Magneto-optical diagnosis of symptomatic malaria in Papua New Guinea.

Improved methods for malaria diagnosis are urgently needed. Here, we evaluate a novel method named rotating-crystal magneto-optical detection (RMOD) in 956 suspected malaria patients in Papua New Guinea. RMOD tests can be conducted within minutes and at low cost. We systematically evaluate the capability of RMOD to detect infections by directly comparing it with expert light microscopy, rapid diagnostic tests and polymerase chain reaction on capillary blood samples. We show that compared to light microscopy, RMOD exhibits 82% sensitivity and 84% specificity to detect any malaria infection and 87% sensitivity and 88% specificity to detect Plasmodium vivax. This indicates that RMOD could be useful in P. vivax dominated elimination settings. Parasite density correlates well with the quantitative magneto-optical signal. Importantly, residual hemozoin present in malaria-negative patients is also detectable by RMOD, indicating its ability to detect previous infections. This could be exploited to reveal transmission hotspots in low-transmission settings.

Duplications and losses of genes encoding known elements of the stress defence system of the Aspergilli contribute to the evolution of these filamentous fungi but do not directly influence their environmental stress tolerance.

The contribution of stress protein duplication and deletion events to the evolution of the Aspergilli was studied. We performed a large-scale homology analysis of stress proteins and generated and analysed three stress defence system models based on Saccharomyces cerevisiae, Schizosaccharomyces pombe and Aspergillus nidulans. Although both yeast-based and A. nidulans-based models were suitable to trace evolutionary changes, the A. nidulans-based model performed better in mapping stress protein radiations. The strong Mantel correlation found between the positions of species in the phylogenetic tree on the one hand and either in the A. nidulans-based or S. cerevisiae-based models on the other hand demonstrated that stress protein expansions and reductions contributed significantly to the evolution of the Aspergilli. Interestingly, stress tolerance attributes correlated well with the number of orthologs only for a few stress proteins. Notable examples are Ftr1 iron permease and Fet3 ferro-O2-oxidoreductase, elements of the reductive iron assimilation pathway, in the S. cerevisiae-based model, as well as MpkC, a HogA-like mitogen activated protein kinase in the A. nidulans-based model. In the case of the iron assimilation proteins, the number of orthologs showed a positive correlation with H2O2-induced stress tolerance while the number of MpkC orthologs correlated positively with Congo Red induced cell wall stress, sorbitol induced osmotic stress and H2O2 induced oxidative stress tolerances. For most stress proteins, changes in the number of orthologs did not correlate well with any stress tolerance attributes. As a consequence, stress tolerance patterns of the studied Aspergilli did not correlate with either the sets of stress response proteins in general or with the phylogeny of the species studied. These observations suggest that stress protein duplication and deletion events significantly contributed to the evolution of stress tolerance attributes of Aspergilli. In contrast, there are other processes, which may counterbalance the effects of stress gene duplications or deletions including (i) alterations in the structures of stress proteins leading to changes in their biological activities, (ii) varying biosynthesis of stress proteins, (iii) rewiring stress response regulatory networks or even (iv) acquiring new stress response genes by horizontal gene transfer. All these multilevel changes are indispensable for the successful adaptation of filamentous fungi to altering environmental conditions, especially when these organisms are entering new ecological niches.

Evolution of a regional health-care information system--the design phase.

In 1996 a program of the Soros Foundation was launched to study a regional health care inodel Main stake holders of health care financing and providing in three counties in South-Western Hungary found the idea appealing and the Soros Model Region Program was started. This paper outlines the activity of the second sub-project of the model region program: the development of a regional health care information system. The build-up of a data and knowledge base serving the differing needs of mentioned goals is based on international standards. Availability and user involvement is based on different media for presenting the information as printed publications, CD-ROM data bases and World Wide Web availability. A congruency and coherency principle is maintained by a unified data model used for different purposes and a planned unified communication protocol among all participants in the model region program. Studies regarding health care status, economics and financing on regional level show that a better fitting health care services profile and a more flexible resource management might be achieved based on the mentioned regionality principle.

The impact of social science research on health policy.

The relationship between research and health policy is discussed from a policy process perspective, describing communication problems in the course of policy formulation, implementation and evaluation. Policy process is often expected by researchers to be rational, having logical sequence of steps and the objective evaluation of alternatives based on scientific knowledge. In fact, policies are often formulated without clear problem identification or based on wrong assumption. The timing of research and policy-making differs. Policy-makers need to respond quickly. Evaluations may be regarded by politicians as embarrassing if they point to a need for significant change. It is not satisfactory to consider only research and policy-making: their relationship is influenced by the media, different interest groups and by the general public. Health policy formulation is embedded in the general policy environment of particular societies. Some countries have a long tradition of consensus-building, while in others health reforms have been formulated and introduced in a centralized way. Traditional bio-medical thinking influences health policy-makers. The importance of social and political acceptability tends to be overlooked. The paper emphasizes that we are experiencing an era of scarcity of resources and growing tension concerning allocation decisions. Existing institutions provide insufficient incentives for policy-makers and researchers to promote public dialogue about such issues. The paper concludes that there is a need for new approaches to policy development and implementation, new structures in policy-making, changes in research financing and co-operation between disciplines and new structures for public participation in policy-making. Research should facilitate more open and democratic dialogue about policy options and the consequences of alternative choices.

Characterization of aarA, a pleiotrophic negative regulator of the 2'-N-acetyltransferase in Providencia stuartii.

