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Community involvement in dengue vector control: cluster randomised trial
No full textObjective: To assess the effectiveness of an integrated community
based environmental management strategy to control Aedes aegypti,
the vector of dengue, compared with a routine strategy. Design Cluster
randomised trial. Setting Guantanamo, Cuba. Participants 32
circumscriptions (around 2000 inhabitants each). Interventions: The
circumscriptions were randomly allocated to control clusters (n=16)
comprising routine Aedes control programme (entomological surveillance,
source reduction, selective adulticiding, and health education)
and to intervention clusters (n=16) comprising the routine Aedes control
programme combined with a community based environmental
management approach. Main Outcome: Measures The primary outcome
was levels of Aedes infestation: house index (number of houses
positive for at least one container with immature stages of Ae aegypti per 100 inspected houses), Breteau index (number of containers positive
for immature stages of Ae aegypti per 100 inspected houses), and
the pupae per inhabitant statistic (number of Ae aegypti pupae per
inhabitant). Results: All clusters were subjected to the intended intervention;
all completed the study protocol up to February 2006 and all
were included in the analysis. At baseline the Aedes infestation levels
were comparable between intervention and control clusters: house
index 0.25% v 0.20%, pupae per inhabitant 0.44×10−3v 0.29×10−3. At
the end of the intervention these indices were significantly lower in
the intervention clusters: rate ratio for house indices 0.49 (95% confidence
interval 0.27 to 0.88) and rate ratio for pupae per inhabitant
0.27 (0.09 to 0.76). Conclusion A community based environmental
management embedded in a routine control programme was effective
at reducing levels of Aedes infestation. Trial Registration Current
Controlled Trials ISRCTN8840579
Freezing of stool samples improves real-time PCR detection of Entamoeba dispar and Entamoeba histolytica
No full textPCR as a tool for intestinal parasite diagnosis is expanding since differentiation between Entamoeba histolytica and Entamoeba dispar cysts is impossible with microscopy. Since pre-analytical factors influence DNA detection, we evaluated with real-time PCR the influence of storage time and temperature. We demonstrated an improved DNA detection in frozen stool samples. Copyright 2010 Elsevier B.V. All rights reserved
Under treated necrotizing fasciitis masquerading as ulcerated edematous Mycobacterium ulcerans infection (Buruli Ulcer)
No full textWe report a case of under treated necrotizing fasciitis (NF) in a 65-year-old woman with diabetes misdiagnosed as Mycobacterium ulcerans infection. She came to the Institut Médical Evangélique (IME) with an extensive painful edematous ulcerated lesion on the dorsum of the right foot and ankle. The diagnosis of Buruli ulcer (BU) was based initially on clinical findings and place of residence (Songololo Territory, the largest known focus of BU in Bas-Congo province). Tissue specimens gave negative results for acid-fast bacilli (AFB), culture, and polymerase chain reaction (PCR) for M. ulcerans. Histopathologic analysis revealed marked necrosis of the lower dermis and subcutaneous tissue. No AFB was found. Later, scattered foci of intracellular gram-positive cocci typical of streptococci were seen. Clinicopathologic correlation of these findings strongly supported the diagnosis of NF. This patient shows the difficulties that may be encountered even in known endemic areas in recognizing BU cases purely on clinical findings
Negative staining technique of Heine for the detection of Cryptosporidium spp.: a fast and simple screening technique
No full textAlthough inexpensive and easy to perform, the negative staining technique of Heine for the detection of Cryptosporidium spp. has been largely neglected. The lack of familiarity with the negative staining technique, the misconception that a phase-contrast microscope is indispensible and inferior results due to Köhler-illumination, are possible explanations for its low popularity. While the modified Ziehl-Neelsen staining technique is still considered the Gold Standard for the detection of Cryptosporidium spp., the negative staining technique of Heine should be reconsidered as the screening technique of first choice. Advantages of the negative staining technique of Heine over the modified Ziehl-Neelsen staining are discussed
