected outcomes were left ventricular dysfunction (LVD (43%, predominantly diastolic and valve disease (25%. We also found a high proportion of LVH (50%. Only 24% of all echocardiograms showed no relevant disease. The GP followed the cardiologist's advice to refer the patient for further evaluation in 71%. In recent patients, more echocardiography requests were done for 'cardiac murmur' and 'other' indications, but less for 'dyspnoea'. The proportions of patients with LVD, LVH and valve disease decreased and the proportion of patients with no relevant disease increased. The number of advices by the cardiologists increased. Conclusion Overall, GPs used the open access echocardiography service efficiently (i.e. with a high chance of finding relevant pathology

  18. Is There a Risk of Suburban Transmission of Malaria in Selangor, Malaysia?

    Science.gov (United States)

    Braima, Kamil A.; Sum, Jia-Siang; Ghazali, Amir-Ridhwan M.; Muslimin, Mustakiza; Jeffery, John; Lee, Wenn-Chyau; Shaker, Mohammed R.; Elamin, Alaa-Eldeen M.; Jamaiah, Ibrahim; Lau, Yee-Ling; Rohela, Mahmud; Kamarulzaman, Adeeba; Sitam, Frankie; Mohd-Noh, Rosnida; Abdul-Aziz, Noraishah M.

    2013-01-01

    Background The suburban transmission of malaria in Selangor, Malaysia’s most developed and populous state still remains a concern for public health in this region. Despite much successful control efforts directed at its reduction, sporadic cases, mostly brought in by foreigners have continued to occur. In addition, cases of simian malaria caused by Plasmodium knowlesi, some with fatal outcome have caused grave concern to health workers. The aim of this study was to investigate the possibility of local malaria transmission in suburban regions of Selangor, which are adjacent to secondary rainforests. Findings A malaria survey spanning 7 years (2006 - 2012) was conducted in Selangor. A total of 1623 laboratory confirmed malaria cases were reported from Selangor’s nine districts. While 72.6% of these cases (1178/1623) were attributed to imported malaria (cases originating from other countries), 25.5% (414/1623) were local cases and 1.9% (31/1623) were considered as relapse and unclassified cases combined. In this study, the most prevalent infection was P. vivax (1239 cases, prevalence 76.3%) followed by P. falciparum (211, 13.0%), P. knowlesi (75, 4.6%), P. malariae (71, 4.4%) and P. ovale (1, 0.06%). Mixed infections comprising of P. vivax and P. falciparum were confirmed (26, 1.6%). Entomological surveys targeting the residences of malaria patients’ showed that the most commonly trapped Anopheles species was An. maculatus. No oocysts or sporozoites were found in the An. maculatus collected. Nevertheless, the possibility of An. maculatus being the malaria vector in the investigated locations was high due to its persistent occurrence in these areas. Conclusions Malaria cases reported in this study were mostly imported cases. However the co-existence of local cases and potential Plasmodium spp. vectors should be cause for concern. The results of this survey reflect the need of maintaining closely monitored malaria control programs and continuous extensive malaria

  19. Mosquito Vectors and the Globalization of Plasmodium falciparum Malaria.

    Science.gov (United States)

    Molina-Cruz, Alvaro; Zilversmit, Martine M; Neafsey, Daniel E; Hartl, Daniel L; Barillas-Mury, Carolina

    2016-11-23

    Plasmodium falciparum malaria remains a devastating public health problem. Recent discoveries have shed light on the origin and evolution of Plasmodium parasites and their interactions with their vertebrate and mosquito hosts. P. falciparum malaria originated in Africa from a single horizontal transfer between an infected gorilla and a human, and became global as the result of human migration. Today, P. falciparum malaria is transmitted worldwide by more than 70 different anopheline mosquito species. Recent studies indicate that the mosquito immune system can be a barrier to malaria transmission and that the P. falciparum Pfs47 gene allows the parasite to evade mosquito immune detection. Here, we review the origin and globalization of P. falciparum and integrate this history with analysis of the biology, evolution, and dispersal of the main mosquito vectors. This new perspective broadens our understanding of P. falciparum population structure and the dispersal of important parasite genetic traits.

