Pattern and severity of rheumatic valvular lesions in children in Khartoum, Sudan

We determined the pattern and severity of valvular involvement in 100 Sudanese patients with rheumatic heart disease (RHD) in 2 centres in Khartoum in 2003. All the patients underwent history taking, physical examination and Doppler echocardiography. The commonest lesions were mitral regurgitation (84%) and aortic regurgitation (40%). Mitral stenosis alone was uncommon (9%) which could be due to a low detection rate related to the slow stenotic process and the subtle early signs. This, together with the inconsistent history of rheumatic fever, may lead to an underestimate of the prevalence of RHD. There was a strong correlation between severity of the lesion and irregular prophylaxis (P < 0.001).

Disparities in joint replacement utilization: a quality of care issue

Although total joint replacement is an effective treatment option for end-stage lower extremity osteoarthritis, racial disparities in joint replacement utilization have been well documented. These disparities may be due in part to patient-level factors such as willingness to consider joint replacement and worse expectations of joint replacement outcomes. In addition, African-Americans may have worse outcomes after total joint replacement and are more likely to have surgery performed by surgeons with lower volumes or in hospitals with lower volumes. All of these issues may be considered concerns with the quality of care delivered to African-Americans with osteoarthritis.

Milk Conjugated Linoleic Acid Response to Fish Oil and Sunflower Oil Supplementation to Dairy Cows Managed Under Two Feeding Systems

Earlier research showed that conjugated linoleic acid (CLA) content in milk fat is highest when cows' diets are supplemented with a blend of fish oil (FO) and linoleic acid-rich oils. The objective of this study was to compare the effect of FO and sunflower oil (SFO) supplementation on milk cis-9, trans-11 CLA when dairy cows managed on pasture or in confinement. Fourteen Holstein cows were assigned into 2 treatment groups: cows grazed on alfalfa-grass pasture (PAS) or were fed corn silage-alfalfa hay mix ad libitum (LOT). Both groups were supplemented with a 8.2 kg/d grain supplement containing 640 g of FO and SFO (1:3 wt/ wt). Grain supplement was fed in 2 equal portions after each milking, for a period of 3 wk. Milk samples were collected during the last 3 d of the experimental period. Milk yield was greater with the LOT diet (23.1 kg/ d) compared with the PAS diet (19.4 kg/d). Milk fat percentages (2.51 and 2.95 for the LOT and PAS, respectively) and yields (0.57 and 0.51 kg/d) were similar for the 2 diets. Milk protein percentages were not affected by diets (3.34 and 3.35 for the LOT and PAS diets, respectively), but protein yields were lower for the PAS diet (0.61 kg/d) compared with the LOT diet (0.75 kg/ d). Treatment diets had no effect on milk trans C18:1 concentrations [10.64 and 9.82 g/100 g of total fatty acids (FA) for the LOT and PAS, respectively] or yields (60.65 and 64.01 g/d), but did affect isomers distributions. Concentration (g/100 g of total FA) of vaccenic acid was lower with the LOT diet (2.15) compared with the PAS diet (4.52), whereas concentration of trans-10 C18:1 was greater with the LOT diet (4.99) compared with the PAS diet (1.69). Milk cis-9, trans-11 CLA concentration was greater with the PAS diet (1.52) compared with the LOT diet (0.84). In conclusion, the increase in milk cis-9, trans-11 CLA content was greater when pasture-based diets were supplemented with FO and SFO. The lower cis-9, trans-11 CLA concentration in milk from the confinement-fed cows resulted from trans-10 C18:1 replacing vaccenic acid as the predominant trans C18:1 isomer.

