Randomized controlled trial of artesunate or artemether in Vietnamese adults with severe falciparum malaria

<p>Abstract</p> <p>Background</p> <p>Both artemether and artesunate have been shown to be superior to quinine for the treatment of severe falciparum malaria in Southeast Asian adults, although the magnitude of the superiority has been greater for artesunate than artemether. These two artemisinin derivatives had not been compared in a randomized trial.</p> <p>Methods</p> <p>A randomized double blind trial in 370 adults with severe falciparum malaria; 186 received intramuscular artesunate (2.4 mg/kg immediately followed by 1.2 mg/kg at 12 hours then 24 hours then daily) and 184 received intramuscular artemether (3.6 mg per kilogram immediately followed by 1.8 mg per kilogram daily) was conducted in Viet Nam. Both drugs were given for a minimum of 72 hours.</p> <p>Results</p> <p>There were 13 deaths in the artesunate group (7 percent) and 24 in the artemether group (13 percent); P = 0.052; relative risk of death in the patients given artesunate, 0.54; (95 percent confidence interval 0.28-1.02). Parasitaemia declined more rapidly in the artesunate group. Both drugs were very well tolerated.</p> <p>Conclusions</p> <p>Intramuscular artesunate may be superior to intramuscular artemether for the treatment of severe malaria in adults.</p

Combination Antifungal Therapy for Cryptococcal Meningitis

Background Combination antifungal therapy (amphotericin B deoxycholate and flucytosine) is the recommended treatment for cryptococcal meningitis but has not been shown to reduce mortality, as compared with amphotericin B alone. We performed a randomized, controlled trial to determine whether combining flucytosine or high-dose fluconazole with high-dose amphotericin B improved survival at 14 and 70 days. Methods We conducted a randomized, three-group, open-label trial of induction therapy for cryptococcal meningitis in patients with human immunodeficiency virus infection. All patients received amphotericin B at a dose of 1 mg per kilogram of body weight per day; patients in group 1 were treated for 4 weeks, and those in groups 2 and 3 for 2 weeks. Patients in group 2 concurrently received flucytosine at a dose of 100 mg per kilogram per day for 2 weeks, and those in group 3 concurrently received fluconazole at a dose of 400 mg twice daily for 2 weeks. Results A total of 299 patients were enrolled. Fewer deaths occurred by days 14 and 70 among patients receiving amphotericin B and flucytosine than among those receiving amphotericin B alone (15 vs. 25 deaths by day 14; hazard ratio, 0.57; 95% confidence interval [CI], 0.30 to 1.08; unadjusted P=0.08; and 30 vs. 44 deaths by day 70; hazard ratio, 0.61; 95% CI, 0.39 to 0.97; unadjusted P=0.04). Combination therapy with fluconazole had no significant effect on survival, as compared with monotherapy (hazard ratio for death by 14 days, 0.78; 95% CI, 0.44 to 1.41; P=0.42; hazard ratio for death by 70 days, 0.71; 95% CI, 0.45 to 1.11; P=0.13). Amphotericin B plus flucytosine was associated with significantly increased rates of yeast clearance from cerebrospinal fluid (−0.42 log10 colony-forming units [CFU] per milliliter per day vs. −0.31 and −0.32 log10 CFU per milliliter per day in groups 1 and 3, respectively; P<0.001 for both comparisons). Rates of adverse events were similar in all groups, although neutropenia was more frequent in patients receiving a combination therapy. Conclusions Amphotericin B plus flucytosine, as compared with amphotericin B alone, is associated with improved survival among patients with cryptococcal meningitis. A survival benefit of amphotericin B plus fluconazole was not found

Advanced cotton fibers exhibit efficient photocatalytic self-cleaning and antimicrobial activity

Functional cotton fibers have a wide range of applications in domestic, commercial, and military settings, and so enhancing the properties of these materials can yield substantial benefits. Herein, we report the creation of functional fibers that are self-cleaning, anti-microbial, and protective against UV radiation. A uniform, and high surface area films of TiO2 were deposited on cotton fibers and gold/silver nanoparticles were directly incorporated on the nanostructured TiO2 surface. The synthetic method is simple and the produced TiO2 film is homogenous and the nanoparticles were shown to be effectively distributed on the surface using a simple photocatalytic reduction method. The Ag/Au-TiO2 coated fibers was morphologically characterized using atomic force microscopy (AFM) and scanning electron microscopy/energy dispersive X-ray spectroscopy (SEM/EDS), and the self-cleaning properties of noble metal nanoparticle/TiO2 coated fibers were demonstrated by repeated staining followed by exposure to simulated solar light. The 1 mM Ag-TiO2 coated fabric was observed to have the largest improvement in rate of stain extinction compared to the untreated fibers with a methylene blue stain, and the 1 mM Au-TiO2 coated fibers were observed to have the largest improvement versus untreated fibers when stained with Congo red. The fibers maintained consistent photocatalytic activity over multiple cycles, and the resistance of the Ag/Au-TiO2 coated cotton to degradation was verified using Fourier transform infrared spectroscopy (FTIR). An efficient anti-microbial activity of the fibers was confirmed by exposure of the fibers to bacterial culture (Escherichia Coli) and direct observation of antimicrobial activity

