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Cañete R, Noda AL, Rodríguez M, Brito K, Herrera E, Kofoed PE, Ursing J. 5-Nitroimidazole refractory giardiasis is common in Matanzas, Cuba and effectively treated by secnidazole plus high-dose mebendazole or quinacrine: a prospective observational cohort study. Clin Microbiol Infect 2020; 26:1092.e1-1092.e6. [PMID: 31901492 DOI: 10.1016/j.cmi.2019.12.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/24/2019] [Accepted: 12/25/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To evaluate the effectiveness and tolerability of secnidazole combined with high-dose mebendazole for treatment of 5-nitroimidazole-resistant giardiasis. METHOD Adults with microscopically verified Giardia intestinalis monoinfection attending a secondary level hospital in Matanzas City, Cuba were prospectively included in a cohort. A recently introduced treatment ladder consisting of metronidazole as first-line treatment, followed by secnidazole, tinidazole, secnidazole plus mebendazole and quinacrine as second-to fifth-line treatments, respectively, was used. Adverse events and treatment success were determined by questioning and microscopy on concentrated stool samples, respectively on days 3, 5 and 7 after the end of treatment. If G. intestinalis was detected on day 3, 5 or 7, then the infection was classified as refractory and no further microscopy was performed. RESULTS A total of 456 individuals were included. Metronidazole, 500 mg three times daily for 5 days, cured 248/456 (54%) patients. A single 2-g secnidazole dose as second-line treatment cured 50/208 (24%) patients. A single 2-g tinidazole dose as third-line treatment cured 43/158 (27%) patients. Three rounds of 5-nitroimidazole therapy therefore cured 341/456 (75%) patients. Secnidazole plus mebendazole (200 mg every 8 hours for 3 days) cured 100/115 (87%) of nitroimidazole refractory infections. Quinacrine cured the remaining 15 patients. All treatments were well tolerated. CONCLUSIONS 5-Nitroimidazole refractory giardiasis was common, indicating that an alternative first-line treatment may be needed. Retreatment of metronidazole refractory giardiasis with an alternative 5-nitroimidazole was suboptimal, indicating cross-resistance. Mebendazole plus secnidazole were well tolerated and effective for the treatment of 5-nitroimidazole refractory G. intestinalis infection in this setting.
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Affiliation(s)
- R Cañete
- Council of Scientific Societies of Health, University of Medical Sciences, and Centre for Hygiene, Epidemiology and Microbiology, Matanzas City, Cuba
| | - A L Noda
- Paediatric Hospital 'Eliseo Noel Caamaño', Matanzas City, Cuba
| | - M Rodríguez
- Haematology and Immunology Institute, Havana, Cuba
| | - K Brito
- University of Medical Sciences, Matanzas, Cuba
| | - E Herrera
- University of Medical Sciences, Matanzas, Cuba
| | - P-E Kofoed
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau; Department of Paediatrics, Lillebaelt Hospital, Kolding, Denmark
| | - J Ursing
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Infectious Diseases, Danderyd Hospital, Stockholm, Sweden.
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Nissen TN, Birk NM, Blok BA, Arts RJW, Andersen A, Kjærgaard J, Thøstesen LM, Hoffmann T, Jeppesen DL, Nielsen SD, Kofoed PE, Stensballe LG, Aaby P, Ruhwald M, Netea MG, Benn CS, Pryds O. Bacillus Calmette-Guérin vaccination at birth and in vitro cytokine responses to non-specific stimulation. A randomized clinical trial. Eur J Clin Microbiol Infect Dis 2017; 37:29-41. [PMID: 28890996 DOI: 10.1007/s10096-017-3097-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 08/21/2017] [Indexed: 11/29/2022]
Abstract
Several studies have shown increased in vitro cytokine responses to non-related pathogens after Bacillus Calmette-Guérin (BCG) vaccination. A total of 158 infants (80 BCG administered within 7 days of birth; 78 controls) were bled 4 days post-randomization, and at age 3 and 13 months. Geometric mean concentrations of IL-1β, TNF-α, IL-6 (24 h stimulation) and IFN-γ, IL-10, IL-17, IL-22 (96 h stimulation) in response to in vitro stimulation with RPMI, LPS, PHA, Escherichia coli, Streptococcus pneumoniae, Candida albicans and BCG were compared among BCG vaccinated children and controls. BCG vaccination did not affect in vitro cytokine production, except IFN-γ and IL-22 response to BCG. Stratifying for 'age at randomization' we found a potentiating effect of BCG on cytokine production (TNF-α, IL-6, IL-10) in the 4 days post randomization stimulations, among children who were vaccinated at age 2-7 days versus age 0-1 days. BCG vaccination did not potentiate cytokine production to non-BCG antigens. At 4 days post randomization, BCG was associated with higher cytokine production in the later randomized children.
