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. Peer Reviewed Title: Independent association between rate of clearance of infection and clinical outcome of HIV-associated cryptococcal meningitis: analysis of a combined cohort of 262 patients. Author: Bicanic T; Muzoora C; Brouwer AE; Meintjes G; Longley N; Taseera K; Rebe K; Loyse A; Jarvis J; Bekker LG; Wood R; Limmathurotsakul D; Chierakul W; Stepniewska K; White NJ; Jaffar S; Harrison TS Source: Clinical Infectious Diseases. 2009 Sep 1;49(5):702-9. Abstract: BACKGROUND: Progress in therapy for cryptococcal meningitis has been slow because of the lack of a suitable marker of treatment response. Previously, we demonstrated the statistical power of a novel endpoint, the rate of clearance of infection, based on serial quantitative cultures of cerebrospinal fluid, to differentiate the fungicidal activity of alternative antifungal drug regimens. We hypothesized that the rate of clearance of infection should also be a clinically meaningful endpoint. METHODS: We combined data from cohorts of patients with human immunodeficiency virus-associated cryptococcal meningitis from Thailand, South Africa, and Uganda, for whom the rate of clearance of infection was determined, and clinical and laboratory data prospectively collected, and explored the association between the rate of clearance of infection and mortality by Cox survival analyses. RESULTS: The combined cohort comprised 262 subjects. Altered mental status at presentation, a high baseline organism load, and a slow rate of clearance of infection were independently associated with increased mortality at 2 and 10 weeks. Rate of clearance of infection was associated with antifungal drug regimen and baseline cerebrospinal fluid interferon-gamma levels. CONCLUSIONS: The results support the use of the rate of clearance of infection or early fungicidal activity as a means to explore antifungal drug dosages and combinations in phase II studies. An increased understanding of how the factors determining outcome interrelate may help clarify opportunities for intervention. Language: English Keywords: SOUTH AFRICA | THAILAND | UGANDA | RESEARCH REPORT | CLIENTS | MENINGITIS | HIV INFECTIONS | DRUGS | INTERVENTIONS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Asia, Southeastern | Asia | Africa, Eastern | Program Activities | Programs | Organization and Administration | Central Nervous System Effects | Central Nervous System | Physiology | Biology | Viral Diseases | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 342967 |
| 3. 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 |
| 4. Title: Neurological disorders in HIV-infected children in India. Author: Gupta S; Shah DM; Shah I Source: Annals of Tropical Paediatrics. 2009 Sep;29(3):177-81. Abstract: There are few studies of HIV-related neurological disorders from centres in low-income countries where facilities are available for detailed investigation. METHODS: Records of all patients attending the paediatric HIV outpatient department at B. J. Wadia Hospital for Children, Mumbai between April 2000 and March 2008 were reviewed. Of 668 HIV-infected patients, 48 (7.2%) had neurological manifestations and are included in this study. RESULTS: Twenty-six (54.2%) children had HIV encephalopathy. Other causes of neurological manifestations include febrile convulsion in five (10.4%), bacterial meningitis in three (6.3%), epilepsy in two (4.2%), tuberculous meningitis and progressive multi-focal encephalopathy in two (4.2%) each and toxoplasmosis, vasculitis, acute demyelinating encephalomyelitis, anti-phospholipid antibody syndrome, Down's syndrome, birth asphyxia, herpes simplex encephalopathy and mitochondrial encephalopathy in one (2.1%) each. Mean (SD) age at presentation was 4.36 (3.38) years with a range of 2 months to 15 years. The common subtle neurological manifestations were abnormal deep tendon reflexes and extensor plantar reflexes. The common symptomatic manifestations were delayed milestones in 21 children (43.8%) and seizures in 19 (39.6%). Seizures were more common in males (54%) than in females (25%) (p=0.038). In children <5 years, delayed milestones was the most common manifestation while focal neurological deficits were