  20. World Malaria Report: time to acknowledge Plasmodium knowlesi malaria.

    Science.gov (United States)

    Barber, Bridget E; Rajahram, Giri S; Grigg, Matthew J; William, Timothy; Anstey, Nicholas M

    2017-03-31

    The 2016 World Health Organization (WHO) World Malaria Report documents substantial progress towards control and elimination of malaria. However, major challenges remain. In some regions of Southeast Asia, the simian parasite Plasmodium knowlesi has emerged as an important cause of human malaria, and the authors believe this species warrants regular inclusion in the World Malaria Report. Plasmodium knowlesi is the most common cause of malaria in Malaysia, and cases have also been reported in nearly all countries of Southeast Asia. Outside of Malaysia, P. knowlesi is frequently misdiagnosed by microscopy as Plasmodium falciparum or Plasmodium vivax. Thus, P. knowlesi may be underdiagnosed in affected regions and its true incidence underestimated. Acknowledgement in the World Malaria Report of the regional importance of P. knowlesi will facilitate efforts to improve surveillance of this emerging parasite. Furthermore, increased recognition will likely lead to improved delivery of effective treatment for this potentially fatal infection, as has occurred in Malaysia where P. knowlesi case-fatality rates have fallen despite rising incidence. In a number of knowlesi-endemic countries, substantial progress has been made towards the elimination of P. vivax and P. falciparum. However, efforts to eliminate these human-only species should not preclude efforts to reduce human malaria from P. knowlesi. The regional importance of knowlesi malaria was recognized by the WHO with its recent Evidence Review Group meeting on knowlesi malaria to address strategies for prevention and mitigation. The WHO World Malaria Report has an appropriate focus on falciparum and vivax malaria, the major causes of global mortality and morbidity. However, the authors hope that in future years this important publication will also incorporate data on the progress and challenges in reducing knowlesi malaria in regions where transmission occurs.

  1. The impact of endemic and epidemic malaria on the risk of stillbirth in two areas of Tanzania with different malaria transmission patterns

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    Mutabingwa TK

    2006-10-01

    Full Text Available Abstract Background The impact of malaria on the risk of stillbirth is still under debate. The aim of the present analysis was to determine comparative changes in stillbirth prevalence between two areas of Tanzania with different malaria transmission patterns in order to estimate the malaria attributable component. Methods A retrospective analysis was completed of stillbirth differences between primigravidae and multigravidae in relation to malaria cases and transmission patterns for two different areas of Tanzania with a focus on the effects of the El Niño southern climatic oscillation (ENSO. One area, Kagera, experiences outbreaks of malaria, and the other area, Morogoro, is holoendemic. Delivery and malaria data were collected over a six year period from records of the two district hospitals in these locations. Results There was a significantly higher prevalence of low birthweight in primigravidae compared to multigravidae for both data sets. Low birthweight and stillbirth prevalence (17.5% and 4.8% were significantly higher in Kilosa compared to Ndolage (11.9% and 2.4%. There was a significant difference in stillbirth prevalence between Ndolage and Kilosa between malaria seasons (2.4% and 5.6% respectively, p Conclusion Malaria exposure during pregnancy has a delayed effect on birthweight outcomes, but a more acute effect on stillbirth risk.

  2. Conversions from anatomic shoulder replacements to reverse total shoulder arthroplasty: do the indications for initial surgery influence the clinical outcome after revision surgery?

    Science.gov (United States)

    Holschen, Malte; Franetzki, Bastian; Witt, Kai-Axel; Liem, Dennis; Steinbeck, Jörn

    2017-02-01

    The most frequent indications for anatomic shoulder replacement are glenohumeral osteoarthritis and fractures of the humeral head. If anatomic shoulder prostheses fail, reverse total shoulder arthroplasty is often the only remaining treatment option. This study evaluates the influence of indications for primary shoulder arthroplasty on the clinical outcome after conversion to reverse total shoulder arthroplasty. From 2010 to 2012, 44 failed shoulder arthroplasties were converted to reverse total shoulder arthroplasty. Forty-four patients were available for follow-up after a mean of 24 months (14-36 months). Twenty-three of them had received an initial shoulder replacement because of osteoarthritis, while the remaining 21 patients had been treated for a fracture of the humeral head. At follow-up, patients were assessed with X-rays, constant-, and ASES scores. The total number of observed complications was higher in patients revised because of failed fracture arthroplasty (24 vs. 9%). Patients initially treated for osteoarthritis achieved a higher ASES score (71 vs. 59 points; p = 0.048). The normalized constant score was not different between the two observed groups (osteoarthritis 73% vs. fracture 67%: p = 0.45). Complications occurred more often in patients who had initially suffered from a fracture of the humeral head (fracture 23.8% vs. osteoarthritis 8.7%). Scapular notching was more frequent after initial fracture arthroplasty (33 vs. 14%). Indications for initial shoulder replacement have an influence on the clinical outcome after conversion to reverse total shoulder arthroplasty. Patients initially treated for a fracture of the humeral head have a lower subjective outcome and a higher complication rate in comparison with patients initially treated for osteoarthritis. IV (Retrospective study).

