Inter-observer variation in the assessment of clinical signs in sick Tanzanian children

We assessed the inter-observer agreement in identification of a range of 24 clinical signs associated with disease presentation in 327 children aged 0·41) although there was only fair agreement (Kappa-score 0·21-0·40) in the detection of neck stiffness and chest indrawing and slight agreement in the detection of dehydration (Kappa-score 0·199). All objective neurological signs were less reliably assessed in infants than in older children. The difficulties surrounding the diagnosis of impaired consciousness in young children should increase vigilance in the diagnosis and management of neurological complications of illnesses in infanc

Conformal Mappings and Dispersionless Toda hierarchy

Let $\mathfrak{D}$ be the space consists of pairs $(f,g)$, where $f$ is a univalent function on the unit disc with $f(0)=0$, $g$ is a univalent function on the exterior of the unit disc with $g(\infty)=\infty$ and $f'(0)g'(\infty)=1$. In this article, we define the time variables $t_n, n\in \Z$, on $\mathfrak{D}$ which are holomorphic with respect to the natural complex structure on $\mathfrak{D}$ and can serve as local complex coordinates for $\mathfrak{D}$. We show that the evolutions of the pair $(f,g)$ with respect to these time coordinates are governed by the dispersionless Toda hierarchy flows. An explicit tau function is constructed for the dispersionless Toda hierarchy. By restricting $\mathfrak{D}$ to the subspace $\Sigma$ consists of pairs where $f(w)=1/\bar{g(1/\bar{w})}$, we obtain the integrable hierarchy of conformal mappings considered by Wiegmann and Zabrodin \cite{WZ}. Since every $C^1$ homeomorphism $\gamma$ of the unit circle corresponds uniquely to an element $(f,g)$ of $\mathfrak{D}$ under the conformal welding $\gamma=g^{-1}\circ f$, the space $\text{Homeo}_{C}(S^1)$ can be naturally identified as a subspace of $\mathfrak{D}$ characterized by $f(S^1)=g(S^1)$. We show that we can naturally define complexified vector fields \pa_n, n\in \Z on $\text{Homeo}_{C}(S^1)$ so that the evolutions of $(f,g)$ on $\text{Homeo}_{C}(S^1)$ with respect to \pa_n satisfy the dispersionless Toda hierarchy. Finally, we show that there is a similar integrable structure for the Riemann mappings $(f^{-1}, g^{-1})$. Moreover, in the latter case, the time variables are Fourier coefficients of $\gamma$ and $1/\gamma^{-1}$.Comment: 23 pages. This is to replace the previous preprint arXiv:0808.072

The incidence of clinical malaria detected by active case detection in children in Ifakara, southern Tanzania

Between July 2000 and June 2001, we used weekly active case detection (ACD) of clinical malaria episodes in 618 children aged <5 years to describe the epidemiology of malaria in Ifakara, southern Tanzania. Plasmodium falciparum-positive blood slides prepared from children with axillary temperature ⩾ 37.5°C were used to define clinical malaria and a rolling cross-sectional survey documented the prevalences of parasitaemia and anaemia. A random subsample of children was visited daily for 1 month at the end of the study to assess the effect of more frequent visits on estimated incidence rates. Only 50 (8%) children had 1 or more episodes of clinical malaria during the year, an overall incidence of 0.275 episodes/100 child-weeks-at-risk, with no age dependence. The maximum parasite prevalence of 25% was reached in children aged 4 years. The incidence of illness was significantly lower in children visited daily than in those visited weekly., suggesting a marked effect of frequent visits on estimated incidence rates. We conclude that the age pattern of malaria detected through ACD is a more robust epidemiological indicator than absolute incidence rate estimates and that, in contrast to the surrounding area, Ifakara town is subject to only moderate perennial malaria transmissio

Plasmodium species mixed infections in two areas of Manhiça District, Mozambique

We compared the distribution patterns of individual Plasmodium species and mixed-species infections in two geographically close endemic areas, but showing environmental differences. Comparisons concerned circulating Plasmodium infections in both human and mosquito vector populations in the dry and wet seasons, at a micro-epidemiological level (households). Both areas revealed a very high overall prevalence of infection, all year-round and in all age groups. Plasmodium falciparum was the predominant species, being found in the vast majority of infected individuals regardless of the presence of other species. Plasmodium malariae and Plasmodium ovale occurred almost exclusively in mixed infections. Seasonal variation in P. malariae prevalence was observed in one area but not in the other. A decrease in P. malariae prevalence concurred with a marked increase of P. falciparum prevalence. However this was strongly dependent on age and when analysing infections at the individual level, a different pattern between co-infecting species was unveiled. Regarding transmission patterns, in both areas, P. falciparum gametocytes predominated in single infections regardless of age and P. malariae gametocyte carriage increased when its overall prevalence decreased

