Rapid immunochromatographic diagnosis and Rolling Back Malaria--experiences from an African control program.

Malaria is a re-emerging disease in much of Africa. In response, the World Health Organization launched the Roll Back Malaria (RBM) initiative. One of six key principles adopted is the early detection of malaria cases. However, the importance of definitive diagnosis and potential value of field deployment of rapid malaria tests in RBM has been largely ignored. The Lowveld Region of Mpumalanga Province, South Africa, is home to a predominantly non-immune population, of approximately 850000 inhabitants, who are at risk of seasonal Plasmodium falciparum malaria. Malaria treatment in this area is usually only initiated on detection of malaria parasites in the peripheral bloodstream, as many other rickettsial and viral febrile illness mimic malaria. The malaria control programme traditionally relied on light microscopy of Giemsa-stained thick blood films for malaria diagnosis. This review summarizes operational research findings that led to the introduction of rapid malaria card tests for primary diagnosis of malaria throughout the Mpumalanga malaria area. Subsequent operational research and extensive experience over a four-year period since introducing the ICT Malaria Pf test appears to confirm the local appropriateness of this diagnostic modality. A laboratory is not required and clinic staff are empowered to make a prompt definitive diagnosis, limiting delays in initiating correct therapy. The simple, accurate and rapid non-microscopic means now available for diagnosing malaria could play an important role in Rolling Back Malaria in selected areas.

Comparative double blind study of the efficacy and safety of tenoxicam vs. piroxicam in osteoarthritis of knee and hip joints.

The efficacy and safety of tenoxicam was compared to that of piroxicam in 48 Nigerian patients with Osteoarthritis of the knee or hips. Of these 31 females and 11 males, with a mean age of 52.5 +/- 11.0 years, were evaluated for comparable efficacy and tolerability. On fulfilling the selection criteria each patient was treated with either tenoxicam 20 mg or piroxicam 20 mg daily for six weeks. Efficacy was evaluated in terms of presence of pain (at rest, with mobility and after one day of normal activity), functional status and physicians global assessment of therapeutic efficacy. Tolerability was evaluated by incidence of adverse events whilst safety was evaluated by measurement of haematological and biochemical profile pre and post therapy. Thirty seven patients had been on previous medication before being switched over to trial drug. There was a dose change in three patients in the piroxicam group due to inefficacy. Also there was loss of efficacy during maintenance in one patient in the piroxicam group. Clinical efficacy was judged excellent or good in 82.3% of patients with tenoxicam and 76.0% with piroxicam. Tolerability was excellent or good in 88.2% of patients with tenoxicam and 60.0% with piroxicam. The incidence of adverse event was 15.8% with tenoxicam and 21.7% with piroxicam. Overall, when judged on various evaluation parameters, tenoxicam 20 mg/day appears to be more effective and better tolerated than piroxicam 20 mg/day, though these differences were not statistically significant.

The formation of aneurysms.

Arterial aneurysms account for a significant proportion of the various diseases treated by the vascular surgeon. Refinements of surgical technique have reduced the morbidity and mortality, yet, we have no effective medical therapy to prevent the growth of small aneurysms. Although the pathogenesis of aneurysmal disease has received attention, the complex nature of the process has not been fully elucidated. The emergence of new and refined techniques in the fields of immunology, biochemistry, cell biology, and genetics has advanced the understanding of the dynamic interactions within a diseased vessel. Although past work was descriptive, investigators are now studying the role of the local inflammatory infiltrates and the destructive proteolytic enzymes they produce and regulate. The clinical observations we make regarding the familial tendency of abdominal aortic aneurysms (AAA) underscores the importance of research directed at identifying an aneurysm-related gene. As new pieces are added to the puzzle and the picture of AAA pathogenesis becomes more clear, we can expect the development of new therapeutic measures directed at controlling the critical matrix changes, and thus the growth of small AAA, as well as screening methods searching for AAA-associated genes.

Hospital-wide educational program decreases red blood cell transfusions.

BACKGROUND: Because of the numerous risks associated with the use of packed red blood cells (RBCs), it is critical that they be transfused only when appropriate. A hospital-wide educational program was developed in an attempt to improve the transfusion practices and provide a framework for blood bank audit at a Veterans Affairs teaching hospital. MATERIALS AND METHODS: The program required physicians to fill out an information sheet that listed appropriate criteria for transfusion. Charts were reviewed to determine if the transfusion met these criteria. If the transfusion was deemed inappropriate by peer review, the staff physician was notified by letter. The information sheet was used on a voluntary basis without chart review in 1989 and on a mandatory basis beginning in 1990. Transfusion rates and mortality were adjusted to patient days of hospitalization and evaluated using chi 2 analysis. RESULTS: While voluntary use did not affect transfusion rate, mandatory implementation resulted in a 26% decline (P < 0.001) between 1989 and 1990 in the number of RBC units transfused per patient days of hospitalization. A diminished use of RBCs persisted in the subsequent years. There was no increase in mortality during this time to suggest a detrimental effect from the decrease in RBC transfusion. No apparent variation in the hospital population could account for the changes. CONCLUSION: Use of a unique and simple transfusion request sheet as an educational tool resulted in improved transfusion practices at a Veteran Affairs teaching hospital.