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Affiliation(s)
- T N Nissen
- Department of Pediatrics, 460, Copenhagen University Hospital, Kettegaard Allé 30, DK-2650, Hvidovre, Denmark.
| | - N M Birk
- Department of Pediatrics, 460, Copenhagen University Hospital, Kettegaard Allé 30, DK-2650, Hvidovre, Denmark
| | - B A Blok
- Division of Experimental Internal Medicine, Department of Internal Medicine, Radboud University Medical Center and Radboud Center for Infectious Diseases, Geert Grooteplein 10, 6525GA, Nijmegen, The Netherlands.,Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej 5, DK-2300, Copenhagen S, Denmark.,Odense Patient data Explorative Network, Odense University Hospital/Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - R J W Arts
- Division of Experimental Internal Medicine, Department of Internal Medicine, Radboud University Medical Center and Radboud Center for Infectious Diseases, Geert Grooteplein 10, 6525GA, Nijmegen, The Netherlands
| | - A Andersen
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej 5, DK-2300, Copenhagen S, Denmark
| | - J Kjærgaard
- The Child and Adolescent Clinic 4072, Juliane Marie Centret, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100, Copenhagen Ø, Denmark
| | - L M Thøstesen
- Department of Pediatrics, Kolding Hospital, Skovvangen 2-8, DK-6000, Kolding, Denmark
| | - T Hoffmann
- Department of Pediatrics, 460, Copenhagen University Hospital, Kettegaard Allé 30, DK-2650, Hvidovre, Denmark
| | - D L Jeppesen
- Department of Pediatrics, 460, Copenhagen University Hospital, Kettegaard Allé 30, DK-2650, Hvidovre, Denmark
| | - S D Nielsen
- Viro-immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100, Copenhagen Ø, Denmark
| | - P-E Kofoed
- Department of Pediatrics, Kolding Hospital, Skovvangen 2-8, DK-6000, Kolding, Denmark
| | - L G Stensballe
- The Child and Adolescent Clinic 4072, Juliane Marie Centret, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100, Copenhagen Ø, Denmark
| | - P Aaby
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej 5, DK-2300, Copenhagen S, Denmark
| | - M Ruhwald
- Human Immunology, Infectious Disease Immunology, Division of Vaccine, Statens Serum Institut, DK-2300, Artillerivej 5, Denmark
| | - M G Netea
- Division of Experimental Internal Medicine, Department of Internal Medicine, Radboud University Medical Center and Radboud Center for Infectious Diseases, Geert Grooteplein 10, 6525GA, Nijmegen, The Netherlands
| | - C S Benn
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej 5, DK-2300, Copenhagen S, Denmark.,Odense Patient data Explorative Network, Odense University Hospital/Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - O Pryds
- Department of Pediatrics, 460, Copenhagen University Hospital, Kettegaard Allé 30, DK-2650, Hvidovre, Denmark
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3
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Abstract
AIM To evaluate whether the metabolic status had been influenced by the longer interval between visits because of a strike at the diabetes outpatient clinic. METHODS During the strike from April 16 to June 15, 2008 all routine visits were cancelled. The HbA1c values from the last two visits prior to and the first two visits after the strike were compared with the values from the same periods the previous year. Danish speaking patients answered a questionnaire. RESULTS For 155 children included, the mean HbA1c values before the strike were 8.1 and 8.1 (p = 0.39), while the value increased to 8.5 at the first visit (p < 0.0001) and 8.4 at the second visit following the strike (p = 0.14). No differences were found between any of the HbA1c values measured in 2007 (p > 0.05). Of the 152 questionnaires handed out, 113 (74.3%) were returned. Of these, 48 (42.5%) stated to have needed help, and 49 (43.3%) that their children's diabetes had deteriorated because of the strike. CONCLUSIONS In this unplanned study, the increase of 0.4% in mean HbA1c supports previous findings that the interval between visits at a diabetic clinic is important for ensuring an acceptable metabolic control in children with diabetes.
