Decreased clearance of von Willebrand factor in a patient with type 2B von Willebrand disease following development of immune thrombocytopenia

We report a case of concurrent type 2B von Willebrand disease (VWD) and immune thrombocytopenia (ITP). The patient had characteristic loss of von Willebrand factor (VWF) high molecular weight multimers (HMWM) but a normal platelet count in the initial 8 years after diagnosis of type 2B VWD. When he developed severe thrombocytopenia, however, both his VWD indices and VWF HMWM normalized. As his platelet count increased, he again lost the HMWM and his VWD indices decreased. These results suggest that the severe thrombocytopenia led to decreased clearance of VWF, especially the HMWM.     

Sleeping under Insecticide-treated Nets to Prevent Malaria in Nigeria: What Do We Know?

Malaria remains a public-health concern in Nigeria despite huge global investments in the production and distribution of insecticide-treated bednets (ITNs) to protect people from Plasmodium falciparum parasite. Information on the use of ITNs is needed for designing strategies for its effective use. Focus group discussions (FGDs) were conducted in communities from 3 geopolitical zones of Nigeria. The people had poor knowledge of malaria and mosquito bites, which resulted in wrong perception and misuse of the nets as door and window blinds to “protect entire household” since only two nets were given per household. The use of community structures (traditional leaders/village heads, youths, churches, and mosques) was suggested to ensure effective distribution of nets, sensitize, and monitor net-use in the communities. Health education would dispel misconceptions that ITNs could kill, curtail human fertility, and that local gin (Kai-Kai) would induce sleep and make one oblivious of mosquito nuisance.Key words: Insecticide-treated bednets, Malaria, Mosquito nets, Utilization, Nigeria     

Compliance with Intermittent Presumptive Treatment and Insecticide Treated Nets Use During Pregnancy in Enugu State,Nigeria

To identify key socio-demographic and knowledge factors associated with compliance with recommended use of commodities for preventing malaria in pregnancy (MIP) in Enugu State, Nigeria. Cross-sectional study of 720 women who delivered within 6 months preceding the survey in three local government areas in Enugu State was conducted using a structured questionnaire. About half (51.6 %) of the women used IPTp1 while 25.9 % took IPTp2 as recommended during their most recent pregnancy. Forty-one percent of the women slept under insecticide treat nets (ITN) during the most recent pregnancy but only 15.4 % did so as recommended every night. Socio-demographic and knowledge factors associated with compliance were identified. Compliance with intermittent presumptive treatment in pregnancy (IPTp) recommendation was more common among those in the rural setting (26.9 %) compared to the peri-urban (20.3 %) and urban (17.3 %) (P = 0.032). Those with good knowledge of the causes, effects and prevention of malaria during pregnancy complied more (23.7 %) than those with poor knowledge (17.0 %) (P = 0.020). With respect to sleeping under ITN, more of those with post secondary education, good knowledge of MIP and currently living with a partner used ITN every night during the last pregnancy. Knowledge about the MIP issues and having a partner influence compliance with relevant preventives. Efforts to increase compliance with recommended practices to prevent MIP should focus on providing health education to pregnant women and their partners, who reinforce what the women are told during antenatal care. More qualitative studies need to be conducted on this subject.     

The PATH (Prospective Antifungal Therapy) Alliance® registry and invasive fungal infections: update 2012

The Prospective Antifungal Therapy Alliance (PATH Alliance®) performed prospective surveillance of invasive fungal infections (IFIs) among patients hospitalized at 25 medical centers in North America between 2004 and 2008, collecting information on the epidemiology, diagnosis, treatment, and mortality rates of IFIs. In total, 7526 IFIs were identified in 6845 patients. Candida spp. (73.4%) were the most common pathogens, followed by Aspergillus spp. (13.3%), and other yeasts (6.2%). Culture was the most frequently used diagnostic test in the majority of IFI categories. Most patients with invasive candidiasis were treated with fluconazole (48.3%) and the echinocandins (34.0%), while voriconazole (45.5%) was the main antifungal agent for invasive aspergillosis. The 12-week survival rate ranged from 37.5% for hematopoietic stem cell transplant recipients to ~ 75.0% for those with HIV/AIDS. In summary, the findings of the PATH Alliance® registry provide a better understanding of the epidemiology of a vast variety and large numbers of IFIs.     

Characteristics of Nigerian women taking sulfadoxine/pyrimethamine twice during pregnancy for the prevention of malaria

Objective

To investigate the characteristics of women in Nigeria who are likely to take sulfadoxine/pyrimethamine (SP) as recommended for the prevention of malaria in pregnancy to reduce maternal and child mortality rates.

Methods

A cross-sectional survey of 1380 women was conducted using a structured questionnaire. The women had given birth within 6 months prior to the survey and were drawn from 6 local government areas in Nigeria.

Results

Several demographic factors—older age bracket, ever attended school, currently living with a partner, ever married, and wealth—were significantly associated with compliance. Compliance was higher among respondents who had ever been married than among those who had never been married (χ² = 6.733; P = 0.006). Compliance was also higher among those in paid employment (χ² = 17.110; P < 0.001) and those in a higher wealth quintile (χ² = 34.861; P < 0.001). Knowledge of malaria, which included prevention of malaria in pregnancy through use of IPTp with 2 doses of SP, showed a positive association with compliance. Compliance with 2 doses of SP among those with good knowledge was higher (63.9%) than among those with poor knowledge (46.9%) (χ² = 26.981; P < 0.001).

Conclusion

The present findings could help in targeting health education programs to specific subgroups of women to increase compliance with the recommended 2 doses of SP for the prevention of malaria in pregnancy.