Reduced paediatric hospitalizations for malaria and febrile illness patterns following implementation of community-based malaria control programme in rural Rwanda

<p>Abstract</p> <p>Background</p> <p>Malaria control is currently receiving significant international commitment. As part of this commitment, Rwanda has undertaken a two-pronged approach to combating malaria via mass distribution of long-lasting insecticidal-treated nets and distribution of antimalarial medications by community health workers. This study attempted to measure the impact of these interventions on paediatric hospitalizations for malaria and on laboratory markers of disease severity.</p> <p>Methods</p> <p>A retrospective analysis of hospital records pre- and post-community-based malaria control interventions at a district hospital in rural Rwanda was performed. The interventions took place in August 2006 in the region served by the hospital and consisted of mass insecticide treated net distribution and community health workers antimalarial medication disbursement. The study periods consisted of the December–February high transmission seasons pre- and post-rollout. The record review examined a total of 551 paediatric admissions to identify 1) laboratory-confirmed malaria, defined by thick smear examination, 2) suspected malaria, defined as fever and symptoms consistent with malaria in the absence of an alternate cause, and 3) all-cause admissions. To define the impact of the intervention on clinical markers of malaria disease, trends in admission peripheral parasitaemia and haemoglobin were analyzed. To define accuracy of clinical diagnoses, trends in proportions of malaria admissions which were microscopy-confirmed before and after the intervention were examined. Finally, to assess overall management of febrile illnesses antibiotic use was described.</p> <p>Results</p> <p>Of the 551 total admissions, 268 (48.6%) and 437 (79.3%) were attributable to laboratory-confirmed and suspected malaria, respectively. The absolute number of admissions due to suspected malaria was smaller during the post-intervention period (N = 150) relative to the pre-intervention period (N = 287), in spite of an increase in the absolute number of hospitalizations due to other causes during the post-intervention period. The percentage of suspected malaria admissions that were laboratory-confirmed was greater during the pre-intervention period (80.4%) relative to the post-intervention period (48.1%, prevalence ratio [PR]: 1.67; 95% CI: 1.39 – 2.02; chi-squared p-value < 0.0001). Among children admitted with laboratory-confirmed malaria, the risk of high parasitaemia was higher during the pre-intervention period relative to the post-intervention period (age-adjusted PR: 1.62; 95% CI: 1.11 – 2.38; chi-squared p-value = 0.004), and the risk of severe anaemia was more than twofold greater during the pre-intervention period (age-adjusted PR: 2.47; 95% CI: 0.84 – 7.24; chi-squared p-value = 0.08). Antibiotic use was common, with 70.7% of all children with clinical malaria and 86.4% of children with slide-negative malaria receiving antibacterial therapy.</p> <p>Conclusion</p> <p>This study suggests that both admissions for malaria and laboratory markers of clinical disease among children may be rapidly reduced following community-based malaria control efforts. Additionally, this study highlights the problem of over-diagnosis and over-treatment of malaria in malaria-endemic regions, especially as malaria prevalence falls. More accurate diagnosis and management of febrile illnesses is critically needed both now and as fever aetiologies change with further reductions in malaria.</p

Myocardial production and release of MCP-1 and SDF-1 following myocardial infarction: differences between mice and man

<p>Abstract</p> <p>Background</p> <p>Stem cell homing to the heart is mediated by the release of chemo-attractant cytokines. Stromal derived factor -1 alpha (SDF-1a) and monocyte chemotactic factor 1(MCP-1) are detectable in peripheral blood after myocardial infarction (MI). It remains unknown if they are produced by, and released from, the heart in order to attract stem cells to repair the damaged myocardium.</p> <p>Methods</p> <p>Murine hearts were studied for expression of MCP-1 and SDF-1a at day 3 and day 28 following myocardial infarction to determine whether production is increased following MI. In addition, we studied the coronary artery and coronary sinus (venous) blood from patients with normal coronary arteries, stable coronary artery disease (CAD), unstable angina and MI to determine whether these cytokines are released from the heart into the systemic circulation following MI.</p> <p>Results</p> <p>Both MCP-1 and SDF-1a are constitutively produced and released by the heart. MCP-1 mRNA is upregulated following murine experimental MI, but SDF-1a is suppressed. There is less release of SDF-1a into the systemic circulation in patients with all stages of CAD including MI, mimicking the animal model. However MCP-1 release from the human heart following MI is also suppressed, which is the exact opposite of the animal model.</p> <p>Conclusions</p> <p>SDF-1a and MCP-1 release from the human heart are suppressed following MI. In the case of SDF-1a, the animal model appropriately reflects the human situation. However, for MCP-1 the animal model is the exact opposite of the human condition. Human observational studies like this one are paramount in guiding translation from experimental studies to clinical trials.</p

What Is There to Do If You Find an Old Indian Canoe? Anti-Colonialism in Maritime Archaeology