more common in older children. Of the 13 children who received HAART, nine (60.23%) improved. CONCLUSION: Early diagnosis of neurological disorders in HIV-infected children is important for appropriate investigation and management, especially the introduction of HAART. Language: English Keywords: INDIA | RESEARCH REPORT | RECORDS | CHILDREN | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | NEUROLOGIC EFFECTS | MENINGITIS | TUBERCULOSIS | SIGNS AND SYMPTOMS | EXAMINATIONS AND DIAGNOSES | TREATMENT | MANAGEMENT | ANTIRETROVIRAL THERAPY | Asia, Southern | Asia | Developing Countries | Information Processing | Information | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Viral Diseases | Diseases | Physiology | Biology | Central Nervous System Effects | Central Nervous System | Infections | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Organization and Administration | HIV Document Number: 342530 |
| 5. 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 |
| 6. 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 |
| 7. 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 |
| 8. 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 |
| 9. 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 |
| 10. 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 |
| 11. 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 |
| 12. Title: Gastric and cutaneous dissemination of visceral leishmaniasis in a patient with advanced HIV [letter] Author: Balkhair A; Abid FB Source: International Journal of Infectious Diseases. 2008 Jan;12(1):111-113. Abstract: Visceral leishmaniasis (VL) is a well-recognized opportunistic infection in patients with HIV-1 infection. Several reports indicate a rising trend in VL/HIV co-infection. The majority of HIV/Leishmania co-infected cases show classic features of VL. Atypical features such as dissemination to the gastrointestinal tract and to the skin may also occur. We describe herein a patient with advanced HIV-1 infection residing in a non-endemic area for leishmaniasis. The diagnosis of HIV had been made 4 years prior to this admission. Unfortunately, the Centers for Disease Control and Prevention (CDC) stage at the time of diagnosis was not known. He presented with atypical features of visceral leishmaniasis. In particular, the patient had dissemination to the esophagus, the stomach, and to the skin. (excerpt) Language: English Keywords: OMAN | RESEARCH REPORT | CASE STUDIES | CLINICAL RESEARCH | PERSONS LIVING WITH HIV/AIDS | LEISHMANIASIS | COMPLICATIONS | AIDS | GASTROINTESTINAL EFFECTS | DERMATOLOGICAL EFFECTS | SIGNS AND SYMPTOMS | MENINGITIS | Middle East | Developing Countries | Studies | Research Methodology | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Parasitic Diseases | Physiology | Biology | Central Nervous System Effects | Central Nervous System Document Number: 323230 |
13.  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 |
| 14. 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 |
| 15. Peer Reviewed Title: High-dose amphotericin B with flucytosine for the treatment of cryptococcal meningitis in HIV-infected patients: a randomized trial. Author: Bicanic T; Wood R; Meintjes G; Rebe K; Brouwer A; Loyse A Source: Clinical Infectious Diseases. 2008 Jul 1;47(1):123-30. Abstract: BACKGROUND: The standard therapy for human immunodeficiency virus (HIV)-associated cryptococcal meningitis of amphotericin B (AmB; 0.7 mg/kg per day) plus flucytosine frequently takes >2 weeks to sterilize the cerebral spinal fluid, and acute mortality remains high. A dosage range for AmB of 0.7-1 mg/kg per day is noted in current guidelines, but there are no data comparing 0.7 mg/kg per day with 1 mg/kg per day. METHODS: Sixty-four HIV-seropositive, antiretroviral therapy-naive patients in Cape Town, South Africa, who experienced their first episode of cryptococcal meningitis during the period May 2005-June 2006 were randomized to receive either (1) AmB, 0.7 mg/kg per day, plus flucytosine, 25 mg/kg 4 times per day (group 1; 30 patients); or (2) AmB, 1 mg/kg per day, plus flucytosine, 25 mg/kg 4 times per day (group 2; 34 patients). Regimens were given for 2 weeks, followed by treatment with oral fluconazole. The primary outcome measure was