The response to iron supplementation of pregnant women with the haemoglobin genotype AA or AS

The influence of haemoglobin genotype on the response to iron supplementation was studied in a randomized, double blind, placebo-controlled trial involving 497 multigravid pregnant women from a rural area of The Gambia. Women were randomly allocated to receive either oral iron (60mg elemental iron per day) or placebo. At 36 weeks of pregnancy, women who had received oral iron during pregnancy had higher mean haemoglobin, packed cell volume, plasma iron and ferritin levels than did women who received placebo. Iron supplementation of pregnant women with the AA haemoglobin genotype also resulted in increases in the packed cell volume (PCV) and haemoglobin level measured after delivery, and in the birth weight of the infant. However, in AS women PCV and haemoglobin level at delivery were lower in the supplemented group and supplementation was also associated with reduced birth weights. In malaria endemic areas, pregnant women with the haemoglobin genotype AS may not benefit from iron supplementation during pregnanc

Caracterización de parámetros reproductivos y endocrinos en una población de conejas ibicencas

El conejo ibicenco o conill pagès d’Eivissa es una población originaria de esta isla que actualmente presenta un escaso número de efectivos, ya que está siendo desplazada por otras razas con mayores rendimientos productivos. La conservación de este tipo de poblaciones precisa de la creación de bancos de germoplasma, con lo que es necesario establecer primeramente sus características reproductivas. Por ello, el objetivo del presente trabajo ha sido caracterizar algunos parámetros reproductivos de hembras ibicencas y compararlos con el cruce comercial de California x Neozelandés blanco, que es el habitualmente utilizado en cunicultura para producción. La fertilidad obtenida fue similar en ambos grupos, siendo de un 76,8% y de un 81,3% para las conejas híbridas e ibicencas, respectivamente. La prolificidad, el peso de la camada a 21 días de vida, la producción de leche, el número de gazapos destetados, el peso de la camada al destete y su ganancia media diaria fue superior en los cruces comerciales que en la población ibicenca, presentando ésta última una mayor duración de la gestación y un mayor peso individual al destete. Los ibicencos tardaron un par de días más en alcanzar el peso de sacrificio que los híbridos comerciales, puesto que su ganancia media diaria fue menor y el índice de conversión fue siempre superior, salvo en la última semana que disminuyó y se equiparó al de los híbridos. Respecto a los parámetros endocrinos, tanto las concentraciones de LH como las de progesterona post-ovulación fueron superiores para las hembras híbridas comerciales. finalmente, los datos de caracterización de la respuesta ovárica muestran que las hembras de cruce comercial presentaron un mayor número de folículos preovulatorios y de oocitos por ovario, así como un mayor número de cuerpos lúteos y embriones recuperados, que presentaron además una mayor velocidad de desarrollo embrionario, que las ibicencas. Por tanto, se ha comprobado experimentalmente que el conejo ibicenco, al ser una especie rústica, no seleccionada, presenta características reproductivas menos mejoradas que las de los cruces comerciales, si bien sigue siendo importante su conservación desde el punto de vista del mantenimiento de la biodiversidad genética

Intracellular trafficking and replication of Burkholderia cenocepacia in human cystic fibrosis airway epithelial cells

We investigated the trafficking of Burkholderia cenocepacia , an opportunistic respiratory pathogen of persons with cystic fibrosis (CF), in immortalized CF airway epithelial cells in vitro . Our results indicate that bacteria enter cells in a process involving actin rearrangement. Whereas both live and heat-killed bacteria reside transiently in early endosomes, only live bacteria escape from late endosomes to colocalize in vesicles positive for lysosomal membrane marker LAMP1, endoplasmic reticulum (ER) membrane marker calnexin, and autophagosome marker monodansylcadavarine (MDC). Twenty-four hours after infection, microcolonies of live bacteria were observed in the perinuclear area colocalizing with calnexin. In contrast, after ingestion, dead bacteria colocalized with late endosome marker Rab7, and lysosome markers LAMP1 and cathepsin D, but not with calnexin or MDC. Six to eight hours after ingestion of dead bacteria, degraded bacterial particles were observed in the cytoplasm and in vesicles positive for cathepsin D. These results indicate that live B. cenocepacia gain entry into human CF airway cells by endocytosis, escape from late endosomes to enter autophagosomes that fail to fuse with mature lysosomes, and undergo replication in the ER. This survival and replication strategy may contribute to the capacity of B. cenocepacia to persist in the lungs of infected CF patients.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75744/1/j.1462-5822.2006.00724.x.pd

