1.  Title: Oral contraceptives and the risk of multiple sclerosis: A review of the epidemiologic evidence. Author: Alonso A; Clark CJ Source: Journal of the Neurological Sciences. 2009 May 7; Abstract: Multiple sclerosis (MS) is more frequent in women than in men, suggesting that sex hormones could play a role in the development of MS. For this reason, several studies have assessed whether use of oral contraceptives modifies the risk of MS. In this article, we review the methodology and results of published epidemiologic studies addressing this issue. On the whole, the existing epidemiologic evidence does not support an important effect of oral contraceptive use on the risk of MS, though it does suggest that oral contraceptives might delay the onset of the disease. Language: English Keywords: UNITED KINGDOM | UNITED STATES OF AMERICA | LITERATURE REVIEW | CLINICAL RESEARCH | EPIDEMIOLOGIC METHODS | WOMEN | ORAL CONTRACEPTIVES, SIDE EFFECTS | CONTRACEPTIVE SAFETY | CENTRAL NERVOUS SYSTEM EFFECTS | RISK ASSESSMENT | EPIDEMIOLOGY | Developed Countries | Europe, Western | Europe | North America | Americas | Research Methodology | Demographic Factors | Population | Safety | Public Health | Health | Central Nervous System | Physiology | Biology | Evaluation Document Number: 341145 |
| 2. Title: The prevalence of motor delay among HIV infected children living in Cape Town, South Africa. Author: Ferguson G; Jelsma J Source: International Journal of Rehabilitation Research. 2009 Jun;32(2):108-14. Abstract: Children living with HIV often display delayed motor performance owing to HIV infection of the central nervous system, the effects of opportunistic infections and, indirectly, owing to their social environments. Although these problems have been well documented, the impact of the virus on the development of South African children is less well known. The aim of this study was to document the motor performance of a group of HIV infected children in Cape Town, South Africa. The Bayley Scales of Infant Development Second Edition were administered to 51 HIV infected children [mean age 15.8 months (SD=7.5, range 6.2-31.7 months)] of whom 34 were receiving antiretroviral therapy. Their performance was compared with an age-matched reference sample (n=35), whose HIV status was unknown. The HIV infected sample and the age-matched sample were comparable with regard to caregiver's level of education (P=0.42), employment status (P=0.35) and income (P=0.28). However, the HIV infected sample had significantly more hospital admissions (P<0.01), their caregivers were mostly single (P=0.04) and most lived in formal houses (P<0.01). The prevalence of significant motor delay was 66.7% in the HIV infected sample compared with 5.7% in the age-matched sample. As expected, the performance of the HIV infected sample was significantly poorer than the age-matched sample. However, the extent of the delay is a cause of concern as so many children presented with significant motor delay. Unexpectedly, a significant number of healthy children also displayed delayed performance. It is recommended that the developmental performance of HIV infected children be monitored over an extended period to determine whether the developmental delay can be reduced with treatment. In the interim, there is a need to provide stimulation and treatment to the large number of children who are developmentally delayed as a result of HIV infection, including those uninfected children in the community who are at risk owing to their socio-economic status. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | SAMPLING STUDIES | PERSONS LIVING WITH HIV/AIDS | CHILDREN | ANTIRETROVIRAL THERAPY | CHILD DEVELOPMENT | CENTRAL NERVOUS SYSTEM EFFECTS | PREVALENCE | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Studies | Research Methodology | HIV Infections | Viral Diseases | Diseases | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | HIV | Biology | Central Nervous System | Physiology | Measurement Document Number: 342451 |
| 3. Peer Reviewed Title: The burden of HIV-associated cryptococcal disease [editorial] Author: Harrison TS Source: AIDS. 2009 Feb 20;23(4):531-2. Abstract: In this issue, Park et al. from the Centers for Disease Control, University of Alabama, and Johannesburg, South Africa, have made the first attempt to estimate the global burden of HIV-associated cryptococcal infection. As clearly stated by the authors, the estimates are exactly that -estimates, which rely on the quality of the data on which they are based. Nevertheless, the results are striking, especially for sub-Saharan Africa, where the estimated number of deaths associated with cryptococcal disease, at half a million per year, is comparable with the number attributed to tuberculosis, a much more frequent infection, but one for which we have much more effective and widely available therapy. So are these results credible? The data are sparse, with just three incidence studies driving the estimates for sub- Saharan Africa (ruling out the possibility of evaluating or taking account of possible intraregional differences in incidence); and the reported incidences are variable, resulting in wide ranges for the estimates of cases and associated deaths. However, biases are as possible on the downside as on the upside. As the authors acknowledge, the relatively low incidence estimate from a South African study with which some of the same authors were involved was likely affected by incomplete case ascertainment. (excerpt) Language: English Keywords: GLOBAL | CRITIQUE | METHODOLOGICAL STUDIES | EPIDEMIOLOGIC METHODS | ESTIMATION TECHNIQUES | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | COMPLICATIONS | PREVALENCE | CAUSES OF DEATH | DEATH RATE | ANTIRETROVIRAL THERAPY | CENTRAL NERVOUS SYSTEM EFFECTS | Studies | Research Methodology | Viral Diseases | Diseases | Measurement | Mortality | Population Dynamics | Demographic Factors | Population | HIV | Central Nervous System | Physiology | Biology Document Number: 341160 |
| 4. Title: Self-reported and P3 event-related potential evaluations of condoms: does what we say match how we feel? Author: Lust SA; Bartholow BD Source: Psychophysiology. 2009 Mar;46(2):420-4. Abstract: Research consistently reveals positive self-reported condom evaluations, yet such evaluations often do not predict condom use. Whereas positive self-reports likely reflect social norms regarding prevention of diseases and pregnancy, psychophysiological measures might better assess spontaneous condom evaluations. Here, participants completed a visual oddball task in which condoms and alcoholic beverages were infrequent targets among neutral, positive, and negative context images. Although self-reported condom evaluations were very positive, condom images presented in a negative context produced a smaller P3 than condom images presented in a neutral or positive context, suggesting that spontaneous condom evaluations were more negative than positive. The P3 elicited by alcohol images indicated positive evaluations. The findings underscore the multifaceted nature of evaluations and point to the utility of ERPs for assessing health-related attitudes. Language: English Keywords: MISSOURI | RESEARCH REPORT | KAP SURVEYS | STUDENTS | CONDOM USE | UNIVERSITIES | SELF-PERCEPTION | ALCOHOL USE AND ABUSE | VALUE ORIENTATION | SEXUALLY TRANSMITTED DISEASE PREVENTION | CONTRACEPTION | ATTITUDES | PHYSIOLOGY | CENTRAL NERVOUS SYSTEM EFFECTS | Developed Countries | United States of America | North America | Americas | Surveys | Sampling Studies | Studies | Research Methodology | Education | Risk Reduction Behavior | Behavior | Schools | Perception | Psychological Factors | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Diseases | Family Planning | Biology | Central Nervous System Document Number: 331226 |