early fungicidal activity, as determined by results of serial, quantitative cerebral spinal fluid cryptococcal cultures. Secondary outcome measures were safety and mortality. The median duration of follow-up was 1 year. RESULTS: Early fungicidal activity was significantly greater for group 2 than for group 1 (mean +/- SD, -0.56 +/- 0.24 vs. -0.45 +/- 0.16 log cfu/mL of cerebral spinal fluid per day; P = .02). The incidence of renal impairment did not significantly differ between the 2 groups. Anemia was associated with female sex and, less strongly, with membership in group 2. Renal impairment and anemia reversed after the regimen was switched to fluconazole. Two- and 10-week mortality rates were 6% and 24%, respectively, with no difference between groups. CONCLUSIONS: AmB, 1 mg/kg per day, plus flucytosine is more rapidly fungicidal than is standard-dose AmB plus flucytosine. Because of its size, this study provides limited data on any difference in toxicity between the regimens, but toxicities were manageable and reversible. CLINICAL TRIALS REGISTRATION NUMBER: ISRCTN68133435 (http://www.controlled-trials.com). (author's) Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | CLINICAL TRIALS | PERSONS LIVING WITH HIV/AIDS | MENINGITIS | DRUGS | TREATMENT | ADMINISTRATION AND DOSAGE | HEMOGLOBIN LEVEL | SEX FACTORS | ANEMIA | RENAL EFFECTS | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Clinical Research | Research Methodology | HIV Infections | Viral Diseases | Diseases | Central Nervous System Effects | Central Nervous System | Physiology | Biology | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Hemic System | Population Characteristics | Demographic Factors | Population | Urogenital Effects | Urogenital System Document Number: 328366 |
| 16. Peer Reviewed Title: The use of HAART is associated with decreased risk of death during initial treatment of cryptococcal meningitis in adults in Botswana. Author: Bisson GP; Nthobatsong R; Thakur R; Lesetedi G; Vinekar K; Tebas P; Bennett JE; Gluckman S; Gaolathe T; MacGregor RR Source: JAIDS. Journal of Acquired Immune Deficiency Syndromes. 2008 Oct 1;49(2):227-9. Abstract: OBJECTIVE: The objective of this study was to evaluate outcomes among adults with a first episode of cryptococcal meningitis (CM), comparing those on highly active antiretroviral therapy (HAART) with those not on HAART. METHODS: We conducted a prospective cohort study among HIV-infected adults (aged 18 years and older) with a first episode of CM at the Princess Marina Hospital, in Gaborone, Botswana. The proportions surviving to discharge were compared. Logistic regression was used to evaluate the relationship between HAART use and risk of death in the hospital, adjusting for potential confounders. RESULTS: Ninety-two patients [median CD4 41 cells/mm (interquartile range 22-85)] were included, 26 of whom were on HAART at the time that they developed CM. The in-hospital mortality was lower among those on HAART {2 of 26 (8%) vs 14 of 66 (21%); odds ratio = 0.36 [95% confidence interval (CI) 0.09 to 1.49]}, and this result was statistically significant after adjustment for male sex and tuberculosis [adjusted odds ratio = 0.19 (95% CI 0.04 to 1.00)]. CONCLUSIONS: HAART use at the time of a first admission with CM is associated with decreased risk of death during the acute phase of disease. Reasons for this association should be explored. Language: English Keywords: BOTSWANA | RESEARCH REPORT | COHORT ANALYSIS | PERSONS LIVING WITH HIV/AIDS | CLIENTS | MENINGITIS | ANTIRETROVIRAL THERAPY | ANTIRETROVIRAL DRUGS | TREATMENT | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Program Activities | Programs | Organization and Administration | Central Nervous System Effects | Central Nervous System | Physiology | Biology | HIV | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 329044 |
| 17. 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 |