  3. Is the Outcome Indicator “3rd/4th Degree Perineal Tear in Spontaneous Singleton Births” a Reliable Quality Parameter in Obstetrics?

    OpenAIRE

    Franz, H. B. G.; Erxleben, C. W. J.

    2015-01-01

    Obstetric sphincter damage is the most common cause of fecal incontinence in women. Between one-third and two-thirds of women who sustain a recognized third-degree tear during delivery subsequently suffer from fecal incontinence. We should therefore try to reduce the rate of high-grade tears as much as possible. But this rate can only be used as an outcome indicator for the quality of obstetric departments if the recognition and classification of sphincter injury is similar across departments...

  4. Is the Outcome Indicator “3rd/4th Degree Perineal Tear in Spontaneous Singleton Births” a Reliable Quality Parameter in Obstetrics?

    Science.gov (United States)

    Franz, H. B. G.; Erxleben, C. W. J.

    2015-01-01

    Obstetric sphincter damage is the most common cause of fecal incontinence in women. Between one-third and two-thirds of women who sustain a recognized third-degree tear during delivery subsequently suffer from fecal incontinence. We should therefore try to reduce the rate of high-grade tears as much as possible. But this rate can only be used as an outcome indicator for the quality of obstetric departments if the recognition and classification of sphincter injury is similar across departments in different hospitals. PMID:25797957

  5. Progress toward a malaria vaccine: efficient induction of protective anti-malaria immunity.

    Science.gov (United States)

    Tsuji, M; Rodrigues, E G; Nussenzweig, S

    2001-04-01

    Malaria can be a very severe disease, particularly in young children, pregnant women (mostly in primipara), and malaria naïve adults, and currently ranks among the most prevalent infections in tropical and subtropical areas throughout the world. The widespread occurrence and the increased incidence of malaria in many countries, caused by drug-resistant parasites (Plasmodium falciparum and P. vivax) and insecticide-resistant vectors (Anopheles mosquitoes), indicate the need to develop new methods of controlling this disease. Experimental vaccination with irradiated sporozoites can protect animals and humans against the disease, demonstrating the feasibility of developing an effective malaria vaccine. However, developing a universally effective, long lasting vaccine against this parasitic disease has been a difficult task, due to several problems. One difficulty stems from the complexity of the parasite's life cycle. During their life cycle, malaria parasites change their residence within the host, thus avoiding being re-exposed to the same immunological environment. These parasites also possess some distinct antigens, present at different life stages of the parasite, the so-called stage-specific antigens. While some of the stage-specific antigens can induce protective immune responses in the host, these responses are usually genetically restricted, this being another reason for delaying the development of a universally effective vaccine. The stage-specific antigens must be used as immunogens and introduced into the host by using a delivery system that should efficiently induce protective responses against the respective stages. Here we review several research approaches aimed at inducing protective anti-malaria immunity, overcoming the difficulties described above.

  6. Imported malaria in pregnancy in Madrid

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    Jiménez Beatriz C

    2012-04-01

    Full Text Available Abstract Background Malaria in pregnancy is associated with maternal and foetal morbidity and mortality in endemic areas, but information on imported cases to non-endemic areas is scarce. The aim of this study was to describe the clinical and epidemiological characteristics of malaria in pregnancy in two general hospitals in Madrid, Spain. Methods Retrospective descriptive study of laboratory-confirmed malaria in pregnant women at the Fuenlabrada University Hospital and the Príncipe de Asturias University Hospital, in Madrid, over a six- and 11-year period, respectively. Relevant epidemiological, clinical and laboratory data was obtained from medical records. Results There were 19 pregnant women among 346 malaria cases (5.4%. The average age was 27 years. The gestational age (trimester was: 53% 3rd, 31% 1st, 16% 2nd. All but one were multigravidae. Three were HIV positive. All were sub-Saharan immigrants: two were recently arrived immigrants and seventeen (89% had visited friends and relatives. None had taken prophylaxis nor seeked pre-travel advice. Presentation: 16 symptomatic patients (fever in fourteen, asthenia in two, three asymptomatic. Median delay in diagnosis: 7.5 days. Laboratory tests: anaemia (cut off Hb level 11 g/dl 78.9% (mild 31.6%, moderate 31.6%, severe 15.8% thrombocytopaenia 73.7%, hypoglycaemia 10.5%. All cases were due to Plasmodium falciparum, one case of hyperparasitaemia. Quinine + clindamycin prescribed in 84%. Outcomes: no severe maternal complications or deaths, two abortions, fifteen term pregnancies, no low-birth-weight newborns, two patients were lost to follow-up. Conclusions Though cases of malaria in pregnancy are uncommon, a most at risk group is clearly defined: young sub-Saharan mothers visiting friends and relatives without pre-travel counselling and recently-arrived immigrants. The most common adverse maternal and foetal effects were anaemia and stillbirth. Given that presentation can be asymptomatic