Fifty years of research and fight against tsetse flies and animal trypanosomiasis in Burkina Faso; an overview
No full text
Medical and surgical management of paraneoplastic pyoderma gangrenosum: a case report and review of the literature
No full textWe present a case of a 44-year-old male with pyoderma gangrenosum (PG) presenting simultaneously with diagnosis of acute leukemia. His skin disease was stabilized with corticosteroids and most lesions cleared after chemotherapy-induced remission of the malignancy, but the largest lesion remained necrotic. Surgical treatment of the large necrotic ulcer included debridement followed by split-thickness skin graft while maintaining corticoid therapy. Unfortunately, relapse of the pyoderma gangrenosum with bullous lesions heralded relapse of the ultimately fatal malignancy. This case illustrates: (1) PG presenting simultaneously with a haematologic malignancy (2) Relapse with atypical bullous lesions with return of the malignancy and (3) The use of surgical modalities in managing patients with PG, a disease notorious for surgical complications
Predictors of HIV testing among patients with tuberculosis in north west Ethiopia: a case-control study
No full textBACKGROUND: The acceptance of HIV testing among patients with tuberculosis (TB) is low in Ethiopia. The purpose of this study was to assess predictors of acceptance of HIV testing among patients with TB in North Ethiopia. METHODS: A case control study was conducted in eight randomly selected health facilities in North Ethiopia from February 5 to March 11, 2009. A total of 282 participants (188 controls and 94 cases) were included in the study. Cases were TB patients who refused to be tested for HIV. We used quantitative and qualitative methods of data collection. For the quantitative survey, cases and controls were interviewed by trained nurses using a pre-tested and structured questionnaire. In-depth interviews were conducted with 5 nurse counselors and 15 TB patients. Bivariate and multivariate analysis was done using SPSS 16.0 statistical software. RESULTS: The uptake of HIV testing among TB patients in the study health facilities was 70.6%. The rate of TB/HIV co-infection in those who were tested was 36.2%. From the source population, a total of 282 participants were included in the study. TB patients who had formal education [OR = 2.35, (95%CI: 1.33, 4.13)], high awareness about the benefits of HIV counseling and testing [OR = 3.14, 95%CI: 1.77, 5.50)], and a low stigmatized attitude [OR = 3.16, 95%CI: 1.79, 5.59)] were more likely to accept HIV testing. The qualitative study also revealed that low awareness and stigma were the major reasons for non-acceptance of HIV testing. CONCLUSION: "Knowledge and attitude" factors were the major barriers for HIV testing. Tailored training should be given to TB patients and the community concerning the benefits of HIV testing. During counseling sessions, health workers should focus on barriers of uptake of HIV testing such as stigma and discrimination
Development of an in vitro dual-chamber model of the female genital tract as a screening tool for epithelial toxicity
No full textHeterosexual transmission of human immunodeficiency virus (HIV-1) is the predominant mode of infection worldwide. However, the early steps of transepithelial infection still need to be clarified. Using epithelial cells, originating from the female genital tract, and peripheral blood mononuclear cells as subepithelial target cells, an in vitro dual-chamber model of the female genital tract was developed. Remarkably, an intact layer of some cell types (HEC-1A, CaSki and Ect1) served as a protective barrier against cell-free but not against cell-associated HIV-1 that crossed the epithelial barrier through transmigration. Furthermore, dysfunctions of the epithelial layers were assessed by monitoring transepithelial electric resistance and transepithelial passage of FluoSpheres and HIV-1 after treatment with nonoxynol-9 (N-9). Most of the functional assays showed dysfunction of the epithelial barrier at lower concentrations compared to a widely used colorimetric toxicity assay (WST-1). Finally, N-9 treatment caused a significant increase in the production of interleukin-8 (IL-8) and macrophage inflammatory protein-3alpha (MIP-3alpha) and a decrease of Secretory Leukocyte Protease Inhibitor (SLPI) and Monocyte Chemotactic Protein-1 (MCP-1) in this model. In conclusion, this model is a useful tool to (1) study HIV-1 transmission mechanisms and (2) evaluate epithelial toxicity of candidate microbicides. Copyright 2010 Elsevier B.V. All rights reserved