[Show abstract][Hide abstract] ABSTRACT: In Senegal, a significant decrease of malaria transmission intensity has been noted the last years. Parasitaemia has become lower and, therefore, more difficult to detect by microscopy. In the context of submicroscopic parasitaemia, it has become relevant to rely on relevant malaria surveillance tools to better document malaria epidemiology in such settings. Serological markers have been proposed as an essential tool for malaria surveillance. This study aimed to evaluate the sero-epidemiological situation of Plasmodium falciparum malaria in two sentinel sites in Senegal.
Cross-sectional surveys were carried out in Velingara (south Senegal) and Keur Soce (central Senegal) between September and October 2010. Children under 10 years old, living in these areas, were enrolled using two-level, random sampling methods. P. falciparum infection was diagnosed using microscopy. P. falciparum antibodies against circumsporozoite protein (CSP), apical membrane protein (AMA1) and merozoite surface protein 1_42 (MSP1_42) were measured by ELISA method. A stepwise logistic regression analysis was done to assess factors associated with P. falciparum antibodies carriage.
A total of 1,865 children under 10 years old were enrolled. The overall falciparum malaria prevalence was 4.99% with high prevalence in Velingara of 10.03% compared to Keur Soce of 0.3%. Symptomatic malaria cases (fever associated with parasitaemia) represented 17.37%. Seroprevalence of anti-AMA1, anti-MSP1_42 and anti-CSP antibody was 38.12, 41.55 and 40.38%, respectively. The seroprevalence was more important in Velingara and increased with age, active malaria infection and area of residence.
The use of serological markers can contribute to improved malaria surveillance in areas with declining malaria transmission. This study provided useful baseline information about the sero-epidemiological situation of malaria in Senegal and can contribute to the identification of malaria hot spots in order to concentrate intervention efforts.
PACTR201305000551876 ( http://www.pactr.org ).
[Show abstract][Hide abstract] ABSTRACT: Background:
Artesunate-amodiaquine (AS-AQ) is one of the most widely used artemisinin-based combination
therapies (ACTs) to t
malaria in Africa. We investigated the impact of
different dosing strategies on the efficacy of this combination for the treatment of falciparum malaria.
Individual patient data from AS-AQ clinical trials were pooled using the WorldWide Antimalarial Resistance
Network (WWARN) standardised methodology. Risk factors for treatment failure were identified using a Cox regression
model with shared frailty across study sites.
Forty-three studies representing 9,106 treatments from 1999-2012 were included in the analysis; 4,138 (45.4%)
treatments were with a fixed dose combination with an AQ target dose of 30 mg/kg (FDC), 1,293 (14.2%) with
e of 25 mg/kg (loose NFDC-25), 2,418 (26.6%) with a
non-fixed dose combination with an AQ target dose of 30 mg/kg (loose NFDC-30), and the remaining 1,257 (13.8%)
with a co-blistered non-fixed dose combination with an AQ target dose of 30 mg/kg (co-blistered NFDC). The median
dose of AQ administered was 32.1 mg/kg [IQR: 25.9-38.2], the highest dose being administered to patients treated
with co-blistered NFDC (median = 35.3 mg/kg [IQR: 30.6-43.7]) and the lowest to those treated with loose NFDC-25
(median = 25.0 mg/kg [IQR: 22.7-25.0]). Patients treated with FDC received a median dose of 32.4 mg/kg
[IQR: 27-39.0]. After adjusting for rei
nfections, the corrected antimalarial efficacy on day 28 after treatment
was similar for co-blistered NFDC (97.9% [95% confiden
ce interval (CI): 97.0-98.8%]) and FDC (98.1% [95% CI:
= 0.799), but significantly lower for the loose NFDC-25 (93.4% [95% CI: 91.9%-94.9%]), and loose NFDC-30
(95.0% [95% CI: 94.1%-95.9%]) (
< 0.001 for all comparisons). After controlling for age, AQ dose, baseline parasitemia and
region; treatment with loose NFDC-25 was associated with a 3.5-fold greater risk of recrudescence by day 28 (adjusted
hazard ratio, AHR = 3.51 [95% CI: 2.02-6.12],
< 0.001) compared to FDC, and treatment with loose NFDC-30 was
associated with a higher risk of recrudescence at only three sites.
There was substantial variation in the total dose of amodiaquine administered in different AS-AQ
combination regimens. Fixed dose AS-AQ combinations ensure optimal dosing and provide higher antimalarial
treatment efficacy than the loose individual tablets in all age categories.
[Show abstract][Hide abstract] ABSTRACT: Background
Artemether–lumefantrine is the most widely used artemisinin-based combination therapy for malaria, although treatment failures occur in some regions. We investigated the effect of dosing strategy on efficacy in a pooled analysis from trials done in a wide range of malaria-endemic settings.
