Causes of non-malarial febrile illness in outpatients in Tanzania.

OBJECTIVE: In sub-Saharan Africa, the use of malaria rapid diagnostic tests (mRDT) has raised awareness of alternative fever causes in children but few studies have included adults. To address this gap, we conducted a study of mRDT-negative fever aetiologies among children and adults in Tanzania. METHODS: A total of 1028 patients aged 3 months to 50 years with a febrile illness and negative mRDT were enrolled from a Tanzanian hospital outpatient department. All had a physical examination and cultures from blood, nasopharynx/throat and urine. Patients were followed on Days 7 and 14 and children meeting WHO criteria for pneumonia were followed on Day 2 with chest radiology. RESULTS: Respiratory symptoms were the most frequent presenting complaint, reported by 20.3% of adults and 64.0% (339/530) of children. Of 38 X-rayed children meeting WHO pneumonia criteria, 47.4% had a normal X-ray. Overall, only 1.3% of 1028 blood cultures were positive. Salmonella typhi was the most prevalent pathogen isolated (7/13, 53.8%) and S. typhi patients reported fever for a median of 7 days (range 2-14). Children with bacteraemia did not present with WHO symptoms requiring antibiotic treatment. Young children and adults had similar prevalences of positive urine cultures (24/428 and 29/498, respectively). CONCLUSION: Few outpatient fevers are caused by blood stream bacterial infection, and most adult bacteraemia would be identified by current clinical guidelines although paediatric bacteraemia may be more difficult to diagnose. While pneumonia may be overdiagnosed, urinary tract infection was relatively common. Our results emphasise the difficulty in identifying African children in need of antibiotics among the majority who do not

Assessment of left ventricular volumes using simplified 3-D echocardiography and computed tomography – a phantom and clinical study

<p>Abstract</p> <p>Objectives</p> <p>To compare the accuracy of simplified 3-dimensional (3-D) echocardiography vs. multi-slice computed tomography (MSCT) software for the quantification of left ventricular (LV) volumes.</p> <p>Design</p> <p>Three-D echocardiography (3-planes approach) and MSCT-CardIQ software were calibrated by measuring known volumes of 10 phantoms designed to closely mimic blood-endocardium interface. Subsequently, LV volumes were measured with both the methods in 9 patients referred routinely for coronary angiography and the agreement between the measurements was evaluated.</p> <p>Results</p> <p>Simplified 3D-echocardiography provided higher degree of agreement between the measured and true phantom volumes (mean difference 0 ± 1 ml, variation range +4 to -4 ml) than MSCT software (mean difference 6 ± 5 ml; variation range +22 to -10 ml). The agreement between LV measurements in the patients was considerably poorer, with significantly larger volumes produced by MSCT (mean difference -23 ± 40 ml, variation between +93 and -138 ml).</p> <p>Conclusion</p> <p>Simplified 3-D echocardiography provides more accurate assessment of phantom volumes than MSCT-CardIQ software. The discrepancy between the results of LV measurements with the two methods is even greater and does not warrant their interchangeable diagnostic use.</p

Universities in international networks

This chapter examines the international networks of some universities in Europe. Contacts between universities and researchers are often made easier by formal organisational links, associations and agreements. The ways of organizing research and higher education vary from country to country. Sweden differs from many of the others in that a greater proportion of the research in progress is conducted at state universities and university colleges instead of at independent private institutions. In earlier times higher education and research were the preserve of an exclusive elite. It was at the courts of princes, under the auspices of the Church, and at those universities founded in Europe during the Middle Ages that these select few accumulated knowledge and developed educational ideals. The European Union’s determined concentration on research and higher education during the 1980s and 1990s has few if any international parallels

Radiological imaging of pulmonary emphysema : Preoperative evaluation of candidates for lung volume reduction surgery