Performance Assessment of Broiler Chickens Given Mushroom Extract Alone or in Combination with Probiotics

A study was conducted to evaluate the effect of combined Shiitake mushroom (Lentinus edodes) extract with probiotics (PrimaLac) on the growth and health of broiler chickens. In trial 1, 540 d-of-hatch chicks were randomly assigned to 6 treatment groups, replicated 3 times, with 15 males and 15 females per pen for 3 wk. Dietary probiotics and mushroom treatments were as follows: 1) control feed + ad libitum tap water; 2) control feed + skip-a-day mushroom water; 3) control feed + ad libitum mushroom water; 4) probiotic feed + ad libitum tap water; 5) probiotic feed + skip-a-day mushroom water; 6) probiotic feed + ad libitum mushroom water. Body weight gain, feed consumption and efficiency, mortality, bursa, liver, and spleen relative weights of chicks were taken. In trial 2, the performance of broilers 3 to 7 wk withdrawn from the mushroom extract was evaluated along with the comparative level of fecal biofidobacteria in the control and mushroom extract treatment (trt). Mortality, weight gain, feed consumption and efficiency, carcass yield, fat pads, bursa weights and fecal bifidobacteria were measured in trial 2. In trial 1, significant differences (P < 0.05) in female weight gain (trt 4-0.62 vs. trt 1-0.54 kg) and male spleen weights were observed. In trial 2, significant differences were observed in male weight gain (trt 2-2.40 vs. trt 4-1.12 kg), male and female fat pads, male bursa weights (trt 3-0.15 vs. trt 6-0.39), female carcass yield percentage (trt 1-77.8 vs. trt 4-66.4), and feed consumption and efficiency. Body weights were severely depressed in the male broilers receiving the probiotics feed in treatments 4, 5, and 6, but not in the female broilers. These results indicate that performance differences in gender occur with additives during different grow-out periods, and mushroom extract promotes bifidobacteria growth in broiler chickens after 4 wk of withdrawal. It appears that probiotics and mushroom extract offered no combination potential for weight gain, which was compromised in this study, but possible health-enhanced attributes.

Kinetics of the substitution of dehydroacetic acid in tris (dehydroacetato) Fe(III) complex by 8-hydroxyquinoline, di- and tetra-hydroxyquinone

The ligand substitution reactions of dehydroacetic acid (Hdha) in [Fe(dha)(3)] with second ligand such as 8-hydroxyquinoline (Hquin), 1,4-dihydroxyanthraquinone (H(2)dhaq) and 1,4,5,8-tetra-hydroxyanthraquinone (H(4)thaq) were investigated spectrophotometrically by in low polarity solvents like benzene, chloroform and dichloromethane. It is deduced that the substitution reaction takes place through one successive step. The reaction was performed at four different temperatures (5-25) degrees C, and it exhibits a first order dependence on the concentration of the starting complex. The observed rate constant depends on the concentration of both leaving and entering ligands. The evaluation of the kinetic data gives activation parameters which support an associative mechanism in the transition states and the higher rate of substitution of the dha in Fe(dha)(3) complex is due to entropy effect. The solid complexes were synthesized and characterized by elemental analysis, IR and UV-vis spectral techniques.

Vertical migration of 134Cs bearing soil particles in arid soils: implications for plutonium redistribution

Vertical migration of plutonium in soils at the Waste Isolation Pilot Plant (WIPP) and the Rocky Flats Environmental Technology Site (RFETS) was evaluated based on observed 134Cs migration in soil column experiments. After applying 134Cs-labeled soil particles to the surfaces of large, undisturbed soil cores collected from each site, resulting soil columns were subjected to experimental cycles of irrigation plus drying (treatment columns) or to cycles of irrigation only (control columns). Mean losses of 134Cs inventory from soil surfaces were 3.1 +/- 0.6% cycle(-1) and 0.7 +/- 0.6% cycle(-1) respectively for RFETS treatment and control columns. WIPP columns had mean respective losses of 1.3 +/- 1.2% cycle(-1) and 0.5 +/- 0.2% cycle(-1). Bulk transport of labeled soil particles through soil cracks was an important process in RFETS soils, accounting for 64-86% of total 134Cs migration. Colloidal transport processes governed migration in WIPP soils.