| 5. Title: Why use of dienogest for the first contraceptive pill with estradiol? Author: Mueck AO; Seeger H; Buhling KJ Source: Gynecological Endocrinology. 2009 Aug 11;:1-5. Abstract: Dienogest (DNG) has the essential properties of an effective progestogen for use in a new contraceptive pill using estradiol valerate as estrogenic component - it inhibits ovulation and protects against endometrial proliferation. DNG is a derivative of norethisterone (NET), but has a cyanomethyl- instead of an ethinyl-group in C17 position which may offer a variety of benefits regarding hepatic effects. The similarity to NET is reflected in the high endometriotropy and in similar pharmacokinetics like short plasma half-live and high bioavailability. However, DNG also elicits properties of progesterone derivatives like neutrality in metabolic and cardiovascular system and considerable antiandrogenic activity, the latter increased by lack of binding to SHBG as specific property of DNG. It has no glucocorticoid and antimineralocorticoid activity and has no antiestrogenic activity with the consequence that possible beneficial estradiol effects should not be antagonized. This may be of special importance for the tolerability and safety of the first pill with estradiol valerate instead of ethinylestradiol, although well-designed postmarketing studies are still ongoing to demonstrate what can be expected on the basis of pharmacology. Language: English Keywords: GERMANY | CRITIQUE | ORAL CONTRACEPTIVES, PHASIC | LOW-DOSE PROGESTINS | ESTRADIOL | CONTRACEPTIVE SAFETY | ENDOMETRIAL EFFECTS | HEPATIC EFFECTS | CENTRAL NERVOUS SYSTEM EFFECTS | MENSTRUAL CYCLE | HORMONE REPLACEMENT THERAPY | Europe, Central | Europe | Developed Countries | Oral Contraceptives, Combined | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Estrogens | Hormones | Endocrine System | Physiology | Biology | Safety | Public Health | Health | Endometrium | Uterus | Genitalia, Female | Genitalia | Urogenital System | Central Nervous System | Menstruation | Reproduction | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care Document Number: 342487 |
| 6. Peer Reviewed Title: Age patterns of severe paediatric malaria and their relationship to Plasmodium falciparum transmission intensity. Author: Okiro EA; Al-Taiar A; Reyburn H; Idro R; Berkley JA; Snow RW Source: Malaria Journal. 2009;8:4. Abstract: BACKGROUND: The understanding of the epidemiology of severe malaria in African children remains incomplete across the spectrum of Plasmodium falciparum transmission intensities through which communities might expect to transition, as intervention coverage expands. METHODS: Paediatric admission data were assembled from 13 hospitals serving 17 communities between 1990 and 2007. Estimates of Plasmodium falciparum transmission intensity in these communities were assembled to be spatially and temporally congruent to the clinical admission data. The analysis focused on the relationships between community derived parasite prevalence and the age and clinical presentation of paediatric malaria in children aged 0-9 years admitted to hospital. RESULTS: As transmission intensity declined a greater proportion of malaria admissions were in older children. There was a strong linear relationship between increasing transmission intensity and the proportion of paediatric malaria admissions that were infants (R2 = 0.73, p < 0.001). Cerebral malaria was reported among 4% and severe malaria anaemia among 17% of all malaria admissions. At higher transmission intensity cerebral malaria was a less common presentation compared to lower transmission sites. There was no obvious relationship between the proportions of children with severe malaria anaemia and transmission intensity. CONCLUSION: As the intensity of malaria transmission declines in Africa through the scaling up of insecticide-treated nets and other vector control measures a focus of disease prevention among very young children becomes less appropriate. The understanding of the relationship between parasite exposure and patterns of disease risk should be used to adapt malaria control strategies in different epidemiological settings. Language: English Keywords: AFRICA, SUB SAHARAN | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | CHILDREN | COMMUNITY | PREVALENCE | AGE FACTORS | MALARIA | HUMAN GEOGRAPHY | TIME FACTORS | LOCALE | CENTRAL NERVOUS SYSTEM EFFECTS | ANEMIA | INFECTION TRANSMISSION | Africa | Developing Countries | Research Methodology | Youth | Population Characteristics | Demographic Factors | Population | Residence Characteristics | Population Distribution | Geographic Factors | Measurement | Parasitic Diseases | Diseases | Geography | Social Sciences | Science | Sociocultural Factors | Population Dynamics | Central Nervous System | Physiology | Biology | Infections Document Number: 330371 |
| 7. Title: Antiepileptic drugs: are women aware of interactions with oral contraceptives and potential teratogenicity? Author: Pack AM; Davis AR; Kritzer J; Yoon A; Camus A Source: Epilepsy and Behavior. 2009 Apr;14(4):640-4. Abstract: Women with epilepsy (WWE)'s knowledge of the interaction between antiepileptic drugs (AEDs) and oral contraceptives (OCs) and the potential teratogenicity of AEDs has received limited study. We conducted a cross-sectional questionnaire study (English or Spanish) among young WWE (18-44 years) to assess demographic characteristics, current AED use, and knowledge of AED interactions with OCs and teratogenicity. We used the Food and Drug Administration's classification system to categorize each AED's teratogenic potential. Participants (n=148) had a mean age of 32 years (SD 8); 32% spoke Spanish and described themselves as Hispanic. Among women prescribed a cytochrome p450-inducing AED, 65% were unaware of decreased OC efficacy. Forty percent of those prescribed Category D AEDs were unaware of potential teratogenic effects. WWE have limited knowledge of the potential interaction between AEDs and OCs and the teratogenic effects of AEDs. Educational efforts should highlight the reproductive health effects of AEDs in WWE. Language: English Keywords: NEW YORK | RESEARCH REPORT | KAP SURVEYS | CROSS SECTIONAL ANALYSIS | WOMEN | HISPANICS | ORAL CONTRACEPTIVES, SIDE EFFECTS | DRUG INTERACTIONS | CENTRAL NERVOUS SYSTEM EFFECTS | KNOWLEDGE | Developed Countries | United States of America | North America | Americas | Surveys | Sampling Studies | Studies | Research Methodology | Demographic Factors | Population | Ethnic Groups | Cultural Background | Population Characteristics | Contraceptive Safety | Safety | Public Health | Health | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Central Nervous System | Physiology | Biology | Sociocultural Factors Document Number: 341110 |
| 8. Peer Reviewed Title: Estimation of the current global burden of cryptococcal meningitis among persons living with HIV/AIDS. Author: Park BJ; Wannemuehler KA; Marston BJ; Govender N; Pappas PG; Chiller TM Source: AIDS. 2009 Feb 20;23(4):525-30. Abstract: OBJECTIVE: Cryptococcal meningitis is one of the most important HIV-related opportunistic infections, especially in the developing world. In order to help develop global strategies and priorities for prevention and treatment, it is important to estimate the burden of cryptococcal meningitis. DESIGN: Global burden of disease estimation using published studies. METHODS: We used the median incidence rate of available studies in a geographic region to estimate the region-specific cryptococcal meningitis incidence; this was multiplied by the 2007 United Nations Programme on HIV/AIDS HIV population estimate for each region to estimate cryptococcal meningitis cases. To estimate deaths, we assumed a 9% 3-month case-fatality rate among high-income regions, a 55% rate among low-income and middle-income regions, and a 70% rate in sub-Saharan Africa, based on studies published in these areas and expert opinion. RESULTS: Published incidence ranged from 0.04 to 12% per year among persons with HIV. Sub-Saharan Africa had the highest yearly burden estimate (median incidence 3.2%, 720 000 cases; range, 144 000-1.3 million). Median incidence was lowest in Western and Central Europe and Oceania (Language: English Keywords: GLOBAL | AFRICA, SUB SAHARAN | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | ESTIMATION TECHNIQUES | CROSS-CULTURAL COMPARISONS | PERSONS LIVING WITH HIV/AIDS | PREVALENCE | CENTRAL NERVOUS SYSTEM EFFECTS | MENINGITIS | COMPLICATIONS | HUMAN GEOGRAPHY | DEATH RATE | ECONOMIC DEVELOPMENT | Africa | Developing Countries | Research Methodology | Comparative Studies | Studies | HIV Infections | Viral Diseases | Diseases | Measurement | Central Nervous System | Physiology | Biology | Geography | Social Sciences | Science | Sociocultural Factors | Mortality | Population Dynamics | Demographic Factors | Population | Economic Factors Document Number: 341165 |