| 18. Peer Reviewed Title: Sensitivity and specificity of an index for the diagnosis of TB meningitis in patients in an urban teaching hospital in Malawi. Author: Checkley AM; Njalale Y; Scarborough M; Zjilstra EE Source: Tropical Medicine and International Health. 2008 Aug;13(8):1042-6. Abstract: Tuberculous (TB) meningitis is difficult to diagnose and has a high mortality rate, particularly when presentation is delayed. A diagnostic index developed in Vietnam, an area of low-HIV seroprevalence, has been proposed as a means to differentiate TB meningitis from acute bacterial meningitis using clinical and laboratory features. We applied this index over a 4-month period to adults presenting with meningitis to an urban teaching hospital in Malawi, where HIV seroprevalence is 70% among medical inpatients. Eighty-five consecutive eligible patients were studied. Nine had TB meningitis, 64 bacterial meningitis and 12 cryptococcal meningitis. The sensitivity of the diagnostic index for predicting TB meningitis was 78%, with a specificity of 43%, too low to be used in the diagnosis of TB meningitis in this setting. This finding is likely to be generalizable to other southern African countries with similarly high-HIV seroprevalences. Language: English Keywords: MALAWI | VIETNAM | RESEARCH REPORT | URBAN AREAS | CLIENTS | MENINGITIS | HIV | TUBERCULOSIS | LABORATORY EXAMINATIONS AND DIAGNOSES | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Asia, Southeastern | Asia | Geographic Factors | Population | Program Activities | Programs | Organization and Administration | Central Nervous System Effects | Central Nervous System | Physiology | Biology | HIV Infections | Viral Diseases | Diseases | Infections | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 328561 |
| 19. 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 |
| 20. Title: Treatment of cryptococcal meningitis in Peruvian AIDS patients using amphotericin B and fluconazole. Author: Dammert P; Bustamante B; Ticona E; Llanos-Cuentas A; Huaroto L Source: Journal of Infection. 2008 Sep;57(3):260-5. Abstract: OBJECTIVES: To describe the mycologic and clinical outcomes and factors associated with failure in Peruvian patients with AIDS-associated cryptococcal meningitis (CM) treated with amphotericin B deoxycholate (Amph B) followed by fluconazole. METHODS: Patients were treated with intravenous Amph B 0.7 mg/kg/day for 2 or 3 weeks followed by oral fluconazole 400mg/day for 7 or 8 weeks. Clinical and laboratory evaluations including cerebrospinal fluid (CSF) studies were performed at baseline and at weeks 2 and 10. RESULTS: The CSF cultures were negative in 25% and 68% of 47 patients at weeks 2 and 10, respectively. In the univariate analysis, baseline low body mass index (BMI), hyponatremia, low serum albumin, positive blood culture and CSF antigen titers >or=1024 were associated with a positive CSF culture at week 2. Baseline positive urine culture, positive blood culture, any positive extraneural culture and CSF opening pressure at week 2 >or=300 mm H2O were associated with a positive CSF culture at week 10. In the multivariate analysis no association was found. CONCLUSIONS: Therapy with Amph B and fluconazole, combined with aggressive management of elevated intracranial pressure (ICP), results in low CSF sterilization rates at week 2 and acceptable CSF sterilization rates at week 10 when compared with other series. Language: English Keywords: PERU | RESEARCH REPORT | CLINICAL RESEARCH | MULTIVARIATE ANALYSIS | PERSONS LIVING WITH HIV/AIDS | MENINGITIS | AIDS | ANTIBIOTICS | COMPLICATIONS | ADMINISTRATION AND DOSAGE | TIME FACTORS | BODY WEIGHT | PROTEINS | South America, Western | South America | Latin America | Americas | Developing Countries | Research Methodology | Data Analysis | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Central Nervous System Effects | Central Nervous System | Physiology | Biology | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Population Dynamics | Demographic Factors | Population Document Number: 328844 |
| 21. 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 |