Measles vaccination in the presence of maternal antibodies primes for a balanced humoral and cellular response to revaccination

Early or low dose antigen exposure can prime the immune system for subsequent responses; the so-called "prime-boost" effect. In the context of a Sudanese measles vaccine trial, we assessed whether or not such early exposure could influence the response to revaccination. Children received either Connaught high titer vaccine (CN: n = 53; 10(4.7)pfu) or meningococcal A + C vaccine as a placebo (MEN: n = 58) at 5 months of age. At 9 months of age, all received standard titer Schwarz vaccine (SCH: 10(3.9)pfu). Neutralizing antibodies were measured before initial vaccination and at 9 months of age (plaque reduction neutralization assay (PRN)) and again at 5 years of age (syncytium inhibition assay (SIA)). Lymphoproliferative responses to measles virus (MV) antigens were evaluated at 5 years of age. Eleven of the 53 CN-SCH children (21%) had sub-protective neutralizing antibody titers prior to revaccination (log PRN 1.5 +/- 0.03 versus 2.9 +/- 0.07 in the remaining 42 children; P < 0.004). Maternal antibody titers at the time of initial vaccination in these 11 were high (PRN 2.44 +/- 0.12 versus 1.9 +/- 0.04; P < 0.0001). At 5 years of age, neutralizing antibodies were comparable in the 11 CN-SCH poor responders (log SIA 2.1 +/- 0.09), the remaining CN-SCH children (2.2 +/- 0.06) and the MEN-SCH group vaccinated only once at 9 months of age (2.25 +/- 0.06). In contrast, 7/11 of the CN-SCH poor responders (64%) had stimulation indices (SI) > 3 in response to MV antigens at 5 years of age (SI 3.1 +/- 0.6) compared with only 14% in the remaining children of the CN-SCH group (2.0 +/- 0.3; P = 0.05) and 8% in the MEN-SCH group (1.4 +/- 0.2; P < 0.0003). These data suggest that early measles vaccination in the presence of maternal antibodies can sometimes prime for a balanced humoral and cellular immune response to subsequent revaccination.

Surveillance of measles in the Sudan using filter paper blood samples

Dried blood spots collected on filter paper are considered potential clinical specimens for measles surveillance because of their ease of collection, storage, and transport. The usefulness of these samples for surveillance of measles was evaluated in a field setting. Blood spots were collected by finger-prick from 316 clinically diagnosed measles patients in suburban Khartoum, mostly within a week after onset of the rash. Samples were collected between October, 2000 and April, 2003, and stored at 4 degrees C. Measles virus-specific IgM antibodies were detected in 200 (63%) of the samples using an "in-house" IgM capture ELISA. For 201 samples reconstitution and IgM measurement was repeated 1 year after initial testing with essentially the same results, showing the stability of IgM in the filter paper under these conditions. In a limited number of samples (n = 38) measles virus-specific IgM was also tested with a commercial indirect IgM ELISA. Although the results of the two assays correlated well, the "in-house" IgM capture ELISA proved slightly more sensitive. Measles virus-specific reverse transcriptase polymerase chain reaction (RT-PCR) amplicons were obtained from 16 of 57 (28%) samples tested. Sequencing of the 3' 456 nucleotides of the nucleoprotein gene showed the continued endemic circulation of genotype B3 viruses identified previously in this region. Although problems related to limited sample quantities were encountered, the present study confirms the usefulness of dried blood spots for measles surveillance. The results also demonstrate that measles continues to be endemic in the Sudan.

Measles virus protein-specific IgM, IgA, and IgG subclass responses during the acute and convalescent phase of infection

The availability of new generation serological assays allowed re-evaluation of the antibody response to measles virus. IgM, IgA, total IgG, and IgG subclass responses were studied to the three major immunogenic measles virus proteins: the fusion protein (F), haemagglutinin (H), and nucleoprotein (N). Plasma samples were obtained from clinically diagnosed measles cases (n = 146) in Khartoum (Sudan) within a week after onset of the rash. Convalescent phase samples were collected from 32 of 117 laboratory-confirmed measles cases at different time points after onset of rash. Glycoprotein-specific IgM, IgG, and IgA antibody levels correlated well to the N-specific response. For IgG and IgA, responses to F were higher than to H. IgA antibody levels were undetectable in about one third of the laboratory-confirmed cases during the acute phase, but positive in all patients tested 1-4 weeks after infection. IgM levels declined rapidly and were lost 3-6 months after infection. IgA levels declined slowly during the first year but did not return to background levels during the subsequent 2 years. IgG avidity maturation was detected during a 3-6 month period after infection. The predominant IgG subclasses during the acute phase were IgG(1) and IgG(3). The latter was lost in the convalescent phase, while the IgG(4) isotype showed a slight rise afterwards. Interestingly, acute phase IgG(3) and IgA responses were associated, and were only detected in samples with high IgG. This study provides a comprehensive perspective on the antibody response to wild-type measles virus infection.