| 9. Title: Benefits and risks of stavudine therapy for HIV-associated neurologic complications in Uganda. Author: Sacktor N; Nakasujja N; Skolasky RL; Robertson K; Musisi S; Ronald A; Katabira E; Clifford DB Source: Neurology. 2009 Jan 13;72(2):165-70. Abstract: BACKGROUND: The frequency of HIV dementia in a recent study of HIV+ individuals at the Infectious Disease Institute in Kampala, Uganda, was 31%. Coformulated generic drugs, which include stavudine, are the most common regimens to treat HIV infection in Uganda and many other parts of Africa. OBJECTIVE: To evaluate the benefits and risks of stavudine-based highly active antiretroviral therapy (HAART) for HIV-associated cognitive impairment and distal sensory neuropathy. The study compared neuropsychological performance changes in HIV+ individuals initiating HAART for 6 months and HIV- individuals receiving no treatment for 6 months. The risk of antiretroviral toxic neuropathy as a result of the initiation of stavudine-based HAART was also examined. METHODS: At baseline, 102 HIV+ individuals in Uganda received neurologic, neuropsychological, and functional assessments; began HAART; and were followed up for 6 months. Twenty-five HIV- individuals received identical clinical assessments and were followed up for 6 months. RESULTS: In HIV+ individuals, there was improvement in verbal memory, motor and psychomotor speed, executive thinking, and verbal fluency. After adjusting for differences in sex, HIV+ individuals demonstrated significant improvement in the Color Trails 2 test (p = 0.025) compared with HIV- individuals. Symptoms of neuropathy developed in 38% of previously asymptomatic HIV+ patients after initiation of the stavudine-based HAART. CONCLUSIONS: After the initiation of highly active antiretroviral therapy (HAART) including stavudine, HIV+ individuals with cognitive impairment improve significantly as demonstrated by improved performance on a test of executive function. However, peripheral neurotoxicity occurred in 30 patients, presumably because of stavudine-based HAART, suggesting the need for less toxic therapy. Language: English Keywords: UGANDA | RESEARCH REPORT | CLINICAL RESEARCH | PERSONS LIVING WITH HIV/AIDS | CENTRAL NERVOUS SYSTEM EFFECTS | COMPLICATIONS | AIDS | MENTAL DISORDERS | ANTIRETROVIRAL THERAPY | TOXICITY | PSYCHOLOGICAL FACTORS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Central Nervous System | Physiology | Biology | HIV | Behavior Document Number: 330235 |
10.  Peer Reviewed Title: Clinical malaria in African pregnant women. Author: Bardaji A; Sigauque B; Romagosa C; Bruni L; Sanz S Source: Malaria Journal. 2008 Jan 30;7(27):[23] p. Abstract: There is a widespread notion, based on limited information, that in areas of stable malaria transmission most pregnant women with Plasmodium falciparum infection are asymptomatic. This study aim to characterize the clinical presentation of malaria in African pregnant women and to evaluate the adequacy of case management based on clinical complaints. A hospital-based descriptive study between August 2003 and November 2005 was conducted at the maternity clinic of a rural hospital in Mozambique. All women attending the maternity clinic were invited to participate. A total of 2,330 women made 3,437 eligible visits, 3129 were analysed, the remainder were excluded because diagnostic results were unavailable or they were repeat visits. Women gave a standardized clinical history and had a medical exam. Malaria parasitaemia and haematocrit in capillary blood was determined for all women with signs or symptoms compatible with malaria including: presence and history of fever, arthromyalgias, headache, history of convulsions and pallor. Outcome measure was association of malaria symptoms or signs with positive blood slide for malaria parasitaemia. In 77.4% of visits pregnant women had symptoms suggestive of malaria; 23% (708/3129) were in the first trimester. Malaria parasitaemia was confirmed in 26.9% (842/3129) of visits. Headache, arthromyalgias and history of fever were the most common symptoms (86.5%, 74.8% and 65.4%) presented, but their positive predictive values for malaria parasitaemia were low [28% (27-30), 29% (28-31), and 33% (31-35), respectively]. Symptoms suggestive of malaria were very frequent among pregnant women attending a rural maternity clinic in an area of stable malaria transmission. However, less than a third of them were parasitaemic. In the absence of microscopy or rapid diagnostic tests, a large proportion of women, including those in the first trimester of gestation, would be unnecessarily receiving antimalarial drugs, often those with unknown safety profiles for pregnancy. Accessibility to malaria diagnostic tools needs to be improved for pregnant women and drugs with a safety profile in all gestational ages are urgently needed. (author's) Language: English Keywords: MOZAMBIQUE | RESEARCH REPORT | CLINICAL RESEARCH | EPIDEMIOLOGIC METHODS | PREGNANT WOMEN | WOMEN IN DEVELOPMENT | MALARIA | HEMATOCRIT | SIGNS AND SYMPTOMS | FEVER | HEADACHE | CENTRAL NERVOUS SYSTEM EFFECTS | PREVALENCE | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | Parasitic Diseases | Diseases | Laboratory Procedures | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Body Temperature | Physiology | Biology | Central Nervous System | Measurement Document Number: 324321 |
| 11. Title: Facilitated acquisition of the classically conditioned eyeblink response in women taking oral contraceptives. Author: Beck KD; McLaughlin J; Bergen MT; Cominski TP; Moldow RL; Servatius RJ Source: Behavioural Pharmacology. 2008 Dec;19(8):821-8. Abstract: Although anecdotal reports suggest that associative learning processes are affected by menstrual phase, empirical evidence has been equivocal. Moreover, there is a dearth of research concerning fluctuations of artificial or exogenous female hormones on learning and memory. Therefore, in this preliminary study we assessed learning in women who take oral contraceptives and those who do not during the three phases of the menstrual cycle: early, middle, and later cycle. The behavioral assessment included short-trace eyeblink conditioning, acoustic startle reactivity, and a fine motor coordination task (grooved pegboard). Oral contraceptive users generally acquired the conditioned eyeblink response better than non-users. Similar enhancements were observed for fine motor coordination and startle responsiveness. Further research will need to distinguish whether the hormone influence is upon the associative processes or the sensory-motor pathways involved in nonassociative learning. Language: English Keywords: NEW JERSEY | RESEARCH REPORT | CLINICAL RESEARCH | CASE CONTROL STUDIES | WOMEN | ORAL CONTRACEPTIVES, SIDE EFFECTS | OPHTHALMOLOGICAL EFFECTS | EYESIGHT | MENSTRUAL CYCLE | BEHAVIOR | CENTRAL NERVOUS SYSTEM EFFECTS | SENSORY EFFECTS | United States of America | North America | Americas | Developed Countries | Research Methodology | Studies | Demographic Factors | Population | Contraceptive Safety | Safety | Public Health | Health | Physiology | Biology | Menstruation | Reproduction | Central Nervous System Document Number: 330965 |
| 12. Title: Effect of antiepileptic drugs on oral contraceptives. Author: Carl JS; Weaver SP; Tweed E; Edgerton L Source: American Family Physician. 2008 Sep 1;78(5):634-5. Abstract: Clinical Question: Do antiepileptic drugs affect oral contraceptive effectiveness? Evidence-Based Answer: We found no studies that measure, or even estimate, any increase in pregnancy rates in women taking antiepileptic drugs. Antiepileptic drugs known to induce the hepatic cytochrome P450 (CYP450) isoenzyme cause decreased sex hormone levels in women taking oral contraceptives, raising the potential for decreased effectiveness of oral contraceptives and increased risk of unplanned pregnancy. (Strength of Recommendation [SOR]: C, based on small cohort studies). Antiepileptic drugs that do not induce this hepatic isoenzyme are not thought to compromise the effectiveness of oral contraceptives. (SOR: C, based on small cohort studies and randomized controlled trials). (excerpt) Language: English Keywords: UNITED STATES OF AMERICA | CRITIQUE | RECOMMENDATIONS | CLINICAL RESEARCH | WOMEN | DRUG INTERACTIONS | ORAL CONTRACEPTIVES | ORAL CONTRACEPTIVES, LOW-DOSE | CONTRACEPTIVE EFFECTIVENESS | CENTRAL NERVOUS SYSTEM EFFECTS | ENZYMATIC EFFECTS | CONTRACEPTIVE AGENTS, ESTROGEN | ADMINISTRATION AND DOSAGE | ORAL CONTRACEPTIVES, CONTRAINDICATIONS | Developed Countries | North America | Americas | Research Methodology | Demographic Factors | Population | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Contraceptive Methods | Contraception | Family Planning | Central Nervous System | Physiology | Biology | Enzymes and Enzyme Inhibitors | Contraceptive Agents, Female | Contraceptive Agents | Contraceptive Safety | Safety | Public Health Document Number: 328504 |
