Detection of malaria in relation to fever and grade of malnutrition among malnourished children in Ethiopia.

SETTING: Forty-eight nutritional rehabilitation centres in southern Ethiopia. OBJECTIVE: To determine 1) the frequency of temperature recording under programme conditions, 2) the proportion of malnourished children with and without fever who had falciparum malaria and 3) the association between malaria and grade of malnutrition. DESIGN: This was a retrospective analysis of routine programme data. RESULTS: Of 19 200 malnourished children, 16 716 (mean age 4.4 years, 7412 males) underwent a rapid malaria diagnostic test (Paracheck Pf (®)). Malnutrition was graded as severe (38%), moderate (35%) and mild (27%). Temperature was not recorded in 15 248 (91%) children. Malaria was diagnosed in 57 (28%) children with fever (n = 206) and 122 (10%) children with no fever (n = 1262). The prevalence of falciparum malaria was 9%. Malaria prevalence was significantly associated with grade of malnutrition: Paracheck Pf was positive in respectively 5%, 8% and 10% of children with mild, moderate and severe malnutrition (χ(2) for trend 78, P < 0.001). CONCLUSIONS: This study shows the value of routine malaria screening in malnourished children, especially those with more severe grades of malnutrition, irrespective of fever. Operational shortcomings are highlighted and ways forward to address these problems are discussed.

Functional display of family 11 endoxylanases on the surface of phage M13.

Two family 11 endoxylanases (EC 3.2.1.8) were functionally displayed on the surface of bacteriophage M13. The genes encoding endo-1,4-xylanase I from Aspergillus niger (ExlA) and endo-1,4-xylanase A from Bacillus subtilis (XynA) were fused to the gene encoding the minor coat protein g3p in phagemid vector pHOS31. Phage rescue resulted in functional monovalent display of the enzymes as was demonstrated by three independent tests. Firstly, purified recombinant phage particles showed a clear hydrolytic activity in an activity assay based on insoluble, chromagenic arabinoxylan substrate. Secondly, specific binding of endoxylanase displaying phages to immobilized endoxylanase inhibitors was demonstrated by interaction ELISA. Finally, two rounds of selection and amplification in a biopanning procedure against immobilized endoxylanase inhibitor were performed. Phages displaying endoxylanases were strongly enriched from background phages displaying unrelated proteins. These results open perspectives to use phage display for analysing protein-protein interactions at the interface between endoxylanases and their inhibitors. In addition, this technology should enable engineering of endoxylanases into novel variants with altered binding properties towards endoxylanase inhibitors.

Predictions of in situ solid/liquid distribution of radiocaesium in soils.

Previous work has demonstrated that plant uptake of radiocaesium (RCs) is related to the activity concentration of RCs in soil solution, which is linked to the soil/soil solution distribution coefficient, K(D). The solid-liquid distribution of RCs is generally studied in soil suspensions in the laboratory and there are few reported measurements for in situ soil solutions. From a data set of 53 different soils (contaminated with either 134CsCl or 137CsCl) used in pot trials to investigate grass uptake of RCs, we analysed the variation of in situ K(D) with measured soil properties. The soils differed widely in % clay (0.5-58%), organic matter content (1.9-96%) and pH (2.4-7.0, CaCl2). The K(D) varied between 29 and 375,000 L kg-' (median 1460 L kg(-1)). Stepwise multiple regression analysis showed a significant correlation between the log K(D) and pH (p < 0.001), log %clay (p < 0.01) and log exchangeable K (p < 0.001) (overall R2 = 0.70). The in situ K(D) values were further compared to K(D)S predicted using an existing model, which assumes that RCs sorption occurs on specific sites and regular ion-exchange sites on the soil solid phase. Sorption of RCs on specific sites was quantified from the radiocaesium interception potential (RIP) measured for each soil and the soil solution concentrations of K+ and NH4+. The in situ log K(D) correlated well with the predicted K(D) (R2 = 0.85 before plant growth, R2 = 0.83 after plant growth). However, the observations were fivefold to eightfold higher than the predictions, particularly for the mineral soils. We attribute the under-prediction to the long contact times (minimum 4 weeks) between the RCs tracers and our experimental soils relative to the short (24 h) contact times used in RIP measurements. We conclude that our data confirmed the model but that ageing of RCs in soil is a factor that needs to be considered to better predict in situ KD values.

[Influenza vaccine in 85-and-over aged: motivation of elderly and family physicians to vaccinate or not]. / Influenzavaccinatie bij 85-plussers: de motieven van ouderen en huisartsen om wel of niet te vaccineren.

OBJECTIVE: To determine on what grounds persons over 85 years are or are not vaccinated against influenza. DESIGN: Descriptive. SETTING: Gerontological Research Centre and Department of General Practice Medicine, University of Leiden, the Netherlands. METHOD: A random sample (n = 331) of the general population of Leiden aged 85 years or older and not institutionalized were interviewed. Early in October 1993, 163 interviews were suitable for analysis (response rate 54%). An analysis of non-responders revealed no significant difference as regards gender and housing, but persons aged 90 and older were under-represented. The general practitioners (n = 41) of the 163 elderly persons were interviewed about these persons (response: n = 127; 78%) and about influenza vaccination in general (response: n = 33; 82%). RESULTS: The vaccination coverage rates were 51% according to the elderly and 56% according to the GPs; those of elderly people with an indication (48% according to themselves and 64% according to the GP) 52% and 67%, respectively. Reasons for elderly people not to accept vaccination were that they considered vaccination unnecessary, that they felt well and wanted to avoid possible adverse effects. A doctor's recommendation to have vaccination done was a positive influence. GPs' motives not to vaccinate were absence of an indication and the elderly person's wish. CONCLUSION: Only two-thirds of those over 85 not living in a nursing home with an indication for influenza vaccination were indeed vaccinated. Information about the possible damage done by influenza and about the pros and cons of vaccination, together with a doctor's advice to be vaccinated appeared to have a positive effect on the vaccination coverage.

Musculoskeletal disorders and disability in persons aged 85 and over: a community survey.

OBJECTIVES: To study the prevalences of musculoskeletal disorders and disability in the elderly, and the relationship between them. METHODS: A community sample of 73 females and 32 males aged 85 and over underwent a standardised examination at home. Musculoskeletal disorders were classified according to published clinical criteria. The relative effects on disability (a walking distance of < 500 m or dependency in activities of daily living (ADL)) of musculoskeletal disorders and comorbidity were analysed by logistic regression. RESULTS: Musculoskeletal pain was reported by 57% of those interviewed. A major restriction of joint movement range was frequent in the shoulder but uncommon in other joints. A shoulder disorder was found in 27% of subjects, rheumatoid arthritis in 1% and osteoarthritis (OA) of the hand, hip, and knee in five, seven, and 18% of subjects, respectively. Disability was frequent: a walking distance of < 500 m was found in 60% and ADL dependency in 40% of the group. Factors related to one or both of these disability measures included female gender, hip and knee OA, impaired vision, cognitive impairment and neurological disease. CONCLUSION: Musculoskeletal pain and disorders, in addition to disability were frequent in this very elderly population. However, as a cause of disability, other disorders were at least as important as musculoskeletal disorders.