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Affiliation(s)
- P-E Kofoed
- .Initiative of Health Services Research, University of Southern Denmark, Kolding Hospital, Kolding, Denmark.Department of Paediatrics, Kolding Hospital, Kolding, Denmark
| | - J Thomsen
- .Initiative of Health Services Research, University of Southern Denmark, Kolding Hospital, Kolding, Denmark.Department of Paediatrics, Kolding Hospital, Kolding, Denmark
| | - J Ammentorp
- .Initiative of Health Services Research, University of Southern Denmark, Kolding Hospital, Kolding, Denmark.Department of Paediatrics, Kolding Hospital, Kolding, Denmark
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Poulsen A, Qureshi K, Lisse I, Kofoed PE, Nielsen J, Vestergaard BF, Aaby P. A household study of chickenpox in Guinea-Bissau: intensity of exposure is a determinant of severity. J Infect 2002; 45:237-42. [PMID: 12423611 DOI: 10.1053/jinf.2002.1049] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determinate the relative importance of state of nutrition and intensity of exposure for clinical severity of chickenpox in a developing country. METHODS A prospective household study was performed in a semi-urban area in Bissau, the capital of Guinea-Bissau, between December 1994 and June 1995. Antibodies were measured in the acute and the convalescence phase to assess validity of clinical diagnoses. The clinical severity of infection was assessed by number of pox, fever response and skin infections. Severity was compared for index cases, i.e. the first case in the house, and secondary and tertiary cases infected following exposure at home. RESULT Chickenpox was diagnosed in 165 persons. The clinician's and the mothers' diagnoses corresponded well with the serological results. Median age was 36 months (range 3 months to 30.3 years). There was no correlation between nutritional status measured by arm-circumference and severity of infection. The number of pox was higher for secondary cases than for index cases (median 106 vs. 89, P<0.01), the difference being more pronounced for girls (P=0.018) than for boys (P=0.575). The risk of skin infection as a complication was correlated with the number of pox (P<0.001). CONCLUSION Chickenpox was recognised correctly by Guinean mothers. The age distribution in Guinea-Bissau resembled the pattern in developed countries. The intensity of exposure was a major determinant of severity, especially for girls.
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Affiliation(s)
- A Poulsen
- Projecto de Saude de Bandim, Guinea-Bissau, Denmark.
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Stensballe LG, Trautner S, Kofoed PE, Nante E, Hedegaard K, Jensen IP, Aaby P. Comparison of nasopharyngeal aspirate and nasal swab specimens for detection of respiratory syncytial virus in different settings in a developing country. Trop Med Int Health 2002; 7:317-21. [PMID: 11952947 DOI: 10.1046/j.1365-3156.2002.00867.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare detection of respiratory syncytial virus (RSV) for diagnostic purposes using nasopharyngeal aspirate (NPA) and nasal swabs (NS) in different clinical settings in a community study in Guinea-Bissau. METHOD During 1996-98 paired specimens were obtained from 635 children under 5 years of age (median: 274 days; interquartile range: 144-453 days) with symptoms of lower respiratory infections (LRI). The specimens were analysed by an enzyme-linked immunosorbent assay for RSV antigen in Guinea-Bissau and re-analysed in Denmark using the same assay. The gold standard for RSV antigen detection was defined as any test being positive. RESULTS RSV antigen was detected in 84 (13%) children, the prevalence being 19% (41/219) among infants aged < 6 months, 12% (22/184) in infants aged 6-11 months, and 9% (21/230) in older children. Sensitivity of antigen detection was higher in NPA (92% in analyses in Guinea-Bissau and 98% in Denmark) than in NS (63% in analyses in Guinea-Bissau, 71% in Denmark). Specificity of RSV antigen detection was equally high in NPA and NS (99-100%). Time since onset of symptoms was significantly shorter in RSV antigen positive than negative samples. Sensitivity did not depend on clinical setting or age of the child. CONCLUSION Using NS samples was associated with a 27-31% reduction in sensitivity compared with NPA specimens. As NPAs are costly and considered a nuisance by the population, it might be cost-effective in larger epidemiological studies to lose 25-30% in sensitivity but be able to collect samples from a much larger population.