  7. Surveillance of imported hospital requiring malaria in Portugal: can it be improved?

    Science.gov (United States)

    Fonseca, Ana Glória; Simões Dias, Sara; Baptista, João Luís; Torgal, Jorge

    2016-06-01

    Although eradicated in Portugal, malaria keeps taking its toll on travellers and migrants from endemic countries. Completeness of hospital requiring malaria notification in Portugal 2000-11 was estimated, using two-source capture-recapture method. Data sources were: national surveillance database of notifiable diseases and the national database of the Diagnosis-Related Groups resulting from National Health Service (NHS) hospital episodes. The completeness of notification was 21,2% for all malaria cases and 26,5% for malaria deaths, indicating significant underreporting and urging for complementary data source in surveillance, for disease burden estimates and retrospective monitoring, namely hospital episodes statistics.

  8. MALARIA DI DUSUN BAKAL, DESA CAMPUREJO, KECAMATAN TRETEP, KABUPATEN TEMANGGUNG

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    Umi Widyastuti

    2011-12-01

    Full Text Available ENGLISHMalaria spot survey was conducted in Hamlet Bakal, Campurejo Village, District Tretep, Temanggung Regency in view of the increasing cases in this area. The aims of the survey was to obtain information about the epidemiology of malaria transmission in Bakal Hamlet, Campurejo Village include: Entomology (especially suspected vectors, density and habitat, the social environment (focusing on the behavior and migration of patient / case and parasitology includes slides and blood examination to confirm the patient post-treatment. The main result is that the mosquito An. aconitus (as suspected vector of malaria would be found in this area with density of 0.91 / person / hour was found resting outside the house / around the cage. Anopheles mosquitoes habitat are found in Bakal Hamlet, Campurejo Village among other rivers, ditches and ponds. Local malaria transmission occur in Bakal Hamlet, Campurejo Village with the indicator case, the source of transmission is supported by other cases (patients with P. falciparum and the finding of a mosquito An . aconitus as a suspected vector. Post-treatment blood examination showed that seven patients of malaria (indigenous suspects are not found anymore malaria parasites (negative examination. Advised to increase surveillance of malaria on the population migrants (migration in Temanggung Regency area, especially Bakal Hamlet, Campurejo Village, District Tretep. It is necessary to educate the community to increase knowledge, particularly about how to protect themselves to prevent transmission of malaria, due to local transmission of malaria occurs in the area.INDONESIAKegiatan spot survai malaria telah dilakukan di Dusun Bakal, Desa Campurejo, Kecamatan Tretep, Kabupaten Temanggung sehubungan dengan adanya peningkatan kasus di daerah tersebut. Survei bertujuan untuk memperoleh informasi tentang Epidemiologi penularan malaria di Dusun Bakal, Desa Campurejo meliputi: Entomologi (khususnya tersangka vektor

  9. Initial evidence of reduction of malaria cases and deaths in Rwanda and Ethiopia due to rapid scale-up of malaria prevention and treatment

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    Gausi Khoti

    2009-01-01

    Full Text Available Abstract Background An increasing number of malaria-endemic African countries are rapidly scaling up malaria prevention and treatment. To have an initial estimate of the impact of these efforts, time trends in health facility records were evaluated in selected districts in Ethiopia and Rwanda, where long-lasting insecticidal nets (LLIN and artemisinin-based combination therapy (ACT had been distributed nationwide by 2007. Methods In Ethiopia, a stratified convenience sample covered four major regions where (moderately endemic malaria occurs. In Rwanda, two districts were sampled in all five provinces, with one rural health centre and one rural hospital selected in each district. The main impact indicator was percentage change in number of in-patient malaria cases and deaths in children Results In-patient malaria cases and deaths in children Conclusion Initial evidence indicated that the combination of mass distribution of LLIN to all children

  10. Severe congenital malaria acquired in utero.

    Science.gov (United States)

