Increasing prevalence of wildtypes in the dihydrofolate reductase gene of Plasmodium falciparum in an area with high levels of sulfadoxine/pyrimethamine resistance after introduction of treated bed nets

In Magoda and Mpapayu villages in Tanzania, we have previously found comparable high prevalence of Plasmodium falciparum resistance to sulfadoxine/pyrimethamine (S/P) in vivo and of mutations in the dihydrofolate reductase (dhfr) and dihydropteroate synthetase (dhps) genes of P. falciparum responsible for resistance to S/P. In December 1998, Magoda received insecticide-treated nets (ITNs), whereas ITNs were introduced in Mpapayu in March 2001. We have studied the effect of ITNs on P. falciparum resistance genes by monitoring the prevalence of dhfr and dhps genotypes in children less than five years old living in the villages from 1998 to 2000. In 2000, after two years of bed net use, the prevalence of wild types in codon 51, 59, and 108 of dhfr increased significantly in Magoda compared with previous years. Furthermore, the prevalence of dhfr wild types was significantly higher in Magoda than in Mpapayu in 2000. The impact of ITNs on the transmission intensity seems not only to affect the overall malaria morbidity, but may even facilitate restoration of susceptibility to antimalarial drugs.     

High reinfection rate and treatment failures in children treated with amodiaquine for falciparum malaria in Muheza villages, Northeastern Tanzania

In May 2003, we studied amodiaquine (AQ) efficacy in children < 5 years of age with uncomplicated falciparum malaria in Magoda and Mpapayu (with insecticide treated nets [ITNs]) and Mgome (without ITNs) in Muheza, Tanzania. The trial involved 28 days of follow-up, and data were adjusted by polymerase chain reaction (PCR) genotyping of msp1 and msp2 genes. Additionally, Pfcrt codon 72-76 polymorphisms were studied by PCR and sequence-specific oligonucleotide probe (SSOP) ELISA. In 54 cases with complete follow-up, a significant difference in late treatment failure (LTF) rates was seen (60.7% in ITN versus 88.5% in non-ITN villages, P = 0.02) before PCR correction. However, after PCR correction, 23 cases (60.5%) were confirmed as reinfections, giving a true LTF rate of 21.4% (6/28) and 34.6% (9/26) in the above settings, respectively. Frequency of Pfcrt CVIET haplotype mutation pretreatment was high (97.0%); the remaining samples were CVMNK. We conclude that AQ alone is no longer effective in the study area.     

The Pilates method: history and philosophy

Until the mid-1980s the Pilates Method of exercise was little known outside the world of dance but has grown in popularity rapidly in the last decade: coming out of obscurity. Pilates method is much more than a list of exercises. It is a way of connecting and conditioning the whole being-body and mind. This article traces its history in context and examines the initial principles of the method, with the beginnings of modern developments.     

Management of cervical cancer in pregnancy

Carcinoma of the cervix is the most common gynecologic cancer found during pregnancy. Management and treatment of this condition depend on cancer stage, estimated gestational age, and ethical, religious, and personal desires. Review of the medical literature in English from 1965 to 1998 is presented with recommendations for management.     

徐凤纳甲法的实验研究--电针阳经开穴的效应差异

以正常在校大学生为实验对象 ,按徐凤纳甲法的 10日开穴按时取穴 ,在相同条件下观察了电针阳经开穴对心收缩时间间期 (STI)的效应差异。结果发现 ,按时电针后 ,六条阳经的开穴对STI各指标的影响均有所不同。其中大肠经组开穴的PEPI电针前后差值间的差异有着显著意义 (P <0 0 5 ) ,三焦经组开穴的LVETI电针前后差值间的差别有着显著意义 (P <0 0 5 )。本实验结果表明 ,按照徐凤纳甲法的 10日开穴按时取穴电针 ,各阳经开穴的电针效应之间有着一定的差异性。     

Increased incidence of pre-diabetes mellitus at a department of rheumatology: a retrospective study

We aimed to retrospectively review the incidence of pre-diabetes mellitus (preDM), one of the factors in metabolic syndrome screening, in patients with rheumatic diseases. We examined the levels of hemoglobin A1c (HbA1c) in a total of 498 patients with rheumatic diseases between April 2007 and March 2008 at the Department of Rheumatology in Nagasaki University Hospital. Of the 498 patients, 409 (82.1%) had HbA1c levels higher than 5.6% (National Glycohemoglobin Standardization Program; NGSP) and were recommended for health guidance with a focus on metabolic syndrome. Serum HbA1c levels higher than 6.0%, a possible indicator of DM, were seen in 227 patients (45.6%). Serum HbA1c levels higher than 6.5%, which constitute a high risk for DM, were found in 115 patients (23.1%). PreDM increased gradually with age. Our results suggest that the incidence of preDM may be higher in patients with rheumatic diseases than in patients with other diseases and that these patients should receive healthcare guidance to prevent metabolic syndrome.     

Acquisition of antibodies to merozoite surface protein 3 among residents of Korogwe, north eastern Tanzania

Background

Scrub typhus is a mite-borne bacterial infection of humans caused by Orientia tsutsugamushi that causes a generalized vasculitis that may involve the tissues of any organ system. The aim of this study was to identify factors associated to severe complications from scrub typhus.

Methods

We conducted this prospective, case-control study on scrub typhus patients who presented to the Department of Internal Medicine at Chosun University Hospital between September, 2004 and December, 2006. Cases were 89 scrub typhus patients with severe complications and controls were 119 scrub typhus patients without severe complications.

Results

There were significant differences in the absence of eschar, white blood cell (WBC) counts, hemoglobin, albumin, serum creatinine, fibrinogen, C-reactive protein (CRP), and active partial thromboplastin time (aPTT) between the two groups. Multivariate analysis demonstrated that only the following four factors were significantly associated with the severe complications of scrub typhus: (1) age ≥ 60 years (odd ratio [OR] = 3.13, P = 0.002, confidence interval [CI] = 1.53-6.41), (2) the absence of eschar (OR = 6.62, P = 0.03, CI = 1.22-35.8, (3) WBC counts > 10, 000/mm3 (OR = 3.6, P = 0.001, CI = 1.65-7.89), and (4) albumin ≤ 3.0 g/dL (OR = 5.01, P = 0.004, CI = 1.69-14.86).

Conclusions

Our results suggest that clinicians should be aware of the potential for complications, when scrub typhus patients are older (≥ 60 years), presents without eschar, or laboratory findings such as WBC counts > 10, 000/mm3, and serum albumin level ≤ 3.0 g/dL. Close observation and intensive care for scrub typhus patients with the potential for complications may prevent serious complications with subsequent reduction in its mortality rate.     

中医科专病专护的做法与成效

为顺应护理学科的飞速发展,提高专科护理质量,本文在深入开展整体护理,培养护理人员高素质的同时,开展专病专护工作.在实施具有中医特色的、以中西医结合的护理方法对本科专治的7个特殊病种进行分类实施;并制定了一系列有效的护理措施,在临床实践中取得了初步成效.