Lung volume reduction surgery (LVRS) for pulmonary emphysema, first described by Brantigan in 1957, was re-introduced by Cooper et al in 1995. From a surgical point of view, information on the extent and distribution of emphysema is mandatory and also partly determines the outcome. No consensus exists on the best method for describing emphysema severity and heterogeneity in candidates for LVRS. The aims of this thesis were to define a suitable CT-technique for visual evaluation of severe emphysema, to design an objective model for classification of emphysema heterogeneity and to evaluate the additional information gained by lung perfusion scintigraphy in classification of emphysema. Study I investigated whether radiologists in evaluating severe emphysema subjectively preferred high resolution computed tomography (HRCT) or spiral computed tomography (CT). HRCT was preferred in 56%, spiral CT in 19% and in 25%, the techniques were considered equal. Study II investigated which of three types of images yielded the best results in estimating the degree of emphysema. In the grading of emphysema, the radiologists performed similarly with both HRCT and spiral CT, while "density-masked" images (an image of a quantitative measurement) gave significantly better results. Study III investigated whether spiral CT was superior to HRCT in evaluating the heterogeneity of emphysema and whether the combination of both CT-techniques improved the evaluation. Spiral CT was significantly better compared to HRCT, while the combination of the techniques did not improve the evaluation. Study IV presented a method for classification of emphysema heterogeneity that was calculated objectively, surgically oriented and classifies each lung separately. Study V investigated whether lung perfusion scintigraphy (LPS) contributes to the preoperative classification of emphysema heterogeneity compared to classification based only on CT. The answer was yes, and hence both CT and LPS should be included when assessing emphysema heterogeneity prior to LVRS. To conclude, in contrast to subjective preferences, visual evaluation of emphysema should be based on spiral CT (10 mm slice thickness and reconstruction with a high spatial algorithm) instead of HRCT in potential candidates for LVRS. The presentation of images as "densitymasked" images improves the visual evaluation of degree of emphysema. This type of imaging can easily be performed on all CT scanners and can thus be recommended as part of a complete CT examination. The addition of lung perfusion scintigraphy to spiral CT of the lungs improves the classification of emphysema heterogeneity in candidates for LVRS. A method for objective classification of emphysema heterogeneity has been developed

Brief report: "the autism epidemic". The registered prevalence of autism in a Swedish urban area

The objective of this study was to establish rates of diagnosed autism spectrum disorders (ASDs) in a circumscribed geographical region. The total population born in 1977-1994, living in Göteborg Sweden in 2001, was screened for ASD in registers of the Child Neuropsychiatry Clinic. The minimum registered rate of autistic disorder was 20.5 in 10,000. Other ASDs were 32.9 in 10,000, including 9.2 in 10,000 with Asperger syndrome. Males predominated. In the youngest group (7-12 years), 1.23% had a registered diagnosis of ASD. There was an increase in the rate of diagnosed registered ASD over time; the cause was not determined. The increase tended to level off in the younger age cohort, perhaps due to Asperger syndrome cases missed in screening

Cytokine expression in tumors treated with donor lymphocyte infusions after allogeneic hematopoietic stem cell transplantation

Aims: Risk factors for disease relapse are remaining tumor or leukemic cells or mixed chimerism (MC) following allogeneic hematopoietic stem cell transplantation. Donor lymphocyte infusion (DLI) after stem cell transplantation can contribute to complete donor chimerism and graft-versus-tumor/leukemia effect. We evaluate cytokine secretion at the single-cell level using ELISpot in relation to DLI effect on disease response. Patients &amp; methods: Blood samples were collected from four patients with solid tumors and four with hematological malignancies before DLI, and 1 and 3 weeks after DLI. Tumor response was evaluated according to the international Response Evaluation Criteria In Solid Tumors (RECIST) method. Indications for DLI were stable disease or MC and/or progressive disease in solid tumors, and molecular or early relapse, or MC in hematological malignancies. ELISpot was performed for TNF-α, IFN-γ, IL-12, IL-4, IL-10 and IL-13 cytokines. Results: Depending on the disease response, patients were divided into two groups: responders and nonresponders. Responders were patients who achieved partial response (one renal cell cancer) or stable disease (one prostate cancer) or clinical remission (two acute myeloid leukemia). Patients who relapsed, progressed or rejected the graft were the nonresponders. DLI rescued the renal cell cancer patient, who has partial response, and two acute myeloid leukemia patients, who are in clinical remission. Patients who responded tended to have a higher expression of TNF-α, IFN-γ, IL-12 and IL-10 than those who did not respond. Conclusions: DLI can act when the patients’ mononuclear cells have normal or increased capacity to produce TNF-α, IFN-γ, IL-12 and IL-10. Assessment of these cytokines may be useful to predict those patients who will respond to DLI therapy. </jats:p