Women’s involvement in coffee agroforestry value-chains: Financial training, Village Savings and Loans Associations, and Decision power in Northwest Vietnam

Globally, in the coffee sector and smallholder agriculture in developing countries, there is a distinct gender gap in key factors that enable women’s active participation in and contribution to the coffee value chain and in farm and domestic decisions, such as decisions over credit, agricultural inputs, and training opportunities and division of labor and time. This study assesses Village Savings and Loans Associations (VSLA) impacts and related training on gender equality and women’s access to coffee markets in an ongoing coffee- project in northwest Vietnam. All 169 women in this survey received gender equality and finance training, with one group being members of a VSLA and taking out small loans. With Women’s Empowerment in Agriculture Index (WEAI), women rated their perception of their decision-making power over a range of 18 tasks related to household and agricultural responsibilities and use of income and social activities over 18 months. There were significant improvements in decision-making power in categories with previously low participation and increased sharing of domestic responsibilities. The categories with the biggest gains were decision-making over large purchases and use of income, especially for VSLA-members who sought out market information before engaging with potential coffee buyers and enhanced their negotiating abilities to arrange more favorable outcomes successfully. These results indicate that active gender and finance training translated to real changes in gender dynamics, and membership of a VSLA also helped women improve their financial literacy and improve their negotiating abilities. Husbands to women in the study also began to reconsider gender roles and shift towards equal sharing of responsibility and decision- making with their wives. Based on this study, we recommend (1) implementing gender and finance training and enabling access to loans for women as a means for their inclusion in agriculture value chains, and (2) engaging the whole household in gender training in order for all family members to be receptive to adjustments in the gender division of responsibility, labor and decision-making. The results indicate the conditions under which women can benefit from activities involving agroforestry systems that also enhance carbon sequestration for climate change mitigation compared to coffee monoculture

Sex recognition by odour and variation in the uropygial gland secretion in starlings

1. Although a growing body of evidence supports that olfaction based on chemical compounds emitted by birds may play a role in individual recognition, the possible role of chemical cues in sexual selection of birds has been only preliminarily studied.2. We investigated for the first time whether a passerine bird, the spotless starling Sturnus unicolor, was able to discriminate the sex of conspecifics by using olfactory cues and whether the size and secretion composition of the uropygial gland convey information on sex, age and reproductive status in this species.3. We performed a blind choice experiment during mating, and we found that starlings were able to discriminate the sex of conspecifics by using chemical cues alone. Both male and female starlings preferred male scents. Furthermore, the analysis of the chemical composition of the uropygial gland secretion by using gas chromatography–mass spectrometry (GC–MS) revealed differences between sexes, ages and reproductive status.4. In conclusion, our study reveals for first time that a passerine species can discriminate the sex of conspecifics by relying on chemical cues and suggests that the uropygial gland secretion may potentially function as a chemical signal used in mate choice and/or intrasexual competition in this species.This research was funded by the Spanish Ministry of Education and Science ⁄ FEDER (CGL2008-00718) and PIE 200930I029 to J. M. Avilés and D. Parejo.The study was conducted under licence of the Junta de Andalucía GC–MS analyses were performed by Dr. Rafael Núñez at the Scientific Instrumentation Service (EEZ, CSIC) (Granada, Spain).Peer reviewe

Trypan Blue Dye Enters Viable Cells Incubated with the Pore-Forming Toxin HlyII of Bacillus cereus

Trypan blue is a dye that has been widely used for selective staining of dead tissues or cells. Here, we show that the pore-forming toxin HlyII of Bacillus cereus allows trypan blue staining of macrophage cells, despite the cells remaining viable and metabolically active. These findings suggest that the dye enters viable cells through the pores. To our knowledge, this is the first demonstration that trypan blue may enter viable cells. Consequently, the use of trypan blue staining as a marker of vital status should be interpreted with caution. The blue coloration does not necessarily indicate cell lysis, but may rather indicate pore formation in the cell membranes and more generally increased membrane permeability