| 22. Title: Serotype 6C is associated with penicillin-susceptible meningeal infections in human immunodeficiency virus (HIV)-infected adults among invasive pneumococcal isolates previously identified as serotype 6A in South Africa. Author: du Plessis M; von Gottberg A; Madhi SA; Hattingh O; de Gouveia L; Klugman KP Source: International Journal of Antimicrobial Agents. 2008 Nov;32 Suppl 1:S66-70. Abstract: A newly described pneumococcal serotype (6C) is indistinguishable from serotype 6A when using the conventional Quellung serotyping method. Serotype 6A isolates were screened by polymerase chain reaction (PCR) for the wciN region of the capsular locus. This study detected serotype 6C among invasive pneumococcal disease (IPD) isolates from national laboratory-based surveillance (2005-2006) in South Africa. No serotype 6C isolates were identified among 23 serotype 6A cases from children enrolled in a 9-valent pneumococcal conjugate vaccine trial (1998-2005). Of 8167 IPD cases reported nationally, viable isolates were available for serotyping in 87% of cases (n=7080). Quellung serotyping identified 608 serotype 6A isolates, of which 606 were further tested for serotype 6C. PCR confirmed serotype 6C in 5% (30/606) of the isolates tested. Serotype 6C isolates were: less likely than 6A to cause disease in children compared with adults (6/30 (20%) vs. 311/550 (57%); P<0.001); more likely to cause laboratory-confirmed meningitis (15/30 (50%) vs. 167/578 (29%); P=0.01); and more likely to demonstrate susceptibility to penicillin (non-susceptibility 0/30 vs. 129/578 (22%); P=0.004). No association with gender, human immunodeficiency virus (HIV) co-infection or case fatality rate was observed. Although serotype 6C prevalence was low, its epidemiology may differ from the other serogroup 6 pneumococci. Our data from the vaccine efficacy trial suggest that cross-protection of the conjugate vaccine is against true serotype 6A strains. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | METHODOLOGICAL STUDIES | CLINICAL RESEARCH | CHILDREN | MENINGITIS | HIV INFECTIONS | COMPLICATIONS | PNEUMONIA | LABORATORY EXAMINATIONS AND DIAGNOSES | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Central Nervous System Effects | Central Nervous System | Physiology | Biology | Viral Diseases | Diseases | Pulmonary Effects | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 330291 |
| 23. Title: Epidemiology and outcomes of bacterial meningitis in Mexican children: 10-year experience (1993-2003). Author: Franco-Paredes C; Lammoglia L; Hernandez I; Santos-Preciado JI Source: International Journal of Infectious Diseases. 2008 Jul;12(4):380-386. Abstract: Acute bacterial meningitis remains an important cause of morbidity, neurologic sequelae, and mortality in children in Latin America. We retrospectively reviewed the hospital-based medical records of children diagnosed with acute bacterial meningitis, aged 1 month to 18 years, at a large inner city referral Hospital in Mexico City, for a 10-year period (1993-2003). To characterize the epidemiology, clinical features, and outcomes of acute bacterial meningitis, we subdivided our study into two time periods: the period prior to the routine use of Haemophilus influenzae type b (Hib) vaccine (1993-1998) and the period after the vaccine became available (1999-2003). Results: A total of 218 cases of acute bacterial meningitis were identified during the study period. The most frequently affected age group was that of children aged between 1 and 6 months. Hib was the most commonly isolated pathogen, found in 50% of cases. However, its incidence declined significantly after the introduction of the combined diphtheria, tetanus, pertussis, hepatitis B, and conjugated Hib (DTP-HB/Hib) pentavalent vaccine into the universal vaccination schedule for children in 1998. Streptococcus pneumoniae followed as the second most commonly isolated bacterial pathogen. Neisseria meningitidis was isolated in only a few cases, confirming the historically low incidence of this pathogen in Mexico. Identified risk factors for death were found to include the presence of septic shock and intracranial hypertension, but were not attributable to any particular bacterial pathogen. In our hospital, acute bacterial meningitis remains a severe disease with important sequelae and mortality. The incidence of Hib meningitis cases has declined since the introduction of the Hib vaccine. However, S. pneumoniae persists as an important cause of bacterial meningitis, highlighting the need for the implementation of vaccination policies against this pathogen. (author's) Language: English Keywords: MEXICO | RESEARCH REPORT | RETROSPECTIVE STUDIES | RECORDS | HOSPITALS | EPIDEMIOLOGY | INCIDENCE | CHILD | MENINGITIS | PNEUMONIA | VACCINES | Developing Countries | North America | Americas | Studies | Research Methodology | Information Processing | Information | Health Facilities | Delivery of Health Care | Health | Public Health | Measurement | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Central Nervous System Effects | Central Nervous System | Physiology | Biology | Pulmonary Effects | Medical Procedures | Medicine | Health Services Document Number: 327337 |
