Severe malaria in children leads to a significant impairment of transitory otoacoustic emissions--a prospective multicenter cohort study.

BACKGROUND: Severe malaria may influence inner ear function, although this possibility has not been examined prospectively. In a retrospective analysis, hearing impairment was found in 9 of 23 patients with cerebral malaria. An objective method to quickly evaluate the function of the inner ear are the otoacoustic emissions. Negative transient otoacoustic emissions are associated with a threshold shift of 20 dB and above. METHODS: This prospective multicenter study analyses otoacoustic emissions in patients with severe malaria up to the age of 10 years. In three study sites (Ghana, Gabon, Kenya) 144 patients with severe malaria and 108 control children were included. All malaria patients were treated with parental artesunate. RESULTS: In the control group, 92.6 % (n = 108, 95 % confidence interval 86.19-6.2 %) passed otoacoustic emission screening. In malaria patients, 58.5 % (n = 94, malaria vs controls p < 0.001, 95 % confidence interval 48.4-67.9 %) passed otoacoustic emission screening at the baseline measurement. The value increased to 65.2 % (n = 66, p < 0.001, 95 % confidence interval 53.1-75.5 %) at follow up 14-28 days after diagnosis of malaria. The study population was divided into severe non-cerebral malaria and severe malaria with neurological symptoms (cerebral malaria). Whereas otoacoustic emissions in severe malaria improved to a passing percentage of 72.9 % (n = 48, 95 % confidence interval 59-83.4 %) at follow-up, the patients with cerebral malaria showed a drop in the passing percentage to 33 % (n = 18) 3-7 days after diagnosis. This shows a significant impairment in the cerebral malaria group (p = 0.012 at days 3-7, 95 % confidence interval 16.3-56.3 %; p = 0.031 at day 14-28, 95 % confidence interval 24.5-66.3 %). CONCLUSION: The presented data show that 40 % of children have involvement of the inner ear early in severe malaria. In children, audiological screening after severe malaria infection is not currently recommended, but is worth investigating in larger studies

Evaluation of a learner-designed course for teaching health research skills in Ghana

<p>Abstract</p> <p>Background</p> <p>In developing countries the ability to conduct locally-relevant health research and high quality education are key tools in the fight against poverty. The objective of our study was to evaluate the effectiveness of a novel UK accredited, learner-designed research skills course delivered in a teaching hospital in Ghana.</p> <p>Methods</p> <p>Study participants were 15 mixed speciality health professionals from Komfo Anokye Teaching Hospital, Kumasi, Ghana. Effectiveness measures included process, content and outcome indicators to evaluate changes in learners' confidence and competence in research, and assessment of the impact of the course on changing research-related thinking and behaviour. Results were verified using two independent methods.</p> <p>Results</p> <p>14/15 learners gained research competence assessed against UK Quality Assurance Agency criteria. After the course there was a 36% increase in the groups' positive responses to statements concerning confidence in research-related attitudes, intentions and actions. The greatest improvement (45% increase) was in learners' actions, which focused on strengthening institutional research capacity. 79% of paired before/after responses indicated positive changes in individual learners' research-related attitudes (n = 53), 81% in intention (n = 52) and 85% in action (n = 52). The course had increased learners' confidence to start and manage research, and enhanced life-long skills such as reflective practice and self-confidence. Doing their own research within the work environment, reflecting on personal research experiences and utilising peer support and pooled knowledge were critical elements that promoted learning.</p> <p>Conclusion</p> <p>Learners in Ghana were able to design and undertake a novel course that developed individual and institutional research capacity and met international standards. Learning by doing and a supportive peer community at work were critical elements in promoting learning in this environment where tutors were scarce. Our study provides a model for delivering and evaluating innovative educational interventions in developing countries to assess whether they meet external quality criteria and achieve their objectives.</p

A −436C>A Polymorphism in the Human FAS Gene Promoter Associated with Severe Childhood Malaria

Human genetics and immune responses are considered to critically influence the outcome of malaria infections including life-threatening syndromes caused by Plasmodium falciparum. An important role in immune regulation is assigned to the apoptosis-signaling cell surface receptor CD95 (Fas, APO-1), encoded by the gene FAS. Here, a candidate-gene association study including variant discovery at the FAS gene locus was carried out in a case-control group comprising 1,195 pediatric cases of severe falciparum malaria and 769 unaffected controls from a region highly endemic for malaria in Ghana, West Africa. We found the A allele of c.−436C>A (rs9658676) located in the promoter region of FAS to be significantly associated with protection from severe childhood malaria (odds ratio 0.71, 95% confidence interval 0.58–0.88, pempirical = 0.02) and confirmed this finding in a replication group of 1,412 additional severe malaria cases and 2,659 community controls from the same geographic area. The combined analysis resulted in an odds ratio of 0.71 (95% confidence interval 0.62–0.80, p = 1.8×10−7, n = 6035). The association applied to c.−436AA homozygotes (odds ratio 0.47, 95% confidence interval 0.36–0.60) and to a lesser extent to c.−436AC heterozygotes (odds ratio 0.73, 95% confidence interval 0.63–0.84), and also to all phenotypic subgroups studied, including severe malaria anemia, cerebral malaria, and other malaria complications. Quantitative FACS analyses assessing CD95 surface expression of peripheral blood mononuclear cells of naïve donors showed a significantly higher proportion of CD69+CD95+ cells among persons homozygous for the protective A allele compared to AC heterozygotes and CC homozygotes, indicating a functional role of the associated CD95 variant, possibly in supporting lymphocyte apoptosis