Ion-selective electrode for the determination of prazosin in tablets

A poly (vinylchloride) (PVC) membrane electrode selective for prazosinium cation based on prazosinium-phosphotungstate (PZ)(3)PT ion-associate is prepared. The electrode exhibits a linear response with an approximate Nernstian slope over the range of 2.7 x 10(-6)-10(-2) M. Calibration graph slope of the electrode is 58 mV PZ(-1) concentration decade when preconditioned by soaking in distilled water for 1 h-20 days. The working pH of the electrode ranged from 1.5 to 6.4 and exhibits very good selectivity for the PZ with respect to a large number of inorganic cations and organic substances of biological importance. The standard additions method and potentiometric titration are used to determine the PZ in pure solution and in pharmaceutical preparations with satisfactory results.

Classification of perinatal death in a developing country

OBJECTIVES

To evaluate and compare the three most commonly used perinatal death classification systems: (1) the Nordic-Baltic; (2) the Aberdeen; and (3) the Wigglesworth, and assess their applicability in a developing country (Sudan) with a high perinatal mortality rate, and their justification for practical use in quality assurance and audit activities.

METHODS

At Omdurman Maternity Hospital (OMH), Khartoum, Sudan, 166 perinatal deaths were prospectively assessed during a 3-month period (May-August 2000) with a total of 2260 births. Narratives of 166 perinatal deaths were prepared for the purpose of audit. A panel of two Danish and one Sudanese obstetrician categorized the cases according to: (1) the Nordic-Baltic; (2) the Aberdeen; and (3) the Wigglesworth classification.

RESULTS

By all three classifications a similar fraction of cases (approx. 85%) were allocated to one category only, and in 15% of cases the assessors were in doubt into which of two categories the cases should be allocated. The necessary information is often not available, giving at least 40% classified as 'unknown' in the Aberdeen classification, whereas the Wigglesworth classification results in an even larger group of unspecified asphyxia.

CONCLUSION

Classification of perinatal deaths in developing countries is associated with problems regarding application, validity and usefulness. The Nordic-Baltic classification seems to be most suitable for appropriate stratification using routinely recorded variables and providing categories associated with specific levels of care.

Plutonium in Colorado residents: results of autopsy bone samples collected during 1975-1979

Concentrations of (239,240)Pu and the 240Pu/239Pu atom ratios were measured in rib samples from 55 non-occupationally exposed Colorado residents. Samples were collected at autopsy during 1975-1979 under an earlier study intended to compare plutonium levels in liver and lung of people who lived at various proximities to the Rocky Flats Environmental Technology Site (RFETS) near Denver. Overall, median (239,240)Pu concentrations from rib samples were 100, 80, and 57 microBq g(-1) ash weight for area locations A, B, and C, respectively. Area A encompassed subjects who lived within 25 km of RFETS, area B was between 25 and 50 km from RFETS, and area C included all of Colorado outside 50 km from the site and east of the continental divide. The corresponding median plutonium skeletal burdens estimated for these area locations were 146, 93, and 71 mBq, respectively. A statistically significant difference was noted only between plutonium concentrations in male rib samples and their skeletal burdens from area A compared to area C. However, based on a regression analysis of all study subjects, distance from RFETS was not statistically correlated to plutonium rib concentrations or skeletal burdens in this sample. Overall, median 240Pu/239Pu atom ratios were 0.20, 0.18, and 0.17 for areas A, B, and C, respectively. Although higher (239,240)Pu concentrations and skeletal burdens were indicated in area A males than area C males, we cannot conclude that RFETS releases may have caused this difference. The decreasing trends in the 240Pu/239Pu ratios with distance from RFETS are contrary with such a conclusion and strongly indicate that the material was primarily global fallout rather than weapons-grade plutonium that was processed at RFETS. Furthermore, there are other plausible explanations for the differences observed between area A and C residents. These include a decreasing trend in global fallout from the Rocky Mountain foothills eastward, smoking history differences, sample selection criteria, and possibly other unidentified factors. Nevertheless, estimated levels of total plutonium in this sample of Colorado residents were low and within the range of reported literature values for general, world-wide populations.