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Stensballe LG, Kofoed PE, Nante EJ, Sambo M, Jensen IP, Aaby P. Duration of secretory IgM and IgA antibodies to respiratory syncytial virus in a community study in Guinea-Bissau. Acta Paediatr 2000; 89:421-6. [PMID: 10830453 DOI: 10.1080/080352500750028122] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Respiratory syncytial virus (RSV) is probably the single major cause of lower respiratory infection (LRI) among infants worldwide. Its relative importance may be underestimated, as the diagnosis is based on antigen detection and antigen may only be detectable in the early phase of infection. We have therefore assessed the duration of secretory IgM and IgA antibody responses and whether assays for these antibodies can be used to improve the diagnosing of RSV-associated infections. During two RSV epidemics in Guinea-Bissau, 32 RSV antigen-positive children with LRI were followed with sequential nasopharyngeal suction on days 7, 14, 30, 60 and 120 in the first epidemic and every fortnight for 6 mo after the second epidemic to measure the duration of secretory IgM and IgA responses. Nearly all of the children had an IgM response during the first month after infection. The response ratio was highest on days 7 and 14, being 84% and 71%, respectively. After 30 d the IgM response decreased rapidly. Among 27 age- and sex-matched controls, only 1 child was positive for IgM. During the second epidemic, when the children were followed more intensively, half of the children were IgM-positive after the acute phase of infection. A secondary response may be more likely in children with low IgM responses in the acute phase (RR = 2.08 (95% confidence interval (CI) 0.92-4.70)). The IgA response was highest on days 28 and 42 after antigen detection, 72% having a detectable IgA response within the first 1.5 mo. Among 27 controls, only 2 were IgA-positive (7%). In the second epidemic with more intensive follow-up, 62% (8/13) of the IgA-positive children had a response that lasted 10 wk. Of the children with no persistent IgA response, half (5/10) had a subsequent IgA-positive response after the first 42 d. All of these children had a simultaneous IgM-positive response. When 29 of the children were tested after an epidemic when they were 1-3-y-old, >80% again had high IgM (24/29, 82%) and IgA (28/29, 94%) levels. Among samples collected over a 1-y period from infants with LRI in a community morbidity surveillance conducted at the local health centre and via paediatric outpatient consultation, 17% (110/659) were antigen-positive, 26% (171/659) IgM-positive and 38% (248/659) either antigen- or IgM-positive. IgM responses are short-lived among infants and may therefore be used as an indication of recent RSV infection among children with LRI. Using both antigen and IgM detection may significantly improve our detection of RSV infections.
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Kofoed PE, Lopes F, Johansson P, Dias F, Sandström A, Aaby P, Rombo L. Low-dose quinine for treatment of Plasmodium falciparum malaria in Guinea-Bissau. Trans R Soc Trop Med Hyg 1999; 93:547-9. [PMID: 10696419 DOI: 10.1016/s0035-9203(99)90377-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
The recommended dose of 10 mg quinine/kg bodyweight 3 times a day for 7 days for treatment of malaria is so high that many patients experience cinchonism. We have earlier obtained good results with 7 days' treatment with 20 mg Quinimax/kg bodyweight divided into 2 daily doses. In order to identify the lowest effective dose, children with symptomatic malaria were treated with quinine twice a day for 7 days. They were assigned to 1 of 3 groups treated daily with 10 mg/kg, 15 mg/kg, or 20 mg/kg bodyweight, respectively; 42, 46, and 34 children, respectively, received treatment and completed 5 weeks of follow-up. The cumulative percentages of all children with parasitaemia during follow-up on day 28 or before were 33%, 13% and 12%, respectively. Treatment with 10 mg quinine salt/kg daily for 7 days gave a significantly higher rate of recrudescence than did treatment with 15 or 20 mg/kg daily. Thus at least 15 mg of quinine salt/kg bodyweight daily should be recommended for treatment of symptomatic Plasmodium falciparum malaria in Guinea-Bissau.