    Poespoprodjo, Jeanne R; Hasanuddin, Afdal; Fobia, Wendelina; Sugiarto, Paulus; Kenangalem, Enny; Lampah, Daniel A; Tjitra, Emiliana; Price, Ric N; Anstey, Nicholas M

    2010-04-01

    Vertical transmission of Plasmodium falciparum is under-recognized and usually associated with asymptomatic low-level parasitemia at birth. We report symptomatic congenital malaria presenting as a neonatal sepsis syndrome. The presence at birth of a high asexual parasitemia, gametocytemia, and splenomegaly indicated in utero rather than intrapartum transmission. The neonate was successfully treated with intravenous artesunate followed by oral dihydroartemisinin-piperaquine, without apparent adverse effects.

  11. Clinical factors for severity of Plasmodium falciparum malaria in hospitalized adults in Thailand.

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    Patrick Sagaki

    Full Text Available Plasmodium falciparum is a major cause of severe malaria in Southeast Asia, however, there is limited information regarding clinical factors associated with the severity of falciparum malaria from this region. We performed a retrospective case-control study to compare clinical factors and outcomes between patients with severe and non-severe malaria, and to identify clinical factors associated with the requirement for intensive care unit (ICU admission of patients with severe falciparum malaria among hospitalized adults in Southeast Asia. A total of 255 patients with falciparum malaria in the Hospital for Tropical Diseases in Bangkok, Thailand between 2006 and 2012 were included. We identified 104 patients with severe malaria (cases and 151 patients with non-severe malaria (controls. Patients with falciparum malaria with following clinical and laboratory characteristics on admission (1 referrals, (2 no prior history of malaria, (3 body temperature of >38.5°C, (4 white blood cell counts >10×10(9/µL, (5 presence of schizonts in peripheral blood smears, and (6 albumin concentrations of <3.5 g/dL, were more likely to develop severe malaria (P<0.05. Among patients with severe malaria, patients who met ≥3 of the 2010 WHO criteria had sensitivity of 79.2% and specificity of 81.8% for requiring ICU admission. Multivariate analysis identified the following as independent associated factors for severe malaria requiring ICU admission; (1 ethnicity of Thai [odds ratio (OR = 3.601, 95% confidence interval (CI = 1.011-12.822] or Myanmar [OR = 3.610, 95% CI = 1.138-11.445]; (2 referrals [OR = 3.571, 95% CI = 1.306-9.762]; (3 no prior history of malaria [OR = 5.887, 95% CI = 1.354-25.594]; and (4 albumin concentrations of <3.5 g/dL [OR = 7.200, 95% CI = 1.802-28.759]. Our findings are important for the clinical management of patients with malaria because it can help early identification of patients that could develop

  12. Clinical Factors for Severity of Plasmodium falciparum Malaria in Hospitalized Adults in Thailand

    Science.gov (United States)

    Sagaki, Patrick; Thanachartwet, Vipa; Desakorn, Varunee; Sahassananda, Duangjai; Chamnanchanunt, Supat; Chierakul, Wirongrong; Pitisuttithum, Punnee; Ruangkanchanasetr, Prajej

    2013-01-01

    Plasmodium falciparum is a major cause of severe malaria in Southeast Asia, however, there is limited information regarding clinical factors associated with the severity of falciparum malaria from this region. We performed a retrospective case-control study to compare clinical factors and outcomes between patients with severe and non-severe malaria, and to identify clinical factors associated with the requirement for intensive care unit (ICU) admission of patients with severe falciparum malaria among hospitalized adults in Southeast Asia. A total of 255 patients with falciparum malaria in the Hospital for Tropical Diseases in Bangkok, Thailand between 2006 and 2012 were included. We identified 104 patients with severe malaria (cases) and 151 patients with non-severe malaria (controls). Patients with falciparum malaria with following clinical and laboratory characteristics on admission (1) referrals, (2) no prior history of malaria, (3) body temperature of >38.5°C, (4) white blood cell counts >10×109/µL, (5) presence of schizonts in peripheral blood smears, and (6) albumin concentrations of <3.5 g/dL, were more likely to develop severe malaria (P<0.05). Among patients with severe malaria, patients who met ≥3 of the 2010 WHO criteria had sensitivity of 79.2% and specificity of 81.8% for requiring ICU admission. Multivariate analysis identified the following as independent associated factors for severe malaria requiring ICU admission; (1) ethnicity of Thai [odds ratio (OR) = 3.601, 95% confidence interval (CI) = 1.011–12.822] or Myanmar [OR = 3.610, 95% CI = 1.138–11.445]; (2) referrals [OR = 3.571, 95% CI = 1.306–9.762]; (3) no prior history of malaria [OR = 5.887, 95% CI = 1.354–25.594]; and (4) albumin concentrations of <3.5 g/dL [OR = 7.200, 95% CI = 1.802–28.759]. Our findings are important for the clinical management of patients with malaria because it can help early identification of patients that could

