Malaria infection among pregnant women attending antenatal clinics in six Rwandan districts

OBJECTIVES: The aim of the study was to assess the knowledge, attitude and practices of pregnant women towards malaria and their association with malaria morbidity. METHODS: Cross-sectional malaria survey of 1432 pregnant women attending six health centres, each of them situated in a specific health district in Rwanda from September to October 2002. RESULTS: The overall prevalence of malaria infection was 13.6% and all infections but two were caused by Plasmodium falciparum. The six health districts were significantly different in terms of malaria prevalence, which varied between 11.5% and 15.4% in four and was <5% in the other two districts. The prevalence of anaemia and splenomegaly mirrored that of malaria infection. In three districts, the prevalence of infection was significantly higher in primigravidae than in secundigravidae and multigravidae (P = 0.01), while in two others it did not vary with parity. Bed net use was low - only 13.1% of the women had at least one bed net at home and 8.3% of them slept under it - and significantly different between districts. Most women knew that malaria might have serious consequences for their pregnancy and that insecticide-treated bed nets are useful for malaria prevention. However, the bed net market price [1525 Rwandan Francs (RFr), approximately 1.6] was much higher than that considered as affordable and acceptable (389 RFr, approximately 0.3). CONCLUSION: Malaria in pregnancy is a major problem in Rwanda, even in the districts of low transmission. Bed net use among pregnant women is low. The option of providing free insecticide-treated bed nets to pregnant women should be explored and possibly implemented; it could rapidly increase bed net use and earlier attendance to antenatal clinics with clear benefits for the women's health.     

Mortality Probability Model (MPM II0–72) bei Patienten einer kardiologischen Intensivstation

Zusammenfassung Fragestellung Die Diskriminierungsf?higkeit bezüglich überleben und Versterben sowie die Kalibrierung der Mortalit?tsprognose durch das Mortality Probability Model (MPM II) sollte in dieser prospektiven Studie bei Patienten einer kardiologischen Intensivstation evaluiert werden. Methode Alle konsekutiven Patienten der kardiologischen Intensivstation mit einer Liegedauer >12 Stunden wurden zwischen 12/97 und 2/98 in diese prospektive Studie eingeschlossen (Ausschluss: Wiederaufnahmen). MPM II wurde bei Aufnahme (MPM II₀), nach 24 (MPM II₂₄), 48 (MPM II₄₈) und 72 Stunden (MPM II₇₂) erhoben. SAPS II wurde nach 24 Stunden bestimmt. Die Wahrscheinlichkeit der Krankenhausmortalit?t (Pr) für die jeweiligen Modelle wurde berechnet. Die Fl?che unter der Receiver Operating Characteristic (AUC) Kurve diente zur Analyse der Diskriminierungsf?higkeit. Die Kalibrierung der Modelle wurden anhand der standardisierten Mortalit?tsratio (SMR) und dem Goodness of fit (GOF) Test untersucht. Ergebnisse 303 Patienten (62,4±12,6 Jahre, 71,3% M?nner) wurden eingeschlossen. Die Intensivmortalit?t betrug 8,3%, die Krankenhausmortalit?t 14,5%. Die mittlere Liegedauer auf der Intensivstation lag bei 3,7 Tage (1–36 Tage), die mittlere Krankenhausliegedauer bei 15,2 Tage (1–79). Pr war in beiden Modellen für nicht überlebende Patienten signifikant h?her. AUC (±SD): SAPS II 0,77±0,05, MPM II₀ 0,77±0,04, MPM II₂₄ 0,72±0,05, MPM II₄₈ 0,85±0,05 und MPM II₇₂ 0,78±0,06. Die SMR für SAPS II betrug 1,25 (0,91–1,69), für MPM II₀ 1,37 (0,99–1,84), MPM II₂₄ 1,32 (0,89–1,87), MPM II₄₈ 1,07 (0,69–1,58) und für MPM II₇₂ 1,19 (0,74–1,82). Der GOF-C-Test zeigte einen signifikanten Unterschied zwischen vorhergesagter und beobachteter Mortalit?t für den MPM II₀ (χ²=39,44 [p<0,001, df=9]), der GOF H Test für den MPM II₇₂ (χ²=15,35 [p=0,01, df=6]). Diagnose- und Alterskategorien sowie Aufnahmemodus wiesen ebenfalls variable SMRs auf. Schlussfolgerung Die Mortalit?tsvorhersage durch das MPM-II-Modell war zufriedenstellend. Die SMR zeigte jedoch eine statistisch nicht signifikante Untersch?tzung der Mortalit?t. Die Abweichung der vorhergesagten von der beobachteten Mortalit?t trat v.a. in den h?heren Risikostrata auf. Eine unterschiedliche Patientenselektion („case mix”) und divergente Vorbehandlungen der Patienten („lead time”) beeinflussen die Performance von MPM II_0–72. Daher scheint eine Anpassung des Vorhersagemodells an die Zielpopulation („customization”) erforderlich zu sein. Eingegangen: 12. M?rz 2001 Akzeptiert: 5. April 2001     