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Affiliation(s)
- P E Kofoed
- Department of Paediatrics, Kolding Hospital, Denmark
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8
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9
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Jensen IP, Thisted E, Glikmann G, Obel N, Kofoed PE, Sambo M, Valerius NH, Mordhorst CH. Secretory IgM and IgA antibodies to respiratory syncytial virus in nasopharyngeal aspirates: a diagnostic supplement to antigen detection. Clin Diagn Virol 1997; 8:219-26. [PMID: 9406652 DOI: 10.1016/s0928-0197(97)10002-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND RSV-shedding during an RSV-infection declines dramatically after the first week of infection. It could be of interest to be able to diagnose RSV-infection for a longer period of time by detection of specific RSV-IgM and RSV-IgA in nasopharyngeal aspirates (NPA) in order to minimize unnecessary antibiotics. OBJECTIVES To evaluate an ELISA to detect specific RSV-IgM and RSV-IgA in NPA as a supplement to RSV-antigen detection. STUDY DESIGN A total of 104 NPA from 101 children (median age 9 months) with acute respiratory disease (group 1) admitted to hospital and consecutive NPA (collected on day 0, 7, 14, 30 and 60) from 11 children (median age 3 months) with a proven RSV infection (group 2) were collected. All NPA from group 1 were analysed for RSV-antigen, RSV-IgM and RSV-IgA. NPA from group 2 were analysed for RSV-IgM and RSV-IgA. RESULTS Thirty-five NPA in group 1 were positive for RSV-antigen and 64 were positive for RSV-antigen test alone found 44% and the RSV-IgM test alone found 80%. In group 2 8/11 (73%) has an excellent RSV-IgM response day 7, the rest responded later. Only 5/11 (46%) had a less pronounced RSV-IgA response on day 7, three cases responded later and three did not respond at all. RSV-IgM disappeared in 8/11 (73%) and RSV-IgA in 7/8 (88%) between day 30-60. CONCLUSIONS Specific RSV-IgM is a valuable supplement to RSV-antigen detection for the diagnosis of acute and recent RSV infection.
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Affiliation(s)
- I P Jensen
- Department of Virology, Statens Serum Institut, Copenhagen, Denmark.
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10
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Kofoed PE, Mapaba E, Lopes F, Pussick F, Aaby P, Rombo L. Comparison of 3, 5 and 7 days' treatment with Quinimax for falciparum malaria in Guinea-Bissau. Trans R Soc Trop Med Hyg 1997; 91:462-4. [PMID: 9373656 DOI: 10.1016/s0035-9203(97)90286-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
For treatment of malaria, the World Health Organization recommends 10 mg of quinine per kg body-weight 3 times a day for at least 7 d. In Guinea-Bissau, as in several other African countries, a 3 d treatment regimen (10 mg/kg twice daily) is currently used. We therefore compared the 3 d treatment period with periods of 5 and 7 d. A total of 145 children with clinical malaria due to monoinfection with Plasmodium falciparum, with > or = 20 parasites per 200 leucocytes, were treated with intramuscular Quinimax 10 mg per kg body-weight twice daily for 3, 5 or 7 d. The children were then examined once weekly for 4 weeks. Following the 3 d treatment regimen, 34 of 43 children (79%) had parasitaemia on day 28 or before; following the 5 d treatment regimen, 36 of 40 children (90%) did so; and following the 7 d treatment regimen, 7 of 62 children (11%) were parasitaemic at that time. This study thus suggests that the currently recommended 3 d Quinimax treatment regimen in Guinea-Bissau for moderate and severe malaria is not effective.
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Affiliation(s)
- P E Kofoed
- Projecto de Saúde de Bandim, Guinea-Bissau
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11
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Affiliation(s)
- P E Kofoed
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
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12
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Zeitlyn S, Rahman AK, Nielsen BH, Gomes M, Kofoed PE, Mahalanabis D. Compliance with diphtheria, tetanus, and pertussis immunisation in Bangladesh: factors identifying high risk groups. BMJ 1992; 304:606-9. [PMID: 1559089 PMCID: PMC1881328 DOI: 10.1136/bmj.304.6827.606] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To evaluate factors associated with non-compliance with having second vaccination against diphtheria, tetanus, and pertussis in a treatment centre in Dhaka to determine which children were most at risk of not completing immunisation. DESIGN Cohort study of infants given first dose of the vaccine and followed up six weeks later to ascertain compliance with having second dose. Factors associated with non-compliance were evaluated. SETTING Dhaka treatment centre of the International Centre for Diarrhoeal Disease Research, Bangladesh. SUBJECTS 136 unimmunised children aged 6 weeks to 23 months who lived within reach of the treatment centre. At time of the six week follow up 16 of the children could not be traced and seven had died. INTERVENTIONS All children received their first dose of the vaccine. In each case health education workers had informed the mother about the value of immunisation, and she was given clear instructions to bring the child back after four weeks for the second dose. MAIN OUTCOME MEASURE Rate of non-compliance with advice to return child for second vaccination. RESULTS 46 of 113 children (41%) received the second dose of the vaccine. Factors most closely associated with mothers' failure to comply with the second dose were lack of education and low income. Children whose mothers knew most about immunisation at first interview were more likely to have their second dose. CONCLUSIONS Preventive health care services such as immunisation are appropriately offered in treatment centres, but compliance among children varies with socioeconomic status and mother's education. Further research should be aimed at ways to make health education more effective among uneducated parents.
