Paracheck-pf® Test Versus Microscopy in the Diagnosis of Falciparum Malaria in Arbaminch Zuria Woreda of South Ethiopia

Background

Malaria is a major cause of morbidity and mortality in Ethiopia. Rapid diagnostic tests such as Paracheck Pf are the major tools for falciparum malaria diagnosis as an alternative to microscopy in peripheral health facilities. The objective of this study was to evaluate the sensitivity and specificity of Paracheck Pf against microscopy for diagnosis of P.falciparum infection and observe the persistence of the antigen for an elongated period.

Methods

Cross sectional study was undertaken in Arbaminch Zuria at Shele health center from October 2008 to January 2009. Paracheck-Pf versus microscopy comparison was done in conjunction with an artemisinin-based combination therapy efficacy monitoring for a period of 28 days. Standard microscopic procedures were done by experienced laboratory technicians and paracheck-Pf was performed in accordance with the manufacturer''s instruction.

Results

out of 1293 examined blood films, 400(31%) were found to be malaria positive. Considering microscopy as the gold standard, paracheck-pf showed sensitivity of 94.1 %( 95%CI: 89.9–98.3%) and specificity of 80.0% (95%CI: 67.6–92.4%). The positive and negative predictive values were 93.3 %( 95%CI: 88.8–97.8%) and 82.1% (95%CI: 70–94.1%), respectively. Comparing microscopy results 98.7 % (79/80), 60% (48/80), 48.1% (37/77), and 44.6 %( 33/74) were also found to be positive by paracheck-pf at days7, 14, 21, and 28, respectively.

Conclusion

Paracheck Pf® has a comparable diagnostic performance in detecting P. falciparum infections through the persistence of frequent false positivity is a limitation. Thus, this diagnostic test is not appropriate for monitoring of treatment effect.     

Polysomnographic and clinical correlates of behaviorally observed daytime sleep in nursing home residents

BACKGROUND: The causes of daytime sleepiness among nursing home residents have not been well recognized. This study examines clinical and polysomnographic factors that are associated with daytime sleepiness among nursing home residents. METHODS: One hundred seventy-four nursing home residents from eight nursing homes in Atlanta, Georgia, participated in the study. Demographic and clinical data were obtained from medical records and assessment of participants obtained by trained research staff. Daytime sleepiness was determined by behavioral sleep-wake observation performed every 15 minutes. Overnight polysomnography was performed in a subgroup of the sample. RESULTS: The mean +/- standard deviation age was 83.4 +/- 8.8 years, and 136 participants were women (78%). The mean percentage +/- standard deviation of behavioral observations with sleep (BOS%) was 19.5 +/- 13.3%. Participants who were able to ambulate independently had significantly lower BOS% (14.2 +/- 9.6 vs 21.2 +/- 6.0, p =.001). Mini-Mental State Examination score was negatively correlated with BOS% (rho = -.279, p =.001). Among 48 participants who had polysomnography, sleep latency, total sleep time, wake after sleep onset, and sleep efficiency were not associated with BOS%. There was a significant negative correlation between BOS% and percentage of time spent in rapid eye movement sleep (rho = -.367, p =.010). Linear regression analyses, with BOS% as the dependent variable, showed that percentage of time spent in rapid eye movement sleep was the only variable independently predicting BOS%. CONCLUSION: Absence of association between BOS% and nocturnal sleep suggests that the causes of daytime sleepiness and nocturnal sleep problems may not be related. This finding may have important implications for interventions that aim to reduce daytime sleepiness among nursing home residents.     

Malaria in pregnancy: clinical features and outcome of treatment

Over two consecutive malaria seasons in 1987 and 1988, 37 patients were admitted to the Gonder College Hospital with malaria in pregnancy. In 10 patients the diagnosis was missed initially and delayed for up to 72 hours after admission. The differential diagnoses considered on first line included incomplete abortion, labour, postpartum haemorrhage, and fulminant hepatitis in pregnancy. Twelve patients (32.4%) died, five of these died undelivered. Fifteen pregnancies (40.5%) ended up in abortion, preterm delivery with early neonatal death and still birth. This study has shown that malaria in pregnancy can have different clinical manifestations that may mislead the physician. This may delay the diagnosis and initiation of treatment which may have a fatal outcome for both the mother and the baby.     

Risk factors for active trachoma in children and trichiasis in adults: a household survey in Amhara Regional State, Ethiopia

Identification of risk factors is essential for planning and implementing effective trachoma control programmes. We aimed to investigate risk factors for active trachoma and trichiasis in Amhara Regional State, Ethiopia. A survey was undertaken and eligible participants (children aged 1-9 years and adults aged 15 years and above) examined for trachoma. Risk factors were assessed through interviews and observations. Using ordinal logistic regression, associations between signs of active trachoma in children and potential risk factors were explored. Associations between trichiasis in adults and potential risk factors were investigated using conventional logistic regression. A total of 5427 children from 2845 households and 9098 adults from 4039 households were included in the analysis. Ocular discharge [odds ratio (OR)=5.9; 95% CI 4.8-7.2], nasal discharge (OR=1.6; 95% CI 1.3-1.9), thatch roof in household (OR=1.3; 95% CI 1.0-1.5), no electricity in household (OR=2.4; 95% CI 1.3-4.3) and increasing altitude (Ptrend<0.001) were independently associated with severity of active trachoma. Trichiasis was associated with increasing age (ORper 5 year increase=1.5; 95% CI 1.4-1.7), female gender (OR=4.5; 95% CI 3.5-5.8), increasing prevalence of active trachoma in children (Ptrend=0.003) and increasing altitude (Ptrend=0.015).     

C-reactive protein (CRP) promoter polymorphisms influence circulating CRP levels in a genome-wide association study of African Americans

C-reactive protein (CRP) is an acute phase reactant protein produced primarily by the liver. Circulating CRP levels are influenced by genetic and non-genetic factors, including infection and obesity. Genome-wide association studies (GWAS) provide an unbiased approach towards identifying loci influencing CRP levels. None of the six GWAS for CRP levels has been conducted in an African ancestry population. The present study aims to: (i) identify genetic variants that influence serum CRP in African Americans (AA) using a genome-wide association approach and replicate these findings in West Africans (WA), (ii) assess transferability of major signals for CRP reported in European ancestry populations (EA) to AA and (iii) use the weak linkage disequilibrium (LD) structure characteristic of African ancestry populations to fine-map the previously reported CRP locus. The discovery cohort comprised 837 unrelated AA, with the replication of significant single-nucleotide polymorphisms (SNPs) assessed in 486 WA. The association analysis was conducted with 2 366 856 genotyped and imputed SNPs under an additive genetic model with adjustment for appropriate covariates. Genome-wide and replication significances were set at P < 5 × 10(-8) and P < 0.05, respectively. Ten SNPs in?(CRP pseudogene-1) CRPP1 and CRP genes were associated with serum CRP (P = 2.4 × 10(-09) to 4.3 × 10(-11)). All but one of the top-scoring SNPs associated with CRP in AA were successfully replicated in WA. CRP signals previously identified in EA samples were transferable to AAs, and we were able to fine-map this signal, reducing the region of interest from the 25 kb of LD around the locus in the HapMap CEU sample to only 8 kb in our AA sample.