Determining viability of fresh or cryopreserved homograft valves at implantation

Summary Studies of homograft valves in the past two decades have suggested that viable valves, i.e., those maintaining chemical and structural integrity of their leaflet intercellular matrix, have a better long-term function than nonviable valves. The most effective qualitative methods of assessing leaflet viability involve destruction of the valve leaflets; thus, these methods have been limited to random use in selected valves. A study was conducted in swine in an attempt to establish a control tissue which could be tested in place of the homograft leaflets, thereby determining viability levels of every valve clinically implanted and correlating the results with long-term clinical function. Thirty samples each of the aortic and pulmonary artery wall and tricuspid leaflet were compared with aortic and pulmonary leaflets. Utilizing the technique of C¹⁴-proline uptake, viability was assessed at procurement, following sterilization, and following cryopreservation and short-term storage. The tricuspid leaflet was found to retain the same level of viability as the aortic and pulmonary leaflets before and after the cryopreservation period. It was concluded that the tricuspid leaflet could be utilized as the control tissue.     

Caerulein-induced acute pancreatitis in mice that constitutively overexpress Reg/PAP genes

Background  

The cystic fibrosis (CF) mouse pancreas has constitutively elevated expression of the Reg/PAP cell stress genes (60-fold greater Reg3α, and 10-fold greater PAP/Reg3β and Reg3γ). These genes are suggested to be involved in protection or recovery from pancreatic injury.     

Transgenic expression of β1 antibody in brain neurons impairs age-dependent amyloid deposition in APP23 mice

Heterologous expression of the functional amyloid beta (Aβ) antibody β1 in the central nervous system was engineered to maximize antibody exposure in the brain and assess the effects on Aβ production and accumulation in these conditions. A single open reading frame encoding the heavy and light chains of β1 linked by the mouth and foot virus peptide 2A was expressed in brain neurons of transgenic mice. Two of the resulting BIN66 transgenic lines were crossed with APP23 mice, which develop severe central amyloidosis. Brain concentrations at steady-state 5 times greater than those found after peripheral β1 administration were obtained. Similar brain and plasma β1 concentrations indicated robust antibody efflux from the brain. In preplaque mice, β1 formed a complex with Aβ that caused a modest Aβ increase in brain and plasma. At 11 months of age, β1 expression reduced amyloid by 97% compared with age-matched APP23 mice. Interference of β1 with β-secretase cleavage of amyloid precursor protein was relatively small. Our data suggest that severely impaired amyloid formation was primarily mediated by a complex of β1 with soluble Aβ, which might have prevented Aβ aggregation or favored transport out of the brain.     

Further specimens of the Asian tiger mosquito Aedes albopictus (Diptera, Culicidae) trapped in southwest Germany

After two previous demonstrations of introductions of the Asian tiger mosquito, Aedes albopictus, into southern Germany in 2007 and 2011, another three specimens were trapped in the city of Freiburg in the Upper Rhine Valley. The females were caught in early September 2011 (n?=?2) and mid-July 2012 (n?=?1). The trap was located at a railway container station where cargo is transferred to trains from trucks predominantly coming from southern Europe where A. albopictus is widely distributed. The reported findings confirm vehicle transport of A. albopictus to be an important and probably frequent mode of importation, and suggest that more regular and intense monitoring for invasive mosquito species in the Upper Rhine Valley should be undertaken in order to detect an establishment and implement adequate control measures in good time.     

Implementing an Innovative Cardiac Assist System in a Nonuniversity Hospital—Feasibility,Complications, and First Results

To evaluate the feasibility of implementing a cardiac assist system in a nonuniversity hospital we analyzed 18 consecutive patients treated with venoarterial membrane oxygenation. The system was used electively in 5/18 (27.8%) patients during high‐risk interventions. Thirteen patients (72.2%) were treated in emergency situations. The extracorporal system could be initiated successfully in all patients. Periprocedural complications were hemolysis in 3/18 (16.7%), disseminated intravascular coagulation in 2/18 (11.1%), cerebral ischemia in 1/18 (5.6%), and local infection in 2/18 (11.1%) patients. None of these led to a discontinuation of the therapy. All electively treated patients were successfully weaned from the extracorporeal system. In 9/13 (69.2%) emergency patients the system was removed successfully. The 60‐day survival rate of the emergency patients was 53.8% (7/13). Our experience confirms that an innovative extracorporeal circulatory support system can be implemented in a nonuniversity hospital at a tolerable risk and a low complication and high procedural success rate.