Treatment of malaria restricted to laboratory-confirmed cases: a prospective cohort study in Ugandan children.

BACKGROUND: Presumptive treatment of malaria in febrile children is widely advocated in Africa. This may occur in the absence of diagnostic testing or even when diagnostic testing is performed but fails to detect malaria parasites. Such over-treatment of malaria has been tolerated in the era of inexpensive and safe monotherapy. However, with the introduction of new artemisinin-based combination therapy (ACT), presumptive treatment becomes economically and clinically less acceptable. METHODS: The risks and benefits of only treating children with microscopy confirmed malaria using a prospective cohort design were investigated. A representative sample of 601 children between one and 10 years of age were recruited from a census population in Kampala, Uganda and were followed for all of their health care needs in a study clinic. Standard microscopy was performed each time a child presented with a new episode of fever and antimalarial therapy given only if the blood smear was positive. RESULTS: Of 5,895 visits for new medical problems 40% were for febrile illnesses. Of the 2,359 episodes of new febrile illnesses, blood smears were initially reported as negative in 1,608 (68%) and no antimalarial therapy was given. Six of these initially negative smears were reported to be positive following quality control reading of all blood smears: four of these patients were subsequently diagnosed with uncomplicated malaria and two cleared their parasites without antimalarial treatment. Of the 1,602 new febrile illnesses in which the final blood smear reading was classified as negative, only 13 episodes (0.8%) were diagnosed with malaria in the subsequent 7 days. All 13 of these episodes of malaria were uncomplicated and were successfully treated. CONCLUSION: In this urban setting, malaria was responsible for only 32% of febrile episodes. Withholding antimalarial therapy in febrile children with negative blood smears was safe and saved over 1,600 antimalarial treatments in 601 children over an 18-month period. In the era of expensive ACT, directing resources towards improving diagnostic and treatment practices may provide a cost-effective measure for promoting rational use of antimalarial therapy

Analisis Dampak Paparan Medan Magnet Extremely Low Frequency (Elf) Intensitas >100 Terhadap Kelainan Kongenital Bayi Tikus Putih Stain Wistar

Using by electric toolsasPC, handphone, television, et alradiate ofradiation ofelectryand magnetic fieldthats extrim low frequencyusuallythe mean is Extremely Low Frequency (ELF). Near all objectthat characteristic of metal can be pull by magnit. The part of magnetic fieldcan penetratebuild, trees dan the other object. Undirectly the magnetic fieldgaveeffect for body. Many experimentshowed thatmagnetic fieldhave givenbad effectfor health.The objectivesof this research are inspectthe effectof magnetic field ELF with intensity of150, 300, and450for the mass of bodybaby ofwhite mouse, forunnormalypart of body baby of white mouse, and forendure of live baby of white mouse.Design of this research used post test control design.Result of this researchshowedthatthere are not different of significantfor all of groupfor the mass of bodybaby ofwhite mouse and unnormalypart of body baby of white mouse.So,forendure of live baby of white mousethere are different of significant forcontrol and experiment group.The declarationconclusingthatthe radiation of magnetic field ELF intensity of150, 300, and450didn\u27t give effectthe mass of bodybaby ofwhite mouse and unnormalypart of body baby of white mouse.. But forendure of live baby of white mouse, for mother usthat be radiated by magnetic fieldare exposed to 50% untilday to 15. Conclusion of this reseach are radiation of magnetic field ELF intensity150 , 300and450 gave effectfor the mass of bodybaby ofwhite mouse.Radiation of magnetic field ELF intensity150 , 300and450 gave effect for endure of live baby of white mouse.Radiation of magnetic field ELF intensity150 , 300and450 didn\u27t give effect for endure of live baby of white mous

Primeras tablas de selvicultura a la carta para masas regulares de Pinus nigra Arn. del Prepirineo Catalán

Three detailed management models are developed for even-aged black pine (Pinus nigra Arn.) stands of the Pyrenees. These models consist of a descriptive part, named Final Stand Type, from the first thinning to the regeneration concepts. Several goals to be reached in terms of final medium diameters and rotations are defined for each site index class. This part is complemented by Management Tables that represent quantitatively the stand evolution according to the proposed treatment regimen.Starting by a selective thinning combined with low thinning, weights and rotations of interventions are spread out at intervals depending on the growth dynamics of the species in the different site index classes. Finally, comparative economic valuation is carried out between the proposed models and the management as uneven-aged forest, which is the traditional management method of these stands in the Pyrenees.Se proponen modelos de gestión detallados para el pino laricio (Pinus nigra Arn.) del Pirineo. Los modelos constan de una parte descriptiva del régimen de tratamientos, denominada Tipo de Bosque Final, desde los primeros clareos hasta las cortas de regeneración, en los que en función de la calidad se definen objetivos a alcanzar en términos de diámetros medios finales y turno. esta se complementa con unas Tablas de Selvicultura a la carta que plasman cuantitativamente la evolución de la masa de acuerdo con el régimen de tratamientos propuesto. Se parte de las claras selectivas mixtas seguida de una clara por lo bajo como tipo de clara, escalonándose los pesos y rotaciones de las intervenciones en función de la dinámica de crecimiento de la especie en las distintas calidades de estación. Por último se realiza una valoración económica comparativa entre los modelos propuestos y la gestión como masa irregular, método tradicional de gestión de estos bosques en el Prepirineo catalán