  13. Perfusion MRI derived indices of microvascular shunting and flow control correlate with tumor grade and outcome in patients with cerebral glioma

    DEFF Research Database (Denmark)

    Tietze, Anna; Mouridsen, Kim; Lassen-Ramshad, Yasmin

    2015-01-01

    of microvascular flow control and the extent to which oxygen can be extracted by tumor tissue. The ability of these parameters and CBV to differentiate tumor grade were assessed by receiver operating characteristic curves and logistic regression. Their ability to predict time to progression and overall survival......Objectives: Deficient microvascular blood flow control is thought to cause tumor hypoxia and increase resistance to therapy. In glioma patients, we tested whether perfusion-weighted MRI (PWI) based indices of microvascular flow control provide more information on tumor grade and patient outcome...... than does the established PWI angiogenesis marker, cerebral blood volume (CBV). Material and Methods: Seventy-two glioma patients (sixty high-grade, twelve low-grade gliomas) were included. Capillary transit time heterogeneity (CTH) and COV, its ratio to blood mean transit time, provide indices...

  14. Feasibility of home management using ACT for childhood malaria episodes in an urban setting.

    Science.gov (United States)

    Nsagha, Dickson S; Elat, Jean-Bosco N; Ndong, Proper Ab; Tata, Peter N; Tayong, Maureen-Nill N; Pokem, Francois F; Wankah, Christian C

    2012-01-01

    Over 90% of malaria cases occur in Sub-Saharan Africa, where a child under the age of 5 years dies from this illness every 30 seconds. The majority of families in Sub- Saharan Africa treat malaria at home, but therapy is often incomplete, hence the World Health Organization has adopted the strategy of home management of malaria to solve the problem. The purpose of this study was to determine community perception and the treatment response to episodes of childhood malaria in an urban setting prior to implementation of home management using artemisinin-based combination therapy (ACT). This qualitative exploratory study on the home management of malaria in urban children under 5 years of age used 15 focus group discussions and 20 in-depth interviews in various categories of caregivers of children under 5 years. One hundred and eighteen people participated in the focus group discussions and 20 in the in-depth interviews. The study explored beliefs and knowledge about malaria, mothers' perception of home management of the disease, health-seeking behavior, prepackaged treatment of malaria using ACT and a rapid diagnostic test, preferred channels for home management of uncomplicated malaria, communication, the role of the community in home management of malaria, and the motivation of drug distributors in the community. The mothers' perception of malaria was the outcome of events other than mosquito bites. Home treatment is very common and is guided by the way mothers perceive signs and symptoms of malaria. Frequent change of malarial drugs by the national health policy and financial difficulties were the main problems mothers faced in treating febrile children. Rapid diagnostic testing and prepackaged ACT for simple malaria in children under 5 years would be accepted if it was offered at an affordable price. Tribalism and religious beliefs might hinder the delivery of home management of malaria. The availability of rapid diagnostic testing and ACT all year round is one of

  15. A refined estimate of the malaria burden in Niger

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    Doudou Maimouna

    2012-03-01

    Full Text Available Abstract Background The health authorities of Niger have implemented several malaria prevention and control programmes in recent years. These interventions broadly follow WHO guidelines and international recommendations and are based on interventions that have proved successful in other parts of Africa. Most performance indicators are satisfactory but, paradoxically, despite the mobilization of considerable human and financial resources, the malaria-fighting programme in Niger seems to have stalled, as it has not yet yielded the expected significant decrease in malaria burden. Indeed, the number of malaria cases reported by the National Health Information System has actually increased by a factor of five over the last decade, from about 600,000 in 2000 to about 3,000,000 in 2010. One of the weaknesses of the national reporting system is that the recording of malaria cases is still based on a presumptive diagnosis approach, which overestimates malaria incidence. Methods An extensive nationwide survey was carried out to determine by microscopy and RDT testing, the proportion of febrile patients consulting at health facilities for suspected malaria actually suffering from the disease, as a means of assessing the magnitude of this problem and obtaining a better estimate of malaria morbidity in Niger. Results In total, 12,576 febrile patients were included in this study; 57% of the slides analysed were positive for the malaria parasite during the rainy season, when transmission rates are high, and 9% of the slides analysed were positive during the dry season, when transmission rates are lower. The replacement of microscopy methods by rapid diagnostic tests resulted in an even lower rate of confirmation, with only 42% of cases testing positive during the rainy season, and 4% during the dry season. Fever alone has a low predictive value, with a low specificity and sensitivity. These data highlight the absolute necessity of confirming all reported