Following Max Liboiron’s claim that pollution is colonialism, the anti-colonial maritime archaeologist’s role in the Anthropocene might be to reframe research questions, so that focus is directed toward interactions between marine and maritime, and that the colonial ‘resurrectionist’ approach that has dominated nautical archaeology ought to be reconsidered altogether. This normative statement is put to the test with a 4000-year-old waterlogged dugout canoe that was illegally excavated from the Cooper River in South Carolina, USA. Upon retrieval, the affected tribal entities were brought into consultation with archaeologists and conservators to help decide how to proceed with the canoe’s remains. Tribal representatives reached a consensus to preserve the canoe with PEG and display it in a public museum. This procedure follows the resurrectionist model typical of maritime archaeology in the West, now the dominant protocol globally, where the scholar acts as savior by lifting entire wrecks from watery graves and promising to grant them immortality in utopian museum spaces. However, this immortalizing procedure is at odds with some Indigenous values, voiced by tribal representatives, which embrace life cycles and distributed agency. In the end, the desire to preserve the canoe as a perpetual symbol of intertribal unity dominated concerns surrounding the canoe’s own life, spirit, and autonomy, and that plasticizing it would permanently alter its substance and essence. We argue that the object of the canoe has become subservient to its postcolonial symbolism of Indigenous unity, resilience, and resistance. Further, by subscribing to the resurrectionist model of maritime archaeology, the immortalized canoe now bears the irony of colonial metaphor, as an unintended consequence of its preservation. We echo Audre Lorde’s famous sentiment by wondering if an anticolonial maritime archaeology can ever hope to dismantle the master’s boat using the master’s tools. The conclusions reached here have implications for other maritime and museum contexts too, including the highly publicized case of the wrecked 1859–1860 slave ship, Clotilda

What Is There to Do If You Find an Old Indian Canoe? Anti-Colonialism in Maritime Archaeology

Following Max Liboiron&rsquo;s claim that pollution is colonialism, the anti-colonial maritime archaeologist&rsquo;s role in the Anthropocene might be to reframe research questions, so that focus is directed toward interactions between marine and maritime, and that the colonial &lsquo;resurrectionist&rsquo; approach that has dominated nautical archaeology ought to be reconsidered altogether. This normative statement is put to the test with a 4000-year-old waterlogged dugout canoe that was illegally excavated from the Cooper River in South Carolina, USA. Upon retrieval, the affected tribal entities were brought into consultation with archaeologists and conservators to help decide how to proceed with the canoe&rsquo;s remains. Tribal representatives reached a consensus to preserve the canoe with PEG and display it in a public museum. This procedure follows the resurrectionist model typical of maritime archaeology in the West, now the dominant protocol globally, where the scholar acts as savior by lifting entire wrecks from watery graves and promising to grant them immortality in utopian museum spaces. However, this immortalizing procedure is at odds with some Indigenous values, voiced by tribal representatives, which embrace life cycles and distributed agency. In the end, the desire to preserve the canoe as a perpetual symbol of intertribal unity dominated concerns surrounding the canoe&rsquo;s own life, spirit, and autonomy, and that plasticizing it would permanently alter its substance and essence. We argue that the object of the canoe has become subservient to its postcolonial symbolism of Indigenous unity, resilience, and resistance. Further, by subscribing to the resurrectionist model of maritime archaeology, the immortalized canoe now bears the irony of colonial metaphor, as an unintended consequence of its preservation. We echo Audre Lorde&rsquo;s famous sentiment by wondering if an anticolonial maritime archaeology can ever hope to dismantle the master&rsquo;s boat using the master&rsquo;s tools. The conclusions reached here have implications for other maritime and museum contexts too, including the highly publicized case of the wrecked 1859&ndash;1860 slave ship, Clotilda

Leukemia Inhibitory Factor Prevents the Death of Axotomised Sensory Neurons in the Dorsal-Root Ganglia of the Neonatal Rat

Leukemia inhibitory factor (LIF) has several characteristics of a neurotrophic factor for sensory neurons. Here we have investigated whether LIF also supports the survival of axotomised sensory neurons in vivo. Newborn rat pups received a unilateral sciatic nerve transection and the injury site was treated with gelfoam soaked in phosphate buffered saline (PBS), nerve growth factor (NGF), or LIF. Neuronal nucleoli in the L5 dorsal root ganglia were counted, appropriate corrections applied, and the resultant neuronal loss expressed as a percentage of the contralateral intact side. In animals where LIF was administered neuronal loss was significantly reduced: 2 days after LIF treatment neuronal loss was 19.5% compared to 43% in PBS-treated animals; 3 days after LIF treatment neuronal loss was 20.4% compared to 40.2% in PBS-treated animals; however, 7 days after LIF treatment there was no significant reduction in the number of neurons lost. The degree of rescue of sensory neurons in vivo by LIF was found to be similar to NGF, which was not surprising as both factors supported the survival of a similar population of sensory neurons in vitro. Rescue was not observed when LIF-containing gelfoam was placed away from the axotomised nerve, suggesting that LIF's action may be associated with its retrograde transport or direct signalling at the site of nerve injury. (C) 1994 Wiley-Liss, Inc