| 13. Peer Reviewed Title: Antiretroviral drugs for preventing mother-to-child transmission of HIV in sub-Saharan Africa: balancing efficacy and infant toxicity. Author: Ciaranello AL; Seage GR 3rd; Freedberg KA; Weinstein MC; Lockman S; Walensky RP Source: AIDS. 2008 Nov 12;22(17):2359-69. Abstract: OBJECTIVE: Antiretroviral drugs can prevent mother-to-child transmission of HIV infection, but in-utero antiretroviral exposure may be associated with neurologic symptoms due to mitochondrial toxicity. We sought to identify the currently recommended regimen to prevent mother-to-child transmission that optimally balances risks of pediatric HIV infection and neurologic mitochondrial toxicity. DESIGN: Published MTCT and mitochondrial toxicity data were used in a decision analytic model of MTCT among women in sub-Saharan Africa. METHODS: We investigated the HIV and mitochondrial toxicity risks associated with no antiretroviral prophylaxis and five recommended regimens ranging from single-dose nevirapine to three-drug antiretroviral therapy (ART). Sensitivity analyses varied all parameters, including infant feeding strategy and the disability of mitochondrial toxicity relative to HIV. RESULTS: Provision of no antiretroviral drugs is the least effective and least toxic strategy, with 18-month HIV risk of 30.4% and mitochondrial toxicity risk of 0.2% (breastfed infants). With increasing drug number and duration, HIV risk decreases markedly (to 4.9% with three-drug ART), but mitochondrial toxicity risk also increases (to 2.2%, also with three-drug ART). Despite increased toxicity, three-drug ART minimizes total adverse pediatric outcomes (HIV plus mitochondrial toxicity), unless the highest published risks are true for both HIV and mitochondrial toxicity, or the disability from mitochondrial toxicity exceeds 6.4 times that of HIV infection. CONCLUSION: The risk of pediatric mitochondrial toxicity from effective regimens to prevent mother-to-child transmission is at least an order of magnitude lower than the risk of HIV infection associated with less-effective regimens. Concern regarding mitochondrial toxicity should not currently limit the use of three-drug ART to prevent mother-to-child transmission where it is available. Language: English Keywords: AFRICA, SUB SAHARAN | RESEARCH REPORT | CLINICAL RESEARCH | COMPARATIVE STUDIES | FETUS | TOXICITY | ANTIRETROVIRAL THERAPY | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | HIV PREVENTION | CENTRAL NERVOUS SYSTEM EFFECTS | ADMINISTRATION AND DOSAGE | BREASTFEEDING | TIME FACTORS | Africa | Developing Countries | Research Methodology | Studies | Pregnancy | Reproduction | Physiology | Biology | HIV | HIV Infections | Viral Diseases | Diseases | Disease Transmission Control | Prevention and Control | Central Nervous System | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Infant Nutrition | Nutrition | Population Dynamics | Demographic Factors | Population Document Number: 330275 |
| 14. Peer Reviewed Title: The relationship between age and the manifestations of and mortality associated with severe malaria. Author: Dondorp AM; Lee SJ; Faiz MA; Mishra S; Price R Source: Clinical Infectious Diseases. 2008 Jul;47(2):151-157. Abstract: The reported case-fatality rate associated with severe malaria varies widely. Whether age is an independent risk factor is uncertain. In a large, multicenter treatment trial conducted in Asia, the presenting manifestations and outcome of severe malaria were analyzed in relation to age. Among 1050 patients with severe malaria, the mortality increased stepwise, from 6.1% in children (age, less than 10 years) to 36.5% in patients aged greater than 50 years (P less than .001). Compared with adults aged 21-50 years, the decreased risk of death among children (adjusted odds ratio, 0.06; 95% confidence interval, 0.01-0.23; P less than .001) and the increased risk of death among patients aged greater than 50 years (adjusted odds ratio, 1.88; 95% confidence interval, 1.01-3.52; P = .046) was independent of the variation in presenting manifestations. The incidence of anemia and convulsions decreased with age, whereas the incidence of hyperparasitemia, jaundice, and renal insufficiency increased with age. Coma and metabolic acidosis did not vary with age and were the strongest predictors of a fatal outcome. The number of severity signs at hospital admission also had a strong prognostic value. Presenting syndromes in severe malaria depend on age, although the incidence and the strong prognostic significance of coma and acidosis are similar at all ages. Age is an independent risk factor for a fatal outcome of the disease. (author's) Language: English Keywords: ASIA | RESEARCH REPORT | CLINICAL RESEARCH | EPIDEMIOLOGIC METHODS | MALARIA | AGE FACTORS | DEATH RATE | ANEMIA | CAUSES OF DEATH | JAUNDICE | CENTRAL NERVOUS SYSTEM EFFECTS | RENAL EFFECTS | METABOLIC EFFECTS | PREVALENCE | COMPLICATIONS | Developing Countries | Research Methodology | Parasitic Diseases | Diseases | Population Characteristics | Demographic Factors | Population | Mortality | Population Dynamics | Signs and Symptoms | Central Nervous System | Physiology | Biology | Urogenital Effects | Urogenital System | Measurement Document Number: 327407 |
| 15. Peer Reviewed Title: Plasmodium vivax and mixed infections are associated with severe malaria in children: A prospective cohort study from Papua New Guinea. Author: Genton B; D’Acremont V; Rare L; Baea K; Reeder JC Source: PLoS Medicine. 2008 Jun;5(6):e127. Abstract: Severe malaria (SM) is classically associated with Plasmodium falciparum infection. Little information is available on the contribution of P. vivax to severe disease. There are some epidemiological indications that P. vivax or mixed infections protect against complications and deaths. A large morbidity surveillance conducted in an area where the four species coexist allowed us to estimate rates of SM among patients infected with one or several species. This was a prospective cohort study conducted within the framework of the Malaria Vaccine Epidemiology and Evaluation Project. All presumptive malaria cases presenting at two rural health facilities over an 8-y period were investigated with history taking, clinical examination, and laboratory assessment. Case definition of SM was based on the World Health Organization (WHO) criteria adapted for the setting (i.e., clinical diagnosis of malaria associated with asexual blood stage parasitaemia and recent history of fits, or coma, or respiratory distress, or anaemia [haemoglobin < 5 g/dl]). Out of 17,201 presumptive malaria cases, 9,537 (55%) had a confirmed Plasmodium parasitaemia. Among those, 6.2% (95% confidence interval [CI] 5.7%-6.8%) fulfilled the case definition of SM, most of them in children < 5 y. In this age group, the proportion of SM was 11.7% (10.4%-13.2%) for P. falciparum, 8.8% (7.1%-10.7%) for P. vivax, and 17.3% (11.7%-24.2%) for mixed P. falciparum and P. vivax infections. P. vivax SM presented more often with respiratory distress than did P. falciparum (60% versus 41%, p = 0.002), but less often with anaemia (19% versus 41%, p = 0.0001). P. vivax monoinfections as well as mixed Plasmodium infections are associated with SM. There is no indication that mixed infections protected against SM. Interventions targeted toward P. falciparum only might be insufficient to eliminate the overall malaria burden, and especially severe disease, in areas where P. falciparum and P. vivax coexist. (author's) Language: English Keywords: PAPUA NEW GUINEA | RESEARCH REPORT | COHORT ANALYSIS | CLINICAL RESEARCH | EPIDEMIOLOGIC METHODS | PROSPECTIVE STUDIES | CHILDREN | RURAL POPULATION | COMPLICATIONS | MALARIA | INFECTIONS | PREVALENCE | ANEMIA | RESPIRATORY INSUFFICIENCY | CENTRAL NERVOUS SYSTEM EFFECTS | Oceania | Developing Countries | Research Methodology | Studies | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Diseases | Parasitic Diseases | Measurement | Pulmonary Effects | Physiology | Biology | Central Nervous System Document Number: 327412 |