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Affiliation(s)
- S Zeitlyn
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
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Islam MA, Kofoed PE, Begum S. Can mothers safely prepare labon-gur salt-sugar solution after demonstration in a diarrhoeal hospital? Trop Geogr Med 1992; 44:81-5. [PMID: 1496730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Home-based salt-sugar solution (SSS) prepared with labon (locally produced sea salt) and gur (unrefined brown sugar) has been recommended as a cheap, locally available and a simple tool to prevent and treat diarrhoeal dehydration. Preparation of labon-gur SSS is demonstrated to the patients and the attendants at ICDDR, Bangladesh. To evaluate performances, 150 mothers were asked to measure labon and gur by finger pinch and first method and 100 mothers measured half a seer of water to prepare labon-gur SSS, shortly after the demonstration sessions. 4.0% of the samples exceeded the upper safety limit while 1.3% exceeded the upper danger limit for salt and 98.7% samples of gur were within safe and effective range. Mothers' performances were not different with regard to their educational status and prior practice at home. 80% knew about the solution before coming to the hospital and 45% had utilized this knowledge. Our study suggests that demonstration of home-based SSS in a diarrhoeal hospital may positively affect health education and that health personnel should actively participate in increasing health awareness.
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Affiliation(s)
- M A Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka
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Abstract
OBJECTIVE To study the uptake of vaccination offered to women and children attending a curative health facility. DESIGN Prospective survey over eight months of the uptake of vaccination offered to unimmunised women and children attending a diarrhoeal treatment centre as patients or attendants. SETTING The International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh. SUBJECTS An estimated 19,349 unimmunised women aged 15 to 45 and 17,372 children attending the centre for treatment or accompanying patients between 1 January and 31 August 1989. MAIN OUTCOME MEASURES The number of women and children who were unimmunised or incompletely immunised was calculated and the percentage of this target population accepting vaccination was recorded. RESULTS 7530 (84.2%) Of 8944 eligible children and 7730 (40.4%) of 19,138 eligible women were vaccinated. Of the children, 63.8% were boys, 75.9% were aged under 1 year, and 23.0% were aged 1 to 2 years. The estimated number of missed opportunities for vaccination was 716 among the children (8.0% of the target population) and 11,408 among the women (59.6% of those eligible). CONCLUSION It is possible to establish immunisation services at a health facility treating acutely ill patients.
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Affiliation(s)
- P E Kofoed
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
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15
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Kofoed PE, Engel K, Kildeberg P. [Testing of a liquid, ready-to-use, breast milk substitute in the county of Funen]. Ugeskr Laeger 1990; 152:2407-11. [PMID: 2402809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A newly developed liquid ready-to-use cow's milk based formula (BD) was used as the sole nutrient in 314 healthy term infants below the age of 28 weeks--except for supplementary feeding introduced at an average age of 142 days. The incidence of dyspeptic problems (constipation, diarrhea, vomiting), the parents' and visiting nurses' comments on the product, and the causes of "BD failure" (termination of BD feeding because of suspected cow's milk allergy, dyspepsia, etc.) were recorded as were rates of weight gain and linear growth. It is concluded that BD is a valuable alternative to existing powdered milk formulas and that the growth of the infants compared satisfactorily with published reference values.
