Prototype positive control wells for malaria rapid diagnostic tests: Prospective evaluation of implementation among health workers in Lao People's Democratic Republic and Uganda

Rapid diagnostic tests (RDTs) are widely used for malaria diagnosis, but lack of quality control at point of care restricts trust in test results. Prototype positive control wells (PCW) containing recombinant malaria antigens have been developed to identify poor-quality RDT lots. This study assessed community and facility health workers' (HW) ability to use PCWs to detect degraded RDTs, the impact of PCW availability on RDT use and prescribing, and preferred strategies for implementation in Lao People's Democratic Republic (Laos) and Uganda. A total of 557 HWs participated in Laos (267) and Uganda (290). After training, most (88% to ≥ 99%) participants correctly performed the six key individual PCW steps; performance was generally maintained during the 6-month study period. Nearly all (97%) reported a correct action based on PCW use at routine work sites. In Uganda, where data for 127,775 individual patients were available, PCW introduction in health facilities was followed by a decrease in antimalarial prescribing for RDT-negative patients ≥ 5 years of age (4.7–1.9%); among community-based HWs, the decrease was 12.2% (P < 0.05) for all patients. Qualitative data revealed PCWs as a way to confirm RDT quality and restore confidence in RDT results. HWs in malaria-endemic areas are able to use prototype PCWs for quality control of malaria RDTs. PCW availability can improve HWs' confidence in RDT results, and benefit malaria diagnostic programs. Lessons learned from this study may be valuable for introduction of other point-of-care diagnostic and quality-control tools. Future work should evaluate longer term impacts of PCWs on patient management

The Situation of PCDD/Fs and Dioxin-like PCBs after the Flooding of River Elbe and Mulde in 2002

Following the Elbe and Mulde flooding in August 2002 a series of research and monitoring programmes were conducted to assess the contamination of the flooded areas with PCDD/Fs and related compounds and to identify related threats to the food chain. The present paper reports an overview of PCDD/F and dioxin-like PCB results obtained for soil samples from the floodplains and behind broken dikes, river sediments and feedstuff produced on the floodplains, and some products from animals fed with feedstuffs grown on the contaminated floodplains. The highest contamination levels in soil were found in periodically flooded pastureland riverside of the dikes. PCDD/Fs in most samples from pasture land exceeded the German threshold of 5 pg/g I-TEQ. Maximum concentrations in soil were up to 2100 pg/g I-TEQ. PCDD/Fs in agricultural soils, usually not flooded except during 2002, did not exceed the threshold of 40 pg/g. Maximum concentrations in soil were below 10 pg/g I-TEQ. PCDD/Fs in playgrounds and sporting areas did not exceed the threshold of 100 pg/g I-TEQ in soil, maximum concentrations were around 25 pg/g I-TEQ. Dioxin-like PCBs were of minor importance for the WHO-TEQ in soil and sediment but dominate the WHO-TEQ in Elbe fish. Monitoring, The soils behind broken dikes only affected by the 2002 flood were only marginally contaminated with PCDD/Fs. In contrast, most soils from the pasture lands riverside of the dikes, continuously affected by periodic flooding, revealed high contamination levels. This demonstrates that the 2002 flooding had only minor impact on the contamination of soils The downstream concentration profile of Elbe sediments and alluvial soils identifies the Germany rivers Mulde and Saale as important input sources. The related congener distribution suggests input from former metallurgic processing (magnesium) in the Mulde and Saale catchment. The downstream contamination profile in the sediments showed one order of magnitude lower PCDD/F levels and the peak contamination was located about 200 km further upstream when compared to the floodplains. Analytical surveys on feedstuffs cultivated on the contaminated floodplains did not reveal significant soil-grass transfer of PCDD/Fs, which indicates a low mobility of the PCDD/Fs present in the floodplains. However, co-ingestion of soil by grazing animals gave a clear signal of contaminant uptake and demonstrates the necessity of a careful agri-management of the floodplains of Elbe and Mulde.JRC.H.5-Rural, water and ecosystem resource

Clinical and etiological heterogeneity in patients with tracheo-esophageal malformations and associated anomalies

Esophageal Atresia (EA) is a severe developmental defect of the foregut that presents with or without a Tracheo-Esophageal Fistula (TEF). The prevalence of EA/TEF over time and around the world has been relatively stable. EA/TEF is manifested in a broad spectrum of anomalies: in some patients it manifests as an isolated atresia or fistula, but in over half it affects several organ systems. While the associated malformations are often those of the VACTERL spectrum (Vertebral, Anorectal, Cardiac, Tracheo-Esophageal, Renal and Limb), many patients are affected by other malformations, such as microcephaly, micrognathia, pyloric stenosis, duodenal atresia, a single umbilical artery, and anomalies of the genitourinary, respiratory and gastrointestinal systems. Though EA/TEF is a genetically heterogeneous condition, recurrent genes and loci are sometimes affected. Tracheo-Esophageal (TE) defects are in fact a variable feature in several known single gene disorders and in patients with specific recurrent Copy Number Variations and structural chromosomal aberrations. At present, a causal genetic aberration can be identified in 11e12% of patients. In most, EA/TEF is a sporadic finding; the familial recurrence rate is low (1%). As this suggests that epigenetic and environmental factors also contribute to the disease, non-syndromic EA/TEF is generally believed to be a multifactorial condition. Several population-based studies and case reports describe a wide range of associated risks, including age, diabetes, drug use, herbicides, smoking and fetal alcohol exposure. The phenotypical and genetic heterogeneity seen in EA/TEF patients indicates not one underlying cause, but several. Unraveling the complex multifactorial and heterogeneous etiology of EA/TEF and associated features will require large cohorts of patients. Combined statistical analysis of component findings, genome sequencing, and genome wide association studies will elucidate new causal genetic defects and predisposing loci in the etiology within specific sub-populations. Improved knowledge of environmental risk factors, genetic predisposition and causal genetic syndromes may improve prediction and parental counseling, and prevent co-morbidity. (C) 2014 Elsevier Masson SAS. All rights reserved