| 16. Peer Reviewed Title: Developmental status at age 12 months according to birth weight and family income: a comparison of two Brazilian birth cohorts. Author: Halpern R; Barros AJ; Matijasevich A; Santos IS; Victora CG; Barros FC Source: Cadernos de Saude Publica. 2008;24 Suppl 3:S444-50. Abstract: Two cohorts of children born in the city of Pelotas, Southern Brazil, in 1993 and 2004, were compared in terms of neuro-psychomotor development at the age of 12 months. Children were evaluated using the Denver II screening test. Analyses were performed using the Poisson regression technique. The prevalence of suspected developmental delay fell from 37.1% in 1993 to 21.4% in 2004 and was inversely proportional to family income and birth weight. Among children born weighing under 2,000 g, there was a fourfold reduction in the prevalence of developmental delay between 1993 and 2004. With regard to family income, the poorest group showed the greatest reduction between the two cohorts--a 30% reduction in risk. Our results confirm the influence of income and birth weight on child development. The decrease in the prevalence of developmental delay in the last decade reflects, among other factors, improvements in neonatal care, increased coverage of developmental monitoring in the first year of life, and longer breastfeeding duration. Despite this reduction, the prevalence of developmental delay is still high, reinforcing the need for early diagnosis and intervention. Language: English Keywords: BRAZIL | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | COHORT ANALYSIS | LONGITUDINAL STUDIES | INFANT | PREVALENCE | CHILD DEVELOPMENT | BIRTH WEIGHT | INCOME | CENTRAL NERVOUS SYSTEM EFFECTS | SEX FACTORS | Developing Countries | South America, Eastern | South America | Latin America | Americas | Research Methodology | Studies | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Measurement | Biology | Body Weight | Physiology | Socioeconomic Factors | Economic Factors | Central Nervous System Document Number: 330449 |
| 17. Title: Computer tomographic findings of the brain in HIV-patients at Ramathibodi Hospital. Author: Hongsakul K; Laothamatas J Source: Journal of the Medical Association of Thailand. 2008 Jun;91(6):895-907. Abstract: OBJECTIVE: To determine the underlying cause of the brain lesions in adult HIV patients referred for CT scan at Ramathibodi Hospital and to evaluate accuracy of CT for the diagnosis of the brain lesion. MATERIAL AND METHOD: Data from first CT scan of the brain of 195 adult HIV patients at Ramathibodi Hospital were reviewed The final diagnoses from medical records were assessed followed by CSF analysis, pathological report, and therapeutic treatment. The accuracy of the CT brain was evaluated using sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). RESULTS: One hundred ninety five adult seropositive patients for HIV underwent CT scan of the brain, 59% were HIV encephalopathy (HIVE), 22% toxoplasmosis, 9% cryptococcoma, 5% tuberculous meningitis, 4% tuberculoma, 3% progressive multifocal leukoencephalopathy (PML), 2% lymphoma, and 1% normal. In non-specified causes (from CT scan), 33% were meningitis, 4% cerebritis, and 5% infarction. CT was found to have high sensitivity, specificity, PPV, and NPV for toxoplasmosis (92%, 96%, 86%, and 98%, respectively). CONCLUSION: HIV encephalopathy was the most common finding of adult HIV brains. Toxoplasmosis was the most common opportunistic parenchymal brain lesion in adult HIV brains. CT was the modality of choice for diagnosis and exclusion of toxoplasmosis, but it cannot determine the cause of disease showing meningitis pattern. Language: English Keywords: PAKISTAN | RESEARCH REPORT | PERSONS LIVING WITH HIV/AIDS | TESTING | CENTRAL NERVOUS SYSTEM EFFECTS | COMPUTERS | EXAMINATIONS AND DIAGNOSES | Developing Countries | Asia, Southern | Asia | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Measurement | Research Methodology | Central Nervous System | Physiology | Biology | Information Processing | Information | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 328715 |
| 18. Title: Effect of an oral contraceptive with chlormadinone acetate on depressive mood : analysis of data from four observational studies. Author: Huber JC; Heskamp ML; Schramm GA Source: Clinical Drug Investigation. 2008;28(12):783-91. Abstract: BACKGROUND and objective: Many women of reproductive age experience depressive mood symptoms such as sudden mood swings, irritability, nervousness, excitability and anxiety. Although not defined as a disease, these disturbing mental symptoms are associated with a considerable decrease in quality of life. Molecular pharmacology research over the last 20 years has shown that endogenous steroid hormones may interact with the CNS. Some of these hormones, i.e. the sex hormone progesterone and its 3alpha-reduced metabolites allopregnanolone (3alpha,5alpha-tetrahydroprogesterone) and epipregnanolone (3alpha,5beta-tetrahydroprogesterone, eltanolone), influence mood-balancing and anxiolytic effects via the gamma-aminobutyric acid receptor A (GABA(A)), a major inhibiting receptor of the CNS. Activation of GABA(A) receptor results in mood balancing, anxiolytic, antiepileptic and sedative actions. When oral contraception is considered, it should be taken into account that the various synthetic progestogens used may differ in their influence on mental state. For instance, there is strong clinical evidence of mood-balancing effects for the progesterone derivative chlormadinone acetate (CMA). The aim of these studies was to describe the clinical effects of CMA in combination with ethinylestradiol on depressive mood symptoms. METHODS: Data from four prospective, non-interventional observational studies involving nearly 50 000 women were analysed. The studies documented use of four, six and 12 treatment cycles of the 28-day conventional regimen, as well as providing data on extended cycle regimens. The women in these studies were prescribed CMA 2 mg and ethinylestradiol (EE) 0.03 mg according to gynaecologists' usual practice. RESULTS: Clinical data from the studies confirmed that intake of CMA 2 mg and EE 0.03 mg promotes emotional well-being and reduces mood swings. Improvement in depressive mood was documented after four, six and 12 treatment cycles of the conventional intake regimen as well as with an extended-cycle regimen of CMA/EE. CONCLUSION: CMA 2 mg combined with EE 0.3 mg improves symptoms of depressive mood. The high structural congruence between the endogenous GABA(A) modulator epipregnanolone and the CMA metabolite M-V suggests a direct GABAergic, mood stabilizing function of CMA. We propose a theoretical concept - the CMA-GABA(A) model - that could explain the positive psychotropic effect of CMA. Language: English Keywords: GERMANY | RESEARCH REPORT | DATA ANALYSIS | WOMEN | CHLORMADINONE ACETATE | ORAL CONTRACEPTIVES, SIDE EFFECTS | DEPRESSION | EMOTIONS | ETHINYL ESTRADIOL | CENTRAL NERVOUS SYSTEM EFFECTS | Europe, Central | Europe | Developed Countries | Research Methodology | Demographic Factors | Population | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Contraceptive Safety | Safety | Public Health | Health | Mental Disorders | Diseases | Psychological Factors | Behavior | Contraceptive Agents, Estrogen | Central Nervous System | Physiology | Biology Document Number: 329792 |