  16. Malaria's deadly grip

    DEFF Research Database (Denmark)

    Smith, Joseph D; Rowe, J Alexandra; Higgins, Matthew K

    2013-01-01

    Cytoadhesion of Plasmodium falciparum-infected erythrocytes to host microvasculature is a key virulence determinant. Parasite binding is mediated by a large family of clonally variant adhesion proteins, termed P. falciparum erythrocyte membrane protein 1 (PfEMP1), encoded by var genes and expressed...... at the infected erythrocyte surface. Although PfEMP1 proteins have extensively diverged under opposing selection pressure to maintain ligand binding while avoiding antibody-mediated detection, recent work has revealed they can be classified into different groups based on chromosome location and domain composition......EMP1 subtypes appear to be specialized for infection of malaria naïve hosts. Here, we discuss recent findings on the origins and evolution of the var gene family, the structure-function of PfEMP1 proteins, and a distinct subset of PfEMP1 variants that have been associated with severe childhood malaria....

  17. Transfection of malaria parasites.

    Science.gov (United States)

    Waters, A P; Thomas, A W; van Dijk, M R; Janse, C J

    1997-10-01

    The stable genetic transformation of three phylogenetically diverse species of Plasmodium, the parasitic etiological agent of malaria, is now possible. The parasite is haploid throughout the vast majority of its life cycle. Therefore with the single selectable marker activity and protocols currently available, it is possible not only to express introduced transgenes but also to study the effects of site-specific homologous recombination such as gene knockout. Transgene expression will allow the detailed study of many aspects of the cellular biology of malaria parasites, for example, the mechanisms underlying drug resistance and protein trafficking. We describe here the methods for propagation of the two animal models (Plasmodium berghei and Plasmodium knowlesi) and for transfection of these two species and the human parasite, Plasmodium falciparum. Examples of transgene expression are given.

  18. PENELITIAN OBAT ANTI MALARIA

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    Emiliana Tjitra

    2012-09-01

    Full Text Available Some sensitivity tests of antimalarial drugs had been done by National Institute of Health Research and Development in collaboration with Directorate General of Communicable Disease Control and Environment Health, Naval Medical Research Unit No.2 and Faculty of Medicine University of Indonesia. In-vivo and or in-vitro Plasmodium falciparum multidrug resistance was reported from 11 provinces : Aceh, North Sumatera, Riau, Lampung, West Java, Jakarta (imported case, Central Java, East Kalimantan, South Sulawesi, East Nusa Tenggara and Irian Jaya. Only quinine had a good response for treatment of falciparum malaria resistant to multidrug. R falciparum resistant to mefloquine or halofantrine was found although it was not available in Indonesia yet. Chloroquine prophylaxis using standard dose was still effective in Tanjung Pinang and Central Java. To support the successfulness of treatment in malaria control programme, further studies on alternative antimalaria drugs is needed.

  19. Intravenous artesunate reduces parasite clearance time, duration of intensive care, and hospital treatment in patients with severe malaria in Europe

    DEFF Research Database (Denmark)

    Kurth, Florian; Develoux, Michel; Mechain, Matthieu;

    2015-01-01

    Intravenous artesunate improves survival in severe malaria, but clinical trial data from nonendemic countries are scarce. The TropNet severe malaria database was analyzed to compare outcomes of artesunate vs quinine treatment. Artesunate reduced parasite clearance time and duration of intensive...

