Variations in helminth faecal egg counts in Kato-Katz thick smears and their implications in assessing infection status with Schistosoma mansoni

Examination of stool specimens by Kato-Katz (K-K) thick smears is the standard method recommended by the WHO for field diagnosis of intestinal schistosomiasis. However, there is increasing concern that this technique has low diagnostic sensitivity. In 326 study subjects, we compared the diagnostic yield of examining one, three or five Kato-Katz thick smears prepared from one stool specimen using 41.7 mg templates. In a subset of 169 subjects who had no demonstrable Schistosoma mansoni eggs in their first three Kato-Katz thick smears, we assessed the comparative advantage of examining an additional three Kato-Katz thick smears from another stool specimen, taken four weeks later, to that of cumulative yield obtained by examining all five Kato-Katz thick smears derived from the first stool specimen. For all helminth infections, single Kato-Katz thick smear-based prevalence estimates were significantly lower than those obtained from triplet or quintet Kato-Katz thick smears. Prevalence of S. mansoni infection based on single, triplet and quintet Kato-Katz thick smears from one stool specimen were 31.3%, 45.7% and 52.1%, respectively. Prevalence estimate of S. mansoni based on quintet Kato-Katz thick smears from the first day stool specimens was not different from cumulative estimate obtained with two triplet Kato-Katz thick smears from two stool specimens, 52.1% and 52.8%, respectively. In conclusion, either examination of quintet Kato-Katz thick smears from one stool specimen using 41.7 mg template or initial triplet Kato-Katz thick smears from one stool specimen, and if these are negative, followed by examination of additional triplet Kato-Katz thick smears from subsequent day stool specimen can adequately assess individuals for infection status with S. mansoni.     

Perception of dental fluorosis among adolescents living in urban areas of Ethiopia

The objective of the study was to assess the perception of dental fluorosis among adolescents residing in two urban areas in Ethiopia: Addis Ababa (low-fluoride drinking water) and Nazreth (high-fluoride drinking water). Students aged 12-15 years, enrolled in two junior secondary schools in Addis Ababa (n = 161) and two similar schools in Nazreth (n = 177) responded to evaluative statements concerning the appearance of anterior maxillary teeth. Color photographs depicting dental fluorosis (TF score 2, 3, 5 and 7) in maxillary front teeth were used as reference during structured interviews. A majority of the students from Addis Ababa and Nazreth were dissatisfied with the appearance of teeth having TF scores 2 and above. More than 66% of the students from both areas confirmed a need for dental consultation concerning fluorotic teeth with TF > or = [corrected] 2. As compared to their counterparts in Nazreth, children in Addis Ababa felt more embarrassed with TF score 2 and 3 (p < 0.01). TF scores 5 and 7 were found unacceptable both in Addis Ababa and in Nazreth. Students in Addis Ababa, more frequently than their counterparts in Nazreth, believed (erroneously) that dental fluorosis were related to neglect on the part of the child. The present findings confirm that fluorotic teeth constitute a social problem among junior secondary school children residing in low-fluoride as well as in high-fluoride urban areas in Ethiopia and, thereby, corroborate the public concern for safe drinking water.     

Topical role of brachytherapy: economic and organizational aspects

Brachytherapy for the recent technological advances, represents a fundamental "therapeutic step" in a multidisciplinary approach based on surgery, external beam radiotherapy and chemotherapy, if necessary. The various professionals involved, each within their personal skills, participate in the formulation of a correct therapeutic program. The widespread use of high dose rate brachytherapy leads to consider that the machines should be supplied to major radiotherapy centers only, because the procedure requires the combination with external beam radiotherapy.     

Comparison of urinary amino acids and trace elements (copper, zinc and manganese) of recent neurolathyrism patients and healthy controls from Ethiopia

OBJECTIVE: The irreversibly crippling disease neurolathyrism is caused by prolonged over-consumption of Lathyrus sativus seed. The molecular mechanism of toxicity is unclear and more biochemical information is needed. METHODS: The urinary amino acids from 5 recent patients and 9 healthy subjects in Ethiopia were analysed by HPLC after PITC (phenyl isothiocyanate) derivatisation. The trace elements Cu, Zn and Mn of urine and seeds were determined by atomic absorption spectroscopy. RESULTS: The free amino acids aspartic acid, glycine, beta-aminoisobutyric acid, arginine, alpha-aminoadipic acid and phenylalanine were statistically higher (p<0.05) in urine from patients than in urine from control subjects. The trace element Cu was also statistically higher (p<0.05) in patient urine. CONCLUSION: The amino acid metabolism of the neurolathyrism patients is disturbed by over-consumption of grass pea seeds. The high concentrations of Cu found in the patient urine might indicate the involvement of trace elements in the aetiology of neurolathyrism.     