| 19. Title: Screening for developmental problems at primary care level: A field programme in San Isidro, Argentina. Author: Lejarraga H; Menendez AM; Menzano E; Guerra L; Biancato S Source: Paediatric and Perinatal Epidemiology. 2008 Mar;22(2):180-187. Abstract: Information on prevalence and type of problems of psychomotor development (PPD) is necessary for implementation of specific care programmes at field level. With the purpose of obtaining this information, a screening test, the Prueba Nacional de Pesquisa (PRUNAPE) for PPD was implemented in three health centres in San Isidro, a city near Buenos Aires, attended by different socio-economic groups: centres A and B were located in the inner city, and C in a middle-class area. The test was administered by three previously trained paediatricians to 839 apparently healthy children aged 0-5 years. The failure rates were 24%, 19% and 16% in centres A, B and C respectively (20% in total). Out of the 170 children failing the test and referred to hospital for diagnosis and treatment, only 96 complied and went through a series of studies carried out by a previously prepared multidisciplinary team. With the exception of children who failed the Battelle test [classified as Global Developmental Delay (GDD)], finaldiagnoses were classified according to Diagnostic and Statistical Manual of Mental Disorders, 4th edition: GDD (60 children), pervasive developmental disorders (11), communication disorders (10), motor disorders (6, of whom 2 were with cerebral palsy), attention deficit disorders (5), attachment disorders (2), normal children (3). Co-morbidity was present in 22 affected children. Forty-three per cent of children failing the test did not attend hospital or did not complete studies because of major social and family problems, the family not living in the area, or the parents preferring to consult their own paediatrician. Health centres and children not selected in a randomised way, and a significant proportion of them not complying with the indication of hospital referral were major sources of bias, so that PPD prevalences, positive and negative predictive values should be interpreted with great caution. Further studies accounting for these sources of bias are needed to confirm the observed prevalence of PPD. Training of health personnel, at hospital and health centre level, priority settings, and operational research to evaluate effectiveness of treatments and care delivery systems at field level are necessary in Argentina for optimal use of limited healthcare resources. (author's) Language: English Keywords: ARGENTINA | RESEARCH REPORT | METHODOLOGICAL STUDIES | CLINICAL RESEARCH | EPIDEMIOLOGIC METHODS | CHILDREN | PRIMARY HEALTH CARE | SCREENING | CHILD DEVELOPMENT | CENTRAL NERVOUS SYSTEM EFFECTS | INTERPERSONAL COMMUNICATION | COMPLICATIONS | REFERRAL AND CONSULTATION | South America, Southern | South America | Latin America | Americas | Developing Countries | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Health Services | Delivery of Health Care | Health | Examinations and Diagnoses | Medical Procedures | Medicine | Biology | Central Nervous System | Physiology | Communication | Diseases | Program Activities | Programs | Organization and Administration Document Number: 324778 |
| 20. Title: Lessons learned about opportunistic infections in southeast Asia. Author: Nissapatorn V Source: Southeast Asian Journal of Tropical Medicine and Public Health. 2008 Jul;39(4):625-41. Abstract: Southeast Asia is a region where the number of people infected with HIV/AIDS is one of the fastest growing in the world. Tuberculosis (TB) has grown along with the HIV epidemic. TB is not only the most common AIDS-defining illness but is also the leading cause of morbidity and mortality in AIDS patients. Cryptococcosis (meningitis or disseminated) is one of the most common opportunistic infections in AIDS patients. Cryptococcal meningitis is the first in the differential diagnosis considered with meningeal irritation. Penicillosis, a unique systemic mycosis, is an important emerging public health problem and has been classified as an AIDS defining illness in endemic areas like Thailand. Pneumocystis carinii (jiroveci) pneumonia has been one of the most important opportunistic infections in AIDS patients. Among parasitic infections, cryptosporidiosis is the most common intestinal protozoan infection relating to diarrhea in AIDS patients and toxoplasmosis is the only parasitic infection of the nervous system with a substantial incidence, up to 14.8%. Cytomegalovirus (CMV) retinitis has a lower prevalence compared to other opportunistic infections. In the era of highly active antiretroviral therapy (HAART), the incidence of opportunistic infections has significantly reduced in the past few years. Subsequently, the phenomena of immune restoration inflammatory syndrome (IRIS) in AIDS patients has been reported in this region as a result of HAART. Language: English Keywords: ASIA, SOUTHEASTERN | LITERATURE REVIEW | EPIDEMIOLOGIC METHODS | PERSONS LIVING WITH HIV/AIDS | PREVALENCE | TUBERCULOSIS | CAUSES OF DEATH | AIDS | COMPLICATIONS | MENINGITIS | BACTERIAL AND FUNGAL DISEASES | PNEUMONIA | PARASITIC DISEASES | CENTRAL NERVOUS SYSTEM EFFECTS | ANTIRETROVIRAL THERAPY | Asia | Developing Countries | Research Methodology | HIV Infections | Viral Diseases | Diseases | Measurement | Infections | Mortality | Population Dynamics | Demographic Factors | Population | Central Nervous System | Physiology | Biology | Pulmonary Effects | HIV Document Number: 330585 |
| 21. Peer Reviewed Title: The International HIV Dementia Scale is a useful screening tool for HIV-associated dementia/cognitive impairment in HIV-infected adults in Yaounde-Cameroon. Author: Njamnshi AK; Djientcheu Vde P; Fonsah JY; Yepnjio FN; Njamnshi DM; Muna WE Source: JAIDS. Journal of Acquired Immune Deficiency Syndromes. 2008 Dec 1;49(4):393-7. Abstract: OBJECTIVE: As a baseline for a series of studies on HIV-associated dementia (HAD), we sought to assess the usefulness of the recently developed International HIV Dementia Scale (IHDS) as a screening tool for HAD or HIV-associated cognitive impairment (HACI) in HIV-positive adults in Yaounde-Cameroon. DESIGN: The frequency of HAD/HACI is largely unknown in resource-limited countries. In Cameroon, few studies suggest that HAD may be frequent but no specific study had so far investigated the problem. We therefore used a case-control study design involving HIV-positive adults as cases and HIV-negative individuals as controls to determine the usefulness of the IHDS as a screening instrument. METHODS: HIV-positive adults followed up in an HIV outpatient clinic were matched to HIV-negative subjects for age and sex and screened using IHDS. RESULTS: Overall, 204 HIV-positive individuals and 204 HIV-negative subjects were screened. The HIV-positive subjects had a significantly lower IHDS mean total score of 10.87 compared with the HIV-negative subjects with a score of 11.28 (P = 0.00). Abnormal scores (< or = 10) on the IHDS were found in 21.1% of the HIV-positive subjects and in 2.5% of the HIV-negative subjects (P = 5.0 x 10(-10)). CONCLUSIONS: These results suggest that the prevalence of possible HAD/HACI may be higher in Cameroon than the previous estimates and demonstrate that the IHDS can be used as a screening tool for HAD in Cameroon. We therefore suggest that all studies on HAD in Cameroon should strategically start with the IHDS as a screening tool. Language: English Keywords: CAMEROON | RESEARCH REPORT | METHODOLOGICAL STUDIES | CLINICAL RESEARCH | EVALUATION INDEXES | EVALUATION RESEARCH | CASE CONTROL STUDIES | ADULTS | PERSONS LIVING WITH HIV/AIDS | CENTRAL NERVOUS SYSTEM EFFECTS | SCREENING | COMPLICATIONS | AIDS | HEALTH STATUS INDEXES | MENTAL DISORDERS | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Quantitative Evaluation | Evaluation | Evaluation Methodology | Studies | Age Factors | Population Characteristics | Demographic Factors | Population | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Central Nervous System | Physiology | Biology | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 330326 |