| 24. 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 |
| 25. 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 |
| 26. Peer Reviewed Title: A phase II, randomized study on an investigational DTPw-HBV / Hib-MenAC conjugate vaccine administered to infants in northern Ghana. Author: Hodgson A; Forgor AA; Chandramohan D; Reed Z; Binka F Source: PLoS One. 2008 May;3(5):e2159. Abstract: Combining meningococcal vaccination with routine immunization in infancy may reduce the burden of meningococcal meningitis, especially in the meningitis belt of Africa. We have evaluated the immunogenicity, persistence of immune response, immune memory and safety of an investigational DTPw-HBV/Hib-MenAC conjugate vaccine given to infants in Northern Ghana. In this phase II, double blind, randomized, controlled study, 280 infants were primed with DTPw-HBV/Hib-MenAC or DTPw-HBV/Hib vaccines at 6, 10 and 14 weeks of age. At 12 months of age, children in each group received a challenge dose of serogroup A+C polysaccharides. Antibody responses were assessed pre, and one month-post dose 3 of the priming schedule and pre and 1 month after administration of the challenge dose. One month post-dose 3, 87.8% and 88.2% of subjects in the study group had bactericidal meningococcal serogroup A (SBA-MenA) and meningococcal serogroup C (SBA-MenC) antibody titres greater than or equal to 1:8 respectively. Seroprotection/seropositivity rates to the 5 antigens administered in the routine EPI schedule were non-inferior in children in the study group compared to those in the control group. The percentages of subjects in the study group with persisting SBA-MenA titres greater than or equal to 1:8 or SBA-MenC titres greater than or equal to 1:8 at the age of 12 months prior to challenge were significantly higher than in control group (47.7% vs 25.7% and 56.4% vs 5.1% respectively). The administration of 10 mg of serogroup A polysaccharide increased the SBA-MenA GMT by 14.0-fold in the DTPW-HBV/Hib-MenAC-group compared to a 3.8 fold increase in the control-group. Corresponding fold-increases in SBA-MenC titres following challenge with 10 mg of group C polysaccharide were 18.8 and 1.9 respectively. Reactogenicity following primary vaccination or the administration of the challenge dose was similar in both groups, except for swelling (Grade 3) after primary vaccination which was more frequent in children in the vaccine than inthe control group (23.7%; 95%CI [19.6-28.1] of doses vs 14.1%; 95% CI [10.9-17.8] of doses). Fifty-nine SAEs (including 8 deaths), none of them related to vaccination, were reported during the entire study. Three dose primary vaccination with DTPw-HBV/Hib-MenAC was non-inferior to DTPw-HBV/Hib for the 5 common antigens used in the routine EPI schedule and induced bactericidal antibodies against Neisseria meningitidis of serogroups A and C in the majority of infants. Serogroup A and C bactericidal antibody levels had fallen below titres associated with protection in nearly half of the infants by the age of 12 months confirming that a booster dose is required at about that age. An enhanced memory response was shown after polysaccharide challenge. This vaccine could provide protection against 7 important childhood diseases (including meningococcal A and C) and be of particular value in countries of the African meningitis belt. (author's) Language: English Keywords: GHANA | RESEARCH REPORT | CASE CONTROL STUDIES | INFANT | MENINGITIS | VACCINES | ADMINISTRATION AND DOSAGE | IMMUNIZATION | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Central Nervous System Effects | Central Nervous System | Physiology | Biology | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Drugs | Treatment | Primary Health Care Document Number: 326864 |
