Abstract Since 1990, South Asia has experienced a resurgence of kala-azar (visceral leishmaniasis). To determine risk factors for kala-azar, we performed cross-sectional surveys over a 3-year period in a Bangladeshi community. By history, active case detection, and serologic screening, 155 of 2,356 residents had kala-azar with onset from 2000 to 2003. Risk was highest for persons 3–45 years of age, and no significant difference by sex was seen. In age-adjusted multivariable models, 3 factors were identified: proximity to a previous kala-azar patient (odds ratio [OR] 25.4, 95% confidence interval [CI] 15–44 within household; OR 3.2 95% CI 1.7–6.1 within 50 m), bed net use in summer (OR 0.7, 95% CI 0.53–0.93), and cattle per 1,000 m2 (OR 0.8, 95% CI 0.70–0.94]). No difference was seen by income, education, or occupation; land ownership or other assets; housing materials and condition; or keeping goats or chickens inside bedrooms. Our data confirm strong clustering and suggest that insecticide-treated nets could be effective in preventing kala-azar.
Enantiomers of 5-ethyl-5-phenylhydantoin (EPH) were administered to dogs, and urinary metabolites were quantitated. After administration of (R)-EPH, the urinary products included unchanged drug, 5-ethyl-5-(4-hydroxyphenyl)hydantoin (p-EHPH), 5-ethyl-5-(3-hydroxyphenyl)hydantoin (m-EHPH), and an N-glucuronide of EPH. Administration of (S)-EPH gave urinary products consisting of unchanged drug, p-EHPH, m-EHPH, an N-glucuronide of EPH, and a dihydrodiol metabolite, which has been isolated and identified as (5 S)-5-[(3R,4R)-3,4-dihydroxy-1,5-cyclohexadien-1-yl]-5-ethylhydantoin. The levorotatory isomers of p- and m-EHPH have been assigned the (R)-configuration. An unidentified metabolite of EPH has been detected through its reactivity under basic conditions to yield 2-ethyl-2-phenylhydantoic acid, which can be cyclized with acid to EPH. Quantitative studies of the disposition of single oral doses of (R)-, (S)-, and (RS)-EPH by these metabolic routes suggest that the metabolism of one enantiomer is unaffected by the presence of the other enantiomer. Stereoselectivities of metabolic pathways are discussed in relation to stereoselectivities observed for phenytoin metabolism in the dog.
Limited data exist on the immunogenicity of the 2009 influenza A (H1N1) vaccine among immunocompromised persons, including those with human immunodeficiency virus (HIV) infection.We compared the immunogenicity and tolerability of a single dose of the monovalent 2009 influenza A (H1N1) vaccine (strain A/California/7/2009H1N1) between HIV-infected and HIV-uninfected adults 18-50 years of age. The primary end point was an antibody titer of ≥ 1:40 at day 28 after vaccination in those with a prevaccination level of ≤ 1:10, as measured by hemagglutination-inhibition assay. Geometric mean titers, influenza-like illnesses, and tolerability were also evaluated.One hundred thirty-one participants were evaluated (65 HIV-infected and 66 HIV-uninfected patients), with a median age of 35 years (interquartile range, 27-42 years). HIV-infected persons had a median CD4 cell count of 581 cells/mm(3) (interquartile range, 476-814 cells/mm(3)) , and 82% were receiving antiretroviral medications. At baseline, 35 patients (27%) had antibody titers of >1:10. HIV-infected patients (29 [56%] of 52), compared with HIV-uninfected persons (35 [80%] of 44), were significantly less likely to develop an antibody response (odds ratio, .20; P = .003). Changes in the median geometric mean titer from baseline to day 28 were also significantly lower in HIV-infected patients than in HIV-uninfected persons (75 vs 153; P = .001). Five influenza-like illnesses occurred (2 cases in HIV-infected persons), but none was attributable to the 2009 influenza H1N1 virus. The vaccine was well tolerated in both groups.Despite high CD4 cell counts and receipt of antiretroviral medications, HIV-infected adults generated significantly poorer antibody responses, compared with HIV-uninfected persons. Future studies evaluating a 2-dose series or more-immunogenic influenza A (H1N1) vaccines among HIV-infected adults are needed (ClinicalTrials.gov NCT00996970).
An open study was undertaken to assess the efficacy and tolerance of oral zuclopenthixol in 40 patients with functional psychotic illness. Patients received zuclopenthixol dihydrochloride (25 mg tablets) in daily doses of 25 to 150 mg according to clinical response. Assessments were performed at weekly intervals using either the Bech-Rafaelsen Mania Scale (BRMS) or the Brief Psychiatric Rating Scale (BPRS), as appropriate; in addition, a Clinical Global Impression (CGI) was recorded and side-effect inventory completed. Patients were to be studied for a maximum of 13 weeks or until a successful response to treatment was obtained. Success was defined as a score of less than 15 on the BRMS or BPRS, accompanied by a marked or moderate improvement on the CGI. Twenty-six (65.0%) patients had a successful response to treatment within 3 weeks; this increased to 35 (87.5%) by Week 4. There were significant reductions in the total BPRS and total BRMS scores from Week 1 onwards. Most sub-scales and sub-items also showed significant improvements. Four patients were withdrawn from the study, (3 due to lack of efficacy and 1 with side-effects). One patient was non-evaluable due to concomitant chlorpromazine therapy. Side-effects were slight and the medication was well tolerated. Twenty-five patients received antiparkinsonian treatment during the study.