Frequent Premature Atrial Contractions Are Associated With Poorer Cognitive Function in the Atherosclerosis Risk in Communities (ARIC) Study

Objective: To evaluate the association of premature atrial contraction (PAC) frequency with cognitive test scores and prevalence of dementia or mild cognitive impairment (MCI). Materials and Methods: We conducted a cross-sectional analysis using Atherosclerosis Risk in Communities study visit 6 (January 1, 2016, through December 31, 2017) data. We included 2163 participants without atrial fibrillation (AF) (age mean ± SD, 79±4 years; 1273 (58.9%) female; and 604 (27.97.0% Black) who underwent cognitive testing and wore a leadless, ambulatory electrocardiogram monitor for 14 days. We categorized PAC frequency based on the percent of beats: less than 1%, minimal; 1% to <5%, occasional; greater than or equal to 5%, frequent. We derived cognitive domain-specific factor scores (memory, executive function, language, and global z-score). Dementia and MCI were adjudicated. Results: During a mean analyzable time of 12.6±2.6 days, 339 (15.7%) had occasional PACs and 107 (4.9%) had frequent PACs. Individuals with frequent PACs (vs minimal) had lower executive function factor scores by 0.30 (95% CI, -0.46 to -0.14) and lower global factor scores by 0.20 (95% CI, -0.33 to -0.07) after multivariable adjustment. Individuals with frequent PACs (vs minimal) had higher odds of prevalent dementia or MCI after multivariable adjustment (odds ratio, 1.74; 95% CI, 1.09 to 2.79). These associations were unchanged with additional adjustment for stroke. Conclusion: In community-dwelling older adults without AF, frequent PACs were cross-sectionally associated with lower executive and global cognitive function and greater prevalence of dementia or MCI, independently of stroke. Our findings lend support to the notion that atrial cardiomyopathy may be a driver of AF-related outcomes. Further research to confirm these associations prospectively and to elucidate underlying mechanisms is warranted

Prevalence and characteristics of subclinical atrial fibrillation in a community-dwelling elderly population: The ARIC study

Background: The prevalence of subclinical atrial fibrillation (AF) in the elderly general population is unclear. We sought to define the prevalence of subclinical AF in a community-based elderly population and to characterize subclinical AF and the incremental diagnostic yield of 4 versus 2 weeks of continuous ECG monitoring. Methods: We conducted a cross-sectional analysis within the community-based multicenter observational ARIC study (Atherosclerosis Risk in Communities) using visit 6 (2016-2017) data. The 2616 ARIC study participants who wore a leadless, ambulatory ECG monitor (Zio XT Patch) for up to 2 weeks were aged 79±5 years, 42% men, and 26% black. In a subset, 386 participants without clinically recognized AF wore the monitor twice, each time for up to 2 weeks. We characterized the prevalence of subclinical AF (ie, AF detected on the Zio XT Patch without clinically recognized AF) over 2 weeks of monitoring and the diagnostic yield of 4 versus 2 weeks of monitoring. Results: The prevalence of subclinical AF was 2.5%; the prevalence of subclinical AF was 3.3% among white men, 2.5% among white women, 2.1% among black men, and 1.6% among black women. Subclinical AF was mostly intermittent (75%). Among those with intermittent subclinical AF, 91% had AF burden ≤10% during the monitoring period. In a subset of 386 participants without clinical AF, 78% more subclinical AF was detected by 4 weeks versus 2 weeks of ECG monitoring. Conclusions: In our study, the prevalence of subclinical AF was lower than previously reported and monitoring beyond 2 weeks provided substantial incremental diagnostic yield. Future studies should focus on individuals with higher risk to increase diagnostic yield and consider continuous monitoring duration longer than 2 weeks