Assessing the efficacy of chloroquine and sulfadoxine-pyrimethamine for treatment of uncomplicated Plasmodium falciparum malaria in the Democratic Republic of Congo

We evaluated the in vivo responses to chloroquine (CQ), the first line antimalarial, and to sulfadoxine-pyrimethamine (SP), the most readily available and affordable alternative treatment, in children under 5 with acute uncomplicated Plasmodium falciparum malaria in seven sites of Democratic Republic of Congo (DRC) between May 2000 and November 2001, using the standard 14-day WHO protocol. In the CQ group, the overall treatment failure rate was 45.4% (95% CI: 40.1-50.8) of 350 infections successfully tested; in the SP group it was 7.5% (95% CI: 5.0-11.0) of 333 infections. Of 191 patients who had an adequate clinical response (ACR) in the CQ group, 127 (66.5%; range: 62.5-71.4) still had parasitaemia on day 14. In the SP group, only 21 (6.8%; range: 2.2-12.8) of 308 patients with an ACR were still parasitaemic on day 14. Using pooled data from three rural sites, haematological recovery was better in the SP group (mean of haematocrit difference between days 14 and 0 among anaemic children: 4.7 vs. 3.2; P < 0.01, Wilcoxon test). These findings suggest that CQ is no longer effective in DRC and that SP may be a good alternative for its replacement as first line antimalarial treatment. The Ministry of Health (MOH) therefore now recommends SP as the first line antimalarial drug in DRC, as an interim step, 18 months after launching the first study. Additional studies are needed to select alternative therapies that might replace SP or improve its efficacy, should it prove ineffective in the future.     

Anti-HIV antibodies in the CSF of AIDS patients: a serological and immunoblotting study.

CSF and serum samples from 16 AIDS patients were tested for the presence of anti-HIV antibodies either by classical serological methods or by an immunoblot technique based on agarose gel isoelectric focusing and transfer of the specific IgG antibodies onto HIV antigens-loaded nitrocellulose sheets. This method enabled the demonstration of an intrathecal synthesis of anti-HIV oligoclonal IgG antibodies, often superimposed on diffuse polyclonal production, in 14 patients. The two negative cases were devoid of neurological signs or symptoms. However, two patients classified in stage II of the disease (asymptomatic infection) displayed an intrathecal synthesis of anti-HIV antibodies.     

Studies on the characterisation of the cause of leucoreduction failures, with particular reference to extra gatal events.

The causes of leucodepletion failure are multifactoral and can be related to haematological variability in blood donors or donation, defective filters, poor specimen handling or ageing, and/or the presence of non-adhering leucocyte/platelets. Since refiltering removes all types of leucocytes, including the populations appearing as extra gated events, we have developed a practical method for refiltering the failed leucodepleted components on standard filters and back-flushing the second filter to assess the nature of the WBC sub-population. In practice, recovered leucocytes from red cell filters and whole blood mainly consist of neutrophils. Those from platelet and plasma filters were mainly lymphocyte with considerable differences depending on the type of leucodepletion process. Atypical leucocytes are often seen in some pre-/post-cellular leucofiltered components. These appear characteristically as small WBC with a lower affinity for filter matrix, or as cell fragment, pinched leucocyte or apoptotic cells. Different reagents in use show variable sensitivity in identifying these extra gatal events. Storage of leucodepleted samples also induces different types of abnormality in leucocyte dot plot. A useful practical approach for characterisation of the nature of leucocyte sub-populations causing failure in leucodepleted components is provided.     

Mumps complications and effects of mumps vaccination, England and Wales, 2002-2006

We analyzed data from hospital admissions and enhanced mumps surveillance to assess mumps complications during the largest mumps outbreak in England and Wales, 2004-2005, and their association with mumps vaccination. When compared with nonoutbreak periods, the outbreak was associated with a clear increase in hospitalized patients with orchitis, meningitis, and pancreatitis. Routine mumps surveillance and hospital data showed that 6.1% of estimated mumps patients were hospitalized, 4.4% had orchitis, 0.35% meningitis, and 0.33% pancreatitis. Enhanced surveillance data showed 2.9% of mumps patients were hospitalized, 6.1% had orchitis, 0.3% had meningitis, and 0.25% had pancreatitis. Risk was reduced for hospitalization (odds ratio [OR] 0.54, 95% confidence interval [CI] 0.43-0.68), mumps orchitis (OR 0.72, 95% CI 0.56-0.93) and mumps meningitis (OR 0.28, 95% CI 0.14-0.56) when patient had received 1 dose of measles, mumps, and rubella vaccine. The protective effect of vaccination on disease severity is critical in assessing the total effects of current and future mumps control strategies.     

