PfHRP2 and PfLDH antigen detection for monitoring the efficacy of artemisinin-based combination therapy (ACT) in the treatment of uncomplicated falciparum malaria

<p>Abstract</p> <p>Background</p> <p>An assessment of the accuracy of two malaria rapid diagnostic tests (RDT) for the detection of <it>Plasmodium falciparum </it>histidine-rich protein 2 (<it>Pf</it>HRP2) or <it>Pf </it>lactate dehydrogenase (<it>Pf</it>LDH) was undertaken in children aged between six and 59 months included in an anti-malarial efficacy study in Benin.</p> <p>Methods</p> <p>In Allada (Benin), 205 children aged 6-59 months with falciparum malaria received either artesunate-amodiaquine (ASAQ), artemether-lumefantrine (AL), or sulphadoxine-pyrimethamine (SP). Children included in the study were simultaneously followed by both RDT and high-quality microscopy for up to 42 days.</p> <p>Results</p> <p>At the time of inclusion, <it>Pf</it>HRP2-based tests were positive in 203 children (99%) and <it>Pf</it>LDH-based tests were positive in 204 (99.5%). During follow-up, independent of the treatment received, only 17.3% (28/162) of children effectively cured were negative with the <it>Pf</it>HRP2 RDT at day 3, with a gradual increase in specificity until day 42. The specificity of antigen detection with the <it>Pf</it>LDH test was 87% (141/162) on day 3, and between 92% and 100% on days 7 to 42. A statistical difference was observed between the persistence of <it>Pf</it>HRP2 and <it>Pf</it>LDH antigenaemia during follow-up in children treated with artemisinin-based combination therapy (ACT) but not with SP.</p> <p>Conclusion</p> <p>Although both RDTs are as sensitive as microscopy in detecting true malaria cases, the <it>Pf</it>HRP2 RDT had very low specificity during follow-up until day 28. On the other hand, the <it>Pf</it>LDH test could be used to detect failures and, therefore, to assess anti-malarial efficacy.</p

Malaria Rapid Testing by Community Health Workers Is Effective and Safe for Targeting Malaria Treatment: Randomised Cross-Over Trial in Tanzania

Early diagnosis and prompt, effective treatment of uncomplicated malaria is critical to prevent severe disease, death and malaria transmission. We assessed the impact of rapid malaria diagnostic tests (RDTs) by community health workers (CHWs) on provision of artemisinin-based combination therapy (ACT) and health outcome in fever patients. Twenty-two CHWs from five villages in Kibaha District, a high-malaria transmission area in Coast Region, Tanzania, were trained to manage uncomplicated malaria using RDT aided diagnosis or clinical diagnosis (CD) only. Each CHW was randomly assigned to use either RDT or CD the first week and thereafter alternating weekly. Primary outcome was provision of ACT and main secondary outcomes were referral rates and health status by days 3 and 7. The CHWs enrolled 2930 fever patients during five months of whom 1988 (67.8%) presented within 24 hours of fever onset. ACT was provided to 775 of 1457 (53.2%) patients during RDT weeks and to 1422 of 1473 (96.5%) patients during CD weeks (Odds Ratio (OR) 0.039, 95% CI 0.029-0.053). The CHWs adhered to the RDT results in 1411 of 1457 (96.8%, 95% CI 95.8-97.6) patients. More patients were referred on inclusion day during RDT weeks (10.0%) compared to CD weeks (1.6%). Referral during days 1-7 and perceived non-recovery on days 3 and 7 were also more common after RDT aided diagnosis. However, no fatal or severe malaria occurred among 682 patients in the RDT group who were not treated with ACT, supporting the safety of withholding ACT to RDT negative patients. RDTs in the hands of CHWs may safely improve early and well-targeted ACT treatment in malaria patients at community level in Africa.\ud \ud \ud \u

Efficacy of artesunate-amodiaquine and artemether-lumefantrine fixed-dose combinations for the treatment of uncomplicated Plasmodium falciparum malaria among children aged six to 59 months in Nimba County, Liberia: an open-label randomized non-inferiority trial.

Prospective efficacy monitoring of anti-malarial treatments is imperative for timely detection of resistance development. The in vivo efficacy of artesunate-amodiaquine (ASAQ) fixed-dose combination (FDC) was compared to that of artemether-lumefantrine (AL) among children aged six to 59 months in Nimba County, Liberia, where Plasmodium falciparum malaria is endemic and efficacy data are scarce

Enhancement of the Electron Spin Resonance of Single-Walled Carbon Nanotubes by Oxygen Removal

We have observed a nearly fourfold increase in the electron spin resonance (ESR) signal from an ensemble of single-walled carbon nanotubes (SWCNTs) due to oxygen desorption. By performing temperature-dependent ESR spectroscopy both before and after thermal annealing, we found that the ESR in SWCNTs can be reversibly altered via the molecular oxygen content in the samples. Independent of the presence of adsorbed oxygen, a Curie-law (spin susceptibility $\propto 1/T$) is seen from $\sim$4 K to 300 K, indicating that the probed spins are finite-level species. For both the pre-annealed and post-annealed sample conditions, the ESR linewidth decreased as the temperature was increased, a phenomenon we identify as motional narrowing. From the temperature dependence of the linewidth, we extracted an estimate of the intertube hopping frequency; for both sample conditions, we found this hopping frequency to be $\sim$100 GHz. Since the spin hopping frequency changes only slightly when oxygen is desorbed, we conclude that only the spin susceptibility, not spin transport, is affected by the presence of physisorbed molecular oxygen in SWCNT ensembles. Surprisingly, no linewidth change is observed when the amount of oxygen in the SWCNT sample is altered, contrary to other carbonaceous systems and certain 1D conducting polymers. We hypothesize that physisorbed molecular oxygen acts as an acceptor ($p$-type), compensating the donor-like ($n$-type) defects that are responsible for the ESR signal in bulk SWCNTs.Comment: 14 pages, 7 figure

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

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How Sustaining ERP Project Legitimacy? Two Cases of Successful Implementations

International audienc

Légitimation d'un "ERP maison" au sein d'une multinationale : cas du projet Bridge de Schneider Electric

International audienc

Légitimation d'un "ERP maison" au sein d'une multinationale : cas du projet Bridge de Schneider Electric

International audienc

Contributions à l’étude de l’influence de l’oxygène sur les raies RPE dans les polymères conducteurs

L’élargissement des raies RPE en présence d'oxygène a été étudié dans le polymère conducteur polyaniline en poudre ou sous forme de film. Nous nous sommes intéressés à l'influence de la pression d'oxygène appliquée et à la cinétique d'évolution de la largeur de raie après introduction d’un mélange gazeux renfermant de l'oxygène (O2+He et O2+Ar)