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Affiliation(s)
- P E Kofoed
- Odense Sygehus, paediatrisk afdeling H og klinisk-kemisk afdeling, og Amtssundhedsplejen på Fyn
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Kofoed PE. [Breast milk substitutes based on cow milk]. Ugeskr Laeger 1990; 152:2404-7. [PMID: 2205958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
"Adapted" or "humanized" breast-milk substitutes based on cows' milk are manufactured according to directives from a publication issued by the Ministry of Agriculture. The accepted recommendations for the daily intake (RDA) of nutrients is adjusted to the neonates' relatively low tolerance and provides a certain margin of safety in case of illness and slight inaccuracies in preparation. The recommendations are, however, often based on animal experiments, studies of pathological conditions etc. because the needs of the neonate are not known. There is a fundamental difference between RDA for chemical energy and various nutrients as the energy requirement is stated on the basis of average values while the requirements for specific nutrients are gives as upper and lower limiting values. In addition to nutrients, a long series of hormones, enzymes and antimicrobial factors are transferred to the infant via breast-milk. The nutritional significance of these is entirely or partially unknown. It is thus impossible to give the bottle-fed infant a diet which is quantitatively and qualitatively identical with that of a breastfed baby. Nevertheless, experience has shown that bottle-feeding usually proceeds satisfactorily. Galactosaemia and certain forms of medication in the mother constitute absolute contraindications to breast-feeding while phenylketonuria, certain maternal infections are relative contraindications to breast-feeding. Mothers should be prepared for breast-feeding already during pregnancy but in the cases where the mother cannot, should not or does not wish to breast-feed, it is important to counteract any feelings of guilt, neglect or incompetence and, on the other hand, give her thorough training in artificial feeding of the infant.
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Hansen LP, Jacobsen BB, Kofoed PE, Larsen ML, Tougaard L, Johansen I. Serum fructosamine and HbA1c in diabetic children before and after attending a winter camp. Acta Paediatr Scand 1989; 78:451-2. [PMID: 2741687 DOI: 10.1111/j.1651-2227.1989.tb11108.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- L P Hansen
- Department of Paediatrics, Odense University Hospital, Denmark
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Kofoed PE, Larsen C, Elle B, Høst A. [Usefulness of ultrasonic scanning in the diagnosis of infantile hypertrophic pyloric stenosis]. Ugeskr Laeger 1989; 151:644-5. [PMID: 2646798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Kofoed PE, Simonsen G. Some perinatal risk factors in a developing country. East Afr Med J 1988; 65:535-40. [PMID: 3229372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Abstract
To evaluate the usefulness of ultrasound in hypertrophic pyloric stenosis (HPS) and to analyse the correlation between the dimensions of the pyloric muscle and the age and the weight of the child, 34 children with suspected HPS and 34 controls were examined. An overlap between the dimensions of the pyloric muscle in the HPS group and in the controls stresses the need to assess the muscle length, the muscle diameter, and the muscle wall thickness in establishing the sonographic diagnosis of HPS. We found the following criteria useful: muscle length greater than or equal to 19 mm, muscle diameter greater than or equal to 10 mm, and muscle wall thickness greater than or equal to 4 mm. The results did not confirm previous reports of increasing dimensions of the pyloric muscle with age and weight.
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Affiliation(s)
- P E Kofoed
- Department of Pediatrics, University Hospital of Odense, Denmark
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Kofoed PE, Simonsen G. Neonatal tetanus in Machakos, Kenya. East Afr Med J 1988; 65:16-7. [PMID: 3416789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Kofoed PE, Høst A, Elle B, Larsen C. [Ultrasound studies of hypertrophic pyloric stenosis]. Ugeskr Laeger 1987; 149:2975-7. [PMID: 3324426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Skov BG, Kofoed PE, Nielsen B. Gastrointestinal perforation due to congenital absence of intestinal musculature. A case report. Acta Chir Scand 1986; 152:779-80. [PMID: 3591209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A case of gastrointestinal perforation caused by congenital absence of intestinal musculature is reported. The diagnosis of this condition can be secured only by histologic examination, and removal of all diseased intestine is a prerequisite for cure.
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Zorri R, Kofoed PE. [Persistent pulmonary hypertension in the newborn infant]. Ugeskr Laeger 1986; 148:168-70. [PMID: 3952839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Christensen PD, Kofoed PE, Seyer-Hansen K. Painless myocardial infarction in diabetes mellitus--a myth? Dan Med Bull 1985; 32:273-5. [PMID: 4053700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
One hundred and ten consecutive diabetic patients with acute myocardial infarction (AMI) were compared to a matched group of non-diabetics with AMI, and the pain experienced during the acute episode by each patient was estimated by counting the number of morphine injections given. No significant difference was found regarding the frequency of painless infarctions, the distribution of injections given during the first three days in the coronary unit, or the need for injections after that time. We conclude that contrary to the common supposition, painless AMI in hospitalised patients is almost as frequent among nondiabetics as among diabetics.
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