| 22. Peer Reviewed Title: Early home treatment of childhood fevers with ineffective antimalarials is deleterious in the outcome of severe malaria. Author: Orimadegun AE; Amodu OK; Olumese PE; Omotade OO Source: Malaria Journal. 2008;7:143. Abstract: BACKGROUND: Early diagnosis and prompt treatment including appropriate home-based treatment of malaria is a major strategy for malaria control. A major determinant of clinical outcome in case management is compliance and adherence to effective antimalarial regimen. Home-based malaria treatment with inappropriate medicines is ineffective and there is insufficient evidence on how this contributes to the outcome of severe malaria. This study evaluated the effects of pre-hospital antimalarial drugs use on the presentation and outcome of severe malaria in children in Ibadan, Nigeria. METHODS: Two hundred and sixty-eight children with a median age of 30 months comprising 114 children with cerebral malaria and 154 with severe malarial anaemia (as defined by WHO) were prospectively enrolled. Data on socio-demographic data, treatments given at home, clinical course and outcome of admission were collected and analysed. RESULTS: A total of 168 children had treatment with an antimalarial treatment at home before presenting at the hospital when there was no improvement. There were no significant differences in the haematocrit levels, parasite counts and nutritional status of the pre-hospital treated and untreated groups. The most commonly used antimalarial medicine was chloroquine. Treatment policy was revised to Artemesinin-based Combination Therapy (ACT) in 2005 as a response to unacceptable levels of therapeutic failures with chloroquine, however chloroquine use remains high. The risk of presenting as cerebral malaria was 1.63 times higher with pre-hospital use of chloroquine for treatment of malaria, with a four-fold increase in the risk of mortality. Controlling for other confounding factors including age and clinical severity, pre-hospital treatment with chloroquine was an independent predictor of mortality. CONCLUSION: This study showed that, home treatment with chloroquine significantly impacts on the outcome of severe malaria. This finding underscores the need for wide-scale monitoring to withdraw chloroquine from circulation in Nigeria and efforts intensified at promoting prompt treatment with effective medicines in the community. Language: English Keywords: NIGERIA | RESEARCH REPORT | CLINICAL RESEARCH | CHILDREN | FEVER | MALARIA | HOME CARE | ANTIMALARIAL DRUGS | COMPLICATIONS | HEMATOCRIT | PREVALENCE | DEATH RATE | AGE FACTORS | CENTRAL NERVOUS SYSTEM EFFECTS | ANEMIA | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Youth | Population Characteristics | Demographic Factors | Population | Body Temperature | Physiology | Biology | Parasitic Diseases | Diseases | Care and Support | Health Services | Delivery of Health Care | Health | Laboratory Procedures | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Measurement | Mortality | Population Dynamics | Central Nervous System Document Number: 329290 |
| 23. Peer Reviewed Title: Artemisinin derivatives versus quinine in treating severe malaria in children: a systematic review. Author: Praygod G; de Frey A; Eisenhut M Source: Malaria Journal. 2008;7:210. Abstract: BACKGROUND: The efficacy of intravenous quinine, which is the mainstay for treating severe malaria in children, is decreasing in South East Asia and Africa. Artemisinin derivatives are a potential alternative to quinine. However, their efficacy compared to quinine in treating severe malaria in children is not clearly understood. The objective of this review was to assess the efficacy of parenteral artemisinin derivatives versus parenteral quinine in treating severe malaria in children. METHODS: All randomized controlled studies comparing parenteral artemisinin derivatives with parenteral quinine in treating severe malaria in children were included in the review. Data bases searched were: The Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4, 2007), MEDLINE (1966 to February 2008), EMBASE (1980 to February 2008), and LILACS (1982 to February 2008). Dichotomous variables were compared using risk ratios (RR) and the continuous data using weighted mean difference (WMD). RESULTS: Twelve trials were included (1,524 subjects). There was no difference in mortality between artemisinin derivatives and quinine (RR = 0.90, 95% CI 0.73 to 1.12). The artemisinin derivatives resolved coma faster than quinine (WMD = -4.61, 95% CI: -7.21 to -2.00, fixed effect model), but when trials with adequate concealment only were considered this differences disappeared. There was no statistically significant difference between the two groups in parasite clearance time, fever clearance time, incidence of neurological sequelae and 28th day cure rate. One trial reported significantly more local reactions at the injection site with intramuscular quinine compared to artemether. None of the trials was adequately powered to demonstrate equivalence. CONCLUSION: There was no evidence that treatment of children with severe malaria with parenteral artemisinin derivatives was associated with lower mortality or long-term morbidity compared to parenteral quinine. Future studies require adequately powered equivalence trial design to decide whether both drugs are equally effective. Language: English Keywords: DEVELOPING COUNTRIES | LITERATURE REVIEW | CLINICAL TRIALS | EPIDEMIOLOGIC METHODS | COMPARATIVE STUDIES | CHILDREN | ANTIMALARIAL DRUGS | DEATH RATE | CHILD MORTALITY | SIDE EFFECTS | FEVER | PREVALENCE | CENTRAL NERVOUS SYSTEM EFFECTS | TIME FACTORS | LONGTERM EFFECTS | Clinical Research | Research Methodology | Studies | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Malaria | Parasitic Diseases | Diseases | Mortality | Population Dynamics | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Body Temperature | Physiology | Biology | Measurement | Central Nervous System Document Number: 329374 |
| 24. Title: Direct detection of the multidrug resistance genome of Haemophilus influenzae in cerebrospinal fluid of children: Implications for treatment of meningitis. Author: Saha SK; Darmstadt GL; Baqui AH; Islam N; Qazi S Source: Pediatric Infectious Disease Journal. 2008 Jan;27(1):49-53. Abstract: Multidrug resistance (MDR), specifically to ampicillin and chloramphenicol, has complicated the treatment of Haemophilus influenzae type b (Hib) meningitis. This is worsened by use of prior antibiotics, which limits identification of the causative agent by culture and increases reliance on antigen detection. We aimed to develop a PCR assay for detecting the family of Haemophilus integrating and conjugative elements (ICEs) represented by ICEHin1056 among antibiotic resistant Hib, and then apply this directly to CSF to diagnose Hib meningitis and predict organism susceptibility, irrespective of culture results. Primers specific for orf 51 of ICEHin1056 were designed and multiplexed with Bex primers, specific for H. influenzae, and tested on culture positive and negative cases. Of 73 Hib isolates, orf 51 PCR amplicons, predicting the presence of ICEs, were found in all 33 MDR isolates while only in 1 of 33 sensitive strains. The remaining 7 ampicillin susceptible, chloramphenicol and tetracycline resistant strains did not produce a PCR product to orf 51. PCR amplification from CSF specimens of these culture positive cases produced identical results with 100% and 97% positive and negative predictive values, respectively. Multiplex PCR to detect Bex and orf 51 identified another 16 MDR Hib cases among 81 culture-negative CSF samples. Direct PCR for orf 51 in CSF identified resistance pattern of 51% more Hib strains than culture alone (110 versus 73). The ability to detect MDR, in culture negative Hib meningitis cases has significant implications for better directing antibiotic treatment of meningitis cases and thus for preventing disability and death. (author's) Language: English Keywords: BANGLADESH | RESEARCH REPORT | METHODOLOGICAL STUDIES | CLINICAL RESEARCH | GENETIC TECHNIQUES | CHILDREN | CENTRAL NERVOUS SYSTEM EFFECTS | DRUG RESISTANCE | INFLUENZA | MENINGITIS | ANTIGENS | LABORATORY EXAMINATIONS AND DIAGNOSES | GENETICS | Developing Countries | Asia, Southern | Asia | Research Methodology | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Central Nervous System | Physiology | Biology | Treatment | Viral Diseases | Diseases | Immunologic Factors | Immunity | Immune System Document Number: 323211 |
| 25. Title: Frequency and characteristics of HIV-associated sensory neuropathy among HIV patients in Bangkok, Thailand [letter] Author: Sithinamsuwan P; Punthanamongkol S; Valcour V; Onsanit S; Nidhinandana S; Thitivichianlert S; Shikuma C Source: JAIDS. Journal of Acquired Immune Deficiency Syndromes. 2008 Dec 1;49(4):456-8. Abstract: Language: English Keywords: THAILAND | RESEARCH REPORT | CLINICAL RESEARCH | CROSS SECTIONAL ANALYSIS | URBAN POPULATION | PERSONS LIVING WITH HIV/AIDS | NEUROLOGIC EFFECTS | AIDS | TOXICITY | COMPLICATIONS | ANTIRETROVIRAL THERAPY | IMMUNITY, CELLULAR | CENTRAL NERVOUS SYSTEM EFFECTS | Developing Countries | Asia, Southeastern | Asia | Research Methodology | Population Characteristics | Demographic Factors | Population | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Physiology | Biology | HIV | Immunity | Immune System | Central Nervous System Document Number: 330267 |