Gamma Ray Flashes Produced by Lightning Observed at Ground Level by TETRA-II

In its first 2 years of operation, the ground-based Terrestrial gamma ray flash and Energetic Thunderstorm Rooftop Array (TETRA)-II array of gamma ray detectors has recorded 22 bursts of gamma rays of millisecond-scale duration associated with lightning. In this study, we present the TETRA-II observations detected at the three TETRA-II ground-level sites in Louisiana, Puerto Rico, and Panama together with the simultaneous radio frequency signals from the lightning data sets VAISALA Global Lightning Dataset, VAISALA National Lightning Detection Network, Earth Networks Total Lightning Network, andWorld Wide Lightning Location Network. The relative timing between the gamma ray events and the lightning activity is a key parameter for understanding the production mechanism(s) of the bursts. The gamma ray time profiles and their correlation with radio sferics suggest that the gamma ray events are initiated by lightning leader activity and are produced near the last stage of lightning leader channel development prior to the lightning return stroke

Longitudinal study of urban malaria in a cohort of Ugandan children: description of study site, census and recruitment

BACKGROUND: Studies of malaria in well-defined cohorts offer important data about the epidemiology of this complex disease, but few have been done in urban African populations. To generate a sampling frame for a longitudinal study of malaria incidence and treatment in Kampala, Uganda, a census, mapping and survey project was conducted. METHODS: All households in a geographically defined area were enumerated and mapped. Probability sampling was used to recruit a representative sample of children and collect baseline descriptive data for future longitudinal studies. RESULTS: 16,172 residents living in 4931 households in a densely-populated community (18,824 persons/km(2)) were enumerated. A total of 582 households were approached with at least one child less than 10 years of age in order to recruit 601 children living in 322 households. At enrollment, 19% were parasitaemic, 24% were anaemic, 43% used bednets, and 6% used insecticide-treated nets. Low G6PD activity (OR = 0.33, P = 0.009) and bednet use (OR = 0.64, P = 0.045) were associated with a decreased risk of parasitaemia. Increasing age (OR = 0.62 for each year, P < 0.001) and bednet use (OR = 0.58, P = 0.02) were associated with a decreased risk of anaemia CONCLUSION: Detailed surveys of target populations in urban Africa can provide valuable descriptive data and provide a sampling frame for recruitment of representative cohorts for longitudinal studies. Plans to use a multi-disciplinary approach to improve the understanding of the distribution and determinants of malaria incidence and response to therapy in this population are discussed

Incidence of Malaria and Efficacy of Combination Antimalarial Therapies over 4 Years in an Urban Cohort of Ugandan Children

Combination therapies are now recommended to treat uncomplicated malaria. We used a longitudinal design to assess the incidence of malaria and compare the efficacies of 3 combination regimens in Kampala, Uganda.Children aged 1-10 years were enrolled from randomly selected households in 2004-05 and 2007, and were followed at least monthly through 2008. Insecticide-treated bednets (ITNs) were provided in 2006. Children were randomized upon their first episode, and then treated for all episodes of uncomplicated malaria with amodiaquine/sulfadoxine-pyrimethamine (AQ/SP), artesunate/amodiaquine (AS/AQ), or artemether/lumefantrine (AL). Risks of parasitological failure were determined for each episode of uncomplicated malaria and clinical parameters were followed. A total of 690 children experienced 1464 episodes of malaria. 96% of these episodes were uncomplicated malaria and treated with study drugs; 94% were due to Plasmodium falciparum. The rank order of treatment efficacy was AL > AS/AQ > AQ/SP. Failure rates increased over time for AQ/SP, but not the artemisinin-based regimens. Over the 4-year course of the study the prevalence of asymptomatic parasitemia decreased from 11.8% to 1.4%, the incidence of malaria decreased from 1.55 to 0.32 per person year, and the prevalence of anemia (hemoglobin <10 gm/dL) decreased from 5.9% to 1.0%. No episodes of severe malaria (based on WHO criteria) and no deaths were seen.With ready access to combination therapies and distribution of ITNs, responses were excellent for artemisinin-containing regimens, severe malaria was not seen, and the incidence of malaria and prevalence of parasitemia and anemia decreased steadily over time.isrctn.org ISRCTN37517549

Clinical Performance of an Automated Reader in Interpreting Malaria Rapid Diagnostic Tests in Tanzania.