Protein kinase C isoforms in human aortic smooth muscle cells.

PURPOSE: To identify the protein kinase C (PKC) isoforms in human arterial smooth muscle cells (SMC) and define their subcellular location in the resting state and in response to the PKC activator, 12-O-tetradecanoylphorbol 13-acetate (TPA). METHODS: Arterial SMC cultures established from transplant donor aorta were treated with 100 nM TPA or control media, then mechanically lysed. PKC from the soluble and particulate fraction were separated by centrifugation, and protein normalized immunoblots were performed with antibodies to the PKC isoforms alpha, betaI, betaII, delta, epsilon, gamma and zeta. Bands were detected by enhanced chemiluminescence and analyzed densitometrically, with results expressed as the mean percentage of each fraction +/- SEM. Translocation was defined as a significant (p < 0.05) change in the particulate fraction for each isoform. Immunofluorescent staining of cultured SMC visualized the resting location and stimulated translocation of each isoform. RESULTS: Isoforms alpha and betaI were detected primarily in the soluble fraction, translocating to the particulate fraction with TPA stimulation (p < 0.0001). The isoforms betaII, delta, and epsilon were found primarily in the particulate fraction and did not translocate. Immunofluorescent staining confirmed these locations. Neither gamma or zeta were detected in these SMC. CONCLUSIONS: The PKC isoforms expressed in human arterial SMC differ from those reported in animal models. Their specific locations and response to stimulation suggest unique functions in cellular regulation and provide the groundwork for further investigation into their role in the development of vascular disease and regulation of matrix metabolism.

Pathogenesis of abdominal aortic aneurysm: an update and look toward the future.

To date, aneurysm research has been primarily descriptive, reiterating the complex nature of the disease process. Enhanced by the convergence of matrix biochemistry, cell biology and immunology, this work is providing important new insight into how matrix metabolism is regulated in the diseased aorta. The focus is now on the inflammatory process and its regulation of the matrix remodeling which occurs with abdominal aortic aneurysm. A family of matrix-degrading enzymes appear to have a central role in this process. As we have learned from the evolution of the treatment of other pathologic processes such as peptic ulcer disease, the most effective pharmacologic therapies are designed from a thorough understanding of the pathophysiology of the disease. We are quickly moving forward in formulating a comprehensive understanding of the various complex interactions that result in the formation of aortic aneurysm. Given the progress of the past decade, we can expect the identification of aneurysm-associated genes and clinical trials of anti-inflammatory medications and protease inhibitors as we enter the 21st century.

Macrophage products inhibit human aortic smooth muscle cell proliferation and alter 1 alpha (I) procollagen expression.

While the role of the foam cell in early atherogenesis has been well characterized, much less is known about the interaction between infiltrating macrophages and medial smooth muscle cells (SMC) in chronic atherosclerosis. Our purpose was to determine the effects of soluble macrophage mediators on normal human aortic SMC proliferation and matrix expression. Human aortic SMC in subconfluent culture were exposed to supernatants from activated lipopolysaccharide (LPS) and nonactivated macrophages. SMC proliferation and type-I procollagen expression were determined. Both activated and nonactivated macrophage supernatants exhibited a potent growth inhibitory effect which became apparent at 48 hours. While nonactivated macrophage supernatant had no effect on procollagen expression, activated supernatant inhibited its expression. (33%; p < 0.05) These findings are consistent with the loss of medial SMC and matrix proteins associated with chronic atherosclerosis.

[Postmenopausal endometrial tuberculosis, A report of 2 cases and a literature survey]. / Postmenopousale endometriale tuberkulose. 'n Bespreking van 2 gevalle en 'n literatuuroorsig.

Postmenopausal endometrial tuberculosis is an uncommon condition. Two patients with this disease, 1 of whom also presented with a pyometra, are described. They were the only 2 patients with this disease out of 21742 patients admitted to the Department of Obstetrics and Gynaecology, Tygerberg Hospital. Both were treated with standard antituberculosis drugs for 9 months. No further episodes of postmenopausal bleeding occurred during or directly after treatment, and a follow-up hysteroscopic examination showed a completely atrophic endometrial lining.

Fracture of the penis. Case report.

A rare case of fracture of the penis is reported. Review of the literature shows only 58 previously reported cases. (Meares 1971) A simple method of treatment under local anaesthesia is described.