Albert Schweitzer Hospital

About: Albert Schweitzer Hospital is a healthcare organization based out in Lambaréné, Gabon. It is known for research contribution in the topics: Population & Plasmodium falciparum. The organization has 1029 authors who have published 1568 publications receiving 43581 citations.

Patient blood management in elective total hip- and knee-replacement surgery (part 2): a randomized controlled trial on blood salvage as transfusion alternative using a restrictive transfusion policy in patients with a preoperative hemoglobin above 13 g/dl.

Abstract: Background:Patient blood management is introduced as a new concept that involves the combined use of transfusion alternatives. In elective adult total hip- or knee-replacement surgery patients, the authors conducted a large randomized study on the integrated use of erythropoietin, cell saver, and/or

The Lambaréné Organ Dysfunction Score (LODS) Is a Simple Clinical Predictor of Fatal Malaria in African Children

Abstract: Background. Plasmodium falciparum malaria accounts for >1 million deaths annually, mostly among young children in sub-Saharan Africa. Identifying those individuals who are likely to die is crucial. Several factors have been independently associated with death. Because malaria is a systemic disease, a quantitative score combining such risk factors may be superior. Methods. We used both forward and backward stepwise logistic regression to select the best predictors of death, as evaluated for 23,890 African children with severe P. falciparum malaria. The study was conducted from December 2000 through May 2005 in 6 hospital-based research units (in Banjul in the Gambia, Blantyre in Malawi, Kilifi in Kenya, Kumasi in Ghana, and Lambarene and Libreville in Gabon) in a network established to study severe malaria in African children (ie, the SMAC Network). Results. The Lambarene Organ Dysfunction Score (LODS) combines 3 variables: coma, prostration, and deep breathing. A LODS >0 (odd ratio, 9.6; 95% confidence interval, 8.0-11.4) has 85% sensitivity to predict death, and a LODS <3 is highly (98%) specific for survival. Conclusions. The LODS is a simple clinical predictor of fatal malaria in African children. This score provides accurate and rapid identification of children needing either referral or increased attention.

In vitro activity of ferroquine (sar97193) is independent of chloroquine resistance in plasmodium falciparum

Abstract: Nowadays, chloroquine-resistant malaria appears in almost all endemic regions. Ferroquine is a derivative of chloroquine and shows good activity in vitro and in animal models, but the development of cross-resistance is of concern. We tested in vitro susceptibilities of Plasmodium falciparum field isolates from Gabon to ferroquine, chloroquine, and artesunate. As expected, chloroquine resistance was present in all parasite isolates (median 50% inhibitory concentration = 113 nmol/L). Ferroquine (1.94 nmol/L) and artesunate (0.96 nmol/L) were highly active, and no significant correlation between any of the three drugs was observed. In contrast to our findings, previous studies showed an association between chloroquine and ferroquine activities. We could reproduce this association by using different initial parasitemias, but analysis of covariance revealed that initial parasitemia and not parasite strain was the critical determinant for the correlation between chloroquine and ferroquine activities. We conclude that ferroquine is highly active in chloroquine-resistant parasites, and we anticipate no enhanced selection for resistance against ferroquine in chloroquine-resistant parasites.

Prognostic Value of Circulating Pigmented Cells in African Children with Malaria

Abstract: Giovanni Maria Lancisi, in 1716, was the first to describe the presence of black pigment in human liver, brain, and spleen, but he did not associate these changes with malaria. In 1825, Etienne Bailly reported the dark color of cortical gray matter he observed during autopsies in 1822 of patients from Rome with malarial fever, and Richard Bright confirmed this in his autopsy accounts in 1831. However, these observations of discolored tissues were not extended to the recognition of malarial pigment in corpuscles until Schutz, in 1846, and Meckel von Helmsbach, independently a year later, described brown pigment in the blood of people who died of “pernicious fever.” These early accounts of malarial pigment have recently been reviewed by Poser and Bruyn [1]. It is now recognized that this pigment in patients with malaria, known also as hemozoin, is a degradation product of hemoglobin formed in the process of detoxifying free heme and that it can be found in parasitized erythrocytes, monocytes, and granulocytes of patients with malaria. The formation of malarial pigment (i.e., hemozoin) is a coordinated 2-component process involving both lipids and histidine-rich proteins of Plasmodium falciparum [2]. Malarial pigment has a number of biological effects, some of which may affect immune defense mechanisms. It inhibits macrophage function [3, 4] and dendritic cell functions [5], and it can suppress erythropoiesis [6, 7]. By suppressing prostaglandin E2 production, it leads to tumor necrosis factor overproduction, which in turn is associated with malarial anemia [8]. In addition to these pathophysiological effects, hemozoin in circulating cells may also be useful in diagnosing malaria [9] and in predicting outcome. In 1995, two independent, small studies demonstrated the potential of intraleukocytic pigment as a prognostic factor in malaria [10, 11]. The Gabonese study showed a correlation between the presence of pigment in monocytes and the degree of anemia in children with malaria and a correlation between pigment in neutrophils and parasitemia [10]. The Thai study suggested that the number of pigment-containing neutrophils in adult patients with malaria was a rapid and simple prognostic test [11]. In a follow-up study from Nigeria, the pigment-containing neutrophil count was also a simple marker of disease severity in childhood malaria [12]. However, none of these studies was large enough to detect an association between circulating pigment and mortality. To obtain more-definitive evidence of the prognostic significance of circulating pigments for, primarily, malaria-associated mortality, our clinical network for Severe Malaria in African Children (SMAC) undertook a large, multicenter study of the prognostic significance of circulating pigment [13]. Because our sites spanned Africa and included a variety of different epidemiological settings, the sample could more completely include the epidemiologic diversity of falciparum malaria in Africa and could generate a sample size large enough to identify any association between circulating pigment and disease outcome. Between the beginning and the completion of the SMAC study, 3 other smaller studies (from Gabon [14], Mali [15], and Kenya [7]) were performed; they reported findings similar to those described in the earlier studies.

Skin diseases among schoolchildren in Ghana, Gabon, and Rwanda

Abstract: Objectives Skin diseases, especially skin infections, among schoolchildren in Africa can be a major health problem. The objective of this study was to determine the prevalences of skin diseases among children in rural and urban schools in three different African countries and to study the influence of socioeconomic level. Methods Cross-sectional, population-based studies were performed in Ghana, Gabon, and Rwanda. Point prevalences of skin diseases were estimated on the basis of physical examination by at least one dermatologist. Results A total of 4839 schoolchildren were seen. The overall prevalence of schoolchildren with any skin disease was high and amounted to 34.6% and 42.0% in two Ghanaian studies, 45.8% in Gabon, and 26.7% in Rwanda. In children with skin diseases, skin infections represented the greatest proportion of disease, accounting for 14.7% and 17.6% of skin disease in the Ghanaian studies, and 27.7% and 22.7% in Gabon and Rwanda, respectively. Diseases with the highest prevalence were tinea capitis and bacterial skin infections, especially in rural areas and in schools serving children living at lower socioeconomic levels. Conclusions The prevalences of skin diseases among African schoolchildren were high. Skin infections such as tinea capitis and pyoderma predominated.