Parasitological confirmation of malaria is now recommended in all febrile patients by the World Health Organization (WHO) to reduce inappropriate use of anti-malarial drugs. Widespread implementation of rapid diagnostic tests (RDTs) is regarded as an effective strategy to achieve this goal. However, the quality of diagnosis provided by RDTs in remote rural dispensaries and health centres is not ideal. Feasible RDT quality control programmes in these settings are challenging. Collection of information regarding diagnostic events is also very deficient in low-resource countries. A prospective cohort of consecutive patients aged more than one year from both genders, seeking routine care for febrile episodes at dispensaries located in the Bagamoyo district of Tanzania, were enrolled into the study after signing an informed consent form. Blood samples were taken for thick blood smear (TBS) microscopic examination and malaria RDT (SD Bioline Malaria Antigen Pf/PanTM (SD RDT)). RDT results were interpreted by both visual interpretation and DekiReaderTM device. Results of visual interpretation were used for case management purposes. Microscopy was considered the "gold standard test" to assess the sensitivity and specificity of the DekiReader interpretation and to compare it to visual interpretation. In total, 1,346 febrile subjects were included in the final analysis. The SD RDT, when used in conjunction with the DekiReader and upon visual interpretation, had sensitivities of 95.3% (95% CI, 90.6-97.7) and 94.7% (95% CI, 89.8--97.3) respectively, and specificities of 94.6% (95% CI, 93.5--96.1) and 95.6% (95% CI, 94.2--96.6), respectively to gold standard. There was a high percentage of overall agreement between the two methods of interpretation. The sensitivity and specificity of the DekiReader in interpretation of SD RDTs were comparable to previous reports and showed high agreement to visual interpretation (>98%). The results of the study reflect the situation in real practice and show good performance characteristics of DekiReader on interpreting malaria RDTs in the hands of local laboratory technicians. They also suggest that a system like this could provide great benefits to the health care system. Further studies to look at ease of use by community health workers, and cost benefit of the system are warranted

Gamma Ray Flashes Produced by Lightning Observed at Ground Level by TETRA-II

In its first 2 years of operation, the ground-based Terrestrial gamma ray flash and Energetic Thunderstorm Rooftop Array(TETRA)-II array of gamma ray detectors has recorded 22 bursts of gamma rays of millisecond-scale duration associated with lightning. In this study, we present the TETRA-II observations detected at the three TETRA-II ground-level sites in Louisiana, Puerto Rico, and Panama together with the simultaneous radio frequency signals from the VAISALA Global Lightning Data set, VAISALA National Lightning Detection Network, Earth Networks Total Lightning Network, and World Wide Lightning Location Network. The relative timing between the gamma ray events and the lightning activity is a key parameter for understanding the production mechanism(s) of the bursts. The gamma ray time profiles and their correlation with radio sferics suggest that the gamma ray events are initiated by lightning leader activity and are produced near the last stage of lightning leader channel development prior to the lightning return stroke.Comment: 10 pages, 9 figure

Time To Move from Presumptive Malaria Treatment to Laboratory-Confirmed Diagnosis and Treatment in African Children with Fever

Background to the debate: Current guidelines recommend that all fever episodes in African children be treated presumptively with antimalarial drugs. But declining malarial transmission in parts of sub-Saharan Africa, declining proportions of fevers due to malaria, and the availability of rapid diagnostic tests mean it may be time for this policy to change. This debate examines whether enough evidence exists to support abandoning presumptive treatment and whether African health systems have the capacity to support a shift toward laboratory-confirmed rather than presumptive diagnosis and treatment of malaria in children under five

Accuracy of Xpert Ultra in the diagnosis of pulmonary tuberculosis among children in Uganda: a sub-study from the SHINE trial

Background: Childhood tuberculosis presents significant diagnostic challenges associated with paucibacillary disease, and requires a more sensitive test. We evaluated the diagnostic accuracy of XpertMTB/Rif Ultra (Ultra) compared to other microbiological tests using respiratory samples from Ugandan children in the SHINE trial.Design/Methods: SHINE is a randomized trial evaluating shorter treatment in 1204 children with minimal TB disease in Africa/India. Among 352 samples and one cervical lymph node fine needle aspirate, one sample was randomly selected per patient and tested with Xpert MTB/Rif (Xpert), Lowenstein Jensen (LJ) and liquid (MGIT) cultures. We selected only uncontaminated stored sample pellet for Ultra testing. We estimated sensitivity of Xpert and Ultra against culture and a composite microbiological reference standard (any positive result).Results: Of 398 children, 353 (89%) had culture, Xpert and Ultra results. Median age was 2.8-years (IQR 1.3-5.3); 8.5% (30/353) HIV-infected, 54.4% (192/353) male. 31/353 (9%) were positive by LJ and/or MGIT; 36 (10%) by Ultra and 16 (5%) by Xpert. Sensitivities were (%; 95% CI), 58% (39-65% (18/31)) for Ultra and 45% (27-64% (14/31)) for Xpert against any culture-positive, with false-positives of <1% and 5.5% for Xpert and Ultra. Against a composite microbiological reference, sensitives were 72% (58-84% (36/50) for Ultra, and 32% (20-47% (16/50)) for Xpert. However, there were 17 samples that are positive only on Ultra (majority trace).Conclusions: Among children screened for minimal TB in Uganda, Ultra has higher sensitivity than Xpert. This represents an important advance for a condition which has posed a diagnostic challenge for decades