Genetic characterization of wild-type measles viruses circulating in suburban Khartoum, 1997-2000

Measles remains endemic in many East African countries, where it is often associated with high morbidity and mortality. We collected clinical specimens from Sudanese measles patients between July 1997 and July 2000. Sequencing of the 3' 456 nucleotides of the nucleoprotein gene from 33 measles virus (MV) isolates and 8 RNA samples extracted from clinical specimens demonstrated the presence of a single endemic MV strain with little sequence variation over time (overall nucleotide divergence of 0 to 1.3%). This was confirmed by sequencing of the complete H gene of two isolates from 1997 and two from 2000, in which the overall divergence ranged between 0 and 0.5%. Comparison with MV reference strains demonstrated that the viruses belonged to clade B, genotype B3, and were most closely related to a set of viruses recently isolated in Nigeria. Our study demonstrates a remarkable genetic stability of an endemically circulating MV strain.

Measles in suburban Khartoum: an epidemiological and clinical study

Clinical and epidemiological data were collected from 187 clinically diagnosed measles patients in Haj Yousif area, suburban Khartoum. Laboratory tests confirmed the diagnosis in 141 (75%) of the cases, but demonstrated that in 46 (25%) patients the clinical symptoms were not caused by an acute measles virus (MV) infection. According to their vaccination card, 59% of the laboratory-confirmed measles cases had been vaccinated for measles. Compared with non-measles rash disease cases, confirmed measles cases more often had severe illness (P < 0.0001), were dehydrated (P=0.01) at presentation and less likely to recover without complications [OR 0.19 (95% CI 0.09, 0.39)]. There was no difference in death rate (P=0.20). Underweight [weight-for-age Z score (WAZ) <or= -2 SD] was an independent predictor of recovery with complications [OR 0.4 (95% CI 0.2, 0.99)]. Severe measles cases (those who developed diarrhoea, pneumonia, otitis media, encephalitis or haemorrhagic rash) had similar vaccination rates and time intervals since vaccination as uncomplicated measles cases. Although severe measles had lower WAZ-scores (P=0.004), none of the nutritional parameters studied were predictive of outcome. Mortality was higher in the severe measles group [OR 8.8 (95% CI 1.7, 85.2)]. In 11 of 141 confirmed measles cases serological evidence of a recent infection with another virus was found, most commonly varicella zoster virus and dengue virus; spotted fever and rubella were among the most frequent diagnoses in 17 of 47 cases of the non-measles cases.

Nutritional stunting in Egypt: which nutrient is responsible?

We looked at the relationship between linear growth retardation and deficiencies of certain nutrients in Egyptian children. A group of 107 stunted children aged between 10 and 18 years were subjected to history-taking, physical examination and laboratory investigations. Selected cases were referred to radiology for assessment of bone age. Thirty-nine children were enrolled as controls. Serum haemoglobin, alpha-tocopherol, retinol and magnesium levels were significantly decreased in stunted children compared with the controls. Serum zinc levels were also lower in the stunted group but not significantly so. We conclude that several nutrient deficiencies occur simultaneously in stunted children and all of them may be responsible for stunting.

Impact of nutritional rehabilitation on enzymatic antioxidant levels in protein energy malnutrition

To assess the role of enzymatic antioxidants in the pathogenesis of protein energy malnutrition (PEM) and the effect of nutritional rehabilitation, we studied 30 infants with PEM (mean age 10.63 +/- 4.39 months: 10 marasmic; 8 with kwashiorkor; 12 with marasmic kwashiorkor) and 15 controls. All underwent clinical examination and laboratory investigations, including superoxide dismutase (SOD) and glutathione peroxidase (GPx) estimation before and after nutrition rehabilitation. SOD and GPx were significantly lower in all malnourished infants compared to controls, and significantly increased after nutritional rehabilitation. These significant correlations suggest that antioxidants could be introduced during PEM nutritional rehabilitation to decrease morbidity and mortality.

