History of malaria treatment as a predictor of subsequent subclinical parasitaemia: A cross-sectional survey and malaria case records from three villages in Pailin, western Cambodia

Background: Treatment of the sub-clinical reservoir of malaria, which may maintain transmission, could be an important component of elimination strategies. The reliable detection of asymptomatic infections with low levels of parasitaemia requires high-volume quantitative polymerase chain reaction (uPCR), which is impractical to conduct on a large scale. It is unknown to what extent sub-clinical parasitaemias originate from recent or older clinical episodes. This study explored the association between clinical history of malaria and subsequent sub-clinical parasitaemia. Methods: In June 2013 a cross-sectional survey was conducted in three villages in Pailin, western Cambodia. Demographic and epidemiological data and blood samples were collected. Blood was tested for malaria by high-volume qP

Optimising Strategies for Plasmodium falciparum Malaria Elimination in Cambodia: Primaquine, Mass Drug Administration and Artemisinin Resistance

Malaria elimination requires a variety of approaches individually optimized for different transmission settings. A recent field study in an area of low seasonal transmission in South West Cambodia demonstrated dramatic reductions in malaria parasite prevalence following both mass drug administration (MDA) and high treatment coverage of symptomatic patients with artemisinin-piperaquine plus primaquine. This study employed multiple combined strategies and it was unclear what contribution each made to the reductions in malaria.A mathematical model fitted to the trial results was used to assess the effects of the various components of these interventions, design optimal elimination strategies, and explore their interactions with artemisinin resistance, which has recently been discovered in Western Cambodia. The modelling indicated that most of the initial reduction of P. falciparum malaria resulted from MDA with artemisinin-piperaquine. The subsequent continued decline and near elimination resulted mainly from high coverage with artemisinin-piperaquine treatment. Both these strategies were more effective with the addition of primaquine. MDA with artemisinin combination therapy (ACT) increased the proportion of artemisinin resistant infections, although much less than treatment of symptomatic cases with ACT, and this increase was slowed by adding primaquine. Artemisinin resistance reduced the effectiveness of interventions using ACT when the prevalence of resistance was very high. The main results were robust to assumptions about primaquine action, and immunity.The key messages of these modelling results for policy makers were: high coverage with ACT treatment can produce a long-term reduction in malaria whereas the impact of MDA is generally only short-term; primaquine enhances the effect of ACT in eliminating malaria and reduces the increase in proportion of artemisinin resistant infections; parasite prevalence is a better surveillance measure for elimination programmes than numbers of symptomatic cases; combinations of interventions are most effective and sustained efforts are crucial for successful elimination

Effects of Ethanol and NAP on Cerebellar Expression of the Neural Cell Adhesion Molecule L1

The neural cell adhesion molecule L1 is critical for brain development and plays a role in learning and memory in the adult. Ethanol inhibits L1-mediated cell adhesion and neurite outgrowth in cerebellar granule neurons (CGNs), and these actions might underlie the cerebellar dysmorphology of fetal alcohol spectrum disorders. The peptide NAP potently blocks ethanol inhibition of L1 adhesion and prevents ethanol teratogenesis. We used quantitative RT-PCR and Western blotting of extracts of cerebellar slices, CGNs, and astrocytes from postnatal day 7 (PD7) rats to investigate whether ethanol and NAP act in part by regulating the expression of L1. Treatment of cerebellar slices with 20 mM ethanol, 10−12 M NAP, or both for 4 hours, 24 hours, and 10 days did not significantly affect L1 mRNA and protein levels. Similar treatment for 4 or 24 hours did not regulate L1 expression in primary cultures of CGNs and astrocytes, the predominant cerebellar cell types. Because ethanol also damages the adult cerebellum, we studied the effects of chronic ethanol exposure in adult rats. One year of binge drinking did not alter L1 gene and protein expression in extracts from whole cerebellum. Thus, ethanol does not alter L1 expression in the developing or adult cerebellum; more likely, ethanol disrupts L1 function by modifying its conformation and signaling. Likewise, NAP antagonizes the actions of ethanol without altering L1 expression