| 26. Peer Reviewed Title: Prenatal exposure to maternal infections and epilepsy in childhood: A population-based cohort study. Author: Sun Y; Vestergaard M; Christensen J; Nahmias AJ; Olsen J Source: Pediatrics. 2008 May;121(5):e1100-e1107. Abstract: We estimated the association between prenatal exposure to maternal infections and the subsequent risk for epilepsy in childhood. We included 90 619 singletons who were born between September 1997 and June 2003 in the Danish National Birth Cohort and followed them up to December 2005. Information on maternal infections during pregnancy (cystitis, pyelonephritis, diarrhea, coughs lasting _1 week, vaginal yeast infection, genital herpes, venereal warts, and herpes labialis) was prospectively reported by mothers in 2 computer-assisted telephone interviews in early and midgestation; information on maternal cystitis and pyelonephritis during late period of pregnancy was also collected in a third interview after birth. Children who received a diagnosis of epilepsy as inpatients or outpatients were retrieved from the Danish National Hospital Register. We identified 646 children with a diagnosis of epilepsy during up to 8 years of follow-up time. Cox proportional hazards regression models were used to estimate incidence rate ratio and 95% confidence interval. Children who were exposed to maternal cystitis, pyelonephritis, diarrhea, coughs, and/or vaginal yeast infection some maternal infections in prenatal life had an increased risk for epilepsy. Coughs lasting greater than 1 week were associated with an increased risk for epilepsy only in the first year of life, as was vaginal yeast infection only in children who were born preterm. These associations remained unchanged for children without cerebral palsy, congenital malformation, or a low Apgar score at 5 minutes. Prenatal exposure to some maternal infections was associated with an increased risk for epilepsy in childhood. (author's) Language: English Keywords: DENMARK | RESEARCH REPORT | INTERVIEWS | COHORT ANALYSIS | PREGNANT WOMEN | INFANT | PREGNANCY | INFECTIONS | EXPOSURE | MOTHER-TO-CHILD TRANSMISSION | RISK FACTORS | CENTRAL NERVOUS SYSTEM EFFECTS | Developed Countries | Europe, Northern | Europe | Data Collection | Research Methodology | Population Characteristics | Demographic Factors | Population | Youth | Age Factors | Reproduction | Diseases | Biology | Transmission | Central Nervous System | Physiology Document Number: 326573 |
| 27. Title: Prevalence of HIV-associated cryptococcal meningitis and utility of microbiological determinants for its diagnosis in a tertiary care center. Author: Thakur R; Sarma S; Kushwaha S Source: Indian Journal of Pathology and Microbiology. 2008 Apr-Jun;51(2):212-4. Abstract: CONTEXT: Human immunodeficiency virus (HIV) infection continues to be the most important risk factor for the development of central nervous system (CNS) cryptococcosis, which in turn is an important contributor to morbidity and mortality in HIV-infected patients. Early diagnosis of such patients is the key to their therapeutic success. AIMS: This study was undertaken to find out the prevalence of CNS cryptococcosis and to assess the role of microbiological parameters for its specific diagnosis in HIV-reactive hospitalized patients admitted with meningeal signs in a tertiary care setting. MATERIALS AND METHODS: A total of 104 patients suspected to be suffering from meningitis/meningoencephalitis were subjected to cerebrospinal fluid (CSF) analysis (including India ink preparation, culture by conventional methods and Bactec MGIT 960 system, antigen detection) and tests for HIV antibodies by standard laboratory operating procedures. RESULTS: The prevalence of HIV infection in our study group was 12.5% (13/104), while the prevalence of cryptococcal CNS infection in HIV-reactive cohort was 46% (6/13). Additionally, 15.3% (2/13) of the patients from this cohort were positive for Mycobacterium tuberculosis. CONCLUSIONS: High prevalence of cryptococcal CNS infections in HIV-infected patients underscores the importance of precise and early microbiological diagnosis for better management of such patients. Language: English Keywords: INDIA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | PERSONS LIVING WITH HIV/AIDS | PREVALENCE | MENINGITIS | HIV INFECTIONS | LABORATORY EXAMINATIONS AND DIAGNOSES | COMPLICATIONS | CENTRAL NERVOUS SYSTEM EFFECTS | ENCEPHALITIS | SEROCONVERSION | Developing Countries | Asia, Southern | Asia | Research Methodology | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Measurement | Central Nervous System | Physiology | Biology | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Immunity | Immune System Document Number: 328780 |
| 28. Peer Reviewed Title: Platelet-induced clumping of Plasmodium falciparum - infected erythrocytes from Malawian patients with cerebral malaria - possible modulation in vivo by thrombocytopenia. Author: Wassmer SC; Taylor T; MacLennan CA; Kanjala M; Mukaka M Source: Journal of Infectious Diseases. 2008;197:72-78. Abstract: Platelets may play a role in the pathogenesis of human cerebral malaria (CM), and they have been shown to induce clumping of Plasmodium falciparum-parasitized red blood cells (PRBCs) in vitro. Both thrombocytopenia and platelet-induced PRBC clumping are associated with severe malaria and, especially, with CM. In the present study, we investigated the occurrence of the clumping phenomenon in patients with CM by isolating and coincubating their plasma and PRBCs ex vivo. Malawian children with CM all had low platelet counts, with the degree of thrombocytopenia directly proportional to the density of parasitemia. Plasma samples obtained from these patients subsequently induced weak PRBC clumping. When the assays were repeated, with the plasma platelet concentrations adjusted to within the physiological range considered to be normal, massive clumping occurred. The results of this study suggest that thrombocytopenia may, through reduction of platelet-mediated clumping of PRBCs, provide a protective mechanism for the host during CM. (author's) Language: English Keywords: MALAWI | RESEARCH REPORT | CLIENTS | CHILDREN | MALARIA | CENTRAL NERVOUS SYSTEM EFFECTS | BLOOD | CYTOLOGY | PARASITES | LABORATORY PROCEDURES | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Program Activities | Programs | Organization and Administration | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Parasitic Diseases | Diseases | Central Nervous System | Physiology | Biology | Hemic System | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 325733 |
| 29. Title: Does prenatal exposure to arsenic affect infant development? Source: Health and Science Bulletin. 2007 Sep;5(3):1-21. Abstract: Arsenic is a widely distributed environmental pollutant. Many people are exposed to arsenic contaminated drinking water in different regions of the world due to elevated levels in ground water. It is a neurotoxicant and known to cause cancer, skin diseases and other chronic diseases. Recently a few cross sectional studies in school-aged children reported a negative association of arsenic exposure with children's development. Siripityakunkit and colleagues found a significant association between high arsenic levels in hair and impaired visual perception in 6-9 year old Thai children who were chronically exposed to arsenic contaminated drinking water. Calderon and Rosado reported co-exposure of arsenic and lead in primary school children from smelter areas in Mexico associated with lower verbal intelligence and long-term memory. Similarly, in Taiwan, long-term arsenic-exposure through drinking water was associated with lower scores in three out of four performance tests in a dose response manner. Two studies in Bangladesh reported an association between exposures to high well water arsenic and reduced intellectual function, even after adjusting for covariates. These studies indicate that children as young as 6 years old may suffer from subtle developmental deficits due to arsenic exposure. (excerpt) Language: English Keywords: BANGLADESH | RESEARCH REPORT | LONGITUDINAL STUDIES | PREGNANT WOMEN | INFANT | WATER QUALITY | CHILD DEVELOPMENT | TESTING | ENVIRONMENTAL POLLUTION | CENTRAL NERVOUS SYSTEM EFFECTS | Developing Countries | Asia, Southern | Asia | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Youth | Age Factors | Water | |