We have utilized transposon mutagenesis to obtain insertional mutations in Providencia stuartii that activate the chromosomal aac(2')-la gene. Two closely linked mini-Tn5Cm insertions were obtained in a locus designated aarA, and a single insertion was obtained in a separate locus, aarC. Nucleotide sequence analysis, complementation studies, and localization of the sites of mini-Tn5Cm insertion have allowed the identification of the aarA coding region. The deduced AarA protein had a molecular mass of 31,086 kDa and displayed characteristics of an integral membrane protein. A strain deleted for the aarA gene by allelic exchange showed at least a fourfold increase in the accumulation of aac(2')-la mRNA and an eightfold increase in aminoglycoside resistance. Mutations in aarA were pleiotrophic and also resulted in loss of pigmentation and a deficiency in cell separation during division.

[Non-traumatic intrahepatic bile-duct perforation in an adult]. / Felnöttkori nem traumás eredetü intrahepaticus epeút perforáció.

Authors report a case of a patient suffered from intrahepatic bile duct perforation caused by stenosis of the papilla of Vater. With the help of data of medical literature there are analysed the etiological factors of bile duct perforations and the pathological process that leads to perforation. There is emphasized that the only way to avoid the sepsis and other postoperative complications on operation carried out in an early time and the supplemented intensive care. Authors call attention for the importance of carefully carried out intraoperative revision of bile system in cases of biliary peritonitis.

Characterization and transcriptional regulation of the 2'-N-acetyltransferase gene from Providencia stuartii.

We have cloned the chromosomally encoded 2'-N-acetyltransferase gene [aac(2')-Ia] from Providencia stuartii. DNA sequence analysis of the cloned insert identified a single open reading frame, which is capable of encoding a protein with a predicted molecular mass of 20,073 Da. The deduced AAC(2')-Ia protein showed no significant homology to other proteins, including all of the AAC(3) and AAC(6') proteins. Primer extension analysis was used to identify the aac(2')-Ia promoter, which contained an unusual sequence (CTTTTT) at the -35 region. Expression of the aac(2')-Ia gene occurs at low levels in wild-type P. stuartii strains; therefore, they are aminoglycoside susceptible. We have isolated mutants with high-level AAC(2')-Ia expression at a frequency of 4.8 x 10(-6). Detailed analysis of one mutant demonstrated a 12.2-fold increase in the accumulation of aac(2')-Ia mRNA. In addition, the levels of beta-galactosidase expression from a plasmid-encoded aac(2')-lacZ transcriptional fusion were increased 11.5-fold in this mutant relative to those in an isogenic wild-type strain. These results suggested that a trans-acting factor, designated aar (for aminoglycoside acetyltransferase regulator), controls AAC(2')-Ia expression in P. stuartii.

Early surgery for ruptured cerebral aneurysm.

Preliminary experience with 150 consecutive cases of ruptured cerebral aneurysms operated on within 48 hours is reported. The rationale of this emergency procedure is to prevent early rerupture and also to prevent neurological ischaemic consequences of the subarachnoid haemorrhage likely to develop in the first week after a rupture. The acceptable outcome of the surgically treated cases (87% excellent and good outcome) has been favourably matched to those of a group of equal number of consecutive cases seen in suitable condition for surgery within 48 hours by medical personnel but that remained unoperated for various reasons. The incidence of delayed neurological ischaemia as the definite cause of death is lower in the group operated on in the acute stage than those with delayed surgery, although the overall incidence of clinical vasospasm does not seem significantly lower than in the delayed surgery group.

The Hungarian country profile: inequalities in health and health care in Hungary.

Analysis of occupational, educational, urban/rural and regional data over several decades demonstrate large disparities in the availability of health care and in infant and adult mortality. Life expectancy increased in the immediate post-war period but in the late sixties improvement ceased and life expectancy at age 40 began to fall. Mortality has been particularly high for middle-aged males. Analysis by cause of death suggests the persistence of older poverty-type diseases co-existing with the newer lifestyle diseases. Reasons for system dysfunctioning are discussed--lack of health resources, rigid institutional structures, lack of integrated health policies, failure to adjust the distribution of resources to changing needs etc. The analysis raises the question of how to achieve a balance between equity and efficiency.

[Management of malignant pleural effusion by tetracycline pleurodesis]. / Malignus mellkasi folyadékgyülemek kezelése tetraciklin pleurodézissel.

Eleven patients were treated with chest tube drainage and intrapleural instillation of tetracycline for malignant pleural effusion. In ten cases this procedure for 6-10 days achieved complete resolution of pleural fluid and produced pleurodesis. Only one patient needed longer treatment, but it was also successful. Fluid recurrence was not recognised during the follow-up period. This method is very effective and simple, so the authors recommend the tetracycline pleurodesis for the palliative management of malignant pleural effusions.

Surgical treatment of multiple intracranial aneurysms.

Patients with multiple intracranial aneurysms present a great challenge to neurosurgical practice. The presence of one or more additional aneurysms, whether recognized or unrecognized, along with the source of the haemorrhage profoundly changes the outcome. It also alters the timing and strategy of surgery. In this study the experiences gained from 138 cases with a total of 317 aneurysms are discussed. The analysis of the clinical data, our results and the factors influencing the outcome suggest that the risk of clipping all aneurysms simultaneously are less than the risk of a rebleed from an untreated, previously silent sac even in the early postoperative period.

The surgery of middle cerebral artery aneurysms.

Aneurysms of the middle cerebral bifurcation represent an interesting entity among intracranial saccular aneurysms. Their shape, size, situation, and in particular their relation to the middle cerebral trunk and its branches show wide variations. Topographical analysis of the angiograms offers a great deal of interest in planning surgery. Our experience with 289 patients with middle cerebral artery aneurysms operated on since 1977 are presented. Factors such as number of previous haemorrhages, timing of surgery, preoperative condition, major intraoperative bleeding or brain oedema and delayed postoperative deterioration play a major role in the outcome. Others such as severity of the subarachnoid bleed, age, size of the sac seem to have much less influence.