Evaluation of light microscopy and rapid diagnostic test for the detection of malaria under operational field conditions: a household survey in Ethiopia.

BACKGROUND: In most resource-poor settings, malaria is usually diagnosed based on clinical signs and symptoms and not by detection of parasites in the blood using microscopy or rapid diagnostic tests (RDT). In population-based malaria surveys, accurate diagnosis is important: microscopy provides the gold standard, whilst RDTs allow immediate findings and treatment. The concordance between RDTs and microscopy in low or unstable transmission areas has not been evaluated. OBJECTIVES: This study aimed to estimate the prevalence of malaria parasites in randomly selected malarious areas of Amhara, Oromia, and Southern Nations, Nationalities and Peoples' (SNNP) regions of Ethiopia, using microscopy and RDT, and to investigate the agreement between microscopy and RDT under field conditions. METHODS: A population-based survey was conducted in 224 randomly selected clusters of 25 households each in Amhara, Oromia and SNNP regions, between December 2006 and February 2007. Fingerpick blood samples from all persons living in even-numbered households were tested using two methods: light microscopy of Giemsa-stained blood slides; and RDT (ParaScreen device for Pan/Pf). RESULTS: A total of 13,960 people were eligible for malaria parasite testing of whom 11,504 (82%) were included in the analysis. Overall slide positivity rate was 4.1% (95% confidence interval [CI] 3.4-5.0%) while ParaScreen RDT was positive in 3.3% (95% CI 2.6-4.1%) of those tested. Considering microscopy as the gold standard, ParaScreen RDT exhibited high specificity (98.5%; 95% CI 98.3-98.7) and moderate sensitivity (47.5%; 95% CI 42.8-52.2) with a positive predictive value of 56.8% (95% CI 51.7-61.9) and negative predictive value of 97.6% (95% CI 97.6-98.1%) under field conditions. CONCLUSION: Blood slide microscopy remains the preferred option for population-based prevalence surveys of malaria parasitaemia. The level of agreement between microscopy and RDT warrants further investigation in different transmission settings and in the clinical situation

Adding to Your Tool Box: Laser Therapy for Vascular Anomalies

Adjuvant laser therapy of vascular anomalies is based on the principle of selective photo-thermolysis, through targeted destruction of selected chromophores with minimal injury to surrounding tissue. Choice of laser wavelength, treatment parameters, and predicted response to therapy are dependent on the dominant chromophore within the vascular anomaly, lesional location, and target depth, with relatively superficial and mucosal lesions producing the best response to therapy. Lasers can be safely combined with multi-modal approaches for vascular anomalies, including sclerotherapy, surgical excision, and systemic therapy. In this manuscript, we review the laser literature on a range of vascular anomalies, and provide indications, appropriate therapeutic and warning endpoints in the skin, pearls/pitfalls, and multi-disciplinary approaches for pediatric dermatologists pursuing laser as adjuvant therapy for vascular anomalies

Lung Abscess as a Complication of Appendicitis

Molla Asnake,1 Suleman Hassen,2 Anteneh Messele,1 Yosef Habtemariam,1 Sisay Mengistu,2 Bizuayehu Tassew,2 Tsegaw Worku,1 Woineab Tadeg1 1Department of Medicine, School of Medicine, College of Health Sciences, Mizan-Tepi University, Mizan Aman, Ethiopia; 2Department of Surgery, College of Health Sciences, Mizan-Tepi University, Mizan Aman, EthiopiaCorrespondence: Molla Asnake, Email [email protected]: Appendicitis is an inflammation of the vermiform appendix (located near the base of the cecum). A lung abscess is a cavitary lesion containing necrotic lung tissue or an infected fluid component. It mainly occurs as a result of lung parenchymal disease. The patient was a 25-year-old male who first presented with a 1-week history of productive cough and chest pain associated with low-grade fever. He was diagnosed with a lung abscess as a complication of perforated retro cecal appendicitis. We report this in consideration of reducing the challenge of delay in diagnosis of this rare complication, and to avoid mistreatment specifically when the patient’s chest x-ray resembles empyema. Additionally, we encourage doing further studies on this topic.Keywords: lung abscess, sepsis, perforated appendiciti

The Evaluation of a Rapid In Situ HIV Confirmation Test in a Programme with a High Failure Rate of the WHO HIV Two-Test Diagnostic Algorithm

BACKGROUND: Concerns about false-positive HIV results led to a review of testing procedures used in a Médecins Sans Frontières (MSF) HIV programme in Bukavu, eastern Democratic Republic of Congo. In addition to the WHO HIV rapid diagnostic test algorithm (RDT) (two positive RDTs alone for HIV diagnosis) used in voluntary counselling and testing (VCT) sites we evaluated in situ a practical field-based confirmation test against western blot WB. In addition, we aimed to determine the false-positive rate of the WHO two-test algorithm compared with our adapted protocol including confirmation testing, and whether weakly reactive compared with strongly reactive rapid test results were more likely to be false positives. METHODOLOGY/PRINCIPAL FINDINGS: 2864 clients presenting to MSF VCT centres in Bukavu during January to May 2006 were tested using Determine HIV-1/2 and UniGold HIV rapid tests in parallel by nurse counsellors. Plasma samples on 229 clients confirmed as double RDT positive by laboratory retesting were further tested using both WB and the Orgenics Immunocomb Combfirm HIV confirmation test (OIC-HIV). Of these, 24 samples were negative or indeterminate by WB representing a false-positive rate of the WHO two-test algorithm of 10.5% (95%CI 6.6-15.2). 17 of the 229 samples were weakly positive on rapid testing and all were negative or indeterminate by WB. The false-positive rate fell to 3.3% (95%CI 1.3-6.7) when only strong-positive rapid test results were considered. Agreement between OIC-HIV and WB was 99.1% (95%CI 96.9-99.9%) with no false OIC-HIV positives if stringent criteria for positive OIC-HIV diagnoses were used. CONCLUSIONS: The WHO HIV two-test diagnostic algorithm produced an unacceptably high level of false-positive diagnoses in our setting, especially if results were weakly positive. The most probable causes of the false-positive results were serological cross-reactivity or non-specific immune reactivity. Our findings show that the OIC-HIV confirmation test is practical and effective in field contexts. We propose that all double-positive HIV RDT samples should undergo further testing to confirm HIV seropositivity until the accuracy of the RDT testing algorithm has been established at programme level