Biomonitoring of metals and trace elements in urine of central Ethiopian populations

Biomonitoring of chemical concentrations in humans is important for detecting, monitoring, and addressing a wide range of health threats. However, it is virtually absent across many African nations, including Ethiopia. This study aims to determine urinary concentrations for metals and trace elements in populations living in the central Ethiopian Rift Valley. The region is unindustralized, rural, and characterized by unique geologic rifting and volcanic activities that have produced vast pyroclastic materials, forming its aquifer and fertile agricultural soils. Millions of people in the region rely on wells for drinking water and are engaged in cereal-based subsistence agriculture. We enrolled a total of 386 residents aged 10–50 years old (201 females and 185 males). The levels of 23 elements except F^─ were quantified in water and urine samples by ICP-MS. Mean concentrations of B, F^─, Ca, and Mg were measured in mg/L levels, while concentrations of Mo, Zn, Sr, Rb, and Li ranged between 100 and 700?μg/L. Mean concentrations between 5 and 15?μg/L were found for Ni, Cu, and Mn, while Ag, Be, Cd, Co, Pb, Sb, Th, TI, and U were all below 5?μg/L. Arsenic and Al had mean concentrations between 30 and 50?μg/L. Mean urinary concentrations of Ca, Cu, Mg, Pb, Sr, and Zn were significantly higher in males than females, whereas Co and Mn were higher in females. Finally, younger individuals (10–30 years) had significantly higher mean concentrations of B, Cd, Co, Mg, Mo, and Pb than those between 31 and 50 years, whereas only Ca was higher in the older age group. The concentration ranges of B, Mo, Mn, TI, Li, Zn, and in particular F^─ (0.44–44.6?mg/L) and As (2.2–164?μg/L) in urine were higher than the reference ranges reported in healthy unexposed North American and European populations, while those for the remaining 16 elements were comparable to published reference ranges from such settings. The established concentration ranges are important to monitor future changes in exposure, and risk factors for disease, that might stem from the economic growth and industrialization that is currently underway in the region.     

The prevalence of primary headache disorders in Ethiopia

Background

Knowledge of the epidemiology of primary headache disorders in sub-Saharan Africa (SSA) remains very limited. We performed a population-based survey in rural and urban areas of Ethiopia, using methods similar to those of an earlier study in Zambia and tested in multiple other countries by Lifting The Burden.

Methods

In a cross-sectional survey we visited households unannounced in four regions of Ethiopia: the mostly urban populations in Addis Ababa and its environs and rural populations of selected districts in Oromia, Amhara and South Nations Nationalities and People’s Regions States (SNNPRS). We used cluster-randomized sampling: within clusters we randomly selected households, and one adult member (18–65 years old) of each household. The HARDSHIP structured questionnaire, translated into the local languages, was administered face-to-face by trained interviewers. Demographic enquiry was followed by diagnostic questions based on ICHD-II criteria.

Results

From 2,528 households approached, 2,385 of 2,391 eligible members (1,064 [44.7%] male, 596 [25.0%] urban) consented to interview (participating proportion 99.8%). Headache in the preceding year was reported by 1,071 participants (44.9% [95% CI: 42.4–46.3]; males 37.7%, females 49.9%), and headache yesterday by 170 (7.1% [6.2–8.2]; males 45 [4.1%], females 125 [9.2%]). Adjusted for gender, age and habitation (urban/rural), 1-year prevalence of migraine was 17.7%, of tension-type headache (TTH) 20.6%, of all headache on ≥15 days/month 3.2%, and of probable medication-overuse headache (pMOH) 0.7%. The adjusted prevalence of headache yesterday was 6.4%. Very few cases (1.6%) were unclassifiable. All headache disorders were more common in females. TTH was less common in urban areas (OR: 0.3; p?<?0.0001), but pMOH was very strongly associated (OR: 6.1; p?<?0.0001) with urban dwelling. Education was negatively associated with migraine (OR: 0.5–0.7; p?<?0.05) but (at university level) positively with pMOH (OR: 2.9; p?=?0.067). Income above ETB 500/month showed similar associations: negatively with migraine (OR: 0.8; p?=?0.035), positively with pMOH (OR: 2.1; p?=?0.164).

Conclusions

Findings for migraine and TTH in Ethiopia were quite similar to those from Zambia, another SSA country; pMOH was much less prevalent but, as in Zambia, essentially an urban problem. Primary headache disorders are at least as prevalent in SSA as in high-income western countries.

     

Target registration errors with surface imaging system in conformal radiotherapy for prostate cancer: study on 19 patients

Purpose

Accurate patient setup is a prerequisite for conformal radiotherapy (3D-CRT) and is based on various methods, including surface imaging systems. To evaluate the validity of a surface imaging system (AlignRT), we analysed setup reproducibility of a cohort of patients.

Materials and methods

Nineteen patients affected by prostate adenocarcinoma were enrolled in this study. We acquired 653 surface images and 99 digital portal images (DPI). Setup errors were found by matching surface images with computed tomography (CT) and DPI images.

Results

The setup errors from the threshold of 5 mm detected by AlignRT along the Y, Z and X axes occurred in 47.4%, 42.1% and 5.3% of patients, respectively. For the threshold of 3 mm, shifts along the Y, Z and X axes were observed in 68%, 69% and 10%, respectively. Comparing AlignRT and DPI, we found a statistically significant difference in the detection of shifts along the Y and Z axes. For a threshold ??5 mm, the two systems provided corresponding setup errors along the Y and Z axes, whereas along the X axis, the threshold was not necessary.

Conclusions

AlignRT is an accurate technique for setup in 3D-CRT prostate cancer patients, especially along the lateral direction.