  20. Initial evidence of reduction of malaria cases and deaths in Rwanda and Ethiopia due to rapid scale-up of malaria prevention and treatment

    Science.gov (United States)

    Otten, Mac; Aregawi, Maru; Were, Wilson; Karema, Corine; Medin, Ambachew; Bekele, Worku; Jima, Daddi; Gausi, Khoti; Komatsu, Ryuichi; Korenromp, Eline; Low-Beer, Daniel; Grabowsky, Mark

    2009-01-01

    Background An increasing number of malaria-endemic African countries are rapidly scaling up malaria prevention and treatment. To have an initial estimate of the impact of these efforts, time trends in health facility records were evaluated in selected districts in Ethiopia and Rwanda, where long-lasting insecticidal nets (LLIN) and artemisinin-based combination therapy (ACT) had been distributed nationwide by 2007. Methods In Ethiopia, a stratified convenience sample covered four major regions where (moderately) endemic malaria occurs. In Rwanda, two districts were sampled in all five provinces, with one rural health centre and one rural hospital selected in each district. The main impact indicator was percentage change in number of in-patient malaria cases and deaths in children < 5 years old prior to (2001–2005/6) and after (2007) nationwide implementation of LLIN and ACT. Results In-patient malaria cases and deaths in children < 5 years old in Rwanda fell by 55% and 67%, respectively, and in Ethiopia by 73% and 62%. Over this same time period, non-malaria cases and deaths generally remained stable or increased. Conclusion Initial evidence indicated that the combination of mass distribution of LLIN to all children < 5 years or all households and nationwide distribution of ACT in the public sector was associated with substantial declines of in-patient malaria cases and deaths in Rwanda and Ethiopia. Clinic-based data was a useful tool for local monitoring of the impact of malaria programmes. PMID:19144183

  1. Accelerating to Zero: Strategies to Eliminate Malaria in the Peruvian Amazon

    Science.gov (United States)

    Quispe, Antonio M.; Llanos-Cuentas, Alejandro; Rodriguez, Hugo; Clendenes, Martin; Cabezas, Cesar; Leon, Luis M.; Chuquiyauri, Raul; Moreno, Marta; Kaslow, David C.; Grogl, Max; Herrera, Sócrates; Magill, Alan J.; Kosek, Margaret; Vinetz, Joseph M.; Lescano, Andres G.; Gotuzzo, Eduardo

    2016-01-01

    In February 2014, the Malaria Elimination Working Group, in partnership with the Peruvian Ministry of Health (MoH), hosted its first international conference on malaria elimination in Iquitos, Peru. The 2-day meeting gathered 85 malaria experts, including 18 international panelists, 23 stakeholders from different malaria-endemic regions of Peru, and 11 MoH authorities. The main outcome was consensus that implementing a malaria elimination project in the Amazon region is achievable, but would require: 1) a comprehensive strategic plan, 2) the altering of current programmatic guidelines from control toward elimination by including symptomatic as well as asymptomatic individuals for antimalarial therapy and transmission-blocking interventions, and 3) the prioritization of community-based active case detection with proper rapid diagnostic tests to interrupt transmission. Elimination efforts must involve key stakeholders and experts at every level of government and include integrated research activities to evaluate, implement, and tailor sustainable interventions appropriate to the region.

  2. Analysing the quality of routine malaria data in Mozambique

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    Sundby Johanne

    2004-03-01

    Full Text Available Abstract Background In Mozambique, malaria is the principal cause of morbidity and mortality. Efforts are being made to increase control activities within communities. These activities require management decisions based on evidence of malaria incidence. Although some data generated are of poor quality, there is little research towards improving the reporting systems. Methods An analysis of the quality of routine malaria data was performed in selected districts in Southern Mozambique from August to September 2003. The aim was to assess the quality of the source data in terms of completeness, correctness and consistency across management levels. Results Analysis revealed primary data to be of poor quality. The diversity of reporting systems with limited coordination give rise to redundancies and wastage of resources. There was evidence of "invention" of data in health facilities contributing to an incorrect representation of malaria incidence. Large, "non-clinical", time-based variations of malaria cases due to reporting delays were also noted, contributing to false alerts of outbreaks. Furthermore, targets established in the national strategic plan for malaria cannot be calculated through the existing systems; this is the case, for example, for data related to pregnant women and children under-five years. Discussion and recommendations The existing reporting system for malaria is currently not satisfying the information needs of managers. It is suggested that one standardized system, including the creation of one form to include the essential variables required for the calculation of key indicators by age, gender and pregnancy status, and to establish a national database that maps malaria by location.

  3. [Monkey malaria (Plasmodium knowlesi infection) after travelling to Thailand].

    Science.gov (United States)

    Kroidl, Inge; Seilmaier, Michael; Berens-Riha, Nicole; Bretzel, Gisela; Wendtner, Clemens; Löscher, Thomas

    2015-05-01

    A case of malaria caused by Plasmodium knowlesi is described in a 52-year-old female German traveler after returning from Thailand. P. knowlesi is a parasite of macaques in Southeast Asia and has been recognized in recent years as an important and probably increasing cause of human