Job strain and self-reported health among working women and men: an analysis of the 1994/5 Canadian National Population Health Survey

This paper explores the associations, for working women and men, of high strain jobs with self-rated health in the 1994/95 Canadian National Population Health Survey (NPHS). NPHS data were obtained on men (n = 4230) and women (n = 4043), aged 18-64 who answered an abbreviated version oF the job content questionnaire (JCQ). Using the upper and lower tertiles of psychological demands and decision latitude as cut points we classified workers into high strain and other jobs. Self-rated health was the outcome. We used polytomous logistic regression analyses and controlled for potential personal and home confounders; two risk parameters were estimated: for the odds of reporting poor/fair and good health both vs. very good/excellent health. High strain work was reported by 11% of women and 9% of men. After adjusting for potential confounders, high job strain was consistently associated with worse self-rated health in both models for each gender.

Work correlates of back problems and activity restriction due to musculoskeletal disorders in the Canadian national population health survey (NPHS) 1994-5 data

OBJECTIVES

To describe the prevalence of musculoskeletal problems in the Canadian working population and to determine cross sectional associations between such problems and work factors, particularly job strain and physical demand variables.

METHODS

The Canadian 1994 national population health survey (NPHS) sampled 4230 working men and 4043 working women (ages 18-64) who answered an abbreviated version of the job content questionnaire. Workers were classified into four strain categories: high, passive, active, and low. Outcomes were restricted activity due to musculoskeletal disorders and the diagnosis of a back problem (both yes or no). Survey weights were incorporated to allow for different probabilities of selection. Logistic regression analyses were carried out separately for women and men, controlling for sociodemographic factors.

RESULTS

Prevalence of chronic back problems diagnosed by a health practitioner was 14.5% among men and 12.5% among women. Men had a 6.6% prevalence of restricted activity due to musculoskeletal disorders, whereas the corresponding figure for women was 5.3%. Women, but not men, in high strain jobs were more likely to report both back problems (odds ratio (OR) 1.60, 95% confidence interval (95% CI) 1.14 to 2.28) and restricted activity (OR 1.98, 95% CI 1.16 to 3.48) compared with those in low strain jobs. High physical exertion was an independent predictor of back problems in both sexes. For both men and women, low social support at work and high job insecurity were independent predictors of restricted activity due to musculoskeletal disorders. Conversely, chronic back problems contributed to explanation of high job strain among women (OR 1.76, 95% CI 1.30 to 2.39) and high physical exertion among men (OR 1.39, 95% CI 1.09 to 1.77), whereas restricted activity due to musculoskeletal disorders contributed to explanation of high job insecurity in both sexes.

CONCLUSIONS

Associations of interest between work stressors and musculoskeletal problems in this cross sectional study provide evidence for physical and psychosocial factors both affecting disability and being affected by disability in a working population.

Rheumatology patient and physician concordance with respect to important health and symptom status outcomes

OBJECTIVE

In chronic diseases such as arthritis, patients' priorities and values are of prime importance in the measurement of outcome. Relatively few indices take this into account. We sought to identify individual rheumatology patients' choices for important health and symptom status outcomes and assess physicians' ability to detect them.

METHODS

A cross-sectional, observational study design was used to examine rheumatology patients' choices for important health and symptom status outcomes. A descriptive summary of patients' choices of "most important" health and symptom status outcomes was compiled. The sensitivity and specificity of physicians' ability to detect their patients' choices for important health or symptom status outcomes were calculated.

RESULTS

The sample consisted of 79 rheumatology patients, 30 men and 49 women, with a mean age of 52.6 years. The feeling of being in control was the mental health outcome rated most important by the largest number of the patients (42%); cognitive function (making decisions, solving problems) (22%), feelings of being happy (18%), and feelings of being satisfied (16%) were also rated as being "most important" by many patients. Feelings of hope were rated "most important" by the fewest patients (2%). The physicians' sensitivity to detecting patients' choices of most important outcomes was highest for social functioning and lowest for mental functioning. The specificity to detect patients' choices of less important outcomes was highest for physical functioning and lowest for symptom status.