Immunohaematological reference values in human immunodeficiency virus-negative adolescent and adults in rural northern Tanzania

<p>Abstract</p> <p>Background</p> <p>The amount of CD4 T cells is used for monitoring HIV progression and improvement, and to make decisions to start antiretroviral therapy and prophylactic drugs for opportunistic infections. The aim of this study was to determine normal reference values for CD4 T cells, lymphocytes, leucocytes and haemoglobin level in healthy, HIV negative adolescents and adults in rural northern Tanzania.</p> <p>Methods</p> <p>A cross sectional study was conducted from September 2006 to March 2007 in rural northern Tanzania. Participants were recruited from voluntary HIV counselling and testing clinics. Patients were counselled for HIV test and those who consented were tested for HIV. Clinical screening was done, and blood samples were collected for CD4 T cell counts and complete blood cell counts.</p> <p>Results</p> <p>We enrolled 102 participants, forty two (41.2%) males and 60 (58.8%) females. The mean age was 32.6 ± 95% CI 30.2–35.0. The mean absolute CD4 T cell count was 745.8 ± 95% CI 695.5–796.3, absolute CD8 T cells 504.6 ± 95% CI 461.7–547.5, absolute leukocyte count 5.1 ± 95% CI 4.8–5.4, absolute lymphocyte count 1.8 ± 95% CI 1.7–1.9, and haemoglobin level 13.2 ± 95% CI 12.7–13.7. Females had significantly higher mean absolute CD4 T cell count (p = 0.008), mean absolute CD8 T cell count (p = 0.009) and significantly lower mean haemoglobin level than males (p = 0.003)</p> <p>Conclusion</p> <p>Immunohaematological values found in this study were different from standard values for western countries. Females had significantly higher mean CD4 T cell counts and lower mean haemoglobin levels than males. This raises the issue of the appropriateness of the present reference values and guidelines for monitoring HIV/AIDS patients in Tanzania.</p

Determination and analysis of film reject rate at eight selected governmental diagnostic X-ray facilities in Tigray Region, Northern Ethiopian

Background: In radiography examination, it is common to encounter patients undergoing repeated X-ray exposure after the rejection of a film image due to poor image quality. This subjects the patients to unnecessary radiation exposure and extra cost for the facility. This fact has required to investigate the causes of film rejection in common X-ray examinations. Aims: This study aims to obtain images, which are adequate for the clinical diagnostic purpose with minimum radiation dose to the patient in X-ray radiographic examination using film rejects analysis. Methods: A prospective, crosssectional study design was carried out for 3 months. The film rejection rate data were collected using standardized checklist as recommended by the National Radiation Protection Authority and International Atomic Energy Agency. Daily recordings were compiled by frontline radiographers and senior physicians. Statistical Analysis Used: Data were analyzed descriptively using SPSS of version 23 software. Results: Overall rejection rate was 319 (10.02%) in 3183 X-ray exposures. The rejection rates by hospitals are 33.7% in Adwa, 13% in Aksum, 9.6% in Suhul, 9.2% in AbiAdi, 7.7% in Humera, 7% in Wukro, 4.3% in Lemlem Karl, and 2.9% in Alamata General Hospitals. Conclusions: Rejected films were found to have been caused by numerous factors including incorrect exposure, poor technical judgment, patient motion, and improper film processing. Hence, strategies need to be developed within medical imaging departments to improve the situation

Essential Oil of Otostegia integrifolia Benth: Composition, Antimicrobial and Antioxidant Activities

Composition, antioxidant and antimicrobial activities of the essential oil of Otostegia integrifolia Benth. were studied. GC/MS analyses revealed the presence of 37 constituents representing 84.88% of the oil with α- pinene (31.33%), 1-octen-3-ol (11.78%) and trans-caryophyllene (11.35%) constituting more than 50% of its components. When tested for its antioxidant activity using 2,2-diphenyl-1-picrylhydrazyl (DPPH), the oil reduced DPPH in a concentration dependent manner with an EC50 value of 5.32 μl/ml. Similarly, the oil was shown to possess strong and broad spectrum antimicrobial activity against several Gram-positive and Gram -negative bacterial strains as well as fungal pathogens. The minimum inhibitory concentration (MIC) of the oil ranged from 5 to 100 μg/ml and 50 to 100 μg/ml against the bacterial and fungal strains tested, respectively. The oil (MIC=5 μg/ml) was found to be more potent than ciprofloxacin (MIC=10 μg/ml) against some E. coli strains. The antifungal activity of the oil was either comparable to or better than griseofulvin against most of the fungal pathogens tested. The study provides evidence for an excellent broadspectrum antimicrobial and significant antioxidant activity of O. integrifolia essential oil, a possible explanation for the traditional use of the plant.Keywords: essential oil, Otostegia integrifolia, α-pinene, 2,2-diphenyl-1-picrylhydrazyl, antimicrobial activit