| 27. 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 |
| 28. 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 |
| 29. Peer Reviewed Title: Outcomes of cryptococcal meningitis in Uganda before and after the availability of highly active antiretroviral therapy. Author: Kambugu A; Meya DB; Rhein J; O'Brien M; Janoff EN Source: Clinical Infectious Diseases. 2008;46:1694-1701. Abstract: Cryptococcal meningitis (CM) is the proximate cause of death in 20%-30% of persons with acquired immunodeficiency syndrome in Africa. Two prospective, observational cohorts enrolled human immunodeficiency virus (HIV)-infected, antiretroviral-naive persons with CM in Kampala, Uganda. The first cohort was enrolled in 2001-2002 (n = 92), prior to the availability of highly active antiretroviral therapy (HAART), and the second was enrolled in 2006-2007 (n = 44), when HAART was available. Ugandans presented with prolonged CM symptoms (median duration, 14 days; interquartile range, 7-21 days). The 14-day survival rates were 49% in 2001-2002 and 80% in 2006 (P less than .001). HAART was started 35_13 days after CM diagnosis and does not explain the improved 14-day survival rate in 2006. In 2006-2007, the survival rate continued to decrease after hospitalization, with only 55% surviving to initiate HAART as an outpatient. Probable cryptococcal-related immune reconstitution inflammatory syndrome occurred in 42% of patients, with 4 deaths. At 6 months after CM diagnosis, 18 persons (41%) were alive and receiving HAART in 2007. The median cerebral spinal fluid (CSF) opening pressure was 330 mm H2O; 81% of patients had elevated pressure (greater than 200 mm H2O). Only 5 patients consented to therapeutic lumbar puncture. There was a trend for higher mortality for pressures greater than 250 mm H2O (odds ratio [OR], 2.1; 95% confidence interval [CI], 0.9-5.2; P = .09). Initial CSF WBC counts of less than 5 cells/mL were associated with failure of CSF sterilization (OR, 17.3; 95% CI, 3.1-94.3; P less than .001), and protein levels less than 35 mg/dL were associated with higher mortality (OR, 2.0; 95% CI, 1.2-3.3; P = .007). Significant CM-associated mortality persists, despite the administration of amphotericin B and HIV therapy, because of the high mortality rate before receipt of HAART and because of immune reconstitution inflammatory syndrome-related complications after HAART initiation. Approaches to increase acceptance of therapeutic lumbar punctures are needed. (author's) Language: English Keywords: UGANDA | RESEARCH REPORT | PROSPECTIVE STUDIES | PERSONS LIVING WITH HIV/AIDS | MENINGITIS | ANTIRETROVIRAL THERAPY | TREATMENT | MORTALITY | SIGNS AND SYMPTOMS | TOXICITY | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Central Nervous System Effects | Central Nervous System | Physiology | Biology | HIV | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Population Dynamics | Demographic Factors | Population Document Number: 326632 |
| 30. Title: Epidemiological profile of cryptococcal meningitis patients in Rio Grande do Sul, Brazil. Author: Leal AL; Faganello J; Fuentefria AM; Boldo JT; Bassanesi MC Source: Mycopathologia. 2008 Aug;166(2):71-5. Abstract: Cryptococcosis is a major opportunistic mycosis which has meningitis as its most frequent clinical presentation and can be fatal in the absence of antifungal therapy. The aetiological agents are Cryptococcus neoformans, which affects mainly immunocompromised subjects, and C. gattii, the aetiologic agent for cryptococcosis in healthy individuals. A recent outbreak of cryptococcosis on Vancouver Island, Canada, raised the level of concern about the epidemiology of this disease. In Brazil, between 1980 and 2002, six per cent of AIDS patients had cryptococcosis in course at the time of diagnosis. To identify the profile of cryptococcal meningitis patients in Rio Grande do Sul (RS), Brazil, a retroactive study was realized using data from patients registered at Laboratorio Central de Saude Publica IPB-LACEN/RS from 2000 to 2005. Most of the patients were men (77.12%), Caucasian (83.5%), median age between thirty and thirty-nine years old (46.24%) and HIV positive (95%). Language: English Keywords: BRAZIL | |