CONCLUSION

In this study involving 4 rheumatologists, patients were found to differ in their choices of important health and symptom status outcomes. Physicians often fail to identify these choices.

Variation in perceptions of treatment and self-care practices in elderly with osteoarthritis: a comparison between African American and white patients

OBJECTIVE

To compare elderly African American and white patients with osteoarthritis of the knee or hip with respect to their perceptions of the efficacy of traditional and complementary treatments and their self-care practices.

METHODS

An observational, cross-sectional study design using structured questionnaires was employed.

RESULTS

The sample consisted of 593 patients (44% African American and 56% white). The 2 groups were comparable with respect to age, disease severity or functional status, and comorbidities. African Americans were more likely than whites to report lower educational level and household income. African Americans were also more likely than whites to perceive various traditional and complementary care modalities as efficacious. However, they were less likely than whites to perceive joint replacement therapy as efficacious (odds ratio 0.52, 95% confidence interval 0.28-0.98). African American patients were more likely than white patients to rely on self-care measures for their arthritis.

CONCLUSION

African American and white patients with osteoarthritis of the knee or hip differ with respect to their perceptions of traditional and complementary treatments for arthritis and their self-care practices.

Evaluation of laboratory techniques for differentiation between Entamoeba histolytica and Entamoeba dispar

Incorporation of clinical, epidemiological and serological parameters to the studies of Entamoeba histolytica resulted in the conclusion that species complex comprising two morphologically identical amoeba were implicated with the disease. The two organisms are E. histolytica and E. dispar. The former is a pathogen and responsible for invasive amoebiasis while the later is a gut commensal. Clearly accurate diagnostic tools are required to distinguish the two species. The use of a stool ELISA has been shown to be useful. A monoclonal enzyme linked immunosorbent assay based kit to detect antigen of E.histolytica only in stool was evaluated in comparison to the results of the microscopical examination of the stools and that of enzyme linked immunosorbent assay used to detect the anti- E. histolytica IgG in serum. This study demonstrated that E. dispar is prevalent in the community and offers promise for E. histolytica monoclonal enzyme immunoassay for the qualitative and semiquantitative determination of sensu lato antigen in stool as a sensitive tool for detection and distinction of E. histolytica from E. dispar infections.

Variation in perceptions of treatment and self-care practices in elderly with osteoarthritis: a comparison between African American and white patients

OBJECTIVE

To compare elderly African American and white patients with osteoarthritis of the knee or hip with respect to their perceptions of the efficacy of traditional and complementary treatments and their self-care practices.

METHODS

An observational, cross-sectional study design using structured questionnaires was employed.

RESULTS

The sample consisted of 593 patients (44% African American and 56% white). The 2 groups were comparable with respect to age, disease severity or functional status, and comorbidities. African Americans were more likely than whites to report lower educational level and household income. African Americans were also more likely than whites to perceive various traditional and complementary care modalities as efficacious. However, they were less likely than whites to perceive joint replacement therapy as efficacious (odds ratio 0.52, 95% confidence interval 0.28-0.98). African American patients were more likely than white patients to rely on self-care measures for their arthritis.

CONCLUSION

African American and white patients with osteoarthritis of the knee or hip differ with respect to their perceptions of traditional and complementary treatments for arthritis and their self-care practices.

Prevention of measles in Sudan: a prospective study on vaccination, diagnosis and epidemiology

Despite the availability of safe and effective live attenuated vaccines, measles continues to be endemic in many developing countries. Control and elimination of measles will be especially difficult in East Africa, because of its limited infrastructure and political instability. We have studied diagnostic and epidemiological aspects of measles in suburban Khartoum, Sudan. Prospective studies were carried out in a cohort of clinically diagnosed measles cases and in a cohort of newborns, which were both followed up for 2 years. The studies intended to provide a rational basis for improvement of measles vaccination strategies, and strengthen measles research infrastructure in Khartoum.