We searched PubMed for clinical trials that enrolled and treated patients with artemether–lumefantrine and were published from 1960 to December, 2012. We merged individual patient data from these trials by use of standardised methods. The primary endpoint was the PCR-adjusted risk of Plasmodium falciparum recrudescence by day 28. Secondary endpoints consisted of the PCR-adjusted risk of P falciparum recurrence by day 42, PCR-unadjusted risk of P falciparum recurrence by day 42, early parasite clearance, and gametocyte carriage. Risk factors for PCR-adjusted recrudescence were identified using Cox's regression model with frailty shared across the study sites.
We included 61 studies done between January, 1998, and December, 2012, and included 14 327 patients in our analyses. The PCR-adjusted therapeutic efficacy was 97·6% (95% CI 97·4–97·9) at day 28 and 96·0% (95·6–96·5) at day 42. After controlling for age and parasitaemia, patients prescribed a higher dose of artemether had a lower risk of having parasitaemia on day 1 (adjusted odds ratio [OR] 0·92, 95% CI 0·86–0·99 for every 1 mg/kg increase in daily artemether dose; p=0·024), but not on day 2 (p=0·69) or day 3 (0·087). In Asia, children weighing 10–15 kg who received a total lumefantrine dose less than 60 mg/kg had the lowest PCR-adjusted efficacy (91·7%, 95% CI 86·5–96·9). In Africa, the risk of treatment failure was greatest in malnourished children aged 1–3 years (PCR-adjusted efficacy 94·3%, 95% CI 92·3–96·3). A higher artemether dose was associated with a lower gametocyte presence within 14 days of treatment (adjusted OR 0·92, 95% CI 0·85–0·99; p=0·037 for every 1 mg/kg increase in total artemether dose).
The recommended dose of artemether–lumefantrine provides reliable efficacy in most patients with uncomplicated malaria. However, therapeutic efficacy was lowest in young children from Asia and young underweight children from Africa; a higher dose regimen should be assessed in these groups.
The Lancet Infectious Diseases 03/2015; 15(6):692-702. · 19.45 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study evaluated the one-year clinical performance of a one-step, self-etch adhesive (Optibond All-in-One, Kerr, CA, USA) combined with a composite (Herculite XRV Ultra, Kerr Hawe, CA, USA) to restore NCCLs with or without prior acid etching. Restorations performed by the same practitioner were evaluated at baseline and after 3, 6, and 12 months using modified USPHS criteria. At 6 months, the recall rate was 100%. The retention rate was 84.2% for restorations with prior acid etching, but statistically significant differences were observed between baseline and 6 months. Without acid etching, the retention rate was 77%, and no statistically significant difference was noted between 3 and 6 months. Marginal integrity (93.7% with and 87.7% without acid etching) and discoloration (95.3% with and 92.9% without acid etching) were scored as Alpha or Bravo, with better results after acid etching. After one year, the recall rate was 58.06%. Loss of pulp vitality, postoperative sensitivity, or secondary caries were not observed. After one year retention rate was of 90.6% and 76.9% with and without acid conditioning. Optibond All-in-One performs at a satisfactory clinical performance level for restoration of NCCLs after 12 months especially after acid etching.
International Journal of Dentistry 01/2015; 2015:984065. DOI:10.1155/2015/984065
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to compare the shaping ability of two single-file systems and conventional rotary instruments in severely curved root canals of extracted human molars.
Mesiobuccal canals of 120 mandibular molars with angles of curvature ranging between 25(°) and 35(°) and radii of curvature from 5 to 9 mm, were divided into three groups (n=40). In each group the canals were instrumented with either WaveOne (W), Reciproc (R) or ProTaper (P). The time required for canal shaping and the frequency of broken instruments were recorded. The standardized pre and post-instrumentation radiographs were taken to determine changes in working length (WL) and straightening of canal curvature. The presence of blockage or perforation was also evaluated. Data were analyzed using the one-way analysis of variance (ANOVA) and post-hoc Tukey's test. The level of significance was set at 0.05.
Both single-instrument systems reduced the canal preparation time by approximately 50% (P<0.05). No incidence of broken instruments from single-file systems was reported; however, two F2 instruments in the P group were broken (P<0.05). Reduction in WL and straightening of canal curvature was observed in all three systems with the highest scores belonging to P system (P<0.05). No case of blockage or perforation was found during shaping in any group.
Single-file systems shaped curved canals with substantial saving in time and a significant decrease in incidence of instrument separation, change in WL, and straightening of canal curvature.