Urinary cytokines in <i>Schistosoma haematobium</i>-infected schoolchildren from Tana Delta District of Kenya

BACKGROUND: Pathological changes due to infection with Schistosoma haematobium include cytokine-mediated urinary tract inflammation. The involved cytokines may be excreted in urine and their presence in urine may therefore reflect S. haematobium-related urinary tract pathology. The present study, for the first time, reports on the relationship between selected cytokines in urine and infection with S. haematobium in children from an area highly affected by this parasite. METHODS: Children aged 5–12 years from two primary schools in Tana Delta District of Kenya were examined for S. haematobium eggs using urine filtration technique, for haematuria using dipstix and for eosinophil cationic protein (ECP), IL-6, IFN- γ, TNF-α and IL-10 levels using ELISA, and for S. haematobium-related urinary tract pathology using ultrasonography. In addition, venous blood was examined for serum IL-6, IFN- γ, TNF-α and IL-10 levels using ELISA. RESULTS: There was no significant correlation between urinary and serum levels of IL-6, IFN- γ, TNF-α or IL-10. There was no significant difference in geometric mean intensity (GMI) in any of the serum cytokines, or in urinary TNF-α or IFN-γ, between children with light and heavy S. haematobium infections. However, children with heavy S. haematobium infections had significantly higher GMI of urinary IL-6 (p < 0.001) and lower GMI of urinary IL-10 (p = 0.002) than children with light infections. There was also a significant positive correlation between urinary IL-6 and urinary ECP (p < 0.001) and a significant negative correlation between urinary IL-10 and urinary ECP (p = 0.012). CONCLUSION: Urinary IL-6 was positively correlated to and IL-10 was negatively correlated to infection intensity and urinary tract inflammation in S. haematobium-infected children. Urinary IL-6 and IL-10 ELISA may be a useful non-invasive tool to complement the already available tools for studying S. haematobium-related urinary tract pathology in children. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/1471-2334-14-501) contains supplementary material, which is available to authorized users

The role of group work in teaching general practice specialty registrars

With the onset of the new assessment procedures and regulations requiring GP trainees to have one general practice-based educational supervisor throughout their training programme, there are fears that course organisers and trainers will spend an increasing amount of time conducting assessments and appraisals, and less time teaching trainees, to the detriment of their learning. The new GP curriculum is explicit about the areas in which GP trainees should be proficient. The Learning and Teaching Guide emphasises the importance of reflecting on experience as part of the learning process, and comments on the importance of group work in providing peer support, the shaping of attitudes and preparation for assessments. This paper forms a review of the effectiveness of facilitated group work and its role in delivering the new curriculum in a way that complements, supports and is integrated with the teaching that trainers provide and self-directed learning sets. The teaching of the curriculum for general practice within three years is only possible because of the structured teaching that exists within its training programmes, and removal of group work would reduce the time that the GP trainees have for reflective learning by up to a third as well as removing the peer aspect of their learning. Facilitators have an important role to play in maximising the benefits of group work by concentrating on maintaining its safety for the participants and its focus. The use of group work does not replace the teaching of evidence-based medicine or in-house teaching: it enhances and encourages it. However, a better understanding of the role of each would enhance the whole