Vaccine efficacy (VE) is commonly estimated through proportional hazards modelling of the time to first infection or disease, even when the event of interest can recur. These methods can result in biased estimates when VE is heterogeneous across levels of exposure and susceptibility in subjects. These two factors are important sources of unmeasured heterogeneity, since they vary within and across areas, and often cannot be individually quantified. We propose an estimator of VE per exposure that accounts for heterogeneous susceptibility and exposure for a repeated measures study with binary recurrent outcomes. The estimator requires only information about the probability distribution of environmental exposures. Through simulation studies, we compare the properties of this estimator with proportional hazards estimation under the heterogeneity of exposure. The methods are applied to a reanalysis of a malaria vaccine trial in Brazil.
Reviews 93 The upward mobility that Soto exemplifies is limned by his mother in “Piedra”: “Mexicanos pruning orange trees on ladders, and our mother’s talk that if our grades didn’t improve we would be like those people.” In the same sketch, a young Soto climbs a hill, far above his picnicking family, the river, the world, and “Except for the wind it was quiet, and I was quiet too, with just one thought, and this thought was happiness. ... I will have my chance.” These brief pieces are autobiographical and understated, though several feel unpolished. In “A Short History of Sex,” readers experience the frustration and curiosity of a virginal boy who overhears others say, ‘“ It feels like the inside of your mouth.’ What feels like that?” Unfortunately, his hot curiosity is not well developed and the interesting essay just sort of drifts, demanding another revision, as do several others. But that is small potatoes, since Lesser Evils is another confirmation of Gary Soto’s special vision and flashing talent, and is well worth reading. GERALD HASLAM Sonoma State University The Death of Jean-Paul Sartre and Other Poems. By Gerald Locklin. (Madi son, WI: Ghost Pony Press, 1987. 32 pages, $4.50.) Children of a Lesser Demagogue. By Gerald Locklin. (Stockton, CA: Worm wood Review Press, 1987. 80 pages, $4.00.) A Constituency of Dunces. By Gerald Locklin. (Niagara Falls, NY: A Slip stream Publication, 1988. 40 pages, $3.00.) The Death of Jean-Paul Sartre includes nineteen of Gerald Locklin’s poems, Children of a Lesser Demagogue has seventy-six, and A Constituency of Dunces thirty-two. All three collections deal with half a dozen recurring subjects and themes: feminism; teaching; art and poetry; marriage and the family; philosophy and logic; and contemporary mores. Occasionally Locklin himself becomes the subject of a poem; and then, as in all his other poems, wit, humor, and irony abound. His best short poems are like bons mots: why our species has survived i notice that whenever igive my little boy a cookie or cracker or handful of popcorn to feed the pigeons he eats it. (Constituency 8) His worst poems voice his antipathy to feminists, as in these lines from “The Women Have Won”: 94 Western American Literature sexism is what communism used to be, and [sic] unwritten but punishable crime. it means whatever the women want it to mean. (Death 16) But in “Old MacDonald Had a Madonna,” Locklin jokes disarmingly about the charges that he is a sexist: “you are a misogynist,” she says; “are there any women, over the age of twelve, you haven’t written nastily about?” “yes,” i say, “i have never written anything uncomplimentary about farm women.” (Children 60) Locklin’s seriocomic thrusts at feminists possess a liveliness characteristic of all his work, a liveliness that makes it hard to put down a Locklin book until you’ve savored every poem. He uses wit, humor, and wordplay as existentialist weapons to survive the warfare of modern life with his integrity intact. And he moves the reader into battle, too, as in the following poem: Feast or Famine: Multiple Guess tonight at nine i had the choice of watching the mysterious stranger of mark twain, starting over by dan wakefield, return to the planet of the apes, or the go-between, adapted by harold pinter, from a novel by e. p. hartley, and directed by joseph losey, starring julie christie and, of course, the man who has appeared in every british film since 1950, alan bates. the choice i made told me a lot about myself. (Children 75) But given the absence of coyotes and cowboys in his work, can Locklin be called a western poet? Yes, because most of his poems in some way explore or comment on the California scene and because he joins other western writers in warning us that we’re fast approaching ecocide. In spite of such western foreboding, Locklin’s poems have the ebullience of Richard Brautigan’s without any Baudelairean affectations; and although each of Locklin’s three new collections is distinctive, I recommend them all. In “A Triple Homage,” Locklin refers to Hemingway’s observation that “if...
Malaria parasites are genetically diverse at all levels of endemicity. In contrast, the merozoite surface protein (MSP) alleles in samples from 2 isolated populations of Yanomami Amerindians during an epidemic of Plasmodium falciparum were identical. The nonvariable restriction fragment length polymorphism patterns further suggested that the sequential outbreak comprised only a single P. falciparum genotype. By examination of serial samples from single human infections, the MSP characteristics were found to remain constant throughout the course of infection. An apparent clonal population structure of parasites seemed to cause outbreaks in small isolated villages. The use of standard molecular epidemiologic methods to measure genetic diversity in malaria revealed the occurrence of a genetically monomorphic population of P. falciparum within a human community.
