MOLECULAR CHARACTERISATION OF ECHINOCOCCUS GRANULOSUS SPECIES/STRAINS IN HUMAN INFECTIONS FROM TURKANA, KENYA.

BACKGROUND: Cystic echinococcosis (CE) or hydatid disease is a neglected, economically important zoonotic disease endemic in pastoralist communities, in particular the Turkana community of Kenya. It is caused by the larval stage of the highly diverse species complex of Echinococcusgranulosus sensu lato (s.l). The situation on the genetic diversity in humans in Kenya is not well established. OBJECTIVE: To characterise Echinococcus granulosus (s.1) species/strains isolated from humans undergoing surgery in Turkana, Kenya. DESIGN: A Cross sectional study. SETTING: The Kakuma Mission Hospital and Centre for Microbiology Research, Kenya Medical Research Institute. SUBJECTS: Eighty (80) parasite samples from 26 subjects were analysed by Polymerase chain reaction--Restriction fragment length polymorphism (PCR-RFLP) targeting the nad 1 gene for molecular characterization. RESULTS: Two different genotypes of E. granulosus were identified from the samples analysed: E. granulosus sensu stricto (G1-G3) 85% of the samples analysed and E. canadensis G6/7 (15%). Most of the hydatid cysts (35%) were isolated from the liver. Other sites where cysts were isolated from include: kidney, abdomen, omentum, retroperitonium and the submandibular. Majority of cysts presented as CE1 (50%) and CE3B (42%) images according to WHO ultrasound classification. Both males and females were infected with E. granulosus s.s but only the females showed infection with E. canadensis G6/7. Chi-square test revealed significant difference between age of individuals and cysts classification by ultrasound. In addition, there was an association between cyst presentation (single or multiple) and genotype whereby all the E. canadensis G6/7 cases presented as single cysts in the infected persons. CONCLUSION: This study corroborates previous reports that E. canadensis G6/7 strain is present in Turkana, a place where initially only E. granulosus s.s (G1-G3) was known to be present and that E. granulosis (G1-G3) remains the most widespread genotype infecting humans in the Turkana community.

[Actuator design and control exemplified by a urologic implant]. / Aktorik und Steuerung Am Beispiel eines Urologischen Implantats.

The state of the art concerning the use of actuators and sensors and the intelligent microprocessor-based control will be discussed on the basis of a novel urological implant, a fine tuned, sensor controlled artificial sphincter. A set of powerful actuators with a reaction time lower than 10 ms have been realised due to an appropriate design of components. This has been achieved at a supply voltage of 4.2 V and a power input lower than 0.1 mW. An optimal reliability as well as the comfort in operating the implant by the physician and the patient was gained by the use of different data technologies being adapted to the implanted system.

[Threatened fibula fracture by transosseous migration of a leaded glass fragment]. / Drohende Fibulafraktur durch transossäre Wanderung einer Bleiglasscherbe.

A case of a 24-year-old man is reported: At the age of ten he was injured by a pane of glass in the region of the medial ankle joint. 14 years later a piece of broken glass which was overlooked during wound toilet, had penetrated to the lateral ankle. The foreign body was impacted in the distal fibula which was sensitive to pressure. Our case shows the importance of a careful inspection of every wound. An unrecognized foreign body may cause severe complications later on.

Medical student education for primary health care: who teaches what, when?

Since primary health care (PHC) is central to good doctoring and pervades all levels of medical services, a suitable system for teaching it must be developed. Whereas the traditional approach in teaching has been toward a set objective, PHC requires an approach that aims to meet urgent and changing needs. The PHC doctor must adapt to the prevailing requirements of his practice. Other teaching implications are those of organization and team training and continuing medical education. The conflict between different approaches is considered in an attempt to resolve the problem of who teaches what, when.

[The objective-structured clinical examination (OSCE)]. / Die objektief-struktureerde kliniese eksamen (OSKE).

The objective-structured clinical examination (OSCE) as described by Harden and Gleeson could be evaluated for a specific, limited skill (history and physical examination) on two third-year classes. The candidates were also evaluated on the same skills by conventional techniques in the Departments of Paediatrics, and Obstetrics and Gynaecology during the same examination period. The results were comparable and had significant Spearman rank correlations with the overall mark. The new method is highly acceptable to both students and examiners, and especially noteworthy was the fact that 93% of students experienced this test as a learning situation. They assessed it as an objective and fair evaluation, an opinion shared by most of the participating examiners. It would appear justified to use this test instrument more often, and in other combinations of disciplines and for other skills in subsequent years of the course.

Photoregulated ion binding.

A photoregulated chelating agent has been synthesized. It is a photochromic azobenzene compound containing two iminodiacetic acid groups and can exists as cis and trans stereoisomers. The planar trans isomer does not bind zinc ions. On exposure to light of 320 nanometers, the trans isomer is converted to a nonplanar cis isomer, which, because of cooperativity between the two iminodiacetic acid groups, binds zinc ions with the value of the binding constant estimated to be 1.1 x 10(5) +/- 9.2 x 10(5) liters per mole at a ratio of one molecule of chelating agent to one zinc ion. The interconversion of the cis and trans isomers is reversible, suggesting possible application of this class of compounds as photoresponsive ion pumps.

[Mumps meningitis--bromine-82 partition test and cerebrospinal fluid glucose]. / Pampoentjie--meningitis--broom-82 partisietoets en serebrospinale vog glukose.

A case of mumps meningitis is reported where a low cerebrospinal fluid (CSF) glucose level, a positive bromine-82 partition test and the fact that the patient's sister had recently had tuberculous meningitis complicated the diagnosis. Mumps meningitis may be associated with low CSF glucose levels. Patients with viral meningitis usually have normal CSF glucose levels, and, during a recent study, false-positive results of 82Br partition tests were not found. Mumps meningitis, however, proves to be an important exception.