GENERAL CHARACTERISTICS OF PATIENTS WITH SHOULDER PROBLEMS

Amaç: Omuz ekleminden ve özellikle de eklem çevresindeki yumuşak dokulardan kökenalan problemler üst ekstremite ağrılarının en önemli nedenini oluşturur. Çalışmamızın amacıomuz ağrısı yakınması ile başvuran hastaların klinik özelliklerinin değerlendirilmesidir.Gereç ve yöntem: Omuz ağrısı yakınması ile başvuran 709 hastanın 744 omuzuretrospektif olarak değerlendirildi.Bulgular: Hastaların yaş ortalaması 55,16  10,88 yıl idi ve 395 hastada sağ, 279 hastadasol ve 35 hastada her iki omuz etkilenmişti. Vakaların %35,4'ünde travma öyküsü mevcuttu.Klinik ve radyolojik olarak yapılan değerlendirmelerde hastaların %45'inde subakromiyalsıkışma sendromu, %39,4'ünde rotator kaf rüptürü, %1,5'inde bisipital tendinit, %6,5'indeakromioklavikuler eklem dejenerasyonu, %2,2'sinde kalsifik tendinit, %5'inde donuk omuzve %0,4'ünde glenohumeral eklem artrozu saptandı. Subakromiyal sıkışma sendromu olanhastalar ile rotator kaf rüptürü olan hastaların karşılaştırılmasında rüptürü olan hastalarınyaş ortalamalarının daha yüksek ve "American Shoulder Elbow Score" (ASES) skorlarınındaha düşük olduğu ancak "Constant" skorları arasında herhangi bir fark olmadığı görüldü.Bu iki grup etiolojideki travma açısından değerlendirildiğinde rotator kaf rüptürü olan gruptatravma öyküsünün subakromiyal sıkışma sendromlu hastalara göre anlamlı olarak dahafazla olduğu ve travma öyküsünün rotator kafta rüptür riskini 2,9 kat arttırdığı görüldü.Sonuç: Omuz ağrısı nedenleri arasında rotator kaf sorunları çok önemli bir yer tutmaktadır.Travma ve yaş rotator kafta rüptür insidansını arttırmaktadır.Objective: Problems originating from the shoulder joint and periarticular soft tissues arethe most important causes of upper limb pain. The aim of this study was to investigate theclinical charactersitic patients.Material and method: Seven hundred forty-four shoulders 709 patients wereretrospectively studied.Results: The mean age of the patients was 55.16  10.88 years. Right shoulder wasinvolved in 395 patients, left in 279, and both shoulders in 35 patients. Thirty-five percenthad a history of trauma. According to clinical and radiological assessments, 45 % of patientswere diagnosed as subacromial impingement syndrome, 39.4 % roator cuff tears, 1.5 %bicipital tendinitis, 6.5 % degeneration of the acromioclavicular joint, 2.2 % calcific tendinitis,5 % frozen shoulder, and 0.4 % osteoarthritis of the glenohumeral joint. When the patientswith subacromial impingement syndrome were compared with the patients with rotator cuff tears, the mean age of the patients with rotator cuff tears was significantly higher andAmerican Shoulder Elbow Scores (ASES) were lower than the patients with subacromialimpingement syndrome. There were no significant differences between the Constant scores.Significantly more patients with rotator cuff tears had a history of trauma than patients withsubacromial impingement syndrome, and trauma increased the risk of rotator cuff tears 2.9times.Conclusion: Rotator cuff problems is one of the most common causes of shoulder painand functional limitations. Trauma and age are risk factors for rotator cuff rupture

History of malaria treatment as a predictor of subsequent subclinical parasitaemia: a cross-sectional survey and malaria case records from three villages in Pailin, western Cambodia

Background Treatment of the sub-clinical reservoir of malaria, which may maintain transmission, could be an important component of elimination strategies. The reliable detection of asymptomatic infections with low levels of parasitaemia requires high-volume quantitative polymerase chain reaction (uPCR), which is impractical to conduct on a large scale. It is unknown to what extent sub-clinical parasitaemias originate from recent or older clinical episodes. This study explored the association between clinical history of malaria and subsequent sub-clinical parasitaemia. Methods In June 2013 a cross-sectional survey was conducted in three villages in Pailin, western Cambodia. Demographic and epidemiological data and blood samples were collected. Blood was tested for malaria by high-volume qPCR. Positive samples were analysed by nested PCR to determine the Plasmodium species. To identify previous episodes of malaria, case records were collected from village malaria workers and local health facilities and linked to study participants. Results Among 1343 participants, 40/122 (32.8 %) with a history of clinical malaria were parasitaemic during the cross-sectional survey, compared to 172/1221 (14.1 %) without this history (p Conclusions A clinical episode of vivax malaria was associated with subsequent sub-clinical parasitaemia. Treatment of P. vivax with artemisinin-based combination therapy without primaquine often resulted in recurrent episodes. Targeting individuals with a history of clinical malaria will be insufficient to eliminate the sub-clinical reservoir as they constitute a minority of parasitaemias.</p

Insecticide-treated bednets for the prevention of Plasmodium falciparum malaria in Cambodia: a cluster-randomized trial.

OBJECTIVES: To validate and quantify the impact of insecticide-treated bednets (ITN) on malaria morbidity and mortality in Cambodia. METHODS: A paired, cluster-randomized trial of ITN was conducted in Rattanakiri, North East Cambodia. Thirty-four villages with a total population of 10,726 were randomized to receive deltamethrin-impregnated bednets or to control (no net provision). Cross-sectional surveys measured Plasmodium falciparum prevalence at baseline and 10 months after ITN distribution. Village malaria volunteers in control and intervention villages treated dipstick-positive P. falciparum cases with artesunate and mefloquine. The resulting passive surveillance data were used as an estimate of the incidence of clinical P. falciparum infections. RESULTS: There was a protective efficacy of 28% in P. falciparum incidence (adjusted rate ratio 0.72, 95% CI 0.47-1.08) and 9% in P. falciparum prevalence (adjusted prevalence ratio 0.91, 95% CI 0.65-1.28) in ITN relative to control villages; however, neither of these estimates reached statistical significance. Individual-level analysis indicated a greater reduction in P. falciparum prevalence among under 5-year-olds (adjusted OR = 0.63, 95% CI 0.26-1.53) compared to older individuals (interaction P = 0.042). The protective efficacy of 35% (95% CI -28, 67%) with respect to clinical P. falciparum incidence in under 5-year-olds was more pronounced than the corresponding estimates for prevalence but was again not significant. CONCLUSIONS: Lack of statistical significance in the results is likely to be due to a lack of power. The analysis provides further evidence for ITN effectiveness in South East Asia, particularly among individuals under 5 years of age