Oral Fluid Testing during 10 Years of Rubella Elimination, England and Wales

Surveillance of rubella in England and Wales has included immunoglobulin M testing of oral (crevicular) fluid from reported case-patients since 1994. The need for laboratory confirmation to monitor rubella elimination is emphasized by poor sensitivity (51%, 95% confidence interval 48.9%–54.0%) and specificity (55%, 95% confidence interval 53.7%–55.6%) of the clinical case definition. During 1999–2008, oral fluid from 11,709 (84%) of 13,952 reported case-patients was tested; 143 (1.0%) cases were confirmed and 11,566 (99%) were discarded (annual investigation and discard rate of clinically suspected rubella cases was 2,208/100,000 population). Incidence of confirmed rubella increased from 0.50 to 0.77/1 million population when oral fluid testing was included. Oral fluid tests confirmed that cases were more likely to be in older, unvaccinated men. Testing of oral fluid has improved ascertainment of confirmed rubella in children and men and provided additional information for assessing UK progress toward the World Health Organization elimination goal.     

Effects of dietary zinc deprivation on zinc concentration and ratio of apo/holo-activities of angiotensin converting enzyme in serum of mice

Objective

The aim of the present study was to evaluate the effects of dietary zinc deprivation on zinc concentration, the activity of angiotensin converting enzyme (ACE) and ratio of apo/holo-activities of ACE (ACE ratio) in the serum of mice.

Methods

Twenty-two male mice were deprived of dietary zinc for up to 9 days. Zinc concentration in the serum was measured by means of atomic absorption spectrometry. Also, the activity of ACE in the serum was measured by HPLC as the activity of holo-ACE. After addition of zinc to the serum in vitro, the increase of ACE activity over the initial value was determined as that of apo-ACE. Finally, the ratio of apo/holo-ACE activities was calculated.

Results

There was a significant decrease of zinc concentration, but a slight decrease of the activity of ACE in the serum of mice by intake of zinc-deficient diet for 9 days. ACE ratio tended to increase on day 5 and was significantly increased on day 9 in mice deprived of dietary zinc.

Conclusion

These findings suggest that ACE ratio is as sensitive as serum zinc concentration for the evaluation of zinc deficiency and can be used for the biochemical diagnosis of zinc nutritional status in patients with zinc deficiency-induced taste impairment.     

Zinc deficiency in patients with idiopathic taste impairment with regard to angiotensin converting enzyme activity

OBJECTIVE: The present study aimed at measuring the ratio of apo/holo activities of angiotensin converting enzyme (ACE) ratio in the serum of patients with taste impairment to evaluate their status of zinc nutrition. METHODS: Nineteen patients complaining of taste impairment were divided into two groups: zinc-deficiency taste impairment (n=6) and idiopathic taste impairment (n=13) and compared to 30 volunteers. Zinc concentrations in the serum were measured by atomic absorption spectrometry (normal values: 64-111 microg/dl). Patients with zincemia values of <63 microg/dl with no history of other disorder or medication known to cause dysgeusia were diagnosed as zinc deficient, while those with the same condition and values >64 microg/dl were considered to belong to the idiopathic group. The activities of ACE in the serum were measured spectrophotometrically as the activity of the holo-ACE, and after addition of 80 microM of zinc to the serum in vitro, the increase of ACE activity over initial value in the serum was determined as that of the apo-ACE. Finally, the apo/holo-ACE activities ratio was used as an index of zinc nutritional status. RESULTS: The mean concentrations of zinc in the serum were 77.4+/-8.4 microg/dl in volunteers, 77.6+/-8.4 microg/dl in the idiopathic patients and significantly decreased at 55.7+/-5.8 microg/dl in zinc-deficiency patients. ACE activities in the serum were 14.7+/-7.6, 14.5+/-4.0 and 14.1+/-3.3 IU/l in volunteers, the idiopathic group and zinc-deficiency taste impairment group, respectively. The mean ACE ratios were 1.10+/-0.6% in volunteers and significantly increased at 9.8 +/- 4.0% in the idiopathic group and at 13.7+/-6.6% in zinc-deficiency taste impairment group. CONCLUSION: The results of the present study indicated that zinc deficiency is a predominant factor underlying hypogeusia even when zinc concentrations are within normal ranges in the serum and show that clinically, ACE ratio may be a more sensitive indicator of the zinc nutritional status than measuring zinc concentration in the serum.