Composition of fruit volatiles and annual changes in the volatiles of leaves of Eucalyptus camaldulensis Dehn. growing in Greece

The chemical components of the essential oils obtained from fruits of Eucalyptus camaldulensis and of those obtained from its leaves during the course of one year, were analysed by GC and GC-MS. From the identified 52 constituents of the fruit essential oil, representing the 62.0% of the total oil, spathulenol (19.0%), β-pinene (8.8%) and p-cymene (4.8%) were found as the main components, while the concentration of 1,8-cineole, the main leaf constituent, was relatively low (3.8%). The composition of the leaf essential oil varied qualitatively and quantitatively over the course of 1 year. Generally, from the identified 43 constituents representing the 74.7-94.2%, the main constituent was 1,8-cineole (25.3-44.2%). Although spathulenol was the second most abundant constituent (highest concentration 19.2%), there were months when its concentration was exceptionally low (0.5%). Copyright © 2003 John Wiley &amp; Sons, Ltd

Triterpenoids from Eucalyptus camaldulensis Dehnh. tissue cultures

Achemical study on tissue cultures from leaves and flowers of E. camaldulensis DEHNH. afforded the new natural product (2α,3β)-2,3,23- trihydroxy-13,28-epoxyurs-11-en-28-one (dryobalanolide) together with the known pentacyclic triterpenoids: betulinic acid, oleanolic acid, ursolic acid, (2α,3β)-2,3,23-trihydroxyolean-12-en-28-oic acid (arjunolic acid), (2α,3β)-2,3,23-trihydroxyurs-12-en-28-oic acid (asiatic acid), (2α)-2-hydroxyursolic acid, (2α)-2-hydroxyoleanolic acid (maslinic acid), as well as β-sitosterol. The extracts and the isolated compounds were evaluated against eleven human pathogenic microorganisms, exhibiting a very interesting antibacterial spectrum of activities. © 2008 Verlag Helvetica Chimica Acta AG

The origin of copper-induced medicarpin accumulation and its secretion from roots of young fenugreek seedlings are regulated by copper concentration

Isoflavonoid pterocarpans, like medicarpin (M), are produced by leguminous plants in response to biotic or abiotic elicitation from either their glycosidic conjugate pools or by de novo synthesis. In an attempt to clarify M origin in response to copper elicitation, intact Trigonella foenum-graecum (fenugreek) seedlings and cell suspension cultures were treated with CuCl2, and the accumulated isoflavonoid aglycones and their glycosides were determined by High Performance Liquid Chromatography (HPLC). Our results show that copper induces the de novo synthesis of M in a concentration dependent manner. In roots, where copper accumulated in high amounts, only part of M was formed de novo, while another part was formed at the expense of its malonyl glucoside (MGM). In contrast, when tissue copper concentration was low, like in shoots, or in roots treated with low CuCl2, M was formed only by de novo synthesis. The increase of phenylalanine ammonia lyase activity (PAL) as well as the accumulation of chalcone synthase (CHS) and vestitone reductase (VR) specific transcripts are consistent with the de novo synthesis of M induced by copper. The non-linear negative correlation of the studied copper concentrations to the amount of M excreted in the seedling growth medium suggests the existence of an M secretion process which is regulated by copper concentration. The possible involvement of an ATP-dependent transporter in the copper-induced M excretion is discussed. © 2008 Elsevier Ireland Ltd. All rights reserved

Chemosystematic value of the essential oil composition of Thuja species cultivated in poland-antimicrobial activity

In the framework of the correlation between chemotaxonomy and chemical analysis studies, the chemical composition of the essential oils of four varieties of Thuja species cultivated in Poland - T. occidentalis &apos;globosa&apos;, T. occidentalis &apos;aurea&apos;, T. plicata and T. plicata &apos;gracialis&apos; - were investigated by GC and GC-MS. Thirty-one compounds were identified from T. occidentalis &apos;globosa&apos;, representing 96.92% of the total oil; twenty-seven from T. occidentalis &apos;aurea&apos; (94.34%); thirty-one from T. plicata (94.75%); and thirty compounds from T. plicata &apos;gracialis&apos; (96.36%). The main constituents in all samples were the monoterpene ketones α-and β-thujone, fenchone and sabinene, as well as the diterpenes beyerene and rimuene. The chemosystematic value of the total ketone content of all samples (which varied from 54.30-69.18%) has been discussed and investigated. The constituents, beyerene and the mixture of α-and β-thujone, were isolated from the oils and tested against six Gram-positive and-negative bacteria and three pathogenic fungi. The oils of the two T. plicata species exhibited significant antimicrobial activity, while the mixture of α-and β-thujone showed very strong activity as well

Are Malaria Risk Factors Based on Gender? A Mixed-Methods Survey in an Urban Setting in Ghana

Malaria still represents one of the most debilitating and deadly diseases in the world. It has been suggested that malaria has different impacts on women and men due to both social and biological factors. A gender perspective is therefore important to understand how to eliminate malaria. This study aimed to investigate malaria from a gender perspective in a non-for-profit private health facility, HopeXchange Medical Centre, based in Kumasi (Ghana). A sequential mixed-methods design, comprising quantitative and qualitative methods, was used. This study found low ownership (40%) and use (19%) of insecticide-treated nets (ITNs). Most malaria cases were women (62%), who were less educated and had more external risk factors associated with infection. Our study reported a trend of preferring malaria self-medication at home, which was practiced mostly by men (43%). Our data suggest that women are more likely to be exposed to malaria infections than men, especially due to their prolonged exposure to mosquito bites during the most dangerous hours. Our study highlighted the need for future malaria control policies to be more focused on social and behavioral aspects and from a gender perspective